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Chiang BJ et al, 2017: The efficacy of extracorporeal shockwave lithotripsy for symptomatic ureteral stones: Predictors of treatment failure without the assistance of computed tomography.

Chiang BJ, Liao CH, Lin YH.
Department of Life Science, National Taiwan Normal University, Taipei, Taiwan.
Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan.
Department of Urology, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.

Abstract

OBJECTIVES: Non-contrast computed tomography (NCCT) is not always performed clinically if the diagnosis of ureteral calculi has been confirmed using other radiographic imaging modalities. The aim of this study was to identify predictors of successful extracorporeal shockwave lithotripsy (ESWL) without assistance of NCCT.
METHODS: We retrospectively reviewed the medical records of patients with symptomatic solitary ureteral stones who underwent ESWL between November 2015 and January 2016. Abdominal plain radiography or intravenous urography were performed before ESWL for localization. The exclusion criteria were repeated sessions of ESWL for the target stone and congenital genitourinary tract anomalies. The demographic characteristics, clinical history, medical charges, or imaging features of the stones were recorded. Successful treatment was defined as no fragments detected on radiography or ultrasonography in 4 weeks. For radiolucent calculi, successful treatment was regarded as cases without hydronephrosis, symptoms, or hematuria. Patients experiencing intractable pain and undergoing subsequent auxiliary surgeries were regarded as having ESWL treatment failure.
RESULTS: Age (odds ratio [OR], 1.042; 95% confidence interval [CI], 1.007-1.078), history of ipsilateral renal or ureteral calculi episodes (OR, 2.669; 95% CI, 1.281-5.687), stone burden (OR, 3.499; 95% CI, 1.284-9.530), and radiopaque stone (OR, 2.351; 95% CI, 1.049-5.267) were significant predictors of ESWL failure in all patients.
CONCLUSIONS: For treating symptomatic ureteral stones, those with smaller size, radiolucency, and without a history of ipsilateral renal or ureteral calculi could be considered for first-line therapy with ESWL.

PLoS One. 2017 Sep 20;12(9):e0184855. doi: 10.1371/journal.pone.0184855. eCollection 2017.

 

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Commentaires 1

Hans-Göran Tiselius le mercredi 21 février 2018 09:38

In this report the authors studied the outcome of SWL for ureteral stones without imaging with NCCT. Instead they used KUB and IVP. This corresponds to the clinical situation during the first 10-13 years of experience with SWL. In Sweden there was a slowly increasing use of NCCT from around 1998 and forwards. Today NCCT seems to be overused.
The identified predictors of SWL failure were old patient, previous stones in the same ureter, as well as large and radiopaque stones. Most unexpected was the observation that radiolucent stones were so successfully removed when their identification and treatment required IVP!
A success rate of 66% is slightly lower than the one-session success recorded for patients treated for ureteral stones with the SLX-F2 lithotripter [1]. One aspect that needs consideration is that successful SWL treatment necessitates treatment according to the response by the stone; not by the patient. If such a rule was followed is difficult to know, because it is mentioned in the treatment section that there was “a gradual power increase to a maximum of 13 kV…if tolerated.” Details on analgesic regime are not mentioned.
Although the authors have included some commonly reported measurements such as BC (buttock circumference) and WC (waist circumference), it is difficult to know the general importance of these factors given the different body habitus in the Taiwanese population.
Reference
1. Tiselius HG. How efficient is extracorporeal shockwave lithotripsy with modern lithotripters for removal of ureteral stones?
J Endourol. 2008 22:249-55

In this report the authors studied the outcome of SWL for ureteral stones without imaging with NCCT. Instead they used KUB and IVP. This corresponds to the clinical situation during the first 10-13 years of experience with SWL. In Sweden there was a slowly increasing use of NCCT from around 1998 and forwards. Today NCCT seems to be overused. The identified predictors of SWL failure were old patient, previous stones in the same ureter, as well as large and radiopaque stones. Most unexpected was the observation that radiolucent stones were so successfully removed when their identification and treatment required IVP! A success rate of 66% is slightly lower than the one-session success recorded for patients treated for ureteral stones with the SLX-F2 lithotripter [1]. One aspect that needs consideration is that successful SWL treatment necessitates treatment according to the response by the stone; not by the patient. If such a rule was followed is difficult to know, because it is mentioned in the treatment section that there was “a gradual power increase to a maximum of 13 kV…if tolerated.” Details on analgesic regime are not mentioned. Although the authors have included some commonly reported measurements such as BC (buttock circumference) and WC (waist circumference), it is difficult to know the general importance of these factors given the different body habitus in the Taiwanese population. Reference 1. Tiselius HG. How efficient is extracorporeal shockwave lithotripsy with modern lithotripters for removal of ureteral stones? J Endourol. 2008 22:249-55
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