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Rasheed Y. et al., 2023: Extracorporeal Shock Wave Lithotripsy (ESWL) Outcome Based on CT Scan and Patient Parameters Using ESWL Score

Rasheed Y, Nazim SM, Zakaria M, Nasir MB, Khan S.
Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
Department of Surgery, PNS Shifa Hospital, Karachi, Pakistan.

Abstract

Objective: To prospectively evaluate ESWL (extracorporeal shock wave lithotripsy) outcomes and validate ESWL Score.

Study design: An observational study.

Place and duration of study: The Aga Khan University Hospital, from January 2021 to December 2021.

Methodology: Patients with symptomatic, solitary, radio-opaque renal stone measuring <15 mm with normal renal functions were included in this study. Stone size <11mm, BMI <27 Kg/m2, and stone density <900 Hounsfield units (HU) were all given 1 point each to give a total ESWL Score between 0-3 to each patient. Patients were evaluated after 4-weeks for the outcome i.e. stone clearance and complications.

Results: A total of 146 patients were included in the study. Median values for age, stone size, BMI and stone density were 40 years, 8 mm, 27 Kg/m2, and 774 HU respectively. Post ESWL, 99 (68%) patients were stone-free while 47 (32%) patients had residual stones. The stone clearance increased with the increasing score: 50% for ESWL score 0, 55.6% for ESWL score 1, 66.1% for ESWL score 2, and 85.7% for ESWL score 3 (p=0.01). The area under the curve (AUC) of ESWL score was 0.655 with 95 % CI (p=0.001).

Conclusion: ESWL Score is a useful predictor of the success of ESWL. It can help decide the individualised and appropriate modality of treatment and assist with patient counselling.
J Coll Physicians Surg Pak. 2023 Feb;33(2):199-204. doi: 10.29271/jcpsp.2023.02.199. PMID: 36797631

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Comments 1

Peter Alken on Wednesday, 19 July 2023 10:30

If all SWL studies would be precisely structured and the papers written in the clear fashion as the present one, understanding the message and comparing it with other studies would be very easy. The author revalidate a score described by an Argentinian group (1). The latter used a DUET MAGNA lithotripter (2) equipped with two shock wave heads. It is supposed to cause less parenchymal trauma as the shock wave travels through two different paths to the stone (3).
The present study used a Siemens Modularis lithotripter.

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

The present authors suggest scores 2 and 3 to be favourable for a SWL treatment to consult patients accordingly. This would primarily exclude 33 % (48/146) patients from SWL and 26 % (25/98) of those treated would experience a failure. In the Bengio (1) study, only 51% (58/ 114) were stone free.
The studies are in several ways not comparable: different lithotripters, slightly different inclusion criteria, different evaluation of SFR.
The best scoring system to predict SWL success is yet to come.
1 Bengió RG, et al. Sistema predictivo de éxito adaptado a nuestro medio para mejorar los resultados de la Litotricia Extracorpórea [Predictive score of success adapted to our environment to improve results of extracorporeal lithotripsy]. Arch Esp Urol. 2016 Sep;69(7):398-404. Spanish. PMID: 27617549.

2 https://www.direxgroup.com/products/lithotripsy/duet-magna

3 Handa RK, et al. Assessment of renal injury with a clinical dual head lithotriptor delivering 240 shock waves per minute. J Urol. 2009 Feb;181(2):884-9. doi: 10.1016/j.juro.2008.10.065. Epub 2008 Dec 17. PMID: 19095269; PMCID: PMC2717702.
Free PMC article

Peter Alken

If all SWL studies would be precisely structured and the papers written in the clear fashion as the present one, understanding the message and comparing it with other studies would be very easy. The author revalidate a score described by an Argentinian group (1). The latter used a DUET MAGNA lithotripter (2) equipped with two shock wave heads. It is supposed to cause less parenchymal trauma as the shock wave travels through two different paths to the stone (3). The present study used a Siemens Modularis lithotripter. [img]https://www.storzmedical.com/images/blog/Rasheed.png[/img] The present authors suggest scores 2 and 3 to be favourable for a SWL treatment to consult patients accordingly. This would primarily exclude 33 % (48/146) patients from SWL and 26 % (25/98) of those treated would experience a failure. In the Bengio (1) study, only 51% (58/ 114) were stone free. The studies are in several ways not comparable: different lithotripters, slightly different inclusion criteria, different evaluation of SFR. The best scoring system to predict SWL success is yet to come. 1 Bengió RG, et al. Sistema predictivo de éxito adaptado a nuestro medio para mejorar los resultados de la Litotricia Extracorpórea [Predictive score of success adapted to our environment to improve results of extracorporeal lithotripsy]. Arch Esp Urol. 2016 Sep;69(7):398-404. Spanish. PMID: 27617549. 2 https://www.direxgroup.com/products/lithotripsy/duet-magna 3 Handa RK, et al. Assessment of renal injury with a clinical dual head lithotriptor delivering 240 shock waves per minute. J Urol. 2009 Feb;181(2):884-9. doi: 10.1016/j.juro.2008.10.065. Epub 2008 Dec 17. PMID: 19095269; PMCID: PMC2717702. Free PMC article Peter Alken
Tuesday, 21 May 2024