Cytological evaluation of urothelial damage in extracorporeal shock-wave lithotripsy

Introduction The study proposed a technique for early detection of the damaging effect of shock waves on the urinary tract tissues, for monitoring the state of urothelial cells in the early post-procedure period and choosing an adequate method for preventing and managing possible compIications. Materials and methods The study analyzed the urine samples of 300 patients aged 20 to 50 years, who for the first time underwent ESWL for kidney stones. The urine sediment smears were fixed in the May-Grunwald stain and stained with azure eosin solution according to Pappenheim. Besides evaIuating generaI cytoIogic characteristics, a morphometric examination of urine sediment was performed. Results and discussion To define quantitative parameters, the total number of epithelial cells (£ep) was determined with further calculation of the mean number of epithelial cells in the field of view (Xep= £ep/10). Correlation between the number of abnormal epithelial cells (Xcp) and the total number of epithelial cells (£ep) was analyzed. The resulted «destruction index» (DI) was the «pool» of all cytopathological changes in epithelial cells DI = Xcp/£ep. Immediately after ESWL, DI markedly increased with significant difference (р<0.05) in numeric values. Two hours after the procedure, the DI reduced compared to the previous value. And only at day 4 DI was close to the norm, although remaining somewhat elevated. Conclusion Extracorporeal shock waves lithotripsy produces the acute urotheIiaI damage resuIting in cytopathoIogicaI changes of varying severity. The above-mentioned technique provides objective and highly significant clinical and diagnostic information on the state of the urothelium after the exposure to shock waves.

urinary stone disease, urolithiasis, extracorporeal lithotripsy, shock waves, urine cytology, urothelial destruction