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Optimization of shockwave lithotripsy use for single medium sized hard renal stone with stone density ≥ 1000 HU. A prospective study

Abstract

Purpose

To identify shock wave lithotripsy (SWL) success predictors in hard renal stones (average stone density ≥ 1000 HU).

Materials

We prospectively evaluated patients who underwent SWL for hard renal stones between April 2018 and December 2020. Radiological parameters were identified, e.g., stone site, size, the average density in addition to stone core and shell mean density, and renal cortical thickness (RKT). SWL sessions were performed using Doli-S lithotripter till a maximum of 3–4 sessions with 2–4 weeks interval. Initial response to SWL included stone fragmentation and decreased stone size after the first SWL. Treatment success was considered if complete clearance of renal stones occurred or in case of clinically insignificant residual fragments ≤ 4 mm after 12 weeks follow up by NCCT.

Results

Out of 1878 patients who underwent SWL, the study included 157 patients with hard renal stones. Treatment overall success was found in 92 patients (58.6%) where 69 patients (43.9%) had complete stone clearance. On multivariate analysis, stone shell density < 901 HU, maximum stone size < 1 cm, RKT > 1.95 cm and initial treatment response were associated with increased the success rate after SWL for hard renal stones (P = 0.0001, 0.009, < 0.0001 and < 0.0001, respectively).

Conclusion

In hard renal stones, treatment overall success was found in 58.6% where complete stone clearance was found in 43.9%. Stone outer shell fragility, lower stone size, increased RKT and initial response to SWL were associated with a higher success rate at 12-week follow-up.

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Data availability

Data available when needed.

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Funding

No funds were received.

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Affiliations

Authors

Contributions

MAE manuscript writing, data analysis. D-ET manuscript revision, MA, ME, MA, and RA data collection. RTA radiological data evaluation. YO and KZS study supervisors and manuscript revision.

Corresponding author

Correspondence to M. A. Elbaset.

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Ethical approval

The study was approved by local ethical committee.

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Consent was taken from all participants.

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Cite this article

Elbaset, M.A., Taha, DE., Anas, M. et al. Optimization of shockwave lithotripsy use for single medium sized hard renal stone with stone density ≥ 1000 HU. A prospective study. World J Urol (2021). https://doi.org/10.1007/s00345-021-03807-1

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Keywords

  • Shockwave lithotripsy (SWL)
  • Hard stones
  • Stone free rate