Stone Density and Skin to Stone Distance in Non-Contrast Computed Tomography as Prognostic Indicators for the Success of Extra Corporeal Shockwave Lithotripsy in Ureteral Stone Disease
Hany Mostafa Abdallah, Samir El-Sayed Abdelfattah El-Ghobashy, Mohamed Hussein Badawy, Mohamed Ibrahim El-Moazen, Ahmed Mahmoud ElShafei- General Medicine
Background
Ureteral stones are a major health concern with a worldwide rising prevalence. Ureteral stones formed in the kidney and then descending the ureter commonly manifest themselves as renal colic. Extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy are the two primary treatment modalities for the management of symptomatic ureteral calculi,
Aim of the Work
In this study we tried to assess the prognostic value of patient and stone characteristics in potential candidates for ESWL in ureteral stones.
Patients and Methods
We studied the records of 66 patients with upper ureteral calculi who underwent ESWL. We considered patients being stone free (SF) or when < 4 mm fragments were detected. Age, gender, skin to-stone distance, maximum stone length, stone Hounsfield units (HU) were explored in uni- and multivariate regression analysis.
Results
We found that obesity (BMI > 29.3), high stone density (HU) >935, skin to stone distance >10 and presence of ureteral stent were all factors impeding success of treatment. On the other hand, higher shock intensity and number of shocks per session were positive predictors of treatment success.
Conclusion
It was concluded that the evaluation of patient and stone characteristics pre ESWL can predict the success of treatment for ureteric stones and we recommend thorough evaluation of the parameters before treatment to determine the best treatment modality for each patient. To date there seems to be value in using these variables to aid in better selecting patients for ESWL and thus improving the efficacy of ESWL. Our study was limited by the number of centers and participants. A wider range of participants would probably achieve more efficient results. Further studies on a larger scale would be better to further validate these results.