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- Jendeberg, Johan, 1972-, et al.
(författare)
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Single-energy CT predicts uric acid stones with accuracy comparable to dual-energy CT-prospective validation of a quantitative method
- 2021
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Ingår i: European Radiology. - : Springer. - 0938-7994 .- 1432-1084. ; 31:8, s. 5980-5989
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To prospectively validate three quantitative single-energy CT (SE-CT) methods for classifying uric acid (UA) and non-uric acid (non-UA) stones.METHODS: Between September 2018 and September 2019, 116 study participants were prospectively included in the study if they had at least one 3-20-mm urinary stone on an initial urinary tract SE-CT scan. An additional dual-energy CT (DE-CT) scan was performed, limited to the stone of interest. Additionally, to include a sufficient number of UA stones, eight participants with confirmed UA stone on DE-CT were retrospectively included. The SE-CT stone features used in the prediction models were (1) maximum attenuation (maxHU) and (2) the peak point Laplacian (ppLapl) calculated at the position in the stone with maxHU. Two prediction models were previously published methods (ppLapl-maxHU and maxHU) and the third was derived from the previous results based on the k-nearest neighbors (kNN) algorithm (kNN-ppLapl-maxHU). The three methods were evaluated on this new independent stone dataset. The reference standard was the CT vendor's DE-CT application for kidney stones.RESULTS: Altogether 124 participants (59 ± 14 years, 91 men) with 106 non-UA and 37 UA stones were evaluated. For classification of UA and non-UA stones, the sensitivity, specificity, and accuracy were 100% (37/37), 97% (103/106), and 98% (140/143), respectively, for kNN-ppLapl-maxHU; 95% (35/37), 98% (104/106), and 97% (139/143) for ppLapl-maxHU; and 92% (34/37), 94% (100/106), and 94% (134/143) for maxHU.CONCLUSION: A quantitative SE-CT method (kNN-ppLapl-maxHU) can classify UA stones with accuracy comparable to DE-CT.KEY POINTS:• Single-energy CT is the first-line diagnostic tool for suspected renal colic.• A single-energy CT method based on the internal urinary stone attenuation distribution can classify urinary stones into uric acid and non-uric acid stones with high accuracy.• This immensely increases the availability of in vivo stone analysis.
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| 3. |
- Popiolek, Marcin, 1981-, et al.
(författare)
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Finding the optimal candidate for shock wave lithotripsy : external validation and comparison of five prediction models
- 2023
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Ingår i: Urolithiasis. - : Springer. - 2194-7228 .- 2194-7236. ; 51:1
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Tidskriftsartikel (refereegranskat)abstract
- We aimed to externally validate five previously published predictive models (Ng score, Triple D score, S3HoCKwave score, Kim nomogram, Niwa nomogram) for shock wave lithotripsy (SWL) single-session outcomes in patients with a solitary stone in the upper ureter. The validation cohort included patients treated with SWL from September 2011 to December 2019 at our institution. Patient-related variables were retrospectively collected from the hospital records. Stone-related data including all measurements were retrieved from computed tomography prior to SWL. We estimated discrimination using area under the curve (AUC), calibration, and clinical net benefit based on decision curve analysis (DCA). A total of 384 patients with proximal ureter stones treated with SWL were included in the analysis. Median age was 55.5 years, and 282 (73%) of the sample were men. Median stone length was 8.0 mm. All models significantly predicted the SWL outcomes after one session. S3HoCKwave score, Niwa, and Kim nomograms had the highest accuracy in predicting outcomes, with AUC 0.716, 0.714 and 0.701, respectively. These three models outperformed both the Ng (AUC: 0.670) and Triple D (AUC: 0.667) scoring systems, approaching statistical significance (P = 0.05). Of all the models, the Niwa nomogram showed the strongest calibration and highest net benefit in DCA. To conclude, the models showed small differences in predictive power. The Niwa nomogram, however, demonstrated acceptable discrimination, the most accurate calibration, and the highest net benefit whilst having relatively simple design. Therefore, it could be useful for counselling patients with a solitary stone in the upper ureter.
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| 4. |
- Popiolek, Marcin, et al.
(författare)
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Natural history of early, localized prostate cancer : A final report from three decades of follow-up
- 2013
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Ingår i: European Urology. - : Elsevier. - 0302-2838 .- 1873-7560. ; 63:3, s. 428-435
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Tidskriftsartikel (refereegranskat)abstract
- Background: Most localized prostate cancers are believed to have an indolent course. Within 15 yr of diagnosis, most deaths among men with prostate cancer (PCa) can be attributed to other competing causes. However, data from studies with extended follow-up are insufficient to determine appropriate treatment for men with localized disease.Objective: To investigate the long-term natural history of untreated, early-stage PCa.Design, setting, and participants: We conducted a population-based, prospective-cohort study using a consecutive sample of 223 patients with untreated, localized PCa from a regionally well-defined catchment area in central Sweden. All subjects were initially managed with observation. Androgen deprivation therapy was administered when symptomatic tumor progression occurred.Outcome measurements and statistical analysis: Based on >30 yr of follow-up, the main outcome measures were: progression-free, cause-specific, and overall survival, and rates of progression and mortality per 1000 person-years.Results and limitations: After 32 yr of follow-up, all but 3 (1%) of the 223 men had died. We observed 90 (41.4%) local progression events and 41 (18.4%) cases of progression to distant metastasis. In total, 38 (17%) men died of PCa. Cause-specific survival decreased between 15 and 20 yr, but stabilized with further follow-up. All nine men with Gleason grade 8-10 disease died within the first 10 yr of follow-up, five (55%) from PCa. Survival for men with well-differentiated, nonpalpable tumors declined slowly through 20 yr, and more rapidly between 20 and 25 yr (from 75.2% [95% confidence interval, 48.4-89.3] to 25% [95% confidence interval, 22.0-72.5]). It is unclear whether these data are relevant for tumors detected by elevated prostate-specific antigen levels.Conclusions: Although localized PCa most often has an indolent course, local progression and distant metastasis can develop over the long term, even among patients considered low risk at diagnosis.
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| 6. |
- Wagenius, Magnus, et al.
(författare)
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Factors influencing stone-free rate of Extracorporeal Shock Wave Lithotripsy (ESWL) : a cohort study
- 2022
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Ingår i: Scandinavian journal of urology. - : Taylor & Francis. - 2168-1805 .- 2168-1813. ; 56:3, s. 237-243
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the success rate of Extracorporeal Shock Wave Lithotripsy (ESWL) therapy and identify relevant treatment-specific factors affecting stone-free rate (SFR) after ESWL.Materials and methods: All ESWL treatments in the years 2016-2019, in angelholm Hospital, Skane, Sweden were analysed retrospectively. Primary outcome was stone-free rate (SFR) at 3 months. Univariate logistic regression was used followed by multivariable regression. Lasso analysis was made to adjust for treatment-specific factors such as age, stone size, skin-to-stone distance (SSD), stone attenuation, number of treatments, stone location and presence of a urinary stent.Results: Factors affecting successful ESWL treatment were lower age (p < 0.001), smaller stone size and volume (both p = 0.001). SSD, stone attenuation, sex, laterality and drainage did not have an effect on SFR in this study. After the first ESWL treatment session, 46.7% of the patients were stone-free.Conclusion: Results indicate that stone size and age are the most predictive factors for ESWL outcome. Based on this, we present a simple model for prediction of SFR after ESWL, to be used when counseling patients before ESWL treatment.
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| 7. |
- Wagenius, Magnus, et al.
(författare)
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Percutaneous nephrolithotomy and modern aspects of complications and antibiotic treatment
- 2020
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Ingår i: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813. ; 54:2, s. 162-170
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The incidence of urinary stones is increasing across the globe. Surgical treatment includes extracorporal shock-wave lithotripsy (ESWL), ureterolithotripsy (URS), percutaneous nephrolitotomy (PCNL) and rarely open surgery. This single center study describes complications to PCNL focusing on infections, bacterial growth/resistance and antibiotic prophylaxis/treatment. Materials and methods: All patients treated for kidney stones with PCNL at Ängelholm Hospital in north-western Scania, Sweden from January 2009 to December 2015 were included. A dipstick test and a bacterial culture was made on all patients. Kidney stones were analysed for composition and cultured for bacteria. Results: In total, 186 patients underwent PCNL, all receiving perioperative antibiotics. Thirty percent (56/186) had a positive urinary culture taken before surgery and 33.3% (62/186) had positive stone culture. The concordance between urinary and stone culture was 57.1%. Both positive stone and urinary culture increased the risk of complications after surgery (p = 0.002 and p = 0.017, respectively). Complications occurred in 16% (30/186). Eight patients (4.3%) developed sepsis. The most common bacteria in urine were Enterococcus faecalis and Escherichia coli, both 20%. The most common stone-bacteria reported was Enterococcus faecalis (26%). Conclusion: This study has a total complication rate of 16%, approximately 10% of those are severe. The most common complication to PCNL was infection (60%), followed by bleeding (5.4%), reoperation (1.6%) and pain (0.5%). The high prevalence of E. faecalis might need to be considered, however the results should be validated in a larger cohort, possibly with a higher rate of antibiotic resistance, before a change of guidelines regarding prophylactic antibiotics could be proposed.
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| 8. |
- Wagenius, Magnus, et al.
(författare)
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Ureteroscopy : A population based study of clinical complications and possible risk factors for stone surgery
- 2019
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Ingår i: Central European Journal of Urology. - : Polish Urological Association. - 2080-4806 .- 2080-4873. ; 72:3, s. 285-295
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Tidskriftsartikel (refereegranskat)abstract
- Introduction The aim of this study was to describe the complications of ureteroscopy (URS) and to investigate whether performing URS outside normal working hours leads to increased risk for clinically significant complications. Material and methods A cohort of 486 consecutive patients treated with URS, with a total of 567 sessions between 2009 and 2015 at Helsingborg/Ängelholm Hospital, Sweden, was analyzed. Outcome was complications within 14 days after URS treatment. Results We found no increased risk of complications related to URS performed outside normal working hours. Stone-free rate (SFR) in the distal third of the ureter was 95.2% (315/331), in the middle ureter 92.8% (90/97), in the proximal ureter 84.0% (63/75) and 69.0% (40/58) in renal pelvis. The overall complication rate was 10.6% (n = 60). None of the potential risk factors for complications showed any significance when adjusted for age and gender. We found an inverse relationship between stenting and SFR (p = 0.002). The most common preoperatively cultured bacteria was Escherichia coli. With adequate antibiotics, there was no increased risk of complications. There was an increased risk of complications after URS related to age, but not with gender. Conclusions URS in modern setting provides excellent results with adequate SFR and low morbidity. Time of day, the presence of urological specialized operating nurses did not affect the risk of complications and we found no other significant risk factors for complications. Escherichia coli was the most commonly found bacteria in preoperative cultures. The risk of complications increases with age. For patients >65 years old, this should be considered in preoperative counseling.
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