Success Of Extracorporeal Shock Wave Lithotripsy Research Articles

Role of Multi-Detector Computed Tomography Indices in Predicting Extracorporeal Shockwave Lithotripsy Outcome in Patients With Nephrolithiasis

BackgroundNephrolithiasis is one of the most common renal pathologies and is routinely encountered in daily practice. Non-contrast computed tomography (NCCT) is the gold standard diagnostic imaging modality for urolithiasis. The role of HU (Hounsfield units) in calculus as a predictor of extracorporeal shock wave lithotripsy (ESWL) has been studied in the past. This study aims to evaluate the role of HU value and various other NCCT indices in predicting the outcome of ESWL.Material and methodsThis was a prospective observational study that included 45 patients suffering from nephrolithiasis who underwent NCCT-KUB (kidney, ureter, and bladder) followed by ESWL. The NCCT indices were evaluated and correlated with the outcome of ESWL. NCCT-KUB was performed using multidetector SIEMENS® SOMATOM EMOTION 16-slice CT scanner (SIEMENS, Munich, Germany).ResultsIn our study, the HU value turned out to be a statistically significant predictor of ESWL success (p <0.05), and the renal pelvis also proved to be a good prognostic indicator for ESWL success. The cut-off value of <1179 HU favored a successful outcome of ESWL, while if >1179 HU, ESWL is likely to fail. Hence, the successful outcome of ESWL is inversely proportional to the HU value. Renal pelvic calculi (n=14) showed a 100% success rate, which was better than all other calculus locations (p<0.05). However, the rest of the indices did not show any statistical significance.ConclusionMulti-detector NCCT-KUB indices can help in the selection of patients with a good prognosis for ESWL, which will prevent the patient from undergoing undesired invasive procedures.

Predicting ESWL success by determination of Hounsfield unit on non-contrast CT is clinically irrelevant in children.

The necessity of determining stone density by non-contrast computerized tomography (NCCT) before extracorporeal shock wave lithotripsy (ESWL) is a controversial topic due to the radiation exposure. We aimed to investigate whether stone density is helpful in predicting the success of ESWL in pediatric patients or not. In this retrospective study, database of a single center was used to identify 232 children aged between 2 and 16years. Patients with abnormal renal anatomy, distal obstruction, a known cystine stone disease, a previous history of an intervention regarding stone, and an insufficient follow-up period (< 3months) were excluded from the study. A total of 209 patients were included in the study (94 with NCCT, 115 without NCCT). Groups were compared in terms of stone size, stone location, and stone-free rate at 3months after a single ESWL session. The mean age was 6.17 ± 3.27years and 120 (57.4%) of the patients were male and 89 (42.6%) were female. Mean stone size was 11.7mm in NCCT group and 12.3mm in non-NCCT group (p 0.128). The complete stone clearance rate in NCCT and non-NCCT group at 3months after ESWL was 57.4% (54/94) and 54.7% (63/115), respectively, and there was no statistically significant difference (p 0.316). In conclusion, unnecessary NCCT use should be avoided before ESWL considering the similar success rates after ESWL and the risk of exposure to radiation.

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

Is pain perception different in pediatric and adult patients undergoing stone crushing procedure after the application of multimodal analgesia?

Aim: Extracorporeal shock wave lithotripsy (ESWL) is an important modality in the treatment of urinary system stone disease in children and adults. However, ESWL may be painful and stressful procedure. We aimed to examine the differences between pain perception felt during ESWL in children and adult patients after the application of multimodal analgesia. Method: Patients who underwent the stone crushing procedure under multimodal analgesia at the ESWL unit of Mersin University Hospital Urology Clinic between May 2010 and December 2010, were divided into two groups as pediatric and adult. Using the VAS form, the adult patients’ and pediatric patients' pain perception felt during ESWL, were scored and compared. Results: The difference between the mean scores of pain perception felt during ESWL were not significant for all three sessions in both groups. But the difference between the mean scores of pain perception felt during all ESWL sessions between the pediatric and adult groups were significant for all three sessions. The success rate for SWL was calculated as 83.3% for the pediatric group and 80% for the adult group. Conclusion: ESWL is a painful procedure. Our ESWL success rate is compatible with the literature. The pediatric and adult patients successfully completed the ESWL procedure with multimodal analgesia. The pain perception felt during ESWL score was higher in pediatric cases.

Success of extracorporeal shock wave lithotripsy based on CT texture analysis.

The aims of the study were to evaluate whether computerised tomography texture analysis (CTTA) based on non-contrast computed tomography (NCCT) has predictive value for the success of extracorporeal-shockwave lithotripsy (ESWL) in upper urinary tract stones (UUTS). This study included 156 of 356 patients undergoing ESWL for UUTS sized 0.5-2cm from 2015 to 2019. Patients with congenital kidney anomalies, radiolucent stones, multiple stones, treated for upper urinary tract stones previously and lower pole stones were excluded from study. The number of ESWL sessions of the patients was as follows: 78 (50%) patients had 1 session, 30 (19.2%) patients had 2 sessions and 48 (30.8%) patients had >2 sessions. First- and second-order CTTA properties of patients' UUTS were evaluated using texture analysis software (LIFEx Software). Other clinical features such as Hounsfield Unit (HU), initial stone size, body-mass index (BMI) and skin to stone distance (SSD) was recorded. The patients were divided into two groups according to ESWL success. Cases with residual stones larger than 4mm were considered failed cases. BMI, the standard deviation of HU, SSD, skewness, kurtosis, entropy and all second-order statistics were found to be statistically different between the two groups except for correlation (P<.05). Multivariate analysis showed longer SSD and four new parameters of CTTA (kurtosis, entropy, dissimilarity and energy by the distribution of pixel grey levels in the UUTS) to be significant predictors for unsuccessful ESWL outcomes. SSD and second-order CTTA properties (dissimilarity and energy) had an area under ROC curve of 0.802, 0.850 and 0.824 at a 95% confidence interval. ESWL success rate in all patients was 76.9%. CTTA can help select patients who will undergo ESWL for upper urinary tract stones. Thus, we can reduce treatment costs and ESWL complications by preventing unnecessary ESWL applications.

The effect of stone and patient characteristics in predicting extra-corporal shock wave lithotripsy success rate: A cross sectional study

IntroductionWe determine the effect of patient characteristics (age, sex, and body mass index BMI) and stone characteristics (density, location, and size) by non-contrast computed tomography of the kidneys, ureters, and bladder (CT-KUB) in predicting the success of extracorporeal shock wave lithotripsy (ESWL) in the treatment of kidney and ureteric stones. We present this study to further enrich the knowledge of physicians towards the effect of different patient characteristics upon predicting extra-corporal shock wave lithotripsy success rates. MethodsWe evaluated 155 patients who received ESWL for renal and ureteric stone measuring 3–20 mm (mm), over a 3-month period. The stone size in millimeters, density in Hounsfield units (HU) and its location was determined on pre-treatment CT-KUB. ESWL was successful if post-treatment residual renal stone fragments were ≤3 mm and for ureteric stones should be totally cleared. ResultsThe overall success of ESWL treatment was observed in 65.8% of the 155 patients. There was no significant difference seen when the effect of patients age, sex and BMI were studied with ESWL outcome with P values were 0.155, 0.101 and 0.415 respectively. Also, stone location either in the kidney or ureter has no statistically significant effect on ESWL response rate. while stone density and size determined on CT KUB have statistically significant effect on the success rate of ESWL with a P-value of 0.002 and 0.000 respectively. ConclusionsThis study shows that determination of stone density and stone size on CT KUB pre ESWL can help to predict the outcome of ESWL. We propose that stone density <500 HU and stone size < 5 mm are highly likely to result in successful ESWL.

Predictive factors of extracorporeal shock wave lithotripsy failure in the treatment of patients with ureterolithiasis

Efficacy of different approaches to the treatment in patients with ureteral calculi and predictive factors for the success are the objects of contemporary studies. However, only few on them studied the duration factor of typical ureterolithiasis symptoms and changes of the ureter wall as predictive factors of extracorporeal shock wave lithotripsy (ESWL) failure in patients with ureteral stones. The aim of the study was to determine the peculiarities of histological changes in the ureter wall as a result of calculus presence and to evaluate the predictive factors of ESWL failure in patients with ureterolithiasis. Materials and methods. An analysis of the treatment by ESWL in 662 patients with ureterolithiasis was performed. The patients were divided into two groups: Group 1, n = 629 (95.0 %) individuals with effective ESWL and Group 2, n = 33 (5.0 %) patients with ESWL failure when calculi were not eliminated. Stones were found in 378 (57.0 %) patients in the upper third of the ureter, in 50 (7.6 %) – in the middle and in 234 (35.4 %) – in the lower third. For determining the predictors of ESWL failure, the Spearman’s Rank Correlation Coefficient was used. Results. The overall ESWL efficacy in our study was 95.0 %. The strong inverse correlation was found between the ESWL success and duration of symptoms (r = -0.92) and stone size (r = -0.68). Stone localization in the ureter did not influence the ESWL outcomes (r = 0.27). Conclusions. Increasing of the period from the manifestation of primary clinical symptoms to the implementation of ESWL reduces the treatment efficacy. Patients with ureteral stones more than 15 mm have lower stone-free rates after ESWL.

Correlative investigation between routine clinical parameters of dual-energy computed tomography and the outcomes of extracorporeal shock wave lithotripsy in children with urolithiasis: a retrospective study.

To evaluate the associations of DECT parameters with extracorporeal shock wave lithotripsy (ESWL) outcomes in pediatric patients. A retrospective study of consecutive patients with calculi who underwent ESWL and DECT in our hospital was performed in 2011-2019. The primary outcome was DECT imaging's correlation with ESWL outcomes. The secondary outcome was to determine DECT parameters independently predicting ESWL outcomes, including stone-free (SF) and residual stone (RS) statuses. The study included 207 patients. The mean CT attenuations at 140 kVp, 80 kVp, and 120 kVp and effective atomic number (Zeff) were significantly correlated with stone free (SF) and residual stone (RS) (P < 0.05). Areas under the curves (AUCs) of CT attenuations at 120 kVp, 80 kVp, 140 kVp, and dual-energy index (DEI) were 0.784 (95% CI 0.672-0.897), 0.780 (95% CI 0.677-0.884), 0.766 (95% CI 0.658-0.885), and 0.709 (95% CI 0.578-0.840) (all P < 0.05). With cutoffs of 882.5, 1330.5, 1042.5, and 0.103 for CT attenuations at 140 kVp, 80 kVp, 120 kVp, and DEI, respectively, sensitivities and specificities were 75.0% and 31.1%, 83.3% and 31.8%, 80.3% and 31.1%, and 58.3% and 44.7%, respectively. Our results demonstrated that the parameters of DECT could be used to predict ESWL outcomes (especially the SF status) in children with urolithiasis. ESWL success can be accurately predicted by DECT, and it is hard to predict ESWL failure.

Extracorporeal Shock Wave Lithotripsy and Combined Therapy in Children: Efficacy and Long-Term Results.

Background: Extracorporeal shock wave lithotripsy (ESWL) is nowadays the first choice for the treatment of upper urinary tract stones smaller than 2 cm, considering its low complications and high success rate.Aim: To present an update of the current situation of ESWL treatment and to analyse our series of patients and the efficacy of combined lithiasis treatment in different locations and sizes.Patients and Method: Retrospective study including patients with urolithiasis treated with ESWL between 2007 and 2019. Collected data included: gender and age at treatment, presentation symptoms, imaging studies, stone location and size, complications and stone clearance. Success was defined as stone-free status or the presence of clinically insignificant residual fragments (<4 mm after 3 months follow-up). Patients with residual stones larger than 4 mm after 3 months were programmed for another ESWL session or received a combined sandwich therapy, followed by URS or percutaneous approach.Results: Between 2007 and 2019, 37 patients presented a total of 41 lithiasis episodes that were treated with ESWL sessions. Median age at first procedure was 9 years old (1–17) and median follow-up time was 6 years (3–12). Stones were located in the renal pelvis, followed by the lower, middle and upper calyx, proximal ureter, and 51% of our patients had multiple lithiasis. Median stone size was 12 mm (5–45), the main component being calcium oxalate (34%). During immediate postoperative period, 8 patients (19%) presented complications: renal colic, hematuria and urinary tract infection. After the first ESWL, 41% of the patients (n = 17) were stone-free. Out of the 24 residual lithiasis episodes (58%), three patients (7%) underwent a second ESWL session. In the remaining 19 patients, ESWL was combined with URS or percutaneous approach to achieve complete stone clearance. Overall stone free status after combined therapy was 95% (n = 39).Conclusion: These data support that ESWL is an effective minimally invasive technique, with low cost and morbidity, reproducible and safe for the treatment of stone disease in children. Even though lithiasis size seems to be a significant factor in ESWL success, in combination with other lithotripsy procedures it can reach very high rates of stone clearance.

Can we successfully predict the outcome for extracorporeal shock wave lithotripsy (ESWL) for medium size renal stones? A single-center experience.

Extracorporeal shock wave lithotripsy (ESWL) is one of the most used modalities in treatment of renal stones, but its effectiveness can be influenced by many factors related to the patient or the stone itself which may affect the success of stone disintegration. The aim of our study was to investigate the predictive value of some patient and stone-related factors for ESWL success for renal stones. A total of 100 patients with single radiopaque renal stone 10-20 mm in diameter, undergoing ESWL were enrolled in this study. All patients had non contrast computed tomography (NCCT) done before ESWL. We evaluated body mass index (BMI), skin-to-stone distance (SSD), stone size and Hounsfield density comparing these values between stone free (SF) and residual stone (RS) groups. Of the 100 patients, 70% had successful disintegration. There was no significant difference between stone free (SF) and residual stone (RS) groups as regard age or BMI. Meanwhile, there was a significant difference between SF and RS groups as regard stones' density and SSD, with higher values in RS group but there was statistically insignificant difference as regard stone size (p = 0.522). Using logistic regression analysis, we found that Hounsfield unit (HU) was better in predicting successful disintegration than SSD but without statistical significance. HU and SSD are the independent predictive factors for ESWL outcome, and they should be considered when planning ESWL in treatment of medium size renal stones.

Outcomes of extracorporeal shock wave lithotripsy for ureteral stones according to ESWL intensity.

BackgroundWe evaluated the treatment outcomes of ureteral stones according to energy intensity generated by extracorporeal shock wave lithotripsy (ESWL).MethodsWe retrospectively analyzed 150 patients who underwent ESWL for treatment of ureteral stones between September 2018 and February 2020. All stones were confirmed by a computed tomography examination, and the size, location, skin-to-stone distance, and Hounsfield units (HU) of the stones were assessed. In addition, patient characteristics including body mass index and estimated glomerular filtration rate, which can affect treatment outcome, were also evaluated. The success or failure of ESWL was confirmed according to the session, and the factors affecting the treatment outcome were analyzed using a logistic regression model.ResultsOf the 150 patients, 82 (54.7%) had stones in the proximal ureter, 5 (3.3%) in the mid, and 63 (42.0%) in the distal ureter. Patients underwent ESWL an average of 1.5 times, and the success rate according to session was 65.3% for the first, 83.3% for the second, and 90.0% for the third session. A multivariate analysis revealed that stone size [odds ratio (OR) 0.81, 95% confidence interval (CI), 0.66–0.99, P=0.049] and HU (OR 0.99, 95% CI, 0.98–0.99, P=0.001) were significant factors affecting the success rate after the first ESWL session; ESWL intensity was not related to success rate. Stone size (OR 0.78, 95% CI, 0.62–0.96, P=0.022) was the only significant factor affecting the success rate in the third session.ConclusionsStone size and HU affected the ESWL success rate. ESWL intensity was not significantly related to the success rate, so it should be adjusted according to patient pain and the degree of stone fragmentation.

How to maximize the efficacy of shockwave lithotripsy.

Since its introduction in the early 1980s, extracorporeal shockwave lithotripsy (ESWL) has proven to be a minimally invasive and efficient procedure for the management of renal calculi. It is currently one of the most recommended treatments for small- and medium-sized stones (<20 mm) in most guidelines internationally. The recent coronavirus disease 2019 (COVID-19) outbreak could lead to a further increase in ESWL use as it avoids a general anesthetic and its potential complications in patients with COVID-19 infection. Most publications exhibit ESWL stone-free rates (SFRs) of 70%-80%; however, this is often not the case in many centers, with multiple factors affecting the efficacy of the intervention. Various stone and patient factors have been shown to influence the ESWL success. Stone position, density and size, skin-to-stone distance, and body-mass index contribute to SFRs. Modifications in the lithotripter design and revisions in the technique have also improved the SFRs over the years, with slower shock rates, power-ramping protocols, combined real-time ultrasound, and fluoroscopy imaging technology, all enhancing the efficacy. The adjuvant use of pharmacological agents, such as alpha-blockers, potassium citrate, and the emerging microbubble technology, has also been investigated and shown promising results. Arguably, the most significant determinant of the success of ESWL in a particular unit is how the lithotripsy service is set up and monitored. Careful patient selection, dedicated personnel, and post-treatment imaging review are essential for the optimization of ESWL. Through an analysis of the published studies, this review aimed to explore the measures that contribute to an effectual lithotripsy service in depth.

Testing the New Parameters affecting The Outcome of Extracorporeal Shockwave Lithotripsy for Upper Ureteric Stones

Background: Extracorporeal Shock wave lithotripsy (ESWL) is widely used in treating patients with ureteralstones because it is effective, safe, and noninvasive. Based on factors such as size and the location of stones,there is a significant variation in the overall stone-free rate (SFR).Aim of the study: To evaluate the effect of ureteral wall thickness (UWT), stone attenuation, the time fromfirst attack of pain till first session of ESWL and stone/ rib density on the outcome of SWL in the treatmentof upper ureteral stones (UUS).Patient and methods: A prospective study when 127 patients with radio-opaque UUS ranging from 7 to 20mm and treated by ESWL were included in this study. The effect of (stone/ 12th rib) density by KUB, ureteralwall thickness by NCCT and the time from first attack of pain till first ESWL session was studied.Results: The overall successful fragmentation was 75.5%, with the overall success rates in the low density(LD) and high density (HD) groups were 83.8% and 52.94%, respectively. The average number of SWLsessions needed in the two groups for success was 1.9 compared with 2.7 sessions (p&lt;0.05). For stones &lt;10 mm; those with ureteral wall thickness &lt;3.25 mm have success rate about 90.3% VS 69.7% with uretericwall thickness &gt; 3.25 mm which is highly significant. Early ESWL within the first 24 hours of acute attackof first pain has successful fragmentation of 85.45%. With significant effect on number of ESWL sessions.The stone free rate reaches 91.1% for stones &lt;10 mm.Conclusions: The stone free rate is inversely affected by stone /12th rib density ; ureteral wall thickness andthe time from first attack of pain till first session of ESWL, were important predictors of successful ESWL.

COMPARISON OF THE SUCCESS OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY (ESWL) WITH AND WITHOUT DJ STENTING IN PROXIMAL URETERIC STONE

BACKGROUND &amp; OBJECTIVE: There is disagreement in the use of ureteral double-J stent before the extracorporeal shock wave lithotripsy (ESWL), although most of the urologists suggest using stent in shock wave lithotripsy technique for stones bigger than 20mm, for preventing the risk of developing steinstrasse. To compare the success of ESWL with and without DJ stenting in proximal ureteric stone. METHODOLOGY: A total of 60 patients form both genders, between 15 to 55 years of age, with a single proximal ureteric stone, were included. Patients with solitary functioning kidney, multiple stones, pregnancy, pyonephrosis and sepsis were excluded. In Group-A, ESWL without DJ stenting was completed while in Group-B, ESWL with DJ stent placement was done. In all patients, at least 4 sessions were done fortnightly. Patients were followed regularly and final success was noted after one month of completion of ESWL sessions.&#x0D; RESULTS: The mean age was 36.85 ± 8.61 years. From 60 patients, 29 (48.33%) were men and 231 (51.67%) were women.Mean body mass index (BMI) was 28.30±2.20 kg/m . The average size of the stone was 12.47 ± 2.57 mm. Success (according to stone removal) of Group-A (ESWL without DJS) was seen in 26 (86.67%) patients while in Group-B (ESWL with DJS) was seen in 16 (53.33%) patients with P-value of 0.005. &#x0D; CONCLUSION: This study concluded that success (in terms of stone clearance) of extracorporeal shock wave lithotripsy (ESWL) without DJ stenting is higher compared to with DJ stenting in upper ureteric stone.

Factors affecting the success of pediatric extracorporeal shock wave lithotripsy therapy: 26-year experience at a single institution.

Despite its widespread use, few studies have evaluated the success of extracorporeal shock wave lithotripsy (ESWL) in pediatric patients with several parameters and a large group of patients. In the present study, we aimed to analyze the factors that affect the outcomes of pediatric ESWL treatment, which we have practiced for 26 years. This study included 1012 pediatric patients who underwent ESWL between March 1991 and November 2017. Pre-procedure radiological evaluations were performed using kidney-ureter-bladder and/ or urinary system ultrasonography. Demographic data, stone characteristics, and ESWL treatment data and complications were recorded and univariate and multivariate analyses were performed for the stone-free rate (SFR). Receiver operating characteristic (ROC) analysis was performed to determine the cut-off values for stone size to predict ESWL success for both kidney and ureteral stones. Age, body mass index (BMI), congenital renal anomaly, stone location, stone size, number of stones, and stone composition significantly affected the SFRs in univariate analysis; however, only age, BMI, stone location, and stone size were significant in the multivariate analysis. If no residual fragments were detected after three sessions of ESWL application, the procedure was considered successful. The cut-off stone size values for the kidney and ureter that predicted treatment success were 96.28 mm2 and 44.16 mm < sup > 2 < /sup > , respectively. ESWL is an effective and safe treatment in the pediatric age group that provides high SFRs. Age, BMI, and stone location, size, and composition are particularly critical factors that can predict the success of ESWL.

Particularities and Efficacy of Extracorporeal Shock Wave Lithotripsy in Children

Background: Extracorporeal shock wave lithotripsy (ESWL) was first introduced in paediatric population in 1986. Given the more frequent recurrence in children, compared to adults, urinary stones treatments should require minimal invasive treatment methods. In this study, we aimed to evaluate the profile of the young patient with lithiasis who can benefit from ESWL, analysing the experience of 2 clinical departments. Materials and Methods: We have retrospectively reviewed the medical records of 54 children who underwent ESWL for urolithiasis. ESWL success rate was defined as stone-free status or the presence of clinically insignificant residual fragments. Data were analysed using the STATA 14.2. Results: In our study, the incidence of renal-ureteral calculi is significantly higher in girls (68.5%), compared to boys (31.5%). In total, 83.3% of patients showed a favourable outcome after treatment and the remaining 16.7% showed minimal complications. The presence of complications and remaining calculi was correlated to children age. The overall stone free rate was 88.9%. For calculus of 8.5 mm, only one ESWL session is recommended. Conclusions: The high percentage of cases with favourable outcome indicate that ESWL treatment is effective, considering the minimal cost, minimal invasiveness, repeatability and no need for general anaesthesia.

Impact of body mass index on success, complications and failure of extracorporeal shock wave lithotripsy

Introduction: Extracorporeal shock wave lithotripsy (ESWL) is known as the most common method in treating urinary stones (70%) and is a selective method to treat small urinary stones (&lt;2-2.5 cm). General opinion is that the success rate of ESWL in obese patients is low and risk of complications is high. Objectives: The aim of this study was to evaluate the impact of body mass index (BMI) and the stone-to-skin distance on success, complications and failure of ESWL. Patients and Methods: In this study, 222 patients who referred to lithotripsy clinic of Kashani hospital of Shahrekord to break stones with diameters of 5 to 20 mm participated in the study. Their urinary stones were in kidneys, lower calyces, upper calyces, pelvis or proximal ureter and were divided into two equal groups of BMI &gt;25 kg/m2 and BMI &lt;25 kg/m2 . Assessing the position and diameter of the stones was based on radiographic findings such as sonography and CT scan. Regarding success, failure and complications of lithotripsy, two groups were compared. Results: Around 105 and 117 patients out of 222 subjects, were respectively assigned in BMI&gt;25 kg/ m2 and BMI &lt;25 kg/m2 groups. The failure and success of both groups were statistically significant (P=0.023). In terms of treatment outcomes, difference between two groups was high in low skinto-stone distance (SSD). Logistic regression showed that both BMI and SSD are effective factors in treating the stone while SSD was more effective (P=0.004) than BMI (P=0.023) since SSD&gt;7.5 cm predicts treatment failure. Conclusion: BMI and SSD are effective factors on the outcome of ESWL. Higher BMI and SSD&gt; 7.5 cm are effective factors on treatment failure.

Predictive factors of successful extracorporeal shockwave lithotripsy (ESWL) for renal stones: evidence of retrospective study

Background:&#x0D; Extracorporeal shockwave lithotripsy (ESWL) has proved to be effective in treating ureterolithiasis. This study aimed to investigate the predictive factors related to success ESWL among patient presented with renal stone.&#x0D; Methods: &#x0D; A retrospective study was conducted among 40 patients who underwent ESWL at the urology department, Baquba Teaching Hospital, Diyala University, Iraq. Data was collected between1st October 2018 and 31st January 2019 for renal stones diagnosed by non-enhanced spiral computed tomography (NCCT). The success rate defined as no stone or the remnant stones &lt; 4 mm. We analyzed predictive factors by using multiple linear regression.&#x0D; Results: &#x0D; The success rates ranged from 50-90%. In the univariate analysis, body mass index (BMI), skin-to-stone distance (SSD)and the renal stone-attenuation value (in Hounsfield units, HU) were found to be significantly correlated with the outcome of ESWL (p&lt;0.05). However, in the multiple linear regression, only the HU (B = -0.619, P &lt; 0.0001; 95% confidence interval [CI]:0.03 to 0.07) was theindependent predictive factor.&#x0D; Conclusion: &#x0D; Hounsfield Unit is an independent predictive factor influencing the success of ESWL for treating renal stones.

The Influence of Pain on the Outcome of Extracorporeal Shockwave Lithotripsy

Introduction: The aim of this study was to determine the predictive value of pain scores on the efficacy of extracor-poreal shockwave lithotripsy (ESWL) and to identify other predictive risk factors for treatment success. Materials and Methods: A total of 476 patients who underwent ESWL (piezoelectric lithotripsy) for urolithiasis between September 2011 and December 2015 were identified. The primary end-point of this study was success rate, which was evaluated 4 months after ESWL. The secondary outcome was the occurrence of complications as a result of ESWL. Results: The average pain perception was reported at 5 on a scale from 0 to 10. The overall success rate of ESWL was found to be 43.9% and the success rate after the first ESWL was 35.1%. Univari-ate analysis showed no significant correlation between pain score and success of ESWL (p = 0.135). The level of intensity was correlated with pain scores (Pearson correlation -0.423, p < 0.001). Univariate analysis identified five predictive factors: sex, stone location, stone size, hydronephrosis and the use of tamsulosin. Multivariate logistic regression analysis showed that sex, stone location and size independently in-fluenced the success of ESWL (p = 0.045, p = 0.001 and p < 0.001). Conclusion: No correlation was found between the pain scores and efficacy of ESWL. Despite this absence, pain scores during ESWL sessions remain high and additional analgesia would improve patient satisfaction.

Single extracorporeal shock-wave lithotripsy for proximal ureter stones: Can CT texture analysis technique help predict the therapeutic effect?

PurposeTo explore whether the computed tomography texture analysis (CTTA) technique can help predict the curative effects of a single extracorporeal shock-wave lithotripsy (ESWL) for proximal ureteral stones. Materials and methodsIn all, 100 patients with proximal ureteral stone underwent non-enhanced multi-detector computed tomography (MDCT) before ESWL. The patients were divided into success and failure groups. Success of ESWL was defined as the patients being stone-free or having residual stone fragments of ≤2 mm. Traditional characteristics, such as stone size, body mass index (BMI), and skin-to-stone distance (SSD), and CTTA metrics, such as the mean Hounsfield unit (HU) density, entropy, kurtosis, and skewness, were analyzed and compared between two groups by univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were generated to determine Youden index-based cutoff values. ResultFailure of stone removal was observed in 36 patients (36%). Stone height, stone cross-sectional diameter, largest cross-sectional area, stone volume, stone density (mean HU), and CTTA metrics (kurtosis and entropy) were the significant independent predictors of ESWL success on univariate analysis (p < 0.05). On multivariate analysis, mean HU, skewness, and kurtosis were shown to be significant predictors of ESWL success (p < 0.05). In subgroup analysis based on the cutoff value of mean stone density (HU = 857), the only significant independent factor associated with both subgroups was kurtosis (p < 0.05). ConclusionsAs a quantitative analysis method, CTTA may be helpful in selecting appropriate ESWL patients. High kurtosis and low mean HU values simultaneously indicate a relatively higher ESWL success rate.