SWL literature
SWL Literature

Elawady H. et al., 2021: Can we successfully predict the outcome for extracorporeal shock wave lithotripsy (ESWL) for medium size renal stones? A single-center experience.

Elawady H, Mahmoud MA, Samir M.
Department of Urology, Ain Shams University, Cairo, Egypt.

Abstract

Background: Extracorporeal shock wave lithotripsy (ESWL) is one of the most used modalities in treatment of renal stones, but its effectiveness can be influenced by many factors related to the patient or the stone itself which may affect the success of stone disintegration. The aim of our study was to investigate the predictive value of some patient and stone-related factors for ESWL success for renal stones.

Methods: A total of 100 patients with single radiopaque renal stone 10-20 mm in diameter, undergoing ESWL were enrolled in this study. All patients had non contrast computed tomography (NCCT) done before ESWL. We evaluated body mass index (BMI), skin-to-stone distance (SSD), stone size and Hounsfield density comparing these values between stone free (SF) and residual stone (RS) groups.

Results: Of the 100 patients, 70% had successful disintegration. There was no significant difference between stone free (SF) and residual stone (RS) groups as regard age or BMI. Meanwhile, there was a significant difference between SF and RS groups as regard stones' density and SSD, with higher values in RS group but there was statistically insignificant difference as regard stone size (p = 0.522). Using logistic regression analysis, we found that Hounsfield unit (HU) was better in predicting successful disintegration than SSD but without statistical significance.

Conclusion: HU and SSD are the independent predictive factors for ESWL outcome, and they should be considered when planning ESWL in treatment of medium size renal stones.
Urologia. 2021 May 13:3915603211016355. doi: 10.1177/03915603211016355. Online ahead of print. PMID: 33985373.

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Comments 1

Peter Alken on Thursday, October 07 2021 08:30

The authors call it a prospective study probably in a sense that everything you do in the future is prospective. However, it was in fact a retrospective collection of data of 100 patients. It is not clear if these were consecutive patients or if they were selected which would have caused a selection bias.
“NCCT were done to all the patients”, however the stone size was measured in cm.
Residual Stones “(RS) was defined as failure of stone disintegration or persistence of fragment > 4 mm after three sessions which was indication for another treatment modality.” The number of sessions is not indicated nor the secondary treatments. No complications are reported.
“Follow up was performed two weeks after ESWL by KUB and ultrasonography to assess for fragmentation.” KUB and ultrasonography are insufficient tools for fragment detection and lead to false high stone free rates. Two weeks post ESWL is too early to determine the success and leads to false low stone free rates. “Of the 100 patients, 70 were classified as SF and 30 as having RS, mean ± SD of residual stone size was 6.50 ± 1.76 ranged from 5 to 10 mm.”

What is new and what does this result tell the reader?
There is nothing new.
“The main disadvantages of our study are mainly the wide range of stone size 10–20 mm, also we did not consider some factors like (stone volume, surface area, and Hounsfield density), pain, procedure complications and patient compliance. So, further multicenter studies on a larger number of patients are needed to validate our results.”

Where was this paper published?
The Urologia Journal is published since 1965 and has a low impact factor of 0,723, rising. It is an open access journal of the SAGE publisher: “Urologia Journal is an international English language peer-reviewed journal providing practical, timely, and state of the art contributions on clinical research and experience in the urological field. It publishes high quality papers with contributions from eminent leading experts.”

Did the authors pay for publication?
“There are no fees payable to submit or publish in this journal.”

Was this paper reviewed?
Part of the peer review policy of this journal is:
“As part of the submission process - the author - will be asked to provide the names of peers who could be called upon to review your manuscript. Recommended reviewers should be experts in their fields and should be able to provide an objective assessment of the manuscript. Please be aware of any conflicts of interest when recommending reviewers. Examples of conflicts of interest include (but are not limited to) the below:
• The reviewer should have no prior knowledge of your submission
• The reviewer should not have recently collaborated with any of the authors
• Reviewer nominees from the same institution as any of the authors are not permitted
You will also be asked to nominate peers who you do not wish to review your manuscript (opposed reviewers).”

Why was this paper published?
Generally, an academic degree in medicine can only be obtained when the candidate has published a certain number of papers. In many countries the clinical and research work is emerging and, naturally, way behind the standards set since many years in more advanced countries. The manuscript rejection rate in standard high impact journals is high, between 70 % and 80 %. Thus for many authors the only chance to fulfil the task is by publishing in low impact journals or by paying for publication. Such publications may be just reflecting the status of the basic and clinical research situation in a given country but may not add to the general knowledge of the topic dealt with.

Why did I add this information?
Some of the visitors of this site may not be familiar with publishing policies and why and how some manuscripts make it into journals

Peter Alken

The authors call it a prospective study probably in a sense that everything you do in the future is prospective. However, it was in fact a retrospective collection of data of 100 patients. It is not clear if these were consecutive patients or if they were selected which would have caused a selection bias. “NCCT were done to all the patients”, however the stone size was measured in cm. Residual Stones “(RS) was defined as failure of stone disintegration or persistence of fragment > 4 mm after three sessions which was indication for another treatment modality.” The number of sessions is not indicated nor the secondary treatments. No complications are reported. “Follow up was performed two weeks after ESWL by KUB and ultrasonography to assess for fragmentation.” KUB and ultrasonography are insufficient tools for fragment detection and lead to false high stone free rates. Two weeks post ESWL is too early to determine the success and leads to false low stone free rates. “Of the 100 patients, 70 were classified as SF and 30 as having RS, mean ± SD of residual stone size was 6.50 ± 1.76 ranged from 5 to 10 mm.” What is new and what does this result tell the reader? There is nothing new. “The main disadvantages of our study are mainly the wide range of stone size 10–20 mm, also we did not consider some factors like (stone volume, surface area, and Hounsfield density), pain, procedure complications and patient compliance. So, further multicenter studies on a larger number of patients are needed to validate our results.” Where was this paper published? The Urologia Journal is published since 1965 and has a low impact factor of 0,723, rising. It is an open access journal of the SAGE publisher: “Urologia Journal is an international English language peer-reviewed journal providing practical, timely, and state of the art contributions on clinical research and experience in the urological field. It publishes high quality papers with contributions from eminent leading experts.” Did the authors pay for publication? “There are no fees payable to submit or publish in this journal.” Was this paper reviewed? Part of the peer review policy of this journal is: “As part of the submission process - the author - will be asked to provide the names of peers who could be called upon to review your manuscript. Recommended reviewers should be experts in their fields and should be able to provide an objective assessment of the manuscript. Please be aware of any conflicts of interest when recommending reviewers. Examples of conflicts of interest include (but are not limited to) the below: • The reviewer should have no prior knowledge of your submission • The reviewer should not have recently collaborated with any of the authors • Reviewer nominees from the same institution as any of the authors are not permitted You will also be asked to nominate peers who you do not wish to review your manuscript (opposed reviewers).” Why was this paper published? Generally, an academic degree in medicine can only be obtained when the candidate has published a certain number of papers. In many countries the clinical and research work is emerging and, naturally, way behind the standards set since many years in more advanced countries. The manuscript rejection rate in standard high impact journals is high, between 70 % and 80 %. Thus for many authors the only chance to fulfil the task is by publishing in low impact journals or by paying for publication. Such publications may be just reflecting the status of the basic and clinical research situation in a given country but may not add to the general knowledge of the topic dealt with. Why did I add this information? Some of the visitors of this site may not be familiar with publishing policies and why and how some manuscripts make it into journals Peter Alken
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Sunday, December 05 2021

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