Yonsei Med J.  2017 Sep;58(5):1000-1005. 10.3349/ymj.2017.58.5.1000.

Impact of Pretreatment Hydronephrosis on the Success Rate of Shock Wave Lithotripsy in Patients with Ureteral Stone

• Chang KD
• Lee JY
• Park SY
• Kang DH
• Lee HH
• Cho KS

• KMID: 2418937
• DOI: http://doi.org/10.3349/ymj.2017.58.5.1000

Abstract

PURPOSE
To evaluate predictors of the success rate for one session of shock wave lithotripsy (SWL), focusing on the relationships between pretreatment hydronephrosis grade and one-session SWL success rates.
MATERIALS AND METHODS
The medical records of 1824 consecutive patients who underwent an initial session of SWL for treatment of urinary stones between 2005 and 2013 were reviewed. After exclusion, 700 patients with a single, 4-20 mm diameter radiopaque calculus were included in the study.
RESULTS
The mean maximal stone length (MSL) and skin-to-stone distance were 9.2±3.9 and 110.8±18.9 mm, respectively. The average values for mean stone density (MSD) and stone heterogeneity index (SHI) were 707.0±272.1 and 244.9±110.1, respectively. One-session success rates were 68.4, 75.0, 75.1, 54.0, and 10.5% in patients with hydronephrosis grade 0, 1, 2, 3, and 4, respectively. Patients were classified into success or failure groups based on SWL outcome. Multivariate logistic regression analyses revealed that MSL [odds ratio (OR) 0.888, 95% confidence intervals (CI): 0.841-0.934, p<0.001], MSD (OR 0.996, 95% CI: 0.995-0.997, p<0.001), SHI (OR 1.007, 95% CI: 1.005-1.010, p<0.001), and pretreatment hydronephrosis grade (OR 0.601, 95% CI: 0.368-0.988, p=0.043) were significantly associated with one-session success.
CONCLUSION
Pretreatment grades 3 or 4 hydronephrosis were associated with failure of SWL in patients with a single ureteral stone. In the presence of severe hydronephrosis, especially hydronephrosis grade 4; physicians should proceed cautiously in choosing and offering SWL as the primary treatment for ureteral stone.

Keyword

Ureteral calculi; high-energy shock waves; lithotripsy; hydronephrosis

MeSH Terms

Aged
Female
Humans
Hydronephrosis/*complications
*Lithotripsy
Logistic Models
Male
Middle Aged
Multivariate Analysis
Treatment Outcome
Ureteral Calculi/*complications/*therapy

Reference

1. Frabboni R, Santi V, Ronchi M, Gaiani S, Costanza N, Ferrari G, et al. In situ echoguided extracorporeal shock wave lithotripsy of ureteric stones with the Dornier MPL 9000: a multicentric study group. Br J Urol. 1994; 73:487–493.

2. Creagh TA, Williams NN, Cronin K, Kerin MJ, Smith JM, Fitzpatrick JM. In situ ESWL for ureteric calculi: the optimum treatment? Ir J Med Sci. 1993; 162:348–350.

3. Singal RK, Denstedt JD. Contemporary management of ureteral stones. Urol Clin North Am. 1997; 24:59–70.

4. Srivastava A, Ahlawat R, Kumar A, Kapoor R, Bhandari M. Management of impacted upper ureteric calculi: results of lithotripsy and percutaneous litholapaxy. Br J Urol. 1992; 70:252–257.

5. Delakas D, Karyotis I, Daskalopoulos G, Lianos E, Mavromanolakis E. Independent predictors of failure of shockwave lithotripsy for ureteral stones employing a second-generation lithotripter. J Endourol. 2003; 17:201–205.

6. Wang M, Shi Q, Wang X, Yang K, Yang R. Prediction of outcome of extracorporeal shock wave lithotripsy in the management of ureteric calculi. Urol Res. 2011; 39:51–57.

7. El-Assmy A, El-Nahas AR, Youssef RF, El-Hefnawy AS, Sheir KZ. Impact of the degree of hydronephrosis on the efficacy of in situ extracorporeal shock-wave lithotripsy for proximal ureteral calculi. Scand J Urol Nephrol. 2007; 41:208–213.

8. Kageyama S, Hirai S, Higashi Y. [An investigation of factors associated with failure of extracorporeal shock wave lithotripsy for ureteral calculi]. Hinyokika Kiyo. 2000; 46:371–376.

9. Cho KS, Jung HD, Ham WS, Chung DY, Kang YJ, Jang WS, et al. Optimal skin-to-stone distance is a positive predictor for successful outcomes in upper ureter calculi following extracorporeal shock wave lithotripsy: a Bayesian model averaging approach. PLoS One. 2015; 10:e0144912.

10. Chung DY, Cho KS, Lee DH, Han JH, Kang DH, Jung HD, et al. Impact of colic pain as a significant factor for predicting the stone free rate of one-session shock wave lithotripsy for treating ureter stones: a Bayesian logistic regression model analysis. PLoS One. 2015; 10:e0123800.

11. Lee JY, Kim JH, Kang DH, Chung DY, Lee DH, Jung HD, et al. Stone heterogeneity index as the standard deviation of Hounsfield units: a novel predictor for shock-wave lithotripsy outcomes in ureter calculi. Sci Rep. 2016; 6:23988.

12. Seitz C, Fajkovic H, Waldert M, Tanovic E, Remzi M, Kramer G, et al. Extracorporeal shock wave lithotripsy in the treatment of proximal ureteral stones: does the presence and degree of hydronephrosis affect success? Eur Urol. 2006; 49:378–383.

13. Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol. 1993; 23:478–480.

14. Skolarikos A, Alivizatos G, de la Rosette J. Extracorporeal shock wave lithotripsy 25 years later: complications and their prevention. Eur Urol. 2006; 50:981–990.

15. Augustin H. Prediction of stone-free rate after ESWL. Eur Urol. 2007; 52:318–320.

16. Kim HH, Lee JH, Park MS, Lee SE, Kim SW. In situ extracorporeal shockwave lithotripsy for ureteral calculi: investigation of factors influencing stone fragmentation and appropriate number of sessions for changing treatment modality. J Endourol. 1996; 10:501–505.

17. Gupta NP, Ansari MS, Kesarvani P, Kapoor A, Mukhopadhyay S. Role of computed tomography with no contrast medium enhancement in predicting the outcome of extracorporeal shock wave lithotripsy for urinary calculi. BJU Int. 2005; 95:1285–1288.

18. Lim KH, Jung JH, Kwon JH, Lee YS, Bae J, Cho MC, et al. Can stone density on plain radiography predict the outcome of extracorporeal shockwave lithotripsy for ureteral stones? Korean J Urol. 2015; 56:56–62.

19. Hofbauer J, Tuerk C, Höbarth K, Hasun R, Marberger M. ESWL in situ or ureteroscopy for ureteric stones? World J Urol. 1993; 11:54–58.

20. Kanao K, Nakashima J, Nakagawa K, Asakura H, Miyajima A, Oya M, et al. Preoperative nomograms for predicting stone-free rate after extracorporeal shock wave lithotripsy. J Urol. 2006; 176(4 Pt 1):1453–1456.

21. Abe T, Akakura K, Kawaguchi M, Ueda T, Ichikawa T, Ito H, et al. Outcomes of shockwave lithotripsy for upper urinary-tract stones: a large-scale study at a single institution. J Endourol. 2005; 19:768–773.

22. Mugiya S, Ito T, Maruyama S, Hadano S, Nagae H. Endoscopic features of impacted ureteral stones. J Urol. 2004; 171:89–91.

23. Morgentaler A, Bridge SS, Dretler SP. Management of the impacted ureteral calculus. J Urol. 1990; 143:263–266.

24. Mugiya S, Nagata M, Un-No T, Takayama T, Suzuki K, Fujita K. Endoscopic management of impacted ureteral stones using a small caliber ureteroscope and a laser lithotriptor. J Urol. 2000; 164:329–331.

25. Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU guidelines on interventional treatment for urolithiasis. Eur Urol. 2016; 69:475–482.