CT-Determined Stone-Free Rates For Ureteroscopy Of Upper-Tract Stones

Main Category: Urology / Nephrology
Also Included In: Pediatrics / Children's Health;  MRI / PET / Ultrasound
Article Date: 31 Mar 2009 - 5:00 PDT

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UroToday.com - After ureteroscopy, success is defined with either x-ray or IVP in adult series with ultrasound added in pediatric series. These imaging modalities are not sensitive and may overestimate stone-free rates.

Dr. Amanda Macejko et al. evaluated the use of CT scans to assess stone-free rates after ureteroscopy. They evaluated a total of 92 patients who underwent 113 ureteroscopic procedures for either renal or ureteral stones. They used stone-free clearance rates for ≤2 mm and ≤4 mm residual stone fragments. With a mean of 1.87 stones and a mean stone diameter of 8 ± 6 mm, the group had an overall stone-free rate of 50.4%. The rates were significantly higher for ureteral stones (80%) than renal stones (34.8%) (P = 0.0001). Renal units with multiple stones were less likely to be stone-free than those with single stones (P = 0.011). No difference in SFRs was found between lower pole and non-lower-pole stones.

The group concluded that if you use a more sensitive system such as CT, the stone-free rates will be lower than if you utilize KUB or IVP. This poses an interesting dilemma since there are risks with stone fragments and CT scans. Defining the clinical significance of these stone fragments will be paramount as the clinical significance of repeated use of CT scan has already been established as a risk factor for malignancy.

Macejko A, Okotie OT, Zhao LC, Liu J, Perry K, Nadler RB

J Endourol. 2009 Mar 1. Epub ahead of print.
doi:10.1089/end.2008.0240

Written by UroToday.com Medical Editor Pasquale Casale, MD

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