STORZ MEDICAL – Literature Databases
STORZ MEDICAL – Literature Databases
Literature Databases
Literature Databases

Ibrahim A. et al., 2022: Can we predict the ancillary treatments after extracorporeal shockwave lithotripsy for renal and upper ureteral stones?

Ibrahim A, Elatreisy A, Khogeer A, Ahmadi A, Mishra S, Faisal M, Sabnis R, Aube-Peterkin M, Carrier S, Ganpule A, Desai M.
Urology Department, Al-Azhar University, Cairo.
Urology Department, Al-Azhar University, Cairo.
Department of Surgery, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah.
Muljhibhai Patel Urological Hospital, Nadiad.
Muljhibhai Patel Urological Hospital, Nadiad.
Urology Department, Al-Azhar University, Cairo.
Muljhibhai Patel Urological Hospital, Nadiad.
Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC.
Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC.
Muljhibhai Patel Urological Hospital, Nadiad.
Muljhibhai Patel Urological Hospital, Nadiad.

Abstract

Objective: To quantify the predictors for the ancillary treatments after extracorporeal shock wave lithotripsy (SWL) for renal and upper ureteral stones.

Materials and methods: From January 2014 to January 2017, patients undergoing SWL using an electromagnetic lithotripter machine (Compact Delta; Dornier MedTech GmbH, Wessling, Germany) for renal and upper ureteral stones ≤ 20 mm were retrospectively reviewed. All patients underwent CT urography prior to SWL. The cohort was subdivided into three groups according to stone attenuation values in Hounsfield Units (HU). Group I; HU < 500 (n = 20), group II; HU 500-1000 (n = 51) and group III; HU ≥ 1000 (n = 180). The parameters included for multivariate analysis were stone size, location, multiplicity, stone attenuation value, number of shocks and stone clearance rate by 3 months. The ancillary treatments were ureteroscopy (URS), ureteral stenting and hospital readmission for pain or fever.

Results: A total of 251 patients were included in the study. The overall SWL success rate was 92.4%. Mean stone size was 10.9 ± 2.1, 11.6 ± 3 and 11.4 ± 3.6 mm and mean stone attenuation values were 364 ± 125, 811 ± 154 and 1285 ± 171 HU for groups I, II and III respectively. The stone clearance rates by 3 months were 96%, 92% and 88.4% for groups I, II and III respectively. On subgroup analysis, group III required ancillary treatments in 70% of patients whereas group I, II, did not require any ancillary treatments. On multivariate analysis, stone multiplicity, stone location (lower calyceal stones) and HU were independent significant predictors for the need for ancillary treatments after SWL (p values < 0.05).

Conclusions: Patients with stone attenuation value (HU) > 1000, multiple stones and/or lower calyceal stones have higher risk to necessitate ancillary treatments after SWL. These patients would likely benefit from upfront endoscopic lithotripsy for treating symptomatic renal or upper ureteral stones.
Arch Ital Urol Androl. 2022 Dec 27;94(4):439-442. doi: 10.4081/aiua.2022.4.439. PMID: 36576455. FREE ARTICLE

0
 

Comments 1

Hans-Göran Tiselius on Friday, 13 January 2023 09:40

The authors of this report studied the need of ancillary treatment after SWL. It is of note that the overall success rate with SWL was 92.4% (!) which indeed is very good. The 251 patients were sub-grouped in terms of HU and the Table below summarizes the essential information.

https://www.storzmedical.com/images/blog/Ibrahim.png

It is of note that none of the patients with HU or Admission were recorded in 7.8%.

It is slightly difficult to follow the different percentages that the author present in the article, but it stands to reason that all ancillary treatments occurred in Group III (which is the largest group). Those procedures accounted for 7.8%. The number 70% presented in the abstract seems to be incorrect.

Hans-Göran Tiselius

The authors of this report studied the need of ancillary treatment after SWL. It is of note that the overall success rate with SWL was 92.4% (!) which indeed is very good. The 251 patients were sub-grouped in terms of HU and the Table below summarizes the essential information. [img]https://www.storzmedical.com/images/blog/Ibrahim.png[/img] It is of note that none of the patients with HU or Admission were recorded in 7.8%. It is slightly difficult to follow the different percentages that the author present in the article, but it stands to reason that all ancillary treatments occurred in Group III (which is the largest group). Those procedures accounted for 7.8%. The number 70% presented in the abstract seems to be incorrect. Hans-Göran Tiselius
Monday, 20 May 2024