Impact of the Mayo adhesive probability score on ESWL outcomes for proximal ureteral stones

This study aimed to evaluate the predictive value of the Mayo Adhesive Probability (MAP) score for extracorporeal shock wave lithotripsy (ESWL) success in patients with proximal ureteral stones. We retrospectively analyzed 216 patients who underwent ESWL for isolated proximal ureteral stones between March 2020 and May 2025. Demographic and radiological parameters, including stone size, stone density, skin-to-stone distance, and MAP score, were recorded. The MAP score was calculated using non-contrast computed tomography by assessing posterior perinephric fat thickness and perinephric fat stranding. Treatment success was defined as no ureteral stone; residual fragments ≤ 4 mm were permitted only if located in the kidney after the ESWL procedure at 3-month follow-up. Logistic regression analysis was performed to identify independent predictors of ESWL success. The overall ESWL success rate was 63%. Patients with a MAP score < 3 achieved significantly higher success rates than those with a MAP score ≥ 3 (76.9% vs. 45.3%). In multivariate logistic regression analysis, stone size > 10 mm (odds ratio [OR] 0.340, 95% confidence interval [CI] 0.179-0.647), MAP score ≥ 3 (OR 0.266, 95% CI 0.140-0.507), and a prolonged interval between computed tomography and ESWL (OR 0.956, 95% CI 0.927-0.985) were identified as independent predictors of reduced success. A higher MAP score, larger stone size, and longer pre-treatment interval are associated with lower ESWL success in proximal ureteral stones. MAP scoring provides a simple, reproducible, imaging-based tool that may assist in patient selection and support treatment planning.