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Yoshioka T. et al., 2020: Development and validation of a prediction model for failed shockwave lithotripsy of upper urinary tract calculi using computed tomography information: the S3HoCKwave score

Yoshioka T, Ikenoue T, Hashimoto H, Otsuki H, Oeda T, Ishito N, Watanabe R, Saika T, Araki M, Fukuhara S, Yamamoto Y; Okayama-Ehime S.W.L. Study Group.
Department of Healthcare Epidemiology, Graduate School of Medicine, Kyoto University School of Public Health, Yoshida-Konoe-machi, Sakyo-ku, Kyoto-shi, Kyoto, 606-8501, Japan.
Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, 1, Hikarigaoka, Fukushima-shi, Fukushima, 960-1295, Japan.
Kyoto University Graduate School of Medicine/Human Health Science, 53 Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Urology, Okayama Central Hospital, 6-3, Ishima-kita-machi, Kita-ku, Okayama-shi, Okayama, 700-0017, Japan.
Department of Urology, Abiko Toho Hospital, 1851-1, Abiko, Abiko-shi, Chiba-ken, 270-1166, Japan.
Department of Urology, Onomichi Municipal Hospital, 3-1170-177, Shin-Takayama, Onomichi-shi, Hiroshima, 722-8503, Japan.
Department of Urology, Kurashiki Medical Center, 250, Bakuro-cho, Kurashiki-shi, Okayama, 710-8522, Japan.
Department of Urology, Matsuyama Shimin Hospital, 2-6-5, Ohte-machi, Matsuyama-shi, Ehime, 790-0067, Japan.
Department of Urology, Ehime University Graduate School of Medicine, Shizukawa, To-on-shi, Ehime, 791-0295, Japan.
Department of Urology, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan.
Department of Healthcare Epidemiology, Graduate School of Medicine, Kyoto University School of Public Health, Yoshida-Konoe-machi, Sakyo-ku, Kyoto-shi, Kyoto, 606-8501, Japan.

Abstract

PURPOSE:
To develop and validate a new clinical prediction model that accurately predicts the failure of shockwave lithotripsy (SWL) using information obtained from non-contrast-enhanced computed tomography (NCCT).

METHODS:
This multicentre retrospective cohort study consecutively enrolled patients diagnosed with upper urinary tract calculi by NCCT at five hospitals in Japan from January 1, 2006 to December 31, 2016. Among the candidate predictors, we selected the six most significant predictors a priori. The main outcome was SWL failure after three sessions. Model calibration was evaluated by the calibration slope and the Hosmer-Lemeshow test. Discrimination was evaluated by the receiver-operating characteristic curves and the area under the curve (AUC). A multivariable logistic regression analysis was performed; based on the estimated β coefficients, predictive scores were generated.

RESULTS:
Of 2695 patients, 2271 were included. Patients were divided into the development cohort (1666 patients) and validation cohort (605 patients) according to geographical factors. We developed a clinical prediction model with scores ranging from 0 to 49 points. We named the prediction model the S3HoCKwave score based on the initials of the predictors (sex, skin-to-stone distance, size, Hounsfield units, colic, and kidney or ureter). As a result of internal validation, the optimism-corrected AUC was 0.72. In the validation cohort, the Hosmer-Lemeshow test did not show statistical significance (P = 0.33), and the AUC was 0.71 (95% confidence interval 0.65-0.76).

CONCLUSIONS:
The S3HoCKwave score is easy to understand, has a relatively high predictive value, and allows clinicians to make appropriate treatment selections.
World J Urol. 2020 Feb 22. doi: 10.1007/s00345-020-03125-y. [Epub ahead of print] PMID: 32088747

1
 

Comments 1

Hans-Göran Tiselius on Tuesday, May 12 2020 08:15

It is a dream to be able to predict the outcome of every surgical procedure. This is, however, a difficult task influenced by numerous different factors. Few surgical procedures other than SWL have been subject to so many attempts. In this article a scoring system has been developed with the purpose of predicting SWL results and thus decide whether SWL is an appropriate treatment or not. The authors claim that their approach is more convenient than the use of a nomogram. This conclusion can of course be left to the readers, but there are several examples in the literature used for treatment prediction and accordingly decision on the most appropriate treatment. I have summarized some of these attempts in the Table below.
There are various observations on the importance of different factors. Most commonly, however, location, stone size and stone density. It is however wishful thinking that it will be possible to predict the outcome in every patient because there are also other important factors such as: type of lithotripter, how the treatment is carried out, how much attention that has been paid the avoid obstacles to shock wave transmission, how good pain treatment that has been given as well as other factors of patient cooperation. Control of respiratory movement of the target.

The most important factors considered in different reports are shown in this table.

 https://www.storzmedical.com/images/blog/Tiselius_Yoshioka.JPG

HN = grade of hydronephrosis; LOC = Localisation; No = number of stones; Ana = anatomy
* Triple-D score; “Quadruple-D score; # Paediatric
In the scoring used in the current manuscript I am surprised that the author chose suc a high score for stone located in the distal ureter.
It is essential to have a rough idea of what the lithotripter can do and what can be expected, but I am not convinced of the advantage of scoring systems or nomograms.

References

1.Kim JK, Ha SB, Jeon CH, Oh JJ, Cho SY, Oh SJ, Kim HH, Jeong CWClinical Nomograms to Predict Stone-Free Rates after Shock-Wave Lithotripsy: Development and Internal-Validation.PLoS One. 2016 Feb 18;11(2):e0149333. doi: 10.1371/journal.pone.0149333. eCollection 2016.

2.Ozgor F, Tosun M, Kayali Y, Savun M, Binbay M, Tepeler A.
External Validation and Evaluation of Reliability and Validity of the Triple D Score to Predict Stone-Free Status After Extracorporeal Shockwave Lithotripsy.
J Endourol. 2017 Feb;31(2):169-173. doi: 10.1089/end.2016.0721. Epub 2017 Jan 4

3.Dogan HS, Altan M, Citamak B, Bozaci AC, Karabulut E, Tekgul S.
A new nomogram for prediction of outcome of pediatric shock-wave lithotripsy.
J Pediatr Urol. 2015 Apr;11(2):84.e1-6. doi: 10.1016/j.jpurol.2015.01.004. Epub 2015 Mar 5.

4.Onal B, Tansu N, Demirkesen O, Yalcin V, Huang L, Nguyen HT, Cilento BG, Erozenci A.
Nomogram and scoring system for predicting stone-free status after extracorporeal shock wave lithotripsy in children with urolithiasis.
BJU Int. 2013 Feb;111(2):344-52. doi: 10.1111/j.1464-410X.2012.11281.x. Epub 2012 Jun
5.Wiesenthal JD, Ghiculete D, Ray AA, Honey RJ, Pace KT.
A clinical nomogram to predict the successful shock wave lithotripsy of renal and ureteral calculi.
J Urol. 2011 Aug;186(2):556-62. doi: 10.1016/j.juro.2011.03.109.

6. Skolarikos A, Mitsogiannis H, Deliveliotis C.
Indications, prediction of success and methods to improve outcome of shock wave lithotripsy of renal and upper ureteral calculi.
Arch Ital Urol Androl. 2010 Mar;82(1):56-63. Review

7. Kanao K, Nakashima J, Nakagawa K, Asakura H, Miyajima A, Oya M, Ohigashi T, Murai M.
Preoperative nomograms for predicting stone-free rate after extracorporeal shock wave lithotripsy.
J Urol. 2006 Oct;176(4 Pt 1):1453-6; discussion 1456-7
8.Niwa N, Matsumoto K, Miyahara M, Omura M, Kobayashi H, Kikuchi E, Miyajima A, Miyata K, Oya M.
Simple and practical nomograms for predicting the stone-free rate after shock wave lithotripsy in patients with a solitary upper ureteral stone.
World J Urol. 2017 Sep;35(9):1455-1461. doi: 10.1007/s00345-017-2014-8. Epub 2017 Feb 20.

9. Ichiyanagi O, Fukuhara H, Kurokawa M, Izumi T, Suzuki H, Naito S, Nishida H, Kato T, Tsuchiya N.
Reinforcement of the Triple D score with simple addition of the intrarenal location for the prediction of the stone-free rate after shockwave lithotripsy for renal stones 10-20 mm in diameter.
Int Urol Nephrol. 2019 Feb;51(2):239-245. doi: 10.1007/s11255-018-02066-1. Epub 2019 Jan 2

Hans-Göran Tiselius

It is a dream to be able to predict the outcome of every surgical procedure. This is, however, a difficult task influenced by numerous different factors. Few surgical procedures other than SWL have been subject to so many attempts. In this article a scoring system has been developed with the purpose of predicting SWL results and thus decide whether SWL is an appropriate treatment or not. The authors claim that their approach is more convenient than the use of a nomogram. This conclusion can of course be left to the readers, but there are several examples in the literature used for treatment prediction and accordingly decision on the most appropriate treatment. I have summarized some of these attempts in the Table below. There are various observations on the importance of different factors. Most commonly, however, location, stone size and stone density. It is however wishful thinking that it will be possible to predict the outcome in every patient because there are also other important factors such as: type of lithotripter, how the treatment is carried out, how much attention that has been paid the avoid obstacles to shock wave transmission, how good pain treatment that has been given as well as other factors of patient cooperation. Control of respiratory movement of the target. The most important factors considered in different reports are shown in this table. [img] https://www.storzmedical.com/images/blog/Tiselius_Yoshioka.JPG [/img] HN = grade of hydronephrosis; LOC = Localisation; No = number of stones; Ana = anatomy * Triple-D score; “Quadruple-D score; # Paediatric In the scoring used in the current manuscript I am surprised that the author chose suc a high score for stone located in the distal ureter. It is essential to have a rough idea of what the lithotripter can do and what can be expected, but I am not convinced of the advantage of scoring systems or nomograms. References 1.Kim JK, Ha SB, Jeon CH, Oh JJ, Cho SY, Oh SJ, Kim HH, Jeong CWClinical Nomograms to Predict Stone-Free Rates after Shock-Wave Lithotripsy: Development and Internal-Validation.PLoS One. 2016 Feb 18;11(2):e0149333. doi: 10.1371/journal.pone.0149333. eCollection 2016. 2.Ozgor F, Tosun M, Kayali Y, Savun M, Binbay M, Tepeler A. External Validation and Evaluation of Reliability and Validity of the Triple D Score to Predict Stone-Free Status After Extracorporeal Shockwave Lithotripsy. J Endourol. 2017 Feb;31(2):169-173. doi: 10.1089/end.2016.0721. Epub 2017 Jan 4 3.Dogan HS, Altan M, Citamak B, Bozaci AC, Karabulut E, Tekgul S. A new nomogram for prediction of outcome of pediatric shock-wave lithotripsy. J Pediatr Urol. 2015 Apr;11(2):84.e1-6. doi: 10.1016/j.jpurol.2015.01.004. Epub 2015 Mar 5. 4.Onal B, Tansu N, Demirkesen O, Yalcin V, Huang L, Nguyen HT, Cilento BG, Erozenci A. Nomogram and scoring system for predicting stone-free status after extracorporeal shock wave lithotripsy in children with urolithiasis. BJU Int. 2013 Feb;111(2):344-52. doi: 10.1111/j.1464-410X.2012.11281.x. Epub 2012 Jun 5.Wiesenthal JD, Ghiculete D, Ray AA, Honey RJ, Pace KT. A clinical nomogram to predict the successful shock wave lithotripsy of renal and ureteral calculi. J Urol. 2011 Aug;186(2):556-62. doi: 10.1016/j.juro.2011.03.109. 6. Skolarikos A, Mitsogiannis H, Deliveliotis C. Indications, prediction of success and methods to improve outcome of shock wave lithotripsy of renal and upper ureteral calculi. Arch Ital Urol Androl. 2010 Mar;82(1):56-63. Review 7. Kanao K, Nakashima J, Nakagawa K, Asakura H, Miyajima A, Oya M, Ohigashi T, Murai M. Preoperative nomograms for predicting stone-free rate after extracorporeal shock wave lithotripsy. J Urol. 2006 Oct;176(4 Pt 1):1453-6; discussion 1456-7 8.Niwa N, Matsumoto K, Miyahara M, Omura M, Kobayashi H, Kikuchi E, Miyajima A, Miyata K, Oya M. Simple and practical nomograms for predicting the stone-free rate after shock wave lithotripsy in patients with a solitary upper ureteral stone. World J Urol. 2017 Sep;35(9):1455-1461. doi: 10.1007/s00345-017-2014-8. Epub 2017 Feb 20. 9. Ichiyanagi O, Fukuhara H, Kurokawa M, Izumi T, Suzuki H, Naito S, Nishida H, Kato T, Tsuchiya N. Reinforcement of the Triple D score with simple addition of the intrarenal location for the prediction of the stone-free rate after shockwave lithotripsy for renal stones 10-20 mm in diameter. Int Urol Nephrol. 2019 Feb;51(2):239-245. doi: 10.1007/s11255-018-02066-1. Epub 2019 Jan 2 Hans-Göran Tiselius
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