Predictive factors of extracorporeal shock wave lithotripsy failure in the treatment of patients with ureterolithiasis




ureterolithiasis, treatment, extracorporeal shockwave lithotripsy, predictors


Efficacy of different approaches to the treatment in patients with ureteral calculi and predictive factors for the success are the objects of contemporary studies. However, only few on them studied the duration factor of typical ureterolithiasis symptoms and changes of the ureter wall as predictive factors of extracorporeal shock wave lithotripsy (ESWL) failure in patients with ureteral stones.

The aim of the study was to determine the peculiarities of histological changes in the ureter wall as a result of calculus presence and to evaluate the predictive factors of ESWL failure in patients with ureterolithiasis.

Materials and methods. An analysis of the treatment by ESWL in 662 patients with ureterolithiasis was performed. The patients were divided into two groups: Group 1, n = 629 (95.0 %) individuals with effective ESWL and Group 2, n = 33 (5.0 %) patients with ESWL failure when calculi were not eliminated. Stones were found in 378 (57.0 %) patients in the upper third of the ureter, in 50 (7.6 %) – in the middle and in 234 (35.4 %) – in the lower third. For determining the predictors of ESWL failure, the Spearman’s Rank Correlation Coefficient was used.

Results. The overall ESWL efficacy in our study was 95.0 %. The strong inverse correlation was found between the ESWL success and duration of symptoms (r = -0.92) and stone size (r = -0.68). Stone localization in the ureter did not influence the ESWL outcomes (r = 0.27).

Conclusions. Increasing of the period from the manifestation of primary clinical symptoms to the implementation of ESWL reduces the treatment efficacy. Patients with ureteral stones more than 15 mm have lower stone-free rates after ESWL.


Author Biographies

O. S. Vozianov, State Institution “Institute of Urology of the National Academy of Medical Sciences of Ukraine”, Kyiv

MD, Urologist

S. O. Vozianov, State Institution “Institute of Urology of the National Academy of Medical Sciences of Ukraine”, Kyiv

MD, PhD, DSc, Professor, Head of the State Institution


Glazer, K., Brea, I., & Vaitla, P. (2021). Ureterolithiasis. StatPearls.

Fisang, C., Anding, R., Müller, S. C., Latz, S., & Laube, N. (2015). Urolithiasis - an Interdisciplinary Diagnostic, Therapeutic and Secondary Preventive Challenge. Deutsches Ärzteblatt International, 112(6), 83-91.

Song, L., & Maalouf, N. M. (2020). Nephrolithiasis. In K. R. Feingold, B. Anawalt, A. Boyce, G. Chrousos, W. W. de Herder, K. Dhatariya, K. Dungan, A. Grossman, J. M. Hershman, J. Hofland, S. Kalra, G. Kaltsas, C. Koch, P. Kopp, M. Korbonits, C. S. Kovacs, W. Kuohung, B. Laferrère, E. A. McGee, & D. P. Wilson (Eds.), Endotext., Inc.

Rule, A. D., Lieske, J. C., Li, X., Melton, L. J., Krambeck, A. E., & Bergstralh, E. J. (2014). The ROKS Nomogram for Predicting a Second Symptomatic Stone Episode. Journal of the American Society of Nephrology, 25(12), 2878-2886.

Cui, H. W., Silva, M. D., Mills, A. W., North, B. V., & Turney, B. W. (2019). Predicting shockwave lithotripsy outcome for urolithiasis using clinical and stone computed tomography texture analysis variables. Scientific Reports, 9(1), Article 14674.

Yamashita, S., Kohjimoto, Y., Iwahashi, Y., Iguchi, T., Nishizawa, S., Kikkawa, K., & Hara, I. (2018). Noncontrast Computed Tomography Parameters for Predicting Shock Wave Lithotripsy Outcome in Upper Urinary Tract Stone Cases. BioMed Research International, 2018, Article 9253952.

Türk, C., Neisius, A., Petrik, A., Seitz, C., Skolarikos, A., Thomas, K., Davis, N., Donaldson, J., Lombardo, R., Grivas, N., & Ruhayel, Y. (2020). EAU Guidelines on Urolithiasis.

Yazici, O., Tuncer, M., Sahin, C., Demirkol, M. K., Kafkasli, A., & Sarica, K. (2015). Shock Wave Lithotripsy in Ureteral Stones: Evaluation of Patient and Stone Related Predictive Factors. International Brazilian Journal of Urology, 41(4), 676-682.

Alabi, T. O., Jeje, E. A., Ogunjimi, M. A., & Ojewola, R. W. (2019). Endoscopic management of ureteric stones: Our initial experience. Nigerian Journal of Surgery, 25(1), 26-29.

Drake, T., Grivas, N., Dabestani, S., Knoll, T., Lam, T., Maclennan, S., Petrik, A., Skolarikos, A., Straub, M., Tuerk, C., Yuan, C. Y., & Sarica, K. (2017). What are the Benefits and Harms of Ureteroscopy Compared with Shock-wave Lithotripsy in the Treatment of Upper Ureteral Stones? A Systematic Review. European Urology, 72(5), 772-786.

Wiesenthal, J. D., Ghiculete, D., Ray, A. A., Honey, R. J., & Pace, K. T. (2011). A Clinical Nomogram to Predict the Successful Shock Wave Lithotripsy of Renal and Ureteral Calculi. The Journal of Urology, 186(2), 556-562.

Lee, J. Y., Kim, J. H., Kang, D. H., Chung, D. Y., Lee, D. H., Do Jung, H., Kwon, J. K., & Cho, K. S. (2016). Stone heterogeneity index as the standard deviation of Hounsfield units: A novel predictor for shock-wave lithotripsy outcomes in ureter calculi. Scientific Reports, 6, Article 23988.

El-Nahas, A. R., El-Assmy, A. M., Mansour, O., & Sheir, K. Z. (2007). A Prospective Multivariate Analysis of Factors Predicting Stone Disintegration by Extracorporeal Shock Wave Lithotripsy: The Value of High-Resolution Noncontrast Computed Tomography. European Urology, 51(6), 1688-1694.

Vogt, B., & Chokri, I. (2020). Histological Inflammation in Human Ureter either Healthy or Fitted with Double-Pigtail Stent or a Thin 0.3 F Suture Thread: A Preliminary Study. Advances in Urology, 2020, Article 1204897.

Hamamoto, S., Okada, S., Inoue, T., Sugino, T., Unno, R., Taguchi, K., Ando, R., Okada, A., Miura, H., Matsuda, T., & Yasui, T. (2020). Prospective evaluation and classification of endoscopic findings for ureteral calculi. Scientific Reports, 10(1), Article 12292.

Etafy, M., Morsi, G. A., Beshir, M. S., Soliman, S. S., Galal, H. A., & Ortiz-Vanderdys, C. (2014). Management of lower ureteric stones: a prospective study. Central European Journal of Urology, 66(4), 456-462.




How to Cite

Vozianov OS, Vozianov SO. Predictive factors of extracorporeal shock wave lithotripsy failure in the treatment of patients with ureterolithiasis. Zaporozhye Medical Journal [Internet]. 2021Sep.1 [cited 2024Jul.17];23(5):664-9. Available from:



Original research