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Liang J. et al., 2023: Factors influencing the efficacy of ultrasound-guided extracorporeal shockwave lithotripsy in the treatment of ureteral stones: a retrospective study.

Liang J, Xie L, Gao H, Yang R, Liu J, Liu C.
Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, He Xi District, Tianjin, China.
Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Pingjiang Road 23, He Xi District, Tianjin, China.

Abstract

The aim of the study was to analyze the factors influencing the efficacy of ultrasound-guided extracorporeal shockwave lithotripsy (ESWL) in the treatment of ureteral stones. The clinical data of 8102 patients (6083 men and 2019 women) who presented with ureteral stones were retrospectively analyzed. All the patients were treated with ultrasound-guided ESWL. The stone-free rate (SFR) was calculated to evaluate the effect of ESWL. The characteristics of the patients and their stones, and the ESWL parameters applied were compared to identify the factors affecting the treatment outcomes. The SFR and that following one ESWL session were 94.6% (7663/8102) and 75.4% (6107/8102), respectively. Multivariate analysis showed that stone location (OR 0.656, p < 0.001), stone size (OR 1.103, p < 0.001), and degree of hydronephrosis (OR 1.952, p < 0.001) independently affected SFR; and age (OR 1.005, p = 0.022), stone location (OR 0.729, p < 0.001), stone size (OR 1.103, p < 0.001), degree of hydronephrosis (OR 1.387, p = 0.001), maximum energy level(OR 0.691, p < 0.001) independently affected SFR following one session. Ultrasound-guided ESWL is effective in all levels of ureteral stones. Large stone size and moderate hydronephrosis are correlated with treatment failure. Ultrasound-guided ESWL may be the first choice for distal ureteral stones.

Urolithiasis. 2023 Dec 20;52(1):15. doi: 10.1007/s00240-023-01512-9. PMID: 38117370

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Comments 1

Hans-Göran Tiselius on Thursday, 04 April 2024 11:00

The advantages of SWL are obvious. It is a non-invasive procedure that can be carried out without general or regional anesthesia, albeit not without appropriate analgesics and/or sedatives. Carefully performed the success with SWL is usually better than indicated in common comparisons with endoscopy.

The main disadvantage is that fluoroscopy has remained the standard method for stone positioning and recording of disintegration. Although ultrasound is the alternative method, fluoroscopy is easier to learn and therefore still preferred by most operators. Radiation-free SWL is indeed very attractive and works well in the hands of experts. This is clearly shown in this article in which ultrasound was used for treatment of more than 8000 patients with ureteral stones.

Continuous monitoring of the procedure is mentioned as an advantage. It is not clear, however, if ultrasound imaging was monitored and managed in a remote set up. This is desirable to allow for operators to carry out the treatment without being directly at the SWL table. From the figure in the report, it seems likely that this is possible.

One of the disadvantages with fluoroscopy is that treatment progress must be checked frequently to optimize treatment and to adjust patient position accordingly. This requirement has increased with the small focal volumes in modern lithotripters. It thus is exciting that the authors of this article were so successful with ultrasound monitoring.

The bottom-line is that stone location, stone size, and degree of hydronephrosis as well as patient age and energy levels were important factors for the treatment outcome. The overall stone-free rates of 94.5% and as high as 75.4% after one session are impressive! The reader can get further interesting details by reading the article.
It stands to reason, however, that ultrasound systems must be made extremely user-friendly, and that the method is commonly applied. It is highly desirable that the treatment process can be controlled from a remote panel. It is of course necessary to have close contact with the patient during the treatment, but without need to stand close to the SWL source during the whole treatment.
It is stated that the best results were recorded for distal ureteral stones and that results with proximal ureteral stones also were very good. Nothing is mentioned about stones in the mid ureter, but it is assumed that stones in that position might be more difficult to localize and follow.’

Hans-Göran Tiselius

The advantages of SWL are obvious. It is a non-invasive procedure that can be carried out without general or regional anesthesia, albeit not without appropriate analgesics and/or sedatives. Carefully performed the success with SWL is usually better than indicated in common comparisons with endoscopy. The main disadvantage is that fluoroscopy has remained the standard method for stone positioning and recording of disintegration. Although ultrasound is the alternative method, fluoroscopy is easier to learn and therefore still preferred by most operators. Radiation-free SWL is indeed very attractive and works well in the hands of experts. This is clearly shown in this article in which ultrasound was used for treatment of more than 8000 patients with ureteral stones. Continuous monitoring of the procedure is mentioned as an advantage. It is not clear, however, if ultrasound imaging was monitored and managed in a remote set up. This is desirable to allow for operators to carry out the treatment without being directly at the SWL table. From the figure in the report, it seems likely that this is possible. One of the disadvantages with fluoroscopy is that treatment progress must be checked frequently to optimize treatment and to adjust patient position accordingly. This requirement has increased with the small focal volumes in modern lithotripters. It thus is exciting that the authors of this article were so successful with ultrasound monitoring. The bottom-line is that stone location, stone size, and degree of hydronephrosis as well as patient age and energy levels were important factors for the treatment outcome. The overall stone-free rates of 94.5% and as high as 75.4% after one session are impressive! The reader can get further interesting details by reading the article. It stands to reason, however, that ultrasound systems must be made extremely user-friendly, and that the method is commonly applied. It is highly desirable that the treatment process can be controlled from a remote panel. It is of course necessary to have close contact with the patient during the treatment, but without need to stand close to the SWL source during the whole treatment. It is stated that the best results were recorded for distal ureteral stones and that results with proximal ureteral stones also were very good. Nothing is mentioned about stones in the mid ureter, but it is assumed that stones in that position might be more difficult to localize and follow.’ Hans-Göran Tiselius
Monday, 20 May 2024