Predictive factors and treatment outcomes of Steinstrasse following shock wave lithotripsy for ureteral calculi: A Bayesian regression model analysis

다국어 초록 (Multilingual Abstract)

Purpose: This study aims to assess the predictive factors and treatment outcomes of Steinstrasse formation following shock wave lithotripsy (SWL) for ureter stone.
Materials and Methods: The medical records of 1,418 ureter stone patients who underwent one-session SWL from November 2005 to May 2013 at our medical institute were retrospectively reviewed. Finally, 551 patients met inclusion criteria. Maximal length and location of stone, stone attenuation (Hounsfield units), and skin-to-stone distance (SSD) were determined on pretreatment non-contrast computed tomography.
Results: Of 551 patients, 12 patients (2.2% of total cohort) developed Steinstrasse after one-session SWL. The Steinstrasse incidence was significantly associated with stone size, stone attenuation value, and SSD. Prophylactic ureter stenting was not a statistically significant predictor of Steinstrasse formation. After propensity-score matching, Steinstrasse group showed a significant shorter SSD compare to non-Steinstrasse group. Multivariate logistic regression and Bayesian analysis revealed that stone size, stone attenuation and SSD were significant predictor of Steinstrasse formation following SWL for ureter stone. The Steinstrasse resolved spontaneously in six patients and remaining six patients were treated by additional SWL. None of patients with Steinstrasse required ureteral stenting, percutaneous drainage, or consequent surgical intervention.
Conclusions: Steinstrasse formation following SWL for ureter stone was rare event but nonnegligible. Large stone size, high stone attenuation and short SSD were significant predictors of Steinstrasse formation following SWL for ureter stone. Majority of patients with Steinstrasse formation could be treated conservatively in this clinical scenario.

참고문헌 (Reference)

1 강동혁, "Ureteral stenting can be a negative predictor for successful outcome following shock wave lithotripsy in patients with ureteral stones" 대한비뇨의학회 57 (57): 408-416, 2016

2 Coptcoat MJ, "The steinstrasse: a legacy of extracorporeal lithotripsy?" 14 : 93-95, 1988

3 Sulaiman MN, "The role of ureteral stent placement in the prevention of Steinstrasse" 13 : 151-155, 1999

4 Fedullo LM, "The development of steinstrassen after ESWL: frequency, natural history, and radiologic management" 151 : 1145-1147, 1988

5 Moursy E, "Tamsulosin as an expulsive therapy for steinstrasse after extracorporeal shock wave lithotripsy: a randomized controlled study" 44 : 315-319, 2010

6 Lee JY, "Stone heterogeneity index as the standard deviation of Hounsfield units: a novel predictor for shock-wave lithotripsy outcomes in ureter calculi" 6 : 23988-, 2016

7 Perks AE, "Stone attenuation and skin-to-stone distance on computed tomography predicts for stone fragmentation by shock wave lithotripsy" 72 : 765-769, 2008

8 Michio Tanaka, "Stone Attenuation Value and Cross-Sectional Area on Computed Tomography Predict the Success of Shock Wave Lithotripsy" 대한비뇨의학회 54 (54): 454-459, 2013

9 Pareek G, "Shock wave lithotripsy success determined by skin-to-stone distance on computed tomography" 66 : 941-944, 2005

10 Gupta NP, "Role of computed tomography with no contrast medium enhancement in predicting the outcome of extracorporeal shock wave lithotripsy for urinary calculi" 95 : 1285-1288, 2005

11 Madbouly K, "Risk factors for the formation of a steinstrasse after extracorporeal shock wave lithotripsy: a statistical model" 167 : 1239-1242, 2002

12 Hay KE, "Risk factors for bovine respiratory disease in Australian feedlot cattle: use of a causal diagram-informed approach to estimate effects of animal mixing and movements before feedlot entry" 117 : 160-169, 2014

13 김인경, "Prognostic Factors for Urachal Cancer: A Bayesian Model-Averaging Approach" 대한비뇨의학회 55 (55): 574-580, 2014

14 Onal B, "Predictive factors and management of steinstrasse after shock wave lithotripsy in pediatric urolithiasis--a multivariate analysis study" 80 : 1127-1131, 2012

15 최지웅, "Predictive Factors of the Outcome of Extracorporeal Shockwave Lithotripsy for Ureteral Stones" 대한비뇨의학회 53 (53): 424-430, 2012

16 Cho KS, "Optimal skin-to-stone distance is a positive predictor for successful outcomes in upper ureter calculi following extracorporeal shock wave lithotripsy: a Bayesian model averaging approach" 10 : e0144912-, 2015

17 Rubin DB, "Matching using estimated propensity scores: relating theory to practice" 52 : 249-264, 1996

18 Chung DY, "Impact of colic pain as a significant factor for predicting the stone free rate of one-session shock wave lithotripsy for treating ureter stones: a Bayesian logistic regression model analysis" 10 : e0123800-, 2015

19 장기돈, "Impact of Pretreatment Hydronephrosis on the Success Rate of Shock Wave Lithotripsy in Patients with Ureteral Stone" 연세대학교의과대학 58 (58): 1000-1005, 2017

20 Wiesenthal JD, "Evaluating the importance of mean stone density and skin-to-stone distance in predicting successful shock wave lithotripsy of renal and ureteric calculi" 38 : 307-313, 2010

21 Habib EI, "Effect of size and site on the outcome of extracorporeal shock wave lithotripsy of proximal urinary stones in children" 9 : 323-327, 2013

22 El-Nahas AR, "A prospective multivariate analysis of factors predicting stone disintegration by extracorporeal shock wave lithotripsy: the value of high-resolution noncontrast computed tomography" 51 : 1688-1693, 2007