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Noble PA, Hamilton BD, Gerber G. Stone decision engine accurately predicts stone removal and treatment complications for shock wave lithotripsy and laser ureterorenoscopy patients. PLoS One 2024; 19:e0301812. [PMID: 38696418 PMCID: PMC11065282 DOI: 10.1371/journal.pone.0301812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/24/2024] [Indexed: 05/04/2024] Open
Abstract
Kidney stones form when mineral salts crystallize in the urinary tract. While most stones exit the body in the urine stream, some can block the ureteropelvic junction or ureters, leading to severe lower back pain, blood in the urine, vomiting, and painful urination. Imaging technologies, such as X-rays or ureterorenoscopy (URS), are typically used to detect kidney stones. Subsequently, these stones are fragmented into smaller pieces using shock wave lithotripsy (SWL) or laser URS. Both treatments yield subtly different patient outcomes. To predict successful stone removal and complication outcomes, Artificial Neural Network models were trained on 15,126 SWL and 2,116 URS patient records. These records include patient metrics like Body Mass Index and age, as well as treatment outcomes obtained using various medical instruments and healthcare professionals. Due to the low number of outcome failures in the data (e.g., treatment complications), Nearest Neighbor and Synthetic Minority Oversampling Technique (SMOTE) models were implemented to improve prediction accuracies. To reduce noise in the predictions, ensemble modeling was employed. The average prediction accuracies based on Confusion Matrices for SWL stone removal and treatment complications were 84.8% and 95.0%, respectively, while those for URS were 89.0% and 92.2%, respectively. The average prediction accuracies for SWL based on Area-Under-the-Curve were 74.7% and 62.9%, respectively, while those for URS were 77.2% and 78.9%, respectively. Taken together, the approach yielded moderate to high accurate predictions, regardless of treatment or outcome. These models were incorporated into a Stone Decision Engine web application (http://peteranoble.com/webapps.html) that suggests the best interventions to healthcare providers based on individual patient metrics.
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Affiliation(s)
- Peter A. Noble
- Department of Microbiology, University of Alabama Birmingham, Birmingham, AL, United States of America
| | - Blake D. Hamilton
- School of Medicine, University of Utah, Salt Lake City, UT, United States of America
| | - Glenn Gerber
- University of Chicago Medical Center, Chicago, IL, United States of America
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Morena T, Vismara Fugini A, Veccia A, Riva M, Peroni A. Outcomes of primary ureteroscopic lithotripsy: The role of maximum ureteral wall thickness at the site of stone impaction. Urologia 2024; 91:117-124. [PMID: 37491955 DOI: 10.1177/03915603231189618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
OBJECTIVES To verify if the maximum thickness of the ureteral wall at the stone site (m-UWT) can affect the outcomes of primary retrograde ureteroscopic lithotripsy (P-URSL) within a single-center dataset. MATERIAL AND METHODS We retrospectively reviewed data on 354 consecutive URSL performed from January 2020 to May 2022 at "Fondazione Poliambulanza" in Brescia (Italy). We included patients older than 18 years who underwent URSL for a single ureteral stone with a maximum diameter ranging from 5 to 10 mm. Patients with anatomical abnormalities, a positive preoperative urinary culture, or without a NCCT performed during the acute event were excluded. Patients were treated in an emergency setting (P-URSL within 48 h from the diagnosis of acute ureteral colic) or in a delayed one (D-URSL after a period of maximum 90 days of ureteral double-j stenting). For the resulting 139 patients we recorded demographic, clinical and stone-related features and perioperative data. We processed these data by univariate and multivariate analysis, and with a logistic regression analysis. RESULTS Of the 139 included procedures, 63 were P-URSL and 76 D-URSL. At the univariate analysis we found that stone diameter (OR 0.845, p = 0.017), stone volume (OR 0.023, p = 0.001), stone density (OR 0.998, p = 0.000) and m-UWT (OR 0.499, p = 0.013) are predictors of P-URSL. Stone density (OR 0.998, p = 0.002) is an independent predictor of P-URSL at the multivariate analysis. At a logistic regression analysis, a distal ureteric position (OR 0.189, p = 0.014), stone diameter (OR 1.289, p = 0.006), and m-UWT (OR 2.297, p = 0.02) were found to be statistically significant predictors of incomplete stone clearance in patients undergoing P-URSL. m-UWT is the only predictor of short-term postoperative adverse events in patients undergoing P-URSL (OR 3.386, p < 0.001). From a descriptive analysis, it emerged that an increased m-UWT (>2 mm) significantly correlates to an endoscopic finding of ureteritis' signs and to an increase in operative time, hospital stay and post-procedural stenting time. A m-UWT greater than 2 mm also correlates with a lower stone free rate (SFR) and with a significant increase in both short and long-term postoperative complications. CONCLUSIONS Our study confirmed a connection between m-UWT and poor endoscopic findings, as well as a direct correlation with the main morphometric parameters of the stone and finally with the outcomes of P-URSL itself. Further studies are necessary to validate our results, so that m-UWT might be routinely considered a useful tool in the decision-making process for P-URSL.
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Affiliation(s)
- Tonino Morena
- Urology Unit, Fondazione Poliambulanza Hospital, Brescia, Italy
| | | | | | - Marianna Riva
- Urology Unit, Fondazione Poliambulanza Hospital, Brescia, Italy
- Urology Unit, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Angelo Peroni
- Urology Unit, Fondazione Poliambulanza Hospital, Brescia, Italy
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Sabhan AH, Alwan AAA. The feasibility of ultrasound-guided mini-percutaneous nephrolithotomy for ESWL-resistant lower calyx renal stones of up to two centimeters: a single center experience. J Med Life 2023; 16:520-525. [PMID: 37305831 PMCID: PMC10251387 DOI: 10.25122/jml-2023-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/07/2023] [Indexed: 06/13/2023] Open
Abstract
Lower pole renal stones present a significant challenge in urologic practice due to difficulty in accessing the calyx and eliminating fragments. Management options for these stones include watchful waiting for asymptomatic stones, extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopy (URS), and percutaneous nephrolithotomy (PCNL). Mini-PCNL is a newer modification of conventional PCNL. The study aimed to assess the feasibility of mini-PCNL in treating lower pole renal stones equal to or less than 20mm that were not responsive to ESWL therapy. We included 42 patients (24 male and 18 female) with a mean age of 40±2.3 who underwent mini-PCNL at a single urology center between June 2020 and July 2022 and assessed operative and postoperative outcomes. The mean total operative time was 47±3.11 minutes, ranging from 40 to 60 minutes. The stone-free rate was 90%, and the overall complication rate was 26%, which included minor bleeding (5%), hematuria (7%), pain (12%), and fever (2%). The mean hospital stay was 80±3.34 hours (3-4 days). Our findings suggest that mini-PCNL is an effective treatment option for lower pole renal stones that are not responsive to ESWL therapy. The immediate stone-free rate was high, with minimum non-serious complications.
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Affiliation(s)
- Ali Hadi Sabhan
- Department of Surgery, College of Medicine, University of Al-Qadisiyah, Al-Diwaneyah, Iraq
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Bulbul E, Tutar O, Gultekin MH, Ilki Y, Citgez S, Onal B. The association between ureteral wall thickness and need for additional procedures after primary ureteroscopy in patients with ureteral stones above the iliac crest. Aktuelle Urol 2023; 54:37-43. [PMID: 36473485 DOI: 10.1055/a-1840-0682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To examine the parameters affecting the need for additional procedures in the primary ureteroscopy treatment in patients with ureteral stones above the iliac crest level. METHODS Seventy-one patients were included in the study who were ≥ 18 years old and had undergone ureteroscopy (URS) for ureteral stones above the iliac crest level between 2018-2020 and had a non-contrast-enhanced abdominal computed tomography before the procedures were included in the study. Patients and stone characteristics were prospectively collected. The results were evaluated six weeks after URS. The absence of any residual fragment was thought to indicate stone-free status. The patients with failure were referred for the additional procedures. RESULTS The median patient age was 51 years [interquartile range (IQR): 18-66]. The median transverse stone diameter was 9.5 mm (IQR: 7.1-11.4), and the median ureteral wall thickness (UWT) was 5.8 mm (IQR: 4.3-6.5). In the univariate analysis, UWT (p < 0.001), presence of multiple stones (p = 0.008), and stone length (p = 0.022) affected stone-free status. The multivariate analysis revealed UWT as the only independent factor affecting the need for additional procedures after URS (p = 0.028). In the receiver operating characteristic curve analysis, the best threshold value for UWT according to the outcomes was identified as 5.8 mm. CONCLUSION Ureteral wall thickness was the only independent parameter determining the need for additional procedures and affecting the treatment outcomes after the URS procedure.
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Affiliation(s)
- Emre Bulbul
- Department of Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Onur Tutar
- Department of Radiology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Hamza Gultekin
- Department of Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Yavuz Ilki
- Department of Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sinharib Citgez
- Department of Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Bulent Onal
- Department of Urology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Abdrabuh AM, El-Agamy ESI, Elhelaly MA, Abouelgreed TA, Abdel-Al I, Youssof HA, Elatreisy A, Shalkamy O, Elebiary M, Agha M, Tagreda I, Alrefaey A, Elawadey E. Value of preoperative ureteral wall thickness in prediction of impaction of ureteric stones stratified by size in laser ureteroscopic lithotripsy. BMC Urol 2023; 23:3. [PMID: 36609272 PMCID: PMC9825030 DOI: 10.1186/s12894-022-01168-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/23/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To evaluate the role of preoperative UWT in the prediction of impaction of ureteral stones stratified according to stone size in ureteroscopic laser lithotripsy. PATIENT AND METHODS This study included 154 patients submitted to URSL for ureteral stones. Radiological data comprised the presence of hydronephrosis, anteroposterior pelvic diameter (PAPD), proximal ureteric diameter (PUD), and maximum UWT at the stone site. Collected stone characteristics were stone size, side, number, site, and density. RESULTS The study included 154 patients subjected to URSL. They comprised 74 patients (48.1%) with impacted stones and 80 (51.9%) with non-impacted stones. Patients were stratified into those with stone size ≤ 10 mm and others with stone size > 10 mm. In the former group, we found that stone impaction was significantly associated with higher PAPD, PUD, and UWT. In patients with stone size > 10 mm, stone impaction was related to higher UWT, more stone number, and higher frequency of stones located in the lower ureter. ROC curve analysis revealed good power of UWT in discrimination of stone impaction in all patients [AUC (95% CI) 0.65 (0.55-0.74)] at a cut-off of 3.8 mm, in patients with stone size ≤ 10 mm [AUC (95% CI) 0.76 (0.61-0.91)] at a cut-off of 4.1 mm and in patients with stone size > 10 mm [AUC (95% CI) 0.72 (0.62-0.83)] at a cut-off of 3.0 mm. CONCLUSIONS Stratifying ureteric stones according to size would render UWT a more practical and clinically-oriented approach for the preoperative prediction of stone impaction.
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Affiliation(s)
- Abdrabuh M. Abdrabuh
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt
| | - El-Sayed I. El-Agamy
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt ,Present Address: Armed forced Hospital, Alhada, Saudi Arabia
| | - Mohamed A. Elhelaly
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt ,Present Address: Armed forced Hospital, Alhada, Saudi Arabia
| | - Tamer A. Abouelgreed
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt
| | - Ibrahim Abdel-Al
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Assuit Branch, Assuit, Egypt
| | | | - Adel Elatreisy
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt
| | - Osama Shalkamy
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt
| | - Mohamed Elebiary
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt
| | - Mohammed Agha
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt
| | - Ibrahim Tagreda
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt
| | - Ahmed Alrefaey
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt
| | - Elsayed Elawadey
- grid.411303.40000 0001 2155 6022Urology Department, Al-Azhar University, Cairo, Egypt
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De Nunzio C, Gallo G, Lombardo R, Franco A, Gravina C, Stira J, Cicione A, Tema G, Cremona A, Pignatelli M, Tubaro A. Ureteral wall thickness and distal ureteral density in patients with residual fragments after Ho:YAG laser semi-rigid ureterolithotripsy. Lasers Med Sci 2022; 38:19. [PMID: 36564640 DOI: 10.1007/s10103-022-03672-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/15/2022] [Indexed: 12/25/2022]
Abstract
Recent data suggest that greater ureteral density distal to ureteral stones or increased ureteral wall thickness (UWT) can predict impacted stones. The aim of our study was to evaluate if patients with residual fragments present with greater ureteral density and larger UWT when compared to stone-free patients. From January onward, a consecutive series of patients undergoing semi rigid Ho:YAG laser ureterolithotripsy (ULT) for ureteral stones were enrolled. A non-contrast enhanced computed tomography (CT) scan was performed before the procedure to evaluate distal ureteral density (DUD) and wall ureteral thickness (UWT) at the site of ureteral stones. Patients with residual fragments were compared to stone-free patients using a matched-pair analysis (1:1 scenario). Cases were matched sequentially using the following criteria: age, gender, body mass index (BMI), stone length, hydronephrosis, location of stones, and mean Hounsfield unit (HU) of the stone. Overall, 160 patients were enrolled, mean age was 57.9 ± 14 years, mean BMI was 25.8 ± 4 kg/m2, mean length of the stone was 10.6 ± 4.9 mm, and mean UWT was 1.4 ± 1.6 mm. A total of 150/160 (94%) patients presented hydronephrosis; mean HU stone was 868 ± 327; mean DUD was 54 ± 17.8 HU. Ureteral distal density (51.7 vs 56.6; p = 0.535) and ureteral distal thickness (1.39 vs 1.54; p = 0.078) were similar in both groups of patients. In our study, the evaluation of distal ureteral density does not predict stone-free rate. Further studies should evaluate the role for preoperative computer tomography in predicting surgery outcome.
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Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy.
| | - Giacomo Gallo
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy
| | - Riccardo Lombardo
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy
| | - Antonio Franco
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy
| | - Carmen Gravina
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy
| | - Jordi Stira
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy
| | - Antonio Cicione
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy
| | - Giorgia Tema
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy
| | - Antonio Cremona
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy
| | - Matteo Pignatelli
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy
| | - Andrea Tubaro
- Department of Urology, "Sant'Andrea" Hospital, La Sapienza" University, Rome, Italy
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Caglayan A, Horsanali MO, Kocadurdu K, Ismailoglu E, Guneyli S. Deep learning model-assisted detection of kidney stones on computed tomography. Int Braz J Urol 2022; 48:830-839. [PMID: 35838509 PMCID: PMC9388181 DOI: 10.1590/s1677-5538.ibju.2022.0132] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/05/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: The aim of this study was to investigate the success of a deep learning model in detecting kidney stones in different planes according to stone size on unenhanced computed tomography (CT) images. Materials and Methods: This retrospective study included 455 patients who underwent CT scanning for kidney stones between January 2016 and January 2020; of them, 405 were diagnosed with kidney stones and 50 were not. Patients with renal stones of 0–1 cm, 1–2 cm, and >2 cm in size were classified into groups 1, 2, and 3, respectively. Two radiologists reviewed 2,959 CT images of 455 patients in three planes. Subsequently, these CT images were evaluated using a deep learning model. The accuracy rate, sensitivity, specificity, and positive and negative predictive values of the deep learning model were determined. Results: The training group accuracy rates of the deep learning model were 98.2%, 99.1%, and 97.3% in the axial plane; 99.1%, 98.2%, and 97.3% in the coronal plane; and 98.2%, 98.2%, and 98.2% in the sagittal plane, respectively. The testing group accuracy rates of the deep learning model were 78%, 68% and 70% in the axial plane; 63%, 72%, and 64% in the coronal plane; and 85%, 89%, and 93% in the sagittal plane, respectively. Conclusions: The use of deep learning algorithms for the detection of kidney stones is reliable and effective. Additionally, these algorithms can reduce the reporting time and cost of CT-dependent urolithiasis detection, leading to early diagnosis and management.
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Affiliation(s)
- Alper Caglayan
- Department of Urology, Izmir Bakırcay University Cigli Training and Research Hospital, Izmir, Turkey
| | - Mustafa Ozan Horsanali
- Department of Urology, Izmir Bakırcay University Cigli Training and Research Hospital, Izmir, Turkey
| | - Kenan Kocadurdu
- Department of Information Systems, Izmir Bakırcay University Cigli Training and Research Hospital, Izmir, Turkey
| | - Eren Ismailoglu
- Deparment of Radiology, Izmir Bakırçay University, Faculty of Medicine, Izmir, Turkey
| | - Serkan Guneyli
- Deparment of Radiology, Izmir Bakırçay University, Faculty of Medicine, Izmir, Turkey
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Polat S, Danacioglu YO, Soytas M, Yarimoglu S, Koras O, Fakir AE, Seker KG, Degirmenci T. External validation of the T.O.HO. score and derivation of the modified T.O.HO. score for predicting stone-free status after flexible ureteroscopy in ureteral and renal stones. Int J Clin Pract 2021; 75:e14653. [PMID: 34320257 DOI: 10.1111/ijcp.14653] [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: 05/24/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The T.O.HO. scoring system was developed to predict stone-free status after flexible ureterenoscopy (fURS) lithotripsy applied for ureter and renal stones. This study aimed to perform the external validation of the T.O.HO. score in the Turkish population and propose a modification for this system. MATERIAL METHODS Patients who underwent fURS for kidney and ureteral stones between January 2017 and January 2020 were retrospectively analysed. The patient and stone characteristics and perioperative findings were noted. The T.O.HO. score was externally validated and compared with the STONE score. Stone-free parameters were evaluated with the multivariate analysis. Based on the results of this analysis, the T.O.HO. score was modified and internally validated. RESULTS A total of 621 patients were included in the study. The stone-free rate was determined as 79.8% (496/621) after fURS. The regression analysis showed that stone area had better predictive power than stone diameter (P = .025). Lower pole (reference), middle pole [odds ratio (OR) = 0.492 P = .016] and middle ureteral (OR = 0.227, P = .024) localisations, stone density (OR = 1.001, P < .001), and stone volume (OR = 1.008, P < .001) were determined as independent predictive markers for stone-free status. Based on the effect size of the stone surface area in the nomogram, stone volume was divided into five categories, at 1-point intervals. The AUC values of the T.O.HO., STONE, and modified T.O.HO. score in predicting stone-free status were calculated as 0.758, 0.634, and 0.821, respectively. The modified T.O.HO. created by adding stone volume was statistically significantly superior to the original version (ROC curve comparison, P < .001). CONCLUSION The T.O.HO. score effectively predicted stone-free status after fURS. However, modified T.O.HO. SS showed the best predictive performance compared with original T.O.HO. SS.
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Affiliation(s)
- Salih Polat
- Department of Urology, Faculty of Medicine, Amasya University, Amasya, Turkey
| | - Yavuz Onur Danacioglu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Soytas
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | - Serkan Yarimoglu
- Department of Urology, Bozyaka Research and Training Hospital, University of Health Sciences, Izmir, Turkey
| | - Omer Koras
- Faculty of Medicine, Department of Urology, Hatay Mustafa Kemal University, Hatay, Turkey
| | - Ali Emre Fakir
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | | | - Tansu Degirmenci
- Department of Urology, Bozyaka Research and Training Hospital, University of Health Sciences, Izmir, Turkey
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Is there any predictive value of the ratio of the upper to the lower diameter of the ureter for ureteral stone impaction? Curr Urol 2021; 15:161-166. [PMID: 34552456 PMCID: PMC8451323 DOI: 10.1097/cu9.0000000000000019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 02/26/2020] [Indexed: 01/17/2023] Open
Abstract
Background: We aimed to determine if the ratio of the upper to the lower diameter of the ureter could have any predictive value for ureteral stone impaction. Materials and methods: Patients who had a solitary unilateral ureteric stone, determined by noncontrast computerized tomography, were assessed if they had undergone ureteroscopic lithotripsy. A total of 111 patients, 84 males (76%), and 27 females (24%), were recruited to the study. Demographic data of the patients and preoperative radiological parameters based on noncontrast computerized tomography were recorded. The impaction status was also assessed during the operation. Results: Of the 111 patients, ureteral stones in 63 (57%) patients were determined to be impacted, and ureteral stones in 48 (43%) were nonimpacted. Impacted stones were more common in older patients, female patients, and patients with an American Society of Anesthesiologists score of 2. Conclusions: Significant relationships were found between the impaction status and transverse stone length, longest stone length, upper diameter of the ureter, ratio (upper diameter of the ureter/lower diameter of the ureter), and anteroposterior diameter of the pelvis. These parameters were higher in patients with impacted stones.
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10
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De Nunzio C, Ghahhari J, Lombardo R, Russo GI, Albano A, Franco A, Baldassarri V, Nacchia A, Lopez J, Luque P, Ribal MJ, Alcaraz A, Tubaro A. Development of a nomogram predicting the probability of stone free rate in patients with ureteral stones eligible for semi-rigid primary laser uretero-litothripsy. World J Urol 2021; 39:4267-4274. [PMID: 34173845 PMCID: PMC8571227 DOI: 10.1007/s00345-021-03768-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Few tools are available to predict uretero-lithotripsy outcomes in patients with ureteral stones. Aim of our study was to develop a nomogram predicting the probability of stone free rate in patients undergoing semi-rigid uretero-lithotripsy (ULT) for ureteral stones. Methods From January 2014 onwards, patients undergoing semi-rigid Ho: YAG laser uretero-lithotripsy for ureteral stones were prospectively enrolled in two centers. Patients were preoperatively evaluated with accurate clinical history, urinalysis and renal function. Non-contrast CT was used to define number, location and length of the stones and eventually the presence of hydronephrosis. A nomogram was generated based on the logistic regression model used to predict ULT success. Results Overall, 356 patients with mean age of 54 years (IQR 44/65) were enrolled. 285/356 (80%) patients were stone free at 1 month. On multivariate analysis single stone (OR 1.93, 95% CI 1.05–3.53, p = 0.034), stone size (OR 0.92, 95% CI 0.87–0.97, p = 0.005), distal position (OR 2.12, 95% CI 1.29–3.48, p = 0.003) and the absence of hydronephrosis (OR 2.02, 95% CI 1.08–3.78, p = 0.029) were predictors of success and these were used to develop a nomogram. The nomogram based on the model presented good discrimination (area under the curve [AUC]: 0.75), good calibration (Hosmer–Lemeshow test, p > 0.5) and a net benefit in the range of probabilities between 15 and 65%. Internal validation resulted in an AUC of 0.74. Conclusions The implementation of our nomogram could better council patients before treatment and could be used to identify patients at risk of failure. External validation is warranted before its clinical implementation.
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Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, "Sant'Andrea" Hospital, "La Sapienza" University, Rome, Italy.
| | - Jamil Ghahhari
- Department of Urology, "Sant'Andrea" Hospital, "La Sapienza" University, Rome, Italy
| | - Riccardo Lombardo
- Department of Urology, "Sant'Andrea" Hospital, "La Sapienza" University, Rome, Italy
| | - Giorgio Ivan Russo
- Department of Urology, "Sant'Andrea" Hospital, "La Sapienza" University, Rome, Italy
| | - Ana Albano
- Hospital Clinic Barcelona, Barcelona, Spain
| | - Antonio Franco
- Department of Urology, "Sant'Andrea" Hospital, "La Sapienza" University, Rome, Italy
| | - Valeria Baldassarri
- Department of Urology, "Sant'Andrea" Hospital, "La Sapienza" University, Rome, Italy
| | - Antonio Nacchia
- Department of Urology, "Sant'Andrea" Hospital, "La Sapienza" University, Rome, Italy
| | - Juan Lopez
- Hospital Clinic Barcelona, Barcelona, Spain
| | | | | | | | - Andrea Tubaro
- Department of Urology, "Sant'Andrea" Hospital, "La Sapienza" University, Rome, Italy
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11
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Hameed BMZ, Shah M, Naik N, Singh Khanuja H, Paul R, Somani BK. Application of Artificial Intelligence-Based Classifiers to Predict the Outcome Measures and Stone-Free Status Following Percutaneous Nephrolithotomy for Staghorn Calculi: Cross-Validation of Data and Estimation of Accuracy. J Endourol 2021; 35:1307-1313. [PMID: 33691473 DOI: 10.1089/end.2020.1136] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective: To develop a decision support system (DSS) for the prediction of the postoperative outcome of a kidney stone treatment procedure, particularly percutaneous nephrolithotomy (PCNL) to serve as a promising tool to provide counseling before an operation. Materials and Methods: The overall procedure includes data collection and prediction model development. Pre-/postoperative variables of 100 patients with staghorn calculus, who underwent PCNL, were collected. For feature vector, variables and categories including patient history variables, kidney stone parameters, and laboratory data were considered. The prediction model was developed using machine learning techniques, which include dimensionality reduction and supervised classification. Multiple classifier scheme was used for prediction. The derived DSS was evaluated by running the leave-one-patient-out cross-validation approach on the data set. Results: The system provided favorable accuracy (81%) in predicting the outcome of a treatment procedure. Performance in predicting the stone-free rate with the Minimum Redundancy Maximum Relevance feature (MRMR) treatment extracting top 3 features using Random Forest (RF) was 67%, with MRMR treatment extracting top 5 features using RF was 63%, and with MRMR treatment extracting top 10 features using Decision Tree was 62%. The statistical significance using standard error between the best area under the curves (AUCs) obtained from the Linear Discriminant Analysis (LDA) and MRMR. The results obtained from the LDA approach (0.81 AUC) was statistically significant (p = 0.027, z = 2.21) from the MRMR (0.64 AUC) (p = 0.05). Conclusion: The promising results of the developed DSS could be used in assisting urologists to provide counseling, predict a surgical outcome, and ultimately choose an appropriate surgical treatment for removing kidney stones.
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Affiliation(s)
- B M Zeeshan Hameed
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.,KMC Innovation Centre, Manipal Academy of Higher Education, Manipal, Karnataka, India.,iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, Karnataka
| | - Milap Shah
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.,iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, Karnataka
| | - Nithesh Naik
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, Karnataka.,Department of Mechanical and Manufacturing Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Harneet Singh Khanuja
- Information and Communication Technology, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, India
| | - Rahul Paul
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bhaskar K Somani
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group, Manipal, Karnataka.,Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
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12
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Jones P, Pietropaolo A, Chew BH, Somani BK. Atlas of scoring systems, grading tools and nomograms in Endourology: A comprehensive overview from The TOWER Endourological Society research group. J Endourol 2021; 35:1863-1882. [PMID: 33878937 DOI: 10.1089/end.2021.0124] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION With an increase in the prevalence of kidney stone disease (KSD), there has been a universal drive to develop reliable and user-friendly tools such as grading systems and predictive nomograms. An atlas of scoring systems, grading tools and nomograms in Endourology is provided in this paper. METHODS A comprehensive search of world literature was performed to identify nomograms, grading systems and classification tools in endourology related to KSD. Each of these were reviewed by the authors and have been evaluated in a narrative format with details on those which are externally validated and their respective citation count on google scholar. RESULTS A total of 54 endourological tools have been described in our atlas of endourological scoring systems, grading tools and nomograms. Of the tools, 23 (43%) are published in the last 3 years showing an increasing interest in this area. This includes 5 for percutaneous nephrolithotomy (PCNL), 6 for flexible ureteroscopy (fURS), 3 for semi-rigid URS (sURS), 9 for shockwave lithotripsy (SWL), 2 for stent encrustations, 3 for intra-operative appearance at the time of URS and 3 to classify intra-operative ureteric injury. There were 3 tools for renal colic assessment, one each for prediction of future stone event, stone classification and stone impaction and 2 for need of emergency intervention in ureteric stone. While 2 tools are related to stone recurrence, 6 are related to post-procedural complications. There are now 2 tools for simulation in endourology and 5 for patient reported outcome measures (PROMS). CONCLUSIONS A number of reliable and established tools exist currently in endourology. Each of these offers their own respective advantages and disadvantages. While nomograms and scoring systems can help in the decision making, these must be tailored to individual patients based on their specific clinical scenarios, expectations and informed consent.
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Affiliation(s)
- Patrick Jones
- Haukeland University Hospital, 60498, Urology, Bergen, Norway;
| | - Amelia Pietropaolo
- University Hospital Southampton NHS Foundation Trust, 7425, Urology, Southampton, Southampton , United Kingdom of Great Britain and Northern Ireland;
| | - Ben H Chew
- University of British Columbia, Urologic Sciences, Vancouver, British Columbia, Canada;
| | - Bhaskar K Somani
- University Hospital Southampton NHS Foundation Trust, 7425, Urology, Southampton, Southampton , United Kingdom of Great Britain and Northern Ireland.,University of Southampton, 7423, Southampton, Hampshire, United Kingdom of Great Britain and Northern Ireland;
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13
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Sakamoto S. Editorial Comment to Nomograms predicting the outcomes of endoscopic treatments for pediatric upper urinary tract calculi. Int J Urol 2021; 28:301. [PMID: 33368626 DOI: 10.1111/iju.14463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Shinichi Sakamoto
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
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14
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Anan G. Editorial Comment to Novel prediction scoring system for simple assessment of stone-free status after flexible ureteroscopy lithotripsy: T.O.HO. score. Int J Urol 2020; 27:748. [PMID: 32700374 DOI: 10.1111/iju.14324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Go Anan
- Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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15
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Okita K, Hatakeyama S, Imai A, Tanaka T, Hamano I, Okamoto T, Tobisawa Y, Yoneyama T, Yamamoto H, Yoneyama T, Hashimoto Y, Nakaji S, Suzuki T, Ohyama C. STone Episode Prediction: Development and validation of the prediction nomogram for urolithiasis. Int J Urol 2020; 27:344-349. [DOI: 10.1111/iju.14203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/26/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Kazutaka Okita
- Department of UrologyHirosaki University Graduate School of Medicine Hirosaki Aomori Japan
| | - Shingo Hatakeyama
- Department of UrologyHirosaki University Graduate School of Medicine Hirosaki Aomori Japan
| | - Atsushi Imai
- Department of UrologyHirosaki University Graduate School of Medicine Hirosaki Aomori Japan
| | - Toshikazu Tanaka
- Department of UrologyHirosaki University Graduate School of Medicine Hirosaki Aomori Japan
| | - Itsuto Hamano
- Department of UrologyHirosaki University Graduate School of Medicine Hirosaki Aomori Japan
| | - Teppei Okamoto
- Department of UrologyHirosaki University Graduate School of Medicine Hirosaki Aomori Japan
| | - Yuki Tobisawa
- Department of UrologyHirosaki University Graduate School of Medicine Hirosaki Aomori Japan
| | - Tohru Yoneyama
- Department of Advanced Transplant and Regenerative MedicineHirosaki University Graduate School of Medicine Hirosaki Aomori Japan
| | - Hayato Yamamoto
- Department of UrologyHirosaki University Graduate School of Medicine Hirosaki Aomori Japan
| | - Takahiro Yoneyama
- Department of UrologyHirosaki University Graduate School of Medicine Hirosaki Aomori Japan
| | - Yasuhiro Hashimoto
- Department of Advanced Transplant and Regenerative MedicineHirosaki University Graduate School of Medicine Hirosaki Aomori Japan
| | - Shigeyuki Nakaji
- Department of Social Medicine Hirosaki University Graduate School of Medicine Hirosaki Aomori Japan
| | - Tadashi Suzuki
- Department of Urology Oyokyo Kidney Research Institute Hirosaki Aomori Japan
| | - Chikara Ohyama
- Department of UrologyHirosaki University Graduate School of Medicine Hirosaki Aomori Japan
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16
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Shabaniyan T, Parsaei H, Aminsharifi A, Movahedi MM, Jahromi AT, Pouyesh S, Parvin H. An artificial intelligence-based clinical decision support system for large kidney stone treatment. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:771-779. [PMID: 31332724 DOI: 10.1007/s13246-019-00780-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/14/2019] [Indexed: 12/11/2022]
Abstract
A decision support system (DSS) was developed to predict postoperative outcome of a kidney stone treatment procedure, particularly percutaneous nephrolithotomy (PCNL). The system can serve as a promising tool to provide counseling before an operation. The overall procedure includes data collection and prediction model development. Pre/postoperative variables of 254 patients were collected. For feature vector, we used 26 variables from three categories including patient history variables, kidney stone parameters, and laboratory data. The prediction model was developed using machine learning techniques, which includes dimensionality reduction and supervised classification. A novel method based on the combination of sequential forward selection and Fisher's discriminant analysis was developed to reduce the dimensionality of the feature space and to improve the performance of the system. Multiple classifier scheme was used for prediction. The derived DSS was evaluated by running leave-one-patient-out cross-validation approach on the dataset. The system provided favorable accuracy (94.8%) in predicting the outcome of a treatment procedure. The system also correctly estimated 85.2% of the cases that required stent placement after the removal of a stone. In predicting whether the patient might require a blood transfusion during the surgery or not, the system predicted 95.0% of the cases correctly. The results are promising and show that the developed DSS could be used in assisting urologists to provide counseling, predict a surgical outcome, and ultimately choose an appropriate surgical treatment for removing kidney stones.
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Affiliation(s)
- Tayyebe Shabaniyan
- Department of Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Parsaei
- Department of Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Alireza Aminsharifi
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mehdi Movahedi
- Department of Medical Physics and Engineering, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Torabi Jahromi
- Electrical and Electronic Engineering Group, Engineering College, Persian Gulf University, Bushehr, Iran
| | - Shima Pouyesh
- Department of Computer Engineering, Islamic Azad University, Yasooj, Iran
| | - Hamid Parvin
- Department of Computer Engineering, Islamic Azad University, Nourabad Mamasani, Iran
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17
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De Nunzio C, Bellangino M, Voglino OA, Baldassarri V, Lombardo R, Pignatelli M, Tema G, Berardi E, Cremona A, Tubaro A. External validation of Imamura nomogram as a tool to predict preoperatively laser semi-rigid ureterolithotripsy outcomes. MINERVA UROL NEFROL 2018; 71:531-536. [PMID: 30547902 DOI: 10.23736/s0393-2249.18.03243-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND We aimed to validate Imamura nomogram for prediction of stone free rate in patients undergoing ureterolithotripsy (ULT). METHODS From January 2013 to June 2016, patients undergoing laser semi-rigid ULT were prospectively enrolled at our center. All patients were preoperatively assessed with clinical history, blood samples, uranalysis and non-contrast enhanced computed tomography (CT). Treatment efficacy was assessed 1 month later by non-contrast enhanced CT. ROC curve was used to evaluate the performance characteristics of Imamura nomogram. RESULTS Overall, we enrolled 275 patients. Median age was 55 years (IQR: 46/64), median length of stone was 9.8 mm (IQR: 7.5/12). Pyuria was detected in 6/275 (2.1%) patients. Stones were located at ureteropelvic junction in 55/275 (19%) patients, proximal ureter in 74/275 (26%) patients, middle and distal ureter in 66/275 (24%) patients and 82/275 (30%) patients, respectively. At 1-month follow-up, 209/275 (76%) patients were stone free. Imamura nomogram presented an AUC of 0.67 (95% CI: 0.580-0.761) for the prediction of stone free rate. At the best cut-off value of 75%, sensitivity was 76%, specificity was 55%, positive predictive value (PPV) was 83% and negative predictive value was 45%. CONCLUSIONS We firstly validated Imamura nomogram in a European cohort study. It proved a reasonable accuracy (area under curve: 0.67) and a good PPV (83%). Further studies should confirm our results to support the routine clinical use of Imamura nomogram as a tool to predict ULT outcomes.
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Affiliation(s)
- Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy -
| | | | - Olivia A Voglino
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Valeria Baldassarri
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Riccardo Lombardo
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Matteo Pignatelli
- Department of Radiology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Giorgia Tema
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Eva Berardi
- Department of Radiology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Antonio Cremona
- Department of Radiology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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18
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Kucukdurmaz F, Efe E, Sahinkanat T, Amasyalı AS, Resim S. Ureteroscopy With Holmium:Yag Laser Lithotripsy for Ureteral Stones in Preschool Children: Analysis of the Factors Affecting the Complications and Success. Urology 2018; 111:162-167. [DOI: 10.1016/j.urology.2017.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/24/2017] [Accepted: 09/06/2017] [Indexed: 12/23/2022]
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19
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Yoshida T, Inoue T, Omura N, Okada S, Hamamoto S, Kinoshita H, Matsuda T. Ureteral Wall Thickness as a Preoperative Indicator of Impacted Stones in Patients With Ureteral Stones Undergoing Ureteroscopic Lithotripsy. Urology 2017; 106:45-49. [PMID: 28499762 DOI: 10.1016/j.urology.2017.04.047] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/29/2017] [Accepted: 04/30/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the clinical significance of ureteral wall thickness (UWT) to predict the presence of impacted stones in patients with ureteral stones undergoing ureteroscopic lithotripsy (URSL). MATERIALS AND METHODS We retrospectively analyzed 130 procedures in patients with ureteral stones who underwent URSL between January 2014 and September 2016. Maximum UWT at the stone site was measured from computed tomography images. Clinical predictors of impacted stones were assessed using univariate and multivariate logistic regression analyses. Receiver operating characteristic curve analysis was applied to determine the UWT cutoff value and to evaluate its accuracy in predicting impacted stones. Moreover, we evaluated the association between UWT and endoscopic findings, as well as surgical outcomes. RESULTS Of the 130 procedures, 50 (38.5%) involved patients with impacted stones. The univariate analysis showed significant differences in age, hydronephrosis, stone location, stone burden, and UWT in patients with and without impacted stones, and the multivariate analysis showed that age, stones in the middle ureter, and UWT (odds ratio 5.43, P < .001) were independent predictors of impacted stones. The receiver operating characteristic analysis showed that 3.49 mm was the optimal cutoff value for UWT, with a predictive accuracy of 0.87. High UWTs were associated with the presence of ureteral edema, polyps, white lesions, stone fixation, longer operation time, and lower endoscopic stone-free rate, compared with low UWTs (P < .05 each). CONCLUSION High UWT is associated not only with a higher risk of impacted stones but also with poor endoscopic findings and adverse surgical outcomes in patients with ureteral stones undergoing URSL.
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Affiliation(s)
- Takashi Yoshida
- Department of Urology and Andrology, Kansai Medical University, Kori Hospital, Osaka, Japan
| | - Takaaki Inoue
- Department of Urology and Andrology, Kansai Medical University General Medical Center, Osaka, Japan.
| | - Naoto Omura
- Department of Radiology, Kansai Medical University, Kori Hospital, Osaka, Japan
| | - Shinsuke Okada
- Department of Urology, Gyotoku General Hospital, Ichikawa, Chiba, Japan
| | - Shuzo Hamamoto
- Department of Nephrourology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University Hospital, Osaka, Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University Hospital, Osaka, Japan
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20
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Messaoudi N, Sennour K, Daudon M, Omar ZK, Attar A, Addou A. Prediction of successful treatment by extracorporeal shock wave lithotripsy based on crystalluria-composition correlations of urinary calculi. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2015. [DOI: 10.1016/s2222-1808(15)60969-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Utsumi T, Kamiya N, Endo T, Yano M, Kamijima S, Kawamura K, Imamoto T, Naya Y, Ichikawa T, Suzuki H. Development of a novel nomogram to predict hypertension cure after laparoscopic adrenalectomy in patients with primary aldosteronism. World J Surg 2015; 38:2640-4. [PMID: 24831672 DOI: 10.1007/s00268-014-2612-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Primary aldosteronism is the most common curable cause of secondary hypertension. Despite resection, however, many patients with primary aldosteronism continue to require antihypertensive drugs to control their blood pressure. Although many patients with primary aldosteronism want to know the postoperative probability of hypertension cure before surgery, there are no predictive models calculating its probability. We therefore developed a nomogram to predict hypertension cure in patients with primary aldosteronism after laparoscopic adrenalectomy. METHODS We retrospectively surveyed 132 Japanese patients with primary aldosteronism who were treated by unilateral laparoscopic adrenalectomy. Hypertension cure was defined as normal blood pressure (<140/90 mmHg) without antihypertensive drugs 6 months postoperatively. We developed a novel nomogram that postoperatively predicted cured hypertension in 105 (80 %) randomly selected patients and validated it with the remaining 27 (20 %). RESULTS At 6 months, blood pressure had normalized in 42 % of patients without antihypertensive drugs. Duration of hypertension, preoperative number of antihypertensive drug classes, age, and sex were incorporated into a novel nomogram as independent predictors of hypertension cure. The value of the area under the receiver operating characteristics curve for this nomogram was 0.83-which was significantly higher than that of the Aldosteronoma Resolution Score-on internal validation. CONCLUSIONS We developed the first nomogram that can accurately predict postoperative hypertension cure in patients with primary aldosteronism. This nomogram can help clinicians calculate the probability of postoperative hypertension cure in patients with primary aldosteronism and objectively inform them of their hypertension outcome before laparoscopic adrenalectomy.
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Affiliation(s)
- Takanobu Utsumi
- Department of Urology, Toho University Sakura Medical Center, 564-1 Shimoshizu, Sakura-shi, Chiba, 285-8741, Japan,
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Evaluation of Hounsfield Units as a predictive factor for the outcome of extracorporeal shock wave lithotripsy and stone composition. Urolithiasis 2014; 43:69-75. [DOI: 10.1007/s00240-014-0712-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 08/05/2014] [Indexed: 10/24/2022]
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23
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Ito H, Sakamaki K, Kawahara T, Terao H, Yasuda K, Kuroda S, Yao M, Kubota Y, Matsuzaki J. Development and internal validation of a nomogram for predicting stone-free status after flexible ureteroscopy for renal stones. BJU Int 2014; 115:446-51. [PMID: 24731157 DOI: 10.1111/bju.12775] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop and internally validate a preoperative nomogram for predicting stone-free status (SF) after flexible ureteroscopy (fURS) for renal stones, as there is a need to predict the outcome of fURS for the treatment of renal stone disease. PATIENTS AND METHODS We retrospectively analysed 310 fURS procedures for renal stone removal performed between December 2009 and April 2013. Final outcome of fURS was determined by computed tomography 3 months after the last fURS session. Assessed preoperative factors included stone volume and number, age, sex, presence of hydronephrosis and lower pole calculi, and ureteric stent placement. Multivariate logistic regression analysis with backward selection was used to model the relationship between preoperative factors and SF after fURS. Bootstrapping was used to internally validate the nomogram. RESULTS Five independent predictors of SF after fURS were identified: stone volume (P < 0.001), presence of lower pole calculi (P = 0.001), operator with experience of >50 fURS (P = 0.026), stone number (P = 0.075), and presence of hydronephrosis (P = 0.047). We developed a nomogram to predict SF after fURS using these five preoperative characteristics. Total nomogram score (maximum 25) was derived from summing individual scores of each predictive variable; a high total score was predictive of successful fURS outcome, whereas a low total score was predictive of unsuccessful outcome. The area under the receiver operating characteristics for nomogram predictions was 0.87. CONCLUSION The nomogram can be used to reliably predict SF based on patient characteristics after fURS treatment of renal stone disease.
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Affiliation(s)
- Hiroki Ito
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan; Department of Urology, Ohguchi East General Hospital, Yokohama, Japan
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Computed tomography-based novel prediction model for the stone-free rate of ureteroscopic lithotripsy. Urolithiasis 2013; 42:75-9. [PMID: 24162952 DOI: 10.1007/s00240-013-0609-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 09/25/2013] [Indexed: 02/06/2023]
Abstract
The purpose of this study was to evaluate whether computed tomography (CT) parameters can predict the success of ureteroscopic lithotripsy (URSL) and establish a model for predicting the success rates of a single URSL procedure for the treatment of a single ureteral stone. We retrospectively reviewed the records of 237 patients who underwent URSL for ureteral stones diagnosed by CT between January 2009 and June 2012. Stone-free status was defined as the absence of stones or residual stone fragments <2 mm by ureteroscopy and plain abdominal radiography. We analyzed the correlations between the outcome of URSL and the patients' sex, age, height, body weight, body mass index, and history of ureteral stone. Stone factors such as the diameter (D), stone height (H), volumetric stone burden (VSB; D(2) × H × 5 mm × π × 1/6), estimated stone location (ESL; number of axial cut images between the stone and uretero-vesical junction), tissue rim sign (RS; 0-3), perinephric edema (0-3), hydronephrosis (0-3), and Hounsfield unit (HU) were also analyzed. We then developed a model to predict the probability of successful URSL by applying a logistic model to our data. The success rate of URSL was 85.7% (203/237). Univariate analysis found that stone diameter, length, VSB, ESL, HU and RS significantly affected the stone-free rate. Multivariate analysis indicated that stone diameter, ESL and RS independently influenced the stone-free rate. The logistic model indicated that success rates = 1/[1 + exp{-6.146 + 0.071(D) + 0.153(ESL) + 1.534(RS)}] with an area under the receiver operating characteristic curve of 0.825. Stone diameter, ESL, and RS were independent predictors of the outcome of a single URSL for a single ureteral stone.
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Elsheemy MS, Maher A, Mursi K, Shouman AM, Shoukry AI, Morsi HA, Meshref A. Holmium:YAG laser ureteroscopic lithotripsy for ureteric calculi in children: predictive factors for complications and success. World J Urol 2013; 32:985-90. [PMID: 23979150 DOI: 10.1007/s00345-013-1152-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 08/10/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To evaluate the impact of age, stone size, location, radiolucency, extraction of stone fragments, size of ureteroscope and presence and degree of hydronephrosis on the efficacy and safety of holmium:YAG (Ho:YAG) laser lithotripsy in the ureteroscopic treatment of ureteral stones in children. METHODS Between October 2011 and May 2013, a total of 104 patients were managed using semirigid Ho:YAG ureterolithotripsy. Patient age, stone size and site, radiolucency, use of extraction devices, degree of hydronephrosis and size of ureteroscope were compared for operative time, success and complications. RESULTS In all, 128 URS were done with a mean age of 4.7 years. The mean stones size was 11 mm. Success rate was 81.25 %. Causes of failure were 12.5 % access failure, 1.5 % extravasation and 4.7 % stone migration. Overall complications were 23.4 %. Failure of dilatation and extravasation were detected only in children <2 years old. Extravasation was significantly higher in smaller ureters and cases with stone size >15 mm. Stone migration was significantly higher in upper ureteric stones. CONCLUSIONS Failure and complications rates in Ho:YAG ureterolithotripsy were significantly affected by younger age (<2 years), upper ureteric stones and smaller ureters but were not related to stone radiolucency or degree of hydronephrosis. Larger stones (>15 mm) were associated with increased complications. After multivariate analysis, the age of the patients remained significant predictor for failure of dilatation and stone migration, while size of the ureter was the only significant predicting factor for failure.
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Affiliation(s)
- Mohammed S Elsheemy
- Division of Pediatric Urology, Aboul-Riche Children's Hospital, Cairo University, Cairo, Egypt,
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