EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY(ESWL) OUTCOME BASED ON CT SCAN AND PATIENT PARAMETERS USING ESWL SCORE IN A TERTIARY CARE HOSPITAL

Abstract

Objective: To assess the outcome of ESWL and to confirm the validity of the ESWL score in predicting stone-free status.

Methods: This prospective observational study was conducted at Jinnah Postgraduate Medical Centre (JPMC), Karachi from 1^st October, 2025 to 6^th March , 2026 and included 94 adult patients undergoing ESWL for renal calculi. Stone-free status was assessed at 4-week follow-up. ESWL score components (BMI <27 kg/m², stone size <11 mm, and stone density <900 HU) were calculated, and the association between ESWL score and treatment outcome was analyzed using SPSS v27. Receiver operating characteristic (ROC) curve analysis was performed for prediction of the ESWL score.

Results: The median age was 41 years (IQR 32–46), and 60 patients (63.8%) were male. At 4 weeks, 68 patients (72.3%) achieved stone‑free status. Smaller stone size (9.0 vs 10.2 mm, p=0.015), lower stone density (803 vs 913 HU, p=0.022), upper‑pole location (p=0.039), and treatment by experienced operators (p=0.017) were significantly associated with stone‑free outcome. All individual ESWL score components were significantly predictive of success (p<0.05). Stone-free rates increased progressively with higher ESWL scores, from 16.7% for score 0 to 96.0% for score 3 (p<0.001). An ESWL score cut‑off of ≥2 demonstrated an area under the ROC curve of 0.74 (95% CI 0.63–0.84), with sensitivity of 79.4%, specificity of 50.0%, and overall diagnostic accuracy of 71.3%.

Conclusion: ESWL remains an effective treatment modality for appropriately selected patients with renal calculi.