The success of extracorporeal shock-wave lithotripsy based on the stone-attenuation value from non-contrast computed tomography

Peer review under responsibility of Arab Association of Urology.

Abstract

Objective:

To determine the utility of the urinary stone-attenuation value (SAV, in Hounsfield units, HU) from non-contrast computed tomography (NCCT) for predicting the success of extracorporeal shock-wave lithotripsy (ESWL).

Patients and methods:

The study included 305 patients with renal calculi of ⩽30 mm and upper ureteric calculi of ⩽20 mm. The SAV was measured using NCCT. Numerical variables were compared using a one-way analysis of variance with posthoc multiple two-group comparisons. Univariate and multivariate regression analysis models were used to test the preferential effect of the independent variable(s) on the success of ESWL.

Results:

Patients were grouped according to the SAV as group 1 (⩽500 HU, 81 patients), group 2 (501–1000 HU, 141 patients) and group 3 (>1000 HU, 83 patients). ESWL was successful in 253 patients (83%). The rate of stone clearance was 100% in group 1, 95.7% (135/141) in group 2 and 44.6% (37/83) in group 3 (P = 0.001).

Conclusions:

The SAV value is an independent predictor of the success of ESWL and a useful tool for planning stone treatment. Patients with a SAV ⩾956 HU are not ideal candidates for ESWL. The inclusion criteria for ESWL of stones with a SAV <500 HU can be expanded with regard to stone size, site, age, renal function and coagulation profile. In patients with a SAV of 500–1000 HU, factors like a body mass index of >30 kg/m² and a lower calyceal location make them less ideal for ESWL.

Keywords:

• Urinary calculi
• Stone attenuation value
• BMI
• ESWL
• Lower calyceal stone

Abbreviations:

• SAV, stone-attenuation value
• HU, Hounsfield unit
• NCCT, non-contrast computed tomography
• BMI, body mass index
• US, ultrasonography
• ROC, receiver operating characteristic (curve)

Notes

Peer review under responsibility of Arab Association of Urology.