Factors influencing extracorporeal shock wave lithotripsy efficiency for optimal patient selection

Introduction: Current literature suggests various predictors related to the stone and patient, which could influence stone fragmentation and clearance rates. Aim: To establish clinical characteristics of stone disease for patients undergoing extracorporeal shockwave lithotripsy (ESWL) which may predict the success of the procedure. Material and methods: One hundred and nine patients with renal stone disease diagnosed by non-contrast computed tomography (NCCT) who underwent ESWL between January 2015 and December 2019 were included in the study. Endpoints: patient being stone free (SF) or when < 4 mm fragments were detected. Age, gender, location, skin-to-stone distance, maximum stone length, stone volume, stone surface area, mean stone Hounsfield units (HU) and highest HU score were explored in uni- and multivariate regression analysis. Results: Stone size revealed the highest prognostic power for ESWL failure, where OR for stone volume and stone surface area were 1.06 (1.03-1.10) and 1.04 (1.02-1.06), respectively (all p < 0.01) while a tendency was observed for skin-to-stone distance 1.02 (1.00-1.03). The amount of energy applied during the procedure to one cubic milli-meter of stone volume (SMLI/stone volume) was predictive for treatment success (OR = 0.60, 95% CI: 0.41-0.87, p < 0.01). Stone volume (OR = 1.06, 95% CI: 1.00-1.14, p = 0.01) and stone surface area (OR = 1.03, 95% CI: 1.01-1.06, p = 0.02) remained as statistically significant prognostic factors for treatment failure. Conclusions: Both greater stone volume and stone surface area, as well as lower power delivered per stone volume unit during the ESWL procedure, were found to be significant factors and could be useful to predict treatment failure.