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PLOS ONE  2013 

Utility and Limitation of Cumulative Stone Diameter in Predicting Urinary Stone Burden at Flexible Ureteroscopy with Holmium Laser Lithotripsy: A Single-Center Experience

DOI: 10.1371/journal.pone.0065060

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Abstract:

Purpose To 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 Methods Patients 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. Results In 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. Conclusions In 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.

References

[1]  Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, et al. (2007) EAU/AUA Nephrolithiasis Guideline Panel. 2007 guideline for the management of ureteral calculi. J Urol 178(6): 2418–34.
[2]  Tiselius HG, Ackermann D, Alken P, Buck C, Conort P, et al. (2001) Working Party on Lithiasis, European Association of Urology. Guidelines on urolithiasis. Eur Urol 40(4): 362–71.
[3]  Breda A, Ogunyemi O, Leppert JT, Schulam PG (2009) Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Eur Urol 55(5): 1190–6.
[4]  Riley JM, Stearman L, Troxel S (2009) Retrograde ureteroscopy for renal stones larger than 2.5 cm. J Endourol 23(9): 1395–8.
[5]  Mariani AJ (2007) Combined electrohydraulic and holmium:YAG laser ureteroscopic nephrolithotripsy of large (greater than 4 cm) renal calculi. J Urol 177(1): 168–73.
[6]  Tan PK, Tan EC, Tung KH, Foo KT (1995) Extracorporeal shock wave lithotripsy monotherapy for selected staghorn stones. Singapore Med J 36(1): 53–5.
[7]  Lam HS, Lingeman JE, Barron M, Newman DM, Mosbaugh PG (1992) Staghorn calculi: analysis of treatment results between initial percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy monotherapy with reference to surface area. J Urol 147(5): 1219–25.
[8]  Ito H, Kawahara T, Terao H, Ogawa T, Yao M (2012) 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. Urology 80(3): 524–8.
[9]  Hyams ES, Bruhn A, Lipkin M, Shah O (2010) Heterogeneity in the reporting of disease characteristics and treatment outcomes in studies evaluating treatments for nephrolithiasis. J Endourol 24(9): 1411–4.
[10]  Ito H, Kawahara T, Terao H, Ogawa T, Yao M (2012) Predictive value of attenuation coefficients measured as hounsfield units on noncontrast computed tomography during flexible ureteroscopy with holmium laser lithotripsy: a single-center experience. J Endourol 26(9): 1125–30.
[11]  Eisner BH, Kambadakone A, Monga M, Anderson JK, Thoreson AA (2009) Computerized tomography magnified bone windows are superior to standard soft tissue windows for accurate measurement of stone size: an in vitro and clinical study. J Urol 181(4): 1710–5.
[12]  Bewick V, Cheek L, Ball J (2004) Statistics review 13: Receiver operating characteristic (ROC) curves. Crit Care 8: 508–512.
[13]  Narepalem N, Sundaram CP, Boridy IC (2002) Comparison of helical computerized tomography and plain radiography for estimating urinary stone size. J Urol 167(3): 1235–8.
[14]  Parsons JK, Lancini V, Shetye K (2003) Urinary stone size: comparison of abdominal plain radiography and noncontrast CT measurements. J Endourol 17(9): 725–8.
[15]  Dundee P, Bouchier-Hayes D, Haxhimolla H (2006) Renal tract calculi: comparison of stone size on plain radiography and noncontrast spiral CT scan. J Endourol 20(12): 1005–9.

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