Extracorporeal Shock Wave Lithotripsy Sessions Research Articles

The effects of pretreatment oral hydration on extracorporeal shockwave lithotripsy outcomes

Introduction: We sought to investigate the effects of pretreatment oral hydration on the outcomes of extracorporeal shockwave lithotripsy (ESWL). Methods: 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. Results: 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). Conclusions: Pretreatment oral hydration, together with holding urine during ESWL, has increased stone disintegration and SFR. This simple and safe technique improves the ESWL outcomes.

Impact of Extracorporeal Shock Wave Lithotripsy (ESWL) on Kidney Length and Corticomedullary Differentiation in Patients With Renal Stones: A Case-Control Study.

Background The effect of extracorporeal shock wave lithotripsy (ESWL) on kidney morphology was evaluated sonographically in patients with renal stones. This study aimed to investigate the effects of ESWL on the kidneys after consecutive sessions. Methods This case-control study included adult participants from December 2018 to August 2022 in three major centers of ESWL treatment. Data were collected from 392 patients (336 treated with ESWL and 56 in the control group). Data were analyzed using SPSS Statistics (IBM Corp., Armonk, USA). Both binary logistic regression and generalized linear regression were applied to determine the factors that predicted the effect of ESWL on kidney length (KL) and cortico-medullary differentiation (CMD). Results The overall effect of ESWL treatment on patients with renal stones was observed in 19.9% disturbed CMD, and 11.6% decreased parenchymal thickness. KL was significantly decreased in patients exposed to ESWL compared to controls (9.103 vs.10.291 cm, p-value < .001). KL decreased significantly as the number of ESWL sessions increased (r = -.209, p-value < .001). After adjustment, the frequencies of ESWL and hydronephrosis were significantly associated with CMD distortion. Patients who were exposed to more than one ESWL session had 2.64 increased odds of distorted CMD as compared to controls (AOR=2.64, 95% CI = 1.040-6.683), and those with hydronephrosis had 1.70 increased odds of distorted CMD as compared to controls (AOR=1.70, 95% CI = 1.188-2.434). Conclusion ESWL significantly affected the renal length and CMD in patients with renal stones. The frequency of ESWL sessions significantly decreased KL and disturbed CMD in patients with renal stones. The outcome was not affected by the number of stones.

Transperitoneal Laparoscopic Pyelolithotomy in Pelvic Ectopic Kidneys: Experience From a Northern Indian Tertiary Care Institution.

Introduction The ectopic pelvic kidneys have a higher likelihood of developing renal stones due to urinary stasis caused by the abnormal position of the renal pelvis, altered course of the ureter, and kidney malrotation. This retrospective study highlights the safety, efficacy, and feasibility of performing transperitoneal laparoscopic pyelolithotomy in cases of pelvic ectopic kidney. Methodology The 15 patients with ectopic pelvic kidneys and nephrolithiasis underwent laparoscopic pyelolithotomy. The kidney was exposed either by moving the bowel or using a trans-mesocolic approach. A surgical procedure was performed to remove stones from the renal pelvis using laparoscopic forceps. Following the placement of a double J stent, the incision in the renal pelvis was closed. The procedure was completed after the intraperitoneal drain was inserted. Results A total of 15 patients underwent the transperitoneal laparoscopic pyelolithotomy procedure, with a male-to-female ratio of 3:2. The average age of the patients was 41 (25-58) years, while the average size of the stones was 3.8 cm. Additionally, seven (46.6%) patients had the presence of caliceal stones in conjunction with the pelvic stone. Out of the 15 patients, some had stones on the left side (n = 9, 60%), while others had stones on the right side (n= 6, 40%). The operation with an average duration was 125 minutes with a range of (90-190). Fourteen (93.3%) patients were found to be free of stones. A patient required extracorporeal shock wave lithotripsy (ESWL) to address a small caliceal residual stone measuring 8 mm. After just one session of ESWL, this stone was completely cleared. All stones were successfully removed, resulting in a 100% stone-free rate. Conclusions Laparoscopic pyelolithotomy is a highly effective and efficient procedure for treating large and numerous stones in the ectopic pelvic kidney. This method has a significant level of efficiency in removing stones with limited consequences.

Comparison of ureteral stone measurements for predicting the efficacy of a single session of extracorporeal shockwave lithotripsy: one-, two-, and three-dimensional computed tomography measurements.

The objective of this study was to compare the value of one-, two- and three-dimensional computed tomography (CT) measurements for predicting the efficacy of a single session of extracorporeal shock wave lithotripsy (ESWL) in patients with a single ureteral stone. A total of 165 patients were included based on the inclusion and exclusion criteria. Different models were constructed using a combination of patients' clinical data and measurements obtained by manual sketching and automated extraction software. Multivariate logistic regression was used to develop the models. Receiver operating characteristic curves were used to assess the performance of the models. There was good interobserver agreement for all measurements in different dimensions (P < 0.001). We also found that hydronephrosis, the largest diameter, the largest area, volume, and mean CT value were significantly greater in the failure group than in the success group (P < 0.01). Furthermore, all sizes and CT measurement values were found to be independent predictors for predicting efficacy after one session of ESWL (P < 0.05). In addition, the multivariate logistic analysis showed that the area under the curve (AUC) for two-dimensional and three-dimensional measurements was superior to that of one-dimensional measurement (P < 0.01). However, when size alone was included as a measurable predictor, there was no significant difference in the AUC among the one-, two-, and three-dimensional measurements (P > 0.05). In summary, after adjusting for clinical data, two- and three-dimensional measurements combining ureteral stone size and CT values were found to be the best predictors of ESWL efficacy, and software-based three-dimensional measurements should be considered to avoid interobserver variability in clinical practice.

Development of a novel CT-based index for predicting the number of extracorporeal shockwave lithotripsy (ESWL) sessions required for successful fragmentation of obstructing pancreatic duct stones

Background & aimExtracorporeal shock wave lithotripsy (ESWL) is used for the treatment of pancreatic duct stones (PDS) in patients with chronic pancreatitis (CP). We aimed to develop a CT based index to predict the required number of ESWL sessions for technical success. MethodsWe retrospectively evaluated patients with PDS secondary to CP who underwent ESWL. Technical success was defined as the complete fragmentation of stones to <3 mm. CT features including PDS size, number, location, and density in Hounsfield units (HU) were noted. We analyzed the relationship between PDS characteristics and the number of ESWL sessions required for technical success. A multiple linear regression model was used to combine size and density into the pancreatic duct stone (PDS) index that was translated into a web-based calculator. ResultsThere were 206 subjects (mean age 38.6 ± 13.7 years, 59.2% male) who underwent ESWL. PDS size showed a moderate correlation with the number of ESWL sessions (r = 0.42, p < 0.01). PDS in the head required a fewer number of sessions in comparison to those in the body (1.4 ± 0.6 vs. 1.6 ± 0.7, p = 0.01). There was a strong correlation between PDS density and the number of ESWL sessions (r = 0.617, p-value <0.01). The PDS index {0.3793 + [0.0009755 x PDS density (HU)] + [0.02549 x PDS size (mm)]} could accurately predict the required number of ESWL sessions with an AUC of 0.872 (p < 0.01). ConclusionThe PDS index is a useful predictor of the number of ESWL sessions needed for technical success that can help in planning and patient counseling.

A Predictive Strategy for Nonsurgical Management of Pancreatic Stones.

We set out to predict whether nonsurgical treatment is likely to succeed in removing pancreatic stones in a given patient and also to determine an optimal maximal number of extracorporeal shock wave lithotripsy (ESWL) sessions for treatment of pancreatolithiasis in that patient. We ascertained the number of ESWL sessions for each of 164 patients undergoing that treatment for pancreatolithiasis between 1992 and 2020. Median follow-up duration was 31 months (range, 0-239), median age was 58 years (22-83), and the male to female ratio was 5.1:1.0. Patients were divided into 2 groups based upon an optimal maximal number of ESWL sessions determined by receiver operating characteristic analysis. Total stone clearance was achieved in 130 of 164 patients (79%). The median number of ESWL sessions was 3 (1-61). Receiver operating characteristic analysis determined 7 to be the optimal maximal number of sessions. Complete clearance was more frequent (87%) among the 131 patients requiring 7 or fewer ESWL sessions than among the 33 undergoing more (48%, P < 0.001). Seventeen patients (52%) undergoing 8 or more sessions still had residual stones. If any pancreatic stones persist after 7 ESWL sessions, we recommend transition to medical or surgical treatments.

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.

Optimal Shock Wave Frequency and Energy, Important Factors for Renal Stone Fragmentation in ESWL: A Prospective Randomized Trial

Background: Kidney stones are crystalline structures with high prevalence rate across the globe. Different treatment method are used to treat renal stones among which extracorporeal shock wave lithotripsy (ESWL) shows promising results for stone free rate among non-invasive treatment modalities. Different factors govern effectiveness of lithotripsy among which shock wave frequency and energy had always been in debate as they have direct effect on responsiveness of ESWL. Objective: Comparison of different energy and shock wave frequency levels in terms of effectiveness in stone fragmentation. Study Design: Prospective randomized study. Settings: Department of Urology, DHQ Hospital/Faisalabad Medical University, Faisalabad Pakistan. Duration: April 2018 to September 2020 (2.5 Years). Methods: 120 patients enrolled using non probable consecutive sampling according to inclusion and exclusion criteria. Patients subjected to four sessions of ESWL using electromagnetic lithotripter and stones observed for fragmentation. Patients divided into four groups i.e. A, B, C and D depending upon frequency and energy of shock waves applied.(Group-A: Frequency 60 shocks/min Energy 50)(Group B: Frequency 90 shocks/min Energy 50)(Group C: Frequency 60 shocks/min Energy 65)( Group D: Frequency 90 shocks/min Energy 65). Each group further divided into subgroups 1 and 2 according to age as subgroup I patients having age 15-35 years and subgroup II having age 36-55 years. Statistical analysis done and P &lt; 0.05 was taken as statistically significant. Results: 120 patients enrolled from age 15-55 years with mean age 37.191 + 11.09. Results showed that response of ESWL is statistically significant when frequency is low however both energy levels have equal response for effectiveness. Conclusion: We conclude that ESWL is an effective treatment method for renal stones when frequency of shock waves is less and combining it with low levels of energy shows with promising stone fragmentation rate with minimal side effects.

Factors influencing the efficacy of ultrasound-guided extracorporeal shockwave lithotripsy in the treatment of ureteral stones: a retrospective study.

The aim of the study was to analyze the factors influencing the efficacy of ultrasound-guided extracorporeal shockwave lithotripsy (ESWL) in the treatment of ureteral stones. The clinical data of 8102 patients (6083 men and 2019 women) who presented with ureteral stones were retrospectively analyzed. All the patients were treated with ultrasound-guided ESWL. The stone-free rate (SFR) was calculated to evaluate the effect of ESWL. The characteristics of the patients and their stones, and the ESWL parameters applied were compared to identify the factors affecting the treatment outcomes. The SFR and that following one ESWL session were 94.6% (7663/8102) and 75.4% (6107/8102), respectively. Multivariate analysis showed that stone location (OR 0.656, p < 0.001), stone size (OR 1.103, p < 0.001), and degree of hydronephrosis (OR 1.952, p < 0.001) independently affected SFR; and age (OR 1.005, p = 0.022), stone location (OR 0.729, p < 0.001), stone size (OR 1.103, p < 0.001), degree of hydronephrosis (OR 1.387, p = 0.001), maximum energy level(OR 0.691, p < 0.001) independently affected SFR following one session. Ultrasound-guided ESWL is effective in all levels of ureteral stones. Large stone size and moderate hydronephrosis are correlated with treatment failure. Ultrasound-guided ESWL may be the first choice for distal ureteral stones.

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.

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

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).

Extracorporeal shock wave lithotripsy and endoscopic pancreatic stenting without pancreatic sphincterotomy for the treatment of pancreatolithiasis: a case series.

Endoscopic therapy and extracorporeal shock wave lithotripsy (ESWL) are recommended as the first choice in treating pancreatolithiasis. Endoscopic therapy is generally performed using endoscopic pancreatic sphincterotomy (EPST). Herein, we report our experience implementing a treatment protocol, combining endoscopic therapy and ESWL without EPST, for pancreatolithiasis. The inpatient treatment plan was performed every 3months with a set number of sessions of ESWL with endoscopic pancreatic stenting (EPS) implanted or replaced. Finally, treatment was terminated when the stone was removed after implantation of a 10-Fr stent and crushed to approximately 3mm or after spontaneous stone discharge. Eight patients were included in this study; the median time to stone disappearance was 208.5days. The median number of inpatient treatment cycles, endoscopic retrograde cholangiopancreatography, and ESWL sessions was 2.5, 3, and 3, respectively. No serious adverse events were observed in all patients. Therefore, combining ESWL and EPS without EPST can safely treat pancreatolithiasis.

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.

Which frequency is better for pediatric shock wave lithotripsy? Low intermediate or high: A systematic review and meta-analysis.

To explore the optimal frequency for pediatric extracorporeal shock wave lithotripsy (ESWL) in the treatment of upper urinary stones. A systematic literature search was undertaken using PubMed, Embase, Web of Science and Cochrane Central Register of Controlled Trials databases to identify eligible studies published before January 2023. Primary outcomes were perioperative efficacy parameters, including ESWL time, anesthesia time for ESWL sessions, success rates after each session, additional interventions needed, and treatment sessions per patient. Secondary outcomes were postoperative complications and efficiency quotient. Four controlled studies involving 263 pediatric patients were enrolled in our meta-analysis. In the comparison between the low-frequency and intermediate-frequency groups, we observed no significant difference as regards anesthesia time for ESWL session (WMD = -4.98, 95% CI -21.55∼11.58, p = 0.56), success rates after ESWL sessions (first session: OR = 0.02 95%CI -0.12∼0.17, p = 0.74; second session: OR = 1.04 95%CI 0.56∼1.90, p = 0.91; third session: OR = 1.62 95%CI 0.73∼3.60, p = 0.24), treatment sessions needed (WMD = 0.08 95%CI -0.21∼0.36, p = 0.60), additional interventions after ESWL (OR=0.99 95%CI 0.40∼2.47, p = 0.99) and rates of Clavien grade 2 complications (OR = 0.92 95%CI 0.18∼4.69, p = 0.92). However, the intermediate-frequency group may exhibit potential benefits in Clavien grade 1 complications. In the comparison between intermediate-frequency and high-frequency, the eligible studies exhibited higher success rates in the intermediate-frequency group after the first session, the second session and the third session. More sessions may be required in the high-frequency group. With respect to other perioperative, postoperative parameters and major complications, the results were similar. Intermediate-frequency and low-frequency had similar success rates and seemed to be the optimal frequency for pediatric ESWL. Nevertheless, future large-volume, well-designed RCTs are awaited to confirm and update the findings of this analysis. https://www.crd.york.ac.uk/prospero/, identifier: CRD42022333646.

Place of extracorporeal shockwave lithotripsy in the treatment of urolithiasis in the region of Gharb Chrarda Bni Hssen (Morocco).

The extracorporeal shockwave lithotripsy (ESWL) is a minimally invasive therapeutic approach which has been widely used through the last years. The aim of this study was to evaluate the effectiveness of ESWL in the treatment of nephrolithiasis in Gharb Chrarda Bni Hssen area (North of Morocco). A retrospective study of 590 patients with urinary stone was conducted between February 2009 and January 2013 in the Centre of Lithotripsy Anoual Clinic Kenitra. The treatment consisted in one or several sessions of ESWL. Evaluation of efficiency was based on radiological examinations using abdominal echography during the consultation with the urologist after the last session. There were 306 males and 184 females aged 17-79years. The medium size of stone was 12.3 ± 5mm. The average number of sessions and shock waves were 4 and 2490, respectively. The shockwave session was continued until stone fragmentation was observed when 4000 shocks were given. Failure of stone fragmentation or the presence of fragments larger than 4mm were indications of repeat ESWL sessions. 92% of patient stones were completely cleared (p < 0,05%). The majority of patients were asymptomatic. This data show that the ESWL is extremely successful in treating human kidney stone. It is the first line of choice as a treatment modality for this pathology by the population of this area.

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.

Encrusted ureteral double J stents risk factors: A retrospective study

Background: The consequences and potential complications of encrusted double J (DJ) stents can be devastating. This work retrospectively reviews a series of Yemeni patients with encrusted DJ stents and shares the experience of handling such a challenging subject. Materials and Methods: A retrospective study was carried out from January 2016 to February 2021 at the Urology center, 48 Model Hospital, and Al-Khamseen Hospital, Sana’a, Yemen. About 30 patients with encrusted DJ stents for more than six months treated with various urological procedures were included in this study. The demographic characteristics, duration and indication of DJ stent placement, and surgical intervention were gathered and analyzed. Univariate analysis was performed to determine risk factors of long-standing encrusted DJ stent. Result: The mean age of patients was 31± 12.4 years (range 5–69), including 20 (66.7%) males and 10 (33.3%) females. The mean duration of DJ stents was 31.8± 20.8 months (12–120 months). The most common cause of long-standing encrusted DJ stent was poor compliance in 15 (50%) patients, followed by ignorance of DJ stent in 11 (36.7%) patients, and inability to access the hospital in 4 (13.3%) patients. Extracorporeal shock wave lithotripsy (ESWL) was the most common intervention performed in 11 (36.7%) patients as a single procedure. Multiple sessions of ESWL with another endourological procedure were required in 10 (33.3%) patients. A nephrectomy was performed on one (3.3%) patient due to a nonfunctional kidney. In univariate analysis, a longer duration of DJ stenting was associated with the need for multiple treatment modalities (p= 0.001). Factors such as poor compliance and farming community were associated with encrusted DJ stents in the female gender (p &lt;0.05). In the male gender, ignorance of DJ stents was associated with encrusted DJ stents (p &lt;0.05). Conclusion: A longer duration of DJ stenting is associated with worse outcomes, including DJ encrustation and the need for invasive and multiple treatment modalities. Poor compliance, residing in farming communities, and ignorance of the DJ stents are associated with long-standing encrusted risks and should be considered by the treating physicians.

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