Assessing the Predictive Accuracy of the S.T.O.N.E. Score for Stone-Free Rates in Semirigid Pneumatic Ureteral Lithotripsy: Implications for Validation.

IF 2 Q2 UROLOGY & NEPHROLOGY

Research and Reports in Urology Pub Date : 2025-05-01 eCollection Date: 2025-01-01 DOI:10.2147/RRU.S515846

Faisal Ahmed, Khaled Al-Kohlany, Khalil Al-Naggar, Ibrahim Alnadhari, Abdulfattah Yahya Altam, Mohamed Badheeb

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引用次数: 0

Abstract

Background: The lack of reliable predictive tools for outcomes following ureteral lithotripsy (ULT) presents significant challenges in clinical decision-making. This study evaluates the efficacy of the S.T.O.N.E. score-an assessment incorporating Size, Topography, Obstruction, Number, and Hounsfield units (HU)-in predicting the likelihood of achieving a stone-free rate (SFR) in patients undergoing semirigid pneumatic ULT.

Methods: This retrospective analysis involved 266 patients with ureteral stones who underwent ULT at IBB University Hospitals from April 2021 to September 2023. The S.T.O.N.E. score was derived from preoperative CT scans, and a nomogram was created to predict SFR failure. Discrimination and calibration were assessed using the area under the receiver operating characteristic curve (AUC) and calibration curve, while decision curve analysis (DCA) evaluated clinical utility.

Results: The cohort's mean age was 47.7 ± 15 years, with a predominance of males (72.2%). The mean S.T.O.N.E. score was 7.8 ± 1.8. The overall SFR of 85.3% and residual stones were detected in 39 patients (14.7%). Multivariate analysis identified higher HU (AOR: 1.01; 95% CI: 1.00-1.01; P < 0.001), proximal stone location (AOR: 15.13; 95% CI: 1.52-51.13; P = 0.020), moderate (AOR: 34.23; 95% CI: 8.28-141.45; P < 0.001) and severe hydronephrosis (AOR: 33.75; 95% CI: 4.55-250.36; P = 0.0006), and larger stone size (AOR: 1.51; 95% CI: 1.30-1.75; P < 0.0001) as significant predictors of SFR failure. The S.T.O.N.E. score effectively predicts SFR failure, with an optimal threshold of > 8 achieving 85.0% accuracy. The model demonstrated 72.0% sensitivity, 81.0% specificity, and strong calibration. DCA indicated clinical utility, differentiating between low- and high-risk patients based on their S.T.O.N.E. scores.

Conclusion: The S.T.O.N.E. score is a valuable tool for predicting post-ULT SFR, aiding preoperative decision-making and potentially improving surgical outcomes by identifying high-risk patients. Further validation in diverse populations is needed to confirm its clinical utility.

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评估半硬质输尿管气压碎石术中S.T.O.N.E.评分对无石率的预测准确性：验证的意义。

背景：输尿管碎石术（ULT）后预后缺乏可靠的预测工具，这对临床决策提出了重大挑战。本研究评估了S.T.O.N.E.评分的有效性，该评分包括大小、地形、阻塞、数量和霍斯菲尔德单位（HU），用于预测接受半刚性气动ULT患者实现无结石率（SFR）的可能性。方法：回顾性分析2021年4月至2023年9月在IBB大学医院接受ULT治疗的266例输尿管结石患者。S.T.O.N.E.评分来自术前CT扫描，并创建nomogram来预测SFR失败。使用受试者工作特征曲线（AUC）和校准曲线下面积评估鉴别和校准，而决策曲线分析（DCA）评估临床效用。结果：队列平均年龄47.7±15岁，男性居多（72.2%）。平均S.T.O.N.E.评分为7.8±1.8。总SFR为85.3%，残留结石39例（14.7%）。多因素分析发现较高的HU (AOR: 1.01；95% ci: 1.00-1.01；P < 0.001)，近端结石定位(AOR: 15.13；95% ci: 1.52-51.13；P = 0.020)、中度(AOR: 34.23；95% ci: 8.28-141.45；P < 0.001)和严重肾积水(AOR: 33.75；95% ci: 4.55-250.36；P = 0.0006)，更大的结石尺寸(AOR: 1.51；95% ci: 1.30-1.75；P < 0.0001)作为SFR失败的重要预测因子。S.T.O.N.E.评分有效预测SFR失败，最佳阈值为bb0.8，准确率为85.0%。该模型灵敏度为72.0%，特异度为81.0%，具有较强的校准性。DCA显示临床效用，根据患者的S.T.O.N.E.评分区分低危患者。结论：S.T.O.N.E.评分是预测ult术后SFR的一个有价值的工具，有助于术前决策，并通过识别高危患者来潜在地改善手术结果。需要在不同人群中进一步验证以确认其临床应用。

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来源期刊

Research and Reports in Urology UROLOGY & NEPHROLOGY-

CiteScore

3.40

自引率

0.00%

发文量

审稿时长

16 weeks

期刊介绍： Research and Reports in Urology is an international, peer-reviewed, open access, online journal. Publishing original research, reports, editorials, reviews and commentaries on all aspects of adult and pediatric urology in the clinic and laboratory including the following topics: Pathology, pathophysiology of urological disease Investigation and treatment of urological disease Pharmacology of drugs used for the treatment of urological disease Although the main focus of the journal is to publish research and clinical results in humans; preclinical, animal and in vitro studies will be published where they will shed light on disease processes and potential new therapies. Issues of patient safety and quality of care will also be considered.