Perkütan Nefrolitotomi’de Skorlama Sistemlerinin Cerrahi Başarıyı Öngörmedeki Yeri: Tek Merkez Sonuçları

Yıl 2023, , 94 - 101, 30.09.2023

Emre Şam , Ekrem Güner

https://doi.org/10.54233/endouroloji.20231503-1345152

Öz

Amaç: Biz bu çalışmada, perkütan nefrolitotomide (PNL) en yaygın kullanılan modeller olan Guy’s skoru,
S.T.O.N.E skoru ve CROES nomogramının taşsızlığı öngörme etkinliklerini ve hangi modelin taşsızlığı daha
başarılı öngördüğünü belirlemeyi amaçladık.
Gereç ve Yöntemler: Tersiyer akademik merkezimizde, 2009 ile 2018 tarihleri arasında böbrek taşı
nedeniyle PNL uygulanan 18 yaşından büyük hastaların verileri retrospektif olarak değerlendirildi.
İncelenen parametreler, hastaların demografik verileri, taşa ait özellikler, Guy’s skoru, S.T.O.N.E. skoru, CROES
nomogramı, operasyon süresi, transfüzyon oranı, hastanede kalış süresi ve taşsızlık idi. Taşsızlık açısından
kestirim değerleri receiver operating characteristic (ROC) curve analizi kullanılarak belirlendi.
Bulgular: Çalışmaya toplam 200 hasta dahil edildi. Hastaların yaş ortalaması 43,7 ± 14,6 yıl idi. Hastaların
ortalama taş skorları sırası ile şöyle idi: Guy’s skoru: 2,11 ± 1,01, S,T,O,N,E skoru: 7,54 ± 1,73, CROES nomogramı:
194 ± 62,7, Taşsızlık oranı %66 olarak belirlendi. Taşsızlık sağlanamayan hastalarda taşsızlık sağlananlara göre
Guy’s skoru ve S.T.O.N.E skorunun anlamlı yüksek, CROES nomogramının ise anlamlı düşük olduğu belirlendi
(sırasıyla p<0,001, p<0,001 ve p<0.001). Kestirim değeri ve eğri altındaki alan (AUC) sırasıyla Guy’s skoru için
2,5 ve 0,770, S.T.O.N.E skoru için 7,5 ve 0,722 ve CROES nomogramı için 185 ve 0,843 idi.
Sonuç: PNL’de taşsızlığı öngörmede Guy’s skoru, S.T.O.N.E skoru ile CROES nomogramı etkili modellerdir.

Anahtar Kelimeler

CROES nomogramı, Guy’s skoru, perkütan nefrolitotomi, S.T.O.N.E skoru, taşsızlık

Etik Beyan

Bakirkoy Dr. Sadi Konuk Education and Research Hospital Clinical Trials Ethics Committee Date Protocol: 02.09.2019/2019-17-22.

The Role of Scoring Systems in Predicting Surgical Success in Percutaneous Nephrolithotomy: Results from a Single Center

Öz

Objective: In this study, we aimed to determine the effectiveness of Guy’s score, S.T.O.N.E score, and CROES
nomogram, the most widely used models in percutaneous nephrolithotomy (PNL) for predicting stone-free
status, and to determine which model predicts stone-free status more successfully.
Materials and Methods: The data of patients older than 18 years of age who underwent PNL for kidney
stones at our tertiary academic center between 2009 and 2018 were retrospectively analyzed. Examined
parameters included the demographic data of patients, stone characteristics, Guy’s score, S.T.O.N.E. score,
CROES nomogram, surgical duration, transfusion rate, length of stay, and stone-free status. Prediction
values for stone-free status were determined using receiver operating characteristic (ROC) curve analysis.
Results: A total of 200 patients were included in the study. The mean age of the patients was 43.7 ± 14.6
years. The mean stone scores of the patients were as follows: Guy’s score: 2.11 ± 1.01; S.T.O.N.E. score: 7.54
± 1.73; and CROES nomogram: 194 ± 62.7. The stone-free rate was determined to be 66%. The Guy’s and
S.T.O.N.E. scores were significantly higher, and the CROES nomogram was significantly lower in non-stonefree
patients compared to stone-free patients (p<0.001, p<0.001, and p<0.001, respectively). The cut-off
value and area under curve (AUC) were 2.5 and 0.770 for Guy’s score, 7.5 and 0.722 for S.T.O.N.E score, and
185 and 0.843 for CROES nomogram, respectively.
Conclusion: Guy’s score, S.T.O.N.E score, and CROES nomogram are effective models in predicting stonefree
status in PNL.

Anahtar Kelimeler

CROES nomogram, Guy’s score, percutaneous nephrolithotomy, S.T.O.N.E score, stone-free

Kaynakça

• 1. Yıldırım Ç, Salman MY, Yavuz A, Bayar G. Individualized Management of 1-2 cm Kidney Stones in the Lower Pole Calyces. Grand J Urol. 2023;3:42-48. https://doi.org/10.5505/gju.2023.70883
• 2. de Souza Melo PA, Vicentini FC, Beraldi AA, Hisano M, Murta CB, de Almeida Claro JF. Outcomes of more than 1 000 percutaneous nephrolithotomies and validation of Guy’s stone score. BJU Int. 2018;121:640-646. https://doi.org/10.1111/bju.14129
• 3. De La Rosette J, Assimos D, Desai M, et al. The clinical research office of the endourological society percutaneous nephrolithotomy global study: Indications, complications, and outcomes in 5803 patients. J Endourol. 2011;25:11-17. https://doi.org/10.1089/end.2010.0424
• 4. Thomas K, Smith NC, Hegarty N, Glass JM. The guy’s stone score-grading the complexity of percutaneous nephrolithotomy procedures. Urology. 2011;78:277-281. https://doi.org/10.1016/j.urology.2010.12.026
• 5. Okhunov Z, Friedlander JI, George AK, et al. S.T.O.N.E. nephrolithometry: Novel surgical classification system for kidney calculi. Urology. 2013;81:1154-1160. https://doi.org/10.1016/j.urology.2012.10.083
• 6. Smith A, Averch TD, Shahrour K, et al. A nephrolithometric nomogram to predict treatment success of percutaneous nephrolithotomy. J Urol. 2013;190:149-156. https://doi.org/10.1016/j.juro.2013.01.047
• 7. Withington J, Armitage J, Finch W, Wiseman O, Glass J, Burgess N. Assessment of Stone Complexity for PCNL: A Systematic Review of the Literature, How Best Can We Record Stone Complexity in PCNL? J Endourol. 2016;30:13-23. https://doi.org/10.1089/end.2015.0278
• 8. Tiselius HG, Andersson A. Stone burden in an average Swedish population of stone formers requiring active stone removal: How can the stone size be estimated in the clinical routine? Eur Urol. 2003;43:275-281. https://doi.org/10.1016/S0302-2838(03)00006-X
• 9. Vernez SL, Okhunov Z, Motamedinia P, Bird V, Okeke Z, Smith A. Nephrolithometric Scoring Systems to Predict Outcomes of Percutaneous Nephrolithotomy. Rev Urol. 2016;18:15-27
• 10. Ingimarsson JP, Dagrosa LM, Hyams ES, Pais VM. External validation of a preoperative renal stone grading system: Reproducibility and inter-rater concordance of the Guy’s stone score using preoperative computed tomography and rigorous postoperative stone-free criteria. Urology. 2014;83:45-49. https://doi.org/10.1016/j.urology.2013.09.008
• 11. Vicentini FC, Serzedello FR, Thomas K, et al. 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 Uro.l 2017;43:1102-1109. https://doi.org/10.1590/S1677-5538.IBJU.2016.0586
• 12. Farhan M, Nazim SM, Salam B, Ather MH. Prospective evaluation of outcome of percutaneous nephrolithotomy using the “STONE” nephrolithometry score: A single-centre experience. Arab J Urol. 2015;13:264-269. https://doi.org/10.1016/j.aju.2015.07.006
• 13. 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. https://doi.org/10.1016/j.urology.2014.09.010
• 14. Danis E, Polat EC, Bozkurt M, et al. Application of S.T.O.N.E. Nephrolithometry Score for Prediction of Stone-Free Status and Complication Rates in Patients Who Underwent Percutaneous Nephrolitotomy for Renal Stone. J Laparoendosc Adv Surg Tech. 2022;32:372-377. https://doi.org/10.1089/lap.2021.0197
• 15. Sfoungaristos S, Gofrit ON, Yutkin V, Landau EH, Pode D, Duvdevani M. External Validation of CROES Nephrolithometry as a Preoperative Predictive System for Percutaneous Nephrolithotomy Outcomes. J Urol. 2016;195:372-376. https://doi.org/10.1016/j.juro.2015.08.079
• 16. Singla A, Khattar N, Nayyar R, Mehra S, Goel H, Sood R. How practical is the application of percutaneous nephrolithotomy scoring systems? Prospective study comparing Guy’s Stone Score, S.T.O.N.E. score and the Clinical Research Office of the Endourological Society (CROES) nomogram. Arab J Urol. 2017;15:7-16. https://doi.org/10.1016/j.aju.2016.11.005
• 17. Labadie K, Okhunov Z, Akhavein A, et al. Evaluation and Comparison of Urolithiasis Scoring Systems Used in Percutaneous Kidney Stone Surgery. J Urol. 2015;193:154-159. https://doi.org/10.1016/j.juro.2014.07.104
• 18. Ozgor F, Yanaral F, Savun M, Ozdemir H, Sarilar O, Binbay M. Comparison of STONE, CROES and Guy’s nephrolithometry scoring systems for predicting stone-free status and complication rates after percutaneous nephrolithotomy in obese patients. Urolithiasis. 2018;46:471-477. https://doi.org/10.1007/s00240-017-1003-0