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EAU 2018: Can We Predict The Ancillary Treatments After Extracorporeal Shockwave Lithotripsy For Renal And Upper Ureteral Stones?

Copenhagen, Denmark (UroToday.com) Dr. Ibrahim, clinical urologist from the McGill University Health Centre in Montreal, Canada, elaborated on his findings regarding patient readmission to treatment centers after undergoing extracorporeal shockwave lithotripsy (ESWL). These ancillary treatments mostly include ureteroscopy (URS) and readmission to the hospital on account of pain or fever, which is detrimental to the patient due to repeat surgery while it also burdens the surgical waiting lists for urological departments. Though it is already commonly seen in urologic centers, the predictors for these ancillary treatments have yet to be identified. Therefore, Dr. Ibrahim presents his findings on the predictors of ancillary treatments following ESWL for renal and upper ureteral stones less than 20 mm.

In a retrospective chart analysis between January 2013 to January 2016, patients were identified who underwent ESWL using an electromagnetic lithotripter machine for renal and upper ureteral stones ≤ 20 mm. CT scans were carried out in all patients prior to ESWL. Once patients were collected, they were grouped based on their stone attenuation values (HU): Group I included HU < 500 (n=20), Group II included HU 500-1000 (n=51), and Group III included HU > 1000 (n=180). Data points and parameters collected were stone size, location, multiplicity, stone attenuation value, number of shocks, and stone clearance at the end of 3 months. Ancillary treatments included URS, ureteral stenting, and hospital readmission for pain or fever.

A total of 251 patients were enrolled in the current study. The success rates, mean stone size, and stone clearance rates were not significantly different between the three groups. Group III required URS and ureteral stenting in 10 cases and hospital readmission was observed in 4 cases. This was shown to be an interesting value, since Groups I and II did not require any ancillary retreatment following ESWL. Following multivariate analysis of the predictive parameters, it was determined that stone multiplicity, stone location (lower calyceal stones), and HU were significant predictors for ancillary retreatment following ESWL.

In closing, Dr. Ibrahim reiterated his findings from this study which showed that patients with an HU value greater than 1000, multiple stones, and/or lower calyceal stones had a significantly higher risk of ancillary retreatment following ESWL. He suggested that patients with these conditions be offered endoscopic lithotripsy as a first line therapy to avoid the need for retreatment. Additionally, he stressed that these results must be repeated in a prospective study to confirm the results, since there was a slight selection bias due to the retrospective nature of the study itself.

Speaker: Ahmed Ibrahim

Authors: Ibrahim A., Elatreisy A., Ganpule A., Khalaf I., Desai M.

Written by: Zachary Valley, Department of Urology, University of California-Irvine, at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark