Screening Of Clinical Indicators For Evaluation Of Ureteral Incarcerated Stones Before Operation

Objective:On the basis of meta-analysis of predictive factors for ureteral incarcerated stones,468 cases of ureteral stones were retrospectively analyzed,and the clinical indicators of incarcerated stones were analyzed to guide the accurate diagnosis of impected stones before clinical operation.Methods:1.A meta-analysis of predictive factors for the impaction of ureteral stonesSearch Cochrane Library,EMbase,Pubmed,CNKI,CBM,VIP and Wanfang database.The literature retrieval time was from the establishment of the database to October 2021.Research reports on the predictive factors of ureteral incarcerated calculi were collected.The quality of the literature was evaluated with the Newcastle ottawa scale,effective data were extracted,and the data were analyzed with the Stata16.0 software.2.Screening of clinical indicators for evaluation of ureteral incarcerated stones before operationReasonable inclusion and exclusion criteria were established,and the clinical data of 137 patients who met the criteria of incarcerated ureteral calculi were collected from the Department of Urology in our hospital from October 2018 to August 2022.SPSS23.0 statistical analysis software was used for univariate and multivariate analysis of the basic information,laboratory and examination data of patients.Use Graph Pad Prism software to draw ROC curve to evaluate the prediction effect of relevant indicators and draw conclusions.Results:1.A meta-analysis of predictive factors for the impaction of ureteral stonesA total of 8 literatures were included,including 514 cases in the case group and824 cases in the control group.Meta-analysis showed that ureteral wall thickness was an risk factor for ureteral incarcerated calculi（OR=1.78,95%CI:1.39～2.16,P<0.01）.Subgroup analysis showed that the heterogeneity of ureteral wall thickness decreased from 86.8%to 24.8%in the Chinese population（OR=1.75,95%CI:1.59～1.91,P<0.01）.Sensitivity analysis demonstrated that there was no marked change in the results after changing the analysis model,and there was no publication bias among the included studies.2.Screening of clinical indicators for evaluation of ureteral incarcerated stones before operationA total of 137 cases and 331 controls were included.Analysis results showed that positive urine culture,hydronephrosis and preoperative maximum thickness of ureter wall at the site of calculi were independent risk factors for incarcerated calculi（OR=2.625,2.869,12.093;P=0.005,0.001,<0.001）;ROC curve showed that the UWT_maxat the stone before surgery and the area under the combined curve of the three were 0.902 and 0.928,respectively;the threshold of UWT_maxat the stone before surgery was 3.45mm;the sensitivity was 81.0%and the specificity was 85.5%;the combined prediction sensitivity was 82.5%and the specificity was 88.2%.Conclusions:The results of meta-analysis indicated that existing studies have shown that ureteral wall thickness alone can effectively predict whether calculi are impacted.Retrospective analysis showed that UWT_maxat the site of preoperative calculi,hydronephrosis and positive urine culture were independent risk factors for calculi incarceration,and there were three findings suggesting that ureteral calculi were incarcerated calculi.