{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T04:13:56Z","timestamp":1782965636171,"version":"3.54.5"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T00:00:00Z","timestamp":1756771200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005758","name":"Universit\u00e0 Politecnica delle Marche","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005758","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Urol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim and objective<\/jats:title>\n                    <jats:p>Flexible ureteroscopy (fURS) is a well-established modality for managing urolithiasis in patients with congenital renal anomalies such as horseshoe kidneys (HK), malrotated kidneys (MK), and pelvic ectopic kidneys (PEK). Still, these anatomical variants present unique challenges that complicate stone clearance and procedural planning. We aim to apply machine learning (ML) and explainable artificial intelligence (XAI) techniques to identify predictors of stone-free status (SFS) following fURS in patients with anomalous kidneys.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analysed adult patients with HK, MK, or EK who underwent fURS and laser lithotripsy for renal stones at a tertiary referral center. A ML model incorporating clinical and intraoperative variables was developed to predict SFS. SHAP (SHapley Additive exPlanations) values and decision tree analysis were used to interpret feature importance and model behaviour.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 569 cases were analysed between 2017 and 2021, with a female: male ratio of 3:1. Regarding anatomical anomalies, 50.62% had HSK, 22.67% had PEK and 26.71% had MK. Most of the patients presented with multiple (59.58%), small (76.80%) and soft stones (56.94%). MK showed the highest SFS rates, suggesting this is the most favourable anomaly for fURS. The presence of residual fragments at the end of the procedure was the strongest negative predictor of SFS, followed by longer operative time and older patient age. PEK exhibited the greatest heterogeneity in outcomes. SHAP analysis provided individualized and global insights into feature contributions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Explainable AI offers a transparent and clinically meaningful approach to predicting SFS in patients with renal anomalies undergoing fURS. These insights can guide preoperative risk stratification and inform surgical strategy in a domain where standardised evidence is lacking.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00345-025-05904-x","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T12:54:20Z","timestamp":1756817660000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Flexible ureteroscopy in renal anomalies: an explainable AI model for surgical outcome prediction from EAU endourology"],"prefix":"10.1007","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2031-347X","authenticated-orcid":false,"given":"Carlotta","family":"Nedbal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vineet","family":"Gauhar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sairam","family":"Adithya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nithesh","family":"Naik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shilpa","family":"Gite","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Het","family":"Sevalia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Castellani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Gregori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fr\u00e9d\u00e9ric","family":"Panthier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiloren","family":"Tanidir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil","family":"Shrestha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikram","family":"Sridharan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boyke","family":"Soebhali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Amine","family":"Lakmichi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeed Biin","family":"Hamri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhaskar Kumar","family":"Somani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,2]]},"reference":[{"key":"5904_CR1","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.urology.2021.10.003","volume":"159","author":"E Garc\u00eda Rojo","year":"2022","unstructured":"Garc\u00eda Rojo E, Teoh JY-C, Castellani D et al (2022) Real-world global outcomes of retrograde intrarenal surgery in anomalous kidneys: A high volume international multicenter study. Urology 159:41\u201347. https:\/\/doi.org\/10.1016\/j.urology.2021.10.003","journal-title":"Urology"},{"key":"5904_CR2","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.1007\/s00345-019-02810-x","volume":"38","author":"L Lavan","year":"2020","unstructured":"Lavan L, Herrmann T, Netsch C et al (2020) Outcomes of ureteroscopy for stone disease in anomalous kidneys: a systematic review. World J Urol 38:1135\u20131146. https:\/\/doi.org\/10.1007\/s00345-019-02810-x","journal-title":"World J Urol"},{"key":"5904_CR3","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1080\/20905998.2024.2312699","volume":"22","author":"T Spinos","year":"2024","unstructured":"Spinos T, Tatanis V, Seitz C et al (2024) Percutaneous nephrolithotomy (PCNL) versus other treatments for stone management in horseshoe kidneys: A systematic review. Arab J Urol 22:243\u2013252. https:\/\/doi.org\/10.1080\/20905998.2024.2312699","journal-title":"Arab J Urol"},{"key":"5904_CR4","unstructured":"Skolarikos A, Jung H, Neisius A et al (2023) EAU Guidelines on Urolithiasis. In: Edn. presented at the EAU Annual Congress Milan 2023. https:\/\/uroweb.org\/guidelines\/urolithiasis. Accessed 11 Oct 2023"},{"key":"5904_CR5","doi-asserted-by":"publisher","first-page":"726233","DOI":"10.3389\/fsurg.2021.726233","volume":"8","author":"X Yi","year":"2021","unstructured":"Yi X, Cao D, You P et al (2021) Comparison of the efficacy and safety of extracorporeal shock wave lithotripsy and flexible ureteroscopy for treatment of urolithiasis in horseshoe kidney patients: A systematic review and Meta-Analysis. Front Surg 8:726233. https:\/\/doi.org\/10.3389\/fsurg.2021.726233","journal-title":"Front Surg"},{"key":"5904_CR6","doi-asserted-by":"publisher","unstructured":"Cormio A, Mantovan M, Palantrani V et al (2025) A narrative review on extracorporeal shock wave lithotripsy, ureterolithotripsy, and percutaneous nephrolithotripsy in patients with anomalous kidneys. Minerva Urol Nephrol 77. https:\/\/doi.org\/10.23736\/S2724-6051.25.06001-X","DOI":"10.23736\/S2724-6051.25.06001-X"},{"key":"5904_CR7","doi-asserted-by":"publisher","unstructured":"Wani M, Mohamed AHA, Brown G et al (2023) Challenges and options for management of stones in anomalous kidneys: a review of current literature. Ther Adv Urol 15. https:\/\/doi.org\/10.1177\/17562872231217797","DOI":"10.1177\/17562872231217797"},{"key":"5904_CR8","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1159\/000500328","volume":"103","author":"H Chen","year":"2019","unstructured":"Chen H, Chen G, Pan Y et al (2019) No wound for stones\u2009<\u20092\u00a0cm in horseshoe kidney: A systematic review of comparative studies. Urol Int 103:249\u2013255. https:\/\/doi.org\/10.1159\/000500328","journal-title":"Urol Int"},{"key":"5904_CR9","doi-asserted-by":"publisher","first-page":"226","DOI":"10.3897\/folmed.65.e77728","volume":"65","author":"G Ozmerdiven","year":"2023","unstructured":"Ozmerdiven G, G\u00fcler Y, Cicek C et al (2023) The role of retrograde intrarenal surgery in kidney stones of upper urinary system anomalies. Folia Med (Plovdiv) 65:226\u2013234. https:\/\/doi.org\/10.3897\/folmed.65.e77728","journal-title":"Folia Med (Plovdiv)"},{"key":"5904_CR10","doi-asserted-by":"publisher","first-page":"691","DOI":"10.23736\/S0393-2249.20.03792-3","volume":"72","author":"M Salvi","year":"2020","unstructured":"Salvi M, Muto G, Tuccio A et al (2020) Active treatment of renal stones in pelvic ectopic kidney: systematic review of literature. Minerva Urol Nefrol 72:691\u2013697. https:\/\/doi.org\/10.23736\/S0393-2249.20.03792-3","journal-title":"Minerva Urol Nefrol"},{"key":"5904_CR11","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1097\/CU9.0000000000000199","volume":"17","author":"Y Qaoud","year":"2023","unstructured":"Qaoud Y, Al Tali M, Boland F et al (2023) Comparative evaluation of urolithiasis management options in patients with horseshoe kidney: A systematic review and meta-analysis. Curr Urol 17:193\u2013205. https:\/\/doi.org\/10.1097\/CU9.0000000000000199","journal-title":"Curr Urol"},{"key":"5904_CR12","doi-asserted-by":"crossref","unstructured":"Guliev BG, Komyakov BK, Agagyulov MU, Andriyanov AA (2024) Retrograde endoscopic treatment of stones in horseshoe kidney. Urologiia. (3):50\u201356. Russian. PMID: 39563563.","DOI":"10.18565\/urology.2024.3.50-56"},{"key":"5904_CR13","doi-asserted-by":"publisher","unstructured":"Lim EJ, Teoh JY, Fong KY et al (2023) Propensity score-matched analysis comparing retrograde intrarenal surgery with percutaneous nephrolithotomy in anomalous kidneys. Minerva Urol Nephrol 74. https:\/\/doi.org\/10.23736\/S2724-6051.22.04664-X","DOI":"10.23736\/S2724-6051.22.04664-X"}],"container-title":["World Journal of Urology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00345-025-05904-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00345-025-05904-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00345-025-05904-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T11:33:56Z","timestamp":1781609636000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00345-025-05904-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,2]]},"references-count":13,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["5904"],"URL":"https:\/\/doi.org\/10.1007\/s00345-025-05904-x","relation":{},"ISSN":["1433-8726"],"issn-type":[{"value":"1433-8726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,2]]},"assertion":[{"value":"23 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Ethical approval given the anonymous and retrospective nature of the study, no ethical approval was needed according to our Internal Review Board (IRB).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Consent to participate all patients included in the study signed an informed consent for data collection and research analysis.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human ethics and consent to participate"}}],"article-number":"530"}}