Abstract
PurposeTo retrospectively assess the clinical utility in ureteroscopy (URS) planning of cumulative stone diameter (CSD), which does not account for stone width or depth, as a predictor of URS outcome and compare it with stone volume.Materials and MethodsPatients with renal stones treated at a single institute by flexible URS were retrospectively evaluated. To assess the clinical utility of CSD, relationships between stone-free (SF) status and stone burden (CSD and volume) were analyzed using the area under the receiver operating characteristics (AUROC) curve. To identify stone number impact on CSD, the AUROC of CSD divided by stone number was evaluated. Correlation coefficients of CSD and stone volume were also calculated for groups by stone number.ResultsIn cases with CSD <20.0 mm, CSD and stone volume revealed equal ability to predict SF status. In cases with CSD ≥20.0 mm, stone volume showed higher predictive ability. The ROC curves for cases with ≥4 stones showed that CSD was less predictive of SF status than stone volume. The correlation coefficients of CSD and stone volume by stone number were 0.922 for 1 stone, 0.900 for 2–3 stones, and 0.661 for ≥4 stones.ConclusionsIn cases with CSD ≥20.0 mm or ≥4 stones, we should evaluate stone volume for a more predictive stone burden, and pretreatment non-contrast CT seems sufficient. In cases with CSD <20.0 mm or 1–3 stones, CSD was as valid a predictor of preoperative stone burden as stone volume, so preoperative kidney-ureter-bladder (KUB) films may be sufficient.
Highlights
With the development of smaller caliber semirigid and flexible ureteroscopes, ureteroscopy (URS) has become a safer and more established modality for treating any type of urinary stone [1,2]
The ROC curves for cases with $4 stones showed that cumulative stone diameter (CSD) was less predictive of SF status than stone volume
We previously examined the utility and priority of three parameters of renal stone burden at URS and found that stone volume determined by non-contrast computed tomography (NCCT) and CSD obtained by kidney-ureter-bladder (KUB) films were significantly and independently predictive of stone status after URS [8]
Summary
With the development of smaller caliber semirigid and flexible ureteroscopes, ureteroscopy (URS) has become a safer and more established modality for treating any type of urinary stone [1,2]. Determining preoperative predictors of post-URS stone-free (SF) status remains crucial for maximizing the efficacy and safety of this procedure. There are no formal guidelines for the preoperative assessment of stone burden [8,9]. Several stone parameters that reflect stone burden, including the cumulative diameter, surface area (SA), and volume, have been considered in URS studies [8,9]. We previously examined the utility and priority of three parameters of renal stone burden (cumulative stone diameter [CSD], SA, and volume) at URS and found that stone volume determined by non-contrast computed tomography (NCCT) and CSD obtained by kidney-ureter-bladder (KUB) films were significantly and independently predictive of stone status after URS [8]
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