Washino S. et al., 2021: Association between time to lithotripsy and stone-free rate in patients with ureteral stones undergoing shock wave lithotripsy
Washino S, Hayase T, Miyagawa T, Arai Y.
The Department of Urology, Nishi-Omiya Hospital, Saitama, Japan.
The Department of Urology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
The Department of Urology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
The Department of Urology, Nishi-Omiya Hospital, Saitama, Japan.
Abstract
Early shock wave lithotripsy is associated with higher stone-free rate compared to delayed treatment of ureteral stones, but may constitute overtreatment because ureteral stones can pass spontaneously. We studied the association between time to treatment and stone-free rate in patients with ureteral stones to determine optimal shock wave lithotripsy timing. We retrospectively analyzed 537 patients undergoing shock wave lithotripsy for ureteral stones. Patients were divided into five groups according to time from onset of symptoms to lithotripsy-urgent (0-3 days), early (4-30 days), late (31-60 days), long-delayed lithotripsy (≥ 61 days), and asymptomatic. Stone-free rates were compared among groups. Mean age and stone size were 55.6 ± 13.1 years and 7.48 ± 3.29 mm, respectively. Mean number of shock wave lithotripsy sessions and stone-free rate were 1.37 and 91.6%, respectively, in the overall population. Stone-free rates were 95.2%, 96.8%, 91.3%, 86.3%, and 82.7% in urgent, early, late, long-delayed lithotripsy, and asymptomatic groups, respectively. Long-delayed lithotripsy and asymptomatic groups had significantly more lithotripsy sessions and lower stone-free rate, compared to urgent and early lithotripsy groups. In multivariate analysis, time to lithotripsy [long-delayed lithotripsy (odds ratio: 0.273, p = 0.004) and asymptomatic nature (odds ratio: 0.236, p = 0.002)] and age (odds ratio: 0.959, p = 0.003) independently affected stone-free rate. In conclusion, time to lithotripsy is a strong predictive factor for stone-free status following shock wave lithotripsy. Urgent shock wave lithotripsy did not improve stone-free rate if performed within 1 month. However, time to shock wave lithotripsy > 2 months reduced likelihood of stone-free status.
Urolithiasis. 2021 Jan 2:1-8. doi: 10.1007/s00240-020-01232-4. Online ahead of print. PMID: 33386902. FREE ARTICLE
Comments 1
A nice study on a large patient group with clear results and WITHOUT the standard conclusion phrase of so many papers: “Further studies with more patients and a longer follow up have to confirm our results.”
I missed some references with similar or differing views on the subject (1-7).
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2 Seitz C, et al. Rapid extracorporeal shock wave lithotripsy for proximal ureteral calculi in colic versus noncolic patients. Eur Urol. 2007 Oct;52(4):1223-7. doi: 10.1016/j.eururo.2007.02.001.
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4 Panah A, et al. Factors predicting success of emergency extracorporeal shockwave lithotripsy (eESWL) in ureteric calculi--a single centre experience from the United Kingdom (UK). Urolithiasis. 2013 Oct;41(5):437-41. doi: 10.1007/s00240-013-0580-9
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5 Chung DY, et al. Impact of colic pain as a significant factor for predicting the stone free rate of one-session shock wave lithotripsy for treating ureter stones: a Bayesian logistic regression model analysis. PLoS One. 2015 Apr 22;10(4):e0123800. doi: 10.1371/journal.pone.0123800.
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6 Kim CH, et al. The Efficacy of Early Extracorporeal Shockwave Lithotripsy for the Treatment of Ureteral Stones. Urol J. 2019 Aug 18;16(4):331-336. doi: 10.22037/uj.v0i0.4537
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7 Cornelius J, et al. Immediate Shockwave Lithotripsy vs Delayed Shockwave Lithotripsy After Urgent Ureteral Stenting in Patients with Ureteral or Pyeloureteral Urolithiasis: A Matched-Pair Analysis. J Endourol. 2020 Dec 28. doi: 10.1089/end.2020.0384
Peter Alken