Xu H. et al., 2024: Reply to Editorial Comment on "The Association Between Stone Heterogenicity and the Success of Shock Wave Lithotripsy for High Density Upper Urinary Tract Stones".

Hanfeng Xu, Song Bai 
Urology. 2024 Nov 19:S0090-4295(24)01077-X. doi: 10.1016/j.urology.2024.11.026

Abstract

no abstract available

Comment Peter Alken

This is a reply of the authors of a previous publication (1) to an editorial comment by Sorensen(2)
“There were also several limitations. First, the observational design prevents a causal relationship from being inferred. Second, although we adjusted for many confounding factors and performed comprehensive subgroup analyses, residual and unmeasured confounding biases might also have been affected. Third, there needs to be more information on the composition of individual urinary stones. Fourth, the variability in the procedure and the type of lithotripter among different SWL centers has also been shown to affect the results not assessed in this study. Fifth, the treatment outcome was evaluated by KUB/ultrasound (less than 4 mm cutoff for success) 1 month after shock wave lithotripsy instead of CT, which may overestimate the success rate. Sixth, there was also variability in inaccurate measurements, regions of interest, and lack of centralized radiology review. Hence, a randomized controlled trial with standard procedure is warranted. Nevertheless, this is the first multicentre prospective study to investigate the association between the stone heterogenicity and treatment outcome of shock wave lithotripsy in patients with high-density upper urinary tract stones.”(1)
1 Xu H, et al. The Association Between Stone Heterogenicity and the Success of Shock Wave Lithotripsy for High Density Upper Urinary Tract Stones: A Muti-Center Prospective Cohort. Urology. 2025 Feb;196:57-63. doi: 10.1016/j.urology.2024.10.069. Epub 2024 Nov 20. PMID: 39577810.
2 Sorensen MD. Editorial Comment on "The Association Between Stone Heterogenicity and the Success of SWL for High Density Upper Urinary Tract Stones". Urology. 2025 Feb;196:64. doi: 10.1016/j.urology.2024.11.017. Epub 2024 Nov 16. PMID: 39557368.

Peter Alken