الفهرس 
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Abstract
Urinary tract stone disease constitutes an important part of daily urological practice in the world’s various geographic regions as well as in our country. Extracorporeal shockwave lithotripsy (SWL) was introduced as a minimally-invasive treatment option for renal stones (10-20mm) . it can be performed effectively to achieve a higher stone-free rate SFR .
Aside from technological issues, there are numerous other aspects that affect SFR of SWL; one of the most important ones is proper patient selection. Stone proportions (stone volume, density, number, burden, and composition), renal proportions (degree of hydronephrosis, intra renal antomy, anomalies of the pelvic-calyceal system, and renal function), and some patient characteristics—such as obesity—all have an impact on SFR after SWL.
The Quadrable D scoring system (D; stone dimensions = stone volume SV, D; stone density HU, D; stone distribution, D; skin to stone distance = SSD) is a simple manual nomogram score that can be used in routine radiography. It includes SSD, which is affected by BMI and the degree of obesity.
This study’s objective was to perform external validation of the Quadrable D score as a significant predictor of the SFR following SWL for 10–20 mm solitary renal stones.
We used the Quadrable D score for the prediction of SFR of renal stones 10–20 mm after SWL in our prospective, randomized clinical study at the Nephrology and Urology Minia University Hospital. There were 100 patients in total (64 men and 36 women), ranging in age from 18 to 65 years old.
Patients with quadrable D scores of 0, 1, 2, 3, and 4 were 4, 16, 29, 37, and 17, respectively.
According to our study, 63 patients had no stones after the first session, 8 had no stones after the second session, and 29 had residual stones after the second sessions of SWL.
Regarding the scoring system, The Quadruple D score of 0,1,2,3 and 4 points showed SFRs of 0%, 0%, 46.15% (= 12 pts ), 84.21% (=32 pts) and 100%(=19 pts ), respectively after 1st session and The Quadruple D score of 0,1,2 and 3 points showed SFRs of 0%, 0%, 42.8% (= 6 pts ) ,and 33.3% ( =2 pts ) ,respectively after 2nd session .
Significant predictors of SWL outcomes have been shown to be SSD and BMI, clinical indications of obesity. 47 patients in the stone-free group (70%) had a BMI of less than 25, compared to 24 patients (82.7%) in the group with residual stones who had a BMI of 30 to 34.9.
Renal Stone distribution had impact of success rate of SWL , After 1st session most of stone free group 40 patients (59.7%) were pelvic stones where 18 patients (62.07%) of residual group were lower calyceal stones .
Our research found no correlation between preoperative ureteric stenting and SFR following SWL. Furthermore , patients developed bothersome symptoms.
Regarding the complications of endourological procedures ex: URS, RIRS , PCNL , SWL complications are very minimal and SWL continues to be awidely accepted, noninvasive option for the treatment of urinary calculi.
Conclusion
Finally, the following conclusions could be drawn from our study:
- SWL is one of minimal invasive option for treatment of fenal stones less than 20 mm with minimal complictions .
- Quadrable D scoring system is one of simple manual nomogram for prediction SFR after SWL and effective tool in selecting the most appropriate candidates for SWL .
- Using the Quadrable D Score may improve the cost effectiveness of SWL by limiting its use only to patients likely to have favorable outcomes.
- Further studies are warranted to assess clinical usefulness and the accuracy of Quadrable D nomogram in different patient groups. especially, for patients with ureteric stones.