Could twinkling artifact be a parameter in predicting the success of shock wave lithotripsy? A prospective study

SEVİM M., Alkis O., Kartal İ. G., Kazan H. O., Sonmez O. Y., Korkmaz M., ...More

Central European Journal of Urology, vol.76, no.3, pp.227-232, 2023 (ESCI) identifier

  • Publication Type: Article / Article
  • Volume: 76 Issue: 3
  • Publication Date: 2023
  • Doi Number: 10.5173/ceju.2023.20
  • Journal Name: Central European Journal of Urology
  • Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus, Academic Search Premier, CAB Abstracts, Central & Eastern European Academic Source (CEEAS), EMBASE
  • Page Numbers: pp.227-232
  • Keywords: color Doppler ultrasonography, kidney stone, shock wave lithotripsy, twinkling artifact
  • Kütahya Health Sciences University Affiliated: Yes


Introduction It is important to predict success before the treatment of urolithiasis. We aimed to predict the success of shock wave lithotripsy (SWL) by comparing twinkling artifact (TA) revealed through colour Doppler ultrasonography (CDUS) with stone density in non-contrast computed tomography (NCCT). Material and methods Eighty patients who underwent SWL between January 2021 and January 2022 were included in the study. Patients with stones of 5–20 mm in the renal pelvis and proximal ureter at NCCT were included. Patients’ demographics, Hounsfield units (HU) in NCCT, and TA grades in CDUS were recorded. The stone-free rate after SWL, additional treatments, overall success rates, and the association between TA and success rates were evaluated. Results The mean age was 47.41 ±15.08 years. The mean BMI was 24.49 ±3.67 kg/m2. Twenty-three (28.8%) patients were TA grade 0, 33 (41.2%) patients were grade 1, and 24 (30%) were grade 2. The mean HU of TA grades 0, 1, and 2 of stones were 628 ±107, 864 ±123, and 1166 ±292, respectively. The HU increased along with the increase in the TA grade of the stone (p <0.01). The mean number of SWL sessions was 2.26 ±0.75 in patients with TA grade 0, and 2.92 ±0.40 in patients with TA grade 2. The mean number of SWL sessions increased along with the increase in TA grade (p <0.01). The stone-free rate decreased as the TA grade increased. Stone diameter and TA were the only predictors of SWL success. Conclusions We think that TA may be useful in predicting SWL success.