BERKELEY, CA (UroToday.com) - Extracorporeal shockwave lithotripsy (ESWL) has been a successful treatment for ureteral stones. Studies of predictive factors of ESWL failure with ureteral stones have not yielded results sufficient to prevent ESWL failure. In the present series, we investigated predictive factors of these ESWL failures compared with cases of ESWL success.
A total of 90 patients with ureteral stones, treated using ESWL, were enrolled. Patients’ demographic data including age, gender, body mass index (BMI), symptoms, and calculous characteristics including location, size, episode, and the grade of hydronephrosis were recorded.
We defined ESWL failure as being if the patient had a stone > 3mm after the first session of ESWL, and we used the the PiezoLith 3000, a third-generation electrohydraulic shockwave lithotripter with ultrasonic and fluoroscopic stone localization. Statistical results were performed using univariate and multivariate analyses for the predictive factors of ESWL failure.
In univariate analysis, calculous location, size, and grade of hydronephrosis between two groups displayed significant differences (p<0.05). The predictive factors of ESWL failure were BMI >25 kg/m2 (odds ratio (OR)=3.5, 95% confidence interval (CI): 1.1 to 11.0), calculous size ≥1 cm (OR=10.5, 95% CI: 3.0 to 36.2), calculous location (mid ureter; OR=8.49, 95% CI:1.5 to 45.7), and severe grade of hydronephrosis (OR=12.3, 95% CI:1.9 to 79.5).
If we used another type of lithotripter or another power setting, our results might have been different. Despite the limitations of our study, our results suggest that ESWL failure for ureteral stones can be predicted when patients have one of the following risk factors: BMI >25 kg/m2, stone size ≥1 cm, mid-ureter stone, and severe hydronephrosis. Surgical management should be offered when confronted with patients with these risk factors.
Seung Il Jung, MD, PhD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Associate Professor, Department of Urology, Chonnam National University Hwasun Hospital, 322 Seoyang-ro, Hwasun-eup, Hawsun-gun, Jeollanam-do, 519-763, Republic of Korea