Success rate of expanded indications (non-adherence to guidelines) for SWL using semi-integrated lithotripter in a mid volume stone center

Abstract

Aim: Shock wave lithotripsy (SWL) has emerged and established itself as a first-line option for management of urolithiasis. There are not many studies examining patterns adhering or not, to the latest AUA/EAU guidelines. The aim of the study was to assess the success of expanded indications (non-adherence to guidelines) of patients managed by SWL for urinary stone disease using a semi-integrated lithotripter at a single tertiary center and to compare the results of a group of patients undergoing SWL with indications adhering to the guidelines.

Patients and Methods: One hundred and nine cases undergoing SLW for renal or ureteral stones were evaluated. The procedures were performed by a single SWL technician with a Dornier Compact Delta II® semi-integrated lithotripter. Stone free rates were evaluated with KUB 10 days following SWL. Cases were divided into 2 groups namely: Group 1, adherence to guidelines for SWL indications and Group 2, expanded criteria (stone size>20mm, lower pole stone size>10mm, attenuation > 1000 HU)(non-adherence). Success rate among groups were compared.

Results: Group1 and 2 had 17 and 92 cases, respectively. Group 1 and 2 had stone free rate of 60% (9/15) vs 28% (26/94), (p=0.018), where 20% (3/15) vs 36% (34/94), [not significant (ns)] of patients had fragmentation but not complete stone passage and 20% (3/15) vs 18% (17/94), (ns), had no fragmentation at all, and 2 vs 15 patients were lost on follow up, respectively. One complication with a patient having streintrasse and 10 patients with emergency department visit for renal colic was observed on Group 2.

Conclusion: Adherence to guidelines for selecting patients undergoing SWL procedure has significant impact on SFRs