Alić J. et al., 2022: The Efficiency of Extracorporeal Shock Wave Lithotripsy (ESWL) in the Treatment of Distal Ureteral Stones: An Unjustly Forgotten Option?
Alić J, Heljić J, Hadžiosmanović O, Kulovac B, Lepara Z, Spahović H, Bajramović S, Aganović D.
Urology, Clinical Center University of Sarajevo, Sarajevo, BIH.
Pediatrics, General Hospital "Prim. dr Abdulah Nakaš", Sarajevo, BIH.
Urology and Reconstructive Surgery, Sarajevo School of Science and Technology, Sarajevo, BIH.
Introduction The optimal management of distal ureteral stones remains a matter of debate since current guidelines favor ureteroscopy over extracorporeal shock wave lithotripsy (ESWL). We aimed to evaluate the efficiency of ESWL for distal ureteral stones and to identify factors that affect treatment outcomes. Materials and methods The retrospective study included records of 115 patients with distal ureteral stones, 5 mm to 18 mm in size, undergoing 223 ESWL sessions as an outpatient procedure. Early fragmentation and three-month follow-up stone-free rate (SFR) was assessed through radiographic imaging. Treatment was successful if there were no residual fragments or they were ≤4 mm, three months after the last session. Results The mean ±standard deviation (range) stone size was 9.68 ±3.10 (5.00-18.0) mm. The mean body mass index (BMI) was 24.3 ±2.67 (18.4-29.8) kg/m² with a significant correlation between BMI and stone size (r2 =0.324, p <0.001). Patients underwent ESWL an average of 1.7 ±1.36 times (1-5), while 68 patients (59.1%) became stone-free after one session. The overall SFR was 82.6%; for patients with stone sizes ≤10 mm and >10 mm, it was 99% and 9.4%, respectively. Cumulative SFR after the second session was 77%. In 20 (17%) patients the treatment was a failure. Complications occurred in 10.4%, while auxiliary procedures were needed in 8.7% of cases, both significantly affected by the stone size (p <0.001). The efficiency quotient (EQ) was 0.76. Treatment outcome was significantly different depending on stone size, BMI, number of sessions, complications, and auxiliary procedures (p <0.001, p =0.022, p <0.001, p <0.001, p <0.001, respectively). Univariate regression analysis identified stone size and BMI as significant predictors of treatment outcome (odds ratio (OR) 3.84, 95% confidence interval (CI): 2.31-8.97, p =0.001, and OR 1.25, 95% CI: 1.04-1.54, p =0.024, respectively). Conclusions Extracorporeal shock wave lithotripsy continues to be a safe and effective option for managing simple calculi in distal ureters with a diameter of ≤10 mm. The stone size and BMI remain significant predictors of treatment outcome.
Cureus. 2022 Sep 1;14(9):e28671. doi: 10.7759/cureus.28671. eCollection 2022 Sep. PMID: 36196280. FREE ARTICLE
This paper presents nothing what is not already known about the subject. The conclusion that ESWL is an option is in line with current guidelines. Why did the authors do the work? The answer could be, it is an author driven publication (ADP) : 1. Reviewing one's own records helps to find out whether the quality of one's clinical work is in order: a department quality publication (DQP) 2.The authors are working at a university department. There they may need to publish a certain number of publications to get professional or academic degrees: a career publication (CP). 3. Internal funding of the department may depend on the scientific output documented among other things by publications: a department status publication (DSP).
The paper would not have made it into one of the classical urological journals because it offers no new message. It is a formally absolutely well written, which obviously reflects a perfect editing process. Why did a publisher accept the paper? The answers could be, this is a publisher driven publication (PDP): 1. The publisher offers clinicians and scientists who are sick of complicated review processes or those working in “poor” standard countries the opportunity to publish: an opportunity to publish paper (OPP). 2. The publisher wants to make money: a publisher profit paper (PPP).
Cureus published this paper. Strolling around on their home page one gets a sense of a different philosophy of publishing that fits into modern times.
Those interested in the publisher’s background may study:
In December 2022 Springer Nature announced the acquisition of the Cureus journal https://group.springernature.com/gp/group/media/press-releases/springer-nature-acquires-cureus/23793592 with an interesting remark: “With its innovative business model, Cureus solves the challenge of open access (OA) publishing of peer-reviewed articles by medical professionals without access to research grant funds.”
Business without funds? Magical money. Sounds like a win-win fusion of interests.
With 8 authors and nothing new I think this is a career publication (CP) and an opportunity to publish paper (OPP).
P. S.: I will use the abbreviations in future reviews to characterize my opinion on publications.