Shock Wave Lithotripsy In Patients Research Articles

Treatment modalities for small-sized urolithiases and their impact on health-related quality of life.

Health-related quality of life (HRQoL) is often reduced in patients with urolithiasis. The objective of this study was to perform a systematic review to describe impact on HRQoL based on different modalities of treatment for small urolithiases with a diameter smaller or equal to 10 mm. Electronic databases were searched with no language or date restrictions to identify studies which were included if they reported: adult patients (≥18 years old), renal or ureteral stone(s) confirmed on imagery, validated reporting of HRQoL, and stone diameter equal or smaller than 10 mm undergoing active surveillance, medical expulsive therapy (MET), shockwave lithotripsy (SWL), or ureteroscopy (URS). Of 672 citations, nine articles were eligible. Five studies (all ureteral) reported HRQoL according to medical stone management. Three of them found that HRQoL in MET patients was better than in active surveillance patients and two studies found no difference in HRQoL between MET and active surveillance groups. Four studies (three ureteral, one renal) reported HRQoL according to surgical stone management. Of the ureteral stone studies, two reported better HRQoL in URS patients than in SWL patients, while one study found no difference between URS and SWL groups. In the renal stone study, SWL patients had better HRQoL than URS patients. Patients with urinary stones 10 mm or smaller have better HRQoL when treated with MET vs. active surveillance, when treated with SWL vs. URS for renal stones, and when treated with URS vs. SWL for ureteral stones. There is an important need for more studies on this topic.

Predictive markers for infections after extracorporeal shockwave lithotripsy in patients with kidney stone based on a large prospective cohort.

Infections in patients with kidney stones after extracorporeal shockwave lithotripsy (SWL) is a common clinical issue. However, the associated factors are unclear. Therefore, we aim to develop and validate a predictive model for infections after SWL in patients with kidney stone. Between June 2020 and May 2022, consecutive kidney stone patients were enrolled. Of them, 553 patients comprised the development cohort. One hundred sixty-five patients comprised the validation cohort. The data were prospectively collected. The stepwise selection was applied using the likelihood ratio test with Akaike's information criterion as the stopping rule; A predictive model was constructed through multivariate logistic regression. The performance was evaluated regarding discrimination, calibration, and clinical usefulness. Predictors of infections after SWL in treating kidney stones included older age (OR = 1.026, p = 0.041), female (OR = 2.066, p = 0.039), higher BMI (OR = 1.072, p = 0.039), lower stone density (OR = 0.995, p < 0.001), and higher grade of hydronephrosis (OR = 5.148, p < 0.001). For the validation cohort, the model showed good discrimination with an area under the receiver operating characteristic curve of 0.839 (95% CI 0.736, 0.941) and good calibration. Decision curve analysis demonstrated that the model was also clinically useful. This study indicated that age, gender, BMI, stone density, and hydronephrosis grade were significant predictors of infections after SWL in treating kidney stones. It provided evidence in optimizing prevention and perioperative treatment strategies to reduce the risk of infection after SWL.

The Role of Oral Dissolution Therapy in Increasing the Efficacy of Extracorporeal Shockwave Lithotripsy in Patients with Less Than 2 Centimeters of Renal Stones: A Systematic Review

The prevalence of renal stones is about 15% of the population. The trend is increasing with a high recurrence rate of up to 50% in 5 years, demanding a more sophisticated treatment for renal stones. ESWL is a treatment for less than 2 cm renal stones with good outcomes. Although ESWL is a technique with many advantages, many factors contribute to the outcome of ESWL with size and stones density as the most important factor. Oral dissolution therapy (ODT) has been used for decades and its effect on renal stones is beneficial to dissolve and prevent renal stones recurrence. The combination of ODT and ESWL is not yet recommended by current guidelines. The purpose of this systematic review is to summarize the latest evidence on the role of ODT in increasing the efficacy of ESWL for renal stones. The database used in this study are PubMed and Cochrane using keywords “urolithiasis”, “renal”, “shock wave”, “citrate”, and “oral dissolution therapy”. The outcome of the article sought is stone fragmentation after ESWL. 4 studies were included, and 3 compared the outcome between ESWL alone and ESWL combined with ODT. The outcome of combined therapy shows superior outcomes compared to ESWL alone with fewer sessions required for stone clearance or a higher chance for stone fragmentation. One study in children showed 100% stone clearance after ESWL with ODT, which was higher than the average success rate of ESWL in children with renal stones. Oral dissolution therapy may have a role in increasing the efficacy of extracorporeal shockwave lithotripsy for patients with less than 2 cm renal stones.

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

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

Ten-Year Sepsis Rates Comparing Extracorporeal Shock Wave Lithotripsy and Ureterorenoscopic Laser Lithotripsy in an Australian Population

ObjectivesTo compare the rate and predictors of septic complications after shock wave lithotripsy (SWL) and flexible ureteroscopy and laser lithotripsy (FURS) in an Australian population.MethodsHospital admission data were extracted from the Victorian Admitted Episodes Dataset (VAED) regarding all elective admissions for SWL and FURS for treatment of intrarenal stones from 2009 to 2018, inclusive. Sepsis was defined by the ICD-10 diagnostic code, A41.ResultsThere were 13 154 inpatient episodes analysed, comprising SWL (6033) and ureterorenoscopic laser lithotripsy (7121). Males made up 67.43% of SWL patients and 63.34% of FURS patients. Median age was 57 years in both groups. Median American Society of Anesthesiologists physical status classification grade (ASA grade) was 2 for both groups, but proportionally more FURS patients were ASA grade 3 to 4 (P &lt; 0.001). Postoperative sepsis was more common in the FURS group (1.43% vs. 0.03%), as was intensive care unit admission (1.00% vs. 0.10%). Average length of stay was longer for FURS (1.43 days vs. 1.06 days). There were 4 inpatient deaths, all from the FURS group. FURS procedure, female sex, and a higher ASA grade were each independent predictors of sepsis.ConclusionsFURS may have a significantly higher relative risk of postoperative sepsis than SWL in high-risk patients as determined in this study. While overall risk is low, higher comorbidity (ASA grade 3 or 4) and female sex were independent predictors of sepsis. For these patients in particular, and when clinically appropriate, SWL may be considered as a potentially safer alternative to FURS.

Success Rate and Complications of Extracorporeal Shock Wave Lithotripsy in Patients Referring to the Kowsar Hospital in Semnan

Background and Objective: Treatment with Extracorporeal Shock Wave Lithotripsy (ESWL) is a low-cost method with a short hospitalization period. However, several complications have been reported for this method. This study was designed to investigate the efficiency and side effects of ESWL. Materials and Methods: In a cross-sectional study, all available files of cases in the stone crusher unit were evaluated according to the inclusion and exclusion criteria from April 2013 to April 2016. Preliminary information before lithotripsy, including patients' demographic characteristics and also treatment success, and complications, was assessed. Results: The success rate of ESWL was 81.4%, which had no significant relationship with gender, age, and body mass index. The mean size of the stones was 10.9±5.4 mm, which was associated with the success rate. In terms of stone location, the highest frequency was observed in the right lower calyx, followed by the left pelvis. The most common complications were ecchymosis (84.3%), hematuria (20.6%), and severe pain (15.3%). There was a significant difference in the incidence of complications in patients with different stone sizes (p&lt;0.01). The occurrence of complications had a significant relationship with the location of the stone (p&lt;0.01). Stones located in the pelvis and lower calyces caused the most complications. Conclusion: The results showed that ESWL had a high success rate and was a suitable method for the treatment of urinary stones. The success rate was associated with the stone size, which, therefore, is an important factor in choosing this approach.

MP54-07 STENTS AND SHOCKWAVE LITHOTRIPSY - THE WHO AND THE WHY: RESULTS FROM A STATEWIDE COLLABORATIVE

You have accessJournal of UrologyCME1 Apr 2023MP54-07 STENTS AND SHOCKWAVE LITHOTRIPSY - THE WHO AND THE WHY: RESULTS FROM A STATEWIDE COLLABORATIVE Sami E. Majdalany, Monica van Til, Stephanie Daignault-Newton, David Leavitt, Khurshid Ghani, Casey Dauw, Naveen Kachroo, and Michigan Urological Surgery Improvement Collaborative Sami E. MajdalanySami E. Majdalany More articles by this author , Monica van TilMonica van Til More articles by this author , Stephanie Daignault-NewtonStephanie Daignault-Newton More articles by this author , David LeavittDavid Leavitt More articles by this author , Khurshid GhaniKhurshid Ghani More articles by this author , Casey DauwCasey Dauw More articles by this author , Naveen KachrooNaveen Kachroo More articles by this author , and Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Shockwave lithotripsy (SWL) is a commonly performed stone procedure in the US. AUA guidelines do not recommend routine stent placement for SWL patients. We evaluated statewide practice patterns and predictors for stent placement at the time of SWL and whether stent placement affected stone free rates (SFR) and 30-day complication rates. METHODS: Adult patients undergoing SWL between 2016-2022 were identified using the MUSIC Reducing Operative Complications from Kidney Stones prospectively collected registry. We determined stent usage prior and during SWL across practices and collected demographic, clinical, stone and procedural factors. Outcomes included peri-operative management, complications and SFR. Multivariable logistic regression was used to identify predictors of stent placement at time of SWL. RESULTS: Among 13,063 cases identified from 35 practices (222 urologists), wide practice variation in stent placement patterns were noted ranging from 0-17% (Figure 1). Overall, 2.3% cases were stented at the time of SWL and 15.5% had a prior stent. Stent on a string was performed in 26 cases (9%) by 11 urologists (54% by 1 provider). Stented SWL patients (prior/time of SWL) were more likely to be older, have a higher Charlson comorbidity index, solitary kidney, 1st upper tract stone, ureteral stone, larger stone, hydronephrosis and positive urinalysis/urine culture (all p<0.01). Stented patients were more likely to have peri-op and post-op antibiotics and anticholinergics (p<0.001). Predictors of stent placement at time of SWL included ureteral stones (OR1.6, 95%CI 1.1-2.3, p=0.01), larger stones (OR1.2, 95%CI 1.216-1.23, p<0.001), African-American race (OR1.8, 95%CI 1.03-3.0, p=0.039) and hydronephrosis (OR1.8, 95%CI 1.3-2.6, p<0.001). There were no differences in emergency department (ED) visits between stented and unstented patients (5.3% vs 3.9%, p=0.21) or 60-day SFR (34% vs 40%, p=0.10). Stented patients had significantly higher infectious complications (3% vs 0.6%, p<0.001). CONCLUSIONS: Variation exists amongst urologists regarding stent usage with SWL, influenced by specific patient and stone factors as well as provider preference. Although ED visits and SFR did not differ, stented patients had a significantly increased post operative infection rate. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e756 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sami E. Majdalany More articles by this author Monica van Til More articles by this author Stephanie Daignault-Newton More articles by this author David Leavitt More articles by this author Khurshid Ghani More articles by this author Casey Dauw More articles by this author Naveen Kachroo More articles by this author Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF downloadLoading ...

Unplanned 120-Day ED Visits and Readmission Rates Following Common Stone Procedures

ObjectiveTo quantify emergency department (ED) visits and hospital admissions (HA) after common urologic stone procedures including ureteroscopy (URS), shockwave lithotripsy (SWL), and percutaneous nephrolithotomy (PCL) which are a concern of payors, providers, and patients. Materials and MethodsThis is a retrospective cohort study using claims data from the IBM MarketScan Commercial and Medicare Supplement databases. Adults with a urologic stone diagnosis and no history of stone procedure in prior 12 months who underwent stone procedures between 2012 and 2017 were included. All-cause ED visits and HA were evaluated during 30, 60, 90, and 120-day periods following the index urologic stone procedure. ResultsA total of 166,287 patients were included in the analytic cohort. For inpatient-indexed procedures, cumulative ED visits rates following stone procedure at 120 days was 18.8% for URS, 19.2% for SWL, and 23.6% for PCL. A similar trend was observed with ED visit rates, following outpatient indexed procedures at 120 days with a cumulative rate of 14.2% of SWL patients, 14.9% of URS patients, and 17.3% of PCL. A similar trend was found when examining HA. ED and HA rates increased steadily through the 120-day time period. ConclusionRates of ED visits and HA following common stone procedures continue to rise at least up to 120 days following the index procedure whether in the outpatient or inpatient settings. While rates of unplanned care are similar for URS and SWL, patients undergoing PCL return to the hospital at higher rates.

Development and validation of a predictive model for stone-free failure after extracorporeal shockwave lithotripsy in patients with ureteral stone in a large prospective cohort

To develop and validate a nomogram for predicting stone-free failure after shock wave lithotripsy (SWL) guided by ultrasound in patients with ureteral stones. The development cohort consisted of 1698 patients who underwent SWL guided by ultrasound at our center from June 2020 through August 2021. Multivariate unconditional logistic regression analysis was used for building a predictive nomogram with regression coefficients. An independent validation cohort consisted of 712 consecutive patients from September 2020 through April 2021. The performance of the predictive model was assessed in regard to discrimination, calibration, and clinical usefulness. Predictors of stone-free failure included distal stone location (odds ratio = 1.540, P < 0.001), larger stone size (odds ratio = 1.722, P < 0.001), higher stone density (odds ratio = 1.722, P < 0.001), larger skin to stone distance (SSD) (odds ratio = 1.058, P < 0.001), and higher grade of hydronephrosis (odds ratio = 1.755, P = 0.010). For the validation cohort, the model showed good discrimination with an area under the receiver operating characteristic curve of 0.925 (95% confidence interval, 0.898, 0.953) and good calibration (unreliability test, P = 0.412). Decision curve analysis demonstrated that the model was also clinically useful. This study demonstrated that stone location, stone size, stone density, SSD, and hydronephrosis grade were significant predictors of stone-free failure after SWL guided by ultrasound in patients with ureteral stones. This may guide clinical practice.

Development and validation of a predictive model for major complications after extracorporeal shockwave lithotripsy in patients with ureteral stones: based on a large prospective cohort.

The risk factors of complications after SWL are not well characterized. Therefore, based on a large prospective cohort, we aimed to develop and validate a nomogram for predicting major complications afterextracorporeal shockwave lithotripsy (SWL) in patients with ureteral stones. The development cohort included 1522 patients with ureteral stones who underwent SWL between June 2020 and August 2021 in our hospital. Five hundred and fifty-three patients with ureteral stones participated in the validation cohort from September 2020 to April 2022. The data were prospectively recorded. Backward stepwise selection was applied using the likelihood ratio test with Akaike's information criterion as the stopping rule. The efficacy of this predictive model was assessed concerning its clinical usefulness, calibration, and discrimination. Finally, 7.2% (110/1522) of patients in the development cohort and 8.7% (48/553) of those in the validation cohort suffered from major complications. We identified five predictive factors for major complications: age, gender, stone size, Hounsfield unit of stone, and hydronephrosis. This model showed good discrimination with an area under the receiver operating characteristic curves of 0.885 (0.872-0.940) and good calibration (P = 0.139). The decision curve analysis showed that the model was clinically valuable. In this large prospective cohort, we found that older age, female gender, higher Hounsfield unit, size, and grade of hydronephrosis were risk predictors of major complications after SWL. This nomogram will be helpful in preoperative risk stratification to provide individualized treatment recommendations for each patient. Furthermore, early identification and appropriate management of high-risk patients may decrease postoperative morbidity.

Development and validation of a predictive model for treatment outcome after emergency extracorporeal shockwave lithotripsy in patients with symptomatic ureteral stones during the COVID-19 pandemic: in a large prospective cohort.

The predictors of treatment outcome after emergency extracorporeal shockwave lithotripsy (SWL) are not well characterized. Therefore, based on a large prospective cohort, we aimed to develop and validate a nomogram for predicting treatment outcome after emergency SWL in patients with symptomatic ureteral stones. The development cohort included 358 patients with symptomatic ureteral stones who underwent emergency SWL between June 2020 and August 2021 in our hospital. One hundred and twenty-nine patients with symptomatic ureteral stones participated in the validation cohort from September 2021 to April 2022. The data were prospectively recorded. The backward stepwise selection was applied using the likelihood ratio test with Akaike's information criterion as the stopping rule. The efficacy of this predictive model was assessed concerning its clinical usefulness, calibration, and discrimination. Finally, 15.6% (56/358) of patients in the development cohort and 14.0% (18/129) of those in the validation cohort suffered from stone-free failure after emergency SWL. We identified four predictors for stone-free failure: stone size, stone density, skin to stone distance (SSD), and degree of hydronephrosis. This model showed good discrimination with an area under the receiver operating characteristic (AUROC) curves of 0.935 (0.899-0.971) and good calibration (P = 0.059). The decision curve analysis showed that the model was clinically valuable. In this large prospective cohort, we found that stone size, stone density, SSD, and degree of hydronephrosis were predictors of treatment outcome after emergency SWL. This nomogram will be helpful in preoperative risk stratification to provide individualized treatment recommendations for each patient. Furthermore, early identification and appropriate management of patients may increase the success rate of emergency SWL during the COVID-19 pandemic.

Long-term evaluation of outcomes and costs of urolithiasis re-interventions after ureteroscopy, extracorporeal shockwave lithotripsy and percutaneous nephrolithotomy based on German health insurance claims data

PurposeComparisons of ureteroscopy (URS), extracorporeal shockwave lithotripsy (SWL) and percutaneous nephrolithotomy (PCNL) for urolithiasis considering long-term follow-up are rare. We aimed to analyze re-intervention rates, costs and sick leave days of URS, SWL and PCNL patients within 7 years.MethodsThis retrospective cohort study was based on German health insurance claims data. We included 54,609 urolithiasis patients incidentally treated in 2008–2010. We investigated time to re-intervention, number of sick leave days and healthcare costs. We applied negative binomial, extended Cox regression and gamma models.Results54% were incidentally treated with URS, 40% with SWL and 6% with PCNL. 15% of URS, 26% of SWL and 23% of PCNL patients were re-treated within 7 years. Time to re-intervention was significantly lower for PCNL (955 days) and SWL (937 days) than URS (1078 days) patients. Costs for incident treatment were significantly higher for PCNL (2760€) and lower for SWL (1342€) than URS (1334€) patients. Yet, total costs including re-interventions were significantly higher for PCNL (5783€) and SWL (3240€) than URS (2979€) patients. Total number of sick leave days was increased for PCNL (13.0 days) and SWL (10.1 days) compared to URS (6.8 days) patients.ConclusionThis study describes outcomes after use of different intervention options for urolithiasis. URS patients showed longest time free of re-interventions and lowest number of sick leave days. Although SWL patients initially had lower costs, URS patients had lower costs in the long run. PCNL patients showed high costs and sick leave days.

Predictors of successful emergency shock wave lithotripsy for acute renal colic

The role of emergency shockwave lithotripsy (SWL) in persistent pain control in patients with ureteral stones is not well established. The aim of this study is to evaluate efficacy as well as the predicting variables for successful early SWL patients with symptomatic ureteral stones. Eighty-six patients with a persistent renal colic secondary to single ureteral stone (6–12 mm) were prospectively enrolled in this study. SWL was performed within 24 h of the onset of flank pain. Pain control and stone-free rate after emergency SWL session were 58.1% and 44.2%, respectively. Seven patients required post-SWL ureteroscopy and ureteral stent placement for uncontrolled pain. The overall 3-month stone-free rate after SWL monotherapy was 83.7%. On multivariate analysis, predictors for pain relief after emergency SWL were lower Hounsfield (HU) stone density, mild hydronephrosis (HN) at presentation and presentation during the first colic episode. Lower HU stone density was the single predictor of successful stone clearance after single emergency SWL session on multivariate analysis. In conclusion, early SWL is feasible and effective in management of ureteral stones presented by renal colic with low HU.

Прогностичні фактори ефективності екстракорпоральної ударно-хвильової літотрипсії у пацієнтів з уретеролітіазом

The purpose of the work was to study prognostic factors for the effectiveness of extracorporeal shock wave lithotripsy in patients with ureterolithiasis. Materials and methods. The study included 53 patients with ureteral stones up to 2 cm in size. All patients underwent extracorporeal shock wave lithotripsy under ultrasound control, with a pulse rate of 90 per minute and a maximum number of pulses of 2000 per session. The outcome of treatment was evaluated by ultrasound on day 5 after the extracorporeal shock wave lithotripsy session. If there were stone fragments larger than 5 mm, a second extracorporeal shock wave lithotripsy session was performed. Treatment was considered effective in the absence of stone fragments in the urinary tract 4 weeks after extracorporeal shock wave lithotripsy. Results and discussion. The data were analyzed to identify clinical and radiological factors associated with treatment failure. As a result of the treatment, 46 (86.4%) patients were found to have no stones in the urinary tract (the condition is “stone free”), 9 (13.6%) had stone fragments larger than 5 mm 4 weeks after extracorporeal shock wave lithotripsy, and therefore contact ureterolithotripsy was performed. As complications, 7 (13.2%) patients had an exacerbation of chronic pyelonephritis, which required percutaneous nephrostomy. As the results showed, age, gender, body mass index, and Hausfield units did not differ significantly in terms of extracorporeal shock wave lithotripsy results. Factors that significantly affected the prognosis of extracorporeal shock wave lithotripsy success were the size of the stone and skin-stone distance. Body mass index did not significantly affect the outcome of lithotripsy in this study. The stone density index according to computed tomography data is considered by many authors to be a predictor of the effectiveness of fragmentation, but in our study this indicator was not a significant predictor of the effectiveness of extracorporeal shock wave lithotripsy, which allows us to think that there are other factors, namely the features of the internal structure of the stone, which determine its compliance with the shock wave. Conclusion. The size of the stone and the skin-stone distance are prognostic factors that affect the effectiveness of extracorporeal shock wave lithotripsy in patients with ureterolithiasis. Body mass index and stone density in Hausfield units did not significantly affect extracorporeal shock wave lithotripsy outcome in this study

Variables measured on three-dimensional computed tomography are preferred for predicting the outcomes of shock wave lithotripsy.

Shock wave lithotripsy (SWL) is used to treat upper urinary tract stones. Recently, some volume analyzers have enabled preoperative assessment using three-dimensional computed tomography (3D-CT). We evaluated the efficacy of 3D-CT variables for predicting the outcomes of SWL. The study population included 193 patients who underwent SWL between November 2014 and August 2020. In addition to conventional two-dimensional computed tomography (2D-CT) assessments, 3D-CT assessments of targeted stones were retrospectively performed, and stone size and stone density (SD) were measured. The successful and unsuccessful treatment groups were compared and risk factors for an unsuccessful first SWL session were investigated. The predictive accuracy of variables measured on 3D-CT was evaluated by receiver operating characteristic curves and multivariate analyses. The success rate of the first SWL session was 73.1%. Stone volume, mean SD and highest SD on 3D-CT were significantly higher in the unsuccessful group than in the successful group. Stone volume showed a higher area under the curve (AUC) than the estimated volumetric stone burden and stone diameter, which were measured on 2D-CT (0.729, 0.683, and 0.672, respectively). The AUCs of the mean SD and highest SD on 3D-CT were higher than those on 2D-CT (0.699, 0.680, 0.617, and 0.627, respectively). Multivariate analyses identified stone volume (≥ 0.29ml), mean SD on 3D-CT (≥ 421 HU), and absence of hydronephrosis as independent predictive factors for unsuccessful SWL. 3D-CT variables were promising predictors of the outcomes of SWL. Preoperative 3D-CT assessment is helpful for selecting favorable patients for SWL.

MP22-10 COMPARISON OF FLUOROSCOPY TIME DURING URETEROSCOPY AND EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR RENAL STONES

You have accessJournal of UrologyImaging/Radiology: Uroradiology II (MP22)1 Sep 2021MP22-10 COMPARISON OF FLUOROSCOPY TIME DURING URETEROSCOPY AND EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR RENAL STONES Mohamed Keheila, Akin Amasyali, Joshua Belle, Nikoli Brown, Jason Groegler, Joseph Hutton, Mohammad Hajiha, and D. Duane Baldwin Mohamed KeheilaMohamed Keheila More articles by this author , Akin AmasyaliAkin Amasyali More articles by this author , Joshua BelleJoshua Belle More articles by this author , Nikoli BrownNikoli Brown More articles by this author , Jason GroeglerJason Groegler More articles by this author , Joseph HuttonJoseph Hutton More articles by this author , Mohammad HajihaMohammad Hajiha More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002013.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are minimal data comparing fluoroscopy time between ureteroscopy (URS) and extracorporeal shockwave lithotripsy (SWL). One prior study showed no difference in fluoroscopy time between the two modalities. Over time, techniques to reduce fluoroscopy during URS have evolved. The purpose of this study was to compare the outcomes and fluoroscopy times between URS and SWL for renal stones in modern practice. METHODS: Outcomes were retrospectively collected from 364 patients who underwent URS and 444 patients who underwent SWL for urolithiasis targeted using fluoroscopy in a single academic institution from July 2012 to February 2019. Patients with ureteral stones, renal stones <5 mm and >20 mm, and those who underwent both URS and SWL were excluded. After patient matching, 86 URS and 237 SWL patients were included for analysis. Mann-Whitney U and Chi-square tests were used to compare fluoroscopy time and clinical outcomes with p<0.05 considered significant. RESULTS: Gender distribution, age, BMI, stone size, and stone location were not different between patients. Total mean number of stones was higher in the URS group (2.4±1.4) compared to SWL group (1.5±0.9, p<0.05). Fluoroscopy time was greater in patients who underwent SWL (189.3±98.5 seconds) compared to those undergoing URS (6.7±11.9 seconds; p<0.05). Ureteroscopy had a significantly higher SFR compared to SWL (p<0.05). Both groups had similar complication rates (4.7 vs. 7.0%, p=0.32) and Clavien-Dindo scores. CONCLUSIONS: Our study demonstrates that in the modern era, SWL results in ∼27x increased radiation exposure compared to URS. In addition, this study agrees with prior findings demonstrating that URS has a higher stone free rate with a similar complication rate compared to SWL. This highlights the importance of developing strategies for reducing fluoroscopy time while performing SWL such as the use of ultrasound guidance. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e394-e394 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Keheila More articles by this author Akin Amasyali More articles by this author Joshua Belle More articles by this author Nikoli Brown More articles by this author Jason Groegler More articles by this author Joseph Hutton More articles by this author Mohammad Hajiha More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement Loading ...

Impact of Percutaneous Nephrostomy on the Efficacy of in Situ Shock Wave Lithotripsy for Upper Ureteral Stones.

To investigate whether a Percutaneous nephrostomy (PCN) has any impact on the success rate of shock wave lithotripsy (SWL) and to estimate the probability of stone-free in SWL patients with upper ureter stones. Overall, 236 patients who underwent SWL for upper ureter stones between 2015 and 2019 were evaluated. Forty-nine patients who underwent PCN during SWL were identified. Medical data of the patients were retrospectively reviewed, and possible prognostic features were evaluated. Out of all patients, 147 patients were selected through propensity score matching. There were no significant differences between the PCN and no PCN groups, except for a lower stone-free rate (55.1% vs. 74.5%, p = .018) and one-session success rate (24.5% vs. 50.0%, p = .003) in the PCN group. In univariate analysis, a younger age, the female sex, a smaller size of stone, lower mean stone density (MSD), and absence of PCN were positive predictive factors of being stone-free in patients who underwent SWL. In multivariate analysis, a smaller size, lower MSD, and absence of PCN were positive predictive factors of being stone-free in patients who underwent SWL. Stone size, MSD, and PCN were prognostic factors that influence the outcome of SWL. The presence of PCN during SWL is associated with adverse success rates in patients with upper ureter stones.

The reasons of unsatisfactory results of extracorporeal shock wave lithotripsy in patients with ureterolithiasis

The article dedicate to the problem of failure of extracorporeal shockwave lithotripsy in patients with ureterolithiasis and reveal the changes which appear in the ureter in the location of the stone.The aim. Analysis of the results of treatment in patients, suffering ureteric stones, using the ureterolithotripsy procedure after failure extracorporeal shockwave lithotripsy.&#x0D; Materials and methods. In 137 patients with ureteric stones, whom ureterolithotripsy procedure after failure extracorporeal shockwave lithotripsy was conducted, the symptoms of the disease, the diagnostic methods value, efficacy of surgical treatment and reasons of the failure of previous method of treatment were analyzed.&#x0D; Results. In 135 patients endoscopic removal of stones has been succeeded, in 2 patients because of total obliteration of the ureter, uretero-ureteral anastomosis has been performed. If the symptoms, with are characteristic of ureterolithiasis, persists up to one week stones don’t cause significant macroscopic changes to the ureter wall. If the stone persists in the ureter longer than a week we identified local appearing of oedema. Long–term (more than two months) ureteric stone persistence increase the risk of intramucosal “ingrowth” of the calculi greatly.&#x0D; Conclusion. The URS and ESWL are high effective and minimal invasive methods of surgical intervention for patients with ureterolithiasis, guaranteeing high level of postoperative “stone free rate”. Prolongation of the stone insertion time in the ureter causes the ureteric wall changes, complicating performance of minimal invasive interventions (ureterolithotripsy and extracorporeal shock–wave lithotripsy) and reduce its efficacy.

Which has more complications?—Shockwave lithotripsy versus endoscopic treatment of renal calculi with 1‐year follow‐up in an Australian population

Introduction and objectivesRenal calculi are a common medical problem with incidence rates calculated to be approximately 6%‐9% in men & 3%‐4% in women worldwide. Incidence appears to be increasing. This study compares emergency presentations and unplanned readmissions between extracorporeal shock wave lithotripsy (SWL) and pyeloscopic stone treatment in the population of Victoria, Australia after 1‐year follow‐up.MethodsThis is a population study comparing all patients with renal calculi electively treated with SWL to those initially treated with flexible ureteroscopy (URS) in Victoria, Australia. We used data linkage across the state of Victoria to follow patients treated with either modality in a 12 months period (with no urological surgery in the prior 12 months). Each patient's emergency presentations and subsequent re‐admissions were followed up for 1 year after their index treatment to assess for stone complications. We assessed for selection bias between the two patient groups by comparing age, gender, insurance status, geographical location, and comorbidity scores.ResultsWe report stone‐related complications for 739 flexible URS and 1317 SWL procedures undertaken across public and private hospitals in Victoria over 12 months. Unplanned emergency presentations within 60‐days of surgery were (22/739) 2.98% for flexible URS patients and (83/1317) 6.30% for SWL patients (P = .001); however, at 12 months, this became 16.23% (120/739) for flexible URS patients and 12.83% (169/1317) for SWL patients (P = .034). Flexible URS patients were more likely than SWL patients to be admitted with 71.76% of flexible URS versus 53.97% of SWL patients requiring an admission at any given emergency presentation (P ≤ .001) within 12 months. On multivariate analysis, both flexible URS ([OR] 1.67, CI 1.23‐2.26, P = .001) and being a public patient ([OR] 3.06, CI 2.24‐4.18, P < .001) significantly increased the likelihood that patients required an unplanned re‐admission within 12 months.ConclusionsThere is work needed to reduce emergency presentations and unplanned re‐admissions after both SWL and flexible URS. At 12‐months follow‐up, unplanned emergency visits and re‐admission rates were significantly more after flexible URS. Symptoms at emergency presentation indicate that better education regarding stent management is needed, especially in the public health care system.

Comparison of Slow Rate versus Fast Rate Extracorporeal Shock Wave Lithotripsy in Patients with Urolithiasis

Objectives: To compare the success of slow rate with fast rate extracorporeal shock wave lithotripsy in patients undergoing treatment of urolithiasis. Study design: Randomized controlled trial Place &amp; Duration of Study: This study was conducted in Urology Department of Sandeman Civil Hospital, Quetta for one year duration from 1stApril 2020 to 30thMarch 2021. Methods: Total ninety patients who were divided in two equal groups i.e. Group A in which patients received treatment with slow rate extracorporeal shock wave lithotripsy and group B in which patients received treatment with fast rate extracorporeal shock wave lithotripsy. Results: There were 32 (71.1%) male patients and 13 (28.9%) female patients in group A. In group B, there were 28 (62.2%) male patients and 17 (37.8%) female patients. Mean age in group A was 35.61+4.19 years while in group B, the mean age was 34.11+69.32 years. The success rate of slow rate extracorporeal shock wave lithotripsy was 36 (80%) and that of fast rate extracorporeal shock wave lithotripsy was 21 (46.7%) (p-&lt;0.05). Conclusions: The slow rate extracorporeal shock wave lithotripsy is better than fast rate extracorporeal shock wave lithotripsy for elimination of urolithiasis. Keywords: Extracorporeal shock wave lithotripsy, Slow rate ESWL, Fast rate ESWL