Aydamirov M. et al., 2025: Impact of hydronephrosis on shockwave lithotripsy outcomes for upper ureteral stones.
Mubariz Aydamirov 1, Kadir Karkin 2, Bugra Aksay 2, Ediz Vuruskan 2, Muslum Ahmet Tunckiran 3
1Department of Urology, Başkent University Alanya Application and Research Center, Antalya, Turkey.
2Department of Urology, Health Sciences University, Adana City Training and Research Hospital, Adana, Turkey.
3Department of Urology, Başkent University Alanya Application and Research Center, Antalya, Turkey.
Abstract
Purpose: To investigate the effect of the degree of hydronephrosis on extracorporeal shockwave lithotripsy (SWL) success in patients who underwent SWL due to upper ureteral stones.
Methods: Medical records of 878 patients who underwent SWL were retrospectively reviewed. Patients with isolated unilateral 6-10 mm radiopaque upper ureteral stones above the upper border of the sacroiliac joint were included in the study. The primary endpoint of the study was the relationship between the degree of hydronephrosis with upper ureteral stones and the stone clearance time, number of SWL sessions, and success, while the secondary endpoint was the effect of the presence of severe hydronephrosis (SFU grade 3) on SWL success.
Results: The mean age of the patients was 41.3 ± 10.9 years. The mean stone size was 8.2 (6-10) mm. Ureteropelvic junction stones were present in 24 (20%) patients. The mean stone clearance time was 14.6 ± 9.7 days. One-month SWL success was determined as 85%. SWL success rates decreased as the degree of hydronephrosis increased (p = 0.047). Being 45 years of age and older increased the risk of SWL failure by 16.25 times (OR = 16.25, p = 0.017). Increasing the stone clearance time by 1 day increased the risk of SWL failure by 1.17 times (OR = 1.17, p = 0.006), and increasing the number of SWL sessions by 1 session increased the risk of SWL failure by 7.69 times (OR = 7.69, p = 0.016). The presence of severe hydronephrosis (grade 3) did not affect SWL success (OR = 5.56, p = 0.071).
Conclusion: According to our study results, as the degree of hydronephrosis increases in 6-10 mm upper ureteral stones, the number of SWL sessions increases, stone expulsion times prolong, and 1-month success rates decrease.
Int Urol Nephrol. 2025 Jan 16. doi: 10.1007/s11255-025-04376-7. Online ahead of print.
PMID: 39821148
Comments 1
There are controversial results of SWL of proximal ureteral stones in patients with hydronephrosis. That was the background for the authors to study the relationship. The overall conclusion was that with increased degrees of hydronephrosis, the number of SWL sessions, stone expulsion time and 1 month success rates were decreased. The authors’ results need to be studied in detail.
It is important to note that in patients with hydronephrosis grades 1 and 2, the success rates after 1 month were 100 and 90%. Apparently good results! Only for patients with hydronephrosis grade 3 was the success after 1 month reduced to 69%. It is unknown in how many patients with grade 2 and 3 hydronephrosis that endourology really was necessary!
It is difficult to understand the authors’ final statement that “..the presence of severe hydronephrosis /Grade 3) does not affect SWL success.
It is the reviewer’s conclusion that the result of SWL was exceptionally good in Grade 1 and Grade 2 patients. The outcome was surprisingly good, and in the absence of information on stone composition and I think that the only conclusion that can be drawn is thar the success rate is negatively affected by hydronephrosis Grade 3. It is of note that no patients in that group had PJU-stones.
It is likely that in some patients with low grade hydronephrosis SWL might be positively affected. In high grade hydronephrosis treated with additional procedures such as intra-ureteral manipulation with or without a stent, improved results can be expected.
Hans-Göran Tiselius