Kachroo Naveen, Jain Rajat, Maskal Sarah, Alshara Luay, Armanyous Sherif, Milk Jason, Kahn Leonard, Monga Manoj, Sivalingam Sri
Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
University of Rochester Medical Center, Rochester, New York, USA.
J Endourol. 2021 Apr;35(4):429-435. doi: 10.1089/end.2020.0645. Epub 2020 Oct 27.
A number of clinical and radiological predictors of either stone impaction or ureteral stone passage (SP) have been proposed. We aimed at identifying the key predictors of successful SP by using readily available CT-based tools/measurements. Patients presenting to the emergency department from February 2017 to February 2018 with an acute unilateral ureteral stone confirmed on non-contrast CT and managed conservatively were followed for SP. Patients with renal impairment, sepsis or requiring emergent intervention were excluded. Patients were followed at 1 month to confirm SP (stone collection/repeat imaging) or failure of passage. The CT variables analyzed included: Stone factors [location, size, volume, HU density (HUD)], impaction factors [ureteral HUD above and below the stone, maximal ureteral wall thickness (UWT) at the stone site, contralateral UWT, and ureteral diameter above and below the stone]. Binary logistic regression analysis was performed to identify predictors of SP. Forty-nine patients met study inclusion criteria, of whom 32 (65.3%) passed the stone without further intervention. Patients with successful passage were more likely to have smaller, lower volume and less dense stones located in the distal ureter ( < 0.01). Lower ureteral HUD below the stone, lower maximal UWT, and lower ureteral diameter above the stone were associated with successful passage ( < 0.01). On multivariable logistic regression analysis, only maximal UWT at the stone site was a significant independent predictor of SP outcome ( = 0.01). Youden's criterion identified 2.3 mm as the optimal UWT cut-off point, which will accurately predict SP with 82.4% sensitivity and 87.5% specificity. Maximal UWT at the stone site was the most significant predictor of successful passage in acute unilateral ureteral stones, with an optimal cut-off point of 2.3 mm. Further prospective studies are needed to accurately predict spontaneous SP.
已经提出了一些关于结石嵌顿或输尿管结石排出（SP）的临床和影像学预测指标。我们旨在通过使用易于获得的基于CT的工具/测量方法来确定成功SP的关键预测指标。对2017年2月至2018年2月因非增强CT确诊为急性单侧输尿管结石并接受保守治疗而到急诊科就诊的患者进行SP随访。排除有肾功能损害、脓毒症或需要紧急干预的患者。在1个月时对患者进行随访，以确认SP（结石排出/重复成像）或排出失败。分析的CT变量包括：结石因素[位置、大小、体积、HU密度（HUD）]、嵌顿因素[结石上方和下方的输尿管HUD、结石部位的最大输尿管壁厚度（UWT）、对侧UWT以及结石上方和下方的输尿管直径]。进行二元逻辑回归分析以确定SP的预测指标。49例患者符合研究纳入标准，其中32例（65.3%）未进一步干预即排出结石。成功排出结石的患者更有可能在输尿管远端有更小、体积更小和密度更低的结石（<0.01）。结石下方较低的输尿管HUD、较低的最大UWT以及结石上方较低的输尿管直径与成功排出有关（<0.01）。在多变量逻辑回归分析中，仅结石部位的最大UWT是SP结果的显著独立预测指标（=0.01）。约登标准确定2.3mm为最佳UWT切点，其将以82.4%的敏感性和87.5%的特异性准确预测SP。结石部位的最大UWT是急性单侧输尿管结石成功排出的最显著预测指标，最佳切点为2.3mm。需要进一步的前瞻性研究来准确预测自发性SP。
