Gezmiş CT. et al., 2025: Impact of the Mayo adhesive probability score on ESWL outcomes for proximal ureteral stones.

Cem Tuğrul Gezmiş, Nusret Can Çilesiz, Serdar Turan, Mustafa Satılmışoğlu, Ali Eroğlu, Mustafa Bahadır Can Balcı
Urolithiasis 2025 Oct 23;53(1):201. doi: 10.1007/s00240-025-01878-y

Abstract

This study aimed to evaluate the predictive value of the Mayo Adhesive Probability (MAP) score for extracorporeal shock wave lithotripsy (ESWL) success in patients with proximal ureteral stones. We retrospectively analyzed 216 patients who underwent ESWL for isolated proximal ureteral stones between March 2020 and May 2025. Demographic and radiological parameters, including stone size, stone density, skin-to-stone distance, and MAP score, were recorded. The MAP score was calculated using non-contrast computed tomography by assessing posterior perinephric fat thickness and perinephric fat stranding. Treatment success was defined as no ureteral stone; residual fragments ≤ 4 mm were permitted only if located in the kidney after the ESWL procedure at 3-month follow-up. Logistic regression analysis was performed to identify independent predictors of ESWL success. The overall ESWL success rate was 63%. Patients with a MAP score < 3 achieved significantly higher success rates than those with a MAP score ≥ 3 (76.9% vs. 45.3%). In multivariate logistic regression analysis, stone size > 10 mm (odds ratio [OR] 0.340, 95% confidence interval [CI] 0.179-0.647), MAP score ≥ 3 (OR 0.266, 95% CI 0.140-0.507), and a prolonged interval between computed tomography and ESWL (OR 0.956, 95% CI 0.927-0.985) were identified as independent predictors of reduced success. A higher MAP score, larger stone size, and longer pre-treatment interval are associated with lower ESWL success in proximal ureteral stones. MAP scoring provides a simple, reproducible, imaging-based tool that may assist in patient selection and support treatment planning.

Comment Peter Alken

Our Turkish colleagues seem to like the MAP score (1-3) which was originally developed > 10 years ago (4) to predict nothing more but the presence of adherent perinephric fat during partial nephrectomy. The paper is well written. A few limitations are named. One among them is that “a formal interobserver reliability analysis of MAP scoring was not conducted.” This will probably soon be solved because software to measure the amount of hyperdense areas in the perinephric fatty tissue will soon be used for objective quantification.  And more papers will appear on the same subject. One limitation will soon become something not regarded and to be mentioned as a limitation: “stone composition analysis was not available, and its potential influence on ESWL outcomes could not be assessed.” Although stone analysis is considered an essential diagnostic step in the assessment of stone patients, it has quietly disappeared from many endourological articles.

1. Uzun E, Senel S, Polat ME, Arabaci HB, Koudonas A, Olcucuoglu E. The predictive ability of Mayo adhesive probability score for evaluating intraoperative bleeding in standard percutaneous nephrolithotomy in adult patients. Urolithiasis. 2024 Jul 28;52(1):108. doi: 10.1007/s00240-024-01611-1. PMID: 39068638.

2. Ipek OM, Dincer E, Sevinc AH, Sevinc BH, Canakci C, Ozkaptan O. Predictive performance of Triple-D, Quadruple-D, and Mayo adhesive probability scores in ESWL for renal stones: a retrospective cohort study. Urolithiasis. 2025 May 22;53(1):96. doi: 10.1007/s00240-025-01765-6. PMID: 40402229; PMCID: PMC12098459.

3. Caglar U, Halis A, Yazili HB, Ayranci A, Sarilar O, Ozgor F. The impact of Mayo Adhesion probability score on the success of extracorporeal shock wave lithotripsy for kidney stones. Urolithiasis. 2024 Dec 16;53(1):8. doi: 10.1007/s00240-024-01680-2. PMID: 39680210.

4. Davidiuk AJ, Parker AS, Thomas CS, Leibovich BC, Castle EP, Heckman MG, Custer K, Thiel DD. Mayo adhesive probability score: an accurate image-based scoring system to predict adherent perinephric fat in partial nephrectomy. Eur Urol. 2014 Dec;66(6):1165-71. doi: 10.1016/j.eururo.2014.08.054. Epub 2014 Sep 2. PMID: 25192968.

Peter Alken