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Samir M, Galaleldine A, El-Zayat T, Eldin ND, Mahmoud MA, Mostafa D. Can shear wave elastography predict the success of shock‑wave lithotripsy used in renal stones treatment? A prospective study. World J Urol 2024; 42:160. [PMID: 38488885 PMCID: PMC10943162 DOI: 10.1007/s00345-024-04855-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/06/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE To evaluate the usage of shear wave elastography (SWE) in the prediction of the success rate of shock‑wave lithotripsy (SWL) treatment of renal stones. PATIENTS AND METHODS In the present study, SWL was performed for 100 patients presented with renal stones in the duration from May 2022 to August 2023. The patients were divided into 2 groups SWL responders and non-responders. The study compared between the 2 groups in terms of baseline parameters of the patients as age, sex, body mass index (BMI), stone size, stone location, stone density (HU), skin-to-stone distance (SSD), the degree of hydronephrosis and the stone elastography values. RESULTS There was no statistically significant relation between stone-free rate and degree of obstruction (p = 0.628), stone size (p = 0.390) upper calyceal location (p = 0.17), middle calyceal location (p = 0.66), and renal pelvis location (p = 1.0). Nevertheless, a statistically significant relation was found as regards lower calyceal location, stone density (HU), and stone Elastography values using multivariate analysis. CONCLUSIONS Measurement of stone density by shear wave elastography (SWE) can be used as an alternative to HU in decision-making before SWL. SWL success depends mainly on stone site, HU, and SWE values.
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Owen K, Joe W, Ivander A, Palgunadi IN, Adhyatma KP. Role of Noncontrast Computed Tomography Parameters in Predicting the Outcome of Extracorporeal Shock Wave Lithotripsy for Upper Urinary Stones Cases: A Meta-analysis. Acad Radiol 2023:S1076-6332(23)00556-1. [PMID: 37985292 DOI: 10.1016/j.acra.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/09/2023] [Accepted: 10/10/2023] [Indexed: 11/22/2023]
Abstract
RATIONALE Extracorporeal shock wave lithotripsy (ESWL) is widely considered the primary approach for managing urinary tract stones. This study aimed to assess the predictive factors associated with non-contrast computed tomography (NCCT)-based parameters of upper urinary stones in relation to the outcomes of ESWL. MATERIALS AND METHODS A systematic search was conducted in PubMed, ScienceDirect, Web of Science, and Cochrane Library to identify all relevant studies published up to June 3, 2023. Several NCCT-based parameters to predict ESWL outcomes, comprised of mean stone density (MSD), skin-to-stone distance (SSD), and stone size, were extracted and analyzed using Review Manager software. RESULTS Out of 979 publications screened, a total of 39 publications, involving 7869 patients, were enrolled in the analysis. The pooled estimate demonstrated significant differences between MSD, and stone size between successful and failure of stone fragmentation groups, in which lower values of these parameters are associated with successful ESWL outcomes. CONCLUSION The results from the current study suggested that lower NCCT parameters, notably MSD, SSD, and stone size, are significantly associated with successful ESWL outcome. However, additional large-scale prospective studies are required to utilize these parameters effectively, and the optimal cutoff value should be determined.
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Affiliation(s)
- Kevin Owen
- Bangli General Hospital, Bangli, Indonesia (K.O.).
| | - Wilbert Joe
- Regional Public Hospital dr.M. Thomsen Nias, Gunungsitoli, Indonesia (W.J.)
| | - Alvin Ivander
- Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia (A.I.)
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Non-contrast computed tomography-based factors in predicting ESWL success: A systematic review and meta-analysis. Prog Urol 2023; 33:27-47. [PMID: 36202729 DOI: 10.1016/j.purol.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE We assessed the efficacy of some predictive factors that can be measured with non-contrast computed tomography and may affect ESWL success with a systematic review and meta-analysis. MATERIALS AND METHODS All data sources were broadly investigated up to April 2022. Data were extracted from the relevant studies and analyzed with RevMan software. In a random effects model, standard mean difference (SMD) and risk ratio (RR) values were given with 95% confidence intervals. RESULTS In total, pooled analysis included 7148 patients in 43 studies. The combined effect estimate showed significant differences between the ESWL success and ESWL failure groups in terms of Hounsfield unit (HU), Hounsfield density (HD), skin to stone distance (SSD), ureteral wall thickness (UWT), stone volume, stone area, abdominal fat parameters, diameter of proximal ureter, and hydronephrosis. However, perinephric stranding and renal cortical thickness were not found to be statistically significant between the study groups. CONCLUSIONS HU, HD, SSD, UWT, stone volume, stone area, abdominal fat parameters, diameter of proximal ureter and hydronephrosis are effective factors for prediction of ESWL success. It is important to decide on treatment before the procedure for stones with appropriate diameter for ESWL.
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Ureteral calculi lithotripsy for single ureteral calculi: can DNN-assisted model help preoperatively predict risk factors for sepsis? Eur Radiol 2022; 32:8540-8549. [PMID: 35731290 DOI: 10.1007/s00330-022-08882-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 04/28/2022] [Accepted: 05/12/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To explore the utility of radiomics and deep learning model in assessing the risk factors for sepsis after flexible ureteroscopy lithotripsy (FURL) or percutaneous nephrolithotomy (PCNL) in patients with ureteral calculi. METHODS This retrospective analysis included 847 patients with treatment-naive proximal ureteral calculi who received FURL or PCNL. All participants were preoperatively conducted non-contrast computed tomography scans, and relevant clinical information was meanwhile collected. After propensity score matching, the radiomics model was established to predict the onset of sepsis. A deep learning model was also adapted to further improve the prediction accuracy. Performance of these trained models was verified in another independent external validation set including 40 cases of ureteral calculi patients. RESULTS The overall incidence of sepsis after FURL or PCNL was 5.9%. The least absolute shrinkage and selection operator (LASSO) regression analysis revealed 26 predictive variables, with an overall AUC of 0.881 (95% CI, 0.813-0.931) and an AUC of 0.783 (95% CI, 0.766-0.801) in external validation cohort. Judicious adaption of a deep neural network (DNN) model to our dataset improved the AUC to 0.920 (95% CI, 0.906-0.933) in the internal validation. To eliminate the overfitting, external validation was carried out for DNN model (AUC = 0.874 (95% CI, 0.858-0.891)). CONCLUSIONS The DNN was more effective than the LASSO model in revealing risk factors for sepsis after FURL or PCNL in single ureteral calculi patients, and females are more susceptible to sepsis than males. Deep learning models have the potential to act as gatekeepers to facilitate patient stratification. KEY POINTS • Both the least absolute shrinkage and selection operator (LASSO) and deep neural network (DNN) models were shown to be effective in sepsis prediction. • The DNN model achieved superior prediction capability, with an AUC of 0.920 (95% CI, 0.906-0.933). • DNN-assisted model has potential to serve as a gatekeeper to facilitate patient stratification.
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Yu Q, Liu J, Lin H, Lei P, Fan B. Application of Radiomics Model of CT Images in the Identification of Ureteral Calculus and Phlebolith. Int J Clin Pract 2022; 2022:5478908. [PMID: 36474549 PMCID: PMC9678460 DOI: 10.1155/2022/5478908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/24/2022] [Accepted: 11/05/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate the clinical application of the three-dimensional (3D) radiomics model of the CT image in the diagnosis and identification of ureteral calculus and phlebolith. METHOD Sixty-one cases of ureteral calculus and 61 cases of phlebolith were retrospectively investigated. The enrolled patients were randomly categorized into the training set (n = 86) and the testing set (n = 36) with a ratio of 7 : 3. The plain CT scan images of all samples were manually segmented by the ITK-SNAP software, followed by radiomics analysis through the Analysis Kit software. A total of 1316 texture features were extracted. Then, the maximum correlation minimum redundancy criterion and the least absolute shrinkage and selection operator algorithm were used for texture feature selection. The feature subset with the most predictability was selected to establish the 3D radiomics model. The performance of the model was evaluated by the receiver operating characteristic (ROC) curve, and the area under the ROC curve (AUC) was also calculated. Additionally, the decision curve was used to evaluate the clinical application of the model. RESULTS The 10 selected radiomics features were significantly related to the identification and diagnosis of ureteral calculus and phlebolith. The radiomics model showed good identification efficiency for ureteral calculus and phlebolith in the training set (AUC = 0.98; 95%CI: 0.96-1.00) and testing set (AUC = 0.98; 95%CI: 0.95-1.00). The decision curve thus demonstrated the clinical application of the radiomics model. CONCLUSIONS The 3D radiomics model based on plain CT scan images indicated good performance in the identification and prediction of ureteral calculus and phlebolith and was expected to provide an effective detection method for clinical diagnosis.
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Affiliation(s)
- Qiuyue Yu
- Department of Radiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang 330006, China
| | - Jiaqi Liu
- Department of Radiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang 330006, China
| | - Huashan Lin
- Department of Pharmaceutical Diagnosis, GE Healthcare, Changsha 410005, China
| | - Pinggui Lei
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, China
| | - Bing Fan
- Department of Radiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang 330006, China
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Erkoc M, Bozkurt M, Besiroglu H, Canat L, Atalay HA. Success of extracorporeal shock wave lithotripsy based on CT texture analysis. Int J Clin Pract 2021; 75:e14823. [PMID: 34491588 DOI: 10.1111/ijcp.14823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/28/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The aims of the study were to evaluate whether computerised tomography texture analysis (CTTA) based on non-contrast computed tomography (NCCT) has predictive value for the success of extracorporeal-shockwave lithotripsy (ESWL) in upper urinary tract stones (UUTS). METHODS This study included 156 of 356 patients undergoing ESWL for UUTS sized 0.5-2 cm from 2015 to 2019. Patients with congenital kidney anomalies, radiolucent stones, multiple stones, treated for upper urinary tract stones previously and lower pole stones were excluded from study. The number of ESWL sessions of the patients was as follows: 78 (50%) patients had 1 session, 30 (19.2%) patients had 2 sessions and 48 (30.8%) patients had >2 sessions. First- and second-order CTTA properties of patients' UUTS were evaluated using texture analysis software (LIFEx Software). Other clinical features such as Hounsfield Unit (HU), initial stone size, body-mass index (BMI) and skin to stone distance (SSD) was recorded. The patients were divided into two groups according to ESWL success. Cases with residual stones larger than 4 mm were considered failed cases. RESULTS BMI, the standard deviation of HU, SSD, skewness, kurtosis, entropy and all second-order statistics were found to be statistically different between the two groups except for correlation (P < .05). Multivariate analysis showed longer SSD and four new parameters of CTTA (kurtosis, entropy, dissimilarity and energy by the distribution of pixel grey levels in the UUTS) to be significant predictors for unsuccessful ESWL outcomes. SSD and second-order CTTA properties (dissimilarity and energy) had an area under ROC curve of 0.802, 0.850 and 0.824 at a 95% confidence interval. ESWL success rate in all patients was 76.9%. CONCLUSION CTTA can help select patients who will undergo ESWL for upper urinary tract stones. Thus, we can reduce treatment costs and ESWL complications by preventing unnecessary ESWL applications.
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Affiliation(s)
- Mustafa Erkoc
- Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Muammer Bozkurt
- Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Huseyin Besiroglu
- Department of Urology, Faculty of Medical School, Istanbul-Cerrahpasa University, Istanbul, Turkey
| | - Lutfi Canat
- Department of Urology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Hasan A Atalay
- Department of Urology, Beylikduzu State Hospital, Istanbul, Turkey
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Demir M, Dere O, Yağmur İ, Katı B, Pelit ES, Albayrak İH, Çiftçi H. Usability of shear wave elastography to predict the success of extracorporeal shock-wave lithotripsy: prospective pilot study. Urolithiasis 2020; 49:255-260. [PMID: 33104861 DOI: 10.1007/s00240-020-01221-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
The present study is intended to investigate the usability of shear wave elastography (SWE) in predicting the success of extracorporeal shock-wave lithotripsy (ESWL) used in kidney stone treatment. ESWL was performed on a total number of 52 patients diagnosed with kidney stones between May 2019 and July 2020. The presence of a residual stone greater than 4 mm was accepted as failure. The patients were divided into two groups as ESWL success and ESWL failure. SWE and Hounsfield unit (HU) measurements of stones were performed in all patients before ESWL. The two groups were compared in terms of age, gender, stone localisation, stone size, body mass index (BMI), skin-to-stone distance, HU, and SWE values of the stones. ESWL was successful in 30 of the 52 patients included in the study, while it failed in 22 of them. While the mean SWE value was 7.3 (7.9 ± 2.2) kPa in patients with success in ESWL, it was 14.6 (17.9 ± 10.2) kPa in those with failed ESWL. The mean HU was 883.5 (841.4 ± 191.1) in patients with success in ESWL and 1078 (1115.5 ± 183) in those with failed ESWL. Both SWE and HU values of the stones were found to be statistically significantly lower in the successful group (p < 0.05). It was seen that SWE and HU values were correlated to each other. The groups of successful and failed ESWL did not differ significantly in terms of age, gender distribution, stone size, BMI, and skin-to-stone distance (p > 0.05). With SWE, the hardness of the stone can be measured and its suitability for ESWL can be evaluated. It can be used as an alternative parameter to HU before ESWL treatment, since it has a lower cost compared to computed tomography (CT) and does not contain radiation.
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Affiliation(s)
- Mehmet Demir
- Department of Urology, Harran University, Şanlıurfa, Turkey.
| | - Osman Dere
- Department of Radiology, Harran University, Şanlıurfa, Turkey
| | - İsmail Yağmur
- Department of Urology, Harran University, Şanlıurfa, Turkey
| | - Bülent Katı
- Department of Urology, Harran University, Şanlıurfa, Turkey
| | | | | | - Halil Çiftçi
- Department of Urology, Harran University, Şanlıurfa, Turkey
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Xun Y, Chen M, Liang P, Tripathi P, Deng H, Zhou Z, Xie Q, Li C, Wang S, Li Z, Hu D, Kamel I. A Novel Clinical-Radiomics Model Pre-operatively Predicted the Stone-Free Rate of Flexible Ureteroscopy Strategy in Kidney Stone Patients. Front Med (Lausanne) 2020; 7:576925. [PMID: 33178719 PMCID: PMC7593485 DOI: 10.3389/fmed.2020.576925] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/11/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose: The purpose of the study is to develop and validate a novel clinical–radiomics nomogram model for pre-operatively predicting the stone-free rate of flexible ureteroscopy (fURS) in kidney stone patients. Patients and Methods: Altogether, 2,129 fURS cases with kidney stones were retrospectively analyzed, and 264 patients with a solitary kidney stone were included in a further study. For lower calyx calculi, a radiomics model was generated in a primary cohort of 99 patients who underwent non-contrast-enhanced computed tomography (NCCT). Radiomics feature selection and signature building were conducted by using the least absolute shrinkage and selection operator (LASSO) method. Multivariate logistic regression analysis was employed to build a model incorporating radiomics and potential clinical factors. Model performance was evaluated by its discrimination, calibration, and clinical utility. The model was internally validated in 43 patients. Results: The overall success rate of fURS was 72%, while the stone-free rate (SFR) for lower calyx calculi and non-lower calyx calculi was 56.3 and 90.16%, respectively. On multivariate logistic regression analysis of the primary cohort, independent predictors for SFR were radiomics signature, stone volume, operator experience, and hydronephrosis level, which were all selected into the nomogram. The area under the curve (AUC) of clinical–radiomics model was 0.949 and 0.947 in the primary and validation cohorts, respectively. Moreover, the calibration curve showed a satisfactory predictive accuracy, and the decision curve analysis indicated that the nomogram has superior clinical application value. Conclusion: In this novel clinical–radiomics model, the radiomics scores, stone volume, hydronephrosis level, and operator experience were crucial for the flexible ureteroscopy strategy.
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Affiliation(s)
- Yang Xun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mingzhen Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Liang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pratik Tripathi
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huchuan Deng
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Ziling Zhou
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Qingguo Xie
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Cong Li
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ihab Kamel
- Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins Medical Institutions, Baltimore, MD, United States
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Al-Dessoukey AA, ElSheemy MS, Abdallah M, Moussa AS, Sayed O, Abdallah R, Massoud AM, Abdelhamid MH, Ragheb AM, Ghoneima W, Abdelbary AM, Elmarakbi AA. Ultraslow full-power shock wave lithotripsy protocol in the management of high attenuation value upper ureteric stones: A randomized comparative study. Int J Urol 2020; 28:33-39. [PMID: 32985780 DOI: 10.1111/iju.14381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of ultraslow full-power shock wave lithotripsy protocol in the management of high attenuation value upper ureteric stones compared with slow-rate, power-ramping shock wave lithotripsy. METHODS This was a randomized trial enrolling patients with a single high attenuation value (≥1000 HU) upper ureteric stones between January 2019 and July 2019. Ultraslow full-power shock wave lithotripsy (54 patients) was applied at a rate of 30 shock waves/min with power ramping from 6 to 18 kV for 100 shock waves, then a safety pause for 2 min, followed by ramping 18-22 kV for 100 shock waves, then a safety pause for 2 min. Then, full power (22 kV) was maintained until the end of the session. Slow-rate, power-ramping shock wave lithotripsy (47 patients) was applied at a rate of 60 shock waves/min with power ramping from 6 to 10 kV during the first 500 shock waves, then from 11 to 22 kV during the next 1000 shock waves, then maintained on 22 kV in the last 1500 shock waves. Up to three sessions were carried out with a follow up 3 months after the last session. The primary outcome was the stone-free rate. Perioperative data of the two protocols were compared. RESULTS There was no significant difference in preoperative data. The stone-free rate was significantly higher in ultraslow full-power shock wave lithotripsy after single (92.6% vs 23.4%) and multiple (96.3% vs 63.8%) sessions. Most complications were mild, with no significant difference between both groups (9.3% vs 12.8%; P = 0.573). Logistic regression analysis identified ultraslow full-power shock wave lithotripsy protocol as the only significant independent factor for the stone-free rate (odds ratio 12.589, P = 0.025). CONCLUSION Ultraslow full-power shock wave lithotripsy for high attenuation value upper ureteric stones is associated with a significantly higher stone-free rate, and with mild complications that are comparable to those of standard shock wave lithotripsy.
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Affiliation(s)
- Ahmad A Al-Dessoukey
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | | | - Mahmoud Abdallah
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Ayman S Moussa
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Osama Sayed
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Rabie Abdallah
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Amr M Massoud
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | | | - Ahmed M Ragheb
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Waleed Ghoneima
- Department of Urology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed M Abdelbary
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Akram A Elmarakbi
- Department of Urology, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
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Guler Y, Erbin A, Kafkasli A, Ozmerdiven G. Factors affecting success in the treatment of proximal ureteral stones larger than 1 cm with extracorporeal shockwave lithotripsy in adult patients. Urolithiasis 2020; 49:51-56. [PMID: 32279108 DOI: 10.1007/s00240-020-01186-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/01/2020] [Indexed: 11/27/2022]
Abstract
The aim of the study was to analyze the factors predicting success for the treatment of proximal ureteral stones larger than 1 cm with extracorporeal shockwave lithotripsy (SWL) in adult patients. Between January 2014 and December 2018, 480 adult patients in total underwent SWL and data were retrospectively evaluated. Patients with multiple ureteral stones, solitary kidney, congenital abnormality, skeletal system abnormality, history of previous urinary system surgery and SWL, renal insufficiency, patients who could not tolerate SWL and pediatric patients were excluded from the study. The remaining 415 patients were divided into two groups as success (Group 1, n = 307) and failure (Group 2, n = 108). The overall success rate was 73.9%. The values of stone size, Hounsfield Unit (HU), skin to stone distance (SSD), ureteral wall thickness (UWT), proximal ureter diameter, renal pelvis diameter, hydronephrosis grade, and duration of renal colic were significantly higher in Group 2 compared to Group 1. In binary logistic regression analyses, HU, UWT, and proximal ureter diameter were found to be independent predictors. HU, UWT, and proximal ureter diameter had sensitivity and specificity of 92-92%, 88-23%, and 87-46%, with cutoff values of 740 HU, 2.5 mm and 8.5 mm, respectively. The area under the curve values were 0.96, 0.97, and 0.96 for HU, UWT, and proximal ureter diameter, respectively. The CT-based parameters, including HU, UWT, and proximal ureter diameter are independent predictive factors with excellent accuracy for the treatment of proximal ureteral stones larger than 1 cm with SWL in adult patients. Based on these factors, SWL can be considered for proximal ureteral stones larger than 1 cm.
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Affiliation(s)
- Yavuz Guler
- Department of Urology, Private Safa Hospital, Istanbul, Turkey
| | - Akif Erbin
- Department of Urology, Haseki Traning and Research Hospital, Istanbul, Turkey.
| | - Alper Kafkasli
- Department of Urology, Dr. Lutfi Kirdar Kartal Traning and Research Hospital, Istanbul, Turkey
| | - Gokhun Ozmerdiven
- Department of Urology, Istanbul Aydin University Medical Faculty, Istanbul, Turkey
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Cui HW, Silva MD, Mills AW, North BV, Turney BW. Predicting shockwave lithotripsy outcome for urolithiasis using clinical and stone computed tomography texture analysis variables. Sci Rep 2019; 9:14674. [PMID: 31604986 PMCID: PMC6788981 DOI: 10.1038/s41598-019-51026-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 08/14/2019] [Indexed: 11/09/2022] Open
Abstract
We aimed to develop and evaluate a statistical model, which included known pre-treatment factors and new computed tomography texture analysis (CTTA) variables, for its ability to predict the likelihood of a successful outcome after extracorporeal shockwave lithotripsy (SWL) treatment for renal and ureteric stones. Up to half of patients undergoing SWL may fail treatment. Better prediction of which cases will likely succeed SWL will help patients to make an informed decision on the most effective treatment modality for their stone. 19 pre-treatment factors for SWL success, including 6 CTTA variables, were collected from 459 SWL cases at a single centre. Univariate and multivariable analyses were performed by independent statisticians to predict the probability of a stone free (both with and without residual fragments) outcome after SWL. A multivariable model had an overall accuracy of 66% on Receiver Operator Curve (ROC) analysis to predict for successful SWL outcome. The variables most frequently chosen for the model were those which represented stone size. Although previous studies have suggested SWL can be reliably predicted using pre-treatment factors and that analysis of CT stone images may improve outcome prediction, the results from this study have not produced a useful model for SWL outcome prediction.
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Affiliation(s)
- Helen W Cui
- Oxford Stone Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.
| | | | | | | | - Benjamin W Turney
- Oxford Stone Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
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12
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Scotland KB, Safaee Ardekani G, Chan JYH, Paterson RF, Chew BH. Total Surface Area Influences Stone Free Outcomes in Shock Wave Lithotripsy for Distal Ureteral Calculi. J Endourol 2019; 33:661-666. [PMID: 30860394 DOI: 10.1089/end.2019.0120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Current American Urological Association guidelines recommend ureteroscopy (URS) as primary management of distal ureteral stones and shock wave lithotripsy (SWL) as a secondary option. Utilization of SWL in the management of nephrolithiasis in North America has decreased. We hypothesized that SWL continues to be an effective option in the management of distal ureteral calculi and studied data from our center in patients who received SWL for distal ureteral stones. Methods: A retrospective review was performed of 104 patients treated initially with SWL for distal ureteral calculi between 2011 and 2018 at this institution. The success rate of SWL was assessed through radiologic imaging and if subsequent procedures were required to render patients stone free. Results: Operative note and chart review identified 104 patients who presented with distal ureteral stones and were treated with SWL as the initial form of management. Average patient age was 52.2 ± 15.3 years, average BMI was 27.4 ± 5.7, and average total axial stone surface area was 25.96 ± 14.32 mm2. Of these patients, 78.8% (n = 82) were stone free following one SWL and required no subsequent procedures. Of these patients, 87.5% (n = 91) were stone free following a second SWL, and 87.5% (n = 91) were stone free following a secondary URS. After the initial SWL, residual stones were identified in 21.2% of patients (n = 22). Four patients, 3.8%, required a salvage URS following a failed second SWL to achieve stone-free status. Conclusion: One SWL procedure offers a stone-free rate (SFR) of 78.8% and after two SWLs an 87.5% SFR. Only 12.5% of patients undergoing SWL at our center required URS to achieve a stone-free status. SWL is an effective modality in the treatment of distal ureteral stones.
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Affiliation(s)
- Kymora B Scotland
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Justin Y H Chan
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Ryan F Paterson
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Ben H Chew
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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