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Chiang YT, Chen SM, Tsui HM, Juang HH, Lin CW, Chiang MH, Liu CH, Hu SW, Kao WT, Chen KC, Tzou KY, Wu CC, Wu WL, Tsui KH. Ultrasound-guided extracorporeal shock wave lithotripsy with minimal x-ray exposure prevented genitourinary tract injury patients with urolithiasis in Taiwan. Sci Prog 2023; 106:368504231220988. [PMID: 38130182 PMCID: PMC10864817 DOI: 10.1177/00368504231220988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND This study investigated the use of ultrasound-guided extracorporeal shock wave lithotripsy (ESWL) to break stones in the genitourinary tract and prevent genitourinary injury. Our goals were to achieve accurate focusing and minimal X-ray exposure for the benefit of the patients. METHODS The LiteMed LM-9200 lithotripter with ultrasonography and fluoroscopy was used for two different procedures: autoaimed and autoperiodical. These procedures enabled dual focusing on stone localization and tracking. RESULTS Out of 108 patients who underwent autoperiodical procedures, 29 had no gross hematuria. Among the 335 patients who received autoaimed procedures, 194 had no gross hematuria. The average duration of X-ray exposure during autoperiodical and autoaimed procedures was 120 and 50 s, respectively. CONCLUSION The ultrasound-guided ESWL with minimal X-ray exposure was found to be useful in treating genitourinary upper-tract urolithiasis in the autoaimed procedure. Patients who underwent the autoaimed procedure experienced less gross hematuria compared to those who underwent the autoperiodical procedure.
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Affiliation(s)
- Yi-Te Chiang
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
| | - Shao-Ming Chen
- Department of Urology, Heping Campus, Taipei City Hospital, Taipei, Taiwan
| | - Hsuan-Mao Tsui
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
| | - Horng-Heng Juang
- Department of Anatomy, School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chia-Wei Lin
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
| | - Meng-Han Chiang
- Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia-Hung Liu
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
| | - Su-Wei Hu
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
| | - Wei-Tang Kao
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Chou Chen
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
| | - Kai-Yi Tzou
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
| | - Chia-Chang Wu
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
| | - Wen-Ling Wu
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
| | - Ke-Hung Tsui
- Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
- Department of Urology, Shuang Ho Hospital, Shuang Ho Cancer Center, Taipei Cancer Center, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
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Nabheerong P, Kengkla K, Saokaew S, Naravejsakul K. Diagnostic accuracy of Doppler twinkling artifact for identifying urolithiasis: a systematic review and meta-analysis. J Ultrasound 2023; 26:321-331. [PMID: 36705851 PMCID: PMC10247947 DOI: 10.1007/s40477-022-00759-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/23/2022] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The goal of this study was to perform a comprehensive meta-analysis to assess the overall diagnostic value of Doppler twinkling for the diagnosis of urolithiasis. METHODS We systematically searched the PubMed, EMBASE, and Cochrane Library databases from inception through May 31, 2021. Studies including patients with urolithiasis who underwent color flow Doppler sampling to highlight the twinkling artifact and computed tomography were included. Diagnostic test meta-analysis was performed with a bivariate model. We used summary receiver operating characteristic curves to summarize the overall diagnostic performance. The weighted sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were calculated. RESULTS Sixteen studies involving 4572 patients were included in the systematic review and meta-analysis. The weighted sensitivity was 0.86 (95% confidence interval [CI] 0.72-0.94), specificity 0.92 (95% CI 0.75-0.98), positive likelihood ratio 11.3, negative likelihood ratio 0.2, and diagnostic odds ratio 75.5. CONCLUSION The Doppler twinkling artifact has good diagnostic value for the diagnosis of urolithiasis and should be used as a complementary tool in the diagnosis of urolithiasis.
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Affiliation(s)
- Pennipat Nabheerong
- Department of Diagnostic Radiology, School of Medicine, University of Phayao, Phayao, Thailand
| | - Kirati Kengkla
- Division of Clinical Pharmacy, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
- UNIt of Excellence on Clinical Outcomes Research and IntegratioN (UNICORN), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
- Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - Surasak Saokaew
- UNIt of Excellence on Clinical Outcomes Research and IntegratioN (UNICORN), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
- Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
- Division of Social and Administrative Pharmacy, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
| | - Krittin Naravejsakul
- Division of Urology, Department of Surgery ,School of Medicine, University of Phayao, Phayao, Thailand.
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Puttmann K, Dajusta D, Rehfuss AW. Does twinkle artifact truly represent a kidney stone on renal ultrasound? J Pediatr Urol 2021; 17:475.e1-475.e6. [PMID: 33867287 DOI: 10.1016/j.jpurol.2021.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/26/2021] [Accepted: 03/25/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Nephrolithiasis is detected on ultrasound by the presence of an echogenic focus, posterior acoustic shadowing and/or twinkle artifact (TA). TA has been shown to be highly predictive of nephrolithiasis in adults with renal colic and ureteral stones. We sought to evaluate if TA is reliable for diagnosing nephrolithiasis in the pediatric population. METHODS We reviewed renal ultrasound reports indicating presence or absence of TA associated with a single echogenic focus in the kidney or ureter. Exclusion criteria were age >18, multiple echogenic foci or medullary calcinosis, no follow-up, or TA located outside the kidney or ureter. Stone was confirmed either by CT within 3 months of color Doppler ultrasound, visualization on ureteroscopy, or patient report of passing the stone. RESULTS Five hundred and ninety-nine ultrasound reports were reviewed and 293 met inclusion criteria. Sixty-nine had diffuse twinkle without echogenic focus and 224 showed TA with single echogenic focus. 135 patients had confirmatory information available (Summary Table). Nephrolithiasis was diagnosed using TA and confirmed on confirmatory studies for 49 ultrasounds. The majority of confirmed stones were in the kidney (n = 40; 82%) and mean size of confirmed stones on ultrasound was 5 mm (range 1.5-10). Sensitivity, specificity, positive predictive value and negative predictive value of TA for detecting nephrolithiasis were 83%, 78%, 74% and 86% respectively. CONCLUSIONS Compared to the adult literature, TA in children has lower sensitivity, specificity and positive predictive value, but similar negative predictive value for diagnosing nephrolithiasis. This may be related to renal location and smaller stone size. The presence of TA should be weighed in the setting of other clinical and radiographic evidence of nephrolithiasis.
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Affiliation(s)
- Kathleen Puttmann
- Department of Urology, Ohio State University Wexner Medical Center, Columbus, OH, 43212, USA; Department of Urology, Nationwide Children's Hospital, Columbus, OH, 43205, USA.
| | - Daniel Dajusta
- Department of Urology, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Alexandra W Rehfuss
- Department of Urology, Nationwide Children's Hospital, Columbus, OH, 43205, USA; Division of Urology, Albany Medical Center, Albany, NY, 12208, USA
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Gilani SA, Bacha R, Manzoor I. Sonography and Test-Feeding in the Diagnosis of Infantile Hypertrophic Pyloric Stenosis. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/8756479320961075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To determine the use of sonography and test-feeding in the diagnosis of infantile hypertrophic pyloric stenosis (IHPS). Methodology: A total of 79 infants from 2 weeks up to 12 weeks presenting with clinical signs (projectile vomiting) of IHPS were included in the study while sent to sonography. The study duration was February 2014 to December 2019. Results: The mean age of patients was 5.18 ± 2.69 weeks ranging from 1 to 12 weeks. Male gender was predominant with 62 (78.5%) cases. Of the total 79 cases, 36 (54.6%) were suggested as positive cases of IHPS and 43 (54.4%) were as normal with sonography. Most of the cases of IHPS (23; 29.1%) were observed in firstborn babies. Mean pyloric length in normal and IHPS was 12.69 ± 0.87 and 20.78 ± 2.28 mm, respectively, and mean pyloric muscle thickness in the normal and IHPS was 2.24 ± 0.36 and 5.27 ± 0.82 mm, respectively, while mean pyloric diameter in normal and IHPS was 12.69 ±0.87 and 15.01± 2.52 mm, respectively. Conclusion: The reliability of sonographic findings was better than test-feeding in the diagnosis of IHPS. Male infants, in this cohort, were five times more susceptible to develop IHPS, compared with females.
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Affiliation(s)
- Syed Amir Gilani
- University Institute of Radiological Sciences and Medical Imaging Technology, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
| | - Raham Bacha
- University Institute of Radiological Sciences and Medical Imaging Technology, Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan
- Gilani Ultrasound Center, Lahore, Pakistan
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