الفهرس 
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Abstract
Uolithiasis is a the commonest disease facing the urological clinic. The prevalence of urinary stones has progressively increased in the
industrialized nations, and a similar trend is being observed in developing
countries due to changing social and economic conditions. In addition,
many patients will be affected by multiple stones throughout their
lifetime.
Nowadays non-contrast Multi-Detector Computed Tomography
(MDCT) is recognized as the most accurate method for detection of
calculi in the urinary tract.
Many methods of treatment of the urolithiasis are present, among
which the extracorporeal lithotripsy with shock waves (ESWL) remain
the gold standard in management of urinary calculi. ESWL has changed
dramatically the management of urolithiasis. Widespread use of the
technology, development of smaller devices, modified indication, and the
lower cost of the procedure revolutionized the approach to stone patients.
ESWL offers several advantages over other modalities of stone
treatment; it is a minimally invasive procedure often not requiring deep
anesthesia, it is an outpatient treatment, and most of the patients can
resume their work within two days after the procedure. The outcome of
stone clearance after ESWL is strongly related many factors such as stone
size and composition, the number of stones.
Key factors in the management of these patients remain the
location, size and chemical composition of the stone .The ability to
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predict outcome of ESWL before treatment enables the urologist to select
the appropriate therapy.
Smaller stone size will increase the success rate of ESWL. On the
other hand larger stone size will further increase the required sessions for
ESWL success & even failure of ESWL. Kidney stone less than 2 cm &
ureteric stone less than 1cm are more suitable for ESWL and give good
result.
Small stone density will increase the success rate of ESWL. While
larger stone density will increase the hardness of the stone and thus
require more ESWL sessions & even ESWL failure. The suitable stone
density for ESWL usually below 1000HU. Stone density less than 500
usually need one session while stone density range from 500 to 1000 HU
usually need two session.
Concerning stone location, lower calyx stones were the least site
for the stone clearance after ESWL while upper & middle calyx were the
highest site for stone clearance after ESWL, location of stone in the
urinary tract play a role but in combination with other factors in
predicting the outcome of ESWL.
Multi-detector Computed tomography(MDCT) provides accurate
size & density of the stone in additional to accurate anatomical detail of
vital structures, providing valuable data for management decisions, and
predicting the outcome of ESWL.