Can stone density on plain radiography predict the outcome of extracorporeal shockwave lithotripsy for ureteral stones?

Lim, Ki Hong; Jung, Jinkyung; Kwon, Jae-Hyun; Lee, Yong Seok; Bae, Jun Ho; Cho, Min Chul; Lee, Kwang Soo; Lee, Hae Won

doi:10.4111/kju.2015.56.1.56

Cited by 16 publications

(16 citation statements)

References 21 publications

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“…The success rate in the LD group was 87.8% in our series, which was higher than that reported in previous studies [24,25]. However, in the previous studies, the stones were all <20 mm in diameter.…”

Section: Discussioncontrasting

confidence: 55%

“…However, CT is costly and exposes patients to more radiation than a standard X-ray; therefore, CT is not yet a primary radiological imaging modality for renal stones in China. A KUB is often required preoperatively to plan lithotripsy treatment, and the hardness of the stones can be roughly estimated from their appearance on KUB [24]. However, data regarding the efficacy of KUB for prediction of ESWL outcome are limited.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of Renal Stones ≥20 mm with Extracorporeal Shock Wave Lithotripsy

Wang²,

Lu³

et al. 2015

Urol Int

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Aims: To identify subgroups of patients with renal stones ≥20 mm that are more suitable for extracorporeal shock wave lithotripsy (ESWL) monotherapy. Methods: A total of 376 patients with renal stones ≥20 mm underwent monotherapy with ESWL. The treatment outcome was evaluated after 3 months of follow-up. A stone-free status or fragmentation of stones to 4 mm or smaller was considered efficacious. Results: At 3 months after treatment, the overall stone-free rate was 64.4%, and the efficacy rate was 70.7%. The efficacy rate was 89.4% for patients with a residual stone surface area ≤50% of baseline after the first ESWL, while the efficacy rate was 32.4% for other patients. The efficacy was 92.2% for stones ≤400 mm² and those with lower radiodensity, as determined by a plain (KUB) film. Conclusions: For renal stones with a surface area ≤400 mm² and a radiodensity equal to or less than that of the 12th rib as determined by a KUB film, ESWL may be considered the first line of treatment, even for stones with a diameter ≥20 mm. For large stones requiring repeat treatments, the surface area of the residual stones after the first ESWL is a predictor of the final treatment result.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Treatment of Renal Stones ≥20 mm with Extracorporeal Shock Wave Lithotripsy

Wang²,

Lu³

et al. 2015

Urol Int

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“…MSD is well-known as a potentially useful independent predictor of SWL outcomes 2 3 4 5 6 7 8 9 10 11 12 13 . MSD is the mean value of the Hounsfield units (HUs) of each pixel in a certain stone area that can be easily determined from non-contrast computed tomography (NCCT) using a picture archiving and communication system (PACS) 14 . Generally, a PACS can also provide additional pixel statistics such as the minimum, maximum, and standard deviation of HU values.…”

mentioning

confidence: 99%

Stone heterogeneity index as the standard deviation of Hounsfield units: A novel predictor for shock-wave lithotripsy outcomes in ureter calculi

Lee

Kim

Kang

et al. 2016

Sci Rep

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We investigated whether stone heterogeneity index (SHI), which a proxy of such variations, was defined as the standard deviation of a Hounsfield unit (HU) on non-contrast computed tomography (NCCT), can be a novel predictor for shock-wave lithotripsy (SWL) outcomes in patients with ureteral stones. Medical records were obtained from the consecutive database of 1,519 patients who underwent the first session of SWL for urinary stones between 2005 and 2013. Ultimately, 604 patients with radiopaque ureteral stones were eligible for this study. Stone related variables including stone size, mean stone density (MSD), skin-to-stone distance, and SHI were obtained on NCCT. Patients were classified into the low and high SHI groups using mean SHI and compared. One-session success rate in the high SHI group was better than in the low SHI group (74.3% vs. 63.9%, P = 0.008). Multivariate logistic regression analyses revealed that smaller stone size (OR 0.889, 95% CI: 0.841–0.937, P < 0.001), lower MSD (OR 0.995, 95% CI: 0.994–0.996, P < 0.001), and higher SHI (OR 1.011, 95% CI: 1.008–1.014, P < 0.001) were independent predictors of one-session success. The radiologic heterogeneity of urinary stones or SHI was an independent predictor for SWL success in patients with ureteral calculi and a useful clinical parameter for stone fragility.

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“…[12,13] Also, some other studies have studied the relationship between stone density and ESWL or PCNL outcomes. [14][15][16][17] To our knowledge, no study has compared the results of PCNL in patients with radiopaque and radiolucent stones. The authors of this study had some presumptions about the probable effects of stone opacity on PCNL results.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the outcomes of complete supine percutaneous nephrolithotomy in patients with radiopaque and radiolucent kidney stones

Falahatkar

Mokhtari

Amin

et al. 2017

Turkish Journal of Urology

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Objective: This study compared the stone opacity effect in patients who had radiopaque and radiolucent stones in percutaneous nephrolithotomy (PCNL) results. Material and methods:The medical records of 171 complete supine PCNL procedures were gathered. Patients were categorized into two groups: those with radiopaque (n=141) and those with radiolucent (n=30) stones. Kidney, ureter and bladder x-ray was done a day after PCNL and Ultrasound imaging was done two weeks later to evaluate the stone free rate. A stone free result was defined as having less than 4 mm residual stone size. Outcome parameters were compared by univariate analysis and those which were significantly different between the two groups were assessed by multivariate binary logistic regression analysis.Results: There were no significant differences in age, sex, body mass index, hypertension, diabetes mellitus, pre-surgery hemoglobin, pre-surgery serum creatinine, stone and also surgery-related parameters between the two groups. Stone free rate, surgery time, complication-related parameters, hemoglobin drop, serum creatinine and glomerular filtration rate (GFR) changes were similar in both groups based on univariate analysis. The radiopaque group had higher post-surgery GFR (p= 0.04) and longer hospital stay (p= 0.009). However, opacity had no effect on these outcomes after multivariate analysis. Higher post-surgery GFR was seen in patient with higher GFR before surgery (p<0.0001). Also, higher hemoglobin before surgery was correlated with less hospital stay (p= 0.001). Conclusion:The complete supine percutaneous nephrolithotomy outcomes are similar in patients with radiopaque and radiolucent stones.

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Can stone density on plain radiography predict the outcome of extracorporeal shockwave lithotripsy for ureteral stones?

Cited by 16 publications

References 21 publications

Treatment of Renal Stones ≥20 mm with Extracorporeal Shock Wave Lithotripsy

Treatment of Renal Stones ≥20 mm with Extracorporeal Shock Wave Lithotripsy

Stone heterogeneity index as the standard deviation of Hounsfield units: A novel predictor for shock-wave lithotripsy outcomes in ureter calculi

Comparison of the outcomes of complete supine percutaneous nephrolithotomy in patients with radiopaque and radiolucent kidney stones

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