Comparison of three scoring system in the terms of stone-free status after Retrograde Intrarenal Surgery

Year 2021, Volume: 13 Issue: 2, 56 - 60, 31.07.2021

Ahmet Tahra , Erdem Zengin Resul Sobay Eyüp Küçük

Abstract

Objective: Retrograde intrarenal surgery (RIRS) is safe and effective, minimally invasive method for renal stones however there is no accepted method for predicting stone-free rate after RIRS. We aimed to compare Resorlu-Unsal stone score, R.I.R.S scoring system, Modified Seoul National University Stone complexity (S-ReSC) scoring systems to evaluate the stone-free rates after flexible ureterorenoscopy (f-URS) for kidney Stones.
Material and Methods: Patients who underwent RIRC in 2018-2019 were evaluated retrospectively. Ninety-three patients who underwent postoperative Computerized Tomography (CT) to evaluate stone-free status were included in the study. Scoring was performed by the preoperative imaging of the patients. Stone-free status was defined as no fragment in postoperative CT. Factors affecting stone-free status were evaluated.
Results: The mean age was 45.07 ± 13.32 years. The mean stone size was 15.4 ± 4.31 mm. The stone-free rate was 82.8%. The median Resorlu-Unsal score was 0 (0-3), R.I.R.S score was 5 (4-10) and S-ReSC was 1 (1-12). Stone size and scoring systems were found to be significant in predicting stone-free in univariate analysis meanwhile only R.I.R.S. scoring system and S-ReSC scores were determined as predictive factors for stone-free in multivariate analysis (Table 1). In the ROC curve, all scoring systems had a high predictive ability in terms of stone-free rate.
Conclusion: All scoring systems are effective in determining the stone-free rate for f-URS. The predictability of S-ReSC and R.I.R.S. scoring systems were higher.

Keywords

Kidney Stone, Retrograde intrarenal surgery, Scoring system

Retrograd İntrarenal Cerrahi sonrası taşsızlık değerlendirilmesinde üç skorlama sisteminin karşılaştırılması

Abstract

Amaç: Retrograd intrarenal cerrahi (RIRC) böbrek taşları için etkin ve güvenilir, minimal invaziv bir yöntemdir ancak cerrahi sonrası taşsızlık oranını değerlendirmek için kabul edilmiş bir yöntem yoktur. Bu çalışmamızda, fleksible üreterorenoskopi(f-URS) sonrası taşsızlık oranlarını değerlendirmek için kullanılan Resorlu-Ünsal taş skoru, R.I.R.S skorlama sistemi (R.I.R.S scoring system), Modifiye Seoul Ulusal Üniversitesi Taş kompleksi [Modified Seoul National University Stone Complex (S-ReSC)] skorlama sistemlerini karşılaştırmayı amaçladık.
Gereç ve Yöntemler: 2018-2019 yıllarında RIRC uygulanan hastalar retrospektif olarak değerlendirildi. Taşsızlık durumunu değerlendirmek için postoperatif Bilgisayarlı Tomografi (BT) ile görüntüleme yapılan 93 hasta çalışmaya dahil edildi. Hastaların preoperatif görüntülemeleri ile Resorlu-Ünsal taş skoru, R.I.R.S skorlama sistemi (R.I.R.S scoring system), Modifiye Seoul National University Stone Complex (S-ReSC) skorlama sistemleri ile skorlama yapıldı . Postoperatif BT’de rezidü fragman olmaması taşsızlık olarak tanımlandı. Taşsızlık durumunu etkileyen faktörler değerlendirildi.
Bulgular: Ortalama yaş 45.07 ± 13.32 yıl idi. Ortalama taş boyutu 15.4 ± 4.31 mm idi. Taşsızlık oranı %82.8 idi. Ortanca Resorlu-Ünsal taş skoru 0 (0-3), R.I.R.S skoru 5 (4-10) ve S-ReSC skoru 1 (1-12) idi. Tek değişkenli analizde taş boyutu ve skorlama sistemleri taşsızlığı öngörmede anlamlı bulunurken, çok değişkenli analizde taşsızlık için sadece R.I.R.S. skorlama sistemi ve S-ReSC skorları öngörücü faktör olarak belirlendi. ROC eğrisinde tüm skorlama sistemleri taşsızlık oranı açısından yüksek öngörücülüğe sahip idi.
Sonuç: Retrograd intrarenal cerrahi sonrası taşsızlık değerlendirilmesi için tüm skorlama sistemleri etkindir. Çalışmamızda Modifiye S-ReSC ve R.I.R.S skorlama sistemleri ile taşsızlık öngörülebilirliği daha yüksek bulunmuştur.

Keywords

Böbrek taşı, Retrograd İntrarenal Cerrahi, Skorlama Yöntemleri

References

• 1. Van Cleynenbreugel B, Kilic O, Akand M. Retrograde intrarenal surgery for renal stones - Part 1. Turk J Urol. 2017;43(2):112-21.doi:10.5152/tud.2017.03708
• 2. Kilic O, Akand M, Van Cleynenbreugel B. Retrograde intrarenal surgery for renal stones - Part 2. Turk J Urol. 2017;43(3):252-60.doi:10.5152/tud.2017.22697
• 3. Turk C, Petrik A, Sarica K, et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. 2016;69(3):475-82.doi:10.1016/j.eururo.2015.07.041
• 4. Breda A, Angerri O. Retrograde intrarenal surgery for kidney stones larger than 2.5 cm. Curr Opin Urol. 2014;24(2):179-83.doi:10.1097/MOU.0000000000000030
• 5. Geraghty R, Abourmarzouk O, Rai B, Biyani CS, Rukin NJ, Somani BK. Evidence for Ureterorenoscopy and Laser Fragmentation (URSL) for Large Renal Stones in the Modern Era. Curr Urol Rep. 2015;16(8):54.doi:10.1007/s11934-015-0529-3 6. Resorlu B, Unsal A, Gulec H, Oztuna D. A new scoring system for predicting stone-free rate after retrograde intrarenal surgery: the "resorlu-unsal stone score". Urology. 2012;80(3):512-8.doi:10.1016/j.urology.2012.02.072
• 7. Xiao Y, Li D, Chen L, et al. The R.I.R.S. scoring system: An innovative scoring system for predicting stone-free rate following retrograde intrarenal surgery. BMC Urol. 2017;17(1):105.doi:10.1186/s12894-017-0297-0
• 8. Jung JW, Lee BK, Park YH, et al. Modified Seoul National University Renal Stone Complexity score for retrograde intrarenal surgery. Urolithiasis. 2014;42(4):335-40.doi:10.1007/s00240-014-0650-7
• 9. Sanguedolce F, Bozzini G, Chew B, Kallidonis P, de la Rosette J. The Evolving Role of Retrograde Intrarenal Surgery in the Treatment of Urolithiasis. Eur Urol Focus. 2017;3(1):46-55.doi:10.1016/j.euf.2017.04.007
• 10. Akman T, Binbay M, Ozgor F, et al. Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2-4 cm stones: a matched-pair analysis. BJU Int. 2012;109(9):1384-9.doi:10.1111/j.1464-410X.2011.10691.x
• 11. Wilhelm K, Hein S, Adams F, Schlager D, Miernik A, Schoenthaler M. Ultra-mini PCNL versus flexible ureteroscopy: a matched analysis of analgesic consumption and treatment-related patient satisfaction in patients with renal stones 10-35 mm. World J Urol. 2015;33(12):2131-6.doi:10.1007/s00345-015-1585-5
• 12. Kang SK, Cho KS, Kang DH, Jung HD, Kwon JK, Lee JY. Systematic review and meta-analysis to compare success rates of retrograde intrarenal surgery versus percutaneous nephrolithotomy for renal stones >2 cm: An update. Medicine (Baltimore). 2017;96(49):e9119.doi:10.1097/MD.0000000000009119
• 13. Tonyali S, Yilmaz M, Karaaslan M, Ceylan C, Isikay L. Prediction of stone-free status after single-session retrograde intrarenal surgery for renal stones. Turk J Urol. 2018;44(6):473-7.doi:10.5152/tud.2018.88615
• 14. Ito H, Sakamaki K, Kawahara T, et al. Development and internal validation of a nomogram for predicting stone-free status after flexible ureteroscopy for renal stones. BJU Int. 2015;115(3):446-51.doi:10.1111/bju.12775
• 15. Ozbek R, Senocak C, Haberal HB, Damar E, Sadioglu FE, Bozkurt OF. Comparison of scoring systems for predicting stone-free status and complications after retrograde intrarenal surgery. World J Urol. 2020.doi:10.1007/s00345-020-03478-4
• 16. Xu Y, Min Z, Wan SP, Nie H, Duan G. Complications of retrograde intrarenal surgery classified by the modified Clavien grading system. Urolithiasis. 2018;46(2):197-202.doi:10.1007/s00240-017-0961-6