A Prediction Model Using Machine Learning Algorithm for Assessing Stone-Free Status after Single Session Shock Wave Lithotripsy to Treat Ureteral Stones

Choo, Min Soo; Uhmn, Saangyong; Kim, Jong Keun; Han, Jun Hyun; Kim, Dong Hoi; Kim, Jin; Lee, Seong Ho

doi:10.1016/j.juro.2018.06.077

Cited by 45 publications

(27 citation statements)

References 17 publications

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“…Our previous study on SWL also found that CTTA, a quantitative analysis method, may be useful in improving medical decision-making on ESWL patients ( 9 ). Similarly, several pieces of research showed that establishing a prediction model utilizing radiomics or machine learning may contribute to a better predictive efficacy for pre-operative estimation of PCNL or SWL outcomes ( 12 , 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…Actually, this new methodology, named radiomics, has been proven to be capable of influencing and altering the diagnosis and treatment strategies in the field of tumors (10,11). Moreover, several investigations showed that predictive model based on radiomics or machine learning can better predict the post-operative outcome of certain surgical treatments (PCNL or SWL) (12,13). It is important to develop a novel predictive model for fURS that combines radiomics features and clinical indicators, particularly for the lower renal stones.…”

Section: Introductionmentioning

confidence: 99%

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A Novel Clinical-Radiomics Model Pre-operatively Predicted the Stone-Free Rate of Flexible Ureteroscopy Strategy in Kidney Stone Patients

et al. 2020

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The purpose of the study is to develop and validate a novel clinical-radiomics nomogram model for pre-operatively predicting the stone-free rate of flexible ureteroscopy (fURS) in kidney stone patients. Patients and Methods: Altogether, 2,129 fURS cases with kidney stones were retrospectively analyzed, and 264 patients with a solitary kidney stone were included in a further study. For lower calyx calculi, a radiomics model was generated in a primary cohort of 99 patients who underwent non-contrast-enhanced computed tomography (NCCT). Radiomics feature selection and signature building were conducted by using the least absolute shrinkage and selection operator (LASSO) method. Multivariate logistic regression analysis was employed to build a model incorporating radiomics and potential clinical factors. Model performance was evaluated by its discrimination, calibration, and clinical utility. The model was internally validated in 43 patients. Results: The overall success rate of fURS was 72%, while the stone-free rate (SFR) for lower calyx calculi and non-lower calyx calculi was 56.3 and 90.16%, respectively. On multivariate logistic regression analysis of the primary cohort, independent predictors for SFR were radiomics signature, stone volume, operator experience, and hydronephrosis level, which were all selected into the nomogram. The area under the curve (AUC) of clinical-radiomics model was 0.949 and 0.947 in the primary and validation cohorts, respectively. Moreover, the calibration curve showed a satisfactory predictive accuracy, and the decision curve analysis indicated that the nomogram has superior clinical application value. Conclusion: In this novel clinical-radiomics model, the radiomics scores, stone volume, hydronephrosis level, and operator experience were crucial for the flexible ureteroscopy strategy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Novel Clinical-Radiomics Model Pre-operatively Predicted the Stone-Free Rate of Flexible Ureteroscopy Strategy in Kidney Stone Patients

et al. 2020

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“…Many studies have evaluated different risk factors for failure of SWL on ureteric stones. Large stone size, HAV as measured in HU, high SSD and the presence of ureteric stents were reported as risk factors 11,14–17 . SW rate is another important factor with better stone fragmentation and better renal safety profile on slowing the rate down to 30–60 SW/min rather than 90–150 SW/min 18–20 .…”

Section: Introductionmentioning

confidence: 99%

Ultraslow full‐power shock wave lithotripsy protocol in the management of high attenuation value upper ureteric stones: A randomized comparative study

et al. 2020

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ObjectivesTo evaluate the efficacy and safety of ultraslow full‐power shock wave lithotripsy protocol in the management of high attenuation value upper ureteric stones compared with slow‐rate, power‐ramping shock wave lithotripsy.MethodsThis was a randomized trial enrolling patients with a single high attenuation value (≥1000 HU) upper ureteric stones between January 2019 and July 2019. Ultraslow full‐power shock wave lithotripsy (54 patients) was applied at a rate of 30 shock waves/min with power ramping from 6 to 18 kV for 100 shock waves, then a safety pause for 2 min, followed by ramping 18–22 kV for 100 shock waves, then a safety pause for 2 min. Then, full power (22 kV) was maintained until the end of the session. Slow‐rate, power‐ramping shock wave lithotripsy (47 patients) was applied at a rate of 60 shock waves/min with power ramping from 6 to 10 kV during the first 500 shock waves, then from 11 to 22 kV during the next 1000 shock waves, then maintained on 22 kV in the last 1500 shock waves. Up to three sessions were carried out with a follow up 3 months after the last session. The primary outcome was the stone‐free rate. Perioperative data of the two protocols were compared.ResultsThere was no significant difference in preoperative data. The stone‐free rate was significantly higher in ultraslow full‐power shock wave lithotripsy after single (92.6% vs 23.4%) and multiple (96.3% vs 63.8%) sessions. Most complications were mild, with no significant difference between both groups (9.3% vs 12.8%; P = 0.573). Logistic regression analysis identified ultraslow full‐power shock wave lithotripsy protocol as the only significant independent factor for the stone‐free rate (odds ratio 12.589, P = 0.025).ConclusionUltraslow full‐power shock wave lithotripsy for high attenuation value upper ureteric stones is associated with a significantly higher stone‐free rate, and with mild complications that are comparable to those of standard shock wave lithotripsy.

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“…Patients aged between 18 and 80 years with single LPS of 1.5-3.5 cm were included in this study. Stone volume were calculated using the equation: length × width × height × π/6 [15]. Exclusion criteria are as follows: patients with renal malignancy, ectopic kidney, transplanted kidney stone, spongy kidney, polycystic kidney and uncontrolled pyonephrosis.…”

Section: Methodsmentioning

confidence: 99%

Comparative analysis of retrograde intrarenal surgery and modified ultra-mini percutaneous nephrolithotomy in management of lower pole renal stones (1.5–3.5 cm)

Lai

Shah

et al. 2020

BMC Urol

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Background: To compare the safety and efficacy of retrograde intrarenal surgery (RIRS) and modified Ultra-mini percutaneous nephrolithotomy (UMP) in semi-supine combined lithotomy position for the management of 1.5-3.5 cm lower pole renal stones (LPSs). Methods: A total of 63 patients with 1.5-3.5 cm LPSs who underwent RIRS (n = 33) or modified UMP (n = 30) in diameter between January 2017 and January 2019 were analyzed retrospectively. Modified UMP was performed in semi-supine combined lithotomy position and a 9.5/11.5 F ureteral access sheath (UAS) was inserted during the procedure in order to maintain low pelvic pressure and to facilitate the removal of stone fragments. Base-line parameters, stone characteristics, illness condition, operation time, postoperative hemoglobin (Hb) drop, postoperative creatinine (Cr) elevation, length of hospital stay, length of postoperative hospital stay, stone-free rate (SFR) and complications were compared between the two groups. Results: There were no significant differences between the two groups in base-line parameters, stone characteristics and illness condition. The mean operating time of RIRS group was longer than UMP group (95.61 ± 21.9 vs. 55.0 ± 16.1 min, p < 0.001). The mean postoperative Hb drop was less in RIRS group (7.42 ± 4.7 vs. 15.70 ± 9.8 g/L, p < 0.001). The length of hospital stay and postoperative hospital stay for RIRS were shorter than UMP (4.76 ± 1.1 vs. 5.83 ± 0.8 d, p < 0.001, 2.97 ± 0.9 vs. 4.07 ± 0.9 d, p < 0.001). The Early SFR was higher in UMP group (54.5 vs. 80.0%, p < 0.050) while SFR at 1-month and 3-months postoperatively was similar in both groups (p = 0.504, p = 0.675). There were no significant differences between the two groups in complications (p = 0.228). Conclusion: For patients with 1.5-3.5 cm LPSs, both modified UMP and RIRS are safe and viable. The modified UMP technique was used in this study, application semi-supine combined lithotomy position and the retention of UAS can improve the surgical efficiency and maintain low pressure perfusion in the kidney, which resulted in superior treatment efficacy. Therefore, we highly recommend this technique for LPSs with heavy stone burdens.

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A Prediction Model Using Machine Learning Algorithm for Assessing Stone-Free Status after Single Session Shock Wave Lithotripsy to Treat Ureteral Stones

Abstract: We applied a machine learning algorithm, a subfield of artificial intelligence, to predict the outcome after single session shock wave lithotripsy for ureteral stones. A 92.29% accurate decision model was developed with 15 factors and an average ROC AUC of 0.951.

Cited by 45 publications

References 17 publications

A Novel Clinical-Radiomics Model Pre-operatively Predicted the Stone-Free Rate of Flexible Ureteroscopy Strategy in Kidney Stone Patients

A Novel Clinical-Radiomics Model Pre-operatively Predicted the Stone-Free Rate of Flexible Ureteroscopy Strategy in Kidney Stone Patients

Ultraslow full‐power shock wave lithotripsy protocol in the management of high attenuation value upper ureteric stones: A randomized comparative study

Comparative analysis of retrograde intrarenal surgery and modified ultra-mini percutaneous nephrolithotomy in management of lower pole renal stones (1.5–3.5 cm)

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