Development and validation of a predictive model for stone-free failure after extracorporeal shockwave lithotripsy in patients with ureteral stone in a large prospective cohort

Purpose. To design a new nomogram predicting the probability of stone‐free status of shock wave lithotripsy (SWL) in patients with ureteral stones. Materials and Methods. We retrospectively enrolled 2,144 patients with ureteral stones who underwent SWL between January 1993 and April 2020. The demographic and clinical parameters were assessed. The predictors of stone‐free status following SWL were identified. A logistic regression‐based nomogram was created by including the significant predictors in the multivariate analysis. Results. The mean age was 42.93 ± 13.85 in the stone‐free group (Group 1) and 46.51 ± 13.66 in the treatment‐failure group (Group 2) (p = 0.001). The cutoff value of the age was 45.5 years. The mean stone load was 0.71 ± 0.36 cm2 in Group 1 and 0.96 ± 0.51 cm2 in Group 2 (p = 0.001). Of the 2,144 patients, 1,708 (79.6%) were stone‐free within the first three SWL sessions. According to the multiple logistic regression analysis, older age, a stone load larger than 1 cm2, the presence of multiple stones, third‐generation lithotripter use, and pre‐SWL catheterization were statistically associated with low stone‐free rates. The C‐index was determined to be 0.75 in the bootstrapping method. Conclusion. A stone load larger than 1 cm2, age older than 45.5 years, the presence of multiple stones, new‐ (third‐) generation lithotripter use, and pre‐SWL catheterization had statistically significant effects on lower stone‐free rates in patients who underwent SWL due to ureteral stones. A nomogram was developed to predict the success of SWL. As a result of the internal validation of the nomogram, it was concluded to be suitable for clinical use.

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Applying urinary ultrasound to predict the risk of spontaneous ureteral stone passage: a retrospective cohort study

Wang,

Di,

Qin

et al. 2024

BMC Urol

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Background To assess the value of urological ultrasound in predicting the risk of spontaneous passage of ureteral stones. Methods Clinical and ultrasound data were collected consecutively from patients receiving conservative treatment for ureteral stones, and the outcome of spontaneous passage was followed up for 1 month. Ultrasound variables independently associated with the risk of spontaneous stone passage were screened. A logistic regression prediction model was constructed based on the independent risk factors, and the discriminative efficacy and clinical utility of the prediction model in inferring the risk of spontaneous passing were assessed by the receiver operating characteristic (ROC) curve, calibration curve and clinical decision curve. Results A total of 163 patients undergoing conservative treatment for ureteral stones were included in the study, with a mean age of 45.95 ± 13.01 years. Among them, 47 cases (28.83%) experienced failure of spontaneous stone passage. Multivariable analysis revealed that stone length (OR: 2.622, P = 0.027), distal stone location (OR: 0.219, P = 0.003), and ureteral jetting frequency (OR: 6.541, P < 0.001) were independent risk factors for spontaneous stone passage. A prediction model incorporating stone length, stone location, and affected ureteral jetting frequency was developed to assess the risk of spontaneous stone passage. The area under the ROC curve was 0.814 (95% CI: 0.747–0.882), indicating good discriminatory power. The prediction model also demonstrated favorable net clinical benefit. Conclusion A prediction model based on ultrasound-derived stone length, location, and ureteral jetting frequency can accurately evaluate the risk of spontaneous stone passage in patients with ureteral stones, providing a basis for optimizing the clinical decision-making on ureteral stones, and has reliable clinical application value.

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Development and validation of a predictive model for stone-free failure after extracorporeal shockwave lithotripsy in patients with ureteral stone in a large prospective cohort

Cited by 3 publications

References 19 publications

The association between renal pelvis urine density and the risk of severe infectious complications in patient with symptom-free hydronephrosis after shock wave lithotripsy: a multi-center prospective study

The association between renal pelvis urine density and the risk of severe infectious complications in patient with symptom-free hydronephrosis after shock wave lithotripsy: a multi-center prospective study

A New Nomogram to Predict the Success of Shock Wave Lithotripsy in Ureteral Stones

Applying urinary ultrasound to predict the risk of spontaneous ureteral stone passage: a retrospective cohort study

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