INTRODUCTION: Contemporary predictive tools for PCNL outcomes include Guy's Stone Score, S.T.O.N.E. Nephrolithometry, and CROES (Clinical Research Office of the Endourological Society) nephrolithometric nomogram.
We compared each scoring system using the same cohort to determine which was the most predictive of surgical outcomes.
METHODS: We retrospectively reviewed patients who underwent PCNL between 2009 and 2012 at three academic institutions. We calculated Guy's Stone Score, S.T.O.N.E. Nephrolithometry, and CROES nephrolithometric nomogram based on preoperative computerized tomography (CT) images. A single observer at each institution reviewed all images and assigned scores. Univariate and multivariate analysis was performed to determine the most predictive scoring system.
RESULTS: We enrolled 246 patients. Mean Guy's Scores for patients who were stone-free versus who had residual stones were 2.2 and 2.7 respectively (p< 0.001). Mean S.T.O.N.E. scores for patients who were stone-free versus who had residual stones were 8.3 and 9.5, respectively (p< 0.001). Mean CROES nomogram scores for patients who were stone free versus those who had residual stones were 222 and 187, respectively (p< 0.001). In logistic regression analysis, Guy's Score, S.T.O.N.E. Nephrolithometry and CROES nomogram were significantly associated with stone-free status (SFS), (p= 0.02, 0.004, < 0.001 respectively). Guy's Score and S.T.O.N.E. Nephrolithometry were associated with estimated blood loss (EBL) (p< 0.0001, p=0.03) and length of stay (LOS) (p=0.03, p=0.009 respectively). The CROES nomogram was not predictive of EBL or LOS.
CONCLUSIONS: All scoring systems and stone burden were equally predictive of SFS. Guy's Score and S.T.O.N.E. Nephrolithometry were associated with EBL and LOS. A single scoring system should be adopted to unify reporting.
Written by:
Labadie K, Okhunov Z, Akhavein A, Moreira D, Moreno-Palacios J, Del Junco M, Okeke Z, Bird V, Smith AD, Landman J. Are you the author?
Department of Urology, University of California, Irvine; Department of Urology, University of Florida, Gainesville; Smith Institute for Urology, North Shore LIJ Health System; Department of Urology, University of California, Irvine.
Reference: J Urol. 2014 Jul 31. pii: S0022-5347(14)04142-1.
doi: 10.1016/j.juro.2014.07.104
PubMed Abstract
PMID: 25088952
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