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Monday, April 10, 2006

Surprise Side Effects of Kidney Stone Pulverization

From today's NYT, a potential risk of diabetes and high blood pressure from the blasting of kidney stones:

In the study, which is to be published on Monday from the Mayo Clinic, patients who underwent the pulverizing procedure, known as lithotripsy, developed diabetes at almost four times the rate of those whose kidney stones were treated by other methods. The lithotripsy group also developed high blood pressure about 50 percent more often than a group treated by other methods, the study in The Journal of Urology found.

As with most such findings, of course, it's not at all clear that the findings should mean lithrotripsy should be abandoned, especially considering the alternatives -- instead, the risk should be in the mix of information considered.

The story has an interesting narrative about the article's path to publication as well:

[T]he Mayo team sent its paper to The Journal of the American Medical Association, which rejected it without sending it to independent experts for review, saying it was too specific a topic for its readers, Dr. Krambeck said.

So her team then sent the paper to The Journal of Urology [which accepted it with changes].

Last August, the Mayo team presented its findings at an international meeting, Dr. Krambeck said, but for a number of reasons the clinic did not issue an alert for the thousands of people considering lithotripsy.

Her team did not want to release the findings early because the Mayo Clinic is one of a very few medical centers that still uses the same model lithotripter, Dornier HM3, in use in 1985, she said.

* * *

Another reason for not issuing an earlier alert is that many journals impose strict embargoes on releasing information in papers before publication.

* * *

Dr. Assimos of Wake Forest defended the delay as "appropriate."

Mayo urologists discuss all alternatives for treating kidney stones with patients but use lithotripsy less than other procedures, Dr. Krambeck said. After learning the results of their study, the doctors began informing patients who were considering lithotripsy about "correlations with possible side effects" but without specifying which ones or the data, she said. Now they will provide that information.

Speaking of peer review (honest, we were -- look back), Blog 702 has a posting about my article.  Thanks, Blog 702!

http://lawprofessors.typepad.com/tortsprof/2006/04/surprise_side_e.html

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Comments

I had lithotripsy in April for a kidney stone. I have been in severe pain since the procedure.
Pain in the lower back, down into the leg. I have been in the hospital on 2 different occassions, emergeny on 3 different occassions
for severe pain and side effects from Oxycodone.
I have had back injections, 3 times, and I am still in pain.
It has put my life on hold and and caused me extreme distress.
i am wondering if anyone else has experienced this from Lithotripsy?

Posted by: Ray boyles | Jun 11, 2007 9:52:13 AM

I had lithotripsy in 1992 at the age of fifteen. I do not have diabetes, and my blood pressure remains characteristically low as it has since i can remember. I remember having a bruise on my back after the procedure and taking it easy for about a week, but then i recuperated and was back to normal.

Posted by: adam | Apr 26, 2008 10:21:56 PM

I had lithotripsy in April. I experienced great pain about two days later. I was taking oxycodone every two to three hours until revisiting the doctor four days later. He took more test and found I had stones still to large to pass. I developed a fever and my kidney started swelling. I was given a stint the same day. The pain subsided a lot. Doc decided to give me a different procedure about three weeks later. I haven't had any problems since.

But, it does seem like my stomach and mid-section spreaded and I have not gained any weight. In fact, I lost a few pounds. My stomach is soft with a different feel, but it doesn't feel swollen.

Has anyone experienced this or anything like it.?

Posted by: L C | Jun 19, 2008 5:01:37 PM

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