Paediatric Surgery (Ukraine). 2026. 2(91): 83-88. doi: 10.15574/PS.2026.2(91).8388
Nakonechnyy R. A., Nakonechnyi A. Y.
SNPE «Danylo Halytskyi Lviv National Medical University», Ukraine

For citation: Nakonechnyy RA, Nakonechnyi AY. (2026). Predictive value of 3D volumetry and stone densitometry in planning extracorporeal shock wave lithotripsy in children. Paediatric Surgery (Ukraine). 2(91): 83-88. doi: 10.15574/PS.2026.2(91).8388.
Article received: May 03, 2026. Accepted for publication: Jun 15, 2026.

Extracorporeal shock wave lithotripsy (ESWL) remains the method of choice for urolithiasis in children. However, the stone-free rate (SFR) varies widely, as traditional 2D measurement of stone diameter usually does not reflect the true characteristics of the calculus.
Aim – to determine the predictive accuracy and cut-off values of 3D volume and densitometric parameters as predictors of ESWL efficacy in children.
Materials and methods. The treatment outcomes of 72 patients aged 1 to 17 years were retrospectively analyzed. Based on сomputed tomography (CT) segmentation data (3D Slicer), the 3D volume (V), mean (HUmean), and maximum (HUmax) stone densities were calculated. ROC (Receiver Operating Characteristic) analysis was used for the statistical evaluation with calculation of the area under the curve (AUC).
Results. The 3D stone volume demonstrated the highest predictive value (AUC=0.829). Its optimal cut-off (OC) value was >184.9 mm³ with a specificity of 92.7% in predicting failure. The maximum stone density also proved to be a significant predictor (OC>934 HU; AUC=0.704). In contrast, the mean stone density and patient age did not show statistically significant predictive value.
Conclusions. 3D volumetry is a more accurate tool for planning ESWL than linear measurements. The OC values of volume (184.9 mm³) and stone density (934 HU) allow for an objective choice between extracorporeal and contact lithotripsy, minimizing the number of ineffective ESWL interventions under general anesthesia in children.
The study was conducted in accordance with the Helsinki Declaration principles. Informed consent was obtained from the parents (or their legal guardians) and children participating in the study.
No conflict of interests was declared by the authors.
Keywords: urolithiasis, extracorporeal shock wave lithotripsy, 3D volumetry, сomputed tomography densitometry, ROC analysis, children.

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