Computed tomography findings predicting the success of silodosin for medical expulsive therapy of ureteral stones

Abstract

Aim of the study is to investigate the relationship between non-contrast computed tomography (NCCT) findings and stone expulsion rate with medical expulsive therapy (MET) using silodosin for ureteral stones in male adults. Between January 2014 and June 2015, we retrospectively reviewed the patient charts with uncomplicated ureteral stones on NCCT images, who were treated with silodosin for MET. Stone diameter, volume and hounsfield units (HU) measured by NCCT and treatment findings were noted at the end of treatment. Patients were divided into three groups according to the localization as distal, mid and proximal ureteral stones. NCCT and treatment findings were compared between MET success and failure groups in different localizations. Stone expulsion rate was 81.3% for 134 distal, 45.5% for 22 mid and 27.7% for 47 proximal stones. Stone diameter, volume, and HU were significantly lower for success groups with distal and proximal stones (p < 0.05). In ROC analysis the cut-off values for stone volume and HU were detected as 48.7 mm and 598 HU for success group with proximal stones. Stone expulsion rate was found to be 24 times more (OR = 24; p = 0.001) in patients with <598 HU and 14 times more (OR = 14; p = 0.002) in patients with <48.7 mm proximal stones. Lower stone diameter, volume and HU were significant predictors of success with silodosin for MET for ureteral stones. Patients with <598 HU and/or <48.7 mm proximal stones may be prescribed silodosin for MET.

Can the Hounsfield unit predict the success of medical expulsive therapy using silodosin in 4‐ to 10‐mm distal ureteral stones?

“…For the success group with mid‐ureteral stones, the researchers found significantly lower values only for the stone diameter and volume. It was also noted that the MET success rate for proximal and distal ureteral stones was 24 times higher in patients with an HU of ˂598 and 14 times higher in those with a stone volume of ˂48.7 mm 3 10 . Similarly, the multivariate regression analysis undertaken in the current study revealed that HU and stone area might be effective parameters in predicting the success of MET in distal ureteric stones.…”

“…It was also noted that the MET success rate for proximal and distal ureteral stones was 24 times higher in patients with an HU of ˂598 and 14 times higher in those with a stone volume of ˂48.7 mm 3 . 10 Similarly, the multivariate regression analysis undertaken in the current study revealed that HU and stone area might be effective parameters in predicting the success of MET in distal ureteric stones. We consider it an expected finding that during the 4-week follow-up of patients, the number of pain attacks and emergency service visits was lower in the stone expulsion success group compared to the patients who did not pass the stone.…”

“…The HU values, which have been increasingly utilized in recent years, provide clinicians with clues concerning the hardness and composition of urinary system stones and make an informed decision. There are studies indicating that HU can also help predict the success of extracorporeal shock‐wave lithotripsy (ESWL) in urinary stone disease, as well as predicting success in the MET of ureteric stones 8‐10 …”

“…There are studies indicating that HU can also help predict the success of extracorporeal shock-wave lithotripsy (ESWL) in urinary stone disease, as well as predicting success in the MET of ureteric stones. [8][9][10] In this study, we aimed to investigate the predictive ability of HU calculated on non-contrast computed tomography (NCCT) for the success of MET using silodosin for 4-to 10-mm distal ureteric stones.…”