Shock Wave Lithotripsy Treatment Research Articles

Stone decision engine accurately predicts stone removal and treatment complications for shock wave lithotripsy and laser ureterorenoscopy patients.

Kidney stones form when mineral salts crystallize in the urinary tract. While most stones exit the body in the urine stream, some can block the ureteropelvic junction or ureters, leading to severe lower back pain, blood in the urine, vomiting, and painful urination. Imaging technologies, such as X-rays or ureterorenoscopy (URS), are typically used to detect kidney stones. Subsequently, these stones are fragmented into smaller pieces using shock wave lithotripsy (SWL) or laser URS. Both treatments yield subtly different patient outcomes. To predict successful stone removal and complication outcomes, Artificial Neural Network models were trained on 15,126 SWL and 2,116 URS patient records. These records include patient metrics like Body Mass Index and age, as well as treatment outcomes obtained using various medical instruments and healthcare professionals. Due to the low number of outcome failures in the data (e.g., treatment complications), Nearest Neighbor and Synthetic Minority Oversampling Technique (SMOTE) models were implemented to improve prediction accuracies. To reduce noise in the predictions, ensemble modeling was employed. The average prediction accuracies based on Confusion Matrices for SWL stone removal and treatment complications were 84.8% and 95.0%, respectively, while those for URS were 89.0% and 92.2%, respectively. The average prediction accuracies for SWL based on Area-Under-the-Curve were 74.7% and 62.9%, respectively, while those for URS were 77.2% and 78.9%, respectively. Taken together, the approach yielded moderate to high accurate predictions, regardless of treatment or outcome. These models were incorporated into a Stone Decision Engine web application (http://peteranoble.com/webapps.html) that suggests the best interventions to healthcare providers based on individual patient metrics.

The association between renal pelvis urine density and the risk of severe infectious complications in patient with symptom-free hydronephrosis after shock wave lithotripsy: a multi-center prospective study.

Finding reliable and easy-to-obtain predictors of severe infectious complications after shock wave lithotripsy (SWL) is a major clinical need, particular in symptom-free hydronephrosis. Therefore, we aim to prospectively investigate the predictive value of Hounsfield units (HU) in renal pelvis urine for the risk of severe infectious complications in patients with ureteral stones and symptom-free hydronephrosis after SWL. This multi-center prospective study was conducted from June 2020 to December 2023. The HU of renal pelvis urine was measured by non-enhanced computed tomography. The severe infectious complications included systemic inflammatory response syndrome, sepsis, and septic shock. Binary logistic regression models assessed the odds ratios (ORs) and 95% confidence intervals (CIs). Finally, 1,436 patients with ureteral stones were enrolled in this study. 8.9% (128/1,436) of patients experienced severe infectious complications after SWL treatment. After adjusting confounding variables, compared with the patients in the lowest renal pelvis urine density quartile, the OR (95% CI) for the highest quartile was 32.36 (13.32, 78.60). There was a positive linear association between the HU value of renal pelvis urine and the risk of severe infectious complications after SWL (P for trend < 0.001). Furthermore, this association was also observed stratified by age, gender, BMI, stone size, stone location and hydronephrosis grade (all P for interaction > 0.05). Additionally, the nonlinear association employed by restricted cubic splines is not statistically significant (nonlinear P = 0.256). The AUROC and 95%CI of renal pelvis urine density were 0.895 (0.862 to 0.927, P value < 0.001). The cut-off value was 12.0 HU with 78.59% sensitivity and 85.94% specificity. This multi-center prospective study demonstrated a positive linear association between HU in renal pelvis urine and the risk of severe infectious complications in patients with ureteral stones and symptom-free hydronephrosis after SWL, regardless of age, gender, BMI, stone size, stone location, and hydronephrosis grade. These findings might be helpful in the SWL treatment decision-making process.

Methods for Assessing Renal Нemodynamics after Minimally lnvasive Treatment of Urolithiasis

The purpose of research. Urolithiasis occupies a leading place among all urological diseases after infectious and inflammatory ones. /n addition, it does not lose its relevance due to the fact that the number of patients with this disease is steadily increasing. Тhe aim of the study is to study the peculiarities of changes in renal hemodynamics after minimally invasive methods of treatment of urolithiasis remote shock wave lithotripsy (DLТ) and percutaneous nephrolithotripsy (РNL) to improve the quality of medical care for urological patients.Methods. Numerous studies have shown in detail the effectiveness of using remote shock wave lithotripsy and percutaneous nephrolithotorypsy in the treatment of kidney stones. Тhese methods are minimally invasive, well tolerated by patients, and reduce the risks of complications, but they are accompanied by kidney injury, in particular, microcirculation disorders. Тhe use of the Dopplerographic method of investigation allows for a highly informative assessment of the degree of impaired renal microcirculation for the diagnosis of urolithiasis, including for the assessment of hemodynamics after minimally invasive treatment methods.Results. Тhe work shows that when using dopplerography of renal vessels after remote shock wave lithotripsy and percutaneous nephrolithotorypsy, a violation of hemodynamics after DLТ is noted in dynamics already on the first day. In addition, the terms of normalization of indicators are longer in comparison with hemodynamics after РNL. Аlso, with РNL, there is a gradual increase in blood flow indicators in the dynamics of the postoperative period.Conclusion. Тhe work shows that ultrasound Dopplerography is an effective method of dynamic assessment of renal blood flow, and the indicator of renal damage is the resistance index, mainly in the interlobular arteries.

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.

Extracorporeal shock wave lithotripsy for treatment of large pediatric renal pelvic stone burden more than 2 cm

The high recurrence rates in pediatric urolithiasis indicate the need for none invasive or a minimally invasive treatment such as SWL. Therefore, EAU, ESPU and AUA recommend SWL as a first line treatment for renal calculi ≤ 2, and RIRS or PCNL for renal calculi > 2cm. SWL is superior to RIRS and PCNL as it is inexpensive, outpatient procedure, and it has a high SFR in well selected cases specially pediatrics. On the other hand, SWL therapy has a limited efficacy with a lower SFR, and high retreatment rate and/or additional interventions for treatment of larger and harder renal calculi. We carried out this study to evaluate the efficacy and safety of SWL for treatment of renal stones > 2cm to extend its indications for pediatric renal calculi. Between January 2016 and April 2022, we reviewed the records of patients with renal calculi treated by SWL, mini-PCNL, RIRS and open surgery in our institution. Forty-nine eligible children aged 1-5 years old, presented with renal pelvic and/or calyceal calculi measuring 2-3.9cm and underwent SWL therapy were picked up and participated in the study. The data of an additional eligible 79 children with the same age and had renal pelvic and/or calyceal calculi > 2cm up to stag horn calculi and underwent mini-PCNL, RIRS and open renal surgery were also picked up and participated in the study. We retrieved the following preoperative data from the records of the eligible patients; age, gender, weight, length, radiological findings (stone size, side, site, number and radio-density), renal function tests, routine laboratory findings, and urine analysis. The outcomes data in the form of; operative time, fluoroscopy time, hospital stay, SFRs, retreatment rates and complication rates were also retrieved from the records of patients treated with SWL and other techniques. Also, we collected the SWL characteristics in terms of; position, number and frequency of shocks, voltage, time of the session and U/S monitoring to assess stone fragmentation. All SWL procedures were performed according to the institution's standards. The mean age of patients treated with SWL was 3.23±1.19 years old, the mean size of the treated calculi was 2.31±0.49 and the mean length of the SSD was 8.2±1.4cm. All patients had NCCT scan and the mean radio-density of the treated calculi was 572 ± 169.08 HUs based on NCCT scans Table (1). Single- and two-session SFRs of SWL therapy were 75.5% (37/49 patients) and 93.9% (46/49 patients), respectively. The overall success rate was 95.9% (47/49 patients) after three-session of SWL. Complications experienced by 7 patients (14.3%) in the form of fever (4.1%), vomiting (4.1%), abdominal pain (4/1%), and hematuria (2%). All complications were managed in outpatient settings. Our results were obtained on the basis of preoperative NCCT scans for all patients and postoperative plain KUB films and real-time abdominal U/S. Furthermore, single-session SFRs for SWL, mini-PCNL, RIRS and open surgery were 75.5%, 82.1%, 73.7% and 90.6%, respectively. Two-session SFRs by the same technique were 93.9%, 92.8%, and 89.5% for SWL, mini-PCNL and RIRS, respectively. A lower overall complication rate and higher overall SFR were found with SWL therapy compared to other techniques, Fig. (1). Being a non-invasive outpatient procedure with a low complication rate and good spontaneous passage of stone fragments is the main advantage of SWL. In this study, the overall SFR is 93.9% where 46 out of 49 patients were completely rendered stone free after three session of SWL with overall success rate 95.9%. Badawy etal. reported overall success rates of 83.4% for renal stones with a mean stone size of 12.5±7.2mm. In children with renal stones measuring 18.2mm, Ramakrishnan etal. reported a 97% SFR in accordance with our results. The high overall success rate (95.9%) and SFR (93.9%) in our research were attributed to the regular use of ramping procedure, low shock wave rate, percussion diuretics inversion (PDI) approach and alpha blocker therapy in all participants and short SSD. The limitations of our study are small sample of patients and its retrospective nature. The non-invasive nature and replicability of the SWL procedure, along with the high success and low complication rates, give us a new insight to consider its application for treating pediatric renal calculi > 2cm over the other more invasive techniques. Short SSD, the use of ramping procedure, low shock wave rate, 2min break, PDI approach and alpha blockers therapy help better success of SWL. IV.

Comparative study between ultra-mini-percutaneous nephrolithotomy versus stented extracorporeal shock wave lithotripsy for treatment of renal stones in Egypt

ABSTRACT Objectives The purpose of this study is to compare results, safety and outcome of ultra-mini-percutaneous nephrolithotomy (PCNL) versus stented shock wave lithotripsy (SWL) for the management of renal calculi sized 10–20 mm. Methods This study was conducted at Urology Department, Faculty of Medicine, Ain Shams University. After meeting inclusion and exclusion criteria, 90 patients were randomized to either ultra-mini-PCNL group or stented SWL group through the closed-envelope technique, with 45 patients in each group. Patient data were collected preoperatively, immediately postoperatively and 2 and 4 weeks postoperatively assessing operative time, hospital stay, complications including haematuria, fever, the need for blood transfusion, residual stones and the need for retreatment. Results Stone-free rate (SFR) was higher in the ultra-mini-PCNL group compared to the stented SWL group, with no statistically significant difference with P-value = 0.316. As for the need for retreatment, it was slightly higher in the stented SWL group compared to the ultra-mini-PCNL group, yet this difference was statistically insignificant with P-value = 0.681. We found no statistically significant difference between both groups regarding post-operative complications including fever, haematuria and need for blood transfusion, respectively. Operative time and hospital stay were significantly higher in the ultra-mini-PCNL group compared to the stented SWL group with P-value < 0.001 for both. Conclusion Both stented SWL and ultra-mini-PCNL are good treatment choices for renal stones sized less than 2 cm with low complication rates. Stone size indices were significant predictor for the need for retreatment. Further studies to compare SFR based on stone size in both interventions are needed.

The Factors That Affecting Shockwave Lithotripsy Treatment Outcome of Kidney Stones

The Factors That Affecting Shockwave Lithotripsy Treatment Outcome of Kidney Stones

Storz Medical Lithotripsy Index Predicts Success of Shock Wave Lithotripsy in Ureteric Stones.

The aim of this study is to evaluate the factors affecting treatment success in patients who underwent Shock wave lithotripsy (SWL) for ureter stones and to investigate the effect of Storz Medical Lithotripsy Index (SMLI) on treatment effectiveness in ureteric stones. Prospective data was collected on patients undergoing SWL treatment for ureter stones between January 2013 and May 2021. Stone location, number, and size were determined with Non contrast CT (NCCT) for all patients. All patients underwent SWL with a Storz Modulith SLK lithotripsy machine with local anaesthesia. The total amount of energy applied to the stone was calculated using the Storz Medical Lithotripsy Index (SMLI). All patients were evaluated for stone-free status by X-ray at least 2 weeks after treatment. The success of the procedure was defined as the patient being completely stone free (SF) or detection of residual fragments < 4 mm that did not require further treatment Results: A total of 1199 patients with ureter stones were included in the study. The mean age of the patients was 43.11±10.65(18-73), and the mean BMI was 27.87±8.12(19.02-38.65). During SWL, 89.3% of patients demonstrated excellent pain tolerance (1070/1199). A total of 119 patients could not tolerate pain during SWL (10.7%). Treatment success was associated with fewer treatment sessions (2.04±1.64 vs. 2.50±1.48; p<0.001), smaller stone size (7.35±2.99 vs. 9.02±3.81; p<0.001) and higher SMLI/stone size (29.70±17.48 vs. 24.98±16.01; p<0.001). In the univariate and multivariate regression analysis, the factors affecting the success of the treatment were the number of sessions (OR: 1.147), stone size (OR: 1.112), SMLI/stone size (OR: 1.115) and pain tolerance (OR: 0.740). In the treatment of ureteral stones with SWL, number of sessions, stone size, SMLI/stone size, and pain tolerance are the factors affecting success. SMLI per stone size is a statistically significant factor for predicting SWL success.

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

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

The New Lithotripsy Index predicts success of shock wave lithotripsy.

The aim of this study is to evaluate the factors affecting treatment success in patients who underwent Shock wave lithotripsy (SWL) and to investigate the effect of the Storz Medical Lithotripsy Index (SMLI) on treatment effectiveness. Prospective data were collected on patients undergoing SWL treatment for kidney stones between January 2013 and May 2021. Stone location, number and size were determined with non-contrast CT (NCCT) for all patients. All patients underwent SWL with a Storz Modulith SLK lithotripsy machine without anaesthesia. The total amount of energy applied to the stone was calculated using the SMLI. All patients were evaluated for stone-free status by X-ray at least 2weeks after treatment. The success of the procedure was defined as the patient being completely stone free or the detection of residual fragments < 4mm that did not require further treatment. A total of 1230 patients with kidney stones were included in the study. The mean age of the patients was 42.33 ± 11.78 (18-75), and the mean BMI was 28.47 ± 8.78 (19.25-38.52). During SWL, 75.6% of patients demonstrated excellent pain tolerance (930/1230). A total of 116 patients could not tolerate the pain during SWL (9.4%). Treatment success was associated with fewer treatment sessions (2.34 ± 1.75 vs. 2.90 ± 2.04; p < 0.001), smaller stone size (7.52 ± 3.29 vs 8.60 ± 3.93; p < 0.001) and higher SMLI/stone size (25.11 ± 13.63 vs. 22.27 ± 14.50; p < 0.001). In the univariate and multivariate regression analysis, the factors affecting the success of the treatment were the number of sessions (OR 1.170), stone size (OR 1.142), number of shocks (OR 1.005), SMLI/stone size (OR 1.024) and pain tolerance (OR 0.692). In the treatment of kidney stones with SWL, stone site, stone size, SMLI/stone size, and pain tolerance are the factors affecting success. SMLI per stone size is a statistically significant factor for predicting SWL success.

GeoBioMed perspectives on kidney stone recurrence from the reactive surface area of SWL-derived particles

Shock wave lithotripsy (SWL) is an effective and commonly applied clinical treatment for human kidney stones. Yet the success of SWL is counterbalanced by the risk of retained fragments causing recurrent stone formation, which may require retreatment. This study has applied GeoBioMed experimental and analytical approaches to determine the size frequency distribution, fracture patterns, and reactive surface area of SWL-derived particles within the context of their original crystal growth structure (crystalline architecture) as revealed by confocal autofluorescence (CAF) and super-resolution autofluorescence (SRAF) microscopy. Multiple calcium oxalate (CaOx) stones were removed from a Mayo Clinic patient using standard percutaneous nephrolithotomy (PCNL) and shock pulse lithotripsy (SPL). This produced approximately 4–12 mm-diameter PCNL-derived fragments that were experimentally treated ex vivo with SWL to form hundreds of smaller particles. Fractures propagated through the crystalline architecture of PCNL-derived fragments in a variety of geometric orientations to form rectangular, pointed, concentrically spalled, and irregular SWL-derived particles. Size frequency distributions ranged from fine silt (4–8 μm) to very fine pebbles (2–4 mm), according to the Wentworth grain size scale, with a mean size of fine sand (125–250 μm). Importantly, these SWL-derived particles are smaller than the 3–4 mm-diameter detection limit of clinical computed tomography (CT) techniques and can be retained on internal kidney membrane surfaces. This creates clinically undetectable crystallization seed points with extremely high reactive surface areas, which dramatically enhance the multiple events of crystallization and dissolution (diagenetic phase transitions) that may lead to the high rates of CaOx kidney stone recurrence after SWL treatment.

Technique, Feasibility, Utility, Limitations, and Future Perspectives of a New Technique of Applying Direct In-Scope Suction to Improve Outcomes of Retrograde Intrarenal Surgery for Stones.

Retrograde intrarenal surgery (RIRS) is accepted as a primary modality for the management of renal stones up to 2 cm. The limitations of RIRS in larger volume stones include limited visualization due to the snow-globe effect and persistence of fragments that cannot be removed. We describe a new, simple, cost-effective modification that can be attached to any flexible ureteroscope which allows simultaneous/alternating suction and aspiration during/after laser lithotripsy using the scope as a conduit to remove the fragments or dust from the pelvicalyceal system called direct in-scope suction (DISS) technique. Between September 2020 and September 2021, 30 patients with kidney stones underwent RIRS with the DISS technique. They were compared with 28 patients who underwent RIRS with a 11Fr/13Fr suction ureteral access sheaths (SUASs) in the same period. RIRS and laser lithotripsy were carried out traditionally with a Holmium laser for the SUAS group or a thulium fiber laser for the DISS group. There was no difference in age, gender, and history of renal lithiasis between the two groups. Ten (40%) patients had multiple stones in the DISS groups, whilst there were no patients with multiple stones in the SUAS group. Median stone size was significantly higher in the DISS group [22.0 (18.0–28.8) vs. 13.0 (11.8–15.0) millimeters, p < 0.001]. Median surgical time was significantly longer in the DISS group [80.0 (60.0–100) minutes] as compared to the SUAS group [47.5 (41.5–60.3) minutes, p < 0.001]. Hospital stay was significantly shorter in the DISS group [1.00 (0.667–1.00) vs. 1.00 (1.00–2.00) days, p = 0.02]. Postoperative complications were minor, and there was no significant difference between the two groups. The incidence of residual fragments did not significantly differ between the two groups [10 (33.3%) in the DISS group vs. 10 (35.7%) in the SUAS group, p = 0.99] but 10 (33.3%) patients required a further RIRS for residual fragments in the DISS group, whilst only one (3.6%) patient in the SUAS group required a subsequent shock wave lithotripsy treatment. Our audit study highlighted that RIRS with DISS technique was feasible with an acceptable rate of retreatment as compared to RIRS with SUAS.

Complications Post Extracorporeal Shock Wave Lithotripsy: Literature Review Study

Since its introduction in 1980, Extracorporeal Shock Wave Lithotripsy (ESWL) has completely changed how urolithiasis is treated. A recognised, secure and efficient therapeutic alternative to surgical urolithiasis treatment is Electroshock Wave Therapy (ESWL). A tiny percentage of individuals do experience ESWL complications and when they do, the kidney is frequently involved. The important literature on extracorporeal Shock Wave Lithotripsy (SWL) treatment and complications was examined and reviewed in order to pinpoint potential issues following SWL. The development and transit of fragments, infections, effects on renal and non-renal tissues and impacts on kidney function are the main causes of complications after SWL. Each of these risks can be avoided by taking the proper precautions, such as adhering to the contraindications, identifying and treating concurrent disorders or infections and using the SWL in the safest and most effective manner possible while personalising the treatment for each patient. In conclusion, SWL is a successful and largely non-invasive method of treating kidney stones. There are various contraindications and potential consequences, just like with any other sort of therapy, though. The danger of the emergence of others might be significantly reduced by strict adherence to the first; however, this must be completely understood in order to put every preventive step at our disposal into action. Different studies mentioning different cases and statistics related to the complications post ESWL were considered and reviewed for this document.

Music for Health: From Ear to Kidney.

Music for Health: From Ear to Kidney.

Robotic Partial Nephrectomy in the Treatment of a Posterior Excluded Caliceal Diverticulum with a Renal Calculus

Clinical History: A 64-year-old woman with a history of nephrolithiasis presented with intermittent severe left flank pain. CT scan showed a 1-cm left renal calculus within the periphery of the kidney. The renal parenchyma eroded around the calculus, suggesting a caliceal diverticulum (CD). Shockwave lithotripsy treatment of stone within the CD was ineffective. Owing to the supracostal location and averse to nephrostomy tube and ureteral stent, the patient opted for a partial nephrectomy (PN). Physical Examination: NAD, AAOx3. Abdomen was soft, nontender, and nondistended. No costovertebral tenderness. Diagnosis: Right CD with kidney stones. Intervention: Robot-assisted laparoscopic right PN with intraoperative ultrasonography was performed. The CD was noted with stones within, and extracted without incident. Warm ischemia time was 15 minutes with excellent hemostasis and repair. There were no intraoperative complications and the patient was stable after the procedure. Follow-Up/Outcomes: Patient had an uncomplicated hospital course and was discharged home on postoperative day 1. Pathology analysis was consistent with an excluded diverticulum with renal calculi. Postoperative noncontrast CT of abdomen/pelvis showed complete treatment of the stone burden and CD. Patient was symptom free at 1-, 3-, 6-, and 12-month follow-up visits and no stones were seen on imaging. Our series of patients includes the aforementioned patient who underwent a retroperitoneal PN and another patient who underwent transperitoneal PN for large upper pole CD. The second patient reported history of recurrent urinary tract infections, which have since resolved. Her 3-month CT was unremarkable and she is symptom free. Both patients were refractory to extracorporeal shockwave lithotripsy treatment done previously. No competing financial interests exist. Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure. Runtime of video: 4 mins 59 secs

Urological stone disease: a 5-year update of stone management using Hospital Episode Statistics.

To reassess the trends in upper urinary tract (UUT) stone disease burden and management in the UK during the last 5 years. The present paper is our third quinquennial analysis of trends in the management of renal stones in England. Data were collected using the Hospital Episode Statistics database for the years 2015-2020 inclusive. These were then analysed, summarized and presented. The number of UUT stone episodes increased by 2.2% from 86 742 in 2014-2015 to 88 632 in 2019-2020 but annual prevalence remained static at 0.14%. The number of UUT stone episodes in those of working age has remained static but increased by 9% for patients aged > 60 years (from 27 329 to 29 842). The number of shockwave lithotripsy (SWL) treatments decreased by 6.8%. There was a further increase in the use of ureteroscopy (URS) between 2015 and 2020 of 18.9%. Within this subgroup, flexible URS had the most rapid increase in use, with a rise of 20.4% from 7108 to 8558 recorded cases. Over the 20-year period from 2000 to 2020 there was a remarkable 257% increase in URS cases. There was a further decline in open surgery for UUT stone disease by 40%. Stone surgery day-case numbers have increased by 14.7% (from 31 014 to 35 566), with a corresponding decline in the number of bed days of 14.3%. Emergency cases increased by 40%, while elective cases saw a slight increase of 1.9%. The present study shows a plateauing in the prevalence of UUT stone disease in England in the last 5 years, with a move towards day-case procedures and an increase in the proportion of emergency work. For the first time in England, URS has overtaken SWL as the most common procedure for treating UUT stone disease, which might reflect patients' or physicians' preference for a more effective definitive treatment.

MP28-04 VALIDATION OF A SURGICAL DECISION AID FOR PATIENTS WITH NEPHROLITHIASIS: SHOCKWAVE LITHOTRIPSY VERSUS URETEROSCOPY

You have accessJournal of UrologyCME1 May 2022MP28-04 VALIDATION OF A SURGICAL DECISION AID FOR PATIENTS WITH NEPHROLITHIASIS: SHOCKWAVE LITHOTRIPSY VERSUS URETEROSCOPY John Michael DiBianco, Stephanie Daignault-Newton, Bronson Conrado, Sarah T. Hawley, Giulia Lane, Khurshid R. Ghani, Casey A. Dauw, and for the Michigan Urological Surgery Improvement Collaborative John Michael DiBiancoJohn Michael DiBianco More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , Bronson ConradoBronson Conrado More articles by this author , Sarah T. HawleySarah T. Hawley More articles by this author , Giulia LaneGiulia Lane More articles by this author , Khurshid R. GhaniKhurshid R. Ghani More articles by this author , Casey A. DauwCasey A. Dauw More articles by this author , and for the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002571.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Shared decision making is recommended for patients with symptomatic nephrolithiasis to assist the deciding between ureteroscopy (URS) or shockwave lithotripsy (SWL). The practice of shared decision making remains low in this population. We aimed to develop a surgical decision aid (SDA) to facilitate treatment decision making for patients with nephrolithiasis. METHODS: The scope of the SDA was identified through discussions with patients, patient advocates and urologists in the Michigan Urological Surgery Improvement Collaborative (MUSIC). A steering committee consisted of patient advocates, MUSIC coordinating center, decision making content experts, biostatisticians and MUSIC urologists. Content domains were assessed through best available evidence and expert opinion. For content validation we conducted anonymous survey of 35 MUSIC urologists. Content Validity Ratios (CVR), numeric value indicating degree of expert validity, were calculated. Face validation interviews were conducted with patient advocates. RESULTS: A prototype using descriptive plain language and pictorial information was designed for nephrolithiasis patients who are candidates for SWL or URS. Page 1 addressed patient education and page 2 informed urologists of patient treatment goals. Six content domains were chosen: anesthesia type, effectiveness, number of procedures, risk, pain and recovery. 91.4% and 85.7% of urologists indicated that Page 1 and Page 2 accomplished their goals, respectively (Table 1). Anesthesia type was the only domain to receive a lower than acceptable CVR. Patient advocates reported high levels of face validation (Table 2). CONCLUSIONS: We developed a SWL vs URS treatment choice SDA with promising content and face validity. Agreement and contradiction between content and face validation regarding relevance of anesthesia type and recovery time indicate further work is required to determine clinical utility and understand its potential ability to improve patient understanding and treatment satisfaction. Source of Funding: Blue Cross Blue Shield of Michigan © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e461 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Michael DiBianco More articles by this author Stephanie Daignault-Newton More articles by this author Bronson Conrado More articles by this author Sarah T. Hawley More articles by this author Giulia Lane More articles by this author Khurshid R. Ghani More articles by this author Casey A. Dauw More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF DownloadLoading ...

No-show after extracorporeal shock wave lithotripsy treatment in endourology clinic: Can we build a typical patient profile?

ObjectivesPatients “no‐show” in outpatient clinics is a worldwide challenge. Healthcare providers and patients suffer from negative impacts that include increased expenditure, clinical management ineffectiveness, and decreased access to care. This study aims to evaluate no‐show rate among extracorporeal shock wave lithotripsy patients visiting endourology clinic and to identify the demographic and clinical predictors of no‐show.MethodsA cross‐sectional and historical cohort study using electronic medical records. We included 790 patients aged >18 years old referred for endourology clinic following shock wave lithotripsy during 2010–2017 at Hadassah Medical Center in Israel. We predicted no‐show rate following shock wave lithotripsy by various patient characteristics by a multivariate logistic regression model.ResultsOverall, 291 (36.8%) patients did not arrive for postoperative clinic. Of these, 91 (11.52%) patients referred to Emergency Department. Patients who were younger in age (odds ratio 1.49, 95% confidence interval 1.08–2.04), patients who underwent hospitalization ≥3 days (odds ratio 1.63, 95% confidence interval 1.11–2.41) and patients who had undergone a stent‐free shock wave lithotripsy (odds ratio 5.71, 95% confidence interval 2.40–13.57) were significantly associated with higher no‐show rate. Larger stone size was associated with reduction in no‐show rate with every millimeter increase of stone diameter was associated with a reduction of 6.1% probability for no‐show (odds ratio 0.94, 95% confidence interval 0.89–0.99).ConclusionsPredicting patients' characteristics and no‐show patterns is necessary to improve clinical management efficiency, access to care, and costs. We showed that patients who were younger, patients who underwent stent‐free shock wave lithotripsy, patients who had a smaller stone, and patients who underwent a longer hospitalization were more prone to miss their appointment. Paying attention to the characteristics of individual patients may assist in implementing intervening program of patient scheduling.

A novel model using computed tomography parameters to predict shock wave lithotripsy success in ureteral stones at different locations

ObjectiveTo combine non-contrast computerized tomography (NCCT)-based parameters with stone and patient characteristics that are already known to affect shock wave lithotripsy (SWL) success and assess this novel model’s effectiveness in predicting SWL success for single ureteral stones in different locations. Materials and methodsData of patients treated by SWL for a single ureteral stone between January 2017 and January 2019 were retrospectively reviewed. Demographic parameters of patients and stone characteristics were combined with NCCT-based parameters. NCCT-based parameters included the presence or absence of hydronephrosis, perinephric stranding, periureteral edema, diameter of the proximal ureter, ureteral wall thickness (UWT) at ureteral stone site. The logistic regression method was used for the development of a useful predictive model. Subsequently, the receiver operating curve was used to determine cut-off levels, and a scoring system was developed for prediction of SWL success. ResultsStone-free rate was 77,1% (267/346) in the entire cohort. Univariate analysis revealed that age, stone volume, density, perinephric stranding, diameter of proximal ureter, and UWT, were associated with SWL success. In multivariate analysis, proximal ureteral stone location, stone volume, density, and UWT were independent predictors of SWL success. The formula used during logistic regression analysis was: 1/[1 + exp {−8.856 + 0.008 (stone volume) + 0.002 (stone density) + 0.673 (UWT) + 1026 (proximal ureteral stone)}]. The scores of 0, 1, 2, 3 and 4 were associated with 97,8%, 83,4%, 60,8%, 33,2% and 11,1% success rates, respectively, in the prediction model based on these parameters. ConclusionWe conclude that our model can facilitate decision-making for SWL treatment of ureteral stones in different locations.

Supine is Superior to Prone Position in Treating the Distal Ureteral Calculi During Extracorporeal Shockwave Lithotripsy: An Updated Meta-Analysis.

Although extracorporeal shockwave lithotripsy (SWL) has been confirmed to be effective in treating ureteral stone, a definitive conclusion on which patient's position is the optimal option during SWL treatment remains unclear. We, therefore, performed this updated meta-analysis to further clarify it. PubMed, Embase, and Cochrane library were performed to capture all potentially eligible studies from their inception to October 2020. After screening eligible studies, extracting essential data, and assessing the risk of bias, we used STATA 14.0 to complete all statistical analyses. We included 7 studies involving 8 cohorts in the final analysis. Our meta-analysis suggested that the prone position was inferior to the supine position in terms of stone fragmentation and stone clearance rate after completing the first treatment (95% CI: 0.30-0.63; OR = 0.44;), however, subgroup analysis indicated that the difference between supine and prone positions for stone fragmentation and the stone clearance rate was only getting statistical significance for distal ureteral stone (95% CI: 0.23-0.53; OR = 0.35). Moreover, subgroup analysis of two eligible randomized controlled trials suggested that the mean number of sessions per patient in the supine group was less than that in the prone group (95% CI: 0.11-0.48; WMD = 0.294). No major and severe complication was detected to be done with the association with positions. SWL of the supine position may be the preferred option because this strategy can increase the distal ureteral stone-free rate compared to the prone position.