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Patients Undergoing Ureteroscopic Lithotripsy May Be Excellent Single Session SWL Candidates Based Upon Triple D Score
Timothy Tran, MD, Andrew Leone, MD, Simone Thavaseelan, MD, Gyan Pareek, MD.
Brown University, Providence, RI, USA.
BACKGROUND: The Triple D (DDD) score incorporates preoperative computed tomography (CT) findings to predict the probability of shockwave lithotripsy (SWL) success. While technologic advancements have yielded comparative improvements in stone free (SF) rates with ureterorenoscopy (URS), the cost of a single SWL treatment remains lower. A recent cost-effectiveness analysis reported that SWL outperforms URS when the predicted SF rate is greater than 65-67%. We hypothesize that many patients undergoing URS with a favorable DDD score may have been excellent SWL candidates. Therefore, we analyzed DDD scores in our URS population in order to predict SF rates had these patients undergone SWL.
METHODS: The last 100 patients undergoing URS at our institution were retrospectively reviewed. 75 had available preoperative CT imaging. Patients with distal ureteral stones, acute colic, or multiple stones larger than 4.0 mm on the side of treatment were excluded from our analysis. Triple D score was determined based upon calculation of stone density, skin-to-stone distance and stone volume.
RESULTS: 61 patients met inclusion criteria. A total of 29/61 (47.5%) of patients had a DDD score greater than or equal to 2. Among these, 22/61 (36.0%) patients had a DDD score of 2 and 7/61 (11.4%) had a DDD score of 3, which correlate with SWL SF rates of 75% and 95%, respectively. The overall URS SF rate for our cohort was 92%. 66% of patients that failed initial treatment had multiple stones and the remaining 33% had stone volume greater than 500 mm3.
CONCLUSIONS: Cost-effective stone treatment is driven by careful patient selection. Preoperative calculation of the Triple D score identifies patients with a high probability for successful SWL. We conclude that many patients undergoing URS as first line therapy would be excellent single-session SWL candidates. These findings reinforce the importance of proper patient selection, which allow for SWL to be a noninvasive and cost-effective treatment modality for the management of urinary stones.
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