Glybochko PV. et al., 2019: The clinical role of X-ray computed tomography to predict the clinical efficiency of extracorporeal shock wave lithotripsy
Glybochko PV, Alyaev YG, Rudenko VI, Rapoport LM, Grigoryan VA, Butnaru DV, Perekalina AN, Kraev IG, Korolev DO.
I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
Research Institute of Uronephrology and Human Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
Department of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
AIM: To evaluate the clinical efficiency of computed tomography for diagnostics of patients with urolithiasis and the choice of treatment strategy. MATERIAL AND METHODS: The study was carried out at the Urological Clinic of I.M. Sechenov First Moscow State Medical University and included 1044 patients with urinary stones. The ultimate goal of this study was to predict the clinical efficiency of extracorporeal shock wave lithotripsy using a combination of computed tomography and densitometry. Extracorporeal shock wave lithotripsy was performed on "Siemens Lithostar Plus," "Siemens Modularis Uro," and "Dornier Gemini" lithotripters. Statistical analysis of clinical data included evaluation of individual sampling groups and calculation of weighted arithmetic mean ( M). RESULTS: The efficiency of extracorporeal shock wave lithotripsy has been determined primarily using X-ray analysis of the concrement outlines and the structure (homogeneous or heterogeneous) of its central zone. However, in terms of efficiency and repetition rate (the number of fragmentation procedures required for complete clearance) of extracorporeal shock wave lithotripsy, the mean density of the concrement along the whole length of its three-dimensional structure (expressed in Hounsfield units) appeared to be the most reliable and informative predictive index in this study. CONCLUSION: The combination of computed tomography with densitometry in the treatment of patients with urolithiasis allows one (1) to determine the exact localization, size, X-ray structure, and structural density of urinary stones and (2) to predict, on the basis of densitometric data histograms, the clinical efficiency and repetition rate of extracorporeal shock wave lithotripsy with due regard to the X-ray structure of peripheral and central zones, and mean density (in Hounsfield units) of urinary concrements.
Urologia. 2019 May;86(2):63-68. doi: 10.1177/0391560317749422. Epub 2018 Mar 26.
The authors of this Russian study emphasise the value of CT-examination as a tool for prediction of SWL success.
Measurements were carried out to determine stone contour, morphology of the nuclear zone of the stone and density along the entire three-dimensional length of the stone.
Similar to previously reported results stones with sharp contour required more treatment sessions than those with blurred contour. Homogeneous stones required more sessions than those that had a heterogeneous morphology. Most important, however, was obviously the stone density.
The treatment outcome was as follows:
Note: Treatments were carried out with Siemens Lithostar Plus, Siemens Modularis Uno and Dornier Gemini lithotripters.