Cargando…

The Efficiency of Extracorporeal Shock Wave Lithotripsy (ESWL) in the Treatment of Distal Ureteral Stones: An Unjustly Forgotten Option?

Introduction The optimal management of distal ureteral stones remains a matter of debate since current guidelines favor ureteroscopy over extracorporeal shock wave lithotripsy (ESWL). We aimed to evaluate the efficiency of ESWL for distal ureteral stones and to identify factors that affect treatment...

Descripción completa

Detalles Bibliográficos
Autores principales: Alić, Jasmin, Heljić, Jasmina, Hadžiosmanović, Osman, Kulovac, Benjamin, Lepara, Zahid, Spahović, Hajrudin, Bajramović, Senad, Aganović, Damir
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9525100/
https://www.ncbi.nlm.nih.gov/pubmed/36196280
http://dx.doi.org/10.7759/cureus.28671
_version_ 1784800635351203840
author Alić, Jasmin
Heljić, Jasmina
Hadžiosmanović, Osman
Kulovac, Benjamin
Lepara, Zahid
Spahović, Hajrudin
Bajramović, Senad
Aganović, Damir
author_facet Alić, Jasmin
Heljić, Jasmina
Hadžiosmanović, Osman
Kulovac, Benjamin
Lepara, Zahid
Spahović, Hajrudin
Bajramović, Senad
Aganović, Damir
author_sort Alić, Jasmin
collection PubMed
description Introduction The optimal management of distal ureteral stones remains a matter of debate since current guidelines favor ureteroscopy over extracorporeal shock wave lithotripsy (ESWL). We aimed to evaluate the efficiency of ESWL for distal ureteral stones and to identify factors that affect treatment outcomes. Materials and methods The retrospective study included records of 115 patients with distal ureteral stones, 5 mm to 18 mm in size, undergoing 223 ESWL sessions as an outpatient procedure. Early fragmentation and three-month follow-up stone-free rate (SFR) was assessed through radiographic imaging. Treatment was successful if there were no residual fragments or they were ≤4 mm, three months after the last session. Results The mean ±standard deviation (range) stone size was 9.68 ±3.10 (5.00-18.0) mm. The mean body mass index (BMI) was 24.3 ±2.67 (18.4-29.8) kg/m² with a significant correlation between BMI and stone size (r(2 )=0.324, p <0.001). Patients underwent ESWL an average of 1.7 ±1.36 times (1-5), while 68 patients (59.1%) became stone-free after one session. The overall SFR was 82.6%; for patients with stone sizes ≤10 mm and >10 mm, it was 99% and 9.4%, respectively. Cumulative SFR after the second session was 77%. In 20 (17%) patients the treatment was a failure. Complications occurred in 10.4%, while auxiliary procedures were needed in 8.7% of cases, both significantly affected by the stone size (p <0.001). The efficiency quotient (EQ) was 0.76. Treatment outcome was significantly different depending on stone size, BMI, number of sessions, complications, and auxiliary procedures (p <0.001, p =0.022, p <0.001, p <0.001, p <0.001, respectively). Univariate regression analysis identified stone size and BMI as significant predictors of treatment outcome (odds ratio (OR) 3.84, 95% confidence interval (CI): 2.31-8.97, p =0.001, and OR 1.25, 95% CI: 1.04-1.54, p =0.024, respectively). Conclusions Extracorporeal shock wave lithotripsy continues to be a safe and effective option for managing simple calculi in distal ureters with a diameter of ≤10 mm. The stone size and BMI remain significant predictors of treatment outcome. 
format Online
Article
Text
id pubmed-9525100
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-95251002022-10-03 The Efficiency of Extracorporeal Shock Wave Lithotripsy (ESWL) in the Treatment of Distal Ureteral Stones: An Unjustly Forgotten Option? Alić, Jasmin Heljić, Jasmina Hadžiosmanović, Osman Kulovac, Benjamin Lepara, Zahid Spahović, Hajrudin Bajramović, Senad Aganović, Damir Cureus Urology Introduction The optimal management of distal ureteral stones remains a matter of debate since current guidelines favor ureteroscopy over extracorporeal shock wave lithotripsy (ESWL). We aimed to evaluate the efficiency of ESWL for distal ureteral stones and to identify factors that affect treatment outcomes. Materials and methods The retrospective study included records of 115 patients with distal ureteral stones, 5 mm to 18 mm in size, undergoing 223 ESWL sessions as an outpatient procedure. Early fragmentation and three-month follow-up stone-free rate (SFR) was assessed through radiographic imaging. Treatment was successful if there were no residual fragments or they were ≤4 mm, three months after the last session. Results The mean ±standard deviation (range) stone size was 9.68 ±3.10 (5.00-18.0) mm. The mean body mass index (BMI) was 24.3 ±2.67 (18.4-29.8) kg/m² with a significant correlation between BMI and stone size (r(2 )=0.324, p <0.001). Patients underwent ESWL an average of 1.7 ±1.36 times (1-5), while 68 patients (59.1%) became stone-free after one session. The overall SFR was 82.6%; for patients with stone sizes ≤10 mm and >10 mm, it was 99% and 9.4%, respectively. Cumulative SFR after the second session was 77%. In 20 (17%) patients the treatment was a failure. Complications occurred in 10.4%, while auxiliary procedures were needed in 8.7% of cases, both significantly affected by the stone size (p <0.001). The efficiency quotient (EQ) was 0.76. Treatment outcome was significantly different depending on stone size, BMI, number of sessions, complications, and auxiliary procedures (p <0.001, p =0.022, p <0.001, p <0.001, p <0.001, respectively). Univariate regression analysis identified stone size and BMI as significant predictors of treatment outcome (odds ratio (OR) 3.84, 95% confidence interval (CI): 2.31-8.97, p =0.001, and OR 1.25, 95% CI: 1.04-1.54, p =0.024, respectively). Conclusions Extracorporeal shock wave lithotripsy continues to be a safe and effective option for managing simple calculi in distal ureters with a diameter of ≤10 mm. The stone size and BMI remain significant predictors of treatment outcome.  Cureus 2022-09-01 /pmc/articles/PMC9525100/ /pubmed/36196280 http://dx.doi.org/10.7759/cureus.28671 Text en Copyright © 2022, Alić et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Urology
Alić, Jasmin
Heljić, Jasmina
Hadžiosmanović, Osman
Kulovac, Benjamin
Lepara, Zahid
Spahović, Hajrudin
Bajramović, Senad
Aganović, Damir
The Efficiency of Extracorporeal Shock Wave Lithotripsy (ESWL) in the Treatment of Distal Ureteral Stones: An Unjustly Forgotten Option?
title The Efficiency of Extracorporeal Shock Wave Lithotripsy (ESWL) in the Treatment of Distal Ureteral Stones: An Unjustly Forgotten Option?
title_full The Efficiency of Extracorporeal Shock Wave Lithotripsy (ESWL) in the Treatment of Distal Ureteral Stones: An Unjustly Forgotten Option?
title_fullStr The Efficiency of Extracorporeal Shock Wave Lithotripsy (ESWL) in the Treatment of Distal Ureteral Stones: An Unjustly Forgotten Option?
title_full_unstemmed The Efficiency of Extracorporeal Shock Wave Lithotripsy (ESWL) in the Treatment of Distal Ureteral Stones: An Unjustly Forgotten Option?
title_short The Efficiency of Extracorporeal Shock Wave Lithotripsy (ESWL) in the Treatment of Distal Ureteral Stones: An Unjustly Forgotten Option?
title_sort efficiency of extracorporeal shock wave lithotripsy (eswl) in the treatment of distal ureteral stones: an unjustly forgotten option?
topic Urology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9525100/
https://www.ncbi.nlm.nih.gov/pubmed/36196280
http://dx.doi.org/10.7759/cureus.28671
work_keys_str_mv AT alicjasmin theefficiencyofextracorporealshockwavelithotripsyeswlinthetreatmentofdistalureteralstonesanunjustlyforgottenoption
AT heljicjasmina theefficiencyofextracorporealshockwavelithotripsyeswlinthetreatmentofdistalureteralstonesanunjustlyforgottenoption
AT hadziosmanovicosman theefficiencyofextracorporealshockwavelithotripsyeswlinthetreatmentofdistalureteralstonesanunjustlyforgottenoption
AT kulovacbenjamin theefficiencyofextracorporealshockwavelithotripsyeswlinthetreatmentofdistalureteralstonesanunjustlyforgottenoption
AT leparazahid theefficiencyofextracorporealshockwavelithotripsyeswlinthetreatmentofdistalureteralstonesanunjustlyforgottenoption
AT spahovichajrudin theefficiencyofextracorporealshockwavelithotripsyeswlinthetreatmentofdistalureteralstonesanunjustlyforgottenoption
AT bajramovicsenad theefficiencyofextracorporealshockwavelithotripsyeswlinthetreatmentofdistalureteralstonesanunjustlyforgottenoption
AT aganovicdamir theefficiencyofextracorporealshockwavelithotripsyeswlinthetreatmentofdistalureteralstonesanunjustlyforgottenoption
AT alicjasmin efficiencyofextracorporealshockwavelithotripsyeswlinthetreatmentofdistalureteralstonesanunjustlyforgottenoption
AT heljicjasmina efficiencyofextracorporealshockwavelithotripsyeswlinthetreatmentofdistalureteralstonesanunjustlyforgottenoption
AT hadziosmanovicosman efficiencyofextracorporealshockwavelithotripsyeswlinthetreatmentofdistalureteralstonesanunjustlyforgottenoption
AT kulovacbenjamin efficiencyofextracorporealshockwavelithotripsyeswlinthetreatmentofdistalureteralstonesanunjustlyforgottenoption
AT leparazahid efficiencyofextracorporealshockwavelithotripsyeswlinthetreatmentofdistalureteralstonesanunjustlyforgottenoption
AT spahovichajrudin efficiencyofextracorporealshockwavelithotripsyeswlinthetreatmentofdistalureteralstonesanunjustlyforgottenoption
AT bajramovicsenad efficiencyofextracorporealshockwavelithotripsyeswlinthetreatmentofdistalureteralstonesanunjustlyforgottenoption
AT aganovicdamir efficiencyofextracorporealshockwavelithotripsyeswlinthetreatmentofdistalureteralstonesanunjustlyforgottenoption