Chang KD et al, 2017: Impact of Pretreatment Hydronephrosis on the Success Rate of Shock Wave Lithotripsy in Patients with Ureteral Stone.
Chang KD, Lee JY, Park SY, Kang DH, Lee HH, Cho KS.
Department of Urology and Urological Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Urology and Urological Science Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
PURPOSE: To evaluate predictors of the success rate for one session of shock wave lithotripsy (SWL), focusing on the relationships between pretreatment hydronephrosis grade and one-session SWL success rates.
MATERIALS AND METHODS: The medical records of 1824 consecutive patients who underwent an initial session of SWL for treatment of urinary stones between 2005 and 2013 were reviewed. After exclusion, 700 patients with a single, 4-20 mm diameter radiopaque calculus were included in the study.
RESULTS: The mean maximal stone length (MSL) and skin-to-stone distance were 9.2±3.9 and 110.8±18.9 mm, respectively. The average values for mean stone density (MSD) and stone heterogeneity index (SHI) were 707.0±272.1 and 244.9±110.1, respectively. One-session success rates were 68.4, 75.0, 75.1, 54.0, and 10.5% in patients with hydronephrosis grade 0, 1, 2, 3, and 4, respectively. Patients were classified into success or failure groups based on SWL outcome. Multivariate logistic regression analyses revealed that MSL [odds ratio (OR) 0.888, 95% confidence intervals (CI): 0.841-0.934, p<0.001], MSD (OR 0.996, 95% CI: 0.995-0.997, p<0.001), SHI (OR 1.007, 95% CI: 1.005-1.010, p<0.001), and pretreatment hydronephrosis grade (OR 0.601, 95% CI: 0.368-0.988, p=0.043) were significantly associated with one-session success.
CONCLUSION: Pretreatment grades 3 or 4 hydronephrosis were associated with failure of SWL in patients with a single ureteral stone. In the presence of severe hydronephrosis, especially hydronephrosis grade 4; physicians should proceed cautiously in choosing and offering SWL as the primary treatment for ureteral stone.
Yonsei Med J. 2017 Sep;58(5):1000-1005. doi: 10.3349/ymj.2017.58.5.1000. FREE ARTICLE
The number of patients with grade 3 and 4 hydronephrosis was small (100 and 19 resp.). In these cases the one-session success rate was: 54/ 100 and 2/29. The recommendation not to treat patients with this degree of hydronephrosis seems to be justified at least for the grade 4 group; but a 50 % single-session primary success rate in the grade 3-group is not bad. Unfortunately no information is given about the results after 2nd or 3rd ESWL applications.