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The ratio of CT attenuation values of the ureter above/below ureteral stones is a useful preoperative factor for predicting impacted ureteral stones

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Abstract

Impacted stones typically make it difficult to perform ureteroscopic lithotripsy (URSL), so it is useful to preoperatively predict such impaction. We focused on CT attenuation values of the ureter above and below the stone (‘HU above’ and ‘HU below’) and calculated their ratio (HAB ratio; HU above/HU below ratio). The aim was to investigate whether HAB ratio could predict impacted stones preoperatively. Between 2011 and 2019, 171 patients from our hospital that had URSL for ureteral stones with pretreatment non-contrast computed tomography (NCCT) were retrospectively identified. Ureteral wall thickness (UWT), ureteral wall volume (UWV) and HAB ratio (‘HU above’ divided by ‘HU below’) were recorded. Impacted stones were defined as fixed stones that did not move by means of ureteroscopic manipulation or water pressure. Of the 171 procedures, 46 (27%) involved patients with impacted stones. Comparing patient characteristics and stone parameters according to impaction status, factors with significant difference included grade of hydronephrosis, UWT, and HAB ratio (all P < 0.01). Multivariate analysis indicated that significant independent predictors of impacted stones were thicker UWT and lower HAB ratio (all P < 0.01). HAB ratio was a significant preoperative predictor of stone impaction in patients undergoing URSL for ureteral stones. HAB ratio may be informative for selecting the treatment and preoperative preparations.

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Abbreviations

AUC:

Area under curve

BMI:

Body mass index

CTU:

Computed tomographic urography

HAB ratio:

HU above/HU below ratio

HU:

Hounsfield unit

IVU:

Intravenous urography

MSD:

Mean stone density

NCCT:

Non-contrast computed tomography

OR:

Odds ratio

SFR:

Stone-free rate

SWL:

Shock wave lithotripsy

URSL:

Ureteroscopic lithotripsy

UWT:

Ureteral wall thickness

UWV:

Ureteral wall volume

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Acknowledgements

This document was proof-read and edited by Benjamin Phillis at the Clinical Study Support Center, Wakayama Medical University. The authors are grateful to Takashi Nishiyama, Radiological technologist at Wakayama Medical University, for his help in manuscript writing.

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The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Urology, Wakayama Medical University, 811-1, Kimiidera, Wakayama, Wakayama, 641-0012, Japan

    Ryusuke Deguchi, Shimpei Yamashita, Yuya Iwahashi, Satoshi Muraoka, Kazuro Kikkawa, Yasuo Kohjimoto & Isao Hara

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  1. Ryusuke Deguchi
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  2. Shimpei Yamashita
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  3. Yuya Iwahashi
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  4. Satoshi Muraoka
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  5. Kazuro Kikkawa
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  6. Yasuo Kohjimoto
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  7. Isao Hara
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Contributions

RD wrote the main manuscript text and prepared figures 1-3 and table 1-2. All authors reviewed the manuscript.

Corresponding author

Correspondence to Shimpei Yamashita.

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All authors declare that they have no conflict of interest.

Ethical approval

All procedures were carried out in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration. This study was approved by Wakayama Medical University Ethics Committee (No.3487).

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Informed consent was obtained from all individual participants included in the study.

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Deguchi, R., Yamashita, S., Iwahashi, Y. et al. The ratio of CT attenuation values of the ureter above/below ureteral stones is a useful preoperative factor for predicting impacted ureteral stones. Urolithiasis 50, 643–649 (2022). https://doi.org/10.1007/s00240-022-01354-x

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  • DOI: https://doi.org/10.1007/s00240-022-01354-x

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