A nomogram to predict “pure” vs. “mixed” uric acid urinary stones

Purpose: Uric acid stones (UAS) can be treated non-invasively by oral chemolysis. However, it is crucial to identify individuals who are most likely to benefit from this approach, specifically, patients with pure UAS. The aim of this study was to develop a nomogram that can differentiate between pure and mixed UAS. Methods: A retrospective analysis of demographic, clinical and stone composition data of patients with a predominant UAS composition (≥ 50%) treated between 2014 and 2022. Results: A total of 135 patients were included in the analysis, 37.8% had mixed UAS (50–90% UA) and 62.2% had pure UAS (≥ 95% UA). The mean stone density and the percentage of radiopaque stones in the pure UAS group were significantly lower than those in the mixed UAS group (450 Hounsfield Units [HU] vs. 600 HU, and 24% vs. 58%, respectively). A stepwise multivariate logistic regression revealed that lower stone density, bigger size, decreased stone opacity and older age are predictive variables for pure UAS. Accordingly, a nomogram was generated with a receiver operating characteristic (ROC) curve that showed an area under the curve (AUC) of 0.78. A patient with a total score of 156 has a probability of > 95% for pure UAS. Conclusion: Imaging and demographic data can be used to identify patients with pure UAS. The nomogram may be useful for counseling patients regarding oral chemolysis. Future validation of the nomogram with a different data set is required to assess its efficacy.