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Predicting the Impacted Ureteral Stone with Computed Tomography.

Timothy Y Tran1, Jacob N Bamberger2, Kyle A Blum3

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Preoperative noncontrast computed tomography (CT) can predict impacted ureteral stones. Distal ureteral density above 27 Hounsfield units (HU) on CT is a significant predictor, aiding surgical planning.

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Area of Science:

  • Urology
  • Radiology
  • Medical Imaging

Background:

  • Preoperative identification of impacted ureteral stones is crucial for patient preparation and surgical decision-making.
  • Factors predicting ureteral stone impaction are not well-established.
  • Noncontrast computed tomography (CT) is commonly used for stone evaluation.

Purpose of the Study:

  • To evaluate if preoperative computed tomography (CT) findings can predict the presence of an impacted ureteral stone.
  • To identify specific CT parameters associated with ureteral stone impaction.
  • To determine the diagnostic performance of distal ureteral density in predicting impaction.

Main Methods:

  • Retrospective review of patients undergoing ureteroscopic treatment for impacted ureteral stones (June 2014-July 2016).
  • Exclusion of patients with prior ureteral prestenting or stone treatment.
  • Analysis of noncontrast CT images for stone size, volume, hydronephrosis, and Hounsfield units (HU) of stone and ureter.
  • Comparison with a control group of patients with nonimpacted stones.

Main Results:

  • Impacted stones were associated with larger stone size, volume, higher ureteral HU, higher HU ratio, and greater hydronephrosis on univariate analysis.
  • Multivariate analysis identified ureteral HU under the stone as a significant predictor of impaction (OR 1.17; 95% CI 1.11-1.25).
  • Distal ureteral density ≥ 27 HU showed 85% sensitivity, 85% specificity, 89% PPV, and 81% NPV for impaction.

Conclusions:

  • Impacted ureteral stones are linked to a distal ureteral density threshold of 27 HU or greater.
  • Preoperative noncontrast CT measurement of distal ureteral density can help predict impacted stones.
  • This finding may assist in optimizing patient management and surgical planning for ureteral stones.