Editorial Comment to “Stone at the same location for 2 months predicts impacted stones and stone‐free status after shock wave lithotripsy for ureteral stones: A Funabashi clinic expert study”

This is the authors' abstract. We don't add key points for this paper.

In recent years, the treatment of urolithiasis has focused exclusively on endoscopic lithotripsy. However, extracorporeal shock wave lithotripsy (ESWL) remains an appropriate treatment option for ureteral stones measuring smaller than 10 mm or between 10 and 20 mm in diameter. Compared with endoscopic lithotripsy, ESWL has a slightly lower treatment success rate and may provide less of a sense of accomplishment for the surgeon. However, its minimal invasiveness to the patient and overwhelmingly low complication rate make ESWL a reasonable choice.1 This paper reports a high treatment success rate with excellent ESWL techniques.2 Although the median diameter of the ureteral stones analyzed was 7 mm, which is smaller than those treated with URS, the results again demonstrate that ESWL can have a sufficient therapeutic effect when performed by an expert with sufficient experience and skill. The results also showed that SSL2 (stone at the same location ≥2 months) can be an independent and significant predictive factor in addition to conventional predictive factors. In this paper, the mean stone density (MSD) was measured using the conventional 2-dimensional CT, but the MSD automatically calculated using three-dimensional CT analyzer is more useful. There are reports that it is useful as a predictor of success.3 In the future, it should be actively used as a predictor of ESWL success. In addition, it cannot be denied that one of the reasons for the high treatment success rate in negative SSL2 was that the treatment targets included ureteral stones that would normally pass naturally. However, since ESWL is designed to reduce the size of stones even if it does not completely disintegrate them, thus promoting natural passage, such criticism may not be warranted. In addition, the treatment effect of this study was evaluated by KUB, not by non-contrast CT(NCCT), which may not be accurate. However, considering the medical cost, not evaluating all cases with NCCT is the real world, and this will not be subject to criticism. Recently, an increasing number of hospitals have been unable to upgrade their aging ESWL equipment. Also, with the shift to endoscopic surgery, some companies have exited the ESWL business. However, ESWL will never die. Once ESWL has become too widespread, it may eventually be concentrated in specialized hospitals again. The author declares no conflict of interest.