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Objective To investigate whether the visualization modality (ultrasound or fluoroscopy) used during shockwave lithotripsy (SWL) affects the clinical outcome in those instances where both imaging modalities are optional. Methods Between November 2014 and July 2016, 114 patients with radiopaque upper urinary tract calculi were randomly assigned to an ultrasound- or fluoroscopy-guided SWL group in a prospective, open-label, single-center study. A standardized SWL protocol was used. The stone-free rate and the positive outcome rate (stone-free or asymptomatic residual fragments ≤ 4 mm) were compared. Results The stone-free rate was 52% in the ultrasound-guided group compared to 42% in the fluoroscopy-guided group (p = 0.06) and the positive outcome rate was 79% in the ultrasound-guided group compared to 70% in the fluoroscopy-guided group (p = 0.28). These results were not significantly different but proved to be noninferior based on a Wilson confidence interval of independent proportions (noninferiority limit 10%). The mean number of SWL sessions was not significantly different (p = 0.4). Conclusion Our study demonstrated that the clinical results of ultrasound-guided SWL were not inferior to the results of fluoroscopy-guided SWL, while no ionizing radiation is needed.

We present the case of a 33-year old woman with osteogenesis imperfecta (OI) with progressive hearing loss and persisting vertigo. On CT-scan, symmetric extensive lucency in the pericochlear bony otic capsule and promontorium was demonstrated. The MRI-scan demonstrated symmetric areas of increased signal intensity on the T2-images with moderate contrast enhancement in the same regions. These findings correlate histologically by undermineralized thickened bone, the hallmark of OI. Hearing loss is an important clinical feature in patients with OI. The value of temporal bone imaging lies in additional confirmation of the diagnosis, determining the extent disease and excluding concomitant pathology.

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