DIAGNOSTIC POTENTIAL OF MULTI-SECTION COMPUTED TOMOGRAPHY IN SURGICAL TREATMENT OF UROLITHIASIS BY THE METHOD OF EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY

Urolithiasis is still a growing problem. In the Russian Federation in recent years, the increase in people suffering from urolithiasis amounted to 25.1%. The choice of the optimal method for eliminating renal localization stones with a size of 10 to 20 mm remains debatable. Extracorporeal shock-wave lithotripsy (ESWL), despite a number of unconditional advantages, has a significant traumatic effect on the renal parenchyma. When the predicted effectiveness of ESWL is low, it is advisable to consider alternative endourological techniques. The «gold standard» of diagnostic imaging in patients with urolithiasis and the main tool for preoperative prediction of the success of surgical treatment is multi-section computed tomography (MSCT).
The aim of the study is to improve the results of treatment of patients with urolithiasis by searching for additional diagnostic capabilities of MSCT in predicting the results of ESWL in patients with nephrolithiasis.
The study provides data on the analysis of the results of surgical treatment of 127 patients with urolithiasis, who underwent clinical, laboratory and radiological examination, and performed ESWL in the conditions of the urology clinic №1 of the Saratov State Medical University in the period of 2021-2022.
The main prognostic criteria for the success of ESWL, along with anamnesis and clinical data, are still localization, the maximum size of urinary stone and its average density (HU). The most promising direction is to evaluate the structure of the stone in vivo, using additional MSCT parameters, such as «uniformity» and the number of density «cores». Such a differentiated approach allows optimizing the clinical algorithm for choosing surgical tactics in patients with nephrolithiasis, increasing the number of successful lithotripsies, avoiding excessive traumatization of the renal parenchyma. 

1. Kaprin A.D., Apolikhin O.I., Sivkov A.V., Anokhin N.V., Gadzhiev N.K., Malkhasyan V.A., Akopyan G.N., Prosyannikov M.Yu. The incidence of urolithiasis in the Russian Federation from 2005 to 2020. Experimental and Clinical Urology, 2022;15(2)10-17; (in Russ.) https://doi.org/10.29188/2222-8543-2022-15-2-10-17

2. Türk С, Knoll T, Petrik A. [et al.]. European Association of Urology. Guideline: Urolithialsis, 2022.

3. Chekhonackaya M.L., Rossolovskij A. H., Emel'yanova H.B. i dr. Comprehensive assessment of the state of the renal parenchyma after extracorporeal shock wave lithotripsy in patients with nephrolithiasis. V sb.: Aktual'nye voprosy urologii: endokrinologicheskie i ginekologicheskie aspekty urologicheskogo zdorov'ya: Materialy mezhregion, nauch.-prakt konf. Penza, 2017; s. 82-85 (in Russ.)

4. Connors, B. A., Evan, A. P., Blomgren, P. M., Hsi, R. S., Harper, J. D., Sorensen, M. D.et al. Comparison of Tissue Injury from Focused Ultrasonic Propulsion of Kidney Stones Versus Extracorporeal Shock Wave Lithotripsy. The Journal of Urology, 191(1), 235-241. http://doi.org/10.1016/j.juro.2013.07.087

5. Andreas Neisius, Michael E Lipkin, Jens J Rassweiler, Pei Zhong, Glenn M Preminger, Thomas Knoll. Shock wave lithotripsy: the new phoenix? World J Urol 2015 Feb;33(2):213-21. doi: 10.1007/s00345-014-1369-3.

6. P V Glybochko, Yu G Alyaev, L M Rapoport, M E Enikeev, D G Tsarichenko, E V Shpot, D O Korolev, A A Vorobyev, D V Enikeev. Laparoscopic pyelolithotomy and its role in modern surgery of nephrolithiasis. Urologiia. 2017 Sep;(4):12-17. (in Russ.) DOI: https://dx.doi.org/10.18565/urol.2017.4.12-17

7. Lee Joo Yong, Jae Heon Kim, Dong Hyuk Kang, Doo Yong Chung, Dae Hun Lee, Hae Do Jung, Jong Kyou Kwon, Kang Su Cho. Stone heterogeneity index as the standard deviation of Hounsfield units: A novel predictor for shock-wave lithotripsy outcomes in ureter calculi. Sci Rep. 2016 Apr 1;6:23988. doi: 10.1038/srep23988.

8. Foda K. Abdeldaeim H, Youssif M, Assem A. Calculating the number of shock waves, expulsion time, and optimum stone parameters based on noncontrast computerized tomography characteristics. Urology 2013 Nov;82(5):1026-31. doi: 10.1016/j.urology.2013.06.061. Epub 2013 Sep 14.

9. Bobylev D.A., Chehonatskaya M. L., Osadchuk M. A., Rossolovsky A.N., Ilyasova E.B., Osnovin O.V., Kireeva N.V., Kryuchkov I.A., Chehonatsky I.A. Prediction of results of remote shock-wave lithotripsy in patients with nephrolithiasis. REJR. 2018; (2): 110-115 (in Russ.).

10. Bobylev D.A. External shock wave lithotripsy prediction of efficiency according to multislice computed tomography. Innovacionnye tekhnologii v fundamental'noj, klinicheskoj i profilakticheskoj medicine: sbornik nauchnyh trudov SSMU im. V.I. Razumovskogo Minzdrava Rossii. Saratov, 2018:17-18. (in Russ.)

11. L B Kapanadze, V I Rudenko, N S Serova, L M Rapoport, K A Aleksandrova, A A Novikov. Dual-energy computed tomography in the diagnostics of urolithiasis. Urologiia 2019 Dec;(5):31-36. (in Russ.) DOI: https://dx.doi.org/10.18565/urology.2019.5.31-36

12. Helen W. Cui, Mafalda D. Silva, Andrew W. Mills. Predicting shockwave lithotripsy outcome for urolithiasis using clinical and stone computed tomography texture analysis variables. Sci Rep. 2019 Oct 11;9(1):14674. doi: 10.1038/s41598-019-51026-x.