The Predictive Value Of The Upper And Lower Diameter Ratio Of Ureteral Calculi In Predicting Impacted Stones

Objective:Evaluate the predictive value of the ratio of the upper and lower diameter of the ureteral stone for ureteral impacted stones.Methods:Review the clinical data of 173 patients with ureteral stones admitted to the Department of Urology,Third Hospital of Shanxi Medical University for retrospective analysis.Compare the general information such as gender and age,as well as the stone diameter,stone CT value,renal pelvic diameter,ureter diameter 3cm away from the stone,and the ratio of upper and lower ureteral diameters between patients with impacted and non-impacted ureteral stones.Random number method was used to divide patients into training and validation groups.Independent influencing factors were obtained through LASSO analysis,and a column chart model was established.The predictive performance of the model was validated using receiver operating characteristic(ROC)curve and area under the curve(AUC).The net benefit of patients was analyzed through clinical decision curve analysis(DCA).Results:There was no statistically significant difference(P>0.05)in general information such as sex,BMI,and the presence of underlying diseases between two groups of patients.Single-factor logistic regression analysis showed that the influencing factors were: stone diameter(HR=17.744,P<0.001),CT value(HR=1.002,P=0.002),D1 (HR=3.913,P=0.001),D2(HR=0.014,P<0.001),and DDR(HR=2.995,P<0.001).The influencing factors selected by LASSO regression were stone diameter,CT value,and the ratio of ureteral diameter between the upper and lower segments.The ROC curve was plotted based on the model fitting results,and the AUC of the model was 0.862.DCA indicated that the model could increase the net benefit rate of patients by about 21%.Conclusion:Measuring the ratio of the upper and lower diameters of the ureter using CT and establishing a model can help clinical doctors to predict the probability of developing an obstructive kidney stone before surgery.This can assist the surgeon in evaluating the difficulty of the procedure,reducing surgical risks,and minimizing patient discomfort.