The Most Reliable Preoperative Assessment of Renal Stone Burden as a Predictor of Stone-free Status After Flexible Ureteroscopy With Holmium Laser Lithotripsy: A Single-center Experience

Abstract

To examine which parameters should be measured to preoperatively determine the stone burden as predictors of stone-free (SF) status after a single flexible ureteroscopy (URS). Although several stone parameters reportedly influence the outcome of treatment for urinary stones, the most reliable indicators of stone burden remain unclear. Patients with renal stones treated by flexible URS with holmium laser lithotripsy between October 2009 and December 2011 at a single institute were retrospectively evaluated. The SF status was determined by kidney-ureter-bladder (KUB) films at postoperative day 1. Correlations of possible predictors with the SF status were analyzed using a logistic regression model. According to the univariate analysis, the following variables were significantly associated with failed treatment: number of stones (P = .001), cumulative stone diameter (CSD) (P < .001), stone surface area (SA) (P < .001), stone volume (P < .001), and presence of lower pole calculi (P = .008). According to the multivariate analysis, the stone volume (P < .001) and the CSD (P = .015) were found to be independent predictors of SF status. The SA (P = .598) had no significant independent influence on the SF status. Among the several parameters regarding the renal stone burden, the stone volume determined by noncontrast computed tomography and the CSD of the KUB were significantly and independently inversely related to the success rate of URS. Among the 3 parameters of stone burden, the SA was found to have a lower clinical utility and priority as a predictor of a SF status after URS.