The Impact of Preoperative CT Assessment of Mid-ureteral Diameter on the Success Rate of Primary Ureteral Stent Insertion in Patients with Complex Renal Calculi
Gao Xiang
Zhang Hongbo
Zhang Dakun
Zheng Han
Gao Jiyuan
Meng Qiang
Zhang Lang
Guo Tingxiu
Abstract：Objective:To investigate the impact of preoperative computed tomography(CT)assessment of mid-ureteral diameter on the success of single-stage ureteral access sheath(UAS)placement in patients with complex re-nal calculi.Methods:A total of 200 patients with complex renal calculi treated at the Urology Department of Beijing Longfu Hospital between April 2020 and May 2023 were enrolled.Patients were categorized into a Success group(n=115)or a Failure group(n=85)based on the outcome of single-stage UAS placement during primary lithotripsy.Clinical data and mid-ureteral diameter were compared between groups.The Least Absolute Shrinkage and Selection Operator(LASSO)regression and multivariable logistic regression analyses were employed to identify risk factors in-fluencing single-stage UAS placement success.The association between mid-ureteral diameter and successful sheath placement was analyzed using a generalized linear mixed-effects model.The dose-response relationship between mid-ureteral diameter and placement success was visualized using restricted cubic splines.A predictive model based on the regression equation y=1-1/(1+e-z)was developed and validated.Results:The mid-ureteral diameter was signifi-cantly larger in the Success group compared to the Failure group(P<0.05).LASSO regression and multivariable lo-gistic regression analyses,after adjusting for potential confounders,identified body mass index(BMI),stone num-ber,stone size,stone type,and mid-ureteral diameter as significant independent factors influencing single-stage UAS placement failure(P<0.05).Mid-ureteral diameter demonstrated a significant inverse correlation with the risk of UAS placement failure(P<0.001),independent of sex.Bootstrap internal validation indicated good discrimination and calibration of the predictive model.Conclusion:Preoperative CT assessment of mid-ureteral diameter is a signifi-cant predictor for successful single-stage UAS placement in patients with complex renal calculi.Mid-ureteral diameter is an independent risk factor influencing the outcome of single-stage sheath placement.
Keywords：complex renal calculimid-ureteral diameterprimary successful ureteral stent placement
Publication Date：2025-06-28
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：9( 167-175 )