Objectives: To determine whether a neural network is superior to standard computational methods in predicting stone regrowth after shock wave lithotripsy (SWL) and to determine whether the presence of residual fragments, as an independent variable, increases risk.
Methods: We reviewed the records of 98 patients with renal or ureteral calculi treated by primary SWL at a single institution and followed up for at least 1 year; residual stone fragment growth or new stone occurrence was determined from abdominal radiographs. A neural network was programmed and trained to predict an increased stone volume over time utilizing input variables, including previous stone events, metabolic abnormality, directed medical therapy, infection, caliectasis, and residual fragments after SWL. Patient data were partitioned into a training set of 65 examples and a test set of 33. The neural network did not encounter the test set until training was complete.
Results: The average follow-up period was 3.5 years (range 1 to 10). Of 98 patients, 47 had residual stone fragments 3 months after SWL; of these 47, 8 had increased stone volume at last follow-up visit. Of 51 patients stone free after SWL, 4 had stone recurrence. Coexisting risk factors were incorporated into a neural computational model to determine which of the risk factors was individually predictive of stone growth. The classification accuracy of the neural model in the test set was 91%, with a sensitivity of 91%, a specificity of 92%, and a receiver operating characteristic curve area of 0.964, results significantly better than those yielded by linear and quadratic discriminant function analysis.
Conclusions: A computational tool was developed to predict accurately the risk of future stone activity in patients treated by SWL. Use of the neural network demonstrates that none of the risk factors for stone growth, including the presence of residual fragments, is individually predictive of continuing stone formation.