The following is a summary of “Endoscopic Stone Composition Identification: Is Accuracy Improved by Stone Appearance During Laser Lithotripsy?” published in the December 2023 issue of Urology by Rodriguez-Alvarez, et al.

For a study, researchers sought to assess whether videos during laser lithotripsy enhance the accuracy and confidence of urologists in stone identification compared to still pictures.

Representative pictures and videos of four major stone types from eight different patients undergoing ureteroscopy with holmium laser lithotripsy were obtained. A REDCap survey was distributed to members of the Endourological Society, containing pictures and corresponding videos of each stone undergoing laser lithotripsy, along with clinical information. Multiple-choice questions about stone composition and confidence levels were included for each picture and video. Accuracy, confidence levels, and rates of rectification (change from incorrect to correct answer) or confounding (correct to incorrect) after watching videos were analyzed.

A total of 187 urologists responded to the survey. The accuracy rate of stone identification with pictures was 43.8% compared to 46.1% with videos (P = .27). Accuracy for individual stones varied widely and was generally low. Videos only improved accuracy for one cystine stone. After viewing videos, participants were more likely to rectify rather than confound their answers. Urologists expressed greater confidence with videos than with pictures alone (65.4% vs 53.7%, respectively; P <.001); however, confident answers were not more likely to yield accurate predictions with videos versus still pictures.

Using videos during laser lithotripsy marginally enhances stone identification accuracy compared to still pictures alone. Overall, accuracy in stone identification remains low regardless of confidence level, picture, or lithotripsy video visualization. Urologists should exercise caution in using the appearance of endoscopic stones to guide metabolic management.

Reference: goldjournal.net/article/S0090-4295(23)00845-2/abstract