POSSIBILITIES OF MULTISPIRICAL COMPUTED TOMOGRAPHY IN PREDICTING RECURRENT LITHOGENESIS AFTER THE EXTRACTION LITHOTRIPSY

 

Mikhaylin S.D., Kapanadze L.B., Rudenko V.I., Krupinov G.E., Serova N.S.

 

Sechenov University. Moscow, Russia.

Purpose. To evaluate the possibilities of predicting recurrent lithogenesis in patients after extracorporeal shock wave lithotripsy (ESWL), taking into account stone parameters assessed using multislice computed tomography (MSCT) data, as well as the anatomical features of the renal pelvis.

Materials and methods. Lithogenesis after ESWL was assessed in a pro- and retrospective study in 47 patients (100%), including 25 men (53.2%) and 22 women (46.8%). All patients underwent multislice computed tomography scanning using an Aquilion One 640 CT scanner (Canon, Japan). Postoperatively, X-ray phase analysis or infrared spectroscopy were used to detail and finally establish the physicochemical composition of urinary stones (fragments).

Results. In 26 of 47 patients (55%), complete passage of stone fragments after ESWL was observed by the time of hospital discharge. However, in 21 patients (45%), during a 3-month follow-up after ESWL with assessment of the SFR indicator, non-passage of stone fragments was observed in 12 of them (57%), which led to false recurrent stone formation. Statistical analysis showed high sensitivity and specificity of the calculus homogeneity parameter in predicting the presence of residual fragments after ESWL, AUC=0.89. When analyzing the correlation interactions between these parameters and the effectiveness of ESWL, the most significant statistical dependence with false recurrence in urolithiasis was noted for a urinary stone size of 16 to 19 mm (r = 0.42, p < 0.05) and a density of 1001–1500 HU (r = 0.52, p < 0.001). The mean skin-to-stone distance (SSD) in the group of patients with residual stones was 107.7 ± 28.9 mm (p ≤ 0.05). Analysis of urinary stone localization in the renal pelvic system (RPS) in the setting of false recurrence of urolithiasis after ESWL revealed a direct correlation between urolithiasis recurrence after ESWL and stone localization in the lower group of calyces (r = 0.55, p < 0.01). In case of false recurrence of urolithiasis, a statistically significant correlation (r = 0.04, p < 0.01) with RPS parameters (IL ≥ 27 mm, IW ≤ 4 mm, IPA ≤ 90º) was determined.

Discussion. The possibility of using stone density and size parameters to predict the results of extracorporeal shock wave lithotripsy (ESWL) has been repeatedly discussed in various publications. In our study, we found statistically significant differences in these parameters between patients who underwent 1 and 2 ESWL sessions for complete stone removal, and their correlation with treatment outcomes was low. We believe that these parameters are not reliable for assessing the risk of recurrent lithogenesis. Combined analysis of these parameters, along with an assessment of the structural features of stones and the anatomy of the renal pelvis and calyces, can significantly improve the ability of MSCT to predict recurrent stone formation in patients after ESWL.

Conclusion. This study assessed the feasibility of predicting recurrent stone formation in patients undergoing extracorporeal shock wave lithotripsy using various stone parameters obtained from multislice computed tomography. The results demonstrate the need for a comprehensive approach, including analysis of stone structural features, renal pelvicalyceal system (RPS) anatomy, and calculus location within the RPS, to more accurately predict recurrence. Combined data analysis can significantly improve the predictive capabilities of MSCT and aid in optimizing patient treatment after ESWL.

 

Keywords: MSCT in prognosis, urolithiasis, extracorporeal shock wave lithotripsy, urolithiasis, residual stones, multislice computed tomography.

 

Corresponding author: Mikhailin S. D., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Mikhaylin S.D., Kapanadze L.B., Rudenko V.I., Krupinov G.E., Serova N.S. Possibilities of multispirical computed tomography in predicting recurrent lithogenesis after the extraction lithotripsy. REJR 2026; 16(1):126-137. DOI: 10.21569/2222-7415-2026-16-1-126-137.

Received: 25.03.26 Accepted:            14.04.26