Department of Urologic Surgery, University of Minnesota Medical Center and Amplatz Children's Hospital, Minneapolis, Minnesota, USA.
J Urol. 2010 Oct;184(4 Suppl):1804-9. doi: 10.1016/j.juro.2010.03.112. Epub 2010 Aug 21.
We determined whether stone attenuation can predict stone fragmentation after shock wave lithotripsy in the pediatric population. Previous studies show that preoperative attenuation in HU on noncontrast computerized tomography predicts shock wave lithotripsy success. To our knowledge study of this parameter in the pediatric population has been lacking to date.
We performed a multi-institutional review of the records of 53 pediatric patients 1 to 18 years old who underwent shock wave lithotripsy for 3.8 to 36.0 mm renal calculi. Stone size, average skin-to-stone distance and attenuation value were determined by bone windows on preoperative noncontrast computerized tomography. Success was defined as radiographically stone-free status at 2 to 12-week followup after a single lithotripsy session without the need for further sessions or ancillary procedures.
After lithotripsy 33 patients (62%) were stone-free and 20 had incomplete fragmentation or required additional procedures. Mean ± SD stone attenuation in successfully treated patients vs those with incomplete fragmentation was 710 ± 294 vs 994 ± 379 HU (p = 0.007). Logistical regression analysis revealed that only attenuation in HU was a significant predictor of success. When patients were stratified into 2 groups (less than 1,000 and 1,000 HU or greater), the shock wave lithotripsy success rate was 77% and 33%, respectively (p <0.003).
Stone attenuation less than 1,000 HU is a significant predictor of shock wave lithotripsy success in the pediatric population. This finding suggests that attenuation values have a similar predictive value in the pediatric population as that previously reported in the adult population.
我们旨在确定结石衰减是否可以预测小儿冲击波碎石术后结石碎裂。先前的研究表明，非增强计算机断层扫描上的术前 HU 衰减可预测冲击波碎石术的成功。据我们所知，目前尚未对该参数在儿科人群中的研究。
我们对 53 名 1 至 18 岁接受冲击波碎石治疗 3.8 至 36.0mm 肾结石的小儿患者的记录进行了多机构回顾。结石大小、平均皮肤至结石距离和衰减值通过术前非增强计算机断层扫描的骨窗确定。成功定义为单次碎石治疗后 2 至 12 周随访时无放射学结石残留状态，无需进一步治疗或辅助治疗。
碎石后 33 名患者（62%）结石完全清除，20 名患者结石不完全碎裂或需要进一步治疗。成功治疗患者与不完全碎裂患者的平均（± SD）结石衰减值分别为 710 ± 294 与 994 ± 379 HU（p = 0.007）。逻辑回归分析显示，只有 HU 衰减是成功的显著预测因素。当患者分为 2 组（小于 1000 HU 和 1000 HU 或更高）时，冲击波碎石成功率分别为 77%和 33%（p <0.003）。
结石衰减值小于 1000 HU 是小儿冲击波碎石术成功的重要预测因素。这一发现表明，衰减值在小儿人群中的预测价值与先前在成人人群中的报告相似。
