Computerized Tomography Attenuation Value of Renal Calculus: Can It Predict Successful Fragmentation of the Calculus by Extracorporeal Shock Wave Lithotripsy? A Preliminary Study

Joseph, Peter M.; Mandal, Arup Kumar; Singh, Shrawan Kumar; MANDAL, PURABI; Sankhwar, Satya Narayan; Sharma, Sumit

doi:10.1016/s0022-5347(05)65064-1

Cited by 187 publications

(108 citation statements)

References 16 publications

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“…This result differs from several published studies [9][10][11]13,14]. The likely explanation for this discrepancy is that the fragility data in the present study were normalized to stone size, a procedure that was not done in any of the previous studies.…”

Section: Discussioncontrasting

confidence: 98%

“…Helical computed tomography (CT) has been proposed as a means to predict the success or failure of lithotripsy [6,8], and a number of studies have attempted to utilize CT numbers (in Hounsfield units, which are related to x-ray attenuation values) as a predictor of stone fragility [9][10][11][12][13][14]. However, given the resolution of clinical CT and the effects of volume averaging, the simple measure of Hounsfield units in stones is most likely to correlate with stone size [15,16], and stone size correlates with the number of SW's required for comminution [5].…”

Section: Introductionmentioning

confidence: 99%

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CT visible internal stone structure, but not Hounsfield unit value, of calcium oxalate monohydrate (COM) calculi predicts lithotripsy fragility in vitro

et al. 2007

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COM stones are often resistant to breakage using shock wave (SW) lithotripsy. It would be useful to identify by computed tomography (CT) those COM stones that are susceptible to SW's. For this study, 47 COM stones (4-10 mm in diameter) were scanned with micro CT to verify composition and also for assessment of heterogeneity (presence of pronounced lobulation, voids, or apatite inclusions) by blinded observers. Stones were then placed in water and scanned using 64-channel helical CT. As with micro CT, heterogeneity was assessed by blinded observers, using high-bone viewing windows. Then stones were broken in a lithotripter (Dornier Doli-50) over 2 mm mesh, and SW's counted. Results showed that classification of stones using micro CT was highly repeatable among observers (κ=0.81), and also predictive of stone fragility. Stones graded as homogeneous required 1874±821 SW/g for comminution, while stones with visible structure required half as many SW/g, 912±678. Similarly, when stones were graded by appearance on helical CT, classification was repeatable (κ=0.40), and homogeneous stones required more SW's for comminution than did heterogeneous stones (1702±993 SW/g, compared to 907±773). Stone fragility normalized to stone size did not correlate with Hounsfield units (p=0.85). In conclusion, COM stones of homogeneous structure require almost twice as many SW's to comminute than stones of similar mineral composition that exhibit internal structural features that are visible by CT. This suggests that stone fragility in patients could be predicted using pre-treatment CT imaging. The findings also show that Hounsfield unit values of COM stones did not correlate with stone fragility. Thus, it is stone

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Section: Discussioncontrasting

confidence: 98%

Section: Introductionmentioning

confidence: 99%

CT visible internal stone structure, but not Hounsfield unit value, of calcium oxalate monohydrate (COM) calculi predicts lithotripsy fragility in vitro

et al. 2007

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“…The success rate for stones with an attenuation value>1000 HF units was significantly lower than that for stones with a value of <1000 HF units. The mean attenuation value and the number of shocks required for calculus fragmentation correlated significantly [20].…”

Section: Discussionmentioning

confidence: 91%

“…Joseph et al, [20] evaluated the CT attenuation value of renal calculi as a predictor of successful fragmentation using ESWL in 30 patients. The success rate for stones with an attenuation value>1000 HF units was significantly lower than that for stones with a value of <1000 HF units.…”

Section: Discussionmentioning

confidence: 99%

Success Rate of Stone Recurrence after Extracorporeal Shockwave Lithotripsy and Factors affecting Success of Treatment among Egyptian Patients

Gadalla¹

2016

Med Surg Urol

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Objectives: To evaluate the factors that affect the success rate of ESWL for treatment of renal stones and to estimate the prevalence of stone recurrence during a 1-year period. Materials and Methods:During the period of January, 2010 and December, 2010, prospective study of 142 subjects with single or multiple renal stones (<30 mm, largest diameter) undergone ESWL monotherapyby Siemens-LITHOSKOP lithotriptor. The results of treatment were assessedafter a follow-up period of 3 months. Treatment success was a complete clearance of the stones or presence of insignificantresidual fragments<4 millimeters. Correlation of the success rate with the characteristics of the subjects, conditionsof the urinary tract and features of the stone was done.Results: During the 3-months follow-up period, the success rate was 111/142 (78%). Re-treatment was needed in 75 patients (52.8%). Post-treatment procedures were done in 12 subjects (8.4%). Post-ESWL complications were observed in 5 subjects (3.5%). Out of 10 prognosticfactors studied, 5 had a powerful influence on the success rate, which are: renal morphology, presence of congenital anomalies, size of stone, site of stone and treated stones number. Other factors including age, sex, nationality, stonenature (de novo or recurrent) and ureteric stenting had no significant impact on the success rate. Conclusions:Prediction of success of treatment with ESWL and the recurrence depends and may be predicted by renal morphology, presence of congenital anomalies, size of stone, site of stone and treated stones number.

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“…Therefore efforts are being made to predict the stone composition in situ especially using CT scans. Hounsfield units have been correlated with disintegration by SWL [35], but there are problems with this (see Williams et al in this volume). Additionally, such measurements are not yet standardized and the correlations that have been reported are not specific enough to be used in clinical cases.…”

Section: Prediction Of Successmentioning

confidence: 99%

The Future of SWL: A Global Perspective

Köhrmann¹

2007

AIP Conference Proceedings

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Abstract. The future relevance of shock wave lithotripsy (SWL) to the treatment of urinary stones has been questioned by some. This paper reviews recent developments with an aim to predict the level of usefulness of SWL for the future. The incidence of urolithiasis is increasing throughout the world, and existing metaphylaxis is not widely effective. This results in an increasing need for active stone removal. SWL was and is a well established treatment modality for urolithiasis in the upper urinary tract. For most stone situations there will remain a reasonable choice between SWL versus endoscopic procedures, and it is unlikely that endoscopic procedures will displace SWL completely in general practice. In conclusion, SWL will continue to play an established, if slightly reduced, role in stone treatment in the future.

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Computerized Tomography Attenuation Value of Renal Calculus: Can It Predict Successful Fragmentation of the Calculus by Extracorporeal Shock Wave Lithotripsy? A Preliminary Study

Abstract: The CT attenuation value of renal calculi can help to differentiate stones that are likely to fragment easily on ESWL from those that would require a greater number of shock waves for fragmentation or may fail to fragment on ESWL.

Cited by 187 publications

References 16 publications

CT visible internal stone structure, but not Hounsfield unit value, of calcium oxalate monohydrate (COM) calculi predicts lithotripsy fragility in vitro

CT visible internal stone structure, but not Hounsfield unit value, of calcium oxalate monohydrate (COM) calculi predicts lithotripsy fragility in vitro

Success Rate of Stone Recurrence after Extracorporeal Shockwave Lithotripsy and Factors affecting Success of Treatment among Egyptian Patients

The Future of SWL: A Global Perspective

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