STONE DENSITY HOUNSFIELD UNIT VALUE DETERMINED BY UNENHANCED COMPUTED TOMOGRAPHY IN PREDICTING THE OUTCOME OF PERCUTANEOUS NEPHROLITHOTOMY

Volume 13 , Issue 4 , July 2025 , Pages 341-347

Authors

Aso O Rashid 1 ; Zana Abubakr Sharif 2

1 College of Medicine. University of Sulaimani, Kurdistan Region, Iraq

2 Sualimania Teaching Hospital, Ministry of Health, Kurdistan Region, Iraq

DOI logo 10.17656/jsmc.10428

Keywords

Abstract

Background
A successful percutaneous nephrolithotomy (PNL) requires appropriate preoperative planning, and noncontrast computerized tomography NCCT has become an important imaging method in diagnosing urolithiasis,
providing stone measurements, location, and density (Hounsfi eld units). Stone density (HU) measurement is
routinely performed in clinical practice to defi ne the hardness and composition of kidney stones and predict
the stone treatment outcome.
Objective
To evaluate the outcome of percutaneous nephrolithotomy regarding stone-free rate, complications, and
operation time using the Hounsfi eld unit value determined by non-contrast computed tomography.
Patients and Methods
Sixty patients were electively selected for PCNL; the inclusion criteria were all adult patients with renal stones
who needed PNL. The exclusion criteria were renal stones in the obstructed pyelonephritic kidney, stone with
sepsis, ectopic kidney, and transplanted kidney. The patients were divided into two groups—the low HU
group (HU ≤ 1000) and the high HU group (HU> 1000) based on stone density. In addition, the intraoperative
and postoperative data, including the operation time, stone-free rate, and post-PCNL complications, were
recorded—a comparative study designed between the two differences in HU stone density and the outcome
of the procedure.
Results
Our study includes 31 (51.7%) males and 29 (48.3%) females. Twenty-seven patients had an HU value ≤ 1000,
and 33 had an HU value >1000. Intraoperative complications occurred in 3 (4.92%) patients with high stone
density, including extravasation (n = 2) and bleeding (n = 1). Postoperative complications occurred in 11
(18.03%) patients (nine patients with low and two with high stone density). The postoperative stone residual
was found in 4 patients with low stone density. Operation time was longer in high-stone-density groups than
in low-stone-density groups (P-value < 0.001).
Conclusion
Preoperative assessment of stone density impacts outcomes in percutaneous nephrolithotomy. High stone
densities are associated with longer operating times, higher intraoperative complications, and higher stonefree rates. Conversely, Low-density stone has a shorter operative time, higher postoperative complications,
and lower stone-free rates.

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  • First online26 July 2025
  • Published at26 July 2025

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