Department of Urology and Andrology, Kori Hospital, Kansai Medical University, 8-45 Kori Hondori cyou, Neyagawa, Osaka, 572-8551, Japan.
Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
World J Urol. 2019 May;37(5):913-919. doi: 10.1007/s00345-018-2461-x. Epub 2018 Aug 28.
To evaluate the clinical significance of ureteral wall thickness (UWT) for predicting spontaneous passage (SP) of uncomplicated ureteral stones of ≤ 10 mm.
We retrospectively reviewed 418 patients with a diagnosis of uncomplicated ureteral stones who presented to Kori Hospital from 2011 to 2018. The maximum stone diameter and UWT at the stone site were measured from axial computed tomography images. Clinical predictors of 4-week SP were assessed using univariate and multivariate analyses. Receiver operating characteristic (ROC) curve analysis was applied to evaluate the accuracy of factors in predicting SP of ureteral stones.
Of the 418 patients, 202 (48.3%) spontaneously passed their stones within 4 weeks of their initial visit. Multivariate analysis showed that stone location, stone size, and UWT (odds ratio, 0.40; P < 0.001) were independent predictors of 4-week SP. ROC analysis showed that 2.71 mm was the optimal cut-off value for UWT, with a predictive accuracy of 0.83. Low UWT had a significantly higher 4-week SP rate than high UWT (76.4% vs. 14.7%, respectively; P < 0.001). In addition, high UWT was associated with a higher risk of stone-related complications within 4 weeks compared with low UWT (16.4% vs. 7.2%, respectively; P = 0.0044).
UWT can serve as a potential predictive factor for 4-week SP and may help physicians to select patients who require immediate interventions among those with ≤ 10-mm ureteral stones.
评估输尿管壁厚度（UWT）在预测≤10mm 单纯输尿管结石自发排出（SP）中的临床意义。
我们回顾性分析了 2011 年至 2018 年期间在 Kori 医院就诊的 418 例单纯输尿管结石患者的资料。从轴向 CT 图像测量结石部位的最大结石直径和 UWT。使用单变量和多变量分析评估 4 周 SP 的临床预测因素。应用受试者工作特征（ROC）曲线分析评估各因素预测输尿管结石 SP 的准确性。
418 例患者中，202 例（48.3%）在初始就诊后 4 周内自发排石。多变量分析显示，结石位置、结石大小和 UWT（比值比，0.40；P<0.001）是 4 周 SP 的独立预测因素。ROC 分析显示，UWT 的 2.71mm 为最佳截断值，预测准确率为 0.83。UWT 较低者 4 周 SP 率显著高于 UWT 较高者（分别为 76.4%和 14.7%；P<0.001）。此外，UWT 较高者与 UWT 较低者相比，4 周内结石相关并发症的风险更高（分别为 16.4%和 7.2%；P=0.0044）。
UWT 可作为 4 周 SP 的潜在预测因素，有助于医生在≤10mm 输尿管结石患者中选择需要立即干预的患者。
