Comparison of Extracorporeal Shock Wave Lithotripsy (ESWL) With and Without DJ Stenting in Proximal Ureteric and Renal Pelvis Stones
DOI:
https://doi.org/10.51985/JBUMDC2025615Keywords:
Lithotripsy, Shock Wave, Stents, Urolithiasis, Kidney Calculi, Treatment Outcome, Risk Factors, Minimally InvasiveAbstract
Introduction: Urolithiasis requires effective management. ESWL is common for proximal ureteric and renal pelvis stones, but the role of routine DJ stenting is debated. This study evaluates its impact on stone clearance for 1.5–2 cm stones. Study Design and Setting: A prospective comparative cohort study was conducted over a six-month period from September 2024 to February 2025.
Methodology:A total of 70 patients with renal pelvis or proximal ureteric stones (1.5–2.0 cm, =1000 HU) were enrolled through non-probability consecutive sampling and divided into two equal groups: Group A (ESWL without DJ stent) and Group B (ESWL with DJ stent) by simple randomization through lottery technique. Patients underwent up to five ESWL sessions using the Dornier Sigma Plus 2 lithotripter. Treatment success was defined as complete stone clearance confirmed by X-ray KUB and ultrasound one month after the final session. Data were analyzed using SPSS version 26, Chi square tests were applied, with significance set at p = 0.05
Results:Stone clearance was achieved in 29 (82.9%) patients in the DJ stent group and 27 (77.1%) in the non-stented group. Statistical analysis revealed no significant difference between the groups (p = 0.550). Subgroup analysis by stone size, density, and Body Mass Index (BMI) showed no clear correlation with treatment success.
Conclusion: The findings indicate that routine DJ stenting does not notably improve stone clearance in ESWL for 1.5–2 cm proximal ureteric and renal pelvis stones. A selective, risk-based stenting approach is advised, particularly in resourceconstrained settings
References
1. EMJ Urology. Extracorporeal shockwave lithotripsy in
urolithiasis: current evidence and clinical insights. EMJ Urol.
2025;13(1):82–97. [https://doi.org/10.33590/ emjurol/NBZA7
146]
2. Manzoor H, Leslie SW, Saikali SW. Extracorporeal
Shockwave Lithotripsy. [Updated 2024 Oct 18]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2025
Jan–. Available from: [https://www.ncbi.nlm.nih.gov/books/
NBK560887/]
3. Tomescu P, Pãnuº A, Mitroi G, Drãgoescu O, Stoica L, Dena
S, Enache E. Assessment of Extracorporeal Shock Wave
Lithotripsy (ESWL) Therapeutic Efficiency in Urolithiasis.
Curr Health Sci J. 2009;35(1):40–3.
4. Rasheed Y, Nazim SM, Zakaria M, Nasir MB, Khan S.
Extracorporeal shock wave lithotripsy (ESWL) outcome
based on CT scan and patient parameters using ESWL score.
J Coll Physicians Surg Pak. 2023;33(2):199–204. [https://
doi.org/ 10.29271/jcpsp.2023.02.199]
5. Memon WA, El Khalid S, Sharif I, Saulat S, Haider A,
Asadullah A, Tariq S. The efficacy of JJ stent on stone-free
rate after extracorporeal shock wave lithotripsy: A retrospective
study. Pak J Med Dent. 2022;10(2):1–6. [https://doi.org/
10.36283/PJMD10-2/005]
6. Gerriets V, Anderson J, Nappe TM. Mononucleosis. In:
StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing; 2021 [cited 2025 May 7]. Available from:
[https://www.ncbi.nlm.nih.gov/books/NBK470387/]
7. Shinde S, Al Balushi Y, Hossny M, Jose S, Al Busaidy S.
Factors Affecting the Outcome of Extracorporeal Shockwave
Lithotripsy in Urinary Stone Treatment. Oman Med J.
2018;33(3):209–17. [https://doi.org/10.5001/omj.2018.39]
8. Pogula VR, Reddy S, Galeti EH, Rasool M. Stenting versus
non-stenting before extracorporeal shock wave lithotripsy for
proximal ureteric stones: A prospective interventional study.
Asian J Med Sci. 2022;13(3):118–124. [https://www.nepjol.
info/index.php/AJMS/article/view/38918]
9. Balagobi B, Sripandurangana R, Sivashankar M, Varothayan
S, Dinoshiga K, Heerthikan K, et al. The effect of routine
ureteral stent placement on post-ureteroscopy complications:
A prospective study from a resource-limited setting. Sri Lanka
J Surg. 2023;41(3):19–23. [https://doi.org/10.4038/sljs. v41i03.
9077]
10. Tailly, G. G. (2013). Extracorporeal shock wave lithotripsy
today. Indian Journal of Urology, 29(3), 200–207. https://doi.
org/10.4103/0970-1591.117283
11. Cao, L., Wang, Y., Yu, T., Sun, Y., He, J., Zhong, Y., ... &
Sun, X. (2020). The effectiveness and safety of extracorporeal
shock wave lithotripsy for the management of kidney stones:
A protocol of systematic review and meta-analysis. Medicine,
99(38), e21910. https://doi.org/10.1097/ MD.00000000000
21910 European Association of Urology. (2022). EAU
Guidelines on Urolithiasis. Retrieved from https://uroweb.org/
guidelines/ urolithiasis/chapter/guidelines
12. Pansota, M. S., Shafqat, S., &Tabassum, S. A. (2020).
Comparison of the success of extracorporeal shock wave
lithotripsy (ESWL) with and without DJ stenting in proximal
ureteric stone. Journal of University Medical & Dental College,
11(2), 21–26. https://doi.org/10.37723/jumdc.v11i2.303
13. Park H, Park M, Park T. Two–year experience with ureteral
stones: extracorporeal shockwave lithotripsy v ureteroscopic
manipulation. J Endourol. 1998;12:501–504. doi: 10.1089/end.
1998.12.501.
14. Kijvikai K, Haleblian GE, Preminger GM, de la Rosette J.
Shock wave lithotripsy or ureteroscopy for the management
of proximal ureteral calculi: an old discussion revisited. J
Urol. 2007;178:1157–1163. doi: 10.1016/j.juro.2007.05.132.
15. Abdelaziz H, Elabiad Y, Aderrouj I, Janane A, Ghadouane
M, Ameur A, Abbar M. The usefulness of stone density and
patient stoutness in predicting extracorporeal shock wave
efficiency: Results in a North African ethnic group. Can
UrolAssoc J. 2014;8(7-8):E567–E569. https://doi.org/10.5489/
cuaj.1849
16. Pricop C, Radavoi GD, Puia D, Vechiu C, Jinga V. Obesity:
a delicate issue choosing the ESWL treatment for patients
with kidney and ureteral stones? ActaEndocrinol (Buchar).
2019;15(1):133–8. doi:10.4183/aeb.2019.133
17. Ahmad, M., & Saleem, N. (2021). Adjunctive therapies with
ESWL for improving stone clearance: A review. International
Urology Review, 25(3), 233–239.
18. Zulfiqar, S., & Khalid, S. (2022). Evaluating the role of DJ
stents in preventing post-ESWL complications for ureteral
stones. Urology Journal, 18(4), 112–117.
19. Pettenati C, El Fegoun AB, Hupertan V, Dominique S, Ravery
V. Double J stent reduces the efficacy of extracorporeal shock
wave lithotripsy in the treatment of lumbar ureteral stones.
Cent European J Urol. 2013;66(3):309–13. doi:10.5173/ceju.
2013.03.art14
20. Wiseman OJ, et al. Magnetic DJ stents: a randomized controlled
trial. J Endourol. 2024;38(1):45–52.
21. Mosayyebi A, et al. Advances in ureteral stent technology.
Nat Rev Urol. 2023;20:15–28
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