Endoscopic stone composition identification: is accuracy improved by stone appearance during laser lithotripsy?

• Published in: Urology (Ridgewood, N.J.) N.J.), 2023-12, Vol.182, p.67-72
• Main Authors: Rodriguez-Alvarez, Juan Sebastian, Khooblall, Prajit, Brar, Harmenjit, Fedrigon, Donald, Gutierrez-Aceves, Jorge, Monga, Manoj, De, Smita
• Format: Article
• Language: English
• Subjects: Humans; Kidney Calculi - therapy; Lasers, Solid-State - therapeutic use; Lithotripsy; Lithotripsy, Laser; Treatment Outcome; Ureteral Calculi - therapy; Ureteroscopy
• ISSN: 0090-4295; 1527-9995; 1527-9995
• DOI: 10.1016/j.urology.2023.09.025

To evaluate if videos during laser lithotripsy increase accuracy and confidence of stone identification by Urologists compared to still pictures. We obtained representative pictures and videos of 4 major stone types from 8 different patients during ureteroscopy with holmium laser lithotripsy. A REDCap survey was created and emailed to members of the Endourological Society. The survey included a picture followed by the corresponding video of each stone undergoing laser lithotripsy, and additional clinical information. Each picture and video included multiple-choice questions about stone composition and response confidence level. Accuracy, confidence levels, and rates of rectification (change from incorrect to correct answer) or confounding (correct to incorrect) after watching videos were analyzed. 187 urologists responded to the survey. The accuracy rate of stone identification with pictures was 43.8 % vs. 46.1 % with videos (p = 0.27). Accuracy for individual stones was low, and highly variable. Video only improved accuracy for one cystine stone. After viewing videos, participants were more likely to rectify vs. confound their answers. Urologists were more likely to be confident with videos than pictures alone (65.4% vs. 53.7%, respectively; p