Ureteral wall thickness at the ureterovesical junction as a significant factor in predicting medical expulsive therapy of ureterovesical junction stones

Ureteral wall thickness at the ureterovesical junction as a significant factor in predicting medical expulsive therapy of ureterovesical junction stones | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Ureteral wall thickness at the ureterovesical junction as a significant factor in predicting medical expulsive therapy of ureterovesical junction stones Tiancan Yang, Jian Ji, Yafei Wang, Xiaowen Gao, Lingmin Lei, Lvyang Chen, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6555355/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Aug, 2025 Read the published version in BMC Urology → Version 1 posted 13 You are reading this latest preprint version Abstract Background To evaluate ureteral wall thickness (UWT) at the ureterovesical junction (UVJ) for predicting spontaneous passage (SP) of uncomplicated UVJ stones. Patients and Methods We retrospectively reviewed 170 patients≥ 18 years old ,and size≤ 10 mm of single UVJ stone, who were examined and treated in the Third People's Hospital of Yunnan Province from January 2020 to January 2024 . The analysis included the size of the stones, the maximum UWT at the stone site, the degree of hydronephrosis, and the time of stone removal.According to the different results after four weeks of medical expulsive therapy (MET), the patients were separated into two categories：Stone-passing group (SPG) and non-stone-passing group (NSPG). Univariate and multivariate logistic regression analysis were utilised to evaluate the clinical predictors of MET.The receiver operating characteristic (ROC) curve was employed to evaluate the accuracy of the UWT at the UVJ in predicting successful MET. Results The SPG comprised 112 cases (65.9%), while the NSPG consisted of 58 cases (34.2%). Univariate analysis, employing both the chi-square test and the Mann-Whitney U test, revealed that gender, age, stone side and degree of hydronephrosis were not statistically significant. However, stone size and UWT were found to be influencing factors in regard to stone removal. Binary logistic regression analysis demonstrated that UWT and size were independent influencing factor of MET. The ROC analysis indicated that 3.705 mm was the ideal threshold for UWT, with sensitivity and specificity levels of 72.4% and 68.7%, with an area under the ROC curve (AUC) of 0.737. Conclusions The UWT at the UVJ has a high predictive value for the MET of stones at this position, thus avoiding the adverse consequences of delayed stone discharge caused by unnecessary surgical operation and MET. Ureterovesical junction stones Ureteral wall thickness Medical expulsive therapy Figures Figure 1 Figure 2 Figure 3 Background Urolithiasis is one of the most common diseases in the urinary system, complications such as pain and inflammation cause major distress in patients ' daily life. The incidence of urinary stones in Asia ranges from 1–5%, while in Europe and North America, the incidence is between 5% and 13%[ 1 ]. Globally, the prevalence can be as high as 10–15%, with ureteral stones accounting for approximately 20% of all urinary stones[ 1 , 2 ]. For stones located at the UVJ, there are several treatment options, primarily divided into conservative treatment and surgical management. These approaches lead to varying levels of patient benefit and associated risks. The goal of MET is to relieve pain, facilitate stone passage, and prevent factors that impede stone expulsion, such as ureteral edema, spasms, and infections[ 3 ]. Non-steroidal anti-inflammatory drugs and α-blockers are commonly used in the conservative treatment of ureteral stones[ 4 ]. The physiological effect of α-blockers on the smooth muscle layer of the ureter is significant, as α-adrenergic receptors are more densely distributed in the distal third of the ureter, including the UVJ[ 3 , 5 , 6 ]. As a continuation of the ureter in the bladder, UVJ represents the narrowest physiological segment of the ureter [ 7 – 9 ]. Most studies have focused on the impact of UWT and stone size on surgical or medical treatments for ureteral stones. However, there is a relative lack of studies specifically addressing the anatomical segment of the UVJ. Therefore, it is crucial to investigate the factors influencing MET for stones located at the UVJ. Materials and Methods We analyzed the data of 170 patients diagnosed with single, ≤ 10 mm ureterovesical junction stones who received MET (tamsulosin) treatment between January 2020 and January 2024. Inclusion criteria: clinically and radiologically diagnosed UVJ stones, single stones of ≤ 10 mm, conservative treatment with oral tamsulosin (0.2 mg once daily) for 4 weeks, and no prior treatments. Exclusion criteria: prior treatment, history of urinary stone surgery, renal insufficiency, congenital urinary anomalies or malignancy. Before starting MET, patients were thoroughly informed about the treatment steps and potential complications, such as delayed stone passage leading to severe hydronephrosis, infection, and pain. Patients who agreed to participate signed informed consent and were followed up regularly to monitor stone SP. Data collected included patient age, sex, stone laterality, hydronephrosis grade (Society for Fetal Urology grading system), stone size, and the UWT at the stone site. Due to the unique anatomical location of the UVJ, we measured the UWT by ultrasound, with the anterior wall thickness substituted for the measurement of the entire ureteral segment due to difficulty visualizing the posterior wall (Fig. 1 and Fig. 2 ). The ultrasound images were obtained by qualified technicians, and all measurements were performed using ImageJ software with a scale from the collected ultrasound images. Statistical Analysis The data were analyzed using SPSS version 26.0. The Chi-square test was used for categorical variables, while the Mann-Whitney U test was applied for continuous variables. Factors with significant differences in univariate analysis were subjected to binary logistic regression. ROC curve analysis was performed to assess the accuracy of UWT in predicting successful stone expulsion with MET. Results A total of 170 patients with UVJ stones were included in the study, with a stone expulsion rate of 65.9%. Based on the outcomes of MET, the patients were divided into two groups:SPG (112 patients) and the NSPG (58 patients). The two groups did not show significant differences in gender, age, stone laterality, or degree of hydronephrosis (p > 0.05) (Table 1 ). Univariate analysis revealed significant differences between the SPG and NSPG in terms of stone size and UWT(Table 1 ). Following the univariate analysis, binary logistic regression was conducted, which indicated that stone size (p = 0.004) and UWT (p < 0.001) are independent factors influencing stone SP(Table 2 ). ROC curve analysis demonstrated that UWT could be used as a predictive factor for the success of MET. The AUC for UWT was 0.737 (Fig. 3 ), with 3.705 mm was a ideal threshold for UWT ,That means that when the UWT of the stone is ≥ 3.705 mm, the stone may spontaneously fail, which demonstrated a sensitivity of 72.4% and specificity of 68.7%. Table 1 Univariate analysis of stone-related variables in the two groups Total Stone-passing group non-stone-passing group P value Gender 0.375 Male 131 84 47 Female 39 28 11 Age, years 40.(29.25,50.75) 45(32,59.75) 0.069 Side 0.230 Left 90 63 27 Right 80 49 31 Stone size (mm) 6(5,7) 7(6,9) 0.002 UWT (mm) 3.435(3.0525,0.8500) 3.97(3.62, 4.8225) <0.001 Hydronephrosis 0.436 Grade 0 74 51 23 Grade 1 91 59 32 Grade 2 4 2 2 Grade 3 1 0 1 Grade 4 0 0 0 Table 2 Multivariate logistic regression analysis Variable OR(95%CI) P value Stone size (mm) 1.407(1.116–1.774) 0.004 UWT (mm) 3.214(1.936–5.333) <0.001 Discussion Ureteral stones account for approximately 20% of all urinary tract stones [ 1 ], with distal ureteral stones representing 70% of all ureteral stones [ 10 ].Previous studies have shown that there are three physiological strictures in the upper urinary tract. However, recent advances in medical imaging technologies and their application in clinical anatomy have challenged this long-standing theory. Minobu Kamo et al. [ 11 ] demonstrated that the most common sites of obstruction are limited to two locations: the renal pelvis-ureter junction and the UVJ. As the most narrow anatomical point in the ureter, UVJ is also the main site of stone retention [ 11 ].The passage of ureteral stones through the UVJ leads to ureteral edema, hypertrophy, interstitial fibrosis, and a cascade of pathological alterations [ 12 ]. These changes contribute to the development of clinical manifestations such as pain, fever, and urinary tract obstruction, which not only complicate treatment but also significantly impair the patient's quality of life. Surgical treatment of distal ureteral stones primarily includes extracorporeal shock wave lithotripsy(ESWL) and ureteroscopic lithotripsy(URSL)[ 13 – 15 ]. Despite significant advancements in surgical techniques, complications such as infection, ureteral injury, and anesthesia-related risks continue to pose substantial challenges. Moreover, both ESWL and URSL are expensive treatment modalities, which not only result in physical harm but also impose a significant economic burden on patients[ 16 ]. In the past few years, the efficacy of MET for distal ureteric stone is controversial. However,According to guidelines and studies, patients patients with uncomplicated ureteral stones ≥ 5 mm and ≤ 10 mm in size should be offered conservative treatment including observation or MET [ 17 – 19 ]. The α-adrenergic receptors in the distal third of the ureter (including the UVJ) are more densely distributed than in the remaining of the ureter[ 7 – 9 ]. α-blockers have been shown to reduce ureteral smooth muscle tone, thus facilitating stone passage and expulsion[ 20 , 21 ]. Compared to surgical interventions, MET reduces healthcare costs and associated risks. UWT has been widely used as a preoperative predictor of stone passage in ureteral stones[ 12 , 22 , 23 ]. Additionally, some studies have utilized UWT to predict the stone expulsion rate following MET [ 10 , 24 , 25 ]. However, to date, no literature has reported the predictive value of UWT at the UVJ for MET. In the present study, there was no significant difference between gender, age, stone laterality, and hydronephrosis severity with the outcomes of MET (p > 0.05). Conversely, Yoshida et al. [ 2 ] reported a significant association between the degree of hydronephrosis and stone passage in their univariate analysis. However, in their multivariate analysis, hydronephrosis severity was not identified as an independent factor influencing stone expulsion. Similarly, Mohamed Samir et al. [ 10 ] found a significant correlation between the degree of hydronephrosis and stone expulsion in both univariate and multivariate analyses. The discrepancy between our findings and those of Yoshida and Samir may be attributed to the different sample size and most cases presenting mild hydronephrosisin our study. In our study, the results of the multifactor analysis indicate that both stone size and UWT are independent influencing factors of MET. Stone size directly impacts the resistance to expulsion, with larger stones exerting mechanical compression on the ureteral wall, leading to ureteral injury and inflammation. This inflammatory response further induces edema or hyperplasia of the ureteral wall, narrowing the ureteral lumen and consequently hindering the mobility of the stone, thereby increasing the risk of stone impaction and ultimately reducing the success rate of MET. The AUC for stone size is 64.5%, suggesting that while the predictive capacity of stone size for MET success is limited, it still holds certain reference value.The UWT in the SPG was significantly smaller than that in the NSPG. Logistic analysis demonstrated a significant correlation between UWT at the UVJ and the success rate of MET, with an AUC of 0.737. The cut-off value for predicting MET failure was identified as UWT ≥ 3.705 mm. Mohamed Samir et al. [ 10 ] reported a UWT cut-off value of 3.75 mm for the distal ureter, while Yoshida et al.[ 2 ] found a UWT cut-off of 2.71 mm for predicting stone passage at 4 weeks.The differences in UWT may be attributed to the anatomical differences between the UVJ and the rest of the ureter. The UVJ is not only encased by the fibromuscular Waldeyer’s sheath but also lacks the circular muscle layer that is present in the remainder of the ureter[ 26 ]. Another possible reason is the variations in measurement methods. While our study utilized ultrasound technology, Mohamed Samir et al.[ 10 ] employed non-contrast spiral CT(NCCT) with a (7×) magnification and soft-tissue window parameters to measure UWT. The standardized method for assessing the UWT was the use of NCCT with a(7×)magnification and soft-tissue window parameters[ 10 , 12 ].However,it should be noted that NCCT cannot accurately calculate UWT at the UVJ[ 10 ].In the current study,we aimed to measure the UWT at the ureterovesical junction,where the ureteral orifice is located within the bladder.The posterior wall of the ureter was obscured by the strong echogenic shadow of the stones;Hence, we used the thickness of the anterior wall of the ureter to represent the UWT at the UVJ (Fig. 1 and Fig. 2 ).In this study, all ultrasound images were acquired by experienced ultrasound specialist. The UWT at the UVJ was measured using ImageJ software with the scale provided in the collected ultrasound images. Each image was measured three times, and the average value of these measurements was used as the final UWT value. The main limitations of this study are the small sample size and the method used to measure tissue thickness at the UVJ. Currently, there is no literature on the measurement technique for the UVJ tissue thickness. In our study, we employed ultrasound to measure the UWT, it has the potential for manual measurement errors. Nevertheless, we believe that the data from this study will make a meaningful contribution to the ongoing research on MET for ureterovesical junction stones. Conclusion The UWT at UVJ may have some predictive value for stone MET, thus avoiding the adverse consequences such as delayed stone clearance caused by MET and unnecessary surgery. Abbreviations UWT ureteral wall thickness UVJ ureterovesical junction SP spontaneous passage MET medical expulsive therapy SPG stone-passing group NSPG non-stone-passing group ROC receiver operating characteristic ESWL extracorporeal shock wave lithotripsy URSL ureteroscopic lithotripsy NCCT non-contrast spiral CT Declarations Clinical trial number Not applicable since it is a retrospective study. Ethics approval Ethical approval for this retrospective study was obtained from the Yunnan Third People ' s Hospital, with the reference number 2024KY117. As this study retrospectively used anonymous patient data collected during routine clinical care and no additional intervention was performed, the ethics committee waived the requirement for individual patient consent. All data were anonymized and handled in accordance with the Declaration of Helsinki. Consent to participate Not applicable, as this study was a retrospective cohort study and did not involve direct interaction with human participants. Data availability The data examined in this study is available from the corresponding authors upon reasonable request. Competing interests The authors declare no competing interests. Funding This work was supported by funds from the Education Scientific Research Fund Project of Yunnan Province(grant number: 2021J0343), National Natural Science Foundation of China. Authors’ contributions TCY wrote the manuscript,obtained and analysed the data; JJ designed the research plan and modified the manuscript; YFW,LML and XWG obtained and analysed the data ; WP and ZDW made tables; YBS,SCF and LYC reviewed the manuscript. Acknowledgements This work was supported by funds from the Education Scientific Research Fund Project of Yunnan Province(grant number: 2021J0343), National Natural Science Foundation of China. 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1","display":"","copyAsset":false,"role":"figure","size":60611,"visible":true,"origin":"","legend":"\u003cp\u003eUltrasound image of ureterovesical junction calculi.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6555355/v1/949485164dbc7ab97c96a44c.jpg"},{"id":82797768,"identity":"db0184fe-6af6-4c44-835d-8ab9eef50110","added_by":"auto","created_at":"2025-05-15 10:46:36","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":43941,"visible":true,"origin":"","legend":"\u003cp\u003eThe stone is enlarged in Fig.a, and the gap between Bladder and Ureteral stone is UWT.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6555355/v1/550ae6796ca94f6306bbc12f.jpg"},{"id":82797765,"identity":"fd533431-3319-4540-b3b6-a8af875b20b8","added_by":"auto","created_at":"2025-05-15 10:46:36","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":28583,"visible":true,"origin":"","legend":"\u003cp\u003eROC curve of logistic model prediction\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6555355/v1/99ac1addf4113bfc3b3b68f1.jpg"},{"id":89847299,"identity":"7041d3b7-f93c-4355-83e4-ba2493007c95","added_by":"auto","created_at":"2025-08-25 16:43:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":679089,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6555355/v1/cab97dd6-a37b-49e3-9405-631a7843e837.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Ureteral wall thickness at the ureterovesical junction as a significant factor in predicting medical expulsive therapy of ureterovesical junction stones","fulltext":[{"header":"Background","content":"\u003cp\u003eUrolithiasis is one of the most common diseases in the urinary system, complications such as pain and inflammation cause major distress in patients ' daily life. The incidence of urinary stones in Asia ranges from 1\u0026ndash;5%, while in Europe and North America, the incidence is between 5% and 13%[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Globally, the prevalence can be as high as 10\u0026ndash;15%, with ureteral stones accounting for approximately 20% of all urinary stones[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. For stones located at the UVJ, there are several treatment options, primarily divided into conservative treatment and surgical management. These approaches lead to varying levels of patient benefit and associated risks. The goal of MET is to relieve pain, facilitate stone passage, and prevent factors that impede stone expulsion, such as ureteral edema, spasms, and infections[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Non-steroidal anti-inflammatory drugs and α-blockers are commonly used in the conservative treatment of ureteral stones[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The physiological effect of α-blockers on the smooth muscle layer of the ureter is significant, as α-adrenergic receptors are more densely distributed in the distal third of the ureter, including the UVJ[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAs a continuation of the ureter in the bladder, UVJ represents the narrowest physiological segment of the ureter [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Most studies have focused on the impact of UWT and stone size on surgical or medical treatments for ureteral stones. However, there is a relative lack of studies specifically addressing the anatomical segment of the UVJ. Therefore, it is crucial to investigate the factors influencing MET for stones located at the UVJ.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eWe analyzed the data of 170 patients diagnosed with single, \u0026le;\u0026thinsp;10 mm ureterovesical junction stones who received MET (tamsulosin) treatment between January 2020 and January 2024. Inclusion criteria: clinically and radiologically diagnosed UVJ stones, single stones of \u0026le;\u0026thinsp;10 mm, conservative treatment with oral tamsulosin (0.2 mg once daily) for 4 weeks, and no prior treatments. Exclusion criteria: prior treatment, history of urinary stone surgery, renal insufficiency, congenital urinary anomalies or malignancy.\u003c/p\u003e \u003cp\u003eBefore starting MET, patients were thoroughly informed about the treatment steps and potential complications, such as delayed stone passage leading to severe hydronephrosis, infection, and pain. Patients who agreed to participate signed informed consent and were followed up regularly to monitor stone SP.\u003c/p\u003e \u003cp\u003eData collected included patient age, sex, stone laterality, hydronephrosis grade (Society for Fetal Urology grading system), stone size, and the UWT at the stone site. Due to the unique anatomical location of the UVJ, we measured the UWT by ultrasound, with the anterior wall thickness substituted for the measurement of the entire ureteral segment due to difficulty visualizing the posterior wall (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The ultrasound images were obtained by qualified technicians, and all measurements were performed using ImageJ software with a scale from the collected ultrasound images.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe data were analyzed using SPSS version 26.0. The Chi-square test was used for categorical variables, while the Mann-Whitney U test was applied for continuous variables. Factors with significant differences in univariate analysis were subjected to binary logistic regression. ROC curve analysis was performed to assess the accuracy of UWT in predicting successful stone expulsion with MET.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 170 patients with UVJ stones were included in the study, with a stone expulsion rate of 65.9%. Based on the outcomes of MET, the patients were divided into two groups:SPG (112 patients) and the NSPG (58 patients). The two groups did not show significant differences in gender, age, stone laterality, or degree of hydronephrosis (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUnivariate analysis revealed significant differences between the SPG and NSPG in terms of stone size and UWT(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Following the univariate analysis, binary logistic regression was conducted, which indicated that stone size (p\u0026thinsp;=\u0026thinsp;0.004) and UWT (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) are independent factors influencing stone SP(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eROC curve analysis demonstrated that UWT could be used as a predictive factor for the success of MET. The AUC for UWT was 0.737 (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), with 3.705 mm was a ideal threshold for UWT ,That means that when the UWT of the stone is \u0026ge;\u0026thinsp;3.705 mm, the stone may spontaneously fail, which demonstrated a sensitivity of 72.4% and specificity of 68.7%.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate analysis of stone-related variables in the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStone-passing group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003enon-stone-passing group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.375\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.(29.25,50.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45(32,59.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.230\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStone size (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(5,7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(6,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUWT (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.435(3.0525,0.8500)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.97(3.62, 4.8225)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHydronephrosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.436\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrade 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate logistic regression analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR(95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStone size (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.407(1.116\u0026ndash;1.774)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUWT (mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.214(1.936\u0026ndash;5.333)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eUreteral stones account for approximately 20% of all urinary tract stones [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], with distal ureteral stones representing 70% of all ureteral stones [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].Previous studies have shown that there are three physiological strictures in the upper urinary tract. However, recent advances in medical imaging technologies and their application in clinical anatomy have challenged this long-standing theory. Minobu Kamo et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] demonstrated that the most common sites of obstruction are limited to two locations: the renal pelvis-ureter junction and the UVJ. As the most narrow anatomical point in the ureter, UVJ is also the main site of stone retention [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].The passage of ureteral stones through the UVJ leads to ureteral edema, hypertrophy, interstitial fibrosis, and a cascade of pathological alterations [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. These changes contribute to the development of clinical manifestations such as pain, fever, and urinary tract obstruction, which not only complicate treatment but also significantly impair the patient's quality of life.\u003c/p\u003e \u003cp\u003eSurgical treatment of distal ureteral stones primarily includes extracorporeal shock wave lithotripsy(ESWL) and ureteroscopic lithotripsy(URSL)[\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Despite significant advancements in surgical techniques, complications such as infection, ureteral injury, and anesthesia-related risks continue to pose substantial challenges. Moreover, both ESWL and URSL are expensive treatment modalities, which not only result in physical harm but also impose a significant economic burden on patients[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the past few years, the efficacy of MET for distal ureteric stone is controversial. However,According to guidelines and studies, patients patients with uncomplicated ureteral stones\u0026thinsp;\u0026ge;\u0026thinsp;5 mm and \u0026le;\u0026thinsp;10 mm in size should be offered conservative treatment including observation or MET [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The α-adrenergic receptors in the distal third of the ureter (including the UVJ) are more densely distributed than in the remaining of the ureter[\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. α-blockers have been shown to reduce ureteral smooth muscle tone, thus facilitating stone passage and expulsion[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Compared to surgical interventions, MET reduces healthcare costs and associated risks. UWT has been widely used as a preoperative predictor of stone passage in ureteral stones[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Additionally, some studies have utilized UWT to predict the stone expulsion rate following MET [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. However, to date, no literature has reported the predictive value of UWT at the UVJ for MET.\u003c/p\u003e \u003cp\u003eIn the present study, there was no significant difference between gender, age, stone laterality, and hydronephrosis severity with the outcomes of MET (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Conversely, Yoshida et al. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] reported a significant association between the degree of hydronephrosis and stone passage in their univariate analysis. However, in their multivariate analysis, hydronephrosis severity was not identified as an independent factor influencing stone expulsion. Similarly, Mohamed Samir et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] found a significant correlation between the degree of hydronephrosis and stone expulsion in both univariate and multivariate analyses. The discrepancy between our findings and those of Yoshida and Samir may be attributed to the different sample size and most cases presenting mild hydronephrosisin our study.\u003c/p\u003e \u003cp\u003eIn our study, the results of the multifactor analysis indicate that both stone size and UWT are independent influencing factors of MET. Stone size directly impacts the resistance to expulsion, with larger stones exerting mechanical compression on the ureteral wall, leading to ureteral injury and inflammation. This inflammatory response further induces edema or hyperplasia of the ureteral wall, narrowing the ureteral lumen and consequently hindering the mobility of the stone, thereby increasing the risk of stone impaction and ultimately reducing the success rate of MET. The AUC for stone size is 64.5%, suggesting that while the predictive capacity of stone size for MET success is limited, it still holds certain reference value.The UWT in the SPG was significantly smaller than that in the NSPG. Logistic analysis demonstrated a significant correlation between UWT at the UVJ and the success rate of MET, with an AUC of 0.737. The cut-off value for predicting MET failure was identified as UWT\u0026thinsp;\u0026ge;\u0026thinsp;3.705 mm. Mohamed Samir et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] reported a UWT cut-off value of 3.75 mm for the distal ureter, while Yoshida et al.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] found a UWT cut-off of 2.71 mm for predicting stone passage at 4 weeks.The differences in UWT may be attributed to the anatomical differences between the UVJ and the rest of the ureter. The UVJ is not only encased by the fibromuscular Waldeyer\u0026rsquo;s sheath but also lacks the circular muscle layer that is present in the remainder of the ureter[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Another possible reason is the variations in measurement methods. While our study utilized ultrasound technology, Mohamed Samir et al.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] employed non-contrast spiral CT(NCCT) with a (7\u0026times;) magnification and soft-tissue window parameters to measure UWT.\u003c/p\u003e \u003cp\u003eThe standardized method for assessing the UWT was the use of NCCT with a(7\u0026times;)magnification and soft-tissue window parameters[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].However,it should be noted that NCCT cannot accurately calculate UWT at the UVJ[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].In the current study,we aimed to measure the UWT at the ureterovesical junction,where the ureteral orifice is located within the bladder.The posterior wall of the ureter was obscured by the strong echogenic shadow of the stones;Hence, we used the thickness of the anterior wall of the ureter to represent the UWT at the UVJ (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).In this study, all ultrasound images were acquired by experienced ultrasound specialist. The UWT at the UVJ was measured using ImageJ software with the scale provided in the collected ultrasound images. Each image was measured three times, and the average value of these measurements was used as the final UWT value.\u003c/p\u003e \u003cp\u003eThe main limitations of this study are the small sample size and the method used to measure tissue thickness at the UVJ. Currently, there is no literature on the measurement technique for the UVJ tissue thickness. In our study, we employed ultrasound to measure the UWT, it has the potential for manual measurement errors. Nevertheless, we believe that the data from this study will make a meaningful contribution to the ongoing research on MET for ureterovesical junction stones.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe UWT at UVJ may have some predictive value for stone MET, thus avoiding the adverse consequences such as delayed stone clearance caused by MET and unnecessary surgery.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eUWT \u0026nbsp; ureteral wall thickness\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUVJ \u0026nbsp; \u0026nbsp;ureterovesical junction\u003c/p\u003e\n\u003cp\u003eSP \u0026nbsp; \u0026nbsp; spontaneous passage\u003c/p\u003e\n\u003cp\u003eMET \u0026nbsp; medical expulsive therapy\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSPG \u0026nbsp; \u0026nbsp;stone-passing group\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNSPG \u0026nbsp; non-stone-passing group\u003c/p\u003e\n\u003cp\u003eROC \u0026nbsp; \u0026nbsp;receiver operating characteristic \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eESWL \u0026nbsp; extracorporeal shock wave lithotripsy\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eURSL \u0026nbsp; ureteroscopic lithotripsy\u003c/p\u003e\n\u003cp\u003eNCCT \u0026nbsp; non-contrast spiral CT\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable since it is a retrospective study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthical approval for this retrospective study was obtained from the Yunnan Third People ' s Hospital, with the reference number 2024KY117. As this study retrospectively used anonymous patient data collected during routine clinical care and no additional intervention was performed, the ethics committee waived the requirement for individual patient consent. All data were anonymized and handled in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable, as this study was a retrospective cohort study and did not involve direct interaction with human participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data examined in this study is available from the corresponding authors upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis work was supported by funds from the Education Scientific Research Fund Project of Yunnan Province(grant number: 2021J0343), National Natural Science Foundation of China.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTCY wrote the manuscript,obtained and analysed the data; JJ designed the research plan and modified the manuscript; YFW,LML and XWG obtained and analysed the data ; WP and ZDW made tables; YBS,SCF and LYC reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by funds from the Education Scientific Research Fund Project of Yunnan Province(grant number: 2021J0343), National Natural Science Foundation of China.\u003c/p\u003e\n\u003cp\u003eThe authors thank all patients involved in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSelvi I, Baydilli N, Tokmak TT, Akinsal EC, Basar H. CT-related parameters and Framingham score as predictors of spontaneous passage of ureteral stones\u0026le; 10 mm: results from a prospective, observational, multicenter study. Urolithiasis. 2021;49(3):227-37.\u003c/li\u003e\n\u003cli\u003eYoshida T, Inoue T, Taguchi M, Omura N, Kinoshita H, Matsuda T. Ureteral wall thickness as a significant factor in predicting spontaneous passage of ureteral stones of\u0026le; 10 mm: a preliminary report. World journal of urology. 2019;37:913-9.\u003c/li\u003e\n\u003cli\u003eAssimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et al. Surgical management of stones: American urological association/endourological society guideline, PART I. The Journal of urology. 2016;196(4):1153-60.\u003c/li\u003e\n\u003cli\u003eHolmlund D. On medical treatment for ureteral stone expulsion. Scandinavian journal of urology. 2018;52(2):94-100.\u003c/li\u003e\n\u003cli\u003eDALRYMPLE NC, VERGA M, ANDERSON KR, BOVE P, COVEY AM, ROSENFIELD AT, et al. The value of unenhanced helical computerized tomography in the management of acute flank pain. The Journal of urology. 1998;159(3):735-40.\u003c/li\u003e\n\u003cli\u003eMoon YJ, Kim H-W, Kim JB, Kim HJ, Chang Y-S. Distribution of ureteral stones and factors affecting their location and expulsion in patients with renal colic. Korean journal of urology. 2015;56(10):717.\u003c/li\u003e\n\u003cli\u003eSingh A, Alter HJ, Littlepage A. A systematic review of medical therapy to facilitate passage of ureteral calculi. Annals of emergency medicine. 2007;50(5):552-63.\u003c/li\u003e\n\u003cli\u003eGriwan M, Singh SK, Paul H, Pawar DS, Verma M. The efficacy of tamsulosin in lower ureteral calculi. Urology annals. 2010;2(2):63-6.\u003c/li\u003e\n\u003cli\u003eTuerxun A, Batuer A, Erturhan S, Eryildirim B, Camur E, Sarica K. Impaction and prediction: does ureteral wall thickness affect the success of medical expulsive therapy in pediatric ureteral stones? Urologia Internationalis. 2017;98(4):436-41.\u003c/li\u003e\n\u003cli\u003eSamir M, Elawady H, Hamid E, Tawfick A. Can ureteral wall thickness (UWT) be used as a potential parameter for decision-making in uncomplicated distal ureteral stones 5\u0026ndash;10 mm in size? A prospective study. World Journal of Urology. 2021:1-7.\u003c/li\u003e\n\u003cli\u003eKamo M, Nozaki T, Horiuchi S, Muraishi N, Yamamura J, Akita K. There are no three physiological narrowings in the upper urinary tract: a new concept of the retroperitoneal anatomy around the ureter. Japanese journal of radiology. 2021;39:407-13.\u003c/li\u003e\n\u003cli\u003eYoshida T, Inoue T, Omura N, Okada S, Hamamoto S, Kinoshita H, et al. Ureteral wall thickness as a preoperative indicator of impacted stones in patients with ureteral stones undergoing ureteroscopic lithotripsy. Urology. 2017;106:45-9.\u003c/li\u003e\n\u003cli\u003eBhanot R, Jones P, Somani B. Minimally invasive surgery for the treatment of ureteric stones\u0026ndash;state-of-the-art review. Research and reports in urology. 2021:227-36.\u003c/li\u003e\n\u003cli\u003eChang C-P, Huang S-H, Tai H-L, Wang B-F, Yen M-Y, Huang K-H, et al. Optimal treatment for distal ureteral calculi: extracorporeal shockwave lithotripsy versus ureteroscopy. Journal of endourology. 2001;15(6):563-6.\u003c/li\u003e\n\u003cli\u003eGong Z, Li Y, Zhang H, Pan C, Li J, Liu G, et al. Prospective comparison of extracorporeal shock wave lithotripsy and ureteroscopy in distal ureteral stones. Urolithiasis. 2023;51(1):86.\u003c/li\u003e\n\u003cli\u003eYu Z-W, Wang R-H, Zhang C-C, Gao J-G. The efficacy and safety of alpha-adrenergic blockers for medical expulsion therapy in patients with ureteral calculi: A meta-analysis of placebo-controlled trials. Medicine. 2021;100(37):e27272.\u003c/li\u003e\n\u003cli\u003eNebot \u0026Aacute;C, de la Encarnacion Castellano C, Romeu JPC, Llopis JAG. Medical expulsive treatment for ureteral stones. Archivos espanoles de urologia. 2021;74(1):80-93.\u003c/li\u003e\n\u003cli\u003eCampschroer T, Zhu X, Vernooij RW, Lock MT. Alpha‐blockers as medical expulsive therapy for ureteral stones. Cochrane Database of Systematic Reviews. 2018(4).\u003c/li\u003e\n\u003cli\u003eLee JY, Andonian S, Bhojani N, Bjazevic J, Chew BH, De S, et al. Canadian Urological Association guideline: Management of ureteral calculi\u0026ndash;Abridged version. Canadian Urological Association Journal. 2021;15(12):383.\u003c/li\u003e\n\u003cli\u003eCOMPARISON OF SILODOSIN AND TAMSULOSIN IN THE MEDICAL EXPULSION THERAPY OF MID AND LOWER URETERIC STONES. Journal of Medical \u0026amp; Health Sciences Review. 2025;2(2).\u003c/li\u003e\n\u003cli\u003eTaheri M, Borumandnia N, Abdi H, Kashi AH, Nourani S, Sheikholeslami S, et al. Which combination of medical expulsive therapy is more effective for treatment of distal ureteral stone in adults? A systematic review and network meta-analysis. BMC urology. 2025;25(1):18.\u003c/li\u003e\n\u003cli\u003eAbdrabuh AM, El-Agamy E-SI, Elhelaly MA, Abouelgreed TA, Abdel-Al I, Youssof HA, et al. Value of preoperative ureteral wall thickness in prediction of impaction of ureteric stones stratified by size in laser ureteroscopic lithotripsy. BMC urology. 2023;23(1):3.\u003c/li\u003e\n\u003cli\u003eRasheed Y, Nazim SM, Mirani KK, Zakaria M, Nasir MB, Nazim SM, et al. A prospective evaluation of the association of ureteral wall thickness with intraoperative stone impaction in ureteroscopy. Cureus. 2023;15(3).\u003c/li\u003e\n\u003cli\u003eElbaset M, Taha D-E, Anas M, Elghareeb A, Abouelkheir RT, Ashour R, et al. Ureteral wall thickness as a predictor for non-invasive treatment success for steinstrasse. Can we save time? World Journal of Urology. 2024;42(1):151.\u003c/li\u003e\n\u003cli\u003eViswas M, Kaushal D, Madhavan K, Malik R, Sarica K, Sahin C. Predictors of spontaneous passage of ureteral calculi in cases receiving Medical Expulsive Therapy: A Prospective, Observational Study. 2023.\u003c/li\u003e\n\u003cli\u003eLescay HA, Jiang J, Leslie SW, Tuma F. Anatomy, abdomen and pelvis ureter. StatPearls [internet]: StatPearls Publishing; 2024.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Ureterovesical junction stones, Ureteral wall thickness, Medical expulsive therapy","lastPublishedDoi":"10.21203/rs.3.rs-6555355/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6555355/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u003c/strong\u003eTo evaluate ureteral wall thickness (UWT) at the ureterovesical junction (UVJ) for predicting spontaneous passage (SP) of uncomplicated UVJ stones.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatients and Methods \u003c/strong\u003eWe retrospectively reviewed 170 patients≥ 18 years old ,and size≤ 10 mm of single UVJ stone, who were examined and treated in the Third People's Hospital of Yunnan Province from January 2020 to January 2024 . The analysis included the size of the stones, the maximum UWT at the stone site, the degree of hydronephrosis, and the time of stone removal.According to the different results after four weeks of medical expulsive therapy (MET), the patients were separated into two categories：Stone-passing group (SPG) and non-stone-passing group (NSPG). Univariate and multivariate logistic regression analysis were utilised to evaluate the clinical predictors of MET.The receiver operating characteristic (ROC) curve was employed to evaluate the accuracy of the UWT at the UVJ in predicting successful MET.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eThe SPG comprised 112 cases (65.9%), while the NSPG consisted of 58 cases (34.2%). Univariate analysis, employing both the chi-square test and the Mann-Whitney U test, revealed that gender, age, stone side and degree of hydronephrosis were not statistically significant. However, stone size and UWT were found to be influencing factors in regard to stone removal. Binary logistic regression analysis demonstrated that UWT and size were independent influencing factor of MET. The ROC analysis indicated that 3.705 mm was the ideal threshold for UWT, with sensitivity and specificity levels of 72.4% and 68.7%, with an area under the ROC curve (AUC) of 0.737.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e The UWT at the UVJ has a high predictive value for the MET of stones at this position, thus avoiding the adverse consequences of delayed stone discharge caused by unnecessary surgical operation and MET.\u003c/p\u003e","manuscriptTitle":"Ureteral wall thickness at the ureterovesical junction as a significant factor in predicting medical expulsive therapy of ureterovesical junction stones","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-15 10:46:31","doi":"10.21203/rs.3.rs-6555355/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-13T11:25:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-10T07:34:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-28T11:20:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"184604667052988448109161615933750936691","date":"2025-05-14T07:40:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"212118535617825426654726575968627907720","date":"2025-05-13T13:31:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"107013792509583438673783871406238574513","date":"2025-05-12T13:13:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-12T07:56:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"278293335263332836418701260185645466697","date":"2025-05-12T06:53:22+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-12T06:10:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-12T06:06:35+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-08T14:00:41+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-08T11:26:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Urology","date":"2025-05-08T11:25:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ab31a73f-df3a-47ea-b8d0-203ed9f13888","owner":[],"postedDate":"May 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-25T16:36:54+00:00","versionOfRecord":{"articleIdentity":"rs-6555355","link":"https://doi.org/10.1186/s12894-025-01890-9","journal":{"identity":"bmc-urology","isVorOnly":false,"title":"BMC Urology"},"publishedOn":"2025-08-23 16:29:38","publishedOnDateReadable":"August 23rd, 2025"},"versionCreatedAt":"2025-05-15 10:46:31","video":"","vorDoi":"10.1186/s12894-025-01890-9","vorDoiUrl":"https://doi.org/10.1186/s12894-025-01890-9","workflowStages":[]},"version":"v1","identity":"rs-6555355","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6555355","identity":"rs-6555355","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}