Platinum open access journal
pISSN 2466-0493 eISSN 2466-054X
Indexed in MEDLINE, SCIE, Scopus, DOAJ and more
    Korean J Urol. 2006 Nov;47(11):1210-1219. Korean.
    Published online Nov 30, 2006.
    https://doi.org/10.4111/kju.2006.47.11.1210
    Copyright © 2006 The Korean Urological Association
    Original Article

    The Use of Dual Energy X-ray Absorptiometry in the Prediction of Stone Fragility in Extracorporeal Shock Wave Lithotripsy

    Hee Jong Kim, Jeong Oh Lee, and Bo Hyun Han
      • Department of Urology, Maryknoll Hospital, Busan, Korea.
    • Corresponding author (Email: ljouro@yahoo.co.kr )
    Received May 19, 2006; Accepted September 20, 2006.

    Abstract

    Purpose

    The aim of this study was to determine whether the stone mineral content (SMC) and stone mineral density (SMD), as measured by dual energy X-ray absorptiometry, can predict the stone fragility in extracorporeal shock wave lithotripsy (ESWL).

    Materials and Methods

    In the experimental study, the stone size, weight, SMC and SMD of 111 urinary calculi, obtained by open surgery, were measured. The SMC and SMD were measured using dual energy X-ray absorptiometry, which is the gold standard for measuring the bone mineral content and density. The number of shock waves necessary for full fragmentation was accepted as a measure of the stone fragility in ESWL (EDAP-sonolith Praktis). In the clinical study, the stone size, SMC and SMD were measured in a total of 48 patients with a solitary renal stone of less than 3cm. Prior to ESWL all patients underwent dual energy X-ray absorptiometry to calculate the SMC and SMD. The correlations between the number of total shock waves and the stone size, SMC and SMD were analyzed.

    Results

    In the experimental study, the stone size, stone weight, SMC and SMD values correlated with total shock waves, with a correlation coefficients (R) of 0.79, 0.95, 0.99 and 0.86, respectively (n=111). In the clinical study, the mean stone size, mean MC and MD values differed significantly between the clinically successful and failed ESWL (n=36 and n=12), respectively (p=0.0002, p=0.004, p=0.004). On a simple regression analysis, the SMC (R2=0.74), SMD (R2=0.56) and stone size (R2=0.51) were significant factors in predicting the number of shock waves. Using the receiver operating characteristic curves for comparing the stone size, SMC and SMD in relation to the number of shock waves, the areas under the respective curves were 0.79, 0.84 and 0.81 with cut-off values of 1.8, 1.4 and 1.8.

    Conclusions

    The stone size, SMC and SMD measured by dual energy x-ray absorptiometry may provide a prediction of the outcome of patients prior to ESWL treatment. Patients with high SMC (greater than 1.4gm) could be recommended for percutaneous nephrolithotripsy or another treatment modality, thus, avoiding the unnecessary cost of prior ESWL.

    Keywords
    Extracorporeal shockwave lithotripsy; Bone mineral content; Bone mineral density

    Figures

    Fig. 1
    In vitro relationship between (A) stone size, as measured using X-ray and the number of shock waves (y=445.4x-224.1; R2=0.62, p<0.001), (B) stone weight, as measured using electron balance and the number of shock waves (y=182.3x+231.9; R2=0.90, p<0.001), (C) stone mineral content (SMC), as measured using dual energy X-ray absorptiometry and the number of shock waves (y=264.2x+287.9; R2=0.99, p<0.001), (D) stone mineral density (SMD), as measured using dual energy X-ray absorptiometry and the number of shock waves (y=284.7x+281.7; R2=0.75, p<0.001), (E) stone mineral content (SMC), as measured using dual energy X-ray absorptiometry and the stone weight (y=1.31x+0.48; R2=0.90, p<0.001).

    Fig. 2
    Receiver operating characteristic curves comparing the stone size, SMC and SMD with the number of shock waves. SMC: stone mineral content, SMD: stone mineral density.

    Fig. 3
    In vivo relationship between (A) stone size, as measured using X-ray and the number of shock waves (y=1195.1x+1540.5; R2=0.51, p<0.0005), (B) stone mineral content (SMC), as measured using dual energy X-ray absorptiometry and the number of shock waves (y=2,416.1x+2,033.9; R2=0.74, p<0.0005), (C) stone mineral density (SMD), as measured using dual energy X-ray absorptiometry and the number of shock waves (y=1,461.1x+2,218.6; R2=0.56, p<0.0005).

    Tables

    Table 1
    Reproducibility of SMC and SMD in vitro and in vivo

    Table 2
    Correlation coefficients of the number of shock waves for the various parameters in vitro

    Table 3
    Result of a simple regression analysis in vitro

    Table 4
    Result of a multiple regression analysis in vitro

    Table 5
    Descriptive statistics on patients with successful and failed ESWL

    Table 6
    Correlation coefficients of the number of shock waves for the various parameters in vivo

    Table 7
    Sensitivity and specificity calculated for the stone size, SMC and SMD values according to number of shock waves

    Table 8
    Result of a simple regression analysis in vivo

    Table 9
    Result of a multiple regression analysis in vivo

    References

      1. Chaussy C, Brendel W, Schmiedt E. Extracorporeally induced destruction of kidney stones by shock waves. Lancet 1980;2:1265–1268.
      1. Chaussy C, Schmiedt E. Shock wave treatment for stones in the upper urinary tract. Urol Clin North Am 1983;10:743–750.
      1. Leusmann DB, Niggemann H, Roth S, von Ahlen H. Recurrence rates and severity of urinary calculi. Scand J Urol Nephrol 1995;29:279–283.
      1. Fernstrom I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol 1976;10:257–259.
      1. Perez-Castro Ellendt E, Martinez-Pineiro JA. Transurethral ureteroscopy. A current urological procedure. Arch Esp Urol 1980;33:445–460.
      1. Tiselius HG. Anesthesia-free in situ extracorporeal shock wave lithotripsy of ureteral stones. J Urol 1991;146:8–12.
      1. Politis G, Griffith DP. ESWL: stone-free efficacy based upon stone size and location. World J Urol 1987;5:255–258.
      1. Dretler SP. Management of ureteral calculi. AUA Update Series 1988;7:41–47.
      1. Lingeman JE, Newman D, Mertz JH, Mosbaugh PG, Steele RE, Kahnoski RJ, et al. Extracorporeal shock wave lithotripsy: the methodist hospital of Indiana experience. J Urol 1986;135:1134–1137.
      1. Dretler SP. Stone fragility-a new therapeutic distinction. J Urol 1988;139:1124–1127.
      1. Nakada SY, Pearle MS, Sable JJ, Gardner SM, McClennon BL, Clayman RV. Extracorporeal shock wave lithotripsy of middle ureteral stones: are ureteral stents necessary? Urology 1995;46:649–652.
      1. Lee GH, Kim HJ. Treatment of ureteral stone using Modulith SL-20: analysis of the factors influencing on stone fragmentation. Korean J Urol 1996;37:888–893.
      1. Yong SC, Park DS, Lee JM. Major factors influencing on the success of extracorporeal shock wave lithotripsy. Korean J Urol 1994;35:265–271.
      1. Kim BH, Chung YC, Chung HS, Park CH. Success rate of extracorporeal shock wave lithotripsy according to operator. Korean J Urol 2005;46:270–274.
      1. Sampaio FJ, Aragao AH. Inferior pole collecting system anatomy: its probable role in extracorporeal shock wave lithotripsy. J Urol 1992;147:322–324.
      1. Chaussy CG, Fuchs GJ. Extracorporeal shock wave lithotripsy. Monogr Urol 1987;4:80–83.
      1. Mattelaer P, Schroder T, Fischer N, Jakes G. In situ extracorporeal shock wave lithotripsy of distal ureteral stones: parameters for therapeutic success. Urol Int 1994;53:87–91.
      1. Saw KC, McAteer JA, Fineberg NS, Monga AG, Chua GT, Lingeman JE, et al. Calcium stone fragility is predicted by helical CT attenuation values. J Endourol 2000;14:471–474.
      1. Sakamoto W, Kishimoto T, Takegaki Y, Sugimoto T, Wada S, Yamamoto K, et al. Stone fragility - measurement of stone mineral content by dual photon absorptiometry. Eur Urol 1991;20:150–153.
      1. Zanchetta JR, Bogado CE, Sanchez TV, Gigler C, Ghirlanda J. In vivo measurement of the mineral content of renal calculi by dual-photon absorptiometry. Correlation with its fragility to extracorporeal shock wave lithotripsy. Medicina (B Aires) 1995;55:307–310.
      1. Banks LM. Dual energy X-ray absorptiometry (DXA). In: Grainger RG, Allison DJ, editors. A textbook of medical imaging. 3rd ed. London: Churchill livingstone; 1997. pp. 125-136.
      1. Demirbas M, Ergen A, Ozakardes H. Stone fragility in shock wave lithotripsy can be predicted in vitro. Int Urol Nephrol 1998;30:553–557.
      1. Mandhani A, Raghavendran M, Srivastava A, Kapoor R, Singh U, Kumar A, et al. Prediction of fragility of urinary calculi by dual X-ray absorptiometry. J Urol 2003;170:1097–1100.
      1. Jergas M, Genant HK. Current methods and recent advances in the diagnosis of osteoporosis. Arthritis Rheum 1993;36:1649–1662.
      1. Johnston CC Jr, Slemenda CW, Melton LJ. Clinical use of bone densitiometry. N Engl J Med 1991;324:1105–1109.
    MeSH Terms
    Absorptiometry, Photon*
    Bone Density
    Humans
    Lithotripsy*
    ROC Curve
    Shock*
    Urinary Calculi
    Metrics
    Share
    Figures
    slide
    slide
    slide

    1 / 3

    Tables
    slide
    slide
    slide
    slide
    slide
    slide
    slide
    slide
    slide

    1 / 9

    PERMALINK