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Al-Zubi M. et al., 2021: The effect of stone and patient characteristics in predicting extra-corporal shock wave lithotripsy success rate: A cross sectional study

Al-Zubi M, Al Sleibi A, Elayan BM, Al-Issawi SZ, Bani-Hani M, Alsharei A, AlSmadi J, Abualhaj S, Ibrahim AY.
Department of Surgery, Urology Division, Faculty of Medicine, Yarmouk University, Irbid, Jordan.
Department of Clinical Sciences, Al-Balqa Applied University, Jordan.
Faculty of Medicine, Yarmouk University, Irbid, Jordan.
Department of Urology, Faculty of Medicine, Hashemite University, Zarqa, Jordan.
Department of Clinical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan.
Department of Surgery and Special Surgery, Urology Division, The Hashemite University, Faculty of Medicine, Jordan.
Department of Clinical Science, Mutah University, Jordan.
Department of Clinical Science, Radiology Division, Faculty of Medicine, Yarmouk University, Irbid, Jordan.

Abstract

Introduction: We determine the effect of patient characteristics (age, sex, and body mass index BMI) and stone characteristics (density, location, and size) by non-contrast computed tomography of the kidneys, ureters, and bladder (CT-KUB) in predicting the success of extracorporeal shock wave lithotripsy (ESWL) in the treatment of kidney and ureteric stones. We present this study to further enrich the knowledge of physicians towards the effect of different patient characteristics upon predicting extra-corporal shock wave lithotripsy success rates.

Methods: We evaluated 155 patients who received ESWL for renal and ureteric stone measuring 3-20 mm (mm), over a 3-month period. The stone size in millimeters, density in Hounsfield units (HU) and its location was determined on pre-treatment CT-KUB. ESWL was successful if post-treatment residual renal stone fragments were ≤3 mm and for ureteric stones should be totally cleared.

Results: The overall success of ESWL treatment was observed in 65.8% of the 155 patients. There was no significant difference seen when the effect of patients age, sex and BMI were studied with ESWL outcome with P values were 0.155, 0.101 and 0.415 respectively. Also, stone location either in the kidney or ureter has no statistically significant effect on ESWL response rate. while stone density and size determined on CT KUB have statistically significant effect on the success rate of ESWL with a P-value of 0.002 and 0.000 respectively.

Conclusions: This study shows that determination of stone density and stone size on CT KUB pre ESWL can help to predict the outcome of ESWL. We propose that stone density <500 HU and stone size < 5 mm are highly likely to result in successful ESWL.
Ann Med Surg (Lond). 2021 Sep 10;70:102829. doi: 10.1016/j.amsu.2021.102829. eCollection 2021 Oct. PMID: 34540217. FREE ARTICLE

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Comments 1

Hans-Göran Tiselius on Wednesday, 09 March 2022 09:30

It is surprising that 40 (!) years after the introduction of SWL, there still is a need to define selection criteria for this treatment modality. The major reason for that probably is that SWL today is carried out in so many ways and with many different lithotripters. None of these factors were detailed in this article.
It should be noted that in the 155 patients, the authors included those with stones measuring 3 mm and accordingly a non-disintegrated stone of this size, passed or remaining in the urinary tract, would be considered as successfully treated!

As many as 2/3 of the patients had their stones in the ureter and in view of that the success rate of 66% is lower than expected. Obviously, none of the patients required or was given more than one treatment session.

The conclusion that successful treatment result should be expected only with stones

It is surprising that 40 (!) years after the introduction of SWL, there still is a need to define selection criteria for this treatment modality. The major reason for that probably is that SWL today is carried out in so many ways and with many different lithotripters. None of these factors were detailed in this article. It should be noted that in the 155 patients, the authors included those with stones measuring 3 mm and accordingly a non-disintegrated stone of this size, passed or remaining in the urinary tract, would be considered as successfully treated! As many as 2/3 of the patients had their stones in the ureter and in view of that the success rate of 66% is lower than expected. Obviously, none of the patients required or was given more than one treatment session. The conclusion that successful treatment result should be expected only with stones
Saturday, 18 May 2024