ArticleWorld journal of urology2026
Slice thickness matters: CT-based evaluation of stone-free status with grade classification after RIRS.
Article in World journal of urology, 2026. 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
purposeThis study aimed to evaluate the influence of computed tomography (CT) slice thickness on stone-free status (SFS) assessment following retrograde intrarenal surgery (RIRS).
methodsThis retrospective single-center cohort study included 145 patients who underwent RIRS with MOSES technology between October 2022 and March 2023. Postoperative SFS was assessed using low-dose CT images reconstructed at 1-mm and 5-mm axial slice thicknesses. SFS was defined as follows: Grade A, no stones visible; Grade B, residual stone ≤ 2 mm; Grade C, residual stone 2.1-4 mm; and Grade D, residual stone > 4 mm. SFS grade distributions were compared using the McNemar-Bowker test. Residual stones were evaluated according to maximum stone diameter (MSD) and maximum attenuation value.
resultsSFS grade distributions differed significantly between the two slice thicknesses (p < 0.001), with 5-mm images shifting patients toward more favorable SFS categories. Grade A increased from 42.8% (62/145) to 57.2% (83/145). Favorable SFS (Grades A-B) increased from 83.4% (121/145) to 93.8% (136/145), an absolute increase of 10.3% points (95% CI 5.4-15.3). Overall, 35 patients (24.1%; 95% CI 17.9-31.7%) were reclassified, with no reclassification to a worse grade. MSD and attenuation values were significantly lower on 5-mm images, indicating undermeasurement of residual stone size and attenuation values with thicker-slice reconstructions.
conclusionCT reconstruction slice thickness significantly affected SFS assessment after RIRS. Thicker reconstructions may artifactually increase the apparent stone-free rate by underdetecting or undermeasuring small residual stones. When evaluating SFS with CT, the imaging protocol, including slice thickness, should be clearly reported.
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