Evaluation with Decision Trees of Efficacy and Safety of Semirigid Ureteroscopy in the Treatment of Proximal Ureteral Calculi

Abstract

Purpose: The decision on the choice of proximal ureteral stone therapy depends on many factors, and sometimes urologists have difficulty in choosing the treatment option. This study is aimed at evaluating the factors affecting the success of semirigid ureterorenoscopy (URS) using the “decision tree” method. Materials and Methods: From January 2005 to November 2015, the data of consecutive patients treated for proximal ureteral stone were retrospectively analyzed. A total of 920 patients with proximal ureteral stone treated with semirigid URS were included in the study. All statistically significant attributes were tested using the decision tree method. Results: The model created using decision tree had a sensitivity of 0.993 and an accuracy of 0.857. While URS treatment was successful in 752 patients (81.7%), it was unsuccessful in 168 patients (18.3%). According to the decision tree method, the most important factor affecting the success of URS is whether the stone is impacted to the ureteral wall. The second most important factor affecting treatment was intramural stricture requiring dilatation if the stone is impacted, and the size of the stone if not impacted. Conclusions: Our study suggests that the impacted stone, intramural stricture requiring dilatation and stone size may have a significant effect on the success rate of semirigid URS for proximal ureteral stone. Further studies with population-based and longitudinal design should be conducted to confirm this finding.

Pneumatic vs laser lithotripsy for mid-ureteric stones: Clinical and cost effectiveness results of a prospective trial in a developing country

“…The management of stone disease has been revolutionised. The miniaturisation of scopes and sophistication of medical instrumentation is driving urological practice into a high-technological performance with its economic impact, particularly in developing countries [ 2 , 13 ].…”

“…URS with lithotripsy is the benchmark treatment for large mid-ureteric stones. Despite the availability of several energy sources, pneumatic and laser energy are favoured for their high SFRs (>90%) [ 8 ] and lower morbidity rates [ 13 , 14 ].…”

Radiation Exposure during Ureterorenoscopy and Laser Lithotripsy: An Analysis of Stone Characteristics

“…Plain abdominal radiographs, CT of the kidneys, ureters and bladder (CT KUB) scans and procedures involving fluoroscopy expose patients to the equivalent of the year- ly effective dose of ionising radiation. Ureterorenoscopy and laser lithotripsy (URS + LL) is a safe and effective treatment option for ureteral and renal stones of small or moderate size, which is conventionally aided by fluoroscopy [2,3].…”

Is spinal anesthesia an alternative and feasible method for proximal ureteral stone treatment?

“…Stone disease in the urinary system has a high prevalence that varies depending on climate, geography, ethnic background, diet, and genetic factors. Ureteral stones are observed in 20% of urinary system stones [ 1 , 2 ]. Patients with urinary system stones have a 50% chance of relapsing within ten years of their first diagnosis [ 2 ].…”