Outcome Of Shock Wave Lithotripsy Research Articles

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.

Extracorporeal shock wave lithotripsy, ureterolithotripsy, and percutaneous nephrolithotripsy challenges in managing spinal cord neuropathy patients. Lessons learned from a scoping review.

We aim to review the outcomes of shock wave lithotripsy (SWL), ureteroscopy, and percutaneous nephrolithotripsy (PCNL) for renal and ureteral stones in spinal cord neuropathy patients (SNP). A literature search was performed on 8th March 2023 using PubMed, EMBASE, and Google Scholar with no date limit. Preclinical/animal studies, reviews, letters to the editor, case reports, and meeting abstracts were excluded. Only English papers were accepted. Thirty-five articles were accepted. Five studies focused on SWL, 17 on PCNL, and 6 on ureteroscopy. The remaining articles employed more than one procedure. Stone composition has shifted from struvite to the more common calcium phosphate. SWL showed a very poor stone-free rate (SFR) likely due to challenges in patient positioning, stone visualization, localization, and inability to pass fragments spontaneously. Flexible ureteroscopy and PCNL were associated with a high incidence of infectious complications, long hospital stays, high blood transfusion rate, and intensive care admissions. There were also cases of death. Both procedures were challenging due to genitourinary reconstruction, scoliosis and kyphosis, rib-cage deformity, lower limb contractures, and severe comorbidity which also affected anesthesia. SFR was lower than in non-neurological patients. SWL, ureterolithotripsy, and PCNL should be considered challenging procedures in SNP due to positioning issues, an increased risk of intra and peri-operative morbidity, and even mortality. Computed tomography should be recommended to assess residual fragments as it becomes imperative to minimize a re-intervention in SNP who should be preferably treated in referral centers.

AI prediction of extracorporeal shock wave lithotripsy outcomes for ureteral stones by machine learning-based analysis with a variety of stone and patient characteristics.

We propose an artificial intelligence prediction method for extracorporeal shock wave lithotripsy treatment outcomes by analysis of a wide variety of variables. We retrospectively reviewed the records of 171 patients from between January 2009 and November 2019 that underwent shock wave lithotripsy at Wakayama Medical University, Japan, for ureteral stones shown on preoperative non-contrast computed tomography. This prediction method consisted of stone area extraction, stone analyzing factor extraction from non-contrast computed tomography images, and shock wave lithotripsy treatment result prediction by a non-linear support vector machine for analysis of 15 input and automatic measurement factors. Input factors included patient age, skin-to-stone distance, and maximum ureteral wall thickness, and the automatic measurement factors included 11 non-contrast computed tomography image texture factors in the stone area and stone volume. Permutation feature importance was also applied to the artificial intelligence prediction results to analyze the importance of each factor relating to estimate decision grounds. The prediction performance was evaluated by five-fold cross-validation, it obtained 0.742 of the mean area under the receiver operating characteristic curve. The proposed method is shown by these results to have robust data diversity and effective clinical application. As a result of permutation feature importance, some factors that showed high p-values in the significant difference tests were thought to have a high contribution to the proposed prediction method. Future issues include validation using a larger volume of high-resolution clinical non-contrast computed tomography image data and the application of deep learning.

Does pre-stenting influence outcomes of shockwave lithotripsy? A systematic review and meta-analysis.

To determine whether preoperative use of JJ stents in patients undergoing shockwave lithotripsy (SWL) impacts on stone clearance and the rate of postoperative complications. We screened multiple databases from inception to January 2021, using the relevant search terms for SWL in patients with a preoperative stent. Inclusion criteria were randomised controlled trials of ≥20 patients aged >18 years who had had SWL with a JJ stent. This review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42023443195). Statistical analysis was performed using 'meta' in R. There were seven eligible studies (403 patients receiving JJ stents and 394 controls). There was no significant difference in the stone-free rate (SFR) following SWL with a JJ stent compared to SWL alone. When considering the complication rates, there was a significantly reduced risk of steinstrasse in patients with a JJ stent. However, there was no significant difference in the risk of other complications including pain, fever, and haematuria, and no significant difference in the likelihood of requiring auxiliary procedures or re-treatment. There was a reduced risk of steinstrasse in patients undergoing SWL with a JJ stent compared to SWL alone. However, there was no significant difference in the risk of other postoperative complications. Use of a JJ stent had no effect on the efficacy of SWL, with no significant difference in the SFR.

Effectiveness of extracorporeal shock wave lithotripsy in urolithiasis patients under 2 years of age.

In this study, we present our extracorporeal shock wave lithotripsy (ESWL) outcomes in urolithiasis patients under the age of two. The procedure was performed with patients < 2 years of age sedated, under anesthesia using ketamine and Dormicum (midazolam), in the supine position. Fragmentation was evaluated by fluoroscopy after the procedure. A total of 74 procedures were performed on 65 kidneys. One patient with bilateral stones had two sessions of ESWL on the right side; three sessions of ESWL were performed in one patient with a unilateral stone, and two sessions were performed in seven patients with unilateral stones. All other patients underwent one session of ESWL. As post-procedural complications, hematuria was observed in 14 patients (12 mild and 2 significant), and vomiting occurred in 1 patient. Ureterorenoscopy was performed in 5 patients, and percutaneous nephrolithotomy in 6 patients due to a failed procedure. As a result, ESWL treatment is effective and has advantages such as a short hospitalization time, good reproducibility, cost-effectiveness, and a low rate of complications. Therefore, we recommend ESWL as the first-line treatment for renal and proximal ureteral stones in infants < 2 years of age.

Outcomes of Flexible Ureteroscopy vs Extracorporeal Shock Wave Lithotripsy for Renal Stones in Pediatric Patients: A European Association of Urology Urolithiasis Guidelines Systematic Review and Meta-Analysis.

We sought to determine which treatment between flexible ureteroscopy and shock wave lithotripsy has a better stone-free rate in pediatric patients (<18 years) with renal or proximal ureteric stones (<2 cm). Subanalysis for all outcomes for randomized controlled trials only. Using PubMed, Web of Science, and the Cochrane database, we identified studies (randomized clinical trials and prospective comparative nonrandomized studies) published until August 2022 reporting surgical outcomes of pediatrics patients undergoing flexible ureteroscopy and shock wave lithotripsy with renal or proximal ureteric stones <2 cm (PROSPERO ID: CRD42022378790). Only randomized controlled trials were considered for meta-analysis. Stone-free rate, operative time, and complications were analyzed. Analysis was performed in R. A total of 6 studies identified, of which 3 were randomized clinical trials and 4 had data on renal stones. A total of 669 patients were analyzed. Mean age ranged from 4.4 to 12.4 years. The shock wave lithotripsy group presented a range of stone-free rate between 21 and 90% while the flexible ureteroscopy group presented a range of stone-free rates between 37% and 97%. Meta-analysis of randomized controlled trials only (n=302) demonstrated significantly higher stone-free rate in flexible ureteroscopy vs shock wave lithotripsy (RR = 1.17, 95% CI: 1.04-1.33, P = 0.01), operative time (mean difference = +16.4 minutes, 95% CI: 7.3-25.5, P < 0.01) and hospital stay (mean difference = +0.25 days, 95% CI: 0.14-0.36, P < 0.001). But no difference in fluoroscopy exposure time (mean difference = -21.0 seconds, 95% CI: -42.6 to 0.56, P = 0.07), Clavien I-II (RR = 1.23, 95% CI: 0.71-2.12, P = 0.45) or Clavien III-V complications (RR = 1.04, 95% CI: 0.32-3.42, P = 0.95). Flexible ureteroscopy has a significantly higher stone-free rate than shock wave lithotripsy, with no difference in complication rate or fluoroscopy exposure time, and significantly higher operative times and hospital stay. However, the current evidence base for this is weak and further randomized trials are needed.

Stone Heterogeneity Index as a New Parameter for Prediction of Shockwave Lithotripsy Outcomes

Background Renal stones are a major public health concern with continuously increasing prevalence. Extracorporeal shock wave lithotripsy (ESWL) which was introduced more than three decades ago as an authentic modality for the treatment of urinary stone disease is considered first choice of treatment for nearly all kind of urinary tract calculi. The outcome of ESWL for renal and ureteral stones depends on many factors, including stone size, Hounsfield Unit (HU), Skin Stone Distance (SSD) and Body Mass Index (BMI). Objective To introduce the concept of Stone Heterogeneity Index (SHI) as a single factor or in combination with other factors that predict the outcome of extracorporeal shock wave lithotripsy for adult patients with renal or ureteral stones. Methods This is a prospective study conducted on 60 Patients with renal and ureteral stones planned to have ESWL sessions attending urology outpatient clinic in Ain shams university and Misr University for Science and Technology hospitals. Results The radiologic heterogeneity of a urinary stone or SHI was independently associated with SWL success in patients with renal and ureteral calculi. SHI in the success group was 246.49 ± 82.13 while in the failure group was 159.20 ± 47.59 with Cutoff point &amp;lt; 183 predicting failure of ESWL outcome. SHI between success and failure groups was statistically significant being higher in success group. (p = 0.000). Conclusion SHI will play a promising role when determining a treatment modality in patients with a urinary stone, and especially when selecting the proper SWL candidates from the patients with a stone of large size or high Mean Stone Density (MSD).

The use of Quadruple-D score for predicting the outcome of extracorporeal shock wave lithotripsy in less than 2 cm renal stones

The use of Quadruple-D score for predicting the outcome of extracorporeal shock wave lithotripsy in less than 2 cm renal stones

Shockwave Lithotripsy for De-Novo Urolithiasis after Kidney Transplantation: A Systematic Review of the Literature.

Allograft urolithiasis is an uncommon, challenging, and potentially dangerous clinical problem. Treatment of allograft stones includes external shockwave lithotripsy (SWL), flexible ureteroscopy and lasertripsy (fURSL), or percutaneous nephrolithotomy (PCNL). A gap in the literature and guidelines exists regarding the treatment of patients in this setting. The aim of this systematic review was to collect preoperative and treatment characteristics and evaluate the outcomes of post-transplant SWL for stone disease. A systematic search in the literature was performed, including articles up to March 2023. Only original English articles were selected. Eight articles (81 patients) were included in the review. Patients were mainly male, with a mean age of 41.9 years (±7.07). The mean stone size was 13.18 mm (±2.28 mm). Stones were predominantly located in the kidney (n = 18, 62%). The overall stone-free rate and complication rates were 81% (range: 50-100%) and 17.2% (14/81), respectively, with only one major complication reported. A pre-operative drainage was placed in eleven (13.5%) patients. Five patients (6.71%) required a second treatment for residual fragments. SWL is a safe and effective option to treat de novo stones after transplantation. Larger studies are needed to better address allograft urolithiasis management.

Efficacy of extracorporeal shock wave lithotripsy for post-transplant kidney stones. Hope or Disappointment?

Nephrolithiasis in a transplanted kidney is an important medical and social problem. The presence of renal calculi may not manifest clinically for a long time due to the peculiarities of the surgical intervention during organ transplantation. Development of chronic urinary tract infection and deterioration of the functional ability of the renal transplant in the presence of kidney stones can lead to graft death, which is an immediate threat to the patient’s life. Existing Russian guidelines on the treatment of urolithiasis currently lack a clear strategy for the management of kidney transplant recipients.Objective: to systematize literature data on analysis of the outcomes of extracorporeal shock wave lithotripsy (ESWL) and other methods in patients with post-transplant kidney stones.Results. Thirty-five publications on the research topic were selected. We summarized the information on various therapy options for patients with stones in transplanted kidney: endourological approach, ESWL, percutaneous nephrolithotripsy (PCNL), open surgical treatment (nephrostomy, pyelolithotomy). A modern foreign algorithm for the management of patients with post-transplant kidney stones depending on the severity of obstruction with sepsis and the size of the renal calculi is presented.Conclusion. 1. The presence of stones in a kidney graft is a clinical situation that requires surgical treatment. 2. In clinical practice, different methods of treatment can be used, such as open intervention, ESWL, PCNL, retrograde transurethral manipulations. 3. In most cases, patient management tactics depend on the clinical picture (presence/absence of obstruction) and the size of the calculi. 4. The use of ESWL, as the most frequently used method, testifies to its efficiency and low-traumatic effect.

Ureteral Wall Thickness (UWT) is an Effective Predictor of Ureteral Stone Impaction and Management Outcomes: A Systematic-Review and Meta-Analysis.

Ureteral stone impaction is associated with unfavorable endourologic outcomes, however reliable predictors of stone impaction are limited. We aimed to assess the performance of ureteral wall thickness (UWT) on non-contrast computed tomography as a predictor of ureteral stone impaction and failure rates of spontaneous stone passage, shockwave lithotripsy, and retrograde guidewire and stent passage. This study was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA). A search was conducted in April 2022 for all adult, human and English language studies investigating UWT using PROSPERO, OVID Medline, OVID EMBASE, Wiley Cochrane Library, Proquest Dissertations and Theses Global and SCOPUS. A systematic review and meta-analysis using random effects model were conducted. Risk of bias was assessed using the MINORS score. Fourteen studies with a pooled population of 2987 patients were included for quantitative analysis and 34 studies were included in our qualitative review. Meta-analysis findings suggest that a thinner UWT is associated with more favorable subgroup stone outcomes. Thinner UWT suggests a lack of stone impaction and was associated with improved rates of spontaneous stone passage, successful retrograde guidewire and stent placement, and improved shockwave lithotripsy outcomes. Studies lack a standardized UWT measurement protocol. UWT is a non-invasive measure that predicts ureteral stone impaction and thin measurements are predictive of successful outcomes. Variability in measurement methods confirms that a standardized UWT protocol is needed, and the clinical utility of UWT is yet to be determined.

Finding the optimal candidate for shock wave lithotripsy: external validation and comparison of five prediction models

We aimed to externally validate five previously published predictive models (Ng score, Triple D score, S3HoCKwave score, Kim nomogram, Niwa nomogram) for shock wave lithotripsy (SWL) single-session outcomes in patients with a solitary stone in the upper ureter. The validation cohort included patients treated with SWL from September 2011 to December 2019 at our institution. Patient-related variables were retrospectively collected from the hospital records. Stone-related data including all measurements were retrieved from computed tomography prior to SWL. We estimated discrimination using area under the curve (AUC), calibration, and clinical net benefit based on decision curve analysis (DCA). A total of 384 patients with proximal ureter stones treated with SWL were included in the analysis. Median age was 55.5 years, and 282 (73%) of the sample were men. Median stone length was 8.0 mm. All models significantly predicted the SWL outcomes after one session. S3HoCKwave score, Niwa, and Kim nomograms had the highest accuracy in predicting outcomes, with AUC 0.716, 0.714 and 0.701, respectively. These three models outperformed both the Ng (AUC: 0.670) and Triple D (AUC: 0.667) scoring systems, approaching statistical significance (P = 0.05). Of all the models, the Niwa nomogram showed the strongest calibration and highest net benefit in DCA. To conclude, the models showed small differences in predictive power. The Niwa nomogram, however, demonstrated acceptable discrimination, the most accurate calibration, and the highest net benefit whilst having relatively simple design. Therefore, it could be useful for counselling patients with a solitary stone in the upper ureter.

Is Triple D Score Effective to Predict the Stone-Free Rate After Shockwave Lithotripsy in Pediatric Population.

Triple D score was developed using skin-to-stone distance, stone density, and stone volume for prediction of extracorporeal shockwave lithotripsy (SWL) outcomes in adults. SWL is the first-line treatment method for kidney stones smaller than 2 cm in children however it was not validated in pediatric population. The present paper aims to validate Triple D score in pediatric patients. Of the 269 children treated with SWL between 2007 and 2021, a total of 147 children who had adequate follow-up data and evaluated with non-contrast computed tomography before SWL, were included in the study. Parameters were calculated for each of the stone volume (SV), skin-to-stone distance (SSD), and stone density (SD) variables. Receiver operator characteristic analysis was used to set cut-off values. Triple D scores were calculated, and success rates were determined for each score. Stone-free status was determined as complete clearance after three months of final SWL. The median age of the study group was 7 (range 1 to 16). Ninety-three of the 147 (63%) children had stone-free status. Mean SV, SSD and SD values were significantly higher in SWL failed group than stone-free group after detecting cutoff values of 155 mm3, 6.5 cm, and 550 HU, respectively. Stone-free rates were detected as 23.8%, 35.1%, 74.0%, and 92.0% with the Triple D scores of 0, 1, 2, and 3 points. Our study confirms that Triple D scores supports the SWL outcomes in pediatric population. We believe that our research on Triple D score validation in children is of great clinical importance although various factors may affect to predict the success of SWL.

Role of Patient Age and Stone Density in Predicting Outcomes of Shockwave Lithotripsy in Lower Ureteral Stones.

Shockwave lithotripsy (SWL) is an important tool for treating ureteral stones, especially when ureteroscoy (URS) is not readily available. The aim of the study was to identify factors associated with the success of shockwave lithotripsy (SWL) in the treatment of lower ureteral stones. Total of 105 consecutive patients with single lower ureteral stones treated with SWL between January 2021 and February 2022 were reviewed retrospectively. Clinical and stone parameters including age, gender, and body mass index (BMI), stone length, and stone density were analyzed. SWL procedures were done using electro-conductive lithotripter Sonolith i-sys (EDAP TMS, Vaulx-en-Velin, France). We evaluated available clinical and radiologic features that might have been related to successful SWL treatment. Treatment was successful in 67/105 patients (63.8%). Multivariate logistic regression revealed that a successful outcome was significantly related to mean stone density (MSD) (95% CI: 1.004- 1.009) and the patients age (95% CI: 1.022- 1.13). Gender, BMI, and stone length were not an independent predicting factors. Stone density and patient age were independent predictors of successful outcome after two SWLs in the lower ureter. However, gender, BMI, and stone length did not independently predict treatment success.

Shock Wave Lithotripsy Outcomes for Upper and Lower Ureteral Stones in Non-obese and Non-Pre-stented Adults: Is One Session Sufficient?

PurposeThis study aims to evaluate differences in shock wave lithotripsy (SWL) outcomes between upper and lower ureteral stones and identify patients who are likely to have a stone-free status after one session of SWL.Materials and methodsAfter approval from the institutional review board and from a prospectively maintained database of 628 patients, 182 were retrospectively identified, who have had SWL for a single lower or upper ureteral stone and met the inclusion criteria. Age, body mass index (BMI), and stone size were similar among the groups. This study included non-pre-stented patients with solitary lower or upper ureteral radiopaque stones identified on non-contrast-enhanced computed tomography (NCCT), did not have acute obstruction, and had either normal body mass index (BMI) or overweight status. Patients were treated with Sonolith i-sys electroconductive lithotripter (focal length: 21 cm) (EDAP TMS, Vaulx‐en‐Velin, France). Success was defined as the absence of residual of any size or a residual of ≤2 mm on NCCT after one month, whereas failure was having fragments >2 mm or requiring surgical intervention. Post-SWL assessments were completed one week after every session with an X-ray of the kidney-ureter-bladder (KUB-XR) and NCCT after one month.ResultsThe upper and lower ureteral stone-free rates (SFRs) were 95% and 64.7%, respectively. Of them, 65% and 45%, respectively, were stone-free after one session. The cohort having a stone-free status after one SWL session was similar in age, sex, BMI, and stone density. The upper ureteral stone arm has a significant chance for one SFR session with a larger stone size, shocks per session, and maximum power delivered. In the receiver operating characteristic (ROC) curves, the optimal cut point number of sessions of 1.5, mean stone density (MSD) of 895, and stone size of 10.5 mm are the most likely to have successful SWL in the ureter.ConclusionFor patients having ureteral stones with favorable factors, SWL modality is effective and safe. Moreover, SWL can be done for one or two sessions only with the presence of favorable factors.

The Outcome of Shock Wave Lithotripsy (SWL) in the Treatment of Urinary Stone Disease: 115 Cases in SOMCH

Purpose: Urinary stone disease is a systemic metabolic and recurrent disease. It is the third most common disease of the urinary tract. Urolithiasis affects 4%-15% of the world population and this is increasing. Treatment of urinary stone disease moved dramatically from open operative procedures to endoscopic, minimally invasive, and noninvasive methods. The introduction of shock wave lithotripsy (SWL) has revolutionized the treatment of urinary stones with the concept of disintegration of stones. The present study aims to evaluate the outcome of SWL in the treatment of urinary stone disease. Methods and Materials: This retrospective observational study was conducted in the department of urology, SOMCH from June 2019- to March 2021. Renal stone &lt;2.0 cm &amp; upper Ureteric stone &lt;1.5 cm were included and radiolucent stones, patients having ureteral obstruction with grossly impaired renal function, UTI, uncontrolled bleeding disorder, pregnancy &amp; BMI &gt;30kg/m2 were excluded. A total of 115 patients was enrolled. SWL with Siemens Lithoskope (3rd generation) lithotripter was used with a standard number of shock waves 2500-3500 per session &amp; an energy setting of 3.0-3.5 KV. NSAID was given in suppository form and intravenous pethidine just before starting shock for analgesia and all were under antibiotic prophylaxis. Patients were discharged the day after the SWL procedure with the advice of follow-up every 2 weeks for 3 months. All patients were followed up with history, urine R/M/E &amp; C/S to detect UTI, plain X-ray KUB region to see stone clearance or any other complications. Results: Total 179 sessions of SWL procedure done for 115 patients (1.55/ patient) with the urinary stone of both gender between 19 to 70 years. Of them, 82(71.3%) were male and 33(28.7%) female and 94(81.5%) were in the 20-60 years age group. Renal stones 78(67.9%), upper ureteric stones 37(32.1%), and 70(60.8%) were on the left side. Preprocedure stenting was done in 35(30.4%) patients due to obstruction &amp; residual stones. 70(60.9%) have achieved stone clearance after the first session of SWL. After a maximum of 3 sessions of SWL and 3 months follow up found that 99(86%) patients were stone-free. Only 16(14%) found treatment failure and needed auxiliary procedures like URS, RIRS, etc because of hard stone, steinstrasse, and patients’ non-compliance due to pain &amp; fearlessness. 13(11.3%) patients complain of moderate pain after SWL and needed a maximum of 2 days of hospitalization with an injectable pain killer. UTI was found in 9(7.8%) patients, of the 7(6.1%) were pre-stenting. Gross hematuria was found in 2(1.7%) patients due to HDN &amp; UTI. Conclusion: As the stone clearance rate is high with fewer complications however multiple sessions are required, SWL, a noninvasive procedure, is a good option for the treatment of urinary stone disease. Bangladesh J. Urol. 2021; 24(2): 166-169

Outcome of extracorporeal shock wave lithotripsy for renal and upper ureteric stone clearance

Introduction: Extracorporeal shockwave lithotripsy (ESWL) is a day care, less invasive procedure not requiring anesthesia for the treatment of renal and ureteric stones. &#x0D; Method: This was a cross sectional study of retrospectively collected data on ESWL during May 2018 to January 2020 at the department of Urology, Bir Hospital, National Academy of Medical Sciences (NAMS), Nepal. The data on ESWL for renal and upper ureteric stone up to the size of 20 mm were included. Stone clearance was defined as stone fragment &lt;4 mm on kidney ureter bladder (KUB) X-ray or ultrasonography (USG) during follow up at 1 - 3 mo. Ethical approval was obtained from NAMS ethical committee. Microsoft Excel was used for descriptive analysis of age, gender, stone size, density, location, hydronephrosis, and clearance. A Chi square test was used for association, and a p-value &lt;0.05 considered statistically significant.&#x0D; Result: Out of 79 cases, overall stone clearance was 48(60.8%), 100% for &lt;10 mm (14/14) and density &lt;500 HU (5/5), and 80% for upper ureteric stone (4/5) and 74.1% for those without hydronephrosis (20/27). Patients in age group of 20-39 y accounted for 48(60.8%), males 52(65.8%), 52(65%) had 10-15 mm stones, 46(58.2%) in pelvis, 48(60.8%) density of 751-1000 HU, and mild hydronephrosis present in 44(55.7%).&#x0D; Conclusion: Stone clearance were highest (100%) for small stone &lt;10 mm size and low density &lt;500 HU. The stone clearance rate decreased as the size, density, and hydronephrosis increased.

Are the current nomograms sufficient to predict shockwave lithotripsy outcomes?

Introduction and objectivesTo investigate factors affecting SWL outcomes, validate three current nomograms (Kim JK, Triple D and S3HoCKwave) and compare the predictive ability of the nomograms for SWL outcomes in upper urinary tract stones. Patients and methodsMedical records of patients with renal and proximal ureteral stones treated with SWL between March 2013 and October 2020 were retrospectively reviewed. Factors affecting SWL success were analyzed with multivariate logistic regression analysis and the three predictive scoring systems compared with the area under the curve (AUC). ResultsA total of 580 patients were included in our study. The overall stone free rate was 61% and 144/580 patients (24.8%) were stone free after one session. In multivariate logistic regression analysis, stone location at upper calyx (OR:2.988; 95%Cl: 1.350–6.612; p = 0.007), middle calyx (OR:3.036; 95%Cl: 1.472–6.258; p = 0.003), and lower calyx (OR:2.131; 95%Cl: 1.182–3.839; p = 0.012), as well as number of stones (OR:1.663; 95%Cl: 1.140–2.425; p = 0.008), maximum diameter of stone (OR:1.156; 95%Cl: 1.098–1.217; p < 0.001) and maximum Hounsfield Unit (OR:1.001; 95%Cl: 1.001–1.002; p < 0.001) were independent risk factors of SWL failure. The AUCs of the Kim JK, Triple D and S2HoCKwave scores for predicting SWL success were 0.678, 0.548, and 0.626 respectively. ConclusionsStone location, number, maximal diameter, and maximum HU were independent predictive factors for SWL outcome in the treatment of upper urinary tract stones. Current nomograms, “Kim JK nomogram”, “Triple D score” and “S3HoCKwave score” can predict treatment success after SWL, but all of them have poor discrimination according to AUC analysis.

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.

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.