Peri-Calculus Ureteral Thickness (P-CUT) on CT Predicts Stone Impaction at Time of Surgery: A Prospective Study

Ryan Chandhoke, Jacob N Bamberger, Blair Gallante, William Atallah, Mantu Gupta
Journal of Endourology 2019 October 25

INTRODUCTION AND OBJECTIVES: Ureteroscopic management of impacted ureteral stones poses multiple challenges. We examined whether ureteral thickness measured on preoperative non-contrast computed tomography (CT) is predictive of stone impaction at the time of ureteroscopy (URS).

METHODS: 38 patients with preoperative CT scan and undergoing URS for ureteral stones were prospectively studied. Ureteral thickness directly above, around (PCUT), and below the calculus were determined on CT scan. The cross-sectional surface area around the stone (P-CUT) was also calculated. Stones were considered impacted at surgery if contrast had difficulty passing, a guidewire could not pass, and the stone was visually impacted >5 on a Likert scale. The surgeon determining intraoperative impaction and the individual measuring the ureteral thickness on CT were blinded.

RESULTS: 14 of the 38 patients were found to have an impacted ureteral stone at the time of surgery. Patients with an intra-operative finding of an impacted stone had significantly higher ureteral thickness above, around (P-CUT), below the calculus, and P-CUT surface area with all four p-values < 0.001. P-CUT surface area was independently predictive of impaction at the time of surgery on multivariate analysis. A mean P-CUT of 6.1mm and 1.6mm and P-CUT surface area of 92.6mm2 and 15.4mm2 were noted for the impacted and non-impacted stones, respectively.

CONCLUSION: Ureteral thicknesses above, around (P-CUT), and below the calculus are readily measurable on CT scan. P-CUT surface area can also be calculated for a stronger representation of ureteral thickness. These four parameters are predictive of ureteral stone impaction and useful for surgical planning and patient counseling.

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