Effect of Skin-to-Stone Distance on Shockwave Lithotripsy Success

Jacobs, Bruce L.; Smaldone, Marc C.; Smaldone, Arlene; Ricchiuti, Daniel; Averch, Timothy D.

doi:10.1089/end.2008.0169

Cited by 29 publications

(15 citation statements)

References 29 publications

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“…The efficacy of SWL was decreased in patients with higher serum creatinine concentrations in our study, which is compatible with other reports [29,30]. Lee et al.…”

Section: Discussionsupporting

confidence: 93%

Noncontrast computed tomography can predict the outcome of shockwave lithotripsy via accurate stone measurement and abdominal fat distribution determination

Geng¹,

Tu²,

Shih³

et al. 2014

The Kaohsiung J of Med Scie

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Urolithiasis is a common disease of the urinary system. Extracorporeal shockwave lithotripsy (SWL) has become one of the standard treatments for renal and ureteral stones; however, the success rates range widely and failure of stone disintegration may cause additional outlay, alternative procedures, and even complications. We used the data available from noncontrast abdominal computed tomography (NCCT) to evaluate the impact of stone parameters and abdominal fat distribution on calculus-free rates following SWL. We retrospectively reviewed 328 patients who had urinary stones and had undergone SWL from August 2012 to August 2013. All of them received pre-SWL NCCT; 1 month after SWL, radiography was arranged to evaluate the condition of the fragments. These patients were classified into stone-free group and residual stone group. Unenhanced computed tomography variables, including stone attenuation, abdominal fat area, and skin-to-stone distance (SSD) were analyzed. In all, 197 (60%) were classified as stone-free and 132 (40%) as having residual stone. The mean ages were 49.35 ± 13.22 years and 55.32 ± 13.52 years, respectively. On univariate analysis, age, stone size, stone surface area, stone attenuation, SSD, total fat area (TFA), abdominal circumference, serum creatinine, and the severity of hydronephrosis revealed statistical significance between these two groups. From multivariate logistic regression analysis, the independent parameters impacting SWL outcomes were stone size, stone attenuation, TFA, and serum creatinine. [Adjusted odds ratios and (95% confidence intervals): 9.49 (3.72-24.20), 2.25 (1.22-4.14), 2.20 (1.10-4.40), and 2.89 (1.35-6.21) respectively, all p < 0.05]. In the present study, stone size, stone attenuation, TFA and serum creatinine were four independent predictors for stone-free rates after SWL. These findings suggest that pretreatment NCCT may predict the outcomes after SWL. Consequently, we can use these predictors for selecting the optimal treatment for patients with urinary stones.

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“…The efficacy of SWL was decreased in patients with higher serum creatinine concentrations in our study, which is compatible with other reports [29,30]. Lee et al.…”

Section: Discussionsupporting

confidence: 93%

Noncontrast computed tomography can predict the outcome of shockwave lithotripsy via accurate stone measurement and abdominal fat distribution determination

Geng¹,

Tu²,

Shih³

et al. 2014

The Kaohsiung J of Med Scie

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“…SSD as a predictor of SWL success remains controversial. Until recently, SSD was a significant factor in a half of published studies, and in the rest studies, there was no significant difference in SSD for success or stone-free rate after SWL [22][23][24][25][26][27]. In the present study, SSD was also not a significant predictor for one-session stone-free status after SWL.…”

Section: Discussioncontrasting

confidence: 58%

94 Impact of colic pain as a significant factor for predicting the stone free rate of one-session shock wave lithotripsy for treating ureter stones: A Bayesian logistic regression model analysis

Cho

et al. 2015

European Urology Supplements

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PurposeThis study was conducted to evaluate colic pain as a prognostic pretreatment factor that can influence ureter stone clearance and to estimate the probability of stone-free status in shock wave lithotripsy (SWL) patients with a ureter stone. Materials and MethodsWe retrospectively reviewed the medical records of 1,418 patients who underwent their first SWL between 2005 and 2013. Among these patients, 551 had a ureter stone measuring 4-20 mm and were thus eligible for our analyses. The colic pain as the chief complaint was defined as either subjective flank pain during history taking and physical examination. Propensity-scores for established for colic pain was calculated for each patient using multivariate logistic regression based upon the following covariates: age, maximal stone length (MSL), and mean stone density (MSD). Each factor was evaluated as predictor for stonefree status by Bayesian and non-Bayesian logistic regression model. ResultsAfter propensity-score matching, 217 patients were extracted in each group from the total patient cohort. There were no statistical differences in variables used in propensity-score matching. One-session success and stone-free rate were also higher in the painful group (73.7% and 71.0%, respectively) than in the painless group (63.6% and 60.4%, respectively). In multivariate non-Bayesian and Bayesian logistic regression models, a painful stone, PLOS ONE |

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“…When the skin-to-stone distance is large, the stone cannot be positioned precisely at the focal point of the lithotripter without inverting the cushion of the treatment head—a situation almost certain to produce very poor coupling. Data on the trade-off between coupling and positioning of the stone along the axis of a lithotripter in obese patients have never been reported, although tellingly a recent study found no effect of skin-to-stone distance when using the HM3, a lithotripter for which coupling is not an issue 103. With many lithotripters, however, the stone can be broken even if it is positioned distal to the focal point 104.…”

Section: Other Challengesmentioning

confidence: 99%

Shock wave lithotripsy: advances in technology and technique

et al. 2009

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Shock wave lithotripsy (SWL) is the only noninvasive method for stone removal. Once considered as a primary option for the treatment of virtually all stones, SWL is now recognized to have important limitations that restrict its use. In particular, the effectiveness of SWL is severely limited by stone burden, and treatment with shock waves carries the risk of acute injury with the potential for long-term adverse effects. Research aiming to characterize the renal response to shock waves and to determine the mechanisms of shock wave action in stone breakage and renal injury has begun to suggest new treatment strategies to improve success rates and safety. Urologists can achieve better outcomes by treating at slower shock wave rate using a step-wise protocol. The aim is to achieve stone comminution using as few shock waves and at as low a power level as possible. Important challenges remain, including the need to improve acoustic coupling, enhance stone targeting, better determine when stone breakage is complete, and minimize the occurrence of residual stone fragments. New technologies have begun to address many of these issues, and hold considerable promise for the future.

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Effect of Skin-to-Stone Distance on Shockwave Lithotripsy Success

Abstract: Multiple variables have been shown to be associated with SWL success. In our sample of patients with preoperative CT scans, SSD was found to have no effect on SWL success.

Cited by 29 publications

References 29 publications

Noncontrast computed tomography can predict the outcome of shockwave lithotripsy via accurate stone measurement and abdominal fat distribution determination

Noncontrast computed tomography can predict the outcome of shockwave lithotripsy via accurate stone measurement and abdominal fat distribution determination

94 Impact of colic pain as a significant factor for predicting the stone free rate of one-session shock wave lithotripsy for treating ureter stones: A Bayesian logistic regression model analysis

Shock wave lithotripsy: advances in technology and technique

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