Body mass index and buttock circumference are independent predictors of disintegration failure in extracorporeal shock wave lithotripsy for ureteral calculi

By-products of lithotripsy: Are they related to abdominal fat and wave characteristics?

Objectives

This study aimed to evaluate the correlations between by-products of extracorporeal shock wave lithotripsy (ESWL) and some physical parameters such as abdominal fat, energy levels, and shock wave pulses.

Methods

A total of 40 patients (20 men and 20 women), aged 37.18 ± 10.64 years, with renal or ureteral stones were recruited. All patients were treated with ESWL, and their abdominal fat was measured using an Omron body fat monitor and the body mass index (BMI). Parameters such as the levels of malondialdehyde (MDA), ketones, and protein in urine were measured before and after ESWL using a Bio Doctor Analyzer. The wave characteristics of the lithotripsy procedure and the wave pulses were determined.

Results

The mean levels of urinary MDA and ketones showed statistically significant increases in post-ESWL compared with pre-ESWL values. The results showed significant elevations in MDA and ketones in both male and female patients. In addition, there was a significant correlation between MDA/ketones and energy levels and between ketones and BMI in female patients. The analysis also revealed that the shock wave pulse had an insignificant impact on the by-product parameters.

Conclusion

An energy level of ≤4 J is recommended for overweight and obese patients undergoing ESWL. In addition, measurement of the post-ESWL MDA urinary level should be performed as a routine test, especially in obese male patients.

The efficacy of extracorporeal shockwave lithotripsy for symptomatic ureteral stones: Predictors of treatment failure without the assistance of computed tomography

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.

Is scoring system of computed tomography based metric parameters can accurately predicts shock wave lithotripsy stone-free rates and aid in the development of treatment strategies?

Objective:

The objective was to determine the predicting success of shock wave lithotripsy (SWL) using a combination of computed tomography based metric parameters to improve the treatment plan.

Patients and Methods:

Consecutive 180 patients with symptomatic upper urinary tract calculi 20 mm or less were enrolled in our study underwent extracorporeal SWL were divided into two main groups, according to the stone size, Group A (92 patients with stone ≤10 mm) and Group B (88 patients with stone >10 mm). Both groups were evaluated, according to the skin to stone distance (SSD) and Hounsfield units (≤500, 500–1000 and >1000 HU).

Results:

Both groups were comparable in baseline data and stone characteristics. About 92.3% of Group A rendered stone-free, whereas 77.2% were stone-free in Group B (P = 0.001). Furthermore, in both group SWL success rates was a significantly higher for stones with lower attenuation <830 HU than with stones >830 HU (P < 0.034). SSD were statistically differences in SWL outcome (P < 0.02). Simultaneous consideration of three parameters stone size, stone attenuation value, and SSD; we found that stone-free rate (SFR) was 100% for stone attenuation value <830 HU for stone <10 mm or >10 mm but total number SWL sessions and shock waves required for the larger stone group were higher than in the smaller group (P < 0.01). Furthermore, SFR was 83.3% and 37.5% for stone <10 mm, mean HU >830, SSD 90 mm and SSD >120 mm, respectively. On the other hand, SFR was 52.6% and 28.57% for stone >10 mm, mean HU >830, SSD <90 mm and SSD >120 mm, respectively.

Conclusion:

Stone size, stone density (HU), and SSD is simple to calculate and can be reported by radiologists to applying combined score help to augment predictive power of SWL, reduce cost, and improving of treatment strategies.