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

Yoon, Ji Hyung; Park, Sejun; Kim, Seong Cheol; Park, Sungchan; Moon, Kee‐Chan; Cheon, Sang Hyeon; Kwon, Taekmin

doi:10.21037/tau-20-1397

Cited by 11 publications

(9 citation statements)

References 27 publications

(32 reference statements)

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“…In our study, 65% of patients were male, and 35% were female, with a male/female ratio of 1.87. Age analysis shows that majority of patients were in the age group 40 to 60 years, which is consistent with previous reports in the literature [ 10 , 20 , 21 ]. This emphasizes the role of urolithiasis as a significant medical but also socio-economic problem due to its potential to incapacitate the available human resources, combined with the rising cost of treatment.…”

Section: Discussionsupporting

confidence: 91%

“…Males are considered to be three times more susceptible to urolithiasis because of testosterone-induced oxalate production and smaller ureteral caliber [ 5 ]. Yazici et al report the proposed 3:1 ratio in their findings, while other studies showed no statistically significant difference regarding sex [ 20 , 21 ]. In our study, 65% of patients were male, and 35% were female, with a male/female ratio of 1.87.…”

Section: Discussionmentioning

confidence: 95%

“…Taking these results into consideration, follow-up ESWL treatment after initial failure should be reconsidered. While there are no definitive guidelines on the number of recommended ESWL treatments per single stone, most authors suggest no more than three, due to previously discussed minimal improvement in cumulative SFR [ 21 , 24 ]. The ultimate decision depends on time to retreatment, patient preference, and overall clinical practice of the institution regarding urolithic procedures.…”

Section: Discussionmentioning

confidence: 99%

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The Efficiency of Extracorporeal Shock Wave Lithotripsy (ESWL) in the Treatment of Distal Ureteral Stones: An Unjustly Forgotten Option?

Alić¹,

Heljić²,

Hadžiosmanović³

et al. 2022

Cureus

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IntroductionThe optimal management of distal ureteral stones remains a matter of debate since current guidelines favor ureteroscopy over extracorporeal shock wave lithotripsy (ESWL). We aimed to evaluate the efficiency of ESWL for distal ureteral stones and to identify factors that affect treatment outcomes. Materials and methodsThe retrospective study included records of 115 patients with distal ureteral stones, 5 mm to 18 mm in size, undergoing 223 ESWL sessions as an outpatient procedure. Early fragmentation and three-month follow-up stone-free rate (SFR) was assessed through radiographic imaging. Treatment was successful if there were no residual fragments or they were ≤4 mm, three months after the last session. ResultsThe mean ±standard deviation (range) stone size was 9.68 ±3.10 (5.00-18.0) mm. The mean body mass index (BMI) was 24.3 ±2.67 (18.4-29.8) kg/m² with a significant correlation between BMI and stone size (r 2 =0.324, p <0.001). Patients underwent ESWL an average of 1.7 ±1.36 times (1-5), while 68 patients (59.1%) became stone-free after one session. The overall SFR was 82.6%; for patients with stone sizes ≤10 mm and >10 mm, it was 99% and 9.4%, respectively. Cumulative SFR after the second session was 77%. In 20 (17%) patients the treatment was a failure. Complications occurred in 10.4%, while auxiliary procedures were needed in 8.7% of cases, both significantly affected by the stone size (p <0.001). The efficiency quotient (EQ) was 0.76. Treatment outcome was significantly different depending on stone size, BMI, number of sessions, complications, and auxiliary procedures (p <0.001, p =0.022, p <0.001, p <0.001, p <0.001, respectively). Univariate regression analysis identified stone size and BMI as significant predictors of treatment outcome (odds ratio (OR) 3.84, 95% confidence interval (CI): 2.31-8.97, p =0.001, and OR 1.25, 95% CI: 1.04-1.54, p =0.024, respectively). ConclusionsExtracorporeal shock wave lithotripsy continues to be a safe and effective option for managing simple calculi in distal ureters with a diameter of ≤10 mm. The stone size and BMI remain significant predictors of treatment outcome.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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The Efficiency of Extracorporeal Shock Wave Lithotripsy (ESWL) in the Treatment of Distal Ureteral Stones: An Unjustly Forgotten Option?

Alić¹,

Heljić²,

Hadžiosmanović³

et al. 2022

Cureus

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“…Previous studies have shown SWL variables affecting treatment outcomes include gender [ 39 – 42 ], age [ 39 , 42 – 44 ], SSD [ 40 , 45 – 50 ], BMI [ 39 , 50 ], stone number [ 39 , 42 , 43 ], stone size [ 39 – 43 , 46 , 47 , 50 – 56 ], stone location [ 39 , 41 – 43 , 48 , 51 , 52 , 56 , 57 ], and stone characteristics [ 33 – 48 , 51 , 54 – 58 ]. Variables affecting URS outcomes include stone number [ 59 , 60 ], stone size [ 53 , 59 ], stone location [ 59 , 60 ], and stone characteristics [ 59 , 60 ].…”

Section: Discussionmentioning

confidence: 99%

Stone decision engine accurately predicts stone removal and treatment complications for shock wave lithotripsy and laser ureterorenoscopy patients

Noble,

Hamilton,

Gerber

2024

PLoS ONE

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Kidney stones form when mineral salts crystallize in the urinary tract. While most stones exit the body in the urine stream, some can block the ureteropelvic junction or ureters, leading to severe lower back pain, blood in the urine, vomiting, and painful urination. Imaging technologies, such as X-rays or ureterorenoscopy (URS), are typically used to detect kidney stones. Subsequently, these stones are fragmented into smaller pieces using shock wave lithotripsy (SWL) or laser URS. Both treatments yield subtly different patient outcomes. To predict successful stone removal and complication outcomes, Artificial Neural Network models were trained on 15,126 SWL and 2,116 URS patient records. These records include patient metrics like Body Mass Index and age, as well as treatment outcomes obtained using various medical instruments and healthcare professionals. Due to the low number of outcome failures in the data (e.g., treatment complications), Nearest Neighbor and Synthetic Minority Oversampling Technique (SMOTE) models were implemented to improve prediction accuracies. To reduce noise in the predictions, ensemble modeling was employed. The average prediction accuracies based on Confusion Matrices for SWL stone removal and treatment complications were 84.8% and 95.0%, respectively, while those for URS were 89.0% and 92.2%, respectively. The average prediction accuracies for SWL based on Area-Under-the-Curve were 74.7% and 62.9%, respectively, while those for URS were 77.2% and 78.9%, respectively. Taken together, the approach yielded moderate to high accurate predictions, regardless of treatment or outcome. These models were incorporated into a Stone Decision Engine web application (http://peteranoble.com/webapps.html) that suggests the best interventions to healthcare providers based on individual patient metrics.

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“…ESWL provides a good therapeutic outcome, especially for less than 1 cm ureteral stones [2]. The ESWL success rate mainly rely on different factors such as renal anatomy (urinary anomaly, hydronephrosis, stenosis, calyceal diverticulum), patient-associated factors (obesity, skin-tostone distance, and renal function), and stones (size, location, components, and density) [3,4]. Various approaches for increasing ESWL success rate have been investigated.…”

Section: Introductionmentioning

confidence: 99%

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

Ahmad¹,

Rehman²,

Khan³

et al. 2022

PJMHS

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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

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

Cited by 11 publications

References 27 publications

The Efficiency of Extracorporeal Shock Wave Lithotripsy (ESWL) in the Treatment of Distal Ureteral Stones: An Unjustly Forgotten Option?

The Efficiency of Extracorporeal Shock Wave Lithotripsy (ESWL) in the Treatment of Distal Ureteral Stones: An Unjustly Forgotten Option?

Stone decision engine accurately predicts stone removal and treatment complications for shock wave lithotripsy and laser ureterorenoscopy patients

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

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