Is there a superiority of the stone volume measured in 3-D non-contrast tomography to the stone area in predicting the stone-freeness of the retrograde intrarenal surgery success?

Yıl 2023, Cilt: 16 Sayı: 2, 258 - 264, 05.04.2023

Yurdaer Kaynak , Hakan Kılıçarslan , Emre Okeer , Burhan Coşkun

https://doi.org/10.31362/patd.1190940

Öz

Objectives: To examine the predictive effect of preoperative stone volume (SV) against stone area (SA) on stone-free status (SF) following retrograde ıntrarenal surgery (RIRS).
Materials and methods: We retrospectively examined the medical records of 68 RIRS patients with renal calculi who were eligible. Patients having Non-Contrast Tomography (NCCT) before and subsequent to RIRS were included, however staghorn stones and inability to access were omitted. SF status was determined by the absence of visible stones on the NCCT three months after RIRS. Using a software reconstruction tool using 3-D NCCT, a radiologist determined stone load characteristics, such as SA and SV. Using a logistic regression model, the assessment of potential SF status determinants was conducted.
Results: Age, stone density, quantity and position of stones, usage of access sheath, failed prior SWL, and procedures were not substantially linked with non-SF status, however gender (p=0.014), SA (p=0.001), and SV (p=0.002) were strongly associated with non-SF status. The association between SV and SA was strong (r=0.866, p<0.001). A pairwise assessment of the ROC curves for SV and SA revealed no statistically significant difference in their specificities (p=0.274). Nevertheless, the multivariate analysis showed that SA was the sole independent predictor of SF status (p=0.001).
Conclusions: Both SA and SV were strongly suggestive of SF status after the RIRS. However, SA was only identified as an independent predictor of SF status after RIRS and as a sufficient predictor of SF status after RIRS.

Anahtar Kelimeler

stone burden, 3-D measurement, lazer litotripsi, success treatment

Destekleyen Kurum

yok

Teşekkür

-

Retrograd intrarenal cerrahinin taşsızlığını öngörmede üç boyutlu kontrastsız bilgisayarlı tomografi ile ölçülen taş volümünün taş alanına bir üstünlüğü var mıdır?

Öz

Amaç: Retrograd intrarenal cerrahi (RIRC) sonrasında preoperatif taş volümü (TV) ve taş alanı (TA) ölçümlerinin taşsızlık durumu (TD) üzerine prediktif etkisini değerlendirmek.
Gereç ve yöntem: Böbrek taşları için RIRC yapılan, çalışma kriterlerine uygun 68 hastanın medikal kayıtlarını retrospektif olarak değerlendirdik. Operasyon öncesi ve sonrası kontrastsız bilgisayarlı tomografileri (KBT) olan hastalar çalışmaya dahil edilirken, sataghorn taşı olan ve taşa ulaşılamayan hastalar çalışma dışı bırakıldı. TD durumu RIRC operasyonu sonrasındaki 3. aydaki KBT’de görülebilir taş olmaması olarak tanımlandı. Bir radyolog 3 boyutlu KBT üzerindeki bir yazılım programı kullanarak TA ve TV gibi taş yükü karakteristiklerini tespit etti. Lojistik regresyon analizleri kullanılarak potansiyel TD tanımlayıcılarının değerlendirilmesi yapıldı.
Bulgular: TD ile taşın dansisitesi, lokalizasyonu ve sayısı, erişim kılıfı kullanımı, önceden geçirilmiş başarısız SWL ve operasyonlar ilişkili bulunmazken, cinsiyet, TA ve TV güçlü şekilde ilişkili bulundu (p=0,014), (p<0,001), ve (p=0,002), sırasıyla. TA ve TV’nin pairwise ROC eğri analizleri kıyaslandığında özgünlükleri açısından TD belirlemede aralarında istatistiki anlamlı bir fark olmadığı görüldü (p=0.274). Bununla birlikte, multivariate analizler SA’nın TD’yi belirlemede tek bağımsız prediktör olduğunu ortaya koydu (p=0,001).
Sonuç: Hem SA hem de SV RIRC operasyonu sonrasında TD’yi tahmin etmede fikir vericidir. Bununla birlikte SA, RIRC operasyonu sonrasında TD’yi bilmede tek bağımsız prediktördür ve tek başına yeterlidir.

Anahtar Kelimeler

Taş yükü, 3 boyutlu ölçüm, lazer litotripsi, tedavi başarısı

Kaynakça

• 1.Hiroki Ito, Takashi Kawahara, Hideyuki Terao, Takehiko Ogawa, Masahiro Yao, Yoshinobu Kubota, Januchi Matsuzaki. Evaluation of preoperative measurement of stone surface area as a predictor of stone- free status after combined ureteroscopy with holmium laser lithotripsy: A single-center experience. J. Endourol 2013; 27: 715-721 doi: 10.1089/end.2012.0548. Epub 2013 Apr 3
• 1.Hiroki Ito, Takashi Kawahara, Hideyuki Terao, Takehiko Ogawa, Masahiro Yao, Yoshinobu Kubota, Januchi Matsuzaki. Evaluation of preoperative measurement of stone surface area as a predictor of stone- free status after combined ureteroscopy with holmium laser lithotripsy: A single-center experience. J. Endourol 2013; 27: 715-721 doi: 10.1089/end.2012.0548. Epub 2013 Apr 3
• 2. Alberto Breda, Oreoluwa Ogunyemi, John T. Leppert, Peter G. Schulam. Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Euro Urol 2009; 55: 1190-1197.doi: 10.1016/j.eururo.2008.06.019. Epub 2008 Jun 13 3. Mudassar Hussain, Peter acher, Branamir Penev, Mark cynk. Redefining the limits of flexible ureterenoscopy. J Endourol 2011;25:45-49.doi: 10.1089/end.2010.0236. Epub 2010 Nov 4
• 2. Alberto Breda, Oreoluwa Ogunyemi, John T. Leppert, Peter G. Schulam. Flexible ureteroscopy and laser lithotripsy for multiple unilateral intrarenal stones. Euro Urol 2009; 55: 1190-1197.doi: 10.1016/j.eururo.2008.06.019. Epub 2008 Jun 13 3. Mudassar Hussain, Peter acher, Branamir Penev, Mark cynk. Redefining the limits of flexible ureterenoscopy. J Endourol 2011;25:45-49.doi: 10.1089/end.2010.0236. Epub 2010 Nov 4
• 4. Hiroki Ito, Takashi Kawahara, Hideyuki Terao, Takehiko Ogawa, Mashiıro Yao, Yoshinobu Kubota, Januchi Matsuzaki .The most reliable preoperative assessment of stone burden as a predictor of stone-free status after flexible ureteroscopy with holmium laser lithotripsy: A single center experience. 2012 Urology; 80: 524-528.doi: 10.1016/j.urology.2012.04.001. Epub 2012 Jun 1. PMID: 22658621
• 4. Hiroki Ito, Takashi Kawahara, Hideyuki Terao, Takehiko Ogawa, Mashiıro Yao, Yoshinobu Kubota, Januchi Matsuzaki .The most reliable preoperative assessment of stone burden as a predictor of stone-free status after flexible ureteroscopy with holmium laser lithotripsy: A single center experience. 2012 Urology; 80: 524-528.doi: 10.1016/j.urology.2012.04.001. Epub 2012 Jun 1. PMID: 22658621
• 5. Shine S. Urinary calculus: IVU vs. CT renal stone? A critically appraised topic. Abdom Imaging 2008; 33: 41–3 doi: 10.1007/s00261-007-9307-0
• 5. Shine S. Urinary calculus: IVU vs. CT renal stone? A critically appraised topic. Abdom Imaging 2008; 33: 41–3 doi: 10.1007/s00261-007-9307-0
• 6. Worster A, Preyra I, Weaver B, Haines T. The accuracy of noncontrast helical computed tomography versus intravenous pyelography in the diagnosis of suspected acute urolithiasis: a meta-analysis. Ann Emerg Med 2002; 40: 280–286. doi: 10.1067/mem.2002.126170
• 6. Worster A, Preyra I, Weaver B, Haines T. The accuracy of noncontrast helical computed tomography versus intravenous pyelography in the diagnosis of suspected acute urolithiasis: a meta-analysis. Ann Emerg Med 2002; 40: 280–286. doi: 10.1067/mem.2002.126170
• 7. C. Turk (chair), T. Knoll (vice-chair), A. Petrik, K. Sarica, C. Seitz, A. Skolarikos, M. Straub: EAU guidelines on urolithiasis, 2013.
• 7. C. Turk (chair), T. Knoll (vice-chair), A. Petrik, K. Sarica, C. Seitz, A. Skolarikos, M. Straub: EAU guidelines on urolithiasis, 2013.
• 8.Yoshida S, Hayashi T, Morozumi M, Osada H, Honda N, Yamada T. Three-dimensional assessment of urinary stone on non-contrast helical computed tomography as the predictor of stone-street formation after extracorporeal shock wave lithotripsy for stones smaller than 20 mm. Int J Urol 2007; 14: 665–7V DOI: 10.1111/j.1442-2042.2007.01767.x
• 8.Yoshida S, Hayashi T, Morozumi M, Osada H, Honda N, Yamada T. Three-dimensional assessment of urinary stone on non-contrast helical computed tomography as the predictor of stone-street formation after extracorporeal shock wave lithotripsy for stones smaller than 20 mm. Int J Urol 2007; 14: 665–7V DOI: 10.1111/j.1442-2042.2007.01767.x
• 9. Bandi G, Meiners RJ, Pickhardt PJ, Nakada SY. Stone measurement by volumetric three-dimensional computed tomography for predicting the outcome after extracorporeal shock wave lithotripsy. BJU Int 2009; 103:524–8 doi: 10.1111/j.1464-410X.2008.08069.x. Epub 2008 Oct 31
• 9. Bandi G, Meiners RJ, Pickhardt PJ, Nakada SY. Stone measurement by volumetric three-dimensional computed tomography for predicting the outcome after extracorporeal shock wave lithotripsy. BJU Int 2009; 103:524–8 doi: 10.1111/j.1464-410X.2008.08069.x. Epub 2008 Oct 31
• 10. H-G Tiselius, P. Alken, C. Buck, M. Gallucci, T Knoll, K. Sarica, Chr. Turk. EAU guidelines on urolithiasis 2008.
• 10. H-G Tiselius, P. Alken, C. Buck, M. Gallucci, T Knoll, K. Sarica, Chr. Turk. EAU guidelines on urolithiasis 2008.
• 11. William Finch, Richard Johnston, Nadeem Shaida, Andrew Winterbottom, Oliver Wiseman. BJU Int.2014;113:610-614. Measuring stone volume – three- dimensional software reconstruction or an ellipsoid algebra formula.doi: 10.1111/bju.12456. Epub 2014 Jan 15
• 11. William Finch, Richard Johnston, Nadeem Shaida, Andrew Winterbottom, Oliver Wiseman. BJU Int.2014;113:610-614. Measuring stone volume – three- dimensional software reconstruction or an ellipsoid algebra formula.doi: 10.1111/bju.12456. Epub 2014 Jan 15
• 12. Hubert J, Blum A, Cormier L, Claudon M, Regent D, Mangin P. Three-dimensional CT-scan reconstruction of renal calculi. A new tool for mapping-out staghorn calculi and follow-up of radiolucent stones. Eur Urol 1997; 31: 297–301. doi: 10.1159/000474471
• 12. Hubert J, Blum A, Cormier L, Claudon M, Regent D, Mangin P. Three-dimensional CT-scan reconstruction of renal calculi. A new tool for mapping-out staghorn calculi and follow-up of radiolucent stones. Eur Urol 1997; 31: 297–301. doi: 10.1159/000474471
• 13. Demehri S, Kalra MK, Rybicki FJ et al. Quantification of urinary stone volume: attenuation threshold-based CT method – a technical note. Radiology 2011; 258: 915–22.doi: 10.1148/radiol.10100333
• 13. Demehri S, Kalra MK, Rybicki FJ et al. Quantification of urinary stone volume: attenuation threshold-based CT method – a technical note. Radiology 2011; 258: 915–22.doi: 10.1148/radiol.10100333
• 14. Olcott EW, Sommer FG, Napel S. Accuracy of detection and measurement of renal calculi: in vitro comparison of three-dimensional spiral CT, radiography and nephrotomography. Radiology. 1997;204:19-25.doi: 10.1148/radiology.204.1.9205217
• 14. Olcott EW, Sommer FG, Napel S. Accuracy of detection and measurement of renal calculi: in vitro comparison of three-dimensional spiral CT, radiography and nephrotomography. Radiology. 1997;204:19-25.doi: 10.1148/radiology.204.1.9205217