Stone Attenuation and Skin-to-Stone Distance on Computed Tomography Predicts for Stone Fragmentation by Shock Wave Lithotripsy

Perks, Alexandra E.; Schuler, Trevor; Lee, Jason; Ghiculete, Daniela; Chung, Dae-Gyun; Honey, R. John D'a.; Pace, Kenneth T.

doi:10.1016/j.urology.2008.05.046

Cited by 199 publications

(145 citation statements)

References 23 publications

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“…Their result supported that SSD could predict SWL stone free rates [9]. An SSD > 110 mm was reported to be a significant predictor of an unfavorable outcome after SWL whereas SSD of < 90 mm can predict SWL success [9,10]. In our series, SSD was not a significant predictor of SW and session numbers.…”

Section: Discussionsupporting

confidence: 75%

The Influence of Stone Size, Skin to Stone Distance and Hydronephrosis on Extracorporeal Shock Wave Lithotripsy Session and Shock Wave Numbers in Ureteral Stones

Çakıroğlu¹,

Eyyupoglu

Taş

et al. 2013

World J Nephrol Urol

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Section: Discussionsupporting

confidence: 75%

The Influence of Stone Size, Skin to Stone Distance and Hydronephrosis on Extracorporeal Shock Wave Lithotripsy Session and Shock Wave Numbers in Ureteral Stones

Çakıroğlu¹,

Eyyupoglu

Taş

et al. 2013

World J Nephrol Urol

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“…Body habitus and renal anatomy both affect SWL outcome (Table 2). Obesity, specifically skin to stone distance (SSD) measured on axial imaging, predicts outcome, with greater than 9 or 10 cm having a poor result [26][27][28] . This is because the shock wave fired loses energy as it travels through excess body fat in a patient with an elevated body mass index [29] .…”

Section: Patient Selectionmentioning

confidence: 99%

Strategies to optimize shock wave lithotripsy outcome: Patient selection and treatment parameters

Semins

Matlaga

2015

WJN

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Shock wave lithotripsy (SWL) was introduced in 1980, modernizing the treatment of upper urinary tract stones, and quickly became the most commonly utilized technique to treat kidney stones. Over the past 5-10 years, however, use of SWL has been declining because it is not as reliably effective as more modern technology. SWL success rates vary considerably and there is abundant literature predicting outcome based on patient-and stone-specific parameters. Herein we discuss the ways to optimize SWL outcomes by reviewing proper patient selection utilizing stone characteristics and patient features. Stone size, number, location, density, composition, and patient body habitus and renal anatomy are all discussed. We also review the technical parameters during SWL that can be controlled to improve results further, including type of anesthesia, coupling, shock wave rate, focal zones, pressures, and active monitoring. Following these basic principles and selection criteria will help maximize success rate. Core tip: Shock wave lithotripsy is a commonly utilized technology for kidney stone treatment that has declining efficacy over the past decade. The paper outlines how to optimize outcomes with proper patient selection and control of treatment parameters.

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“…Similarly, Perks et al [12] noted that the combination of an SSD less than 9.0 cm and a stone attenuation value less than 900 HU was a good predictor of SWL success as compared with other groups (OR, 7.1; 95% CI, 1.6 to 32; p＜0.01). However, in the present study, SSD did not differ significantly between the success and failure groups.…”

Section: Discussionmentioning

confidence: 85%

“…Several technique of measuring stone attenuation value have been used in previous reports. Perks et al [12] investigated 2 methods elliptical region of interest (incorporating the largest cross-sectional area, excluding adjacent soft tissue) and mean attenuation calculated from three small, nonoverlapping regions of interest in each stone and found that these methods were significantly correlated (r 2 =0.98, p＜0.001). We modified the former method to calculate maximum stone cross-sectional area and contour the inner edge of the stone without including the surrounding soft tissue.…”

Section: Discussionmentioning

confidence: 99%

1461 Stone Attenuation Value and Cross-Sectional Area on Computed Tomography Predict the Success of Shock Wave Lithotripsy

Tanaka¹,

Yokota²,

Toyonaga³

et al. 2010

Journal of Urology

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Purpose: To identify the parameters on noncontrast computed tomography (NCCT) that best predict the success of shock wave lithotripsy (SWL). Materials and Methods:We reviewed the records of 75 patients who underwent SWL for urinary calculi measuring 5 to 20 mm. Using NCCT images, we estimated the largest stone cross-sectional area and contoured the inner edge of the stone. Clinical outcome was classified as successful (stone-free or ＜4 mm in diameter) or failed (stone fragments, ≥4 mm). The impact of preoperative parameters was evaluated by univariate and multivariate analysis. Results: The overall success rate was 73.3%. Average stone attenuation value, stone length, and stone cross-sectional area in the success and failure groups were 627.4±166.5 HU (Hounsfield unit) vs. 788.1±233.9 HU (p=0.002), 11.7±3.8 mm vs. 14.2±3.6 mm (p=0.015), and 0.31±0.17 cm 2 vs. 0.57±0.41 cm 2 (p＜0.001), respectively. In the multivariate analysis, stone attenuation value was the only independent predictor of SWL success (p=0.023), although stone cross-sectional area had a tendency to be associated with SWL success (p=0.053). Patients were then classified into four groups by using cutoff values of 780 HU for stone attenuation value and 0.4 cm 2 for cross-sectional area. By use of these cutoff values, the group with a low stone attenuation value and a low cross-sectional area was more than 11.6 times as likely to have a successful result on SWL as were all other groups (odds ratio, 11.6; 95% confidence interval, 3.9 to 54.7; p＜0.001). Conclusions: Stone attenuation value and stone cross-sectional area are good predictors of extracorporeal SWL outcome.

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Stone Attenuation and Skin-to-Stone Distance on Computed Tomography Predicts for Stone Fragmentation by Shock Wave Lithotripsy

Cited by 199 publications

References 23 publications

The Influence of Stone Size, Skin to Stone Distance and Hydronephrosis on Extracorporeal Shock Wave Lithotripsy Session and Shock Wave Numbers in Ureteral Stones

The Influence of Stone Size, Skin to Stone Distance and Hydronephrosis on Extracorporeal Shock Wave Lithotripsy Session and Shock Wave Numbers in Ureteral Stones

Strategies to optimize shock wave lithotripsy outcome: Patient selection and treatment parameters

1461 Stone Attenuation Value and Cross-Sectional Area on Computed Tomography Predict the Success of Shock Wave Lithotripsy

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