Category: Clinical Stones: SWL
Introduction & Objective :
The Triple D Score is a scoring system, which incorporates three metrics - stone density, stone volume (dimensions), and skin-to-stone distance (SSD), to augment the prediction of extracorporeal shock wave lithotripsy (ESWL) treatment outcome. Our objective is to predict the efficacy of ESWL stone free rates using Triple D scoring system.
A retrospective analysis was performed over a period of 1 year at MPUH, retrieving 50 cases of renal and upper ureteric stones who underwent ESWL with available preoperative CT scan. In all the cases stone density, ellipsoid stone volume (ESV) and skin to stone distance (SSD) was determined and triple D score was calculated. The ROC curves were established to determine the cut off value for each parameter.
Thirty six out of 50 patients (72%) who underwent ESWL were stone free after single session treatment. ESV, SSD, and stone density were significant predictors of ESWL success. Based upon the ROC curves, cutoffs of <150 mm3 for ESV, <85 mm for SSD, and <900 HU for stone density were established. A Triple D Score of 0, 1, 2, and 3 correlated with ESWL success rates 50.0%, 62.5%, 80%, and 87.5% respectively.
The Triple D Score appears to be a useful predictor of ESWL treatment outcomes. The use of ESWL in patients with score 2 or above shall allow us to improve operative outcomes and guide us for suitable patient identification.
Rohit Maheshwari– Resident, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
Vikas Garg– Resident, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
Arvind Ganpule– Vice Chairman, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
Sudharsan Balaji– Fellow in Endourology, Laparoscopy and Robotics, Dr., Nadiad, Gujarat, India
Ravindra Sabnis– Chairman, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
Mahesh Desai– Consultant Urologist and Managing Trustee, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
Fellow in Endourology, Laparoscopy and Robotics
Nadiad, Gujarat, India
I am Dr. Sudharsan Balaji, MBBS MS MRCS DNB (Urology), working as a Fellow in Endourology, laparoscopy and Robotics in Muljibhai Patel Urological Hospital, Nadiad, India. I finished my Undergraduation and Postgraduation from Stanley Medical College, Chennai in 2009 and 2013 respectively. I finished ny Urological degree from my almamater MPUH, Nadiad in 2017 and was awarded the Endourological Society Fellowship on the same year. I have 15 publications to my credit, authored 3 book chapters and associate editor of a book titled "Monograph Series in Urology - Endourology and laparoscopy". I have so far 14 national and international presentations in various urological conferences till date. I was offered a visiting Scholarship in Pediatric Urology in Cincinnati Childrens' Hospital in 2015. I have specific interests in Endourology, Transplant and Minimally invasive pediatric urology. I see myself as laparoscopic/Robotic pediatric reconstruction in the future, which is my area of interest and expertise.