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Ultrasound Probes Successful in Breaking Up Kidney Stones

By MedImaging International staff writers
Posted on 27 Oct 2009

Image: Colored urogram of a patient’s abdomen showing a blocked ureter due to a kidney stone (Photo courtesy of SPL).

When kidney stones become trapped in the urinary tract, the pain can be agonizing and debilitating. A comparatively new ultrasound probe procedure has the highest success rate for breaking down kidney stones in the lower "funnel” region of the kidney, instead of the shock wave treatment used for many years, according to a review of studies.

However, the reviewers cautioned that the studies were small, encompassing only 214 patients, and the study methodology was of low quality. The review appears in issue 4, 2009 of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The investigators looked at the effectiveness of three minimally invasive procedures: the older treatment, called extracorporeal shock wave lithotripsy (ESWL); the ultrasound procedure, or percutaneous nephrolithotomy (PCNL); and retrograde intrarenal surgery (RIRS), which uses a fiberoptic endoscope.

ESWL, which has been in use since 1980, sends shock waves directly to the kidney stone to break it up so it can pass through the urinary tract. In the PCNL approach, the surgeon makes a small incision at the patient's back to put the scope into the kidney and then passes a tube into the kidney through which the surgeon can pass a laser ultrasound probe to remove or break the stone into tiny pieces.

The RIRS procedure involves a fiberoptic endoscope placed through the urethra and into the bladder. The scope locates stones, which the clinician can then disintegrate with an ultrasound probe. "We found that the ultrasound probe had a much higher success rate in terms of stone-free kidneys than using shock waves,” said lead author Attasit Srisubat, M.D., from the Institute of Medical Research and Technology Assessment (Bangkok, Thailand). "The success rate of using a fiberoptic endoscope did not differ significantly from shock wave treatment. However, the use of shock wave treatment did result in less time in the hospital and a shorter duration of treatment.” The overall success rates of each treatment reviewed did not relate to patients' age, race, or sex.

Kidney stones are rock-hard masses that form when crystals separate from urine. For most people, kidney stones do not pose a major medical problem because they typically pass through the body's urine stream without any difficulty, but when stones grow too large, intense pain can result, as well as infection, blood in the urine, and even kidney failure.

There are three main funnels in the kidney upper, middle, and lower. The review studies focus on kidney stones in the lower funnel (or lower pole), which drains the bottom third of the kidney's urine collecting system. Risk factors for developing kidney stones include "family history, anatomical abnormalities of kidney diseases, [and] medications, such as whether a person is taking calcium supplements or vitamin D supplements,” Dr. Srisubat said.

Medicine helps some people, but other patients need an alternative approach. With the expanded use of minimally invasive treatments, the need for open surgery to remove stones has decreased.

Glenn Preminger, M.D., from the division of urologic surgery with Duke University Medical (Durham, NC, USA), routinely performs all three noninvasive forms of stone removal. "All of these treatments work relatively well depending on the size, location and composition of the stone,” he said. "For certain stones that are large or are of a hard composition, they may not fragment well with shock wave treatment. For these we prefer to use an endoscopic means of stone removal.”

Anthony Smith, M.D., chief of the division of urology at the University of New Mexico School of Medicine (Albuquerque, NM, USA), reported they also use all three methods compared in the review for kidney stone removal. "My overall impression is that we are using less and less shock wave treatment and more ureteroscopic intervention with the laser. With the new bidirectional ureteroscopes, we are able to treat larger stones in the upper urinary tract with great success,” he said.

Dr. Smith reported that his facility does use shock wave treatment for smaller stones that clearly are visible on film. "But we think we have better success with lower pole stones using either ureteroscopic or percutaneous approaches.”

Related Links:
Duke University Medical
University of New Mexico School of Medicine

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56 (957.96585083008): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294726175 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 11629.104614258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

58 (!!!!! 7688.9991760254): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

59 (224.82872009277): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

60 (!!!!! 1348.9723205566): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

61 (!!!!! 2732.9921722412): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (!!!!! 1498.9376068115): SELECT fid FROM jos_deeppockets WHERE id=294726175 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294726175 AND published='1' LIMIT 1

63 (667.09518432617): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=214 ORDER BY `ordering`

64 (!!!!! 5113.8401031494): select jos_twitters.link from jos_twitters where cat=10

65 (930.0708770752): select jos_facebook.link from jos_facebook where cat=10

66 (!!!!! 2904.8919677734): select jos_google_plus.link from jos_google_plus where cat=10

67 (380.03921508789): select jos_linkedin.link from jos_linkedin where cat=10

68 (359.05838012695): SELECT fid FROM jos_deeppockets WHERE id=294726175 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294726175 AND published='1' LIMIT 1

69 (679.96978759766): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=214 ORDER BY `ordering`

70 (808.9542388916): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726175 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (!!!!! 1675.1289367676): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726175 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (!!!!! 3640.1748657227): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (!!!!! 3076.7917633057): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (89.168548583984): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (48.160552978516): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (413.89465332031): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (!!!!! 2048.0155944824): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (674.96299743652): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (258.9225769043): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (236.03439331055): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (667.81044006348): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726175 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (992.0597076416): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726175 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (53.882598876953): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (238.89541625977): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (!!!!! 1059.0553283691): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (69.856643676758): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (375.03242492676): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

105 (320.1961517334): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

106 (600.81481933594): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294726175 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (920.05729675293): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294726175 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 2242.8035736084): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

109 (817.06047058105): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

110 (78.916549682617): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294726175 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (651.12113952637): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294726175 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (678.06243896484): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (458.95576477051): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (102.04315185547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

115 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

116 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

117 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

118 (97.036361694336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

119 (57.220458984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

120 (142.09747314453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

121 (69.141387939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

122 (482.08236694336): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 174136.87705994): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (!!!!! 2189.1593933105): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726175 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726175 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (612.97416687012): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (719.07043457031): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (!!!!! 1996.9940185547): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (!!!!! 1876.8310546875): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (!!!!! 2706.0508728027): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (462.05520629883): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (641.1075592041): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (198.1258392334): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (!!!!! 3648.9963531494): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (470.16143798828): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (!!!!! 5660.0570678711): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (!!!!! 1711.8453979492): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (87.976455688477): SELECT name FROM jos_deeppockets WHERE id=214

138 (100.13580322266): SELECT name FROM jos_deeppockets WHERE id=214

139 (806.09321594238): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (!!!!! 7452.9647827148): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (!!!!! 2234.935760498): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

142 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

143 (!!!!! 23402.92930603): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 2846.0025787354): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294726175 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (166.89300537109): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294726175 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (506.87789916992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (263.92936706543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (115.87142944336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

149 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

150 (!!!!! 1918.0774688721): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (123.02398681641): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

152 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

153 (60.081481933594): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294726175 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294726175 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (44.107437133789): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=214 or channel_id is null)

155 (40.054321289062): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=214 or channel_id is null)

156 (53.167343139648): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (211.00044250488): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

158 (85.115432739258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294726175 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294726175 AND published='1' LIMIT 1

159 (82.015991210938): select jos_twitters.link from jos_twitters where cat=10

160 (51.021575927734): select jos_facebook.link from jos_facebook where cat=10

161 (37.908554077148): select jos_google_plus.link from jos_google_plus where cat=10

162 (36.954879760742): select jos_linkedin.link from jos_linkedin where cat=10

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