Radiographic Parameters in Non-Contrast Computed Tomography Predict the Success of Percutaneous Nephrolithotomy
Keywords:
computed tomogram parameters, percutaneous nephrolithitomyAbstract
Aim: To evaluate whether non-contrast Computed Tomogram (CT) parameters (stone density, localization, size & degree of pelvicalceal system dilatation) predict the outcome of percutaneous Nephrolithotomy (PCNL).
Method: This study included 68 patients (43 male & 25 female) with renal calculi scheduled for PCNL. They were examined by non-contrast CT to determine calculus size, calculus density, calculus location & degree of pelvicalceal system dilatation. Ultrasound at scheduled PCNL follow-up one and two months later and undertaken by 2 radiologist at the same unit (HD11XE Philips 2010 unit) checked for residual stones. Stones equal or more than 4 mm in largest diameter was regarded as significant.
Result : CT parameters that were associated with more residual stones ( P value <0.001) included density less than 700 HU, upper calyx location, presence of preoperative hydronephrosis and large stone size.
Conclusion: pre-operative CT can predict the outcome of PCNL. Stone parameters that predict the oucome of PCNL included stone density, less than 700 HU, upper calyceal stone, large size stone & the presence of pre-operative hydronephrosis.
References
Smith RC, Levine J, Rosenfield AT. Helical CT of urinary tract stones. Epidemiology, origin, pathophysiology, diagnosis, and management. RadiolClin North Am. 1999; 37:911–52.
Chen MY, Zagoria RJ. Can noncontrast helical computed tomography replace intravenous urography for evaluation of patients with acute urinary tract colic? J Emerg Med. 1999; 17:299–303.
Boulay I, Holtz P, Foley WD, White B, Begun FP. Ureteral calculi: diagnostic efficacy of helical CT and implications for treatment of patients. AJR Am J Roentgenol. 1999; 172:1485–90.
Assi Z, Platt JF, Francis IR, et al. Sensitivity of CT scout radiography and abdominal radiography for revealing ureteral calculi on helical CT: implications for radiologic follow-up. AJR Am J Roentgenol. Aug 2000; 175(2):333-7.
Miller OF, Rineer SK, Reichard SR, Buckley RG,Donovan MS, Graham IR et al. Prospective comparison of unenhanced spiral computed tomography and intravenous urogram in the evaluation of acute flank pain. Urology 1998;52:982-7.
Vieweg J, Teh C, Freed K, Leder RA, Smith RH, Nelson RH et al. Unenhanced helical computerized tomographyfor the evaluation of patients with acute flank pain. J Urol 1998; 160:679-84.
Palmer JS, Donaher ER, O’Riordan MA, Dell KM. Diagnosis of pediatric urolithiasis: role of ultrasound and computerized tomography. J Urol 2005; 174:1413-1414.
Ketelslegers E, Van Beers BE Urinary calculi: improved detection and characterization with thin-slice multidetector CT. Eur Radiol 2006; 16(1):161–165.
Lin WC Uppot RN,Li CS, Hahn PF, Sahani DV Value of automated coronal reformations from 64-section multidetector row computerized tomography in the diagnosis of urinary stone disease. J Urol 2007;178(3 pt 1):907–911
Metser U, Ghai S, Ong YY, Lockwood G, Radomski SB Assessment of urinary tract calculi with 64- MDCT: the axial versus coronal plane. Am J Roentgenol 2009; 192(6):1509–1513.
Dalla Palma L, Pozzi-Mucelli R, Stacul F Present-day imaging of patients with renal colic. EurRadiol 2001; 11(1):4–17.
Saw KC, McAteer JA, Monga AG, Chua GT, Lingeman JE, Williams JC Jr.Helical CT of urinary calculi: effect of stone composition, stone size, and scan collimation. Am J Roentgenol 2000; 175(2):329–332.
Coşkun M, Tekin MI, Peşkircioglu L, Tarhan NC, Ozkardeş H Spiralcomputed tomography: role in determination of chemical compositions of pure and mixed urinary stones—an in vitro study. Urology 2004; 64(2):237–240.
Gagnon RF, Alli AI, Edwardes MD, Watters AK, Tsoukas CM. Low urine pH is associated with reduced indinavir crystalluria in indinavir-treated HIV-infected individuals. ClinNephrol. 2006;65:13-21.
Ghani KR, Patel U, Anson K. Computed tomography for percutaneous renal access. J Endourol 2009; 23:1633–1639.
Gedik A, Tutus A, Kayan D, et al. Percutaneous nephrolithotomy in pediatric patients: Is computerized tomography a must? Urol Res 2011; 39:45–49.
Thiruchelvam N, Mostafid H, Ubhayakar G. Planning percutaneous nephrolithotomy using multidetector computed tomography urography, multiplanar reconstruction and three-dimensional reformatting. BJU Int 2005; 95: 1280–1284.
Huang CC, Chuang CK, Wong YC, et al. Useful prediction of ureteral calculi visibility on abdominal radiographs based on calculi characteristics on unenhanced helical CT and CT scout radiographs. Int J ClinPract 2009; 63: 292–298.
Saw KC, McAteer JA, Fineberg NS, et al. Calcium stone fragility is predicted by helical CT attenuation values. J Endourol 2000; 14:471–474.
Pareek G, Armenakas NA, Fracchia JA. Hounsfield units on computerized tomography predict stone-free rates after extracorporeal shock wave lithotripsy. J Urol 2003; 169:1679–1681.
Turna B, Umul M, Demiryoguran S, et al. How do increasing stone surface area and stone configuration affect overall outcome of percutaneous nephrolithotomy? J Endourol 2007; 21:34–43.
Ray AA, Ghiculete D, Pace KT, Honey RJ. Limitations to ultrasound in the detection and measurement of urinary tract calculi. Urology 2010; 76:295–300.
Deveci S, Cosxkun M, Tekin MI, and et al. Spiral computed tomography:Role in determination of chemical compositions of pure and mixed urinary stones—an in vitro study. Urology 2004; 64:237–240.
Arvind P. Ganpule, MRD. What’s new in percutaneous nephrolithotomy. Arab Journal of Urology. 2012; 11:367-371
Newman DM, Scott JW, Lingeman JE. Two-year follow-up of patientstreated with extracorporeal shock wave lithotripsy. J Endourol 1988; 2:163–171.
Graff J, Deidrichs W, Schulze H. Long-term followup in 1,003 extracorporealshock wave lithotripsy patients. J Urol 1988; 140:479–483.
Lim JK, Hyun JS, Chung KH. Cost and effectiveness of different treatment options for renal calculi larger than 2cm. Korean J Urol 2002; 43:454–458.
Lojanapiwat B. Previous open nephrolithotomy: Does it affect percutaneousnephrolithotomy techniques and outcome? J Endourol 2006; 20:17–20.
Sountoulides P, Metaxa L, Cindolo L. Is CT is mandatory for detection of residual stone fragments after PCNL? Journal of Endourology ; 27, Number 11,November 2013. 1341-1348.