ANAHEIM, CA (UroToday.com) - One year ago Segura and colleagues from the Mayo Clinic reported an alarming observation of an association between SWL and subsequent development of diabetes mellitus; hypothesizing sub-clinical pancreatic injury from this treatment modality as the ideology. Gettman and colleagues have continued this research in their prospective review of 24 randomly selected renal stone patients treated by ureteroscopy and intracorporeal EHL and the electrohydraulic SWL device.

They measured serum amylase and lipase on the day prior, and two hours after the lithotripsy procedures in all patients. The patient groups were demographically similar. However, more SWL group patients had a post treatment elevation in serum amylase (25% versus 8.3%, respectfully) and serum lipase (25% versus 8.3%, respectfully) compared to the ureteroscopy and intracorporeal EHL group. While these elevations in pancreatic enzymes were elevated from baseline, all were within the lab's range of normal values. Interestingly, only left sided SWL treated stones were observed to have elevations changes in lipase and amylase. These observations further suggest that the pancreas is affected by electrohydraulic SWL and may explain the increased risk of development of diabetes mellitus. It would be interesting to know how many of the patients in this study with renal pelvis versus caliceal stones exhibited the enzyme increases post-treatment. This acute study reaffirms the concern for the acute pancreatic effect of SWL and demands further evaluation of the chronic effect of SWL on pancreatic function.

( ABST [1262] )

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Written by Elspeth M. McDougall, MD, a Contributing Editor with UroToday.

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