Abstract
Purpose
To develop and validate a nomogram for predicting stone-free failure after shock wave lithotripsy (SWL) guided by ultrasound in patients with ureteral stones.
Methods
The development cohort consisted of 1698 patients who underwent SWL guided by ultrasound at our center from June 2020 through August 2021. Multivariate unconditional logistic regression analysis was used for building a predictive nomogram with regression coefficients. An independent validation cohort consisted of 712 consecutive patients from September 2020 through April 2021. The performance of the predictive model was assessed in regard to discrimination, calibration, and clinical usefulness.
Results
Predictors of stone-free failure included distal stone location (odds ratio = 1.540, P < 0.001), larger stone size (odds ratio = 1.722, P < 0.001), higher stone density (odds ratio = 1.722, P < 0.001), larger skin to stone distance (SSD) (odds ratio = 1.058, P < 0.001), and higher grade of hydronephrosis (odds ratio = 1.755, P = 0.010). For the validation cohort, the model showed good discrimination with an area under the receiver operating characteristic curve of 0.925 (95% confidence interval, 0.898, 0.953) and good calibration (unreliability test, P = 0.412). Decision curve analysis demonstrated that the model was also clinically useful.
Conclusions
This study demonstrated that stone location, stone size, stone density, SSD, and hydronephrosis grade were significant predictors of stone-free failure after SWL guided by ultrasound in patients with ureteral stones. This may guide clinical practice.
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Acknowledgements
We give special thanks to all the colleagues at the Department of Urology of Shengjing Hospital for their help and support. We thank International Science Editing (http://www.internationalscienceediting.com) for editing this manuscript. The authors would like to thank all of the study participants.
Funding
This study was financially supported by the 345 Talent Project of Shengjing Hospital, Natural Science Foundation of Liaoning Science and Technology Department (2020-BS-093), and Natural Science Foundation of Liaoning Education Department (QN2019013). These sponsors had no role in the study design; in the collection, analysis or interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
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SB and ZL had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. SB and ZL: Protocol/project development. XY, JL, CP, GL, and SB: Data collection or management. XY, and SB: Data analysis. XY, ZL, and SB: Manuscript writing/editing.
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Song Bai certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: none.
Ethical statement
Ethical approval (2020PS520K) was provided by the Ethics Committee of Shengjing Hospital Affiliated China Medical University. Informed consent from all eligible subjects were obtained. The clinical research registry UIN is ChiCTR2000033789. The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki.
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345_2023_4358_MOESM1_ESM.tif
Supplementary figure 1. Flow chart of development and validation cohort. SWL, extracorporeal shock wave lithotripsy; CT, computer tomograph. (TIF 463 KB)
345_2023_4358_MOESM2_ESM.tif
Supplementary figure 2. Discrimination, calibration, and decision curve analysis for the model. A. ROC in the development cohort; B. ROC in the validation cohort. C. Calibration plot. D. Decision Curve Analysis. ROC, receiver operating characteristic curve. (TIF 5412 KB)
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Yin, X., Li, J., Pan, C. et al. Development and validation of a predictive model for stone-free failure after extracorporeal shockwave lithotripsy in patients with ureteral stone in a large prospective cohort. World J Urol 41, 1431–1436 (2023). https://doi.org/10.1007/s00345-023-04358-3
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DOI: https://doi.org/10.1007/s00345-023-04358-3