USE OF COMPUTED TOMOGRAPHY-BASED NOMOGRAM IN ADULT AGE PATIENTS TO PREDICT SUCCESS RATES AFTER SHOCK WAVE LITHOTRIPSY FOR RENAL STONES: A SINGLE CENTER EXPERIENCE

Authors

  • Nadeem Iqbal Shifa International hospital Islamabad.Pakistan.
  • Aisha Hasan Riphah International University,Rawalpindi.
  • Gurdeep Singh PKLI.
  • Mohammad Haroon Hassan shifa international hospital Islamabad,Pakistan.
  • Ahsan Nazar shifa international hospital Islamabad,Pakistan.
  • Muhammad Haroon Khilan shifa international hospital Islamabad,Pakistan.
  • Shahzeb Irfan Malik shifa international hospital Islamabad,Pakistan.
  • Muhammad Athar Khawaja shifa international hospital Islamabad,Pakistan.
  • Saeed Akhter shifa international hospital Islamabad,Pakistan.
  • Daud Iqbal Registrar Cardiology Faculty Ayub Teaching Hospital
  • Faheemullah Khan Resident Diagnostic Radiology at Aga khan university Hospital, Karachi.

Abstract

Background: The Triple D score is a novel and easy to use nomogram to predict shock-wave lithotripsy (SWL) outcomes. It is based on Computed Tomography (CT scan) parameters including stone density, skin-to-stone distance, and stone volume. However, its use has not been validated much as studies are sparse regarding its use. Our aim was to validate and evaluate accuracy of the Triple D scoring system in predicting SWL success rates. Methods: It was a prospective study of 277 patients who had undergone SWL procedure for renal stones. They were evaluated by using non-contrast tomography, before undergoing SWL. CT scan-based parameters including distance of stone to skin (SSD), stone volume (SV), stone density was assessed. Computation of Cut off values was done with receiver operating characteristics analysis. Score was assigned on the basis of these cut-off values and success rate of SWL was determined. This score ranged from 0 (least favourable score) to 3 (most favourable score). Results: Stone-free status was attained in 160 patients (57.7%), and 117 (42.3%) patients were labelled to have failed the procedure. Differences between these two groups in terms of Stone volume, stone density and skin to stone distance were significant. Triple D scores of zero,1, 2, and 3 had stone-free rates of 3.6%, 52.56%, 53.3%, and 93.1% respectively (p-vaue<0.001). Conclusion: shock-wave lithotripsy outcomes can be predicted with use of Triple D score and hence, it’s externally corroborated. It may help urologist in appropriate patient selection and hence decision making and patient counselling.

Author Biography

Nadeem Iqbal, Shifa International hospital Islamabad.Pakistan.

Post graduate trainee urology at shifa international hospital Islamabad,Pakistan.

References

Chaussy C, Brendel W, Schmiedt E. Extracorporeally induced destruction of kidney stones by shock waves. Lancet 1980;2:1265–8.

Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol 2016;69(3):475–82.

Iqbal N, Malik Y, Nadeem U, Khalid M, Pirzada A, Majeed M, et al. Comparison of ureteroscopic pneumatic lithotripsy and extracorporeal shock wave lithotripsy for the management of proximal ureteral stones: A single center experience. Turk J Urol 2018;44(3):221–7.

Nadler RB. Predicting stone-free rates. J Urol. 2009 ;181:949-50. doi: 10.1016/j.juro.2008.12.022.

Pearle MS, Lingeman JE, Leveillee R, Kuo R, Preminger GM, Nadler RB, et al. Prospective, randomized trial comparing shock wave lithotripsy and ureteroscopy for lower pole caliceal calculi 1 cm or less. J Urol 2008;179(5 Suppl):S69–73.

Oberlin DT, Flum AS, Bachrach L, Matulewicz RS, Flury SC. Contemporary surgical trends in the management of upper tract calculi. J Urol 2015;193(3):880–4.

Patel T, Kozakowski K, Hruby G, Gupta M. Skin to stone distance is an independent predictor of stone-free status following shockwave lithotripsy. J Endourol 2009;23(9):1383–5.

Onal B, Citgez S, Tansu N, Demirdag C, Dogan C, Gonul B, et al. Predictive factors and management of steinstrasse after shock wave lithotripsy in pediatric urolithiasis--a multivariate analysis study. Urology 2012;80(5):1127–31.

Tiselius HG, Chaussy CG. Arguments for choosing extracorporeal shockwave lithotripsy for removal of urinary tract stones. Urolithiasis 2015;43:387–396.

Iqbal N, Muhammad S, Zafar W, Tashfeen R, Faiz J, Hasan A, et al. Stone-Free-Rate After Extracorporeal Shockwave Lithotripsy in the Management of Pediatric Renal Stones in Lower Pole and Other Locations - A Comparative Study. J Coll Physicians Surg Pak 2016;26:908–11.

Ouzaid I, Al-qahtani S, Dominique S, Hupertan V, Fernandez P, Hermieu JF, et al. A 970 Hounsfield units (HU) threshold of kidney stone density on non-contrast computed tomography (NCCT) improves patients’ selection for extracorporeal shockwave lithotripsy (ESWL): Evidence from a prospective study. BJU Int 2012;110(11 Pt B):E438–42.

Pareek G, Hedican SP, Lee FT Jr, Nakada SY. Shock wave lithotripsy success determined by skin-to-stone distance on computed tomography. Urology 2005;66:941–4.

Yazici O, Tuncer M, Sahin C, Demirkol MK, Kafkasli A, Sarica K. Shock Wave Lithotripsy in Ureteral Stones: Evaluation of Patient and Stone Related PredictiveFactors. Int Braz J Urol 2015;41:676–82.

Tran TY, McGillen K, Cone EB, Pareek G. Triple D Score is a reportable predictor of shockwave lithotripsy stone-free rates. J Endourol 2015;29:226–30.

Bhojani N, Lingeman JE. Shockwave lithotripsy-new concepts and optimizing treatment parameters. Urol Clin North Am 2013;40:59–66.

Iqbal N, Assad S, Rahat Aleman Bhatti J, Hasan A, Shabbir MU, Akhter S. Comparison of Extracorporeal Shock Wave Lithotripsy for Urolithiasis Between Children and Adults: A Single Centre Study. Cureus 2016;29(9):e810.

Deem S, Defade B, Modak A, Emmett M, Martinez F, Davalos J. Percutaneous nephrolithotomy versus extracorporeal shock wave lithotripsy for moderate sized kidney stones. Urology 2011;78:739–43.

Ng CF, Siu DY, Wong A, Goggins W, Chan ES, Wong KT. Development of a scoring system from noncontrast computerized tomography measurements to improve the selection of upper ureteral stone for extracorporeal shock wave lithotripsy. J Urol

;181:1151–7.

Joseph P, Mandal AK, Singh SK, Mandal P, Sankhwar SN, Sharma SK. Computerized tomography attenuation value of renal calculus: Can it predict successful fragmentation of the calculus by extracorporeal shock wave lithotripsy? J Urol 2002;167:1968–71.

Ghoneim IA, Ziada AM, El Katib SE. Predictive factors of lower calyceal stone clearance after extracorporeal shockwave lithotripsy (ESWL): a focus on infundibulopelvic anatomy. Eur Urol 2005;48:296–302.

Dogan HS, Altan M, Citamak B, Bozaci AC, Karabulut E, Tekgul S. A new nomogram for prediction of outcome of pediatric shock-wave lithotripsy. J Pediatr Urol 2015;11:84 e1–6.

Park BH, Choi H, Kim JB, Chang YS. Analyzing the effect of distance from skin to stone by computed tomography scan on the extracorporeal shock wave lithotripsy stone-free rate of renal stones. Korean J Urol 2012;53:40–3.

Al-Ali BM, Patzak J, Lutfi A, Pummer K, Augustin H. Impact of urinary stone volume on computed tomography stone attenuations measured in Hounsfield units in a large group of Austrian patients with urolithiasis. Cent European J Urol 2014;67(3):289–95.

Bandi G, Meiners RJ, Pickhardt PJ, Nakada SY. Stone measurement by volumetric three-dimensional computed tomography for predicting the outcome after extracorporeal shock wave lithotripsy. BJU Int 2009;103:524–8.

El-Nahas AR, El-Assmy AM, Mansour O, Sheir KZ. A prospective multivariate analysis of factors predicting stone disintegration by extracorporeal shock wave lithotipsy: yhe value of high-resolution non contrast computed tomography. Eur Urol 2007;51:1688–93.

Perks AE, Schuler TD, Lee J, Ghiculete D, Chung DG, D'A Honey RJ, et al. Stone attenuation and skin-to-stone distance on computed tomography predicts for stone fragmentation by shock wave lithotripsy. Urology 2008;72(4):765–9.

Wiesenthal JD, Ghiculete D, D’A Honey RJ, Pace KT. Evaluating the importance of mean stone density and skinto-stone distance in predicting successful shock wave lithotripsy of renal and ureteric calculi. Urol Res 2010;38:307–13.

Nakasato T, Morita J, Ogawa Y. Evaluation of Hounsfield Units as a predictive factor for the outcome of extracorporeal shock wave lithotripsyand stone composition. Urolithiasis 2015;43:69–75.

Gökce MI, Esen B, Gülpınar B, Süer E, Gülpınar Ö. External Validation of Triple D Score in an Elderly (≥65 Years) Population for Prediction of Success Following Shockwave Lithotripsy. J Endourol 2016;30:1009–16.

Ozgor F, Tosun M, Kayali Y, Savun M, Binbay M, Tepeler A. External Validation and Evaluation of Reliability and Validity of the Triple D Score to PredictStone-Free Status After Extracorporeal Shockwave Lithotripsy. J Endourol 2017;31:169–73.

Published

2021-06-28

Most read articles by the same author(s)

1 2 > >>