Outcome Of Extracorporeal Shock Wave Lithotripsy (Eswl) Of Lower Ureteric Stones

Abstract

Urolithiasis is a prevailing urological condition, with ureteric stones affecting around 22% of cases, mostly causing severe pain and other complications. Surveillance, medical therapy, and interventions including non-invasive and invasive are various treatment options. However, extracorporeal shockwave lithotripsy (ESWL) is one of commonly used primary non-invasive technique in treatment for kidney and ureteric stones due to its success rate and cost-effectiveness. Thus, its effectiveness for lower ureteric stones is arguable due to anatomical and technical challenges. Factors such as stone size, density, and patient BMI influence ESWL success. This study aims to evaluate ESWL outcomes for lower ureteric stones, providing insights to refine treatment strategies and improve patient care.To determine the outcomes of extracorporeal shock wave lithotripsy for lower ureteric stones and evaluate the factors influencing these outcomes.This cross-sectional study was conducted at the Institute of Kidney Diseases, Peshawar, from September 2024 to February 2025, enrolling 171 patients with lower ureteric stones. Subject underwent evaluation, including ultrasound, X-ray KUB, BMI calculation, and investigations before ESWL treatment using an electromagnetic lithotripter. Patients received maximum up to three sessions of ESWL, with success defined as stone-free status as stone <4mm on ultrasound. These outcomes were assessed after two weeks. Data were analyzed using SPSS 23, with statistical tests applied to identify predictors of treatment success.The study consisted of 113 males (66.1%) and 58 females (33.9%), with a mean age of 37.3 years. The stones averaged 9.8 mm in size. Extracorporeal shockwave lithotripsy (ESWL) was successful in 83.6% of cases, while 16.4% required auxiliary procedures. The mean number of sessions needed to achieve stone-free status was 1.5. The successful outcomes were 92.6% in stones less than 10 mm, and 72.4% in stones more than 10mm (p-value 0.001). Moreover, successful outcomes was 71.1% in BMI more than 30 kg/m2, and more than 80% in BMI < 30 kg/m2 (p-value 0.02).Extracorporeal shock wave lithotripsy (ESWL) maintains its role as a safe, non-invasive treatment for well-selected lower ureteric stones. The major predictors of positive outcomes included stones stone size and body mass index (BMI). These findings support existing evidence on prognostic factors for ESWL efficacy, offering perceptions to improve patient selection for successful outcomes and reduced unnecessary interventions. In future, the studies should aim to develop protocols that incorporate variables such as stone density, impaction duration, and anatomical factors.

Keywords: extracorporeal shockwave lithotripsy, lower ureteric stone, distal ureteric stone, calculi, body mass index, stone size