Presentation Authors: Agustín Asensio Matas, Benjamín Blasco Beltrán, Jorge Subirá Ríos, Olivia Matos Orozco, Daniel Hijazo Gascón, Laura Muñiz Suarez, Paula Gayarre Abril, Jorge Rioja Zuazu*, José Antonio Pérez Arbej, Victoria Capapé Poves, Carlos Blanco Chamorro, Zaragoza, Spain
Introduction: Ultrasound (US) is an alternative image method for ESWL focalization. It has been used at our institution since 2007 and 5 stone fragmentation signs have been observed.We aim to describe and establish US fragmentation signs seen during the procedure and envisage to build a fragmentation model based on the US signs visualized.
Methods: Between January 2012 and December 2016, 351 patients who underwent US-ESWL were retrospectively analyzed from our ESWL data base. Treatment protocols were performed based on stone size, localization and US or Rx characteristics. BMI and patient characteristics were also studied. After treatment, US control was performed 20 to 30 days after ESWL, and success was defined as stone disappearance or stone fragments smaller than 2 mm on US. A second treatment ESWL session was proposed when the residual stone size was greater than 3 mm in diameter.
Results: Five stone fragmentation signs were observed and defined as 'dispersion', 'increase in echogenicity', 'medal sign', 'increase of posterior shadow', and 'jump'. All signs were statistically significant for stone fragmentation (Fischer test, p < 0.05) but the 'medal sign' (p=0.1085; IC= 0.87-1.01) Stone fragmentation probability was 50% when no sign was observed; 75% with 1 sign observed; 95% with 2 signs observed and 100% with 3 or more signs observed.
Conclusions: US signs visualization provides successful real time information and treatment can be defined as satisfactory upon visualization of at least 3 signs or more.