1
|
Yang B, Zhong J, Yang Y, Xu J, Liu H, Liu J. Machine learning constructs a diagnostic prediction model for calculous pyonephrosis. Urolithiasis 2024; 52:96. [PMID: 38896174 PMCID: PMC11186887 DOI: 10.1007/s00240-024-01587-y] [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: 04/06/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024]
Abstract
In order to provide decision-making support for the auxiliary diagnosis and individualized treatment of calculous pyonephrosis, the study aims to analyze the clinical features of the condition, investigate its risk factors, and develop a prediction model of the condition using machine learning techniques. A retrospective analysis was conducted on the clinical data of 268 patients with calculous renal pelvic effusion who underwent ultrasonography-guided percutaneous renal puncture and drainage in our hospital during January 2018 to December 2022. The patients were included into two groups, one for pyonephrosis and the other for hydronephrosis. At a random ratio of 7:3, the research cohort was split into training and testing data sets. Single factor analysis was utilized to examine the 43 characteristics of the hydronephrosis group and the pyonephrosis group using the T test, Spearman rank correlation test and chi-square test. Disparities in the characteristic distributions between the two groups in the training and test sets were noted. The features were filtered using the minimal absolute value shrinkage and selection operator on the training set of data. Auxiliary diagnostic prediction models were established using the following five machine learning (ML) algorithms: random forest (RF), xtreme gradient boosting (XGBoost), support vector machines (SVM), gradient boosting decision trees (GBDT) and logistic regression (LR). The area under the curve (AUC) was used to compare the performance, and the best model was chosen. The decision curve was used to evaluate the clinical practicability of the models. The models with the greatest AUC in the training dataset were RF (1.000), followed by XGBoost (0.999), GBDT (0.977), and SVM (0.971). The lowest AUC was obtained by LR (0.938). With the greatest AUC in the test dataset going to GBDT (0.967), followed by LR (0.957), XGBoost (0.950), SVM (0.939) and RF (0.924). LR, GBDT and RF models had the highest accuracy were 0.873, followed by SVM, and the lowest was XGBoost. Out of the five models, the LR model had the best sensitivity and specificity is 0.923 and 0.887. The GBDT model had the highest AUC among the five models of calculous pyonephrosis developed using the ML, followed by the LR model. The LR model was considered be the best prediction model when combined with clinical operability. As it comes to diagnosing pyonephrosis, the LR model was more credible and had better prediction accuracy than common analysis approaches. Its nomogram can be used as an additional non-invasive diagnostic technique.
Collapse
Affiliation(s)
- Bin Yang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, 650101, China
| | - Jiao Zhong
- Department of Urology, The Second People's Hospital of Yibin City, No. 96, North Street, Yibin, 644000, China
| | - Yalin Yang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, 650101, China
| | - Jin Xu
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, 650101, China
| | - Hua Liu
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, 650101, China
| | - Jianhe Liu
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, NO. 374 Dianmian Avenue, Wuhua District, Kunming, 650101, China.
| |
Collapse
|
2
|
Uğur R, Yağmur İ. Urgent ureterorenoscopy as a primary treatment for ureteral stone: why not? Urolithiasis 2024; 52:69. [PMID: 38653876 DOI: 10.1007/s00240-024-01569-0] [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: 08/30/2023] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
To evaluate the feasibility of urgent ureteroscopy (uURS) and elective ureteroscopy (eURS) in the management of patients with renal colic due to ureteral stones. Patients who were operated for ureteral stones between September 2020 and March 2022 were determined retrospectively. The patients who were operated within the first 24 h constituted the uURS group, while the patients who were operated after 24 h were classified as eURS. No limiting factors such as age, gender and concomitant disease were determined as inclusion criteria. Patients with bilateral or multiple ureteral stones, bleeding diathesis, patients requiring emergency nephrostomy or decompression with ureteral JJ stent, and pregnant women were not included. The two groups were compared in terms of stone-free rate, complications, and overall outcomes. According to the inclusion-exclusion criteria, a total of 572 patients were identified, including 142 female and 430 male patients. There were 219 patients in the first group, the uURS arm, and 353 patients in the eURS arm. The mean stone size was 8.1 ± 2.6. The stone-free rate was found to be 87.8% (502) in general, and 92 and 85% for uURS and eURS, respectively. No major intraoperative or postoperative complications were observed in any of the patients. Urgent URS can be performed effectively and safely as the primary treatment in patients with renal colic due to ureteral stones. In this way, the primary treatment of the patient is carried out, as well as the increased workload, additional examination, treatment and related morbidities are prevented.
Collapse
Affiliation(s)
- Ramazan Uğur
- Department of Urology, University of Health Sciences, Başakşehir Çam and Sakura City Hospital, Başakşehir Olympic Boulevard Road, 34480, Başakşehir, Istanbul, Turkey.
| | - İlyas Yağmur
- Department of Urology, Yenişehir, Viranşehir State Hospital, Viranşehir - Ceylanpınar Street, No:3, 63700, Viranşehir, Şanlıurfa, Turkey
| |
Collapse
|
3
|
Zhang KP, Zhang Y, Chao M. Which is the best way for patients with ureteral obstruction? Percutaneous nephrostomy versus double J stenting. Medicine (Baltimore) 2022; 101:e31194. [PMID: 36397363 PMCID: PMC9666138 DOI: 10.1097/md.0000000000031194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Percutaneous nephrostomy (PCN) and Double J stenting (DJS) are the 2 main treatment options of ureteral obstruction. We evaluate which of these 2 methods is superior concerning the course of procedure, postoperative complication and quality of life. METHODS A detailed review of electronic databases including PubMed, Embase, Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure up to February 21st, 2021 was searched. Continuous data were evaluated using mean difference (MD) with 95% confidence interval (CI), while nominal data were analyzed by risk ratio (RR) with 95% CI. Meanwhile, we performed the subgroup analysis based on study design, disease type, sample size, sepsis, DJ diameter, nephrostomy diameter, anesthesia type and guidance under X-ray or ultrasound. RESULTS There were 18 previous studies included in current study. As a result, we found that there were significant differences in fluoroscopy time (MD = 0.31; 95% CI, 0.14-0.48, P < .001) and hospital stay (MD = 1.23; 95% CI, 0.60-1.85, P < .001). However, no statistic difference was detected in operative time (MD = 5.40; 95% CI, -1.78 to 12.58, P = .140) between the paired groups. Although DJS showed a higher rate of postoperative complications (25.19% vs 17.61%), there was no significant difference in the incidence of complications following DJS and PCN (RR = 0.92; 95% CI, 0.60-1.43; P = .720). Based on the EuroQol analysis, the 2 main treatment options had different impacts on quality of life. The pooled results showed that PCN patients reported more difficulties in self-care compared to DJS patients (RR = 3.07; 95% CI, 1.32-7.14; P = .009). CONCLUSIONS DJS is a safe and better method of temporary urinary diversion than PCN for management of ureteral obstruction with shorter fluoroscopy time and hospital stay. As for quality of life, patients receiving PCN had a distinct difficulty in self-care compared to those receiving DJS. However, these 2 treatment options often depends on the individual situation.
Collapse
Affiliation(s)
- Kai-Ping Zhang
- Department of Urology, Anhui Provincial Children’s Hospital/Children’s Hospital of Fudan University (Affiliated Anhui Branch), Hefei, China
| | - Yin Zhang
- Department of Urology, Anhui Provincial Children’s Hospital/Children’s Hospital of Fudan University (Affiliated Anhui Branch), Hefei, China
| | - Min Chao
- Department of Urology, Anhui Provincial Children’s Hospital/Children’s Hospital of Fudan University (Affiliated Anhui Branch), Hefei, China
- * Correspondence: Min Chao, Department of Urology, Anhui Provincial Children’s Hospital/Children’s Hospital of Fudan University (Affiliated Anhui Branch), No. 39 Wangjiang East Road, Hefei 230051, Anhui Province, P. R. China (e-mail: )
| |
Collapse
|
4
|
Liu J, Jiang Y, Liu Z, Song Q, Li Z. A Case of Misdiagnosed as Upper Urinary Tract Obstruction Caused by the Fungal Ball. Infect Drug Resist 2022; 15:6109-6114. [PMID: 36277247 PMCID: PMC9585907 DOI: 10.2147/idr.s380291] [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: 06/28/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022] Open
Abstract
Upper urinary tract obstruction caused by fungal balls is a rare urinary system disease. We admitted an elderly man with symptoms of urinary tract infection and diabetes mellitus. When the patient was transported into the hospital, a CT scan revealed right renal pelvis dilatation and gas buildup, routine urinalysis showing full field of view of white blood cells and middle urinary bacteria and fungi cultures came back negative, leading to the incorrect diagnosis of emphysematous pyelonephritis with Aerogenes infection. When the diagnosis is confirmed, surgery and antifungal therapy are used to deal with both the obstruction and the fungal ball.
Collapse
Affiliation(s)
- Jian Liu
- Department of Urology, The First Affiliated Hospital of Hunan Normal University Hunan Provincial People’s Hospital, Changsha, People’s Republic of China
| | - Ying Jiang
- Department of Urology, The First Affiliated Hospital of Hunan Normal University Hunan Provincial People’s Hospital, Changsha, People’s Republic of China
| | - Zhe Liu
- Department of Urology, The First Affiliated Hospital of Hunan Normal University Hunan Provincial People’s Hospital, Changsha, People’s Republic of China
| | - Qun Song
- Department of Urology, The First Affiliated Hospital of Hunan Normal University Hunan Provincial People’s Hospital, Changsha, People’s Republic of China
| | - Zhuo Li
- Department of Urology, The First Affiliated Hospital of Hunan Normal University Hunan Provincial People’s Hospital, Changsha, People’s Republic of China,Correspondence: Zhuo Li, Tel +8615197591937, Email
| |
Collapse
|
5
|
Wang Y, Gao L, Xu M, Li W, Mao Y, Wang F, Wang L, Da J, Wang Z. A novel spherical-headed fascial dilator is feasible for second-stage ultrasound guided percutaneous nephrolithotomy: A pilot study. Asian J Urol 2021; 8:424-429. [PMID: 34765450 PMCID: PMC8566357 DOI: 10.1016/j.ajur.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 09/23/2020] [Accepted: 12/01/2020] [Indexed: 10/24/2022] Open
Abstract
Objective In second-stage percutaneous nephrolithotomy (PCNL), because the hydronephrosis has been decompressed, the dilated renal pelvis has resolved and the space is small. Consequently, introduction of the tip of the Amplatz dilator can cause injury to the opposite side of the renal-pelvic mucosa. In this study, we report the experimental and initial clinical performance of a spherical-headed fascial dilator developed specifically for second-stage PCNL. Methods The novel spherical-headed dilator was compared with existing tapered-headed dilators in configuration and in puncture resistance utilizing a static puncture test. Subsequently, a pilot clinical study was conducted during which patients scheduled to undergo second-stage PCNL from June 2019 to October 2019 in our center were enrolled. A typical ultrasound guided PCNL procedure was performed with the exception that the new spherical-headed fascial dilator was substituted for a tapered-headed one. Results Experimentally, stab resistance against polyethylene film was significantly increased using the novel spherical-headed dilator compared to the traditional tapered-headed dilators (p<0.005). In the clinical study, the novel dilators were successfully introduced into the renal pelvis and passed down the collecting system in all eight second-stage PCNL cases. There were no cases of renal pelvic perforation or brisk hemorrhage nor need for transfusion. Conclusion The design of the novel spherical-headed fascial dilator avoided the concentration of pressure at the tapered tip of the current Amplatz dilator by increasing the contact area and uniformly distributing and diffusing the pressure. Therefore, it is feasible to use the spherical-headed fascial dilator for second-stage PCNL.
Collapse
Affiliation(s)
- Yiwei Wang
- Department of Urology, Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Liheng Gao
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China
| | - Mingxi Xu
- Department of Urology, Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Wenfeng Li
- Department of Urology, Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yuanshen Mao
- Department of Urology, Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Fujun Wang
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China
| | - Lu Wang
- Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China
| | - Jun Da
- Department of Urology, Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhong Wang
- Department of Urology, Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| |
Collapse
|
6
|
Hong S, Yang Y, Zhang Q, Zhuo S, Wang L. Recurrent primary pyogenic ventriculitis in an adult woman: a case report. BMC Neurol 2021; 21:401. [PMID: 34666698 PMCID: PMC8525037 DOI: 10.1186/s12883-021-02422-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/29/2021] [Indexed: 11/22/2022] Open
Abstract
Background Recurrent primary pyogenic ventriculitis has not been reported previously. We present a unique case of recurrent primary pyogenic ventriculitis in an adult. And we believe that our study makes a significant contribution to the literature. Case presentation An adult woman with uncontrolled diabetes experienced two episodes of pyogenic ventriculitis caused by Escherichia coli over 4 years. She had typical imaging features, and the source of infection was undetermined. After antibiotic treatment, she recovered fully. Conclusions Early recognition and therapy will improve patient prognosis.
Collapse
Affiliation(s)
- Shanyan Hong
- Department of Clinical Nutrition, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, China.,Department of Neurology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Yingxia Yang
- Department of Neurology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Qianying Zhang
- Department of Medical Imaging, the 910th hospital of the People's Liberation Army, Quanzhou, 362000, Fujian, China
| | - Shitu Zhuo
- Department of Neurology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Lingxing Wang
- Department of Neurology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, China.
| |
Collapse
|
7
|
Zhang Z, Fang L, Chen D, Li W, Peng N, Thakker PU, Zhang Y, Wang X. A Modified Endoscopic Primary Realignment of Severe Bulbar Urethral Injury. J Endourol 2021; 35:335-341. [PMID: 33040587 DOI: 10.1089/end.2020.0567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose: Male urethral injury is a common urologic emergency in developing countries. Whether early or late treatment of urethral injuries is often multifactorial and controversial. The goal of this study is to determine whether early realignment can reduce postsurgical complications and evaluate the clinical feasibility of emergency endoscopic urethroplasty using single rigid ureteroscopy in the treatment of bulbar urethral severe injury. Patients and Methods: Between September 2013 and March 2019, 15 male adult patients (mean age 35 years; from 21 to 62 years) with severe bulbar urethral injury were enrolled into the current study. The patients mainly presented with dysuria or painful urination (15/15, 100%), urethral bleeding (13/15, 86.7%), and urinary retention (11/15, 73.3%). Six of them had swelling of perineal or scrotal soft tissue, while four had testicular contusion. No pelvic fracture was found in all cases with CT scanning of the pelvic cavity. The bulbar urethral at grade IV was confirmed to be completely ruptured in all cases by endoscopy during operation. The modified endoscopic primary realignment was performed. Results: This new urethral repair technique was effectively performed in all patients and none converted to open operation. Mean operation time was 42.3 ± 11.5 minutes (28-52 minutes) and the mean Foley catheter indwelling time was 34.5 ± 6.9 days (28-42 days). During a follow-up of 41.3 ± 22.8 months (12-64 months), mild urethral strictures (grade I) (19.7 ± 9.5 weeks, 10-27 weeks postsurgery) developed in 8 patients (53.3%) and then were all improved 2.1 ± 0.8 months (1.3-2.9 months) after periodic dilatations of the urethra (4-10 times). Erectile dysfunction (ED) occurred in three patients (20%) after surgery, who recovered from mild ED to normal by administration with oral sildenafil (100 mg, three times a week) for 12 weeks. The International Index of Erectile Function-5 (IIEF-5) score was significantly improved after surgery (M ± SD, 25 ± 3) compared with before (16.4 ± 3.5) (p < 0.05). No incontinence and other complications occurred in all cases. Conclusions: Early endoscopic realignment via suprapubic puncture cystostomy by single rigid ureteroscopy provides an effective, feasible, and safe procedure for severe bulbar urethral injury.
Collapse
Affiliation(s)
- Zejian Zhang
- Department of Urology, Shenzhen Long-hua District Central Hospital, The Affiliated Central Hospital of Shenzhen Long-hua District, Guangdong Medical University, Shenzhen, China
| | - Liekui Fang
- Urinary Surgery Department of the Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen Third People's Hospital, Shenzhen, China
| | - Dong Chen
- Department of Urology, Shenzhen Long-hua District Central Hospital, The Affiliated Central Hospital of Shenzhen Long-hua District, Guangdong Medical University, Shenzhen, China
| | - Wei Li
- Department of Urology, Shenzhen Long-hua District Central Hospital, The Affiliated Central Hospital of Shenzhen Long-hua District, Guangdong Medical University, Shenzhen, China
| | - Naixiong Peng
- Department of Urology, Shenzhen Long-hua District Central Hospital, The Affiliated Central Hospital of Shenzhen Long-hua District, Guangdong Medical University, Shenzhen, China
| | - Parth U Thakker
- Department of Urology and Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Yuanyuan Zhang
- Department of Urology and Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Xisheng Wang
- Department of Urology, Shenzhen Long-hua District Central Hospital, The Affiliated Central Hospital of Shenzhen Long-hua District, Guangdong Medical University, Shenzhen, China
| |
Collapse
|