Computed Tomography-Derived visceral fat area is associated with increased risk of kidney stone recurrence.

Visceral adiposity has been implicated in metabolic dysregulation and chronic inflammation, both of which may contribute to kidney stone recurrence. However, accurate and reproducible quantification of visceral fat in routine clinical practice remains challenging. This study aimed to investigate the association between visceral fat area (VFA) quantified from computed tomography (CT) images and the risk of kidney stone recurrence. We retrospectively analyzed patients with urolithiasis who underwent abdominal CT imaging. Visceral fat area was automatically quantified using a previously validated artificial intelligence (AI)-based CT segmentation system. Clinical characteristics and stone recurrence outcomes were collected. Multivariable regression models were applied to assess the association between VFA and stone recurrence after adjustment for relevant confounders. A total of 131 patients were included, of whom 73 (48%) experienced stone recurrence during a mean follow-up of 47 weeks. Patients with recurrence had significantly higher visceral fat area. High VFA was independently associated with increased recurrence risk (adjusted hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.03 to 2.82). Subgroup analyses demonstrated a stronger association in younger patients (HR 2.45, 95% CI 1.23 to 4.89), while no significant association was observed in older patients or across sexes. CT-derived visceral fat area was independently associated with kidney stone recurrence in this retrospective cohort. These findings suggest that visceral adiposity may serve as a useful imaging biomarker for risk stratification. Further prospective studies are warranted to validate its clinical utility.