Journal of endourology最新文献

{"title":"Peritoneal Window Technique: A Novel Sutureless Technique to Decrease the Rate of Symptomatic Lymphocele after Robot-Assisted Radical Prostatectomy with Extended Pelvic Lymph Node Dissection.","authors":"Eric Qualkenbush, Yeonsoo S Lee, Amanda Kahn, Neda Qosja, Alex Hochwald, Amanda Myers, Andrew Zganjar, Ram Pathak, Raymond Pak","doi":"10.1089/end.2025.0093","DOIUrl":"https://doi.org/10.1089/end.2025.0093","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Robot-assisted radical prostatectomy (RARP) with extended pelvic lymph node dissection (PLND) represents the gold standard surgical treatment for high-risk localized prostate cancer. PLND carries the risk of lymphocele formation, which can lead to complications such as deep vein thrombosis (DVT), infection, and voiding dysfunction. Many techniques have been described to minimize lymphocele formation, yet no method has seen widespread use or been described as sutureless. The objective of this study is to describe the novel, sutureless peritoneal window (PWIN) technique and assess its efficacy in lymphocele prophylaxis for extended PLND. <b><i>Methods:</i></b> This was a retrospective review of patients with high-risk prostate cancer undergoing RARP with extended PLND by a single surgeon from 2018 to 2024. PLND was carried out in the usual manner with bipolar cautery. PWIN technique is performed by excising a 3 × 5 cm PWIN over the lymphadenectomy bed to maintain lymphatic communication with the abdominal cavity. The primary outcome was a comparison between the incidence of symptomatic lymphoceles (SLs) with PWIN <i>vs</i> standard technique. SLs were defined as lymphoceles presenting with pain, DVT, voiding dysfunction, or infectious symptoms. Patients with asymptomatic lymphoceles were excluded. <b><i>Results:</i></b> Our study included 199 patients who underwent RARP with extended PLND. There were 46 patients (23.1%) in the standard approach group and 153 patients (76.9%) in the PWIN group. We identified 5/46 (10.9%) SLs in the standard technique, which were significantly higher than the 3/153 (2.0%) observed in the PWIN group (p = 0.017). There was no difference between the standard and PWIN cohorts regarding symptomology or treatment of their lymphocele. <b><i>Conclusion:</i></b> This study describes a novel, sutureless PWIN technique that significantly decreases SL after extended PLND. This technique offers a practical, time-efficient, and cost-effective alternative for lymphocele prevention. Future prospective studies are warranted to validate these findings.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258191","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":"Radiographical Changes after Ureteral Rest for Robotic Ureteral Reconstruction.","authors":"Matthew Lee, Nathan Liss, Kelley Zhao, Omar Agosto, Daniel D Eun","doi":"10.1089/end.2024.0920","DOIUrl":"https://doi.org/10.1089/end.2024.0920","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> We evaluate radiographical changes involved with the implementation of ureteral rest before robotic ureteral reconstruction (RUR) for the management of ureteral strictures. <b><i>Materials and Methods:</i></b> We retrospectively reviewed our single-institutional robotic ureteral surgery database to identify all consecutive patients who underwent ureteral rest before RUR for the surgical management of ureteral strictures between 1/2018 and 12/2022. Ureteral rest was defined as having the absence of hardware across a strictured segment before definitive surgical repair. All patients who obtained both pre- and post-ureteral rest retrograde and/or antegrade pyelograms were included for analysis. An experienced genitourinary radiologist reviewed all pre- and post-retrograde and/or antegrade pyelograms to determine stricture quality and length. Primary outcomes included the change in stricture quality and the difference in ureteral stricture length after ureteral rest. <b><i>Results:</i></b> Overall, 50 patients met the inclusion criteria. Preoperative stricture quality was determined to be narrowed in 86.0% and obliterative in 14.0% of patients. The median duration of ureteral rest was 11.1 (interquartile range [IQR] 5.7-22.8) weeks. Of those with narrowed strictures, 12.0% progressed to obliterative strictures after ureteral rest. There were 37 (74.0%) patients who had an increase in stricture length after ureteral rest. The median growth in stricture length after ureteral rest was 0.2 (IQR: -0.2-0.4) centimeters. At a median follow-up of 6.2 (IQR: 2.9-10.0) months, 88.0% of patients were surgically successful. <b><i>Conclusions</i></b><i>:</i> Ureteral rest can lead to changes in stricture quality, which may be valuable in surgical decision-making.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258192","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":"Urinary Outcomes of Minimally Invasive Treatments for Prostate Cancer-A Systematic Review by Young Academic Urologists' Urotechnology Working Group.","authors":"Mark Taratkin, Alexander Androsov, Andrey Morozov, Camilla Azilgareeva, Juan Gomez Rivas, Stefano Puliatti, Enrico Checcucci, Ines Rivero Belenchon, Karl-Friedrich Kowalewski, Severin Rodler, Pietro Piazza, Loïc Baekelandt, Alessandro Veccia, Pieter De Backer, Harun Fajkovic, Dmitry Enikeev, Giovanni E Cacciamani","doi":"10.1089/end.2024.0129","DOIUrl":"https://doi.org/10.1089/end.2024.0129","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Minimally invasive treatments (MITs) have emerged as viable treatment options for carefully selected patients with localized disease. Their major advantage is that MITs enable the preservation of nearby healthy prostate tissue and critical structures such as the urethral sphincter and neurovascular bundles without compromising oncologic outcomes. The aim of the current review is to describe the impact of different MITs for prostate cancer (PCa) on urinary continence. <b><i>Materials and Methods:</i></b> A systematic literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were as follows: all clinical trials conducted and related to the urinary outcomes (UO) of PCa MITs. Exclusion criteria were as follows: any reviews, articles, conference abstracts, articles whose subject fell outside the scope of this review, or any articles published more than 5 years ago. <b><i>Results:</i></b> In the course of the last 5 years, a total of 114 articles on MITs of PCa have been published. Among them, only 36 dealt with the UO for MITs. Brachytherapy, cryoablation, and high-intensity focused ultrasound (HIFU) seem to be the most widely used technologies, whereas irreversible electroporation, focal brachytherapy, focal cryoablation, and multi-parametric magnetic resonance imaging-ultrasound-guided (mpMRI-US-guided) HIFU seem to be the safest techniques in terms of UO. <b><i>Conclusion:</i></b> The use of MITs for treating PCa is a fast-growing option that can help preserve functional parameters and urinary continence close to their normal levels. It should be noted that although there are currently limited data available on all MITs for the treatment of PCa, the ones that have been extensively studied have shown promising results.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258193","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":"Assessing Renal Function Recovery Following Treatment for Post-Robot-Assisted Partial Nephrectomy Renal Artery Pseudoaneurysm.","authors":"Amanda E Kahn, Laura E Geldmaker, Neda Qosja, Daniela A Haehn, Taylor F Fuqua, Vartika Tiwari, Alex Hochwald, Colleen S Thomas, David D Thiel","doi":"10.1089/end.2025.0046","DOIUrl":"https://doi.org/10.1089/end.2025.0046","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> To evaluate the impact of the treatment for renal artery pseudoaneurysm (RAP) on long-term renal function after robot-assisted partial nephrectomy (RAPN). <b><i>Materials:</i></b> We retrospectively reviewed 581 consecutive RAPNs performed by a single surgeon from February 2008 to February 2022. We evaluated patient variables, postoperative complications, and renal function at postoperative day one, 1 month, and 6 months after RAPN. Renal function was defined as estimated glomerular filtration rate (eGFR) based on the chronic kidney disease epidemiology collaboration Cr 2009 equation. We utilized the Fisher's exact test and Kruskal-Wallis rank sum test to analyze our data through categorical and continuous variables. <b><i>Results:</i></b> Twenty-one patients (3.61%) developed a symptomatic RAP after RAPN that was treated with Interventional Radiology embolization. Patients with a RAP had a median age of 61.8 years (IQR: 53.5-69.7), median preoperative eGFR of 83.9 (IQR: 69.5-85.2), median BMI of 29.4 (IQR: 25.4-33.1), and median mass size of 3 cm (IQR: 2.5-4.2). There was no statistical difference in baseline characteristics between patients with RAP and patients without RAP. Patients with RAP had a longer length of stay (LOS) (3.0 IQR: 2.0-4.0 <i>vs</i> 2.0 IQR: 2.0-3.0). Patients with a RAP had a larger change in absolute eGFR value based on the difference from baseline to 1 month and 6 months (1 month: 20.5 <i>vs</i> 11.2, <i>p</i> < 0.001; 6 months: 18.1 <i>vs</i> 10.4, <i>p</i> = 0.001). RAP patients were also less likely to be within 10% of pre-RAPN levels (1 month: 24% <i>vs</i> 49%, <i>p</i> = 0.021; 6 months: 18% <i>vs</i> 47%, <i>p</i> = 0.016). <b><i>Conclusions:</i></b> Patients treated for RAP post-RAPN had a decrease in renal function recovery at 1 month and 6-month intervals compared to patients not requiring post-RAPN RAP treatment.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258190","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":"Ureteral Stricture Occurrence after Transmural Ureteroscopic Ureteral Injury: A Previously Undocumented Concern.","authors":"Andrei D Cumpanas, Seyed Amiryaghoub M Lavasani, Jaime Altamirano-Villarroel, Seyedamirvala Saadat, Jacob C Tsai, Brandon Camp, Jaylen M Lee, Marissa Ericson, Bruce M Gao, Zachary E Tano, Pengbo Jiang, Roshan M Patel, Jaime Landman, Ralph V Clayman","doi":"10.1089/end.2024.0702","DOIUrl":"https://doi.org/10.1089/end.2024.0702","url":null,"abstract":"<p><p><b><i>Take Home Message:</i></b> Ureteral stricture risk rises exponentially with the depth of the ureteral injury. Indeed, when superficial or transmural ureteral splitting occurred, the odds of developing a <i>de novo</i> stricture rose by 13- and 40-fold, respectively. <b><i>Purpose:</i></b> Although the reported incidence of ureteral strictures following ureteroscopy (URS) is low (0.3%-3%), we hypothesize the risk may rise as the depth of ureteral injury increases. <b><i>Materials and Methods:</i></b> Between 2018 and 2022, 550 patients underwent URS for upper tract calculi; each of these patients had a postureteroscopic lesion scale (PULS) grading and follow-up imaging 3-6 months after a surgical procedure. Patients with preexisting strictures, or strictures formed at the site of an impacted stone, were excluded. <b><i>Results:</i></b> With a median follow-up of 23 months, <i>de novo</i> stricture rates for the 550 patients were 0.73% (4/550). More specifically, while strictures among patients with PULS 0 and 1 were minimal, 0% (0/235) and 0.48% (1/208), respectively. However, the stricture rate increased to 1.1% (1/92) for PULS 2 and jumped to 13.3% (2/15) among those patients with PULS 3 injuries. On a Firth penalized logistic regression analysis, we found that when urothelial splitting (i.e., PULS 2 or higher) or periureteral fat (i.e., a PULS 3 transmural injury) was visualized, the odds of developing a stricture were 13 and 40 times higher, respectively. Based on these findings, we sought to simplify the existing ureteral injury grades and improve ureteral stricture prognostication by creating a novel dichotomous injury scale. <b><i>Conclusions:</i></b> Iatrogenic ureteral stricture rates rose sharply when ureteral wall integrity was disrupted. This was most notable for a transmural injury, which resulted in a stricture rate of 13.3% (2/15 patients). Using a simplified two-stage scoring system (University of California, Irvine [UCI] 0, 1, or 2), clinicians may be better able to identify patients (i.e., UCI 2) at high risk for post-URS stricture formation.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248193","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":"Changes in Kidney Volume after Robot-Assisted Partial Nephrectomy and Impact on Postoperative Renal Function.","authors":"Asuka Sano, Takayuki Sugiyama, Yuto Matsushita, Hiromitsu Watanabe, Keita Tamura, Daisuke Motoyama, Atsushi Otsuka, Hideaki Miyake","doi":"10.1089/end.2024.0244","DOIUrl":"https://doi.org/10.1089/end.2024.0244","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> The objectives of this study were to measure the changes in kidney volume after robot-assisted partial nephrectomy (RAPN) and examine the impact on the postoperative renal function. <b><i>Methods:</i></b> This study included 58 patients undergoing RAPN at our institution between July 2017 and November 2019. Kidney volume was measured with Synapse VINCENTv3.1 (Fujifilm Medical Co., Tokyo, Japan) based on the findings on contrast-enhanced CT before and after RAPN. <b><i>Results:</i></b> At 1 week post-RAPN, kidney volumes on the operated side, contralateral side, and overall were significantly larger compared with preoperative measurements (110.6%, <i>p</i> < 0.001; 113.2%, <i>p</i> < 0.001; 112.1%, <i>p</i> < 0.001, respectively). By 1 year postoperation, the operated-side and total kidney volumes had significantly decreased compared with the preoperative levels (83.2%, <i>p</i> < 0.001; 92.7%, <i>p</i> < 0.001), whereas the contralateral kidney volume showed a slight but significant increase (102.1%, <i>p</i> = 0.027). In addition, the estimated glomerular filtration rate (eGFR) decreased by 12.8% at 1 year after RAPN compared with the preoperative value. Multivariate analysis revealed that age, warm ischemia time, and changes in total kidney volume at 1 year had independent impacts on changes in eGFR. Furthermore, only changes in kidney volume on the operated and contralateral sides were shown to be independently associated with changes in total kidney volume 1 year after RAPN. A higher R.E.N.A.L. nephrometry score, L score, and a smaller preoperative total kidney volume were identified as independent predictors of contralateral renal enlargement 1 year after RAPN. <b><i>Conclusions:</i></b> This study confirmed the occurrence of compensatory hypertrophy of the contralateral kidney after RAPN. This phenomenon associated with a higher R.E.N.A.L. nephrometry score, L score, and a smaller preoperative total kidney volume.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248192","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":"Can Anatomical Measurements on Preoperative Pelvic Magnetic Resonance Imaging Predict Postoperative Urinary Incontinence after Holmium Laser Enucleation of the Prostate?","authors":"Shayan Smani, Amir I Khan, Ankur U Choksi, Benjamin H Press, Syed N Rahman, Christopher S Hayden, Mursal Gardezi, Michael Jalfon, Jason Lee, Preston C Sprenkle, Daniel S Kellner","doi":"10.1089/end.2025.0006","DOIUrl":"https://doi.org/10.1089/end.2025.0006","url":null,"abstract":"<p><p><b><i>Background and Objective:</i></b> Anatomical dimensions of the prostate and membranous urethra are well-established predictors of urinary incontinence following robotic prostatectomy. However, their role in predicting incontinence after holmium laser enucleation of the prostate (HoLEP) remains underexplored. This study aimed to evaluate the predictive value of preoperative anatomical measurements, including membranous urethral length (MUL), membranous urethral angle (MUA), levator ani thickness (LAT), and intravesical prostatic protrusion length (IPPL), in assessing the risk of early postoperative urinary incontinence following HoLEP. <b><i>Methods:</i></b> We retrospectively reviewed 122 patients who underwent HoLEP from April 2019 to June 2022 with preoperative MRI imaging. Anatomical features including coronal and sagittal MUL, MUA, LAT, and IPPL were assessed. Urinary incontinence, defined as the use of ≥1 pad per day, was evaluated at 1, 3, and 6 months postoperatively. All logistic regression analyses were adjusted for age, body mass index, postvoid residual, preoperative incontinence, and prostate-specific antigen, and receiver operating characteristic (ROC) curves were constructed to assess the discriminatory utility of MRI anatomical measurements. <b><i>Results:</i></b> Increasing MUL was significantly associated with reduced incontinence risk at 1 month (coronal MUL: odds ratio [OR], 0.85; 95% confidence interval [CI]: 0.75-0.96; <i>p</i> = 0.01; sagittal MUL: OR, 0.89; 95% CI: 0.79-0.99; <i>p</i> = 0.046). No significant associations were found for MUA, LAT, or IPPL. ROC analysis of averaged coronal and sagittal MUL revealed moderate discriminatory power (area under the curve: 0.644), with a threshold of 14 mm identified via the Youden index. Individuals with an MUL <14 mm were at nearly 4-fold increased odds of incontinence at 1 month (OR 3.835, 95% CI: 1.516-9.703, <i>p</i> = 0.005). <b><i>Conclusions:</i></b> Preoperative MUL measurement provides a practical, imaging-based method to predict early postoperative urinary incontinence following HoLEP. Incorporating MUL into preoperative evaluations may improve risk stratification, optimize patient counseling, and guide perioperative management strategies. Further prospective studies are needed to confirm these findings.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225668","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":"MRI Can Replace Early Protocol Biopsy in Patients Undergoing Focal Cryoablation for Prostate Cancer.","authors":"Piroz Bahar, Eugene Oh, Karan Desai, Matthew Jordan, Michael Ayenew, Matthew S Davenport, Jeffrey S Montgomery, Arvin K George","doi":"10.1089/end.2024.0780","DOIUrl":"https://doi.org/10.1089/end.2024.0780","url":null,"abstract":"<p><p><b><i>Introduction and Objectives:</i></b> Assessing oncological success following focal ablation for prostate cancer (PCa) includes prostate-specific antigen (PSA) response and imaging. However, the value of protocol biopsy remains uncertain. Consensus recommendations include follow-up multiparametric MRI (mpMRI) and biopsy despite variable imaging quality, interpretation, and biopsy performance. We aim to determine mpMRI performance characteristics postablation for early in-field (within the ablation zone) failure following focal cryoablation (FC). <b><i>Methods:</i></b> Patients receiving FC from January 1, 2017, to April 21, 2023, at Michigan Medicine were enrolled in a multi-institutional, institutional review board-approved prospective registry. Per protocol, PSA, mpMRI, and ultrasound-MR fusion biopsy of the ablation bed were obtained at 6 to 12 months postablation. Residual PCa was suspected on mpMRI if there was persistent enhancement and impeded diffusion near the ablation zone colocalizing to the intended ablation target. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of postablation mpMRI for Gleason Grade Group (GG) ≥2 PCa were calculated. Chi-squared test was used to perform bivariate analysis. <b><i>Results:</i></b> A total of 76 patients underwent primary ablation, postablation mpMRI, and protocol biopsy. Eight patients underwent repeat cryoablation with postsalvage cryoablation mpMRI and biopsy (<i>N</i> = 84 postablation events). Postablation mpMRI showed persistent PCa in 13.4% (11/84). Postablation biopsy showed GG ≥2 PCa in 7.1% (6/84) of target lesions. MpMRI sensitivity, specificity, PPV, and NPV for detecting untreated GG ≥2 PCa postablation were 83.3%, 92.3%, 45.5%, and 98.6%, respectively, with significant association between positive MRI and biopsy detection of GG ≥2 PCa (<i>p</i> < 0.0001). The positive and negative likelihood ratios for residual disease detection were 10.8 and 0.18. <b><i>Conclusion:</i></b> Postablation mpMRI has a high sensitivity, NPV, and specificity for detecting untreated GG ≥2 PCa. If negative, near-term \"protocol\" biopsy may be safely avoided. Investigation into causes of false positive and negative postablation mpMRI will help identify those who warrant per-protocol biopsy.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215927","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":"Harnessing Artificial Intelligence to Predict Spontaneous Stone Passage: Development and Testing of a Machine Learning-Based Calculator.","authors":"Kavita Gupta, Anna Ricapito, Dara Lundon, Raymond Khargi, Chris Connors, Alan J Yaghoubian, Blair Gallante, William M Atallah, Mantu Gupta","doi":"10.1089/end.2024.0755","DOIUrl":"https://doi.org/10.1089/end.2024.0755","url":null,"abstract":"<p><p><b><i>Objective:</i></b> We sought to use artificial intelligence (AI) to develop and test calculators to predict spontaneous stone passage (SSP) using radiographical and clinical data. <b><i>Methods:</i></b> Consecutive patients with solitary ureteral stones ≤10 mm on CT were prospectively enrolled and managed according to American Urological Association guidelines. The first 70% of patients were placed in the \"training group\" and used to develop the calculators. The latter 30% were enrolled in the \"testing group\" to externally validate the calculators. Exclusion criteria included contraindication to trial of SSP, ureteral stent, and anatomical anomaly. Demographic, clinical, and radiographical data were obtained and fed into machine learning (ML) platforms. SSP was defined as passage of stone without intervention. Calculators were derived from data using multivariate logistic regression. Discrimination, calibration, and clinical utility/net benefit of the developed models were assessed in the validation cohort. Receiver operating characteristic curves were constructed to measure their discriminative ability. <b><i>Results:</i></b> Fifty-one percent of 131 \"training\" patients spontaneously passed their stones. Passed stones were significantly closer to the bladder (8.6 <i>vs</i> 11.8 cm, p = 0.01) and smaller in length, width, and height. Two ML calculators were developed, one supervised machine learning (SML) and the other unsupervised machine learning (USML), and compared to an existing tool Multi-centre Cohort Study Evaluating the role of Inflammatory Markers In Patients Presenting with Acute Ureteric Colic (MIMIC). The SML calculator included maximum stone width (MSW), ureteral diameter above the stone (UDA), and distance from ureterovesical junction to bottom of stone and had an area under the curve (AUC) of 0.737 upon external validation of 58 \"test\" patients. Parameters selected by USML included MSW, UDA, and use of an anticholinergic, and it had an AUC of 0.706. The MIMIC calculator's AUC was 0.588 (0.489-0.686). <b><i>Conclusion:</i></b> We used AI to develop calculators that outperformed an existing tool and can help providers and patients make a better-informed decision for the treatment of ureteral stones.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199315","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":"Predictive Factors for Ureteral Stone Passage in Children.","authors":"William Robert DeFoor, Joonsue Lee, Campbell Grant, Michael Nasser, Christopher Anton, Andrew Trout, Eugene Minevich, Marion Schulte, Andrew Angel, Brian VanderBrink","doi":"10.1089/end.2024.0536","DOIUrl":"https://doi.org/10.1089/end.2024.0536","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To determine if transverse or longitudinal ureteral stone length is associated with the rate of spontaneous stone passage in a pediatric population. <b><i>Methods:</i></b> A retrospective cohort study was performed of children presenting with a ureteral calculus to a single institution from 2010 to 2020. Inclusion criteria included a symptomatic ureteral stone diagnosed by CT. Images were independently reviewed by two pediatric radiologists. An effective stone passage was defined if a patient did not require surgical intervention and follow-up imaging within 6 weeks confirmed the absence of the stone. Univariate and multivariate logistic regression analysis was performed. <b><i>Results:</i></b> A total of 66 subjects (34 female) with a mean age of 14.5 years were included. Fifty-one (77%) were treated with medical expulsive pharmacotherapy. A total of 31/66 (47%) patients passed the stone spontaneously, whereas 35 underwent surgical intervention within 6 weeks. Both longitudinal (odds ratio [OR] = 1.9, 95% confidence interval [CI]: 1.2-3.0) and transverse (OR = 2.6, 95% CI: 1.5-4.7) stone dimensions were associated with likelihood of spontaneous passage on univariable logistic regression. On multivariable regression, transverse stone diameter (OR = 2.5, 95% CI: 1.3-4.5) and history of nephrolithiasis (OR = 4.3, 95% CI: 1.1-17) were the only independent predictors of stone passage. Based on Receiver Operator Curve (ROC) analysis, a transverse diameter of 3.5 mm was optimal to predict stone passage (area under the curve = 0.82, sensitivity = 84%, specificity = 77%). <b><i>Conclusions:</i></b> A ureteral stone measuring less than 3.5 mm in transverse dimension is more likely to pass spontaneously in children. CT scans should report ureteral stone dimensions in the transverse plane.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199316","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}