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Geng JH et al, 2015: Noncontrast computed tomography can predict the outcome of shockwave lithotripsy via accurate stone measurement and abdominal fat distribution determination.

Geng JH, Tu HP, Shih PM, Shen JT, Jang MY, Wu WJ, Li CC, Chou YH, Juan YS.
Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Radiology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan; Department of Radiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

Abstract

Urolithiasis is a common disease of the urinary system. Extracorporeal shockwave lithotripsy (SWL) has become one of the standard treatments for renal and ureteral stones; however, the success rates range widely and failure of stone disintegration may cause additional outlay, alternative procedures, and even complications. We used the data available from noncontrast abdominal computed tomography (NCCT) to evaluate the impact of stone parameters and abdominal fat distribution on calculus-free rates following SWL. We retrospectively reviewed 328 patients who had urinary stones and had undergone SWL from August 2012 to August 2013. All of them received pre-SWL NCCT; 1 month after SWL, radiography was arranged to evaluate the condition of the fragments. These patients were classified into stone-free group and residual stone group. Unenhanced computed tomography variables, including stone attenuation, abdominal fat area, and skin-to-stone distance (SSD) were analyzed. In all, 197 (60%) were classified as stone-free and 132 (40%) as having residual stone. The mean ages were 49.35 ± 13.22 years and 55.32 ± 13.52 years, respectively. On univariate analysis, age, stone size, stone surface area, stone attenuation, SSD, total fat area (TFA), abdominal circumference, serum creatinine, and the severity of hydronephrosis revealed statistical significance between these two groups. From multivariate logistic regression analysis, the independent parameters impacting SWL outcomes were stone size, stone attenuation, TFA, and serum creatinine. [Adjusted odds ratios and (95% confidence intervals): 9.49 (3.72-24.20), 2.25 (1.22-4.14), 2.20 (1.10-4.40), and 2.89 (1.35-6.21) respectively, all p < 0.05]. In the present study, stone size, stone attenuation, TFA and serum creatinine were four independent predictors for stone-free rates after SWL. These findings suggest that pretreatment NCCT may predict the outcomes after SWL. Consequently, we can use these predictors for selecting the optimal treatment for patients with urinary stones. 

Kaohsiung J Med Sci. 2015 Jan;31(1):34-41. doi: 10.1016/j.kjms.2014.10.001. Epub 2014 Nov 6.

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Comments 1

Peter Alken on Wednesday, 15 July 2015 09:05

In a previous study of the same group (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. EurRadiol 2012;22:1624-30) the authors stressed that “To our knowledge, we are the first group to analyse SWL outcomes according to intra-abdominal fat areas evaluated by unenhanced CT.” In that study on the prediction of stone free rates after SWL for ureteric stones the cut of values and the odds ratios for residual stones after a multivariate logistic regression were given (Tab.):

http://storzmedical.com/images/blog/Geng_JH_20151.png

Different from the previous publication in the present study stone size, stone density, TFA and serum creatinine were independent predictors for stone-free rates after SWL. Neither the stone location nor the stone compositions are given and the data cannot easily be compared with those of the previous study. The authors do not specifically refer to their previous publication. I am not sure if “Consequently, we can use these predictors for selecting the optimal treatment for patients with urinary stones.”

In a previous study of the same group (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. EurRadiol 2012;22:1624-30) the authors stressed that “To our knowledge, we are the first group to analyse SWL outcomes according to intra-abdominal fat areas evaluated by unenhanced CT.” In that study on the prediction of stone free rates after SWL for ureteric stones the cut of values and the odds ratios for residual stones after a multivariate logistic regression were given (Tab.): [img]http://storzmedical.com/images/blog/Geng_JH_20151.png[/img] Different from the previous publication in the present study stone size, stone density, TFA and serum creatinine were independent predictors for stone-free rates after SWL. Neither the stone location nor the stone compositions are given and the data cannot easily be compared with those of the previous study. The authors do not specifically refer to their previous publication. I am not sure if “Consequently, we can use these predictors for selecting the optimal treatment for patients with urinary stones.”
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