Objectives: To evaluate Guy's Stone Score (GSS) as a grading system for the complexity of renal calculi before percutaneous nephrolithotomy (PCNL) and as a predictor for stonefree rate (SFR) and potential complications in the setting of a developing country with many cases of advanced complex stone disease. Patients and Methods: We performed a prospective study on 115 patients with renal stones who had PCNL between August 2017 and October 2018. Stone complexity was classified according to GSS using preoperative imaging. The rates of perioperative complications were assessed using the Clavien grading system, and the SFR was assessed in the 3rd postoperative week by abdominal X-ray and renal ultrasound. The χ 2 and one-way ANOVA tests were used for statistical analysis. A p value ≤0.05 was considered significant. Results: The study included 115 patients (77 males) with a mean age of 50.2 (±13.3) years. Cases were classified according to GSS into 4 grades; there were 24 (20.9%) grade I, 48 (41.7%) grade II, 25 (21.7%) grade III, and 18 (15.7%) grade IV cases. There was a significant inverse correlation between GSS grade and SFR (p < 0.001). The rate of complications using the Clavien grading system were significantly higher in GSS grades III and IV (p = 0.002). So were the rates of blood transfusion, the need for > 1 access tract, and the duration of hospitalization. Conclusion: GSS is a simple and easily reproducible system to classify the complexity of renal stones. In our setting, it also proved an excellent tool to predict SFR, perioperative complications, and associated ancillary procedures. Ultimately, it can help surgeons and, above all, patients to make a more informed decision about their surgery.

ObjectiveTo analyse the advanced systems of urology residency in the developed world, to compare them to a system in the developing world, and thereby identify the shortcomings and make recommendations to improve residency programmes for urology in the Kurdistan Region of Iraq.MethodsA survey was conducted amongst the urology Residents (55) in the three governorates of the Kurdistan Region of Iraq, to assess the accessibility of the training programme, the types of the residency programmes, skills acquisition, the use of modern technology for teaching and assessment, the environment of the settings of practice, and the status of research in their training.ResultsAn overwhelming majority (88%) of trainees reported difficulty in securing a training position. A high proportion (43%) felt disappointed at the beginning of their training. There is no unified curriculum of training, and more than two-thirds of the respondents reported a lack of a proper evidence-based medical education. There is no formal subspecialty training programme. Of the respondents, 65% referred to the difficulties in the environment for training, and that there was a low level of research involvement (12%).ConclusionsUrology training is not easily accessible, there is no unified programme of residency, there are limited facilities, and a minimal assessment of practical skills. The environment for practice needs enormous improvements and a strong foundation for research should be created.