Department of Urology, Faculty of Medicine, Toho University, Tokyo, Japan.
Department of Urology, Abiko Toho Hospital, Chiba, Japan.
Int J Urol. 2020 Sep;27(9):742-747. doi: 10.1111/iju.14289. Epub 2020 Jun 27.
To develop a novel simple quantitative scoring model for predicting stone-free status after a flexible ureteroscopy lithotripsy procedure by standardizing the complexity of ureteral stone characteristics.
We retrospectively reviewed 586 patients with renal or ureteral stones who underwent flexible ureteroscopy lithotripsy at Abiko Toho Hospital, Chiba, Japan, from 2015 to 2018. Multivariate regression was applied to examine the relationship between preoperative descriptors and stone-free status, and a nomogram was developed using significant predictors. Next, the individual components of the nomogram were assigned points to form a simple scoring system. The predictive performance of this new scoring system was compared with the STONE score at optimal cut-off values using receiver operating characteristic curve and area under the curve analyses.
Multivariate logistic regression findings showed that factors associated with stone-free status were length, Hounsfield unit and stone location. A nomogram prediction model was developed with an area under the curve value of 0.845, then consequently used to develop a new simple score system termed the T.O.HO. score consisting of three stone characteristics: (T)allness (1-5 points), (O)ccupied lesion (1-3 points) and (HO)unsfield units evaluation (1-3 points). The T.O.HO. score was significantly higher in stone remaining (7.66) than stone-free (5.27; P < 0.001) cases. The area under the curve for the T.O.HO. score was 0.833 at an optimal cut-off value of 7, whereas that for the STONE score was 0.683 at an optimal cut-off value of 9, showing the superiority of this new scoring system.
The T.O.HO. score is a useful tool for predicting stone-free status in patients who have undergone a flexible ureteroscopy lithotripsy procedure.
通过标准化输尿管结石特征的复杂性，开发一种新的简单定量评分模型，以预测软性输尿管镜碎石术后的无石状态。
我们回顾性分析了 2015 年至 2018 年在日本千叶市的有明都医院接受软性输尿管镜碎石术的 586 例肾结石或输尿管结石患者。应用多变量回归分析来检查术前描述符与无石状态之间的关系，并使用显著预测因子开发了一个列线图。接下来，将列线图的各个组成部分赋予分数，形成一个简单的评分系统。使用接收者操作特征曲线和曲线下面积分析，比较新评分系统与最佳截断值的 STONE 评分的预测性能。
多变量逻辑回归结果表明，与无石状态相关的因素是长度、亨氏单位和结石位置。开发了一个列线图预测模型，其曲线下面积值为 0.845，然后用于开发一个新的简单评分系统，称为 T.O.HO. 评分，由三个结石特征组成：（T）allness（1-5 分）、（O）ccupied lesion（1-3 分）和（HO）unsfield units evaluation（1-3 分）。在结石残留（7.66）中，T.O.HO. 评分明显高于无石（5.27；P<0.001）。T.O.HO. 评分的曲线下面积在最佳截断值为 7 时为 0.833，而 STONE 评分的曲线下面积在最佳截断值为 9 时为 0.683，表明该新评分系统具有优越性。
T.O.HO. 评分是预测软性输尿管镜碎石术后无石状态的有用工具。
