Factors influencing stone-free rate of Extracorporeal Shock Wave Lithotripsy (ESWL); a cohort study

Wagenius, Magnus; Oddason, Karl; Utter, Maria; Popiołek, Marcin; Forsvall, Andreas; Lundström, Karl-Johan; Linder, Adam

doi:10.1080/21681805.2022.2055137

Cited by 21 publications

(14 citation statements)

References 42 publications

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“…While calcium apatite stones and struvite stones are sensitive to ESWL, cystine stones are resistant [29]. Stone density can be found by calculating the HU value on non-contrast tomography [30]. However, due to the high radiation risk, non-contrast tomography is not recommended in pediatric patients unless it is necessary [31].…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal shock wave lithotripsy for urinary tract stones in pediatric patients: our 11 years of experience

Öncel

Salar

Bahçeci

2022

Preprint

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Purpose To reveal the efficacy of ESWL in pediatric patients and determine factors that will increase the success rate of this procedure. Materials and Methods The files of patients aged 16 years and under who underwent ESWL at our clinic between January 2010 and December 2021 were retrospectively reviewed. Age, gender, stone area, stone localization, number of sessions, energy and frequency used, complete stone-free status, and secondary intervention requirement were recorded. The absence of stone fragments or the presence of fragments smaller than 3 mm in imaging after ESWL was considered as success. Results This study included 433 pediatric patients. The mean age of the patients was calculated as 12.02 ± 4.67 (range, 1–16) years. The most important factors affecting the number of residual stones were stone localization (p = 0.045) and size (p < 0.0001). When stone localization was compared according to patient age, the patients with a higher age were found to have a significantly higher rate of stones in the proximal ureter than in the lower calyx of the kidney (p = 0.045) and renal pelvis (p = 0.048). Conclusion Based on our 11-year pediatric ESWL experience in our clinic, our stone-free rate increased compared to the first years we started to perform this procedure. Despite advances in laser breaker technology and micro and ultra-thin endoscopic instruments developed for stone intervention, ESWL can still be safely performed as the first choice in stones smaller than 20 mm.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal shock wave lithotripsy for urinary tract stones in pediatric patients: our 11 years of experience

Öncel

Salar

Bahçeci

2022

Preprint

View full text Add to dashboard Cite

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“…While calcium apatite stones and struvite stones are sensitive to ESWL, cystine stones are resistant [29]. Stone density can be found by calculating the HU value on non-contrast tomography [30]. However, due to the high radiation risk, non-contrast tomography is not recommended for pediatric patients unless it is necessary [31].…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal shock wave lithotripsy for urinary tract stones in pediatric patients: Our 11 years of experience

2022

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Background/Aim: Urinary system stone disease creates a significant burden on the health system. Many treatment methods are available, including extracorporeal shock wave lithotripsy (ESWL), endourological procedures, and open and laparoscopic procedures. In recent years, in parallel with technological developments, endourological devices have become more usable in the renal system. For this reason, urologists are opting for endourological procedures more frequently. ESWL is the least invasive procedure for urinary system stone disease, and it has a higher success rate in pediatric patients than in adults. In this retrospective cohort study, we analyzed the data from the pediatric cases in which we used ESWL treatment in our clinic. We aimed to reveal the effectiveness of ESWL and the factors that will increase the success rate of this procedure in light of the current literature. Methods: The files of patients aged 16 years and under who underwent ESWL at the Urology Clinic of University of Health Sciences Sanliurfa Mehmet Akif Inan Training and Research Hospital between January 2010 and December 2021 were retrospectively reviewed. Age, gender, stone area, stone localization, number of sessions, energy and frequency used, complete stone-free status, and secondary intervention requirement were recorded. The absence of stone fragments or the presence of fragments smaller than 3 mm only in imaging after ESWL was considered a success. Results: This study included 433 pediatric patients. The mean age of the patients was calculated as 12.02 (4.67) (range: 1–16) years. The most important factors affecting the number of residual stones were stone localization (P = 0.045) and size (P < 0.001). When stone localization was compared according to patient age, the older patients were found to have a significantly higher rate of stones in the proximal ureter than in the lower calyx of the kidney (P = 0.045) and renal pelvis (P = 0.048). Conclusion: Although there are continual advances in other minimally invasive surgical methods today, ESWL is a treatment method that can be safely applied in pediatric patients. Stone size and stone localization are the two most important factors affecting its success rate.

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“…Although SWL is less invasive than URS and unlike other treatment modalities does not require general anaesthesia, a wide range of factors described in the literature may in uence its e cacy [9]. Factors affecting SWL outcomes include stone size measured as one-dimensional stone length or stone volume, location, density, and skin-to-stone distance (SSD) [10][11][12][13][14]. Furthermore, parameters measured on computed tomography (CT) scans indicating an impacted ureteral stone also seem to be valuable predictors of SWL failure [15,16].…”

Section: Introductionmentioning

confidence: 99%

“…al., stone size and age were found to be independent predictive factors for SWL failure[12]. Ng et al observed that SSD measured vertically in patients with stones in the upper ureter had a signi cant predictive value for SWL outcomes[18].…”

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confidence: 99%

Finding the optimal candidate for shock wave lithotripsy: external validation and comparison of five prediction models

Popiołek

Jendeberg

Sundqvist

et al. 2023

Preprint

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Purpose To externally validate five previously published predictive models (Ng score, Triple D score, S3HoCKwave score, Kim nomogram, Niwa nomogram) for shock wave lithotripsy (SWL) single-session outcomes in patients with a solitary stone in the upper ureter. Methods Patients treated with SWL from September 2011 to December 2019 were included in a retrospective analysis. Patient-related variables were collected from the hospital records. Stone-related data including all measurements were retrieved from computed tomography prior to SWL. We estimated discrimination using area under the curve (AUC), calibration, and clinical net benefit based on decision curve analysis (DCA). Results A total of 384 patients with proximal ureter stones treated with SWL were included in the analysis. Median age was 55.5 years, and 282 (73%) of the sample were men. Median stone size was 8.0 mm. All models significantly predicted the SWL outcomes after one session. S3HoCKwave score, Niwa, and Kim nomograms had the highest accuracy in predicting outcomes, with AUC 0.716, 0.714 and 0.701, respectively. These three models outperformed both the Ng (AUC: 0.670) and Triple D (AUC: 0.667) scoring systems, approaching statistical significance (P = 0.05). Of all the models, the Niwa nomogram showed the strongest calibration and highest net benefit in DCA. Conclusions The models showed small differences in predictive power. The Niwa nomogram, however, demonstrated acceptable discrimination, the most accurate calibration, and the highest net benefit whilst having relatively simple design. Therefore, it could be useful for counselling patients with a solitary stone in the upper ureter.

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Factors influencing stone-free rate of Extracorporeal Shock Wave Lithotripsy (ESWL); a cohort study

Cited by 21 publications

References 42 publications

Extracorporeal shock wave lithotripsy for urinary tract stones in pediatric patients: our 11 years of experience

Extracorporeal shock wave lithotripsy for urinary tract stones in pediatric patients: our 11 years of experience

Extracorporeal shock wave lithotripsy for urinary tract stones in pediatric patients: Our 11 years of experience

Finding the optimal candidate for shock wave lithotripsy: external validation and comparison of five prediction models

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