Predicting Stone-free Status based on Quadruple-D and Triple-D Scores after Extracorporeal Shock-Wave Lithotripsy and Comparing With Broad-Spectrum Population

Abstract

Purpose To compare the Triple-D and Quadruple-D scores in predicting the success of shock-wave lithotripsy (SWL).

Material and Methods We retrospectively reviewed a total of 328 patients who had undergone SWL for stones with an average size of 10–15 mm in the renal pelvis, lower, middle, and upper calyces at the Urology Clinic of Kartal Dr. Lütfi Kırdar City Hospital between 2021 and 2023. Patients were divided into two groups − stone-free and residual − based on pre-and post-SWL imaging. Age, gender, stone location, ellipsoid stone volume (ESV) and side (right/left), stone density (SD), stone-skin distance (SSD), body-mass index (BMI), Triple-D score (TrD-S), and Quadruple-D score (QrD-S) values were recorded and compared. For TrD-S, SV <150 mm³, SD <600 Hounsfield (HU), and SSD <12 cm were scored in the range of 0–3. For QrD-S, lower calyx localization was scored as “0”, and pelvis, middle calyx, and upper calyx stones were scored as “1” in the range of 0–4.

Results Of a total of 328 patients, 219 (66.8%) were stone-free, 109 (33.2%) had residual stones, 211 were male, and 117 were female. Of the stones, 149 were located in the lower calyx, 118 in the middle calyx, 55 in the renal pelvis, and 6 in the upper calyx. ESV was 95.5 and 120 µ/L in the two groups, (p:0.001). Cutoff values of TrD-S and QrD-S were 1.5 and 2.5, and area under the curve (AUC) values were 0.65 and 0.67, respectively, (p:0.001).

Conclusions The Quadruple-D score is at least as successful as the Triple-D score in predicting SWL success.

Zusammenfassung

Ziel Vergleich des Triple-D-Scores und des Quadruple-D-Scores zur Vorhersage des Erfolgs der extrakorporalen Stoßwellenlithotripsie (ESWL).

Material-Methode Insgesamt 328 Patienten, die sich zwischen 2021 und 2023 in der Urologieklinik des Stadtkrankenhauses Kartal Dr. Lütfi Kırdar einer ESWL wegen durchschnittlich 10–15 mm großer Steine im Nierenbecken, im unteren, mittleren und oberen Kelch unterzogen, wurden retrospektiv untersucht. Die Patienten wurden anhand der Bildgebung vor und nach der ESWL in zwei Gruppen eingeteilt: steinfrei und residual. Alter, Geschlecht, Steinlage, ellipsoides Steinvolumen (ESV) und Seite (rechts/links), Steindichte (SD), Steinhautabstand (SSD), Body-Mass-Index (BMI), Triple-D-Score (TrD-S), Quadruple-D-Score (QrD-S) wurden erfasst und verglichen. Für TrD-S wurden SV <150 mm³, SD <600 Hounsfield (HU) und SSD <12 cm im Bereich von 0–3 bewertet. Bei QrD-S wurden die Lokalisierung des unteren Kelchs mit „0“ und die des Beckens, des mittleren Kelchs und des oberen Kelchs mit „1“ im Bereich von 0–4 bewertet.

Ergebnisse Von den insgesamt 328 Patienten waren 219 (66,8 %) steinfrei, 109 (33,2 %) hatten einen Reststein, 211 waren männlich und 117 weiblich. Von den Steinen befanden sich 149 im unteren Kelch, 118 im mittleren Kelch, 55 im Nierenbecken und 6 im oberen Kelch. Der ESV betrug 95,5 und 120 µ/L in den beiden Gruppen (p:0,001). Die Cut-off-Werte von TrD-S und QrD-S lagen bei 1,5 und 2,5, und die Werte der Fläche unter der Kurve (AUC) betrugen 0,65 bzw. 0,67 (p:0,001).

Schlussfolgerungen Der Quadruple-D-Score ist bei der Vorhersage des ESWL-Erfolgs mindestens so erfolgreich wie der Triple-D-Score.

Keywords

lower calyx - shock-wave lithotripsy - stone scores

Schlüsselwörter

Stein scores - Stoßwellenlithotripsie - Unterer Kelch

Publication History

Received: 30 October 2023

Accepted after revision: 07 February 2024

Article published online:
13 March 2024

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