{"title":"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。","authors":"Faisal Ahmed, Khaled Al-Kohlany, Khalil Al-Naggar, Ibrahim Alnadhari, Abdulfattah Yahya Altam, Mohamed Badheeb","doi":"10.2147/RRU.S515846","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":21008,"journal":{"name":"Research and Reports in Urology","volume":"17 ","pages":"139-152"},"PeriodicalIF":2.0000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053771/pdf/","citationCount":"0","resultStr":"{\"title\":\"Assessing the Predictive Accuracy of the S.T.O.N.E. Score for Stone-Free Rates in Semirigid Pneumatic Ureteral Lithotripsy: Implications for Validation.\",\"authors\":\"Faisal Ahmed, Khaled Al-Kohlany, Khalil Al-Naggar, Ibrahim Alnadhari, Abdulfattah Yahya Altam, Mohamed Badheeb\",\"doi\":\"10.2147/RRU.S515846\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":21008,\"journal\":{\"name\":\"Research and Reports in Urology\",\"volume\":\"17 \",\"pages\":\"139-152\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053771/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Research and Reports in Urology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2147/RRU.S515846\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Research and Reports in Urology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2147/RRU.S515846","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Assessing the Predictive Accuracy of the S.T.O.N.E. Score for Stone-Free Rates in Semirigid Pneumatic Ureteral Lithotripsy: Implications for Validation.
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.
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.
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