What ' s known on the subject? and What does the study add?Stone density on non-contrast computed tomography (NCCT) is reported to be a prognosis factor for extracorporeal shockwave lithotripsy (ESWL). In this prospective study, we determined that a 970 HU threshold of stone density is a very specifi c and sensitive threshold beyond which the likelihood to be rendered stone free is poor. Thus, NCCT evaluation of stone density before ESWL may useful to identify which patients should be offered alternative treatment to optimise their outcome.
OBJECTIVE• To evaluate the usefulness of measuring urinary calculi attenuation values by non-contrast computed tomography (NCCT) for predicting the outcome of treatment by extracorporeal shockwave lithotripsy (ESWL).
PATIENTS AND METHODS• We prospectively evaluated 50 patients with urinary calculi of 5 -22 mm undergoing ESWL.• All patients had NCCT at 120 kV and 100 mA on a spiral CT scanner. Patient age, sex, body mass index, stone laterality, stone size, stone attenuation values (Hounsfi eld units [ HU ] ), stone location, and presence of JJ stent were studied as potential predictors.• The outcome was evaluated 4 weeks after the ESWL session by NCCT.• ESWL success was defi ned as patients being stone-free (SF) or with remaining stone fragments of < 4 mm, which were considered as clinically insignifi cant residual fragments (CIRF).
RESULTS• Our survey concluded that 26 patients (52%) were SF, 12 (24%) had CIRF and 12 (24%) had residual fragment on NCCT after a one ESWL treatment.• Stones of patients who became SF or had CIRF had a lower density compared with stones in patients with residual fragments [ mean ( SD ) 715 (260) vs 1196 (171) HU, P < 0.001 ] .• The Youden Index showed that a stone density of 970 HU represented the most sensitive (100%) and specifi c (81%) point on the receiver-operating characteristic curve.• The stone-free rate for stones of < 970 HU was 96% vs 38% for stones of ≥ 970 HU ( P < 0.001). A linear relationship between the calculus density and the success rate of ESWL was identifi ed.
CONCLUSION• The use of NCCT to determine the attenuation values of urinary calculi before ESWL helps to predict treatment outcome, and, consequently, could be helpful in planning alternative treatment for patients with a likelihood of a poor outcome from ESWL.
KEYWORDSshockwave lithotripsy , non-contrast computed tomography , urolithiasis Study Type -Therapy (prospective cohort) Level of Evidence 2b
The 20-core biopsy protocol was more efficient than the 10-core biopsy protocol, especially in patients with prostate specific antigen between 3 and 6 ng/ml. Nevertheless, it is mandatory to confirm whether detected tumors are clinically significant on pathological examination of the radical prostatectomy specimens.
Repeat mid-urethral sling for recurrent female stress urinary incontinence is nearly 77 % successful in a group of patients with persistent urethral hypermobility. A retropubic approach might be preferred for patients with low urethral closure pressures.
IntroductionWe evaluated the effect of the presence of a double J stent on the efficacy of extracorporeal shock wave lithotripsy (ESWL) in the treatment of lumbar ureteral stones.Material and methodsBetween January 2007 and February 2012, we performed a retrospective cohort study. Forty–four patients were treated by ESWL for lumbar ureteral stones and included into two groups for the analysis: group 1, non–stented (n = 27) and group 2, stented patients (n = 17). Treatment efficacy was evaluated by abdominal X–ray or CT–scan at 1 month. Stone–free patients and those with a residual stone ≤4 mm were considered to be cured.ResultsMean stone size and density in groups 1 and 2 were 8.2mm/831HU, and 9.7 mm/986HU respectively. Both groups were comparable for age, BMI, stone size and density, number, and power of ESWL shots given. The success rates in groups 1 and 2 where 81.5% and 47.1%, respectively (p = 0.017). There was no difference between the groups for stones measuring 8 mm or less (p = 0.574). For stones >8 mm, the success rates were respectively 76% and 22.2% for groups 1 and 2 (p = 0.030). Logistic regression analysis revealed a higher failure rate when a double J stent was associated with a stone >8 mm (p = 0.033).ConclusionsThe presence of a double J stent affects the efficacy of ESWL in the treatment of lumbar ureteral stones. This effect is significant for stones >8 mm. Ureteroscopy should be considered as the first–line treatment in such patients.
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