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Moving Beyond Linear Dimensions: Using Stone Volume to Better Predict High-Complexity PCNL Outcomes
Grant Sajdak1, Katya Hanessian1, Ala'a Farkouh1
1Department of Urology, Loma Linda University Health, Loma Linda, California, USA.
Journal of Endourology
|August 3, 2026
Summary
Accurate kidney stone volume, measured by Enterprise Imaging (ENI), better predicts percutaneous nephrolithotomy (PCNL) outcomes than diameter or the scalene ellipsoid formula (ELF). ENI volume is a key factor for predicting stone-free status after PCNL.
Area of Science:
- Nephrology
- Urology
- Medical Imaging
Background:
- Kidney stone size is traditionally measured by diameter for management and research.
- Emerging evidence suggests stone volume may be a more accurate metric.
- Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stone removal.
Purpose of the Study:
- To compare the predictive value of kidney stone volume versus diameter for outcomes after PCNL.
- To evaluate different methods of stone volume measurement.
Main Methods:
- Retrospective review of 220 PCNL patients (January 2017-June 2022).
- Preoperative CT scans analyzed for maximal stone diameter and volume using Enterprise Imaging (ENI) and the scalene ellipsoid formula (ELF).
- Statistical analysis using Spearman's rho and logistic regression (p < 0.05).
Main Results:
- ENI volume showed a stronger association with operation time (ρ = 0.516) than diameter (ρ = 0.270).
- ENI volume was significantly associated with relative (OR=0.9) and absolute (OR=0.93) stone-free status (SFR).
- On multivariate analysis, ENI volume (OR=1.116) and stone density were independent predictors of relative SFR.
Conclusions:
- Accurate stone volume assessment, particularly using ENI, correlates better with PCNL outcomes than diameter or ELF.
- Implementing precise stone volume measurement can enhance patient outcome prediction, guideline development, and research standardization in complex PCNL cases.
