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TAIPEI, TAIWAN ( - Introduction and Objectives: The Triple D (DDD) score utilizes CT findings to predict the probability of shockwave lithotripsy (SWL) success. A recent cost-effectiveness analysis reported that SWL outperforms URS when the SWL stone-free (SF) rate is greater than 65%. We hypothesize that many patients undergoing URS with a favorable DDD score may have been excellent SWL candidates.

wceMethods: The last 100 patients undergoing URS at our institution were reviewed. 75 had available preoperative CT imaging. Patients with distal ureteral stones, acute presentation, or multiple stones larger than 4 mm on the side of treatment were excluded. DDD score was calculated from stone density, volume and skin-to-stone distance.

Results: 61 patients were included. 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 requires careful patient selection. The DDD 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.

Source of Funding: None

Listen to an interview with Timothy Tran, one of the authors of this study.


Presented by Timothy Tran, Andrew Leone, Simone Thavaseelan, and Gyan Pareek at the 32nd World Congress of Endourology & SWL - September 3 - 7, 2014 - Taipei, Taiwan

Alpert Medical School of Brown University, Providence, RI USA


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