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Objective: To evaluate routinely applicable criteria to predict fragmentation of renal calculi by extracorporeal shock wave lithotripsy (ESWL). Patients and Methods: Two hundred and two consecutive patients (121 men, 81 women), median age 48 (range 19–81) years, were treated with the original Dornier HM-3 lithotriptor at a single stone center. Inclusion criteria were: solitary stones, 10–30 mm in greatest diameter, located in renal pelvis or calyces. Based on plain radiographs, the calculi were classified according to their size, form, location, density (compared to the 12th rib), structure and surface. Furthermore, age of the patient, gender and body mass index were also considered for evaluation. Disintegration was documented on day 1 after ESWL by plain X-ray. A multivariate regression analysis was applied to all preoperative parameters, based on the dual variable stone free versus residual fragments. Results: The overall disintegration rate was 95.5%; 42 patients (20.8%) were completely stone free, and 151 patients (74.7%) had clinically insignificant residual fragments (5 mm or smaller). 14.9% of men and 29.6% of women were stone free (p = 0.01). All other parameters did not reach statistical significance. Conclusions: The disintegration rate of the HM-3 is excellent for kidney stones; women did significantly better than men. However, because of this high disintegration rate, a much larger series would be necessary to define possible differences between preinterventional parameters, if there were any at all.

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ureteral stenting. The purpose of this study was to determine differences in patient comfort between 2 test and 2 control stents using a validated Ureteral Stent Symptom Questionnaire (USSQ).METHODS: Two hundred thirty-six patients were randomized in blinded fashion to receive I of 4 stents after a ureteroscopic procedure: P; PP; LLT; or SLT. Patient data were collected prospectively before and after stent placement and removal, 4 days after stent placement, and 30 days after stent removal. The primary endpoint was assessment of comfort as measured by location/extent of body pain and urinary tract symptoms.RESULTS: The 4 stent groups were demographically similar, and most patients (96%) had their stent removed on or after Day 4 (mean device indwell time was 4.1 days). Results of patient assessments (mean score ± standard deviation) on Day 4 and the change in score from Day 4 to Day 30 Post-Removal are summarized below. There was no statistically significant difference between any 2 stent groups. The adverse event profile was similar for test and control stents. Only 3 patients (I PP: 2 LL T) withdrew early from the study because of adverse events.CONCLUSIONS: We present the largest well-controlled clinical trial to employ the USSQ. Statistically significant improvement in comfort with the newly designed loop tail stents was not demonstrated. Two possible explanations are: I) the hypothesis was incorrect; or 2) the tool used to assess comfort (USSQ) was not sensitive enough to discern differences between test and control stents. Further study is warranted.

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