Calculating the Number of Shock Waves, Expulsion Time, and Optimum Stone Parameters Based on Noncontrast Computerized Tomography Characteristics

Foda, Khaled; Abdeldaeim, Hussein M.; Youssif, Mohamed; Assem, Akram

doi:10.1016/j.urology.2013.06.061

Cited by 16 publications

(20 citation statements)

References 19 publications

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“…Consistent with previous studies [ 9 – 11 , 17 , 18 , 22 ], HU was a significant predictor of SFR after SWL in a multivariate analysis in our study. On the other hand, whether HN has an effect on the treatment outcome of SWL is controversial [ 23 , 24 ].…”

Section: Discussionsupporting

confidence: 93%

“…Despite the numerous studies and great efforts to discover factors related to SWL outcomes [ 7 , 9 , 11 , 17 – 22 ], a clear general consensus has yet to be reached. Kanao et al [ 6 ] developed a nomogram to predict lithotripsy success based on stone size, location, and the degree of stone burden.…”

Section: Discussionmentioning

confidence: 99%

“…The maximal and minimal diameters of the stone(s) were measured by using KUB and/or CT, while SSD, mean HU, and grade of HN were identified by using CT. The stone diameters, SSD, and HU were determined from usual techniques; mean HU was measured by using an ellipse constructed to calculate the mean HU value and fit completely within the stone with the Ellipse ROS tool in the bone windows on cross-sectional CT scan, and SSD was measured at 0, 45, and 90 degrees using the electronic caliper [ 9 – 11 ]. Subgroup analysis according to the stone location (renal vs. ureter) was conducted to investigate whether the SFRs differed between two groups.…”

Section: Methodsmentioning

confidence: 99%

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Clinical Nomograms to Predict Stone-Free Rates after Shock-Wave Lithotripsy: Development and Internal-Validation

Kim

Jeon

et al. 2016

PLoS ONE

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PurposeShock-wave lithotripsy (SWL) is accepted as the first line treatment modality for uncomplicated upper urinary tract stones; however, validated prediction models with regards to stone-free rates (SFRs) are still needed. We aimed to develop nomograms predicting SFRs after the first and within the third session of SWL. Computed tomography (CT) information was also modeled for constructing nomograms.Materials and MethodsFrom March 2006 to December 2013, 3028 patients were treated with SWL for ureter and renal stones at our three tertiary institutions. Four cohorts were constructed: Total-development, Total-validation, CT-development, and CT-validation cohorts. The nomograms were developed using multivariate logistic regression models with selected significant variables in a univariate logistic regression model. A C-index was used to assess the discrimination accuracy of nomograms and calibration plots were used to analyze the consistency of prediction.ResultsThe SFR, after the first and within the third session, was 48.3% and 68.8%, respectively. Significant variables were sex, stone location, stone number, and maximal stone diameter in the Total-development cohort, and mean Hounsfield unit (HU) and grade of hydronephrosis (HN) were additional parameters in the CT-development cohort. The C-indices were 0.712 and 0.723 for after the first and within the third session of SWL in the Total-development cohort, and 0.755 and 0.756, in the CT-development cohort, respectively. The calibration plots showed good correspondences.ConclusionsWe constructed and validated nomograms to predict SFR after SWL. To the best of our knowledge, these are the first graphical nomograms to be modeled with CT information. These may be useful for patient counseling and treatment decision-making.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Clinical Nomograms to Predict Stone-Free Rates after Shock-Wave Lithotripsy: Development and Internal-Validation

Kim

Jeon

et al. 2016

PLoS ONE

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“…This would potentially have the advantage of creating high‐volume centres with quality being easier to standardise and monitor; however, this would have to be balanced against patients probably having to travel further to access ESWL. The use of Hounsfield units remains a topic of debate with conflicting data and limited clinical application . Optimising targeting to minimise tissue damage with maximal stone fragmentation remains a challenge and modifications to lithotripters with dual‐imaging modalities, dual heads, alterations in shockwave delivery rate, control of respiratory effort and novel feedback devices have had limited success.…”

mentioning

confidence: 99%

Evolution of extracorporeal shockwave lithotripsy (ESWL)

Thomas

2014

BJU International

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Much has changed since the introduction of extracorporeal shockwave lithotripsy (ESWL); however, in many ways the principles remain constant. This manuscript by Jagtap et al. [1] is a large series of patients over 25 years and encapsulates the changes in ESWL over that time. This paper has all the limitations inherent in a retrospective review but within this offers interesting data. In particular the use of two different machines and refinements in technique are eloquently described. This shows an improvement due to both the change in technology but also in the importance of modifications of technique. The particular factors improving stone-free rate (SFR) were; better localisation with ultrasonography and X-ray, better coupling and use of coupling gel, change in selection criteria for both the patient and stone, ramping up the power and a staff training programme. This emphasis on technique is especially pertinent in healthcare systems where mobile lithotripters are still in use. These are renowned to have lower SFRs than static machines, which may be due to the technical delivery of treatment as much as the efficacy of the lithotripter.What is the future for ESWL? The paper reflects the perception globally that whilst the incidence of urolithiasis is increasing, the use of ESWL is not increasing at the same rate, particularly for ureteric stones, and they cite the potential factors for this. This has also been noted in the UK and our own recent review of Hospital Episode Statistics (HES) data even suggest the rate of ESWL has plateaued for both ureteric (3000/year) and renal (19 500/year) stones in the last 3 years [2,3]. There has been discussion within the UK about centralising endourology services using the same model as for cancer, with provision of static lithotripters within those centres. This would potentially have the advantage of creating high-volume centres with quality being easier to standardise and monitor; however, this would have to be balanced against patients probably having to travel further to access ESWL. The use of Hounsfield units remains a topic of debate with conflicting data and limited clinical application [4,5]. Optimising targeting to minimise tissue damage with maximal stone fragmentation remains a challenge and modifications to lithotripters with dual-imaging modalities, dual heads, alterations in shockwave delivery rate, control of respiratory effort and novel feedback devices have had limited success. Increasing levels of obesity within developed countries are a factor in the utilisation of ESWL, as there is a limit on focal distance. All of these factors along with the continued improvement in the optics, miniaturisation of ureteroscopes and advent of holmium laser have contributed to a surge in the use of ureteroscopy, despite publications and guidelines showing similar success rates [6].

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“…Nesse mesmo estudo, estes autores referiram melhores resultados com uma distância pele-cálculo menor que 11,0 cm, variável que não foi significante em nosso estudo. Foda et al [96] em outro estudo retrospectivo encontraram resultados semelhantes, descrevendo uma densidade menor que 934 UH e uma DPC menor que 10,0 cm como fatores preditivos de sucesso.…”

Section: éTicaunclassified

Avaliação dos fatores preditivos dos resultados da litotripsia extracorpórea por ondas de choque em cálculos renais de cálice inferior

Torricelli¹

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Calculating the Number of Shock Waves, Expulsion Time, and Optimum Stone Parameters Based on Noncontrast Computerized Tomography Characteristics

Cited by 16 publications

References 19 publications

Clinical Nomograms to Predict Stone-Free Rates after Shock-Wave Lithotripsy: Development and Internal-Validation

Clinical Nomograms to Predict Stone-Free Rates after Shock-Wave Lithotripsy: Development and Internal-Validation

Evolution of extracorporeal shockwave lithotripsy (ESWL)

Avaliação dos fatores preditivos dos resultados da litotripsia extracorpórea por ondas de choque em cálculos renais de cálice inferior

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