Outcome Of Extracorporeal Shock Wave Lithotripsy Research Articles

Results of extracorporeal shockwave lithotripsy in the treatment of lower pole vs non-lower pole lithiasis

Results of extracorporeal shockwave lithotripsy in the treatment of lower pole vs non-lower pole lithiasis

Does morbid obesity influence the success and complication rates of extracorporeal shockwave lithotripsy for upper ureteral stones?

The aim of the current study was to investigate whether obesity influences the outcome of extra-corporeal shockwave lithotripsy (ESWL) treatment for upper ureteral stones. This is a retrospective study of 134 patients who underwent ESWL between June 2011 and May 2014. Patients were divided into 2 groups. Group 1 comprised 94 patients of normal weight, and group 2 comprised 40 morbidly obese patients. Patients in both groups had upper ureteral stones. The mean age of groups 1 and 2 was 45.6±12.1 and 45.3±15.5 years, respectively (p=0.98). There was no significant difference in demographic variables between the groups. The mean stone size in groups 1 and 2 was 81.7±25.7 mm(2) and 86.3±22.4 mm(2), respectively (p=0.51), the mean body mass index (BMI) was 27.4±2.9 and 42.9±2.1, respectively (p<0.01), the mean number of ESWL sessions was 2.4±0.6 and 2.4±0.7, respectively (p=0.97), and the mean follow-up time was 7.1±3.4 and 6.6±2.8 weeks, respectively (p=0.67). The overall stone-free rate was 82% in group 1 and 67% in group 2 (p=0.01). It is well-known that morbidly obese patients have higher rates of anesthesia-related problems due to the comorbidities commonly observed in this population. In the current study, we found that ESWL is a safe and acceptable treatment option for morbidly obese patients with upper ureteral stones.

Can stone density on plain radiography predict the outcome of extracorporeal shockwave lithotripsy for ureteral stones?

PurposeThe objective was to determine whether stone density on plain radiography (kidney-ureter-bladder, KUB) could predict the outcome of extracorporeal shockwave lithotripsy (ESWL) for ureteral stones.Materials and MethodsA total of 223 patients treated by ESWL for radio-opaque ureteral stones of 5 to 20 mm were included in this retrospective study. All patients underwent routine blood and urine analyses, plain radiography (KUB), and noncontrast computed tomography (NCCT) before ESWL. Demographic, stone, and radiological characteristics on KUB and NCCT were analyzed. The patients were categorized into two groups: lower-density (LD) group (radiodensity less than or equal to that of the 12th rib, n=163) and higher-density (HD) group (radiodensity greater than that of the 12th rib, n=60). Stone-free status was assessed by KUB every week after ESWL. A successful outcome was defined as stone free within 1 month after ESWL.ResultsMean stone size in the LD group was significantly smaller than that in the HD group (7.5±1.4 mm compared with 9.9±2.9 mm, p=0.002). The overall success rates in the LD and HD groups were 82.1% and 60.0%, respectively (p=0.007). The mean duration of stone-free status and average number of SWL sessions required for success in the two groups were 21.7 compared with 39.2 days and 1.8 compared with 2.3, respectively (p<0.05). On multivariate logistic analysis, stone size and time to ESWL since colic and radiodensity of the stone on KUB were independent predictors of successful ESWL.ConclusionsOur data suggest that larger stone size, longer time to ESWL, and ureteral stones with a radiodensity greater than that of the 12th rib may be at a relatively higher risk of ESWL failure 1 month after the procedure.

History of Ureteral Stenting Negatively Affects the Outcomes of Extracorporeal Shockwave Lithotripsy. Results of a Matched-pair Analysis.

To evaluate the impact of ureteral stenting history to the outcomes of extracorporeal shockwave lithotripsy, we retrospectively analysed patients who underwent shockwave lithotripsy with Dornier Gemini lithotripter between September 2010 and August 2012. Forty seven patients (group A) who had a double J stent which was removed just before the procedure were matched-paired with another 47 patients (group B) who underwent shockwave lithotripsy having no stent history. The correlation between ureteral stenting history and stone-free rates was assessed. Stone-free rates were 68.1% and 87.2% for patients of group A and B, respectively (p=0.026). Postoperative complications were not different between groups. Multivariate analysis revealed that stone size (p=0.007), stone location (p=0.044) and history of ureteral stenting (p=0.046) were independent predictors for stone clearance after shockwave lithotripsy. Ureteral stents adversely affect shockwave lithotripsy outcome, even if they are removed before the procedure. Stenting history should divert treatment plan towards intracorporeal lithotripsy.

Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones.

Stones in the urinary tract are a common medical problem in the general population. At present, the great expansion in minimally invasive techniques has led to the decrease in open surgery. Extracorporeal shock wave lithotripsy (ESWL) has been introduced as an alternative approach which disintegrates stones in the kidney and upper urinary tract through the use of shock waves. Nevertheless, as there are limitations with the success rate in ESWL, other minimally invasive modalities for kidney stones such as percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) are also widely applied. This is an update of a review first published in 2009. This review aimed to assess the effectiveness and complications of ESWL for kidney stones compared with PCNL or RIRS. We searched the Cochrane Renal Group's Specialised Register to 3 March 2014 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. Randomised controlled trials (RCTs) assessing the use of ESWL compared to PCNL or RIRS for kidney stone management. Two authors independently assessed all the studies for inclusion. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes or mean difference (MD) for continuous data with 95% confidence intervals (CI). Five studies (338 patients) were included, four studies compared ESWL to PCNL and one compared ESWL with RIRS. Random sequence generation was reported in three studies and unclear in two. Allocation concealment was not reported in any of the included studies. Blinding of participants and investigators could not be undertaken due to the nature of the interventions; blinding of outcome assessors was not reported. Reporting bias was judged to be low risk in all studies. One study was funded by industry and in one study the number of participants in each group was unbalanced.The success of treatment at three months was significantly greater in the PCNL compared to the ESWL group (3 studies, 201 participants: RR 0.46, 95% CI 0.35 to 0.62). Re-treatment (1 study, 122 participants: RR 1.81, 95% CI 0.66 to 4.99) and using auxiliary procedures (2 studies, 184 participants: RR 9.06, 95% CI 1.20 to 68.64) was significantly increased with ESWL group compared to PCNL. The efficiency quotient (EQ; used to assess the effectiveness of procedures) higher for PCNL than ESWL; however EQ decreased when stone size increased. Duration of treatment (MD -36.00 min, 95% CI -54.10 to -17.90) and hospital stay (1 study, 49 participants: MD -3.30 days, 95% CI -5.45 to -1.15) were significantly shorter in the ESWL group. Overall more complications were reported with PCNL, however we were unable to meta-analyse the included studies due to the differing outcomes reported and the timing of the outcome measurements.One study compared ESWL versus RIRS for lower pole kidney stones. The success of treatment was not significantly different at the end of the third month (58 participants: RR 0.91, 95% CI 0.64 to 1.30). Mean procedural time and mean hospital stay was reported to be longer in the RIRS group. Results from five small studies, with low methodological quality, indicated ESWL is less effective for kidney stones than PCNL but not significantly different from RIRS. Hospital stay and duration of treatment was less with ESWL. Larger RCTs with high methodological quality are required to investigate the effectiveness and complications of ESWL for kidney stones compared to PCNL if there is any technological progress in the non-invasive elimination of the residual fragments. Moreover, further research is required for the outcomes of ESWL and RIRS in lower and non-lower pole studies including PCNL versus RIRS.

Evaluation of Hounsfield Units as a predictive factor for the outcome of extracorporeal shock wave lithotripsy and stone composition.

The objective of this study was to evaluate the utility of the Hounsfield Unit (HU) values as a predictive factor of extracorporeal shock wave lithotripsy outcome for ureteral and renal stones. We also assessed the possibility that HU values could be used to predict stone composition. A retrospective study was performed to measure stone HU values in 260 patients who underwent extracorporeal shock wave lithotripsy (ESWL) for solitary renal and ureteral stones from July 2007 to January 2012. Stone volume, location, skin-to-stone distance, stone HU values, and stone composition were assessed. Success of ESWL was defined as: (1) being stone-free or (2) residual stone fragments <4 mm after 3 months by radiography. Of the 260 assessed patients, 141 (54.2%) were stone-free, 32 (12.3%) had residual stone fragments <4 mm (clinically insignificant stone fragments), and 87 (33.5%) had residual stone fragments ≥4 mm after one round of ESWL. Multivariate analysis revealed that stone location and mean HU were significant predictors of ESWL success. Receiver operating characteristic curves defined cutoff values for predicting treatment outcome. Treatment success rates were significantly higher for stones <815 HU than with stones >815 HU (P < 0.0265). HU of calcium oxalate and calcium phosphate stones were higher than those of uric acid stones, but we could not differentiate between calcium oxalate monohydrate and calcium oxalate dihydrate stones. Evaluation of stone HU values prior to ESWL can predict treatment outcome and aid in the development of treatment strategies.

The usefulness of stone density and patient stoutness in predicting extracorporeal shock wave efficiency: Results in a North African ethnic group.

We determine the role of stone density and skin-to-stone distance (SSD) by non-contrast computed tomography of the kidneys, ureters and bladder (CT-KUB) in predicting the success of extracorporeal shock wave lithotripsy (ESWL). We evaluated 89 patients who received ESWL for renal and upper ureteric calculi measuring 5 to 20 mm, over a 12-month period. The mean stone density in Hounsfield units (HU) and mean SSD in mm was determined on pre-treatment CT-KUB at the CT workstation. ESWL was successful if post-treatment residual stone fragments were ≤3 mm. ESWL success was observed in 68.5% of patients. Mean stone densities were 505 ± 153 and 803 ± 93 HU in the ESWL successful and failure groups, respectively (p < 0.001, student's t-test). The mean SSD were 10.6 ± 2.0 and 11.2 ± 2.6 cm in ESWL successful and failure groups, respectively; this was not statistically significant. This study shows that stone density can help to predict the outcome of ESWL. We propose that stone density <500 HU are highly likely to result in successful ESWL. Conversely, stone densities >800 HU are less likely to be successful.

Efficacy of extracorporeal shockwave lithotripsy using Dornier SII in different levels of ureteral stones.

Objective:The objective of this study was to evaluate the efficacy and safety of the Dornier lithotripter S II system in the treatment of ureteral calculi.Patients and Methods:A total of 97 cases which consists of 54 males and 43 females with ureteral stones were treated by extracorporeal shock wave lithotripsy (ESWL). Mean age was 42.6 years. Inclusion criteria were solitary radiopaque ureteral stones of radiological stone size of ≤1 cm. The stones were not impacted, with normal kidney functions. Procedure time, number of shocks, energy used, number of sessions and complications were reported. The outcome of ESWL was also recorded.Results:Stones were in the abdominal (upper ureter) in 50% of patients, in pelvic (middle ureter) in 47% of patients. All patients had unilateral stones and the mean stone size in maximum length was) 10 mm). Good dye excretion passing the stone was noted in all patients. Mild hydronephrosis was found in 85% of cases. A total of 49 cases were treated by a single session, while in 35% of cases two sessions were enough and 16% received three sessions. The average number of shocks per session was 3125. The average number of shocks per patient was 5962.5 shocks and average energy was 204.3 Joules. The overall stone-free rate 3 months after lithotripsy was 94%. After a single session of lithotripsy, 49 patients (49%) became stone-free. Stone free rates after ESWL for upper, middle ureteral stones were 94%, 95.7% respectively. Additional procedures were needed in only 6 cases (6%) to render patients stone-free after lithotripsy. No serious complications occurred.Conclusion:The Dornier lithotripter S II is very effective in the treatment of ureteral calculi with no major complications.

Predicting stone composition before treatment - can it really drive clinical decisions?

IntroductionDetermination of stone composition is considered to be crucial for the choice of an optimal treatment algorithm. It is especially important for uric acid stones, which can be dissolved by oral chemolysis and for renal stones smaller than 2 cm, which can be treated with extracorporeal shockwave lithotripsy (ESWL).Material and methodsThis short review identifies the latest papers on radiological assessment of stone composition and presents a comprehensive evaluation of current scientific findings.ResultsStone chemical composition is difficult to predict using standard CT imaging, however, attenuation index measured in Hounsfield units (HU) is related to ESWL outcome. Stone density >1000 HU can be considered predictive for ESWL failure. It seems that stone composition is meaningless in determining the outcome of ureterolithotripsy and percutaneous surgery. Alternative imaging techniques such as Dual–Energy CT or analysis of shape, density and homogeneity of stones on plain X–rays are used as promising methods of predicting stone composition and ESWL outcome.ConclusionsNew imaging techniques facilitate the identification of uric acid stones and ESWL–resistant stones. Therefore, they may help in selecting the best therapeutic option.

Long-term clinical outcomes of extracorporeal shockwave lithotripsy in painful chronic calcific pancreatitis

Long-term results of extracorporeal shockwave lithotripsy (ESWL) for large pancreatic duct (PD) stones in patients with idiopathic calcific pancreatitis (CP) are scanty. To evaluate intermediate and long-term results of ESWL in a large cohort of patients with idiopathic CP. Cross-sectional study; retrospective chart review. A high-volume, tertiary-care center for endoscopy and GI diseases. A total of 636 patients with idiopathic CP who underwent ESWL and ERCP were followed-up. Patients were divided into intermediate (24-60 months) and long-term (>60 months) follow-up groups. ESWL and ERCP. Improvement in pain, analgesic use, hospitalization for pain, recurrence of calculi, need for additional intervention, and quality of life. A total of 636 of 1006 patients who underwent ESWL between 2004 and 2009 were followed for a maximum of 96 months. There were 364 patients in the intermediate follow-up group and 272 in the long-term follow-up group. After ESWL and ERCP, absence of pain was seen in 250 patients (68.7%), mild-to-moderate pain in 94 patients (25.4%), and severe pain in 20 patients (5.5%) of the intermediate group. In the long-term group, 164 patients (60.3%) had no pain, 97 patients (35.7%) had mild or moderate episodes of pain, whereas 11 patients (4.04%) had episodic severe pain. Recurrence of calculi was seen in 51 patients (14.01%) in the intermediate follow-up group and in 62 patients (22.8%) in the long-term group. Quality of life improved in a significant number of patients in both groups. Retrospective study, single center, recall bias, and subjective pain and quality-of-life measurement scale. ESWL for large PD calculi offers good results in patients of idiopathic CP on intermediate and long-term follow-up.

1824 DO HIGHER PHYSICAL ACTIVITY LEVELS RESULT IN A BETTER OUTCOME FOLLOWING LITHOTRIPSY?

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (III)1 Apr 20131824 DO HIGHER PHYSICAL ACTIVITY LEVELS RESULT IN A BETTER OUTCOME FOLLOWING LITHOTRIPSY? Rebecca Ilyas, Graham Young, and Karyee Chow Rebecca IlyasRebecca Ilyas Manchester, United Kingdom More articles by this author , Graham YoungGraham Young Manchester, United Kingdom More articles by this author , and Karyee ChowKaryee Chow Manchester, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2187AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It is generally assumed that patients who are physically active have an improved stone clearance rate following extracorporeal shock wave lithotripsy (ESWL), however this has never been formally proven. It was our aim to test the feasibility of measuring physical activity levels with the International Physical Activity Questionnaire (IPAQ) and correlating this with our ESWL success rates. METHODS The IPAQ was administered to 56 patients via a telephone call follow-up post ESWL for urinary tract stones. Information regarding the ESWL treatment was collected including stone size, number, position and 3 month outcome as determined by a plain X-Ray. Post treatment pain scores & BMI were also documented. Analysis of the IPAQ generated an activity score, which was then compared with the ESWL outcome. RESULTS Out of the 56 patients 26 were considered to have had a successful outcome (stone free/clinically insignificant residual fragments). IPAQ scores were significantly higher in this group of patients (68 vs 46; p < 0.01). A lower score was associated with a higher BMI. CONCLUSIONS Physical activity levels can be objectively measured using the IPAQ in our patients following ESWL. In this small study a correlation with ESWL outcome was demonstrated. A larger prospective study is on going to further validate this finding. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e749 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rebecca Ilyas Manchester, United Kingdom More articles by this author Graham Young Manchester, United Kingdom More articles by this author Karyee Chow Manchester, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Extracorporeal shockwave lithotripsy to distal ureteric stones: the transgluteal approach significantly increases stone‐free rates

WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Shockwave lithotripsy (SWL) can be used to treat stones at any position within the ureter, as long as the stone is radio-opaque and there is a path for the shockwave to reach the stone. However the results of SWL to distal ureteric calculi, with the patient in a prone position, were inferior to those of treating stones within the upper ureter. The transguteal approach allows the lithotripsy shockwave to reach the lower ureter via the greater selatle foramen. This study shows that this approach for SWL to distal ureteric calculi is more effective than the prone approach. To compare the outcomes of extracorporeal shockwave lithotripsy (ESWL) for distal ureteric stones treated using the prone and transgluteal (supine) approaches in a tertiary referral stone unit using a fourth generation lithotriptor. We selected consecutive patients undergoing ESWL to distal ureteric stones over 1 year, during which we changed our treatment protocol from a prone to transgluteal (supine) approach. Patients were treated using the Sonolith Vision Lithotriptor (Technomed Medical Systems, Vaulx-en-Velin, France). Outcome was assessed using plain abdominal film of kidney, ureter and bladder (KUB) X-ray taken at 2 weeks then monthly as required. Treatment success was defined as complete clearance of stone fragments and treatment failure was defined as persistence of stone fragments beyond 3 months or the need for ureteroscopy. A total of 38 patients were treated in the prone position and 72 patients using a transgluteal approach. Patient and stone characteristics were identical in both groups. The mean (range) stone size was 7.8 (4-16) mm. The proportions of patients who were stone-free after one treatment session within the prone and transgluteal treatment groups were 40 and 78%, respectively (<0.001). The overall success rates for treatment within the prone and transgluteal groups were 63 and 92%, respectively (<0.001). Transgluteal ESWL to stones within the distal ureter leads to significantly higher stone-free rates than treatment using the prone approach. The majority of patients are rendered stone-free after one session of treatment and the overall success rates are similar to those of ureteroscopic management.

Is there a place for ESWL in the treatment of complicated proximal ureteral stones?

Although recently the minimal invasive urological and endourological methods have been substantially improved, concerns remain about the optimal management of proximal ureteral stones. Even the European Association of Urology Guidelines are not fully clear and leave the choice of treatment method to the urologist's discretion. Both extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) are accepted methods of the proximal ureteral stones management. ESWL is very often used as a first–line procedure because of its minimal invasiveness. It is proper for ureteral stones in all locations, but especially suitable for proximal (lumbar) localization because URS is considered more difficult in the upper part of the ureter. Authors of the paper published in this issue of Central European Journal of Urology have discussed the impact of a double–J stent for the results of ESWL in ureteral lumbar stones [1]. A lot of predictors have been reported to influence ESWL outcome in the management of ureteral calculi [2]. One of them is a double–J stent. As the authors have pointed, there are conflicting opinions on the ESWL effects in the management of ureteral stones in pre–stented patients. There is a quite popular theory that the indwelling stent creates expansion space thus facilitating effects of ESWL. On the other hand many authors stress that a stent can absorb energy of shock waves, impede their propagation and energy transmission thus lowering fragmentation rate. Also, while some suggest that catheters aid fragments passage by passive dilatation of the ureter [3] others point out that double–J stents can cause uretheral oedema, irritation and diminished peristalsis delaying clearance [4]. Results reported by Pettenati et al. show that presence of a double–J stent adversely affect the results of ESWL for stones >8 mm. The main limitation of this study is its retrospective design. However, some prospective studies have also reported that pre–stenting before ESWL does not improve the procedure results. In the recent prospective randomized trial stenting prior ESWL provided no additional advantage over in–situ ESWL. There was no statistical significant difference in stone–free rates between stented and non–stented patients with upper impacted ureteral stones measuring ≤2 cm treated with ESWL (90% vs. 86.7% respectively; p = 0.346) [5]. In another prospective randomized study pre–stenting limited stone–free rates in the ESWL management 4 to 10 mm ureteral stones (68.6% vs. 83.7% for stented and non–stented groups respectively; p = 0.026) and was responsible for higher post–ESWL morbidity and lower quality of live [6]. Therefore routine stenting before ESWL for ureteral lithiasis is not recommended, but in case of complicated lithiasis (sepsis, acute obstructive pyelonephritis, renal insufficiency, severe pain) urgent decompression with a double J stent is often necessary before implementation of definitive treatment. What should be the next step in the management of ureteral stones after recovery from sepsis or any other emergency case? Should we perform ESWL or rather ureteroscopy as a definitive treatment following the double J stent placement? The choice is controversial. Decision should be individual for each patient with a ureteral stone, especially if complicating factors co–exist. However, in my opinion Pettenati's study and other publications support the use of URS as a preferred first–line procedure in complicated lumbar ureteral stones previously managed with a double J stent. Pre–stenting makes ureteroscopy easier, improves stone–free rates and reduces complications risk [7]. With uncomplicated URS there is a higher probability of definitive stone clearance with just one procedure and the stent can be removed earlier. That is an important advantage as lower urinary tract symptoms caused by indwelling stent are noticed in up to 80% of patients. Stent–related complaints interfere with daily activities and are responsible for quality of life deterioration [3]. Patients treated with ESWL are usually not immediately stone–free and very often there is a need for repeated ESWL sessions or other additional procedures which delay definitive treatment, thus lowering the patient's quality of live and increasing costs.

Factors Affecting the Outcome of Extracorporeal Shock Wave Lithotripsy for Unilateral Urinary Stones in Children: A 17-Year Single-Institute Experience

PurposeExtracorporeal shock wave lithotripsy (ESWL) is a first-line treatment for pediatric urinary stone disease. We aimed to determine the factors affecting the outcome of ESWL for unilateral urinary stones in children.Materials and MethodsA total of 81 pediatric patients aged 0 to 16 years with urinary stones treated by ESWL from January 1995 through May 2012 were retrospectively reviewed. All patients were required to have unilateral urinary stone disease. Children who underwent other surgical procedures before ESWL were excluded. Outcomes evaluated after ESWL were the stone-free rate at 3 months after ESWL, success within a single session, and success within three sessions. Factors affecting the success within three sessions were also analyzed.ResultsThe final analysis was for 42 boys and 22 girls (mean age, 9.2±5.2 years). Of these 64 patients, 58 (90.6%) were treated by ESWL without other surgical procedures and 54 (84.4%) were successfully treated within three ESWL sessions. In the multivariate analysis, multiplicity (odds ratio [OR], 0.080; 95% confidence interval [CI], 0.012 to 0.534; p=0.009) and large stone size (>10 mm; OR, 0.112; 95% CI, 0.018 to 0.707; p=0.020) were significant factors that decreased the success rate within three ESWL sessions.ConclusionsMost of the pediatric urinary stone patients in our study (90.6%) were successfully treated by ESWL alone without additional procedures. If a child has a large urinary stone (>10 mm) or multiplicity, clinicians should consider that several ESWL sessions might be needed for successful stone fragmentation.

Re: Which Is More Important in Predicting the Outcome of Extracorporeal Shockwave Lithotripsy of Solitary Renal Stones: Stone Location or Stone Burden?(From: Khalil MM. J Endourol 2012;26:535–539.)

Journal of EndourologyVol. 27, No. 1 Letters to the EditorDean G. Assimos, MD, Section EditorRe: Which Is More Important in Predicting the Outcome of Extracorporeal Shockwave Lithotripsy of Solitary Renal Stones: Stone Location or Stone Burden?(From: Khalil MM. J Endourol 2012;26:535–539.)Apul Goel and Sagorika PaulApul GoelSearch for more papers by this author and Sagorika PaulSearch for more papers by this authorPublished Online:10 Jan 2013https://doi.org/10.1089/end.2012.0403AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Re: Which Is More Important in Predicting the Outcome of Extracorporeal Shockwave Lithotripsy of Solitary Renal Stones: Stone Location or Stone Burden?(From: Khalil MM. J Endourol 2012;26:535–539.)." , 27(1), p. 110FiguresReferencesRelatedDetails Volume 27Issue 1Jan 2013 InformationCopyright 2013, Mary Ann Liebert, Inc.To cite this article:Apul Goel and Sagorika Paul.Re: Which Is More Important in Predicting the Outcome of Extracorporeal Shockwave Lithotripsy of Solitary Renal Stones: Stone Location or Stone Burden?(From: Khalil MM. J Endourol 2012;26:535–539.).Journal of Endourology.Jan 2013.110-110.http://doi.org/10.1089/end.2012.0403Published in Volume: 27 Issue 1: January 10, 2013Online Ahead of Print:September 24, 2012Online Ahead of Editing: July 26, 2012PDF download

Extracorporeal shock wave lithotripsy (ESWL) versus ureteroscopic management for ureteric calculi

Ureteral stones frequently cause renal colic, and if left untreated, can lead to obstructive uropathy. Extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy, with or without intracorporeal lithotripsy, are the most common interventions used to treat ureteral stones. ESWL treatment is less invasive than ureteroscopy, but has some limitations such as a high retreatment rate, and is not available in all centres. Recent advances in ureteroscopy have increased success rates and reduced complication rates. To examine evidence from randomised controlled trials (RCTs) on the outcomes of ESWL or ureteroscopy in the treatment of ureteric calculi. We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library Issue 2, 2011), MEDLINE (1966 to March 2011), EMBASE (1980 to March 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of articles and abstracts from conference proceedings, all without language restriction. RCTs that compared ESWL with ureteroscopic retrieval of ureteric stones were included in this review. Study participants were adults with ureteric stones requiring intervention. Published and unpublished sources were considered for inclusion. Three authors independently assessed study quality, risk of bias, and extracted data. Statistical analyses were performed using the random-effects model. Results were expressed as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous data, both with 95% confidence intervals (CI). Seven RCTs (1205 patients) were included in the review. Stone-free rates were lower in patients who underwent ESWL (7 studies, 1205 participants: RR 0.84, 95% CI 0.73 to 0.96) but re-treatment rates were lower in ureteroscopy patients (6 studies, 1049 participants: RR 6.18, 95% CI 3.68 to 10.38. ESWL-treated patients had less need for auxiliary treatment (5 studies, 751 participants: RR 0.43, 95% CI 0.25 to 0.74; fewer complications (7 studies, 1205 participants: RR 0.54, 95% CI 0.33 to 0.88); and shorter length of hospital stay (2 studies, 198 participants: MD -2.55 days, 95% CI -3.24 to -1.86).Three studies adequately described the randomisation sequence, three studies were unclear on how they randomised, while one study had a high risk of selection bias. All the studies had an unclear risk of performance bias and detection bias, while all had a low risk of attrition bias, reporting bias, or other sources of bias identified. Compared with ESWL, ureteroscopic removal of ureteral stones achieves a greater stone-free state, but with a higher complication rate and longer hospital stay.

Predictive Factors of the Outcome of Extracorporeal Shockwave Lithotripsy for Ureteral Stones

PurposeExtracorporeal Shock Wave Lithotripsy (ESWL) has shown successful outcomes for ureteral stones. We investigated predictive factors for failure of ESWL for treating ureteral stones.Materials and MethodsA total of 153 patients who underwent ESWL between July 2006 and July 2009 for ureteral stones diagnosed by non-enhanced spiral computed tomography were divided into two groups: (group A, stone size ≤10 mm; and group B, stone size >10 mm). The failure was defined as remnant stones >4 mm. We assessed age, sex, body mass index, stone size, laterality, location, skin-to-stone distance (SSD), Hounsfield unit, and the presence of secondary signs (hydronephrosis, renal enlargement, perinephric fat stranding, and tissue rim sign). We analyzed predictive factors by using logistic regression in each group.ResultsThe success rates were 90.2% and 68.6% in group A and B, respectively. In the univariate analysis of each group, stone size, SSD, and all secondary signs showed statistically significant differences in terms of the outcome of ESWL (p<0.05). In the multivariate logistic regression, stone size (odds ratio [OR], 50.005; 95% confidence interval [CI], 6.207 to 402.852) was an independent predictive factor in group A. The presence of perinephric fat standing (OR, 77.634; 95% CI, 1.349 to 446.558) and stone size (OR, 19.718; 95% CI, 1.600 to 243.005) were independent predictive factors in group B.ConclusionsStone size is an independent predictive factor influencing failure of ESWL for treating ureteral stones. In larger ureteral stones (>10 mm), the presence of perinephric fat stranding is also an independent predictive factor.

Treatment of Kidney Stones Using Extracorporeal Shock Wave Lithotripsy (ESWL) and Double-J Stent in Infants

Background. Extracorporeal shock wave lithotripsy (ESWL) has progressively acquired popularity as being the gold standard treatment for upper urinary tract lithiasis in infants since 1980. Our aim was to evaluate the outcome of ESWL for kidney stones and the use of double-J stent in infants. Material and Methods. A prospective clinical trial study performed on 50 infants with renal calculi at pelvic admitted in the Urology ward of Shafa Hospital, Sari, Iran, between 2001 and 2010. Main outcome measure of our study was clearing stones after one or more consecutive sessions of ESWL. Results. The study included 50 patients with renal calculi at pelvic. Among them, there were 35 (70%) boys and 15 (30%) girls with the age ranging from 1 to 13 months (mean of 7 month ± 3 days). All of them were treated by standard ESWL using Simons Lithostor plus machine. The stone sizes ranged from 6 mm to 22 mm. Double-J stents were placed in 11 infants (22%) with stones larger than 13 mm. Most of the patients required only one ESWL session. Conclusion. Since there were no complications following ESWL treatment, we can conclude that, in short term, ESWL is an effective and safe treatment modality for renal lithiasis in infants. In addition, we recommend double-J stent in infants with stones larger than 13 mm.

Which Is More Important in Predicting the Outcome of Extracorporeal Shockwave Lithotripsy of Solitary Renal Stones: Stone Location or Stone Burden?

To assess the effect of stone location and burden on the outcome of extracorporeal shockwave lithotripsy (SWL) as a primary treatment of solitary renal stone. The study included 438 patients with a solitary renal stone who underwent SWL as a primary treatment for their stones. All were evaluated by plain radiography of the kidneys, ureters, and bladder (KUB), ultrasonography, intravenous urography, or noncontrast enhanced CT before SWL and followed up for 3 months after treatment by KUB radiography and/or ultrasonography. Patients were classified into four groups according to stone location (renal pelvis, lower, middle, and upper calix) and three groups according to stone burden (≤ 1 cm(2), 1.1-2 cm(2), and >2 cm(2)). Treatment outcome was considered successful if no residual fragments (stone free) or clinically insignificant nonobstructing residuals less than 4 mm remained after 3 months of follow-up. The mean age of the patients was 45.1 ± 12.5 years. The mean stone burden, number of sessions, and shockwaves for the whole study were 1.3 ± 0.49 cm(2), 2.1 ± 0.7 sessions, and 5616.6 ± 2017.4 shockwaves, respectively. The stone-free rate of the study was 65.1%. The stone-free rates of the stones in the renal pelvis, lower, middle, and upper calices were 72.4%, 56%, 55.6%, and 69%, respectively. The stone-free rate of the stones ≤ 1 cm(2), 1.1 to 2 cm(2), and >2 cm(2) was 50.2%, 39.6%, and 10.2%, respectively (P<0.05). Stone burden rather than stone location is considered as a predicting factor for the outcome of SWL in a solitary renal stone, especially in the renal pelvis and lower calix.

Factors Predicting the Success of Extracorporeal Shock Wave Lithotripsy in the Treatment of Ureteric Calculi

Objective: To evaluate the success of extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteric calculi and determine the factors which influence outcome. Patients and methods: A retrospective audit of patients with a single ureteric stone receiving ESWL was performed. Success was defined as complete stone clearance on post-treatment imaging. Patient demographics and stone characteristics were correlated to ESWL outcome. Results: 108 patients met the inclusion criteria for this study. The mean age of the patients was 52.5 years (range 24–89 years). 80% (86/108) of patients were male. Stone sizes varied from 4 to 19 mm (mean 7.92 mm). The overall ESWL success rate for ureteric stones was 79%. Treatment was more effective for smaller ( p = 0.003) and more located stones ( p = 0.035). Stone size correlated with number of treatments required ( p =0.005). A JJ stent in situ at the time of ESWL reduced the success rate ( p = 0.002). Conclusions: Stone size, site in the ureter, and the presence of a JJ stent were predictors of ESWL success. Our study from a District General Hospital in the UK demonstrates that ESWL may be used with high efficacy to treat ureteric stones.