Vercelli E. et al., 2026: Methodology of peri-operative imaging data reporting for stone disease: a systematic review toward the development of a novel checklist-iSTAR.

Vercelli E, Van den Ende M, Hellemans F, Poelaert F, Pauwaert K, Van Bos E, Boeykens M, De Visschere P, Ghani K, Dauw C, Kallidonis P, Tailly T
World J Urol. 2026 Jun 11;44(1):420. doi: 10.1007/s00345-026-06433-x

Abstract

Purpose: To critically analyze the methodology of imaging data reporting, including timing, modality and stone burden measurement perioperatively, from recently published literature on surgical interventions for stones, and to develop a scoring system to evaluate its quality.

Methods: Articles reporting treatment outcomes in adult patients, published in 2020-2021 by preselected journals, were searched on PubMed and Embase. Recorded data for statistical analysis included type of study and intervention, pre- and postoperative imaging modality and timing, stone burden assessment method and measurement, stone free and treatment success definition or their differentiation. A new 7-point checklist (iSTAR-Imaging for Stone Treatment Assessment Reporting) was developed.

Results: A total of 122 studies were included. Several papers did not report on pre- or postoperative imaging modality (13.9% and 5.7%), nor provided a definition of stone burden measurement or treatment success (43% and 18%). Stone burden was most often assessed with Non-Contrast Computed Tomography (54.9%) and reported as stone diameter (75.4%). Definitions of treatment success varied widely across literature, ranging from 0 mm to allowing 4 mm residual fragments. Preoperative imaging timing lacked in 95.9% of studies, while postoperative timing distribution was heterogeneously present. iSTAR scores resulted in 0/7 (0.8%), 1/7 (0.8%), 2/7 (1.6%), 3/7 (7.4%), 4/7 (16.4%), 5/7 (32%), 6/7 (38.5%) and 7/7 (10.7%), independently from study design.

Conclusion: This research unveils a lack of standardization in reporting of perioperative urolithiasis imaging. iSTAR checklist may help authors to improve data reporting and provide journals and reviewers with a framework to assess imaging methodology quality in submitted manuscripts.

Comment Hans-Göran Tiselius

This is one of the most interesting articles published during this period. The authors have reviewed the imaging procedures before and after stone removal. The pronounced variation clearly explain why literature results differ considerably. The review was based on 122 publications.

I have summarized the essential messages in the report for those readers who do not have full access to the article.

Examination before SWL is commonly based on NCCT (59%) but there was a diversity in the follow-up with NCCT (12%). KUB was more commonly used for determination of the treatment outcome.

The stone-burden most commonly was expressed as stone diameter (75%). Less commonly as stone surface area (21%) and stone volume (19%). This is somewhat surprising in view of the ease by means of which stone volume can be measured today.

Follow-up also varied commonly from 1 to 7 days, but the range was 1-90 days. Follow-up after 1 month or later was also reported. But according to EAU guidelines follow-up results after 4 weeks is recommended.

So, what was the definition of stone-free rates after SWL?

Stone free, completely without fragments (35%).

Fragments (CIRF) < 2 mm (0%).

Fragments 2-4% (47%).

Not reported 18%.

The bottom-line of this message is that there is a need of standardization both in the preoperative imaging and in the follow-up.

Hans-Göran Tiselius