stone passage
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2022 ◽  
Author(s):  
Cagdas Senel ◽  
Ibrahim Can Aykanat ◽  
Ahmet Asfuroglu ◽  
Tanju Keten ◽  
Melih Balci ◽  
...  

Abstract Purpose: To investigate the role of inflammatory markers in predicting the spontaneous passage of ureteral stones. Methods: We retrospectively reviewed 279 patients with ureteral stones sized 4–10 mm that were managed conservatively. The patients were divided into two groups: Group 1 consisted of 137 patients who passed the stone spontaneously; Group 2 comprised 142 patients without spontaneous stone passage. The groups were compared using the Mann-Whitney U and chi-square tests. In addition, univariate and multivariate analyses were performed to identify the significance of the parameters. Results: The mean age of the patients was 41.2 years. The patients in Group 1 had a significantly lower mean stone size, white blood cell count and neutrophil count. In addition, stone location, presence of hydronephrosis and history of urolithiasis were significantly different between the groups. Neutrophil percentage, neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio were insignificantly lower in Group 1. In a multivariate analysis, stone size, distal location and hydronephrosis status significantly predicted the spontaneous stone passage. However, inflammatory markers including white blood cell count, neutrophil count and neutrophil-to-lymphocyte ratio could not determine the likelihood of spontaneous stone passage. Conclusion: Our results suggest that inflammatory markers are no meaningful parameters for the prediction of spontaneous stone passage.


PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260517
Author(s):  
Jee Soo Park ◽  
Dong Wook Kim ◽  
Dongu Lee ◽  
Taeju Lee ◽  
Kyo Chul Koo ◽  
...  

Objectives To develop a prediction model of spontaneous ureteral stone passage (SSP) using machine learning and logistic regression and compare the performance of the two models. Indications for management of ureteral stones are unclear, and the clinician determines whether to wait for SSP or perform active treatment, especially in well-controlled patients, to avoid unwanted complications. Therefore, suggesting the possibility of SSP would help make a clinical decision regarding ureteral stones. Methods Patients diagnosed with unilateral ureteral stones at our emergency department between August 2014 and September 2018 were included and underwent non-contrast-enhanced computed tomography 4 weeks from the first stone episode. Predictors of SSP were applied to build and validate the prediction model using multilayer perceptron (MLP) with the Keras framework. Results Of 833 patients, SSP was observed in 606 (72.7%). SSP rates were 68.2% and 75.6% for stone sizes 5–10 mm and <5 mm, respectively. Stone opacity, location, and whether it was the first ureteral stone episode were significant predictors of SSP. Areas under the curve (AUCs) for receiver operating characteristic (ROC) curves for MLP, and logistic regression were 0.859 and 0.847, respectively, for stones <5 mm, and 0.881 and 0.817, respectively, for 5–10 mm stones. Conclusion SSP prediction models were developed in patients with well-controlled unilateral ureteral stones; the performance of the models was good, especially in identifying SSP for 5–10-mm ureteral stones without definite treatment guidelines. To further improve the performance of these models, future studies should focus on using machine learning techniques in image analysis.


Author(s):  
Catherine Lovegrove

Miss Catherine Lovegrove1,2Mandy Spencer1Prof Ben Turney1,2Ms Naomi Neal1 1 Department of Urology, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK2 University of Oxford Nuffield Department of Surgical Sciences, Oxford, Oxfordshire, UK   Background NICE guidance recommends patients with renal colic be offered surgical treatment, including extracorporeal shockwave lithotripsy (ESWL), within 48 hours if pain is uncontrolled or stones unlikely to pass. We compared outcomes for ureteric stone passage after ESWL with those of observation to ascertain the relative benefits of ESWL. Methods We collected data on stone location, size and number of ESWL treatments required prospectively over 18 months. Stone passage was confirmed radiologically. Data were compared with MIMIC, a multi-centre collaborative study examining spontaneous stone passage after observation alone. Results 166 patients had ESWL for ureteric stones. Median size was 6.5mm (IQR 5.0-8.0mm). 57.2% (N=95) were proximal stones. Smaller stones required fewer treatments (P=0.003). Patients with a ureteric stone <5mm required median 1.0 ESWL treatments (IQR 1.0-2.0). Ureteric stones 5-7mm had median 1.0 treatments (IQR 1.0-2.0) and stones >7mm median 2.0 treatments (IQR 1.0-2.0). Compared to MIMIC, patients with ESWL for stones <5mm were 11% more likely to achieve stone clearance (100.0% vs 89.0%, P=0.001). ESWL for 5-7mm stones had 28.1% greater clearance compared to observation (77.1% vs. 49.0%, P<0.001) and ESWL for stones >7mm 21% greater likelihood of clearance (50.0% vs. 29.0%, P<0.001). Proximal ureteric stones were 16.4% more likely to pass with ESWL than observation (68.4% vs 52%, P=0.02). Distal stones showed similar passage with ESWL (77.5%) and observation (83.0%), P=0.43. Conclusions Proximal ureteric stones and those >5mm stones benefit most from ESWL. Results aid identification of patients whose stones are less likely to pass and warrant urgent review to consider ESWL.


Urology ◽  
2021 ◽  
Author(s):  
Stephen V. Jackman ◽  
Avinash Maganty ◽  
Allan B. Wolfson ◽  
Pamela K. Burrows ◽  
Cora MacPherson ◽  
...  

2021 ◽  
Vol 206 (Supplement 3) ◽  
Author(s):  
Eric Ghiraldi ◽  
Stephanie Hanchuk ◽  
Matthew Buck ◽  
Hari Nair ◽  
Dinesh Singh ◽  
...  
Keyword(s):  

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
C Lovegrove ◽  
M Spencer ◽  
B Turney ◽  
N Neal

Abstract Aim NICE guidance recommends patients with renal colic be offered surgical treatment, including extracorporeal shockwave lithotripsy (ESWL), within 48 hours if pain is uncontrolled or stones unlikely to pass. We compared outcomes for ureteric stone passage after ESWL with those of observation to ascertain the relative benefits of ESWL. Method We collected data on stone location, size, and number of ESWL treatments required prospectively over 18 months. Stone passage was confirmed radiologically. Data were compared with MIMIC, a multi-centre collaborative study examining spontaneous stone passage after observation alone. Results 166 patients had ESWL for ureteric stones. Median size was 6.5mm (IQR 5.0-8.0mm). 57.2% (N = 95) were proximal stones. Smaller stones required fewer treatments (P = 0.003). Patients with a ureteric stone &lt;5mm required median 1.0 ESWL treatments (IQR 1.0-2.0). Ureteric stones 5-7mm had median 1.0 treatments (IQR 1.0-2.0) and stones &gt;7mm median 2.0 treatments (IQR 1.0-2.0). Compared to MIMIC, patients with ESWL for stones &lt;5mm were 11% more likely to achieve stone clearance (100.0% vs 89.0%, P = 0.001). ESWL for 5-7mm stones had 28.1% greater clearance compared to observation (77.1% vs. 49.0%, P &lt; 0.001) and ESWL for stones &gt;7mm 21% greater likelihood of clearance (50.0% vs. 29.0%, P &lt; 0.001). Proximal ureteric stones were 16.4% more likely to pass with ESWL than observation (68.4% vs 52%, P = 0.02). Distal stones showed similar passage with ESWL (77.5%) and observation (83.0%), P = 0.43. Conclusions Proximal ureteric stones and those &gt;5mm stones benefit most from ESWL. Results aid identification of patients whose stones are less likely to pass and warrant urgent review to consider ESWL.


2021 ◽  
Vol 206 (Supplement 3) ◽  
Author(s):  
Maria Pere ◽  
Avinash Maganty ◽  
Allan Wolfson ◽  
Pamela Burrows ◽  
Cora MacPherson ◽  
...  

2021 ◽  
Vol 71 (3) ◽  
pp. 823-26
Author(s):  
Ahsan Rafi ◽  
Wajahat Aziz ◽  
Hammad Ather

Objective: To determine the frequency and factors responsible for access failure during primary ureteroscopy (URS). Study Design: Cross-sectional study. Place and Duration of Study: Aga Khan University, Karachi Pakistan, from Jan to Jul 2019. Methodology: All patients undergoing Ureterorenoscopy for upper urinary tract urolithiasis were included. Ureterorenoscopy was performed with either semi rigid, rigid digital or fiber opticflexible ureterorenoscope as appropriate. Data was collected for demographics, history of stone passage, previous Ureterorenoscopy /double J stenting and history of stent placement. Preoperative imaging reviewed for stone location, size and number. Level of access failure (proximal/mid/distal ureter) was noted. Post-operative complications and need of ancillary procedure was noted. Results: We included 250 participants undergoing ureteroscopy for the upper urinary tract calculi. Mean age of the patients was 44.15 ± 13.76 years. Mean stone size was 9.12 ± 4.23mm. Overall access failure rate was found to be 8% (20/250), all required an ancillary procedure. None of the patients with previous history of endoscopic intervention or stone passage had access failure. On univariate and multivariate analysis only stone location was found to be significant factor predicting access failure. Conclusion: Failure to access is not uncommon during primary ureteroscopy. Access failure is more common in proximal ureteral stone and in patients with no previous episode of ureteral stones and procedure. Information from this study will help in counseling patients’ pre-operatively and may be a guide to urologists on pre stenting of selected patients at high risk of access failure.


2021 ◽  
Vol 16 (3) ◽  
Author(s):  
Nassib Abou Heidar ◽  
Muhieddine Labban ◽  
David-Dan Nguyen ◽  
Adnan El-Achkar ◽  
Mazen Mansour ◽  
...  

Introduction: Recent studies have shown that software-generated 3D stone volume calculations are better predictors of stone burden than measured maximal axial stone diameter. However, no studies have assessed the role of formula estimated stone volume, a more practical and cheaper alternative to software calculations, to predict spontaneous stone passage (SSP). Methods: We retrospectively included patients discharged from our emergency department on conservative treatment for ureteral stone (≤10 mm). We collected patient demographics, comorbidities, and laboratory tests. Using non-contrast computed tomography (CT) reports, stone width, length, and depth (w, l, d, respectively) were used to estimate stone volumes using the ellipsoid formula: V=π*l*w*d*0.167. Using a backward conditional regression, two models were developed incorporating either estimated stone volume or maximal axial stone diameter. A receiver operator characteristic (ROC) curve was constructed and the area under the curve (AUC) was computed and compared to the other model. Results: We included 450 patients; 243 patients (54%) had SSP and 207 patients (46%) failed SSP. The median calculated stone volume was significantly smaller among patients with SSP: 25 (14–60) mm3 vs. 113 (66–180) mm3 (p<0.001). After adjusting for covariates, predictors of retained stone included: neutrophil to lymphocyte ratio (NLR) ≥3.14 (odds ratio [OR] 6, 95 % confidence interval [CI] 3.49–10.33), leukocyte esterase (LE) >75 (OR 4.83, 95% CI 2.12–11.00), and proximal stone (OR 2.11, 95% CI 1.16–3.83). For every 1 mm3 increase in stone volume, the risk of SSP failure increased by 2.5%. The model explained 89.4% (0.864–0.923) of the variability in the outcome. This model was superior to the model including maximal axial diameter (0.881, 0.847–0.909, p=0.04). Conclusions: We present a nomogram incorporating stone volume to better predict SSP. Stone volume estimated using an ellipsoid formula can predict SSP better than maximal axial diameter.


Author(s):  
Parth M. Patel ◽  
Alexander M. Kandabarow ◽  
Victor S. Chen ◽  
Hannah Slovacek ◽  
Abrar Mian ◽  
...  

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