Somiya S. et al., 2025: Clinical outcomes of intravenous urography-assisted shockwave lithotripsy for radiolucent ureteral stones.

Shinya Somiya, Shigeki Koterazawa, Katsuhiro Ito, Takao Haitani, Yuki Makino, Ryuichiro Arakaki, Norio Kawase, Yoshihito Higashi, Hitoshi Yamada, Toru Kanno 
Asian J Urol. 2025 Jan;12(1):66-71. doi: 10.1016/j.ajur.2024.03.002 FREE PMC ARTICLE

Abstract

Objective: We aimed to compare the clinical outcomes of intravenous urography-assisted fluoroscopy-guided shockwave lithotripsy for radiolucent ureteral stones and standard shockwave lithotripsy for radiopaque ureteral stones.

Methods: We retrospectively reviewed 734 patients with ureteral stones treated by fluoroscopy-guided shockwave lithotripsy between March 2014 and March 2021. The primary outcome was a stone-free rate with one session within 30 days, defined as no residual stones without auxiliary treatment. The multivariate analysis was used to examine whether the intravenous urography use predicted treatment success. Furthermore, we compared the outcomes using propensity score matching.

Results: Ninety-eight patients underwent the intravenous urography use protocol (Group I), and the remaining 636 patients underwent the non-intravenous urography protocol (Group N). Stone-free rates with one session within 30 days were 38% and 32% in groups I and N, respectively (p=0.3). No statistical differences were observed in the conversion rate to ureteroscopy (p=0.3) or complication rate (p=0.7) between Group I and Group N. One patient who developed skin redness was considered a complication of the contrast medium. Propensity score matching examined 88 matched pairs. Treatment success was obtained in 31 (35%) patients in Group I and 33 (38%) patients in Group N (p=0.9) within 30 days with one session.

Conclusion: Radiolucent stones can be safely and effectively treated by shockwave lithotripsy with intravenous urography.

Comment Peter Alken

What a crazy paper on ESWL of radiolucent stones without a single word on the oral dissolution of uric acid stones with urinary alkalinisation, minimal costs, no complications, and extremely rare side effects.

Peter Alken