Uncovering New Horizons: Update to Quadruple-D Score to Predict Stone-Free Rate with Advanced Non-invasive Lithotripsy Technology.

Objective: To evaluate the efficacy of the Quadruple-D scoring system in predicting stone-free rate (SFR) using the newer Generation Piezoelectric lithotripter. Methods: A prospective observational study was conducted from January to December 2023, involving patients who underwent extracorporeal shock wave litho- tripsy (ESWL) for renal stones sized 5-20 mm. Evaluation parameters included stone density, skin-to-stone distance (SSD), stone size (ellipsoid stone volume), and location, with Quadruple-D scores calculated based on predetermined cutoffs. Extracorporeal shock wave lithotripsy sessions utilized the "Piezolith 3000 Plus" lithotripter, and SFR was assessed 4 weeks post-procedure. Statistical analysis included Student's t-test and receiver operating characteristic curve analysis. Results: Of the 40 eligible patients, 75% achieved stone-free status post-ESWL. Stone density and SSD emerged as leading predictors of SFR, with new cut-off values identi- fied. Comparative analysis demonstrated improved predictive power of the Piezolith Q-D score over the previous Quadruple-D score (AUC: 84% and 80% respectively). Although stone location and size also influenced outcomes, their significance varied in this study. Conclusion: The Piezolith Q-D score system exhibits promise in predicting SFR post- ESWL with piezoelectric lithotripters. External validation and larger-scale studies are warranted to establish the scoring system's reliability and applicability across diverse populations.