External Validation of Croes Stone Score System to Predict Treatment Success and Complications of Percutaneous Nephrolithotomy

Abstract

Introduction: To validate CROES scoring system for predict treatment success and complication rates of patients who underwent percutaneous nephrolithotomy (PNL).

Material and Methods: We retrospectively analysed 568 patients who underwent PNL from January 2012 to August 2015 at Izmir Bozyaka Research and Training Hospital Urology Department. Sixty-one patients who had more than one access were excluded from the study. All patients evaluated with non-contrast spiral computed tomography (CT) scan before operation.

Stone-free status was assessed on 1-month postoperative visit using kidney-ureter-bladder (KUB) radiograph. CT is reserved for only symptomatic patients, radiolucent stones, and/or suspicion of residual fragments seen on KUB radiography. Residual stone size of <4 mm on KUB or CT was described as clinically insignificant residual fragments, and these patients were considered as stone free.

All patients were evaluated one by one with CROES scoring system. Stone-free status, operation time, fluoroscopy time, length of hospital stay and estimated blood loss were correlated with CROES score. Postoperative complications were scored with Modified Clavien scoring systems and correlated with CROES score.

Results: The mean CROES score was 203,70. Overall stone free rates was %77,9. The mean stone size was 502,01 ± 517,5 (55-2869) mm.. 112 (%22,1) of the patients had residue stone. 159(32,5%) patients experienced postoperative complications.


There was positive correlation between CROES stone scoring system with stone-free rates (p<0,001) and negative correlation with complication rates (p<0,001). There was negative correlation with statistically significant between CROES scoring system with operative time (p<0,001), stone burden (p<0,001), estimated blood loss (>250 mL) (p=0,007) and length of hospital stay (p=0,026). CROES score was found to be independent predictor of SFR in a multivariate logistic regression analysis. (p<0,001). CROES score was not an independent factor for predicting complication.

Conclusion: In the present study, we demonstrated that CROES scoring system can be effectively and reliably used to predict SFR after PCNL. Also, CROES was effective to predict postoperative complications. This scoring system can guide the clinician to predict perioperative and postoperative PCNL outcomes. 

Keywords

• Percutaneous Nephrolithotomy
• CROES scoring systems
• Modification Clavien score system

Perkutan Nefrolitotomi Tedavi Başarısını ve Komplikasyonlarını Öngörmek için Kullanılan Croes Taş Skorlama Sisteminin Validasyonu

Abstract

Giriş: Çalışmamızda perkütan nefrolitotomi (PNL) uygulanan hastalarda tedavi başarısı ve komplikasyon oranlarını öngörmek için kullanılan Endoüroloji derneği klinik araştırma ofisi taş skorlama sisteminin (CROES) validasyonunun yapılması amaçlanmıştır.

Gereç ve Yöntem: Ocak 2012 ile Ağustos 2015 tarihleri arasında İzmir Bozyaka Eğitim ve Araştırma Hastanesi Üroloji Kliniği’nde PNL uygulanan 568 hasta retrospektif olarak değerlendirildi. Bu hastalardan 2 (iki) ve üzeri giriş yapılan 60 hasta çalışmaya dahil edilmedi. Tüm hastalar operasyon öncesi kontrastsız spiral bilgisayarlı tomografi (BT) ile değerlendirildi.

Hastalar postoperatif 1. aydaki kontrollerinde direkt üriner sistem grafisi (DÜSG) ile değerlendirildi. Semptomatik hastalar, non-opak taşı olan ve/veya DÜSG’de şüpheli opasite saptanan hastalar kontrastsız BT ile değerlendirildi. DÜSG ya da BT’de saptanan 4 mm’den küçük rezidü taşlar klinik önemsiz olarak tanımlandı ve bu hastalarda taşsızlık sağlandığı kabul edildi.

CROES skorlama sistemi her hastaya tek tek uygulandı. Bu skorlama sistemi ile taşsızlık oranları, operasyon süreleri, skopi süreleri, hastanede kalış süreleri ve tahmini kan kaybı miktarı korele edildi. Postoperatif komplikasyonlar modifiye Clavien skorlama sistemine göre hesaplandı ve CROES taş skorlama sistemi ile korele edildi.

Bulgular: Ortalama CROES taş skoru 203,70 olarak saptandı. Taşsızlık saptanan hasta sayısı 394 (%77,9) idi. Ortalama taş boyutu 502,01 ± 517,5 (55-2869) mm² olarak hesaplandı. PNL uygulanan hastaların 112 (%22,1)’sinde rezidü taş tespit edildi. Komplikasyon gözlenen toplam hasta sayısı 159 (%32,5) idi.

CROES skoru ile taşsızlık (p<0,01) arasında pozitif korelasyon saptanırken, komplikasyon gelişimi (p=0,001) ile arasında negatif korelasyon saptandı. Ayrıca CROES skoru ile operasyon süresi (p<0,001), hastanede kalış süresi (p=0,026), kanama miktarı (p=0,007) ve taş yükü (p<0,001) arasında negatif bir korelasyon gözlendi. Çok değişkenli analizde CROES skoru taşsızlığı öngörmede bağımsız bir faktör olarak saptandı. (p<0,001) Komplikasyonu öngörmede CROES skorunun bağımsız bir faktör olmadığı görüldü.

Sonuç: Çalışmamızda CROES skorlama sisteminin taşsızlığı ön görmede etkili ve güvenilir bir skorlama sistemi olduğu gösterilmiştir. Ayrıca postoperatif komplikasyonları öngörmede de etkili bir skorlama sistemidir. CROES skorlama sistemi perioperatif ve postoperatif sonuçları öngörmede klinisyenlere rehberlik edebilir. 

Keywords

• Perkütan Nefrolitotomi
• CROES skorlama sistemi
• Modifiye Clavien skorlama sistemi

References

1. 1. Chauhan C. K, Joshi M. J, Vaidya A. D. B. Growth inhibition of struvite crystals in the presence of herbal extract Commiphora wightii. Journal of Materials Science 2008;20:85–92.
2. 2. Robertson W. G, Heyburn P. J, Peacock M, Hanes F. A, Swaminathan R. The effect of high animal protein intake on the risk of calcium stone-formation in the urinary tract. Clinical Science 1979;57:285–288.
3. 3. Singh K. B, Sailo S. Understanding epidemiology and etiologic factors of urolithiasis: an overview. Scientific Visualization 2013;13:169–174.
4. 4. Sofia N. H, Walter T. M. Prevalence and risk factors of kidney stone. Global Journal For Research Analysis 2016;5.
5. 5. Romero V, Akpinar H, Assimos D. G. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Reviews in Urology 2010;12:86–96.
6. 6. Antonelli JA, Maalouf NM, Pearle MS, et al. Use of the National Health and Nutrition Examination Survey to calculate the impact of obesity and diabetes on cost and prevalence of urolithiasis in 2030. Eur Urol 2014;66:724.
7. 7. Rupel E BR. Nephroscopy with removal of stone following nephrostomy for obstructive calculus anuria. J Urol 1941;46:177.
8. 8. Fernstrom I JB. Percutaneous pyelolithotomy. Scand J Urol Nephrol. Urology 1976;10:257.

9. 9. Michel MS, Trojan L RJ. Complications in Percutaneous Nephrolithotomy. Eur Urol. 2007;10:1016.
10. 10. Opondo D, Gravas S, Joyce A et al. Standardization of patient outcomes reporting in percutaneous nephrolithotomy. J Endourol 2014;28:767–774.
11. 11. Smith A, Averch TD, Shahrour K et al. CROES PCNL Study Group. A nephrolitho- metric nomogram to predict treatment success of percutaneous nephrolithotomy. J Urol 2013;190:149.
12. 12. Thomas K, Smith NC, Hegarty N, Glass JM. The Guy’s stone scoreegrading the complexity of percutaneous nephrolithotomy procedures. Urology 2011;78:277.
13. 13. Okhunov Z, Friedlander JI, George AK et al. S.T.O.N.E. nephrolithometry: novel sur- gical classification system for kidney calculi. Urology 2013;81:1154.
14. 14. Jeong CW, Jung JW, Cha WH et al. Seoul national university renal stone complexity score for predicting stone-free rate after percutaneous nephrolithotomy. PLoS One 2013;18:8.
15. 15. Turna B, Umul M, Demiryoguran S, et al. How do increasing stone surface area and stone configuration affect overall outcome of percutaneous nephrolithotomy? J Endourol 2007;21:34–43.
16. 16. Zhu Z, Wang S, Xi Q, et al. Logistic regression model for predicting stone-free rate after minimally invasive percutaneous nephrolithotomy. Urology 2011;78:32–36.
17. 17. Shahrour K, Tomaszewski J, Ortiz T, et al. Predictors of immediate postoperative outcome of single-tract percutaneous nephrolithotomy. Urology 2012;80:19–25.
18. 18. Muslumanoglu AY, Tefekli AH, Karadag MA et al. Impact of percutaenous access point number and location on complication and success rates in percutaneous nephrolithotomy. Urol Int 2006;77:340-346.
19. 19. Antonelli JA, Pearle MS. Advances in percutaneous nephrolithotomy. Urol Clin North Am. 2013; 40: 99-113.
20. 20. de la Rosette J, Assimos D, Desai M, et al. The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, andoutcomes in 5803 patients. J Endourol 2011;25:11-7.
21. 21. Oner S, Okumus MM, Demirbas M, et al. Factors Influencing Complications of Percutaneous Nephrolithotomy: A Single-Center Study. Urol J 2015;12:2317-23.
22. 22. Nakamon T, Kitirattrakarn P, Lojanapiwat B. Outcomes of percutaneous nephrolithotomy: comparison of elderly and younger patients. Int Braz J Urol 2013;39:692-700.
23. 23. Gokce MI, Ozden E, Suer E, et al. Comparison of imaging modalities for detection of residual fragments and prediction of Stone related events following percutaneous nephrolitotomy. Int Braz J Urol 2015;41:86-90.
24. 24. 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.
25. 25. Sfoungaristos S, Gofrit ON, Yutkin V et al. External validation of CROES nephrolithometry as a preoperative predictive system for percutaneous nephrolithotomy outcomes. J Urol 2016;195:372-6.
26. 26. Bozkurt IH, Aydogdu O, Yonguc T et al. Comparison of Guy and Clinical Research Office of the Endourological Society Nephrolithometry Scoring Systems for Predicting Stone-Free Status and Complication Rates After Percutaneous Nephrolithotomy: A Single Center Study with 437 Cases. J Endourol 2016;29:1006-10.
27. 27. Yarimoglu S, Polat S, Bozkurt IH et al. Comparison of S.T.O.N.E and CROES nephrolithometry scoring systems for predicting stone-free status and complication rates after percutaneous nephrolithotomy: a single center study with 262 cases. Urolithiasis 2017;45:489-494.
28. 28. 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 2016;34:1163-8.
29. 29. Choi SW, Bae WJ, Ha US et al. 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 2017;35:449-457.
30. 30. Semins MJ, Bartik L, Chew BH. Multicenter analysis of postoperative CT findings after percutaneous nephrolithotomy:defining complication rates. Urology 2011;78:291-294.
31. 31. Tefekli A, Ali Karadag M, Tepeler K, et al. Classification of percutaneous nephrolithotomy complications using the modified Clavien grading system: Looking for a standard. Eur Urol 2008;53:184-190.
32. 32. de la Rosette JJ, Opondo D, Daels FP, et al. Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy. Eur Urol 2012;62:246-255.