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Fernández Baltar C, Gude Sampedro F, Pérez Fentes D. Does success in percutaneous nephrolithotomy depend only on stone size? Analysis of the predictive capacity for success and complications of the current nephrolithometry scoring systems and their relationship with the stone surface. Actas Urol Esp 2024; 48:603-610. [PMID: 38735437 DOI: 10.1016/j.acuroe.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/18/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE To analyze the predictive capacity of the nephrolithometry scoring systems (GSS, STONE, CROES and S-ReSC) and stone surface regarding success and complications following percutaneous nephrolithotomy (PCNL). METHODS We studied 392 patients who had undergone PCNL in our center. Only patients with a non-contrast CT (n = 240) were finally included for analysis. The predictive capacities for success and complications of the different scoring systems were evaluated using ROC curves and their area under the curve (AUC). RESULTS Regarding success, the S-ReSC system had the highest predictive capacity with an AUC of 0.681 (95% CI 0.610-0.751), followed by the CROES with 0.667 (95% CI 0.595-0.738), the STONE with 0.654 (95% CI 0.579-0.728) and finally the GSS with 0.626 (95% CI 0.555-0.698). The stone surface as a single variable had an AUC of 0.641 (95% CI 0.565-0.718). As for complications, the S-ReSC had the highest AUC with 0.664 (95% CI 0.57-0.758), followed by STONE with 0.663 (95% CI 0.572-0.755), GSS with 0.626 (95% CI 0.555).-0.698) and CROES with 0.614 (95% CI 0.518-0.7). The stone surface alone had an AUC of 0.616 (95% CI 0.522-0.715). CONCLUSION The nephrolithometry scales analyzed show a moderate predictive capacity for success and complications in patients undergoing PCNL in our center. Moreover, stone surface as an independent variable demonstrates moderate predictive capacity for both outcomes.
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Affiliation(s)
- C Fernández Baltar
- Complejo Hospitalario Universitario de Pontevedra, Servicio de Urología, Pontevedra, Spain.
| | - F Gude Sampedro
- Complejo Universitario de Santiago de Compostela, Unidad de Epidemiología, Santiago de Compostela, Spain
| | - D Pérez Fentes
- Complejo Universitario de Santiago de Compostela, Servicio de Urología, Santiago de Compostela, Spain
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He Q, Huang Q, Hou B, Hao Z. Prediction of percutaneous nephrolithotomy outcomes and flexible ureteroscopy outcomes using nephrolithometry scoring systems. Int Urol Nephrol 2024; 56:1585-1593. [PMID: 38103147 DOI: 10.1007/s11255-023-03847-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/05/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Kidney stones account for a high proportion of urological emergencies. The main objective of this paper is to evaluate the predictive ability of five scoring systems for overall stone-free status and postoperative complications after percutaneous nephrolithotomy and retrograde ureteroscopy. MATERIALS AND METHODS This study retrospectively analysed 312 cases of kidney stone patients between January 2021 and May 2022 at our centre. Multivariate logistic regression as well as ROC curves were applied to determine the ability to evaluate each scale to predict stone-free rates and postoperative complications. RESULTS 179 patients have undergone PCNL. After multivariate logistic regression, the S.T.O.N.E score and history of ipsilateral renal surgery were predictive of stone-free status, and the predictive power of the S.T.O.N.E score was higher than that of history of ipsilateral renal surgery. Grade 1 complications were considered to be related to Guy's score and grade 2 complications were considered to be related to history of diabetes mellitus. 133 patients have undergone f-URS. After multivariate logistic regression analysis, the modified S-ReSC score, RUSS score, and R.I.R.S score were predictive of stone-free status, with the R.I.R.S score being the strongest predictor. Evidence of grade 2 complications was considered to be related to abnormal renal function. CONCLUSION For PCNL, the S.T.O.N.E score had the best efficacy in predicting stone-free status, and the Guy's score had the best efficacy in predicting postoperative complications; for f-URS, the R.I.R.S score had the best efficacy in predicting stone-free status, and no scoring system predicted postoperative complications.
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Affiliation(s)
- Qiushi He
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Qingfeng Huang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Bingbing Hou
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Zongyao Hao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
- Institute of Urology, Anhui Medical University, Hefei, China.
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China.
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Farooq K, Hameed N, Zaib Z, Hameed MB, Ausaf H, Shakil F, Afzaal Nawaz M. Comparison of STONE Score, Guy's Stone Score, CROES Nomogram, and Seoul National University Renal Stone Complexity Score in Prognosticating Outcomes of Multiple-Tract Mini-Percutaneous Nephrolithotomy: A Retrospective Study. Cureus 2024; 16:e54790. [PMID: 38529424 PMCID: PMC10961480 DOI: 10.7759/cureus.54790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 03/27/2024] Open
Abstract
Objective The objective of this study was to compare the STONE score (Size of the stone, Topography or location, degree of Obstruction of the urinary system, Number of stones, and Evaluation of Hounsfield units), Guy's stone score (GSS), Clinical Research Office of the Endourological Society (CROES) nomogram, and Seoul National University Renal Stone Complexity Score (RSCS) in prognosticating multiple tract mini-percutaneous nephrolithotomy (mPCNL) outcome. Methodology This descriptive retrospective analysis was carried out at the Urology Department, Lady Reading Hospital, Peshawar, Pakistan. Male and female patients in the age range of 18-70 years who underwent multiple tract mPCNL for renal stones from July 1, 2021, to June 30, 2023, were included in the analysis. Results A total of 110 patients were registered. Stone-free status (SFS) was achieved in 78.2% (n=86), and complications were observed in 13.6% (n=15) patients. The odds ratio for STONE score, GSS, CROES scoring system, and RSCS for predicting the SFS was 7.093 (95%CI 2.40-20.89), 9.333 (95%CI 2.92-29.81), 11.70 (95%CI 2.56-53.38) and 3.450 (95%CI 1.25-9.53), respectively. Conclusion Multiple tract mPCNL is a safe and effective technique for the management of renal stones, producing a high stone-free rate. This study demonstrated adequate efficacy and dependability of the four scoring systems in predicting SFS.
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Affiliation(s)
| | - Najma Hameed
- Radiology, Northwest General Hospital, Peshawar, PAK
| | - Zainab Zaib
- Obstetrics and Gynecology, Lady Reading Hospital, Peshawar, PAK
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Illahi Bux K, Rizwan Ahmed R, Farooq F, Daggula NR, Mahmood J, Wasim U, Kumari S, Jan M, Khan F, Kumari U. Clinical Utility of S.T.O.N.E, Guy's Scoring System, and Renal Stone Complexity Scoring in Predicting Outcome of Single-Tract Percutaneous Nephrolithotomy. Cureus 2023; 15:e50983. [PMID: 38259369 PMCID: PMC10801671 DOI: 10.7759/cureus.50983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Several imaging-based scores have been developed to predict postoperative stone-free state (SFS) and complications. This study aimed to assess the accuracy of the S.T.O.N.E., Guy Scoring System (GSS), and Seoul National University Renal Stone Complexity (S-ReSCS) scores in predicting the outcomes of single-tract percutaneous nephrolithotomy (ST-PCNL). This scoring system holds paramount importance for low-income and low-middle-income countries (LMICs), as it is inexpensive and cost-effective for the healthcare system. METHODOLOGY This retrospective study was carried out with 147 participants. Based on the preoperative computerized tomographic (CT) scan, each patient's S.T.O.N.E. score, GSS, and S-ReSCS were recorded. The modified Clavien grading system was used to document intra- and postoperative complications. RESULTS The mean age of the sample population was 45 years. SFS was achieved in 110 (74.8%) patients. The number of calyces involved (p = 0.008), S.T.O.N.E. scoring (p = 0.001), GSS (p = 0.008), and S-ReSCS (0.001) correlated well with the SFS. Forty-nine (33.33%) patients developed complications. The most common complications fell within Clavien grade II. No statistical significance was noted between the S.T.O.N.E. score, GSS, and S-ReSCS with the modified Clavien grading system. CONCLUSION The S.T.O.N.E. scoring, GSS, and S-ReSCS have a high predictive value for achieving SFS in ST-PCNL. In addition, findings from LMICs are comparable with those from the rest of the world.
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Affiliation(s)
- Kausar Illahi Bux
- Radiology, The Kidney Center, Karachi, PAK
- Radiology, Jinnah Postgraduate Medical Center, Karachi, PAK
| | | | - Faryal Farooq
- Diagnostic Radiology, Jinnah Post Graduate Medical Centre, Karachi, PAK
| | | | - Jawad Mahmood
- Gastroenterology and Hepatology, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | | | - Sajana Kumari
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Muneeb Jan
- Internal Medicine Department, Khyber Teaching Hospital, Peshawar, PAK
- Medicine, Rehman Medical Institute, Peshawar, PAK
- Cardiology, Lady Reading Hospital, Peshawar, PAK
| | | | - Usha Kumari
- Medicine, Dow University of Health Sciences, Karachi, PAK
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Does nephrolithometry scoring systems predict success and complications in miniPCNL? Int Urol Nephrol 2022; 54:1207-1213. [PMID: 35290574 DOI: 10.1007/s11255-022-03174-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Auxiliary nephrolithometric scoring systems (NSSs) have been developed to predict complications and treatment success of conventional percutaneous nephrolithotomy (PCNL). However, to our knowledge, there is no study comparing these NSSs in patients undergoing miniPCNL. This study aimed to compare the NSSs in terms of their ability to predict miniPCNL-related complications and treatment success. METHODS The data of patients undergoing PCNL between September 2016 and May 2018 were retrospectively reviewed through the electronic medical record system, and 140 patients were included in our study. Stone-free status was evaluated using non-contrast computed tomography between 1 and 3 months after the procedure. PCNL was considered successful if the patient was completely stone free. The postsurgical complications were classified according to the modified Clavien-Dindo classification system. RESULTS The Clinical Research Office of the Endourological Society (CROES) and STONE NSSs significantly predicted miniPCNL treatment success (p = 0.043, p = 0.018). However, the Guy's NSS did not significantly predict the treatment success (p = 0.415). Guy's, CROES and STONE NSSs were not found to significantly predict postsurgical complications (p = 0.584, p = 0.823, p = 0.189). CONCLUSION To the best of our knowledge, our study is the first of its kind to investigate the ability of NSSs to predict treatment success and postsurgical complications in patients undergoing miniPCNL. The study found that STONE and CROES NSSs are independent parameters for predicting stone-free status after miniPCNL. In addition, our study found that none of the NSSs were useful in predicting postsurgical complications in patients undergoing miniPCNL.
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Yıldızhan M, Balcı M, Asil E, Kızılkan Y, Aslan Y, Özden C, Tuncel A. Comparison of percutaneous nephrolithotomy and retrograde intrarenal surgery outcomes for kidney stones larger than 2 cm from Guy's stone scoring system perspective. Int J Clin Pract 2021; 75:e14956. [PMID: 34614286 DOI: 10.1111/ijcp.14956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/13/2021] [Accepted: 10/02/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To compare surgical outcomes of percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgeries (RIRS) as a result of kidney stones larger than 2 cm, together with Guy's stone scores (GSS). MATERIALS AND METHODS The data of 811 patients with stone sizes 2-6 cm were operated using PNL (n = 361) and RIRS (n = 450) reviewed retrospectively. GSS were graded 1, 2, 3 or 4 according to the computed tomography findings. Stone-free rate (SFR), operation times, length of hospital stay (LOHS) and Clavien complications (CC) were recorded. RESULTS Although mean operative times were significantly longer in the RIRS group than the PNL group in GSS grades 1, 2 and 3 (P < .001), it was similar between the two groups in GSS grade 4 (P = .186). SFRs in the PNL and RIRS group were 90.3% and 58.4% on post-operative 10th day (P < .001), and it raised up to 95.3% and 81.6% after secondary interventions (P < .001). Significantly higher SFRs observed in the PNL group in GSS grades 1, 2 and 3 categories. On postoperative 10th day, the SFRs were similar in both GSS grade 4 categories (P = .06). LOHS was longer in the PNL group (P < .001). Although LOHS was significantly longer only in GSS grade 3 (P = .043) and GSS grade 4 (P < .001) in the PNL group, it was similar in GSS grade 1 and 2 between groups. Clavien complications increased in line with GSS in the PNL group (P < .001), but the difference did not differ between GSS grade 3 and 4. CONCLUSION SF of PNL in a single session and short operation time seems to be significant especially in GSS grades 1, 2 and 3 category stones. Although the number of patients in the GSS 4 group is very small to claim this, RIRS might be considered as an alternative to PNL in a special group of patients such as GSS grade 4 because of its lower complication rates and shorter LOHS.
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Affiliation(s)
| | - Melih Balcı
- Department of Urology, Ankara City Hospital, Ankara, Turkey
- Department of Urology Affiliated with Ankara City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Erem Asil
- Department of Urology, Ankara City Hospital, Ankara, Turkey
| | | | - Yılmaz Aslan
- Department of Urology Affiliated with Ankara City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Cüneyt Özden
- Department of Urology Affiliated with Ankara City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
| | - Altuğ Tuncel
- Department of Urology Affiliated with Ankara City Hospital, Faculty of Medicine, University of Health Sciences, Ankara, Turkey
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Poudyal S. Current insights on haemorrhagic complications in percutaneous nephrolithotomy. Asian J Urol 2021; 9:81-93. [PMID: 35198401 PMCID: PMC8841251 DOI: 10.1016/j.ajur.2021.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/10/2020] [Accepted: 12/11/2020] [Indexed: 01/07/2023] Open
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Biswas K, Gupta SK, Tak GR, Ganpule AP, Sabnis RB, Desai MR. Comparison of STONE score, Guy’s stone score and Clinical Research Office of the Endourological Society (CROES) score as predictive tools for percutaneous nephrolithotomy outcome: a prospective study. BJU Int 2020; 126:494-501. [DOI: 10.1111/bju.15130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Krishnendu Biswas
- Urology Department Muljibhai Patel Urological Hospital Nadiad Gujarat India
| | | | - Gopal R. Tak
- Urology Department Muljibhai Patel Urological Hospital Nadiad Gujarat India
| | - Arvind P. Ganpule
- Urology Department Muljibhai Patel Urological Hospital Nadiad Gujarat India
| | - Ravindra B. Sabnis
- Urology Department Muljibhai Patel Urological Hospital Nadiad Gujarat India
| | - Mahesh R. Desai
- Urology Department Muljibhai Patel Urological Hospital Nadiad Gujarat India
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Lai S, Jiao B, Jiang Z, Liu J, Seery S, Chen X, Jin B, Ma X, Liu M, Wang J. Comparing different kidney stone scoring systems for predicting percutaneous nephrolithotomy outcomes: A multicenter retrospective cohort study. Int J Surg 2020; 81:55-60. [PMID: 32738550 DOI: 10.1016/j.ijsu.2020.07.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/26/2020] [Accepted: 07/06/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To compare the predictive performance of five previously described scoring systems (i.e., S.T.O.N.E., Guy's, Clinical Research Office of the Endourological Society (CROES), the Seoul National University Renal Stone Complexity (S-RESC) and the new Stone Kidney Size (SKS) score) for postoperative outcomes regarding stone-free rate (SFR) and complications in adult patients. METHODS Data from 349 patients who underwent percutaneous nephrolithotomy (PCNL) in three urology departments were analyzed. SKS, S.T.O.N.E., S-ReSC, CROES and Guy's nephrolithometry scoring systems were used to retrospectively calculate predictions for each patient. Univariate and multivariate analyses were performed to evaluate factors associated with SFR and complication rates. Receiver operating characteristic (ROC) curves were generated and areas under curves (AUC) were compared to identify the method with the highest predictive value. RESULTS Median SKS, S.T.O.N.E., S-ReSC, CROES and Guy's scores were 4, 7, 3, 170.8 and 2, respectively. Overall, SFR was 67.0% (234/349) with a complications rate of 36.7% (128/349). AUCs of each method for predicting stone-free status, highlighted reasonable predictive capabilities with 0.709, 0.806, 0 0.869, 0.207, and 0.735, respectively; however, the S-ReSC scoring system had the best discriminative performance. According to multivariate logistic regression and AUC results, none were effectively capable of predicting complications. CONCLUSIONS All scoring systems correlated significantly with stone-free status; although, S-ReSC appears to have the greatest predictive ability. This method is also relatively easy to implement and highly reproducible. However, none of the methods analyzed are able to accurately predict postoperative complications.
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Affiliation(s)
- Shicong Lai
- Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Binbin Jiao
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China; Department of Urology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Zhaoqiang Jiang
- Department of Urology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Jianyong Liu
- Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Samuel Seery
- School of Humanities and Social Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xin Chen
- Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Bin Jin
- Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xiaomeng Ma
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ming Liu
- Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Jianye Wang
- Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China; Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Winoker JS, Chandhoke RA, Atallah W, Gupta M. Morphometry scores: Clinical implications in the management of staghorn calculi. Asian J Urol 2020; 7:78-86. [PMID: 32257799 PMCID: PMC7096674 DOI: 10.1016/j.ajur.2019.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/09/2019] [Accepted: 03/07/2019] [Indexed: 10/26/2022] Open
Abstract
Due to their large size, rapid growth, and attendant morbidity, staghorn calculi are complex clinical entities that impose significant treatment-related challenges. Moreover, their relative heterogeneity-in terms of both total stone burden and anatomic distribution-limits the ability to standardize their characterization and the reporting of surgical outcomes. Several morphometry systems currently exist to define the volumetric distribution of renal stones, in general, and to predict the outcomes of percutaneous nephrolithotomy; however, they fall short in their applicability to staghorn stones. In this review, we aim to discuss the clinical utility of morphometry systems and the influence of pelvicalyceal anatomy on the management of these complex calculi.
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Affiliation(s)
- Jared S Winoker
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ryan A Chandhoke
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William Atallah
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Al Adl AM, Mohey A, Abdel Aal A, Abu-Elnasr HAF, El Karamany T, Noureldin YA. Percutaneous Nephrolithotomy Outcomes Based on S.T.O.N.E., GUY, CROES, and S-ReSC Scoring Systems: The First Prospective Study. J Endourol 2020; 34:1223-1228. [PMID: 32098495 DOI: 10.1089/end.2019.0856] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To evaluate predictive capability and clinical applicability of the current nephrolithometric scoring systems of S.T.O.N.E. score, Guy's scoring system (GSS), CROES (Clinical Research Office of the Endourological Society) nomogram, and S-ReSC (Seoul National University Renal Stone Complexity) score for percutaneous nephrolithotomy (PCNL) outcomes in the same cohort in a prospective study. Methods: Consecutive patients undergoing PCNL between 2015 and 2018 were included calculating the four scores in the same cohort. Stone-free status (SFS), complications, operative time (OT), estimated blood loss (EBL), fluoroscopy time, and length of hospital stay were investigated. Receiver operator characteristic (ROC) curves for predictive accuracy and regression analysis for predictors of SFS were performed. Results: In all, 162 PCNLs were accomplished and analyzed. Overall, SFS was 75.9% and complication rate was 30.9%. The mean acquisition time of scores was 52.9 ± 0.5 seconds for GSS, 05.1 ± 0.3 seconds for S.T.O.N.E. score, 224 ± 3.1 seconds for CROES, and 102.6 ± 3.5 seconds for S-ReSC score. SFS had the best association with CROES grade. Clavien grade was associated with S.T.O.N.E. score. Moreover, EBL and OT had best association with S-ReSC score. All scores had comparable predictive accuracy on ROC curves regarding SFS. Stone essence and tract length are not different in cases with residual stones. Number of involved calyces, single vs multiple stones and renal pelvic obstruction were significant predictors of SFS in regression analysis. Conclusion: The four scoring systems had comparable predictive accuracy for SFS. However, S.T.O.N.E. and S-ReSC scores were easily applicable and provided better association with EBL and OT compared with the GSS score. Number of involved calyces, stone multiplicity, and renal pelvic obstruction were significant predictors of SFS; hence, further studies are needed to invent a universally agreeable scoring system covering reported shortcomings in the currently used scores.
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Affiliation(s)
- Ahmed M Al Adl
- Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed Mohey
- Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ashraf Abdel Aal
- Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt
| | | | - Tarek El Karamany
- Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Yasser A Noureldin
- Department of Urology, Faculty of Medicine, Benha University, Benha, Egypt
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12
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Aminsharifi A, Irani D, Tayebi S, Jafari Kafash T, Shabanian T, Parsaei H. Predicting the Postoperative Outcome of Percutaneous Nephrolithotomy with Machine Learning System: Software Validation and Comparative Analysis with Guy's Stone Score and the CROES Nomogram. J Endourol 2020; 34:692-699. [PMID: 31886708 DOI: 10.1089/end.2019.0475] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To validate the output of a machine learning-based software as an intelligible interface for predicting multiple outcomes after percutaneous nephrolithotomy (PCNL). We compared the performance of this system with Guy's stone score (GSS) and the Clinical Research Office of Endourological Society (CROES) nomogram. Patients and Methods: Data from 146 adult patients (87 males, 59%) who underwent PCNL at our institute were used. To validate the system, accuracy of the software for predicting each postoperative outcome was compared with the actual outcome. Similarly, preoperative data were analyzed with GSS and CROES nomograms to determine stone-free status as predicted by these nomograms. A receiver operating characteristic (ROC) curve was generated for each scoring system, and the area under the ROC curve (AUC) was calculated and used to assess the predictive performance of all three models. Results: Overall stone-free rate was 72.6% (106/146). Forty of 146 patients (27.4%) were scheduled for 42 ancillary procedures (extracorporeal shockwave lithotripsy [SWL] [n = 31] or repeat PCNL [n = 11]) to manage residual renal stones. Overall, the machine learning system predicted the PCNL outcomes with an accuracy ranging between 80% and 95.1%. For predicting the stone-free status, the AUC for the software (0.915) was significantly larger than the AUC for GSS (0.615) or CROES nomograms (0.621) (p < 0.001). Conclusion: At the internal institutional level, the machine learning-based software was a promising tool for recording, processing, and predicting outcomes after PCNL. Validation of this system against an external dataset is highly recommended before its widespread application.
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Affiliation(s)
- Alireza Aminsharifi
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran.,Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Dariush Irani
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sona Tayebi
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Tayebeh Shabanian
- Department of Medical Physics and Engineering, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Parsaei
- Department of Medical Physics and Engineering, Shiraz University of Medical Sciences, Shiraz, Iran.,Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Srivastava A, Yadav P, Madhavan K, Sureka SK, Singh UP, Kapoor R, Ansari MS, Lal H, Mishra P. Inter-observer variability amongst surgeons and radiologists in assessment of Guy's Stone Score and S.T.O.N.E. nephrolithometry score: A prospective evaluation. Arab J Urol 2019; 18:118-123. [PMID: 33029417 PMCID: PMC7473116 DOI: 10.1080/2090598x.2019.1703278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective (a) To assess the inter-observer variability amongst surgeons performing percutaneous nephrolithotomy (PCNL) and radiologists for the Guy’s Stone Score (GSS) and S.T.O.N.E. (stone size [S], tract length [T], obstruction [O], number of involved calyces [N], and essence or stone density [E]) nephrolithometry score; (b) To determine which scoring system of the two is better for predicting the stone-free rate (SFR) after PCNL. Patients, subjects and methods Patients undergoing PCNL between February 2016 and September 2016 were prospectively enrolled. Preoperative computed tomography was done in all patients. The GSS and S.T.O.N.E. nephrolithometry score were independently calculated by eight surgeons and four radiologists. The patients were operated on by one of the surgeons (all were consultants). The Fleiss’ κ coefficient was used to assess agreement independently between the surgeons and radiologists. Receiver operating characteristic (ROC) curves were constructed for predicting the SFR using the average of the scores of the surgeons and radiologists separately. Results A total of 157 patients underwent PCNL. The SFR was 71.3% (112/157 patients). The Fleiss’ κ scores ranged from 0.51 to 0.88 (overall 0.79) for the S.T.O.N.E. score and 0.53–0.91 for the GSS, suggesting moderate to very good agreement. The ROC curve for the S.T.O.N.E. nephrolithometry scores of surgeons (area under the curve [AUC] = 0.806) as well as the radiologists (AUC = 0.810) had a higher predictive value for the SFR than the GSS of the surgeons (AUC = 0.738) and the radiologists (AUC = 0.747). Conclusion There is overall good agreement between surgeons and radiologists for both the GSS and S.T.O.N.E. nephrolithometry score. The S.T.O.N.E. score had a higher predictive value for the SFR than the GSS. Abbreviations AUC: area under the curve; GSS: Guy’s Stone Score; KUB: kidneys, ureters and bladder; NCCT: non-contrast CT; PCNL: Percutaneous nephrolithotomy; ROC: receiver operating characteristic; SFR: stone-free rate; S.T.O.N.E.: stone size [S], tract length [T], obstruction [O], number of involved calyces [N], and essence or stone density [E]
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Affiliation(s)
- Aneesh Srivastava
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Priyank Yadav
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Kumar Madhavan
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sanjoy K Sureka
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Uday P Singh
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rakesh Kapoor
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - M S Ansari
- Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Hira Lal
- Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Prabhakar Mishra
- Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Evaluation of three stone-scoring systems for predicting SFR and complications after percutaneous nephrolithotomy: a systematic review and meta-analysis. BMC Urol 2019; 19:57. [PMID: 31262284 PMCID: PMC6604199 DOI: 10.1186/s12894-019-0488-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/23/2019] [Indexed: 12/23/2022] Open
Abstract
Background Clinical studies assessing the feasibility and accuracy of three stone scoring systems’s (SSSs: Guy’s stone score, CROES nomogram and S.T.O.N.E nephrolithometry scoring system) have reported contradictory outcomes. This systematic evaluation was performed to obtain comprehensive evidence with regard to the feasibility and accuracy of three SSSs. Methods A systematic search of Embase, Pubmed, Medline, and the Cochrane Library was conducted to identify studies that compared three SSSs up to Mar 2018. Patients were categorized according to stone free (SF) and no-stone free (NSF), Outcomes of interest included perioperative variables, stone-free rate (SFR), and complications. Results Ten studies estimating three SSSs were included for meta-analysis. The results showed that SF patients had a significantly lower proportion of male (OR = 1.48, P = 0.0007), lower stone burden (WMD = -504.28, P < 0.0001), fewer No of involved calyces (OR = -1.23, P = 0.0007) and lower proportion of staghorn stone (OR = 0.33, P < 0.0001). Moreover, SF patients had significantly lower score of Guy score (WMD = -0.64, P < 0.0001), but, S.T.O.N.E. score (WMD = -1.23, P < 0.0001) and a higher score of CROES nomogram (WMD = 29.48, P = 0.003). However, the comparison of area under curves (AUC) of predicting SFR indicated that there was no remarkable difference between three SSSs. Nonetheless, Guy score was the only stone scoring system that predicted complications after PCNL (WMD = -0.29, 95% CI: − 0.57 to − 0.02, P = 0.03). Conclusions Our meta-analysis indicated that the three SSSs were equally, feasible and accurate for predicting SFR after PCNL. However, Guy score was the only stone scoring system that predicted complications after PCNL. Electronic supplementary material The online version of this article (10.1186/s12894-019-0488-y) contains supplementary material, which is available to authorized users.
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Caglayan V, Onen E, Avci S, Sambel M, Kilic M, Oner S. Comparison of Guy's Stone Score and clinical research of the endourological society nomogram for predicting surgical outcomes after pediatric percutaneous nephrolithotomy: a single center study. MINERVA UROL NEFROL 2019; 71:619-626. [PMID: 31086131 DOI: 10.23736/s0393-2249.19.03405-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to compare the efficacy of Guy's Stone Score (GSS) and Clinical Research of the Endourological Society (CROES) Nomogram in predicting PCNL outcomes in the pediatric patients with kidney stone. METHODS A retrospective review of the clinical data of 120 pediatric patients who underwent PCNL between August 2004 and February 2016 was performed. Patients were grouped according to stone-free (SF) status and complication status. The patients whose history, preoperative physical examination records, biochemical analysis, imaging records were available and who did not neglect the follow-up, were included in the study. The stone size measurement and the scoring system calculation were always performed by the same surgeon. Multivariate logistic regression analysis were performed to identify the factors associated with SF status and complication status. RESULTS CROES score was significantly higher in SF patients compared to the patients with residual stones (P=0.009), while stone burden and GSS were significantly lower (P=0.023 and P=0.025). Median hospitalization day of patients with complications was significantly higher compared to the patients without complication (P=0.005). To have stones located in multiple calyces was the only statistically significant condition when two groups were compared (P=0.014). In multivariate analysis, CROES score was the independent factor associated with SF status (OR:0.984 95% CI: 0.959-1.010 P=0.017) and to have stones located in multiple calyces was the independent factor associated with complication status (OR:0.265 95% CI:0.087-0.808 P=0.02). CONCLUSIONS CROES nomogram is associated with the SFR while GSS is not. Both scoring systems do not have predictive accuracy on complication status. Further studies are required to make modifications in the scoring systems in the pediatric population.
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Affiliation(s)
- Volkan Caglayan
- Department of Urology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey -
| | - Efe Onen
- Department of Urology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Sinan Avci
- Department of Urology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Murat Sambel
- Department of Urology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Metin Kilic
- Department of Urology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Sedat Oner
- Department of Urology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Akçay M, Tosun M, Gevher F, Kalkan S, Ersöz C, Kayalı Y, Tepeler A. Comparison of Scoring Systems in Predicting Success of Percutaneous Nephrolithotomy. Balkan Med J 2019; 36:32-36. [PMID: 30203780 PMCID: PMC6335940 DOI: 10.4274/balkanmedj.2017.1631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Scoring systems are useful to inform the patients about the success and complication rates of the operation prior the surgery. Aims: To determine the applicability of the popular scoring systems (Guy’s, stone size, tract length, obstruction, number of involved calices, and essence/stone density and Clinical Research Office of the Endourological Society) by means of examining preoperative data of patients treated with percutaneous nephrolithotomy. Study Design: Cross sectional study. Methods: We retrospectively reviewed files of the patients who had undergone percutaneous nephrolithotomy in our center between 2011 and 2015. Excluded from the study were patients aged <18 years, and those who were not assessed preoperatively with computed tomography. Preoperative computed tomography images of all patients were assessed by a single observer, and patients were graded based on three scoring system. Demographic data were analyzed along with perioperative data (operation, fluoroscopy, length of hospital stay, changes in hematocrit values, location, and number of access sites, stone-free and complication rates). Results: A total of 298 patients who had been treated with 300 procedures were enrolled into the study. Mean age, stone burden, number of stones, and density were 48.1±12.9 years, 663.5±442.8 mm2, 1.8±1.1 and 888.3±273 HU respectively. Scores of the cases based on Guy’s, stone size, tract length, obstruction, number of involved calices, and essence/stone density, and Clinical Research Office of the Endourological Society scoring system were calculated as 2, 7.6, and 222.1 points respectively. 81.6% of the patients were stone-free. Complications were detected in 30 (9.9%) patients. Based on receiver operating characteristic curve analysis a positive correlation was detected between success rate and scoring systems, i.e., Guy’s (p=<0.001, r=-0.309), stone size, tract length, obstruction, number of involved calices, and essence/stone density (p=<0.001, r=-0.295), and Clinical Research Office of the Endourological Society (p=<0.001, r=0.426). The Clinical Research Office of the Endourological Society scoring system had the highest predictive value. The sensitivity rates rates for Guy’s, Clinical Research Office of the Endourological Society and Stone scoring system were as 78.78%, 80% and 82.34% respectively. Conclusion: All of scoring systems predicted correctly the success of the percutaneous nephrolithotomy procedures. The Clinical Research Office of the Endourological Society scoring system had the highest predictive value.
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Affiliation(s)
- Muzaffer Akçay
- Department of Urology, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Muhammed Tosun
- Department of Urology, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Fatih Gevher
- Department of Urology, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Senad Kalkan
- Department of Urology, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Cevper Ersöz
- Department of Urology, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Yunus Kayalı
- Department of Urology, Bezmialem Vakıf University School of Medicine, İstanbul, Turkey
| | - Abdulkadir Tepeler
- Clinic of Urology, Private Sen Jorj Avusturya Hospital, İstanbul, Turkey
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Senocak C, Ozbek R, Yildirim YE, Bozkurt OF, Unsal A. Predictive ability of Guy's stone score in pediatric patients undergoing percutaneous nephrolithotomy. J Pediatr Urol 2018; 14:437.e1-437.e7. [PMID: 29631882 DOI: 10.1016/j.jpurol.2018.02.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/09/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several authors have evaluated, in a number of external validation and predominantly adult studies, Guy's stone score (GSS) as a predictive tool for the assessment of stone clearance after percutaneous nephrolithotomy (PCNL). However, there are limited and conflicting data investigating whether GSS could be a potential independent factor associated with residual stone rates and complications of PCNL for children. OBJECTIVE The aim of the current study was to evaluate the ability of GSS, as an independent factor, to predict residual stone rates and complications in pediatric patients undergoing PCNL. STUDY DESIGN The records of the pediatric patients who had undergone PCNL for stone disease at the current department were retrospectively reviewed. Variables included patient, stone, and treatment parameters. The GSS was used for assessment of stone complexity. Univariate and multivariate analyses were performed to evaluate factors associated with residual stone rates and complications of pediatric PCNL. RESULTS The study group consisted of 114 children (63 boys and 51 girls) with a median (interquartile range) age of 6 (3-11) years and who had undergone 122 PCNLs (eight bilateral). Multivariate logistic regression analysis (Summary Table) demonstrated that the independent risk factors for increased residual stone rate following pediatric PCNL monotherapy were GSS (OR 3.14, 95% CI 1.31-7.49, P = 0.01) and number of calyces involved (OR 4.02, 95% CI 1.11-14.53, P = 0.033). Multivariate logistic regression analysis demonstrated that the independent risk factors for complications following pediatric PCNL were surgical experience (OR 2.72, 95% CI 1.09-6.82, P = 0.032), and operation time (OR 1.01, 95% CI 1.00-1.03, P = 0.040). DISCUSSION A prediction model is needed to pre-operatively counsel patients and evaluate outcomes for measuring treatment success of PCNL. The GSS provides a simple, reliable and reproducible tool for describing the complexity of PCNL while predicting postoperative stone-free status, despite its limitations. However, little research has been conducted on the applicability of GSS in pediatric patients undergoing PCNL. In addition, conflicting results have been reported about its association with complications of pediatric PCNL. CONCLUSIONS The current study found that although GSS had a significant predictive ability for residual stone rates after pediatric PCNL revealed by multivariate logistic regression, the results did not conclude that complexity of GSS was directly proportional to complications of pediatric PCNL. The factors, including calyceal involvement and surgeon experience, may need to be incorporated in GSS to further improve its ability to predict outcomes of pediatric PCNL. IRB APPROVED PROTOCOL NUMBER 1422.
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Affiliation(s)
- C Senocak
- Department of Urology, Kecioren Training and Research Hospital, Ankara, Turkey.
| | - R Ozbek
- Department of Urology, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Y E Yildirim
- Department of Urology, Kecioren Training and Research Hospital, Ankara, Turkey
| | - O F Bozkurt
- Department of Urology, Kecioren Training and Research Hospital, Ankara, Turkey
| | - A Unsal
- Department of Urology, Gazi University School of Medicine, Ankara, Turkey
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Tseng JS, Lin WR, Sun FJ, Lin TF, Tsai WK, Chiang PK, Lee CC, Chen YH, Chiu AW, Chen M. Predicting Percutaneous Nephrolithotomy Outcomes and Complications in Elderly Patients Using Guy's Scoring System and Charlson Comorbidity Index. INT J GERONTOL 2018. [DOI: 10.1016/j.ijge.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Vicentini FC, Serzedello FR, Thomas K, Marchini GS, Torricelli FCM, Srougi M, Mazzucchi E. What is the quickest scoring system to predict percutaneous nephrolithotomy outcomes? A comparative study among S.T.O.N.E score, guy's stone score and croes nomogram. Int Braz J Urol 2018; 43:1102-1109. [PMID: 28338303 PMCID: PMC5734073 DOI: 10.1590/s1677-5538.ibju.2016.0586] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 11/21/2016] [Indexed: 01/18/2023] Open
Abstract
Objective: To compare the application time and the capacity of the nomograms to predict the success of Guy's Stone Score (GSS), S.T.O.N.E. Nephrolithometry (STONE) and Clinical Research Office of the Endourological Society nephrolithometric nomogram (CROES) of percutaneous nephrolithotomy (PCNL), evaluating the most efficient one for clinical use. Materials and Methods: We studied 48 patients who underwent PCNL by the same surgeon between 2010 and 2011. We calculated GSS, STONE and CROES based on pre-operative non-contrast computed tomography (CT) images and clinical data. A single observer, blinded to the outcomes, reviewed all images and assigned scores. We compared the application time of each nomogram. We used an analysis of variance for repeated measures and multiple comparisons by the Tukey test. We compared the area under the ROC curve (AUC) of the three nomograms two by two to determine the most predictive scoring system. Results: The immediate success rate was 66.7% and complications occurred in 16.7% of cases. The average operative time was 122 minutes. Mean application time was significantly lower for the GSS (27.5 seconds) when compared to 300.6 seconds for STONE and 213.4 seconds for CROES (p<0.001). There was no significant difference among the GSS (AUC=0.653), STONE (AUC=0.563) and CROES (AUC=0.641) in the ability to predict immediate success of PCNL. Conclusions: All three nomograms showed similar ability to predict success of PCNL, however the GSS was the quickest to be applied, what is an important issue for routine clinical use when counseling patients who are candidates to PCNL.
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Affiliation(s)
- Fabio C Vicentini
- Seção de Endourologia, Departamento de Urologia, Hospital de Clínicas, Faculdade de Medicina da Universidade de São Paulo, SP, Brasil
| | | | - Kay Thomas
- Stone Unit, Guy's and St. Thomas' National Health services foundation Hospital, London, United Kingdom
| | | | | | - Miguel Srougi
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Eduardo Mazzucchi
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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Moreno-Palacios J, Avilés-Ibarra OJ, García-Peña E, Torres-Anguiano JR, Serrano-Brambilia EA, López-Sámano VA, Maldonado-Alcaraz E. Rearrangement of the Guy's stone score improves prediction of stone-free rate after percutaneous nephrolithotomy. Turk J Urol 2018; 44:36-41. [PMID: 29484225 DOI: 10.5152/tud.2018.41524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/18/2017] [Indexed: 11/22/2022]
Abstract
Objective We propose a modification of the original Guy's Stone Score (GSS) to hold on 20 % of prognostic discrimination among groups which makes this score a more reliable resource for risk assessment in patients undergoing percutaneous nephrolithotomy (PCNL). Material and methods Historical cohort of 126 patients undergoing PCNL from December 2010 to November 2014 was included in the survey. Every patient was classified according to the original GSS. For the new classification of Guy Stone Score (GSS-M) all of the subgroups included in the scale were analyzed individually and then ranked from better to worst according to the postoperative stone- free rates (SFRs). This ranking led us to reclassify all the original subgroups, clustering them in three new categories according to their SFRs as subgroups of good, intermediate and poor prognosis, trying to achieve at least 20% of prognostic discrimination among the groups. Results Hundred and twenty-six PCNL procedures were evaluated, but only 124 were included for statistical analysis and classified based on SFR according to the GSS as follows: 76% for grade 1, 71% for grade 2, 55% for grade 3 and 20% for grade 4. The SFRs were also assessed for the GSS-M obtaining the following predictive values as 93%, 67% and 44% for the good, intermediate and poor prognostic groups, respectively. The prognostic difference among the GSS-M groups was always >20% (p<0.05). Conclusion The original GSS has limitations to predict SFR because of its poor discrimination power among prognostic groups. This rearrangement improves prediction of SFR and better discriminates risk groups in PCNL.
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Affiliation(s)
- Jorge Moreno-Palacios
- Department of Urology, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Mexico City, Mexico
| | - Oswaldo José Avilés-Ibarra
- Department of Urology, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Mexico City, Mexico
| | - Enrique García-Peña
- Department of Urology, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Mexico City, Mexico
| | - Juan Ramón Torres-Anguiano
- Department of Urology, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Mexico City, Mexico
| | | | | | - Efraín Maldonado-Alcaraz
- Department of Urology, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Mexico City, Mexico
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Felici EM, Diniz ALL, Souza TA, Favorito LA, Resende JAD. Can renal stone size and the use of the nephrolithometric system increase the efficacy of predicting the risk of failure of percutaneous nephrolithotripsy? ACTA ACUST UNITED AC 2017; 44:619-625. [PMID: 29267559 DOI: 10.1590/0100-69912017006014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 09/21/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE to verify the association of success rate of percutaneous lithotripsy, Guy score and size of the stone. METHODS one hundred patients submitted to percutaneous nephrolithotripsy were evaluated. All stones were classified according to Guy Score. Patient free of stone was considered when residual fragments were ≤2mm. RESULTS according to guy Score, 54% were score 1 (Group 1), 18% score 2 (Group 2), 15% score 3 (Group 3), and 13% score 4 (Group 4). Success was observed in 77.77% in Group 1, 27.77% in group 2, 26.6% in Group 3, and 7.69% in Group 4. In patients with Guy score 1, there was statistical significance of prediction of free stone rate when evaluated according to the size of the stone. Among groups 2, 3 and 4 there was no statistical significance, but it was observed a trend in relation to stone size, the bigger the higher the chance of residual fragments. CONCLUSION nephrolithometry by Guy Score and size of the stone are single predictors of success of percutaneous nephrolithotripsy. Stone size may influence success rate of patients with Guy Score 1.
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Predictability and Practicality of Image-Based Scoring Systems for Patient Assessment and Outcome Stratification During Percutaneous Nephrolithotomy: a Contemporary Update. Curr Urol Rep 2017; 18:95. [PMID: 29046986 DOI: 10.1007/s11934-017-0740-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Preoperative nomograms offer systematic and quantitative methods to assess patient- and stone-related characteristics and their impact on successful treatment and potential risk of complication. Discrepancies in the correlation of perioperative variables to patient outcomes have led to the individual development, validation, and application of four independent scoring systems for the percutaneous nephrolithotomy: Guy's stone score, S.T.O.N.E. nephrolithometry, Clinical Research Office of the Endourology Society nomogram, and Seoul National University Renal Stone Complexity. The optimal nomogram should have high predictive ability, be practically integrated into clinical use, and be widely applicable to urinary stone disease. Herein, we seek to provide a contemporary evaluation of the advantages, disadvantages, and commonalities of each scoring system. While the current data is insufficient to conclude which scoring system is destined to become the gold standard, it is crucial that a nephrolithometric scoring system be incorporated into common practice to improve surgical planning, patient counseling, and outcome assessment.
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Yarimoglu S, Bozkurt IH, Aydogdu O, Yonguc T, Sefik E, Topcu YK, Degirmenci T. External validation and comparison of the scoring systems (S.T.O.N.E, GUY, CROES, S-ReSC) for predicting percutaneous nephrolithotomy outcomes for staghorn stones: A single center experience with 160 cases. Kaohsiung J Med Sci 2017; 33:516-522. [PMID: 28962823 DOI: 10.1016/j.kjms.2017.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/19/2017] [Accepted: 06/21/2017] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was validation and comparison of stone scoring systems (S.T.O.N.E, GUY, CROES, S-ReSC) used to predict postoperative stone-free status and complications after percutaneous nephrolithotomy (PCNL) for staghorn stones. A total of 160 patients who had staghorn renal stones and underwent PCNL between January 2012 and August 2015 were included in the current retrospective study. Guy, S.T.O.N.E., S-ReSC (Seoul National University Renal Stone Complexity) and CROES (Clinical Research Office of the Endourological Society) nephrolithometry scores were calculated for each patient, and their potential association with stone-free status, operative and fluoroscopy time, and length of hospital stay (LOS) were evaluated. Postoperative complications were graded according to the modified Clavien classification, and the correlation of scoring systems with postoperative complications was also investigated. The mean CROES, S.T.O.N.E, Guy and S-ReSC scores were 143.5 ± 33.6, 9.7 ± 1.6, 3.5 ± 0.5 and 6.2 ± 2.0 respectively. The overall stone-free rate was 59%. All scoring systems were significantly correlated with stone-free status in univariate analysis. However, Guy and S-ReSC scores were the only significant independent predictor in multivariate analysis. And all four nomograms failed to predict complication rates. Current study demonstrated that Guy and S-ReSC scoring systems could effectively predict postoperative stone-free status for staghorn stones. However all four scoring systems failed to predict complication rates.
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Affiliation(s)
| | | | - Ozgu Aydogdu
- Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Tarik Yonguc
- Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Ertugrul Sefik
- Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Yusuf Kadir Topcu
- Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey.
| | - Tansu Degirmenci
- Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey
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Yarimoglu S, Bozkurt IH, Aydogdu O, Yonguc T, Gunlusoy B, Degirmenci T. External Validation and Comparisons of the Scoring Systems for Predicting Percutaneous Nephrolithotomy Outcomes: A Single Center Experience with 506 Cases. J Laparoendosc Adv Surg Tech A 2017; 27:1284-1289. [PMID: 28873326 DOI: 10.1089/lap.2017.0355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To validate and compare the stone scoring systems (stone size [S], tract length [T], obstruction [O], number of involved calices [N], and essence or stone density [E] [S.T.O.N.E.], Guy's Stone Score [GSS], Clinical Research Office of the Endourological Society [CROES], and Seoul National University Renal Stone Complexity [S-ReSC]) used to predict postoperative stone-free status and complications after percutaneous nephrolithotomy (PCNL). METHODS A total of 567 patients who underwent PCNL for renal stones between January 2012 and August 2015 were included in the recent retrospective study. Sixty-one patients who had not done preoperative CT were excluded from the study. GSS, S.T.O.N.E., S-ReSC, and CROES nephrolithometry scores were calculated for each patient, and their potential association with stone-free status, operative and fluoroscopy time, and length of stay (LOS) was evaluated. Postoperative complications were graded according to the modified Clavien classification, and the correlation of scoring systems with postoperative complications was also investigated. RESULTS The mean CROES, S.T.O.N.E., GSS, and S-ReSC scores were 203.7 ± 59.8, 7.52 ± 1.8, 2.08 ± 0.9, and 3.35 ± 2.2, respectively. The overall stone-free rate was 77.9%. All scoring systems were significantly correlated with stone-free status and operation time. While GSS, S.T.O.N.E., and CROES systems were significantly correlated with complication rates (CR), S-ReSC score failed to predict CR. All scoring systems except S.T.O.N.E. were significantly correlated with LOS. CROES and S-ReSC scores were predictive of estimated blood loss (EBL), while GSS and S.T.O.N.E. failed to predict EBL. CONCLUSIONS Recent study demonstrated that S.T.O.N.E., GSS, CROES, and S-ReSC scoring systems could effectively predict postoperative stone-free status. Although S-ReSC scoring system failed to predict CR, the rest three scoring systems were significantly correlated with postoperative CR.
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Affiliation(s)
| | | | - Ozgu Aydogdu
- 2 Department of Urology, Bozyaka Training and Research Hospital , Izmir, Turkey
| | - Tarik Yonguc
- 2 Department of Urology, Bozyaka Training and Research Hospital , Izmir, Turkey
| | - Bulent Gunlusoy
- 2 Department of Urology, Bozyaka Training and Research Hospital , Izmir, Turkey
| | - Tansu Degirmenci
- 2 Department of Urology, Bozyaka Training and Research Hospital , Izmir, Turkey
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Wu WJ, Okeke Z. Current clinical scoring systems of percutaneous nephrolithotomy outcomes. Nat Rev Urol 2017; 14:459-469. [PMID: 28534536 DOI: 10.1038/nrurol.2017.71] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Percutaneous nephrolithotomy has become the preferred treatment modality for patients with large renal calculi. The technique provides excellent stone clearance, but complication rates are higher than those of minimally invasive techniques, such as ureteroscopy and shockwave lithotripsy. Guy's stone score, S.T.O.N.E. nephrolithometry, the CROES nomogram, and S-ReSC are contemporary scoring systems introduced to provide standardized grading of stone complexity and outcomes of percutaneous stone surgery. Guy's stone score is easy to apply and has been validated in multiple studies. The S.T.O.N.E. score is based on factors determined through CT imaging, which is the currently preferred imaging modality for patients with nephrolithiasis. The CROES nomogram was developed from data in a large multicentre database and has high statistical power. Determination of the S-ReSC score relies on stone location only, providing a simple approach to grading disease complexity. Each system has advantages and disadvantages, but several studies suggest that their ability to predict stone-free rate is comparable. The optimal system should have a high predictive ability, should be simple to use and should be widely applicable. Additional studies are required to evaluate patient clinical factors that influence stone complexity and are predictive of outcomes. A future unified scoring system might incorporate the strengths of each currently available system and optimize care of patients with nephrolithiasis.
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Affiliation(s)
- Wayland J Wu
- Smith Institute for Urology, Hofstra Northwell School of Medicine, 450 Lakeville Road, Suite M41, Lake Success, New York 11042, USA
| | - Zeph Okeke
- Smith Institute for Urology, Hofstra Northwell School of Medicine, 450 Lakeville Road, Suite M41, Lake Success, New York 11042, USA
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Aldaqadossi HA, Khairy Salem H, Kotb Y, Hussein HA, Shaker H, Dikaios N. Prediction of Pediatric Percutaneous Nephrolithotomy Outcomes Using Contemporary Scoring Systems. J Urol 2017; 198:1146-1152. [PMID: 28450096 DOI: 10.1016/j.juro.2017.04.084] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE We evaluate the applicability of contemporary percutaneous nephrolithotomy scoring systems in pediatric patients and compare their predictive power regarding postoperative outcomes. MATERIALS AND METHODS We retrospectively analyzed the records of 125 children who were diagnosed with renal calculi and underwent percutaneous nephrolithotomy between March 2011 and April 2016. Predictive scores, which consisted of Guy's Stone Score, S.T.O.N.E. (stone size, tract length, obstruction, number of involved calyces and essence/stone density) nephrolithometry and CROES (Clinical Research Office of the Endourological Society) nomogram, were calculated for all patients included in the study. Patient demographics, stone-free rate and complications were all analyzed and are reported. RESULTS Median Guy's Stone Score was 2 (IQR 2 to 3) in patients with residual stones (group 1) and 2 (1 to 2) in those who were stone-free (group 2). Median respective CROES nomogram scores were 215 (IQR 210 to 235) and 257 (240 to 264), and S.T.O.N.E. nephrolithometry scores were 8 (7 to 9) and 5 (5 to 6, all p <0.0001). S.T.O.N.E. score demonstrated the greatest accuracy in predicting stone-free rate. Guy's Stone Score was significantly correlated with complications but the CROES and S.T.O.N.E. scores were not significantly correlated with complications. CONCLUSIONS The scoring systems analyzed could be used to predict success of percutaneous nephrolithotomy in the pediatric setting. However, further studies are needed to formulate modifications for use in children. The main variables in the scoring systems, ie stone burden, tract length and case volume, were measured using records from adult patients. Besides these variables, the relatively small pelvicalyceal system and higher incidence of anatomical malformations in children could potentially affect percutaneous nephrolithotomy outcomes.
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Affiliation(s)
| | | | | | | | | | - Nikolaos Dikaios
- Center for Vision, Speech and Signal Processing, University of Surrey, Surrey, United Kingdom
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27
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Landa-Salas JD, Torres-Anguiano JR, Maldonado-Alcaraz E, Lopez-Samano VA, Serrano-Brambila EA, Moreno-Palacios J. [Stone free rate assesment after percutaneous nephrolithotomy using nephrolitometric nomogram]. CIR CIR 2017; 85:510-514. [PMID: 28433235 DOI: 10.1016/j.circir.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 12/05/2016] [Accepted: 03/17/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Percutaneous nephrolithotomy remains the standard of care for kidney stones larger than 2cm. Therefore, setting a prognosis for complete stone resolution through this method is essential. The prognostic tools available have limited prediction. OBJECTIVES To evaluate the stone-free rate in patients undergoing percutaneous nephrolithotomy with the Clinical Research Office of the Endourological Society nomogram and suggest modifications to improve the classification. MATERIAL AND METHODS We analyzed a retrospective cohort of patients undergoing percutaneous nephrolithotomy applying the nephrolithometric nomogram specified. We modified the scale dividing the patients into 3groups: i from 80 to 110 points, II from 111 to 170 points, and III more than 170 points, respectively assessing the stone-free rate (Kruskall-Wallis test was performed, p<0.05). RESULTS A total of 126 patients were included. According to the nehrolithometric nomogram the stone-free rate was 12.5% for patients with fewer than 111 points and 70.9% for those with 111 points or more. In the modification proposed for groups I, IIand III the stone-free rate was 12.5%, 50% and 80% respectively (p=0.000). CONCLUSIONS Evaluation using the nephrolithometric nomogram demonstrated accurate stone-free rate prediction for complex and simple stones, with a lack of discrimination for patients with intermediate scores. Our modification enabled better differentiation of the intermediate groups from the high and low stone-free rate groups.
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Affiliation(s)
- Jason Damián Landa-Salas
- Servicio de Urología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Juan Ramón Torres-Anguiano
- Servicio de Urología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | - Efraín Maldonado-Alcaraz
- Servicio de Urología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Ciudad de México, México
| | | | | | - Jorge Moreno-Palacios
- Servicio de Urología, Hospital de Especialidades Centro Médico Nacional Siglo XXI, Ciudad de México, México.
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Kumar S, Sreenivas J, Karthikeyan VS, Mallya A, Keshavamurthy R. Evaluation of CROES Nephrolithometry Nomogram as a Preoperative Predictive System for Percutaneous Nephrolithotomy Outcomes. J Endourol 2016; 30:1079-1083. [DOI: 10.1089/end.2016.0340] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sumit Kumar
- Department of Urology, Institute of Nephro Urology, Bangalore, India
| | - Jayaram Sreenivas
- Department of Urology, Institute of Nephro Urology, Bangalore, India
| | | | - Ashwin Mallya
- Department of Urology, Institute of Nephro Urology, Bangalore, India
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Choi SW, Bae WJ, Ha US, Hong SH, Lee JY, Kim SW, Cho HJ. Prognostic Impact of Stone-Scoring Systems After Percutaneous Nephrolithotomy for Staghorn Calculi: A Single Center's Experience Over 10 Years. J Endourol 2016; 30:975-81. [DOI: 10.1089/end.2016.0188] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Sae Woong Choi
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Woong Jin Bae
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - U-Syn Ha
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Sae Woong Kim
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Hyuk Jin Cho
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
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Jaipuria J, Suryavanshi M, Sen TK. Comparative testing of reliability and audit utility of ordinal objective calculus complexity scores. Can we make an informed choice yet? BJU Int 2016; 118:958-968. [DOI: 10.1111/bju.13597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Jiten Jaipuria
- Department of Urology; Sri Sathya Sai Institute of Higher Medical Sciences; Anantapur District Andhra Pradesh India
| | - Manav Suryavanshi
- Endourology and Robotic Surgery; Institute of Nephrology and Urology; Medanta - The Medicity; Gurgaon India
| | - Tridib K. Sen
- Department of Urology; Sri Sathya Sai Institute of Higher Medical Sciences; Anantapur District Andhra Pradesh India
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Ghani KR, Andonian S, Bultitude M, Desai M, Giusti G, Okhunov Z, Preminger GM, de la Rosette J. Percutaneous Nephrolithotomy: Update, Trends, and Future Directions. Eur Urol 2016; 70:382-96. [DOI: 10.1016/j.eururo.2016.01.047] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/28/2016] [Indexed: 12/24/2022]
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Choi SW, Bae WJ, Ha US, Hong SH, Lee JY, Kim SW, Cho HJ. Prediction of stone-free status and complication rates after tubeless percutaneous nephrolithotomy: a comparative and retrospective study using three stone-scoring systems and preoperative parameters. World J Urol 2016; 35:449-457. [PMID: 27406175 DOI: 10.1007/s00345-016-1891-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 07/05/2016] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To investigate the factors predictive of surgical outcomes of tubeless percutaneous nephrolithotomy (TPCNL) and to compare the predictability and accuracy of the Guy's stone score, S.T.O.N.E. nephrolithometry, and CROES nomogram. PATIENTS AND METHODS We reviewed retrospectively the surgical outcomes recorded consecutively and imaging data of preoperative computed tomography scans of 141 patients who had undergone TPCNL from June 2012 to October 2015. Guy's, S.T.O.N.E., and CROES stone-scoring systems (SSSs) and other prognostic factors were assessed using univariate and multivariate statistical analyses. RESULTS The initial stone-free and complication rates after TPCNL were 78.7 (111/141) and 17.0 % (24/141). On univariate analysis, all three scoring systems were identified as significant factors in terms of stone-free rate (SFR). The multivariate logistic regression analysis showed that the Guy's stone score and stone burden ≥385 mm2 had significant correlations with stone-free status [odds ratios (OR) = 3.220, p = 0.001 and OR = 6.451, p = 0.002, respectively]. Guy's stone score (OR = 1.879, p = 0.013) was an independent risk factor for the development of complications. The area under the receiver operating characteristic (ROC) curves for the Guy's, S.T.O.N.E., and CROES SSSs and stone burden showed good results (0.821, 0.816, 0.820, and 0.800, respectively). Pairwise comparison of ROC curves showed that there was no significant difference between each final score and stone burden. CONCLUSIONS Of the three scoring systems, Guy's stone score was the only significant predictive factor for SFR and complication rates after TPCNL in the multivariate logistic regression analysis. Stone burden was significantly associated with a postoperative stone-free status (SFS).
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Affiliation(s)
- Sae Woong Choi
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Woong Jin Bae
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - U-Syn Ha
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sung-Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Ji Youl Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sae Woong Kim
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Hyuk Jin Cho
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Comparison of Scoring Systems in Pediatric Mini-Percutaneous Nephrolithotomy. Urology 2016; 93:40-4. [DOI: 10.1016/j.urology.2016.03.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/19/2016] [Accepted: 03/22/2016] [Indexed: 11/23/2022]
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Tailly TO, Okhunov Z, Nadeau BR, Huynh MJ, Labadie K, Akhavein A, Violette PD, Olvera-Posada D, Alenezi H, Amann J, Bird VG, Landman J, Smith AD, Denstedt JD, Razvi H. Multicenter External Validation and Comparison of Stone Scoring Systems in Predicting Outcomes After Percutaneous Nephrolithotomy. J Endourol 2016; 30:594-601. [PMID: 26728427 DOI: 10.1089/end.2015.0700] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Several scoring systems have recently emerged to predict stone-free rate (SFR) and complications after percutaneous nephrolithotomy (PCNL). We aimed to compare the most commonly used scoring systems (Guy's stone score, S.T.O.N.E. nephrolithometry, and CROES nomogram), assess their predictive accuracy for SFR and other postoperative variables, and develop a risk group stratification based on these scoring systems. MATERIALS AND METHODS We performed a retrospective review of patients who have had a PCNL at four academic institutions between 2006 and 2013. Primary outcome was SFR within 3 weeks of the surgery and secondary outcomes were operative time (OT), complications, and length of stay (LOS). We performed chi-squared, t-test, logistic, linear, and Poisson regressions, as well as receiver operating characteristics curve with area under the curve (AUC) calculation. RESULTS We identified 586 patients eligible for analysis. Of these, 67.4% were stone free. Guy's, S.T.O.N.E., and CROES score were predictive of SFR on multivariable logistic regression (odds ratio [OR]: 1.398, 95% confidence interval [CI]: 1.056, 1.852, p = 0.019; OR: 1.417, 85% CI: 1.231, 1.631, p < 0.001; OR: 0.993, 95% CI: 0.988, 0.998, p = 0.004) and have similar predictive accuracy with AUCs of 0.629, 0.671, and 0.646, respectively. On multivariable linear regression, only S.T.O.N.E. was an independent predictor of longer OT (β = 14.556, 95% CI: 12.453, 16.660, p < 0.001). None of the scores were independent predictors of postoperative complications or a longer LOS. Poisson regression allowed for risk group stratification and showed the S.T.O.N.E. score and CROES nomogram to have the most distinct risk groups. CONCLUSIONS The three evaluated scoring systems have similar predictive accuracy of SFR. S.T.O.N.E. has additional value in predicting OT. Risk group stratification can be used for patient counseling. Further research is needed to identify whether or not any is superior to the others with regard to clinical usefulness and predictive accuracy.
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Affiliation(s)
- Thomas O Tailly
- 1 Division of Urology, Department of Surgery, Western University , London, Ontario, Canada .,2 Department of Urology, Ghent University Hospital , Ghent, Belgium
| | - Zhamshid Okhunov
- 3 Department of Urology, University of California , Irvine, California
| | - Brandon R Nadeau
- 4 Department of Radiology, Western University , London, Ontario, Canada
| | - Melissa Jessica Huynh
- 1 Division of Urology, Department of Surgery, Western University , London, Ontario, Canada
| | - Kevin Labadie
- 3 Department of Urology, University of California , Irvine, California
| | - Arash Akhavein
- 5 Department of Urology, University of Florida , Gainesville, Florida
| | - Philippe D Violette
- 1 Division of Urology, Department of Surgery, Western University , London, Ontario, Canada
| | - Daniel Olvera-Posada
- 1 Division of Urology, Department of Surgery, Western University , London, Ontario, Canada
| | - Husain Alenezi
- 1 Division of Urology, Department of Surgery, Western University , London, Ontario, Canada
| | - Justin Amann
- 4 Department of Radiology, Western University , London, Ontario, Canada
| | - Vincent G Bird
- 5 Department of Urology, University of Florida , Gainesville, Florida
| | - Jaime Landman
- 3 Department of Urology, University of California , Irvine, California
| | - Arthur D Smith
- 6 The Smith Institute for Urology, North Shore LIJ Health System , New Hyde Park, New York
| | - John D Denstedt
- 1 Division of Urology, Department of Surgery, Western University , London, Ontario, Canada
| | - Hassan Razvi
- 1 Division of Urology, Department of Surgery, Western University , London, Ontario, Canada
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Sfoungaristos S, Gofrit ON, Pode D, Landau EH, Duvdevani M. Percutaneous nephrolithotomy for staghorn stones: Which nomogram can better predict postoperative outcomes? World J Urol 2015; 34:1163-8. [DOI: 10.1007/s00345-015-1743-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 11/28/2015] [Indexed: 10/22/2022] Open
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