ABSTRACT
OBJECTIVE: The objective was to assess the reliability and validity of "S.T.O.N.E" nephrolithometry scoring system to predict the stone-free rate (SFR) after percutaneous nephrolithotomy (PNL). METHODS: A total of 123 patients with unilateral radiopaque stones ≥2 cm were included in the study. According to S.T.O.N.E score, five parameters available from preoperative computed tomography (CT) without contrast were measured: stone size (S), tract length (T), obstruction (O), number of involved calices (N), and essence of stone (E). The Stone free rates evaluated within one month postoperatively by plain X-ray and/or CT scan without contrast. RESULTS: The mean S.T.O.N.E. score in this study was 7.4 in stone-free (SF) group and 9.3 in residual stone group (P = 0.0001). Patients with SF comprised 82.1% after the first PNL, whereas 17.9% had significant residual stones >4 mm. Postoperative complications were 8%. The most common complications were bleeding requiring transfusion. The size of stone (P = 0.002) and number of calices involved (P = 0.001) had a statistically significant difference between patients with residual stones, other components were not. There was a statistically significant difference between non-SF and SF according to the hospital stay (P = 0.002). CONCLUSION: This score predicted the clearance after PNL. The size of calculi and number of calices involved statistically affected the stone clearance, whereas other S.T.O.N.E scoring parameters were not. There was a statistically significant difference between SF and residual stones groups according to the hospital stay (P = 0.0001).
ABSTRACT
22 year old male presented with self insertion of a foreign body in his urethra 4 years ago. The metal forceps was successfully extracted endoscopically with the aid of the external pressure technique. This is the second time in literature where an open thumb metal forceps is diagnosed. The metal forceps poses additional difficulties during its extraction owing to its sharp open distal ends, which necessitates the use of external pressure technique and expert endoscopic skills. In the case of open metal forceps, we recommend the use of external pressure technique to aid extraction without injuring the urethra any further.
ABSTRACT
OBJECTIVE: The objective was to determine the predicting success of shock wave lithotripsy (SWL) using a combination of computed tomography based metric parameters to improve the treatment plan. PATIENTS AND METHODS: Consecutive 180 patients with symptomatic upper urinary tract calculi 20 mm or less were enrolled in our study underwent extracorporeal SWL were divided into two main groups, according to the stone size, Group A (92 patients with stone ≤10 mm) and Group B (88 patients with stone >10 mm). Both groups were evaluated, according to the skin to stone distance (SSD) and Hounsfield units (≤500, 500-1000 and >1000 HU). RESULTS: Both groups were comparable in baseline data and stone characteristics. About 92.3% of Group A rendered stone-free, whereas 77.2% were stone-free in Group B (P = 0.001). Furthermore, in both group SWL success rates was a significantly higher for stones with lower attenuation <830 HU than with stones >830 HU (P < 0.034). SSD were statistically differences in SWL outcome (P < 0.02). Simultaneous consideration of three parameters stone size, stone attenuation value, and SSD; we found that stone-free rate (SFR) was 100% for stone attenuation value <830 HU for stone <10 mm or >10 mm but total number SWL sessions and shock waves required for the larger stone group were higher than in the smaller group (P < 0.01). Furthermore, SFR was 83.3% and 37.5% for stone <10 mm, mean HU >830, SSD 90 mm and SSD >120 mm, respectively. On the other hand, SFR was 52.6% and 28.57% for stone >10 mm, mean HU >830, SSD <90 mm and SSD >120 mm, respectively. CONCLUSION: Stone size, stone density (HU), and SSD is simple to calculate and can be reported by radiologists to applying combined score help to augment predictive power of SWL, reduce cost, and improving of treatment strategies.
