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Urolithiasis
Published in: Urolithiasis 1/2021

01-02-2021 | Original Paper

Factors affecting success in the treatment of proximal ureteral stones larger than 1 cm with extracorporeal shockwave lithotripsy in adult patients

Authors: Yavuz Guler, Akif Erbin, Alper Kafkasli, Gokhun Ozmerdiven

Published in: Urolithiasis | Issue 1/2021

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Abstract

The aim of the study was to analyze the factors predicting success for the treatment of proximal ureteral stones larger than 1 cm with extracorporeal shockwave lithotripsy (SWL) in adult patients. Between January 2014 and December 2018, 480 adult patients in total underwent SWL and data were retrospectively evaluated. Patients with multiple ureteral stones, solitary kidney, congenital abnormality, skeletal system abnormality, history of previous urinary system surgery and SWL, renal insufficiency, patients who could not tolerate SWL and pediatric patients were excluded from the study. The remaining 415 patients were divided into two groups as success (Group 1, n = 307) and failure (Group 2, n = 108). The overall success rate was 73.9%. The values of stone size, Hounsfield Unit (HU), skin to stone distance (SSD), ureteral wall thickness (UWT), proximal ureter diameter, renal pelvis diameter, hydronephrosis grade, and duration of renal colic were significantly higher in Group 2 compared to Group 1. In binary logistic regression analyses, HU, UWT, and proximal ureter diameter were found to be independent predictors. HU, UWT, and proximal ureter diameter had sensitivity and specificity of 92–92%, 88–23%, and 87–46%, with cutoff values of 740 HU, 2.5 mm and 8.5 mm, respectively. The area under the curve values were 0.96, 0.97, and 0.96 for HU, UWT, and proximal ureter diameter, respectively. The CT-based parameters, including HU, UWT, and proximal ureter diameter are independent predictive factors with excellent accuracy for the treatment of proximal ureteral stones larger than 1 cm with SWL in adult patients. Based on these factors, SWL can be considered for proximal ureteral stones larger than 1 cm.
Literature
1.
Chaussy C, Brendel W, Schniedt E (1980) Extracorporeally induced destruction of kidney stones by shock waves. Lancet 2:1265–1268CrossRef
2.
Srisubat A, Potisat S, Lojanapiwat B, Setthawong V, Laopaiboon M (2014) Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev 24:CD007044
3.
Al-Ansari A, As-Sadiq K, Al-Said S, Younis N, Jaleel OA, Shokeir AA (2006) Prognostic factors of success of extracorporeal shock wave lithotripsy (ESWL) in the treatment of renal stones. Int Urol Nephrol 38:63–67CrossRef
4.
Ouzaid I, Al-qahtani S, Dominique S, Hupertan V, Fernandez P, Hermieu JF et al (2012) A 970 Hounsfield units (HU) threshold of kidney stone density on non-contrast computed tomography (NCCT) improves patients’ selection for extracorporeal shockwave lithotripsy (ESWL): evidence from a prospective study. BJU Int 110:E438–E442CrossRef
5.
El-Nahas AR, El-Assmy AM, Mansour O, Sheir KZ (2007) A prospective multivariate analysis of factors predicting stone disintegration by extracorporeal shock wave lithotripsy: the value of high-resolution noncontrast computed tomography. Eur Urol 51:1688–1694CrossRef
6.
Vakalopoulos I (2009) Development of a mathematical model to predict extracorporeal shockwave lithotripsy outcome. J Endourol 23:891–897CrossRef
7.
Torricelli FC et al (2015) Impact of renal anatomy on shock wave lithotripsy outcomes for lower pole kidney stones: results of a prospective multifactorial analysis controlled by computerized tomography. J Urol 193:2002–2007CrossRef
8.
López-Acón JD, Alba AB, Bahílo-Mateu P, Trassierra-Villa M, de Conca-Baenas MLA, de Ordaz-Jurado DG et al (2017) Analysis of the efficacy and safety of increasing the energy dose applied per session by increasing the number of shock waves in extracorporeal lithotripsy: a prospective and comparative study. J Endourol 31:1289–1294CrossRef
9.
10.
Drake T, Grivas N, Dabestani S, Knoll T, Lam T, Maclennan S et al (2017) What are the benefits and harms of ureteroscopy compared with shock-wave lithotripsy in the treatment of upper ureteral stones? A systematic review. Eur Urol 72:772–786CrossRef
11.
Lawler AC, Ghiraldi EM, Tong C, Friedlander JI (2017) Extracorporeal shock wave therapy: current perspectives and future directions. Curr Urol Rep 18:25CrossRef
12.
Kijvikai K, Haleblian GE, Preminger GM, de la Rosette J (2007) Shock wave lithotripsy or ureteroscopy for the management of proximal ureteral calculi: an old discussion revisited. J Urol 178:1157–1163CrossRef
13.
Park HS, Gong MK, Yoon CY, du Moon G, Cheon J, Choi YD (2016) Computed tomography-based novel prediction model for the outcome of shockwave lithotripsy in proximal ureteral stones. J Endourol 30:810–816CrossRef
14.
Niwa N, Matsumoto K, Miyahara M, Omura M, Kobayashi H, Kikuchi E et al (2017) Simple and practical nomograms for predicting the stone- free rate after shock wave lithotripsy in patients with a solitary upper ureteral stone. World J Urol 35:1455–1461CrossRef
15.
Ng CF, Siu DY, Wong A, Goggins W, Chan ES, Wong KT (2009) Development of a scoring system from noncontrast computerized tomography measurements to improve the selection of upper ureteral stone for extracorporeal shock wave lithotripsy. J Urol 181:1151–1157CrossRef
16.
Wiesenthal JD, Ghiculete D, Ray AA, Honey RJ, Pace KT (2011) A clinical nomogram to predict the successful shock wave lithotripsy of renal and ureteral calculi. J Urol 186:556–562CrossRef
17.
Cho KS, Jung HD, Ham WS, Chung DY, Kang YJ, Jang WS et al (2015) Optimal skin-to-stone distance is a positive predictor for successful outcomes in upper ureter calculi following extracorporeal shock wave lithotripsy: a bayesian model averaging approach. PLoS ONE 14(10):e0144912CrossRef
18.
Nakasato T, Morita J, Ogawa Y (2015) Evaluation of Hounsfield Units as a predictive factor for the outcome of extracorporeal shock wave lithotripsy and stone composition. Urolithiasis 43:69–75CrossRef
19.
Xun Y, Li J, Geng Y, Liu Z, Yu X, Wang X et al (2018) Single extracorporeal shock-wave lithotripsy for proximal ureter stones: Can CT texture analysis technique help predict the therapeutic effect? Eur J Radiol 107:84–89CrossRef
20.
Kim CH, Shin DS, Kim TB, Jung H (2019) The efficacy of early extracorporeal shockwave lithotripsy for the treatment of ureteral stones. Urol J 16:331–336PubMed
21.
Yazici O, Tuncer M, Sahin C, Demirkol MK, Kafkasli A, Sarica K (2015) Shock wave lithotripsy in ureteral stones: evaluation of patient and stone related predictive factors. Int Braz J Urol 41:676–682CrossRef
22.
Sugino Y, Kato T, Furuya S, Sasaki T, Arima K, Sugimura Y (2020) The usefulness of the maximum Hounsfield units (HU) in predicting the shockwave lithotripsy outcome for ureteral stones and the proposal of novel indicators using the maximum HU. Urolithiasis 48:85–91 (Epub ahead of print)CrossRef
23.
Lee JY, Kim JH, Kang DH, Chung DY, Lee DH, Do Jung H et al (2016) Stone heterogeneity index as the standard deviation of Hounsfield units: a novel predictor for shock-wave lithotripsy outcomes in ureter calculi. Sci Rep 6:23988CrossRef
24.
Elibol O, Safak KY, Buz A, Eryildirim B, Erdem K, Sarica K (2017) Radiological noninvasive assessment of ureteral stone impaction into the ureteric wall: a critical evaluation with objective radiological parameters. Investig Clin Urol 58:339–345CrossRef
25.
Sarica K, Kafkasli A, Yazici O, Cetinel AC, Demirkol MK, Tuncer M et al (2015) Ureteral wall thickness at the impacted ureteral stone site: a critical predictor for success rates after SWL. Urolithiasis 43:83–88CrossRef
26.
Yamashita S, Kohjimoto Y, Iguchi T, Nishizawa S, Kikkawa K, Hara I (2019) Ureteral wall volume at ureteral stone site is a critical predictor for shock wave lithotripsy outcomes: comparison with ureteral wall thickness and area. Urolithiasis. https://​doi.​org/​10.​1007/​s00240-019-01154-w
27.
El-Assmy A, El-Nahas AR, Youssef RF, El-Hefnawy AS, Sheir KZ (2007) Impact of the degree of hydronephrosis on the efficacy of in situ extracorporeal shock-wave lithotripsy for proximal ureteral calculi. Scand J Urol Nephrol 41:208–213CrossRef
28.
Seitz C, Fajkovic H, Waldert M, Tanovic E, Remzi M, Kramer G et al (2006) Extracorporeal shock wave lithotripsy in the treatment of proximal ureteral stones: does the presence and degree of hydronephrosis affect success? Eur Urol 49:378–383CrossRef
Metadata
Title
Factors affecting success in the treatment of proximal ureteral stones larger than 1 cm with extracorporeal shockwave lithotripsy in adult patients
Authors
Yavuz Guler
Akif Erbin
Alper Kafkasli
Gokhun Ozmerdiven
Publication date
01-02-2021
Publisher
Springer Berlin Heidelberg
Published in
Urolithiasis / Issue 1/2021
Print ISSN: 2194-7228
Electronic ISSN: 2194-7236
DOI
https://doi.org/10.1007/s00240-020-01186-7

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