Wu B. et al., 2025: Predicting Risk Factors Affecting the Efficacy of Flexible Ureteral Holmium Laser Lithotripsy and Extracorporeal Shock Wave Lithotripsy for Ureteral Calculi Based on Decision Tree Model.
Ben Wu 1, Li Wu 1, Hao He 1, Xiaogui Ding 1, Tong Bao 1, Rui Zhou 1
1Department of Urology, Anqing Municipal Hospital, 246003 Anqing, Anhui, China.
Abstract
Aim: To evaluate the efficacy of flexible ureteroscopic lithotripsy (FURL) and extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteral calculi based on decision tree model.
Methods: A total of 600 patients with ureteral calculi, including 289 treated with FURL and 311 cases with ESWL in Anqing Municipal Hospital from June 2021 to August 2023, were selected as study subjects. Perioperative indicators and stone clearance rate of the two groups were compared, and the preoperative and postoperative (24 and 72 hours) changes of serum creatinine, cystatin C (Cys-C) and microalbumin were observed. The complications during and 7 days after treatment, the influence of perioperative indexes, total stone removal rate and renal function indexes were analyzed using decision tree method, and a complication risk prediction model was constructed.
Results: The operation time, length of hospital stays and postoperative hematuria time in FURL group were shorter than those in ESWL group (p < 0.001), and the usage of painkillers was less frequent in FURL group than in ESWL group (p = 0.002). The total stone removal rate in the FURL group was higher than that in the ESWL group (p < 0.001). Serum creatinine, urinary microalbumin and Cys-C in both groups were lower before surgery than at 24 h and 72 h after surgery (p < 0.05). Serum creatinine, urinary microalbumin and Cys-C in FURL group were lower than those in the ESWL group at 24 and 72 h after operation (p < 0.001). The overall complication rate in the FURL group was lower than that in the ESWL group (p = 0.028). Decision tree model analysis showed that four explanatory variables, including preoperative creatinine, urinary microalbumin, Cys-C and surgical method were identified by screening. The risk statistic of the model was 0.027, and the accuracy, sensitivity and specificity of the model in predicting postoperative complications in patients with ureteral calculi were 97.33%, 97.73% and 97.30%, respectively.
Ann Ital Chir. 2025;96(1):78-85. doi: 10.62713/aic.3702. PMID: 39815840 FREE ARTICLE
Comments 1
The best approach to this article is to look at the Tables.
The number of patients treated with flexible URS (fURS) and SWL were 298 and 311. Stones located in the upper and middle/lower ureters were 230 and 370, respectively. There were no differences in stone size.
Most interestingly, SWL-treated patients were hospitalized and thereby stayed longer in the hospital than fURS patients (Table 2). Hematuria was recorded as a complication, but in the reviewers’ opinion hematuria is an expected consequence of SWL.
The clearance of stones was very good with both methods, 88% for proximal ureteral stones. For middle/ lower stones fURS resulted in stone clearance in 98% and for SWL in 66%. The latter figure is surprisingly poor (Table 3). The minor effect on renal function probably was without clinical significance.
It is unexpected that one SWL-treated patient developed septic shock, but there is no information if any antibiotic regimens were used before SWL. Even more surprising is it that 5 SWL patients had ureteral perforations.
The decision-tree used and proposed by the authors was based on the risk of complications:
Fever
Bladder irritation
Low back pain
Septic shock
Ureteral perforation
Need of stenting.
In further comparison the authors used the following variables to conclude that fURS is superior to SWL.
Operation time
Length of hospital stay
Post-operative hematuria
Stone clearance rate
Pre-op S-creatinine
Microalbuminuria
Cys-C-levels
Hans-Göran Tiselius