To identify shock wave lithotripsy (SWL) success predictors in hard renal stones (average stone density ≥ 1000 HU).
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.
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).
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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Data available when needed.
Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M et al (2016) EAU guidelines on interventional treatment for urolithiasis. Eur Urol 69(3):475–482
Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP et al (2016) Surgical management of stones: American urological association/endourological society guideline part I. J Urol 196(4):1153–1160
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(2):226–230
Wiesenthal JD, Ghiculete D, Honey RJDA, 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(4):307–313
Ouzaid I, Al-qahtani S, Dominique S, Hupertan V, Fernandez P, Hermieu JF et al (2012) A 970 Hounsfield units (HU) threshold of kidney stone density on non-contrast computed tomography (NCCT) improves patients’ selection for extracorporeal shockwave lithotripsy (ESWL): evidence from a prospective study. BJU Int 110(11b):E438–E442
El-Nahas AR, El-Assmy AM, Mansour O, Sheir KZ (2007) A prospective multivariate analysis of factors predicting stone disintegration by extracorporeal shock wave lithotripsy: the value of high-resolution noncontrast computed tomography. Eur Urol 51(6):1688–1694
El-Assmy A, Abou-El-Ghar ME, El-Nahas AR, Refaie HF, Sheir KZ (2011) Multidetector computed tomography: role in determination of urinary stones composition and disintegration with extracorporeal shock wave lithotripsy—an in vitro study. Urology 77(2):286–290
Scales CD Jr, Smith AC, Hanley JM, Saigal CS, Project UDiA (2012) Prevalence of kidney stones in the United States. Eur Urol 62(1):160–165
Abdelhamid M, Mosharafa AA, Ibrahim H, Selim HM, Hamed M, Elghoneimy MN 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(11):1227–1232
Joseph P, Mandal A, Singh S, Mandal P, Sankhwar S, Sharma S (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(5):1968–1971
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(4):344–348
Clavien PA, Barkun J, De Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196
Sheir KZ, Mansour O, Madbouly K, Elsobky E, Abdel-Khalek M (2005) Determination of the chemical composition of urinary calculi by noncontrast spiral computerized tomography. Urol Res 33(2):99–104
Chaussy CG, Tiselius H-G (2018) How can and should we optimize extracorporeal shockwave lithotripsy? Urolithiasis 46(1):3–17
Nakasato T, Morita J, Ogawa Y (2015) Evaluation of Hounsfield Units as a predictive factor for the outcome of extracorporeal shock wave lithotripsy and stone composition. Urolithiasis 43(1):69–75
Saw KC, McAteer JA, Fineberg NS, Monga AG, Chua GT, Lingeman JE et al (2000) Calcium stone fragility is predicted by helical CT attenuation values. J Endourol 14(6):471–474
Perks AE, Schuler TD, Lee J, Ghiculete D, Chung D-G, Honey RJDA et al (2008) Stone attenuation and skin-to-stone distance on computed tomography predicts for stone fragmentation by shock wave lithotripsy. Urology 72(4):765–769
Müllhaupt G, Engeler DS, Schmid H-P, Abt D (2015) How do stone attenuation and skin-to-stone distance in computed tomography influence the performance of shock wave lithotripsy in ureteral stone disease? BMC Urol 15(1):1–8
Ng C-F, Siu DY-W, Wong A, Goggins W, Chan ES, Wong K-T (2009) Development of a scoring system from noncontrast computerized tomography measurements to improve the selection of upper ureteral stone for extracorporeal shock wave lithotripsy. J Urol 181(3):1151–1157
Geng J-H, Tu H-P, Shih PM-C, Shen J-T, Jang M-Y, Wu W-J 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(1):34–41
Perks AE, Gotto G, Teichman JM (2007) Shock wave lithotripsy correlates with stone density on preoperative computerized tomography. J Urol 178(3):912–915
Torricelli FC, Marchini GS, Yamauchi FI, Danilovic A, Vicentini FC, Srougi M et al (2015) Impact of renal anatomy on shock wave lithotripsy outcomes for lower pole kidney stones: results of a prospective multifactorial analysis controlled by computerized tomography. J Urol 193(6):2002–2007
Lingeman JE, Siegel YI, Steele B, Nyhuis AW, Woods JR (1994) Management of lower pole nephrolithiasis: a critical analysis. J Urol 151(3):663–667
Zarse CA, Hameed TA, Jackson ME, Pishchalnikov YA, Lingeman JE, McAteer JA et al (2007) CT visible internal stone structure, but not Hounsfield unit value, of calcium oxalate monohydrate (COM) calculi predicts lithotripsy fragility in vitro. Urol Res 35(4):201–206
Nakada SY, Hoff DG, Attai S, Heisey D, Blankenbaker D, Pozniak M (2000) Determination of stone composition by noncontrast spiral computed tomography in the clinical setting. Urology 55(6):816–819
Wang Z, Bai Y, Wang J (2020) Effects of diuretic administration on outcomes of extracorporeal shockwave lithotripsy: a systematic review and meta-analysis. PLoS ONE 15(3):e0230059
Ng C-F, Luke S, Chiu PK, Teoh JY, Wong K-T, Hou SS (2015) The effect of renal cortical thickness on the treatment outcomes of kidney stones treated with shockwave lithotripsy. Korean J Urol 56(5):379
Elbaset MA, Hashem A, Eraky A, Badawy MA, El-Assmy A, Sheir KZ et al (2020) Optimal non-invasive treatment of 1–2.5 cm radiolucent renal stones: oral dissolution therapy, shock wave lithotripsy or combined treatment—a randomized controlled trial. World J Urol 38(1):207–212
Gadelmoula M, Elderwy AA, Abdelkawi IF, Moeen AM, Althamthami G, Abdel-Moneim AM (2019) Percutaneous nephrolithotomy versus shock wave lithotripsy for high-density moderate-sized renal stones: a prospective randomized study. Urol Ann 11(4):426–431
Gücük A, Üyetürk U, Öztürk U, Kemahli E, Yildiz M, Metin A (2012) Does the Hounsfield unit value determined by computed tomography predict the outcome of percutaneous nephrolithotomy? J Endourol 26(7):792–796
Anastasiadis A, Onal B, Modi P, Turna B, Duvdevani M, Timoney A et al (2013) Impact of stone density on outcomes in percutaneous nephrolithotomy (PCNL): an analysis of the clinical research office of the endourological society (CROES) PCNL global study database. Scand J Urol 47(6):509–514
Xue Y, Zhang P, Yang X, Chong T (2015) The effect of stone composition on the efficacy of retrograde intrarenal surgery: kidney stones 1–3 cm in diameter. J Endourol 29(5):537–541
Gucuk A, Yilmaz B, Gucuk S, Uyeturk U (2019) Are stone density and location useful parameters that can determine the Endourological surgical technique for kidney stones that are smaller than 2 cm? A prospective randomized controlled trial. Urol J 16(3):236–241
Phukan C, Nirmal T, Wann CV, Chandrasingh J, Kumar S, Kekre NS et al (2017) Can we predict the need for intervention in steinstrasse following shock wave lithotripsy? Urol Ann 9(1):51
No funds were received.
Conflict of interest
No conflicts of interest.
The study was approved by local ethical committee.
Consent to participate
Consent was taken from all participants.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
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
- Shockwave lithotripsy (SWL)
- Hard stones
- Stone free rate