Ossandon E et al, 2011: The lithotripsy table height: a novel predictor of outcome in shockwave lithotripsy

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Ossandon E et al, 2011: The lithotripsy table height: a novel predictor of outcome in shockwave lith...

Ossandon E et al, 2011: The lithotripsy table height: a novel predictor of outcome in shockwave lithotripsy

Ossandon E, Recabal P, Acevedo C, Flores JM, Marchant F

Department of Urology, Hospital Clinico Universidad de Chile, Santiago, Chile

Abstract

BACKGROUND: Outcome of Extracorporeal Shockwave Lithotripsy (SWL) is determined by physical factors that affect stone fragmentation and clearance.

PURPOSE: To evaluate the predictive value of the Lithotripsy Table Height (LTH) in SWL outcome. Lithotripsy Table Height (LTH) is a variable that represents skin to therapy head distance, and it is proportional to the energy that reaches the stone.

MATERIALS AND METHODS: A prospective study enrolled patients undergoing SWL for radiopaque urinary stones. All procedures were performed using a Modulith SLX (Karl Storz, Germany) Lithotripter. Patient weight, height and age; stone location and size; number of shock waves delivered, and LTH were recorded. One month post-procedure a KUB was obtained. Logistic regression analysis was used to evaluate the effects of these variables on stone-free outcome. A ROC curve was plotted.

RESULTS: Fifty-six patients were enrolled. After one month follow-up, overall success rate (Stone Free) was 83.9% (n = 47). LTH was the only independent predictor of outcome in both univariate and multivariate analysis (p = 0.029). Stone size (p = 0.45) and BMI (p = 0.32) were not significant. In the ROC curve, LTH showed an Area under the Curve = 0.791. Patients with LTH < 218 (n = 8) had relative risk of residual stones = 7.5, odds Ratio: 6.6 (Stone free rate 37.5% vs. 91.5%).

CONCLUSION: LTH appears to be an independent predictor of SWL outcome. High success rates can be expected if LTH > 218. Patients with lower LTH had a less effective therapy, therefore, worse stone fragmentation and clearance. These findings may help improve patient selection for SWL therapy.

Int Braz J Urol. 2011 May-Jun;37(3):355-61; discussion 361

PMID: 21756383 [PubMed - in process]

Comment

A very interesting paper.

Table height

Lithotripsy Table Height (LTH) was the only independent predictor of outcome in a multivariate analysis Patients with very low LTH 218.

Obviously it is not the SSD or the BMI that have a direct influence on the SWL result but the distance that the shock wave has to travel within the body and the acoustic properties of the tissue that it is passing.

Peter Alken