A prospective observational study on the predictability of Triple-D score versus Quadruple-D score in the success rate of extracorporeal shock wave lithotripsy of renal stones 1–2 cm in diameter

Abstract

Introduction: The aim of the study is to evaluate the clinical efficacy of Triple-D scoring system versus Quadruple-D scoring system for assessing stone-free rate (SFR) in individuals with renal stones measuring 1–2 cm in diameter after extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: The study was conducted on 120 patients who presented to a tertiary care center in eastern India. Systemic random sampling technique was applied with a sampling interval of 2. Triple-D scoring system comprising of three computed tomography based metrics – stone dimension (volume), stone density (Hounsfield unit), and skin-to-stone distance (SSD) was done before ESWL. Stone location was included as an additional parameter to formulate Quadruple-D scoring system where an extra score was given for stones in the non-lower polar region. Stone-free status was assessed by plain abdominal radiography 3 weeks after ESWL. Results: In the study population, stone dimension, stone density, and stone location were positive predictors of SFR after ESWL whereas age, sex, and body mass index of the patients, laterality of the stone and SSD were not. The area under the curve of Triple-D and Quadruple-D scoring systems were 0.598 and 0.674. Conclusion: Triple-D scoring system has been successfully validated as the SFR showed a parallel increase with every positive component. The Quadruple-D scoring system with a simple addition of stone location can further facilitate the validation of Triple-D scoring by increasing SFR, keeping the calculation simple and easy to use. These findings support the incorporation of Quadruple-D scoring system over Triple-D scoring system.

Predictors of stone-free rate after a single-session extracorporeal shockwave lithotripsy for a single kidney stone measuring 10 to 20 mm: A private center experience

“…They found a parallel increase in SFR with an increase in the total score value, proving the validity of this model as an independent predictor. [5] Although we did not implement this model because of the retrospective pattern of the data, which was not available for certain items, our results showed significant differences in SFR relative to the stone size, largest diameter, and HU. Many other studies have reported similar outcomes for these factors for predicting SFR after SWL.…”

“…[1] Skin-to-stone distance with stone density and dimension or volume is the components of a predictive model for the response to SWL, known as the Triple-D score. [2,5] Sengupta et al [5] evaluated the applicability of the Triple-D score in predicting SFR after a single-session SWL for stones measuring 10 to 20 mm. They found a parallel increase in SFR with an increase in the total score value, proving the validity of this model as an independent predictor.…”

“…[3,9] The current series of patients with a stone size of 10 to 20 mm examined a specific point of refining the predictors of SWL success, which was the SFR after a single-session SWL, similar to other studies. [3,5] However, in most studies, predictors of SWL success have usually been evaluated relative to the overall SFR. [7,11,12] These predictors have been classically classified into patient-, stone-, kidney-, and technique-related factors.…”

“…However, the latter includes variability in size, density, intrarenal location, and skin-to-stone distance (SSD) on noncontrast computed tomography (NCCT). [1,3,5] The size of kidney stones is the main predictor of their treatment. For a size less than 10 mm, SWL is still offered as the first treatment option.…”

“…[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Transverse diameter of the stone, mean ± SD (range), mm 10.8 ± 3.9(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) BMI = body mass index; HU = Hounsfield unit; SD = standard deviation; UPJ = ureteropelvic junction.…”