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Evaluation of Hounsfield Units as a predictive factor for the outcome of extracorporeal shock wave lithotripsy and stone composition

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Abstract

The objective of this study was to evaluate the utility of the Hounsfield Unit (HU) values as a predictive factor of extracorporeal shock wave lithotripsy outcome for ureteral and renal stones. We also assessed the possibility that HU values could be used to predict stone composition. A retrospective study was performed to measure stone HU values in 260 patients who underwent extracorporeal shock wave lithotripsy (ESWL) for solitary renal and ureteral stones from July 2007 to January 2012. Stone volume, location, skin-to-stone distance, stone HU values, and stone composition were assessed. Success of ESWL was defined as: (1) being stone-free or (2) residual stone fragments <4 mm after 3 months by radiography. Of the 260 assessed patients, 141 (54.2 %) were stone-free, 32 (12.3 %) had residual stone fragments <4 mm (clinically insignificant stone fragments), and 87 (33.5 %) had residual stone fragments ≥4 mm after one round of ESWL. Multivariate analysis revealed that stone location and mean HU were significant predictors of ESWL success. Receiver operating characteristic curves defined cutoff values for predicting treatment outcome. Treatment success rates were significantly higher for stones <815 HU than with stones >815 HU (P < 0.0265). HU of calcium oxalate and calcium phosphate stones were higher than those of uric acid stones, but we could not differentiate between calcium oxalate monohydrate and calcium oxalate dihydrate stones. Evaluation of stone HU values prior to ESWL can predict treatment outcome and aid in the development of treatment strategies.

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Abbreviations

ESWL:

Extracorporeal shock wave lithotripsy

HU:

Hounsfield Unit

PNL:

Percutaneous nephrolithotomy

TUL:

Transurethral ureterolithotripsy

f-TUL:

Flexible transurethral ureterolithotripsy

SSD:

Skin-to-stone distance

NCCT:

Non-contrast computed tomography

CaOMH:

Calcium oxalate monohydrate

CaODH:

Calcium oxalate dihydrate

ROC:

Receiver operating characteristic

SF:

Stone free

CIRF:

Clinically insignificant residual fragments

AUC:

Area under the curve

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Authors and Affiliations

  1. Department of Urology School of Medicine, Showa University, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan

    Takehiko Nakasato, Jun Morita & Yoshio Ogawa

Authors
  1. Takehiko Nakasato
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  2. Jun Morita
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  3. Yoshio Ogawa
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Correspondence to Takehiko Nakasato.

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Nakasato, T., Morita, J. & Ogawa, Y. Evaluation of Hounsfield Units as a predictive factor for the outcome of extracorporeal shock wave lithotripsy and stone composition. Urolithiasis 43, 69–75 (2015). https://doi.org/10.1007/s00240-014-0712-x

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  • DOI: https://doi.org/10.1007/s00240-014-0712-x

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