InsKid-a new mobile application (app) that measures the infundibulopelvic angle before retrograde intrarenal surgery more reliably than does other approaches: pilot study.

Abstract

This study compared our program's ("InsKid") capability for measuring the infundibulopelvic angle (IPA) with existing ones. Prospectively, data from 50 patients with lower pole kidney stones with indications for retrograde intrarenal surgery (RIRS) were collected. All patients underwent computed tomography (CT)-urography. The IPA of each pelvicalyceal (PCS) unit was measured with the Elbahnasy's, Sampaio's, and "InsKid" methods. Results were compared. Finally, we compared the area under the receiver operating characteristic (ROC) curve (AUC) for predicting stone-free status after RIRS. We defined success as stone fragments ≤ 2mm on the CT scan on the first postoperative day (POD1). The stone-free rate refers to no identifiable stone fragments on the POD1 CT. Test-retest reliability and face validity were defined to estimate psychometric properties of InsKid. The success rate after first procedure was 87.5%. The average value of IPA using the Elbahnasy and Sampaio methods and our program were 85.2° ± 11.9°, 95.1° ± 10.1°, and 79.9° ± 13.0, respectively. There was a significant difference among the InsKid, Elbahnasy, and Sampaio (AUC = 0.762, 0.601, and 0.629, respectively) approaches with respect to the capability of predicting the immediate success of RIRS. Repeated measurement did not affect values of IPA (1.3° ± 0.7, p = 0.67). All specialist appreciated proposed software as highly useful (5/5). This new application reproduces the intraoperative aspects of the PCS more clearly than the other methods and also provides an easy solution for clearly defining the IPA without relying on the central axes.