UNENHANCED COMPUTERIZED AXIAL TOMOGRAPHY TO DETECT RETAINED CALCULI AFTER PERCUTANEOUS ULTRASONIC LITHOTRIPSY

Abstract

No AccessJournal of UrologyClinical Urology: Original Articles1 Aug 1999UNENHANCED COMPUTERIZED AXIAL TOMOGRAPHY TO DETECT RETAINED CALCULI AFTER PERCUTANEOUS ULTRASONIC LITHOTRIPSY TODD B. WALDMANN, DAVID B. LASHLEY, and EUGENE F. FUCHS TODD B. WALDMANNTODD B. WALDMANN More articles by this author , DAVID B. LASHLEYDAVID B. LASHLEY More articles by this author , and EUGENE F. FUCHSEUGENE F. FUCHS More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)68546-1AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We report our experience with unenhanced computerized axial tomography (CT) after percutaneous ultrasonic lithotripsy in patients thought to be at high risk for retained calculi. Materials and Methods: CT was obtained in 121 patients (124 kidneys) within 12 to 36 hours of percutaneous ultrasonic lithotripsy for staghorn or large nonstaghorn renal calculi. Cases were grouped according to the CT findings as no retained calculi, insignificant retained calculi (fragments 1 to 3 mm.), retained calculi amenable to shock wave lithotripsy and retained fragments requiring second look percutaneous ultrasonic lithotripsy or flexible nephroscopy. Results: No calculi were seen in 73 kidneys (59%) and retained calculi were identified in 51 (41%). Shock wave lithotripsy was used to treat 8 patients and another percutaneous ultrasonic lithotripsy or flexible nephroscopy was performed in 23 to remove retained stones. Insignificant calculi were noted in the remaining 21 patients. Conclusions: We believe that postoperative unenhanced CT is superior to plain renal tomography and is the best method to determine if a patient is stone-free after percutaneous ultrasonic lithotripsy. It helps to locate precisely those stones requiring a second percutaneous ultrasonic lithotripsy or nephroscopic extraction. An unenhanced renal CT devoid of calculi obviates routine postoperative second look flexible nephroscopy. We encourage others to consider this technique to define more accurately kidney stone status after percutaneous ultrasonic lithotripsy for large staghorn calculi or in any patient at high risk for retained calculi after percutaneous ultrasonic lithotripsy. References 1 : Long-term stone regrowth and recurrence rates after extracorporeal shock wave lithotripsy. Brit. J. Urol.1993; 72: 688. Google Scholar 2 : Comparison of endoscopic and radiological residual fragment rate following percutaneous nephrolithotripsy. J. Urol.1991; 145: 703. Link, Google Scholar 3 : Our approach to percutaneous therapy for staghorn calculi. Contemp. Urol.1997; 9: 5. Google Scholar 4 : Nephrolithiasis clinical guidelines panel summary report on the management of staghorn calculi. J. Urol.1994; 151: 1648. Link, Google Scholar 5 : Evolution of the technique of combination therapy for staghorn calculi: a decreasing role for extracorporeal shock wave lithotripsy. J. Urol.1992; 148: 1058. Link, Google Scholar 6 : Acute flank pain: comparison of non-contrast-enhanced CT and intravenous urography. Radiology1995; 194: 789. Google Scholar 7 : Detection of ureteral calculi in patients with suspected renal colic: value of reformatted noncontrast helical CT. Amer. J. Rad.1995; 165: 509. Google Scholar 8 : Diagnosis of acute flank pain: value of unenhanced helical CT. Amer. J. Rad.1996; 166: 97. Google Scholar 9 : Computed tomography after percutaneous renal stone extraction. Acta Rad.1987; 28: 55. Google Scholar From the Oregon Health Sciences University, Portland, OregonAccepted for publication March 12, 1999.Presented at annual meeting of American Urological Association, New Orleans, Louisiana, April 12-17, 1997.© 1999 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byPortis A, Laliberte M, Drake S, Holtz C, Rosenberg M and Bretzke C (2018) Intraoperative Fragment Detection During Percutaneous Nephrolithotomy: Evaluation of High Magnification Rotational Fluoroscopy Combined With Aggressive NephroscopyJournal of Urology, VOL. 175, NO. 1, (162-165), Online publication date: 1-Jan-2006. Volume 162Issue 2August 1999Page: 312-314 Advertisement Copyright & Permissions© 1999 by American Urological Association, Inc.MetricsAuthor Information TODD B. WALDMANN More articles by this author DAVID B. LASHLEY More articles by this author EUGENE F. FUCHS More articles by this author Expand All Advertisement PDF downloadLoading ...