Relationship between the Success of Extracorporeal Shock Wave Lithotripsy (ESWL) and the Degree of Hydronephrosis when Treating Patients with Upper Ureteral Stones

Yun Il Kang; Hyung Yoon Moon; Chul Sung Kim

doi:10.4111/kju.2007.48.4.422

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Kang, Moon, and Kim: Relationship between the Success of Extracorporeal Shock Wave Lithotripsy (ESWL) and the Degree of Hydronephrosis when Treating Patients with Upper Ureteral Stones

Original Article

Korean J Urol 2007;48(4):422-427.

Published online: 18 December 2007

DOI: https://doi.org/10.4111/kju.2007.48.4.422

Relationship between the Success of Extracorporeal Shock Wave Lithotripsy (ESWL) and the Degree of Hydronephrosis when Treating Patients with Upper Ureteral Stones

Yun Il Kang, Hyung Yoon Moon, Chul Sung Kim

¹From the Department of Urology, College of Medicine, Chosun University, Gwangju, Korea

Corresponding Author: Hyung-Yun Moon Department of Urology, Chosun University Hospital 588, Seoseok-dong, Dong-gu, Gwangju 501-717 TEL: 062-220-3216, 3210 FAX: 062-232-3210 E-mail: mu-hn@daum.net

Received 15 November 2006 Accepted 20 March 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

We tried to determine the relation between the degree ofstone- induced hydronephrosis and the outcome of extracorporeal shock wave lithotripsy (ESWL) when treating patients with solitary upper ureteral stone.

Materials and Methods

MMMMB βλ MMkldhl 260 proximal ureteral stone patients with or without hydronephrosis were treated with ESWL between January 2003 and December 2006 and 8 of these patients were lost to follow up. The degree of hydronephrosis was defined by performing renal ultrasound. The patients were divided into four groups according to the degree of hydronephrosis. Group 0 (n=30) had no urinary system dilatation, group 1 (n=123) had a mild dilatation of the renal pelvis but no renal calices, group 2 (n=75) had a moderate dilatation of the renal pelvis and group 3 (n=24) had a severe dilatation of the renal pelvis and calices. In addition to the degree of hydronephrosis, the stone size, number of sessions, number of shockwave treatments applied and the success rate of ESWL were recorded.

Results

Infill The success rate after ESWL treatment was 92.9% (n=234). There were no statistically significant differences among the groups for the stone size, number of sessions and number of applied shockwave treatments. There were a trend for a decreased success rate of ESWL with an increased degree of hydronephrosis, but this did not reach statistical significance (p=0.436). After ESWL, a few patients encountered minor complications such as gross hematuria, flank pain, stone street, fever and perirenal hematoma. Yet most cases were treated conservatively and there was no need for hospitalization.

Conclusions:

For the patients in our study who had a solitary calculus in the upper ureter, the degree of hydronephrosis caused by the stone does not affect the success rate after ESWL.

Keywords: Extracorporeal shockwave lithotripsy, Calculi, Hydronephrosis

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Fig. 1.

Success rate of extracorporeal shock wave lithotripsy (ESWL) between the four groups (p=0.436). Group 0 had no urinary system dilatation, group 1 had a mild dilatation of the renal pelvis but not renal calices, group 2 had a moderate dilation of the renal pelvis and group 3 had a severe dilatation of the renal pelvis and calices.

Table 1.

Patients stratified by the degree of hydronephrosis

Group	n=252	Stone size (mm)	No. of sessions	No. of shockwave	Success rate (%)
0	30	7.8 ±2.6	1.4 ±0.8	3.350 ±267	96.7
1	123	7.8 ±2.7	1.5 ±0.9	3.463 ±406	94.3
2	75	8.4 ±2.5	1.9±1.4	3.500 ±339	90.7
3	24	9.0 ±3.1	1.7±1.0	3.396 ±294	87.5
		p=0.120∗	p=0.061∗	p=0.227∗	p=0.436^†

∗: ANOVA test, ^†: Pearson chi-square test

Table 2.

Patients stratified into the non-hydronephrotic and hydronephrotic groups

Group	n=252	Stone size (mm)	No. of sessions	No. of shockwave	Success rate (%)
0	30	7.7 ±2.6	1.4 ±0.8	3.350 ±267	96.7
1-3	222	8.1 ±2.7	1.7±1.1	3.468 ±373	92.3
		p=0.458∗	p=0.293∗	p=0.094∗	p=0.705^†

^∗ : Student's t-test, Pearson chi-square test

Table 3.

Distribution of stone size (< 10mm vs > 10mm) within the hydronephrotic groups

	n=252	Group 0	Group 1	Group 2	Group 3
< 10mm	170	13.5% (n=23)	48.8% (n=83)	29.4% (n=50)	8.2% (n=14)
> 10mm	82	8.5% (n=7)	48.8% (n=40)	30.5% (n=25)	12.2% (n=10)

Pearson chi-square test

Table 4.

Patients stratified by stone size (< 10mm vs >10mm)

	n=252	Stone size	No. of sessions	Success rate
< 10mm	170	6.6±1.4	1.5 ±0.9	96.5%
> 10mm	82	11.3±1.6	2.0±1.4	85.4%
		p < 0.01∗	p=0.04∗	p=0.03^†

∗: Student's t-test, ^†: Pearson chi-square test

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