Abstract
This study explores the risk factors for residual stones and stone recurrence after extracorporeal shock wave lithotripsy (ESWL), aiming to assist in clinical practice to improve the stone clearance rate, reduce the stone recurrence rate, and enhance the surgical outcomes. A retrospective analysis was conducted on 367 patients with ureteral stone who underwent ESWL from February 2022 to February 2025. Among them, 328 patients had complete data. General clinical data, stone characteristics, and follow-up data of the patients were collected. Univariate and multivariate logistic regression analyses were performed on the risk factors for residual stones and stone recurrence after ESWL. In this study, the stone clearance rate after ESWL was 85.37% (280/328), and the stone recurrence rate within 3 months after the operation was 20.36% (57/280). Univariate logistic regression analysis found that body mass index (P = .048), stone size (P < .001), stone density (P = .020), and preoperative serum creatinine (P = .045) were risk factors for residual stones after ESWL. Gender (P = .038), coronary heart disease (CHD, P = .024), and stone density (P = .037) were risk factors for stone recurrence after ESWL. Multivariate logistic regression analysis revealed that stone size (P < .001), stone hardness (P = .036), and preoperative serum creatinine (P = .008) were independent risk factors for residual stones after ESWL. CHD (P = .046) and stone density (P = .046) were independent risk factors for stone recurrence after ESWL. ESWL for ureteral stone has a relatively high stone clearance rate and stone recurrence rate. body mass index, stone size, stone density, and preoperative serum creatinine are independent risk factors for residual stones after ESWL. CHD and stone density are independent risk factors for stone recurrence after ESWL.
Keywords: ESWL, recurrence, risk factors, stone clearance, stone size
1. Introduction
Urolithiasis is one of the most common diseases in the world. This disease affects 2% to 20% of the population, and the recurrence rate within 5 years is approximately 30% to 50%.[1–3] The main treatments for urinary stone include extracorporeal shock wave lithotripsy (ESWL), retrograde flexible ureteroscopic lithotripsy (RIRS), percutaneous nephrolithotomy (PCNL) and open surgery.[4,5] Among them, ESWL has the advantages of being noninvasive, easy to operate, and not requiring hospitalization.[6] However, the high rates of residual stones and recurrence after ESWL are factors that limit the surgical outcomes.
Although multiple ESWL treatments can, to a certain extent, compensate for the lower stone clearance rate, multiple ESWL treatments will bring more burdens, and the incidence of complications will also increase, especially in children.[7,8] Therefore, for high-risk groups with poor single-treatment effects, choosing ureteroscopic lithotripsy may bring greater benefits. Thus, exploring the risk factors affecting the stone clearance effect after a single ESWL treatment is beneficial for clinicians to better select treatment methods.
The high recurrence rate of stones is also an important factor that troubles patients.[9,10] Adjusting from the perspective of factors affecting stone recurrence and reducing the recurrence of stones in patients, prevention is a better treatment method than surgical treatment. Therefore, this study explores the risk factors for stone recurrence in patients with stone clearance after a single ESWL treatment to avoid stone recurrence.
This study analyzes the influencing factors of stone clearance and recurrence after ESWL, aiming to provide some reference for clinicians, to better manage risk factors, reduce the rates of residual stones and recurrence after surgery, and improve the quality of life of patients.
2. Methods
From February 2022 to February 2025, Peking University First Hospital-Miyun Hospital and Beijing YuQuan Hospital performed ESWL on a total of 367 patients with ureteral stone. After screening, 328 patients had complete clinical data and could be included in the research analysis (Fig. 1). Among them, 48 patients had residual stones after ESWL, and all achieved stone clearance after secondary ESWL or RIRS. The clinical data of the patients were collected, including general clinical data, perioperative data, stone characteristics, postoperative stone clearance rate, and the stone recurrence rate within 3 months.
Figure 1.
The flowchart in the study.
Stone clearance is defined as no residual stones or asymptomatic, noninfectious, nonobstructive residual stones ≤ 4 mm shown by computed tomography (CT) examination within 4 weeks after ESWL. Failure to achieve the effect of stone clearance is considered residual stones. Stone recurrence is defined as definite stone clearance after ESWL, and the new appearance of stones found by CT. According to the situation of residual stones, the patients were divided into the stone clearance group and the residual stone group. According to the situation of stone recurrence, the patients were divided into the recurrence group and the non-recurrence group.
Inclusion criteria: ureteral stone clearly identified by CT. Stone size ≤2 cm. Age ≥18 years. Exclusion criteria: pregnant women. Renal insufficiency. Cardiopulmonary dysfunction that cannot tolerate the surgery.
The clinical variables of this study include gender, age, hypertension, diabetes, coronary heart disease (CHD), body mass index (BMI), mayo adhesive probability (MAP) score,[11] side of the stone, stone location, stone size, stone density, distance from the skin to the stone (DSS), preoperative white blood cells, preoperative creatinine value, preoperative C-reactive protein, stone clearance, and stone recurrence. Using the postoperative residual stones and postoperative stone recurrence as the outcomes respectively, the risk factors for residual stones and stone recurrence after ESWL for ureteral stone were explored. Among them, all CHD patients were stable CHD patients who did not receive anticoagulants and antiplatelet therapy. After evaluation by echocardiography and electrocardiogram, cardiologists considered that they could tolerate surgical treatment. All patients were treated with α-blockers or α-1 blockers.
The DSS was calculated as the distance from the skin to the surface of the target stone measured on non-contrast abdominal CT. The stone density was determined by the CT value within the circular region of interest.[12] The stone size was the longest diameter of the stone measured by CT.
This study was conducted in accordance with the principles of the Declaration of Helsinki (revised in 2013) and was approved by the Ethics Committee of Peking University First Hospital-Miyun Hospital. The retrospective analysis of this study waived the need for individual consent.
2.1. Surgical procedure
The patients were fasted for 6 to 8 hours before the operation. ESWL was performed using an XYS. SUI-6X lithotripsy machine (Shenzhen, China). The patients were in a supine position, and lithotripsy was carried out under ultrasound guidance. The number of shock waves was 1500 to 2500 times, the shock frequency was 60 times per minute, the shock energy was 10 to 20 KV, and the time was 30 minutes. After lithotripsy, the patients were instructed to drink plenty of water, engage in appropriate activities, and observe the situation of stone excretion.
All surgeons had clinical experience of more than 10 years, demonstrating a high level of proficiency. In terms of professional title, they were all associate chief physicians.
2.2. Statistical analysis
SPSS version 22.0 (Chicago) was used for statistical analysis. The measurement data conforming to the normal distribution were expressed as mean ± standard deviation; the data with skewed distribution were described by median (range). For continuous variables, the t-test was used to analyze variables conforming to the normal distribution, and the Mann–Whitney U test was used to analyze variables that did not conform to the normal distribution. Fisher exact probability test was used to analyze categorical variables. Univariate binary logistic regression analysis (P < .05) and multivariate logistic regression analysis (P < .05) were used for risk factor analysis.
3. Results
3.1. Stone clearance rate and stone recurrence rate after ESWL
The baseline data of the patients are shown in Table 1. The mean age of the patients was 51.24 ± 13.60 years, the mean BMI was 24.61 ± 3.23 kg/m², and the proportion of males was 67.99% (223/328). The average stone size was 0.73 ± 0.21 cm, and the average stone density was 753.05 ± 283.92 HU. The stone clearance rate was 85.37% (280/328), and the stone recurrence rate was 20.36% (57/280).
Table 1.
Comparison between stone clearance group and residual stone group.
| Variable | Total | Stone clearance group | Residual Stone Group | P-value |
|---|---|---|---|---|
| Patients, n (%) | 328 | 280 | 48 | – |
| Mean age (year) | 51.24 ± 13.60 | 51.35 ± 13.34 | 50.60 ± 14.89 | .728 |
| BMI (kg/m2) | 24.61 ± 3.23 | 24.44 ± 3.13 | 25.56 ± 3.59 | .027 |
| Gender, n (%) | ||||
| Male | 223 (67.99) | 194 (69.29) | 29 (60.42) | .224 |
| Female | 105 (32.01) | 86 (30.71) | 19 (39.58) | |
| Hypertension, n (%) | ||||
| Yes | 83 (25.30) | 75 (26.79) | 8 (16.67) | .350 |
| No | 245 (74.70) | 205 (73.21) | 40 (83.33) | |
| Diabetes mellitus, n (%) | ||||
| Yes | 34 (10.37) | 30 (10.71) | 4 (8.33) | .731 |
| No | 294 (89.63) | 250 (89.29) | 44 (91.67) | |
| CHD, n (%) | ||||
| Yes | 41 (12.50) | 34 (12.14) | 7 (14.58) | .166 |
| No | 287 (87.50) | 246 (87.86) | 41 (85.42) | |
| Side of the stone, n (%) | ||||
| Left side | 193 (58.84) | 169 (60.36) | 24 (50.00) | .035 |
| Right side | 135 (41.16) | 111 (39.64) | 24 (50.00) | |
| MAP, n (%) | ||||
| <3 | 257 (78.35) | 223 (79.64) | 34 (70.83) | .171 |
| ≥3 | 71 (21.65) | 57 (20.36) | 14 (29.17) | |
| Stone location, n (%) | ||||
| Upper segment of the ureter | 148 (45.12) | 120 (42.86) | 28 (58.33) | .169 |
| Middle segment of the ureter | 13 (3.96) | 13 (4.64) | 0 (0.00) | |
| Lower segment of the ureter | 167 (50.92) | 147 (52.50) | 20 (41.67) | |
| Stone size (Maximal diameter, cm) | 0.73 ± 0.21 | 0.71 ± 0.20 | 0.83 ± 0.26 | .004 |
| Stone density (HU) | 753.05 ± 283.92 | 737.71 ± 274.44 | 842.50 ± 316.46 | .038 |
| DSS (mm) | 81.11 ± 15.75 | 81.54 ± 15.51 | 78.63 ± 16.71 | .273 |
| Preoperative white blood cell count (×109/L) | 11.01 ± 13.79 | 11.52 ± 14.82 | 8.03 ± 2.56 | .106 |
| Preoperative serum creatinine (µmol/L) | 80.19 ± 20.95 | 79.22 ± 19.37 | 85.86 ± 27.48 | .043 |
| C-reactive protein (mg/L) | 12.80 ± 18.02 | 13.03 ± 18.16 | 11.46 ± 16.90 | .569 |
BMI = body mass index, CHD = coronary artery heart disease, DSS = distance from the skin to the stone, MAP = mayo adhesion probability.
3.2. Analysis of risk factors for residual stones after ESWL
The clinical data of the patients in the stone clearance group and the residual stone group after ESWL are shown in Table 1. The average BMI of the stone clearance group was 24.44 ± 3.13 kg/m², and that of the residual stone group was 25.56 ± 3.59 kg/m². There was a statistically significant difference between the 2 groups (P = .027). The average stone size in the stone clearance group was 0.71 ± 0.20 cm, and that in the residual stone group was 0.83 ± 0.26 cm, and there was a statistical difference between the 2 groups (P = .004). The average stone density in the stone clearance group was 737.71 ± 274.44 HU, and that in the residual stone group was 842.50 ± 316.46 HU, and there was a statistical difference between the 2 groups (P = .038). The average preoperative creatinine in the stone clearance group was 79.22 ± 19.37 µmol/L, and that in the residual stone group was 85.86 ± 27.48 µmol/L, and there was a statistical difference between the 2 groups (P = .043).
Univariate logistic regression found that BMI (P = .029), stone size (P < .001), stone density (P = .020), and preoperative serum creatinine (P = .045) were risk factors for residual stones after ESWL. Multivariate logistic regression analysis found that BMI (P = .048), stone size (P < .001), stone density (P = .036), and preoperative serum creatinine (P = .008) were independent risk factors for residual stones after ESWL (Table 2).
Table 2.
Analysis of risk factors for residual stones after extracorporeal shock wave lithotripsy.
| Variable | Univariate | Multivariate | ||||
|---|---|---|---|---|---|---|
| OR | 95% CI | P-value | OR | 95% CI | P-value | |
| Mean age | 1.004 | 0.982–1.027 | .727 | – | – | – |
| Gender | 1.478 | 0.786–2.780 | .226 | – | – | – |
| BMI | 0.896 | 0.812–0.989 | .029 | 0.903 | 0.817–0.999 | .048 |
| Hypertension | 0.547 | 0.245–1.221 | .141 | – | – | – |
| Diabetes mellitus | 0.758 | 0.254–2.256 | .618 | – | – | – |
| CHD | 1.235 | 0.513–2.973 | .637 | – | – | – |
| Side of the stone | 1.523 | 0.824–2.814 | .180 | – | – | – |
| MAP | 1.161 | 0.810–3.202 | .174 | – | – | – |
| Stone size | 0.091 | 0.023–0.354 | <.001 | 0.086 | 0.020–0.359 | <.001 |
| Stone density | 0.999 | 0.998–1.000 | .020 | 0.999 | 0.998–1.000 | .042 |
| DSS | 1.011 | 0.993–1.030 | .239 | – | – | – |
| Preoperative white blood cell count | 1.074 | 0.968–1.192 | .179 | – | – | – |
| Preoperative serum creatinine | 0.986 | 0.973–1.000 | .045 | 0.981 | 0.967–0.995 | .009 |
| C-reactive protein | 1.005 | 0.987–1.024 | .582 | – | – | – |
BMI = body mass index, CHD = coronary heart disease, CI = confidence interval, DSS = distance from the skin to the stone, MAP = mayo adhesive probability, OR = odds ratio.
3.3. Analysis of risk factors for stone recurrence after ESWL
The clinical data of the patients in the recurrence group and the non-recurrence group after ESWL are shown in Table 3. The proportion of males in the recurrence group was 57.89%, and that in the non-recurrence group was 72.20%, and there was a statistical difference between the 2 groups (P = .037). The proportion of patients with CHD in the recurrence group was 21.05%, and that in the non-recurrence group was 9.87%, and there was a statistical difference between the 2 groups (P = .021). The average stone density in the recurrence group was 669.44 ± 324.83 HU, and that in the non-recurrence group was 755.16 ± 256.27 HU, and there was a statistical difference between the 2 groups (P = .038).
Table 3.
Comparison between recurrence group and non-recurrence group.
| Variable | Recurrence group | Non-recurrence group | P-value |
|---|---|---|---|
| Patients, n (%) | 57 | 223 | – |
| Mean age (year) | 52.46 ± 13.42 | 51.06 ± 13.27 | .492 |
| BMI (kg/m2) | 24.86 ± 3.21 | 24.53 ± 3.25 | .427 |
| Gender, n (%) | |||
| Male | 33 (57.89) | 161 (72.20) | .037 |
| Female | 24 (42.11) | 62 (27.80) | |
| Hypertension, n (%) | |||
| Yes | 21 (36.84) | 54 (24.22) | .055 |
| No | 36 (63.16) | 169 (75.78) | |
| Diabetes mellitus, n (%) | |||
| Yes | 10 (17.54) | 20 (8.97) | .062 |
| No | 47 (82.46) | 203 (91.03) | |
| CHD, n (%) | |||
| Yes | 12 (21.05) | 22 (9.87) | .021 |
| No | 45 (78.95) | 201 (90.13) | |
| Side of the stone, n (%) | |||
| Left side | 37 (64.91) | 132 (59.19) | .431 |
| Right side | 20 (35.09) | 91 (40.81) | |
| MAP, n (%) | |||
| <3 | 46 (80.70) | 177 (79.37) | .824 |
| ≥3 | 11 (19.30) | 46 (20.63) | |
| Stone location, n (%) | |||
| Upper segment of the ureter | 19 (33.33) | 101 (45.29) | .214 |
| Middle segment of the ureter | 4 (7.02) | 9 (4.04) | |
| Lower segment of the ureter | 34 (59.65) | 113 (50.67) | |
| Stone size (maximal diameter, cm) | 0.74 ± 0.20 | 0.70 ± 0.19 | .212 |
| Stone density (HU) | 669.44 ± 324.83 | 755.16 ± 256.27 | .036 |
| DSS (mm) | 80.47 ± 19.76 | 81.81 ± 14.15 | .638 |
| Preoperative white blood cell count (×109/L) | 8.49 ± 3.20 | 12.30 ± 16.43 | .073 |
| Preoperative serum creatinine (µmol/L) | 79.84 ± 16.65 | 79.06 ± 19.96 | .770 |
| C-reactive protein (mg/L) | 12.19 ± 16.62 | 13.25 ± 18.50 | .695 |
BMI = body mass index, CHD = coronary heart disease, CI = confidence interval, DSS = distance from the skin to the stone, MAP = mayo adhesive probability, OR = odds ratio.
Univariate logistic regression found that gender (P = .038), CHD (P = .024), and stone density (P = .037) were risk factors for stone recurrence after ESWL. Multivariate logistic regression analysis found that CHD (P = .046) and stone density (P = .046) were independent risk factors for stone recurrence after ESWL (Table 4).
Table 4.
Analysis of risk factors for stone recurrence after extracorporeal shock wave lithotripsy.
| Variable | Univariate | Multivariate | ||||
|---|---|---|---|---|---|---|
| OR | 95% CI | P-value | OR | 95% CI | P-value | |
| Mean age | 1.008 | 0.986–1.030 | .483 | – | – | – |
| Gender | 0.530 | 0.290–0.967 | .038 | 0.565 | 0.306–1.045 | .069 |
| BMI | 1.032 | 0.955–1.116 | .426 | – | – | – |
| Hypertension | 0.548 | 0.295–1.018 | .057 | – | – | – |
| Diabetes mellitus | 2.160 | 0.949–4.917 | .067 | – | – | – |
| CHD | 2.436 | 1.123–5.284 | .024 | 2.233 | 1.013–4.922 | .046 |
| MAP | 1.087 | 0.522–2.263 | .824 | – | – | – |
| Side of the stone | 0.784 | 0.428–1.437 | .431 | – | – | – |
| Stone size | 2.587 | 0.624–10.723 | .190 | – | – | – |
| Stone density | 0.999 | 0.998–1.000 | .037 | 0.999 | 0.998–1.000 | .046 |
| DSS | 0.996 | 0.977–1.013 | .562 | – | – | – |
| Preoperative white blood cell count | 0.960 | 0.906–1.017 | .165 | – | – | – |
| Preoperative serum creatinine | 1.002 | 0.987–1.017 | .79 | – | – | – |
| C-reactive protein | 0.997 | 0.980–1.013 | .694 | – | – | – |
BMI = body mass index, CHD = coronary heart disease, CI = confidence interval, DSS = distance from the skin to the stone, MAP = mayo adhesive probability, OR = odds ratio.
4. Discussion
Although with the development of RIRS and PCNL, more and more people tend to use RIRS and PCNL as the main means of treating urinary stone, ESWL is still a safer and less invasive method.[13] Selecting the appropriate population can better enhance the benefits of ESWL. This does not simply refer to the stone size, and other factors are also important reasons affecting the postoperative effect of ESWL.[8,14–16] Therefore, this study mainly explores the risk factors for residual stones and recurrence after ESWL to provide a reference for clinicians in treatment selection.
Literature reports that the stone clearance rate of ESWL treatment exceeds 70%, and it can reach 100% after multiple treatments.[17] In this study, the single-time stone clearance rate was 85.37% (280/328), which is higher than the reported stone clearance rate after ESWL in previous studies, but it is still lower than the stone clearance rate after RIRS and PCNL. It is currently difficult to improve the stone clearance rate by improving the ESWL operation, but the treatment effect of ESWL can be enhanced by screening patients with better indications.
In this study, it was found that BMI (P = .048), stone size (P < .001), stone density (P = .036), and preoperative serum creatinine (P = .008) were independent risk factors for residual stones after ESWL. In the study by Alsagheer et al,[16] it was also found that in the treatment of urinary stone by ESWL, younger patients, those with smaller stone sizes, and lower stone densities had higher stone clearance rates, but only age was an independent risk factor affecting stone clearance. Stone density and stone size are recognized factors affecting surgical outcomes, but few people have explored creatinine value as a risk factor for stones. In this study, a higher creatinine value as a risk factor for residual stones after ESWL may be related to the following reasons: a. A high creatinine value reflects problems with the patient’s metabolic function and may be accompanied by other metabolic disorders, such as abnormal calcium and phosphorus metabolism. These metabolic disorders can affect the formation and development of stones and may also interfere with the dissolution and excretion process of stone fragments after ESWL. b. Long-term renal function abnormalities may affect the concentration and proportion of various substances in urine, leading to changes in the composition and structure of stones. Some stones with special components, such as cystine stones, are harder in texture, have stronger resistance to shock waves, and are difficult to be completely crushed, thus affecting the stone clearance rate. Therefore, the evaluation of renal function before surgery also has certain clinical significance for stone clearance after ESWL.
In the study by Caglar et al,[11] it was also found that BMI serves as a risk factor affecting stone clearance after ESWL. Patients with a high BMI have thicker adipose tissue in the body, which may reduce the efficiency of lithotripsy and lead to incomplete stone fragmentation. Meanwhile, the increase in perirenal fat can make the kidney position relatively deeper or more posterior. If the positioning is inaccurate, the shock wave cannot precisely focus on the stone, thereby affecting the lithotripsy effect. The ureteral peristaltic function in patients with a high BMI may also be weakened (such as long-term metabolic abnormalities affecting smooth muscle function) or the ureter may be compressed by abdominal fat, leading to obstruction of small stone particles after lithotripsy and increasing the probability of residual stones. For people with a high BMI, more exercise and increased water intake should be encouraged, and diuretics and α-blockers can be used as adjuvants for stone expulsion.
In previous studies, the MAP score has demonstrated good predictive efficacy for residual stones after ESWL, where a higher MAP score leads to a higher residual stone rate after ESWL.[11,18] The study by Caglar et al[11] suggested that a high MAP score is associated with inflammatory changes in perirenal adipose tissue. Specifically, congestion and inflammation caused by kidney stones can induce changes in perirenal adipose tissue, which may reduce the effectiveness of shock waves during ESWL treatment. However, in this study, although the proportion of patients with MAP ≥ 3 points in the residual stone group was higher than that in the stone clearance group, no statistical difference was found between the 2 groups. This might be attributed to the small sample size in this study, indicating that the MAP score still requires our attention in ESWL treatment.
The lower ureteral stones also require our attention in ESWL treatment. Previous studies have found that lower ureteral stones have a lower stone clearance rate.[19] Although lower ureteral stones are not blocked by renal parenchyma, thick abdominal fat or intestinal gas in some patients may lead to the attenuation of shock wave energy. The physiological stricture and weak peristaltic function of the ureteral end may also be the causes. However, this study did not find a clear correlation between stone location and ESWL outcome. The results of Tiwari et al[20] are like ours. Their study found that stone size and stone density are factors affecting residual stones after ESWL, but no significant relationship was found between the location of ureteral stones and residual stones after surgery. However, the study by Tiwari et al included 102 patients, which, like our study, also has the limitation of a small sample size.
The high recurrence rate of urinary stones is also a difficult problem that troubles doctors and patients. In previous studies, the probabilities of stone recurrence in the first year, the 10th year, and the 20th year were approximately 37%, 50%, and 75% respectively.[21–23] Most of the studies on the recurrence of urinary stones focus on the changes in parathyroid function, and few explore the impact of chronic diseases on stone recurrence.[24] In this study, the stone recurrence rate within 3 months after ESWL was 20.36%. CHD (P = .046) and stone density (P = .046) were independent risk factors for stone recurrence after ESWL. In patients with CHD, platelets are in an activated state, and the blood is in a hypercoagulable state. In this state, microthrombi are likely to form, which may affect the microcirculation in the kidneys. Renal microcirculation disorders can lead to local tissue hypoxia and metabolic disorders and then affect the reabsorption and secretion functions of the renal tubules for the components of urine, increasing the concentration of stone-forming substances in the urine and promoting stone recurrence. Therefore, the control of chronic diseases such as CHD is also a key point in reducing stone recurrence. For the recurrence of urinary stone, most of them consider thiazide drug treatment to reduce the calcium content in the urine and thus prevent calcium stones.[25] There is little focus on controlling the occurrence and development of chronic diseases. In this study, it is interesting to find that patients with low-density stones have a higher postoperative recurrence rate. Low stone density may be related to the patient’s metabolic state, such as abnormal uric acid metabolism leading to the formation of uric acid stones. If the patient has metabolic disorders, and does not effectively adjust the diet, lifestyle, etc after ESWL, or does not receive corresponding drug treatment for metabolic abnormalities, there will still be a high concentration of stone-forming substances in the urine. For example, if hyperuricemia is not corrected, it is easy to promote the reformation of stones. Therefore, adjusting stone recurrence should focus on adjusting the patient’s chronic diseases and some metabolic dysfunctions. Prevention of recurrence is a better treatment method than choosing an appropriate surgical treatment.
Our study has certain limitations. Firstly, the limitation of the sample size in this study may bring certain biases to the results; Secondly, this study adopted a retrospective analysis method, and there might be failure to include all factors affecting residual stones and recurrence after ESWL in the analysis during data collection, especially key indicators such as urinary calcium excretion, coagulation markers, and stone components.
5. Conclusion
ESWL for the treatment of ureteral stone has a relatively high stone clearance rate and stone recurrence rate. BMI, stone size, stone density, and preoperative serum creatinine are independent risk factors for residual stones after ESWL. CHD and stone density are independent risk factors for stone recurrence after ESWL.
Author contributions
Conceptualization: Rui Meng, Jiandong Wang, Yu Han.
Data curation: Rui Meng, Xiaoyong Lv.
Formal analysis: Rui Meng, Xiaoyong Lv, Yu Han.
Investigation: Rui Meng.
Methodology: Rui Meng, Xiaoyong Lv.
Validation: Zhipeng Zhai.
Writing – original draft: Rui Meng, Jiandong Wang, Yu Han, Zhipeng Zhai.
Writing – review & editing: Rui Meng, Jiandong Wang.
Abbreviations:
- CHD
- coronary heart disease
- CT
- computed tomography
- DSS
- distance from the skin to the stone
- ESWL
- extracorporeal shock wave lithotripsy
- PCNL
- percutaneous nephrolithotomy
- RIRS
- retrograde flexible ureteroscopic lithotripsy
Informed Consent Informed consent was waived due to the retrospective design of the study.
The authors assume full responsibility for every facet of this work. They are committed to thoroughly investigating and appropriately resolving any concerns regarding the accuracy or integrity of any portion of the study. The trial was carried out in strict compliance with the 2013 revised version of the Declaration of Helsinki. This study was approved by the Ethics Committee of Peking University First Hospital-Miyun Hospital (No.: 2021-04).
The authors have no conflicts of interest to disclose.
Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.
How to cite this article: Meng R, Lv X, Wang J, Han Y, Zhai Z. Analysis of risk factors for residual stones and stone recurrence after extracorporeal shock wave lithotripsy for ureteral stone. Medicine 2025;104:37(e44191).
Contributor Information
Xiaoyong Lv, Email: 396864829@qq.com.
Jiandong Wang, Email: 1101326812@qq.com.
Yu Han, Email: 393465287@qq.com.
Zhipeng Zhai, Email: 15600590010@163.com.
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