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  • Review Article
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Current clinical scoring systems of percutaneous nephrolithotomy outcomes

Nature Reviews Urology volume 14, pages 459–469 (2017)Cite this article

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Key Points

  • The need for standardized outcome reporting following percutaneous nephrolithotomy resulted in the creation of the four major validated scoring systems Guy's stone score, S.T.O.N.E. nephrolithometry, CROES nomogram, and S-ReSC score

  • The four scoring systems have similar ability to predict postoperative stone-free rate but their ability to predict complications varies; the Guy's stone score is the only system predictive of both stone-free rate and complications

  • The S.T.O.N.E. score provides the best combination of ability to predict stone-free rate, minimal subjectivity when scoring, and simplicity in clinical application

  • The S-ReSC score provides similar information to the S.T.O.N.E. score but it was created on the basis of expert opinion and no studies exist that compare S-ReSC with other systems

  • The CROES nomogram was created using data from a large multicentre database but its application in daily practice is hindered by the need to know multiple patient characteristics for score calculation

  • Increasing use of scoring will provide additional data on factors that are most predictive of stone-free rate and complications following PCNL and might help create an optimum unified system in the future

Abstract

Percutaneous nephrolithotomy has become the preferred treatment modality for patients with large renal calculi. The technique provides excellent stone clearance, but complication rates are higher than those of minimally invasive techniques, such as ureteroscopy and shockwave lithotripsy. Guy's stone score, S.T.O.N.E. nephrolithometry, the CROES nomogram, and S-ReSC are contemporary scoring systems introduced to provide standardized grading of stone complexity and outcomes of percutaneous stone surgery. Guy's stone score is easy to apply and has been validated in multiple studies. The S.T.O.N.E. score is based on factors determined through CT imaging, which is the currently preferred imaging modality for patients with nephrolithiasis. The CROES nomogram was developed from data in a large multicentre database and has high statistical power. Determination of the S-ReSC score relies on stone location only, providing a simple approach to grading disease complexity. Each system has advantages and disadvantages, but several studies suggest that their ability to predict stone-free rate is comparable. The optimal system should have a high predictive ability, should be simple to use and should be widely applicable. Additional studies are required to evaluate patient clinical factors that influence stone complexity and are predictive of outcomes. A future unified scoring system might incorporate the strengths of each currently available system and optimize care of patients with nephrolithiasis.

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Figure 1: Grades of the Guy's stone score.
Figure 2: Compound calyx involvement.
Figure 3: The CROES nomogram.
Figure 4: The S-ReSC scoring diagram.

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References

  1. Scales, C. D., Smith, A. C., Hanley, J. M. & Saigal, C. S. Prevalence of kidney stones in the United States. Eur. Urol. 62, 160–165 (2012).

    Article  Google Scholar 

  2. Brown, J. Diagnostic and treatment patterns for renal colic in US emergency departments. Int. Urol. Nephrol. 38, 87–92 (2006).

    Article  CAS  Google Scholar 

  3. Preminger, G. G. et al. AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J. Urol. 173, 1991–2000 (2005).

    Article  Google Scholar 

  4. Turk, C. et al. EAU guidelines on interventional treatment for urolithiasis. Eur. Urol. 69, 475–482 (2016).

    Article  Google Scholar 

  5. De, S. et al. Percutaneous nephrolithotomy versus retrograde intrarenal surgery: a systematic review and meta-analysis. Eur. Urol. 67, 125–137 (2015).

    Article  Google Scholar 

  6. Labate, G. et al. The percutaneous nephrolithotomy global study: classification of complications. J. Endourol. 25, 1275–1280 (2011).

    Article  Google Scholar 

  7. Olvera-Posada, D. et al. Risk factors for postoperative complications of percutaneous nephrolithotomy at a tertiary referrral center. J. Urol. 194, 1646–1651 (2015).

    Article  Google Scholar 

  8. Perez-Fentes, D. A., Gude, F., Blanco, M., Novoa, R. & Freire, C. G. Predictive analysis of factors associated with percutaneous stone surgery outcomes. Can. J. Urol. 20, 7050–7059 (2013).

    PubMed  Google Scholar 

  9. Alobaidy, A. et al. Percutaneous nephrolithotomy: critical analysis of unfavorable results. Can. J. Urol. 18, 5542–5547 (2011).

    PubMed  Google Scholar 

  10. Astroza, G. M. et al. Does the nephrostomy tract lenght impact the outcomes of percutaneous nephrolithotomy (PNL)? Int. Urol. Nephrol. 46, 2285–2290 (2014).

    Article  Google Scholar 

  11. Astroza, G. et al. Effect of supine versus prone position on outcomes of percutaneous nephrolithotomy in staghorn calculi: results from the Clinical Research Office of the Endourology Society Study. Urology 82, 1240–1244 (2013).

    Article  Google Scholar 

  12. Anastasiadis, A. et al. Impact of stone density on outcomes in percutaneous nephrolithotomy (PCNL): an analysis of the clinical research office of the endourological society (CROES) PCNL Global Study database. Scand. J. Urol. 47, 509–514 (2013).

    Article  Google Scholar 

  13. Opondo, S. et al. Standardization of patient outcomes reporting in percutaneous nephrolithotomy. J. Endourol. 28, 767–774 (2014).

    Article  Google Scholar 

  14. Thomas, K., Smith, N. C., Hegarty, N. & Glass, J. M. The Guy's stone score — grading the complexity of percutaneous nephrolithotomy procedures. Urology 78, 277–281 (2011).

    Article  Google Scholar 

  15. Okhunov, Z. et al. S.T.O.N.E. nephrolithometry: novel surgical classification system for kidney calculi. Urology 81, 1154–1160 (2013).

    Article  Google Scholar 

  16. Smith, A. et al. A nephrolithometric nomogram to predict treatment success of percutaneous nephrolithotomy. J. Urol. 190, 149–156 (2013).

    Article  Google Scholar 

  17. Jeong, C. W. et al. Seoul National University Renal Stone Complexity score for predicting stone-free rate after percutaneous nephrolithotomy. PLoS ONE 8, e65888 (2013).

    Article  CAS  Google Scholar 

  18. Park, J., Hong, B., Park, T. & Park, H. K. Effectiveness of noncontrast computed tomography in evaluation of residual stones after percutaneous nephrolithotomy. J. Endourol. 21, 684–687 (2007).

    Article  Google Scholar 

  19. Smith, R. C., Verga, M., McCarthy, S. & Rosenfield, A. T. Diagnosis of acute flank pain: value of unenhanced helical CT. AJR Am. J. Roentgenol. 166, 97–101 (1996).

    Article  CAS  Google Scholar 

  20. Pfister, S. A. et al. Unenhanced helical computed tomography versus intravenous urography in patients with acute flank pain: accuracy and economic impact in a randomized prospective trial. Eur. Radiol. 13, 2513–2520 (2003).

    Article  CAS  Google Scholar 

  21. Eray, O. et al. The efficacy of urinalysis, plain films, and spiral CT in ED patients with suspected renal colic. Am. J. Emerg. Med. 21, 152–154 (2003).

    Article  Google Scholar 

  22. Mandal, S. et al. Prospective evaluation of complications using the modified Clavien grading system, and of success rates of percutaneous nephrolithotomy using Guy's stone score: a single-center experience. Indian J. Urol. 28, 392–398 (2012).

    Article  Google Scholar 

  23. Sinha, R. K. et al. Evaluation of stone-free rate using Guy's stone score and assessment of complications using modified Clavien grading system for percutaneous nephro-lithotomy. Urolithiasis 43, 349–353 (2015).

    Article  Google Scholar 

  24. Vicentini, F. C., Marchini, G. S., Mazzucchi, E., Claro, J. F. & Srougi, M. Utility of the Guy's stone score based on computed tomographic scan findings for predicting percutaneous nephrolithotomy outcomes. Urology 83, 1248–1253 (2014).

    Article  Google Scholar 

  25. Sfoungaristos, S. et al. External validation and predictive accuracy assessment of Guy's stone score as a preoperative tool for estimating percutaneous nephrolithotomy outcomes. J. Endourol. 29, 1131–1135 (2015).

    Article  Google Scholar 

  26. Ingimarsson, J. P., Dagrosa, L. M., Hyams, E. S. & Pais, V. M. 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 83, 45–49 (2014).

    Article  Google Scholar 

  27. Noureldin, Y. A., Elkoushy, M. A. & Andonian, S. External validation of the S.T.O.N.E. nephrolithometry scoring system. Can. Urol. Assoc. J. 9, 190–195 (2015).

    Article  Google Scholar 

  28. Akhavein, A., Henriksen, C., Syed, J. & Bird, V. G. Prediction of single procedure success rate using S.T.O.N.E. nephrolithometry surgical classification system with strict criteria for surgical outcome. Urology 85, 69–73 (2015).

    Article  Google Scholar 

  29. Okhunov, Z. et al. Interobserver reliability and reproducibility of S.T.O.N.E. nephrolithometry for renal calculi. J. Endourol. 27, 1303–1306 (2013).

    Article  Google Scholar 

  30. Matlaga, B. R. & Hyams, E. S. Can the Guy's stone score predict PNL outcomes? Nat. Rev. Urol. 8, 363–364 (2011).

    Article  Google Scholar 

  31. Sfoungaristos, S. et al. External validation of CROES nephrolithometry as a preoperative predictive system for percutaneous nephrolithomy outcomes. J. Urol. 195, 372–376 (2016).

    Article  Google Scholar 

  32. Choo, M. S. et al. External validation and evaluation of reliability and validity of the S-ReSC scoring system to predict stone-free status after percutaneous nephrolithotomy. PLoS ONE 9, e83628 (2014).

    Article  Google Scholar 

  33. Noureldin, Y. A., Elkoushy, M. A. & Andonian, S. Which is better? Guy's versus S.T.O.N.E. nephrolithometry scoring systems in predicting stone-free status post-percutaneous nephrolithotomy. World J. Urol. 33, 1821–1825 (2015).

    Article  Google Scholar 

  34. Kumsar, S. et al. Value of preoperative stone scoring systems in predicting the results of percutaneous nephrolithotomy. Cent. European J. Urol. 68, 353–357 (2015).

    Article  Google Scholar 

  35. Bozkurt, I. H. 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. 29, 1006–1010 (2015).

    Article  Google Scholar 

  36. Labadie, K. et al. Evaluation and comparison of urolithiasis scoring systems used in percutaneous kidney stone surgery. J. Urol. 193, 154–159 (2015).

    Article  Google Scholar 

  37. Tailly, T. O. et al. Multi-center external validation and comparison of stone scoring systems in predicting outcomes after percutaneous nephrolithotomy. J. Endourol. 30, 594–601 (2016).

    Article  Google Scholar 

  38. Dhar, M. & Denstedt, J. D. Imaging in diagnosis, treatment, and follow-up of stone patients. Adv. Chronic Kidney Dis. 16, 39–47 (2009).

    Article  Google Scholar 

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Authors and Affiliations

  1. Smith Institute for Urology, Hofstra Northwell School of Medicine, 450 Lakeville Road, Suite M41, Lake Success, 11042, New York, USA

    Wayland J. Wu & Zeph Okeke

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  1. Wayland J. Wu
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Both authors researched data for the article, made substantial contributions to discussion of its content, wrote and reviewed and/or edited the manuscript before submission.

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Correspondence to Zeph Okeke.

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The authors declare no competing financial interests.

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Wu, W., Okeke, Z. Current clinical scoring systems of percutaneous nephrolithotomy outcomes. Nat Rev Urol 14, 459–469 (2017). https://doi.org/10.1038/nrurol.2017.71

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