Determinants of treatment failure and safety profile of extracorporeal shock wave lithotripsy for urolithiasis: A retrospective cohort study
Description
We conducted a retrospective cohort analysis of 941 patients who underwent ESWL for upper tract urolithiasis at a single tertiary care center between January 2018 and May 2023. Treatment success was defined as the absence of fragments >4 mm on follow-up imaging at three months. Demographic, clinical, and stone characteristics were analyzed. Univariate and multivariate logistic regression models were used to identify independent predictors of stone clearance failure and the requirement for auxiliary interventions.
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Steps to reproduce
ESWL procedure ESWL was performed using a second-generation piezoelectric lithotripter (Lithoarm). Stone localization was achieved with integrated fluoroscopy. The shockwave energy setting was initiated at the lowest level (0.03 mJ/mm²) and gradually increased to a maximum of 1.6 mJ/mm² based on patient tolerance and real-time monitoring of fragmentation. The shockwave rate was set at 60-90 shocks per minute, with a maximum of 3500 shocks per session. Analgesia was administered primarily using ketoprofen suppositories, with intravenous sedation using propofol provided selectively based on patient pain tolerance. Additionally, some patients received pethidine for pain control if prior analgesic measures were inadequate. A double-J (DJ) stent was placed pre-ESWL in cases of obstruction, concomitant infection, or large stone burden. Outcome measures and definitions The primary outcome was treatment success, defined as complete stone clearance or the presence of clinically insignificant residual fragments (CIRFs) <4 mm on follow-up imaging (KUB and/or ultrasound) at three months. Retreatment was defined as the need for additional ESWL sessions. Secondary outcomes included the requirement for auxiliary procedures (ureteroscopy - URS, percutaneous nephrolithotomy - PCNL) and the incidence of periprocedural complications.
Institutions
- Ibb University