Shock Wave Lithotripsy Treatment Research Articles

Value of early second session shock wave lithotripsy in treatment of upper ureteric stones compared to laser ureteroscopy.

The safety and efficacy of early second session shock wave lithotripsy (SWL) compared with laser ureteroscopy (URS) for the treatment of upper ureteric stones were evaluated. From January to October 2019, 108 patients with upper ureteric stones (< 1.5cm and ≤ 1000 Hounsfield unit (HU)) were randomized into SWL and laser URS groups. The second SWL session was performed within 48-72h of the first session. Using plain abdominal X-ray and ultrasonography, patients were evaluated 48-72h after the first SWL session and one week after the second and third SWL sessions or one week after URS. The procedure was considered a success when no additional procedures were needed to clear the stone. To determine the stone-free rate (SFR), noncontrast computed tomography of the urinary tract was performed three months postoperatively. In the SWL group, the success rates were 92.6% and 94.4% after the second and third sessions. The SFR was 96.2% in the laser URS group. The success rates were not significantly different between the second and third SWL sessions versus the laser URS (p = 0.418 and 0.660, respectively). Operative and fluoroscopy times were significantly longer in the SWL group (p = 0.001), and JJ stent insertions were needed after laser URS. Ultraslow full-power SWL treatment of patients with upper ureteric stones (< 1.5cm and ≤ 1000 HU) with an early second session is safe and effective compared to laser URS. Patients who do not respond to early second SWL session should be shifted to another treatment modality.

Comment to: Extracorporeal shock wave lithotripsy in Indian children: Predictors of outcome and validation of pre-treatment nomograms, J Pediatr Urol., 2020

We know that SWL is facing a loss in popularity compared to other minimally invasive endourological methods. However, we should always keep in mind that nowadays, SWL (shock wave lithotripsy) is the only non-invasive first-line treatment method for kidney stones smaller than 2 cm. The success rate depends on the patient and the stone-related factors [1], and the patient selection is one of the most critical factors to achieve high success rates in SWL treatment. It is wise to define the patients who will benefit the most from the SWL treatment, and nomograms have been developed for this purpose.

Fragmentation and propulsive effect of shock wave lithotripsy in treatment of small renal calculi

BackgroundSmall renal calculi are frequently observed in clinical practice, and chemo-lytic therapy has limited effects. The purpose of the study is to evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in the treatment of small renal calculi.MethodsWe studied 60 patients with small renal stones from March 2017 to March 2019. After excluding eight patients with incomplete data, the remaining 52 patients were evaluated. Patients with symptomatic single or multiple stones of 6–8 mm in diameter or asymptomatic on ultrasound and kidney-ureter-bladder radiograph were eligible for inclusion. Small stones were treated by ESWL. The data were analyzed using the Statistical Packages for Social Sciences - version 25 (IBM Corporation).ResultsThe mean age of the 52 patients was 34.5 ± 9.5 years. Forty-one (78.8%) patients were symptomatic, while 11 (21.2%) were asymptomatic. Forty-seven (90.4%) had single small renal stones, while four patients had two stones (7.7%) and only one patient had three stones (1.9%). Forty-five stones were successfully treated by ESWL, while 13 stones failed to respond.ConclusionESWL is a useful tool for treating small renal calculi; it works either by fragmenting the stones or by acting as a pushing force. However, further large prospective studies are needed to corroborate the above conclusions.

The role of N-acetylcysteine in preventing hepatic injury associated with systemic oxidative stress after extracorporeal shock wave treatment.

Systemic oxidative stress may cause detrimental consequences for the liver, leading to hepatic fibrogenesis. To investigate histopathological changes in liver tissues due to the increased systemic oxidative stress associated with rat extracorporeal shock wave lithotripsy (SWL) model and to document the consequences of N-acetylcysteine (NAC) administration. In this experimental SWL model, 18 Wistar albino rats were randomly assigned into 3 groups. The control group (group I) had no intervention. Group II underwent SWL treatment with intraperitoneal saline injection. Group III also had SWL with intraperitoneal NAC and was divided into short-term (group III-14 days) and long-term (group III-28 days) subgroup. Hepatectomy was performed for histopathological examinations. Histopathological alterations were evaluated with light microscopy. Immunohistological staining for p53 and myeloperoxidase was also performed. Blood samples revealed a significant increase in plasma oxidative stress index (OSI) after plasma total antioxidant status (TAS) and total oxidant status (TOS) had been measured. It was shown that this increased systemic oxidative stress adversely affected liver tissues. Predominantly, sinusoidal dilatation was remarkably observed in rats with significantly high OSI values (p = 0.043). Similarly, periportal necrosis significantly increased in rats with high OSI values (p = 0.033). p53 positivity was also remarkable in rats with systemic oxidative stress (p = 0.049). N-acetylcysteine administration provided a significant decrease in OSI. N-acetylcysteine also improved all these alterations, including p53 staining. Particularly, sinusoidal dilatation was significantly protected in the long-term NAC group (group III-28 days). We demonstrated that SWL-induced systemic oxidative stress causes histological alterations in liver tissues. Increased p53 and myeloperoxidase staining as markers of oxidative damage were also detected. N-acetylcysteine may protect from these histological and ultra-structural alterations related to oxidative stress.

The utility of automated volume analysis of renal stones before and after shockwave lithotripsy treatment

This study aimed to evaluate the additional utility of an automated method of estimating volume for stones being treated with shockwave lithotripsy (SWL) using computed tomography (CT) images compared to manual measurement. Utility was assessed as the ability to accurately measure stone burden before and after SWL treatment, and whether stone volume is a better predictor of SWL outcome than stone diameter. 72 patients treated with SWL for a renal stone with available CT scans before and after treatment were included. Stone axes measurement and volume estimation using ellipsoid equations were compared to volume estimation using software using CT textural analysis (CTTA) of stone images. There was strong correlation (r > 0.8) between manual and CTTA estimated stone volume. CTTA measured stone volume showed the highest predictive value (r2 = 0.217) for successful SWL outcome on binary logistic regression analysis. Three cases that were originally classified as ‘stone-free with clinically insignificant residual fragments’ based on manual axis measurements actually had a larger stone volume based on CTTA estimation than the smallest fragments remaining for cases with an outcome of ‘not stone-free’. This study suggests objective measurement of total stone volume could improve estimation of stone burden before and after treatment. Current definitions of stone-free status based on manual measurements of residual fragment sizes are not accurate and may underestimate remaining stone burden after treatment. Future studies reporting on the efficacy of different stone treatments should consider using objective stone volume measurements based on CT image analysis as an outcome measure of stone-free state.

Does Previous Open Stone Surgery Affect the Outcome of Shock Wave Lithotripsy Treatment in Children?

Introduction: The aim of the study was to evaluate the efficiency of shock wave lithotripsy (SWL) in children who previously underwent ipsilateral open renal stone surgery (ORSS). Methods: A total of 315 renal units (RUs) with renal stones underwent SWL treatment in our department over a period of 18 years. A total of 274 RUs (87%) with no history of ORSS were categorized as group 1 and 41 RUs (13%) with a history of ORSS were categorized as group 2. The characteristics of the patients and renal stones, as well as the treatment modalities, were reviewed retrospectively, and the results were compared in terms of the rates of stone-free patients and complications. Results: The stone-free rates were statistically lower in patients with an existing history of ORSS (p = 0.002), especially for stones located at the lower calyx (p = 0.006). However, there were no differences between groups in the rate of complications (p = 0.75). History of ipsilateral ORSS, age, and stone burden were independent risk factors that predicted a stone-free status in the regression analysis (p = 0.016, p = 0.045, and p = 0.001, respectively). Conclusion: The overall stone-free rate after SWL was found to be significantly lower in children with a history of ORSS than in those without, and this finding was significantly prominent for lower calyx stones. In spite of the possible difficulties in achieving surgical access due to anatomical changes in retrograde intrarenal surgery or mini-/micro-percutaneous nephrolithotomy, we believe that these techniques might be good alternatives for SWL in future cases.

Use of non-contrast computed tomography determined urinary stone fragility in predicting the outcome of extracorporeal shockwave lithotripsy treatment: a single-center study

Background: Renal stones represent a common urological pathology where standard treatment advised is ESWL in current practice. However, NCCT based determination of stone fragility may help to predict the outcome of ESWL treatment, hence optimizing its clinical use. Therefore, this study evaluated the role of NCCT determined urinary stone fragility in predicting the outcome of ESWL treatment in local clinical settings.&#x0D; Patients and methods: One hundred patients with single renal calculus of 0.6-2 cm in size were included. NCCT based determination of stone fragility in HU units was done for all patients. Patients were then subjected to ESWL, with a maximum of 3000 shock waves given per ESWL session. Plain film and/or ultrasonography was used to monitor ESWL treatment progress with a final NCCT evaluation at 12 weeks to determine the clearance of the calculi for each patient. Association of NCCT based stone fragility and outcome of ESWL was statistically analyzed using Fisher exact test.&#x0D; Results: The mean age of the patients was 37.7 ± 10.9 years with 54% being male. Decreasing stone fragility on NCCT (high = &lt;500HU, moderate = 500-1000HU, and high = 1000HU) required more number and intensity of ESWL sessions (1-2 visits and 3000-6000 shock waves for high stone fragility group, 3-5 visits and 7000-18000 shock waves for the moderate group, and 6 visits and &gt;18000 shock waves for low fragility group, respectively) necessary for clearance of urinary stones (p&lt;0.001). In 98% of patients, the clearance of urinary stones was excellent.&#x0D; Conclusion: Renal stone patients with NCCT determined high and moderate stone fragility show an optimal response after ESWL treatment, whereas, for low fragility renal stones attenuative treatment like percutaneous nephrolithotomy and/or ureteroscopy should be considered instead of ESWL. This approach can enable patient stratification before ESWL therapy ensuring better clinical management of the renal stone disease.

Machine learning prediction of stone-free success in patients with urinary stone after treatment of shock wave lithotripsy

BackgroundThe aims of this study were to determine the predictive value of decision support analysis for the shock wave lithotripsy (SWL) success rate and to analyze the data obtained from patients who underwent SWL to assess the factors influencing the outcome by using machine learning methods.MethodsWe retrospectively reviewed the medical records of 358 patients who underwent SWL for urinary stone (kidney and upper-ureter stone) between 2015 and 2018 and evaluated the possible prognostic features, including patient population characteristics, urinary stone characteristics on a non-contrast, computed tomographic image. We performed 80% training set and 20% test set for the predictions of success and mainly used decision tree-based machine learning algorithms, such as random forest (RF), extreme gradient boosting trees (XGBoost), and light gradient boosting method (LightGBM).ResultsIn machine learning analysis, the prediction accuracies for stone-free were 86.0, 87.5, and 87.9%, and those for one-session success were 78.0, 77.4, and 77.0% using RF, XGBoost, and LightGBM, respectively. In predictions for stone-free, LightGBM yielded the best accuracy and RF yielded the best one in those for one-session success among those methods. The sensitivity and specificity values for machine learning analytics are (0.74 to 0.78 and 0.92 to 0.93) for stone-free and (0.79 to 0.81 and 0.74 to 0.75) for one-session success, respectively. The area under curve (AUC) values for machine learning analytics are (0.84 to 0.85) for stone-free and (0.77 to 0.78) for one-session success and their 95% confidence intervals (CIs) are (0.730 to 0.933) and (0.673 to 0.866) in average of methods, respectively.ConclusionsWe applied a selected machine learning analysis to predict the result after treatment of SWL for urinary stone. About 88% accurate machine learning based predictive model was evaluated. The importance of machine learning algorithm can give matched insights to domain knowledge on effective and influential factors for SWL success outcomes.

Treatment of recurrent renal transplant lithiasis: analysis of our experience and review of the relevant literature

BackgroundRenal transplant lithiasis is a rather unusual disease, and the recurrence of lithiasis presents a challenging situation.MethodsWe retrospectively analyzed the medical history of one patient who suffered renal transplant lithiasis twice, reviewed the relevant literature, and summarized the characteristics of this disease.ResultsWe retrieved 29 relevant studies with an incidence of 0.34 to 3.26% for renal transplant lithiasis. The summarized incidence was 0.52%, and the recurrence rate was 0.082%. The mean interval after transplantation was 33.43 ± 56.70 mo. Most of the patients (28.90%) were asymptomatic. The management included percutaneous nephrolithotripsy (PCNL, 22.10%), ureteroscope (URS, 22.65%), extracorporeal shockwave lithotripsy (ESWL, 18.60%) and conservative treatment (17.13%). In our case, the patient suffered from renal transplant lithiasis at 6 years posttransplantation, and the lithiasis recurred 16 months later. He presented oliguria, infection or acute renal failure (ARF) during the two attacks but without pain. PCNL along with URS and holmium laser lithotripsy were performed. The patient recovered well after surgery, except for a 3 mm residual stone in the calyx after the second surgery. He had normal renal function without any symptoms and was discharged with oral anticalculus drugs and strict follow-up at the clinic. Fortunately, the calculus passed spontaneously about 1 month later.ConclusionsDue to the lack of specific symptoms in the early stage, patients with renal transplant lithiasis may have delayed diagnosis and present ARF. Minimally invasive treatment is optimal, and the combined usage of two or more procedures is beneficial for patients. After surgery, taking anticalculus drugs, correcting metabolic disorders and avoiding UIT are key measures to prevent the recurrence of lithiasis.

The efficacy and safety of diuretics on extracorporeal shockwave lithotripsy treatment of urolithiasis: A systematic review and meta analysis.

Background:The aim of this systematic review and meta-analysis was to demonstrate the efficacy and safety of diuretics on extracorporeal shockwave lithotripsy (SWL) treatment of urolithiasis.Methods:The databases MEDLINE, EMBASE, and the Cochrane Controlled Trial Register of Controlled Trials from January 1980 until November 2019 were searched to identify randomized controlled trials that referred to the use of diuretics on extracorporeal SWL treatment of urolithiasis.Results:Six randomized controlled trials containing 1344 patients were included in this meta-analysis, which compared diuretics with placebo on extracorporeal SWL treatment of urolithiasis. In the analysis, we found that diuretics on extracorporeal SWL treatment were more effective for the management of urinary stones. Compared with placebo, patients who received diuretics during extracorporeal SWL treatment had significantly higher successful stone clearance rate (Odds ratio; 1.73, 95% confidence interval (CI); 1.35 to 2.21, P < .0001), higher stone fragmentation rate (odds ratio; 2.83, 95% CI; 1.30 to 6.16, P = .009), less average number of sessions per stone (mean difference; –0.13; 95% CI, –0.25 to –0.01, P = .03) and similar average number of shocks per stone (mean difference; –126.89; 95% CI, –394.53 to 140.76, P = .35).Conclusion:This systematic review and meta-analysis indicates that diuretics during extracorporeal SWL was effective in the management of urolithiasis with lower risk of complications.

Combined extracorporeal shock wave lithotripsy and endoscopic treatment for pain in chronic pancreatitis (SCHOKE trial): study protocol for a randomized, sham-controlled trial

BackgroundPain is the primary symptom of chronic pancreatitis (CP) and remains a considerable therapeutic challenge. In patients with obstruction of the pancreatic duct, including stones and strictures, endoscopic treatment with or without preceding extracorporeal shock wave lithotripsy (ESWL) has been used for pancreatic duct decompression. The rationale for these procedures is based on the assumption that obstruction of the pancreatic duct leads to ductal hypertension and pain. However, clinical pain symptoms correlate poorly with pancreatic duct morphology, and the evidence for pancreatic duct decompression as an effective treatment for pain is based on case series and comparison between different procedures. No randomized, prospective, sham-controlled trials are currently available. The SCHOKE (Extracorporeal Shock Wave Lithotripsy and Endotherapy for Pain in Chronic Pancreatitis) trial is a randomized, sham-controlled trial designed to determine if pancreatic duct decompression is an effective treatment for pain in patients with CP.MethodsThe SCHOKE trial is a randomized, single-blind, parallel-group, sham-controlled trial designed to evaluate the effect of combined ESWL and endoscopic treatment for pain in patients with CP. In total, 106 adult patients with painful CP and pancreatic duct obstruction will be randomized to combined ESWL and subsequent endoscopic treatment or corresponding sham procedures. The primary outcome is pain relief during the 3-month postrandomization period as documented in a pain diary. Secondary outcomes include quality of life and functional scores, patient global impression of change, change in use of analgesics, frequency of hospitalization, and complications. Standard follow-up is at 3 and 6 months after randomization. In an experimental substudy, quantitative sensory testing obtained before and after intervention will be used to obtain information on central pain processing and to develop models for prediction of treatment outcome.DiscussionThe SCHOKE trial investigates if pancreatic duct decompression, obtained by combined ESWL and endoscopic treatment, is effective for pain treatment in patients with CP.Trial registrationClinicalTrials.gov, NCT03966781. Registered on May 25, 2019.Protocol date and version identifier: March 1, 2020; version 3.0.Sponsor: Rupjyoti Talukdar, Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India.

Health questionnaire analysis and development of satisfaction questionnaire for patients treated with extracorporeal shock wave lithotripsy (SATISLIT)

IntroductionDue to the absence of specific instruments to study the psychosocial sphere of patients undergoing extracorporeal shock wave lithotripsy (SWL), the objective of this study is to develop a satisfaction questionnaire regarding the SWL treatment from a health questionnaire which was already designed and had been previously validated. Material and methodsThe design of the satisfaction questionnaire was carried out in 5 phases, based on a previously validated health scale in patients treated with SWL (ESPTL), including a total cohort of 135 patients treated at our center who received a phone interview. Phase 1: descriptive analysis of the series and scores of the 8 items of ESPTL. Phase 2: U-Mann Whitney comparison of ESPTL based on the patients’ sex. Phase 3: study of ESPTL correlation with age using Spearman’s Rho. Phase 4: grouping by factors of ESPTL, comparison by sex and correlation with age, as performed in phases 2 and 3 with the global score. Phase 5: obtaining the satisfaction subscale -SATISLIT-, descriptive analysis, comparison according to sex, correlation with age and linear regression model of SATISLIT with respect to ESPTL. Results135 patients, 85(63%) men, 50(37%) women. Median (minimum-maximum) age 56 (27–79) and ESPTL score 31 (8–39).Differences in global ESPTL score between men and women (p<.001), as well as in items 1 (p=.029), 3 (p=.002), 6 (p=.006), 7 (p=.005) and 8 (p=.025).Non-significant correlation of ESPTL regarding age. Significant correlation in items 2, 4, 5 and 8 but, very weak (<0.2).4 factors, each one with 2 items, with statistically significant differences regarding sex in F2 (p=.001), F3 (p=.007) and F4 (p=.001). Significant correlation with age only in F1 and F3, but very weak (<0.2).Median (minimum-maximum) SATISLIT 18 (4–20). Statistically significant differences regarding patients’ sex (p=.001). Non-significant correlation with age (p=.836). Significant linear regression of SATISLIT with respect to ESPTL (p<.001). ConclusionsBased on validated health questionnaire, the present work has provided a new instrument called SATISLIT for assessing patients’ satisfaction after treatment with SWL. Future studies with external and temporal validation will be necessary to contrast its real clinical usefulness.

Treatment of urolithiasis using extracorporeal shock wave lithotripsy

Aim: For many years extracorporeal shock wave lithotripsy is known for the first line of treatment of urolithiasis in Perm Regional Clinical Hospital. All of the patients were treated with Dornier MedTech lithotripter. 329 patients were treated by extracorporeal shock wave lithotripsy. Complications were registered in 7 (2,1%) patients. The effectiveness contains 95,7%. Purpose: The aim of this study was to analyze the effectiveness of using extracorporeal shock wave lithotripsy in treatment of urolithiasis. Keywords: Kidney stones; Ureter stones; Extracorporeal shock wave lithotripsy

Recurrence of nephrolithiasis: incidence and risk factors in Egyptian patients

Introduction Recurrence of nephrolithiasis is common. The knowledge of its incidence and risk factors is the base for proper prophylaxis and preservation of renal function. Objective The aim was To study the recurrence rate and risk factors of nephrolithiasis in Egyptian patients. Patients and methods Files of 974 patients with nephrolithiasis (634 males and 340 females, aged 7–70 years) were reviewed. They were managed between 2008 and 2009, with a 10-year follow-up period since the first stone episode for recurrence. Stone characteristics (sizes, sites, and multiplicity), treatment type, post-treatment residual stones, family history, BMI, and recurrence rate were included. Results Of the 974 patients, stone recurrence rate was 44.45% within 10 years of follow-up. Recurrence was significantly higher in young age group of less than 20 years, male sex, average BMI, and positive family history (61.14, 52.99, 50.99, and 55.82%, respectively) within 10 years. Recurrence was significantly higher with stone size greater than 2 cm (24.20%) at the second 5-year follow-up. Recurrence was significantly higher with multiple (56.59%), pelvicalyceal (59.83%), and bilateral (66.95%) renal stones within 10 years. It was significantly higher with shock wave lithotripsy (20.89%) within the second 5-year follow-up, and with presence of residual stones (32.66%) within the first 5-year follow-up. Conclusion Stone recurrence rate increases with increase in observation time. Risk factors for recurrence are young age of onset; male sex; normal BMI; positive family history; large size, multiple, bilateral, and pelvicalyceal stone; shock wave lithotripsy treatment; and presence of residual stones.

Does the degree of stone-induced hydronephrosis affect the outcome of shock-wave lithotripsy in patients with proximal ureteral stones?

Background Shock-wave lithotripsy (SWL) is an effective, well-established approach for treating ureteral calculi. Some studies have shown that patients with collecting system obstruction and ureteral stones had lower stone-free rates after SWL than patients with nonobstructed stones. In contrast, other studies acknowledge that stone-induced urinary obstruction does not decrease success with SWL for ureteral stones. The purpose of this study was to assess whether the degree of stone-induced hydronephrosis in patients with solitary proximal ureteral stones influences the outcome and clearance rates after SWL. Patients and methods This prospective study included 30 patients, with solitary proximal ureteric stones and different degrees of hydronephrosis, who were treated with SWL. Patients were divided into three groups according to the degree of stone-induced hydronephrosis. Group 1 (33.33%) had mild dilation, group 2 (33.33%) had moderate dilation, and group 3 (33.33%) had severe dilation. The Dornier MFL 5000 lithotripter was used to treat the patient groups. The results were compared in terms of stone-free rates, number of shock waves, number of sessions, incidence of complications, number of secondary interventions, and time to stone clearance. Results The average stone size was between 8 and 18 mm. The overall success rate was found to be 80% in patients with severe back pressure compared with 90 and 86.6% success rate in moderate and mild hydronephrosis groups, respectively (P=0.749). Furthermore, there was no statistical significance between the three studied groups regarding clearance time (P=0.721). Conclusions The degree of hydronephrosis secondary to proximal ureteral stones of between 6 and 20 mm has shown not to affect the duration till stone clearance or overall treatment success following SWL treatment.

Análisis de cuestionario de salud y desarrollo de cuestionario de satisfacción en pacientes tratados con litotricia extracorpórea por ondas de choque (SATISLIT)

IntroductionDue to the absence of specific instruments to study the psychosocial sphere of patients undergoing extracorporeal shock wave lithotripsy (SWL), the objective of this study is to develop a satisfaction questionnaire regarding the SWL treatment from a health questionnaire which was already designed and had been previously validated. Material and methodsThe design of the satisfaction questionnaire was carried out in 5 phases, based on a previously validated health scale in patients treated with SWL (ESPTL), including a total cohort of 135 patients treated at our center who received a phone interview. Phase 1: descriptive analysis of the series and scores of the 8 items of ESPTL. Phase 2: U-Mann Whitney comparison of ESPTL based on the patients’ sex. Phase 3: study of ESPTL correlation with age using Spearman's Rho. Phase 4: grouping by factors of ESPTL, comparison by sex and correlation with age, as performed in phases 2 and 3 with the global score. Phase 5: obtaining the satisfaction subscale -SATISLIT-, descriptive analysis, comparison according to sex, correlation with age and linear regression model of SATISLIT with respect to ESPTL. Results135 patients, 85(63%) men, 50(37%) women. Median (minimum-maximum) age 56 (27-79) and ESPTL score 31 (8-39).Differences in global ESPTL score between men and women (p <.001), as well as in items 1 (p =.029), 3 (p =.002), 6 (p =.006), 7 (p =.005) and 8 (p =.025).Non-significant correlation of ESPTL regarding age. Significant correlation in items 2, 4, 5 and 8 but, very weak (<0.2).4 factors, each one with 2 items, with statistically significant differences regarding sex in F2 (p =.001), F3 (p =.007) and F4 (p =.001). Significant correlation with age only in F1 and F3, but very weak (<0.2).Median (minimum-maximum) SATISLIT 18 (4-20). Statistically significant differences regarding patients’ sex (p =.001). Non- significant correlation with age (p =.836). Significant linear regression of SATISLIT with respect to ESPTL (p <.001). ConclusionsBased on validated health questionnaire, the present work has provided a new instrument called SATISLIT for assessing patients’ satisfaction after treatment with SWL. Future studies with external and temporal validation will be necessary to contrast its real clinical usefulness.

Treatment of Lower Pole Renal Stones-Extracorporeal Shock Wave Lithotripsy vs Endourology. A literature review

Urolithiasis is a subject of great interest in the urological world nowadays, due to the increasing incidence of the disease caused by the metabolic disorders that arise from the modern lifestyle, which is often not beneficial to the human body. Also, pathology is intensely debated because its treatment involves significant costs for society. The present article aims to compare the endourological treatment methods with extracorporeal shock waves lithotripsy for lower calyceal lithiasis, which is an intensely debated topic, and the opinions are divided regarding the choice of the optimal method for the management of this pathology. The location of the stone at the level of the inferior calyceal group implies a difficult approach regardless of the chosen treatment method, but also a poor excretion of the remaining fragments, frequently encountering a lower stone-free rate. Thus, the treatment methods were compared, taking into account the anatomic factors, the size of the stone, its hardness, the risk of the occurrence of intraoperative or postoperative complications, the necessity of a possible reintervention and the duration of the intervention. Last but not least, the patient�s preference must be taken into account, obviously, after a physician-patient dialogue explaining to the patient the individual treatment, and being guided to the optimal therapy for the patient.

Treatment of Lower Pole Renal Stones-Extracorporeal Shock Wave Lithotripsy vs Endourology. A literature review

Urolithiasis is a subject of great interest in the urological world nowadays, due to the increasing incidence of the disease caused by the metabolic disorders that arise from the modern lifestyle, which is often not beneficial to the human body. Also, pathology is intensely debated because its treatment involves significant costs for society. The present article aims to compare the endourological treatment methods with extracorporeal shock waves lithotripsy for lower calyceal lithiasis, which is an intensely debated topic, and the opinions are divided regarding the choice of the optimal method for the management of this pathology. The location of the stone at the level of the inferior calyceal group implies a difficult approach regardless of the chosen treatment method, but also a poor excretion of the remaining fragments, frequently encountering a lower stone-free rate. Thus, the treatment methods were compared, taking into account the anatomic factors, the size of the stone, its hardness, the risk of the occurrence of intraoperative or postoperative complications, the necessity of a possible reintervention and the duration of the intervention. Last but not least, the patient’s preference must be taken into account, obviously, after a physician-patient dialogue explaining to the patient the individual treatment, and being guided to the optimal therapy for the patient. Keywords: urinary lithiasis, lower pole stones, extracorporeal shockwave lithotripsy, flexible ureterorenoscopy, percutaneous nephrolithotomy

Predicting shockwave lithotripsy outcome for urolithiasis using clinical and stone computed tomography texture analysis variables

We aimed to develop and evaluate a statistical model, which included known pre-treatment factors and new computed tomography texture analysis (CTTA) variables, for its ability to predict the likelihood of a successful outcome after extracorporeal shockwave lithotripsy (SWL) treatment for renal and ureteric stones. Up to half of patients undergoing SWL may fail treatment. Better prediction of which cases will likely succeed SWL will help patients to make an informed decision on the most effective treatment modality for their stone. 19 pre-treatment factors for SWL success, including 6 CTTA variables, were collected from 459 SWL cases at a single centre. Univariate and multivariable analyses were performed by independent statisticians to predict the probability of a stone free (both with and without residual fragments) outcome after SWL. A multivariable model had an overall accuracy of 66% on Receiver Operator Curve (ROC) analysis to predict for successful SWL outcome. The variables most frequently chosen for the model were those which represented stone size. Although previous studies have suggested SWL can be reliably predicted using pre-treatment factors and that analysis of CT stone images may improve outcome prediction, the results from this study have not produced a useful model for SWL outcome prediction.

P141 - The use of a virtual reality device (HypnoVR®) during external shock wave lithotripsy for treatment of urinary stones: Initial results from a feasibility study

P141 - The use of a virtual reality device (HypnoVR®) during external shock wave lithotripsy for treatment of urinary stones: Initial results from a feasibility study