scholarly journals Spontaneous Upper Urinary Tract Rupture Caused by Ureteric Stones: Clinical Characteristics and Validation of a Radiological Classification System

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1568
Author(s):  
Carolina Bebi ◽  
Matteo Giulio Spinelli ◽  
Gianpaolo Lucignani ◽  
Pierpaolo Biondetti ◽  
Laura Martinetti ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Urinary Tract ◽  
Classification System ◽  
Interobserver Agreement ◽  
Intraclass Correlation ◽  
Upper Urinary Tract ◽  
Free Fluid ◽  
Local Spread ◽  
Radiological Classification ◽  
Urine Extravasation

Background: This study seeks to validate a radiological classification system of spontaneous upper urinary tract rupture (sUUTR) and to analyse its relationship with clinical, laboratory and radiological characteristics of sUUTR. Methods: We analysed data from 66 patients with a computerised tomography (CT)-proven sUUTR treated with ureteral or nephrostomy catheter positioning. Comorbidities were scored with the Charlson Comorbidity Index (CCI). All CT scans were reviewed by two experienced radiologists and one urologist, who classified sUUTR in (a) local spread, (b) free fluid and (c) urinoma. Interobserver agreement for radiological score was evaluated with the Intraclass Correlation Coefficient (ICC) and Cohen’s Kappa analyses. Descriptive statistics and logistic regression models verified the association between clinical variables and sUUTR severity. Results: The interobserver agreement for sUUTR classification was high among radiologists and between the radiologists and the urologist (all Kappa > 0.7), with an overall high interrater reliability (ICC 0.82). Local spread, free fluid and urinoma were found in 24 (36.4%), 39 (59.1%) and 3 (4.5%) cases, respectively. Patients with free fluid/urinoma had higher rate of CCI ≥ 1 than those with local spread (40.5% vs. 16.7%, p = 0.04). Intraoperative absence of urine extravasation was more frequently found in patients with local spread than those with free fluid/urinoma (66.7% vs. 28.6%, p < 0.01). Multivariable logistic regression analysis revealed that local spread (OR 4.5, p < 0.01) was associated with absence of contrast medium extravasation during pyelography, after accounting for stone size, fever and CCI. Conclusions: The analysed sUUTR classification score had good inter/intra-reader reliability among radiologists and urologists. Absence of urine extravasation was five times more frequent in patients with local spread, making conservative treatment feasible in these cases.

Validity of the Novel Radiological Classification System of the Distal Femur

2021 ◽  
Author(s):  
Mustafa Akkaya ◽  
Mehmet Emin Simsek ◽  
Serhat Akcaalan ◽  
Ceyhun Caglar ◽  
Safa Gursoy ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Classification System ◽  
Interobserver Agreement ◽  
Distal Femur ◽  
Intraobserver Agreement ◽  
Alpha Coefficient ◽  
Cronbach’S Alpha ◽  
Cronbach's Alpha ◽  
Percent Agreement ◽  
Radiological Classification

Abstract Objective Aseptic loosening (AL) is among the most important causes of failure after total knee arthroplasty (TKA). However, while there are numerous underlying causes of AL, the morphometry of the distal femur and intramedullary canal has not been sufficiently demonstrated. This study aimed to show the interobserver and intraobserver reliability and validity of the Citak classification, which has been recently defined according to the morphometry of the distal femur and provides a risk factor definition for AL. Materials and Methods A total of 200 patients whose standardized anteroposterior (AP) and lateral images of the knee joint were obtained between October 2019 and April 2020 were retrospectively evaluated in this study. Patients with a history of extra-articular deformity and knee surgery were excluded from the study. For AL, morphologies of the distal femur were identified by two observers using the new radiological classification system of the distal femur. Mean pairwise Cronbach’s alpha coefficient was used to assess the intra- and interobserver agreement of the classification. Results There was excellent interobserver agreement for the 20 cm proximal and 2 cm proximal to the lateral joint line (PLJL) and adductor tubercle (PAD), respectively. The mean Cronbach’s alpha coefficient was 0.96 (range 0.764–0.944) for the PAD and 0.98 (range 0.734–0.929) for the PLJL. There was also an excellent intraobserver agreement, with 93% average pairwise percent agreement for the index group and 95.5% average pairwise percent agreement for the anatomical classification group. Conclusions The level of inter- and intraobserver agreement for the morphology of the distal femur was excellent in the new radiological classification system, which was shown to be beneficial in the planning of revision knee arthroplasty for AL. However, there is a need for further studies in order to make a correlation of the classification with specific intraoperative findings.

scholarly journals Risk factors and prediction model of urosepsis in patients with diabetes after percutaneous nephrolithotomy

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jun Liu ◽  
Qingya Yang ◽  
Jiayi Lan ◽  
Yang Hong ◽  
Xiaobo Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Urinary Tract ◽  
Logistic Regression Analysis ◽  
Upper Urinary Tract ◽  
One Stage ◽  
Positive Urine ◽  
Urinary Tract Stones ◽  
Independent Risk Factors

Abstract Objective To analyze the risk factors of patients with diabetes mellitus (DM) and urosepsis after percutaneous nephrolithotomy (PCNL) for upper urinary tract stones and to develop a nomogram to predict postoperative urosepsis according to the risk factors. Methods The data of patients with type 2 diabetes who underwent one-stage PCNL due to upper urinary tract stones were retrospectively analyzed. The risk factors of patients with postoperative urosepsis were evaluated by univariate and multivariate logistic regression analysis, and the nomogram prediction model was developed according to the regression coefficient. Results One-stage PCNL was successfully completed in 241 patients with DM, and urosepsis occurred in 41 (17.0%) patients after PCNL. Based on multivariate logistic regression analysis, the independent risk factors associated with postoperative urosepsis included preoperative leukocyte elevation (OR = 3.973, P = 0.005), positive urine nitrite (OR = 3.697, P = 0.010), and positive urine culture (OR = 3.562, P = 0.002). According to the results of the logistic regression analysis model, staghorn stones (OR = 2.049, P < 0.1) and complete intraoperative stone clearance (OR = 0.431, P < 0.1), were used to develop the nomogram. Internal validation of the nomogram showed that the concordance index (C-index) was 0.725. Additionally, the Hosmer–Lemeshow test was performed, P = 0.938 > 0.05. Conclusion Preoperative leukocyte elevation, positive urine nitrite, and positive urine culture are independent risk factors for urosepsis after one-stage PCNL for patients with DM with upper urinary tract stones. The nomogram, which is based on independent risk factors that combine stone morphology and intraoperative stone clearance, can help predict the risk of postoperative urosepsis.

scholarly journals Ureteroscopic lithotripsy combined with stent placement contributed to long-term auto-release of lithangiuria in upper urinary tract after ureterolithotripsy

2020 ◽  
Author(s):  
Liujing Sun ◽  
Jun Zhao
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Urinary Tract ◽  
Logistic Regression Analysis ◽  
Stent Placement ◽  
Baseline Level ◽  
Upper Urinary Tract ◽  
Extracorporeal Shock Wave ◽  
Short Diameter

Abstract Background To investigate the clinical efficiency of ureterectasis combined with stent placement in the long-term auto-release of lithangiuria in upper urinary tract after ureterolithotripsy. Methods In this retrospective analysis, we included the patients (male: 314; female: 49; age: 32–78 yrs; median age: 53 yrs) admitted to our hospital between January 2014 and January 2018 underwent ureterolithotripsy (URS group, n = 178) and extracorporeal shock wave lithotripsy (ESWL group, n = 212) for treating lithangiuria in upper urinary tract. All the patients were followed up for 24–59 months after treatment (median: 38 months). Uni-variate and multi-variate Logistic regression analysis was used to analyze the factors that could affect the long-term release of lithangiuria in upper urinary tract. Then we compared the short diameter of the ureter surpassing the stenosis of iliac vessels and the long-term auto-release of lithotripsy between the two groups. Results Logistic regression analysis indicated that the risk of auto-release of the stones in the upper urinary tract in the URS group was significantly higher than that of the ESWL group (OR = 3.357, 95% CI: 1.234–9.137). Stent placement was an independent risk factor for long-term auto-release of lithotripsy (P < 0.01). The short diameter of the ureter surpassing the stenosis of iliac vessels after URS was significantly longer than that of the baseline level (6.06 ± 1.26 mm vs. 3.63 ± 0.98 mm, t = 20.88, P < 0.01). The short diameter of the ureter surpassing the stenosis of iliac vessels after ESWL showed no statistical differences compared with that of the baseline level (3.67 ± 1.02 mm vs. 3.61 ± 0.94 mm, t=-0.798, P = 0.425). Sixteen cases (2.8%) in the URS group showed auto-release of stones during the follow-up, which was significantly higher than that in the ESWL group with 6 cases (13.5%) presented auto-release of stones (χ2 = 6.895, P = 0.09). Conclusions The combination of URS and stent replacement induced obvious ureterctasis, which may contribute to the auto-release of stones in the upper urinary tract in the long-term.

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