Shock wave lithotripsy success determined by skin-to-stone distance on computed tomography

Pareek, Gyan; Hedican, Sean P.; Lee, Fred T.; Nakada, Stephen Y.

doi:10.1016/j.urology.2005.05.011

Cited by 255 publications

(176 citation statements)

References 11 publications

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“…They suggested that patients with a BMI ≥ 30 kg/ m 2 would be more suitable treated by endoscopic manipulation. In another study by the same author, SSD of 12 cm was an independent predictor of unfavorable outcomes, suggesting that SSD might more accurately link obesity with SWL failure (18). Further, SWL may also produce detrimental side effects such as hypertension and diabetes mellitus, which are already risk factors associated with obesity (19).…”

Section: Discussionmentioning

confidence: 98%

Outcomes of intracorporeal lithotripsy of upper tract stones is not affected by BMI and skin-to-stone distance (SSD) in obese and morbid patients

et al. 2013

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Purpose: The purpose of this study is to determine if body mass index (BMI) and stone skin distance (SSD) affect stone free rate (SFR) in obese and morbid obese patients who underwent flexible URS for proximal ureteral or renal stones < 20 mm. Materials and Methods: A retrospective chart review was performed of consecutive patients that underwent flexible URS. Inclusion criteria were: proximal ureteral stones and renal stones less than 20 mm in the preoperative computed tomography (CT). SFR were then compared according to SSD and BMI. Results: A total of 153 patients were eligible for this analysis, 49 (32.02%) with SSD < 10 cm and 104 (67.97%) with SSD ≥ 10 cm. The mean stone size was 10.5 ± 6.4 mm. The overall SFR in our study was 82.4%. The SFR for the SSD < 10 and ≥ 10 were 79.6% and 83.7% respectively (p = 0.698) and for BMI < 30, ≥ 30 and < 40 and ≥ 40 were 82.9%, 81.7% and 90.9% respectively. Regression analysis showed no affect between BMI or SSD regarding SFR. Conclusion: Ureteroscopy should be considered as a first-line of treatment for renal/proximal stones in obese and morbid obese patients. URS may be preferable to SWL in obese patients independently of the SSD, BMI or the location of proximal stones. INTRODuCTIONThe ideal treatment for proximal ureteral and renal stones has become controversial, with the noninvasive nature of shock wave lithotripsy (SWL) and the expansion of endoscopic digital technology. The 2007 update of the EAU/AUA ureteral stone guidelines (1) showed that both ureteroscopy (URS) and SWL should be considered first-line therapy for proximal ureteral stones, as opposed to just SWL as previously reported. On the other hand SWL has emerged as the primary treatment of choice for renal calculi less than 1.5-2 cm (2).In that context, the treatment of urolithiasis in obese patients has gained more importance in the last years since obesity rates have increased markedly since 1980 in the United States (3). Data from the national Center for Health Statistics (2009Statistics ( -2010 showed that 35.7% of adults and 17% of children and adolescents in the United States were obese (4). According to the World Health Organization guidelines, a body mass index (BMI) of 18.5 to 25 kg/m 2 is considered normal, overweight is a BMI of 25 to Outcomes of intracorporeal lithotripsy of upper tract stones is not affected by BMI and skin-to-stone distance (SSD) in obese and morbid patients _______________________________________________

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Section: Discussionmentioning

confidence: 98%

Outcomes of intracorporeal lithotripsy of upper tract stones is not affected by BMI and skin-to-stone distance (SSD) in obese and morbid patients

et al. 2013

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“…BMI as well as fat distribution affects the outcome of extracorporeal shock wave lithotripsy (ESWL). In two studies, increasing BMI and increasing stone-to-skin distance were shown to decrease success of ESWL treatment for renal stones [8,9]. Increasing BMI has also been shown to increase operative times during laparoscopic radical prostatectomy [2].…”

Section: Discussionmentioning

confidence: 99%

Gender differences in subcutaneous and perirenal fat distribution

et al. 2010

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Purpose Body mass index (BMI) has been shown to influence the outcome of various surgical procedures. The purpose of this study is to assess the relationship between BMI, gender, and the distribution of subcutaneous and perirenal fat. Methods A retrospective review was performed for 123 patients who underwent radical or partial nephrectomy. Preoperative CT scans were reviewed by two independent observers. Subcutaneous fat was measured at three locations and perirenal fat was measured at six locations. Statistical analysis was performed using the Student's t test and the Pearson's correlation coefficient. Results Mean anterior subcutaneous fat was significantly greater in females than in males (2.54 vs. 1.78 cm, p \ 0.001) as was mean right posterolateral subcutaneous fat (2.78 vs. 2.21 cm, p = 0.03). With regard to perirenal fat, men were greater than women for all perirenal locations around the left kidney. For the right kidney, men were greater than women for four out of six perirenal positions. In both men and women, BMI was strongly correlated with subcutaneous fat. However, BMI was weakly correlated with perirenal fat. Conclusions Women exceed men in subcutaneous fat, while men exceed women in perirenal fat. Obese patients are very likely to have large amounts of subcutaneous fat, but will not necessarily have proportionally increased fat around their kidneys when compared to the patients with lower BMI. These differences may have important implications for surgical approaches to the kidney.

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“…Treatment algorithms that take into account the size, location, and proximity to surrounding retroperitoneal and abdominal structures have been developed that are predictive of treatment difficulty and complications, however, few studies combining patient and tumor specific variables to predict long-term procedural outcomes have been conducted 16 . Pareek and colleagues first introduced the concept of skin-to-target (stone) distance as a predictor of outcomes for stone disease in the setting of shockwave lithotripsy 17 . Subsequently, Blute and colleagues described skin-totumor (STT) distance for renal cortical neoplasms in a heterogeneous population of patients with benign, malignant, and indeterminant tumors of all sizes 13 .…”

Section: Skin-to-tumor Distance Predicts Treatment Failure Ofmentioning

confidence: 99%

“…The average of the three measurements at 0 degrees posteriorly, 45, and 90 degrees laterally from the skin to the center of the tumor were recorded as the STT 17 ( Figure 1). Probe distance was taken as the average distance from surface of the skin to tip of the probe for each probe based on inter-procedural CT images.…”

Section: Measurementsmentioning

confidence: 99%

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et al. 2017

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Shock wave lithotripsy success determined by skin-to-stone distance on computed tomography

Cited by 255 publications

References 11 publications

Outcomes of intracorporeal lithotripsy of upper tract stones is not affected by BMI and skin-to-stone distance (SSD) in obese and morbid patients

Outcomes of intracorporeal lithotripsy of upper tract stones is not affected by BMI and skin-to-stone distance (SSD) in obese and morbid patients

Gender differences in subcutaneous and perirenal fat distribution

Skin-to-tumor Distance Predicts Treatment Failure of T1A Renal Cell Carcinoma Following Percutaneous Cryoablation

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