SWL literature
SWL Literature

Sengupta S. et al., 2022: A prospective observational study on the predictability of Triple-D score versus Quadruple-D score in the success rate of extracorporeal shock wave lithotripsy of renal stones 1-2 cm in diameter.

Sengupta S, Basu S, Ghosh K.
Department of Urology, RG Kar Medical College and Hospital, Kolkata, West Bengal, India.
Department of Radiology, North Bengal Medical College and Hospital, Siliguri, West Bengal, India.

Abstract

Introduction: The aim of the study is to evaluate the clinical efficacy of Triple-D scoring system versus Quadruple-D scoring system for assessing stone-free rate (SFR) in individuals with renal stones measuring 1-2 cm in diameter after extracorporeal shock wave lithotripsy (ESWL).
Materials and methods: The study was conducted on 120 patients who presented to a tertiary care center in eastern India. Systemic random sampling technique was applied with a sampling interval of 2. Triple-D scoring system comprising of three computed tomography based metrics - stone dimension (volume), stone density (Hounsfield unit), and skin-to-stone distance (SSD) was done before ESWL. Stone location was included as an additional parameter to formulate Quadruple-D scoring system where an extra score was given for stones in the non-lower polar region. Stone-free status was assessed by plain abdominal radiography 3 weeks after ESWL.
Results: In the study population, stone dimension, stone density, and stone location were positive predictors of SFR after ESWL whereas age, sex, and body mass index of the patients, laterality of the stone and SSD were not. The area under the curve of Triple-D and Quadruple-D scoring systems were 0.598 and 0.674.
Conclusion: Triple-D scoring system has been successfully validated as the SFR showed a parallel increase with every positive component. The Quadruple-D scoring system with a simple addition of stone location can further facilitate the validation of Triple-D scoring by increasing SFR, keeping the calculation simple and easy to use. These findings support the incorporation of Quadruple-D scoring system over Triple-D scoring system.
Urol Ann. 2022 Jan-Mar;14(1):37-42. doi: 10.4103/UA.UA_1_21. Epub 2021 Oct 26. PMID: 35197701. FREE ARTICLE

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Comments 1

Hans-Göran Tiselius on Friday, July 01 2022 08:30

There are probably few fields in surgery for which the factors responsible for success or failure have been studied so extensively as for SWL. Many determinants important for treatment outcome have been identified and their combined influence on the result studied. Accordingly, several nomograms have been constructed as tools for mathematical prediction and summary of SWL outcome. Two such methods are Triple-D and Quadruple-D scores. The special attraction of these scores is that they use “0” or “1” input for stone volume, stone density, SSD and whether the stone is in the lower calyx. These two scoring-methods are thus much easier to use clinically than most other comparable methods.

It is of interest to note that when the two scores, in the current article, were compared in Indian patients with stones measuring 10-20 mm, not unexpectedly Quadruple-D scoring was better than Triple-D.

https://www.storzmedical.com/images/blog/Sengupta.png

It is of note, however, that stone density of 600 is a rather low limit but otherwise Quadruple-D score will have to compete with current machine learning systems for prediction of SWL outcome. Future experience will show how such a comparison comes out. Whatever the result will be, the scoring systems undoubtedly are very easy to use clinically.

Hans-Göran Tiselius

There are probably few fields in surgery for which the factors responsible for success or failure have been studied so extensively as for SWL. Many determinants important for treatment outcome have been identified and their combined influence on the result studied. Accordingly, several nomograms have been constructed as tools for mathematical prediction and summary of SWL outcome. Two such methods are Triple-D and Quadruple-D scores. The special attraction of these scores is that they use “0” or “1” input for stone volume, stone density, SSD and whether the stone is in the lower calyx. These two scoring-methods are thus much easier to use clinically than most other comparable methods. It is of interest to note that when the two scores, in the current article, were compared in Indian patients with stones measuring 10-20 mm, not unexpectedly Quadruple-D scoring was better than Triple-D. [img]https://www.storzmedical.com/images/blog/Sengupta.png[/img] It is of note, however, that stone density of 600 is a rather low limit but otherwise Quadruple-D score will have to compete with current machine learning systems for prediction of SWL outcome. Future experience will show how such a comparison comes out. Whatever the result will be, the scoring systems undoubtedly are very easy to use clinically. Hans-Göran Tiselius
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Tuesday, August 09 2022
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