Establishment and verification of a nomogram prediction model for residual stone risk following flexible ureteroscopy lithotripsy in treating 2-3 cm renal calculi
10.3969/j.issn.1009-8291.2025.11.010
- VernacularTitle:输尿管软镜碎石术治疗2～3cm肾结石患者的结石残留风险预测:列线图模型的构建与验证
- Author:
Qi DING
1
;
Xiaohua JIN
1
;
Hailiang ZHU
1
;
Cheng CAO
1
;
Zhijiang FAN
1
;
Wenjian TU
1
;
Feng LI
1
;
Bo FAN
1
Author Information
1. 苏州大学附属常熟医院,常熟市第一人民医院泌尿外科,江苏常熟 215500
- Publication Type:Journal Article
- Keywords:
kidney stones;
flexible ureteroscopy lithotripsy;
residual risk;
nomograph
- From:
Journal of Modern Urology
2025;30(11):967-974
- CountryChina
- Language:Chinese
-
Abstract:
Objective To develop and validate a nomogram prediction model for residual stone risk after flexible ureteroscopic lithotripsy(FURL)in patients with 2-3 cm renal calculi,so as to provide reference for treatment options.Methods Clinical data of 342 patients with renal calculi measuring 2-3 cm undergoing FURL in our hospital during Jun.2017 and Apr.2024 were retrospectively collected.At a 3∶1 randomization ratio,patients were allocated to the training cohort(n=257)and validation cohort(n=85).Patients in the training cohort were stratified into two subgroups based on postoperative stone-free status:residual stone group(n=63)and stone-free group(n=194).Logistic regression analysis was employed to identify factors influencing stone retention and construct the nomogram prediction model.Bootstrapped resampling was applied to validate the model internally,model performance was assessed with calibration curves,Hosmer-Lemeshow test was used to test the degree of fitting,receiver operating characteristic(ROC)curve was plotted to evaluate the predictive accuracy,and decision curve analysis was used to determine the clinical net benefit.The model's generalization capability was evaluated with 10-fold cross-validation of the training set.Results Multivariate logistic regression revealed that stone size,CT value,lower calyx stones,multiple stones,renal infundibulum length(RIL),and renal infundibulum width(RIW)were independent predictors of residual stones(P＜0.05).The nomogram based on the above mentioned parameters demonstrated excellent discrimination,with Bootstrap-validated concordance indices of 0.876(training cohort)and 0.948(validation cohort).Hosmer-Lemeshow tests showed good calibration in both cohorts(P＞0.05).ROC analysis yielded the area under the curve(AUC)of 0.876 and 0.948 for the training and validation cohorts,respectively.The optimal cutoff value was 0.253,with corresponding sensitivity of 84.13％,specificity of 78.35％,and total score of nomogram of 143.The decision curve analysis showed when the threshold probability of the training cohort and verification cohort was 0-0.81 and 0-0.97,respectively,the nomogram could obtain good clinical net benefit in predicting the risk of residual stones.The average accuracy of 10-fold cross-validation was 0.814,and the average AUC was 0.865.Conclusion The nomogram model effectively predicts residual stone risk following FURL for 2-3 cm renal calculi.It is suggested that patients with a total score of ≤143 may consider undergoing FURL.
