Success Rate Of Extracorporeal Shock Wave Lithotripsy Research Articles

Determing the success rate of extracorporeal shock wave lithotripsy in renal pelvis stone of 1-2 cm in size.

Background: Despite its historical significance, ESWL has witnessed changes in its role, necessitating refined technical approaches and stringent patient selection criteria for optimal outcomes. This study aims to assess the efficacy of extracorporeal shock wave lithotripsy (ESWL) for treating renal pelvis stones ranging from one to two centimeters in size.Methodology: A descriptive case series was conducted at the Department of Urology and Renal Transplantation, SIUT, Karachi. The study enrolled 81 patients aged 20 to 60, of both genders, with a single renal pelvis stone sized 1 2 cm. Patients with ureteral obstruction were excluded. Informed consent was obtained before performing extracorporeal shock wave lithotripsy (ESWL). Follow ups were carried out regularly, and final success was assessed one month post ESWL session.Results: The mean age of participants was 41.93 ± 9.67 years, with the majority (54.32%) falling within the 41 to 60 age range. Out of 81 patients, 49 (60.49%) were male and 32 (39.51%) were female, resulting in a male-to-female ratio of 1.5:1. The mean stone size was 14.22 ± 2.01 mm. In the study, the success rate of ESWL for renal pelvis stones sized 1-2 cm was 85.19%, with 69 patients showing successful outcomes.Conclusion: In conclusion, the success rate of ESWL for treating renal pelvis stones sized 1-2 cm is notably high. This finding underscores the effectiveness of this non-invasive procedure in managing such cases.

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<0.01). The occurrence of complications had a significant relationship with the location of the stone (p<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.

Investigating ESWL success rate in the treatment of renal and ureteral stones in children.

Extracorporeal shock wave lithotripsy (ESWL) is one of the most important methods of treatment for stone in children. Therefore, this study was conducted to determine the success rate of ESWL in the treatment of kidney and ureteral stones in children referred to Hasheminejad kidney center during the second half of 2018. This observational prospective study was conducted on 144 children referred to Hasheminejad kidney center during the 2018. The patients were selected using the convenience sampling method. The study was investigating the success rate of ESWL in the treatment of kidney and ureteral stones and effective factors in this regard. A total of 133 patients (92.4%) had stone passage and 37.5% of patients had residual stones, 28.5% of which were less than 5 mm in diameter. Successful results were seen in 131 cases (91%). Successful results were significantly higher in males (p = 0.011) and lower in simultaneous stones in the middle calyx and lower calyx (p = 0.0001). According to the results of this study, it can be inferred that ESWL success rate was above 90% in the treatment of kidney and ureteral stones in children in such a way that with an ESWL session in patients who have been properly selected for this procedure, a success rate of about 62.5% will be available to remove any residual fragments, and nearly 28.5% have residual fragments with a diameter of smaller than 5 mm, which is basically hopeful for a high urinary passage. The present study shows that type and stone location are the factors contributing to the successful ESWL and shows the female gender and the presence of stone in the lower and middle calyx are the risk factors for the lower ESWL success rate.

Factors Affecting the Outcome of Extracorporeal Shockwave Lithotripsy in Urinary Stone Treatment

Background and aim: The recurrence of urinary stones occurs in two thirds of patients within a 20-year period, making urinary stones a common pathology. Among urology pathologies, kidney stones rank third behind urinary infections and conditions of the prostate. The present study intended to assess various factors affecting the extracorporeal shockwave lithotripsy (ESWL) outcome in urinary stone treatment. Methods: This cross-sectional study was carried out on 136 urinary stone patients who underwent extracorporeal shockwave lithotripsy in the Department of Urology, Sahiwal Teaching Hospital, Sahiwal for the duration from September 2021 to August 2022. Computed tomography confirmed the presence of stones and measured the size (3-20 mm), distance from skin to stone, location, and density in Hounsfield units. Patient’s characteristics such as estimated rate of glomerular filtration and BMI were measured. A successful ESWL requires at least a 3mm residual renal stone fragment in post-therapy, and at least a complete clearance of ureteric stones at the end of treatment. SPSS version 26 was used for descriptive statistic. Results: Of the total 136 urinary stone patients, there were 108 (79.4%) male and 28 (20.6%) females. The incidence of stones present in proximal ureter, mid, and distal ureter was 72 (52.9%), 7 (5.1%), and 57 (41.9%) respectively. All the patients underwent ESWL 1.5 times (average), and the success rate in first, second, and third session was 67.8% (n=92), 83.8% (n=114), and 91.2% (n=124) respectively. The overall success rate of ESWL was 80.9%. A multivariate analysis revealed that HU [OR=0.89, 95% CI, 0.96-0.98, P=0.001) and stone size [OR=0.79, 95% CI, 0.62-0.98, P=0.051] were significantly affecting the first ESWL session success rate. Third session success rate was significantly affected by stone size [OR=0.76, 95% CI, 0.58-0.95, P=0.015]. Stent associated higher failure rate [OR=6.425, 95% CI, 2.132-18.235, p=0.001] and ESWL failure was three-times higher in females than in male. Conclusion: The present study found that the overall success rate of ESWL in urinary stone treatment was 80.9%. ESWL success rates were affected by stone size and HU. Patients' pain and fragmentation levels should be considered when adjusting the intensity of ESWL. Keywords: Urinary stone treatment, Outcomes, Extracorporeal shockwave lithotripsy

Extracorporeal Shock Wave Lithotripsy Success Rate and Prognostic Factors

Background: Urinary tract stones are common urological problems with a considerable burden worldwide. Management strategies mostly rely on the stone’s characteristics and the patient’s clinical conditions. Extracorporeal shock wave lithotripsy (ESWL) is a method of choice for managing small calculus. However, the success rate of ESWL and the prognostic factor of success widely vary among different studies. The aim of the present study was to evaluate these prognostic factors in an Iranian population undergoing ESWL. Methods: The present retrospective study was conducted in Imam Ali Hospital of Bojnurd, Iran. Every patient who was referred for the ESWL of distal urethral calculus (5-20 mm) and failed to respond to medical treatment enrolled in this study. The prevalence and relationship between various individual factors and ESWL outcomes were evaluated among the study patients. Results: Among 49 patients (24 males and 25 females) who had urinary tract stones, the mean (±standard deviation) of age was 42.7 (14.04) years. ESWL could successfully treat urinary tract stones in 43 patients (85%). The kidney stone diameter was not related to having a successful procedure (P=0.447). Moreover, the stroke number and receiving tamsulosin were not significantly associated with favorable ESWL outcomes (P=0.909 and P=0.590, respectively). Twenty-seven patients (45.1%) received pethidine during the procedure. There was a significant relationship between receiving analgesics and favorable ESWL outcomes (P=0.033). Conclusion: The results demonstrated that 85% of the distal urinary tract stones that are smaller than 20 mm can be successfully managed by ESWL, and providing analgesics was significantly related to better outcomes.

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.

A Prospective Longitudinal Study onthe Predictability of Quadruple-D Score in the Success Rate of Extracorporeal Shock Wave Lithotripsy for Renal Stones 1-2cm in Diameter

Introduction: Quadruple-D, based on Computed Tomography (CT) derived metrics, is a scoring system that helps urologists to predict the Stone Free Rate (SFR) following Extracorporeal Shock Wave Lithotripsy (ESWL) in renal stones. Aim: To evaluate the efficacy of Quadruple-D scoring system to assess the SFR in individuals with renal stones measuring 1-2 cm in diameter after giving ESWL. Materials and Methods: The study was conducted on 120 patients. Systemic random sampling technique was applied with a sampling interval of two. Quadruple-D scoring, comprising of four Computed Tomography (CT) based metrics that is stonedimension, stone density, Hounsfield units (HU), Skin-to-Stone Distance (SSD) and stone location, was done prior to ESWL. The scores ranged from zero (worst) to four (best) points. Plain abdominal radiography was done three weeks after ESWL to assess SFR. Complete clearance was considered the stone free status. Patients were divided into group A with complete stone clearance and group B with residual stone. All the statistical analysis was done using IBM SPSS 26.0. Student’s t-test or Mann-Whitney U-test was used to compare continuous variables. Fisher’s-exact test and Chi-square test were used to analyse the cross charts between two categories. Results:The mean ellipsoid Stone Volume (SV) was 396.44±163.23 mm3 and 395.81±227.52 mm3 in group A and B, respectively. The stone density was 724.28±210.90 in group A and 814.56±190.63 in group B. In group A, 9.20% and in group B, 34.09% of the patients had stones in lower calyx. The difference between the groups based on the above parameters were statistically significant. The Quadruple-D score was 2.09±0.65 and 1.54±0.79 in group A and B, respectively. The Area Under the Curve (AUC) of Quadruple-D scoring system was 0.674. The age, sex, BMI, laterality of the stone and SSD did not predict stone-free status in this study. Conclusion: Quadruple-D scoring system has been successfully validated as the SFR showed a parallel increase with every positive component. Quadruple-D is an easy to use clinical tool to predict the success rate of ESWL.

Evaluation of Factors Influencing Outcome of Extracorporeal Shock Wave Lithotripsy (Eswl) for Renal Stone in Adult

Background: Renal stone disease is a common disorder with a prevalence ranging from 4-15% in different parts of the world. Modalities of kidney stone management includes drug therapy, extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), Retrograde intrarenal surgery ureteroscopy (RIRS) and open surgery. ESWL is an acceptable technique and widely used because it is a non-invasive treatment and does not require anesthesia and usually done on an outpatient basis. Generally, ESWL is the treatment of choice for kidney stones &lt;1 cm. However, not all ESWL treatments are successful. The success rate has been reported to be between 50%-87%, depending on various factors. This study was conducted in order to evaluate thefactors affecting renal stones treatment by extracorporeal shock wave lithotripsy (ESWL).On the basis of different variables andfactors affecting the renal stones treatment by ESWL was evaluated. Objectives: To evaluate the factors affecting the outcome of Extracorporeal Shock Wave Lithotripsy (ESWL) in the treatment of renal stone in adults.To assess the success and failure rate by using ESWL for treatment of renal stone, to determine the effects of stone related factors to correlate the success rate with characteristics of the patients condition of the urinary tract and stone features; to observe the patient groups most likely to benefit from or fail an initial intervention with ESWL and to evaluate the post ESWL complications. Materials and methods: This is a prospective observational and analytical, hospital based study. Total 500 patients with single or multiple radio-opaque renal stones were treated with ESWL monotherapy using Siemens MODULARIS Variostarlithotriptor. This study was carried out inthe Department of Urology, Combined Military Hospital, Dhaka for a period of two years between 01 July 2015 to 31 July 2017. The results of treatment were evaluated after 3 months of follow-up. Treatment success was defined as complete clearance of the stones or presence of clinically insignificant residual fragments (&lt;3mm). The results of treatment were correlated with the patient characteristics (age, sex, body mass index) and stone features (size, site, number &amp; radio density). Results: At 3-months follow-up, the overall success rate is 87.6%. Among them, repeated ESWL sessions were required in 266 patients (53.2%). Post-ESWL complications were recorded in 62 patients (12.4%). Using the chi-square test, only four factors have a significant impact on the success rate, namely stone site, size (the largest diameter of the stone), stone number, BMI (body mass index) of the patient. The success rate is highest for stones located in the upper calyx (136/136; 100%) and lowest for those located in lower calyx 104/78; 75%) (p=0.001). Stone with a largest diameter of &lt;10mm are associated with a success rate of 93.6% (307/328), compared to 76.2% (131/172) for those with a diameter of &gt;10mm (p=0.001). The success rate was also higher for single stone (396/437; 90.6%) than multiple stones (42/63; 66.7%) (p=.001). Patients with lower BMI (&lt;24) have a better success than higher BMI (&gt;25) (p=.001). Other factors including age, sex and stone radio density compared to ipsilateral 12th rib have no significant impact on the success rate. Conclusion: The success rate of ESWL for the treatment of renal stones can be predicted by stone size, location, number, and patients BMI. Bangladesh Journal of Urology, Vol. 22, No. 2, July 2019 p.141-150

Prognostic Factors of Success of Extracorporeal Shock Wave Lithotripsy 46 (ESWL) in The Treatment of Renal Stones.

Background: Renal calculi are common approximately 50% of patient between the ages of 30and 50 years. The development of endourological and extracorporeal lithotripsy techniques ledto an increasing number of options for the management of renal calculi.&#x0D; Objective: To define factors those have a significant impact on the success rate after extracorporealshock wave lithotripsy (ESWL) for treatment of renal stones.&#x0D; Materials and Methods: Between April 2008 &amp; December 2008, 64 patients with single ormultiple radiopaque renal stones (::s;30mm) were treated with ESWL monotherapy using StortzModulith SLX-F2 lithotriptor.The results of treatment were evaluated after 3 months of followupTreatment success was defined as complete clearance of the stones or presence ofclinically insignificant residual fragments (::s;4mm).The results of treatment were correlated withthe patient characteristics (age, sex, body mass index) and stone features (size, site, nature &amp;radio density).&#x0D; Results: At 3-months follow-up, the overall success rate is 76%. Among them, repeated ESWLsessions are required in 19 patients (53.9%). Post-ESWL complications are recorded in 8patients (12.5%). Using the x2 test, only three factors have a significant impact on the successrate, namely: stone site, size (the largest diameter of the stone), stone number &amp; BMI (BodyMass Index). The success rate is highest for stones located in the upper calyx (15/15; 100%)and lowest for those located in the lower calyx (10/16; 62.5%) (p=.005). Stones with a largestdiameter ot s 15mm are associated with a success rate of 90.2% (37 /41), compared to 52.2%(12/23) for those with a diameter of &gt;15mm (p=.001). The success rate is also higher forsingle stone (46/56; 82%) than multiple stones (3/8; 37.5%) (p=0.005).Patients with lowerBMI (&lt;24) have a better success than higher BMI (&gt;25) (p=0.01)&#x0D; Conclusion: The success rate of ESWL for the treatment of renal stones can be predicted bystone size, location, number and patient BMI.&#x0D; Journal of Surgical Sciences (2016) Vol. 20 (2) :46-50

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.

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.

Patients’ Characteristics and Factors Influencing Success Rate of ESWL in Rumah Sakit Umum Daerah Kardinah, Tegal

Objective: To evaluate which factors influencing success rate of extracorporeal shock wave lithotripsy (ESWL) in Kardinah Hospital Tegal. Material &amp; methods: This was a retrospective study from secondary database of patients diagnosed with ureter or kidney stone whom underwent ESWL procedure in RSUD Kardinah Tegal from April 2012 to November 2015. Multivariate analysis and Chi-square analysis from SPSS ver. 19 were used to evaluate all the factors related to success rate of ESWL. Results: There were 314 patients included in this study with 59.5% of them were male patients. The average age of patients was 50 ± 5.5 years old. In 256 cases of kidney stones, there were 69 (26.9%) cases with size &lt;10mm, 160 (62.5%) cases with a size of 10-20mm, and with a size &gt;20mm by 27 (10.5%) cases. For ureteral stones, there were 46 (79.3%) cases with size &lt;10mm, 11 (18.9%) cases with a size of 10-20mm, and 1 (1.7%) case with size &gt;20mm. In general there were 238 (75.7%) of patients received no additional ESWL procedure while 61 (19.4%) patients underwent 2nd ESWL procedure, 33 (10.5%) patients underwent 3rd ESWL procedure, and 11 (3.5%) patients underwent more than 4 ESWL procedures. Kidney stones with a size &lt;10mm, ureteral stones with size &lt;10mm got, and location of the stone had p value of p=0.0015, p=0.001, and p=0.031 respectively. Other factors such as gender, age, stone opacity, and the number of shock given did not affect the success of ESWL. Type of lithotripter were not related to SFR in patient with kidney stone but was significantly related in ureter stone with p=0.078 and p=0.04 respectively. Conclusion: Most of patients reached stone free condition after the first ESWL procedure. Factors that influence the success of ESWL were the stone size and stone location. Kidney stone size &lt;10mm and ureter stone &lt;10mm had the highest SFR. Types of lithotripter were not related to SFRs in patients with kidney stone but were significantly related in ureteral stone with Medispec EM1000 electromagnetic and Huikang HK-V electromagnetic had the highest SFRs.

Role of multidetector computed tomography without contrast enhancement in predicting the outcome of extracorporeal shock wave lithotripsy for urinary calculi

Objective: The aim of this study was to evaluate the role of nonenhancing computed tomography as a predictive factor for successful extracorporeal shock wave lithotripsy (ESWL) for urinary calculi to avoid the cost of ineffective ESWL. Background: Urolithiasis is a universal problem. Many methods of treatment of urolithiasis are described, among which is ESWLs. The outcome of ESWL is affected by several factors. Multidetector computed tomography (MDCT) can aid the localization of calculi and may provide accurate anatomical detail, providing valuable data such as stone size and stone density as predictors for ESWL success. Materials and methods: This study included 54 patients who presented with symptomatic renal colic and hematuria at the ESWL unit. ESWL was used as the primary treatment option for all patients. All patients were investigated by MDCT before and after ESWL treatment. Successful ESWL was defined when a patient had achieved complete clearance of the stone fragments or had small residual gravels of size less than 4 mm. ESWL failure was defined as no breakage of the stone after three sessions. Results: A high rate of ESWL success after a second session of ESWL was achieved in 26 cases (48.1%), followed by a first session in 15 cases (27.8%), with an overall success rate of 90.7% in 49 cases. Also, smaller size and density of urinary stones will increase the success rate of ESWL. Conclusion: MDCT can be used to provide valuable data on urinary stones to aid treatment decisions and predict the outcome of ESWL.

Prediction of successful treatment by extracorporeal shock wave lithotripsy based on crystalluria-composition correlations of urinary calculi

ObjectiveTo provide correlations between crystalluria and chemical structure of calculi in situ to help making decision in the use of the extracorporeal shock wave lithotripsy (ESWL). MethodsA crystalluria study was carried out on 644 morning urines of 172 nephrolithiasis patients (111 males and 61 females), and 235 of them were in situ stone carriers. After treating by ESWL, the recovered calculi have been analyzed by Fourier transform infrared spectroscopy and their compositions were correlated to the nature of urinary crystals. ResultsWe obtained successful treatment for 109 patients out of 157 and 63 patients out of 78 with stones had a treatment failure (33.2%). The correlations showed that for the overwhelming crystalluria containing calcium oxalate dihydrate (COD) with mixed crystals without calcium oxalate monohydrate, we should have 68% to 88 % success rate. However, the obtained result was 79%. Similarly, for crystalluria with COD + calcium oxalate monohydrate ± carbapatite, the prediction was 11% to 45% and the result was approximately 39%. When the majority of crystalluria was calcium phosphate, the prediction of 50% to 80% was confirmed by 71% success rate. For those majority containing magnesium ammonium phosphate hexahydrate (struvite) ± diammonium urate ± COD, we predicted between 80% to 100%, and the result gave a success rate of 84%. ConclusionsThe analysis of crystalluria of morning urine can help to know the composition of calculi in situ and can predict the success rate of ESWL for maximum efficiency.

Efficacy of Extracorporeal Shock Wave Lithotripsy in Pediatric and Adolescent Urolithiasis

PurposeTo retrospectively evaluate the efficacy of extracorporeal shock wave lithotripsy (ESWL) by age and current condition as a first-line treatment for pediatric and adolescent urolithiasis.Materials and MethodsThe computerized records of 55 children were retrospectively reviewed from March 1991 to July 2007. The children were below 18 years of age and had undergone ESWL monotherapy for urolithiasis. There were 36 boys (65.5%) and 19 girls (34.5%), with a mean age of 8.5 years (range, 0.5-18 years). There were 24 patients aged 7 years or less and 31 patients aged more than 7 years.ResultsThe mean size of the stones was 9.48 mm (range, 4-22 mm). The overall success rate of ESWL was 90.9% (50 children). The mean number of ESWL sessions was 2.02 (range, 1-10). The mean number of ESWL sessions for the patient group aged 7 years or less was 1.16 (range, 1-2) and that for the patient group aged more than 7 years was 2.97 (range, 1-10; p=0.037). There was also a statistically significant difference in the mean number of ESWL sessions between the younger and older patients who needed general anesthesia (1.16 vs. 2.2 sessions, respectively; 0.042).ConclusionsIn the patient group aged 7 years or less, the number of ESWL sessions and the complication rate were comparable with those for endoscopic management. Thus, ESWL is an effective first-line treatment modality for patients aged less than 7 years.

A 970 Hounsfield units (HU) threshold of kidney stone density on non‐contrast computed tomography (NCCT) improves patients' selection for extracorporeal shockwave lithotripsy (ESWL): evidence from a prospective study

What's known on the subject? and What does the study add? Stone density on non-contrast computed tomography (NCCT) is reported to be a prognosis factor for extracorporeal shockwave lithotripsy (ESWL). In this prospective study, we determined that a 970 HU threshold of stone density is a very specific and sensitive threshold beyond which the likelihood to be rendered stone free is poor. Thus, NCCT evaluation of stone density before ESWL may useful to identify which patients should be offered alternative treatment to optimise their outcome. • To evaluate the usefulness of measuring urinary calculi attenuation values by non-contrast computed tomography (NCCT) for predicting the outcome of treatment by extracorporeal shockwave lithotripsy (ESWL). • We prospectively evaluated 50 patients with urinary calculi of 5-22 mm undergoing ESWL. • All patients had NCCT at 120 kV and 100 mA on a spiral CT scanner. Patient age, sex, body mass index, stone laterality, stone size, stone attenuation values (Hounsfield units [HU]), stone location, and presence of JJ stent were studied as potential predictors. • The outcome was evaluated 4 weeks after the ESWL session by NCCT. • ESWL success was defined as patients being stone-free (SF) or with remaining stone fragments of <4 mm, which were considered as clinically insignificant residual fragments (CIRF). • Our survey concluded that 26 patients (52%) were SF, 12 (24%) had CIRF and 12 (24%) had residual fragment on NCCT after a one ESWL treatment. • Stones of patients who became SF or had CIRF had a lower density compared with stones in patients with residual fragments [mean (sd) 715 (260) vs 1196 (171) HU, P < 0.001]. • The Youden Index showed that a stone density of 970 HU represented the most sensitive (100%) and specific (81%) point on the receiver-operating characteristic curve. • The stone-free rate for stones of <970 HU was 96% vs 38% for stones of ≥ 970 HU (P < 0.001). A linear relationship between the calculus density and the success rate of ESWL was identified. • The use of NCCT to determine the attenuation values of urinary calculi before ESWL helps to predict treatment outcome, and, consequently, could be helpful in planning alternative treatment for patients with a likelihood of a poor outcome from ESWL.

Relationship between the Success of Extracorporeal Shock Wave Lithotripsy (ESWL) and the Degree of Hydronephrosis when Treating Patients with Upper Ureteral Stones

Purpose: We tried to determine the relation between the degree ofstoneinduced hydronephrosis and the outcome of extracorporeal shock wave lithotripsy (ESWL) when treating patients with solitary upper ureteral stone. Materials and Methods: 260 proximal ureteral stone patients with or without hydronephrosis were treated with ESWL between January 2003 and December 2006 and 8 of these patients were lost to follow up. The degree of hydronephrosis was defined by performing renal ultrasound. The patients were divided into four groups according to the degree of hydronephrosis. Group 0 (n=30) had no urinary system dilatation, group 1 (n=123) had a mild dilatation of the renal pelvis but no renal calices, group 2 (n=75) had a moderate dilatation of the renal pelvis and group 3 (n=24) had a severe dilatation of the renal pelvis and calices. In addition to the degree of hydronephrosis, the stone size, number of sessions, number of shockwave treatments applied and the success rate of ESWL were recorded. Results: The success rate after ESWL treatment was 92.9% (n=234). There were no statistically significant differences among the groups for the stone size, number of sessions and number of applied shockwave treatments. There were a trend for a decreased success rate of ESWL with an increased degree of hydronephrosis, but this did not reach statistical significance (p=0.436). After ESWL, a few patients encountered minor complications such as gross hematuria, flank pain, stone street, fever and perirenal hematoma. Yet most cases were treated conservatively and there was no need for hospitalization. Conclusions: For the patients in our study who had a solitary calculus in the upper ureter, the degree of hydronephrosis caused by the stone does not affect the success rate after ESWL. (Korean J Urol 2007;48:422-427)

A Prospective Multivariate Analysis of Factors Predicting Stone Disintegration by Extracorporeal Shock Wave Lithotripsy: The Value of High-Resolution Noncontrast Computed Tomography

ObjectiveTo assess the value of noncontrast computed tomography (NCCT) as a possible predictor of renal stone disintegration by shock wave lithotripsy (SWL). Patients and methodsThe study included 120 consecutive patients (71 males, 49 females; mean age: 42.6 yr) with a solitary renal stone of 0.5–2.5cm in length. NCCT was performed using a multidetector row CT scanner at 120KV and 240mA, with 1.25-mm collimation. A bone window was used to measure stone attenuation values. SWL was performed with an electromagnetic lithotripter. Failure of disintegration was defined as no fragmentation of the stone after three sessions. The impact of patients’ sex, age, and body mass index (BMI) and the stones’ laterality, location, volume, mean attenuation value, and the skin-to-stone distance on disintegration were evaluated by univariate and multivariate analyses. ResultsFailure of disintegration was observed in 15 patients (12.5%). BMI and stone density >1000HU were the significant independent predictors of failure (p=0.04 and 0.02, respectively). The success rate of extracorporeal SWL at 3 mo was 87.5% (105 of 120 patients); 90 patients were stone free and 15 had residual fragments <4mm. The only significant predictor of residual fragments was stone density (p<0.001). ConclusionsObesity and increased stone density as detected by NCCT are significant predictors of failure to fragment renal stones by SWL. An alternative treatment should be devised for obese patients with stone density >1000HU.

Prognostic Factors of Success of Extracorporeal Shock Wave Lithotripsy (ESWL) in the Treatment of Renal Stones

To evaluate the factors that affect the success rate of extracorporeal shock wave lithotripsy (ESWL) for treatment of renal stones. Between January 2000 and December 2003, 427 patients with single or multiple renal stones (< 30 mm, largest diameter) underwent ESWL monotherapy using Storz SL 20 lithotriptor. The results of treatment were evaluated after 3 months of follow-up. Treatment success was defined as complete clearance of the stones or presence of clinically insignificant residual fragments < 4 mm. The success rate was correlated with the characteristics of the patients, conditions of the urinary tract and stone features. At 3-month follow-up, the overall success rate was 333/427 (78%). Repeat treatment was needed in 226 patients (53.1%). Post-ESWL auxiliary procedures were required in 36 patients (8.4%). Post-ESWL complications were recorded in 16 patients (3.7%). Of the 10 prognostic factors studied, 5 had a significant impact on the success rate, namely: renal morphology, congenital anomalies, stone size, stone site and number of treated stones. Other factors including age, sex, nationality, stone nature (de novo or recurrent) and ureteric stenting had no significant impact on the success rate. The success rate of ESWL for the treatment of renal stones could be predicted by stone size, location and number, radiological renal features and congenital renal anomalies.

Extracorporeal shock wave lithotripsy of gallstones: 20th anniversary of the first treatment

Twenty years ago, in January 1985, extracorporeal shock wave lithotripsy (ESWL) was first applied successfully in a patient with gallbladder stones. In the following years, the conditions which influence the success rate of ESWL have been extensively investigated. It was shown that the characteristics of the stones, gallbladder emptying and the degree of stone fragmentation are the most important factors which determine the clearance of all fragments from the gallbladder after ESWL. Severe side effects, such as biliary pancreatitis and liver haematoma, were found to be rare and no deaths related to the procedure have been reported. One or more episodes of biliary pain were observed in about one third of patients within the first 3-4 months after ESWL. Follow-up studies after successful treatment, however, have shown that stone recurrence is considerable, limiting the use of ESWL as a non-invasive therapeutic option. Stone recurrence varies between different subgroups of patients indicating that gallbladder motor function and other less well defined factors may be of importance. The recurrence of stones after ESWL is one of the reasons why laparoscopic cholecystectomy has become the standard treatment of symptomatic gallbladder stones today. ESWL has kept its role only in the treatment of bile duct stones resistant to endoscopic extraction. Unless stone recurrence can be decreased by better patient selection and/or other measures to prevent gallstone recurrence, ESWL of gallbladder stones has little chance of surviving.