The Efficacy of Early Extracorporeal Shockwave Lithotripsy for the Treatment of Ureteral Stones

Chang Hee Kim, Dong Seong Shin, Tae Beom Kim, Han Jung



Purpose: To determine the efficacy of early extracorporeal shockwave lithotripsy (e-ESWL) in colic patients with ureteral stones and the patient criteria for the most effective e-ESWL.

Materials and Methods: For 335 patients who were received ESWL due to ureteral stone, were divide in two groups: e-ESWL and d-ESWL by the critical cut-off point. we performed the sensitivity and specificity cut-off analyses to identified the critical cut off point. To assess the difference in the factors affecting ESWL success, univariate and multivariate logistic analyses were implemented with using variables: ESWL success; age; gender; BMI; comorbidity; serum creatinine; stone size; stone location; stone laterality; Hounsfield unit (HU); presence of hydronephrosis; and presence of tissue rim. The subgroup analysis for the screened variables was conducted.

Results: Define optimal e-ESWL to occur within a 24-hour critical cut-off time. Multivariate regression analysis concluded with screened variables: age, stone size, stone location, and HU, that ESWL success was 1.85-fold higher in the e-ESWL patient group. The subgroup analyses the following conditions: ?65 years old by 1.784-fold; ?10 mm stone size by 1.866-fold; mid to distal stone location by 2.234-fold; and ?815 HU by 2.130-fold. When all the conditions were met, the e-ESWL success was 3.22-fold higher.

Conclusions: In case of colic due to ureteral stones, the patient is recommended to receive a lithotripsy within the first 24 hours. E-ESWL is recommended especially in patients who are ?65 years, or with a ureteral stone HU ?815, sized ?10 mm, or in a mid to distal location.

Full Text:

Just Accepted



Teichman JM. Acute renal colic from ureteral calculus. N Engl J Med. 2004;350:684-93.

Ghalayini IF, Al-Ghazo MA, Khader YS. Evaluation of emergency extracorporeal shock wave lithotripsy for obstructing ureteral stones. International braz j urol. 2008;34:433-42.

Türk C, Petřík A, Sarica K, et al. EAU guidelines on interventional treatment for urolithiasis. Eur Urol. 2016;69:475-82.

Dasgupta R, Hegarty N, Thomas K. Emergency shock wave lithotripsy for ureteric stones. Current opinion in urology. 2009;19:196-9.

Cui X, Ji F, Yan H, et al. Comparison between extracorporeal shock wave lithotripsy and ureteroscopic lithotripsy for treating large proximal ureteral stones: a meta-analysis. Urology. 2015;85:748-56.

Seitz C, Fajković H, Remzi M, et al. Rapid extracorporeal shock wave lithotripsy treatment after a first colic episode correlates with accelerated ureteral stone clearance. Eur Urol. 2006;49:1099-106.

Tombal B, Mawlawi H, Feyaerts A, Wese FX, Opsomer R, Van Cangh PJ. Prospective randomized evaluation of emergency extracorporeal shock wave lithotripsy (ESWL) on the short-time outcome of symptomatic ureteral stones. Eur Urol. 2005;47:855-9.

Tligui M, El Khadime M, Tchala K, et al. Emergency extracorporeal shock wave lithotripsy (ESWL) for obstructing ureteral stones. Eur Urol. 2003;43:552-5.

Lucarelli G, Ditonno P, Bettocchi C, et al. Delayed relief of ureteral obstruction is implicated in the long-term development of renal damage and arterial hypertension in patients with unilateral ureteral injury. The Journal of urology. 2013;189:960-5.

Arcaniolo D, De Sio M, Rassweiler J, et al. Emergent versus delayed lithotripsy for obstructing ureteral stones: a cumulative analysis of comparative studies. Urolithiasis. 20171-10.

Picozzi SC, Ricci C, Gaeta M, et al. Urgent shock wave lithotripsy as first-line treatment for ureteral stones: a meta-analysis of 570 patients. Urol Res. 2012;40:725-31.

Mueller SC, Wilbert D, Thueroff JW, Alken P. Extracorporeal shock wave lithotripsy of ureteral stones: clinical experience and experimental findings. The Journal of urology. 1986;135:831-4.

Cummings JM, Boullier JA, Izenberg SD, Kitchens DM, Kothandapani RV. Prediction of spontaneous ureteral calculous passage by an artificial neural network. The Journal of urology. 2000;164:326-8.

Deliveliotis C, Chrisofos M, Albanis S, Serafetinides E, Varkarakis J, Protogerou V. Management and follow-up of impacted ureteral stones. Urol Int. 2003;70:269-72.

Parr N, Pye S, Ritchie A, Tolley D. Mechanisms responsible for diminished fragmentation of ureteral calculi: an experimental and clinical study. The Journal of urology. 1992;148:1079-83.

Choi HJ, Jung J-H, Bae J, Cho MC, Lee HW, Lee KS. Usefulness of early extracorporeal shock wave lithotripsy in colic patients with ureteral stones. Korean journal of urology. 2012;53:853-9.

Nakasato T, Morita J, Ogawa Y. Evaluation of Hounsfield Units as a predictive factor for the outcome of extracorporeal shock wave lithotripsy and stone composition. Urolithiasis. 2015;43:69-75.

Gökce MI, Esen B, Gülpınar B, Süer E, Gülpınar Ö. External Validation of Triple D Score in an Elderly (≥ 65 Years) Population for Prediction of Success Following Shockwave Lithotripsy. J Endourol. 2016;30:1009-16.

Kumar A, Mohanty NK, Jain M, Prakash S, Arora RP. A prospective randomized comparison between early (< 48 hours of onset of colicky pain) versus delayed shockwave lithotripsy for symptomatic upper ureteral calculi: a single center experience. J Endourol. 2010;24:2059-66.

Uguz S, Senkul T, Soydan H, et al. Immediate or delayed SWL in ureteric stones: a prospective and randomized study. Urol Res. 2012;40:739-44.

Ng CF, Wong A, Tolley D. Is extracorporeal shock wave lithotripsy the preferred treatment option for elderly patients with urinary stone? A multivariate analysis of the effect of patient age on treatment outcome. BJU Int. 2007;100:392-5.

Abdel‐Khalek M, Sheir KZ, Mokhtar AA, Eraky I, Kenawy M, Bazeed M. Prediction of success rate after extracorporeal shock‐wave lithotripsy of renal stones A multivariate analysis model. Scand J Urol Nephrol. 2004;38:161-7.

Dhar NB, Thornton J, Karafa MT, Streem SB. A multivariate analysis of risk factors associated with subcapsular hematoma formation following electromagnetic shock wave lithotripsy. The Journal of urology. 2004;172:2271-4.

Ouzaid I, Al‐qahtani S, Dominique S, et al. 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. 2012;110.

Pareek G, Armenakas NA, Panagopoulos G, Bruno JJ, Fracchia JA. Extracorporeal shock wave lithotripsy success based on body mass index and Hounsfield units. Urology. 2005;65:33-6.

Wiesenthal JD, Ghiculete D, Honey RJDA, Pace KT. 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. 2010;38:307-13.

Wang L-J, Wong Y-C, Chuang C-K, et al. Predictions of outcomes of renal stones after extracorporeal shock wave lithotripsy from stone characteristics determined by unenhanced helical computed tomography: a multivariate analysis. Eur Radiol. 2005;15:2238-43.

Pareek G, Armenakas NA, Fracchia JA. Hounsfield units on computerized tomography predict stone-free rates after extracorporeal shock wave lithotripsy. The Journal of urology. 2003;169:1679-81.


Creative Commons License 
This work is licensed under a Creative Commons Attribution 3.0 License