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Factors affecting success in the treatment of proximal ureteral stones larger than 1 cm with extracorporeal shockwave lithotripsy in adult patients

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Abstract

The aim of the study was to analyze the factors predicting success for the treatment of proximal ureteral stones larger than 1 cm with extracorporeal shockwave lithotripsy (SWL) in adult patients. Between January 2014 and December 2018, 480 adult patients in total underwent SWL and data were retrospectively evaluated. Patients with multiple ureteral stones, solitary kidney, congenital abnormality, skeletal system abnormality, history of previous urinary system surgery and SWL, renal insufficiency, patients who could not tolerate SWL and pediatric patients were excluded from the study. The remaining 415 patients were divided into two groups as success (Group 1, n = 307) and failure (Group 2, n = 108). The overall success rate was 73.9%. The values of stone size, Hounsfield Unit (HU), skin to stone distance (SSD), ureteral wall thickness (UWT), proximal ureter diameter, renal pelvis diameter, hydronephrosis grade, and duration of renal colic were significantly higher in Group 2 compared to Group 1. In binary logistic regression analyses, HU, UWT, and proximal ureter diameter were found to be independent predictors. HU, UWT, and proximal ureter diameter had sensitivity and specificity of 92–92%, 88–23%, and 87–46%, with cutoff values of 740 HU, 2.5 mm and 8.5 mm, respectively. The area under the curve values were 0.96, 0.97, and 0.96 for HU, UWT, and proximal ureter diameter, respectively. The CT-based parameters, including HU, UWT, and proximal ureter diameter are independent predictive factors with excellent accuracy for the treatment of proximal ureteral stones larger than 1 cm with SWL in adult patients. Based on these factors, SWL can be considered for proximal ureteral stones larger than 1 cm.

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Funding

No specific grant was received by this study from any commercial, not-for-profit sectors, or public funding agency.

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Authors and Affiliations

  1. Department of Urology, Private Safa Hospital, Istanbul, Turkey

    Yavuz Guler

  2. Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey

    Akif Erbin

  3. Department of Urology, Dr. Lutfi Kirdar Kartal Traning and Research Hospital, Istanbul, Turkey

    Alper Kafkasli

  4. Department of Urology, Istanbul Aydin University Medical Faculty, Istanbul, Turkey

    Gokhun Ozmerdiven

Authors
  1. Yavuz Guler
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  2. Akif Erbin
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  3. Alper Kafkasli
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  4. Gokhun Ozmerdiven
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Correspondence to Akif Erbin.

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Informed consent was obtained from all individual participants included in the study.

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Guler, Y., Erbin, A., Kafkasli, A. et al. Factors affecting success in the treatment of proximal ureteral stones larger than 1 cm with extracorporeal shockwave lithotripsy in adult patients. Urolithiasis 49, 51–56 (2021). https://doi.org/10.1007/s00240-020-01186-7

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