The effect of stone size on the results of extracorporeal shockwave lithotripsy versus semi-rigid ureteroscopic lithotripsy in the management of upper ureteric stones

BACKGROUND: The overall probability that an individual will form stones varies in different regionsof the world. The risk of having urinary tract stones in the developed country populations is between 10-15%. The prevalence of urinary tract stone disease is 13% for adult males and 7% among the females.Most of the patients with ureteric stones present with colicky pain, however some may be asymptomaticand are identified on routine assessment. Large stones typically require active treatment. Stones that donot pass can be removed by different treatment modalities such as Extracorporeal shock wave lithotripsy(ESWL), Ureteroscopic lithotripsy (URSL) and open or laparoscopic ureterolithotomy.OBJECTIVE: To compare the efficacy of Ureteroscopic lithotripsy versus extracorporeal shockwavelithotripsy in the treatment of proximal ureteric stones of size between 10mm to 15mm.MATERIALS AND METHODS: This was a randomized control trial of 138 human subjects,conducted at Department of Urology, Institute of Kidney Diseases, Hayatabad Medical Complex,Peshawar. Total sample size was based on the previously reported stone clearance rates for proximalureteric stones (88% URSL12 and 67.5% for ESWL11), 95% confidence interval and power of 90%.RESULTS: In this study mean age was 47.36 years SD +15.4. Fifty nine percent patients were male and41% patients were female. Eighteen percent patients had stone size 10mm, 19.6% patients had stone size11mm, 19.6% patients had stone size 12mm, 16.7% patients had stone size 13mm, 13.6 patients hadstone size 14mm, 11.6% patients had stone size 15mm. ESWL was effective in 65.2% and was notsuccessful in 34.8%, while in the URSL group 84.1% were treated successfully and in 15.9% patientswith proximal ureteric stones the stone clearance efficacy was not effective.CONCLUSION: Both URSL & ESWL are well accepted minimally invasive modalities of treatmentfor proximal ureteric stones. We conclude that URSL has yielded superior results as compared to theESWL group in treatment of patients with proximal ureteric stones of size 1-1.5cm.KEY WORDS: Ureteroscopic lithotripsy, extracorporeal shockwave lithotripsy, proximal ureteric stones.

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The use of an Artificial Neural Network (ANN) in the evaluation of the Extracorporeal Shockwave Lithotripsy (ESWL) as a treatment of choise for urinary lithiasis.

10.1101/2020.08.11.20172965 ◽

2020 ◽

Author(s):

Athanasios Tsitsiflis ◽

Yiannis Kiouvrekis ◽

Georgios Chasiotis ◽

Georgios Perifanos ◽

Stavros Gavras ◽

...

Keyword(s):

Neural Network ◽

Artificial Neural Network ◽

Univariate Analysis ◽

Extracorporeal Shockwave Lithotripsy ◽

Shockwave Lithotripsy ◽

Stone Size ◽

Extracorporeal Shockwave ◽

Urinary Lithiasis ◽

Artificial Neural ◽

Artificial Neural Network Ann

Purpose: Artificial Neural Networks (ANNs) are simplified computational models simulating the central nervous system. They are widely applied in medicine, since they substantially increase the sensitivity and specificity of the diagnosis, classification and the prognosis of a medical condition. In this study we constructed an artificial neural network to evaluate several parameters of extracorporeal shockwave lithotripsy (ESWL), such as the outcome and safety of the procedure. Materials and methods: Patients with urinary lithiasis suitable for ESWL treatment were enrolled. An artificial neural network (ANN) was designed and a unique algorithm was executed with the use of the well-known numerical computing environment, MATLAB. Medical data were collected from all patients and 12 nodes were used as inputs (sex, age, B.M.I. (Body Mass Index), stone location, stone size, comorbidity, previous ESWL sessions, analgesia, number of shockwaves, shockwave intensity, presence of a ureteral stent and hydronephrosis). Conventional statistical analysis was also performed. Results: 716 patients were finally included in our study. Univariate analysis revealed that diabetes and hydronephrosis were positively correlated to the ESWL complications. Regarding efficacy, univariate analysis revealed that stone location, stone size, the number and density of shockwaves delivered and the presence of a stent in the ureter were independent factors of the ESWL outcome. This was further confirmed when adjusted for sex and age in a multivariate analysis.The performance of the ANN (predictive/real values) at the end of the training state reached 98,72%. The four basic ratios (sensitivity, specificity, PPV, NPV) were calculated for both training and evaluation data sets. The performance of the ANN at the end of the evaluation state was 81,43%. Conclusions: Our ANN achieved high score in predicting the outcome and the side effects of the extracorporeal shockwave lithotripsy treatment for urinary stones. In fact, the accuracy of the network may further improve by using larger sets of data, different architecture in designing the model or using different set of input variables, making ANNs thus, a quite promising instrument for effective, precise and swift medical diagnosis.

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