Marathi Viswas Raghavendra, Kaushal Devashish, Madhavan Kumar, Malik Rajesh, Kp Abhineeth
Department of Urology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
Urologia. 2025 Aug 14:3915603251360160. doi: 10.1177/03915603251360160.
Medical expulsive therapy (MET) has been shown to be a safe and effective option for the spontaneous passage of uncomplicated ureteric stones sizing ⩽10 mm in selected cases. However, there is lack of evidence on the predictors of successful MET. Our objective was to identify parameters that can accurately predict the spontaneous passage of ureteral stones during MET.
Patients receiving MET (Tamsulosin 0.4 mg once daily (OD)) for a single unilateral ureteral calculi sizing ⩽10 mm were followed after 1 month using Non contrast Computed tomography (NCCT). Various parameters such as stone-related parameters (location, density, volume and transverse, longitudinal, and sagittal diameters), ureter-related parameters (diameter, density, and wall thickness at the stone site) and grade of hydronephrosis were evaluated on CT images and analyzed by using univariate, multivariate and receiver operating characteristic (ROC) curve analyses.
Of 55 patients, 31 (56.4%) passed the stone successfully within 4 weeks of MET. Univariate analysis revealed these patients tended to have lower ureteric stones (-value- 0.048), lower longitudinal (-value- 0.024) and transverse stone diameters (-value- 0.006), lower stone volume (-value- 0.015) and ureteral wall thickness (UWT; -value- 0.001). In multivariate analysis, only UWT at the stone site ( 0.036) was a significant predictor of the successful passage of calculus. The UWT cut-off was 2.1 mm with sensitivity and specificity of 83.8% and 62.5%, respectively, with an Area Under Curve (AUC) of 0.7856.
The most significant predictor of successful stone passage in MET of unilateral ureteral stones was maximal UWT, with an optimal cut-off point of 2.1 mm.
在特定病例中，药物排石疗法（MET）已被证明是促使直径小于等于10毫米的单纯性输尿管结石自然排出的一种安全有效的方法。然而，关于MET成功的预测因素，目前缺乏相关证据。我们的目标是确定能够准确预测MET期间输尿管结石自然排出的参数。
对接受MET（坦索罗辛0.4毫克，每日一次）治疗的单侧输尿管结石直径小于等于10毫米的患者，在1个月后采用非增强计算机断层扫描（NCCT）进行随访。在CT图像上评估各种参数，如结石相关参数（位置、密度、体积以及横径、纵径和矢状径）、输尿管相关参数（结石部位的直径、密度和壁厚）以及肾积水程度，并通过单因素分析、多因素分析和受试者工作特征（ROC）曲线分析进行分析。
55例患者中，31例（56.4%）在MET治疗4周内成功排出结石。单因素分析显示，这些患者的输尿管结石位置较低（P值 - 0.048）、结石纵径（P值 - 0.024）和横径较小（P值 - 0.006）、结石体积较小（P值 - 0.015）以及输尿管壁厚度（UWT；P值 - 0.001）较低。多因素分析中，仅结石部位的UWT（P值0.036）是结石成功排出的显著预测因素。UWT的截断值为2.1毫米，敏感性和特异性分别为83.8%和62.5%，曲线下面积（AUC）为0.7856。
单侧输尿管结石MET治疗中结石成功排出的最显著预测因素是最大UWT，最佳截断点为2.1毫米。
