Abstract
BACKGROUND:
Stone disease of the renal system is a challenging problem in urologic practice particularly in our area because of the large stone burden and recurrence. Scoring systems are beneficial to counsel the patients about the success and complication rates before surgery.
OBJECTIVE:
To compare two widely used scoring systems, namely Guy's and S.T.O.N.E. nephrolithometry scores in predicting the outcomes of ultrasound-guided PCNL.
MATERIALS AND METHODS:
In this prospective study, a total of 50 patients underwent PCNL in Al-Imamein Kadhimein Medical City from 1st of October 2018 to 1stof August 2019 and were enrolled. Guy's and S.T.O.N.E. scores were based on non-enhanced CT scan of abdomen and pelvis. Complications were graded using the Clavien-Dindo classification system. Ultrasound was used to guide PCNL in all cases.
RESULTS:
In our study the median age, body mass index (BMI) and stone size were 34.5 years, 31.4 kg/m2 and 765 mm2, respectively. The overall stone-free status was 82%. All complications were grades I-II (60%). The average operative time was 150 minutes. The stone-free status and complications rate were significantly associated with Guy’s score (P < 0.001, P < 0.001) and S.T.O.N.E. score (P < 0.001, P < 0.001), respectively. Moreover, there was a significant positive correlation between Guy's and S.T.O.N.E scores with length of hospital stay (r = 0.277, p < 0.001; r = 0.544, p < 0.001), operative time(r = 0.449, p = 0.001; r = 0.573, p < 0.001) and need for blood transfusion (r = 0.573, p < 0.001; r = 0.568, p < 0.001) respectively. In addition, both Guy's and S.T.O.N.E systems were significantly predictive of stone-free status, need for blood transfusion, operative time and length of hospital stay. The receiver operating characteristic (ROC) showed no significant difference in area under the Guy's and STONE curve (AUC = 0.877 vs. 0.821; p = 0.51).
CONCLUSION:
Both Guy’s and S.T.O.N.E. scoring systems showed a comparable efficacy in predicting the outcomes of PCNL such as stone-free status, necessity for blood transfusion, operative time and length of hospital stay.
10. Mandal S, Goel A, Kathpalia R, Sankhwar S, Singh V, Sinha RJ, et al. Prospective evaluation of complications using the modified Clavien grading system, and of success rates of percutaneous nephrolithotomy using Guy’s Stone Score: A single‑center experience. Indian J Urol 2012; 28:392-8.
11. Jeong CW, Jung JW, Cha WH, Lee BK, Lee S, Jeong SJ, et al. Seoul National University Renal Stone Complexity Score for Predicting Stone-Free Rate after Percutaneous Nephrolithotomy. 2013; 8:e65888.
12. Okhunov Z, Friedlander JI, George AK, Duty BD, Moreira DM, Srinivasan AK, et al. S.T.O.N.E. nephrolithometry: novel surgical classification system for kidney calculi. Urology. 2013; 81:1154-9.
13. Thomas K, Smith NC, Hegarty N, Glass JM. The Guy’s stone score--grading the complexity of percutaneous nephrolithotomy procedures. Urology. 2011; 78:277-81.
14. Vicentini FC, Marchini GS, Mazzucchi E, Claro JF, Srougi M. Utility of the Guy’s stone score based on computed tomographic scan findings for predicting percutaneous nephrolithotomy outcomes. Urology 2014; 83:1248-53.
15. Ingimarsson JP, Dagrosa LM, Hyams ES, Pais VM Jr. External validation of a preoperative renal stone grading system: Reproducibility and inter-rater concordance of the Guy’s stone score using preoperativecomputed tomography and rigorous postoperative stone-free criteria. Urology 2014; 83:45-9.
16. Akhavein A, Henriksen C, Syed J, Bird VG. Prediction of single procedure success rate using S.T.O.N.E. nephrolithometry surgical classification system with strict criteria for surgical outcome. Urology 2015; 85:69-73.
17. Noureldin YA, Elkoushy MA, Andonian S. External validation of the S.T.O.N.E. nephrolithometry scoring system. Can UrolAssoc J 2015; 9:190-5.
18. Labadie K, Okhunov Z, Akhavein A, Moreira DM, Moreno-Palacios J, Del Junco M, et al. Evaluation and comparison of urolithiasis scoring systems used in percutaneous kidney stone surgery. J Urol 2015; 193:154-9.
19. Ujwal Kumar, Vinay Tomar, Sher Singh Yadav, ShivamPriyadarshi, Nachiket Vyas, Neeraj Agarwal, Ram Dayal. STONE score versus Guy’s Stone Score prospective comparative evaluation for success rate and complications in percutaneous nephrolithotomy. 2018 Urology Annals, 10.4103/UA.UA_119_17.
20. El-Nahas AR, Eraky I, Shokeir AA, et al. Percutaneous nephrolithotomy for treating staghorn stones: 10 years of experience of a tertiary-care centre. Arab J Urol. 2012; 10(3): 324-9. doi: 10.1016/j.aju.2012.03.002.
21. Al-Azzawi IS Mohammed Zaki AW, Jwaid HI, Salih SL, and Al-Obaidi AA. The efficacy and safety of percutaneous nephrolithotomy in correlation with different renal stone burdens. Iraqi JMS. 2018; 16:385-92.doi: 10.22578/IJMS.16.4.5.
22. Rahman AU, Ullah A, Khan S, et al. Percutaneous nephrolithotomy for the treatment of renal stones larger than 2.5 cm. JPMI: J Postgrad Med Instit. 2011; 25: 362-67.
)
