CT Imaging Determines Stone Burden Better Than X-Ray

Proximal stone burden correlates with multiple surgeries for encrusted stent removal

THURSDAY, Feb. 3 (HealthDay News) -- Computerized tomography (CT) determines proximal stone burden better than plain film X-rays do in patients with encrusted and retained ureteral stents, according to a study published in the February issue of The Journal of Urology.

John W. Weedin, M.D., from the Baylor College of Medicine in Houston, and colleagues reviewed records of patients who underwent surgical removal of an encrusted and retained ureteral stent or nephrostomy between 2007 and 2009. Patients underwent preoperative imaging consisting of a plain X-ray of the kidneys, ureters, and bladder, and/or CT of the abdomen/pelvis. Encrusted tubes were assessed using the FECal (forgotten, encrusted, calcified) grading system, and the associated stone burden was calculated.

The investigators found 55 encrusted and retained ureteral stents, and one nephrostomy in 52 patients. The average tube duration was 24.9 months. Most tubes were removed endoscopically, and 21.2 percent of the patients required multiple procedures to remove each tube. CT graded stone burden significantly more accurately than did plain X-ray (94.9 versus 64 percent). Plain X-ray underestimated the proximal stone burden in 44.4 percent of patients who underwent multiple surgeries. Proximal stone burden correlated significantly with multiple surgeries and surgical complications.

"Accurately determining the amount of proximal encrustation/stone burden is an important part of preoperative planning and counseling. Patients with a significant amount of proximal stone burden greater than 100 mm² are at risk for requiring multiple surgeries for complete tube and stone removal," the authors write.

One of the study authors disclosed a financial relationship with Intuitive Surgical.

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