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Abdominal fat distribution on computed tomography predicts ureteric calculus fragmentation by shock wave lithotripsy

  • Computed Tomography
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To assess the effects of abdominal fat on shock wave lithotripsy (SWL). We used pre-SWL unenhanced computed tomography (CT) to evaluate the impact of abdominal fat distribution and calculus characteristics on the outcome of SWL.


One hundred and eighty-five patients with a solitary ureteric calculus treated with SWL were retrospectively reviewed. Each patient underwent unenhanced CT within 1 month before SWL treatment. Treatment outcomes were evaluated 1 month later. Unenhanced CT parameters, including calculus surface area, Hounsfield unit (HU) density, abdominal fat area and skin to calculus distance (SSD) were analysed.


One hundred and twenty-eight of the 185 patients were found to be calculus-free following treatment. HU density, total fat area, visceral fat area and SSD were identified as significant variables on multivariate logistic regression analysis. The receiver-operating characteristic analyses showed that total fat area, para/perirenal fat area and visceral fat area were sensitive predictors of SWL outcomes.


This study revealed that higher quantities of abdominal fat, especially visceral fat, are associated with a lower calculus-free rate following SWL treatment. Unenhanced CT is a convenient technique for diagnosing the presence of a calculus, assessing the intra-abdominal fat distribution and thereby helping to predict the outcome of SWL.

Key Points

Unenhanced CT is now widely used to assess ureteric calculi.

The same CT protocol can provide measurements of abdominal fat distribution.

Ureteric calculi are usually treated by shock wave lithotripsy (SWL).

Greater intra-abdominal fat stores are generally associated with poorer SWL results.

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  1. Abe T, Akakura K, Kawaguchi M et al (2005) Outcomes of shockwave lithotripsy for upper urinary-tract calculus: a large-scale study at a single institution. J Endourol 19:768–773

    Article  PubMed  Google Scholar 

  2. Pareek G, Armenakas NA, Fracchia JA (2003) Hounsfield units on computerized tomography predict calculus-free rates after extracorporeal shock wave lithotripsy. J Urol 169:1679–1681

    Article  PubMed  Google Scholar 

  3. Srivastava A, Ahlawat R, Kumar A, Kapoor R, Bhandari M (1992) Management of impacted upper ureteric calculi: results of lithotripsy and percutaneous litholapaxy. Br J Urol 70:252–257

    CAS  Google Scholar 

  4. Juan YS, Huang CH, Wang CJ et al (2008) Predictive role of renal resistance indices in the extracorporeal shock-wave lithotripsy outcome of ureteric calculus. Scand J Urol Nephrol 42:364–368

    Article  PubMed  Google Scholar 

  5. Pearle MS, Watamull LM, Mullican MA (1999) Sensitivity of noncontrast helical computerized tomography and plain film radiography compared to flexible nephroscopy for detecting residual fragments after percutaneous nephrostolithotomy. J Urol 162:23–26

    Article  PubMed  CAS  Google Scholar 

  6. Olcott EW, Sommer FG, Napel S (1997) Accuracy of detection and measurement of renal calculi: in vitro comparison of three-dimensional spiral CT, radiography, and nephrotomography. Radiology 204:19–25

    PubMed  CAS  Google Scholar 

  7. Pareek G, Armenakas NA, Panagopoulos G, Bruno JJ, Fracchia JA (2005) Extracorporeal shock wave lithotripsy success based on body mass index and Hounsfield units. Urology 65:33–36

    Article  PubMed  Google Scholar 

  8. Mezentsev VA (2005) Extracorporeal shock wave lithotripsy in the treatment of renal pelvicalyceal stones in morbidly obese patients. Int Braz J Urol 31:105–110

    Article  PubMed  CAS  Google Scholar 

  9. Perks AE, Schuler TD, Lee J et al (2008) Stone attenuation and skin-to-stone distance on computed tomography predicts for stone fragmentation by shock wave lithotripsy. Urology 72:765–769

    Article  PubMed  Google Scholar 

  10. (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet, 363:157-163.

  11. Tokunaga K, Matsuzawa Y, Ishikawa K, Tarui S (1983) A novel technique for the determination of body fat by computed tomography. Int J Obes 7:437–445

    PubMed  CAS  Google Scholar 

  12. Dixon AK (1983) Abdominal fat assessed by computed tomography: sex difference in distribution. Clin Radiol 34:189–191

    Article  PubMed  CAS  Google Scholar 

  13. Yoshizumi T, Nakamura T, Yamane M et al (1999) Abdominal fat: standardized technique for measurement at CT. Radiology 211:283–286

    PubMed  CAS  Google Scholar 

  14. White W, Klein F (2006) Five-year clinical experience with the Dornier Delta lithotriptor. Urology 68:28–32

    Article  PubMed  Google Scholar 

  15. Dretler SP, Spencer BA (2001) CT and calculus fragility. J Endourol 15:31–36

    Article  PubMed  CAS  Google Scholar 

  16. Yilmaz S, Sindel T, Arslan G et al (1998) Renal colic: comparison of spiral CT, US and IVU in the detection of ureteric calculi. Eur Radiol 8:212–217

    Article  PubMed  CAS  Google Scholar 

  17. Graversen JA, Korets R, Hruby GW et al (2011) Evaluation of bioimpedance as novel predictor of extracorporeal shockwave lithotripsy success. J Endourol 25:1503-1506

    Google Scholar 

  18. Kawasaki S, Aoki K, Hasegawa O et al (2008) Sonographic evaluation of visceral fat by measuring para- and perirenal fat. J Clin Ultrasound 36:129–133

    Article  PubMed  Google Scholar 

  19. El-Nahas AR, El-Assmy AM, Mansour O, Sheir KZ (2007) A prospective multivariate analysis of factors predicting calculus disintegration by extracorporeal shock wave lithotripsy: the value of high-resolution noncontrast computed tomography. Eur Urol 51:1688–1693

    Article  PubMed  Google Scholar 

  20. Fujioka S, Matsuzawa Y, Tokunaga K, Tarui S (1987) Contribution of intra-abdominal fat accumulation to the impairment of glucose and lipid metabolism in human obesity. Metabolism 36:54–59

    Article  PubMed  CAS  Google Scholar 

  21. Hyun YJ, Kim OY, Jang Y et al (2008) Evaluation of metabolic syndrome risk in Korean premenopausal women: not waist circumference but visceral fat. Circ J 72:1308–1315

    Article  PubMed  CAS  Google Scholar 

  22. Hayashi T, Boyko EJ, McNeely MJ, Leonetti DL, Kahn SE, Fujimoto WY (2008) Visceral adiposity, not abdominal subcutaneous fat area, is associated with an increase in future insulin resistance in Japanese Americans. Diabetes 57:1269–1275

    Article  PubMed  CAS  Google Scholar 

  23. Oka R, Miura K, Sakurai M et al (2010) Impacts of visceral adipose tissue and subcutaneous adipose tissue on metabolic risk factors in middle-aged Japanese. Obesity (Silver Spring) 18:153-160

    Google Scholar 

  24. Eguchi M, Tsuchihashi K, Saitoh S et al (2007) Visceral obesity in Japanese patients with metabolic syndrome: reappraisal of diagnostic criteria by CT scan. Hypertens Res 30:315–323

    Article  PubMed  Google Scholar 

  25. Pareek G, Hedican SP, Lee FT Jr, Nakada SY (2005) Shock wave lithotripsy success determined by skin-to-calculus distance on computed tomography. Urology 66:941–944

    Article  PubMed  Google Scholar 

  26. Chou YH, Su CM, Li CC et al (2011) Difference in urinary stone components between obese and non-obese patients. Urol Res 39:283–287

    Article  PubMed  CAS  Google Scholar 

  27. Williams JC Jr, Saw KC, Paterson RF, Hatt EK, McAteer JA, Lingeman JE (2003) Variability of renal stone fragility in shock wave lithotripsy. Urology 61:1092–1096

    Article  PubMed  Google Scholar 

  28. Seitz C, Tanovic E, Kikic Z, Memarsadeghi M, Fajkovic H (2007) Rapid extracorporeal shock wave lithotripsy for proximal ureteral calculi in colic versus noncolic patients. Eur Urol 52:1223–1227

    Article  PubMed  Google Scholar 

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Correspondence to Yung-Shun Juan.

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Juan, HC., Lin, HY., Chou, YH. et al. Abdominal fat distribution on computed tomography predicts ureteric calculus fragmentation by shock wave lithotripsy. Eur Radiol 22, 1624–1630 (2012).

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