Is Percutaneous Nephrolithotomy the Modality of Choice Versus Extracorporeal Shockwave Lithotripsy for a 20 to 30 mm Single Renal Pelvic Stone with ≤1000 Hounsfield Unit in Adults? A Prospective Randomized Comparative Study

Gadelkareem, Rabea Ahmed; Abdelsalam, Yaser M.; Ibraheim, Mohammed Abdelsalam; Reda, Ahmed; Sayed, Mohamed A.; Elazab, Ahmed

doi:10.1089/end.2020.0288

Cited by 3 publications

(10 citation statements)

References 27 publications

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“…Most studies have defined them as stones measuring 10 to 20 mm. [2,4,7,8,[14][15][16][17] However, many other studies have adopted different values, such as 10 to 25 mm, [18] 15 to 25 mm, [19] and 20 to 30 mm, [10,11] in which SWL is mostly incorporated as a treatment option. This may imply that this size spectrum is the most confusing on the scale of stone size relative to the numerous available treatment options, such as SWL, PNL, RIRS, and their varieties and combinations.…”

Section: Discussionmentioning

confidence: 99%

“…[3,5] However, in most studies, predictors of SWL success have usually been evaluated relative to the overall SFR. [7,11,12] These predictors have been classically classified into patient-, stone-, kidney-, and technique-related factors. [1,2] Patient-related factors that are associated with a decreased probability of SWL success include increasing age of the patient, BMI, SSD, and female sex.…”

Section: Discussionmentioning

confidence: 99%

“…Although there is no definitive cutoff value, measures of 900 to 1000 HU have been used to differentiate between high and low stone hardness and SWL success. [2,11] Because of the nonhomogenous stone densities, a further parameter named the heterogeneity index has been studied. Hence, radiological heterogeneity of stones has been reported as an independent predictor of SWL success.…”

Section: Discussionmentioning

confidence: 99%

“…This study aimed to refine the evidence for decision making in the context of the evolving demands of increasing populations, technological advancements, and the current coronavirus disease 2019 (COVID-19) pandemic. [2,3,9,11,14,15] Therefore, the ability to identify which stone cases will respond successfully to SWL remains a point of research that represents the backbone of our rationale for conducting this retrospective study.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Transverse diameter of the stone, mean ± SD (range), mm 10.8 ± 3.9(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) BMI = body mass index; HU = Hounsfield unit; SD = standard deviation; UPJ = ureteropelvic junction.…”

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confidence: 99%

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Predictors of stone-free rate after a single-session extracorporeal shockwave lithotripsy for a single kidney stone measuring 10 to 20 mm: A private center experience

Faddan¹,

Najieb²,

Gadelkareem³

2022

Curr Urol

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Background: Despite the continuous update of guidelines for the management of kidney stones, the ability to predict a successful response to extracorporeal shockwave lithotripsy (SWL) remains a topic of research. This is due to the need to refine the decision making in the context of technological advancements and current pandemics. This study aimed to determine the predictors of stone-free rate (SFR) after single-session SWL in adult patients with a single kidney stone 10 to 20 mm in diameter. Materials and methods: A retrospective review of the records of patients with a single kidney stone 10 to 20 mm in diameter was performed at a private SWL center from December 2019 to February 2021. Univariate and multivariate analyses were performed for stoneand patient-related factors, using the Student t and Mann-Whitney U tests for the quantitative variables and the Fisher exact and Pearson correlation tests for the qualitative variables. Results: A total of 138 patients were eligible for this study, including 92 men and 46 women. The mean age was 38.6 ± 12.4years, and the mean body mass index (BMI) was 25.9 ± 3.4kg/m 2 . Four weeks after SWL, 120 patients (87%) were free of stones, and 18 (13%) needed further treatment. Univariate analyses showed that SFR was negatively correlated with increased BMI ( p = 0.0001), maximum stone length ( p = 0.0001), transverse diameter of the stone ( p = 0.0001), number of shocks per session ( p = 0.052), and Hounsfield unit (HU) ( p = 0.0001). Multivariate analysis revealed that HU ( p = 0.009), maximum stone length ( p = 0.01), BMI ( p = 0.000), and presence of double-J stent ( p = 0.034) were independent risk factors for failure of single-session SWL in the treatment of kidney stones 10 to 20 mm in diameter. The estimated average cost per case was USD 450.5. Conclusions: Increased HU, maximum stone length, BMI, and presence of double-J stents were independent risk factors for low SFR after single-session SWL for a kidney stone 10 to 20 mm in diameter. The cost of SWL remains an advantage in the private sector.

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