目的:为了评估基于CT扫描的参数,特别是输尿管壁厚度(UWT),预测自发性输尿管结石通道。
方法:横截面,分析研究。研究的地点和持续时间:泌尿外科部分,外科,阿加汗大学医院,卡拉奇,巴基斯坦,2023年6月至11月。
方法:有症状的患者,单身,不透射线,单侧输尿管结石,大小≤10mm,肾功能正常,通过非造影CT扫描KUB诊断,并接受保守治疗4周。结石通道(SP)的临床和放射学预测因子,包括石头尺寸,area,偏侧性,location,密度,肾积水程度,结石部位的最大UWT,以及结石上方和下方的输尿管直径和密度,进行了评估。采用二元逻辑回归分析确定结石通过的预测因子。接收器工作特性(ROC)曲线用于找到UWT的最佳截止值。
结果:在34名符合条件的患者中,22(64.7%)自发通过结石。通过的患者结石大小和面积较小,UWT较小。石头位置,偏侧性,肾积水程度,石材密度,输尿管壁直径,结石上方和下方的密度与SP无关。多变量分析显示最大UWT是SP的独立预测因子,具有1.95毫米的截止和0.94的精度。
结论:UWT是本研究中输尿管结石自发通过的唯一最有说服力的因素。通过应用UWT的最佳截止值,在日常实践中做出决定时,它可能是一个非常重要的工具。
背景:输尿管壁厚,医疗驱逐疗法,非对比计算机断层扫描。
OBJECTIVE: To assess CT-scan based parameters, particularly ureteral wall thickness (UWT), in predicting spontaneous ureteral stone passage.
METHODS: Cross-sectional, analytical study. Place and Duration of the Study: Section of Urology, Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan, from June to November 2023.
METHODS: Patients with symptomatic, single, radio-opaque, unilateral ureteral stones having size ≤10 mm with normal kidney functions, diagnosed by non-contrast CT-scan KUB, and treated by conservative option for four weeks were enrolled. Clinical and radiological predictors for stone passage (SP), including stone size, area, laterality, location, density, degree of hydronephrosis, maximal UWT at the stone site, and ureteral diameter and density above and below the stone, were evaluated. Binary logistic regression analysis was employed to identify predictors of stone passage. Receiver operating characteristic (ROC) curve was used to find the optimal cut-off for UWT.
RESULTS: Among 34 eligible patients, 22 (64.7%) passed their stones spontaneously. Patients who passed had smaller stone size and area and lesser UWT. Stone location, laterality, degree of hydronephrosis, stone density, ureteral wall diameter, and density above and below stones were not associated with SP. Multivariate analysis revealed maximum UWT as the independent predictor of SP, with a cut-off of 1.95 mm and an accuracy of 0.94.
CONCLUSIONS: UWT was the single most convincing factor for the spontaneous passage of ureteral stone in this study. By applying UWT\'s optimal cut-off value, it might be an extremely significant tool when taking decisions in daily practice.
BACKGROUND: Ureteral wall thickness, Medical expulsive therapy, Non-contrast computed tomography.