Investig Clin Urol.  2016 Nov;57(6):408-416. 10.4111/icu.2016.57.6.408.

Ureteral stenting can be a negative predictor for successful outcome following shock wave lithotripsy in patients with ureteral stones

• Kang DH
• Cho KS
• Ham WS
• Chung DY
• Kwon JK
• Choi YD
• Lee JY

• KMID: 2451399
• DOI: http://doi.org/10.4111/icu.2016.57.6.408

Abstract

PURPOSE
To evaluate ureteral stenting as a negative predictive factor influencing ureteral stone clearance and to estimate the probability of one-session success in shock wave lithotripsy (SWL) patients with a ureteral stone.
MATERIALS AND METHODS
We retrospectively reviewed the medical records of 1,651 patients who underwent their first SWL. Among these patients, 680 had a ureteral stone measuring 4-20 mm and were thus eligible for our study. The 57 patients who underwent ureteral stenting during SWL were identified. Maximal stone length (MSL), mean stone density (MSD), skin-to-stone distance (SSD), and stone heterogeneity index (SHI) were determined by pre-SWL noncontrast computed tomography.
RESULTS
After propensity score matching, 399 patients were extracted from the total patient cohort. There were no significant differences between stenting and stentless groups after matching, except for a higher one-session success rate in the stentless group (78.6% vs. 49.1%, p=0.026). In multivariate analysis, shorter MSL, lower MSD, higher SHI, and absence of a stent were positive predictors for one-session success in patients who underwent SWL. Using cutoff values of MSL and MSD obtained from receiver operator curve analysis, in patients with a lower MSD (≤784 HU), the success rate was lower in those with a stent (61.1%) than in those without (83.5%) (p=0.001). However, in patients with a higher MSL (>10 mm), the success rate was lower in those with a stent (23.6%) than in those without (52.2%) (p=0.002).
CONCLUSIONS
Ureteral stenting during SWL was a negative predictor of one-session success in patients with a ureteral stone.

Keyword

Lithotripsy; Stents; Treatment outcome; Ureter; Urinary calculi

MeSH Terms

Adult
Aged
Female
Humans
Lithotripsy/adverse effects/*methods
Male
Middle Aged
Prognosis
Propensity Score
Retrospective Studies
Risk Factors
*Stents
Tomography, X-Ray Computed
Treatment Outcome
Ureteral Calculi/diagnostic imaging/pathology/*therapy

Reference

1. Teichman JM. Clinical practice: acute renal colic from ureteral calculus. N Engl J Med. 2004; 350:684–693.

2. Seitz C, Tanovic E, Kikic Z, Memarsadeghi M, Fajkovic H. Rapid extracorporeal shock wave lithotripsy for proximal ureteral calculi in colic versus noncolic patients. Eur Urol. 2007; 52:1223–1227.

3. Salem S, Mehrsai A, Zartab H, Shahdadi N, Pourmand G. Complications and outcomes following extracorporeal shock wave lithotripsy: a prospective study of 3,241 patients. Urol Res. 2010; 38:135–142.

4. Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU Guidelines on diagnosis and conservative management of urolithiasis. Eur Urol. 2016; 69:468–474.

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

6. Kirkali Z, Esen AA, Akan G. Place of double-J stents in extracorporeal shock wave lithotripsy. Eur Urol. 1993; 23:460–462.

7. Shen P, Jiang M, Yang J, Li X, Li Y, Wei W, et al. Use of ureteral stent in extracorporeal shock wave lithotripsy for upper urinary calculi: a systematic review and meta-analysis. J Urol. 2011; 186:1328–1335.

8. Musa AA. Use of double-J stents prior to extracorporeal shock wave lithotripsy is not beneficial: results of a prospective randomized study. Int Urol Nephrol. 2008; 40:19–22.

9. Ghoneim IA, El-Ghoneimy MN, El-Naggar AE, Hammoud KM, El-Gammal MY, Morsi AA. Extracorporeal shock wave lithotripsy in impacted upper ureteral stones: a prospective randomized comparison between stented and non-stented techniques. Urology. 2010; 75:45–50.

10. Chandhoke PS, Barqawi AZ, Wernecke C, Chee-Awai RA. A randomized outcomes trial of ureteral stents for extracorporeal shock wave lithotripsy of solitary kidney or proximal ureteral stones. J Urol. 2002; 167:1981–1983.

11. Sfoungaristos S, Polimeros N, Kavouras A, Perimenis P. Stenting or not prior to extracorporeal shockwave lithotripsy for ureteral stones? Results of a prospective randomized study. Int Urol Nephrol. 2012; 44:731–737.

12. Pettenati C, El Fegoun AB, Hupertan V, Dominique S, Ravery V. Double J stent reduces the efficacy of extracorporeal shock wave lithotripsy in the treatment of lumbar ureteral stones. Cent European J Urol. 2013; 66:309–313.

13. Ozkan B, Dogan C, Can GE, Tansu N, Erozencı A, Onal B. Does ureteral stenting matter for stone size? A retrospectıve analyses of 1361 extracorporeal shock wave lithotripsy patients. Cent European J Urol. 2015; 68:358–364.

14. 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.

15. 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.

16. 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.

17. Rubin DB, Thomas N. Matching using estimated propensity scores: relating theory to practice. Biometrics. 1996; 52:249–264.

18. Lee JY, Diaz RR, Cho KS, Yu HS, Chung JS, Ham WS, et al. Lymphocele after extraperitoneal robot-assisted radical prostatectomy: a propensity score-matching study. Int J Urol. 2013; 20:1169–1176.

19. Mohayuddin N, Malik HA, Hussain M, Tipu SA, Shehzad A, Hashmi A, et al. The outcome of extracorporeal shockwave lithotripsy for renal pelvic stone with and without JJ stent--a comparative study. J Pak Med Assoc. 2009; 59:143–146.

20. El-Assmy A, El-Nahas AR, Sheir KZ. Is pre-shock wave lithotripsy stenting necessary for ureteral stones with moderate or severe hydronephrosis? J Urol. 2006; 176:2059–2062.

21. Mustafa M, Ali-El-Dein B. Stenting in extracorporeal shockwave lithotripsy; may enhance the passage of the fragments! J Pak Med Assoc. 2009; 59:141–143.

22. Nguyen DP, Hnilicka S, Kiss B, Seiler R, Thalmann GN, Roth B. Optimization of extracorporeal shock wave lithotripsy delivery rates achieves excellent outcomes for ureteral stones: results of a prospective randomized trial. J Urol. 2015; 194:418–423.

23. Abdel-Khalek M, Sheir K, Elsobky E, Showkey S, Kenawy M. Prognostic factors for extracorporeal shock-wave lithotripsy of ureteric stones: a multivariate analysis study. Scand J Urol Nephrol. 2003; 37:413–418.

24. Singh I, Gupta NP, Hemal AK, Dogra PN, Ansari MS, Seth A, et al. Impact of power index, hydroureteronephrosis, stone size, and composition on the efficacy of in situ boosted ESWL for primary proximal ureteral calculi. Urology. 2001; 58:16–22.

25. Joshi HB, Obadeyi OO, Rao PN. A comparative analysis of nephrostomy, JJ stent and urgent in situ extracorporeal shock wave lithotripsy for obstructing ureteric stones. BJU Int. 1999; 84:264–269.

26. Kwon JK, Cho KS, Oh CK, Kang DH, Lee H, Ham WS, et al. The beneficial effect of alpha-blockers for ureteral stent-related discomfort: systematic review and network meta-analysis for alfuzosin versus tamsulosin versus placebo. BMC Urol. 2015; 15:55.

27. Abt D, Mordasini L, Warzinek E, Schmid HP, Haile SR, Engeler DS, et al. Is intravesical stent position a predictor of associated morbidity? Korean J Urol. 2015; 56:370–378.

28. Perks AE, Gotto G, Teichman JM. Shock wave lithotripsy correlates with stone density on preoperative computerized tomography. J Urol. 2007; 178(3 Pt 1):912–915.

29. El-Nahas AR, El-Assmy AM, Mansour O, Sheir KZ. A prospective multivariate analysis of factors predicting stone disintegration by extracorporeal shock wave lithotripsy: the value of high-resolution noncontrast computed tomography. Eur Urol. 2007; 51:1688–1693.

30. Pareek G, Armenakas NA, Fracchia JA. Hounsfield units on computerized tomography predict stone-free rates after extracorporeal shock wave lithotripsy. J Urol. 2003; 169:1679–1681.