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

Abstract

PurposeTo 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 MethodsWe 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.ResultsAfter 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).ConclusionsUreteral stenting during SWL was a negative predictor of one-session success in patients with a ureteral stone.

Indications and contraindications for shock wave lithotripsy and how to improve outcomes

“…Circumstances where stenting can be helpful is for obstructing stones, a large stone in a solitary kidney, obstruction with infection, renal failure and intolerable pain [2] . Routine stenting for ureteral stones has shown to decrease SFR by 15%–22% for stones less than 10 mm [92] , [93] , [94] , and the negative effect may be amplified for larger stones [95] . The role of ureteric stents for renal calculi has not been shown to be of any benefit for renal stone clearance and does not seem to have an obvious impact on the development of steinstrasse [96] , [97] .…”

Systematic review and meta-analysis to compare success rates of retrograde intrarenal surgery versus percutaneous nephrolithotomy for renal stones >2 cm

“…[ 4 ] In the EAU guidelines, RIRS and SWL are not recommended as first-line treatments for larger stones in uncomplicated cases, as stone-free rates are less than those with PCNL, and staged procedures have become necessary. [ 5 , 6 ] However, several researchers have reported that RIRS is feasible for stones larger than 2 cm and produces stone-free rates that are similar to those achieved with PCNL. [ 7 ]…”

Chronological Trends in Clinical and Urinary Metabolic Features over 20 Years in Korean Urolithiasis Patients

“…The prevalence and incidence of urolithiasis has been reported to depend on the geographic locations and socioeconomic characteristics of different populations ( 15 ). The incidence of urolithiasis in Korea has progressively increased, in a manner similar to that seen in other developed countries ( 3 16 17 ). A nationwide population-based study reported that the annual incidence of urolithiasis in Korea was 457 per 100,000 population in 2009, which was higher than that of Iran (145.1 per 100,000 population) and Japan (134.0 per 100,000 population), but lower than a range of values (from 0.5% to 1.5%) in western countries ( 3 4 18 ).…”