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The stone density (SD) is not the same in all parts of the stone due to the heterogeneous nature of the stone and the shock wave (SW) passes through tissues of many different densities until it reaches the stone. These factors affect the success of Extracorporeal Shock Wave Lithotripsy (ESWL). We aimed to evaluate the effect of the Variation Coefficient of Stone Density (VCSD) and Renal Cortical Tickness (RCT) on the success of ESWL. Between 2020 and 2023, 510 patients who underwent ESWL were divided into 2 groups treatment success (n:304) and treatment failure (n:206). Non-Contrast Computed Tomography (NCCT) imaging values of hydronephrosis degree of the kidney, stone location, stone volume (SV), stone-skin distance (SSD), SD, Standard deviation of Stone Density (SDSD), VCSD, RCT, Soft-Tissue Thickness (STT), Muscle Thickness (MT) were analyzed. VCSD value was obtained by dividing SDSD by SD. Along the SW, tissues were divided into three components: kidney (renal cortex), muscle and other soft tissues. RCT, MT and SSD were measured at three different angles (0°, 45°, and 90°) and these 3 lengths were averaged. In univariate analysis, Body Mass Index (BMI), SV, SD, VCSD, SSD, RCT and STT were demonstrated to affect ESWL success. In multivariate analysis, low BMI, SV, SD, RCT and large VCSD were significant independent predictors of ESWL success. Among these parameters, VCSD had the highest prediction accuracy, followed by SD, SV, RCT and BMI, respectively. This study demonstrated that VCSD value and RCT are predictive parameters in determining the treatment of patients with urinary calculi and selecting suitable ESWL candidates., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction and Objectives: Somalia was predicted to be in the global stone belt with high urolithiasis prevalence. We aimed to determine the prevalence of urolithiasis and their demographic and computer tomography (CT) characteristics among subjects under CT scans in Mogadishu, Somalia. Materials and Methods: From March 2014 to November 2022, a total of 7,276 patients who underwent an abdominopelvic non-contrast CT scan for various indications were retrospectively reviewed. The mean age was 45.6 years with a standard deviation of 21.1 (range, 0.2-110 years). Patients were subdivided into two categories: adults (≥18 years) and pediatric (≤17 years)., Results: Of the 7,276 patients, 1,075 (14.8%) were diagnosed with urolithiasis. Among those with urolithiasis, 702 (65.3%) were male patients, and 373 (34.7%) were female patients. Among them, adults accounted for 92.7%, while children were 7.3%. Renal stones (nephrolithiasis) were the most common, representing 57% followed by ureteric stones at 35.5%, making upper urinary stones 92.5%. Approximately 70 patients (6.5%) had bladder stones; of these, 26 of them (37%) were accompanied by benign prostatic hyperplasia (BPH). There were 10 urethral stones (0.9%) recorded in the study, all were found in male patients, 8 localized in prostatic urethra, and 2 in the bulbar urethra. The overall mean stone size was 13.2 mm, and 60% of them ranged from 5 to 22 mm. Only 24% of the patients were asymptomatic. Single stones were almost 70%, while staghorn calculi were 8.2%. More than 60% of the patients with urolithiasis showed some degree of hydronephrosis ranging between mild to severe., Conclusion: A CT scan-based urolithiasis prevalence indicates 14.8% in Mogadishu, Somalia, and these results are consistent with the probability calculation of the weights-of-evidence (WofE) methodology based on several risk factors including temperature, climate change, mineral deposit, drinking water quality, and distribution of carbonated rocks. Considering the high prevalence of the disease, Somalia needs to invest more in prevention and treatment facilities while also training urologists that are capable of utilizing minimally invasive techniques in the country., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Dirie, Adam, Garba, Dahie, Sh. Nur, Mohamed, Mohamud and Hassan.)

Objectives: Evaluation of safety, efficacy, and feasibility of emergency extracorporeal shockwave lithotripsy (eESWL) in combating obstructing stones with colic on emergency basis. Materials and methods: From November 2019 to November 2021, 102 subjects underwent emergency ESWL for obstructing ureteric and renal stones with colic within 24 h of presentation. Results: Patients in this study belonged to age group of 18–67 years with mean being 39 years consisting of 85 males and 22 females (M:F = 85:22). Mean stone dimensions were 8.26 mm in length and 7.65 mm in width. A total of 42 patients had their stone in kidney or upper ureter while 24 patients had stone in mid ureter and remaining patients (n = 36) had stone in lower ureter. About 65 patients had their stone completely cleared after single ESWL session while 20 patients required multiple sessions to achieve complete clearance. Of these 17 patients (16.67%) were not rendered stone free even after three sessions and had to undergo ureteroscopic lithotripsy (URSL). Overall Stone Free Rate (SFR) was 83.33%. For stone attenuation of ⩽900 HU, SFR was 97.18% while for >900 HU it was only 51.61%. Conclusion: eESWL is safe, feasible, and efficacious noninvasive alternative for definitive management of obstructing ureteral and renal stones with colic as far as stone clearance and rapid and definitive pain relief are concerned and that too with very minimal morbidity without the need for admission and hence can reduce the prolonged waiting period for endoscopic stone surgery in any high-volume tertiary care hospital. Length, width, and attenuation of stone were found to be the main factors dictating the success of eESWL. [ABSTRACT FROM AUTHOR]

Background: Sonography has been considered an excellent diagnostic imaging technique for the detection of both opaque and nonopaque renal calculi. The sonographic diagnosis of a calculus is usually based on the demonstration of a highly echogenic focus with an associated acoustic shadow. To compare the detection of urinary stones using standard gray scale ultrasound for diagnostic accuracy using the color Doppler "twinkling sign". Material and methods: In our study 90 consecutive patients with various abdominal pathologies (not directly linked to renal lithiasis) were included in our study. All patients then underwent US at our department. Color Doppler US was performed using a red-and-blue color map and power Doppler US using a pink color map with a standardized Doppler protocol to detect the twinkling artifact. For color Doppler, gain was set to the point just below the threshold for color noise and the pulse repetition frequency (= velocity scale) was set to 64 cm/sec to eliminate color flow signals from renal blood flow. The color window size was adjusted to cover the whole renal sinus. Doppler imaging began with continuous sweeps of the renal sinus in the longitudinal and transverse planes. Result: On abdominal CT scans, 81 selected patients showed 90 renal lithiasis equal to or smaller than 5 mm. The diameter of renal lithiasis ranged from 2.6 to 5.0 mm (average diameter 4.1 mm). Out of 90 CT positive lithiasis, 50 (55.6%) were absolutely positive on gray-scale. Out of the 50 lithiasis, 14 were hyperechogenic foci with posterior shadow cone, but with a slight echogenicity difference, 50 showed both posterior shadow cone and a marked echogenicity difference, and 24 showed a marked echogenicity difference without posterior shadow cone. So, the posterior shadow cone appeared 40 out of 50 times, while marked echogenicity difference was detected 84 times. Conclusion: The stone size obtained by US was almost the same as that detected by NCCT; however, US is a limited imaging modality in detecting urinary tract stone, especially when used by an inexperienced radiologist, and in the case of smaller stone size, increased weight, and low grade of hydronephrosis. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the limited sensitivity and size over measurements of ultrasound (US) for ureteral stone, and demonstrate how this influenced medical decisions. Patients and methods: Retrospectively, we analyzed the data of patients with ureterolithiasis estimated by US and non-contrasted computed tomography (NCCT) within 48 h at our institution from January 1st 2014 to June 1st 2017. Stone size was grouped by the longest axis diameter on NCCT: < 5, 5–10, and > 10 mm. Then, US and NCCT results were compared for the sensitivity and measurements. Results: A total of 614 cases of ureterolithiasis were visible on NCCT. The sensitivity of US for ureterolithiasis < 5, 5–10, and > 10 mm were 63.49, 79.06, and 84.67%, respectively (P = 0.001). US overestimated the size in 63.49 and 50.54% of patients with ureterolithiasis < 5 and 5–10 mm compared to NCCT, respectively (P < 0.001). Under the assumptions that patients with ureteral stone < 5, 5–10, and > 10 mm would be simply observed, received medical expulsive therapy (MET), and surgical interventions, 20.94 and 15.33% of patients with stone sized 5–10 and > 10 mm might be improperly observed due to negative US reports. Besides, 63.49 and 50.54% of cases with stone < 5 and 5–10 mm might receive more aggressive interventions ascribed to over measurements of US. Conclusions: Limited sensitivity and size over measurements of US might significantly influence medical decisions for ureteral stone. Inaccurate evaluation of US should be taken in consideration for appropriate counseling options. [ABSTRACT FROM AUTHOR]

Objective:To evaluate the accuracy of ultrasonography (US) in measuring the urinary tract stone using non-contrast computed tomography (NCCT) as the standard reference.Patients and methods:A total of 184 patients suspected with urolithiasis who had undergone NCCT and US radiologic investigation from 2015 to 2017 were enrolled in this study. The sensitivity, specificity, and stone size measured in US were validated by NCCT. Data of the stone size in US were classified into four groups (0–3.5, 3.6–5, 5.1–10, >10 mm) and then compared with NCCT data. Results:In 184 patients, NCCT detected 276 (97.2%) stones, while US could identify 213 (75.5%) stones. Overall sensitivity and specificity of US were 75.4% and 16.7%, respectively. Detection rate of mid and distal ureteral stone was lower than that at other locations. The detection rate increased with the stone size. About 73% concordance was obtained for the stone size measured by US and NCCT (Pearson’s correlation coefficient was 0.841). Factors such as the stone size, amount of hydronephrosis, and weight affected the detection rate of the urinary tract stone using US (P<0.001, P=0.02, and P=0.01, respectively). Conclusion:The stone size obtained by US was almost the same as that detected by NCCT; however, US is a limited imaging modality in detecting urinary tract stone, especially when used by an inexperienced radiologist, and in the case of smaller stone size, increased weight, and low grade of hydronephrosis. [ABSTRACT FROM AUTHOR]