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Ipek OM, Dincer E, Sevinc AH, Sevinc BH, Canakci C, Ozkaptan O. Predictive performance of Triple-D, Quadruple-D, and Mayo adhesive probability scores in ESWL for renal stones: a retrospective cohort study. Urolithiasis 2025; 53:96. [PMID: 40402229 PMCID: PMC12098459 DOI: 10.1007/s00240-025-01765-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2025] [Accepted: 05/08/2025] [Indexed: 05/23/2025]
Abstract
This study aimed to compare the predictive performance of Triple-D, Quadruple-D, and Mayo Adhesive Probability (MAP) scoring systems in estimating stone-free (SF) status following extracorporeal shock wave lithotripsy (ESWL) in patients with renal stones. This retrospective cohort study was conducted on patients who underwent ESWL between January 2020 and January 2024. Pre-treatment non-contrast computed tomography was used to assess stone characteristics and calculate Triple-D, Quadruple-D, and MAP scores. Patients were categorized into stone-free (SF) and residual stone (RS) groups based on imaging performed three months after treatment. Residual fragments of < 4 mm were defined as SF. The study included 198 patients (60.6% male; mean age 45.5 ± 13.1 years). According to logistic regression analysis, a low MAP score (< 2.5) was the strongest independent predictor of SF status (OR: 15.5; 95% CI: 5.1-47.1; p < 0.001), followed by a high Quadruple-D score (> 1.5) (OR: 7.4; 95% CI: 2.2-24.1; p = 0.001) and low stone density (< 600 HU) (OR: 4.9; 95% CI: 1.1-21.8; p = 0.037). Conversely, a higher number of shockwaves and the need for additional procedures were associated with RS (both p < 0.001). Among the scoring systems, MAP score demonstrated the highest predictive accuracy with an AUC of 0.817, outperforming Quadruple-D (AUC: 0.722) and Triple-D (AUC: 0.639). MAP score was the most powerful and accurate independent predictor of SF status after ESWL, offering superior clinical utility compared to Triple-D and Quadruple-D scores in pre-treatment evaluation.
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Affiliation(s)
- Osman Murat Ipek
- Department of Urology, Kartal Dr. Lutfi Kirdar City Hospital, Cevizli Mevkii No:47, D-100, Kartal, İstanbul, 34865, Türkiye.
| | - Erdinc Dincer
- Department of Urology, Kartal Dr. Lutfi Kirdar City Hospital, Cevizli Mevkii No:47, D-100, Kartal, İstanbul, 34865, Türkiye
| | - Ahmet Halil Sevinc
- Department of Urology, Kartal Dr. Lutfi Kirdar City Hospital, Cevizli Mevkii No:47, D-100, Kartal, İstanbul, 34865, Türkiye
| | - Burcu Hanci Sevinc
- Department of Urology, Kartal Dr. Lutfi Kirdar City Hospital, Cevizli Mevkii No:47, D-100, Kartal, İstanbul, 34865, Türkiye
| | - Cengiz Canakci
- Department of Urology, Kartal Dr. Lutfi Kirdar City Hospital, Cevizli Mevkii No:47, D-100, Kartal, İstanbul, 34865, Türkiye
| | - Orkunt Ozkaptan
- Department of Urology, Kartal Dr. Lutfi Kirdar City Hospital, Cevizli Mevkii No:47, D-100, Kartal, İstanbul, 34865, Türkiye
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Iqbal N, Hasan A, Iqbal S, Noureen S, Akhter S. Role of variation coefficient of stone density in determining success of shock wave lithotripsy in urinary calculi. World J Nephrol 2025; 14:96946. [PMID: 40134653 PMCID: PMC11755239 DOI: 10.5527/wjn.v14.i1.96946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 08/10/2024] [Accepted: 09/03/2024] [Indexed: 01/20/2025] Open
Abstract
BACKGROUND Various stone factors can affect the net results of shock wave lithotripsy (SWL). Recently a new factor called variation coefficient of stone density (VCSD) is being considered to have an impact on stone free rates. AIM To assess the role of VCSD in determining success of SWL in urinary calculi. METHODS Charts review was utilized for collection of data variables. The patients were subjected to SWL, using an electromagnetic lithotripter. Mean stone density (MSD), stone heterogeneity index (SHI), and VCSD were calculated by generating regions of interest on computed tomography (CT) images. Role of these factors were determined by applying the relevant statistical tests for continuous and categorical variables and a P value of < 0.05 was gauged to be statistically significant. RESULTS There were a total of 407 patients included in the analysis. The mean age of the subjects in this study was 38.89 ± 14.61 years. In total, 165 out of the 407 patients could not achieve stone free status. The successful group had a significantly lower stone volume as compared to the unsuccessful group (P < 0.0001). Skin to stone distance was not dissimilar among the two groups (P = 0.47). MSD was significantly lower in the successful group (P < 0.0001). SHI and VCSD were both significantly higher in the successful group (P < 0.0001). CONCLUSION VCSD, a useful CT based parameter, can be utilized to gauge stone fragility and hence the prediction of SWL outcomes.
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Affiliation(s)
- Nadeem Iqbal
- Department of Urology and Kidney Transplant, Shifa Intl Hospitals, Islamabad 44790, Pakistan
- Department of Urology, Pakistan Kidney and Liver Institute, Lahore 54000, Punjab, Pakistan
| | - Aisha Hasan
- Department of Biochemistry, Riphah International University, Rawalpindi 44000, Punjab, Pakistan
| | - Sajid Iqbal
- Department of Rehabilitation, PNS Karachi, Karachi 75950, Sindh, Pakistan
| | - Sadaf Noureen
- Department of Medicine, Groves Medical Center, New Malden, London KT3 3PB, United Kingdom
| | - Saeed Akhter
- Department Urology, Shifa International Hospital Islamabad, Islamabad 44000, Pakistan
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Şendoğan F, Bulut M, Çanakçı C, Dinçer E, Şimşek B, Çetin B, Sılay S, Telli O. Quadruple-D score in the success rate of extracorporeal shock wave lithotripsy of renal stones in pediatric population. Urolithiasis 2024; 52:163. [PMID: 39549056 DOI: 10.1007/s00240-024-01657-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 10/29/2024] [Indexed: 11/18/2024]
Abstract
OBJECTIVES Evaluation of the validity of the Quadruple-D score in the prediction of success in pediatric stone disease. MATERIALS AND METHODS Of the 292 children treated with SWL between 2007 and 2023, a total of 158 children who had adequate follow-up data and evaluated with non-contrast computed tomography before SWL, were included in the study. Parameters were calculated for each of the stone volume (SV), skin-to-stone distance (SSD), stone density (SD) and stone location (SL) variables. Receiver operator characteristic analysis was used to set cut-off values. Quadruple-D scores were calculated, and success rates were determined for each score. Stone-free status was determined as complete clearance after three months of final SWL. RESULTS The median age of the study group was 8 (range 1 to 16). One hundred and one of the 158 (64%) children had stone-free status. Mean SV, SSD and SD values were significantly higher in SWL failed group than stone-free group after detecting cutoff values of 150 mm3, 6.7 cm, and 540 HU, respectively. Stone-free rates were detected as 19.6%, 24.7%, 37.2%, 76.2%, and 90.2% with the Quadruple-D scores of 0, 1, 2, 3 and 4 points. CONCLUSIONS Quadruple-D scoring system can further improve Triple-D scoring system by adding stone position parameter to clarify SFR with a simple and easy calculation. We believe that the Quadruple-D score will have better clinical significance than the Triple-D scoring system in predicting the success of SWL in children.
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Affiliation(s)
- Furkan Şendoğan
- Medicana Çamlıca Hospital, Clinic of Urology, Istanbul, Turkey
| | - Mehmet Bulut
- Diyarbakır Selahaddin Eyyubi State Hospital, Clinic of Urology, Diyarbakır, Turkey
| | - Cengiz Çanakçı
- Kartal Dr. Lutfi Kirdar Training and Research Hospital, Clinic of Urology, Istanbul, Turkey
| | - Erdinç Dinçer
- Kartal Dr. Lutfi Kirdar Training and Research Hospital, Clinic of Urology, Istanbul, Turkey
| | - Berkan Şimşek
- Liv Hospital Ulus, Clinic of Urology, Istanbul, Turkey
| | - Bilal Çetin
- Kartal Dr. Lutfi Kirdar Training and Research Hospital, Clinic of Pediatric Urology, Istanbul, Turkey
| | - Selçuk Sılay
- Medipol Acıbadem Hospital, Clinic of Pediatric Urology, Istanbul, Turkey
| | - Onur Telli
- Memorial Şişli Hospital, Clinic of Urology, Istanbul, Turkey.
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Sighinolfi MC, Calcagnile T, Ticonosco M, Kaleci S, DI Bari S, Assumma S, Sarchi L, Panio E, Ferrari R, Piro A, Ragusa A, Ciarlariello S, DA Silva RD, LA Rocca R, Illiano E, Paladini A, Persico F, Giraudo D, DE Marzo E, Grisanti R, Mantica G, Emiliani E, Madonia M, Salvetti M, Bassi P, Montanari E, Bove P, Simonato A, Averch TD, Porpiglia F, Calarco A, Bruschetta S, Manferrari F, Daels FP, Cerruto MA, Antonelli A, Mazzon G, Celia A, Simeone C, Zaramella S, Saita A, Costantini E, Mearini E, DE Dominicis M, Mirone V, Kim FJ, Ferretti S, Puliatti S, Rocco B, Micali S. External validation of a nomogram for outcome prediction in management of medium-sized (1-2 cm) kidney stones. Minerva Urol Nephrol 2024; 76:484-490. [PMID: 38727672 DOI: 10.23736/s2724-6051.24.05672-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
BACKGROUND Stone nomogram by Micali et al., able topredict treatment failure of shock-wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) in the management of single 1-2 cm renal stones, was developed on 2605 patients and showed a high predictive accuracy, with an area under ROC curve of 0.793 at internal validation. The aim of the present study is to externally validate the model to assess whether it displayed a satisfactory predictive performance if applied to different populations. METHODS External validation was retrospectively performed on 3025 patients who underwent an active stone treatment from December 2010 to June 2021 in 26 centers from four countries (Italy, USA, Spain, Argentina). Collected variables included: age, gender, previous renal surgery, preoperative urine culture, hydronephrosis, stone side, site, density, skin-to-stone distance. Treatment failure was the defined outcome (residual fragments >4 mm at three months CT-scan). RESULTS Model discrimination in external validation datasets showed an area under ROC curve of 0.66 (95% 0.59-0.68) with adequate calibration. The retrospective fashion of the study and the lack of generalizability of the tool towards populations from Asia, Africa or Oceania represent limitations of the current analysis. CONCLUSIONS According to the current findings, Micali's nomogram can be used for treatment prediction after SWL, RIRS and PNL; however, a lower discrimination performance than the one at internal validation should be acknowledged, reflecting geographical, temporal and domain limitation of external validation studies. Further prospective evaluation is required to refine and improve the nomogram findings and to validate its clinical value.
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Affiliation(s)
| | - Tommaso Calcagnile
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Ticonosco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Shaniko Kaleci
- Clinical and Experimental Medicine (CEM), Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano DI Bari
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Simone Assumma
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Luca Sarchi
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Enrico Panio
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Ferrari
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Adele Piro
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Ragusa
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Silvia Ciarlariello
- Department of Urology, Morgagni-Pierantoni Hospital, Forlì, Forlì-Cesena, Italy
| | | | - Roberto LA Rocca
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Ester Illiano
- Department of Urology, University of Naples Federico II, Naples, Italy
| | | | - Francesco Persico
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Davide Giraudo
- Department of Urology, Ospedale degli Infermi, Biella, Italy
| | - Enrico DE Marzo
- Department of Urology, Regional Health Care and Social Agency Civil Hospitals of Brescia, Brescia, Italy
| | - Riccardo Grisanti
- Department of Urology, Nuovo Ospedale Civile, Sassuolo, Modena, Italy
| | | | - Esteban Emiliani
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Massimo Madonia
- Department of Urology, Urologic Clinic, University Hospital of Sassari, Sassari, Italy
| | - Michele Salvetti
- Department of Urology, Azienda ULSS8 Berica, Arzignano, Vicenza, Italy
| | | | | | - Pierluigi Bove
- Department of Urology, San Carlo of Nancy Hospital, Rome, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Timothy D Averch
- Department of Urology, Prisma Health Midlands, Columbia, SC, USA
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | | | | | - Francisco P Daels
- Department of Urology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Maria A Cerruto
- Department of Urology, Integrated University Hospital of Verona, Verona, Italy
| | | | - Giorgio Mazzon
- Department of Urology, Civil Hospital of Bassano, Bassano del Grappa, Vicenza, Italy
| | - Antonio Celia
- Department of Urology, Civil Hospital of Bassano, Bassano del Grappa, Vicenza, Italy
| | - Claudio Simeone
- Department of Urology, University of Brescia, Brescia, Italy
| | | | - Alberto Saita
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Ettore Mearini
- Department of Urology, University of Perugia, Perugia, Italy
| | | | - Vincenzo Mirone
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Fernando J Kim
- Department of Urology, Denver Health Medical Center, Denver, CO, USA
| | - Stefania Ferretti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy -
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Owen K, Joe W, Ivander A, Palgunadi IN, Adhyatma KP. Role of Noncontrast Computed Tomography Parameters in Predicting the Outcome of Extracorporeal Shock Wave Lithotripsy for Upper Urinary Stones Cases: A Meta-analysis. Acad Radiol 2024; 31:3282-3296. [PMID: 37985292 DOI: 10.1016/j.acra.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 11/22/2023]
Abstract
RATIONALE Extracorporeal shock wave lithotripsy (ESWL) is widely considered the primary approach for managing urinary tract stones. This study aimed to assess the predictive factors associated with non-contrast computed tomography (NCCT)-based parameters of upper urinary stones in relation to the outcomes of ESWL. MATERIALS AND METHODS A systematic search was conducted in PubMed, ScienceDirect, Web of Science, and Cochrane Library to identify all relevant studies published up to June 3, 2023. Several NCCT-based parameters to predict ESWL outcomes, comprised of mean stone density (MSD), skin-to-stone distance (SSD), and stone size, were extracted and analyzed using Review Manager software. RESULTS Out of 979 publications screened, a total of 39 publications, involving 7869 patients, were enrolled in the analysis. The pooled estimate demonstrated significant differences between MSD, and stone size between successful and failure of stone fragmentation groups, in which lower values of these parameters are associated with successful ESWL outcomes. CONCLUSION The results from the current study suggested that lower NCCT parameters, notably MSD, SSD, and stone size, are significantly associated with successful ESWL outcome. However, additional large-scale prospective studies are required to utilize these parameters effectively, and the optimal cutoff value should be determined.
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Affiliation(s)
- Kevin Owen
- Bangli General Hospital, Bangli, Indonesia (K.O.).
| | - Wilbert Joe
- Regional Public Hospital dr.M. Thomsen Nias, Gunungsitoli, Indonesia (W.J.)
| | - Alvin Ivander
- Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia (A.I.)
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Xu H, Liu B, Tang L. CT-based radiomics for predicting success of shock wave lithotripsy in ureteral stones larger than 1 cm. World J Urol 2024; 42:397. [PMID: 38985166 DOI: 10.1007/s00345-024-05111-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/05/2024] [Indexed: 07/11/2024] Open
Abstract
PURPOSE This study aims to investigate the predictive value of CT-based radiomics in determining the success of extracorporeal shock wave lithotripsy (SWL) treatment for ureteral stones larger than 10mm in adult patients. MATERIALS AND METHODS A total of 301 eligible patients (165/136 successful/unsuccessful) who underwent SWL were retrospectively evaluated and divided into a training cohort (n = 241) and a test cohort (n = 60) following an 8:2 ratio. Univariate analysis was performed to assess clinical characteristics for constructing a nomogram. Radiomics and conventional radiological characteristics of stones were evaluated. Following feature selection, radiomics and radiological models were constructed using logistic regression (LR), support vector machine (SVM), random forest (RF), K nearest neighbor (KNN), and XGBoost. The models' performance was compared using metrics such as the area under the receiver operating characteristic curve (AUC), precision, recall, accuracy, and F1 score. Finally, a nomogram was created incorporating the best image model signature and clinical predictors. RESULTS The SVM-based radiomics model showed superior predictive performance in both training and test cohorts (AUC: 0.956, 0.891, respectively). The nomogram, which combined SVM-based radiomics signature with proximal ureter diameter (PUD), demonstrated further improved predictive performance in the test cohort (AUC: 0.891 vs. 0.939, P = 0.166). CONCLUSIONS Integration of CT-derived radiomics and PUD showed excellent ability to predict SWL treatment success in patients with ureteral stones larger than 10mm, providing a promising approach for clinical decision-making.
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Affiliation(s)
- Huixin Xu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu Province, China
| | - Bo Liu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu Province, China
| | - Lijun Tang
- Department of Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu Province, China.
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Arikan Y, Eksi M, Sungur U, Yoldas M, Keskin MZ. Variation coefficient of stone density and renal cortical thickness: the parameters evaluating non-contrast computed tomography imaging for predict extracorporeal shock wave lithotripsy success. Urolithiasis 2024; 52:53. [PMID: 38564004 DOI: 10.1007/s00240-024-01561-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
The stone density (SD) is not the same in all parts of the stone due to the heterogeneous nature of the stone and the shock wave (SW) passes through tissues of many different densities until it reaches the stone. These factors affect the success of Extracorporeal Shock Wave Lithotripsy (ESWL). We aimed to evaluate the effect of the Variation Coefficient of Stone Density (VCSD) and Renal Cortical Tickness (RCT) on the success of ESWL. Between 2020 and 2023, 510 patients who underwent ESWL were divided into 2 groups treatment success (n:304) and treatment failure (n:206). Non-Contrast Computed Tomography (NCCT) imaging values of hydronephrosis degree of the kidney, stone location, stone volume (SV), stone-skin distance (SSD), SD, Standard deviation of Stone Density (SDSD), VCSD, RCT, Soft-Tissue Thickness (STT), Muscle Thickness (MT) were analyzed. VCSD value was obtained by dividing SDSD by SD. Along the SW, tissues were divided into three components: kidney (renal cortex), muscle and other soft tissues. RCT, MT and SSD were measured at three different angles (0°, 45°, and 90°) and these 3 lengths were averaged. In univariate analysis, Body Mass Index (BMI), SV, SD, VCSD, SSD, RCT and STT were demonstrated to affect ESWL success. In multivariate analysis, low BMI, SV, SD, RCT and large VCSD were significant independent predictors of ESWL success. Among these parameters, VCSD had the highest prediction accuracy, followed by SD, SV, RCT and BMI, respectively. This study demonstrated that VCSD value and RCT are predictive parameters in determining the treatment of patients with urinary calculi and selecting suitable ESWL candidates.
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Affiliation(s)
- Yusuf Arikan
- Department of Urology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey.
| | - Mithat Eksi
- Department of Urology, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ubeyd Sungur
- Department of Urology, University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Yoldas
- Department of Urology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mehmet Zeynel Keskin
- Department of Urology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
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Snicorius M, Drevinskaitė M, Miglinas M, Čekauskas A, Urbonienė V, Bandzevičiūtė R, Čeponkus J, Šablinskas V, Želvys A. A Prospective Study on the Impact of Clinical Factors and Adjusted Triple D System for Success Rate of ESWL. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1827. [PMID: 37893545 PMCID: PMC10608682 DOI: 10.3390/medicina59101827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023]
Abstract
Objective: Our study aimed to evaluate the success rate of ESWL and identify relevant treatment-specific factors affecting treatment outcomes, as well as to assess the accuracy of the updated Triple D scoring system and compare it with older systems. Material and Methods: A prospective study of 71 patients who received ESWL treatment for renal stones that were 5-15 mm in size was completed. The patient having no residual stones or residual stones lesser than 4 mm after ESWL was identified as a treatment success. Univariate and multivariate logistic regression and ROC curves were used to identify important factors for treatment outcomes. Results: Successful treatment was achieved for 66.2% of patients. The stone volume (SV), mean stone density (MD), and delivered power to the stone volume unit ratio (SMLI/SV) were defined as the most critical factors influencing ESWL success. An updated Triple D score system with a, SMLI/SV ratio could be an alternative to older systems and reach an even higher accuracy. A limitation of this study is the limited sample size due to the COVID-19 pandemic. Conclusions: Our results show that the three factors that most influence the success of ESWL are the stone size, mean stone density, and SMLI/SV ratio. Based on this, we present a simple updated triple D score system to predict ESWL success, which could be implemented in future clinical practice.
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Affiliation(s)
- Marius Snicorius
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03225 Vilnius, Lithuania
| | - Mingailė Drevinskaitė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03225 Vilnius, Lithuania
| | - Marius Miglinas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03225 Vilnius, Lithuania
| | - Albertas Čekauskas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03225 Vilnius, Lithuania
| | - Vidita Urbonienė
- Institute of Chemical Physics, Faculty of Physics, Vilnius University, 10222 Vilnius, Lithuania
| | - Rimantė Bandzevičiūtė
- Institute of Chemical Physics, Faculty of Physics, Vilnius University, 10222 Vilnius, Lithuania
| | - Justinas Čeponkus
- Institute of Chemical Physics, Faculty of Physics, Vilnius University, 10222 Vilnius, Lithuania
| | - Valdas Šablinskas
- Institute of Chemical Physics, Faculty of Physics, Vilnius University, 10222 Vilnius, Lithuania
| | - Arunas Želvys
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03225 Vilnius, Lithuania
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Bulut M, Dinçer E, Coşkun A, Can U, Telli O. Is Triple D Score Effective to Predict the Stone-Free Rate After Shockwave Lithotripsy in Pediatric Population? J Endourol 2023; 37:207-211. [PMID: 36094110 DOI: 10.1089/end.2022.0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Introduction: Triple D score was developed using skin-to-stone distance (SSD), stone density (SD), and stone volume (SV) for prediction of extracorporeal shockwave lithotripsy (SWL) outcomes in adults. SWL is the first-line treatment method for kidney stones <2 cm in children, however, it was not validated in the pediatric population. This article aims to validate Triple D score in pediatric patients. Materials and Methods: Of the 269 children treated with SWL between 2007 and 2021, a total of 147 children who had adequate follow-up data and evaluated with noncontrast CT before SWL were included in the study. Parameters were calculated for each of the SV, SSD, and SD variables. Receiver operator characteristic analysis was used to set cutoff values. Triple D scores were calculated, and success rates were determined for each score. Stone-free status was determined as complete clearance after 3 months of final SWL. Results: The median age of the study group was 7 years (range 1-16). Ninety-three of the 147 (63%) children had stone-free status. Mean SV, SSD, and SD values were significantly higher in the SWL-failed group than in the stone-free group after detecting cutoff values of 155 mm3, 6.5 cm, and 550 HU, respectively. Stone-free rates were detected as 23.8%, 35.1%, 74.0%, and 92.0% with the Triple D scores of 0, 1, 2, and 3 points. Conclusions: Our study confirms that Triple D scores support the SWL outcomes in the pediatric population. We believe that our research on Triple D score validation in children is of great clinical importance although various factors may affect to predict the success of SWL. IRB Approval: 2021/514/194/14.
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Affiliation(s)
- Mehmet Bulut
- Clinic of Urology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Erdinç Dinçer
- Clinic of Urology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Alper Coşkun
- Clinic of Urology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Utku Can
- Clinic of Urology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
| | - Onur Telli
- Clinic of Pediatric Urology, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey
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Sengupta S, Basu S, Ghosh K. A prospective observational study on the predictability of Triple-D score versus Quadruple-D score in the success rate of extracorporeal shock wave lithotripsy of renal stones 1–2 cm in diameter. Urol Ann 2022; 14:37-42. [PMID: 35197701 PMCID: PMC8815344 DOI: 10.4103/ua.ua_1_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 07/19/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction: The aim of the study is to evaluate the clinical efficacy of Triple-D scoring system versus Quadruple-D scoring system for assessing stone-free rate (SFR) in individuals with renal stones measuring 1–2 cm in diameter after extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: The study was conducted on 120 patients who presented to a tertiary care center in eastern India. Systemic random sampling technique was applied with a sampling interval of 2. Triple-D scoring system comprising of three computed tomography based metrics – stone dimension (volume), stone density (Hounsfield unit), and skin-to-stone distance (SSD) was done before ESWL. Stone location was included as an additional parameter to formulate Quadruple-D scoring system where an extra score was given for stones in the non-lower polar region. Stone-free status was assessed by plain abdominal radiography 3 weeks after ESWL. Results: In the study population, stone dimension, stone density, and stone location were positive predictors of SFR after ESWL whereas age, sex, and body mass index of the patients, laterality of the stone and SSD were not. The area under the curve of Triple-D and Quadruple-D scoring systems were 0.598 and 0.674. Conclusion: Triple-D scoring system has been successfully validated as the SFR showed a parallel increase with every positive component. The Quadruple-D scoring system with a simple addition of stone location can further facilitate the validation of Triple-D scoring by increasing SFR, keeping the calculation simple and easy to use. These findings support the incorporation of Quadruple-D scoring system over Triple-D scoring system.
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Cetin S, Yavuz Koparal M, Cem Bulut E, Serhat Gurocak O, Ozgur Tan M. Factors to predict shock-wave lithotripsy results in pediatric patients and external validation of a nomogram. Actas Urol Esp 2021; 45:132-138. [PMID: 33162206 DOI: 10.1016/j.acuro.2020.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/06/2020] [Accepted: 03/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the accuracy of the Dogan nomogram in predicting stone-free (SF) rate after a single shock wave lithotripsy (SWL) session and evaluate factors that predict SWL results in children. PATIENTS AND METHODS The study included 68 patients under 18 years of age who had been treated with SWL for radiopaque upper urinary tract stones in our tertiary centre from January 2010 to December 2016. The median age is 50 (6-207) months and median follow-up period is 9 (4-50) months. Patients with known cystine stone disease, abnormal renal anatomy, urinary diversion and multiple stones located in different calyces were excluded like in the original nomogram study. SF status was evaluated by performing plain abdominal radiography and urinary ultrasonography 2 weeks after each SWL session. Patients who were completely free of stones were considered to be SF. Multiple logistic regression analyses were performed to determine the variables affecting SF status. The bootstrap method with 1,000 replicates was used for the external validity of a nomogram developed by Dogan. RESULTS SF rates for each SWL session were determined as 54.4% (37/68) for the first session, 33.3% (7/21) for the second session and 55.6% (5/9) for the third session. Overall, the SF rate was 72.1% (49/68). Multiple logistic regression analysis showed positive and significant correlations of age and stone size with risk of SWL failure. The external calibration plot showed a nearly good validation with Dogan nomogram to predict SWL failure in first session. CONCLUSION Our study demonstrates that the Dogan nomogram can be used to predict the SF status after one session of SWL in pediatric patients.
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Factors influencing extracorporeal shock wave lithotripsy efficiency for optimal patient selection. Wideochir Inne Tech Maloinwazyjne 2021; 16:409-416. [PMID: 34136039 PMCID: PMC8193744 DOI: 10.5114/wiitm.2021.103915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/06/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction Current literature suggests various predictors related to the stone and patient, which could influence stone fragmentation and clearance rates. Aim To establish clinical characteristics of stone disease for patients undergoing extracorporeal shockwave lithotripsy (ESWL) which may predict the success of the procedure. Material and methods One hundred and nine patients with renal stone disease diagnosed by non-contrast computed tomography (NCCT) who underwent ESWL between January 2015 and December 2019 were included in the study. Endpoints: patient being stone free (SF) or when < 4 mm fragments were detected. Age, gender, location, skin-to-stone distance, maximum stone length, stone volume, stone surface area, mean stone Hounsfield units (HU) and highest HU score were explored in uni- and multivariate regression analysis. Results Stone size revealed the highest prognostic power for ESWL failure, where OR for stone volume and stone surface area were 1.06 (1.03–1.10) and 1.04 (1.02–1.06), respectively (all p < 0.01) while a tendency was observed for skin-to-stone distance 1.02 (1.00–1.03). The amount of energy applied during the procedure to one cubic millimeter of stone volume (SMLI/stone volume) was predictive for treatment success (OR = 0.60, 95% CI: 0.41–0.87, p < 0.01). Stone volume (OR = 1.06, 95% CI: 1.00–1.14, p = 0.01) and stone surface area (OR = 1.03, 95% CI: 1.01–1.06, p = 0.02) remained as statistically significant prognostic factors for treatment failure. Conclusions Both greater stone volume and stone surface area, as well as lower power delivered per stone volume unit during the ESWL procedure, were found to be significant factors and could be useful to predict treatment failure.
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Abstract
PURPOSE OF REVIEW The most relevant recent findings on the use of extracorporeal shock wave lithotripsy (ESWL) in adult population to provide an insight of its role in the current and future of stone treatment. Comparing ESWL with other modalities is not in the scope of this review. RECENT FINDINGS We conducted a PubMed/Embase search and reviewed recent publications that include relevant information on the development of ESWL. Low-rate shock waves improve stone breakage, ramping energy modalities improve stone fragmentation and have lower incidence of hematoma and kidney injury. Transgluteal approach is suggested to improve stone-free rates for distal ureteral stones in a single session. Proper coupling is the most important technical aspect of the treatment and coupling improvement can be achieved by optical monitorization. Triple D score is a promising tool in proper patient selection, but external validation is needed. Predictive information arising from computed tomography scans has been refined by the variant coefficient of stone density and 3D texture analysis that might improve outcomes in the future. SUMMARY Recent evidence suggests that modifying techniques and protocols, and better patient selection are the current trends for improving ESWL outcomes. EWSL will keep its role as the single noninvasive treatment in stone management with room for outcome improvement in the future.
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Reinforcement of the Triple D score with simple addition of the intrarenal location for the prediction of the stone-free rate after shockwave lithotripsy for renal stones 10-20 mm in diameter. Int Urol Nephrol 2019; 51:239-245. [PMID: 30604235 DOI: 10.1007/s11255-018-02066-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 12/24/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE We investigated the clinical efficacy of the Triple D score (TrD-S) on stone-free rate (SFR) prediction following shockwave lithotripsy (SWL) for renal stones 10-20 mm in diameter and modified the scoring system to improve outcome prediction. METHODS We retrospectively examined clinical data from the medical records of 226 consecutive patients who underwent SWL for 10-20 mm kidney stones. The TrD-S was calculated according to the cutoffs of < 150 mm3 for stone volume, < 600 Hounsfield unit for stone density, and < 12 cm for skin-to-stone distance on computed tomography. The Quadruple D score was defined as the sum of the TrD-S and stone location (0/1 point for intrarenal stone distribution at lower/non-lower poles, respectively). Complete clearance 3 months after the final SWL was considered the stone-free status. RESULTS The residual group (n = 102) had significantly older age, larger stones, higher stone density, higher lower-pole stone incidence, and lower TrD-S than the stone-free group (n = 124). In the multivariate analysis, age, TrD-S, and non-lower-pole stones independently predicted the SFR. The TrD-Ss of 0, 1, 2, and 3 points showed SFRs of 40.0%, 51.9%, 73.0%, and 100.0%, respectively. The Quadruple D scores of 0, 1, 2, 3, and 4 points showed SFRs of 0.0%, 37.9%, 54.5%, 84.4%, and 100.0%, respectively, with better prediction accuracy than the TrD-S (p = 0.01). CONCLUSIONS The TrD-S is successfully validated for use in Japanese patients with 10-20-mm renal stones. Simple addition of the stone location to the TrD-S could reinforce SFR prediction after SWL.
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Yanaral F, Ozgor F, Savun M, Agbas A, Akbulut F, Sarilar O. Shock-wave Lithotripsy for Pediatric Patients: Which Nomogram Can Better Predict Postoperative Outcomes? Urology 2018; 117:126-130. [DOI: 10.1016/j.urology.2018.03.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/19/2018] [Accepted: 03/24/2018] [Indexed: 11/25/2022]
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Sabour S. Reliability and Validity of the Triple D Score to Predict Stone-Free Status After Extracorporeal Shockwave Lithotripsy: Methodological Mistake. J Endourol 2017; 31:812. [PMID: 28277738 DOI: 10.1089/end.2017.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Siamak Sabour
- 1 Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences , Tehran, I.R. Iran .,2 Department of Clinical Epidemiology, Shahid Beheshti University of Medical Sciences , Tehran, I.R. Iran
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