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Böbrek ve üreter taşlarında ESWL başarısını öngörmede radyografik ve litotriptör parametrelerinin klinik önemi

Year 2021, Volume: 13 Issue: 3, 78 - 84, 29.12.2021
https://doi.org/10.54233/endouroloji.969883

Abstract

Amaç: Ekstrakorporeal şok dalga litotripsi (ESWL), böbrek ve proksimal üreter taşlarının tedavisinde en sık kullanılan yöntemlerdendir. Çalışmamızda, ESWL başarısı için hangi parametrelerin etkili olduğunu saptamayı amaçladık.
Gereç ve Yöntemler: Ocak 2017 ile Aralık 2018 arasında, ESWL uygulanan 253 hasta prospektif olarak elde ettiğimiz ESWL veri tabanımızdan geriye dönük olarak analiz edildi. Kırk dört hastaya üreter taşı nedeniyle ESWL, 209 hastaya böbrek taşı nedeniyle ESWL uygulandı. Taş tipi, taş boyutları, hounsfield birim dansitesi (HBD), taş-cilt mesafesi (TCM) ve taşların yerleşimi, hastaların cinsiyeti ve yaşı, şok dalgalarının gücü ve sayısı ile toplam seans sayısı analiz edildi.
Bulgular: Genel tedavi başarı oranı tüm taşlar için %71,1, böbrek taşları için %70,3 ve üreter taşları için %75 idi. Taş boyutu, şok dalgası sayısı ve HBD böbrek taşlarının başarısını öngörmede etkili parametrelerdi. Yaş ve taş boyutu, tek değişkenli regresyon analizinde üreter taşları için başarının belirleyicileriydi. Çok değişkenli regresyon analizinde hem böbrek hem de üreter taşları için başarıyı öngören tek parametre taş boyutuydu (sırasıyla p=0,002 ve p=0,005). Üreter taşları için başarı oranı, 11,5 mm boyutu kestirim değeri olarak tanımlandığında, %81,8 duyarlılık ve %78 özgüllükle tahmin edilebilir olarak saptandı.
Sonuç: Böbrek taşları ve üreter taşları ESWL ile başarıyla tedavi edilebilir. Daha küçük ve HBD daha düşük olan böbrek taşlarının başarı oranı daha yüksektir. Üreter taşlarında ise daha genç hastalar ve daha küçük taşlar daha etkili bir şekilde parçalanabilir. ESWL başarısı için en önemli parametre taş boyutudur.

References

  • 1. Chaussy C, Schmiedt E, Jocham D, et al (1984) Extracorporeal shock-wave lithotripsy (ESWL) for treatment of urolithiasis. Urology 23:59–66. https://doi.org/10.1016/0090-4295(84)90243-7
  • 2. COVIDSurg Collaborative (2020) Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet Lond Engl 396:27–38. https://doi.org/10.1016/S0140-6736(20)31182-X
  • 3. Maria J. Ribal, Philip Cornford, Alberto Briganti, et al (2021) COVID-19 Recommendations EAU Guidelines Office Rapid Reaction Group: An organisation-wide collaborative effort to adapt the EAU guidelines recommendations to the COVID era. In: Uroweb. https://uroweb.org/guideline/covid-19-recommendations/. Accessed 11 Jul 2021
  • 4. C. Türk, A. Neisius, A. Petřík, C. Seitz, A. Skolarikos, B. Somani, K. Thomas, G. Gambaro, Guidelines Associates: N.F. Davis, J.F. Donaldson, R. Lombardo, L. Tzelves (2021) EAU Guidelines: Urolithiasis. In: Uroweb. https://uroweb.org/guideline/urolithiasis/. Accessed 11 Jul 2021
  • 5. Kim JK, Ha SB, Jeon CH, et al (2016) Clinical Nomograms to Predict Stone-Free Rates after Shock-Wave Lithotripsy: Development and Internal-Validation. PLOS ONE 11:e0149333. https://doi.org/10.1371/journal.pone.0149333
  • 6. Tran TY, McGillen K, Cone EB, Pareek G (2015) Triple D Score Is a Reportable Predictor of Shockwave Lithotripsy Stone-Free Rates. J Endourol 29:226–230. https://doi.org/10.1089/end.2014.0212
  • 7. Abe T, Akakura K, Kawaguchi M, et al (2005) Outcomes of shockwave lithotripsy for upper urinary-tract stones: a large-scale study at a single institution. J Endourol 19:768–773. https://doi.org/10.1089/end.2005.19.768
  • 8. Shinde S, Al Balushi Y, Hossny M, et al (2018) Factors Affecting the Outcome of Extracorporeal Shockwave Lithotripsy in Urinary Stone Treatment. Oman Med J 33:209–217. https://doi.org/10.5001/omj.2018.39
  • 9. Choi JW, Song PH, Kim HT (2012) Predictive factors of the outcome of extracorporeal shockwave lithotripsy for ureteral stones. Korean J Urol 53:424–430. https://doi.org/10.4111/kju.2012.53.6.424
  • 10. Azal Neto W, Reis LO, Pedro RN (2020) Prediction of stone-free rates following extracorporeal shockwave lithotripsy in a contemporary cohort of patients with stone densities exceeding 1000 HU. Scand J Urol 54:344–348. https://doi.org/10.1080/21681805.2020.1782981
  • 11. Pareek G, Armenakas NA, Panagopoulos G, et al (2005) Extracorporeal shock wave lithotripsy success based on body mass index and Hounsfield units. Urology 65:33–36. https://doi.org/10.1016/j.urology.2004.08.004
  • 12. Joseph P, Mandal AK, Singh SK, et al (2002) Computerized tomography attenuation value of renal calculus: can it predict successful fragmentation of the calculus by extracorporeal shock wave lithotripsy? A preliminary study. J Urol 167:1968–1971. https://doi.org/10.1016/s0022-5347(05)65064-1
  • 13. Abdelhamid M, Mosharafa AA, Ibrahim H, et al (2016) A Prospective Evaluation of High-Resolution CT Parameters in Predicting Extracorporeal Shockwave Lithotripsy Success for Upper Urinary Tract Calculi. J Endourol 30:1227–1232. https://doi.org/10.1089/end.2016.0364
  • 14. Wiesenthal JD, Ghiculete D, John D’A Honey R, Pace KT (2010) Evaluating the importance of mean stone density and skin-to-stone distance in predicting successful shock wave lithotripsy of renal and ureteric calculi. Urol Res 38:307–313. https://doi.org/10.1007/s00240-010-0295-0
  • 15. Pareek G, Hedican SP, Lee FT, Nakada SY (2005) Shock wave lithotripsy success determined by skin-to-stone distance on computed tomography. Urology 66:941–944. https://doi.org/10.1016/j.urology.2005.05.011
  • 16. Perks AE, Schuler TD, Lee J, et al (2008) Stone attenuation and skin-to-stone distance on computed tomography predicts for stone fragmentation by shock wave lithotripsy. Urology 72:765–769. https://doi.org/10.1016/j.urology.2008.05.046
  • 17. Jacobs BL, Smaldone MC, Smaldone AM, et al (2008) Effect of Skin-to-Stone Distance on Shockwave Lithotripsy Success. J Endourol 22:1623–1628. https://doi.org/10.1089/end.2008.0169
  • 18. Geng J-H, Tu H-P, Shih PM-C, et al (2015) Noncontrast computed tomography can predict the outcome of shockwave lithotripsy via accurate stone measurement and abdominal fat distribution determination. Kaohsiung J Med Sci 31:34–41. https://doi.org/10.1016/j.kjms.2014.10.001

Clinical significance of radiographic and lithotripter parameters in predicting ESWL success for kidney and ureteral stones

Year 2021, Volume: 13 Issue: 3, 78 - 84, 29.12.2021
https://doi.org/10.54233/endouroloji.969883

Abstract

Objective: Extracorporeal shock wave lithotripsy (ESWL) is the most commonly utilized method for treating renal and proximal ureteral stones. We aimed to observe which parameters are efficacious for ESWL success.
Material and Methods: Between January 2017 and December 2018, 253 patients who underwent ESWL were analyzed retrospectively from our prospectively obtained ESWL database. 44 patients underwent ESWL due to ureteral stones and 209 patients due to kidney stones. Stone type, stone sizes, Hounsfield unit density (HUD), stone-skin distance (SSD) and location of stones, gender, and ages of patients, power, and number of shock waves and total sessions were analyzed.
Results: The overall treatment success rate was 71.1% for all stones, 70.3% for renal stones, and 75% for ureteral stones. Stone size, number of shock waves, and HUD were efficacious parameters to predict success for renal stones. In univariate analyses, age and stone size were predictors of success for ureteral stones. In multivariate analyses, just stone sizes were the only predictor of success for renal and ureteral stones (p=0.002 and p=0.005, respectively). The success rate can be predicted for ureteral stones with a sensitivity of 81.8% and specificity of 78% when 11.5 mm size is defined as a cut-off point.
Conclusion: Renal stones and proximal ureteral stones can be treated successfully with ESWL. Renal stones that are smaller and lower HUD have more success rates. When we talk about ureteral stones, younger patients and smaller stones can be fragmentized more effectively. The most important parameter for ESWL success is stone size.

References

  • 1. Chaussy C, Schmiedt E, Jocham D, et al (1984) Extracorporeal shock-wave lithotripsy (ESWL) for treatment of urolithiasis. Urology 23:59–66. https://doi.org/10.1016/0090-4295(84)90243-7
  • 2. COVIDSurg Collaborative (2020) Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet Lond Engl 396:27–38. https://doi.org/10.1016/S0140-6736(20)31182-X
  • 3. Maria J. Ribal, Philip Cornford, Alberto Briganti, et al (2021) COVID-19 Recommendations EAU Guidelines Office Rapid Reaction Group: An organisation-wide collaborative effort to adapt the EAU guidelines recommendations to the COVID era. In: Uroweb. https://uroweb.org/guideline/covid-19-recommendations/. Accessed 11 Jul 2021
  • 4. C. Türk, A. Neisius, A. Petřík, C. Seitz, A. Skolarikos, B. Somani, K. Thomas, G. Gambaro, Guidelines Associates: N.F. Davis, J.F. Donaldson, R. Lombardo, L. Tzelves (2021) EAU Guidelines: Urolithiasis. In: Uroweb. https://uroweb.org/guideline/urolithiasis/. Accessed 11 Jul 2021
  • 5. Kim JK, Ha SB, Jeon CH, et al (2016) Clinical Nomograms to Predict Stone-Free Rates after Shock-Wave Lithotripsy: Development and Internal-Validation. PLOS ONE 11:e0149333. https://doi.org/10.1371/journal.pone.0149333
  • 6. Tran TY, McGillen K, Cone EB, Pareek G (2015) Triple D Score Is a Reportable Predictor of Shockwave Lithotripsy Stone-Free Rates. J Endourol 29:226–230. https://doi.org/10.1089/end.2014.0212
  • 7. Abe T, Akakura K, Kawaguchi M, et al (2005) Outcomes of shockwave lithotripsy for upper urinary-tract stones: a large-scale study at a single institution. J Endourol 19:768–773. https://doi.org/10.1089/end.2005.19.768
  • 8. Shinde S, Al Balushi Y, Hossny M, et al (2018) Factors Affecting the Outcome of Extracorporeal Shockwave Lithotripsy in Urinary Stone Treatment. Oman Med J 33:209–217. https://doi.org/10.5001/omj.2018.39
  • 9. Choi JW, Song PH, Kim HT (2012) Predictive factors of the outcome of extracorporeal shockwave lithotripsy for ureteral stones. Korean J Urol 53:424–430. https://doi.org/10.4111/kju.2012.53.6.424
  • 10. Azal Neto W, Reis LO, Pedro RN (2020) Prediction of stone-free rates following extracorporeal shockwave lithotripsy in a contemporary cohort of patients with stone densities exceeding 1000 HU. Scand J Urol 54:344–348. https://doi.org/10.1080/21681805.2020.1782981
  • 11. Pareek G, Armenakas NA, Panagopoulos G, et al (2005) Extracorporeal shock wave lithotripsy success based on body mass index and Hounsfield units. Urology 65:33–36. https://doi.org/10.1016/j.urology.2004.08.004
  • 12. Joseph P, Mandal AK, Singh SK, et al (2002) Computerized tomography attenuation value of renal calculus: can it predict successful fragmentation of the calculus by extracorporeal shock wave lithotripsy? A preliminary study. J Urol 167:1968–1971. https://doi.org/10.1016/s0022-5347(05)65064-1
  • 13. Abdelhamid M, Mosharafa AA, Ibrahim H, et al (2016) A Prospective Evaluation of High-Resolution CT Parameters in Predicting Extracorporeal Shockwave Lithotripsy Success for Upper Urinary Tract Calculi. J Endourol 30:1227–1232. https://doi.org/10.1089/end.2016.0364
  • 14. Wiesenthal JD, Ghiculete D, John D’A Honey R, Pace KT (2010) Evaluating the importance of mean stone density and skin-to-stone distance in predicting successful shock wave lithotripsy of renal and ureteric calculi. Urol Res 38:307–313. https://doi.org/10.1007/s00240-010-0295-0
  • 15. Pareek G, Hedican SP, Lee FT, Nakada SY (2005) Shock wave lithotripsy success determined by skin-to-stone distance on computed tomography. Urology 66:941–944. https://doi.org/10.1016/j.urology.2005.05.011
  • 16. Perks AE, Schuler TD, Lee J, et al (2008) Stone attenuation and skin-to-stone distance on computed tomography predicts for stone fragmentation by shock wave lithotripsy. Urology 72:765–769. https://doi.org/10.1016/j.urology.2008.05.046
  • 17. Jacobs BL, Smaldone MC, Smaldone AM, et al (2008) Effect of Skin-to-Stone Distance on Shockwave Lithotripsy Success. J Endourol 22:1623–1628. https://doi.org/10.1089/end.2008.0169
  • 18. Geng J-H, Tu H-P, Shih PM-C, et al (2015) Noncontrast computed tomography can predict the outcome of shockwave lithotripsy via accurate stone measurement and abdominal fat distribution determination. Kaohsiung J Med Sci 31:34–41. https://doi.org/10.1016/j.kjms.2014.10.001
There are 18 citations in total.

Details

Primary Language Turkish
Subjects Urology
Journal Section Research Articles
Authors

Özgür Efiloğlu 0000-0003-4757-803X

Mehmet Çağlar Çakıcı 0000-0002-0176-5887

Hüseyin Özgür Kazan 0000-0001-6812-6927

Ferhat Keser 0000-0002-2803-6481

Asıf Yıldırım 0000-0002-3386-971X

Gokhan Atis 0000-0002-9065-6104

Publication Date December 29, 2021
Published in Issue Year 2021 Volume: 13 Issue: 3

Cite

Vancouver Efiloğlu Ö, Çakıcı MÇ, Kazan HÖ, Keser F, Yıldırım A, Atis G. Böbrek ve üreter taşlarında ESWL başarısını öngörmede radyografik ve litotriptör parametrelerinin klinik önemi. Endourol Bull. 2021;13(3):78-84.