title: Is scoring system of computed tomography based metric parameters can accurately predicts shock wave lithotripsy stone-free rates and aid in the development of treatment strategies?
abstract: OBJECTIVE
  The objective was to determine the predicting success of shock wave lithotripsy (SWL) using a combination of computed tomography based metric parameters to improve the treatment plan.
  
  
  METHODS
  Consecutive 180 patients with symptomatic upper urinary tract calculi 20 mm or less were enrolled in our study underwent extracorporeal SWL were divided into two main groups, according to the stone size, Group A (92 patients with stone ≤10 mm) and Group B (88 patients with stone >10 mm). Both groups were evaluated, according to the skin to stone distance (SSD) and Hounsfield units (≤500, 500-1000 and >1000 HU).
  
  
  RESULTS
  Both groups were comparable in baseline data and stone characteristics. About 92.3% of Group A rendered stone-free, whereas 77.2% were stone-free in Group B (P = 0.001). Furthermore, in both group SWL success rates was a significantly higher for stones with lower attenuation <830 HU than with stones >830 HU (P < 0.034). SSD were statistically differences in SWL outcome (P < 0.02). Simultaneous consideration of three parameters stone size, stone attenuation value, and SSD; we found that stone-free rate (SFR) was 100% for stone attenuation value <830 HU for stone <10 mm or >10 mm but total number SWL sessions and shock waves required for the larger stone group were higher than in the smaller group (P < 0.01). Furthermore, SFR was 83.3% and 37.5% for stone <10 mm, mean HU >830, SSD 90 mm and SSD >120 mm, respectively. On the other hand, SFR was 52.6% and 28.57% for stone >10 mm, mean HU >830, SSD <90 mm and SSD >120 mm, respectively.
  
  
  CONCLUSIONS
  Stone size, stone density (HU), and SSD is simple to calculate and can be reported by radiologists to applying combined score help to augment predictive power of SWL, reduce cost, and improving of treatment strategies.
authors.affiliation: Deparment of Urology, Al-Azar University, Cairo, Egypt.
authors.forename: Yasser Ali
authors.initials: YA
authors.lastname: Badran
authors.affiliation: Deparment of Urology, Al-Azar University, Dmietta, Egypt.
authors.forename: Alsayed Saad
authors.initials: AS
authors.lastname: Abdelaziz
authors.affiliation: Deparment of Urology, Al-Azar University, Cairo, Egypt.
authors.forename: Mohamed Ahmed
authors.initials: MA
authors.lastname: Shehab
authors.affiliation: Deparment of Urology, Al-Azhar university, Assiut, Egypt.
authors.forename: Hazem Abdelsabour Dief
authors.initials: HA
authors.lastname: Mohamed
authors.affiliation: Deparment of Urology, Al-Azar University, Cairo, Egypt.
authors.forename: Absel-Aziz Ali
authors.initials: AA
authors.lastname: Emara
authors.affiliation: Deparment of Anesthesia, Zagazig University, Zagazig, Egypt.
authors.forename: Ali Mohamed Ali
authors.initials: AM
authors.lastname: Elnabtity
authors.affiliation: Deparment of Radiology, Al-Azar University, Cairo, Egypt.
authors.forename: Maged Mohammed
authors.initials: MM
authors.lastname: Ghanem
authors.affiliation: Deparment of Urology, El Fayoum University, Al Fayoum, Egypt.
authors.forename: Hesham Abdel Azim
authors.initials: HA
authors.lastname: ELHelaly
keywords: Hounsfield units; stone; upper urinary tract