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Re: Abdominal Fat Distribution on Computed Tomography Predicts Ureteric Calculus Fragmentation by Shock Wave Lithotripsy
Urological Survey
Urolithiasis/Endourology Re: Abdominal Fat Distribution on Computed Tomography Predicts Ureteric Calculus Fragmentation by Shock Wave Lithotripsy H. C. Juan, H. Y. Lin, Y. H. Chou, Y. H. Yang, P. M. Shih, S. M. Chuang, J. T. Shen and Y. S. Juan Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Eur Radiol 2012; Epub ahead of print.
Objectives: To assess the effects of abdominal fat on shock wave lithotripsy (SWL). We used pre-SWL unenhanced computed tomography (CT) to evaluate the impact of abdominal fat distribution and calculus characteristics on the outcome of SWL. Methods: One hundred and eighty-five patients with a solitary ureteric calculus treated with SWL were retrospectively reviewed. Each patient underwent unenhanced CT within 1 month before SWL treatment. Treatment outcomes were evaluated 1 month later. Unenhanced CT parameters, including calculus surface area, Hounsfield unit (HU) density, abdominal fat area and skin to calculus distance (SSD) were analysed. Results: One hundred and twenty-eight of the 185 patients were found to be calculus-free following treatment. HU density, total fat area, visceral fat area and SSD were identified as significant variables on multivariate logistic regression analysis. The receiver-operating characteristic analyses showed that total fat area, para/ perirenal fat area and visceral fat area were sensitive predictors of SWL outcomes. Conclusion: This study revealed that higher quantities of abdominal fat, especially visceral fat, are associated with a lower calculus-free rate following SWL treatment. Unenhanced CT is a convenient technique for diagnosing the presence of a calculus, assessing the intra-abdominal fat distribution and thereby helping to predict the outcome of SWL. Editorial Comment: The moral of this story is not to judge a book by its cover! There are patients who may look like they are favorable candidates for SWL on the exterior who may have intra-abdominal fat distribution, which has a negative impact on results. Dean Assimos, M.D.
Re: Renal Haemorrhage Risk After Extracorporeal Shockwave Lithotripsy: Results from the Japanese Diagnosis Procedure Combination Database T. Sugihara, H. Yasunaga, H. Horiguchi, H. Nishimatsu, Y. Hirano, S. Matsuda and Y. Homma Department of Urology, Shintoshi Hospital, Iwata; Departments of Urology, and Health Management and Policy, Graduate School of Medicine, University of Tokyo and Department of Urology, Fraternity Memorial Hospital, Tokyo, and Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Fukuoka, Japan BJU Int 2012; Epub ahead of print.
Objective: To assess clinical and mechanical risk factors of clinically significant renal haemorrhage after extracorporeal shock wave lithotripsy (ESWL). Patients and Methods: Patient data were extracted from the Diagnosis Procedure Combination (DPC) database from 6 months per each year, 2006 –2008. The availability of lithotripters in each hospital was identified. We performed logistic 0022-5347/12/1883-0848/0 THE JOURNAL OF UROLOGY® © 2012 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
848
www.jurology.com
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2012.05.036 Vol. 188, 848-850, September 2012 Printed in U.S.A.
Urolithiasis/Endourology Re: Abdominal Fat Distribution on Computed Tomography Predicts Ureteric Calculus Fragmentation by Shock Wave Lithotripsy H. C. Juan, H. Y. Lin, Y. H. Chou, Y. H. Yang, P. M. Shih, S. M. Chuang, J. T. Shen and Y. S. Juan Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Eur Radiol 2012; Epub ahead of print.
Objectives: To assess the effects of abdominal fat on shock wave lithotripsy (SWL). We used pre-SWL unenhanced computed tomography (CT) to evaluate the impact of abdominal fat distribution and calculus characteristics on the outcome of SWL. Methods: One hundred and eighty-five patients with a solitary ureteric calculus treated with SWL were retrospectively reviewed. Each patient underwent unenhanced CT within 1 month before SWL treatment. Treatment outcomes were evaluated 1 month later. Unenhanced CT parameters, including calculus surface area, Hounsfield unit (HU) density, abdominal fat area and skin to calculus distance (SSD) were analysed. Results: One hundred and twenty-eight of the 185 patients were found to be calculus-free following treatment. HU density, total fat area, visceral fat area and SSD were identified as significant variables on multivariate logistic regression analysis. The receiver-operating characteristic analyses showed that total fat area, para/ perirenal fat area and visceral fat area were sensitive predictors of SWL outcomes. Conclusion: This study revealed that higher quantities of abdominal fat, especially visceral fat, are associated with a lower calculus-free rate following SWL treatment. Unenhanced CT is a convenient technique for diagnosing the presence of a calculus, assessing the intra-abdominal fat distribution and thereby helping to predict the outcome of SWL. Editorial Comment: The moral of this story is not to judge a book by its cover! There are patients who may look like they are favorable candidates for SWL on the exterior who may have intra-abdominal fat distribution, which has a negative impact on results. Dean Assimos, M.D.
Re: Renal Haemorrhage Risk After Extracorporeal Shockwave Lithotripsy: Results from the Japanese Diagnosis Procedure Combination Database T. Sugihara, H. Yasunaga, H. Horiguchi, H. Nishimatsu, Y. Hirano, S. Matsuda and Y. Homma Department of Urology, Shintoshi Hospital, Iwata; Departments of Urology, and Health Management and Policy, Graduate School of Medicine, University of Tokyo and Department of Urology, Fraternity Memorial Hospital, Tokyo, and Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Fukuoka, Japan BJU Int 2012; Epub ahead of print.
Objective: To assess clinical and mechanical risk factors of clinically significant renal haemorrhage after extracorporeal shock wave lithotripsy (ESWL). Patients and Methods: Patient data were extracted from the Diagnosis Procedure Combination (DPC) database from 6 months per each year, 2006 –2008. The availability of lithotripters in each hospital was identified. We performed logistic 0022-5347/12/1883-0848/0 THE JOURNAL OF UROLOGY® © 2012 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
848
www.jurology.com
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2012.05.036 Vol. 188, 848-850, September 2012 Printed in U.S.A.