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

Abstract

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.

Extracorporeal shock wave lithotripsy: Retrospective Study on Possible Predictors of Treatment Success and Revisiting the Role of Non-contrast-enhanced Computer Tomography in Kidney and Ureteral Stone Disease

“…Stones located in the lower renal pole, when treated, tend to leave fragments that remain in the calyx and cause recurrent stone formation. The reported SFR for lower pole calculi is 25-95% [29], compared to the SFR of 32% in our study.…”

Extracorporeal shock wave lithotripsy: retrospective study on possible predictors of treatment success and revisiting the role of non-contrast-enhanced computer tomography in kidney and ureteral stone disease

“…It's worth noting that we measured size on KUB rather than NCCT, which may lead the calyx and cause recurrent stone formation. The reported SFR for lower pole calculi is 25-95% [29], compared to the SFR of 32% in our study.…”

Efficacy and Safety of Extracorporeal Shock Wave Lithotripsy (ESWL) in Patients With Infected Ureterohydronephrosis Due to Ureteral Stones Following Double-J Catheter Insertion

“…Each patient in the control group was matched with a case from the study group based on body mass index (BMI) categories: below 18.5-24.9 kg/m 2 (normal), between 25-29.9 kg/m 2 (overweight), and over 30 kg/m 2 (obese), as well as the location and size of the stone. This approach allowed us to form two groups of homogeneous patients regarding the size, location of the stones, and BMI, characteristics known from previous studies [ 19 , 20 ] as predictors of treatment outcomes.…”