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Formula for predicting the impaction of ureteral stones

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Abstract

The purpose of the study was to investigate variables that may predict ureteral stone impaction and create a new model to predict more accurately stone impaction based on preoperative NCCT findings. Data of 238 patients who underwent URS were analyzed. Stone size, stone location, Hounsfield unit (HU) value of the stone, ureteral wall thickness (UWT) and grade of hydronephrosis were recorded. HU values of the ureter which are measured proximal and distal to the stone were recorded. Subsequently, we determined the factors that could predict the stone impaction in univariate and multivariate logistic regression analysis. After the AUC analysis for these factors, we created a new model to predict more accurately stone impaction. The formula was named Impacted Stone Formula (ISF). Stone impaction verified endoscopically. Predictors of impacted stones were evaluated using univariate and multivariate logistic regression analyses. Diagnostic value for the prediction of stone impaction was analyzed with receiver operating characteristic (ROC) incline. Overall, there were 196 patients included in the study. Multivariate regression analysis revealed that the HU below/above ratio, UWT, and grade of hydronephrosis were the crucial predictors of stone impaction (OR 20.53, p < 0.001; OR 10.55, p < 0.001; OR 5.95, p = 0.004, respectively). The ROC analysis revealed a cutoff value of 15.15 (AUC 0.958, p < 0.001, sensitivity 91.0%, specificity 97.7%) for the ISF. In conclusion, ISF is the most precise preoperative predictor of impacted stones in patients with ureteral stones. ISF could be used by the urologists before treatment to help preoperative planning and perioperative clinical course.

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Abbreviations

AUC:

Area under curve

BMI:

Body mass index

CT:

Computed tomography

HU:

Hounsfield unit

ISF:

Impacted stone formula

NCCT:

Non-contrast computed tomography

OR:

Odds ratio

ROC:

Receiver operating characteristic

SWL:

Shock wave lithotripsy

URS:

Ureterorenoscopy

UWT:

Ureteral wall thickness

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Authors and Affiliations

  1. Department of Urology, Okmeydanı Training and Research Hospital, 34384, Şişli-Istanbul, Turkey

    Sait Özbir, Osman Can, Hasan Anıl Atalay, Halil Lütfi Canat, Süleyman Sami Çakır & Alper Ötünçtemur

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  1. Sait Özbir
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  2. Osman Can
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  3. Hasan Anıl Atalay
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  4. Halil Lütfi Canat
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Correspondence to Sait Özbir.

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Özbir, S., Can, O., Atalay, H.A. et al. Formula for predicting the impaction of ureteral stones. Urolithiasis 48, 353–360 (2020). https://doi.org/10.1007/s00240-019-01152-y

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