Advertisement

Noncontrast computed tomography factors that predict the renal stone outcome after shock wave lithotripsy

      Abstract

      Objectives

      Extracorporeal shock wave lithotripsy (ESWL) is a popular treatment for nephrolithiasis. We took advantage of noncontrast abdominal computed tomography (NCCT) to search the possible prognostic factors including abdominal fat distribution influencing stone-free rate.

      Methods

      From August 2008 to August 2010, 145 patients who had renal calculus and had undergone ESWL were retrospectively reviewed. All of them received NCCT assessment before ESWL and were followed up after 1 month for stone clearance. These patients were divided into two groups: one was the stone-free group and the other was the residual-stone group. Affecting parameters included stone size, location, stone surface area, Hounsfield unit density (HU density), skin-to-stone distance (SSD), and abdominal fat area as analyzed between these two groups.

      Results

      Of 145 patients, 70 were stone-free and 75 had residual stone after ESWL treatment and 1-month follow-up. From univariate analysis, stone size, HU density, SSD, and stone surface area were significant predicting factors for ESWL success. On multivariate analysis, the important factors influencing ESWL outcomes were HU density and stone surface area (odds ratio 1.002 vs. 77.18, respectively; P<.05). Abdominal fat accumulation and distribution had no significant difference between these two groups.

      Conclusion

      This study revealed that stone size, HU density, SSD, and stone surface area were associated with stone-free rate after ESWL treatment. Therefore, these factors could be used to assess the feasibility of ESWL before deciding the treatment strategy. Abdominal fat distribution had no significant impact on ESWL outcome for renal stones.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Edvardsson VO
        • Indridason OS
        • Haraldsson G
        • Kjartansson O
        • Palsson R
        Temporal trends in the incidence of kidney stone disease.
        Kidney Int. 2013; 83: 146-152
        • Huang WY
        • Chen YF
        • Carter S
        • Chang HC
        • Lan CF
        • Huang KH
        Epidemiology of upper urinary tract stone disease in a Taiwanese population: a nationwide, population based study.
        J Urol. 2013; 189: 2158-2163
        • Curhan GC
        Epidemiology of stone disease.
        Urol Clin North Am. 2007; 34: 287-293
        • Trinchieri A
        • Coppi F
        • Montanari E
        • Del Nero A
        • Zanetti G
        • Pisani E
        Increase inthe prevalence of symptomatic upper urinary tract stones during the last ten years.
        Eur Urol. 2000; 37: 23-25
        • Juan YS
        • Chuang SM
        • Wu WJ
        • Shen JT
        • Li CC
        • Wang CJ
        • et al.
        Evaluation of intrarenal blood flow by Doppler ultrasonography immediately after extracorporeal shock wave lithotripsy on hydronephrotic kidney.
        Kaohsiung J Med Sci. 2005; 21: 412-417
        • Juan YS
        • Li CC
        • Shen JT
        • Huang CH
        • Chuang SM
        • Wang CJ
        • et al.
        Percutaneous nephrostomy for removal of large impacted upper ureteral stones.
        Kaohsiung J Med Sci. 2007; 23: 412-416
        • Labanaris AP
        • Kuhn R
        • Schott GE
        • Zugor V
        Perirenal hematomas induced by extracorporeal shock wave lithotripsy (ESWL). Therapeutic management.
        ScientificWorldJournal. 2007; 7: 1563-1566
        • Perks AE
        • Schuler TD
        • Lee J
        • Ghiculete D
        • Chung DG
        • D'A Honey RJ
        • et al.
        Stone attenuation and skin-to-stone distance on computed tomography predicts for stone fragmentation by shock wave lithotripsy.
        Urology. 2008; 72: 765-769
        • Park H
        • Park M
        • Park T
        Two-year experience with ureteral stones: extracorporeal shockwave lithotripsy v ureteroscopic manipulation.
        J Endourol. 1998; 12: 501-504
        • Abe T
        • Akakura K
        • Kawaguchi M
        • Ueda T
        • Ichikawa T
        • Ito H
        • et al.
        Outcomes of shockwave lithotripsy for upper urinary-tract stones: a large-scale study at a single institution.
        J Endourol. 2005; 19: 768-773
        • Coz F
        • Orvieto M
        • Bustos M
        • Lyng R
        • Stein C
        • Hinrichs A
        • et al.
        Extracorporeal shockwave lithotripsy of 2000 urinary calculi with the modulith SL-20: success and failure according to size and location of stones.
        J Endourol. 2000; 14: 239-246
        • White W
        • Klein F
        Five-year clinical experience with the Dornier Delta lithotriptor.
        Urology. 2006; 68: 28-32
        • Albala DM
        • Assimos DG
        • Clayman RV
        • Denstedt JD
        • Grasso M
        • Gutierrez-Aceves J
        • et al.
        Lower pole I: a prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis-initial results.
        J Urol. 2001; 166: 2072-2080
        • Pace KT
        • Ghiculete D
        • Harju M
        • Honey RJ
        Shock wave lithotripsy at 60 or 120 shocks per minute: a randomized, double-blind trial.
        J Urol. 2005; 174: 595-599
        • Choi JW
        • Song PH
        • Kim HT
        Predictive factors of the outcome of extracorporeal shockwave lithotripsy for ureteral stones.
        Korean J Urol. 2012; 53: 424-430
        • Wang YH
        • Grenabo L
        • Hedelin H
        • Pettersson S
        • Wikholm G
        • Zachrisson BF
        Analysis of stone fragility in vitro and in vivo with piezoelectric shock waves using the EDAP LT-01.
        J Urol. 1993; 149: 699-702
        • Dretler SP
        Stone fragility–a new therapeutic distinction.
        J Urol. 1988; 139: 1124-1127
        • Tiselius HG
        • Ackermann D
        • Alken P
        • Buck C
        • Conort P
        • Gallucci M
        Guidelines on urolithiasis.
        Eur Urol. 2001; 40: 362-371
        • Semins MJ
        • Shore AD
        • Makary MA
        • Magnuson T
        • Johns R
        • Matlaga BR
        The association of increasing body mass index and kidney stone disease.
        J Urol. 2010; 183: 571-575
        • Tokunaga K
        • Matsuzawa Y
        • Ishikawa K
        • Tarui S
        A novel technique for the determination of body fat by computed tomography.
        Int J Obes. 1983; 7: 437-445
        • Yoshizumi T
        • Nakamura T
        • Yamane M
        • Islam AH
        • Menju M
        • Yamasaki K
        • et al.
        Abdominal fat: standardized technique for measurement at CT.
        Radiology. 1999; 211: 283-286
        • Olcott EW
        • Sommer FG
        • Napel S
        Accuracy of detection and measurement of renal calculi: in vitro comparison of three-dimensional spiral CT, radiography, and nephrotomography.
        Radiology. 1997; 204: 19-25
        • Juan HC
        • Lin HY
        • Chou YH
        • Yang YH
        • Shih PM
        • Chuang SM
        • et al.
        Abdominal fat distribution on computed tomography predicts ureteric calculus fragmentation by shock wave lithotripsy.
        Eur Radiol. 2012; 22: 1624-1630
        • Pareek G
        • Armenakas NA
        • Panagopoulos G
        • Bruno JJ
        • Fracchia JA
        Extracorporeal shock wave lithotripsy success based on body mass index and Hounsfield units.
        Urology. 2005; 65: 33-36
        • Goertz JK
        • Lotterman S
        Can the degree of hydronephrosis on ultrasound predict kidney stone size?.
        Am J Emerg Med. 2010; 28: 813-816
        • Wiesenthal JD
        • Ghiculete D
        • D'A Honey RJ
        • Pace KT
        Evaluating the importance of mean stone density and skin-to-stone distance in predicting successful shock wave lithotripsy of renal and ureteric calculi.
        Urol Res. 2010; 38: 307-313
        • Tanaka M
        • Yokota E
        • Toyonaga Y
        • Shimizu F
        • Ishii Y
        • Fujime M
        • et al.
        Stone attenuation value and cross-sectional area on computed tomography predict the success of shock wave lithotripsy.
        Korean J Urol. 2013; 54: 454-459
        • Kupeli B
        • Tunc L
        • Alkibay T
        • Karaoglan U
        • Bozkirli I
        Pelvicalyceal stone load: a factor affecting the outcome of extracorporeal shockwave lithotripsy for renal pelvic calculi.
        BJU Int. 2001; 88: 854-857
        • Saw KC
        • McAteer JA
        • Fineberg NS
        • Monga AG
        • Chua GT
        • Lingeman JE
        • et al.
        Calcium stone fragility is predicted by helical CT attenuation values.
        J Endourol. 2000; 14: 471-474
        • Bandi G
        • Meiners RJ
        • Pickhardt PJ
        • Nakada SY
        Stone measurement by volumetric three-dimensional computed tomography for predicting the outcome after extracorporeal shock wave lithotripsy.
        BJU Int. 2009; 103: 524-528
        • Lam HS
        • Lingeman JE
        • Barron M
        • Newman DM
        • Mosbaugh PG
        • Steele RE
        • et al.
        Staghorn calculi: analysis of treatment results between initial percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy monotherapy with reference to surface area.
        J Urol. 1992; 147: 1219-1225
        • Buchholz NP
        • Rhabar MH
        • Talati J
        Is measurement of stone surface area necessary for SWL treatment of nonstaghorn calculi?.
        J Endourol. 2002; 16: 215-220
        • Abdel-Khalek M
        • Sheir KZ
        • Mokhtar AA
        • Eraky I
        • Kenawy M
        • Bazeed M
        Prediction of success rate after extracorporeal shock-wave lithotripsy of renal stones — a multivariate analysis model.
        Scand J Urol Nephrol. 2004; 38: 161-167
        • Gupta NP
        • Singh DV
        • Hemal AK
        • Mandal S
        Infundibulopelvic anatomy and clearance of inferior caliceal calculi with shock wave lithotripsy.
        J Urol. 2000; 163: 24-27
        • Juan YS
        • Chuang SM
        • Wu WJ
        • Shen JT
        • Wang CJ
        • Huang CH
        Impact of lower pole anatomy on stone clearance after shock wave lithotripsy.
        Kaohsiung J Med Sci. 2005; 21: 358-364
        • Goktas C
        • Akca O
        • Horuz R
        • Gokhan O
        • Albayrak S
        • Sarica K
        SWL in lower calyceal calculi: evaluation of the treatment results in children and adults.
        Urology. 2011; 78: 1402-1406
        • Li XH
        • Zhao R
        • Liu B
        • Yu YQ
        Determination of urinary stone composition using dual-energy spectral CT: initial in vitro analysis.
        Clin Radiol. 2013; 68: e370-e377
        • Osman MM
        • Alfano Y
        • Kamp S
        • Haecker A
        • Alken P
        • Michel MS
        • et al.
        5-Year-follow-up of patients with clinically insignificant residual fragments after extracorporeal shockwave lithotripsy.
        Eur Urol. 2005; 47: 860-864