Mangaiyarkarasi, S (2009) Role of Non Contrast CT-KUB in Predicting the Stone Fragility and ESWL Success Rate. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION : Stone disease causes enormous social and economic burden to the society. The lifetime prevalence of kidney stone disease is 1-15% with the probability of having a stone varying according to age, gender, race, and geographic location. Management options for renal calculi has changed dramatically during the past 30 years. Minimally invasive techniques, especially the introduction and development of Extra Corporeal Shock Wave Lithotripsy (ESWL) has virtually replaced open surgical stone removal. ESWL was introduced by Christian Chaussay in 1980. Around 80-85% of simple renal calculi can be treated effectively with ESWL. ESWL is a non invasive therapy for urinary calculi with good success rates and decreased morbidity, length of hospitalization and anaesthesia requirement. According to the AUA guidelines, ESWL is the preferred modality of treatment for renal stones of 2cm size. Even large and complex renal calculi can be treated effectively with these minimally invasive techniques. For complete staghorn calculi a combined PCNL and ESWL (Sandwich) therapy has been recommended as the first line of treatment. The density of stone measured by NCCT Hounsfield Unit (HU) varies with stone composition and determines the fragility of a calculus which ultimately determines the clinical outcome in ESWL. NCCT because of its easy availability, superb sensitivity and very high resolution capability, is a good modality for the measurement of stone density. AIM AND OBJECTIVES : To study the density of renal stone by Non contrast CT Scan as measured in HU and its correlation with susceptibility of fragmentation by ESWL. MATERIALS AND METHODS : This is a prospective study conducted in 100 patients of renal stone disease who underwent ESWL treatment at Madras Medical College, Chennai, during the period January 2008 to January 2009. Inclusion Criteria: Patients with renal stones 8mm – 35mm in diameter who have not received any previous treatment for the same. All stones located in a satisfactory functioning, non obstructed renal unit. Exclusion Criteria: Bleeding diathesis, Pregnant females, Uncontrolled infection, Ureteric calculi, Distal obstruction, Congenital Anomalies, Patients with cardiac pacemaker, Lower calyceal stone with unfavourable anatomy. 100 patients with renal stones included in the study. In all patients history and physical examination was done. Baseline investigations included were Complete haemogram, RFT, urine C/S, X-ray KUB, USG KUB and CT KUB. CONCLUSION : For stones with HU < 750 and stone size even upto 3.5cm, stone free rate of 100% can be achieved with ESWL. For stones with 750 – 1000 HU patient may need retreatment (Multiple Sittings ESWL). For stones with HU >1000 other modalities of treatment (Endoscopic and Open Stone Surgery) are preferable to ESWL. NON CONTRAST CT estimation of stone density by HOUNSFIELD UNIT predicts the successful outcome of ESWL therapy.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Non Contrast CT-KUB ; Predict ; Stone Fragility ; ESWL Success Rate. |
| Subjects: | MEDICAL > Urology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 09 Aug 2017 04:50 |
| Last Modified: | 09 Aug 2017 04:50 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2535 |
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