Kaohsiung Journal of Medical Sciences
Volume 24, Issue 10 , Pages 507-513, October 2008

Impact of Hydronephrosis on Treatment Outcome of Solitary Proximal Ureteral Stone After Extracorporeal Shock Wave Lithotripsy

  • Hsi-Lin Hsiao

      Affiliations

    • Department of Urology, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan
    • ,
  • Shu-Pin Huang

      Affiliations

    • Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Wen-Jeng Wu

      Affiliations

    • Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Yung-Chin Lee

      Affiliations

    • Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Wei-Ming Li

      Affiliations

    • Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Yii-Her Chou

      Affiliations

    • Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Ai-Wen Chang

      Affiliations

    • Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Chun-Hsiung Huang

      Affiliations

    • Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Shu-Chin Sun

      Affiliations

    • Department of Anesthesiology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
    • ,
  • Chia-Chu Liu

      Affiliations

    • Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Corresponding Author InformationAddress correspondence and reprint requests to: Dr Chia-Chu Liu, Department of Urology, Kaohsiung Medical University Hospital, Tzyou 1st Road, Kaohsiung 807, Taiwan

Received 6 August 2008; accepted 3 November 2008.

Article Outline

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 ≤ 10 mm, the stone-free rate decreased from 80% in patients with mild hydronephrosis to 56.4% in those with moderate to severe hydro-nephrosis. 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.

Key Words:  ESWL , hydronephrosis , proximal ureter , ultrasonography , urolithiasis

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PII: S1607-551X(09)70009-9

doi:10.1016/S1607-551X(09)70009-9

Kaohsiung Journal of Medical Sciences
Volume 24, Issue 10 , Pages 507-513, October 2008

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