Department of Urology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China.
Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Medicine (Baltimore). 2024 Nov 1;103(44):e40390. doi: 10.1097/MD.0000000000040390.
This study aims to investigate the factors affecting the stone-free rate (SFR) of flexible ureteroscopy and laser lithotripsy (fURSL) for renal stones and establish predictive models by identifying their prognostic factors. We retrospectively examined 252 patients with renal stones who were treated with fURSL between July 2020 and April 2022. We analyzed the relationship between the patient's clinical data (sex, age, and body mass index), stone status (side, size, location, stone/transverse process pixel ratio [STPR], and the CT value of stone [SCTV]), and SFR to determine the relevant factors and analyze their influence. Additionally, a nomogram was constructed based on these prediction results. A total of 252 patients were enrolled based on the inclusion and exclusion criteria. They were reviewed 7, 30, and 90 days postoperatively, with 46, 23, and 10 patients failing to discharge stones, respectively. Univariate Cox proportional hazard regression results revealed that the SFR was correlated with stone location, diameter (D1, diameter of stone measured by computed tomography [CT]; D2, diameter of stone measured by kidney-ureter-bladder abdominal radiography), SCTV, STPR, and operation time. Multivariate Cox proportional hazard regression was used to develop 2 predictive models for the SFR. The influencing factors of model 1 included D1, location, and SCTV, whereas those of model 2 were D2, location, and STPR. The results are shown in the nomogram. Receiver operating characteristic curves showed no significant difference between models 1 and 2 (P = .498), indicating that the nomogram was highly predictive. After 1000 resamples and internal self-validation, the C-indices of models 1 and 2 were 0.924 and 0.895, respectively, showing that the stone clearance predicted by the nomogram matched the actual situation. Stone location, size, and density (SCTV and STPR) were significant predictors of SFR after fURSL. The scoring system based on these factors may be used to guide optimal treatment strategy selection.
本研究旨在探讨影响软性输尿管镜钬激光碎石术（fURSL）治疗肾结石无石率（SFR）的因素，并通过确定其预后因素建立预测模型。我们回顾性分析了 2020 年 7 月至 2022 年 4 月期间接受 fURSL 治疗的 252 例肾结石患者。我们分析了患者的临床数据（性别、年龄和体重指数）、结石情况（侧别、大小、位置、结石/横突比[STPR]和结石 CT 值[SCTV]）与 SFR 之间的关系，以确定相关因素并分析其影响。此外，还基于这些预测结果构建了一个列线图。根据纳入和排除标准，共纳入 252 例患者。术后第 7、30 和 90 天进行复查，分别有 46、23 和 10 例患者未能排出结石。单因素 Cox 比例风险回归结果显示，SFR 与结石位置、直径（D1，CT 测量的结石直径；D2，腹部肾输尿管膀胱平片测量的结石直径）、SCTV、STPR 和手术时间有关。多因素 Cox 比例风险回归用于建立 SFR 的 2 个预测模型。模型 1 的影响因素包括 D1、位置和 SCTV，而模型 2 的影响因素包括 D2、位置和 STPR。结果列于列线图中。受试者工作特征曲线显示模型 1 和模型 2 之间无显著差异（P=0.498），表明该列线图具有高度预测性。经过 1000 次重采样和内部自我验证，模型 1 和模型 2 的 C 指数分别为 0.924 和 0.895，表明列线图预测的结石清除情况与实际情况相符。结石位置、大小和密度（SCTV 和 STPR）是 fURSL 后 SFR 的显著预测因素。基于这些因素的评分系统可用于指导最佳治疗策略的选择。
