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Wednesday 12th April, 2006
Mayo Clinic researchers are sounding an alert about side
effects of shock wave lithotripsy such as diabetes,
ROCHESTER, Minn. -- Mayo Clinic researchers are sounding
an alert about side effects of shock wave lithotripsy: in a
research study, they found this common treatment for kidney
stones to significantly increase the risk for diabetes and
hypertension later in life.
Risk for diabetes was related to the intensity of the treatment
and quantity of the shock waves administered; hypertension was
related to treatment of stones in both kidneys.
Shock wave lithotripsy uses shock waves to break up an impassable
kidney stone into smaller, sandlike pieces which can be passed
spontaneously, usually within a month. The patient and the
lithotriptor that emits the shock waves are placed in a water bath.
Water allows easier conduction of the shock waves through the
patient's tissue and precise focus on the kidney stone.
"This is a completely new finding," says Amy Krambeck, M.D., Mayo
Clinic urology resident and lead study investigator. "This opens the
eyes of the world of urology to the fact that hypertension and
diabetes are potential side effects. We can't say with 100 percent
certainty that the shock wave treatment for the kidney stones caused
diabetes and hypertension, but the association was very strong. The
risk of developing diabetes after shock wave lithotripsy is almost
four times the risk of people with kidney stones treated with
medicine, and the risk of developing hypertension is one and
one-half times, which is a significant risk increase."
The study, which is the first examination of the effects of shock
wave lithotripsy over the long term, involved reviewing charts of
630 patients treated with shock wave lithotripsy in 1985 at Mayo
Clinic. The researchers sent those still alive a questionnaire;
almost 60 percent responded. The researchers matched the patients
treated with lithotripsy to patients similar in age, gender and
initial time of seeing a urologist for kidney stones who received a
different treatment, medicine. Nineteen years post-treatment, those
treated with lithotripsy had 3.75 times the risk of having diabetes
as those given the other kidney stone treatment. The degree of
increased risk rose with greater number and intensity of shocks
administered. Those treated with lithotripsy also had 1.47 times the
risk of having hypertension -- high blood pressure -- than those who
received the other kidney stone treatment; risk was highest for
those who had both kidneys treated.
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The researchers hypothesize that the increase in risk for diabetes
associated with shock wave therapy for kidney stones relates to
damage inflicted to the pancreas, a previously known risk of
lithotripsy, which may affect the islet cells in the pancreas that
make insulin. They believe the increased risk for hypertension may
relate to scarring, which the treatment may cause to the kidneys and
could alter the secretion of hormones centered in the kidneys like
renin, which influence blood pressure.
Drs. Krambeck and Joseph Segura, M.D., Mayo Clinic urologist and
study investigator, say that they continue to use shock wave
treatment, among other alternative treatments for kidney stones.
"Despite the risks, shock wave therapy still can save the day for
patients, and it would be a mistake to put it on the shelf," says
The researchers indicate that they now counsel patients about the
potential risk for diabetes and hypertension prior to shock wave
Dr. Segura stresses the need for kidney stone patients and their
physicians to weigh the pros and cons of shock wave treatment
according to individual situations. "It's a trade-off about whether
the risks are worth taking," he says. "We're assuming doing nothing
is not the right thing to do for patients. You have to look at it in
terms of treatment alternatives -- percutaneous stone removal
[removing a kidney stone through a small incision in the patient's
back using an instrument called a nephroscope] or ureteroscopy
[snaring a stone with a small instrument passed into the ureter
through the bladder and then breaking up the stone with ultrasound
or laser energy] -- each of which has its own set of risks."
The Mayo Clinic researchers examined the long-term effects of
lithotripsy for patients treated with a 1985 lithotriptor, one of
the early models, in this study. Drs. Krambeck and Segura say
additional research studies, including research on newer machines
and different models, are needed on shock wave therapy and risk for
diabetes and hypertension later in life.
Prior to age 70, approximately 10 percent of men and 5 percent of
women will experience a kidney stone, according to the National
Institutes of Health. About 1 million people in the United States
have had shock wave lithotripsy, says Dr. Segura.
- Mayo Clinic