Radiographic prognostic criteria for extracorporeal shock-wave lithotripsy: A study of 485 patients

Bon, D.; Doré, B.; Irani, Jacques; Marroncle, M; Aubert, Jacques

doi:10.1016/s0090-4295(96)00251-8

Cited by 68 publications

(42 citation statements)

References 13 publications

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“…Urinary calculi made of calcium oxalate monohydrate (COM) are among the most common stones affecting the populations of industrialized countries [1,2], and can be especially resistant to shock wave (SW) lithotripsy [3,4]. However, study of stone breakage in vitro has shown that COM stones vary dramatically in their fragility to SW's, with some stones being very resistant, and others quite fragile [5,6], and this variability is consistent with clinical experience [4].…”

Section: Introductionmentioning

confidence: 53%

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: Introductionmentioning

confidence: 53%

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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“…A number of stone characteristics, such as fragility, size, location and composition, are known to affect outcome. 11 Stone fragility correlates with mineral content and stone density. 12 Early work evaluated stone fragility as a predictive factor of ESWL outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Others have shown that smooth, uniform stones that appeared denser than bone (12th rib) on a plain abdominal film responded poorly to ESWL. 11 The main limitation of these studies was their subjective nature of assessment; therefore, they have not progressed widely into clinical practice.…”

Section: Discussionmentioning

confidence: 99%

The usefulness of stone density and patient stoutness in predicting extracorporeal shock wave efficiency: Results in a North African ethnic group

Abdelaziz¹,

Elabiad

Aderrouj

et al. 2014

CUAJ

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Cite as: Can Urol Assoc J 2014;8(7-8):e567-9. http://dx.doi.org/10.5489/cuaj.1849 Published online August 11, 2014. Abstract Introduction:We determine the role of stone density and skin-tostone distance (SSD) by non-contrast computed tomography of the kidneys, ureters and bladder (CT-KUB) in predicting the success of extracorporeal shock wave lithotripsy (ESWL). Methods: We evaluated 89 patients who received ESWL for renal and upper ureteric calculi measuring 5 to 20 mm, over a 12-month period. The mean stone density in Hounsfield units (HU) and mean SSD in mm was determined on pre-treatment CT-KUB at the CT workstation. ESWL was successful if post-treatment residual stone fragments were ≤3 mm. Results: ESWL success was observed in 68.5% of patients. Mean stone densities were 505 ± 153 and 803 ± 93 HU in the ESWL successful and failure groups, respectively (p < 0.001, student's t-test). The mean SSD were 10.6 ± 2.0 and 11.2 ± 2.6 cm in ESWL successful and failure groups, respectively; this was not statistically significant. Conclusions: This study shows that stone density can help to predict the outcome of ESWL. We propose that stone density <500 HU are highly likely to result in successful ESWL. Conversely, stone densities >800 HU are less likely to be successful.

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“…Bon et al [8] examined the associations of the preoperative radiographic appearance of calculi (i.e., homogeneity, density, and morphologic features) with SWL outcome and concluded that density and morphologic features were predictors of SWL success. However, their method of evaluating stone properties used relative measurements.…”

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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Radiographic prognostic criteria for extracorporeal shock-wave lithotripsy: A study of 485 patients

Cited by 68 publications

References 13 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

The usefulness of stone density and patient stoutness in predicting extracorporeal shock wave efficiency: Results in a North African ethnic group

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

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