Journal of endourology最新文献

{"title":"Comparative Analysis of Safety and Efficacy Between Anterior and Posterior Calyceal Entry in Supine Percutaneous Nephrolithotomy.","authors":"Anna Ricapito, Kavita Gupta, Ziv Savin, Kasmira R Gupta, Christopher Connors, Raymond Khargi, Alan J Yaghoubian, Blair Gallante, William M Atallah, Mantu Gupta","doi":"10.1089/end.2024.0508","DOIUrl":"https://doi.org/10.1089/end.2024.0508","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> One advantage of supine percutaneous nephrolithotomy (sPCNL) is the ability to access anterior as well as posterior calyces, but the safety and efficacy of anterior calyceal entry has never been investigated to our knowledge. We prospectively evaluated patients scheduled for sPCNL comparing anterior and posterior calyceal access. <b><i>Materials and Methods:</i></b> After Institutional Review Board approval, we prospectively enrolled 100 consecutive patients undergoing sPCNL from February to September 2023. Primary outcomes included intraoperative complications, blood transfusions, 30-day complication rates, and emergency department (ED) visits or readmissions. Secondary outcomes included stone-free rates (SFR). <b><i>Results:</i></b> Seventy-six patients had anterior calyceal entry and 24 had posterior. No significant differences were found in terms of baseline demographics (age, body mass index), stone characteristics (location, density, complexity), or intraoperative features (operative time, location of access). Safety outcomes, including intraoperative complications (1% <i>vs</i> 4%), blood transfusions (3% <i>vs</i> 8%), 30-day complication rates (17% <i>vs</i> 21%), and ED visits (1% <i>vs</i> 0) or readmissions (11% <i>vs</i> 21%) were comparable between groups. Overall SFRs were equivalent (86% <i>vs</i> 90%). <b><i>Conclusion:</i></b> We found that anterior and posterior accesses in sPCNL offer similar safety and efficacy, with no significant differences in complications or SFRs. Surgeons can select either approach based on patient anatomy and surgical needs without concern for increased complications. Further research is necessary to confirm these findings and guide best practices for calyx selection in sPCNL.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Incision Location Matter? Analysis of Single-Port Cosmesis in Urologic Reconstructive Surgery.","authors":"Michael Raver, Catherine Implicito, Mason Henrich, Qilin Cao, Katherine Kim, Simon Gelman, Sonam Saxena, Ruth Sanchez De La Rosa, Sharon Seidman, Gregory Lovallo, Ravi Munver, Mubashir Billah, Mutahar Ahmed, Michael Stifelman","doi":"10.1089/end.2024.0322","DOIUrl":"https://doi.org/10.1089/end.2024.0322","url":null,"abstract":"<p><p><b><i>Introduction and Objective:</i></b> One potential advantage of single-port (SP) robotic surgery compared with multiport (MP) robotic surgery is improved cosmesis. The only studies in urology patients to suggest this finding did not assess differences based on incision site. Our study evaluated SP, MP, incision location, age, gender, and prior abdominal surgery as predictors of cosmesis and scar consciousness for reconstructive procedures. <b><i>Methods:</i></b> This is a cohort study using an institutional review board-approved prospective genitourinary reconstruction database. Patients at least 3 months from surgery were emailed and called to complete the Consciousness subsection of the Patient Scar Assessment Questionnaire. Bothersome was defined as a score of 11 or greater. Overall consciousness was scored with a single item as \"not conscious\" or \"conscious.\" Pearson's chi-squared, Wilcoxon rank sum, Fisher's exact test, and logistic regression were performed to assess how age, gender, prior surgery, and incision location affect cosmesis. <b><i>Results:</i></b> There were 111 patients (54 MP, 57 SP), of which 27 were SP umbilical, 14 were SP midline nonumbilical, and 16 were SP lower quadrant. On univariate analysis the periumbilical incision had the lowest consciousness. Age was associated with Bother (<i>p</i> = 0.012) and Consciousness (<i>p</i> = 0.002), whereas gender, prior abdominal surgery, and incision site were not significant. On logistic regression, all SP incisions were less likely to be bothered compared with MP, although only SP umbilical was statistically significant (odds ratio [OR] = 0.08, 95% confidence interval [CI]: 0.01,0.38; <i>p</i> = 0.005). Age was also significant on logistic regression for Bother (OR = 0.96, 95% CI: 0.93,0.99; <i>p</i> = 0.005). Gender and prior abdominal surgery were not associated with Bother or Consciousness. <b><i>Conclusions:</i></b> SP periumbilical incisions provide the best outcomes for cosmesis compared with other SP incision sites and MP incisions. This finding should be discussed and taken into account when planning surgical approaches for patients undergoing urinary reconstruction, especially in patients younger than 40 years of age.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Residual Stone Fragments on Risk of Unplanned Stone Events Following Percutaneous Nephrolithotomy.","authors":"Denzel Zhu, Kaela Mali, Christopher Carlisi, Galen Cheng, Karen M Doersch, Scott O Quarrier, Rajat K Jain","doi":"10.1089/end.2024.0435","DOIUrl":"https://doi.org/10.1089/end.2024.0435","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> Residual stone fragments are common after percutaneous nephrolithotomy (PCNL), however, there is an unclear relationship between the presence of these residual stone fragments and the risk of unplanned stone events (USE). We investigated how the size of the largest residual stone fragment (LRSF) impacts the risk of USE post-PCNL. <b><i>Materials and Methods:</i></b> We conducted a retrospective cohort study of PCNL between 2018 and 2022. Preoperative computed tomography of the abdomen and pelvis (CTAP) imaging and postoperative CTAP imaging were reviewed. The primary outcome was the incidence of postoperative USE, defined as stone-related emergency department visits or unplanned stone procedures. LRSF were stratified by five thresholds (no postoperative stone fragments <i>vs</i> ≥0 mm, <2 <i>vs</i> ≥2 mm, <3 <i>vs</i> ≥3 mm, <4 <i>vs</i> ≥4 mm, and <5 <i>vs</i> ≥5 mm), and Cox regression was used to compare the impact of these thresholds on the risk of USE. <b><i>Results:</i></b> After exclusions, we identified 138 patients who underwent PCNL during the study period; 42 patients had a USE. When applying a 4 mm threshold, 52% of patients with LRSF ≥4 mm experienced USE <i>vs</i> 21% with LRSF <4 mm (log-rank <i>p</i> = 0.0004); similarly, with a 5 mm threshold, 62.5% with LRSF ≥5 mm had such events compared with 21% with LRSF <5 mm (log-rank <i>p</i> < 0.00001). A larger LRSF was associated with a greater risk of having a USE. <b><i>Conclusion:</i></b> After PCNL, larger residual stone fragments, particularly those ≥4 mm, are associated with an increased risk of USE. These results demonstrate the value of identifying residual fragments in predicting USE.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bio of Pankaj N Maheshwari, MS, DNB, MCh, FRCS.","authors":"","doi":"10.1089/end.2024.96787.spot","DOIUrl":"https://doi.org/10.1089/end.2024.96787.spot","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital Flexible Ureteroscope: Evaluating Factors Responsible for Damage and Implementing a Mandatory Certification Program for Usage.","authors":"Joao G Porto, Ansh Bhatia, Renil S Titus, Maria Camila Suarez Arbelaez, Mohamadhusni Zarli, Alejandra Guevara, Michael Tradewell, Diana M Lopategui, Ramgopal Satyanarayana, Robert Marcovich, Hemendra N Shah","doi":"10.1089/end.2024.0208","DOIUrl":"https://doi.org/10.1089/end.2024.0208","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Digital flexible ureteroscopes (DFUs) play a crucial role in endourological procedures, and scope breakages are often avoidable with proper measures in place. We aimed to evaluate the effect of mandatory training on DFU durability and to assess the influence of various factors on instrument damage. <b><i>Materials and Methods:</i></b> Mandatory training involving instructional videos on DFU care was introduced for all processing and operating room staff handling DFUs. Only certified personnel were allowed to handle DFUs, with meticulous usage documentation. The average annual usage of each DFU was compared pre and post program implementation. We examined factors such as patient demographics, procedure details, and operator experience impacting scope life using negative binomial regression. <b><i>Results:</i></b> The average usage of DFU increased by 21%, from 6.38 to 7.74 cases. We found that post-graduate year stood out as a significant predictive factor (estimate = 3.28, <i>p</i> = 0.04). Moreover, the streamlined model revealed that previous ureteral-stent use (estimate = 0.94, <i>p</i> < 0.001), struvite stones (estimate = 3.08, <i>p</i> = 0.01), and a higher number of stones (estimate = 0.11, <i>p</i> = 0.04) were associated with an increased number of procedures before DFU breakage, whreas in situ lithotripsy in the lower calyx was associated with a reduced number of procedures before DFU breakage (estimate = -1.11, <i>p</i> = 0.003). <b><i>Conclusion:</i></b> Implementing a mandatory training program showed an increase in DFU durability by 21%, suggesting a potential reduction in annual repair and replacement costs by the same percentage. Furthermore, outcomes were more favorable when experienced practitioners conducted treatments, especially in cases involving struvite stones.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Safety of Prostate Cancer Focal Therapy: MAUDE Database Analysis.","authors":"Zhiyu Qian, Boyuan Xiao, Filippo Dagnino, Julia Feldman, Jonathan Song, Hanna Zurl, Daniel Stelzl, Stephan Korn, Leonardo Reis, Caroline M Moore, Quoc-Dien Trinh, Alexander P Cole","doi":"10.1089/end.2024.0573","DOIUrl":"https://doi.org/10.1089/end.2024.0573","url":null,"abstract":"<p><p><b><i>Objective:</i></b> The aim of this study was to assess the real-world safety profile of medical devices used in focal prostate cancer treatment utilizing the Manufacturer and User Facility Device Experience (MAUDE) database. <b><i>Methods:</i></b> The MAUDE database was searched for reports on high-intensity focused ultrasound (HIFU), cryoablation, laser ablation, and irreversible electroporation (IRE) devices used in prostate cancer treatment from 1993 to 2023. Adverse events were identified and categorized. <b><i>Results:</i></b> We identified 175 reports for HIFU, 1362 for cryoablation, 615 for laser ablation, and 135 for IRE devices, with 28, 284, 126, and 2 respective reports, directly related to prostate cancer treatment. The aggregated data revealed the majority of complications were minor, with 82.5% (<i>n</i> = 363 out of 440 total complications) classified as Clavien-Dindo grade 1 or 2. Common minor complications included erectile dysfunction and urinary retention. Severe complications such as rectal fistulas were noted in HIFU and IRE treatments, along with singular mortality due to pulmonary embolism in cryoablation. <b><i>Conclusions:</i></b> Our analyses from MAUDE reveal that devices used in focal therapy for prostate cancer are predominantly associated with minor complications, underscoring their overall real-world safety profile. However, the occurrence of severe adverse events emphasizes the critical importance of rigorous patient selection and meticulous procedural planning. These findings provide valuable insights into the safety profile of focal therapy devices and contribute to the growing body of evidence on their use in prostate cancer treatment.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-Port Versus Multi-Port Robotic Retroperitoneal Partial Nephrectomy: A Propensity Score-Matched Comparison.","authors":"Seokhwan Bang, Jiwoong Yu, Hoyoung Bae, Dongho Shin, Yong Hyun Park, Hyuk Jin Cho, U-Syn Ha, Ji Youl Lee, Sung-Hoo Hong","doi":"10.1089/end.2024.0493","DOIUrl":"https://doi.org/10.1089/end.2024.0493","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To compare the surgical results of retroperitoneal (RP) robot partial nephrectomy (PNx) using either a single-port robot (SP) or a multi-port robot (MP). <b><i>Materials and Methods:</i></b> We retrospectively reviewed all RP robotic PNx performed at a single institution from September 2021-when the SP robot was introduced to the institution-through April 2023. In total, 125 patients underwent the surgery; 81 patients were treated with surgery using a MP robot whereas 44 patients were treated with surgery using a SP. All MP surgeries were performed with da Vinci Xi (Intuitive, Sunnyvale, California, USA), while all SP surgeries were performed with da Vinci SP (Intuitive, Sunnyvale, California, USA). We performed a propensity score-matching (PSM) analysis of these 125 patients. <b><i>Results:</i></b> There was no significant difference between the two groups after PSM. In terms of operation time, that for MP was 103.68 ± 21.89 minutes whereas that for SP was 95.43 ± 32.22 minutes (<i>p</i>-value = 0.164). Meanwhile, in terms of console time, that for MP was 70.95 ± 21.92 minutes whereas that for SP was 64.14 ± 32.06 minutes (<i>p</i>-value = 0.248). In terms of estimated blood loss was 90.91 ± 91.06 mL in MP and 92.27 ± 104.30 mL in SP (<i>p</i>-value = 0.948). Lastly, there was a statistically significant difference in warm ischemic time, as it was 17.18 ± 6.56 minutes in MP and 13.82 ± 4.59 in SP (<i>p</i>-value = 0.007). There were no statistically significant differences between MP and SP in any other surgical outcomes. <b><i>Conclusions:</i></b> SP robot RP PNx demonstrated comparable outcomes to those achieve using MP procedures. This means SP robot RP PNx can be considered a preferable and more convenient surgical approach than conventional methods, particularly when dealing with small renal masses located in the posterior side of the kidney.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Factors for Success of Robotic Ureteral Reconstruction for Distal Ureteral Strictures.","authors":"Matthew Lee, Kelley Zhao, Brian Chao, Ziho Lee, Ravi Munver, Mutahar Ahmed, Michael D Stifelman, Lee C Zhao, Daniel D Eun","doi":"10.1089/end.2024.0595","DOIUrl":"https://doi.org/10.1089/end.2024.0595","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> To investigate preoperative predictors of surgical success for patients undergoing robotic ureteral reconstruction (RUR) for management of distal ureteral strictures. <b><i>Methods:</i></b> We retrospectively reviewed our multi-institutional Collaborative of Reconstructive Robotic Ureteral Surgery database to identify all consecutive patients undergoing RUR for surgical repair of distal ureteral strictures between 04/2012 and 12/2022. Procedures included refluxing reimplant (58.5%), side to side reimplant (18.0%), ureteroureterostomy (12.7%), non-refluxing reimplant (6.3%), buccal mucosa ureteroplasty (2.8%), and appendiceal bypass ureteroplasty (1.7%). Patients were grouped according to whether they were surgically successful. Preoperative variables between both groups were compared using chi-square tests. All variables with associations of <i>p</i> < 0.2 underwent a binary logistic regression analysis to determine predictive variables of success for RUR (<i>p</i> ≤ 0.05 considered statistically significant). <b><i>Results:</i></b> Overall, 284 patients met inclusion criteria. Univariate analysis showed obesity (<i>p</i> = 0.03), smoking history (<i>p</i> = 0.10), abdominopelvic radiation history (<i>p</i> = 0.14), immunocompromised state (<i>p</i> = 0.12), and ureteral rest (<i>p</i> = 0.01) were notable preoperative factors (<i>p</i> < 0.2). Binary logistic regression analysis further revealed the odds of surgical success in patients with obesity was 0.32 times (CI: 0.12-0.83, <i>p</i> = 0.02) the odds of success for patients without obesity. The odds of surgical success in patients who underwent preoperative ureteral rest was 4.2 times (CI: 1.51-11.77, <i>p</i> < 0.01) the odds of success for patients who did not undergo preoperative ureteral rest. <b><i>Conclusion:</i></b> Preoperative factors including obesity and ureteral rest may affect surgical success of RUR for management of distal ureteral strictures.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Optical Tracking to Distinguish Surgeon Experience During Endoscopic Stone Surgery.","authors":"Amy M Reed, Yizhou Li, Jumanh Atoum, Ayberk Acar, Callahan Henry, Jie Ying Wu, Nicholas Kavoussi","doi":"10.1089/end.2024.0246","DOIUrl":"https://doi.org/10.1089/end.2024.0246","url":null,"abstract":"<p><p><b><i>Introduction and Objectives:</i></b> Optical tracking (OT) has shown potential in assessing surgical skill but has yet to be evaluated for endoscopic urologic surgery. We sought to evaluate the potential for OT to distinguish expert and trainee surgeons during flexible ureteroscopy (fURS) for kidney stone treatment in both simulated and live surgical settings. <b><i>Methods:</i></b> We performed OT analysis of six surgeons performing stone localization during fURS in two settings. In the first setting, surgeons were tasked with fiducial localization in three separate kidney phantoms during fURS. In the second setting, surgeons performed stone localization via fURS in five separate patients. Surgeons were categorized as \"expert\" (<i>n</i> = 3, endourologist, average case volume of >100 fURS per year) or trainee (<i>n</i> = 3, trainee, <100 fURS per year). OT metrics were recorded for both settings using the Microsoft HoloLens 2© as the surgeons viewed the surgical monitor during fURS. Standard OT metrics of experts and trainees were compared, and included: area of eye gaze movement, gaze distance traveled, number of gaze fixation points, percentage of gaze fixation dwell time, and number of saccades. <b><i>Results:</i></b> In the simulated setting, the average time for stone localization was greater for trainees compared to experts (318 seconds <i>vs</i> 52 seconds, <i>p</i> < 0.01). Additionally, the mean area of eye gaze movements with area of interest (AOI) was greater for trainees compared to experts (1430 cm² <i>vs</i> 1060 cm², <i>p</i> < 0.01). The total gaze distance traveled was also greater for trainees compared to experts (1480 cm <i>vs</i> 730 cm, <i>p</i> < 0.01). In the live surgical setting, average time for stone localization was similar for trainees and experts (74 seconds <i>vs</i> 51 seconds, <i>p</i> = 0.05). The total area of eye gaze movements in AOI was greater for trainees compared to experts (700 cm² <i>vs</i> 30 cm², <i>p</i> < 0.01). Additionally, the total gaze distance traveled was greater for trainees compared to experts (14,000 cm <i>vs</i> 680 cm, <i>p</i> < 0.01). This suggests more varied and less point specific concentration on the surgical screen by trainees. There was no difference in percentage of gaze fixation dwell time and number of saccades between experts and trainees in either setting. <b><i>Conclusions:</i></b> OT analysis can objectively distinguish surgical experience between experts and trainee surgeons performing fURS in both simulated and live surgical settings. These findings may play a role in future surgical training and skills assessment.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Construction of a Risk Prediction Model for Ureteral Stricture after Ureteroscopic Holmium Laser Lithotripsy.","authors":"Ping Li, Kangning Wang, Lin Luo, Qingzhi Xie, Yunchou Wu, Qiuling Liao","doi":"10.1089/end.2023.0638","DOIUrl":"10.1089/end.2023.0638","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> To analyze the influencing factors of ureteral stenosis after ureteroscopic holmium laser lithotripsy. <b><i>Methods:</i></b> The clinical data of 427 patients treated with ureteroscopic holmium laser lithotripsy were selected, and the patients were divided into two groups based on the presence or absence of ureteral stenosis after the operation. Univariate and multivariate logistic regression were used to analyze the independent risk factors for postoperative ureteral stenosis, and R software and regression coefficients were used to construct a predictive model. <b><i>Results:</i></b> After a 1-year follow-up of 427 patients, 28 patients (6.56%) developed ureteral stenosis; univariate analysis showed that the occurrence of ureteral stenosis after subureteral holmium laser lithotripsy was related to stone diameter, stone incarceration, degree of hydronephrosis, holmium laser injury of mucosa, and operation time (<i>p</i> < 0.05); further logistic regression analysis showed that a large stone diameter, stone incarceration, and moderate to severe hydronephrosis were independent risk factors for ureteral stenosis after ureteroscopic holmium laser lithotripsy (<i>p</i> < 0.05); According to H-L deviation degree and area under receiver operating characteristic curve test, the results show that the model has high accuracy (<i>χ</i>² = 2.475, <i>p</i> = 0.613) and differentiation (0.875 [95% confidence interval or CI: 0.817-0.919]), and the external verification of the nomogram prediction model was carried out by the verification group. The results showed that the prediction probability of the calibration curve was close to the actual probability and had a good consistency (area under the curve: 0.873 [95 CI: 0.822-0.914]). <b><i>Conclusion:</i></b> The established nomogram model exhibits high accuracy and discriminative ability. It can effectively identify high-risk groups, enabling timely prevention of ureteral stenosis and minimizing the risk of postoperative ureteral stenosis.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}