Non-invasive preoperative assessment of ureteral stone impaction using peri-calculus ureteral thickness on Non-Contrast CT (NCCT) scan: A prospective Study

  • Dr. Pradeep K Sharma Associate Professor, Department of Urology, Dr. SN Medical College, Jodhpur, Rajasthan, India
  • Dr. Vikas Aggarwal Resident, Department of Urology, Dr. SN Medical College, Jodhpur, Rajasthan, India
  • Dr. Shekhar Baweja Resident, Department of Urology, Dr SN Medical College, Jodhpur, Rajasthan, India
  • Dr. Rupesh Nagori Resident, Department of Urology, Dr SN Medical College, Jodhpur, Rajasthan, India
  • Dr. Pawan Katti Resident, Department of Urology, Dr SN Medical College, Jodhpur, Rajasthan, India
  • Dr. M K Chhabra Professor, Department of Urology, Dr SN Medical College, Jodhpur, Rajasthan, India
Keywords: Ureteric thickness, Ureteral stone, NCCT, Stone impaction

Abstract

Background: Ureteral stone can be measured on the NCCT scan as peri-calculus ureteral thickness. If this depicts significant calculus impaction, the patient could be counseled regarding intra-operative risk and incomplete stone clearance. The present study was planned to evaluate the use of NCCT in patients with ureterolithiasis for the prediction of a favorable clinical outcome.

Materials and methods: Patients who underwent ureterorenoscopy for ureteric calculus with pre-operative NCCT scan were included and intraoperative data were recorded. Operating surgeons were blinded for proximal ureteric wall thickness (p-UWT), peri-calculus ureteric wall thickness (p-CUT), and distal ureteric wall thickness (d-UWT) values. The guidewire was negotiated before each URS. Stone was considered impacted if guidewire could not be negotiated in 2 attempts. Intra-operative stone impaction score (SIS) assigned on a scale of 0 (dislodged spontaneously), 1 (dislodged with saline pressure), 2 (dislodged after lithotripsy), 3 (fragments impacted in edema) and 4 (open). Intra-operative findings were correlated to preoperative NCCT measurements of ureteral thickness. Other variables like duration of symptoms, hydronephrosis, stone size in the longest dimension, and stone location were also recorded.

Results: Of total patients 108 patients, 70 patients had non-impacted calculus and 38 patients had impacted calculus. Patients with an impacted calculus had significantly higher p-UWT (9.76 ±3.11mm), p-CUT (6.82±2.57mm), and d-UWT (6.26±2.28mm) as compared to non-impacted. There was a positive correlation in SIS with p-UWT, p-CUT, and p-DWT in both impacted and non-impacted groups.

Conclusion: Pre-operative ureteric wall thickness in proximal, peri, and distal to calculus can predict intraoperative risk and impaction of calculus.

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Published
2020-04-30
How to Cite
Sharma, P. K., Aggarwal, V., Baweja, S., Nagori, R., Katti, P., & Chabbra, M. K. (2020). Non-invasive preoperative assessment of ureteral stone impaction using peri-calculus ureteral thickness on Non-Contrast CT (NCCT) scan: A prospective Study. Surgical Update: International Journal of Surgery and Orthopedics, 6(2), 67-71. https://doi.org/10.17511/ijoso.2020.i02.01
Section
Original Article