Analysis of influencing factors of ureteral stricture after Holmium laser lithotripsy in patients with impacted ureteral calculus and construction of a nomogram prediction model
Zhou Shaohua
Luo Qiyuan
Ye Mushi
Shao Hongchao
Gao Wenbin
Abstract：Objective To analyze the influencing factors of ureteral stricture(US)after holmium laser lithotripsy(HLL)in patients with impacted ureteral calculus(IUC),and to construct a nomogram for predicting the risk of US.Methods From July 2015 to November 2024,679 IUC patients who underwent HLL in our hospital were recruited and assigned into a modeling set(n=475)and a validation set(n=204)in a 7∶3 ratio.All patients completed a 6-month follow-up after surgery.The modeling set was divided into a US group and a non-US group based on the presence or absence of US.Data from the two subgroups were collected for univariate analysis,and logistic regression was used to screen for factors influencing US oc-currence after HLL.A prediction model was constructed based on the identified factors,and the area under the ROC curve(AUC)and calibration curves were used to evaluate the model's predictive performance.External validation was performed using the validation set.Results The incidence of US after HLL in the modeling set was 11.37％.Ureteral impaction time＞3 months[OR(95％CI)=2.779(1.271-6.077)],stone diameter＞1 cm[OR(95％CI)=4.056(2.069-7.952)],moderate to severe hydronephrosis[OR(95％ CI)=4.483(2.156-9.321)],concomitant polyps[OR(95％CI)=4.409(2.145-9.063)],and mucosal injury[OR(95％CI)=3.533(1.843-6.775)]were identified as risk factors for US after HLL in IUC patients.Based on these five factors,a nomogram model was constructed to predict the risk of US after HLL.Both internal and external valida-tions showed that the AUC values were 0.821(95％CI:0.771-0.872)for the modeling set and 0.803(95％CI:0.753-0.854)for the validation set,and the calibration curves demonstrated good fit.Conclusion The nomogram model constructed based on factors including impaction time,calculus diameter,degree of hydronephrosis,presence of polyps,and mucosal injury can effectively predict the risk of US in IUC patients after HLL.
Keywords：Impacted ureteral calculusHolmium laser lithotripsyUreteral strictureInfluencing factorsNomogram
Publication Date：2025-10-18
Online Publishing Date：2025-11-10(First online date of this platform, not the publication date of the document)
Pages：6( 1224-1228,1240 )