Role of computed tomography morphodensitometry in predicting the outcome of shock wave lithotripsy

Objectives: The objective of this study was to predict the outcome of shock wave lithotripsy (SWL) on the basis of computed tomography (CT) morphodensitometry for ureteral and renal stones. We also assessed the possibility that Hounsfield unit (HU) values and the location of the stones could be used to predict the outcome of SWL. Material and methods: A prospective study was performed to measure stone size, location, composition, surface area, surface volume, stone burden, the skin-to-stone distance and the HU for solitary renal and ureteral stones by non-contrast CT studies (NCCT) from August 2013 to September 2015. Success of SWL was defined as: (1) being stone-free or (2) residual stone fragments < 4 mm by radiography/NCCT. Results: Of the 100 assessed patients, 68 patients (68%) were stone-free, 12 (12%) had residual stone fragments < 4 mm (clinically insignificant residual fragments) and 20 (20%) had residual stone fragments ≥ 4 mm/ancillary procedures. Multivariate analysis revealed that stone location and mean HU were significant predictors of SWL success. Receiver operating characteristic curves defined cut-off values for predicting treatment outcome. Treatment success rates were significantly higher for stones < 800 HU than with stones > 800 HU ( p = 0.160). Conclusion: Evaluation of stone HU values and stone location prior to SWL can predict treatment outcome and aid in the development of treatment strategies. Level of evidence 2 & 4

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The comparison of laparoscopy, shock wave lithotripsy and retrograde intrarenal surgery for large proximal ureteral stones

Canadian Urological Association Journal ◽

10.5489/cuaj.346 ◽

2013 ◽

Vol 7 (11-12) ◽

pp. 673 ◽

Cited By ~ 13

Author(s):

Ufuk Ozturk ◽

Nevzat Can Şener ◽

H.N. Goksel Goktug ◽

Adnan Gucuk ◽

Ismail Nalbant ◽

...

Keyword(s):

Shock Wave ◽

Shock Wave Lithotripsy ◽

Ureteral Stones ◽

Complication Rates ◽

Success Rates ◽

Retrograde Intrarenal Surgery ◽

Flexible Ureterorenoscopy ◽

Lower Complication ◽

Lower Complication Rate ◽

Invasive Method

Introduction: In this study we compare the success rates and complication rates of shock wave lithotripsy (SWL), laparoscopic, and ureteroscopic approaches for large (between 1 and 2 cm) proximal ureteral stones.Methods: In total, 151 patients with ureteral stones between 1 and 2 cm in diameter were randomized into 3 groups (52 SWL, 51 laparoscopy and 48 retrograde intrarenal surgery [RIRS]). The groups were compared for stone size, success rates, and complication rates using the modified Clavien grading system.Results: Stone burden of the groups were similar (p = 0.36). The success rates were 96%, 81% and 79%, respectively in the laparoscopy, SWL, and ureteroscopy groups. The success rate in laparoscopy group was significantly higher (p < 0.05). When these groups were compared for complication rates, RIRS seemed to bethe group with the lowest complication rates (4.11%) (p < 0.05). SWL and laparoscopy seem to have similar rates of complication (7.06% and 7.86%, respectively, p = 0.12).Interpretation: To our knowledge, this is the first study to compare the results of laparoscopy, SWL and RIRS in ureteral stones. Our results showed that in management of patients with upper ureteral stones between 1 and 2 cm, laparoscopy is the most successful method based on its stone-free rates and acceptable complication rates. However, the limitations of our study are lack of hospital stay and cost-effectiveness data. Also, studies conducted on larger populations should support our findings. When a less invasive method is the only choice, SWL and flexible ureterorenoscopy methods have similar success rates. RIRS, however, has a lower complication rate than the other approaches.

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Comparison of success rates and financial cost of extracorporeal shock-wave lithotripsy in situ and after manipulation for proximal ureteral stones

Urological Research ◽

10.1007/s00240-003-0337-y ◽

2003 ◽

Vol 31 (4) ◽

pp. 286-290 ◽

Cited By ~ 5

Author(s):

V. Protogerou ◽

S. Albanis ◽

F. Sofras ◽

C. Deliveliotis ◽

J. Varkarakis

Keyword(s):

Shock Wave ◽

Extracorporeal Shock Wave Lithotripsy ◽

Shock Wave Lithotripsy ◽

Ureteral Stones ◽

Success Rates ◽

Financial Cost ◽

Extracorporeal Shock Wave

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Extracorporeal shock wave lithotripsy in the treatment of renal and ureteral stones

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.61.01.065 ◽

2015 ◽

Vol 61 (1) ◽

pp. 65-71 ◽

Cited By ~ 15

Author(s):

Fábio César Miranda Torricelli ◽

Alexandre Danilovic ◽

Fábio Carvalho Vicentini ◽

Giovanni Scala Marchini ◽

Miguel Srougi ◽

...

Keyword(s):

Shock Wave ◽

Extracorporeal Shock Wave Lithotripsy ◽

Shock Wave Lithotripsy ◽

Meta Analysis ◽

Ureteral Stones ◽

Level Of Evidence ◽

Extracorporeal Shock Wave ◽

Double J Stent ◽

High Level ◽

Technical Principles

The use of certain technical principles and the selection of favorable cases can optimize the results of extracorporeal shock wave lithotripsy (ESWL). The aim of this study is to review how ESWL works, its indications and contraindications, predictive factors for success, and its complications. A search was conducted on the Pubmed® database between January 1984 and October 2013 using "shock wave lithotripsy" and "stone" as key-words. Only articles with a high level of evidence, in English, and conducted in humans, such as clinical trials or review/meta-analysis, were included. To optimize the search for the ESWL results, several technical factors including type of lithotripsy device, energy and frequency of pulses, coupling of the patient to the lithotriptor, location of the calculus, and type of anesthesia should be taken into consideration. Other factors related to the patient, stone size and density, skin to stone distance, anatomy of the excretory path, and kidney anomalies are also important. Antibiotic prophylaxis is not necessary, and routine double J stent placement before the procedure is not routinely recommended. Alpha-blockers, particularly tamsulosin, are useful for stones >10mm. Minor complications may occur following ESWL, which generally respond well to clinical interventions. The relationship between ESWL and hypertension/diabetes is not well established.

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