{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T02:33:59Z","timestamp":1788230039852,"version":"build-2803163510"},"reference-count":21,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,5]],"date-time":"2025-10-05T00:00:00Z","timestamp":1759622400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Gachon University Research Fund","award":["2023(GCU-202308020001)"],"award-info":[{"award-number":["2023(GCU-202308020001)"]}]},{"name":"GRRC program of Gyeonggi province","award":["GRRC-Gachon2023(B01)"],"award-info":[{"award-number":["GRRC-Gachon2023(B01)"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Purpose: Timely removal of ureteral stents is critical to prevent complications such as infection, discomfort and stent encrustation or fragmentation, as well as stone formation associated with neglected stents. Current decisions, however, rely heavily on subjective interpretation of postoperative imaging. This study introduces a semi-automated image-processing algorithm that quantitatively evaluates stent morphology, aiming to support objective and reproducible decision-making in minimally invasive urological care. Methods: Two computational approaches were developed to analyze morphological changes in ureteral stents following surgery. The first method employed a vector-based analysis, using the FitLine function to derive unit vectors for each stent segment and calculating inter-vector angles. The second method applied a slope-based analysis, computing gradients between coordinate points to evaluate global straightening of the ureter over time. Results: The vector-angle method did not demonstrate significant temporal changes (p = 0.844). In contrast, the slope-based method identified significant ureteral straightening (p &lt; 0.05), consistent with clinical observations. These results confirm that slope-based quantitative analysis provides reliable insight into postoperative morphological changes. Conclusions: This study presents an algorithm-based and reproducible imaging analysis method that enhances objectivity in postoperative assessment of ureteral stents. By aligning quantitative image processing with clinical decision support, the approach contributes to precision medicine and addresses the absence of standardized criteria for stent removal.<\/jats:p>","DOI":"10.3390\/bioengineering12101084","type":"journal-article","created":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T08:10:51Z","timestamp":1759738251000},"page":"1084","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Toward Supportive Decision-Making for Ureteral Stent Removal: Development of a Morphology-Based X-Ray Analysis"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8163-1424","authenticated-orcid":false,"given":"So","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Biohealth & Medical Engineering, Gachon University, Seongnam 13120, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0443-0051","authenticated-orcid":false,"given":"Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Gachon Biomedical & Convergence Institute, Gachon University Gil Medical Center, Incheon 21555, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Urology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9714-6038","authenticated-orcid":false,"given":"Kwang","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Biohealth & Medical Engineering, Gachon University, Seongnam 13120, Republic of Korea"},{"name":"Gachon Biomedical & Convergence Institute, Gachon University Gil Medical Center, Incheon 21555, Republic of Korea"},{"name":"Department of Biomedical Engineering, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.semcdb.2014.07.014","article-title":"Ureter growth and differentiation","volume":"36","author":"Bohnenpoll","year":"2014","journal-title":"Semin. Cell Dev. Biol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1177\/2051415818772218","article-title":"Contemporary management of ureteral strictures","volume":"12","author":"Vasudevan","year":"2019","journal-title":"J. Clin. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1016\/S0022-5347(01)65037-7","article-title":"Endoscopic management of ureteral strictures","volume":"157","author":"Goldfischer","year":"1997","journal-title":"J. Urol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1007\/s00345-017-2008-6","article-title":"Epidemiology of stone disease across the world","volume":"35","author":"Sorokin","year":"2017","journal-title":"World J. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1038\/ki.2012.320","article-title":"Temporal trends in the incidence of kidney stone disease","volume":"83","author":"Edvardsson","year":"2013","journal-title":"Kidney Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.eururo.2024.05.029","article-title":"Metabolic evaluation and recurrence prevention for urinary stone patients: An EAU guidelines update","volume":"86","author":"Skolarikos","year":"2024","journal-title":"Eur. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"148","DOI":"10.4103\/0974-7796.115731","article-title":"Role of ureteric stents in relieving obstruction in patients with obstructive uropathy","volume":"5","author":"Shehab","year":"2013","journal-title":"Urol. Ann."},{"key":"ref_8","first-page":"49","article-title":"Comprehensive overview of ureteral stents based on clinical aspects, material and design","volume":"76","author":"Bernasconi","year":"2023","journal-title":"Cent. Eur. J. Urol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1136\/bmj.39119.595081.55","article-title":"Outcomes of stenting after uncomplicated ureteroscopy: Systematic review and meta-analysis","volume":"334","author":"Nabi","year":"2007","journal-title":"BMJ"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1159\/000020250","article-title":"Late complications of ureteral stents","volume":"38","author":"Ringel","year":"2000","journal-title":"Eur. Urol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1159\/000447201","article-title":"Pilot study to determine optimal stent duration following ureteroscopy: Three versus seven days","volume":"11","author":"Paul","year":"2018","journal-title":"Curr. Urol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Porto, B.C., Hobaica, N.C., Passerotti, C.C., Sardenberg, R.A., Otoch, J.P., and da Cruz, J.A.S. (2025). Optimal stenting duration following ureteroscopy and nephrolithotomy: Systematic review and meta-analysis. BMC Urol., 25.","DOI":"10.1186\/s12894-025-01765-z"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1089\/end.2023.0189","article-title":"Timing of ureteral stent removal after ureteroscopy on stent-related symptoms: A validated questionnaire comparison of 3 and 7 days stent duration","volume":"38","author":"Heidenberg","year":"2024","journal-title":"J. Endourol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Hu, H., Yan, M., Liu, Z., Qiu, J., Dai, Y., and Tang, Y. (2024). A method for detecting ureteral stent encrustations in medical CT images based on Mask-RCNN and 3D morphological analysis. Front. Physiol., 15.","DOI":"10.3389\/fphys.2024.1432121"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Qiu, J., Yan, M., Wang, H., Liu, Z., Wang, G., Wu, X., Gao, Q., Hu, H., Chen, J., and Dai, Y. (2023). Identifying ureteral stent encrustation using machine learning based on CT radiomics features: A bicentric study. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1202486"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Wang, K., Zhao, Z., Liu, Y., Nai, R., Yuan, C., Wu, P., Li, J., Zhang, X., and Wang, H. (2025). Measurement of ureteral length: Comparison of deep learning-based method and other estimation methods on CT and KUB. Comput. Biol. Med., 184.","DOI":"10.1016\/j.compbiomed.2024.109374"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"104","DOI":"10.12720\/ijeee.1.2.104-106","article-title":"Image edge detection based on OpenCV","volume":"1","author":"Xie","year":"2013","journal-title":"Int. J. Electron. Electr. Eng."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1139\/p66-090","article-title":"Least-squares fitting of a straight line","volume":"44","author":"York","year":"1966","journal-title":"Can. J. Phys."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"540","DOI":"10.4097\/kjae.2015.68.6.540","article-title":"T test as a parametric statistic","volume":"68","author":"Kim","year":"2015","journal-title":"Korean J. Anesthesiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"407","DOI":"10.4103\/aca.ACA_94_19","article-title":"Application of Student\u2019s t-test, analysis of variance, and covariance","volume":"22","author":"Mishra","year":"2019","journal-title":"Ann. Card. Anaesth."},{"key":"ref_21","unstructured":"Hsu, H., and Lachenbruch, P.A. (2014). Paired t test. Wiley StatsRef: Statistics Reference Online, John Wiley & Sons."}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/12\/10\/1084\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T09:05:36Z","timestamp":1760346336000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/12\/10\/1084"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,5]]},"references-count":21,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["bioengineering12101084"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering12101084","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,5]]}}}