Role of pretreatment Doppler ultrasound in the prediction of factors affecting stone-clearance post-shockwave lithotrips
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UROLOGY - ORIGINAL PAPER
Role of pretreatment Doppler ultrasound in the prediction of factors affecting stone‑clearance post‑shockwave lithotripsy for ureteral stones: a prospective study M. A. Elbaset1 · Ahmed Elkarta1 · Ahmed Eraky2 · Mohamed Badawy3 · K. Z. Sheir1 · A. A. Shokeir1 Received: 20 February 2020 / Accepted: 5 April 2020 © Springer Nature B.V. 2020
Abstract Purpose To identify the role of Doppler US (DUS) in the prediction of factors affecting stone-clearance post-SWL for ureteral stones in addition to its role in prediction of pretreatment stone impaction. Methods We prospectively included patients with ureteric stone for SWL between October 2018 and September 2019. Patient’s demographics were collected. Using DUS, resistive index (RI), Δ RI, and ureteric jets were evaluated in both kidneys. Also, stone site, volume, density, skin to stone distance, degree of hydronephrosis, ureteral wall thickness (UWT) were evaluated by NCCT. Univariate and multivariate logistic regression analyses were performed to identify factors that contribute to treatment success. Correlation between ipsilateral RI with other radiological findings predicting stone impaction was done. Results A total of 93 patients were finally included (61 males and 32 females). The mean age was 31.4 ± 7.7 years. The success rate (absence of significant residuals post 1 month by NCCT) was 51.6%. In multivariate analysis, the presence of ureteric jet, ipsilateral lower RI, and ipsilateral lower UWT were independent factors for treatment success (P = 0.0001, 0.002, and 0.03, respectively). Also, ipsilateral absence of ureteric jet, increased hydronephrosis, and increased UWT were correlated with higher ipsilateral RI in prediction of stone impaction. Ipsilateral higher RI was found to achieve higher accuracy in stone impaction prediction (PPV of 94.8%). Conclusion Pretreatment DUS is a useful, non-invasive with a less irradiative tool for prediction of stone impaction and stone-free rate post-SWL for ureteric stones. Keywords Extracorporeal shockwave lithotripsy (SWL) · Ureteric stone · Resistive index (RI) · Doppler ultrasonography (DUS) · Stone impaction
Introduction Urinary stone disease is a foremost health problem worldwide and affects about 5–10% of the population [1]. Of them, ureteral stones represent 20% [2]. Despite remarkable K. Z. Sheir and A. A. Shokeir are equal last author. * M. A. Elbaset [email protected] 1
Urology Department, Clinical Fellow in Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
2
Urology Department, University Hospital Schleswig Holstein-Kiel, Kiel, Germany
3
Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
development of endoscopic technology in recent years, shock wave lithotripsy (SWL) remains one of the most important treatment options in the treatment of ureteral stones as a consequence of its safety and non-invasiveness [2, 3]. Recently, many investigations were done revealing that SWL has a lower treatment s
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