Elbaset MA. et al., 2021: Optimization of shockwave lithotripsy use for single medium sized hard renal stone with stone density 1000 HU. A prospective study.
Elbaset MA, Taha DE, Anas M, Abouelkheir RT, Edwan M, Abdullateef M, Ashour R, Osman Y, Sheir KZ.
Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Urology Department, KafrELshiekh University, Kafr Al Sheikh, Egypt.
Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
Abstract
Purpose: To identify shock wave lithotripsy (SWL) success predictors in hard renal stones (average stone density ≥ 1000 HU).
Materials: We prospectively evaluated patients who underwent SWL for hard renal stones between April 2018 and December 2020. Radiological parameters were identified, e.g., stone site, size, the average density in addition to stone core and shell mean density, and renal cortical thickness (RKT). SWL sessions were performed using Doli-S lithotripter till a maximum of 3-4 sessions with 2-4 weeks interval. Initial response to SWL included stone fragmentation and decreased stone size after the first SWL. Treatment success was considered if complete clearance of renal stones occurred or in case of clinically insignificant residual fragments ≤ 4 mm after 12 weeks follow up by NCCT.
Results: Out of 1878 patients who underwent SWL, the study included 157 patients with hard renal stones. Treatment overall success was found in 92 patients (58.6%) where 69 patients (43.9%) had complete stone clearance. On multivariate analysis, stone shell density < 901 HU, maximum stone size < 1 cm, RKT > 1.95 cm and initial treatment response were associated with increased the success rate after SWL for hard renal stones (P = 0.0001, 0.009, < 0.0001 and < 0.0001, respectively).
Conclusion: In hard renal stones, treatment overall success was found in 58.6% where complete stone clearance was found in 43.9%. Stone outer shell fragility, lower stone size, increased RKT and initial response to SWL were associated with a higher success rate at 12-week follow-up.
World J Urol. 2021 Aug 15. doi: 10.1007/s00345-021-03807-1. Online ahead of print. PMID: 34392391
Comments 1
The article stems from the Urology Department, Urology and Nephrology Center,
Mansoura University, Mansoura, Egypt, which has a good reputation. The argument for writing this paper is “Due to data scarcity regarding predictors for SWL success in hard renal stones, short-term follow-up with limited inclusion criteria, we attempt to define factors affecting the overall treatment success post SWL in hard renal stones after 12-week follow-up. In addition to identify the complications occurred in this specific group of patients.”
It is called a prospective study but basically it is a retrospective analysis of data and it is not clear from the data if all consecutive patients were included. There is nothing new in the article.
Peter Alken