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Yazici O et al, 2015: Shock Wave Lithotripsy in Ureteral Stones: Evaluation of Patient and Stone Related Predictive Factors.

Yazici O, Tuncer M, Sahin C, Demirkol MK, Kafkasli A, Sarica K.
Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.

Abstract

PURPOSE: To evaluate the patient and stone related factors which may influence the final outcome of SWL in the management of ureteral stones.
MATERIALS AND METHODS: Between October 2011 and October 2013, a total of 204 adult patients undergoing SWL for single ureteral stone sizing 5 to 15 mm were included into the study program. The impact of both patient (age, sex, BMI,) and stone related factors (laterality, location, longest diameter and density as CT HU) along with BUN and lastly SSD (skin to stone distance) on fragmentation were analysed by univariate and multivariate analyses.
RESULTS: Stone free rates for proximal and distal ureteral stones were 68.8% and 72.7%, respectively with no statistically significant difference between two groups (p=0.7). According to univariate and multivariate analyses, while higher BMI (mean: 26.8 and 28.1, p=0.048) and stone density values (mean: 702 HU and 930 HU, p < 0.0001) were detected as statistically significant independent predictors of treatment failure for proximal ureteral stones, the only statistically significant predicting parameter for the success rates of SWL in distal ureteral stones was the higher SSD value (median: 114 and 90, p=0.012).
CONCLUSIONS: Our findings have clearly shown that while higher BMI and increased stone attenuation values detected by NCCT were significant factors influencing the final outcome of SWL treatment in proximal ureteral stones; opposite to the literature, high SSD was the only independent predictor of success for the SWL treatment of distal ureteral stones.

Int Braz J Urol. 2015 Jul-Aug;41(4):676-82. doi: 10.1590/S1677-5538.IBJU.2014.0330 

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Comments 1

Hans-Göran Tiselius on Wednesday, 25 November 2015 10:32

In this article the authors describe the outcome of SWL of proximal and distal ureteral stones. Proximal stones were considered together with concrements that in other reports would be referred to as mid ureteral stones. The statement by the authors that “pelvic bone did not cause problems during SWL” is indeed astonishing. This observation is in contrast to my own long-term experience with SWL of ureteral stones. It is also contradicted by recent experimental data reported during the 33rd WCE (2015). It had indeed been of great interest to know how many of the proximal stones (treated with shockwaves directed from the back) that, at the time of treatment, were located between the upper and lower parts of the SI-joint.

It is difficult to understand why the stone size alternatively was described by the longest diameter or largest width. The reason for this question is my concern that only few stones found in the ureter might have had a transverse position. In my own experience this is unusual.

Stone-free rates seem overall to be inferior to those reported in other series of SWL for ureteral stones. It is tempting to speculate that the outcome had been better if the bone obstacle had been appropriately appreciated.

In this article the authors describe the outcome of SWL of proximal and distal ureteral stones. Proximal stones were considered together with concrements that in other reports would be referred to as mid ureteral stones. The statement by the authors that “pelvic bone did not cause problems during SWL” is indeed astonishing. This observation is in contrast to my own long-term experience with SWL of ureteral stones. It is also contradicted by recent experimental data reported during the 33rd WCE (2015). It had indeed been of great interest to know how many of the proximal stones (treated with shockwaves directed from the back) that, at the time of treatment, were located between the upper and lower parts of the SI-joint. It is difficult to understand why the stone size alternatively was described by the longest diameter or largest width. The reason for this question is my concern that only few stones found in the ureter might have had a transverse position. In my own experience this is unusual. Stone-free rates seem overall to be inferior to those reported in other series of SWL for ureteral stones. It is tempting to speculate that the outcome had been better if the bone obstacle had been appropriately appreciated.
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