Evaluation and Comparison of Urolithiasis Scoring Systems Used in Percutaneous Kidney Stone Surgery

Labadie, Kevin P.; Okhunov, Zhamshid; Akhavein, Arash; Moreira, Daniel M.; Moreno‐Palacios, Jorge; Junco, Michael del; Okeke, Zeph; Bird, Vincent G.; Smith, Arthur D.; Landman, Jaime

doi:10.1016/j.juro.2014.07.104

Cited by 119 publications

(122 citation statements)

References 26 publications

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“…Labadie et al 12 compared each system in the same cohort to determine which was more predictive of surgical success. They concluded that all classification systems could equally predict stone-free rate.…”

Section: Discussionmentioning

confidence: 99%

Can renal stone size and the use of the nephrolithometric system increase the efficacy of predicting the risk of failure of percutaneous nephrolithotripsy?

E¹,

Diniz²,

Souza³

et al. 2017

Rev. Col. Bras. Cir.

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Objective : to verify the association of success rate of percutaneous lithotripsy, Guy score and size of the stone. Methods: one hundred patients submitted to percutaneous nephrolithotripsy were evaluated. All stones were classified according to Guy Score. Patient free of stone was considered when residual fragments were ≤2mm. Results: according to guy Score, 54% were score 1 (Group 1), 18% score 2 (Group 2), 15% score 3 (Group 3), and 13% score 4 (Group 4). Success was observed in 77.77% in Group 1, 27.77% in group 2, 26.6% in Group 3, and 7.69% in Group 4. In patients with Guy score 1, there was statistical significance of prediction of free stone rate when evaluated according to the size of the stone. Among groups 2, 3 and 4 there was no statistical significance, but it was observed a trend in relation to stone size, the bigger the higher the chance of residual fragments. Conclusion: nephrolithometry by Guy Score and size of the stone are single predictors of success of percutaneous nephrolithotripsy. Stone size may influence success rate of patients with Guy Score 1.

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Section: Discussionmentioning

confidence: 99%

Can renal stone size and the use of the nephrolithometric system increase the efficacy of predicting the risk of failure of percutaneous nephrolithotripsy?

E¹,

Diniz²,

Souza³

et al. 2017

Rev. Col. Bras. Cir.

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“…All of the factors listed are ranked between 0-100, with a total score obtained ranging between 0-350, with a probability of SFR from 30 to 90%, depending on the total sum obtained. [2] Recently, Labadie et al [9] , evaluated and compared the three scores, finally concluding that all systems similarly predict the SFR, and a single and simple scoring system should be adopted to unify the reporting like the GSS. Bozkurt et al [10] recently compared in a retrospective, single-center study the GSS and the CROES (Clinical Research Office of Endourological Society) nephrolithometric nomogram, concluding that both scorings systems equally predict the postoperative outcomes of PCNL, including SFRs, overall complications, blood loss and operative times.…”

Section: Introductionmentioning

confidence: 99%

Rearrangement of the Guy’s stone score improves prediction of stone-free rate after percutaneous nephrolithotomy

Moreno‐Palacios

García-Peña

et al. 2018

Turkish Journal of Urology

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Objective: We propose a modification of the original Guy´s Stone Score (GSS) to hold on 20 % of prognostic discrimination among groups which makes this score a more reliable resource for risk assessment in patients undergoing percutaneous nephrolithotomy (PCNL). Material and methods:Historical cohort of 126 patients undergoing PCNL from December 2010 to November 2014 was included in the survey. Every patient was classified according to the original GSS. For the new classification of Guy Stone Score (GSS-M) all of the subgroups included in the scale were analyzed individually and then ranked from better to worst according to the postoperative stone-free rates (SFRs). This ranking led us to reclassify all the original subgroups, clustering them in three new categories according to their SFRs as subgroups of good, intermediate and poor prognosis, trying to achieve at least 20% of prognostic discrimination among the groups.Results: Hundred and twenty-six PCNL procedures were evaluated, but only 124 were included for statistical analysis and classified based on SFR according to the GSS as follows: 76% for grade 1, 71% for grade 2, 55% for grade 3 and 20% for grade 4. The SFRs were also assessed for the GSS-M obtaining the following predictive values as 93%, 67% and 44% for the good, intermediate and poor prognostic groups, respectively. The prognostic difference among the GSS-M groups was always >20% (p<0.05). Conclusion:The original GSS has limitations to predict SFR because of its poor discrimination power among prognostic groups. This rearrangement improves prediction of SFR and better discriminates risk groups in PCNL.

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“…and CROES scores also found to be associated with complications), although cross-comparative studies have been fewer [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The only systematic review concluded with ambiguity over the clear superiority of any one system and recommended further validation studies [23].…”

Section: Introductionmentioning

confidence: 99%

“…All that can be proved is whether scores are significantly higher or lower for outcomes other than SFR (which does not really aid in decision making in terms of providing a risk estimate or clinical cut-off point) or break the results of the nomogram score into arbitrary categories (with doubtful clinical relevance and chance of introducing confounding if categories are uneven; as larger categories may inherently carry larger risk) and treat it like a ordinal score [19,21]. 2 Ordinal scores do grade calculus complexity based on radiological characteristics.…”

Section: Introductionmentioning

confidence: 99%

Comparative testing of reliability and audit utility of ordinal objective calculus complexity scores. Can we make an informed choice yet?

2016

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Objectives To assess the reliability of the Guy's Stone Score, the Seoul National University Renal Stone Complexity (S‐ReSC) score and the S.T.O.N.E. scores in percutaneous nephrolithotomy (PCNL), and assess their utility in discriminating outcomes [stone free rate (SFR), complications, need for multiple PCNL sessions, and auxiliary procedures] valid across parameters of experience of surgeon, independence from surgical approach, and variations in institution‐specific instrumentation. Patients and methods A prospectively maintained database of two tertiary institutions was analysed (606 cases). Institutes differed in instrumentation, while the overall surgical team comprised: two trainees (experience <100 cases), two junior consultants (experience 100–200 cases), and two senior surgeons (experience >1000 cases). Scores were assigned and re‐assigned after 4 months by one trainee and an expert surgeon. Inter‐rater and test‐retest agreement were analysed by Cohen's κ and intraclass correlation coefficient. Multivariate logistic regression models were created adjusting outcomes for the institution, comorbidity, Amplatz size, access tract location, the number of punctures, the experience level of the surgeon, and individual scoring system, and receiver operating curves were analysed for comparison. Results Despite some areas of inconsistencies, individually all scores had excellent inter‐rater and test‐retest concordance. On multivariable analyses, while the experience of the surgeon and surgical approach characteristics (such as access tract location, Amplatz size, and number of punctures) remained independently associated with different outcomes in varying combinations, calculus complexity scores were found consistently to be independently associated with all outcomes. The S‐ReSC score had a superior association with SFR, the need for multiple PCNL sessions, and auxiliary procedures. Conclusion Individually all scoring systems performed well. On cross comparison, the S‐ReSC score consistently emerged to be more superiorly associated with all outcomes, signifying the importance of the distributional complexity of the calculus (which also indirectly amalgamates the influence of stone number, size, and anatomical location) in discriminating outcomes. Our study proves the utility of scoring systems in prognosticating multiple outcomes and also clarifies important aspects of their practical application including future roles such as benchmarking, audit, training, and objective assessment of surgical technique modifications.

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Evaluation and Comparison of Urolithiasis Scoring Systems Used in Percutaneous Kidney Stone Surgery

Abstract: All scoring systems and the stone burden equally predicted stone-free status. The Guy and S.T.O.N.E. nephrolithometry scores were associated with estimated blood loss and length of stay. A single scoring system should be adopted to unify reporting.

Cited by 119 publications

References 26 publications

Can renal stone size and the use of the nephrolithometric system increase the efficacy of predicting the risk of failure of percutaneous nephrolithotripsy?

Can renal stone size and the use of the nephrolithometric system increase the efficacy of predicting the risk of failure of percutaneous nephrolithotripsy?

Rearrangement of the Guy’s stone score improves prediction of stone-free rate after percutaneous nephrolithotomy

Comparative testing of reliability and audit utility of ordinal objective calculus complexity scores. Can we make an informed choice yet?

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