Abdülmüttalip ŞİMŞEK, Doğukan SÖKMEN, Bedriye SÖKMEN KOYUNCU, Buğra Doğukan TÖRER, Volkan TUĞCU, Ali İhsan TAŞÇI

ESWL uygulanan renal pelvis taşlarında BT' de taş-cilt mesafesi ve taşın HU (Hounsfield Ünitesi) değerinin başarıya etkisi

Amaç: Günümüzde ESWL tedavisi planlanan renal pelvis taşlarında BT (Bilgisayarlı Tomografi)de taş ile cilt mesafesi ve taşın HU (Hounsfield ünitesi) değerinin ESWL sonrasında taşsızlık (stone-free) oranına etkisini araştırmayı amaçladık. Gereç ve Yöntemler: 1 Ocak 2011 ile 31 Aralık 2012 tarihleri arasında, çapları 10mm - 15mm arasında değişen renal pelvis taşı nedeniyle ESWL tedavisine yönlendirilen 49 hasta retrospektif olarak değerlendirildi. ESWL tedavisi öncesi çekilen kontrastsız batın BTsinde taş - cilt mesafesi ve taşın Hounsfield ünitesi ölçümü yapıldı. 3 seans ESWL tedavisinin ardından hastalar değerlendirildi.. Her bir seans için hastalara ortalama 18 kvde 2234 şok sayısı verildi. İki seans arası en az 7 gün olacak şekilde tedavileri planlandı. ESWL sonrası hastalarda taşsızlık oranları DÜS grafilerle değerlendirildi. Bulgular: Çalışmaya alınan 49 hastanın ortalama yaşı 45,2±15.7yıl, ortalama BMI 25,7±3.5kg/ m2 idi. Ortalama taş boyutu 117,5±58,4 mm2 , taş cilt mesafesi 10,5±1.4cm ve taş yoğunluğu (HU) 878,8±370.4 olarak tespit edildi. Taş cilt mesafesi ortalama 9,5±0,8cmnin altında ve taş yoğunluğu ortalama 680±88,3 altında olan hastalarda (n:30) tamamen taşsızlık sağlandığı izlendi. ESWL sonrası rest taşı kalan hastaların (n:19) ortalama taş cilt mesafesi 11,5±1,3cm ve taş yoğunluğu 1210±220,6 olduğu izlendi. BMI, taş çapı, cilt-taş mesafesi ve taşın yoğunluğu tedavi başarısını etkileyen parametreler olarak tespit edildi. BMI ile cilt-taş mesafesi arasında positif korelasyon bulundu (r=0.48, p

Effect on success of stone-skin distance in CT and HU (Hounsfield unite) for ESWL performed renal pelvis stones

Objectives: We aimed to investigate the effect on success of stone-skin distance in CT (Computed Tomography) and HU (Hounsfield units) for ESWL performed renal pelvis stones. Material and Methods: Between the dates of January 1, 2011 and December 31, 2012, we retrospectively evaluated 49 patients for ESWL performed renal pelvis stones that diameters are changing between 10mm to 15mm. Before ESWL treatment, non-contrast abdominal CT was taken, stone - skin distance, and Hounsfield units of stones were measured. Patients were evaluated after 3 sessions of ESWL. Stone-free rates after ESWL were evaluated in patients with radiographs. Results: 49 patients, mean age 45.2 ± 15.7, included in the study, the mean BMI was 25.7 ± 3.5kg/m2. The mean stone size, stone-skin distance and stone density (HU) were measured respectively 117.5 ± 58.4 mm2 , 10.5 ± 1.4cm and, 878.8 ± 370.4. The mean stone density was found to be a strong predictor value for stone treatment and higher stone density were found in the patients with residual stones (p <0.001). Conclusion: Success of ESWL depends on stone density, stone-skin distance, BMI, and the size of the stone. The success of ESWL treatment is lower for cases with more stone density and more stone-skin distance. These data should be supported with multicenter prospective randomized trials contain larger number of patients.

PDF

___

1. Kostakopoulos A, Stavropoulos NI, Louras G, Deliveliotis C, Dimopoulos C. Experience in 3,500 patients with urinary stones treated with the Dornier HM-4 bath-free lithotriptor. Int Urol Nephrol 1997;29:147-53.
2. El-Damanhoury H, Scharfe T, Ruth J, Roos S, Hohenfellner R. Extracorporeal shock wave lithotripsy of urinary calculi: experience in treatment of 3,278 patients using the Siemens lithostar and lithostar plus. J Urol 1991;145:484-8.
3. Madaan S, Joyce AD. Limitations of extracorporeal shock wavelithotripsy. Curr Opin Urol 2007;17:10913.
4. Armağan Öner, Ali Ulvi Önder. Üriner sistem taş hastalı- ğında açık cerrahi ve ESWL. Üriner Sistem Taş Hastalığı Sempozyum Dizisi 2009;68:19-30.
5. Kohjimoto Y, Iba A, Sasaki Y, Hara I. Metabolic syndrome and nephrolithiasis. Hinyokika Kiyo 2011;57:43-7.
6. Patel T, Kozakowski K, Hruby G, Gupta M. Skin to Stone distance is an independent predictor of stone-free status following shockwave lithotripsy. J Endourol 2009;23:1383-5.
7. Dretler SP. Stone fragility-a new therapeutic distinction. J Urol 1988;139:1124-7.
8. Ouzaid I, Al-Qahtani S, Dominique S, Hupertan V, Fernandez P, Hermieu JF, Delmas V, Ravery V. A 970 Hounsfield units (HU) threshold of kidney stone density on noncontrast computed tomography (NCCT) improves patients selection for extracorporeal shockwave lithotripsy (ESWL): evidence from a prospective study. BJU Int 2012;110:E438- 42.
9. Weld KJ, Montiglio C, Morris MS, Bush AC, Cespedes RD. Shock wave lithotripsy success for renal stones based on patient and stone computed tomography characteristics. Urology 2007 Dec;70:1043-6.
10. Wiesenthal JD, Ghiculete D, DA Honey RJ, Pace KT. Evaluating the importance of mean stone density and skinto-stone distance in predicting successful shock wave lithotripsy of renal and ureteric calculi. Urol Res 2010 Aug;38:307-13.
11. Rassweiler JJ, Knoll T, Köhrmann KU, McAteer JA, Lingeman JE, Cleveland RO, Bailey MR, Chaussy C. Shock wave technology and application: an update. Eur Urol 2011;59:784-96.
12. Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck AC, Gallucci M, Knoll T, Lingeman JE, Nakada SY, Pearle MS, Sarica K, Türk C, Wolf JS. 2007 Guideline for the management of ureteral calculi. Eur Urol 2007;52:1610-31.
13. Pareek G, Armenakas NA, Fracchia JA. Hounsfield units on computerized tomography predict stone-free rates after extracorporeal shock wave lithotripsy. J Urol 2003 May;169:1679-81.
14. Pareek G, Hedican SP, Lee FT Jr, Nakada SY. Shock wave lithotripsy success determined by skin-to-stone distance on computed tomography. Urology 2005 Nov;66:941-4.
15. Wiesenthal JD, Ghiculete D, DA Honey RJ, Pace KT. Evaluating the importance of mean stone density and skinto-stone distance in predicting successful shock wave lithotripsy of renal and ureteric calculi. Urol Res 2010 Aug;38:307-13.
16. Hammad FT, Balakrishnan A. The effect of fat and nonfat components of the skin-to-stone distance on shockwave lithotripsy outcome. J Endourol 2010;24:1825-9.
17. Motley G, Dalrymple N, Keesling C, Fischer J, Harmon W. Hounsfield unit density in the determination of urinary stone composition. Urology 2001 Aug;58:170-3.