ArticleWorld journal of urology2025
Can intraoperative endoscopic evaluation replace postoperative low-dose CT for assessing the stone-free status in vacuum-assisted dedusting lithotripsy.
Article in World journal of urology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo compare the diagnostic accuracy of intraoperative endoscopic assessment with postoperative low-dose computed tomography (LDCT) for determining stone-free status (SFS) following retrograde vacuum-assisted dedusting lithotripsy (VADL) using a tip-flexible vacuum-assisted suction ureteral access sheath (tFVS-UAS) and evaluate the feasibility of replacing routine LDCT with intraoperative evaluation.
methodsThis single-center retrospective study analyzed 1,105 patients undergoing unilateral VADL (December 2022-December 2024). All VADL procedures were performed retrograde using tFVS-UAS. Postoperative LDCT on day 30 served as the reference standard. Agreement between intraoperative endoscopic assessment and LDCT was evaluated using McNemar's test and Kappa statistics. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.
resultsThe overall stone-free rate (SFR) was 83.35% (89.89% for stones ≤ 20 mm; 63.50% for stones > 20 mm). Intraoperative assessment demonstrated high specificity (98.70%, 95% CI: 97.80-99.60%) but low sensitivity (43.48%, 95% CI: 36.35-50.61%), with an NPV of 89.73% and PPV of 86.96%. Subgroup analysis revealed stronger agreement for stones ≤ 20 mm (Kappa = 0.61, NPV = 94.40%) compared to stones > 20 mm (Kappa = 0.40, sensitivity = 40.00%)(Bonferroni-adjusted α = 0.025).
conclusionIntraoperative endoscopic assessment during VADL reliably confirms SFS for stones ≤ 20 mm, potentially reducing the utilization of postoperative LDCT in low-risk patients when SFS is endoscopically verified. However, LDCT remains essential for stones > 20 mm or high-risk scenarios due to limited sensitivity. Clinical implementation requires risk stratification and shared decision-making.
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