Endoscopic Stone Composition Identification: Is Accuracy Improved by Stone Appearance During Laser Lithotripsy?

Area of Science:

• Urology
• Endourology
• Medical Imaging

Background:

• Accurate kidney stone identification is crucial for effective treatment and metabolic management.
• Current methods rely on visual assessment during procedures like ureteroscopy with laser lithotripsy.
• The utility of dynamic video versus static images for improving diagnostic accuracy is not well-established.

Purpose of the Study:

• To compare the accuracy and confidence of urologists in identifying kidney stone types using videos versus still pictures during holmium laser lithotripsy.
• To assess the impact of video visualization on rectification and confounding of stone identification answers.

Main Methods:

• A survey was distributed to urologists, presenting images and videos of four major stone types during ureteroscopy with holmium laser lithotripsy.
• Participants answered multiple-choice questions on stone composition and confidence levels.
• Accuracy, confidence, and answer changes (rectification/confounding) after video viewing were analyzed.

Main Results:

• Overall accuracy for stone identification was low, with no significant difference between pictures (43.8%) and videos (46.1%).
• Videos marginally improved accuracy for only one specific stone type (cystine).
• Urologists reported significantly higher confidence when viewing videos (65.4%) compared to pictures alone (53.7%), but this did not correlate with improved accuracy.

Conclusions:

• Visual identification of kidney stones during laser lithotripsy using endoscopic appearance has low accuracy, regardless of whether videos or still pictures are used.
• Increased confidence with video visualization does not translate to improved diagnostic accuracy.
• Urologists should exercise caution when using endoscopic stone appearance to guide metabolic management strategies.