Joshua D. Wiesenthal

No AccessJournal of UrologyAdult Urology1 Aug 2011A Clinical Nomogram to Predict the Successful Shock Wave Lithotripsy of Renal and Ureteral Calculi Joshua D. Wiesenthal, Daniela Ghiculete, A. Andrew Ray, R. John D.'A. Honey, and Kenneth T. Pace Joshua D. WiesenthalJoshua D. Wiesenthal , Daniela GhiculeteDaniela Ghiculete , A. Andrew RayA. Andrew Ray , R. John D.'A. HoneyR. John D.'A. Honey , and Kenneth T. PaceKenneth T. Pace View All Author Informationhttps://doi.org/10.1016/j.juro.2011.03.109AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Although shock wave lithotripsy is dependent on patient and stone related factors, there are few reliable algorithms predictive of its success. In this study we develop a comprehensive nomogram to predict renal and ureteral stone shock wave lithotripsy outcomes. Materials and Methods: During a 5-year period data from patients treated at our lithotripsy unit were reviewed. Analysis was restricted to patients with a solitary renal or ureteral calculus 20 mm or less. Demographic, stone, patient, treatment and 3-month followup data were collected from a prospective database. All patients were treated using the Philips Lithotron® lithotripter. Results: A total of 422 patients (69.7% male) were analyzed. Mean stone size was 52.3 ± 39.3 mm2 for ureteral stones and 78.9 ± 77.3 mm2 for renal stones, with 95 (43.6%) of the renal stones located in the lower pole. The single treatment success rates for ureteral and renal stones were 60.3% and 70.2%, respectively. On univariate analysis predictors of shock wave lithotripsy success, regardless of stone location, were age (p = 0.01), body mass index (p = 0.01), stone size (p <0.01), mean stone density (p <0.01) and skin to stone distance (p <0.01). By multivariate logistic regression for renal calculi, age, stone area and skin to stone distance were significant predictors with an AUC of 0.75. For ureteral calculi predictive factors included body mass index and stone size (AUC 0.70). Conclusions: Patient and stone parameters have been identified to create a nomogram that predicts shock wave lithotripsy outcomes using the Lithotron lithotripter, which can facilitate optimal treatment based decisions and provide patients with more accurate single treatment success rates for shock wave lithotripsy tailored to patient specific situations. References 1 : 2007 Guideline for the management of ureteral calculi. Eur Urol2007; 52: 1610. Google Scholar 2 : Management of kidney stones. BMJ2007; 334: 468. Google Scholar 3 : Two-year experience with ureteral stones: extracorporeal shockwave lithotripsy v ureteroscopic manipulation. J Endourol1998; 12: 501. 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Link, Google Scholar Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada© 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byMannil M, von Spiczak J, Hermanns T, Poyet C, Alkadhi H and Fankhauser C (2018) Three-Dimensional Texture Analysis with Machine Learning Provides Incremental Predictive Information for Successful Shock Wave Lithotripsy in Patients with Kidney StonesJournal of Urology, VOL. 200, NO. 4, (829-836), Online publication date: 1-Oct-2018.Choo M, Uhmn S, Kim J, Han J, Kim D, Kim J and Lee S (2018) A Prediction Model Using Machine Learning Algorithm for Assessing Stone-Free Status after Single Session Shock Wave Lithotripsy to Treat Ureteral StonesJournal of Urology, VOL. 200, NO. 6, (1371-1377), Online publication date: 1-Dec-2018.Griebling T (2018) Re: Age-Related Delay in Urinary Stone Clearance in Elderly Patients with Solitary Proximal Ureteral Calculi Treated by Extracorporeal Shock Wave LithotripsyJournal of Urology, VOL. 195, NO. 5, (1493-1494), Online publication date: 1-May-2016.Assimos D (2018) Re: S.T.O.N.E. Nephrolithometry: Novel Surgical Classification System for Kidney CalculiJournal of Urology, VOL. 190, NO. 6, (2124-2125), Online publication date: 1-Dec-2013.Assimos D (2018) Re: Predictive Factors of the Outcome of Extracorporeal Shockwave Lithotripsy for Ureteral StonesJournal of Urology, VOL. 188, NO. 6, (2257-2257), Online publication date: 1-Dec-2012. Volume 186Issue 2August 2011Page: 556-562 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Keywordstreatment outcomeurolithiasisnomogramslithotripsyMetricsAuthor Information Joshua D. Wiesenthal Nothing to disclose. More articles by this author Daniela Ghiculete Nothing to disclose. More articles by this author A. Andrew Ray Nothing to disclose. More articles by this author R. John D.'A. Honey Financial interest and/or other relationship with Cook, Boston Scientific and Pleuromed. More articles by this author Kenneth T. Pace Financial interest and/or other relationship with Sanofi-Synthelabo, Cook Urological Inc., Baxter Inc. and Pharmascience Inc. More articles by this author Expand All Advertisement PDF downloadLoading ...

BACKGROUND AND PURPOSE: Shockwave lithotripsy (SWL) is considered a standard treatment for patients with upper-tract stones that are less than 10 mm in diameter, whereas stones that are larger than 20 mm are best managed by percutaneous nephrolithotomy (PCNL). The management of stones between these sizes remains controversial. Our purpose was to review our contemporary series of SWL, ureteroscopy (URS), and PCNL outcomes for intermediate-sized upper tract calculi (100-300 mm(2)). PATIENTS AND METHODS: Analysis was restricted to those patients who were treated for a renal calculus that measured between 100 and 300 mm(2) during a 4-year span. Demographic, stone, patient, treatment, and follow-up data were collected from a prospectively maintained database. RESULTS: A total of 137 patients were referred with nonstaghorn calculi with an area between 100 and 300 mm(2). Fifty-three (38.7%) patients were treated with SWL, while 41 (29.9%) and 43 (31.4%) underwent ureteroscopy and PCNL, respectively. Mean stone area was higher in the PCNL group (P < 0.001), whereas stone density was higher for patients undergoing SWL (P = 0.002). Single treatment success rates were better for PCNL at 95.3%,vs 87.8% for ureteroscopy and 60.4% for SWL, P < 0.001. When allowing for two SWL treatments, the success rate improved to 79.2%, thus equalizing the success of the three treatment modalities (P = 0.66). Auxiliary treatments were more common after SWL (42.3%; P < 0.01). CONCLUSIONS: For intermediate-sized upper-tract stones, when allowing for up to two SWL treatments, there was no significant difference between treatment modalities. Thus, SWL is a reasonably successful treatment alternative for patients who are not fit for a general anesthetic or who prefer SWL over competing treatments, provided they accept a potentially higher number of treatments.

OBJECTIVE: Perinatal testicular torsion (PTT) is a rare event with controversies surrounding its etiology, prebsentation, surgical management and sequelae. Our survey assessed the preferences of pediatric urologists with regard to its management. METHODS: Four cases of unilateral PTT and a questionnaire containing 11 questions about management of common clinical scenarios were mailed to 26 pediatric urologists. The answers were received anonymously and they were analyzed blindly. RESULTS: The response rate was 80% (21/26), with 90% (19/21) of respondents holding academic appointments. In the 2 first cases of PTT with a typical unilateral nonviable testis, 76% (16/21) and 67% (14/21), respectively, opted for surgery. A case of acute postnatal torsion resulted in 100% agreement to urgent scrotal exploration. In the case of an atrophic testis, none of the respondents opted for immediate surgery; yet, 38% (8/21) said they would proceed with a delayed orchiopexy of the contralateral testicle. In the question section, 10% (2/21) responded that they preferred to explore PTT immediately; whereas, 57% (12/21) would delay surgical exploration for a few days until the neonate was better stabilized. One-third of participants (7/21) would not perform a surgical exploration but would just follow the child clinically. A scrotal incision for contralateral orchiopexy was preferred by 52% (11/21), while 48% (10/21) prefer a scrotal approach but would switch to an inguinal incision if a hydrocele were present. Operative intervention was favoured by 80% (8/10) and 46% (5/11) of those with less than and greater than 10 years of practice, respectively. CONCLUSION: This survey revealed that 67% (14/21) of respondents preferred immediate exploration of a torted testis and contralateral orchiopexy, compared with the nonoperative approach. Scrotal incision for the exploration was preferred by most respondents. There was a trend to choose less aggressive treatment as the years of practice increase. Studies of more robust design, such as randomized controlled trials, are necessary to determine the natural history and outcomes of this uncommon type of testicular torsion.