Is extracorporeal lithotripsy a first-line treatment for urinary stones today?

Objective

To evaluate the efficacy and complications of extracorporeal lithotripsy (SWL) as a first-line treatment for renal and ureteral stones

Methods

Retrospective and observational study of all the patients treated with lithotripsy in a third level center between January 2014 and January 2021; characteristics of the patients, the stones, complications and results of SWL is recollected. Multivariate logistic regression of the factors associated with stone size reduction was performed. A statistical analysis of the factors associated with additional treatment after SWL and factors associated with complications is also executed.

Results

1727 patients are included. Stone mean size was 9,5 mm. 1540 (89.4%) patients presented reduction in stone size. In multivariate analysis, stone size (OR = 1.13; p = 0.00), ureteral location of the lithiasis (OR = 1.15; p = 0.052) and number of waves (p = 0.002; OR = 1.00) used in SWL are the factors associated with reduction of stone size. Additional treatment after lithotripsy was needed in 665 patients (38.5%). The factors associated with the need for retreatment were stone size (OR = 1.131; p = 0.000), number of waves (OR = 1.000; p = 0.000), energy (OR = 1.005; p = 0.000). 153 patients (8.8%) suffered complications after SWL. A statistically significant association was found between the size of the lithiasis (p = 0.024, OR = 1.054) and the previous urinary diversion (P = 0.004, OR = 0.571).

Conclusion

Lithotripsy remains an effective treatment as the first line of therapy for reno-ureteral lithiasis with a low percentage of complications.