Stone measurement by volumetric three-dimensional computed tomography for predicting the outcome after extracorporeal shock wave lithotripsy

To evaluate the efficacy of stone volume measured using a three-dimensional (3D) reconstruction of preoperative non-contrast computed tomography (NCCT) as an independent predictor of success after extracorporeal shock wave lithotripsy (ESWL) of upper urinary tract calculi. We evaluated preoperative NCCT in 94 patients who had ESWL for solitary upper urinary tract calculi of 4-20 mm in diameter. Axial images were used to measure the skin-to-stone distance (SSD), Hounsfield Unit (HU) density and axial stone diameter. Stone volume was calculated on a volume-rendered 3D image for each stone. Maximum stone length was determined by comparative measurements of each stone in coronal, sagittal and axial planes, and was also measured on a plain abdominal film before ESWL. For ESWL we used the DoliS lithotripter (Dornier Medical Systems, Marrietta, GA, USA). A plain film at 6 weeks was used to categorize patients as stone-free (SF) or with residual stone. In all, 58 (62%) patients were SF and 36 (38%) had RS; the mean stone volume was significantly different between these groups (274 vs 464 mu L, P = 0.002). Logistic regression analysis showed that stone volume was the strongest predictor of SF status (P < 0.001), compared to peak HU (P = 0.015), mean HU (P = 0.04) and axial stone diameter (P = 0.006). The body mass index, SSD and maximum stone length on NCCT or a plain film did not predict success. A stone volume of < 500 mu L best predicted treatment success (P < 0.001) with 72% of patients with a stone volume of < 500 mu L having a successful outcome, vs only 27% with a stone volume of > 500 mu L. Our study suggests that stone volume is an optimal predictor of SF status after ESWL of solitary upper urinary tract calculi.