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

 Ki Don Chang  ;  Joo Yong Lee  ;  Sung Yoon Park  ;  Dong Hyuk Kang  ;  Hyung Ho Lee  ;  Kang Su Cho 
 YONSEI MEDICAL JOURNAL, Vol.58(5) : 1000-1005, 2017 
Journal Title
Issue Date
Aged ; Female ; Humans ; Hydronephrosis/complications* ; Lithotripsy* ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Treatment Outcome ; Ureteral Calculi/complications* ; Ureteral Calculi/therapy*
Ureteral calculi ; high-energy shock waves ; hydronephrosis ; lithotripsy
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.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Dong Hyuk(강동혁)
Park, Sung Yoon(박성윤)
Lee, Joo Yong(이주용) ORCID logo https://orcid.org/0000-0002-3470-1767
Lee, Hyung Ho(이형호)
Chang, Kidon(장기돈)
Cho, Kang Su(조강수) ORCID logo https://orcid.org/0000-0002-3500-8833
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