Prospective evaluation of acute endocrine pancreatic injury as collateral damage of shock-wave lithotripsy for upper urinary tract stones

Abstract

There has been controversy over whether extracorporeal shock wave lithotripsy (ESWL) can cause damage to the endocrine cells of the pancreas, leading to the later development of diabetes mellitus. Authors from Germany prospectively evaluated acute endocrine pancreatic injury as collateral damage caused by the ESWL for treating upper urinary tract stones. In a careful study they showed that there was no effect on serum levels of variables indicating exocrine and endocrine pancreatic tissue damage, suggesting that the idea that ESWL might lead to future diabetes mellitus is unlikely to be correct.

Objective: To detect acute damage to pancreatic cells by extracorporeal shock wave lithotripsy (ESWL), with a focus on endocrine function, as recently the development of diabetes mellitus has been suggested to be a late complication of treatment of upper urinary tract stones, and injury to pancreatic tissue by ESWL, leading to insufficient endocrine function, has been proposed as an explanation of this effect.

Patients and methods: The study included 12 consecutive patients treated with ESWL for proximal ureteric or kidney stones, using a third-generation electromagnetic lithotripter. To evaluate pancreatic tissue injury caused by ESWL we determined blood variables known to indicate exocrine and endocrine pancreatic cell damage; blood samples were taken before, during, immediately after, and 1 h and 24 h after ESWL to determine the serum levels of amylase, lipase, insulin, glucose, c-peptide and glucagon. Eight patients treated with ESWL for distal ureteric stones were evaluated in the same way and served as the control group.

Results: Neither the variables indicating islet cell damage (c-peptide, insulin and glucagon), nor those indicating damage of exocrine pancreatic cells (amylase and lipase) changed significantly over the time course in both groups.

Conclusion: We could detect no immediate effect on the serum levels of variables indicating exocrine or endocrine pancreatic tissue damage caused by ESWL for urinary tract stones. The hypothesis that ESWL leads to pancreatic trauma with consecutive development of diabetes mellitus therefore seems unlikely.