Prediction of success of extracorporeal shock wave lithotripsy in the treatment of ureteric stones

Objectives To define the factors that affect the success rate of extracorporeal shock wave lithotripsy (ESWL) for the treatment of ureteric stones. Patients and methods Between January 2000 and December 2003, 468 patients with ureteric stones underwent in situ ESWL using Storz SL 20 lithotriptor. The results of treatment were evaluated after 3 months of follow-up. Treatment success was defined as complete clearance of the stones. Characteristics of the patients, condition of the urinary tract and stone features were correlated to the success rate to define the significant predictors of success. Results At 3-month follow-up, the overall success rate was 394/468 (84.2%). Repeat treatment was required in 239 patients (51.1%). Post-ESWL auxiliary procedures were necessary in 58 patients (12.4%). Post-ESWL complications were observed in 11 patients (2.4%). Only three factors had a significant impact on the stone-free rate, namely stone site, stone width and the presence of a ureteral stent. The stone-free rate was highest for stones located in the lumbar ureter (159/183; 86.9%) and lowest for those in iliac ureter (28/40; 70%) (P < 0.05). Stones with a transverse diameter <8 mm were associated with a stone-free rate of 89.9% (248/276), compared to 66.7% (128/192) for those with a transverse diameter of >8 mm (P < 0.01). Non-stented patients had a stone-free rate of 89.2% (313/348), compared to 75.2% (85/113) for stented patients (P < 0.01). Conclusions The site and transverse diameter of the stone and the presence of a ureteral stent are the only significant predictors of success of ESWL therapy for ureteric stones.     

Stone fragility: its therapeutic implications in shock wave lithotripsy of upper urinary tract stones

OBJECTIVE: To analyse the impact of stone composition on stone fragility (fragmentation) and clearance of upper urinary tract stones after shock wave lithotripsy (SWL). MATERIAL AND METHODS: Between 1st July 1998 and 31st July 2001, 300 renal and ureteric units of 290 patients (10 being bilateral) underwent SWL for upper urinary tract calculi. The degree of fragmentation was divided into four types: (I) Excellent, (II) Good, (III) Fair and (IV) No fragmentation. Stone composition was done by X-ray diffraction crystallography. A statistical comparison was made between degree of fragmentation, number of shock waves delivered, voltage setting, number of sessions required and requirements of adjuvant procedures according to the stone composition. RESULTS: Stone analysis revealed that 90% of the patients had calcium oxalate stones. Of these 80% were calcium oxalate monohydrate (COM) and 20% calcium oxalate dehydrate (COD). Struvite, apatite and uric acid stones comprised of 6%, 3% and 1% respectively. Type-I fragmentation was achieved up to 63.96%, 50% and 100% in COD, struvite and uric stones respectively as compared to 44.9% and 44.44% for COM and apatite stones. Type-III fragmentation was seen up to 8.79% and 33.3% respectively in COM and apatite as compared to 5.55% or less in other types of the stones suggesting that COM and apatite stones produce larger fragments. The mean number of shock waves, voltage and number of treatments was significantly higher for COM and apatite stones (p value < 0.005) with a stone free rate of only 65-66% and 65-68% respectively at three months (p value < 0.001). Similarly the number of adjuvant procedures required in COM alone was more, i.e. 31 as compared to 17 procedures in rest of the other kinds of stones (p value < 0.05). CONCLUSION: Stone composition in Indian subcontinent is different from the western world. Fragility of a stone varies with the composition of the stone and affects the therapeutic results.     

An experimental study on residual lithiasis after shock wave lithotripsy

The main objective of this paper was to study residual lithiasis after extracorporeal shock wave lithotripsy (post-ESWL), with the aim of contributing to the development of effective prophylactic measures. In vivo regrown calcium oxalate monohydrate (COM) post-ESWL residual fragments were studied by stereoscopic microscopy, infrared spectroscopy and scanning electron microscopy with an energy dispersive X-ray analyzer. An in vitro system was also used to study the regrowth of post-ESWL fragments of COM calculi. The regrowth was evaluated as the relative increase in the weight of the fragments. The effects of a calcium oxalate crystallization inhibitor (phytate) were also evaluated. All of the in vivo regrown COM real residual post-ESWL fragments exhibited practically the same internal structural features. The in vitro studies demonstrated that the regrowth of post-ESWL residual fragments, in the absence of crystallization inhibitors, occurred even using normocalciuric/normooxaluric urine and could be detected at 24 h. At 144–240 h, the formation of new COM columnar zones was observed. The presence of 1.5 mg/l of phytate totally blocked the growth process. When hypercalciuric/normooxaluric urine was used, significant amounts of disorganized calcium oxalate dihydrate (COD) crystals were formed. The in vitro regrowth of post-ESWL COM fragments was clearly influenced by the presence of crystallization inhibitors. These data also demonstrate the importance that effective prophylactic therapies could exert on preventing recurrence.     

Ovarian apoptosis after shock wave lithotripsy for distal ureteral stones

The objective of this study is to identify any apoptotic effect of shock wave lithotripsy (SWL) for distal ureteral stones on ovarian tissue. Twenty-one female New Zealand White rabbits were divided into three groups of seven rabbits each: I (control), and II, III (treated and killed 14 and 28 days after SWL, respectively). The left distal ureteral segment of the anesthetized (ketamine HCl, 20 mg/kg) animals in groups II and III was exposed to 1,500 shock waves at 17 kV. Localization of the distal ureteral segments was achieved following contrast medium (Iohexol 300 mg of I/ml) injection. The animals were killed on day 14 or 28 after SWL, and the ovaries were removed. The follicle number with apoptotic changes in ovarian tissue was compared with control group. Apoptotic changes were determined by terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end-labeling (TUNEL) method. No increased apoptosis was detected in all groups. The mean number of TUNEL-positive follicle in groups I, II and III was 9.3 ± 2.9, 8.1 ± 2.6 and 8.7 ± 2.9, respectively. There were no statistically significant differences among all groups regarding the number of TUNEL-positive follicle (P = 0.647). Also, no histomorphological change other than apoptosis was detected in the study groups. In conclusion, SWL treatment for distal ureteral stones does not induce apoptotic changes on ovarian tissue.     

钙通道阻滞剂对重症急性胰腺炎大鼠血液流变学的影响

目的探讨钙通道阻滞剂对重症急性胰腺炎(SAP)血液流变学的影响.方法Wistar大鼠45只,随机分为A组,假手术组;B组,SAP组;C组,钙通道阻滞剂治疗组.观察各组血液流变学、酶学、胰腺及肺、肾的病理学改变.结果SAP时低切下全血粘度为(9.5±0.7)、红细胞聚集指数为(2.54±0.14)、红细胞刚性指数为(4.53±0.18),胰腺及胰外器官病理损害严重;治疗组上述各血液流变学指标分别为(7.8±0.5)、(2.17±0.12)、(4.01±0.13),与SAP组比较P值均＜0.05,胰腺及胰外器官的病理损害程度明显减轻(P＜0.05),且血液流变学异常与胰腺病理损害程度呈正相关(P＜0.05).结论钙通道阻滞剂能有效地改善SAP大鼠血液流变学异常,减轻胰腺及胰外器官的病理损害.     

Comparative study of long-term stone recurrence after extracorporeal shock wave lithotripsy and open stone surgery for kidney stones

Background: Extracorporeal shock wave lithotripsy (ESWL) has become the treatment of choice for most calculi of upper urinary tract and the need for open stone surgery (OSS) have considerably reduced. However, stone recurrence is often encountered as a long-term problem requiring re-treatment.
Methods: In the present retrospective study, the recurrence rates of ESWL and OSS were compared in the treatment of kidney calculi. During the 1 year period of the present study, 43 patients were treated by OSS and 400 underwent ESWL (the Dornier MPL 9000 lithotriptor). The recurrence of stone was defined as reappearance of the stone on plain abdominal radiography during the follow-up period.
Results: Complete removal of all stone fragments was achieved in 51.2% of patients ( n = 22) treated with OSS. In the ESWL group, the stone free rate was 56.7% ( n = 237). The recurrence rate was 31.8% within a mean of 40 months (range 32–48 months) in the OSS group, whereas this figure was 13.9%, with a mean period of 46 months (range 42–48 months) in the ESWL group ( P < 0.05). The mean periods of recurrence in ESWL and OSS groups were 20 (range 6–42 months) and 11 months (range 8–44 months), respectively ( P < 0.05). However, the mean stone burdens of both groups were different (2.9 ± 0.8 vs 1.4 ± 1.1 cm). For comparable stone burdens, the recurrence rate was similar. In the ESWL group, stones in the lower calyx, multiple stones and larger stones showed a higher recurrence rate. The recurrence after OSS was also influenced by stone burden.
Conclusions: The results of the present study demonstrate that stone burden may be the primary risk factor for stone recurrence after ESWL and OSS.     

钙通道阻滞剂的镇痛作用及其机制研究进展

背景 电压依赖性钙通道(voltage dependent calcium channels,VDCCs)参与了疼痛的发生及维持机制,钙通道阻滞剂在临床前及临床试验中显示出良好的镇痛作用. 目的 对主要的钙通道阻滞剂的镇痛作用及其机制进行回顾和总结. 内容 背根神经节(dorsal root ganglia,DRG)及脊髓背角感受伤害性刺激的神经元上有大量VDCCs分布,可调控去极化诱导的Ca2+内流,从而影响谷氨酸和P物质等与疼痛有关的神经递质释放.齐考诺肽等钙通道阻滞剂具有明确的镇痛作用,且不易形成耐受性及引起呼吸抑制,但给药途径受限,治疗窗狭窄. 趋向 钙通道阻滞剂的镇痛作用还需进行更深入的研究和探讨,从而开发更加安全方便的新型药物,为临床用药提供更多选择.     

Factors affecting lower calyceal stone clearance after Extracorporeal shock wave lithotripsy

ObjectiveExtracorporeal shock wave lithotripsy (ESWL) is one of the most commonly used procedures to remove renal calculi from the lower calyces. The aim of this work is to study the impact of radiological, anatomical and demographic factors on stone clearance after ESWL of lower calyceal calculi.Patients and methodsThis retrospective study included 150 patients aged between 16 and 70 years who were subjected to ESWL at October 6 University Hospital, Egypt, between June 2008 and October 2011. All the patients had solitary radio-opaque lower calyceal renal stones sized 2 cm or less. Intravenous urography (IVU) was performed to determine the patients’ lower-pole calyceal anatomy (infundibulum width, infundibulum length and the lower-pole infundibulopelvic angle). The patients who were divided into two groups according to the treatment results (Group 1: stone-free patients; Group 2: patients with residual fragments) were followed up for 3 months and re-assessed by plain X-ray.ResultsA total of 126 patients (84%) were stone-free (Group 1), while 24 patients (16%) had residual fragments (Group 2). The stone size was 0.5–1 cm in 76 patients (60.3%) and 1–2 cm in 50 patients (39.7%) of Group 1, respectively, with no statistically significant difference. In patients with a lower-pole infundibulopelvic angle ≥45°, stone clearance was 52% compared to a stone clearance of 32% in patients with a lower-pole infundibulopelvic angle <45° with no statistically significant difference. Regarding the infundibulum length (<35 mm vs. ≥35 mm) and width (<4 mm vs. ≥4 mm), no statistically significant difference was observed between Group 1 and Group 2. Ninety out of 106 patients (84.9%) with a body-mass index (BMI) ≤30 kg/m² were stone-free, compared to 36 out of 44 patients (81.8%) with a BMI > 30 kg/m².ConclusionsThere is no statistically significant effect of stone size, anatomy of the lower calyx and BMI on stone clearance after ESWL of lower calyceal stones. However, small stone size (≤2 cm), a shorter and wider infundibulum and a larger lower-pole infundibulopelvic angle seem to promote a more rapid and more complete stone clearance.     

The effect of treatment strategy on stone comminution efficiency in shock wave lithotripsy

PURPOSE: The comminution of kidney stones in shock wave lithotripsy (SWL) is a dose dependent process caused primarily by the combination of 2 fundamental mechanisms, namely stress waves and cavitation. The effect of treatment strategy with emphasis on enhancing the effect of stress waves or cavitation on stone comminution in SWL was investigated. Because vascular injury in SWL is also dose dependent, optimization of the treatment strategy may produce improved stone comminution with decreased tissue injury in SWL. MATERIALS AND METHODS: Using an in vitro experiment system that mimics stone fragmentation in the renal pelvis spherical BegoStone (Bego USA, Smithfield, Rhode Island) phantoms (diameter 10 mm) were exposed to 1,500 shocks at a pulse repetition rate of 1 Hz in an unmodified HM-3 lithotripter (Dornier Medical Systems, Kennesaw, Georgia). The 3 treatment strategies used were increasing output voltage from 18 to 20 and then to 22 kV every 500 shocks with emphasis on enhancing the effect of cavitation on medium fragments (2 to 4 mm) at the final treatment stage, decreasing output voltage from 22 to 20 and then to 18 kV every 500 shocks with emphasis on enhancing the effect of stress waves on large fragments (greater than 4 mm) at the initial treatment stage and maintaining a constant output voltage at 20 kV, as typically used in SWL procedures. Following shock wave exposure the size distribution of fragments was determined by the sequential sieving method. In addition, pressure waveforms at lithotripter focus (F2) produced at different output settings were measured using a fiber optic probe hydrophone. RESULTS: The rate of stone comminution in SWL varied significantly in a dose dependent manner depending on the treatment strategies used. Specifically the comminution efficiencies produced by the 3 strategies after the initial 500 shocks were 30.7%, 59% and 41.9%, respectively. After 1,000 shocks the corresponding comminution efficiencies became similar (60.2%, 68.1% and 66.4%, respectively) with no statistically significant differences (p = 0.08). After 1,500 shocks the final comminution efficiency produced by the first strategy was 88.7%, which was better than the corresponding values of 81.2% and 83.5%, respectively, for the other 2 strategies. The difference between the final comminution efficiency of the first and second strategies was statistically significant (p = 0.005). CONCLUSIONS: Progressive increase in lithotripter output voltage can produce the best overall stone comminution in vitro.     

Laser-induced shock wave lithotripsy with a regenerative energy converter

Two main mechanisms govern the field of laser lithotripsy. The first mechanism produces mechanical stress inside the stone by absorbing the laser light at the stone surface. Therefore it depends on the stone's optical properties. The second method uses a Q-switched laser and an energy converter to release mechanical shock waves acting on the stone to cause its fragmentation. This method is called laser-induced shock wave lithotripsy (LISL). The converter must be attached to the light transmitting optical fibre and should not provide an increase of the overall diameter of the probe to fit in a small, flexible endoscope. So we used the irrigation liquid, which must be supplied for endoscopic lithotripsy. Adding of Fe³⁺-ions to the isotonic saline solution (0.02 mmol l⁻¹) lowered the intensity threshold for the energy conversion. With this special irrigation liquid we have a continuously regenerating energy converter. It allows the use of bare fibres with spherically shaped tips, which can be easily changed while the endoscope remains inside the patient's body.     

Cystine calculi: correlation of CT-visible structure,CT number,and stone morphology with fragmentation by shock wave lithotripsy

Cystine stones are often highly resistant to shock wave lithotripsy (SWL), but it has been reported that cystine stones of "rough" morphology are actually quite susceptible to SWL. Based on the observation that rough cystine stones contain void regions that are visible by helical computed tomographic (CT) imaging, we hypothesized that the internal structure of cystine stones would correlate with the susceptibility of stones to SWL. Cystine stones with average diameters between 4 and 7 mm were scanned using micro and helical CT, classified morphologically according to published criteria, and broken in a research electrohydraulic lithotripter, with fragments sieved through a 2 mm mesh every 50 SWs. Stones with regions of low X-ray attenuation visible on helical CT required only 650 +/- 312 SW/g for total comminution, while those that did not show CT-visible internal structure required 1,046 +/- 307 SW/g (mean +/- SD, P < 0.004). In addition, both average and minimum values for CT number (in Hounsfield units, HU) correlated with SW/g to comminution (P < 0.003 and P < 0.0003, respectively), and these relationships were independent of stone size. This study also confirmed the relationship between the morphological criteria of Bhatta et al. (J Urol 142:937-940, 1989) and cystine stone fragility: Rough stones required 609 +/- 244 SW/g (n = 11), smooth stones 1,109 +/- 308 SW/g (n = 8), and stones intermediate in morphology 869 +/- 384 SW/g (n = 7; rough different from smooth, P < 0.005). In conclusion, cystine stones that appeared homogeneous by helical CT required 61% more SWs for comminution than did stones showing regions of low X-ray attenuation. These findings demonstrate the feasibility of using helical CT to identify cystine stones that will be susceptible to SWL.     

ESWL后影响肾下盏结石排空的解剖学因素

目的 探讨肾下盏解剖学因素对ＥＳＷＬ后结石排空的影响。方法 １９９５年４月～１９９９年１１月应用Ｓｔｏｒｚ Ｍｏｄｕｌｉｔｈ ＳＬ２０型碎石机治疗肾下盏结石１４５例,测量碎石前ＩＶＵ片肾下盏４项解剖指标,包括结石所在肾下盏肾孟夹角,肾下盏长度,盏颈宽度及肾下盏形状（简单或复杂）。随访３个月,碎石后第１天、２、４周及３个月时复查Ｂ超及ＫＵＢ,分析肾下盏解剖因素与结石排空的关系。结果 ３个月总结石排空     

Calcium channel blockers and prostate cancer

The relationship between calcium channel blockers and prostate cancer has been an area of increased interest to investigators. Calcium channel blockers have been shown to influence cell proliferation, differentiation, and apoptosis. Clinically, the association between calcium channel blockers and the development of prostate cancer has been controversial. However, on a basic science level, there is evidence that calcium channel blockers induce cytotoxicity in androgen receptor positive cell lines and may offer an innovative strategy for the treatment of castration-resistant prostate cancer.     

A prospective multivariate analysis of factors predicting stone disintegration by extracorporeal shock wave lithotripsy: the value of high-resolution noncontrast computed tomography

OBJECTIVE: To assess the value of noncontrast computed tomography (NCCT) as a possible predictor of renal stone disintegration by shock wave lithotripsy (SWL). PATIENTS AND METHODS: The study included 120 consecutive patients (71 males, 49 females; mean age: 42.6 yr) with a solitary renal stone of 0.5-2.5 cm in length. NCCT was performed using a multidetector row CT scanner at 120 KV and 240 mA, with 1.25-mm collimation. A bone window was used to measure stone attenuation values. SWL was performed with an electromagnetic lithotripter. Failure of disintegration was defined as no fragmentation of the stone after three sessions. The impact of patients' sex, age, and body mass index (BMI) and the stones' laterality, location, volume, mean attenuation value, and the skin-to-stone distance on disintegration were evaluated by univariate and multivariate analyses. RESULTS: Failure of disintegration was observed in 15 patients (12.5%). BMI and stone density >1000 HU were the significant independent predictors of failure (p=0.04 and 0.02, respectively). The success rate of extracorporeal SWL at 3 mo was 87.5% (105 of 120 patients); 90 patients were stone free and 15 had residual fragments<4 mm. The only significant predictor of residual fragments was stone density (p<0.001). CONCLUSIONS: Obesity and increased stone density as detected by NCCT are significant predictors of failure to fragment renal stones by SWL. An alternative treatment should be devised for obese patients with stone density>1000 HU.     

钙通道阻滞剂对未成熟心肌的保护作用

目的 观察钙通道阻滞剂对未成熟心肌的保护效果。方法 使用改良的非再循环式Langendorff离体心灌注装置，比较未使用盐酸尼卡地平和分别在缺血前，低温缺血停跳时，复灌初期3个不同时间给与盐酸尼卡地平者的心功能和心肌酶变化，测定缺血后心肌ATP，总钙含量，心肌含水量，观察心肌和冠状动脉内皮细胞结构的变化。结果 实验组的各项指标及对心肌及血管内皮结构保护明显优于对照组，实验组间差别无显著性意义。结论 使用钙通道阻滞剂可以对未成熟心肌产生良好的保护作用。     

钙通道阻滞剂对低温保存大鼠肝脏的保护作用

目的：研究钙通道阻滞剂是否减轻低温保存下肝细胞的钙超载并起到保护肝脏的作用。方法：低温保存大鼠肝细胞于不同时限,按保存液的不同成分分组：（1）对照组：DMEM液;（2）实验Ⅰ组：DMEM液＋Verapamil(维拉帕米）;（3）实验Ⅱ组：DMEM液＋Nifedipine(硝苯地平）;（4）实验Ⅲ组：DMEM液＋Diltiazem(硫氮卓酮）。用Fura-2法测定低温保存下的大鼠肝细胞内钙和肝功能,并在光镜和电镜下观察肝脏的结构。结果：细胞内钙及肝功能测定,各实验组与对照组差异显著;组织学观察,保存0－48h各实验组损伤明显低于对照组。结论钙通道阻滞剂对低温保存肝脏有保护作用,且三类药物中帕米作用最强,硝苯地平和硫氮卓酮次之。     

坦索罗辛在输尿管下段结石ESWL后辅助排石中的作用

目的:探讨α1肾上腺素能受体阻滞剂坦索罗辛在输尿管下段结石ESWL后辅助排石中的效果.方法:64例输尿管下段结石患者随机分成两组,组Ⅰ为对照组,ESWL后应用消炎痛25 mg,3次/d,排石颗粒5 g,3次/d,未应用输尿管平滑肌松弛剂;组Ⅱ为实验组,ESWL后在对照组治疗方案基础上予以口服坦索罗辛0.4mg,1次/d.每例患者观察时间不超过2周.结果:在观察时间内两组排石率分别为42.3%和78.9%.两组比较差异有统计学意义(P＜0.01).观察时间内两组再次发生肾绞痛而需要镇痛药治疗的患者分别为15.4%和7.9%,两组比较差异有统计学意义(P＜0.01).组Ⅱ除1例发生头晕外,无其他不良反应发生.结论:坦索罗辛能提高输尿管下段结石ESWL后的排石率,减少再发生肾绞痛的机率.且安全有效.可作为输尿管下段结石ES-WL后的辅助排石方法.     

The effects of calcium channel blockers on random skin flap survival in the pig model

Summary This study was designed to evaluate the influence of two calcium channel blockers, verapamil and nifedipine, on skin flap survival. These agents were selected because they inhibit the passage of calcium through calcium selective channels in the plasma membrane, thereby blocking calcium mediated electromechanical coupling in contractile tissue and resulting in peripheral arterial vasodilation. Three groups of pigs were used in this study. All skin flaps in this study were 3 cm wide and 12 cm long. The first group (10 flaps) served as controls with no pharmacologic manipulations. Pigs in group II (15 flaps) received verapamil (80 mg orally, three times a day) for 7 days postoperatively. Pigs in group III (15 flaps) received nifedipine (10 mg orally, three times a day) for 7 days postoperatively. Statistical analysis of the results demonstrated that both verapamil and nifedipine resulted in significant enhancement of skin flap survival. The increased survival of the skin flaps produced by nifedipine as compared to verapamil was statistically significant.This study is supported in part by PHS Research Grant DE00853 from the National Institute of Dental Research     

Glycosaminoglycans in urine and extracorporeal shock wave lithotripsy

In 50 calcium oxalate stone-forming patients, the total excretion of glycosaminoglycans (GAGs) and of four subgroups [chondroitin-4-sulfate (CS-A), chondroitin-6-sulfate (CS-C), dermatan sulfate (DS) and hyaluronic acid (HY)] were investigated before extracorporeal shock wave lithotripsy (ESWL) and during the subsequent 5 days. The standard value was determined by reference to a group of healthy test subjects. The excretion of GAGs was significantly higher in healthy test persons than in stone-forming patients. Twenty-four hours after ESWL administration, GAG excretion was enhanced significantly but returned to normal values over the course of 3 days. ESWL had no influence on the proportional composition of GAG subgroups CS-A, CS-C, DS and HY. The increase in GAG excretion after ESWL indicates a transient injury of renal tissue or of the mucus layer lining the urothelium. This lesion, however, can be regarded as temporary with later restitutio ad integrurn.     

逐步提高冲击波能量预处理对体外冲击波碎石术肾损伤的保护作用

目的探讨逐步提高冲击波能量（GESW）预处理对体外冲击波碎石术（ESWL）肾损伤的保护作用及机制。方法制成单肾的40只雌性家兔随机等分为对照组、GESW组、ESWL组、ESWL＋GESW预处理组。GESW组肾接受300次GESW;ESWL组肾接收标准的1500次ESWL：ESWL＋GESW预处理组先按GESW组处理,然后同ESWL组处理。24h时观察肾组织超氧化物歧化酶（SOD）活性、丙二醛（MDA）含量和尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）变化,原位缺口末端标记法（TUNEL）检测凋亡细胞。结果与ESWL组比较,GESW预处理组肾组织SOD活性增高（P〈0．05）,MDA含量和细胞凋亡指数降低（P〈0．01）、尿NAG降低（P〈0．01）。与对照组比较,GESW组各项指标差异无统计学意义（P〉0．05）。结论GESW预处理可减轻ESWL所致的肾损害,与其抗氧化应激损伤、抗细胞凋亡有关。