2009 THE AUTHORS.

JOURNAL COMPILATION 2009 BJU INTERNATIONAL

Upper Urinary Tract
CKD AFFECTS THE STONE-FREE RATE AFTER ESWL FOR PROXIMAL URETERIC STONES
HUNG

et al.

Chronic kidney disease affects the stone-free

rate after extracorporeal shock wave lithotripsy
BJUI BJU INTERNATIONAL
for proximal ureteric stones
Shun-Fa Hung*, Shiu-Dong Chung*†, Shuo-Meng Wang*, Hong-Jeng Yu* and
Ho-Shiang Huang*
*Department of Urology, National Taiwan University Hospital and College of Medicine, National Taiwan University,
and †Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan
Accepted for publication 26 June 2009

Study Type – Therapy (case series)
Level of Evidence 4
OBJECTIVE
To investigate the effect of renal function on
the stone-free rate (SFR) of proximal ureteric
stones (PUS) after extracorporeal shock wave
lithotripsy (ESWL), as urinary obstruction
caused by PUS can impair renal function,
and elevated serum creatinine levels are
associated with decreased ureteric stone
passage.
PATIENTS AND METHODS
From January 2005 to December 2007, 1534
patients had ESWL for urolithiasis, 319
having ESWL in situ for PUS; they were
reviewed retrospectively. Patients requiring
simultaneous treatment of kidney stones,
placement of a double pigtail stent, or
percutaneous pigtail nephrostomy tube were
excluded. We divided patients into groups by
chronic kidney disease (CKD) stage according
to the estimated glomerular filtration rate
(eGFR) of ≥60 and <60 mL/min/1.73 m2.
Stone-free status was defined as no visible
stone fragments on a plain abdominal film at
3 months after ESWL. A logistic regression
model was used to evaluate the possible
significant factors that influenced the SFR of
PUS after ESWL, and to develop a prediction
model.
RESULTS
The overall SFR of PUS (276/319 patients)
was 86.5%; the SFR was 93% in patients
with an eGFR of ≥60 and 50% in those with
an eGFR of <60 (P < 0.001). After univariate
and multivariate analysis, the three
significant factors affecting SFR were an
eGFR of ≥60, stone width, and gender, with
odds ratios (95% confidence intervals)
of 19.54 (8.25–46.30) (P < 0.001), 0.67
(0.55–0.82) (P < 0.001) and 0.16 (0.05–0.50
(P = 0.002), respectively. A logistic regression
model was developed to estimate the
probability of SFR after ESWL, the equation
being 1/(1 + exp [−(3.8137 − 0.3967 × (stone
width) + 2.9724 × eGFR − 1.8120 × Male)]),
where stone width is the observed value
(mm), eGFR = 1 for eGFR ≥60 and 0 for <60,
and male = 1 for male, 0 for female.
CONCLUSIONS
Gender, eGFR ≥60 and a stone width of
>7 mm were significant predictors affecting
the SFR after one session of ESWL for PUS.
KEYWORDS
stone-free rate, extracorporeal shock wave
lithotripsy, ureteric calculi, chronic kidney
disease

INTRODUCTION
A ureteric stone (US), if not treated correctly,
will impair renal function by causing long-
term obstructive uropathy [1]. In a review, the
management of US causing obstructive
uropathy included watchful waiting, ESWL
and ureteroscopic lithotripsy, according to
stone size and location [2,3]. According to the
recent guidelines [2,3], the optimal treatment
for proximal US (PUS) depends on the size of
the stone. Spontaneous stone passage can be
expected in up to 80% of patients with US of
<4 mm in diameter, and the chance of
spontaneous passage is very low for those
with a diameter of >7 mm [4–7]. These
findings imply that the size of PUS is the only
significant factor that influences stone
passage.
A meta-analysis showed that both stone size
and stone position influence the spontaneous
passage rate; the spontaneous passage rate
was 1.2% for ureteric stones of >5 mm and
38% if <5 mm, and 12% for PUS and 45% for
distal US [8]. Therefore, the treatment method
might differ according to the stone size and
location. Expectant management and medical
expulsive therapy were suitable for distal US
of <5 mm [9], but its role in PUS has not yet
been defined.
Both ESWL and ureteroscopy can be first-line
treatments for PUS. The stone-free rate (SFR)
for PUS after ESWL was 82%, vs 81% after
ureteroscopy [2,3], and the SFR increased to
90% after ESWL if the stone was <10 mm.
Several other factors have been reported to
influence the SFR of US after ESWL, including
the duration since renal colic pain before
receiving ESWL [10–13], stone location, stone
transverse diameter, presence of a ureteric
stent [14,15], and renal function [16]. Lee
et al. [16] reported that the SFR was 56.7% for
patients with serum creatinine values of
2.0–2.9 mg/dL and 66.2% if <2.0 mg/dL
(P < 0.05). However, reports from other
authors failed to find a difference in outcome
after ESWL treatment of renal and US
between patients with chronic renal
insufficiency and those who had normal renal

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11 6 2 JOURNAL COMPILATION © 2 0 0 9 B J U I N T E R N A T I O N A L | 1 0 5 , 11 6 2 – 11 6 7 | doi:10.1111/j.1464-410X.2009.08974.x
 CKD AFFECTS THE STONE-FREE RATE AFTER ESWL FOR PROXIMAL URETERIC STONES

size was <4 mm after ESWL, then the patients

TABLE 1 The characteristics of the patients
were treated by observation or medical
expulsive therapy. If the stone did not respond
CKD stage I & II CKD stage III
to ESWL treatment or hydronephrosis
Mean (SD) or n (%) variable (eGFR ≥60) (eGFR <60) P
persisted after ESWL, then the patients had
No. of patients 271 48
ESWL again or an auxiliary procedure (e.g.
Age, years 47.2 (12.8) 55.6 (14.1) <0.001
ureteroscopic lithotripsy) for the residual US.
Age >60 years 40 (15) 21 (44) <0.001
Data collection and analysis were approved by
BMI, kg/m2 23.8 (6.7) 24.3 (6.1) 0.580
a protocol through the Human Subjects
Gender (M/F) 198/73 30/18 0.140
Institutional Review Board of National Taiwan
Hypertension 45 (17) 17 (35) 0.002
University Hospital.
Diabetes mellitus 20 (7) 12 (25) <0.001
Hyperuricaemia 89 (33) 21 (44) 0.140
Using i.v. anaesthesia with alfentanil or
Pyuria before ESWL 113 (42) 30 (63) 0.008
fentanyl, in situ ESWL was delivered using the
Stone site (right/left) 119/152 16/32 0.170
Lithostar Multiline lithotripter (Siemens
Stone width, mm 6.0 (1.9) 6.6 (2.0) 0.080
Medical, Munich, Germany), with the patient
Stone width >7 mm 54 (21) 17 (35) 0.020
supine. The US was localized by fluoroscopy.
Stone length, mm 9.2 (3.2) 10.3 (4.1) 0.080
The mean (SD) shockwave power was
Stone length >10 mm 77 (28) 16 (33) 0.050
16.1 (7.2) kV with the total shock pulses at
SFR 252 (93) 24 (50) <0.001
3632 (816) per session. The shockwave
frequency was set to 60/min.

Student’s t-test was used to compare age,

function [17,18]. Therefore, the effect of renal
function on the SFR after ESWL for PUS
remains unclear.
The chronic kidney disease (CKD) staging
system was developed to assess renal function
and to identify those with CKD in at-risk
groups [19,20]. According to the classification
of CKD [21], stage 1 is defined as patients with
an estimated GFR (eGFR, in mL/min/1.73 m2)
of ≥90, stage 2 as 60–89, stage 3 as 30–59,
stage 4 as 15–29 and stage 5 as <15. An eGFR
of 60 is usually used as the threshold to
evaluate changes in eGFR after intervention
[22]. To evaluate the possible prognostic
factors, including renal function, that might
affect the SFR in patients with PUS after ESWL,
we retrospectively analysed the medical
records of patients who were treated with
ESWL for PUS in our institution. We divided
them into two groups according to their CKD
stage, to evaluate the effect of renal function
on SFR after ESWL. Patients who were CKD
stage 1 or 2 were enrolled into the eGFR ≥60
group and those who were CKD stage 3 were
enrolled into the eGFR <60 group.
PATIENTS AND METHODS
From January 2005 to December 2007, 1534
patients with urolithiasis had ESWL in our
institute; included in the present study were
those with one PUS (from below the PUJ
to the superior aspect of sacroiliac joint)
detected on a plain abdominal film or by IVU.
Patients requiring simultaneous treatment of
their kidney stone or placement of a double
pigtail stent, straight ureteric catheter,
guidewire or percutaneous pigtail
nephrostomy tube for drainage of
hydronephrosis or to aid stone visualization,
were excluded. Of the 1534 patients, 319 had
in situ ESWL for one PUS and were divided
into two groups, as described above. We
retrospectively reviewed the medical records
and X-ray images, and evaluated the possible
prognostic factors affecting the SFR of PUS
after ESWL, i.e. age, body mass index (BMI),
serum creatinine level, status of diabetes,
hypertension, eGFR and hyperuricaemia
before ESWL. The eGFR was calculated using
as 186 × (Scr)−1.154 × (age)−0.203 × (0.742 if
female) × (1.210 if African-American) [21,23],
as detailed on the National Kidney Foundation
website, available at http://www.kidney.org/
professionals/kdoqi/gfr_calculator.cfm.
Urine samples from the enrolled patients were
cultured if pyuria was detected in their urine
analysis before ESWL, and those patients who
had a positive culture were treated with
appropriate antibiotics 24–48 h before ESWL.
The follow-up evaluations routinely included
a plain abdominal X-ray at 2 weeks after
ESWL and renal ultrasonography 4 weeks
after ESWL. Stone-free status was defined
as no visible stone fragments on a plain
abdominal film at 3 months after ESWL.
If hydronephrosis subsided on renal
ultrasonography and/or the residual stone
BMI, stone width and length, and the chi-
square test to compare gender, hypertension,
diabetes mellitus, pyuria, stone site, stone
width >10 mm, stone length >10 mm and the
SFR. Logistic regression was used for the
univariate and multivariate analyses to
identify factors having an affect on SFR. In all
tests, P < 0.05 was considered to indicate
statistical significance.
RESULTS
The overall SFR of the 319 patients with PUS
after ESWL was 86.5% (Table 1). The mean
(SD) stone width for the treated PUS was
6.1 (0.1) mm and the mean length was
9.2 (0.2) mm. There were no patients with CKD
stage 4 or 5 because they had a double pigtail
stent or percutaneous pigtail nephrostomy
tube placed for drainage of hydronephrosis,
and hence were excluded from the study. The
SFR of the eGFR ≥60 group was 93% and this
decreased to 50% in the eGFR <60 group
(P < 0.001). In the eGFR <60 group the mean
age (P < 0.001), incidence of coexistence of
hypertension, diabetes and pyuria before
ESWL (P = 0.008), and percentage of stone
width >7 mm (P = 0.02) were significantly
higher than the eGFR ≥60 group (Table 1).
However, BMI, gender, hyperuricaemia, stone
laterality, mean stone width and length were
comparable in both groups.
When these patients were stratified according
to the status of residual stone at 3 months

© 2009 THE AUTHORS

JOURNAL COMPILATION © 2009 BJU INTERNATIONAL 11 6 3
H U N G ET AL.

FIG. 1. In the logistic regression model, the estimated

TABLE 2 Patients divided into two groups according to SFR
stone-free probability was calculated from the stone
width, gender and eGFR; e.g. when female patients
Mean (SD) or n (%) variable Stone-free Residual stone P
had an eGFR of ≥60 they had the best SFR of PUS
No. of patients 276 43
after ESWL, but when male patients had an eGFR of
Age, years 47.9 (12.8) 52.3 (15.4) 0.070
<60 they had the worst SFR regardless of stone
BMI, kg/m2 23.7 (6.8) 24.8 (5.2) 0.400
width.
Gender (male/female) 191/85 37/6 0.030
Hypertension 47 (17) 15 (35) 0.007 1.0

Estimated Stone-Free
Diabetes mellitus 23 (8) 9 (21) 0.010 0.8

Probability
Hyperuricaemia 91 (33) 19 (44) 0.150
0.6
Pyuria before ESWL 121 (44) 22 (51) 0.370
0.4
Stone site (right/left) 116/160 19/24 0.790 eGFR >
= 60 and female
0.2 eGFR >
= 60 and male
Stone width, mm 5.9 (1.8) 7.3 (1.8) 0.510 eGFR < 60 and female
0.0 eGFR < 60 and male
Stone width >7 mm 52 (19) 19 (35) <0.001
2 4 6 8 10 12
Stone length, mm 9.1 (3.2) 10.9 (4.3) 0.270 Stone Width, mm
Stone length >10 mm 77 (28) 16 (37) 0.210
CKD, eGFR >60 247 (89) 19 (44) <0.001

after ESWL (Table 2) the proportion of male

(P = 0.03), and incidence of coexistence of
hypertension and diabetes (P = 0.01) were
Variable Odds ratio (95% CI) P TABLE 3 significantly higher in the group with residual
Gender Univariate analysis for SFR stone than in the stone-free group. Although
female 1 after ESWL the mean stone width was not significantly
male 0.36 (0.14–0.90) 0.03 different between the stone-free and residual
BMI, kg/m2 stone groups (5.9 vs 7.3 mm, P = 0.51), the
≥25 1 latter group had a higher incidence of a PUS
<25 0.96 (0.50–1.83) 0.90 width of >7 mm (P < 0.001) than the former.
Stone laterality Patients who were stone-free also had a
left 1 higher incidence of an eGFR ≥60 than those in
right 0.92 (0.48–1.80) 0.79 the residual stone group (P < 0.001). Factors
Hypertension such as age, BMI, hyperuricaemia, pyuria
No 1 before ESWL, stone laterality and stone
Yes 0.38 (0.19–0.772) 0.007 length were not significantly different
Diabetes mellitus between the stone-free and residual-stone
No 1 groups.
Yes 0.34 (0.15–0.80) 0.01
Hyperuricaemia In the univariate analysis (Table 3) factors that
No 1 affected SFR after SWL were gender
Yes 0.62 (0.32–1.20) 0.15 (P = 0.03), hypertension (P = 0.007), diabetes
Pyuria before ESWL (P = 0.01), eGFR <60 (P < 0.001), and
No 1 stone width of >7 mm (P < 0.001). In the
Yes 0.75 (0.39–1.42) 0.37 multivariate analysis (Table 4), gender, eGFR
Hydronephrosis <60 and stone width >7 mm were still
No 1 significant factors affecting SFR after SWL. In
Yes 0.48 (0.11–2.14) 0.34 the logistic regression model, female patients
CKD stage with eGFR >60 had the best SFR of PUS after
eGFR ≥60 1 ESWL (Fig. 1).
eGFR <60 13.26 (6.37–27.61) <0.001
Stone width, >7 (mm) After analysis using the logistic regression
No 1 model, only three, i.e. gender, stone width
Yes 0.29 (0.15–0.58) <0.001 >7 mm and eGFR >60, of the five factors
Stone length, >10 (mm) retained a statistically significant effect on
No 1 SFR. Logistic regression showed that these
Yes 0.65 (0.33–1.28) 0.21 factors could be used as significant predictors
of SFR after ESWL (Tables 3,4).

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11 6 4 JOURNAL COMPILATION © 2009 BJU INTERNATIONAL
 CKD AFFECTS THE STONE-FREE RATE AFTER ESWL FOR PROXIMAL URETERIC STONES
TABLE 4 Multivariate analysis of the predictors of PUS after ESWL by fitting a multiple logistic regression
model with stepwise variable selection method
Covariate Estimate (SEM)
Intercept 3.814 (0.883)
Stone width >7 mm −0.397 (0.100)
eGFR >60 2.972 (0.440)
Male gender −1.812 (0.575)
The model include 319 patients; percentage of concordant pairs, 84.4%, percentage of discordant pairs,
10.9%; adjusted generalized R2 = 0.391, deviance goodness-of-fit test P = 0.868, >0.05 ( d.f. 27), Pearson
goodness-of-fit test P = 0.966, >0.05 ( d.f. 27), Hosmer and Lemeshow goodness-of-fit test P = 0.761,
>0.05 ( d.f. 7).
The equation for the logistic regression was:
The predicted value of observation Pi was
⎛ Pˆ ⎞
logit (Pˆi ) = log ⎜ i ⎟ = 3.8137 − 0.3967
⎝ 1 − Pˆi ⎠
× (stone width) + 2.9724 × eGFR
− 1.8120 × Male
where stone width is the observed value
(mm), eGFR = 1 for eGFR ≥60 and 0 for <60,
and male = 1 for male, 0 for female. For
example, for a male patient with a PUS of
10 mm wide, he might have a higher SFR
(0.73) if his eGFR is ≥60 vs <60 (0.12).
DISCUSSION
Based on the present results, the prognostic
factors of gender, stone width >7 mm and
eGFR ≥60 have a significant effect on the SFR
of PUS after ESWL. We also found that the
SFR in patients with serum creatinine values
of ≥1.3 mg/dL (58%) was significantly lower
than in patients with a level of <1.3 mg/dL
(92%), and this finding is consistent with
those of Lee et al. [16]. We used eGFR to
stratify the patients into two groups and
assessed the effect of renal function on the
SFR in patients with PUS after ESWL; the SFR
in the group with an eGFR of ≥60 was
significantly higher than in those with an
eGFR of <60. The large-scale study presented
by Lee et al. evaluated all urinary tract calculi,
including renal pelvic, upper/middle/lower
calyces, and proximal/middle/lower ureter. As
is known, the anatomy of the renal pelvis and
renal calyces (including infundibular width,
length and angle, etc.) will significantly affect
the analysis; we studied the subgroup with
PUS, that will be less affected by renal pelvic
anatomical differences among patients, and
© 2009 THE AUTHORS
JOURNAL COMPILATION © 2009 BJU INTERNATIONAL
Wald chi-square P Odds ratio (95% CI)
18.637 <0.001 –
15.862 <0.001 0.673 (0.553–0.818)
45.607 <0.001 19.540 (8.246–46.30)
9.940 0.002 0.163 (0.053–0.504)
showed that the CKD status has an effect of
the treatment outcome in this clinical setting.
However, the eGFR (from the formula used)
has been the one of the most common and
exact methods used to evaluate renal
function by nephrologists and physicians. We
used the CKD classification to predict the
outcome of PUS after ESWL based on these
results. A possible hypothesis about the
influence of eGFR on the passage of PUS after
SWL is that eGFR could influence excretory
function of the affected kidney. Decreased
renal function impairs renal excretory
function and thus the urine output from the
affected kidney decreases, and therefore the
PUS is more difficult to pass even after ESWL
[16]. However, the eGFR can only evaluate
overall renal function in these patients, and
therefore we cannot confirm the hypothesis
that the affected kidney with a PUS had a
lower eGFR, and contributed to the decreased
excretory function and lower SFR after ESWL.
From the present study, patients with a lower
eGFR had a low SFR of PUS after ESWL, and
decreased renal excretory function might
contribute to this.
The incidence of end-stage renal disease in
Taiwan is the highest in the world, and the
prevalence and incidence of CKD in Taiwan
are also relatively higher than in other
countries [19]. CKD usually involves
comorbidity with diabetes, hypertension,
hyperlipidaemia, or atherosclerotic vascular
disease. In Taiwan, with a relatively high
incidence of CKD, aggressive treatment, such
as ESWL, is necessary for patients with
obstructive uropathy caused by PUS and an
eGFR <60, because they have a higher
probability of renal functional deterioration if
the PUS is left untreated. However, the SFR of
PUS after ESWL in patients who had an eGFR
<60 was only 50%, and therefore auxiliary
procedures should be adopted for these
patients if ESWL fails to prevent renal
function deterioration.
The SFR after ESWL is theoretically impaired
by the ureteric oedema caused by an
impacted obstructive US [14,24]; therefore,
stone width is important in stone passage.
Abdel-khalek et al. [14] reported that the
transverse stone diameter is a prognostic
factor for the US after ESWL. Salman et al.
[25] also reported that the SFR of patients
who had stones with a transverse diameter of
<8 mm was 89.9%, compared to 66.7% for
those with a transverse diameter of >8 mm.
We also had a similar result, with the SFR of
patients who had a stone width of <7 mm
being 90%, compared to 73% for those with a
stone of >7 mm (P = 0.001). After a univariate
and multivariate analysis, stone width was
still a significant factor affecting SFR after
ESWL and was one of three important factors
in our prediction model (Fig. 1).
A few reports have discussed the effect of
gender on the SFR after ESWL. The possible
hypothesis that might account for the
influence of gender on stone passage is the
different composition of US between males
and females. In a study of stone analyses in
Taiwan [26], the incidence of apatite and
struvite stone (Jensen type II) was higher in
female than male patients (22% vs 9%).
Apatite and struvite stones are not as hard as
calcium oxalate monohydrate stones, and are
thought to be fragmented more easily by
ESWL [27]. Thus it might be assumed that
female patients have a higher SFR after
ESWL than males. In the present study, we
found that calcium oxalate was the main
component in 87.4% of the males, whereas
only 78.7% of PUS in females had a calcium
oxalate component (P < 0.05). Apatite with/
without calcium oxalate was also more
common in females (20.3% vs 11.6%) and
these results might explain why gender
influences the SFR after ESWL. However, a
urinary stone usually has more than one
component, with different proportions, and
this makes a statistical analysis difficult.
Therefore, we hypothesise that the possible
mechanism for SFR to be influenced by
gender is through the different stone
composition of PUS; this needs further
evaluation.
Using a logistic regression model, the
prediction model was developed to assess the
11 6 5
H U N G ET AL.
SFR of PUS after ESWL (Table 4 and Fig. 1). A
logistic regression model was designed by
Abdel-Khaleketal et al. [14] to predict the
probability of SFR after ESWL according to
three significant factors, including stone
position, transverse diameter of the stone,
and the presence of a ureteric stent. Salman
et al. [25] also reported the same three
significant predictors. They found that the
SFR was higher for PUS than distal US after
ESWL [14,25]. However, the factors affecting
the SFR of PUS after ESWL have not yet been
defined. Furthermore, ureteric stent insertion
is an optional choice during the primary
treatment of PUS [14,25]; therefore, it was
clearer in the present study to evaluate
prognostic factors under natural conditions
that might influence the SFR after ESWL
because no patients had a ureteric catheter
indwelling. Our result was consistent with
their finding, that the width of the US was a
significant factor, but the threshold was
7 mm.
Hsu et al. [28] reported the risk of acute renal
failure increased in the patients with diabetes
mellitus, diagnosed hypertension and known
proteinuria in the population with CKD. In the
present study, patients with an eGFR <60 had
a higher coincidence of hypertension and
diabetes, and therefore these patients might
be at greater risk of acute renal failure.
After multivariate analysis, diabetes and
hypertension were not significant factors
affecting SFR. The discrepant results for the
role of hypertension and diabetes in the SFR
of PUS after ESWL might be due to the
enrolled patients being stratified according to
their eGFR before they were analysed by
multivariate analysis. Therefore, these two
factors (hypertension and diabetes), which
affect SFR via their effect on renal function,
had no significant role on multivariate
analysis. Other factors affecting the SFR of
renal stones after SWL include the stone
Hounsfield density, skin-to-stone distance
and stone composition [29]. CT is not used
routinely to evaluate stone status in our
hospital, so the stone Hounsfield density and
skin-to-stone distance were not available.
Fewer than half of the patients in the study
sent their fragmented stone chips for analysis.
Most of the analysed specimens were
composed of calcium oxalate and different
proportions of apatite. It is difficult to analyse
the correlation between stone composition
and SFR when using limited data. These
factors needed more study to assess their
values in the SFR of US after ESWL.
11 6 6
Overall, 27 patients (8.5%) in the present
series of 319 had ureteroscopy for auxiliary
procedures of managing the PUS, and six
males (1.9%) had a ureteric stricture that
needed regular JJ stent replacement in three,
endoscopic ureterotomy in two, and uretero-
ureteroneostomy in one. Only one patient
(0.3%) was admitted from the emergency
department for acute pyelonephritis. Abdel-
Khalek et al. [14] reported a complication rate
of 3.4%, and auxiliary procedures were
required in 3%, in patients with US treated
with ESWL. In the present series the overall
complication rate was 2% (seven of 319), the
re-treatment rate was 2% and auxiliary
procedures after ESWL were required in 8.5%
of patients.
The limitations of our study are that it was
retrospective and we had no CT images before
ESWL of the US to measure skin-to-stone
distance. We did not routinely check the
serum creatinine level after ESWL, and we
cannot evaluate the effect of PUS on the
changes in renal function before and after
ESWL. We will follow these patients in the
future and attempt to better understand
whether or not this event could affect their
renal function.
In conclusion, the current standard treatment
for PUS is ESWL, and the SFR is affected by
stone size. Gender, eGFR and stone width
were significant factors affecting the SFR of
PUS after ESWL, by multivariate analysis, and
we developed a logistic regression model to
predict the probability of SFR of PUS after
ESWL, to enable the appropriate treatment for
patients with PUS. More aggressive treatment
is indicated if the patient is male, the stone
width is >7 mm and the eGFR is <60. ESWL is
not adequate for such patients and auxiliary
procedures might be necessary.
CONFLICT OF INTEREST
None declared.
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Correspondence: Ho-Shiang Huang,
Department of Urology, National Taiwan
University Hospital, Tapei, Taiwan.
e-mail: hshuang@ntuh.gov.tw
Abbreviations: CKD, chronic kidney disease;
eGFR, estimated GFR; (P)US, (proximal)
ureteric stone; SFR, stone-free rate; BMI,
body mass index.
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