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Aydamirov M, Karkin K, Altunkol A, Vuruskan E, Kaplan E, Gurlen G, Aksay B, Akgun OF, Gozukara K, Ortaoglu F, Tunckiran MA. The efficacy of early extracorporeal shockwave lithotripsy for the treatment of 5 to 10 mm upper ureteral stones: An observational study. Medicine (Baltimore) 2024; 103:e39103. [PMID: 39058849 PMCID: PMC11272328 DOI: 10.1097/md.0000000000039103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
This study aimed to determine the effectiveness of extracorporeal shockwave lithotripsy (SWL) performed in the early period (within the first 24 hours). Data of patients who underwent SWL with a diagnosis of unilateral radiopaque 5 to 10 mm upper ureteral stones were retrospectively examined. Patients were divided into 2 groups. Group 1 (early SWL) consisted of patients with SWL performed within 24 hours after the onset of colic pain (<24 hours), while group 2 (deferred SWL) comprised patients with SWL performed 24 hours or more from the onset of pain (≥24 hours). The primary endpoint of the study was planned to determine 1-month SFR in both groups. The secondary endpoint was determined to be the factor affecting SWL success. The mean age of 216 patients (130 men, 86 women) included in this study was 46.5 ± 12.1 years. SFR within 1 month was detected in 175 patients (81%). In the early SWL group, the average number of SWL sessions was fewer (1.26 vs 1.83 P = .026) and the time to the stone-free state was shorter (11 vs 15.4 days P = .044). SFR within 1 month was higher in the early SWL group (85.5% vs 71.8% P = .036). In multivariate analysis, stone size, Hounsfield Units, and early SWL were predictive factors for SWL success. Performing SWL within the first 24 hours is highly effective in patients with symptomatic 5 to 10 mm upper ureteral stones.
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Affiliation(s)
- Mubariz Aydamirov
- Department of Urology, Başkent University Alanya Application and Research Center, Antalya, Turkey
| | - Kadir Karkin
- Department of Urology, Health Sciences University, Adana City Training and Research Hospital, Adana, Turkey
| | - Adem Altunkol
- Department of Urology, Health Sciences University, Adana City Training and Research Hospital, Adana, Turkey
| | - Ediz Vuruskan
- Department of Urology, Health Sciences University, Adana City Training and Research Hospital, Adana, Turkey
| | - Eyup Kaplan
- Department of Urology, Abdulkadir Yüksel State Hospital, Gaziantep, Turkey
| | - Guclu Gurlen
- Department of Urology, Health Sciences University, Adana City Training and Research Hospital, Adana, Turkey
| | - Bugra Aksay
- Department of Urology, Health Sciences University, Adana City Training and Research Hospital, Adana, Turkey
| | - Omer Faruk Akgun
- Department of Urology, Health Sciences University, Adana City Training and Research Hospital, Adana, Turkey
| | - Keremhan Gozukara
- Department of Urology, Health Sciences University, Adana City Training and Research Hospital, Adana, Turkey
| | - Ferhat Ortaoglu
- Department of Urology, Health Sciences University, Adana City Training and Research Hospital, Adana, Turkey
| | - Muslum Ahmet Tunckiran
- Department of Urology, Başkent University Alanya Application and Research Center, Antalya, Turkey
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Singh N, Agarwal S, Sarpal R. Prospective Evaluation of Extracorporeal Shockwave Lithotripsy in Renal and Upper Ureteric Stone Treatment: Clinical Assessment and Results. Cureus 2024; 16:e61102. [PMID: 38800778 PMCID: PMC11128184 DOI: 10.7759/cureus.61102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION Extracorporeal shockwave lithotripsy (ESWL) is a widely accepted non-invasive treatment for renal and upper ureteric stones smaller than 2 cm due to its safety and efficacy. Despite advancements in minimally invasive techniques, extracorporeal shockwave lithotripsy remains an important modality. AIMS AND OBJECTIVE This prospective observational study aimed to evaluate the outcomes of ESWL in managing renal and upper ureteric stones measuring less than 2 cm in terms of stone clearance. MATERIAL AND METHODS In a study conducted at a university-affiliated tertiary care hospital, 119 patients with renal and upper ureteric stones underwent extracorporeal shockwave lithotripsy over a 12-month period. Data on patient demographics, stone characteristics, treatment procedures, and complications were collected. Follow-up assessments were performed at two-week intervals for up to two months post-treatment. RESULTS The mean age of patients was 39.78 years, with a mean stone size of 1.2 cm. Right kidney stones were more prevalent (61.3% [n=76]). Complications included fever (19.3% [n=23]), gross haematuria (24.3% [n=29]), and steinstrasse (21.8% [n=26]). The success rate of extracorporeal shockwave lithotripsy was 81.5% (n=97), with 18.5% (n=22) of patients requiring surgical intervention due to incomplete fragmentation or residual fragments >4 mm. Stone size and density played significant roles in treatment success. CONCLUSION Despite advancements in minimally invasive techniques, ESWL retains its significance as a noninvasive and effective treatment option for renal and upper ureteric stones smaller than 2 cm. Its success depends on various factors, including the stone site, size, and composition. ESWL offers advantages such as minimal morbidity, shorter hospital stays, and better patient compliance. Complications such as steinstrasse are manageable with conservative measures or ancillary procedures. While ESWL may be losing ground in some cases, its noninvasive nature and favourable outcomes make it a valuable option in the armamentarium for stone management.
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Affiliation(s)
- Nimisha Singh
- General Surgery, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND
- Plastic and Reconstructive Surgery, Jawaharlal Nehru Medical College (JNMC) Aligarh Muslim University (AMU), Aligarh, IND
| | - Shikhar Agarwal
- Urology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND
| | - Rajeev Sarpal
- Urology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, IND
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Oliveira B, Teixeira B, Magalhães M, Vinagre N, Fraga A, Cavadas V. Extracorporeal shock wave lithotripsy: retrospective study on possible predictors of treatment success and revisiting the role of non-contrast-enhanced computer tomography in kidney and ureteral stone disease. Urolithiasis 2024; 52:65. [PMID: 38630281 PMCID: PMC11024041 DOI: 10.1007/s00240-024-01570-7] [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] [Received: 03/18/2024] [Accepted: 04/06/2024] [Indexed: 04/19/2024]
Abstract
Extracorporeal shock wave lithotripsy (ESWL) is a safe and efficient treatment option for urinary stone disease. The overall stone-free rate (SFR) varies significantly. This study aimed to assess the influence of stone size, location, stone density, and skin-to-stone distance (SSD), on the outcome of ESWL. We assessed whether pre-treatment non-contrast-enhanced CT scan (NCCT) confers significant advantages compared to kidney-ureter-bladder film (KUB) only. We reviewed the medical records of 307 cases (165 men, 142 women) with renal and ureteral stones treated consecutively at our institution with ESWL between 2020 and 2023. 44 of these underwent a NCCT. The outcome of ESWL was defined in two ways: visible stone fragmentation on KUB, and the need for further treatment. Overall success of fragmentation was 85% (261 patients). 61% of patients (n = 184) didn't need any further treatment. Stone size and location correlated significantly with treatment outcomes regarding the need for further treatment (p = 0.004) and stone fragmentation (p = 0.016), respectively. Unlike mean SSD (p = 0.462), the mean attenuation value (MAV) significantly correlated with the need for retreatment (p = 0.016). MAV seems to be a better predictor of treatment success (AUC of the ROC curve: 0.729), compared to stone size (AUC: 0.613). The difference between groups (with and without NCCT) in both treatment outcomes did not reach statistical significance. During decision-making, information regarding SSD and MAV can be useful in more dubious scenarios. However, it appears that their inclusion doesn't provide substantial advantages when compared to relying solely on KUB.
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Affiliation(s)
| | | | | | - Nuno Vinagre
- Unidade Local de Saúde de Santo António, Porto, Portugal
| | - Avelino Fraga
- Unidade Local de Saúde de Santo António, Porto, Portugal
| | - Vítor Cavadas
- Unidade Local de Saúde de Santo António, Porto, Portugal
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Bahilo-Mateu P, Budia-Alba A. Extracorporeal shockwave lithotripsy in the management of urinary stones: New concepts and techniques to improve outcomes. Asian J Urol 2024; 11:143-148. [PMID: 38680578 PMCID: PMC11053317 DOI: 10.1016/j.ajur.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 11/07/2023] [Indexed: 05/01/2024] Open
Abstract
Objective Extracorporeal shockwave lithotripsy (SWL) currently plays an important role in the treatment of urinary tract lithiasis. The purpose of this article was to describe new concepts and procedural strategies that would improve results using SWL as a treatment for urolithiasis, thereby achieving better clinical practice. Methods A systematic review process was carried in PubMed/PMC from January 2003 to March 2023. A narrative synthesis of the most important aspects has been made. Results The important recommendations for the adequate selection of the candidate patient for treatment with SWL are summarized, as well as the new strategies for a better application of the technique. Aspects about intraoperative position, stone localization and monitoring, analgesic control, machine and energy settings, and measures aiming at reduced risk of complications are described. Conclusion To achieve the therapeutic goal of efficient stone disintegration without increasing the risk of complications, it is necessary to make an adequate selection of patients and to pay special attention to several important factors in the application of treatment. Technological development in later generation devices will help to improve current SWL results.
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Affiliation(s)
- Pilar Bahilo-Mateu
- Lithotripsy and Endourology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Alberto Budia-Alba
- Lithotripsy and Endourology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
- Lithotripsy and Endourology Unit, Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
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Tajima A, Bouisset F, Ohashi H, Sakai K, Mizukami T, Rizzini ML, Gallo D, Chiastra C, Morbiducci U, Ali ZA, Spratt JC, Ando H, Amano T, Kitslaar P, Wilgenhof A, Sonck J, De Bruyne B, Collet C. Advanced CT Imaging for the Assessment of Calcific Coronary Artery Disease and PCI Planning. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101299. [PMID: 39131223 PMCID: PMC11307873 DOI: 10.1016/j.jscai.2024.101299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 08/13/2024]
Abstract
Vascular calcification is a hallmark of atherosclerosis and adds considerable challenges for percutaneous coronary intervention (PCI). This review underscores the critical role of coronary computed tomography (CT) angiography in assessing and quantifying vascular calcification for optimal PCI planning. Severe calcification significantly impacts procedural outcomes, necessitating accurate preprocedural evaluation. We describe the potential of coronary CT for calcium assessment and how CT may enhance precision in device selection and procedural strategy. These advancements, along with the ongoing Precise Procedural and PCI Plan study, represent a transformative shift toward personalized PCI interventions, ultimately improving patient outcomes in the challenging landscape of calcified coronary lesions.
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Affiliation(s)
- Atomu Tajima
- Cardiovascular Center, OLV Hospital, Aalst, Belgium
| | | | - Hirofumi Ohashi
- Department of Cardiology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Koshiro Sakai
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | | | - Maurizio Lodi Rizzini
- PolitoMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Diego Gallo
- PolitoMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Claudio Chiastra
- PolitoMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Umberto Morbiducci
- PolitoMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Ziad A. Ali
- St Francis Hospital & Heart Center, Roslyn, New York
| | | | - Hirohiko Ando
- Department of Cardiology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Aichi, Japan
| | | | - Adriaan Wilgenhof
- Cardiovascular Center, OLV Hospital, Aalst, Belgium
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Jeroen Sonck
- Cardiovascular Center, OLV Hospital, Aalst, Belgium
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Keser F, Culpan M, Cakici MC, Atis RG, Yildirim A. The effect of bioelectric impedance analysis on the success of extracorporeal shock wave lithotripsy. Urolithiasis 2023; 51:93. [PMID: 37400587 DOI: 10.1007/s00240-023-01465-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/21/2023] [Indexed: 07/05/2023]
Abstract
Bioelectric impedance analysis (BIA) is a non-invasive method that can show the distribution of fatty and lean mass of the body. In this study, we aimed to determine the effect of BIA on extracorporeal shock wave lithotripsy (SWL) success. Our secondary aim was to determine the factors predicting transition from a single SWL session to multiple sessions. Patients who underwent SWL due to kidney stones were prospectively included. Demographics, pre-procedural BIA parameters (fat percentage, obesity degree, muscle mass, total water and metabolic rate), stone parameters, and number of SWL sessions were recorded. Univariate and multivariate regression analyzes were made to determine independent risk factors for success. Then, the successful group was divided into two subgroups according to their SWL session number as one session or multiple sessions and multivariate regression analysis was made to determine independent risk factors. Stone-free status was achieved in 114 (61.2%) of 186 patients. Stone Hounsfield Unit (HU) (OR: 0.998, p = 0.004), stone volume (OR: 0.999, p = 0.023) and fat percentage (OR: 0.933, p = 0.001) were independent risk factors for stone-free status in multivariate analysis. HU value of the stone (OR: 1.003, p = 0.005) and age (OR: 1.032, p = 0.031) were determined as independent risk factors for transition to multiple sessions in the subgroup analysis of the successful group. Fat percentage, stone volume, and stone density were determined as factors affecting success in SWL. Routine use of BIA may be considered to predict success before SWL. The probability of SWL success in a single session decreases as the age and stone's HU value increase.
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Affiliation(s)
- Ferhat Keser
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Meftun Culpan
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Mehmet Caglar Cakici
- Department of Urology, Istanbul Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | | | - Asif Yildirim
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Garg M, Johnson H, Lee SM, Rai BP, Somani B, Philip J. Role of Hounsfield Unit in Predicting Outcomes of Shock Wave Lithotripsy for Renal Calculi: Outcomes of a Systematic Review. Curr Urol Rep 2023; 24:173-185. [PMID: 36802317 PMCID: PMC10038959 DOI: 10.1007/s11934-023-01145-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2022] [Indexed: 02/23/2023]
Abstract
PURPOSE OF REVIEW Extracorporeal shock wave lithotripsy success rates depend on several stone and patient-related factors, one of which is stone density which is calculated on computed tomography scan in Hounsfield Units. Studies have shown inverse correlation between SWL success and HU; however, there remains considerable variation between studies. We performed a systematic review regarding the use of HU in SWL for renal calculi to consolidate the current evidence and address current knowledge gaps. RECENT FINDINGS Database including MEDLINE, EMBASE, and Scopus were searched from inception through August 2022. Studies in English language analysing stone density/attenuation in adult patients undergoing SWL for renal calculi were included for assessment of Shockwave lithotripsy outcomes, use of stone attenuation to predict success, use of mean and peak stone density and Hounsfield unit density, determination of optimum cut-off values, nomograms/scoring systems, and assessment of stone heterogeneity. 28 studies with a total of 4,206 patients were included in this systematic review with sample size ranging from 30 to 385 patients. Male to female ratio was 1.8, with an average age of 46.3 years. Mean overall ESWL success was 66.5%. Stone size ranged from 4 to 30 mm in diameter. Mean stone density was used by two-third of the studies to predict the appropriate cut-off for SWL success, ranging from 750 to 1000 HU. Additional factors such as peak HU and stone heterogeneity index were also evaluated with variable results. Stone heterogeneity index was considered a better indicator for success in larger stones (cut-off value of 213) and predicting SWL stone clearance in one session. Prediction scores had been attempted, with researchers looking into combining stone density with other factors such as skin to stone distance, stone volume, and differing heterogeneity indices with variable results. Numerous studies demonstrate a link between shockwave lithotripsy outcomes and stone density. Hounsfield unit < 750 has been found to be associated with shockwave lithotripsy success, with likelihood of failure strongly associated with values over 1000. Prospective standardisation of Hounsfield unit measurement and predictive algorithm for shockwave lithotripsy outcome should be considered to strengthen future evidence and help clinicians in the decision making. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) database: CRD42020224647.
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Affiliation(s)
- Megha Garg
- Bristol Urological Institute, North Bristol NHS Trust, West bury-on-Trym, Bristol, BS10 5NB UK
| | - Hans Johnson
- Bristol Urological Institute, North Bristol NHS Trust, West bury-on-Trym, Bristol, BS10 5NB UK
| | - Su-min Lee
- Bristol Urological Institute, North Bristol NHS Trust, West bury-on-Trym, Bristol, BS10 5NB UK
| | | | - Bhaskar Somani
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Joe Philip
- Bristol Urological Institute, North Bristol NHS Trust, West bury-on-Trym, Bristol, BS10 5NB UK
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Akkas F, Sam E, Ayten A, Atar FA, Guner E. Can shock wave lithotripsy lead to impaction of ureteral stones? Minerva Urol Nephrol 2023; 75:85-91. [PMID: 33781025 DOI: 10.23736/s2724-6051.21.04278-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND One of the underlying reasons for shock wave lithotripsy (SWL) resistance is the ureteral stone impaction. This study aimed to investigate the accuracy of the hypothesis, suggesting that SWL per se can be the reason for ureteral stone impaction. METHODS One hundred and seventy-six patients were enrolled in the study. Data of the patients (N.=50) treated with SWL and subsequent semirigid ureteroscopic laser lithotripsy (SULL) in our center between January 2014 and January 2020 were retrospectively reviewed compared with the data of the patients (N.=126) who underwent SULL without prior SWL treatment during the same period. Patients reported to have ureteral stone impaction during SULL were compared with those without stone impaction in terms of demographic parameters, stone characteristics and clinical data, including symptom duration and presence or absence of SWL history. RESULTS The success rate of SULL was determined as 80.1% (141/176). Univariable analysis revealed statistically significant differences between the patients with and without stone impaction concerning stone diameter, stone volume, pre-SULL SWL history, symptom duration and ureteral wall thickness (UWT). Multivariable logistic regression analysis revealed that symptom duration and UWT were independent predictive factors for ureteral stone impaction. CONCLUSIONS Symptom duration and UWT are independent predictors of ureteral stone impaction. Symptom duration and UWT should be considered during treatment planning and informed consent process before proceeding with SULL.
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Affiliation(s)
- Fatih Akkas
- Department of Urology, Erzurum Regional Training and Research Hospital, Health Sciences University Erzurum, Turkey -
| | - Emre Sam
- Department of Urology, Erzurum Regional Training and Research Hospital, Health Sciences University Erzurum, Turkey
| | - Ali Ayten
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Feyzi A Atar
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Ekrem Guner
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Health Sciences University, Istanbul, Turkey
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Gu J, Luo S, Jiang L, Hu D, Zhao G, Tang W. Novel scoring system combined with a virtual reality technique for the preoperative evaluation of the stone-free status after flexible ureteroscopy: the H.L.P.E.S. score. BMC Urol 2022; 22:161. [PMID: 36209157 PMCID: PMC9547458 DOI: 10.1186/s12894-022-01108-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The original S.O.L.V.E. scoring system was modified using virtual reality technology, and a new H.L.P.E.S scoring system was constructed to improve the accuracy of predicting the stone-free rate after flexible ureteroscopy. METHODS We retrospectively analyzed clinical and virtual reality data of 150 patients with renal calculi who underwent flexible ureteroscopy at the First Affiliated Hospital of Chongqing Medical University, Chongqing, China, from September 2019 to January 2022. Factors affecting the stone-free rate were evaluated in univariate and multiple logical regression analyses. Factors were divided by cut-off value under the receiver-operating characteristic curve and scored accordingly to a well-known international scoring system. Area under the curve predicted the stone-free rate. The accuracy and superiority of the stone-free rate after flexible ureterorenoscopy was compared between this scoring system and the S.O.L.V.E, R.I.R.S, T.O.HO, and RUSS scores. RESULTS Multiple logistic regression showed that the stone surface area, renal pelvis volume, and length of the calyces funnel were correlated with stone-free rate (P < 0.01, P = 0.021, P = 0.019, respectively). The H.L.P.E.S. score included stone surface area (1-2 points), renal pelvis volume (1-2 points), length of calyces funnel (1-2 points), pelvic calyceal height (1-2 points), and essence of stone (1-2 points). The area under the receiver-operating characteristic curve of H.L.P.E.S. score was 0.927, which was higher than the S.O.L.V.E., R.I.R.S., T.O.HO, and RUSS scores. CONCLUSION H.L.P.E.S. scoring can effectively predict the stone-free rate after flexible ureteroscopy for renal calculi and is superior to other scoring systems.
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Affiliation(s)
- Jianglin Gu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shengjun Luo
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Jiang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daixing Hu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guozhi Zhao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Tang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Mehra S. Role of Dual-Energy Computed Tomography in Urolithiasis. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1749108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Objectives The objectives of this study are to describe the role of dual-energy computed tomography (DECT) in evaluation of renal stones in current practice and elaborate the imaging findings that need to be reported to help surgeons make an appropriate management strategy for renal stones.
Background Nephrolithiasis is a global problem, affecting people across geographical, cultural, and economic boundaries. Renal stones can be accurately diagnosed on computed tomography.
Discussion With the development of DECT, renal stones can now be better characterized in terms of stone burden, stone composition, and stone fragility.
Conclusion These parameters are helpful to treating surgeons in not only planning an appropriate management for patient but also in predicting the success of the various procedures such as extracorporeal shock wave lithotripsy, flexible ureterorenoscopy, or percutaneous nephrolithotomy. Familiarity with recent developments will help radiologists give an apt description of renal stone to meet the requirements of treating surgeon.
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Affiliation(s)
- Shibani Mehra
- Department of Radiodiagnosis, RML Hospital, Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
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Wagenius M, Oddason K, Utter M, Popiolek M, Forsvall A, Lundström KJ, Linder A. Factors influencing stone-free rate of Extracorporeal Shock Wave Lithotripsy (ESWL); a cohort study. Scand J Urol 2022; 56:237-243. [DOI: 10.1080/21681805.2022.2055137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Magnus Wagenius
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
- Department of Urology Helsingborg Hospital, Helsingborg, Sweden
| | - Karl Oddason
- Department of Urology Helsingborg Hospital, Helsingborg, Sweden
| | - Maria Utter
- Department of Urology Helsingborg Hospital, Helsingborg, Sweden
| | - Marcin Popiolek
- Department or Urology, Örebro University Hospital, Örebro, Sweden
| | - Andreas Forsvall
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
- Department of Urology Helsingborg Hospital, Helsingborg, Sweden
| | - Karl-Johan Lundström
- Institution of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Adam Linder
- Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden
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12
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Efficacy of electromagnetic extracorporeal shockwave lithotripsy on high-density ureteral stones. Prog Urol 2022; 32:608-615. [DOI: 10.1016/j.purol.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/12/2021] [Accepted: 12/27/2021] [Indexed: 11/23/2022]
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Chang CK, Chang CC, Wu VC, Geng JH, Lee HY. The Relationship Between Renal Stones and Primary Aldosteronism. Front Endocrinol (Lausanne) 2022; 13:828839. [PMID: 35222284 PMCID: PMC8864315 DOI: 10.3389/fendo.2022.828839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 01/13/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The association between primary aldosteronism (PA) and nephrolithiasis is still unclear. The hypercalciuria and hypocitraturia of PA patients might be the reason leading to recurrent calcium nephrolithiasis. This study aimed to evaluate the relationship between PA and renal stones, including stone size and density. MATERIALS AND METHODS From February 2010 to March 2021, we retrospectively collected 610 patients who presented to our medical center with hypertension history, and all these patients, suspicious of PA, had PA data survey. In total, 147 patients had kidney stone and were divided into 44 patients with essential hypertension as group 1 and 103 patients with PA as group 2. Pearson χ2 test and independent Student's t-test were performed to examine the differences among variables. RESULTS The mean age was 54.4 ± 12.0 years in group 1 and 53.0 ± 11.1 years in group 2. The incidence rate of renal stones in the PA group was around 24%. No significant differences between the two groups were found for gender, systolic/diastolic blood pressure, duration of hypertension, diabetes mellitus history, and laterality of kidney stone; however, mean stone size was 4.0 ± 3.3 mm in group 1 and 6.5 ± 7.2 mm in group 2, with a significantly larger renal stone size noted in the PA group than that in the essential hypertension group (p = 0.004). Hounsfield unit (HU) density was higher in the PA group vis-à-vis the essential hypertension cohort, although this did not reach a significant difference (p = 0.204). CONCLUSIONS Our study revealed that PA patients had a higher incidence rate of renal stones compared to that of the general population. Besides, the PA-related renal stones also presented as larger and harder than those of the essential hypertension group. Further investigation concerning the association between PA and renal stones is warranted.
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Affiliation(s)
- Chun-Kai Chang
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department and Graduate Institute of Forensic Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Vin-Cent Wu
- Section of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiun-Hung Geng
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Hsiang-Ying Lee
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- *Correspondence: Hsiang-Ying Lee,
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Nagla S, Abou-Farha M, El-Abd A, Gameel T, Eltatawy H. Efficacy of extracorporeal shockwave lithotripsy, with modified position of the machine head in the treatment of lower calyceal stones in obese patients. Urol Ann 2022; 14:81-84. [PMID: 35197708 PMCID: PMC8815349 DOI: 10.4103/ua.ua_176_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/12/2021] [Indexed: 11/21/2022] Open
Abstract
Context: Extracorporeal shock wave lithotripsy (ESWL) has inferior results in the lower calyceal stones, especially in obese patients. Aims: This study aimed at evaluating of the efficacy of extracorporeal shockwave lithotripsy, with modified position of the machine head in the treatment of single lower calyceal stones in obese patients. Settings and Design: This was a prospective study (phase IV trial). Subjects and Methods: We studied the anterior rotation of the shock wave machine head in obese patients for the treatment of lower calyx stones. From February 2015 to June 2019, 105 obese patients (body mass index [BMI] ≥35) having lower calyx stones (≤20 mm) underwent ESWL at our institute. The procedure was done in a supine position, and the head of the shock-wave machine was tilted anteriorly. ESWL was considered successful if the kidney was completely cleared of stones. Statistical Analysis Used: The statistical methods used were descriptive statistics, mean, standard deviation frequency analysis, Chi-square test, unpaired t-test test, and Pearson correlations (r). Results: The mean BMI of these patients was 39.71 ± 2.8 kg/m2, the mean stone size was 17.4 ± 2.1 mm, the mean stone density was 767.1 ± 193.4 Hounsfield unit, and the mean of skin to stone distance (SSD) was 145.4 ± 4.5 mm. ESWL was successful in 86 (81.9%) patients; 13 patients (12.4%) showed complete success after the first session, while 37 (35.2%), 25 (23.8%), and 11 (10.5%) patients showed success after the second, third, and fourth sessions, respectively. ESWL failed in 19 (19.1%) cases. The success rate decreased significantly with higher stone density and SSD (P < 0.001), with negative correlations (r values) of −0.871 and −0.811, respectively. Conclusions: Anterior rotation of the head of the shock wave machine is a suitable option for the treatment of lower calyceal stones in obese patients.
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Lee JY, Andonian S, Bhojani N, Bjazevic J, Chew BH, De S, Elmansy H, Lantz-Powers AG, Pace KT, Schuler TD, Singal RK, Wang P, Ordon M. Canadian Urological Association guideline: Management of ureteral calculi - Abridged version. Can Urol Assoc J 2021; 15:383-393. [PMID: 34847343 PMCID: PMC8631858 DOI: 10.5489/cuaj.7652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jason Y. Lee
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Sero Andonian
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Naeem Bhojani
- Department of Urology, Université de Montréal, Montreal, QC, Canada
| | - Jennifer Bjazevic
- Division of Urology, Department of Surgery, Western University, London, ON, Canada
| | - Ben H. Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Shubha De
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Hazem Elmansy
- Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | | | - Kenneth T. Pace
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Trevor D. Schuler
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Rajiv K. Singal
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Peter Wang
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Michael Ordon
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Implementation of a Technique Based on Hounsfield Units and Hounsfield Density to Determine Kidney Stone Composition. ACTA ACUST UNITED AC 2021; 7:606-613. [PMID: 34698253 PMCID: PMC8544724 DOI: 10.3390/tomography7040051] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/21/2021] [Accepted: 09/29/2021] [Indexed: 11/28/2022]
Abstract
Hounsfield units (HU) are a measure of radiodensity, related to the density of a tissue and the composition of kidney stones. Hounsfield density is what is related to the composition of kidney stones. In the standard acquisition method, these measures are arbitrary and dependent on the operator. This study describes the implementation of a technique based on the HU and Hounsfield density to predict the stone compositions of patients with nephrolithiasis. By conventional percutaneous nephrolithotomy, thirty kidney stone samples corresponding to the cortex, middle, and nucleus were obtained. The HU were obtained by CT scanning with a systematic grid. Hounsfield density was calculated as the HU value divided by the stone’s greatest diameter (HU/mm). With that method and after analyzing the samples by IR-spectroscopy, anhydrous uric acid and ammonium magnesium phosphate were identified as the compounds of kidney stones. Additionally, anhydrous uric acid, magnesium ammonium phosphate, and calcium oxalate monohydrate were identified via Hounsfield density calculation. The study identified HU ranges for stone compounds using a systematic technique that avoids bias in its analysis. In addition, this work could contribute to the timely diagnosis and development of personalized therapies for patients with this pathology.
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Correlative investigation between routine clinical parameters of dual-energy computed tomography and the outcomes of extracorporeal shock wave lithotripsy in children with urolithiasis: a retrospective study. Abdom Radiol (NY) 2021; 46:4881-4887. [PMID: 34114086 DOI: 10.1007/s00261-021-03162-0] [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: 03/17/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the associations of DECT parameters with extracorporeal shock wave lithotripsy (ESWL) outcomes in pediatric patients. METHODS A retrospective study of consecutive patients with calculi who underwent ESWL and DECT in our hospital was performed in 2011-2019. The primary outcome was DECT imaging's correlation with ESWL outcomes. The secondary outcome was to determine DECT parameters independently predicting ESWL outcomes, including stone-free (SF) and residual stone (RS) statuses. RESULTS The study included 207 patients. The mean CT attenuations at 140 kVp, 80 kVp, and 120 kVp and effective atomic number (Zeff) were significantly correlated with stone free (SF) and residual stone (RS) (P < 0.05). Areas under the curves (AUCs) of CT attenuations at 120 kVp, 80 kVp, 140 kVp, and dual-energy index (DEI) were 0.784 (95% CI 0.672-0.897), 0.780 (95% CI 0.677-0.884), 0.766 (95% CI 0.658-0.885), and 0.709 (95% CI 0.578-0.840) (all P < 0.05). With cutoffs of 882.5, 1330.5, 1042.5, and 0.103 for CT attenuations at 140 kVp, 80 kVp, 120 kVp, and DEI, respectively, sensitivities and specificities were 75.0% and 31.1%, 83.3% and 31.8%, 80.3% and 31.1%, and 58.3% and 44.7%, respectively. CONCLUSION Our results demonstrated that the parameters of DECT could be used to predict ESWL outcomes (especially the SF status) in children with urolithiasis. ESWL success can be accurately predicted by DECT, and it is hard to predict ESWL failure.
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The effect of stone and patient characteristics in predicting extra-corporal shock wave lithotripsy success rate: A cross sectional study. Ann Med Surg (Lond) 2021; 70:102829. [PMID: 34540217 PMCID: PMC8441084 DOI: 10.1016/j.amsu.2021.102829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/05/2021] [Accepted: 09/05/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction We determine the effect of patient characteristics (age, sex, and body mass index BMI) and stone characteristics (density, location, and size) by non-contrast computed tomography of the kidneys, ureters, and bladder (CT-KUB) in predicting the success of extracorporeal shock wave lithotripsy (ESWL) in the treatment of kidney and ureteric stones. We present this study to further enrich the knowledge of physicians towards the effect of different patient characteristics upon predicting extra-corporal shock wave lithotripsy success rates. Methods We evaluated 155 patients who received ESWL for renal and ureteric stone measuring 3–20 mm (mm), over a 3-month period. The stone size in millimeters, density in Hounsfield units (HU) and its location was determined on pre-treatment CT-KUB. ESWL was successful if post-treatment residual renal stone fragments were ≤3 mm and for ureteric stones should be totally cleared. Results The overall success of ESWL treatment was observed in 65.8% of the 155 patients. There was no significant difference seen when the effect of patients age, sex and BMI were studied with ESWL outcome with P values were 0.155, 0.101 and 0.415 respectively. Also, stone location either in the kidney or ureter has no statistically significant effect on ESWL response rate. while stone density and size determined on CT KUB have statistically significant effect on the success rate of ESWL with a P-value of 0.002 and 0.000 respectively. Conclusions This study shows that determination of stone density and stone size on CT KUB pre ESWL can help to predict the outcome of ESWL. We propose that stone density <500 HU and stone size < 5 mm are highly likely to result in successful ESWL. Previous studies have reported a wide variation of ESWL success rate ranging from 46% to 91%. Failure of ESWL results in unnecessary exposure of renal parenchyma to shock waves and complications like renal hematoma. Increasing Efforts have been made to determine factors that predict ESWL outcome and improve patients' selection.
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Katib A, Al-Wafi O, Dakkak B, Bawa A, Basheer M, Al-Bilal I. The relationship between the stone-free status after extracorporeal shockwave lithotripsy (ESWL) treatment in different patient and kidney stone characteristics: A single center experience in Saudi Arabia. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211010658] [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
Purpose: The objective was to unveil the relationship between different relevant patient and kidney stone characteristics and the stone-free status post extracorporeal shockwave lithotripsy (ESWL) treatment. Materials and methods: Kidney stones cases referred for ESWL from October 2019 to January 2020 were collected. A total of 225 adult patients who met the criteria of being new cases of single radio-opaque kidney stones measuring 5 to 20 mm were included. We were looking for disintegrated stones down to 4 mm or less as a marker for stone-free (SF) status. The studied parameters were gender, laterality (right or left kidney), location of the stone within the kidney, stone’s density measured in Hounsfield units (HU), stone’s size, and stone-to-skin distance (SSD). Results: Out of the 225 cases treated, only 175 (77.8%) became SF after or during the study timeframe. SF status was achieved after the first session in 131 cases (58.2%). The bivariate analysis of the factors associated with higher SF rates found to be statistically significant were left kidney ( p-value of < 0.01), low stone density ( p-value of < 0.01), short stone–skin distance ( p-value of < 0.01), and small stone size ( p-value of < 0.01). On the other hand, gender and stone location within the kidney showed no association with ESWL outcomes. Conclusion: Kidney laterality, SSD, stone density, and size are influencing parameters on ESWL outcomes and achievement of stone-free status.
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Affiliation(s)
- Atif Katib
- Urology Consultant, Makkah, Saudi Arabia
| | - Osama Al-Wafi
- Family medicine consultant at Makkah Region Directorate, Makkah, Saudi Arabia
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Ahmed AF, Abdelazim H, ElMesery M, El-Feky M, Gomaa A, Tagreda I, Abozied H, Fahim A. Mini-percutaneous nephrolithotomy is a safe alternative to extracorporeal shockwave lithotripsy for high-density, renal stones: a prospective, randomised trial. BJU Int 2021; 128:744-751. [PMID: 34028170 DOI: 10.1111/bju.15493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To compare the outcomes of miniaturised percutaneous nephrolithotomy (mini-PCNL) and extracorporeal shockwave lithotripsy (ESWL) in the management of 10-20 mm, non-lower pole, renal stones. PATIENTS AND METHODS This prospective randomised double-arm trial was conducted at a tertiary care hospital in Egypt from February to December 2020. Adult patients with single, non-lower pole, high-density (≥1000 HU) renal stones were randomised to receive mini-PCNL or ESWL. The stone-free rate (SFR); operative, fluoroscopy and hospitalisation times; blood loss; auxiliary procedures; retreatment; unscheduled hospital readmission; and complications were compared between the groups. RESULTS The primary analysis included 34 patients in the mini-PCNL group and 33 in the ESWL group. Overall, the SFR was 97.1% in the mini-PCNL group vs 30.3% in the ESWL group (P < 0.001). All patients in the ESWL group required retreatment, and none of them were stone-free after the first ESWL session. None of the patients in the mini-PCNL group required retreatment. The overall operative time, fluoroscopy time, auxiliary procedure, retreatment, and unscheduled hospital readmission were significantly higher in the ESWL group. The hospital stay and decrease in the haemoglobin level were significantly higher in the mini-PCNL group. The groups were comparable for the overall complication rate. CONCLUSIONS Mini-PCNL is more effective than ESWL for treating 10-20 mm, high-density, non-lower pole renal stones. Mini-PCNL has the advantages of a high SFR and abolishing the need for retreatment and re-hospitalisation.
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Affiliation(s)
- Abul-Fotouh Ahmed
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hassan Abdelazim
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mahmoud ElMesery
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohammed El-Feky
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Aly Gomaa
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ibrahim Tagreda
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hesham Abozied
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Fahim
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Yoon JH, Park S, Kim SC, Park S, Moon KH, Cheon SH, Kwon T. Outcomes of extracorporeal shock wave lithotripsy for ureteral stones according to ESWL intensity. Transl Androl Urol 2021; 10:1588-1595. [PMID: 33968647 PMCID: PMC8100855 DOI: 10.21037/tau-20-1397] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background We evaluated the treatment outcomes of ureteral stones according to energy intensity generated by extracorporeal shock wave lithotripsy (ESWL). Methods We retrospectively analyzed 150 patients who underwent ESWL for treatment of ureteral stones between September 2018 and February 2020. All stones were confirmed by a computed tomography examination, and the size, location, skin-to-stone distance, and Hounsfield units (HU) of the stones were assessed. In addition, patient characteristics including body mass index and estimated glomerular filtration rate, which can affect treatment outcome, were also evaluated. The success or failure of ESWL was confirmed according to the session, and the factors affecting the treatment outcome were analyzed using a logistic regression model. Results Of the 150 patients, 82 (54.7%) had stones in the proximal ureter, 5 (3.3%) in the mid, and 63 (42.0%) in the distal ureter. Patients underwent ESWL an average of 1.5 times, and the success rate according to session was 65.3% for the first, 83.3% for the second, and 90.0% for the third session. A multivariate analysis revealed that stone size [odds ratio (OR) 0.81, 95% confidence interval (CI), 0.66–0.99, P=0.049] and HU (OR 0.99, 95% CI, 0.98–0.99, P=0.001) were significant factors affecting the success rate after the first ESWL session; ESWL intensity was not related to success rate. Stone size (OR 0.78, 95% CI, 0.62–0.96, P=0.022) was the only significant factor affecting the success rate in the third session. Conclusions Stone size and HU affected the ESWL success rate. ESWL intensity was not significantly related to the success rate, so it should be adjusted according to patient pain and the degree of stone fragmentation.
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Affiliation(s)
- Ji Hyung Yoon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sejun Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seong Cheol Kim
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sungchan Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kyung Hyun Moon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sang Hyeon Cheon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Taekmin Kwon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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Kim DS, Moon SK, Lee SH. Histogram of kidney stones on non-contrast computed tomography to predict successful stone dusting during retrograde intrarenal surgery. World J Urol 2021; 39:3563-3569. [PMID: 33733297 DOI: 10.1007/s00345-021-03659-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/06/2021] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To predict successful dusting of kidney stones during retrograde intrarenal surgery (RIRS) using stone density parameters and histograms measured with non-contrast computed tomography imaging. METHODS Medical records of 49 patients who underwent retrograde intrarenal surgery between January 2018 and January 2019 at Kyung Hee University Hospital were reviewed, and the data of 55 stones were evaluated. Patient age, sex, mean stone density, the highest and lowest measured Hounsfield unit (HU), standard deviation and range of the measured HUs, volume of the most measured HU, and success of dusting were evaluated. Histograms of the measured HUs were created and cutoff values for successful dusting were analyzed. RESULTS Thirty-two stones were successfully dusted during surgery. Dusted stones had a wider range of HU and higher standard deviation. The volume of the most measured HU was smaller in the dusted stones. Successful dusting could be predicted when the volume of the most measured HU was < 8.9 mm3, with range ≥ 853, or when the volume of the most measured HU was < 8.9 mm3, with range < 853, and the mean stone density was < 355. The histograms of HUs of the dusted stones were wide and rugged, while those of dusting failed stones were narrow and peaked. CONCLUSION Evaluation of stone HU histograms showed differences in distribution and proportion. This will help predict surgical outcomes and prepare for intraoperative complications.
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Affiliation(s)
- Dong Soo Kim
- Department of Urology, School of Medicine, Kyung Hee University, Kyung Hee University Medical Center, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Sung Kyoung Moon
- Department of Radiology, School of Medicine, Kyung Hee University, Seoul, 02447, Republic of Korea
| | - Sang Hyub Lee
- Department of Urology, School of Medicine, Kyung Hee University, Kyung Hee University Medical Center, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
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Outcome groups and a practical tool to predict success of shock wave lithotripsy in daily clinical routine. World J Urol 2021; 39:943-951. [PMID: 32436072 DOI: 10.1007/s00345-020-03253-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/08/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To improve outcome prediction of extracorporeal shock wave lithotripsy (SWL) by development of a model based on easily available clinical and radiographical predictors and suitable for daily clinical use. MATERIALS AND METHODS We evaluated predictive factors for SWL success in 517 consecutive patients suffering from urinary calculi who underwent SWL between 2010 and 2018. Analyses included descriptive statistics, receiver operating characteristic statistics and logistic regression. Predictive value was improved by combining parameters using model selection and recursive partitioning. RESULTS Of the 517 patients, 310 (60.0%) had a successful SWL. Best individual predictor of SWL success was mean attenuation (MAV), with an area under the curve (AUC) of 0.668, and an optimal cutpoint (OC) of 987.5 HU. The best multivariable model, including MAV, stone size, skin to stone distance (SSD), presence of an indwelling stent, and four interaction effects, yielded an AUC of 0.736. Recursive partitioning would categorize patients into three outcome groups with high (76.9%), intermediate (41%) and low (10%) success probability. High probability of SWL success (76.9%) was found for patients with a stone with MAV ≤ 987 HU or with MAV > 987 HU but stone size ≤ 11 mm and SSD (45°) ≤ 88 mm. CONCLUSION A model based on four established predictors, and provided as an Excel®-Tool, can clearly improve prediction of SWL success. In addition, patients can be classified into three defined outcome groups based on simple cutpoint combinations. Both tools improve informed decision-making in daily clinical practice and might reduce failure rates.
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Factors influencing extracorporeal shock wave lithotripsy efficiency for optimal patient selection. Wideochir Inne Tech Maloinwazyjne 2021; 16:409-416. [PMID: 34136039 PMCID: PMC8193744 DOI: 10.5114/wiitm.2021.103915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/06/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction Current literature suggests various predictors related to the stone and patient, which could influence stone fragmentation and clearance rates. Aim To establish clinical characteristics of stone disease for patients undergoing extracorporeal shockwave lithotripsy (ESWL) which may predict the success of the procedure. Material and methods One hundred and nine patients with renal stone disease diagnosed by non-contrast computed tomography (NCCT) who underwent ESWL between January 2015 and December 2019 were included in the study. Endpoints: patient being stone free (SF) or when < 4 mm fragments were detected. Age, gender, location, skin-to-stone distance, maximum stone length, stone volume, stone surface area, mean stone Hounsfield units (HU) and highest HU score were explored in uni- and multivariate regression analysis. Results Stone size revealed the highest prognostic power for ESWL failure, where OR for stone volume and stone surface area were 1.06 (1.03–1.10) and 1.04 (1.02–1.06), respectively (all p < 0.01) while a tendency was observed for skin-to-stone distance 1.02 (1.00–1.03). The amount of energy applied during the procedure to one cubic millimeter of stone volume (SMLI/stone volume) was predictive for treatment success (OR = 0.60, 95% CI: 0.41–0.87, p < 0.01). Stone volume (OR = 1.06, 95% CI: 1.00–1.14, p = 0.01) and stone surface area (OR = 1.03, 95% CI: 1.01–1.06, p = 0.02) remained as statistically significant prognostic factors for treatment failure. Conclusions Both greater stone volume and stone surface area, as well as lower power delivered per stone volume unit during the ESWL procedure, were found to be significant factors and could be useful to predict treatment failure.
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Ullah S, Muhammad SR, Farooque R, Farooque U, Farukhuddin F, Bin Zafar MD, Khadke C, Usman A, Perez J, Shehata MA. The Outcomes of Extracorporeal Shock Wave Lithotripsy for High-Density Renal Stone on Non-Contrast Computed Tomography. Cureus 2021; 13:e13271. [PMID: 33728206 PMCID: PMC7949630 DOI: 10.7759/cureus.13271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Urinary lithiasis is usually managed by extracorporeal shock wave lithotripsy (ESWL). Patients are examined using non-contrast computed tomography (NCCT) in order to evaluate the feasibility of ESWL, according to where the stone is located and how big is its size. The objective of this study is to determine the outcomes of ESWL in patients having high-density renal stone, evaluated using NCCT. Materials and methods A descriptive case series study was conducted in the Department of Urology, Sindh Institute of Urology & Transplantation, Karachi for six months. Patients of either gender aged between 25-50 years, who presented with solitary renal and ureteric calculi of 0.5-2 cm in diameter and high-density renal stones [>750 hounsfield units (HU)] were enrolled. ESWL was performed and a satisfactory outcome was defined as complete stone clearance in less than or equal to three ESWL sessions. Statistical Package for Social Sciences (SPSS) (IBM Corp., Armonk, NY) was used to analyze frequencies and percentages of the number of ESWL sessions, complete renal stone clearances, and satisfactory outcomes at the end of 12 weeks. A p-value of <0.05 was considered significant. Results The mean age of the patient was reported to be 34.08 ± 9.53 years. 51.6% male preponderance was noticed. Renal and ureteric stones were found in 69.7% and 30.3% of patients, respectively. 21.3% of patients showed stone clearance after two ESWL sessions, 27% of patients after three ESWL sessions, and 51.6% of patients after four ESWL sessions. Stone clearance was found in 58.2% of patients and a satisfactory outcome was found in 42.6% of patients. Conclusions Our results signify a satisfactory outcome of extracorporeal shock wave lithotripsy for high-density renal stone on non-contrast computed tomography. Further studies on a larger scale are needed to validate these results.
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Affiliation(s)
- Sami Ullah
- Urology, Muhammad Medical College, Mirpur Khas, PAK
| | | | | | - Umar Farooque
- Neurology, Dow University of Health Sciences, Karachi, PAK
| | - Fnu Farukhuddin
- Neurology, University Hospitals Cleveland Medical Center, Cleveland, USA
| | | | - Chinmay Khadke
- Internal Medicine, Rural Medical College (Pravara Institute of Medical Sciences) Pravara Rural Hospital, Loni, IND
| | - Ahmad Usman
- General Surgery, Nishtar Medical University and Hospital, Multan, PAK
| | - Julio Perez
- Internal Medicine, Abrazo Community Health Network, Phoenix, USA
| | - Mostafa A Shehata
- Medicine and Surgery, Alexandria Faculty of Medicine, Alexandria, EGY
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Wang R, Su Y, Mao C, Li S, You M, Xiang S. Laser lithotripsy for proximal ureteral calculi in adults: can 3D CT texture analysis help predict treatment success? Eur Radiol 2020; 31:3734-3744. [PMID: 33210203 DOI: 10.1007/s00330-020-07498-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 09/27/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To explore whether multiple 3D computed tomography texture analysis (3D-CTTA) parameters can predict the therapeutic effects of holmium: YAG laser lithotripsy (LL) on ureteral calculi. METHODS The files from 94 patients (102 stones) with proximal ureteral calculi treated only by LL at a single institution were retrospectively retrieved from January 2016 to March 2019. According to intra-operative observations and postoperative reexamination, samples were divided into a completely crushed and a non-crushed group. Preoperative non-contrast-enhanced computed tomography (NCCT) images obtained by multiple CT scanners were imported to MaZda software for 3D texture analysis (TA). The CT-derived value of each target stone was measured, and 15 TA parameters were extracted by delineating volumes of interest (VOIs). Receiver operating characteristic (ROC) curves were drawn to determine the optimal critical value of each parameter based on the Youden index, and univariable and multivariable logistic regression analyses determined the significant factors for LL success. RESULTS In univariable analysis, significant differences (p < 0.05) were observed among 7 parameters. In multivariable analysis, Perc.01 3D > 2062 (p = 0.03) and Z-fraction of image in runs (Z-Fraction) > 0.45570 (p = 0.009) were significant independent predictors, with odds ratios (ORs) of 24.204 and 60.329, respectively. In subgroup analysis based on the cutoff value of the CT-derived value (HU = 960), Perc.01 3D (OR = 44.154, 95% CI (2.379, 819.618), p = 0.011) and Z-Fraction (OR = 14.519, 95% CI (2.088, 100.953), p = 0.007) remained statistically significant. CONCLUSIONS The combination of 3D-CTTA parameters and the CT-derived value can be used as a quantitative reference to predict whether a target stone could be completely crushed by LL. KEY POINTS • Computed tomography texture analysis (CTTA) may be helpful in selecting suitable laser lithotripsy (LL) patients. • 3D-CTTA better predicts stone fragility than commonly used methods (such as the CT-derived value). • The combination of CTTA and the CT-derived value can be used as a preoperative quantitative reference.
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Affiliation(s)
- Rui Wang
- The Clinical School of Medicine, Dali University, 2 Shenghong Road, Gucheng, Dali, 671000, Yunnan Province, China
| | - Yunshan Su
- Department of Radiology, Second People's Hospital of Yunnan Province, 176 Qingnian Road, Wuhua District, Kunming, 650021, Yunnan Province, China.
| | - Chongwen Mao
- Department of Radiology, Second People's Hospital of Yunnan Province, 176 Qingnian Road, Wuhua District, Kunming, 650021, Yunnan Province, China
| | - Song Li
- Department of Urology, Second People's Hospital of Yunnan Province, 176 Qingnian Road, Wuhua District, Kunming, 650021, Yunnan Province, China
| | - Mengjing You
- Department of Radiology, Second People's Hospital of Yunnan Province, 176 Qingnian Road, Wuhua District, Kunming, 650021, Yunnan Province, China
| | - Shutian Xiang
- Department of Radiology, Second People's Hospital of Yunnan Province, 176 Qingnian Road, Wuhua District, Kunming, 650021, Yunnan Province, China
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Kim JW, Lee YJ, Ha YS, Lee JN, Kim HT, Chun SY, Kim BS. Secondary signs on preoperative CT as predictive factors for febrile urinary tract infection after ureteroscopic lithotripsy. BMC Urol 2020; 20:131. [PMID: 32854678 PMCID: PMC7457253 DOI: 10.1186/s12894-020-00701-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 08/20/2020] [Indexed: 11/29/2022] Open
Abstract
Background Febrile urinary tract infection (UTI) is one of the most common complications after ureteroscopic lithotripsy (URS). We evaluated the effect of secondary signs on preoperative computed tomography (CT) for febrile UTI after URS. Methods In total, 182 patients who underwent URS for ureteral stones from January 2013 to December 2015 were retrospectively included in this study. These patients were divided into two groups according to the presence of postoperative febrile UTI after URS. We compared the clinical factors, stone factors, and secondary signs between the groups. Predictive factors for febrile UTI after URS were analyzed using a multivariate logistic regression model. Results Febrile UTI occurred in 26 of the 182 patients. In univariate analysis, presence of comorbid chronic kidney disease (CKD) and stone size were significantly different between UTI and non-UTI groups. Among secondary signs, presence of hydroureter, perinephric fat stranding, periureteral fat stranding, and tissue rim sign were significantly different between the groups. In multivariate logistic regression analysis, comorbid CKD, stone size, perinephric fat stranding, and tissue rim sign were independent predictive factors for febrile UTI after URS. Conclusion This study demonstrated that secondary signs including perinephric fat stranding and tissue rim sign on preoperative CT, CKD, and stone size are independent predictive factors for febrile UTI after URS.
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Affiliation(s)
- Jin Woo Kim
- Department of Urology, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea
| | - You Jin Lee
- Department of Urology, Pohang Semyeng Christianity Hospital, Pohang, South Korea
| | - Yun-Sok Ha
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Jun Nyung Lee
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, South Korea.,Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Hyun Tae Kim
- Department of Urology, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea.,Department of Urology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - So Young Chun
- BioMedical Research Institute, Joint Institute for Regenerative Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Bum Soo Kim
- Department of Urology, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, South Korea. .,Department of Urology, School of Medicine, Kyungpook National University, Daegu, South Korea.
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28
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Yang SW, Hyon YK, Na HS, Jin L, Lee JG, Park JM, Lee JY, Shin JH, Lim JS, Na YG, Jeon K, Ha T, Kim J, Song KH. Machine learning prediction of stone-free success in patients with urinary stone after treatment of shock wave lithotripsy. BMC Urol 2020; 20:88. [PMID: 32620102 PMCID: PMC7333255 DOI: 10.1186/s12894-020-00662-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/26/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The aims of this study were to determine the predictive value of decision support analysis for the shock wave lithotripsy (SWL) success rate and to analyze the data obtained from patients who underwent SWL to assess the factors influencing the outcome by using machine learning methods. METHODS We retrospectively reviewed the medical records of 358 patients who underwent SWL for urinary stone (kidney and upper-ureter stone) between 2015 and 2018 and evaluated the possible prognostic features, including patient population characteristics, urinary stone characteristics on a non-contrast, computed tomographic image. We performed 80% training set and 20% test set for the predictions of success and mainly used decision tree-based machine learning algorithms, such as random forest (RF), extreme gradient boosting trees (XGBoost), and light gradient boosting method (LightGBM). RESULTS In machine learning analysis, the prediction accuracies for stone-free were 86.0, 87.5, and 87.9%, and those for one-session success were 78.0, 77.4, and 77.0% using RF, XGBoost, and LightGBM, respectively. In predictions for stone-free, LightGBM yielded the best accuracy and RF yielded the best one in those for one-session success among those methods. The sensitivity and specificity values for machine learning analytics are (0.74 to 0.78 and 0.92 to 0.93) for stone-free and (0.79 to 0.81 and 0.74 to 0.75) for one-session success, respectively. The area under curve (AUC) values for machine learning analytics are (0.84 to 0.85) for stone-free and (0.77 to 0.78) for one-session success and their 95% confidence intervals (CIs) are (0.730 to 0.933) and (0.673 to 0.866) in average of methods, respectively. CONCLUSIONS We applied a selected machine learning analysis to predict the result after treatment of SWL for urinary stone. About 88% accurate machine learning based predictive model was evaluated. The importance of machine learning algorithm can give matched insights to domain knowledge on effective and influential factors for SWL success outcomes.
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Affiliation(s)
- Seung Woo Yang
- Department of Urology, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Monwha-ro, Jung-gu, Daejeon, Republic of Korea, 35015
| | - Yun Kyong Hyon
- Division of Medical Mathematics, National Institute for Mathematical Sciences, 70 Yuseong-daero 1689beon-gil, Yuseong-gu, Daejeon, Republic of Korea, 34047
| | - Hyun Seok Na
- Department of Urology, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Monwha-ro, Jung-gu, Daejeon, Republic of Korea, 35015
| | - Long Jin
- Department of Urology, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Monwha-ro, Jung-gu, Daejeon, Republic of Korea, 35015
| | - Jae Geun Lee
- Department of Urology, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Monwha-ro, Jung-gu, Daejeon, Republic of Korea, 35015
| | - Jong Mok Park
- Department of Urology, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Monwha-ro, Jung-gu, Daejeon, Republic of Korea, 35015
| | - Ji Yong Lee
- Department of Urology, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Monwha-ro, Jung-gu, Daejeon, Republic of Korea, 35015
| | - Ju Hyun Shin
- Department of Urology, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Monwha-ro, Jung-gu, Daejeon, Republic of Korea, 35015
| | - Jae Sung Lim
- Department of Urology, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Monwha-ro, Jung-gu, Daejeon, Republic of Korea, 35015
| | - Yong Gil Na
- Department of Urology, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Monwha-ro, Jung-gu, Daejeon, Republic of Korea, 35015
| | - Kiwan Jeon
- Division of Medical Mathematics, National Institute for Mathematical Sciences, 70 Yuseong-daero 1689beon-gil, Yuseong-gu, Daejeon, Republic of Korea, 34047
| | - Taeyoung Ha
- Division of Medical Mathematics, National Institute for Mathematical Sciences, 70 Yuseong-daero 1689beon-gil, Yuseong-gu, Daejeon, Republic of Korea, 34047
| | - Jinbum Kim
- Department of Urology, Konyang University College of Medicine, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon, Republic of Korea, 35365
| | - Ki Hak Song
- Department of Urology, Chungnam National University College of Medicine, Chungnam National University Hospital, 282 Monwha-ro, Jung-gu, Daejeon, Republic of Korea, 35015.
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Azal Neto W, Reis LO, Pedro RN. Prediction of stone-free rates following extracorporeal shockwave lithotripsy in a contemporary cohort of patients with stone densities exceeding 1000 HU. Scand J Urol 2020; 54:344-348. [PMID: 32597283 DOI: 10.1080/21681805.2020.1782981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose: Nephrolithiasis is a common urologic problem, and its incidence is increasing. Shockwave Lithotripsy (SWL) has better results for patients with stones < 1000 HU. We attempted to identify SWL stone-free (SF) predictors for > 1000 HU stones.Methods: From January 2013 to September 2019, patient shared decision consecutive SWL for the treatment of a single > 1000 HU renal stone diagnosed by non-contrast computed tomography (NCCT). Endpoints: Fragmentation and SF or clinically insignificant residual fragments ≤ 4 mm at 4 weeks. Age, gender, stone side, location, size and density, number and average energy (Joules) of shocks were explored on uni- and multivariate regression analysis.Results: All sixty-one patients included were diagnosed with renal stone between 5 and 20 mm (maximum length) and underwent one SWL session only: 62.3% males, median age 48 (21-80) years, mean stone size 9.43 ± 2.9 mm (6.0-20.0), mean density 1210 ± 135 HU (1000-1558). There were 39 (63.9%) cases of SF, 16 (26.2%) of partial success and six (9.8%) of no success. Stone size was the only independent predictor of fragmentation, OR = 1.83, 95% CI = 1.32-2.55, p = 0.0003, and SF OR = 1.91, 95% CI = 1.31-2.78, p = 0.008. The best discriminatory stone size on ROC analysis was 1 cm.Conclusion: Stone size was the only significant success predictor in our cohort, with 76% SF rate for stones < 1 cm in 4 weeks follow-up, supporting that renal stones > 1000 HU may be suitable to SWL.
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Affiliation(s)
- Wilmar Azal Neto
- Department of Urology, State University of Campinas, Unicamp, Campinas, Brazil
| | - Leonardo Oliveira Reis
- Department of Urology, State University of Campinas, Unicamp, Campinas, Brazil.,Department of UroScience, Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, Brazil
| | - Renato Nardi Pedro
- Department of Urology, State University of Campinas, Unicamp, Campinas, Brazil
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30
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Hori S, Otsuki H, Fujio K, Kobayashi H, Nagao K, Nakajima K, Mitsui Y. Novel prediction scoring system for simple assessment of stone‐free status after flexible ureteroscopy lithotripsy: T.O.HO. score. Int J Urol 2020; 27:742-747. [DOI: 10.1111/iju.14289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/18/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Shunsuke Hori
- Department of Urology Faculty of Medicine Toho University TokyoJapan
- Department of Urology Abiko Toho Hospital Chiba Japan
| | - Hideo Otsuki
- Department of Urology Abiko Toho Hospital Chiba Japan
| | - Kei Fujio
- Department of Urology Abiko Toho Hospital Chiba Japan
| | | | - Koichi Nagao
- Department of Urology Faculty of Medicine Toho University TokyoJapan
| | - Koichi Nakajima
- Department of Urology Faculty of Medicine Toho University TokyoJapan
| | - Yozo Mitsui
- Department of Urology Faculty of Medicine Toho University TokyoJapan
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31
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Elbaset MA, Elkarta A, Eraky A, Badawy M, Sheir KZ, Shokeir AA. Role of pretreatment Doppler ultrasound in the prediction of factors affecting stone-clearance post-shockwave lithotripsy for ureteral stones: a prospective study. Int Urol Nephrol 2020; 52:1643-1649. [PMID: 32297179 DOI: 10.1007/s11255-020-02465-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/05/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE To identify the role of Doppler US (DUS) in the prediction of factors affecting stone-clearance post-SWL for ureteral stones in addition to its role in prediction of pretreatment stone impaction. METHODS We prospectively included patients with ureteric stone for SWL between October 2018 and September 2019. Patient's demographics were collected. Using DUS, resistive index (RI), Δ RI, and ureteric jets were evaluated in both kidneys. Also, stone site, volume, density, skin to stone distance, degree of hydronephrosis, ureteral wall thickness (UWT) were evaluated by NCCT. Univariate and multivariate logistic regression analyses were performed to identify factors that contribute to treatment success. Correlation between ipsilateral RI with other radiological findings predicting stone impaction was done. RESULTS A total of 93 patients were finally included (61 males and 32 females). The mean age was 31.4 ± 7.7 years. The success rate (absence of significant residuals post 1 month by NCCT) was 51.6%. In multivariate analysis, the presence of ureteric jet, ipsilateral lower RI, and ipsilateral lower UWT were independent factors for treatment success (P = 0.0001, 0.002, and 0.03, respectively). Also, ipsilateral absence of ureteric jet, increased hydronephrosis, and increased UWT were correlated with higher ipsilateral RI in prediction of stone impaction. Ipsilateral higher RI was found to achieve higher accuracy in stone impaction prediction (PPV of 94.8%). CONCLUSION Pretreatment DUS is a useful, non-invasive with a less irradiative tool for prediction of stone impaction and stone-free rate post-SWL for ureteric stones.
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Affiliation(s)
- M A Elbaset
- Urology Department, Clinical Fellow in Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Ahmed Elkarta
- Urology Department, Clinical Fellow in Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Eraky
- Urology Department, University Hospital Schleswig Holstein-Kiel, Kiel, Germany
| | - Mohamed Badawy
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - K Z Sheir
- Urology Department, Clinical Fellow in Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - A A Shokeir
- Urology Department, Clinical Fellow in Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Disselhorst GW, Reimerink JJ, van der Vijgh RK, Sandkuyl R, Kauer PC, Reinhard R, Tjeenk Willink MM, Jensch S, van Haarst EP. Inter- and Intraobserver Agreement in Measuring Urolithiasis Density on Nonenhanced Computed Tomography. J Endourol 2020; 34:417-422. [DOI: 10.1089/end.2019.0811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - Rutger Sandkuyl
- Department of Urology, OLVG Hospital, Amsterdam, The Netherlands
| | - Paul C. Kauer
- Department of Urology, OLVG Hospital, Amsterdam, The Netherlands
| | - Rinze Reinhard
- Department of Radiology, OLVG Hospital, Amsterdam, The Netherlands
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Gadelmoula M, Elderwy AA, Abdelkawi IF, Moeen AM, Althamthami G, Abdel-Moneim AM. Percutaneous nephrolithotomy versus shock wave lithotripsy for high-density moderate-sized renal stones: A prospective randomized study. Urol Ann 2019; 11:426-431. [PMID: 31649466 PMCID: PMC6798294 DOI: 10.4103/ua.ua_63_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Context: The management of renal stones of high density (>1000 Hounsfield units) on non-contrast computed tomography (NCCT), and moderate sized (15-25 mm) is still debatable. Aims: The aim of this study was to compare the outcomes of percutaneous nephrolithotomy (PCNL) and shock wave lithotripsy (SWL) for the high-density and moderate-sized renal stones regarding the stone-free rate (SFR), morbidity, and patients' quality of life. Settings and Design: This is a prospective randomized study. Patients and Methods: Eighty consecutive patients with renal stones, excluding those with lower calyceal stones, were randomized to receive either PCNL or SWL (40 in each arm). Patients were followed up by abdominal ultrasound and plain X-ray (NCCT if indicated) till clearance of stone. Outcomes, complications, costs, and SF-8 Health Survey scoring were recorded for each group. Statistical Analysis: We used Stata software, version 9.2 (Intercooled STATA®; StataCorp LP College Station, Texas, USA). Comparison of the two groups was made with regard to patient and stone criteria and the procedure details. Continuous variables were compared using the Mann–Whitney U-test with values shown as the median and interquartile range. Categorical variables were compared using the Pearson's Chi-square/Fisher's exact test. Multivariate logistic regression analysis was used to identify variables independently associated with the stone clearance after two sessions of SWL. P < 0.05 was considered statistically significant. Results: The basic characteristics of both groups were comparable. After a single treatment session, the SFR was 80% and 27.5% for PCNL and SWL, respectively (P < 0.001). The overall 3-month SFR was 87.5% versus 90%, respectively (P = 0.723). The median number of the required maneuvers was 1 (range: 1–3) for PCNL versus 2 (range: 1–4) for SWL (P < 0.001). The complication rate was 10% and 7.5%, respectively (P = 0.692). The cost of SWL was significantly lower (P < 0.001). On multivariate analysis, a single stone was an independent predictor for stone clearance after two sessions of SWL (odds ratio: 7.26, 95% confidence interval: 1.13–46.62, P = 0.037). Conclusions: PCNL for the dense, and moderate-sized renal stone provides higher initial success and lower re-treatment rates compared with SWL with comparable outcome after 3 months of therapy. However, SWL is an alternative, especially for a single stone.
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Affiliation(s)
- Mohamed Gadelmoula
- Department of Urology, Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Ahmad A Elderwy
- Department of Urology, Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Islam F Abdelkawi
- Department of Urology, Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Ahmed M Moeen
- Department of Urology, Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Ghaleb Althamthami
- Department of Urology, Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Ahmed M Abdel-Moneim
- Department of Urology, Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
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Ureteral wall volume at ureteral stone site is a critical predictor for shock wave lithotripsy outcomes: comparison with ureteral wall thickness and area. Urolithiasis 2019; 48:361-368. [DOI: 10.1007/s00240-019-01154-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 08/18/2019] [Indexed: 11/27/2022]
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35
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Effects of the stone density on the outcome of percutaneous nephrolithotomy in pediatric population. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.587965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sugino Y, Kato T, Furuya S, Sasaki T, Arima K, Sugimura Y. The usefulness of the maximum Hounsfield units (HU) in predicting the shockwave lithotripsy outcome for ureteral stones and the proposal of novel indicators using the maximum HU. Urolithiasis 2019; 48:85-91. [PMID: 30859262 DOI: 10.1007/s00240-019-01123-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
Computed tomography (CT) attenuation value of ureteral stones is one of the predictors of shockwave lithotripsy (SWL) outcome. It is common to use the mean Hounsfield units (HU) to describe the CT attenuation value. However, an observer bias can occur when measuring the mean HU in the conventional method. On the other hand, our way to obtain only the maximum HU is simpler and less biased. We retrospectively evaluated 464 patients with ureteral stones who underwent SWL and compared predictive accuracy of various factors including maximum and mean HU. Results were determined after a single SWL. Predictors of SWL success were examined by the statistical analysis of successful and failed groups. 324 of the 464 patients who underwent SWL were stone-free after a single SWL. Significant differences were found in factors related to CT attenuation value and stone size. As a result of receiver operating characteristic analysis, it was found that maximum HU and mean HU, major diameter and volume have equivalent prediction accuracy, respectively. Multivariate analysis revealed that maximum HU and major diameter were included in independent predictors. We also examined the new original indicators using maximum HU and major diameter. Stone-resistant probability obtained from the logistic model and Maximum HU and Major diameter Index obtained by multiplying maximum HU by major diameter were useful for predicting SWL success, respectively. In conclusion, maximum HU and mean HU have equivalent predictive accuracy, and maximum HU is easier to measure and less biased than mean HU.
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Affiliation(s)
- Yusuke Sugino
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Mie, Japan. .,Department of Urology, Yokkaichi Hazu Medical Hospital, Mie, Japan.
| | - Takahiro Kato
- Department of Urology, Yokkaichi Hazu Medical Hospital, Mie, Japan
| | - Shigeru Furuya
- Department of Radiology, Yokkaichi Hazu Medical Hospital, Mie, Japan
| | - Takeshi Sasaki
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Mie, Japan
| | - Kiminobu Arima
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Mie, Japan
| | - Yoshiki Sugimura
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Mie, Japan
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Liu R, Su W, Wang J, Gong J, Lu J. Quantitative factors of unenhanced CT for predicting fragmenting efficacy of extracorporeal shock wave lithotripsy on pancreatic duct stones. Clin Radiol 2019; 74:408.e1-408.e7. [PMID: 30808501 DOI: 10.1016/j.crad.2019.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
Abstract
AIM To find potential predictors at unenhanced computed tomography (CT) to evaluate the stone clearance rate (SCR) of pancreatic duct stones (PDS) by extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS A total of 106 consecutive patients with multiple stones of maximal transverse length (MTL) 0.3-3.6 cm in pancreatic head region were enrolled. Unenhanced CT was performed both before and after ESWL therapy. All patients underwent ESWL therapy using an electromagnetic lithotripter, and were divided into three groups with threshold values of >90%, 50-90% and <50% of SCR. Factors including sex, age, MTL, mean stone density (MSD), standard deviation of stone density (SDSD), variation coefficient of stone density (VCSD), attenuation density (AD), pancreatic duct diameter (PDD), skin-to-stone distance (SSD), and number of ESWL sessions were analysed, and their impact on SCR was evaluated by univariate and multivariate analyses. The diagnostic threshold of the independent predicting index was further calculated, and its relationship with SCR and ESWL was analysed by drawing a trend line. RESULTS The only significant predictor of SCR by ESWL was MSD (p<0.05). More courses of ESWL therapy are required in PDS patients with an MSD higher than the cut-off value of 375.4 HU (mean, 2.6 versus 1.8), but with a relatively lower SCR (mean, 43.96 versus 88.68%) . CONCLUSION MSD on pre-treatment unenhanced CT is an independent predictor for SCR of PDS patients treated with ESWL. Using a cut-off value of 375.4 HU, patients with low MSD are good candidates for ESWL therapy.
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Affiliation(s)
- R Liu
- Department of Radiology, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168, Yangpu District, Shanghai, 200433 PR China
| | - W Su
- Department of Nuclear Medicine, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168, Yangpu District, Shanghai, 200433 PR China
| | - J Wang
- Department of Radiology, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168, Yangpu District, Shanghai, 200433 PR China
| | - J Gong
- Department of Radiology, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168, Yangpu District, Shanghai, 200433 PR China.
| | - J Lu
- Department of Radiology, Changhai Hospital Affiliated to the Second Military Medical University, Changhai Road 168, Yangpu District, Shanghai, 200433 PR China.
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Kim JC, Cho KS, Kim DK, Chung DY, Jung HD, Lee JY. Predictors of Uric Acid Stones: Mean Stone Density, Stone Heterogeneity Index, and Variation Coefficient of Stone Density by Single-Energy Non-Contrast Computed Tomography and Urinary pH. J Clin Med 2019; 8:jcm8020243. [PMID: 30781839 PMCID: PMC6407098 DOI: 10.3390/jcm8020243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/09/2019] [Accepted: 02/11/2019] [Indexed: 12/12/2022] Open
Abstract
We analyzed the capacities of pertinent parameters (determined by single-energy non-contrast computed tomography [NCCT]) and urinary pH to predict uric acid stones. We reviewed the medical records of 501 patients whose stones were removed surgically or passed spontaneously between December 2014 and April 2016. Qualifying participants (n = 420) were stratified by the nature of the stone (calcium oxalate, uric acid, or infectious). Based on NCCT, we determined maximal stone length (MSL), mean stone density (MSD), and stone heterogeneity index (SHI) using Hounsfield units (HU) and calculated the variant coefficient of stone density (VCSD = SHI/MSD × 100). Urinary pH was also ascertained. Mean patient age was 55.55 ± 15.46 years. MSD (448.59 ± 173.21 HU), SHI (100.81 ± 77.37 HU), and VCSD (22.58 ± 10.55) proved to be significantly lower in uric acid versus other types of stones, as did urinary pH (5.33 ± 0.56; all p < 0.001). Receiver operating characteristic (ROC) curves depicting predictability of uric acid stones yielded area under ROC curve (AUC) values for MSD, SHI, VCSD, and urinary pH of 0.806 (95% CI: 0.761⁻0.850), 0.893 (95% CI: 0.855⁻0.931), 0.782 (95% CI: 0.726⁻0.839), and 0.797 (95% CI: 0.749⁻0.846), respectively, with corresponding cutpoints of 572.3 HU, 140.4 HU, 25.79, and 6.0. Among these four parameters, SHI was verifiably (DeLong's test) the most effective predictor of uric acid stones (all p < 0.001). Compared with MSD, VCSD, and urinary pH, SHI may better predict uric acid stones, using a cutpoint of 140.4 HU.
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Affiliation(s)
- Jong Chan Kim
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea.
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 06273, Korea.
| | - Do Kyung Kim
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 06273, Korea.
| | - Doo Yong Chung
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea.
| | - Hae Do Jung
- Department of Urology, Yongin Severance Hospital, Yonsei University Health System, Yongin 17046, Korea.
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul 03722, Korea.
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Noncontrast computed tomography factors predictive of extracorporeal shock wave lithotripsy outcomes in patients with pancreatic duct stones. Abdom Radiol (NY) 2018; 43:3367-3373. [PMID: 29766227 PMCID: PMC6208808 DOI: 10.1007/s00261-018-1639-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Purpose To assess the usefulness of factors unique to NCCT for the prediction of ESWL outcomes in patients with pancreatic duct stones. Materials and methods We retrospectively evaluated 148 patients with multiple PDS who had undergone ESWL therapy. All patients received an examination for NCCT both before and after ESWL. The following parameters were measured and recorded: patient characteristics including sex and age; NCCT parameters including mean stone length, mean stone volumes before and after ESWL, mean value of CT attenuation, standard deviation of CT attenuation, variation coefficient of CT attenuation, skin-to-stone distance, and pancreatic duct diameter; ESWL outcome indexes including stone clearance rate calculated using the formula \documentclass[12pt]{minimal}
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\begin{document}$$\frac{V0 - V1}{V0} \times 100\%$$\end{document}V0-V1V0×100%, and the number of ESWL sessions. All patients were divided into groups based on their SCR: A group (SCR ≥ 90%), B group (SCR between 50% and 90%), and C group (SCR < 50%). Analysis of variance was used among the three groups to evaluate the potential predictors of SCR, and a receiver-operating curve was established to determine the optimal cutoff value. Results ANOVA analysis revealed that MSD was the only significant predictor for SCR (p < 0.05), and ROC indicated an optimal cutoff value of +1000.45 HU, with a sensitivity up to 78.0% and specificity of 48.6%. Stones with MSD lower than +1000.45 HU had higher SCR (69.3%) than that of higher-density ones (59.6%). Pearson correlation analysis and histogram indicated a significant positive correlation between ESWL No. and MSL (r = 0.536), MSD (r = 0.250), SDSD (r = 0.247), and PDD (r = 0.227), all values being p < 0.01. Conclusion MSD is the optimal predictor of ESWL efficacy, and PDS with lower MSD had a better clearance rate with fewer fragmentation sessions.
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Mi J, Yin Z, Zhang X, Han W, Jiang X, Wang C, Li X, Li Z, Yu L, Yin L, Cheng L. Study of non-contrast helical computed tomography in evaluating holmium laser lithotripsy for urinary calculus. Exp Ther Med 2018; 16:4585-4589. [PMID: 30542408 PMCID: PMC6257793 DOI: 10.3892/etm.2018.6765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 07/20/2018] [Indexed: 11/26/2022] Open
Abstract
The present study aimed to investigate the correlation between the parameters of non-contrast helical computed tomography (NCHCT) and the total energy of holmium laser lithotripsy, and establish a correlative mathematical model. From March 2016 to February 2017, 120 patients with a single urinary calculus were examined by NCHCT prior to holmium laser lithotripsy. The calculus location was confirmed, the CT value was measured and the volume of the calculus in the established three-dimensional reconstruction model was calculated. The total energy of lithotripsy (TEL) was recorded post-operatively. A significant difference in the TEL between renal calculi and ureteral calculi was identified (P<0.001) and a high and significant correlation between the volume of the calculus and the TEL was determined (Spearman r=0.827, P<0.001). A moderate correlation was identified between the CT value of the calculus and the TEL (Spearman r=0.468, P<0.001). Multivariate linear regression analysis revealed that the location, the volume and the CT value of the calculus were independently associated with the TEL (F=288.858, adjusted R2=0.879, P<0.01). A mathematical model correlating the parameters of NCHCT with the TEL was established, which may provide a foundation to guide the use of energy in holmium laser lithotripsy, and it was possible to estimate the TEL by the location, the volume and the CT value of the calculus.
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Affiliation(s)
- Jia Mi
- Department of Ultrasound, Shandong Provincial Third Hospital, Jinan, Shandong 250031, P.R. China
| | - Zudong Yin
- CT Department, Medical Imaging Center, Shandong Provincial Third Hospital, Jinan, Shandong 250031, P.R. China
| | - Xinyi Zhang
- CT Department, Medical Imaging Center, Shandong Provincial Third Hospital, Jinan, Shandong 250031, P.R. China
| | - Wushi Han
- CT Department, Medical Imaging Center, Shandong Provincial Third Hospital, Jinan, Shandong 250031, P.R. China
| | - Xiangsen Jiang
- CT Department, Medical Imaging Center, Shandong Provincial Third Hospital, Jinan, Shandong 250031, P.R. China
| | - Changbin Wang
- CT Department, Medical Imaging Center, Shandong Provincial Third Hospital, Jinan, Shandong 250031, P.R. China
| | - Xiaobao Li
- CT Department, Medical Imaging Center, Shandong Provincial Third Hospital, Jinan, Shandong 250031, P.R. China
| | - Zhangzhu Li
- CT Department, Medical Imaging Center, Shandong Provincial Third Hospital, Jinan, Shandong 250031, P.R. China
| | - Lei Yu
- CT Department, Medical Imaging Center, Shandong Provincial Third Hospital, Jinan, Shandong 250031, P.R. China
| | - Liang Yin
- CT Department, Medical Imaging Center, Shandong Provincial Third Hospital, Jinan, Shandong 250031, P.R. China
| | - Lin Cheng
- Department of Ultrasound, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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Yamashita S, Kohjimoto Y, Iwahashi Y, Iguchi T, Iba A, Nishizawa S, Hara I. Three‐dimensional mean stone density measurement is superior for predicting extracorporeal shock wave lithotripsy success. Int J Urol 2018; 26:185-191. [DOI: 10.1111/iju.13827] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/21/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Yasuo Kohjimoto
- Department of Urology Wakayama Medical University Wakayama Japan
| | - Yuya Iwahashi
- Department of Urology Wakayama Medical University Wakayama Japan
| | - Takashi Iguchi
- Department of Urology Wakayama Medical University Wakayama Japan
| | - Akinori Iba
- Department of Urology Wakayama Medical University Wakayama Japan
| | | | - Isao Hara
- Department of Urology Wakayama Medical University Wakayama Japan
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Rathee VS, HC V, Khan SW, Singh AK, Shukla PK, Verma A, Trivedi S, Dwivedi US. Role of computed tomography morphodensitometry in predicting the outcome of shock wave lithotripsy. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415818764539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: The objective of this study was to predict the outcome of shock wave lithotripsy (SWL) on the basis of computed tomography (CT) morphodensitometry for ureteral and renal stones. We also assessed the possibility that Hounsfield unit (HU) values and the location of the stones could be used to predict the outcome of SWL. Material and methods: A prospective study was performed to measure stone size, location, composition, surface area, surface volume, stone burden, the skin-to-stone distance and the HU for solitary renal and ureteral stones by non-contrast CT studies (NCCT) from August 2013 to September 2015. Success of SWL was defined as: (1) being stone-free or (2) residual stone fragments < 4 mm by radiography/NCCT. Results: Of the 100 assessed patients, 68 patients (68%) were stone-free, 12 (12%) had residual stone fragments < 4 mm (clinically insignificant residual fragments) and 20 (20%) had residual stone fragments ≥ 4 mm/ancillary procedures. Multivariate analysis revealed that stone location and mean HU were significant predictors of SWL success. Receiver operating characteristic curves defined cut-off values for predicting treatment outcome. Treatment success rates were significantly higher for stones < 800 HU than with stones > 800 HU ( p = 0.160). Conclusion: Evaluation of stone HU values and stone location prior to SWL can predict treatment outcome and aid in the development of treatment strategies. Level of evidence 2 & 4
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Affiliation(s)
- Vazir Singh Rathee
- Department of Urology, Banaras Hindu University Institute of Medical Sciences, Varanasi, India
| | - Vivek HC
- Department of Urology, Banaras Hindu University Institute of Medical Sciences, Varanasi, India
| | - Sartaj Wali Khan
- Department of Urology, Banaras Hindu University Institute of Medical Sciences, Varanasi, India
| | - AK Singh
- Department of Urology, Banaras Hindu University Institute of Medical Sciences, Varanasi, India
| | - Pushpendra Kumar Shukla
- Department of Urology, Banaras Hindu University Institute of Medical Sciences, Varanasi, India
| | - Ashish Verma
- Department of Urology, Banaras Hindu University Institute of Medical Sciences, Varanasi, India
| | - Sameer Trivedi
- Department of Urology, Banaras Hindu University Institute of Medical Sciences, Varanasi, India
| | - Udai Shankar Dwivedi
- Department of Urology, Banaras Hindu University Institute of Medical Sciences, Varanasi, India
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Abstract
Interventional treatment of stones essentially consists of three treatment modalities. Extracorporeal shockwave lithotripsy (ESWL), in addition to uterorenoscopy (URS) and percutaneous nephrolitholapaxy (PCNL) is an essential treatment pillar and is the only noninvasive therapy option for the treatment of urinary stones. After a long period of ESWL being the leading choice in stone treatment, the number of SWL interventions diminished in recent years in favor of the other two treatment modalities (URS and PCNL). This article describes the indications, surgical technique and management of complications of SWL.
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Kang HW, Cho KS, Ham WS, Kang DH, Jung HD, Kwon JK, Choi YD, Lee JY. Predictive factors and treatment outcomes of Steinstrasse following shock wave lithotripsy for ureteral calculi: A Bayesian regression model analysis. Investig Clin Urol 2018. [PMID: 29520387 PMCID: PMC5840115 DOI: 10.4111/icu.2018.59.2.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose This study aims to assess the predictive factors and treatment outcomes of Steinstrasse formation following shock wave lithotripsy (SWL) for ureter stone. Materials and Methods The medical records of 1,418 ureter stone patients who underwent one-session SWL from November 2005 to May 2013 at our medical institute were retrospectively reviewed. Finally, 551 patients met inclusion criteria. Maximal length and location of stone, stone attenuation (Hounsfield units), and skin-to-stone distance (SSD) were determined on pretreatment non-contrast computed tomography. Results Of 551 patients, 12 patients (2.2% of total cohort) developed Steinstrasse after one-session SWL. The Steinstrasse incidence was significantly associated with stone size, stone attenuation value, and SSD. Prophylactic ureter stenting was not a statistically significant predictor of Steinstrasse formation. After propensity-score matching, Steinstrasse group showed a significant shorter SSD compare to non-Steinstrasse group. Multivariate logistic regression and Bayesian analysis revealed that stone size, stone attenuation and SSD were significant predictor of Steinstrasse formation following SWL for ureter stone. The Steinstrasse resolved spontaneously in six patients and remaining six patients were treated by additional SWL. None of patients with Steinstrasse required ureteral stenting, percutaneous drainage, or consequent surgical intervention. Conclusions Steinstrasse formation following SWL for ureter stone was rare event but nonnegligible. Large stone size, high stone attenuation and short SSD were significant predictors of Steinstrasse formation following SWL for ureter stone. Majority of patients with Steinstrasse formation could be treated conservatively in this clinical scenario.
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Affiliation(s)
- Ho Won Kang
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Ham
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hyuk Kang
- Department of Urology, Inha University School of Medicine, Incheon, Korea
| | - Hae Do Jung
- Department of Urology, Yongin Severance Hospital,Yonsei University Health System, Yongin, Korea
| | - Jong Kyou Kwon
- Department of Urology, Severance Check-Up, Yonsei University Health System, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Waqas M, Saqib IUD, Imran Jamil M, Ayaz Khan M, Akhter S. Evaluating the importance of different computed tomography scan-based factors in predicting the outcome of extracorporeal shock wave lithotripsy for renal stones. Investig Clin Urol 2017; 59:25-31. [PMID: 29333511 PMCID: PMC5754579 DOI: 10.4111/icu.2018.59.1.25] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/17/2017] [Indexed: 12/13/2022] Open
Abstract
Purpose To evaluate the impact of various computed tomography scan-based parameters of renal stones on the outcome of extracorporeal shock wave lithotripsy (ESWL). Materials and Methods We conducted a retrospective study of patients who underwent ESWL for renal stones (sized 5–20 mm) from January 2013 to December 2016. We evaluated body mass index, location of the stone, skin-to-stone distance (SSD), stone attenuation value (SAV), stone diameter, Hounsfield density, stone area, and stone volume. Statistical analysis was done and significance was confirmed by multivariate logistic regression analysis. Results Of the 203 patients 122 (60.1%) had successful clearance of the stone. The presence of a double J stenting, a lower pole location, a higher SAV, higher Hounsfield density, larger stone area, larger stone diameter, and higher stone volume were negative predictors of ESWL outcome. When these parameters were analyzed with multivariate logistic regression analysis, stone location, SSD, and SAV were the only significant independent predictors of the outcome of ESWL. Conclusions Stone location, SSD, and SAV are reliable and strong predictors of ESWL outcome for the treatment of renal stones.
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Affiliation(s)
- Muhammad Waqas
- Department of Urology, Shifa International Hospital, Islamabad, Pakistan
| | - Imad-Ud-Din Saqib
- Foundation Year Resident, Shifa International Hospital, Islamabad, Pakistan
| | | | - Mohammad Ayaz Khan
- Department of Urology, Shifa International Hospital, Islamabad, Pakistan
| | - Saeed Akhter
- Department of Urology, Shifa International Hospital, Islamabad, Pakistan
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Abstract
OBJECTIVE To determine whether dual-energy CT (DECT) could accurately differentiate the composition of common canine uroliths in a phantom model. SAMPLE 30 canine uroliths with pure compositions. PROCEDURES Each urolith was composed of ≥ 70% struvite (n = 10), urate (8), cystine (5), calcium oxalate (4), or brushite (3) as determined by standard laboratory methods performed at the Canadian Veterinary Urolith Centre. Uroliths were suspended in an agar phantom, and DECT was performed at low (80 kV) and high (140 kV) energies. The ability of low- and high-energy CT numbers, DECT number, and DECT ratio to distinguish uroliths on the basis of composition was assessed with multivariate ANOVA. RESULTS No single DECT measure differentiated all urolith types. The DECT ratio differentiated urate uroliths from all other types of uroliths. The DECT and low-energy CT numbers were able to differentiate between 8 and 7 pairs of urolith types, respectively. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that DECT was unable to differentiate common types of canine uroliths in an in vitro model; therefore, it is unlikely to be clinically useful for determining urolith composition in vivo. Given that the primary reasons for determining urolith composition in vivo are to predict response to shock wave lithotripsy and develop a treatment plan, future research should focus on the correlation between DECT measurements and urolith fragility rather than urolith composition.
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Chiang BJ, Liao CH, Lin YH. The efficacy of extracorporeal shockwave lithotripsy for symptomatic ureteral stones: Predictors of treatment failure without the assistance of computed tomography. PLoS One 2017; 12:e0184855. [PMID: 28931028 PMCID: PMC5607160 DOI: 10.1371/journal.pone.0184855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/01/2017] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Non-contrast computed tomography (NCCT) is not always performed clinically if the diagnosis of ureteral calculi has been confirmed using other radiographic imaging modalities. The aim of this study was to identify predictors of successful extracorporeal shockwave lithotripsy (ESWL) without assistance of NCCT. METHODS We retrospectively reviewed the medical records of patients with symptomatic solitary ureteral stones who underwent ESWL between November 2015 and January 2016. Abdominal plain radiography or intravenous urography were performed before ESWL for localization. The exclusion criteria were repeated sessions of ESWL for the target stone and congenital genitourinary tract anomalies. The demographic characteristics, clinical history, medical charges, or imaging features of the stones were recorded. Successful treatment was defined as no fragments detected on radiography or ultrasonography in 4 weeks. For radiolucent calculi, successful treatment was regarded as cases without hydronephrosis, symptoms, or hematuria. Patients experiencing intractable pain and undergoing subsequent auxiliary surgeries were regarded as having ESWL treatment failure. RESULTS Age (odds ratio [OR], 1.042; 95% confidence interval [CI], 1.007-1.078), history of ipsilateral renal or ureteral calculi episodes (OR, 2.669; 95% CI, 1.281-5.687), stone burden (OR, 3.499; 95% CI, 1.284-9.530), and radiopaque stone (OR, 2.351; 95% CI, 1.049-5.267) were significant predictors of ESWL failure in all patients. CONCLUSIONS For treating symptomatic ureteral stones, those with smaller size, radiolucency, and without a history of ipsilateral renal or ureteral calculi could be considered for first-line therapy with ESWL.
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Affiliation(s)
- Bing-Juin Chiang
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
- Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Urology, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chun-Hou Liao
- Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Urology, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Yu-Hua Lin
- Division of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City, Taiwan
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
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Chang KD, Lee JY, Park SY, Kang DH, Lee HH, Cho KS. Impact of Pretreatment Hydronephrosis on the Success Rate of Shock Wave Lithotripsy in Patients with Ureteral Stone. Yonsei Med J 2017; 58:1000-1005. [PMID: 28792145 PMCID: PMC5552626 DOI: 10.3349/ymj.2017.58.5.1000] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/18/2017] [Accepted: 04/21/2017] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate predictors of the success rate for one session of shock wave lithotripsy (SWL), focusing on the relationships between pretreatment hydronephrosis grade and one-session SWL success rates. MATERIALS AND METHODS The medical records of 1824 consecutive patients who underwent an initial session of SWL for treatment of urinary stones between 2005 and 2013 were reviewed. After exclusion, 700 patients with a single, 4-20 mm diameter radiopaque calculus were included in the study. RESULTS The mean maximal stone length (MSL) and skin-to-stone distance were 9.2±3.9 and 110.8±18.9 mm, respectively. The average values for mean stone density (MSD) and stone heterogeneity index (SHI) were 707.0±272.1 and 244.9±110.1, respectively. One-session success rates were 68.4, 75.0, 75.1, 54.0, and 10.5% in patients with hydronephrosis grade 0, 1, 2, 3, and 4, respectively. Patients were classified into success or failure groups based on SWL outcome. Multivariate logistic regression analyses revealed that MSL [odds ratio (OR) 0.888, 95% confidence intervals (CI): 0.841-0.934, p<0.001], MSD (OR 0.996, 95% CI: 0.995-0.997, p<0.001), SHI (OR 1.007, 95% CI: 1.005-1.010, p<0.001), and pretreatment hydronephrosis grade (OR 0.601, 95% CI: 0.368-0.988, p=0.043) were significantly associated with one-session success. CONCLUSION Pretreatment grades 3 or 4 hydronephrosis were associated with failure of SWL in patients with a single ureteral stone. In the presence of severe hydronephrosis, especially hydronephrosis grade 4; physicians should proceed cautiously in choosing and offering SWL as the primary treatment for ureteral stone.
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Affiliation(s)
- Ki Don Chang
- Department of Urology and Urological Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Yong Lee
- Department of Urology and Urological Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Yoon Park
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hyuk Kang
- Department of Urology and Urological Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Ho Lee
- Department of Urology and Urological Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Su Cho
- Department of Urology and Urological Science Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Kroczak T, Scotland KB, Chew B, Pace KT. Shockwave lithotripsy: techniques for improving outcomes. World J Urol 2017; 35:1341-1346. [PMID: 28608191 DOI: 10.1007/s00345-017-2056-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/31/2017] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Shock wave lithotripsy (SWL) remains the only effective truly non-invasive treatment for nephrolithiasis. While single-treatment success rates may not equal those of ureteroscopy and percutaneous nephrolithotomy, it has an important role to play in the management of stones. In this paper, we outline the latest evidence-based recommendations for maximizing SWL outcomes, while minimizing complications. MATERIALS AND METHODS A comprehensive review of the current literature was performed regarding maximizing SWL outcomes. RESULTS Several different considerations need to be made regarding patient selection with respect to body habitus, body mass index, anatomical location and underlying urologic abnormalities. Stone composition and stone density (Hounsfield Units) are important prognostic variables. Patient positioning is critical to allow for adequate stone localization with either fluoroscopy or ultrasound. Coupling should be optimized with a low viscosity gel applied to the therapy head first and patient movement should be limited. SWL energy should be increased slowly and shockwave rates of 60 or 90 Hz should be used. Medical expulsive therapy with alpha-blockers after SWL treatment has shown benefit, particularly with stones greater than 10 mm. CONCLUSION While single-treatment success rates may not equal those of ureteroscopy or percutaneous nephrolithotomy, with proper patient selection, optimization of SWL technique, and use of adjunctive treatment after SWL, success rates can be maximized while further reducing the already low rate of serious complications. SWL remains an excellent treatment option for calculi even in 2017.
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Affiliation(s)
- Tadeusz Kroczak
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Kymora B Scotland
- Department of Urology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Ben Chew
- Department of Urology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Kenneth T Pace
- Division of Urology, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada.
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