Impact of hydronephrosis on treatment outcome of solitary proximal ureteral stone after extracorporeal shock wave lithotripsy.
The purpose of this study was to investigate the impact of hydronephrosis on the treatment outcome of patients with a solitary proximal ureteral stone after extracorporeal shock wave lithotripsy (ESWL). A total of 182 consecutive patients who underwent ESWL for a solitary proximal ureteral stone of between 5 and 20 mm in size in our institution were included in this study. The degree of hydronephrosis was defined by renal ultrasonography. Patient data, stone size, shock wave numbers and shock wave energy were also recorded. Treatment outcome was evaluated 3 months after the first session of ESWL. In multivariate analysis, only the maximal stone length (odds ratio [OR], 0.15; 95% confidence interval [CI], 0.03-0.91; p = 0.04) and the degree of hydronephrosis (OR, 0.40; 95% CI, 0.16-0.98; p = 0.045) were significant predicting factors for stone-free status 3 months after ESWL. For stones < or = 10 mm, the stone-free rate decreased from 80% in patients with mild hydronephrosis to 56.4% in those with moderate to severe hydronephrosis. For stones > 10 mm, the stone-free rate decreased further, from 65.2% in patients with mild hydronephrosis to 33.3% in those with moderate to severe hydronephrosis. In summary, patients with a solitary proximal ureteral stone and a stone > 10 mm, the treatment outcome after ESWL was not good if moderate to severe hydronephrosis was noted on ultrasonography. Alternative treatments, such as ureteroscopic lithotripsy, may be appropriate as initial treatment or after failure of one session of ESWL.
Hsiao
Hsi-Lin
HL
Department of Urology, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan.
Huang
Shu-Pin
SP
Wu
Wen-Jeng
WJ
Lee
Yung-Chin
YC
Li
Wei-Ming
WM
Chou
Yii-Her
YH
Chang
Ai-Wen
AW
Huang
Chun-Hsiung
CH
Sun
Shu-Chin
SC
Liu
Chia-Chu
CC
D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology* / Q000628:therapy*; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014545:Urinary Calculi / Q000150:complications* / Q000628:therapy*