Shen Z. et al., 2026: Nomogram Model for Predicting Clinical Efficacy of Emergency Extracorporeal Shock Wave Lithotripsy in Patients with Upper Urinary Tract Calculi: A Single-Centre Retrospective Study.

Shen Z, Zhang S, Gui Y, Wang Y, Yu G.
Arch Esp Urol. 2026 Jan;79(1):88-97. doi: 10.56434/j.arch.esp.urol.20267901.11

 Abstract

Background and aims: To explore the factors influencing the clinical efficacy of emergency extracorporeal shock wave lithotripsy (ESWL) in patients with upper urinary tract calculi, construct a nomogram model for predicting stone expulsion outcomes and validate its performance.

Methods: A retrospective analysis was conducted on the clinical data of 502 patients with upper urinary tract calculi who underwent emergency ESWL at The First Affiliated Hospital of Henan University of Science and Technology from January 2022 to December 2024. All patients were divided into the effective and ineffective groups based on the complete elimination of calculi within 4 weeks after surgery. Differences in general clinical data, urinalysis, liver and renal function indicators, calculus-related characteristics and treatment-related characteristics between the two groups were compared. Multivariate logistic regression was used to identify independent predictors of ESWL efficacy and construct a nomogram model. The model was evaluated using the receiver operating characteristic curve, calibration curve and decision curve analysis.

Results: A total of 140 (27.9%) patients had ineffective treatment. Independent risk factors for failure included long emergency visit-to-ESWL time, high urinary white-blood-cell count, elevated serum creatinine/serum uric acid, large maximum stone diameter, high stone density and severe hydronephrosis; ESWL energy and the number of shocks were mediated associated factors; High estimated glomerular filtration rate and ureteral calculi were protective factors (all p < 0.05). The nomogram showed a good predictive performance (area under the curve = 0.862, 95% confidence interval: 0.793-0.931) with good calibration and net benefit.

Conclusions: A validated nomogram based on independent predictors and mediated factors was constructed to provide a reliable tool for emergency ESWL decision-making.

Comment Hans-Göran Tiselius

This article aims to construct a nomogram for predicting the outcome of SWL for treatment of upper urinary tract stones. There are many such methods presented in the literature, but this one has its focus on emergency SWL. The nomogram is constructed based on SWL results in 502 patients of whom 362 were considered successfully treated and 140 failures.

In Figure 1 it is my understanding that the upper point scale refers to the SWL treatment and the lower “total points” to a summary of treatment and patient characteristics? This is, however, not completely clear.

The authors used SWL energy and SWs as “surrogate measures”. This is an interesting expression that can be interpreted as the operator’s decisions based on the treatment progress. Accordingly, a hard and difficult-to-disintegrate stone calls for both higher energy and greater number of shock waves to achieve fragmentation also in patients without success.

Interestingly, the time to SWL plays an important role and so does apparently also eGFR. The basic step seems to be SWL as early as possible. It must be noted that the time scale in the nomogram is hours, not days!

Hans-Göran Tiselius