title: The role of plain radiography in predicting renal stone fragmentation by shockwave lithotripsy in the era of noncontrast multidetector computed tomography.
abstract: OBJECTIVE
  The objective of this study is to determine if plain radiography has a role in prediction of stone fragmentation by shockwave lithotripsy (SWL).
  
  
  METHODS
  Our study included 106 patients undergoing SWL for renal stones. Based on plain radiography criteria, stones were classified according to density, homogeneity, and outline. We compared the success of SWL in fragmentation of stones with a density equal to or less than bone, nonhomogeneous stones, and stones with irregular outline to its success in stones with a density more than bone, homogeneous stones, and stones with smooth outline.
  
  
  RESULTS
  In plain radiography, stone density equal to or less than bone, nonhomogeneous stones, and stones with irregular outline showed successful SWL fragmentation in 88.8%, 91.2%, and 90.6%, respectively. Stones with a density more than bone, homogeneous stones, and stones with smooth outline showed successful SWL fragmentation in 52.9%, 52.6%, and 57.1%, respectively. CT attenuation value was significantly less in stones successfully fragmented by SWL compared with nonfragmented stone (649±169 and 1465±256, respectively). In homogeneous stones with smooth outline having a density more than bone, we found a significantly lower CT attenuation in patients with successful stone fragmentation by SWL compared with those with failed stone fragmentation (690.9±171 and 1462±212, respectively).
  
  
  CONCLUSIONS
  In relatively large solitary renal pelvic stones, plain radiography can predict the success of stone fragmentation by SWL. Nonhomogeneous stones with irregular outline and a density equal to or less than bone are expected to be successfully fragmented by SWL. Noncontrast CT is only needed, to predict success of SWL, in cases of homogeneous stones with smooth outline and density more than bone.
authors.affiliation: Department of Urology, Minia University , El-Minia, Egypt .
authors.forename: Alayman
authors.initials: A
authors.lastname: Hussein
authors.forename: Ahmed
authors.initials: A
authors.lastname: Anwar
authors.forename: Mamdouh
authors.initials: M
authors.lastname: Abol-Nasr
authors.forename: Emad
authors.initials: E
authors.lastname: Ramadan
authors.forename: Alaa
authors.initials: A
authors.lastname: Shaaban
mesh_terms: D000328:Adult; D015519:Bone Density; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000737:chemistry / Q000000981:diagnostic imaging* / Q000628:therapy*; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D061330:Multidetector Computed Tomography; D012189:Retrospective Studies