title: Secondary signs of non-enhanced CT prior to laser ureterolithotripsy: is treatment outcome predictable?
abstract: OBJECTIVE
  To correlate the presence of secondary signs of non-enhanced computed tomography (NECT) in renal units harboring ureteral calculi with intraoperative findings and treatment outcome after holmium:yttrium-aluminum-garnet laser (Ho:YAG) ureterolithotripsy.
  
  
  METHODS
  Two-hundred patients were prospectively included after ureteral calculi were detected on NECT. All patients underwent Ho:YAG ureterolithotripsy at the Medical University of Vienna. All CT studies were reviewed by one specialized uroradiologist blinded to pre- and postoperative parameters for secondary signs as renal enlargement, perinephric stranding, ureteral dilation, periureteral edema, and ureteral rim sign. The impact of secondary signs on intraoperatively-verified impaction and treatment outcome was evaluated.
  
  
  RESULTS
  Of the 200 patients 85 (42.5%) harbored proximal and 115 (57.5%) harbored distal ureteral calculi. The stone-free rates for proximal and distal calculi were 80% and 97%, respectively. Although proximal stone location and intraoperatively-verified impaction correlated significantly with stone-free rates (P < 0.0001, P = 0.01), the presence of secondary signs could not predict intraoperatively-verified stone impaction or stone-free rates (renal enlargement: P = 0.2, P = 0.5; perinephric stranding: P = 0.7, P = 0.5; ureteral dilation: P = 0.7, P = 0.7; periureteral edema: P = 0.8, P = 0.06; ureteral rim sign: P = 0.8, P = 0.3).
  
  
  CONCLUSIONS
  Preoperative secondary signs seen on NECT in patients harboring ureteral calculi do not correlate with intraoperative findings of impaction, and do not predict treatment outcome after Ho:YAG ureterolithotripsy.
authors.affiliation: Rohrbacher Str. 8, Medical University of Vienna, Austria. drseitz@gmx.at
authors.forename: Christian
authors.initials: C
authors.lastname: Seitz
authors.forename: Mazda
authors.initials: M
authors.lastname: Memarsadeghi
authors.forename: Harun
authors.initials: H
authors.lastname: Fajkovic
authors.forename: Enis
authors.initials: E
authors.lastname: Tanovic
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D017602:Lithotripsy, Laser; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000000981:diagnostic imaging* / Q000628:therapy