Stone Attenuation Value and Cross-Sectional Area on Computed Tomography Predict the Success of Shock Wave Lithotripsy.
10.4111/kju.2013.54.7.454
- Author:
Michio TANAKA
1
;
Eisuke YOKOTA
;
Yoichiro TOYONAGA
;
Fumitaka SHIMIZU
;
Yoshiyuki ISHII
;
Makoto FUJIME
;
Shigeo HORIE
Author Information
1. Department of Urology, Juntendo University, Tokyo, Japan. michio-t@juntendo.ac.jp
- Publication Type:Original Article
- Keywords:
Noncontrast computed tomography;
Treatment outcome
- MeSH:
Humans;
Lithotripsy;
Multivariate Analysis;
Shock;
Treatment Outcome;
Urinary Calculi
- From:Korean Journal of Urology
2013;54(7):454-459
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: To identify the parameters on noncontrast computed tomography (NCCT) that best predict the success of shock wave lithotripsy (SWL). MATERIALS AND METHODS: We reviewed the records of 75 patients who underwent SWL for urinary calculi measuring 5 to 20 mm. Using NCCT images, we estimated the largest stone cross-sectional area and contoured the inner edge of the stone. Clinical outcome was classified as successful (stone-free or <4 mm in diameter) or failed (stone fragments, > or =4 mm). The impact of preoperative parameters was evaluated by univariate and multivariate analysis. RESULTS: The overall success rate was 73.3%. Average stone attenuation value, stone length, and stone cross-sectional area in the success and failure groups were 627.4+/-166.5 HU (Hounsfield unit) vs. 788.1+/-233.9 HU (p=0.002), 11.7+/-3.8 mm vs. 14.2+/-3.6 mm (p=0.015), and 0.31+/-0.17 cm2 vs. 0.57+/-0.41 cm2 (p<0.001), respectively. In the multivariate analysis, stone attenuation value was the only independent predictor of SWL success (p=0.023), although stone cross-sectional area had a tendency to be associated with SWL success (p=0.053). Patients were then classified into four groups by using cutoff values of 780 HU for stone attenuation value and 0.4 cm2 for cross-sectional area. By use of these cutoff values, the group with a low stone attenuation value and a low cross-sectional area was more than 11.6 times as likely to have a successful result on SWL as were all other groups (odds ratio, 11.6; 95% confidence interval, 3.9 to 54.7; p<0.001). CONCLUSIONS: Stone attenuation value and stone cross-sectional area are good predictors of extracorporeal SWL outcome.
