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Bres-Niewada E et al, 2015: Predicting stone composition before treatment - can it really drive clinical decisions?

Bres-Niewada E, Dybowski B, Radziszewski P.
Department of Urology, Medical University of Warsaw, Poland.

Abstract

INTRODUCTION: Determination of stone composition is considered to be crucial for the choice of an optimal treatment algorithm. It is especially important for uric acid stones, which can be dissolved by oral chemolysis and for renal stones smaller than 2 cm, which can be treated with extracorporeal shockwave lithotripsy (ESWL).
MATERIAL AND METHODS: This short review identifies the latest papers on radiological assessment of stone composition and presents a comprehensive evaluation of current scientific findings.
RESULTS: Stone chemical composition is difficult to predict using standard CT imaging, however, attenuation index measured in Hounsfield units (HU) is related to ESWL outcome. Stone density >1000 HU can be considered predictive for ESWL failure. It seems that stone composition is meaningless in determining the outcome of ureterolithotripsy and percutaneous surgery. Alternative imaging techniques
such as Dual-Energy CT or analysis of shape, density and homogeneity of stones on plain X-rays are used as promising methods of predicting stone composition and ESWL outcome.
CONCLUSIONS: New imaging techniques facilitate the identification of uric acid stones and ESWL-resistant stones. Therefore, they may help in selecting the best therapeutic option.

Cent European J Urol. 2014;67(4):392-6. doi: 10.5173/ceju.2014.04.art15. Epub 2014 Dec 5.

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Hans-Göran Tiselius on Tuesday, 23 June 2015 10:13

Prediction of stone composition before SWL remains a matter of debate. It is well recognized that stones with high density are more difficult to disintegrate than those with low density. Disintegration and subsequent stone-free rates depend not only on the stone density (hardness) but also on the size of the stone. For large stones with a high density SWL might accordingly be less successful. It needs to be emphasized, however, that also hard stones (e.g. cystine, brushite) if not too large, can be disintegrated non-invasively. Whether NCCT or dual energy CT examinations are necessary for prediction of stone disintegration is doubtful.

The authors found that HU-levels obtained by careful inspection of the KUB.

Prediction of stone composition before SWL remains a matter of debate. It is well recognized that stones with high density are more difficult to disintegrate than those with low density. Disintegration and subsequent stone-free rates depend not only on the stone density (hardness) but also on the size of the stone. For large stones with a high density SWL might accordingly be less successful. It needs to be emphasized, however, that also hard stones (e.g. cystine, brushite) if not too large, can be disintegrated non-invasively. Whether NCCT or dual energy CT examinations are necessary for prediction of stone disintegration is doubtful. The authors found that HU-levels obtained by careful inspection of the KUB.
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