You have accessJournal of UrologyStone Disease: Surgical Therapy V (MP65)1 Sep 2021MP65-20 ON THE ROCKS: CAN UROLOGISTS IDENTIFY STONE COMPOSITION BASED ON ENDOSCOPIC IMAGES ALONE? A WORLDWIDE SURVEY OF UROLOGISTS Joseph Randall, Bristol Whiles, Raphael Carrera, Jeffrey Thompson, David Duchene, Donald Neff, and Wilson Molina Joseph RandallJoseph Randall More articles by this author , Bristol WhilesBristol Whiles More articles by this author , Raphael CarreraRaphael Carrera More articles by this author , Jeffrey ThompsonJeffrey Thompson More articles by this author , David DucheneDavid Duchene More articles by this author , Donald NeffDonald Neff More articles by this author , and Wilson MolinaWilson Molina More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002105.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: At over $2 billion annually, nephrolithiasis is the second most expensive urologic disease in the United States. Medical prevention relies heavily on laboratory identification of a stone’s chemical composition. We identified an opportunity for cost reduction by sending fewer stones for analysis, particularly in cases where composition is readily determined endoscopically. However, it remains unclear if urologists can reliably predict stone composition based on intraoperative appearance alone. Our objective was to assess urologists’ ability to identify stone composition based on a single, static endoscopic image. METHODS: We captured intraoperative images depicting physical appearance of stones and determined the composition by chemical analysis. We built a survey with images of 10 different stones, representing 6 stone types: calcium oxalate (CaOx) monohydrate, CaOx dihydrate, calcium phosphate (CaP), cystine, struvite, and uric acid. The survey was distributed to members of the Endourological Society and the South Central Section of the American Urological Association. We asked respondents to predict stone composition based on a single image. An exact binomial test with Bonferroni correction assessed respondents’ accuracy. We used linear regression to determine if years of experience, fellowship training, or self-perceived ability to identify stone types improved accuracy. RESULTS: In total, 366 respondents completed the survey. Most were from academic institutions (69%), were fellowship-trained endourologists (57%), and practiced outside of the United States (66%). The majority successfully identified the two images of CaOx monohydrate stones, with success rates of 70% and 63%. For CaOx dihydrate stones (2 images), success rates were 56% and 51%. CaP stones (2 images) were frequently misidentified, with success rates of 23% (brushite) and 10% (apatite). The apatite stone was commonly misclassified as CaOx monohydrate (52%). Additional success rates were: 75% and 38% for struvite (2 images), 42% for uric acid (1 image), and 14% for cystine (1 image). Fellowship training and self-perceived ability improved accuracy by 4% (p=0.01) and 16% (p<0.001) respectively. CONCLUSIONS: Certain stone types, especially CaOx, can be identified by a single static image, potentially reducing unnecessary laboratory costs. Since we only used single images, real-world intraoperative identification could be greater than we predict. Further studies using endoscopic videos during lithotripsy rather than images alone are warranted. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1127-e1128 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Randall More articles by this author Bristol Whiles More articles by this author Raphael Carrera More articles by this author Jeffrey Thompson More articles by this author David Duchene More articles by this author Donald Neff More articles by this author Wilson Molina More articles by this author Expand All Advertisement Loading ...