Shock Wave Lithotripsy is an Efficacious Modality for Obese Patients with Upper Ureteric Calculi : A matched-pair analysis from a dedicated centre treating patients with a skin-to-stone distance of more than 14cm
Author(s):
Mr Abhishek Sharma
,
Mr Abhishek Sharma
Affiliations:
Mr Edward AA Mains
,
Mr Edward AA Mains
Affiliations:
Mr James P Blackmur
,
Mr James P Blackmur
Affiliations:
Mr William KM Gietzman
,
Mr William KM Gietzman
Affiliations:
Mr Ismail El-Mokadem
,
Mr Ismail El-Mokadem
Affiliations:
Mrs Carolann Stephenson
,
Mrs Carolann Stephenson
Affiliations:
Mrs Shirley Wallace
,
Mrs Shirley Wallace
Affiliations:
Mr Simon Phipps
,
Mr Simon Phipps
Affiliations:
Mr Ben G Thomas
,
Mr Ben G Thomas
Affiliations:
Mr David A Tolley
,
Mr David A Tolley
Affiliations:
Mr Mark Cutress
Mr Mark Cutress
Affiliations:
BAUS ePoster online library. Sharma A. 06/26/17; 177360; P3-4 Disclosure(s): None
Mr. Abhishek Sharma
Mr. Abhishek Sharma
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Abstract
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Introduction & Objectives.
Clinical reviews and guidelines indicate that SWL outcomes are poor when treating patients with skin-to-stone distance (SSD) of >12cm. The objective of this study was to assess whether stone-free rates are superior in patients with a lower SSD, using a matched-pair analysis approach.

Patients & Methods
Patients with a solitary radio-opaque upper ureteric calculus diagnosed on CT scanning with a SSD ≤12cm and SSD ≥14cm were selected from a prospectively maintained database. Patients were treated with a Sonolith I-Sys Lithotripter (focal depth 17cm).

Matching criteria consisted of age, sex, maximum stone diameter (+/-2 mm) and stone density in Hounsfield units (+/- 250 HU). Difference between groups was assessed by McNemar’s chi-squared test.

Stone treatment success was defined as stone free (fragments ≤3mm) at 3 months. Failure was defined as persistent fragments beyond 3 months or intervention with ureteroscopy. The outcome was assessed by a plain XR KUB at 2 weeks.

Results
110 matches were made from a cohort of 161 patients with SSD ≥14cm. Group-specific characteristics are shown in Table 1. 81 patients (73.6%) with SSD ≥14cm were deemed stone free at follow up versus 83 patients (76.4%) with SSD ≤12cm (p=0.89). There was no significant difference between number of ESWL sessions undertaken between the control and test groups.

Conclusion
This study demonstrates that SWL can provide efficacious treatment of upper ureteric stones in obese patients, and that the upper threshold of SSD for SWL selection should be revised to allow these patients the benefits of SWL.
Introduction & Objectives.
Clinical reviews and guidelines indicate that SWL outcomes are poor when treating patients with skin-to-stone distance (SSD) of >12cm. The objective of this study was to assess whether stone-free rates are superior in patients with a lower SSD, using a matched-pair analysis approach.

Patients & Methods
Patients with a solitary radio-opaque upper ureteric calculus diagnosed on CT scanning with a SSD ≤12cm and SSD ≥14cm were selected from a prospectively maintained database. Patients were treated with a Sonolith I-Sys Lithotripter (focal depth 17cm).

Matching criteria consisted of age, sex, maximum stone diameter (+/-2 mm) and stone density in Hounsfield units (+/- 250 HU). Difference between groups was assessed by McNemar’s chi-squared test.

Stone treatment success was defined as stone free (fragments ≤3mm) at 3 months. Failure was defined as persistent fragments beyond 3 months or intervention with ureteroscopy. The outcome was assessed by a plain XR KUB at 2 weeks.

Results
110 matches were made from a cohort of 161 patients with SSD ≥14cm. Group-specific characteristics are shown in Table 1. 81 patients (73.6%) with SSD ≥14cm were deemed stone free at follow up versus 83 patients (76.4%) with SSD ≤12cm (p=0.89). There was no significant difference between number of ESWL sessions undertaken between the control and test groups.

Conclusion
This study demonstrates that SWL can provide efficacious treatment of upper ureteric stones in obese patients, and that the upper threshold of SSD for SWL selection should be revised to allow these patients the benefits of SWL.
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