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Reinforcement of the Triple D score with simple addition of the intrarenal location for the prediction of the stone-free rate after shockwave lithotripsy for renal stones 10–20 mm in diameter

  • Urology - Original paper
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Abstract

Purpose

We investigated the clinical efficacy of the Triple D score (TrD-S) on stone-free rate (SFR) prediction following shockwave lithotripsy (SWL) for renal stones 10–20 mm in diameter and modified the scoring system to improve outcome prediction.

Methods

We retrospectively examined clinical data from the medical records of 226 consecutive patients who underwent SWL for 10–20 mm kidney stones. The TrD-S was calculated according to the cutoffs of < 150 mm3 for stone volume, < 600 Hounsfield unit for stone density, and < 12 cm for skin-to-stone distance on computed tomography. The Quadruple D score was defined as the sum of the TrD-S and stone location (0/1 point for intrarenal stone distribution at lower/non-lower poles, respectively). Complete clearance 3 months after the final SWL was considered the stone-free status.

Results

The residual group (n = 102) had significantly older age, larger stones, higher stone density, higher lower-pole stone incidence, and lower TrD-S than the stone-free group (n = 124). In the multivariate analysis, age, TrD-S, and non-lower-pole stones independently predicted the SFR. The TrD-Ss of 0, 1, 2, and 3 points showed SFRs of 40.0%, 51.9%, 73.0%, and 100.0%, respectively. The Quadruple D scores of 0, 1, 2, 3, and 4 points showed SFRs of 0.0%, 37.9%, 54.5%, 84.4%, and 100.0%, respectively, with better prediction accuracy than the TrD-S (p = 0.01).

Conclusions

The TrD-S is successfully validated for use in Japanese patients with 10–20-mm renal stones. Simple addition of the stone location to the TrD-S could reinforce SFR prediction after SWL.

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Acknowledgements

We would like to thank Editage (http://www.editage.jp) for the English language editing.

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Authors and Affiliations

  1. Department of Urology, Yamagata University Faculty of Medicine, 2-2-2 Iida-nishi, Yamagata, 998-9585, Japan

    Osamu Ichiyanagi, Hiroki Fukuhara, Sei Naito, Hayato Nishida, Tomoyuki Kato & Norihiko Tsuchiya

  2. Department of Urology, Yamagata Prefectural Kahoku Hospital, 111 Aza-Gassando, Yachi, Kahoku, 999-3511, Japan

    Osamu Ichiyanagi

  3. Department of Urology, Nihonkai General Hospital, 30 Akiho-cho, Sakata, 998-8501, Japan

    Hiroki Fukuhara & Masayuki Kurokawa

  4. Department of Urology, South Miyagi Medical Center, 38-1 Aza-nishi, Ogawara, Miyagi, 989-1253, Japan

    Takuji Izumi

  5. Department of Urology, Yamagata City Hospital Saiseikan, 1-3-26 Nanoka-mahi, Yamagata, 990-8533, Japan

    Hitoshi Suzuki

Authors
  1. Osamu Ichiyanagi
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  2. Hiroki Fukuhara
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Correspondence to Osamu Ichiyanagi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required, because the present study was retrospective and the anonymity of the participants was ensured.

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For this type of study formal consent is not required, because the present study was retrospective and the anonymity of the participants was ensured.

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Ichiyanagi, O., Fukuhara, H., Kurokawa, M. et al. Reinforcement of the Triple D score with simple addition of the intrarenal location for the prediction of the stone-free rate after shockwave lithotripsy for renal stones 10–20 mm in diameter. Int Urol Nephrol 51, 239–245 (2019). https://doi.org/10.1007/s11255-018-02066-1

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  • DOI: https://doi.org/10.1007/s11255-018-02066-1

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