Outcome Of Extracorporeal Shock Wave Lithotripsy Research Articles

The impact of Mayo Adhesion probability score on the success of extracorporeal shock wave lithotripsy for kidney stones.

Urolithiasis is a prevalent condition in urology, with extracorporeal shock wave lithotripsy (ESWL) serving as a common treatment for kidney stones under 2cm. The Mayo Adhesion Probability (MAP) score, calculated from perinephric fat characteristics, is traditionally used to assess surgical outcomes but has not been explored in the context of ESWL. This study aims to evaluate the effect of MAP score on the success rate of ESWL. This retrospective study included patients who underwent ESWL for kidney stones between January 2018 and June 2024 at a tertiary care center. Demographic data, stone characteristics, and MAP scores were obtained through CT imaging. ESWL success was defined as either complete stone clearance or a residual fragment less than 4mm at three months post-procedure. Logistic regression and ROC analysis were employed to identify predictors of treatment success and to determine the optimal MAP score cutoff. A total of 260 patients were analyzed, divided into two groups: MAP score < 3 (n = 154) and MAP score ≥ 3 (n = 106). Patients with a MAP score ≥ 3 had a significantly lower ESWL success rate (49.1%) compared to those with a MAP score < 3 (71.4%; p = 0.001). Multivariate analysis identified MAP score, BMI, and stone size as significant predictors of ESWL success. ROC analysis established a MAP score cutoff of 2, with 76.5% sensitivity and 64.3% specificity. The MAP score is an independent predictor of ESWL success in kidney stone treatment. Preoperative MAP evaluation may improve patient selection and optimize ESWL outcomes.

The effects of pretreatment oral hydration on extracorporeal shockwave lithotripsy outcomes: A randomized controlled trial.

We sought to investigate the effects of pretreatment oral hydration on the outcomes of extracorporeal shockwave lithotripsy (ESWL). Patients who undergoing ESWL for a single radio-opaque renal or proximal ureteric calculus ≤2 cm in size were randomized into two groups. The oral hydration group (OHG) administered 600 ml of water before ESWL, while the control group (CG) did not. The urine was held during ESWL to create a full bladder induced hydronephrosis. Both groups received the same ESWL protocol at four-week intervals and a maximum of three sessions. The primary outcome was stone-free rate (SFR) at 12 weeks and the secondary outcomes were the total number of shockwaves and the number of ESWL sessions. A total of 154 patients completed the study, 77 patients in each group; both groups were comparable in demographic data and stone characteristics. The SFR was 84.4% in the OHG and 68.8% in the CG group (p=0.036). Stone fragmentation in OHG was significantly higher than CG, 75.3% vs. 58.4% (p=0.040). OHG had more cases of artificial hydronephrosis (55.8% vs. 27.3%, p=0.001) and higher urine volume (375 [148] ml vs. 230 [110] ml, p<0.001). There were no statistically significant differences in the total number of shockwaves and the number of ESWL sessions. The auxiliary procedures in OHG were less than CG (15.6% vs. 31.2%, p=0.049). Pretreatment oral hydration, together with holding urine during ESWL, has increased stone disintegration and SFR. This simple and safe technique improves the ESWL outcomes.

Long-term clinical outcomes of extracorporeal shockwave lithotripsy and endoscopic retrograde cholangiopancreatography for pancreatic duct stone treatment in patients with chronic pancreatitis.

Extracorporeal shock wave lithotripsy for pancreatic stones (P-ESWL) and endoscopic retrograde cholangiopancreatography (ERCP) are the preferred therapeutic approaches for painful chronic pancreatitis (CP) with pancreatic stones. This study aimed to report the short- and long-term outcomes following P-ESWL and ERCP in a large cohort with CP. Patients with painful CP and pancreatic stones >5 mm in size, who underwent P-ESWL and subsequent ERCP between March 2011 and June 2018, were included in this retrospective-prospective mixed observational study. The total stone clearance rates were recorded. All patients were followed up until the end of March 2024, with the visual analogue scale (VAS) for pain, pain type, quality-of-life scores and other relevant information recorded. A total of 2071 patients underwent P-ESWL, and 93.1% of them subsequently underwent ERCP during the study period. Patients were followed up for an average of 11.8 years from the onset of CP and 6.7 years from the first P-ESWL procedure. Complete stone clearance was achieved in 73.7% of the patients. At the end of the follow-up period, 70.1% of the patients achieved complete pain remission. Significant pain type conversion and lower VAS scores were observed in the patients after treatment. Quality-of-life scores and body mass indices increased after P-ESWL and ERCP. P-ESWL and ERCP are effective and minimally invasive treatments for pancreatic stones in patients with painful CP. Most patients achieved complete pain relief, and pain-type conversion was common after treatment. (ClinicalTrials.gov: NCT05916547).

Factors and nomograms determining the effectiveness of extracorporeal shock wave lithotripsy in children with urolithiasis: a literature review

Extracorporeal shock wave lithotripsy (ESWL) is currently the priority method for treating urolithiasis in children. Due to the lack of extended indications for the application of this technique, an active search has been made over the past 30 years to define factors predicting ESWL outcome, to create objective preoperative planning tools, to increase ESWL effectiveness and to reduce the number of anesthetics and unnecessary surgical interventions. Search for the information on predictive factors of ESWL successful intervention and on modern statistical tools predicting lithotripsy effectiveness in children with urolithiasis was made in foreign and domestic sources, like MEDLINE, eLIBRARY, CyberLeninka. The literature analysis has showed that the following factors predispose positive ESWL outcomes: age before six years, smaller calculi size, and shorter skin-to-stone distance. Stone location in the lower calyx group, multiple concrements, and their high density has a negative impact at complete fragment detachment after ESWL. The probability of complete detachment of stone fragments from the lower calyx group decreases under the following anatomic features of kidney collecting system: number of draining calyces is more than one, calyx neck diameter is less than 4 mm, acute angle between the lower infundibulum and renal pelvis. Body mass index and prestenting have a controversial effect at successful ESWL too. Nomograms and scoring systems based on predicting factors are widely used in both adult and pediatric practice. The two most commonly used nomograms in pediatric urology are Onal and Dogan nomograms developed in 2012 and 2015 in Turkey. These nomograms include the following parameters: patient's sex and age, history of ipsilateral surgical interventions as well as stone localization, number and size. Thus, predicting ESWL outcomes using preoperative planning allows to choose the most appropriate treatment modality for a particular patient considering his/her individual anatomical and physiological characteristics and characteristics of the calculi.

Effect of JJ Stent on Outcomes of Extracorporeal Shockwave Lithotripsy of Renal Stones around 2 cm

Abstract Background Urolithiasis is a common problem in Egypt as it lies within the stone belt region extending from Indonesia to Egypt. Economic and dietary factors, dehydration, exposure to heat and possible genetic factors. Urolithiasis is one of the most common problems encountered by urologists. Many factors affect Stone formation like geographical, climatic, ethnic, dietary and genetic factors. The recurrence rate is determined by the primary etiology of stones formation. Aim of the Work Evaluation of the role of JJ stent in enhancing the passage of fragments in patients undergoing extracorporeal shockwave lithotripsy (ESWL) for renal stones with size around 2 cm. Patients and Methods This randomized controlled clinical trial was conducted on 90 patients in the period from December 2021 to July 2022 with age ranged from 24 – 60 years with mean±SD of 44.21 ± 10.99 years; they were 28 females (31.1%) and 62 males (68.9%) and randomly divided into two groups: Group (I): Patients without JJ stent consists of 45 patients &amp; Group (II): Patients with JJ stent consists of 45 patients. Results The analysis of our study results showed no statically significant difference between the two groups regarding SFRs (95.6% in group I &amp; 93.3% in group II), time to SFRs (mean±SD 1.05 ± 0.55 month in group I &amp; 1.20 ± 0.59 month in group II), number of sessions of ESWL (2.11 for group I &amp; 2.37 for group II), auxillary procedures (Two patients in group I (4.4%) 1 patient had PCNL &amp; 1 patient had URS due to steinStrasse 2.2%) &amp; Three patients in group II (6.7%) failed ESWL and had PCNL), number of ER visits (in group I 46.7% &amp; in group II 40 % had attended at least once for the ER, analgesics consumption (In group I 77.8% &amp; In group II 84.4%) &amp; laboratory tests changes like Hb drob between pre &amp; post ESWL in the two groups (-0.02 ± 0.04 &amp; -0.11 ± 0.08 in group I &amp; group II respectively) &amp; the amount of increase in serum creatinine level (post – pre) was found 0.07 ± 0.03 in patients without JJ stent and 0.03 ± 0.04 in patient with JJ stent. Conclusion Routine JJ stent fixation before extracorporeal shock wave lithotripsy in management of renal stones around 2cm is unnecessary because it doesn’t improving free stone rate or enhancing the passage of the fragments during ESWL.

Peroral Pancreatoscopy-Guided Lithotripsy Compared with Extracorporeal Shock Wave Lithotripsy in the Management of Pancreatic Duct Stones in Chronic Pancreatitis: A Multicenter Retrospective Cohort Study.

Extracorporeal shock wave lithotripsy (ESWL) is a common treatment for pancreatic stones in chronic pancreatitis. In contrast, peroral pancreatoscopy-guided lithotripsy (POPS-L) remains underexplored, with limited comparative studies to ESWL. This study compared the treatment outcomes of disposable POPS-L tools and ESWL for pancreatic stones. A retrospective analysis was conducted on 66 patients who had undergone pancreatic stone treatment at three institutions between 2006 and 2022. The treatment outcomes of POPS-L and ESWL were compared. This study included 19 and 47 patients who had undergone POPS-L and ESWL, respectively. In a comparison between POPS-L and ESWL, the stone clearance rates were 78.9% vs. 70.2% (p = 0.55), while the procedure-related complication rates were 21% vs. 6.3% (p = 0.09). The median total session counts were 1 vs. 5 (p < 0.01). The cumulative stone recurrence rates were comparable in both groups. Multivariate analysis revealed no significant factors influencing the stone clearance rates, and the choice between POPS-L and ESWL did not affect the stone clearance rates. POPS-L and ESWL exhibited comparable treatment outcomes in terms of stone clearance, complications, and recurrence rates. Furthermore, POPS-L is advantageous due to the need for fewer sessions to achieve pancreatic stone clearance.

Comparison of Outcomes of Extracorporeal Shockwave Lithotripsy with Ureteroscopic Lasertripsy for Management of Proximal Ureteral Stones.

To compare the outcomes of extracorporeal shockwave lithotripsy with ureterorenoscopy and lasertripsy for managing upper ureteral stones of size 10mm to 15mm. Observational, cross-sectional study. Place and Duration of the Study: Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), from December 2020 to December 2021. A total of 168 patients with the diagnosis of proximal ureteric stone of size 1-1.5 cm were enrolled for this study. Patients were divided into two groups by simple random method. Group 1 patients underwent ureteroscopic lithotripsy (URS) and lasertripsy while Group 2 patients were subjected to extracorporeal shockwave lithotripsy (ESWL). Patients' demography, operative time, duration of hospitalisation, complication rate and stone-free rates, were recorded for both groups. Frequency and percentages were calculated for categorical variables and mean and standard deviation were calculated for continuous variables. For comparison of continuous variables, one-way ANOVA was applied, and Chi-square test was applied to compare the categorical variables. The p-value ≤0.05 was taken as significant. The mean age was of 39.55 ± 14.06 years, with the majority falling within the age group of 26 to 40 years. There were more males (116, 69%) than females (52, 31%). Most of the patients did not have a history of diabetes or hypertension. Sixty-two patients had previous history of stones. The average duration of ureteric stone disease was 3.18 ± 3.14 months. The mean size of the ureteric stone was 10.82 ± 3.19mm. The procedure duration was significantly shorter for URS, as compared to ESWL (33.81 ± 15.42 minutes vs. 45.00 ± 0.00 minutes, p=<0.01. The overall stone clearance rate was significantly higher after URS (83.3%) as compared to ESWL (64.2%, p=0.05). URS was a superior treatment option as compared to ESWL. However, the selection of the most appropriate procedure should be based on a tailored approach considering the patient's preference and the size of the stones. Extracorporeal shockwave lithotripsy (ESWL), Ureteroscopic lithotripsy (URS), Modified clavien classification system (MCCS), Ureteric stone.

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.

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).

A systematic review and meta-analysis on the outcomes of extracorporeal shock wave compared to ureteroscopic lithotripsy for the treatment of ureteral stones

ObjectivesIn this systematic review and meta-analysis, we sought to identify whether extracorporeal shockwave lithotripsy (ESWL) or ureteroscopic lithotripsy (URSL) is the most appropriate method for treating ureteral stones. MethodsWe identified relevant literature by searching the Google Scholar and PubMed databases in accordance with PRISMA guidelines. We focused on the outcomes of extracorporeal shockwave lithotripsy and ureteroscopic lithotripsy. For each method, we compared complications, hematuria, perforation, failure, stone clearance, initial stone-free, operating time, stone size, auxiliary procedures, and overall stone-free outcomes. Our analysis involved meta-analysis, heterogeneity testing, subgroup analysis, meta-regression sensitivity analyses, Egger's tests, Smoothed Variance Egger's (SVE) testing, and Smoothed Variance Thomson (SVT) testing. In addition, we detected publication bias for all outcomes related to the two procedures. ResultsBased on ten eligible studies, we conducted a meta-analysis on a total of 1509 patients. Extracorporeal shockwave lithotripsy was used to treat 677 patients; the remaining 832 patients were treated by the ureteroscopic lithotripsy procedure. Considering the meta-analysis statistical parameters including odds ratio (OR), standardized mean difference (SMD), Q, I2 and their p-values, the overall stone-free, operating time, stone size outcomes were identified with significant OR, SMD, and Q values. The hematuria, failure, and stone clearance outcomes were determined to have significant Q values. The perforation and initial stone free outcomes had significant OR values. And, complications and auxiliary urinary procedures were not significant in terms of OR and Q values. ConclusionsAnalysis indicated that ESWL and URSL procedures are essential for the treatment of ureteral stones, even though the perforation rate is higher for URSL than for ESWL. Overall stone-free rates were better for the URSL procedure.

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.

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.

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

Extracorporeal Shock Wave Lithotripsy Success Rate and Prognostic Factors

Background: Urinary tract stones are common urological problems with a considerable burden worldwide. Management strategies mostly rely on the stone’s characteristics and the patient’s clinical conditions. Extracorporeal shock wave lithotripsy (ESWL) is a method of choice for managing small calculus. However, the success rate of ESWL and the prognostic factor of success widely vary among different studies. The aim of the present study was to evaluate these prognostic factors in an Iranian population undergoing ESWL. Methods: The present retrospective study was conducted in Imam Ali Hospital of Bojnurd, Iran. Every patient who was referred for the ESWL of distal urethral calculus (5-20 mm) and failed to respond to medical treatment enrolled in this study. The prevalence and relationship between various individual factors and ESWL outcomes were evaluated among the study patients. Results: Among 49 patients (24 males and 25 females) who had urinary tract stones, the mean (±standard deviation) of age was 42.7 (14.04) years. ESWL could successfully treat urinary tract stones in 43 patients (85%). The kidney stone diameter was not related to having a successful procedure (P=0.447). Moreover, the stroke number and receiving tamsulosin were not significantly associated with favorable ESWL outcomes (P=0.909 and P=0.590, respectively). Twenty-seven patients (45.1%) received pethidine during the procedure. There was a significant relationship between receiving analgesics and favorable ESWL outcomes (P=0.033). Conclusion: The results demonstrated that 85% of the distal urinary tract stones that are smaller than 20 mm can be successfully managed by ESWL, and providing analgesics was significantly related to better outcomes.

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.

Stenting versus non-stenting before extracorporeal shock wave lithotripsy for proximal ureteric stones: A prospective interventional study

Background: Extracorporeal shock wave lithotripsy (ESWL) has become the first-line treatment for stones in the upper urinary tract measuring &lt;2cm. It is the minor invasive treatment for calculi of the upper urinary tract. Aims and Objectives: This study aims to identify the effect of the presence and absence of a ureteric stent on the outcome of ESWL in patients with proximal ureteric stones. Materials and Methods: This was a prospective cohort study done on 300 patients and wasdivided into two equal groups of 150 each. Group A patients were selected for ESWL with DJ stent, and Group B patients werefor ESWL without DJ stent. Non-contrast CT KUB was done as a functional study along with plainX-ray KUB and ultrasound before the intervention. All treatments were done with Direx Compact XL (electromagnetic generator) device as an outpatient procedure. Patients were followed up radiographically at 15 days, 1 month, 2 months, and in 3 months. Hematuria, steinstrasse, fever, ureteric colic, lower urinary tract symptoms (LUTS), stone clearance, number of ESWL sessions, and secondary procedures were recorded for each group. DJ stent was taken out when the stone disappeared or at the end of 3 months. Variables were compared with Chi-square test. Results: The overall stone-free rate at 3 months was 90.6% (272/300). Clearance after the first sitting, second sitting, and the third sitting wasnot significant between the two groups(P&gt;0.05).There was no significant difference between the two groups in regard to clearance according to the size of the stones. A total of 9.3%(28/300) of patients did not have a successful outcome and were termed as ESWL failures. Post- ESWL complications were significant between the both groups in terms of hematuria and ureteric colic. All the ureteric colic patients had a stone size larger than 13 mm, P=0.0005, which was more in the non-stented (Group B) patients. Most of the lower urinary tract symptoms were seen in stented (Group A) patients, P&lt;0.0001 significant between the two groups, and dysuria was also significant between the two groups with P=0.0033. Conclusion: Pre-ESWL ureteral stenting provides no additional benefit over no stent in situ, although ureteral stents are associated with more irritative symptoms.

Extracorporeal shock wave lithotripsy for the treatment of urinary lithiasis in children

Introduction: Extracorporeal shock wave lithotripsy (ESWL) is an option for the treatment of urinary lithiasis.&#x0D; Objective: To describe the outcomes of ESWL for the treatment of urinary lithiasis in children.&#x0D; Methods: A descriptive and retrospective study of 51 patients with urinary lithiasis that underwent ESWL from 2014 to 2019.&#x0D; Results: Males and 15–18-year-old patients prevailed; 27.4% had prior surgery; 10-20 mm lithiasis of renal location and density between 400-799 HU were the most common; a double J stent was the most utilized urinary derivation prior to lithotripsy treatment; 7.8% required retreatment; 13.7% additional interventions; the stone-free rate was 74.5% at one month and 92.2% at three months. The size of the lithiasis was associated with the success of the treatment (p&lt;0.023). The most frequent complication was steinstrasse; endourologic procedures were the most utilized, grade III b (Clavien-Dindo) prevailed and were associated to older patients (p=0.04), renal lithiasis localization (p=0.017), larger size (p=0.08), and density(p=0.036).&#x0D; Conclusions: ESWL is effective and safe for treating urinary lithiasis in children. Its success was significantly associated to smaller stone size and its complications to patients of older age, larger stone size, density and renal localization of the lithiasis.

Outcome of Extracorporeal Shockwave Lithotripsy as Monotherapy in Upper Urinary Tract Lithiasis

Introduction: Due to its non-invasive nature, extracorporeal shockwave lithotripsy (ESWL) is the preferred treatment modality for uncomplicated renal and ureteral stone &lt; 20 mm in diameter. The success rate of it ranges from 46% to 91% depending on various factors. Objective: To assess the outcome of ESWL as monotherapy in uncomplicated solitary renal and upper ureteric calculus ranging from 10mm to 20mm. Methods: In this retrospective study, the records of 34 patients who underwent Extracorporeal shockwave lithotripsy ESWL inBirat Medical College – Teaching Hospital over a period of one and a half years were reviewed to assess the outcome in terms of stone free rate and complication rate. Results: Mean age of the patients was 30.57±8.44 years and mean calculus size was 14.47±2.68 mm (range 10-20mm). The male and female ratio was 2:1. The success rate was higher for pelvic (83.33%) and upper calyceal (75%) and upper ureteric calculi (75%) compared to other calyces. Clinically significant residual fragment (CSRF) was the most common problem after ESWL (23.33%) at three months after the procedure. Conclusions: The outcome of ESWL as monotherapy for upper urinary tract calculi is acceptable in selected cases three months after the procedure. Keywords: Extracorporeal shockwave lithotripsy; outcome; upper urinary tract calculi.