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Sighinolfi MC, Calcagnile T, Ticonosco M, Kaleci S, DI Bari S, Assumma S, Sarchi L, Panio E, Ferrari R, Piro A, Ragusa A, Ciarlariello S, DA Silva RD, LA Rocca R, Illiano E, Paladini A, Persico F, Giraudo D, DE Marzo E, Grisanti R, Mantica G, Emiliani E, Madonia M, Salvetti M, Bassi P, Montanari E, Bove P, Simonato A, Averch TD, Porpiglia F, Calarco A, Bruschetta S, Manferrari F, Daels FP, Cerruto MA, Antonelli A, Mazzon G, Celia A, Simeone C, Zaramella S, Saita A, Costantini E, Mearini E, DE Dominicis M, Mirone V, Kim FJ, Ferretti S, Puliatti S, Rocco B, Micali S. External validation of a nomogram for outcome prediction in management of medium-sized (1-2 cm) kidney stones. Minerva Urol Nephrol 2024; 76:484-490. [PMID: 38727672 DOI: 10.23736/s2724-6051.24.05672-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2024]
Abstract
BACKGROUND Stone nomogram by Micali et al., able topredict treatment failure of shock-wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) in the management of single 1-2 cm renal stones, was developed on 2605 patients and showed a high predictive accuracy, with an area under ROC curve of 0.793 at internal validation. The aim of the present study is to externally validate the model to assess whether it displayed a satisfactory predictive performance if applied to different populations. METHODS External validation was retrospectively performed on 3025 patients who underwent an active stone treatment from December 2010 to June 2021 in 26 centers from four countries (Italy, USA, Spain, Argentina). Collected variables included: age, gender, previous renal surgery, preoperative urine culture, hydronephrosis, stone side, site, density, skin-to-stone distance. Treatment failure was the defined outcome (residual fragments >4 mm at three months CT-scan). RESULTS Model discrimination in external validation datasets showed an area under ROC curve of 0.66 (95% 0.59-0.68) with adequate calibration. The retrospective fashion of the study and the lack of generalizability of the tool towards populations from Asia, Africa or Oceania represent limitations of the current analysis. CONCLUSIONS According to the current findings, Micali's nomogram can be used for treatment prediction after SWL, RIRS and PNL; however, a lower discrimination performance than the one at internal validation should be acknowledged, reflecting geographical, temporal and domain limitation of external validation studies. Further prospective evaluation is required to refine and improve the nomogram findings and to validate its clinical value.
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Affiliation(s)
| | - Tommaso Calcagnile
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Ticonosco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Shaniko Kaleci
- Clinical and Experimental Medicine (CEM), Department of Surgical, Medical, Dental and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano DI Bari
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Simone Assumma
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Luca Sarchi
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Enrico Panio
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Riccardo Ferrari
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Adele Piro
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Ragusa
- Department of Urology, Campus Biomedico University of Rome, Rome, Italy
| | - Silvia Ciarlariello
- Department of Urology, Morgagni-Pierantoni Hospital, Forlì, Forlì-Cesena, Italy
| | | | - Roberto LA Rocca
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Ester Illiano
- Department of Urology, University of Naples Federico II, Naples, Italy
| | | | - Francesco Persico
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Davide Giraudo
- Department of Urology, Ospedale degli Infermi, Biella, Italy
| | - Enrico DE Marzo
- Department of Urology, Regional Health Care and Social Agency Civil Hospitals of Brescia, Brescia, Italy
| | - Riccardo Grisanti
- Department of Urology, Nuovo Ospedale Civile, Sassuolo, Modena, Italy
| | | | - Esteban Emiliani
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Massimo Madonia
- Department of Urology, Urologic Clinic, University Hospital of Sassari, Sassari, Italy
| | - Michele Salvetti
- Department of Urology, Azienda ULSS8 Berica, Arzignano, Vicenza, Italy
| | | | | | - Pierluigi Bove
- Department of Urology, San Carlo of Nancy Hospital, Rome, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Timothy D Averch
- Department of Urology, Prisma Health Midlands, Columbia, SC, USA
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | | | | | | | - Francisco P Daels
- Department of Urology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Maria A Cerruto
- Department of Urology, Integrated University Hospital of Verona, Verona, Italy
| | | | - Giorgio Mazzon
- Department of Urology, Civil Hospital of Bassano, Bassano del Grappa, Vicenza, Italy
| | - Antonio Celia
- Department of Urology, Civil Hospital of Bassano, Bassano del Grappa, Vicenza, Italy
| | - Claudio Simeone
- Department of Urology, University of Brescia, Brescia, Italy
| | | | - Alberto Saita
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Ettore Mearini
- Department of Urology, University of Perugia, Perugia, Italy
| | | | - Vincenzo Mirone
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Fernando J Kim
- Department of Urology, Denver Health Medical Center, Denver, CO, USA
| | - Stefania Ferretti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy -
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Zou XC, Luo CW, Yuan RM, Jin MN, Zeng T, Chao HC. Develop a radiomics-based machine learning model to predict the stone-free rate post-percutaneous nephrolithotomy. Urolithiasis 2024; 52:64. [PMID: 38613668 DOI: 10.1007/s00240-024-01562-7] [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: 01/15/2024] [Accepted: 03/21/2024] [Indexed: 04/15/2024]
Abstract
Radiomics and machine learning have been extensively utilized in the realm of urinary stones, particularly in forecasting stone treatment outcomes. The objective of this study was to integrate clinical variables and radiomic features to develop a machine learning model for predicting the stone-free rate (SFR) following percutaneous nephrolithotomy (PCNL). A total of 212 eligible patients who underwent PCNL surgery at the Second Affiliated Hospital of Nanchang University were included in a retrospective analysis. Preoperative clinical variables and non-contrast-enhanced CT images of all patients were collected, and radiomic features were extracted after delineating the stone ROI. Univariate analysis was conducted to identify clinical variables strongly correlated with the stone-free rate after PCNL, and the least absolute shrinkage and selection operator algorithm (lasso regression) was utilized to screen radiomic features. Four supervised machine learning algorithms, including Logistic Regression, Random Forest (RF), Extreme Gradient Boosting (XGBoost), and Gradient Boosting Decision Tree (GBDT), were employed. The clinical variables with strong correlation and screened radiomic features were integrated into the four machine learning algorithms to construct a prediction model, and the receiver operating curve was plotted. The area under the receiver operating curve (AUC), the accuracy rate, the specificity, etc., were used to evaluate the predictive performance of the four models. After analyzing postoperative statistics, the stone-free rate following the procedure was found to be 70.3% (n = 149). Among the various clinical variables examined, factors, such as stone number, stone diameter, stone CT value, stone location, and history of stone surgery, were identified as statistically significant in relation to the stone-free rate after PCNL. A total of 121 radiomic features were extracted, and through lasso regression, 7 features most closely associated with the stone-free rate post-PCNL were identified. The predictive accuracy of different models (Logistic Regression, RF, XGBoost, and GBDT) for determining the stone-free rate after PCNL was evaluated, yielding accuracies of 78.1%, 76.6%, 75.0%, and 73.4%, respectively. The corresponding area under the curve AUC (95%CI) were 0.85 (0.83-0.89), 0.81 (0.76-0.85), 0.82 (0.78-0.85), and 0.77 (0.73-0.81), positioning these models among the top performers in logistic regression prediction. In terms of predictive importance scores, the key factors identified by the logistic regression model were number of stone, zone percentage, stone diameter, and surface area. Similarly, the RF model highlighted number of stone, stone CT value, stone diameter, and surface area as the top predictors. Among the four machine learning models, the logistic regression model demonstrated the highest accuracy and discrimination ability in predicting the stone-free rate following PCNL. In comparison to XGBoost and GBDT, RF also exhibited superior accuracy and a certain level of discrimination ability. However, based on the performance of all four models, logistic regression is more likely to aid in clinical decision-making by assisting clinicians in diagnosing PCNL in patients. This enables us to effectively predict the presence of residual stones post-surgery and ultimately select patients who are suitable candidates for PCNL.
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Affiliation(s)
- Xin Chang Zou
- Department of Urology, Second Affiliated Hospital of Nanchang University, Nanchang, 330008, China
| | - Cheng Wei Luo
- Department of Urology, Second Affiliated Hospital of Nanchang University, Nanchang, 330008, China
| | | | - Meng Ni Jin
- Department of Imaging, Second Affiliated Hospital of Nanchang University, Nanchang, 330008, China
| | - Tao Zeng
- Department of Urology, Second Affiliated Hospital of Nanchang University, Nanchang, 330008, China.
| | - Hai Chao Chao
- Department of Urology, Second Affiliated Hospital of Nanchang University, Nanchang, 330008, China
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Mazzon G, Choong S, Celia A. Stone-scoring systems for predicting complications in percutaneous nephrolithotomy: A systematic review of the literature. Asian J Urol 2023. [PMID: 37538152 PMCID: PMC10394284 DOI: 10.1016/j.ajur.2023.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Objective Percutaneous nephrolithotomy is a treatment of choice for larger stones of the upper urinary tract. Currently, several nephrolithometric nomograms for prediction of post-operative surgical outcomes have been proposed, although uncertainties still exist regarding their roles in the estimation of complications. Methods We conducted a systematic review on PubMed and Web of Sciences databases including English studies with at least 100 cases and published between January 2010 and December 2021. We identified original articles evaluating correlations between the Guy's stone score, the stone size (S), tract length (T), obstruction (O), number of involved calices (N), and essence or stone density (E) (S.T.O.N.E.), Clinical Research Office of the Endourological Society (CROES), and Seoul National University Renal Stone Complexity (S-ReSC) scores and post-operative complications in adult patients. We also included newly designed nomograms for prediction of specific complications. Results After an initial search of 549 abstracts, we finally included a total of 18 papers. Of them, 11 investigated traditional nephrolithometric nomograms, while seven newly designed nomograms were used to predict specific complications. Overall, 7316 patients have been involved. In total, 14 out of 18 papers are derived from retrospective single-center studies. Guy's stone score obtained correlation with complications in five, S.T.O.N.E. nephrolithometry score in four, while CROES score and S-ReSC score in three and two, respectively. None of the studies investigated minimally invasive percutaneous nephrolithotomy (PCNL) and all cases have been conducted in prone position. Considering newly designed nomograms, none of them is currently externally validated; five of them predict post-operative infections; the remaining two have been designed for thromboembolic events and urinary leakage. Conclusion This review presents all nomograms currently available in the PCNL field and highlights a certain number of concerns. Published data have appeared contradictory; more recent tools for prediction of post-operative complications are frequently based on small retrospective cohorts and lack external validations. Heterogeneity among studies has also been noticed. More rigorous validations are advisable in the future, involving larger prospective patients' series and with the comparison of different tools.
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Çakıcı MÇ, Karakoyunlu N, Sari S, Ozok HU, Selmi V, Kartal IG, Nalbant I, Sagnak L, Ersoy H. Comparison of Retrograde Intrarenal Surgery and Percutaneous Nephrolithotomy Used in the Treatment of 2–4 cm Kidney Stones in Terms of Pain and Need for Additional Analgesics: A Prospective Randomized Study. J Laparoendosc Adv Surg Tech A 2020; 30:1301-1307. [DOI: 10.1089/lap.2020.0179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Mehmet Çağlar Çakıcı
- Department of Urology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Nihat Karakoyunlu
- Department of Urology, Diskapi Yildirim Beyazit Education and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Sercan Sari
- Department of Urology, Bozok University School of Medicine, Yozgat, Turkey
| | - Hakki Ugur Ozok
- Department of Urology, Karabük University School of Medicine, Karabük, Turkey
| | - Volkan Selmi
- Department of Urology, Bozok University School of Medicine, Yozgat, Turkey
| | - Ibrahim Guven Kartal
- Department of Urology, Diskapi Yildirim Beyazit Education and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Ismail Nalbant
- Department of Urology, Lokman Hekim Etlik Hospital, Ankara, Turkey
| | - Levent Sagnak
- Department of Urology, Diskapi Yildirim Beyazit Education and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Hamit Ersoy
- Department of Urology, Diskapi Yildirim Beyazit Education and Research Hospital, Health Sciences University, Ankara, Turkey
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Bibi M, Sellami A, Chaker K, Ouanes Y, Kheiredine MD, Ben Chehida MA, Ben Rhouma S, Nouira Y. [Do the nephrolithometry scoring systems predict the success of percutaneous nephrolithotomy. Comparison of 4 scores: The Guy's stone score, STONE Score, CROES nomogram and S-ReSC score]. Prog Urol 2019; 29:432-439. [PMID: 31196827 DOI: 10.1016/j.purol.2019.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/03/2019] [Accepted: 05/18/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The aim of the study is to investigate the factors predictive of surgical outcomes of PCNL and to compare the predictability and accuracy of the Guy's stone score, STONE nephrolithometry, CROES nomogram and S-ReSC score. PATIENTS AND METHODS We reviewed retrospectively the surgical outcomes recorded consecutively and imaging data of preoperative computed tomography scans of patients who underwent PCNL from 2013 to 2016. Patients with asymptomatic residual fragments<4mm were considered stone-free. Preoperative abdominopelvic computerized tomography images of the patients were reviewed and scored according The Guy's stone score, STONE nephrolithometry, CROES nomogram, S-ReSC score by one urologist. RESULTS A total of 157 PCNLs were reviewed. The overall stone-free rate was 59% (92/157) with a complication rate of 22% (35/157). Stone Burden<542mm3 is significantly associated with stone-free rate (SFR) (P=0.001). On univariate analysis, all the scoring systems were identified as significant factors in terms of SFR. The Guy's Stone Score, the CROES score and the S-ReSC score were associated with complications (P<0.02). The multivariate logistic regression analysis showed that the CROES score was identified as a significant factor in terms of SFR and complications (P<0.01). The area under the receiver operating characteristic (ROC) curves for stone burden, the Guy's, STONE score, CROES core and S-ReSC scores showed good results (0.737/0.674/0.762/0.746/0.710) respectively. CONCLUSION Although the four scoring systems were significantly associated with SFR, the STONE score was a significant predictive factor for SFR and complications after PCNL. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- M Bibi
- Service d'urologie de l'hôpital La Rabta, Tunis, Tunisie.
| | - A Sellami
- Service d'urologie de l'hôpital La Rabta, Tunis, Tunisie
| | - K Chaker
- Service d'urologie de l'hôpital La Rabta, Tunis, Tunisie
| | - Y Ouanes
- Service d'urologie de l'hôpital La Rabta, Tunis, Tunisie
| | - M D Kheiredine
- Service d'urologie de l'hôpital La Rabta, Tunis, Tunisie
| | | | - S Ben Rhouma
- Service d'urologie de l'hôpital La Rabta, Tunis, Tunisie
| | - Y Nouira
- Service d'urologie de l'hôpital La Rabta, Tunis, Tunisie
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