Korean J Urol.  2015 Jan;56(1):56-62. 10.4111/kju.2015.56.1.56.

Can stone density on plain radiography predict the outcome of extracorporeal shockwave lithotripsy for ureteral stones?

• Lim KH
• Jung JH
• Kwon JH
• Lee YS
• Bae J
• Cho MC
• Lee KS
• Lee HW

• KMID: 2070269
• DOI: http://doi.org/10.4111/kju.2015.56.1.56

Abstract

PURPOSE
The objective was to determine whether stone density on plain radiography (kidney-ureter-bladder, KUB) could predict the outcome of extracorporeal shockwave lithotripsy (ESWL) for ureteral stones.
MATERIALS AND METHODS
A total of 223 patients treated by ESWL for radio-opaque ureteral stones of 5 to 20 mm were included in this retrospective study. All patients underwent routine blood and urine analyses, plain radiography (KUB), and noncontrast computed tomography (NCCT) before ESWL. Demographic, stone, and radiological characteristics on KUB and NCCT were analyzed. The patients were categorized into two groups: lower-density (LD) group (radiodensity less than or equal to that of the 12th rib, n=163) and higher-density (HD) group (radiodensity greater than that of the 12th rib, n=60). Stone-free status was assessed by KUB every week after ESWL. A successful outcome was defined as stone free within 1 month after ESWL.
RESULTS
Mean stone size in the LD group was significantly smaller than that in the HD group (7.5+/-1.4 mm compared with 9.9+/-2.9 mm, p=0.002). The overall success rates in the LD and HD groups were 82.1% and 60.0%, respectively (p=0.007). The mean duration of stone-free status and average number of SWL sessions required for success in the two groups were 21.7 compared with 39.2 days and 1.8 compared with 2.3, respectively (p<0.05). On multivariate logistic analysis, stone size and time to ESWL since colic and radiodensity of the stone on KUB were independent predictors of successful ESWL.
CONCLUSIONS
Our data suggest that larger stone size, longer time to ESWL, and ureteral stones with a radiodensity greater than that of the 12th rib may be at a relatively higher risk of ESWL failure 1 month after the procedure.

Keyword

Bone density; Lithotripsy; Ureteral calculi

MeSH Terms

Adult
Aged
Colic
Female
Humans
*Lithotripsy
Male
Middle Aged
Multivariate Analysis
Retrospective Studies
Tomography, X-Ray Computed
Treatment Outcome
Ureteral Calculi/*radiography/*therapy

Figure

• 

  Fig. 1 Stone density classification compared with the density of the 12th rib: lower (arrow, A), equal (arrow, B), and higher density (arrow, C).

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