Muter S. et al., 2023: Renal stone density on native CT-scan as a predictor of treatment outcomes in shock wave lithotripsy
Muter S, Abd Z, Saeed R.
Department of Surgery, College of Medicine, University of Baghdad, Baghdad, Iraq.
Department of Surgery, College of Medicine, University of Anbar, Al-Ramadi, Iraq.
Department of Community Medicine, College of Medicine, University of Anbar, Al-Ramadi, Iraq.
Extracorporeal shock wave lithotripsy (ESWL) is considered a standard treatment for nephrolith or kidney stones measuring less than 20 mm. Anatomical, machine-related, and stone factors play pivotal roles in treatment outcomes, the latter being the leading role. This paper examined the relationship between stone density on native CT scans and ESWL treatment to remove renal stones concerning several treatments. One hundred and twenty patients (64 males and 56 females) were enrolled and completed the study from April 2019 to September 2020. Inclusion criteria were a single renal pelvis stone of 5-20 mm to be treated for the first time in adult patients with no urinary or musculoskeletal anatomical abnormalities. We assessed patients' renal function and obtained stone characteristics using a native CT scan. Patients were then scheduled for ESWL by the same machine and operator under fluoroscopy, with two-week intervals between treatment sessions when more than one treatment session was required. Before each new session, a new KUB-US was performed to reevaluate the stone. One hundred and twenty patient records were analyzed, 64 (53.3%) males and 56 (46.7%) females, with a mean age of 38.6 years and a mean stone size of 13.15 mm. Treatment with ESWL cleared stones in 76 (63.3%) patients, while 44 (36.7%) failed the treatment. The mean stone density in patients whose stones were cleared was significantly lower (661 vs. 1001) (P<0.001). Estimating renal calculus (or kidney stone) density on a native CT scan might help prognosticate ESWL treatment outcomes regarding stone clearance rates and the number of sessions required to clear a stone.
J Med Life. 2022 Dec;15(12):1579-1584. doi: 10.25122/jml-2022-0153. PMID: 36762325. FREE ARTICLE
This is a prospective study reporting the success of SWL relative to stone characteristics on native CT-scans. The conclusion, based on observations in 120 patients, was that the stone density was a better predictor for success than stone size. The authors’ conclusion is that stone density is a good substitute for the lack of information of stone composition.
It is amazing that none of the patients became stone-free after only ONE session, but HU in responders was 661 compared with 1001 in non-responders. That as many as 87% of the patients required 3 sessions (!) is surprising but can probably be explained by the lithotripter used: Piezolith 3000 plus, 2017. The higher HU, the more sessions.
The bottom-line of this study is that the disintegrating capacity of stones relative to HU must be determined in view of the lithotripter used.