Atlas of Scoring Systems, Grading Tools, and Nomograms in Endourology: A Comprehensive Overview from the TOWER Endourological Society Research Group.

Abstract

Introduction: With an increase in the prevalence of kidney stone disease (KSD), there has been a universal drive to develop reliable and user-friendly tools such as grading systems and predictive nomograms. An atlas of scoring systems (SS), grading tools, and nomograms in Endourology is provided in this article. Methods: A comprehensive search of world literature was performed to identify nomograms, grading systems, and classification tools in endourology related to KSD. Each of these was reviewed by the authors and has been evaluated in a narrative format with details on those that are externally validated and their respective citation count on google scholar. Results: A total of 54 endourological tools have been described in our atlas of endourological SS, grading tools, and nomograms. Of the tools, 23 (43%) have been published in the past 3 years showing an increasing interest in this area. This includes five for percutaneous nephrolithotomy, six for flexible ureteroscopy, three for semi-rigid ureteroscopy (URS), nine for extracorporeal shockwave lithotripsy, two for stent encrustations, three for intraoperative appearance at the time of URS, and three to classify intraoperative ureteric injury. There were three tools for renal colic assessment, one each for prediction of future stone event, stone classification, and stone impaction and two for need of emergency intervention in ureteral stone. Two tools are related to stone recurrence, whereas six are related to postprocedural complications. There are now two tools for simulation in endourology and five for patient-reported outcome measures. Conclusions: A number of reliable and established tools currently exist in endourology. Each of these offers their own respective advantages and disadvantages. Although nomograms and SS can help in the decision making, these must be tailored to individual patients based on their specific clinical scenarios, expectations, and informed consent.