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Utility and limitation of cumulative stone diameter in predicting urinary stone burden at flexible ureteroscopy with holmium laser lithotripsy: a single-center experience.

Ito H, Kawahara T, Terao H, Ogawa T, Yao M, Kubota Y, Matsuzaki J - PLoS ONE (2013)

Bottom Line: To retrospectively assess the clinical utility in ureteroscopy (URS) planning of cumulative stone diameter (CSD), which does not account for stone width or depth, as a predictor of URS outcome and compare it with stone volume.To identify stone number impact on CSD, the AUROC of CSD divided by stone number was evaluated.In cases with CSD <20.0 mm or 1-3 stones, CSD was as valid a predictor of preoperative stone burden as stone volume, so preoperative kidney-ureter-bladder (KUB) films may be sufficient.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Ohguchi East General Hospital, Yokohama City, Japan. pug_daikichi@yahoo.co.jp

ABSTRACT

Purpose: To retrospectively assess the clinical utility in ureteroscopy (URS) planning of cumulative stone diameter (CSD), which does not account for stone width or depth, as a predictor of URS outcome and compare it with stone volume.

Materials and methods: Patients with renal stones treated at a single institute by flexible URS were retrospectively evaluated. To assess the clinical utility of CSD, relationships between stone-free (SF) status and stone burden (CSD and volume) were analyzed using the area under the receiver operating characteristics (AUROC) curve. To identify stone number impact on CSD, the AUROC of CSD divided by stone number was evaluated. Correlation coefficients of CSD and stone volume were also calculated for groups by stone number.

Results: In cases with CSD <20.0 mm, CSD and stone volume revealed equal ability to predict SF status. In cases with CSD ≥20.0 mm, stone volume showed higher predictive ability. The ROC curves for cases with ≥4 stones showed that CSD was less predictive of SF status than stone volume. The correlation coefficients of CSD and stone volume by stone number were 0.922 for 1 stone, 0.900 for 2-3 stones, and 0.661 for ≥4 stones.

Conclusions: In cases with CSD ≥20.0 mm or ≥4 stones, we should evaluate stone volume for a more predictive stone burden, and pretreatment non-contrast CT seems sufficient. In cases with CSD <20.0 mm or 1-3 stones, CSD was as valid a predictor of preoperative stone burden as stone volume, so preoperative kidney-ureter-bladder (KUB) films may be sufficient.

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Related in: MedlinePlus

Receiver operating characteristics (ROC) curve of stone-free (SF) status on postoperative day 1 for the two parameters of stone burden, cumulative stone diameter and stone volume (n = 243).
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pone-0065060-g001: Receiver operating characteristics (ROC) curve of stone-free (SF) status on postoperative day 1 for the two parameters of stone burden, cumulative stone diameter and stone volume (n = 243).

Mentions: The ROC curve of the two parameters of stone burden based on SF status after a single URS are shown in Fig. 1. The single cut-off value of predictive ability between CSD and stone volume was 20.00 mm. This suggests that CSD and stone volume are equally beneficial in predicting stone status after URS for patients with a maximum stone diameter <20.0 mm (Fig. 1). However, in patients with CSD ≥20.0 mm, CSD was inferior to stone volume as a predictor of SF status (Fig. 1). To assess the difference of backgrounds between groups with <20.0 mm diameter and ≥20.0 mm diameter, Table 1 shows a comparison of the patients’ demographic data and perioperative surgical outcomes according to stone diameter. There were significant differences between the <20.0 mm diameter and ≥20.0 mm diameter groups in the following parameters: number of stones (P<0.001), presence of lower pole calculi (P<0.001), diameter (P<0.001), volume (P<0.001), duration of procedure (P<0.001), amount of laser use (P<0.001), and SF rate on postoperative day 1 (P<0.001).


Utility and limitation of cumulative stone diameter in predicting urinary stone burden at flexible ureteroscopy with holmium laser lithotripsy: a single-center experience.

Ito H, Kawahara T, Terao H, Ogawa T, Yao M, Kubota Y, Matsuzaki J - PLoS ONE (2013)

Receiver operating characteristics (ROC) curve of stone-free (SF) status on postoperative day 1 for the two parameters of stone burden, cumulative stone diameter and stone volume (n = 243).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3672212&req=5

pone-0065060-g001: Receiver operating characteristics (ROC) curve of stone-free (SF) status on postoperative day 1 for the two parameters of stone burden, cumulative stone diameter and stone volume (n = 243).
Mentions: The ROC curve of the two parameters of stone burden based on SF status after a single URS are shown in Fig. 1. The single cut-off value of predictive ability between CSD and stone volume was 20.00 mm. This suggests that CSD and stone volume are equally beneficial in predicting stone status after URS for patients with a maximum stone diameter <20.0 mm (Fig. 1). However, in patients with CSD ≥20.0 mm, CSD was inferior to stone volume as a predictor of SF status (Fig. 1). To assess the difference of backgrounds between groups with <20.0 mm diameter and ≥20.0 mm diameter, Table 1 shows a comparison of the patients’ demographic data and perioperative surgical outcomes according to stone diameter. There were significant differences between the <20.0 mm diameter and ≥20.0 mm diameter groups in the following parameters: number of stones (P<0.001), presence of lower pole calculi (P<0.001), diameter (P<0.001), volume (P<0.001), duration of procedure (P<0.001), amount of laser use (P<0.001), and SF rate on postoperative day 1 (P<0.001).

Bottom Line: To retrospectively assess the clinical utility in ureteroscopy (URS) planning of cumulative stone diameter (CSD), which does not account for stone width or depth, as a predictor of URS outcome and compare it with stone volume.To identify stone number impact on CSD, the AUROC of CSD divided by stone number was evaluated.In cases with CSD <20.0 mm or 1-3 stones, CSD was as valid a predictor of preoperative stone burden as stone volume, so preoperative kidney-ureter-bladder (KUB) films may be sufficient.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Ohguchi East General Hospital, Yokohama City, Japan. pug_daikichi@yahoo.co.jp

ABSTRACT

Purpose: To retrospectively assess the clinical utility in ureteroscopy (URS) planning of cumulative stone diameter (CSD), which does not account for stone width or depth, as a predictor of URS outcome and compare it with stone volume.

Materials and methods: Patients with renal stones treated at a single institute by flexible URS were retrospectively evaluated. To assess the clinical utility of CSD, relationships between stone-free (SF) status and stone burden (CSD and volume) were analyzed using the area under the receiver operating characteristics (AUROC) curve. To identify stone number impact on CSD, the AUROC of CSD divided by stone number was evaluated. Correlation coefficients of CSD and stone volume were also calculated for groups by stone number.

Results: In cases with CSD <20.0 mm, CSD and stone volume revealed equal ability to predict SF status. In cases with CSD ≥20.0 mm, stone volume showed higher predictive ability. The ROC curves for cases with ≥4 stones showed that CSD was less predictive of SF status than stone volume. The correlation coefficients of CSD and stone volume by stone number were 0.922 for 1 stone, 0.900 for 2-3 stones, and 0.661 for ≥4 stones.

Conclusions: In cases with CSD ≥20.0 mm or ≥4 stones, we should evaluate stone volume for a more predictive stone burden, and pretreatment non-contrast CT seems sufficient. In cases with CSD <20.0 mm or 1-3 stones, CSD was as valid a predictor of preoperative stone burden as stone volume, so preoperative kidney-ureter-bladder (KUB) films may be sufficient.

Show MeSH
Related in: MedlinePlus