Predictive factors for extracorporeal shockwave lithotripsy success in ureteric stones, does skin-stone distance and hounsfield unit matter?

Abstract

OBJECTIVE: To evaluate the usefulness of measuring stone skin distance and stone attenuation values by non-contrast computed tomography for predicting treatment outcome of ureteric stones by extracorporeal shockwave lithotripsy (ESWL). PATIENT AND METHOD : Retrospective review of 66 patients who underwent ESWL for ureteric stones with pre-ESWL NCCT in 2010–2012. Subjects were stratified into 2 groups, successful ESWL and failed ESWL, with ESWL success defined as stone fragment less than 4 mm at 6 weeks after ESWL. Patient age, sex, stone size, stone location, laterality, shockwave energy, number of shockwave administered, Hounsfield unit (HU), skin to stone distance (SSD), presence of hydronephrosis, pre-ESWL JJ stent or PCN were studied as predictive factors. RESULTS : Patient demographics and stone characteristics were similar between the 2 groups. On univariate analysis, the mean stone size for successful ESWL was 7.9 mm compared with 10.2 mm in the failure group (P = 0.02). For the skin-stone distance, the mean distance for the successful group was 95 mm compared with 104 mm in the failure group (P = 0.04). Concerning the Hounsfield Unit, a mean of 1034 HU was found in the successful compared with 1129 HU in the failure group (P = 0.16) CONCLUSION : Skin to stone distance on non-contrast CT scan is a useful predictive factors for ESWL success for ureteric stones.