Ipek Osman Murat, Dincer Erdinc, Sevinc Ahmet Halil, Sevinc Burcu Hanci, Canakci Cengiz, Ozkaptan Orkunt
Department of Urology, Kartal Dr. Lutfi Kirdar City Hospital, Cevizli Mevkii No:47, D-100, Kartal, İstanbul, 34865, Türkiye.
Urolithiasis. 2025 May 22;53(1):96. doi: 10.1007/s00240-025-01765-6.
This study aimed to compare the predictive performance of Triple-D, Quadruple-D, and Mayo Adhesive Probability (MAP) scoring systems in estimating stone-free (SF) status following extracorporeal shock wave lithotripsy (ESWL) in patients with renal stones. This retrospective cohort study was conducted on patients who underwent ESWL between January 2020 and January 2024. Pre-treatment non-contrast computed tomography was used to assess stone characteristics and calculate Triple-D, Quadruple-D, and MAP scores. Patients were categorized into stone-free (SF) and residual stone (RS) groups based on imaging performed three months after treatment. Residual fragments of < 4 mm were defined as SF. The study included 198 patients (60.6% male; mean age 45.5 ± 13.1 years). According to logistic regression analysis, a low MAP score (< 2.5) was the strongest independent predictor of SF status (OR: 15.5; 95% CI: 5.1-47.1; p < 0.001), followed by a high Quadruple-D score (> 1.5) (OR: 7.4; 95% CI: 2.2-24.1; p = 0.001) and low stone density (< 600 HU) (OR: 4.9; 95% CI: 1.1-21.8; p = 0.037). Conversely, a higher number of shockwaves and the need for additional procedures were associated with RS (both p < 0.001). Among the scoring systems, MAP score demonstrated the highest predictive accuracy with an AUC of 0.817, outperforming Quadruple-D (AUC: 0.722) and Triple-D (AUC: 0.639). MAP score was the most powerful and accurate independent predictor of SF status after ESWL, offering superior clinical utility compared to Triple-D and Quadruple-D scores in pre-treatment evaluation.
本研究旨在比较三联D评分系统、四联D评分系统和梅奥粘连概率（MAP）评分系统在评估肾结石患者体外冲击波碎石术（ESWL）后无结石（SF）状态方面的预测性能。本回顾性队列研究针对2020年1月至2024年1月期间接受ESWL治疗的患者开展。治疗前的非增强计算机断层扫描用于评估结石特征并计算三联D、四联D和MAP评分。根据治疗后三个月进行的影像学检查，将患者分为无结石（SF）组和残余结石（RS）组。小于4毫米的残余碎片定义为SF。该研究纳入了198例患者（男性占60.6%；平均年龄45.5±13.1岁）。根据逻辑回归分析，低MAP评分（<2.5）是SF状态最强的独立预测因素（OR：15.5；95%CI：5.1 - 47.1；p<0.001），其次是高四联D评分（>1.5）（OR：7.4；95%CI：2.2 - 24.1；p = 0.001）和低结石密度（<600 HU）（OR：4.9；95%CI：1.1 - 21.8；p = 0.037）。相反，较高的冲击波次数和需要额外的手术与RS相关（两者p<0.001）。在评分系统中，MAP评分显示出最高的预测准确性，AUC为0.817，优于四联D评分（AUC：0.722）和三联D评分（AUC：0.639）。MAP评分是ESWL后SF状态最有力且准确的独立预测因素，与三联D和四联D评分相比，在治疗前评估中具有更高的临床实用性。
