Meng R. et al., 2025: Analysis of risk factors for residual stones and stone recurrence after extracorporeal shock wave lithotripsy for ureteral stone.

Rui Meng, Xiaoyong Lv, Jiandong Wang, Yu Han, Zhipeng Zhai
Medicine (Baltimore). 2025 Sep 12;104(37):e44191. doi: 10.1097/MD.0000000000044191.
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Abstract

This study explores the risk factors for residual stones and stone recurrence after extracorporeal shock wave lithotripsy (ESWL), aiming to assist in clinical practice to improve the stone clearance rate, reduce the stone recurrence rate, and enhance the surgical outcomes. A retrospective analysis was conducted on 367 patients with ureteral stone who underwent ESWL from February 2022 to February 2025. Among them, 328 patients had complete data. General clinical data, stone characteristics, and follow-up data of the patients were collected. Univariate and multivariate logistic regression analyses were performed on the risk factors for residual stones and stone recurrence after ESWL. In this study, the stone clearance rate after ESWL was 85.37% (280/328), and the stone recurrence rate within 3 months after the operation was 20.36% (57/280). Univariate logistic regression analysis found that body mass index (P = .048), stone size (P < .001), stone density (P = .020), and preoperative serum creatinine (P = .045) were risk factors for residual stones after ESWL. Gender (P = .038), coronary heart disease (CHD, P = .024), and stone density (P = .037) were risk factors for stone recurrence after ESWL. Multivariate logistic regression analysis revealed that stone size (P < .001), stone hardness (P = .036), and preoperative serum creatinine (P = .008) were independent risk factors for residual stones after ESWL. CHD (P = .046) and stone density (P = .046) were independent risk factors for stone recurrence after ESWL. ESWL for ureteral stone has a relatively high stone clearance rate and stone recurrence rate. body mass index, stone size, stone density, and preoperative serum creatinine are independent risk factors for residual stones after ESWL. CHD and stone density are independent risk factors for stone recurrence after ESWL.

Comment Hans-Göran Tiselius

It is of great importance to get information on residual stones and stone recurrence after SWL. In case of remaining stones or stone fragments effective recurrence prevention is highly interesting for the comfort of the patients as well as for reducing the need of repeated stone removal.
The authors of this report used SWL to treat patients with ureteral stones. The advantage by considering ureteral stones is that when disintegrated the fragments are easily eliminated. Accordingly, the authors reached a stone-free state of more than 85% despite the problems of focusing stones with ultrasound. For stones located in the kidney it is easy to follow the further course with radiography. For ureteral stones my question is if residuals bigger 4 mm were given further SWL in situ, if they were left in the ureter or if they were expected to return to the kidney?
The authors claim that clearance of lower ureteral stones was less successful than the case for stones in other parts of the ureter.
To make things slightly clearer it would be of interest to learn how many of the ureteral stones that returned to the kidney and how many that remained in the ureter. For the latter patients I would strongly recommend additional SWL and subsequently focus on the further course of the stone residuals that had returned to the kidney.
Despite these comments the authors can be congratulated to successful SWL of ureteral stones. Moreover, I fully agree that there is need of effective recurrence prevention for residual stone material that is difficult to get rid of with facilitated elimination.

Hans-Göran Tiselius