Success Of Extracorporeal Shock Wave Lithotripsy Research Articles

Variation coefficient of stone density and renal cortical thickness: the parameters evaluating non-contrast computed tomography imaging for predict extracorporeal shock wave lithotripsy success.

The stone density (SD) is not the same in all parts of the stone due to the heterogeneous nature of the stone and the shock wave (SW) passes through tissues of many different densities until it reaches the stone. These factors affect the success of Extracorporeal Shock Wave Lithotripsy (ESWL). We aimed to evaluate the effect of the Variation Coefficient of Stone Density (VCSD) and Renal Cortical Tickness (RCT) on the success of ESWL. Between 2020 and 2023, 510 patients who underwent ESWL were divided into 2 groups treatment success (n:304) and treatment failure (n:206). Non-Contrast Computed Tomography (NCCT) imaging values of hydronephrosis degree of the kidney, stone location, stone volume (SV), stone-skin distance (SSD), SD, Standard deviation of Stone Density (SDSD), VCSD, RCT, Soft-Tissue Thickness (STT), Muscle Thickness (MT) were analyzed. VCSD value was obtained by dividing SDSD by SD. Along the SW, tissues were divided into three components: kidney (renal cortex), muscle and other soft tissues. RCT, MT and SSD were measured at three different angles (0°, 45°, and 90°) and these 3 lengths were averaged. In univariate analysis, Body Mass Index (BMI), SV, SD, VCSD, SSD, RCT and STT were demonstrated to affect ESWL success. In multivariate analysis, low BMI, SV, SD, RCT and large VCSD were significant independent predictors of ESWL success. Among these parameters, VCSD had the highest prediction accuracy, followed by SD, SV, RCT and BMI, respectively. This study demonstrated that VCSD value and RCT are predictive parameters in determining the treatment of patients with urinary calculi and selecting suitable ESWL candidates.

Assessment of pancreatic ductal stone density on non-contrast computed tomography for predicting the outcome of extracorporeal shock wave lithotripsy.

Background and study aims The utility of stone density at non-contrast computed tomography (NCCT) for predicting the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in chronic calcific pancreatitis (CCP) is relatively unexplored. Patients and methods This was a prospective observational study of patients with CCP. Hounsfield units (HU) were determined for the largest pancreatic ductal stone during pretreatment NCCT. All patients underwent ESWL until the largest stone was fragmented to <3mm, followed by endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction. The predictive factors following ESWL for successful stone extraction were studied and the receiver operating characteristic (ROC) curve determined the HU optimal cut-point. Results Eighty-two patients with a median (interquartile range) age of 36 years (range, 29-55); majority male 45 (54.9%), were included. Idiopathic CCP was noted in 78 patients (95.1%). The median stone density (SD) was 1095 HU (range, 860.7-1260.7) and the number of ESWL sessions was 2 (range, 2-3). Complete stone removal at index ERCP was achieved in 55 patients (67.1%). Those with partial clearance (n=27) needed a repeat ERCP, which was successful in 26 (96.3%); one patient (3.7%) underwent surgery. There was a significant, positive correlation between number of ESWL sessions and SD (r=0.797; P <0.001). On bivariate analysis, SD and the number of ESWL sessions revealed a significant association with complete ductal clearance. The optimal cut-point for complete stone removal by the ROC curve was 1106.5 HU (Youden index 0.726), with a sensitivity of 93% and a specificity of 80%. Conclusions The SD is a significant predictor of ESWL success followed by ductal clearance at ERCP, and <1106.5 HU is a predictor of good candidates for ESWL therapy.

Predictive Factors Correlated with Successful Early Endoscopic Removal of Pancreaticolithiasis in Chronic Pancreatitis after Extracorporeal Shock Wave Lithotripsy.

The treatment of chronic pancreatitis (CP) and symptomatic pancreatic duct (PD) calculi often involves techniques like endoscopic retrograde cholangiopancreatography (ERCP), extracorporeal shock wave lithotripsy (ESWL), or a combination of both. However, identifying predictive factors for the successful removal of these calculi remains variable. This study aimed to determine the factors predicting successful ESWL and endoscopic removal in CP and PD calculi patients. We examined data from CP patients who underwent complete PD calculi removal via ESWL combined with ERCP between July 2012 and 2022, and assessed baseline characteristics, imaging findings, and treatment details. Patients were categorized into early- and late-endoscopic complete removal groups (EER and LER groups, respectively). Of the 27 patients analyzed, 74.1% were male with an average age of 44 ± 9.6 years. EER was achieved in 74% of the patients. Patients in the EER group exhibited smaller PD calculi diameter (8.5 vs. 19 mm, p = 0.012) and lower calculus density (964.6 vs. 1313.3 HU, p = 0.041) compared to the LER group. Notably, PD stricture and the rate of PD stent insertion were not different between the groups. A calculus density threshold of 1300 HU on non-contrast CT demonstrated 71% sensitivity and 80% specificity in predicting EER. Smaller and low-density PD calculi may serve as predictors for successful EER, potentially aiding in the management of CP patients with PD calculi.

Efficacy of Isosorbide in Post Extra Corporeal Shock Wake Lithotripsy Stone-Free Time

Background and Objective: Extracorporeal shockwave lithotripsy (ESWL) is mong the the low-risk treatment methods of treating kidney stones. Specialists are looking for ways to remove small stones caused by ESWL in patients as soon as possible. The present study aimed to determine the effect of isosorbide on the duration of renal pelvis excretion after ESWL. Materials and Methods: In this clinical trial, 176 patients with renal pelvis &lt; 20 mm, who were referred to the ESWL Department of Moradi Hospital, Rafsanjan, Iran, in 2019, were examined. After lithotripsy, the patients were randomly assigned into two intervention groups of receivers of isosorbide 20 mg tablets every 12 hours for two weeks and placebo control for two weeks. The collected data was analyzed using Mann-Whitney and Kruskal-Wallis statistical tests. Results: The success of ESWL was 78.2% in the isosorbide group and 77.5% in the placebo group (P=0.919). The average duration of stone excretion in the isosorbide group was 4.21 ± 1.05 days, and the placebo group was 4.79 ± 1.16 (P=0.001). In the isosorbide group, the duration of stone excretion in patients with stone size 16-20 mm was less than 16 mm (P=0.011). The average duration of stone excretion in patients 36-55 years old (P=0.021) and patients with right-sided stones (P=0.008) in the isosorbide group was less than the placebo group. Conclusion: Isosorbide, accompanied by other treatments, reduced the duration of stone excretion after ESWL. Moreover, although Isosorbide can be used to improve the management of patients with kidney stones, more studies are needed to confirm this finding

Success of Extracorporeal Shockwave Lithotripsy (ESWL) in Relation to Triple D Score

Aim: To determine the frequency of success of ESWL in patients with renal stones and to compare the success of ESWL with different Triple D scores in the same group of patients. Methodology: Descriptive study in the Department of Urology, Sindh Institute of Urology and Transplantation Hospital, Karachi from 29thOctober 2020 to 28th April 2020. One hundred and fifteen patients with renal stone seen as radio opaque shadow on X rays KUB were included. CT was performed and stone diameters were measured. Quadruple D-score was defied because stone location is combined with TrD-S ranging from 0 (worst) to 3 (best) points. KUB was used for evaluation of stone free status after 4-weeks of ESWL sessions. Patient can be regarded stone free if complete stone was removed. Results: The mean age was 48.99±10.67 years, the mean size of the stone was 12.99±3.54mm, and the mean triple D score was 1.70±1.00. There were 75(65.22%) males and 40(34.78%) female patients. The success of ESWL was found in 79(68.70%) patients. On comparison of success of ESWL with triple D score, success of ESWL was found in 04(26.7%) having 0 score, in 19(54.3%) having 01 score, in 27(77.1%) having 02 score, and in 29 (96.7%) having 03 score (P&lt;0.001). Conclusion: The triple D score appears to be a useful predictor of ESWL treatment outcomes. Using the Triple D score may improve the cost-effectiveness of ESWL by limiting its use to patients likely to have favourable outcomes. Key Words: Extracorporeal shockwave lithotripsy (ESWL), Triple D score, Renal stone

Evaluation of Skin to Stone Distance by Non-Contrast Computed Tomography as an Independent Predictor of Stone-Free Rate of Extra-Corporeal Shockwave Lithotripsy for Renal Pelvic Stones

Introduction: Pakistan is situated in the Afro-Asian stone belt. We come across a vast majority of patients having renal calculi. The treatment of renal stones has evolved from open surgery to extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in past 20 years. Objective: To determine mean skin to stone distance (SSD) in patients undergoing ESWL for renal pelvic stones and to compare mean SSD between patients with successful ESWL and failed ESWL outcomes for renal pelvic stones. Subjects and Methods: This descriptive case series study was carried out in the Department of Urology, Institute of Kidney Diseases Hayatabad Medical Complex Peshawar from September 2017 to March 2018. A total of 50 patients with renal pelvic stones were enrolled for the study. After consent, non-contrast computed tomography of the kidney ureter and blabber (NCCT KUB) was performed and SSD was measured. All patients underwent ESWL. The patient status either as stone free or having residual stones based on NCCT KUB result was noted on 3rd month. Patients having no stone fragments were defined as stone free and the procedure was defined as successful. Results: The mean age of the patients was 39.02 +/- 12.16 years. 33 (66%) were male and 17 (34%) were female. ESWL was successful in 39 (78%) of patients. 11 (22%) of the patients had residual stones. The mean SSD in patients with successful ESWL outcome was significantly lower than the patients with failed ESWL outcome (10.9 +/- 3.0 vs 14.8 +/- 1.8 cm, p-value = 0.001) Practical Implication: The study results will help the urologists in deciding appropriate treatment modality for patients with renal pelvic stones. Conclusion: We conclude that SSD is lower in patients with successful outcome of ESWL in comparison to those with failed outcome. Therefore pre-treatment NCCT KUB should be used in patients with renal stones to determine the SSD which might predict the outcomes of ESWL. Keywords: Renal calculi, Skin to stone distance, extracorporeal shockwave lithotripsy.

Investigating ESWL success rate in the treatment of renal and ureteral stones in children.

Extracorporeal shock wave lithotripsy (ESWL) is one of the most important methods of treatment for stone in children. Therefore, this study was conducted to determine the success rate of ESWL in the treatment of kidney and ureteral stones in children referred to Hasheminejad kidney center during the second half of 2018. This observational prospective study was conducted on 144 children referred to Hasheminejad kidney center during the 2018. The patients were selected using the convenience sampling method. The study was investigating the success rate of ESWL in the treatment of kidney and ureteral stones and effective factors in this regard. A total of 133 patients (92.4%) had stone passage and 37.5% of patients had residual stones, 28.5% of which were less than 5 mm in diameter. Successful results were seen in 131 cases (91%). Successful results were significantly higher in males (p = 0.011) and lower in simultaneous stones in the middle calyx and lower calyx (p = 0.0001). According to the results of this study, it can be inferred that ESWL success rate was above 90% in the treatment of kidney and ureteral stones in children in such a way that with an ESWL session in patients who have been properly selected for this procedure, a success rate of about 62.5% will be available to remove any residual fragments, and nearly 28.5% have residual fragments with a diameter of smaller than 5 mm, which is basically hopeful for a high urinary passage. The present study shows that type and stone location are the factors contributing to the successful ESWL and shows the female gender and the presence of stone in the lower and middle calyx are the risk factors for the lower ESWL success rate.

Extracorporeal Shock Wave Lithotripsy (ESWL) Outcome Based on CT Scan and Patient Parameters Using ESWL Score.

To prospectively evaluate ESWL (extracorporeal shock wave lithotripsy) outcomes and validate ESWL Score. An observational study. The Aga Khan University Hospital, from January 2021 to December 2021. Patients with symptomatic, solitary, radio-opaque renal stone measuring <15 mm with normal renal functions were included in this study. Stone size <11mm, BMI <27 Kg/m2, and stone density <900 Hounsfield units (HU) were all given 1 point each to give a total ESWL Score between 0-3 to each patient. Patients were evaluated after 4-weeks for the outcome i.e. stone clearance and complications. A total of 146 patients were included in the study. Median values for age, stone size, BMI and stone density were 40 years, 8 mm, 27 Kg/m2, and 774 HU respectively. Post ESWL, 99 (68%) patients were stone-free while 47 (32%) patients had residual stones. The stone clearance increased with the increasing score: 50% for ESWL score 0, 55.6% for ESWL score 1, 66.1% for ESWL score 2, and 85.7% for ESWL score 3 (p=0.01). The area under the curve (AUC) of ESWL score was 0.655 with 95 % CI (p=0.001). ESWL Score is a useful predictor of the success of ESWL. It can help decide the individualised and appropriate modality of treatment and assist with patient counselling. Stone, Lithotripsy, Extracorporeal, Score, Shock wave, Outcome.

Predictive Factors of Efficacy of Extracorporeal Shock Wave Lithotripsy in the Treatment of Kidney Stones of Size &lt;20 Mm: Prospective Monocentric Study

Extracorporeal shock wave lithotripsy (ESWL) is one of the most commonly used therapeutic procedures for the treatment of urolithiasis thanks to its noninvasive approach and satisfactory success rates. However, this technique has certain limitations that have led to several debates concerning the redefinition of its indications. The main objective of our work is to determine the ESWL success’ predictive factors in order to select the right candidates to this procedure. For this, we did a prospective study carried out in the Urology A department of the Ibn Sina University Hospital in Rabat over a period of 12 months, involving 150 patients suffering from kidney stones of size lesser than 20 mm, without history of treatment with ESWL and for whom this technique was indicated, The statistical study was carried out using the software SPSS 13.00. The univariate analysis of our study defined four statistically significant factors associated with the failure of extracorporeal lithotripsy which were: • Multiple number of stones (p 0.015); • BMI&gt; 35 (p 0.009); • Lower calyx location (p 0.028); • Density greater than 1000 HU (p 0.04). A multivariate analysis by logistic regression model using all the significant factors of the univariate study also showed that the same factors would have significant impacts on the outcome of the ESWL at three months. Defining the predictors of success and failure helps to better define the candidates for this technique and to establish a nomogram adapted to each patient.

Extracorporeal Shock Wave Lithotripsy (ESWL): An Evaluation of Success in Low, Medium and High Stone Density

Objective: To find the frequency of patients of renal calculi with different stone densities and to evaluate the success rate of ESWL treatment in selected groups of patients i.e. low, medium and high stone density. Methodology: In this descriptive case series, at Department of Urology, Services Hospital, Lahore was conducted and enrolled a 100 cases with single, radiopaque renal stone of 1-2 cm (10 to 20 mm), between 15-80 years of either gender whereas those with calculus in nonfunctioning kidney (GFR less than 15 ml/min), calculus in Pyonephrotic kidney, presence of JJ stent and having previous surgery for stone on same side or radiolucent stones were excluded from this study. All sessions of ESWL were performed following departmental protocol. 3 weeks after the ESWL session, the outcome was evaluated by plain X-ray KUB and USG KUB. In this analysis, ESWL success was defined as either total stone clearance or the presence of clinically insignificant residual fragments (CIRFs) (4 mm, peripheral, not producing renal colic, with no infection or extensive hematuria). Results: Stone density was in the range of 335-1900 HU with a mean density of 851.1 (±418) HU. Patients with medium density group (500-1000HU) were significantly greater than other two groups. MDG had frequency of 51% followed by LDG (25%) and HDG (24%). Overall, ESWL success rate was 82% in all the 100 patients of renal calculi. Success rate was greatest in LDG i.e. 100%. MDG had a success rate of 90% and only 45.8% of the patients in HDG had succees after ESWL treatment. Success rate decreased as the stone density increased. Conclusion: the stone density has a significant impact on success of ESWL. NCCT stone characteristics like mean density in HU and demographic characteristics are potential predictors for evaluation of success of ESWL. Keywords: Kidney stones, ESWL, Stone density

Renal Stone Density: Determinant of ESWL Success

Background: The worldwide prevalence of developing renal stones is as high as 15% with an estimated 1 in every 5 persons being affected with the condition in Pakistan. Among the many treatment options available for renal calculi, extracorporeal shockwave lithotripsy (ESWL) is among the commonest owing to its non-invasive nature, however, it has its drawbacks; one being limitation against dense stones. &#x0D; Objective: To assess association between stone density (detected on CT KUB) and ESWL outcome among patients with renal calculi.&#x0D; Methodology: This clinical trial was conducted upon a sample of 150 patients (of either gender, aged 16 to 70 years) presenting to the Urology out-patient, emergency and lithotripsy department of Ziauddin University Hospital with renal calculi from 30th August 2017 to 30th September 2019. After taking written informed consent, data was recorded onto a prestructured questionnaire containing inquiries pertaining to basic biodata, sociodemographic details, and disease history, inferences obtained from C.T KUB, operative notes and the eventual treatment outcome. The data obtained was analyzed using SPSS v. 21.0. &#x0D; Results: The mean age of the sample stood at 36.7 (SD ± 3.1). 104 (69.3%) patients had multiple calculi and 46(30.7%) have single calculi with mean density of 812 (SD ± 219) HU. A (having stone density &lt;500-HU) group B (having stone density 501 to 1000-HU) and group C (having stone density &gt;1000-HU). The success of group A was 95.34% group B was 88.5% and group C was 80.3%. Major proportion of the sample (39.3%) required up to 3 ESWL sessions. The stone density was observed to be inversely proportional to the success of ESWL. &#x0D; Conclusion: After careful consideration, it can be concluded that higher stone density is associated with a poor ESWL outcome and thus other treatment modalities may be considered among patients with a stone density of more than 900 HU.

Factors Affecting the Outcome of Extracorporeal Shockwave Lithotripsy in Urinary Stone Treatment

Background and aim: The recurrence of urinary stones occurs in two thirds of patients within a 20-year period, making urinary stones a common pathology. Among urology pathologies, kidney stones rank third behind urinary infections and conditions of the prostate. The present study intended to assess various factors affecting the extracorporeal shockwave lithotripsy (ESWL) outcome in urinary stone treatment. Methods: This cross-sectional study was carried out on 136 urinary stone patients who underwent extracorporeal shockwave lithotripsy in the Department of Urology, Sahiwal Teaching Hospital, Sahiwal for the duration from September 2021 to August 2022. Computed tomography confirmed the presence of stones and measured the size (3-20 mm), distance from skin to stone, location, and density in Hounsfield units. Patient’s characteristics such as estimated rate of glomerular filtration and BMI were measured. A successful ESWL requires at least a 3mm residual renal stone fragment in post-therapy, and at least a complete clearance of ureteric stones at the end of treatment. SPSS version 26 was used for descriptive statistic. Results: Of the total 136 urinary stone patients, there were 108 (79.4%) male and 28 (20.6%) females. The incidence of stones present in proximal ureter, mid, and distal ureter was 72 (52.9%), 7 (5.1%), and 57 (41.9%) respectively. All the patients underwent ESWL 1.5 times (average), and the success rate in first, second, and third session was 67.8% (n=92), 83.8% (n=114), and 91.2% (n=124) respectively. The overall success rate of ESWL was 80.9%. A multivariate analysis revealed that HU [OR=0.89, 95% CI, 0.96-0.98, P=0.001) and stone size [OR=0.79, 95% CI, 0.62-0.98, P=0.051] were significantly affecting the first ESWL session success rate. Third session success rate was significantly affected by stone size [OR=0.76, 95% CI, 0.58-0.95, P=0.015]. Stent associated higher failure rate [OR=6.425, 95% CI, 2.132-18.235, p=0.001] and ESWL failure was three-times higher in females than in male. Conclusion: The present study found that the overall success rate of ESWL in urinary stone treatment was 80.9%. ESWL success rates were affected by stone size and HU. Patients' pain and fragmentation levels should be considered when adjusting the intensity of ESWL. Keywords: Urinary stone treatment, Outcomes, Extracorporeal shockwave lithotripsy

571 Evaluating the Effectiveness of Extracorporeal Shockwave Lithotripsy (ESWL) for Ureteric Stones During COVID-19 Pandemic - A Single Centre Experience

AimReliance on ESWL for treating ureteric stone has increased during the COVID-19 pandemic. We examined the outcomes for ureteric stones treated with our on-site lithotripter to assess the success rate and determine the variables that could affect the outcome results.MethodA retrospective review using electronic records and images of patients who underwent ESWL for ureteric stones (January to December 2020). Univariate and multivariate analysis used to determine stone-free rate predictors (Stone Free rate/SFR: No residual stones on post-ESWL imagining).ResultsA total of 36 patients underwent ESWL for ureteric stones. Mean age was 58 years (21–90), and mean stone size was 8 mm (5–20). Stones were located in the proximal (67%) or lower ureter (33%). Overall SFR was 64% (67% proximal, 33% distal). 64% of patients required only one session to be stone free, with 60% stone free after two sessions. Stones <10mm had a SFR of 67%, compared to 58% for stone >10 mm. The only statistically significant predictor was stone size (longest dimension, p=0.04). No statistical significance with stone location (P=0.09), skin-to-stone distance (SSD) (P=0.7), stone density (P=0.3) or stone volume (P=0.3). In treatment failure, time to definitive ureteroscopy was 4 weeks.ConclusionOur overall SFR was slightly lower than expected but comparable to available literature. This data highlights the importance of patient selection for ESWL and would be useful in counselling about local success rate. More than half of the patients required only one session for stone clearance and stone size was the only significant predictor for successful ESWL.

Role of Triple D Score in Eswl: Our Experience at Urology Department Chandka Medical College Hospital Larkana Pakistan

Aim: To detect usefulness of triple D score in ESWL (extracorporeal shock wave lithotripsy) for management of renal stone. Methodology: Retrospective Study was conducted at Urology department, CMCTH) at SMBBMedical University Larkana. 50 patients underwent ESWL from 2018 to 2020. All the related data were taken as well as demographic details, history and risk factor from the patients. Routine investigation carried out including Blood CP ESR, Urine DR, Blood sugar, Renal profile, urine culture sensitivity and CT KUB. The stone density, skin-to-stone distance, and stone size were calculated by a radiologist. Results: ESWL was performed on 50 patients with average age of 30± 8 years and a sex ratio (male female) of 1:0.3. The stone-free percentage after the first treatment session was 40 percent and 90 percent on 2nd sitting, based on the triple D score, which included stone size, skin to stone distance, and stone density (HU). The mean stone size was 15.8 mm, the Skin to Stone Distance was 6.4 cm, and the stone density was 594 HU were established respectively. Conclusion: The Triple D Score is easy to compute and reported by radiologist. The use of the Triple D Score in ESWL patients has been shown to improve overall ESWL success rates. Keywords: Extracorporeal, Shock, Wave, Lithotripsy, Renal stone and Triple D score

Acute extracorporeal shockwave lithotripsy for ureteric stones - 7-years' experience from a busy district general hospital.

To demonstrate the efficacy and cost-effectiveness of acute extracorporeal shockwave lithotripsy (ESWL) for ureteric stones we present our experience of ESWL in 530 ureteric stone cases, in the largest UK series we are aware of to date. ESWL is underutilised in ureteric stone management. The Getting It Right First Time (GIRFT) report showed just four units nationally treated >10% of acute ureteric stones with ESWL. Despite guideline recommendations as a first-line treatment option, few large volume studies have been published. Retrospective review of prospectively collected data between December 2012 and February 2020 was performed. Data relating to patient demographics, stone characteristics, skin-to-stone distance, and treatment failure were collected. Cost analysis was conducted by the Trust's surgical financial manager. Multivariable analyses were performed to assess for predictors of ESWL success. A success rate of 68% (95% confidence interval 64%-72%) at 6 weeks was observed (n = 530). The median (interquartile range) number of treatment sessions was 2 (1, 2). Stone diameter was observed to be a predictor of ESWL success. The small number of stones treated of >13 mm or >1250 HU had an ~50% chance of successful treatment. Acute ureteric ESWL was less costly than acute ureterorenoscopy, consistent with findings from previous NHS studies. Acute ESWL is a safe, reliable, and financially viable treatment option for a wider spectrum of patients than reflected in international guidelines based on our large, heterogenous series. In the coronavirus disease 2019 (COVID-19) era, with theatre access reduced and concerns over aerosol generating procedures, acute ESWL remains an attractive first-line treatment option.

Treatment outcomes and factors affecting the success of extracorporeal shockwave lithotripsy in urinary stone treatment: a study of ten years of data from Mahasarakham Hospital

Objective: To explore the outcome and factors affecting the success of Extracorporeal Shockwave Lithotripsy in upper urinary stone treatment. Materials and Methods: A retrospective review of 4,293 patients with renal or ureteric stones were treated with ESWL using Siemens Modularis Vario lithotripter at Mahasarakham Hospital between October 2011 and September 2020. NCCT or IVU were used to determine stone characteristics. All patients were followed up at week 12 after treatment to evaluate treatment outcome. The success was defined in cases of the presence of clinically insignificant residual ≤ 4 mm or complete clearance of the stones. Data were tested with multivariate logistic regression analysis to determine the predictors of ESWL success. Results: The overall success rate was 70.1 %. The success rate of patients in the age ≤ 40 years was 78.2% The lowest success rate was from lower calyceal stone with 54.6%, the success rate was 76.3% for stone ≤ 10 mm. and the success rate of stone in surface area ≤ 50 mm2 was 77.0%. The complication rate was 5.2%, and auxiliary procedures were 4%. The mean number of ESWL sessions was 2.1. Multivariable logistic regression analysis demonstrated that age, stone size, stone surface area and stone location were significant predictors of ESWL success. Conclusion: Renal and ureteric stones treatment with ESWL showed good results. Failure of ESWL was observed more in cases of patients with the age of &gt; 40 years, stone size of &gt; 10 mm, stone surface area of &gt; 50 mm2 and location at lower calyx.

The usefulness of the Hounsfield unit and stone heterogeneity variation in predicting the shockwave lithotripsy outcome.

PURPOSE This study aimed to evaluate the use of stone density variation coefficient (SDVC) as an indicator of stone heterogeneity and previously reported parameters for predicting extracorporeal shock wave lithotripsy (ESWL) outcome in urinary calculi. Moreover, a new formula that could be used to predict ESWL success was suggested. METHODS A total of 850 patients, who underwent the first session of ESWL for urinary stones between 2015 and 2020, were examined, and 220 eligible patients were included in the study. Stone density variation coefficient and other parameters associated with stone attenuation values and stone size parameters were studied as potential predictors based on noncontrast com- puted tomography (NCCT). Extracorporeal shock wave lithotripsy success was considered after 3 months by radiography or NCCT. Logistic regression analysis was performed to determine the factors contributing to treatment success. RESULTS For the 220 patients, ESWL success rate was 39.5%. The receiver operating characteristic analysis showed that SDVC (AUC=0.82; 95% confidence interval [CI]: 0.76-0.87; P < .001), mean stone density (AUC=0.81; 95% CI:0.75-0.87; P < .001), maximum stone density (AUC=0.70; 95% CI: 0.63-0.78; P < .001), stone volume (AUC=0.70; 95% CI: 0.62-0.77; P < .001), and major diam- eter (AUC=0.67; 95% CI: 0.59-0.74; P < .001) had significant prediction accuracy from high to low. Additionally, SDVC was found to be successful in predicting ESWL success, especially for patients with high mean stone density (OR = 10; 95% CI: 3.55-28.57; P < .001). The logistic regres- sion model, in which the "stone disintegration probability" (SDP) formula was found, correctly predicted ESWL success with a single session by 79.1%. CONCLUSION In conclusion, size and attenuation values were predictors of treatment success, and the best predictor was SDVC. Evaluation of SDP formula prior to ESWL could predict treatment outcomes and facilitate the decisions regarding treatment strategies.

Factors influencing stone-free rate of Extracorporeal Shock Wave Lithotripsy (ESWL); a cohort study

Objective To evaluate the success rate of Extracorporeal Shock Wave Lithotripsy (ESWL) therapy and identify relevant treatment-specific factors affecting stone-free rate (SFR) after ESWL. Materials and methods All ESWL treatments in the years 2016–2019, in Ängelholm Hospital, Skåne, Sweden were analysed retrospectively. Primary outcome was stone-free rate (SFR) at 3 months. Univariate logistic regression was used followed by multivariable regression. Lasso analysis was made to adjust for treatment-specific factors such as age, stone size, skin-to-stone distance (SSD), stone attenuation, number of treatments, stone location and presence of a urinary stent. Results Factors affecting successful ESWL treatment were lower age (p < 0.001), smaller stone size and volume (both p = 0.001). SSD, stone attenuation, sex, laterality and drainage did not have an effect on SFR in this study. After the first ESWL treatment session, 46.7% of the patients were stone-free. Conclusion Results indicate that stone size and age are the most predictive factors for ESWL outcome. Based on this, we present a simple model for prediction of SFR after ESWL, to be used when counseling patients before ESWL treatment.

Role of Multi-Detector Computed Tomography Indices in Predicting Extracorporeal Shockwave Lithotripsy Outcome in Patients With Nephrolithiasis

BackgroundNephrolithiasis is one of the most common renal pathologies and is routinely encountered in daily practice. Non-contrast computed tomography (NCCT) is the gold standard diagnostic imaging modality for urolithiasis. The role of HU (Hounsfield units) in calculus as a predictor of extracorporeal shock wave lithotripsy (ESWL) has been studied in the past. This study aims to evaluate the role of HU value and various other NCCT indices in predicting the outcome of ESWL.Material and methodsThis was a prospective observational study that included 45 patients suffering from nephrolithiasis who underwent NCCT-KUB (kidney, ureter, and bladder) followed by ESWL. The NCCT indices were evaluated and correlated with the outcome of ESWL. NCCT-KUB was performed using multidetector SIEMENS® SOMATOM EMOTION 16-slice CT scanner (SIEMENS, Munich, Germany).ResultsIn our study, the HU value turned out to be a statistically significant predictor of ESWL success (p <0.05), and the renal pelvis also proved to be a good prognostic indicator for ESWL success. The cut-off value of <1179 HU favored a successful outcome of ESWL, while if >1179 HU, ESWL is likely to fail. Hence, the successful outcome of ESWL is inversely proportional to the HU value. Renal pelvic calculi (n=14) showed a 100% success rate, which was better than all other calculus locations (p<0.05). However, the rest of the indices did not show any statistical significance.ConclusionMulti-detector NCCT-KUB indices can help in the selection of patients with a good prognosis for ESWL, which will prevent the patient from undergoing undesired invasive procedures.

Predicting ESWL success by determination of Hounsfield unit on non-contrast CT is clinically irrelevant in children.

The necessity of determining stone density by non-contrast computerized tomography (NCCT) before extracorporeal shock wave lithotripsy (ESWL) is a controversial topic due to the radiation exposure. We aimed to investigate whether stone density is helpful in predicting the success of ESWL in pediatric patients or not. In this retrospective study, database of a single center was used to identify 232 children aged between 2 and 16years. Patients with abnormal renal anatomy, distal obstruction, a known cystine stone disease, a previous history of an intervention regarding stone, and an insufficient follow-up period (< 3months) were excluded from the study. A total of 209 patients were included in the study (94 with NCCT, 115 without NCCT). Groups were compared in terms of stone size, stone location, and stone-free rate at 3months after a single ESWL session. The mean age was 6.17 ± 3.27years and 120 (57.4%) of the patients were male and 89 (42.6%) were female. Mean stone size was 11.7mm in NCCT group and 12.3mm in non-NCCT group (p 0.128). The complete stone clearance rate in NCCT and non-NCCT group at 3months after ESWL was 57.4% (54/94) and 54.7% (63/115), respectively, and there was no statistically significant difference (p 0.316). In conclusion, unnecessary NCCT use should be avoided before ESWL considering the similar success rates after ESWL and the risk of exposure to radiation.