Success of extracorporeal shockwave lithotripsy for distal ureteric stones in patients with and without hydronephrosis

Abstract

INTRODUCTION: The purpose of the present study was to verify whether ureteral obstruction due to solitary distal ureteric stones affects the outcome of extracorporeal shock wave lithotripsy (ESWL). METHODS: The prospective study included 120 patients with solitary distal ureteral stones that were 6-15 mm in length and located below the lower border of the sacroiliac joint. Patients were assigned to one of 4 groups according to the degree of dilatation of the urinary system. Group 1 (n = 51; 42.5%) had no dilatation; group 2 (n = 41; 34.2%) had mild dilatation; group 3 (n = 20; 16.6%) had moderate dilatation; group 4 (n = 8; 6.7%) had severe dilatation. All patients underwent ESWL using the Siemens Lithostar Plus lithotripter (Siemens Corp; New York, NY, USA). Outcome measures were stone-free rates, number of treatment sessions, stone clearance time, and number and power of the shock waves used. Groups were compared using t and chi-square tests. RESULTS: Three months after the last ESWL session, 95 patients (79.2%) were stone free, 6 patients (5%) had insignificant residual stones, and 19 patients (15.8%) had treatment failure. There was no significant difference in the ESWL outcomes across groups (P =.41). Patients with hydronephrosis required significantly more treatments than patients without obstruction (P <.002). The mean number of days needed to clear the stones progressively increased as hydronephrosis severity increased (P =.007). The groups with hydronephrosis required a significantly larger mean number of shock waves (P <.001). There was no significant group difference in the mean shock wave power used (P =.39). CONCLUSIONS: The presence or degree of hydronephrosis did not significantly affect the overall success of ESWL in treating single distal ureteral stones measuring ≤ 15 mm. However, the presence of hydronephrosis significantly increased the retreatment rate and number of shock waves needed to clear the stone. Hydronephrosis also increased the interval to stone clearance.

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UroToday International Journal

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