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Lepine HL, Vicentini FC, Mazzucchi E, Molina WR, Marchini GS, Torricelli FC, Batagello CA, Danilovic A, Nahas WC. Intraoperative computed tomography for detection of residual stones in endourology procedures: systematic review and meta-analysis. Int Braz J Urol 2024; 50:250-260. [PMID: 38598828 PMCID: PMC11152329 DOI: 10.1590/s1677-5538.ibju.2024.0092] [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: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Success rates in endourological procedures, notably percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS), have demonstrated suboptimal outcomes, leading to more reinterventions and radiation exposure. Recently, the use of intraoperative computed tomography (ICT) scans has been hypothesized as a promising solution for improving outcomes in endourology procedures. With this considered, we conducted a comprehensive systematic review and meta-analysis encompassing all available studies that evaluate the impact of the use of intraoperative CT scans on surgical outcomes compared to conventional fluoroscopic-guided procedures. METHODS This systematic review was conducted in accordance with PRISMA guidelines. Multiple databases were systematically searched up to December of 2023. This study aimed to directly compare the use of an ICT scan with the standard non-ICT-guided procedure. The primary endpoint of interest was success rate, and the secondary endpoints were complications and reintervention rates, while radiation exposure was also evaluated. Data extraction and quality assessment were performed following Cochrane recommendations. Data was presented as an Odds ratio with 95%CI across trials and a random-effects model was selected for pooling of data. RESULTS A comprehensive search yielded 533 studies, resulting in the selection of 3 cohorts including 327 patients (103 ICT vs 224 in non-ICT). Primary outcome was significantly higher in the experimental group versus the control group (84.5% vs 41.4% respectively, 307 patients; 95% CI [3.61, 12.72]; p<0.00001; I2=0). Reintervention rates also decreased from 32.6% in the control to 12.6% in the ICT group (OR 0.34; 95%CI [0.12,0.94]; p =0.04; I2= 48%), whereas complication rates did not exhibit significant differences. Radiation exposure was also significantly reduced in two of the included studies. CONCLUSION This meta-analysis highlights a favorable outcome with intraoperative CT scan use in PCNL procedures, showing a considerable increase in SFR when compared to standard fluoroscopy and nephroscopy. Despite limited studies, our synthesis underscores the potential of ICT scans to significantly reduce residual stones and their consequences for endourology patients, as reinterventions and follow-up ionizing radiation studies.
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Affiliation(s)
- Henrique L. Lepine
- Faculdade de Medicina da Universidade de São PauloSão PauloSPBrasilFaculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil;
| | - Fabio C. Vicentini
- Universidade de São PauloFaculdade de MedicinaDepartamento de Urologia do Hospital das ClínicasSão PauloSPBrasilDepartamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil;
| | - Eduardo Mazzucchi
- Universidade de São PauloFaculdade de MedicinaDepartamento de Urologia do Hospital das ClínicasSão PauloSPBrasilDepartamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil;
| | - Wilson R. Molina
- University of KansasEndourology SectionDepartment of UrologyKansasKSUSADepartment of Urology, Endourology Section, University of Kansas, Kansas City, KS, USA
| | - Giovanni S. Marchini
- Universidade de São PauloFaculdade de MedicinaDepartamento de Urologia do Hospital das ClínicasSão PauloSPBrasilDepartamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil;
| | - Fabio C. Torricelli
- Universidade de São PauloFaculdade de MedicinaDepartamento de Urologia do Hospital das ClínicasSão PauloSPBrasilDepartamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil;
| | - Carlos A. Batagello
- Universidade de São PauloFaculdade de MedicinaDepartamento de Urologia do Hospital das ClínicasSão PauloSPBrasilDepartamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil;
| | - Alexandre Danilovic
- Universidade de São PauloFaculdade de MedicinaDepartamento de Urologia do Hospital das ClínicasSão PauloSPBrasilDepartamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil;
| | - William C. Nahas
- Universidade de São PauloFaculdade de MedicinaDepartamento de Urologia do Hospital das ClínicasSão PauloSPBrasilDepartamento de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil;
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Kandasamy M, Chan M, Xiang H, Chan L, Ridley L. Comparison of diagnostic accuracy of ultra low-dose computed tomography and X-ray of the kidneys, ureters and bladder for urolithiasis in the follow-up setting. J Med Imaging Radiat Oncol 2023. [PMID: 37997533 DOI: 10.1111/1754-9485.13605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION Urolithiasis is frequently followed up with a low-dose computed tomography of the kidneys ureters and bladder (LD-CTKUB) with doses typically less than 3 millisieverts. Although X-ray is a lower dose (0.5-1.1 mSv) alternative for follow up, it has lower diagnostic accuracy and is limited to radiopaque calculi. This study aims to compare the diagnostic accuracy of sub-millisievert ultra-low dose CT (ULD-CTKUB) against X-ray KUB for the follow up of urolithiasis when both are compared against the standard of care of a low-dose CT KUB (LD-CTKUB). METHODS This prospective study included patients with a known diagnosis of urolithiasis on prior CTKUB presenting for follow up. Each patient underwent a repeat reference LD-CTKUB, ULD-CTKUB and X-ray KUB. All imaging studies were interpreted by three readers. The radiation dose and quantitative noise was calculated for each CT. Both CT and X-ray were assessed for the presence, number and size of all calculi ≥2 mm. RESULTS A total of 58 patients were included in this study. LD-CTKUB identified 197 calculi. ULD-CTKUB in our study had a mean effective dose of 0.5 mSv compared to X-ray KUB where doses range in the literature from 0.5 to 1.1 mSv. Per-patient pooled analysis for intrarenal calculi when comparing ULD-CTKUB versus X-ray KUB against a reference LD-CTKUB found a sensitivity of 90% versus 67% (P < 0.01) and specificity of 93% versus 98% (P = 0.18) respectively. For ureteric calculi, the sensitivity was 67% versus 33% (P < 0.01) and specificity 94% versus 94% (P = 1.00) respectively. Per-stone pooled analysis detection rate was 79% for ULD-CTKUB versus 48% for X-ray (P < 0.01) when each was compared to the reference LD-CTKUB. Interobserver agreement was high for intrarenal calculi and moderate for ureteric calculi. CONCLUSION Sub-millisievert ULD-CTKUB had lower doses and higher sensitivity than X-ray in patients requiring follow up of known urolithiasis.
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Affiliation(s)
- Mayooran Kandasamy
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Michael Chan
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Hao Xiang
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | - Lewis Chan
- Department of Urology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Lloyd Ridley
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
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Khalid A, Abdulwahab-Ahmed A, Muhammad AS, Jesini G, Agwu NP, Mungadi IA. An enigma: case series of vesical calculi from prolonged and neglected indwelling catheter. J Surg Case Rep 2023; 2023:rjad018. [PMID: 36741079 PMCID: PMC9890249 DOI: 10.1093/jscr/rjad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/06/2023] [Indexed: 02/05/2023] Open
Abstract
Vesical calculus is a common condition with familiar aetiology in our environment as it is obtained in other parts of the world. Notwithstanding, uncommon aetiology of this pathology still exists though rarely encountered especially where out-of-pocket payment is the norm for accessing health care services. This is a report of three patients with varying indications for indwelling vesical catheter insertion via urethral or suprapubic route and who developed vesical calculus from prolonged and neglected indwelling vesical catheter. These cases are indeed an enigma in contemporary surgical patient care. We share our experience in the care of these patients and to underscore the extra role expected of health care providers in adequate patient education, close attention to guidance and counseling during patients' visits to health facilities.
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Affiliation(s)
- Abdullahi Khalid
- Correspondence address. Tetfund Centre of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University and Teaching Hospital, Sokoto, Nigeria. E-mail:
| | - Abdullah Abdulwahab-Ahmed
- Tetfund Centre of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University and Teaching Hospital, Sokoto, Nigeria
| | - Abubakar Sadiq Muhammad
- Tetfund Centre of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University and Teaching Hospital, Sokoto, Nigeria
| | - Gamdu Jesini
- Tetfund Centre of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University and Teaching Hospital, Sokoto, Nigeria
| | - Ngwobia Peter Agwu
- Tetfund Centre of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University and Teaching Hospital, Sokoto, Nigeria
| | - Isma'ila Arzika Mungadi
- Tetfund Centre of Excellence in Urology and Nephrology, Institute of Urology and Nephrology, Usmanu Danfodiyo University and Teaching Hospital, Sokoto, Nigeria
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Value of deep learning reconstruction at ultra-low-dose CT for evaluation of urolithiasis. Eur Radiol 2022; 32:5954-5963. [PMID: 35357541 DOI: 10.1007/s00330-022-08739-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To determine the diagnostic accuracy and image quality of ultra-low-dose computed tomography (ULDCT) with deep learning reconstruction (DLR) to evaluate patients with suspected urolithiasis, compared with ULDCT with hybrid iterative reconstruction (HIR) by using low-dose CT (LDCT) with HIR as the reference standard. METHODS Patients with suspected urolithiasis were prospectively enrolled and underwent abdominopelvic LDCT, followed by ULDCT if any urinary stone was observed. Radiation exposure, stone characteristics, image noise, signal-to-noise ratio (SNR), and subjective image quality on a 5-point Likert scale were evaluated and compared. RESULTS The average effective radiation dose of ULDCT was significantly lower than that of LDCT (1.28 ± 0.34 vs. 5.49 ± 1.00 mSv, p < 0.001). According to the reference standard (LDCT-HIR), 148 urinary stones were observed in 85.0% (51/60) of patients. ULDCT-DLR detected 143 stones with a rate of 96.6%, and ULDCT-HIR detected 142 stones with a rate of 95.9%. The urinary stones that were not observed with ULDCT-DLR or ULDCT-HIR were renal calculi smaller than 3 mm. There were no significant differences in the detection of clinically significant calculi (≥ 3 mm) or stone size estimation among ULDCT-DLR, ULDCT-HIR, and LDCT-HIR. The image quality of ULDCT-DLR was better than that of ULDCT-HIR and LDCT-HIR with lower image noise, higher SNR, and higher average subjective score. CONCLUSIONS ULDCT-DLR performed comparably to LDCT-HIR in urinary stone detection and size estimation with better image quality and decreased radiation exposure. ULDCT-DLR may have potential to be considered the first-line choice to evaluate urolithiasis in practice. KEY POINTS • Ultra-low-dose computed tomography (ULDCT) has been investigated for diagnosis of urolithiasis, but stone evaluation may be adversely impacted by compromised image quality. • This study evaluated the value of novel deep learning reconstruction (DLR) at ULDCT by comparing the stone evaluation and image quality of ULDCT-DLR to the reference standard of low-dose CT (LDCT) with hybrid iterative reconstruction (HIR). • ULDCT-DLR performed comparably to LDCT-HIR in urinary stone detection and size estimation with better image quality and reduced radiation exposure.
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Delabie A, Bouzerar R, Pichois R, Desdoit X, Vial J, Renard C. Diagnostic performance and image quality of deep learning image reconstruction (DLIR) on unenhanced low-dose abdominal CT for urolithiasis. Acta Radiol 2021; 63:1283-1292. [PMID: 34365803 DOI: 10.1177/02841851211035896] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients with urolithiasis undergo radiation overexposure from computed tomography (CT) scans. Improvement of image reconstruction is necessary for radiation dose reduction. PURPOSE To evaluate a deep learning-based reconstruction algorithm for CT (DLIR) in the detection of urolithiasis at low-dose non-enhanced abdominopelvic CT. MATERIAL AND METHODS A total of 75 patients who underwent low-dose abdominopelvic CT for urolithiasis were retrospectively included. Each examination included three reconstructions: DLIR; filtered back projection (FBP); and hybrid iterative reconstruction (IR; ASiR-V 70%). Image quality was subjectively and objectively assessed using attenuation and noise measurements in order to calculate the signal-to-noise ratio (SNR), absolute contrast, and contrast-to-noise ratio (CNR). Attenuation of the largest stones were also compared. Detectability of urinary stones was assessed by two observers. RESULTS Image noise was significantly reduced with DLIR: 7.2 versus 17 and 22 for ASiR-V 70% and FBP, respectively. Similarly, SNR and CNR were also higher compared to the standard reconstructions. When the structures had close attenuation values, contrast was lower with DLIR compared to ASiR-V. Attenuation of stones was also lowered in the DLIR series. Subjective image quality was significantly higher with DLIR. The detectability of all stones and stones >3 mm was excellent with DLIR for the two observers (intraclass correlation [ICC] = 0.93 vs. 0.96 and 0.95 vs. 0.99). For smaller stones (<3 mm), results were different (ICC = 0.77 vs. 0.86). CONCLUSION For low-dose abdominopelvic CT, DLIR reconstruction exhibited image quality superior to ASiR-V and FBP as well as an excellent detection of urinary stones.
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Affiliation(s)
- Aurélien Delabie
- Department of Radiology, Amiens University Hospital, Amiens Cedex, France
| | - Roger Bouzerar
- Medical Image Processing Unit, Amiens University Hospital, Amiens, France
| | - Raphaël Pichois
- Department of Radiology, Amiens University Hospital, Amiens Cedex, France
| | - Xavier Desdoit
- Department of Radiology, Amiens University Hospital, Amiens Cedex, France
| | - Jérémie Vial
- Department of Radiology, Amiens University Hospital, Amiens Cedex, France
| | - Cédric Renard
- Department of Radiology, Amiens University Hospital, Amiens Cedex, France
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Mussmann B, Hardy M, Jung H, Ding M, Osther PJ, Graumann O. Can Dual Energy CT with Fast kV-Switching Determine Renal Stone Composition Accurately? Acad Radiol 2021; 28:333-338. [PMID: 32217056 DOI: 10.1016/j.acra.2020.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/04/2020] [Accepted: 02/04/2020] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES To determine whether a single source computed tomography (CT) system utilizing fast kV switching and low dose settings can characterize (diameter and chemical composition) renal stones accurately when compared infrared spectroscopy. MATERIALS AND METHODS The chemical composition of 15 renal stones was determined using Fourier transform infrared spectroscopy. The stones were inserted into a porcine kidney and placed within a water tank for CT scanning using both fast kV switching dual energy and standard protocols. Effective atomic number of each stone was measured using scanner software. Stone diameter measurements were repeated twice to determine intra-rater variation and compared to actual stone diameter as measured by micro CT. RESULTS The chemical composition of three stones (one calcium phosphate and two carbonite apatite) could not be determined using the scanner software. The composition of 10/12 remaining stones was correctly identified using dual energy computed tomography (83% absolute agreement; k = 0.69). No statistical difference (p = 0.051) was noted in the mean stone diameter as measured by clinical CT and micro CT. CONCLUSION Dual energy computed tomography using fast kV switching may potentially be developed as a low dose clinical tool for identifying and classifying renal stones in vivo supporting clinical decision-making.
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Affiliation(s)
- Bo Mussmann
- Department of Radiology, Odense University Hospital, Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark; Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark; Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
| | - Maryann Hardy
- Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark; Faculty of Health Studies, University of Bradford, Bradford, UK
| | - Helene Jung
- Urological Research Center, Department of Urology, Lillebaelt Hospital, Vejle, Denmark
| | - Ming Ding
- Department of Orthopaedic surgery and traumatology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Palle J Osther
- Urological Research Center, Department of Urology, Lillebaelt Hospital, Vejle, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark; Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark
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Detection of distal ureteral stones in pregnancy using transvaginal ultrasound. J Ultrasound 2020; 24:397-402. [PMID: 32666258 PMCID: PMC8572244 DOI: 10.1007/s40477-020-00504-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/26/2019] [Indexed: 10/31/2022] Open
Abstract
AIMS To determine the performance of transvaginal ultrasound for the visualization of distal ureteral stones in pregnant patients with renal colic and to evaluate the diagnostic value of secondary findings suggestive of obstructing ureteral stone disease. METHODS We retrospectively identified 129 pregnant patients with a total of 142 encounters with both abdominal and transvaginal ultrasound. Ultrasound images for each patient were reviewed recording the presence of stone with location, hydronephrosis, resistive indices (RI), and status of the ureteral jets. Patients were subcategorized into two groups based on the visualization of distal ureteral stone. RESULTS The transvaginal technique identified 94% (N = 16/17) of sonographically detected stones in the distal ureter/urethra, while the transabdominal technique identified 29% (N = 5/17). The combined imaging for initial assessment of renal colic in pregnancy demonstrated a sensitivity of 89%, specificity 100%, and negative predictive value (NPV) of 98%. The frequency of hydronephrosis was statistically greater in the visualized stone group (94% vs 51%). Mean RI was identical in both groups however the delta RI was significantly elevated in those patients with distal ureteral stones with a mean delta RI value of 0.05. The rate of absence of ureteral jets was not statistically significant. CONCLUSION The present data would suggest a utility of transvaginal ultrasound for the evaluation of the pregnant patient with 94% of distal stones being detected transvaginal versus 29% transabdominally. Additionally, there was significantly increased hydronephrosis and elevated RIs in patients with distal ureteral stones.
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The efficacy of tin-filtration for computed tomography in diagnosing urolithiasis. Clin Imaging 2019; 55:126-131. [PMID: 30818162 DOI: 10.1016/j.clinimag.2019.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 01/07/2019] [Accepted: 02/15/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the radiation dose and image quality of computed tomography urograms (CTU) using tin-filtration compared to conventional CTU (without tin-filtration) examinations in patients with suspected urolithiasis. METHODS Group 1 consisted of 100 patients who were examined using the tin-filtered CTU protocols (Sn100kVp or Sn150kVp); Group 2 consisted of 100 patients who were examined using the same protocols but without tin-filtration (GE-NI41 or GE-NI43). The scanning protocol was based on the patients' body weight (<80 kg and ≥80 kg). The effective doses of all scans were compared between the two groups. Subjective image quality was evaluated by two blinded radiologists. The objective image quality was assessed for noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and figure-of-merit (FOM) using the CTU scans acquired from both the tin-filtered and non-tin-filtered protocols. RESULTS Tin-filtration resulted in the reduction of effective radiation dose ranging between 72% to 88% for the ≥80 kg and <80 kg patient groups respectively. For both groups, tin-filtration resulted in no significant differences in SNR and a significant increase in FOM. For the <80 kg group, tin-filtration resulted in significantly noisier images but with no significant difference in CNR. For the ≥80 kg group, tin-filtration resulted in significantly higher CNR. There was no significant difference in subjective image quality when assessed by the radiologists in terms of diagnostic confidence for urolithiasis. CONCLUSION Tin-filtration significantly reduces patient dose while maintaining diagnostic image quality of CTUs for patients with suspected urolithiasis.
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Li JK, Teoh JY, Ng CF. Updates in endourological management of urolithiasis. Int J Urol 2018; 26:172-183. [PMID: 30575154 DOI: 10.1111/iju.13885] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/21/2018] [Indexed: 12/23/2022]
Abstract
Urinary stone disease, or urolithiasis, is a very common disease with increasing prevalence and incidence. With the advancement of endoscopic techniques, the treatment outcomes of ureteroscopy (or transureteral lithotripsy) and percutaneous nephrolithotomy are continuously improving. In recent years, there have been many new developments in the field, including new endoscopy design, more effective auxiliary tools, improvement in treatment protocols, introduction of robotic technology, combining both ureteroscopy and percutaneous nephrolithotomy (endoscopic combined intrarenal surgery or transureteral lithotripsy-assisted percutaneous nephrolithotomy), improvement in laser technology, and so on. All these new inputs will further improve the treatment efficacy and safety of the procedures, thus benefiting our patients. In the present review, we briefly go through the main steps of ureteroscopy and percutaneous nephrolithotomy, with a concise description and application of these new advances.
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Affiliation(s)
- Joseph Km Li
- S. H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jeremy Yc Teoh
- S. H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chi-Fai Ng
- S. H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
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Wollin DA, Gupta RT, Young B, Cone E, Kaplan A, Marin D, Patel BN, Mazurowski MA, Scales CD, Ferrandino MN, Preminger GM, Lipkin ME. Abdominal Radiography With Digital Tomosynthesis: An Alternative to Computed Tomography for Identification of Urinary Calculi? Urology 2018; 120:56-61. [PMID: 30006268 DOI: 10.1016/j.urology.2018.06.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/28/2018] [Accepted: 06/29/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the accuracy of plain abdominal radiography (kidneys, ureter, and bladder [KUB]) with digital tomosynthesis (DT) to noncontrast computed tomography (NCCT), the gold standard imaging modality for urinary stones. Due to radiation and cost concerns, KUB is often used for diagnosis and follow-up of nephrolithiasis. DT, a novel technique that produces high-quality radiographs with less radiation and/or cost than low-dose NCCT, has not been assessed in this situation. MATERIALS AND METHODS Seven fresh tissue cadavers were implanted with stones of known size and/or composition and imaged with KUB, DT, and NCCT. Four blinded readers (2 urologists, 2 radiologists) evaluated KUBs for presence and/or location of calculi. They then re-evaluated with addition of tomograms to assess additional value. After a memory extinction period, readers evaluated NCCT images. Accuracy of detection was determined using nearest-neighbor match with generalized linear mixed modeling. RESULTS Total of 59 stones were identified on reference read. Overall, NCCT and DT were both superior to KUB alone (P < .001) while the difference between DT and NCCT was not significant (P = .06). When evaluating uric acid stones, NCCT and DT outperformed KUB (P < .01 and P < .05, respectively) while DT and NCCT were similar (P = .16). Intrarenal stones were better evaluated on DT and NCCT (P < .001 compared to KUB), while DT and NCCT were similar (P = 1.00). Accuracy was lower than anticipated across modalities due to use of the cadaver model. CONCLUSION Our study demonstrates DT is superior to KUB for identification of intrarenal calculi and could replace routine use of KUB or NCCT for detecting renal stones, even those composed of uric acid.
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Affiliation(s)
- Daniel A Wollin
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC.
| | - Rajan T Gupta
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC; Department of Radiology, Duke University Medical Center, Durham, NC
| | - Brian Young
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - Eugene Cone
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - Adam Kaplan
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - Daniele Marin
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Bhavik N Patel
- Department of Radiology, Duke University Medical Center, Durham, NC; Department of Radiology, Stanford University, Palo Alto, CA
| | - Maciej A Mazurowski
- Department of Radiology, Duke University Medical Center, Durham, NC; Department of Electrical and Computer Engineering, Duke University, Durham, NC
| | - Charles D Scales
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | | | - Glenn M Preminger
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
| | - Michael E Lipkin
- Division of Urologic Surgery, Duke University Medical Center, Durham, NC
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Abstract
Advances in medical imaging are invaluable in the care of pediatric patients in the emergent setting. The diagnostic accuracy offered by studies using ionizing radiation, such as plain radiography, computed tomography, and fluoroscopy, are not without inherent risks. This article reviews the evidence supporting the risk of ionizing radiation from medical imaging as well as discusses clinical scenarios in which clinicians play an important role in supporting the judicious use of imaging studies.
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Affiliation(s)
- Amy L Puchalski
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Carolinas Medical Center, Levine Children's Hospital, 1000 Blythe Boulevard, Charlotte, NC 28203, USA.
| | - Christyn Magill
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Carolinas Medical Center, Levine Children's Hospital, 1000 Blythe Boulevard, Charlotte, NC 28203, USA
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Chi T, Usawachintachit M, Weinstein S, Kohi MP, Taylor A, Tzou DT, Chang HC, Stoller M, Mongan J. Contrast Enhanced Ultrasound as a Radiation-Free Alternative to Fluoroscopic Nephrostogram for Evaluating Ureteral Patency. J Urol 2017; 198:1367-1373. [PMID: 28743528 DOI: 10.1016/j.juro.2017.07.074] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE We compared contrast enhanced ultrasound and fluoroscopic nephrostography in the evaluation of ureteral patency following percutaneous nephrolithotomy. MATERIALS AND METHODS This prospective cohort, noninferiority study was performed after obtaining institutional review board approval. We enrolled eligible patients with kidney and proximal ureteral stones who underwent percutaneous nephrolithotomy at our center. On postoperative day 1 patients received contrast enhanced ultrasound and fluoroscopic nephrostogram within 2 hours of each other to evaluate ureteral patency, which was the primary outcome of this study. RESULTS A total of 92 pairs of imaging studies were performed in 82 patients during the study period. Five study pairs were excluded due to technical errors that prevented imaging interpretation. Females slightly predominated over males with a mean ± SD age of 50.5 ± 15.9 years and a mean body mass index of 29.6 ± 8.6 kg/m2. Of the remaining 87 sets of studies 69 (79.3%) demonstrated concordant findings regarding ureteral patency for the 2 imaging techniques and 18 (20.7%) were discordant. The nephrostomy tube was removed on the same day in 15 of the 17 patients who demonstrated antegrade urine flow only on contrast enhanced ultrasound and they had no subsequent adverse events. No adverse events were noted related to ultrasound contrast injection. While contrast enhanced ultrasound used no ionizing radiation, fluoroscopic nephrostograms provided a mean radiation exposure dose of 2.8 ± 3.7 mGy. CONCLUSIONS A contrast enhanced ultrasound nephrostogram can be safely performed to evaluate for ureteral patency following percutaneous nephrolithotomy. This imaging technique was mostly concordant with fluoroscopic findings. Most discordance was likely attributable to the higher sensitivity for patency of contrast enhanced ultrasound compared to fluoroscopy.
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Affiliation(s)
- Thomas Chi
- Department of Urology, University of California-San Francisco, California.
| | - Manint Usawachintachit
- Department of Urology, University of California-San Francisco, California; Division of Urology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Stefanie Weinstein
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, California
| | - Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, California
| | - Andrew Taylor
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, California
| | - David T Tzou
- Department of Urology, University of California-San Francisco, California
| | - Helena C Chang
- Department of Urology, University of California-San Francisco, California
| | - Marshall Stoller
- Department of Urology, University of California-San Francisco, California
| | - John Mongan
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, California
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13
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Xiang H, Chan M, Brown V, Huo YR, Chan L, Ridley L. Systematic review and meta-analysis of the diagnostic accuracy of low-dose computed tomography of the kidneys, ureters and bladder for urolithiasis. J Med Imaging Radiat Oncol 2017; 61:582-590. [DOI: 10.1111/1754-9485.12587] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 12/14/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Hao Xiang
- Department of Radiology; Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - Michael Chan
- Department of Radiology; Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - Victoria Brown
- Emergency Department; Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - Ya Ruth Huo
- Faculty of Medicine; University of New South Wales; Sydney New South Wales Australia
| | - Lewis Chan
- Department of Urology and Institute of Academic Surgery; Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - Lloyd Ridley
- Department of Radiology; Concord Repatriation General Hospital; Sydney New South Wales Australia
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14
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Tailly T, Denstedt J. Innovations in percutaneous nephrolithotomy. Int J Surg 2016; 36:665-672. [DOI: 10.1016/j.ijsu.2016.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/02/2016] [Indexed: 12/26/2022]
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15
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O'Kane D, Papa N, Manning T, Quinn J, Hawes A, Smith N, McClintock S, Lawrentschuk N, Bolton DM. Contemporary Accuracy of Digital Abdominal X-Ray for Follow-Up of Pure Calcium Urolithiasis: Is There Still a Role? J Endourol 2016; 30:844-9. [DOI: 10.1089/end.2016.0173] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Dermot O'Kane
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Surgery, University of Melbourne, Victoria, Australia
| | - Nathan Papa
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Todd Manning
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Surgery, University of Melbourne, Victoria, Australia
| | - Jonathan Quinn
- School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Alice Hawes
- School of Medicine, Griffith University, Southport, Queensland, Australia
| | - Neil Smith
- Department of Urology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Scott McClintock
- Department of Urology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Nathan Lawrentschuk
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Surgery, University of Melbourne, Victoria, Australia
| | - Damien M. Bolton
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Surgery, University of Melbourne, Victoria, Australia
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16
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Maidment ADA. Commentary on “Whole-Body Clinical Applications of Digital Tomosynthesis,” with Response from Dr Machida and Colleagues. Radiographics 2016; 36:750-2. [DOI: 10.1148/rg.2016160028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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