Guy's Score Research Articles

Comparison of CROES, Guy's, S.T.O.N.E., and S-ReSC nephrolithometric scoring systems in predicting success and complications in patients undergoing supine mini percutaneous nephrolithotomy.

In addition to the fact that the significance of the nephrolitometric scoring systems (NSSs) remains unclear, no study has been conducted to assess the effectiveness of these scoring systems in percutaneous nephrolithotomy (PNL) performed in the supine position. We aimed to compare the CROES, Guy's scoring system (GSS), S.T.O.N.E., and S-ReSC NSSs for success and complications in patients undergoing supine mini-PNL (m-PNL). The prospectively recorded data of the patients who underwent supine m-PNL was reviewed retrospectively, and a total of 112 patients were included in the study. Demographic, operation, post-procedure data, and CROES, GSS, S.T.O.N.E., and S-ReSC scores were assessed and compared between the stone-free (SF) and residuel groups. There were significant differences between the SF and residual groups in terms of mean CROES, S.T.O.N.E., and S-ReSC scores (p = 0.003, p = 0.009, and p = 0.015, respectively). Similarly, there were significant differences between the grades of these scoring systems and the success of the procedure (p = 0.035, p = 0.007, and p = 0.007, respectively). However, the GSS was insignificant. The area under curve values in ROC analysis of CROES, S.T.O.N.E., and S-ReSC NSSs were 0.695, 0.665, and 0.656, respectively (p = 0.003, p = 0.011, and p = 0.017, respectively). No statistically significant difference was found between the grades of all four NSSs and the complication rates. The study showed a strong correlation between CROES, STONE, and S-ReSC NSSs in predicting SF status after supine m-PNL. However, none of the NSSs could predict the complications.

Complications of Percutaneous Nephrolithotomy: Experience From a Tertiary Care Center.

Introduction Renal stones are mineral concretions in the pelvicalyceal system. Their prevalence and recurrence are increasing globally. Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for the removal of kidney stones. It is a safer technique offering the highest stone-free rates. However, a few complications may still occur. We aimed to evaluate our experiences of PCNL and classify the complications as intraoperative, early postoperative, and late postoperative events. We also aimed to find the predictors of complications in PCNL. Methods A single-center prospective observational study was conducted from June 2021 to October 2022 where all patients who were >18 years old with radiopaque calculus in the kidney and underwent PCNL were included. Statistical analysis was performed using the IBM Statistical Package for Social Sciences (SPSS) software (IBM SPSS Statistics, Armonk, NY). A p-value of <0.05 was considered significant. Results Two hundred one patients including 137 males and 64 females participated in the study. The overall rate of complications was 21.9%. Most of the patients (16.4%) experienced minor complications of Clavien grades 1 and 2. A Clavien grade of >3 included major complications and was noted in 5.5% of patients. No mortality was seen in the postoperative period. Female patients (p = 0.028), a stone burden of >3 cm (p = 0.003), stones in multiple calyces (p = 0.001), hydronephrosis (p = 0.001), history of recently treated urinary tract infection (UTI) (p < 0.001), longer operative time (>91 minutes) (p < 0.001), Guy's stone scores (GSS) III and IV (p < 0.001), complex renal calculi (staghorn) (p = 0.002), and multiple punctures (p = 0.001) were associated with higher complication rates after PCNL. Conclusion Most PCNL-related complications are minor and resolve with conservative or minimally invasive management. However, there are certain complications that can limit the surgical outcome. The overall complication rate in the current study is similar to that reported in the literature. Bleeding was the most common intraoperative complication, whereas hematuria was the most common early postoperative complication. A stone burden of >3 cm, hydronephrosis, longer operative time, higher GSS, and multiple punctures can all affect the rate of complications.

Comparison between Guy’s Stone Score and S.T.O.N.E. Score System in Predicting Stone Free Rate after PCNL

Abstract Background PCNL is the gold standard treatment modality of large and complex kidney stones. We compared the stone free status predicting ability of Guy’s stone score and S.T.O.N.E. score system. Objective To compare to compare between Guy’s stone score and S.T.O.N.E score system in predicting stone free rate after PCNL. Patients and Methods A total number of 40 patients underwent PCNL in the period between December 2021 and May 2022. All cases were evaluated and graded using both Guy score and S.T.O.N.E. score based on preoperative computerized plain ctut. The post operative stone free status was evaluated using post operative plain KUB xray and ctut. Statistical analysis was done to determine relation of the scores with the post-operative stone free status. Also receiver operating characteristics curves (ROC) was drawn and area under the curve was calculated to assess the scores predictability of post-operative stone free status. Results The overall stone free rate of our study was 80%. Mean age of study population was 43 years (±SD10.60). we found that stone free patients had lower mean Guy score (2.00 vs 3.38) and lower mean S.T.O.N.E. score (7.84 vs 9.75). both scores had statistically significant relation with stone free status the P value was 0.001 for Guy score and 0.022 for S.T.O.N.E. score. The post operative stone free status predictability of both scores was assessed by drawing receiver operating characteristics curves (ROC) and the area under the curve was calculated by ROC curve. When comparing area under the curve for both scores we found no great difference between guy score and S.T.O.N.E. score (0.867 – 95% CI 0.735-1.000) vs (0.760– 95% CI 0.569-0.951). Conclusion The study shows that both Guy score and S.T.O.N.E. score systems have similar predicting ability of post PCNL stone free status with strong correlation with post operative stone free status.

Inter-Observer Reliability and Reproducibility of CROES, Guy’s and STONE Nephrolithometry Scoring Systems for Predicting Percutaneous Nephrolithotomy Outcomes

Objective: To assess inter-observer reliability and reproducibility of CROES, Guy’s and S.T.O.N.E. nephrolithometry scoring systems (NSS). Material and Methods: A total of 128 patients who underwent percutaneous nephrolithotomy (PNL) between January 2019 and January 2021 were included in the study. Calculation of the CROES, S.T.O.N.E, and Guy’s NSSs was made by three independent urologists with different academic levels. These were; a very experienced (&gt;500 PCNL cases) endourologist (Rater 1), a urologist who had just finished (&gt;100 PCNL cases) their urology education (Rater 2) and a 3rd year urology resident who had never performed a PCNL operation (Rater 3). All were blinded to the procedure outcomes. Results: An excellent correlation was found between three raters for Guy and S.T.O.N.E. scoring systems (kappa value 0.810-0.962). However, for the CROES score there is an excellent correlation between Rater 1 and Rater 2, but there were good correlations between Rater 1 vs Rater 3 and Rater 2 vs Rater 3 (kappa values 0.910 and 0.698-0.721 respectively). The highest correlation was between Rater 1 and Rater 2 for Guy score (kappa value 0.962) (Table 3). All intra-class correlations were statistically significant (p&lt;0.001). The highest intra-class correlations were seen for the S.T.O.N.E. score (ICC: 0.980). Conclusion: The present study revealed that all three NSS frequently used in current urology practice have reproducible and reliable results. Additionally, we believe that the application of CROES NSS by more experienced clinicians will be effective in obtaining clearer results.

Prognostic Factors for Residual Lithiasis in Patients With Staghorn Calculi Undergoing Percutaneous Nephrolithotomy in the Maya Region of Yucatan, Mexico: A Case-Control Study.

Yucatan stands out as the state with the highest prevalence of urolithiasis in Mexico,placing significant demands on healthcare services, such as consultation and surgical intervention. Staghorn calculi are related to recurrent urinary tract infections, and their management is always surgical. The stone-free rate is a parameter used to measure the success of surgery, with residual stones considered those persisting four weeks after surgical management. There are understudied prognostic factors that can predict the success of achieving stone-free status, taking into account the number of stones, their location, and the anatomical variations of the patient's collecting system. The study aims to determine the prognostic factors for residual lithiasis in patients with staghorn calculi treated with percutaneous nephrolithotomy at the High Specialty Regional Hospital of the Yucatan Peninsula. A case-control study was performed including 188 patients, aged 18 years or older, and diagnosed with staghorn calculus from January 2022 to June 2023, grouping the patients according to their stone-free rate evidence on postoperative computed tomography. Data were collected from the records of the Urology Department at a high-specialty hospital in Yucatan. The groups were analyzed, aiming to establish an association between preoperative factors and postoperative outcomes measured in terms of stone-free rate. A total of 188 patients with staghorn calculi were included, with a predominance in females (58.5%) and a mean age of 45.4 ± 11.9 years. The most common comorbidity was hypertension (29.8%), and 27.7% had a history of recurrent urinary tract infections. Regarding the Sampaio classification, B1 was the most prevalent in our population with 66 cases (35.1%), while Type A2 was the least common (13.8%). According to what was obtained through the multivariate logistic regression model, the calyceal anatomy Type A1 and A2 were associated with residual lithiasis (p= 0.016 OR: 2.994 CI: 1.223-7.331), and Grade IV was associated with a higher rate of residual lithiasis (p=0.005 CI: 1.586-13.100).A statistically significant association was found between stone burden and the presence of residual lithiasis (p=< 0.001). Guy's Score Grade IV showed a higher incidence of residual lithiasis,seemingly associated with stone burden, leading to the conclusion that both factors were categorized as predictors for the development of post-surgical residual lithiasis. Regarding anatomical variations according to Sampaio, it was observed that types A1 and A2 showed a lower rate of stone-free status. Therefore, we also consider them as variables that may influence the achievement of success in endourological management. Personalized patient assessment allows for more accurate prognostic factors, enabling a more comprehensive surgical planning in the presence of staghorn calculi.

Clinical Utility of S.T.O.N.E, Guy's Scoring System, and Renal Stone Complexity Scoring in Predicting Outcome of Single-Tract Percutaneous Nephrolithotomy.

Several imaging-basedscores have been developed to predict postoperative stone-free state (SFS) and complications. This study aimed to assess the accuracyof the S.T.O.N.E., Guy Scoring System (GSS), and Seoul National University Renal Stone Complexity (S-ReSCS) scores inpredicting theoutcomes of single-tract percutaneous nephrolithotomy (ST-PCNL). This scoring system holds paramount importance for low-incomeand low-middle-income countries (LMICs), as it is inexpensive and cost-effective for the healthcare system. This retrospective study was carried out with 147 participants. Based on the preoperative computerized tomographic (CT) scan, each patient's S.T.O.N.E. score, GSS, and S-ReSCS were recorded. The modified Clavien grading system was used to document intra- and postoperative complications. The mean age of the sample population was 45 years. SFS was achieved in 110 (74.8%) patients. The number of calyces involved (p = 0.008), S.T.O.N.E. scoring (p = 0.001), GSS (p = 0.008), and S-ReSCS (0.001) correlated well with the SFS. Forty-nine (33.33%) patients developed complications. The most common complications fell within Clavien grade II. No statistical significance was noted between the S.T.O.N.E. score, GSS, and S-ReSCS with the modified Clavien grading system. The S.T.O.N.E. scoring, GSS, and S-ReSCS have a high predictive value for achieving SFS in ST-PCNL. In addition, findings from LMICs are comparable with those from the rest of the world.

Prediction of percutaneous nephrolithotomy outcomes and flexible ureteroscopy outcomes using nephrolithometry scoring systems.

Kidney stones account for a high proportion of urological emergencies. The main objective of this paper is to evaluate the predictive ability of five scoring systems for overall stone-free status and postoperative complications after percutaneous nephrolithotomy and retrograde ureteroscopy. This study retrospectively analysed 312 cases of kidney stone patients between January 2021 and May 2022 at our centre. Multivariate logistic regression as well as ROC curves were applied to determine the ability to evaluate each scale to predict stone-free rates and postoperative complications. 179 patients have undergone PCNL. After multivariate logistic regression, the S.T.O.N.E score and history of ipsilateral renal surgery were predictive of stone-free status, and the predictive power of the S.T.O.N.E score was higher than that of history of ipsilateral renal surgery. Grade 1 complications were considered to be related to Guy's score and grade 2 complications were considered to be related to history of diabetes mellitus. 133 patients have undergone f-URS. After multivariate logistic regression analysis, the modified S-ReSC score, RUSS score, and R.I.R.S score were predictive of stone-free status, with the R.I.R.S score being the strongest predictor. Evidence of grade 2 complications was considered to be related to abnormal renal function. For PCNL, the S.T.O.N.E score had the best efficacy in predicting stone-free status, and the Guy's score had the best efficacy in predicting postoperative complications; for f-URS, the R.I.R.S score had the best efficacy in predicting stone-free status, and no scoring system predicted postoperative complications.

Comparison between different radiological scoring systems in predicting post-PCNL outcome

Background: Various scoring systems, including Guy's stone score (GSS), S.T.O.N.E. score, and Clinical Research Office of the Endourological Society (CROES) nomogram, have been assessed for predicting post-percutaneous nephrolithotomy (PCNL) success in terms of stone-free status (SFS) and complications. Our study aims to determine the optimal predictor of SFS among these systems and assess their efficacy in predicting perioperative factors and complications, using modified Clavien grade. Methods: This prospective hospital-based cohort study involved 107 patients aged ≥18 years who underwent standard PCNL (tract size &gt;24 Fr) within a year. GSS, S.T.O.N.E. score, and CROES nomogram were calculated using preoperative computed tomography (CT) scans. Comparisons between 'stone-free' and 'residual-stone' groups were statistically analyzed. Results: All parameters effectively predicted SFS. S.T.O.N.E. score exhibited excellent discriminatory power (AUC 0.844; 95% CI: 0.762-0.907), followed by GSS (AUC 0.756; 95% CI: 0.663-0.834) and CROES nomogram (AUC 0.749; 95% CI: 0.656-0.828). S.T.O.N.E. score, with an AUC of 0.844, proved the most accurate predictor at ≤7 cut-off. GUY's score correlated positively with operative time and hospital stay (correlation coefficient 0.403, 0.34). S.T.O.N.E. score also positively correlated with these factors (correlation coefficient 0.443, 0.37). CROES nomogram negatively correlated with operative time and hospital stay (correlation coefficient -0.374, -0.314). Conclusions: All scoring systems effectively predict post-PCNL SFS, with S.T.O.N.E. score being the most predictive. GSS and S.T.O.N.E. score associate significantly with operative time and hospital stay. Both GSS and S.T.O.N.E. score show significant associations with perioperative complications assessed by modified Clavien grade.

Predicting the Stone-Free Status of Percutaneous Nephrolithotomy with the Machine Learning System.

The study aimed to create a machine learning model (MLM) to predict the stone-free status (SFS) of patients undergoing percutaneous nephrolithotomy (PCNL) and compare its performance to the S.T.O.N.E. and Guy's stone scores. This is a retrospective study that included 320 PCNL patients. Pre-operative and post-operative variables were extracted and entered into three MLMs: RFC, SVM, and XGBoost. The methods used to assess the performance of each were mean bootstrap estimate, 10-fold cross-validation, classification report, and AUC. Each model was externally validated and evaluated by mean bootstrap estimate with CI, classification report, and AUC. Out of the 320 patients who underwent PCNL, the SFS was found to be 69.4%. The RFC mean bootstrap estimate was 0.75 and 95% CI: [0.65-0.85], 10-fold cross-validation of 0.744, an accuracy of 0.74, and AUC of 0.761. The XGBoost results were 0.74 [0.63-0.85], 0.759, 0.72, and 0.769, respectively. The SVM results were 0.70 [0.60-0.79], 0.725, 0.74, and 0.751, respectively. The AUC of Guy's stone score and the S.T.O.N.E. score were 0.666 and 0.71, respectively. The RFC external validation set had a mean bootstrap estimate of 0.87 and 95% CI: [0.81-0.92], an accuracy of 0.70, and an AUC of 0.795, While the XGBoost results were 0.84 [0.78-0.91], 0.74, and 0.84, respectively. The SVM results were 0.86 [0.80-0.91], 0.79, and 0.858, respectively. MLMs can be used with high accuracy in predicting SFS for patients undergoing PCNL. MLMs we utilized predicted the SFS with AUCs superior to those of GSS and S.T.O.N.E scores.

Ultrasound-Only Percutaneous Nephrolithotomy Is Safe and Effective Compared to Fluoroscopy-Directed Percutaneous Nephrolithotomy.

Introduction: Outcomes after ultrasound-only percutaneous nephrolithotomy (PCNL), in which no fluoroscopy is used, are not well known. The goal of this study was to compare outcomes of ultrasound-only and fluoroscopy-directed PCNL. Materials and Methods: Prospectively collected data from the Registry for Stones of the Kidney and Ureter database were reviewed for all patients who underwent PCNL at one academic center from 2015 to 2021. Primary outcomes were complications and stone-free rates (no residual fragments ≥3 mm). Results: Of the 141 patients who underwent ultrasound-only PCNL and 147 who underwent fluoroscopy-directed PCNL, there was no difference in complication rates (15% vs 16%, p = 0.87) or stone-free status (71% vs 65%, p = 0.72), respectively. After adjusting for body mass index, American Society of Anesthesiologists (ASA), stone size, and stone complexity by Guy score, ultrasound-only PCNL was not associated with any increased odds of complications (odds ratio [OR] 0.7, 95% confidence interval [CI] 0.3-1.6, p = 0.41) or residual stone fragments ≥3 mm (OR 1.0, 95% CI 0.5-1.9, p = 0.972) compared with fluoroscopy-directed PCNL. Ultrasound-only PCNL was associated with shorter operative time (median 99.5 vs 126 minutes, p < 0.001), and the use of ultrasound remained a significant predictor of short operative time (<100 minutes) after controlling for supine positioning, stone size, and stone complexity by Guy score (OR 2.31, 95% CI 1.01-5.29, p = 0.048). Patients in the ultrasound-only group were spared a mean radiation exposure dose of 10 mGy per procedure. Conclusions: Ultrasound-only PCNL is safe and achieves similar stone-free rates compared with fluoroscopy-directed PCNL with the added benefit of avoidance of radiation.

Evaluation of nephrolithometric scoring systems to predict outcomes and complications of percutaneous nephrolithotomy for staghorn stone

Background/Aim: Urinary system stone disease develops with a frequency of 1-20 % in the general population. There are various surgical methods and percutaneous nephrolithotomy (PCNL) is a commonly used treatment method, especially in large, staghorn kidney stones. Aim of this study was compare stone nomograms in forecasting operative and complicating parameters subsequent to PCNL in staghorn stones. Methods: The study analysed 66 patients with staghorn stones who underwent PCNL between 2017 and 2022, retrospectively. The researcher evaluated the Guy, S.T.O.N.E. and CROSS nephrolithotomy scores in patients using non-contrast computed tomography. The Clavien Dindo Classification was used to evaluate the surgical complication. Results: The mean stone burden, GUY, S.T.O.N.E. and CROES scores were 1114.9 ± 520.18 mm²; 3.64 ± 0.48; 10.11 ± 1.2 and 142.9 ± 31.99, respectively. Total stone-free status (SFS) was achieved in 37.9 % of the patients, while the median stone clearance rate was 93.74 (50-100). While no statistical significance was observed between GUY score and SFS, it was observed in S.T.O.N.E. and CROES scores (p = 0.020 and 0.004, respectively). ROC analysis showed that CROES and S.T.O.N.E. scoring systems and the stone burden parameter showed similar accuracy in the estimation of SFS. The results showed that only the S.T.O.N.E. score showed a significant relationship with the presence of complications (p = 0.034). Conclusion: If the percutaneous nephrolithotomy for staghorn stones in question is, current scoring systems alone couldn't be predictive for postoperative outcomes and degree of complications. Further large scale multicentre prospective studies are needful.

MP44-03 ULTRASOUND-ONLY PERCUTANEOUS NEPHROLITHOTOMY IS SAFE AND EFFECTIVE COMPARED TO FLUOROSCOPY-DIRECTED PCNL

You have accessJournal of UrologyCME1 May 2022MP44-03 ULTRASOUND-ONLY PERCUTANEOUS NEPHROLITHOTOMY IS SAFE AND EFFECTIVE COMPARED TO FLUOROSCOPY-DIRECTED PCNL Nizar Hakam, Gregory Hosier, Xavier Cortez, Fadl Hamouche, Leslie Charondo, Heiko Yang, Carter Chan, Kevin Chang, David Bayne, Marshall Stoller, and Thomas Chi Nizar HakamNizar Hakam More articles by this author , Gregory HosierGregory Hosier More articles by this author , Xavier CortezXavier Cortez More articles by this author , Fadl HamoucheFadl Hamouche More articles by this author , Leslie CharondoLeslie Charondo More articles by this author , Heiko YangHeiko Yang More articles by this author , Carter ChanCarter Chan More articles by this author , Kevin ChangKevin Chang More articles by this author , David BayneDavid Bayne More articles by this author , Marshall StollerMarshall Stoller More articles by this author , and Thomas ChiThomas Chi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002610.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Use of ultrasound guidance for percutaneous nephrolithotomy (PCNL) access has gained popularity. However, reports on ultrasound-only PCNL, in which ultrasound is used for all steps of the procedure, are limited as fluoroscopy is often used for tract dilation and to check for residual stone fragments. The study goal was to compare outcomes for ultrasound-only PCNL compared to fluoroscopy-directed PCNL. METHODS: Prospectively collected data from the Registry for Stones of the Kidney and Ureter (ReSKU) database was reviewed for all patients who underwent PCNL at one academic center from 2015-2021. Primary outcomes were complications (Clavien-Dindo classification) and stone free rates (no residual fragments ≥3 mm) compared between those who underwent ultrasound-only PCNL and fluoroscopy-directed PCNL in which any amount of fluoroscopy was used. RESULTS: 141 patients who underwent ultrasound-only PCNL and 147 who underwent fluoroscopy-directed PCNL were identified. Mean maximum summative stone diameter was 30 mm and 44% were Guy score 3 or 4. Stone and patient characteristics were similar between both groups (Table 1). There was no difference in complication rates (15% vs. 16%, p=0.87) or stone free status (71% vs 65%, p=0.72) between those who underwent ultrasound-only PCNL and fluoroscopy-directed PCNL respectively. Ultrasound-only PCNL was associated with shorter operative time (median 99.5 minutes vs 126 minutes, p<0.001), lower percent drop in hematocrit (2.68% vs 4.91%, p=0.02), higher success rate of access achieved by resident (38.3% vs 16.3%, p<0.001) and more frequent use of supine positioning (68.8% vs 24.5%, p <0.001) compared to fluoroscopy-directed PCNL. After adjusting for BMI, ASA, stone size, and stone complexity by Guy score, ultrasound-only PCNL was not associated with any increased odds of complications (odds ratio [OR] 0.706, 95% confidence interval [CI] 0.305 – 1.635, p=0.416) or residual stone fragment ≥3 mm (OR 0.989, 95% CI 0.524 – 1.866, p=0.972) compared to fluoroscopy-directed PCNL. CONCLUSIONS: Ultrasound-only PCNL is safe and achieves similar stone free rates compared to fluoroscopy-directed PCNL with added benefits of shorter operative time, less blood loss, and avoidance of radiation. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e752 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nizar Hakam More articles by this author Gregory Hosier More articles by this author Xavier Cortez More articles by this author Fadl Hamouche More articles by this author Leslie Charondo More articles by this author Heiko Yang More articles by this author Carter Chan More articles by this author Kevin Chang More articles by this author David Bayne More articles by this author Marshall Stoller More articles by this author Thomas Chi More articles by this author Expand All Advertisement PDF DownloadLoading ...

Innovative way to break the stone: Master lithoclast for bilateral simultaneous Percutaneous Nephrolithotomy.

The objective of our study was to evaluate the efficacy of Master Lithoclast, also known as trilogy lithoclast, in simultaneous bilateral Percutaneous Nephrolithotomy (PCNL). The study was a prospective case series, involving 40 patients undergoing bilateral simultaneous PCNL, with 20 (50%) males and 20 (50%) females. The mean age of subjects was 32.9±7.9 years. In Guy's stone scoring 7(17.5%) patients classified in Group I, 28 (70%) in group II and the remaining 5(12.5%) patients were placed in group III. Total operative time observed was 74.8±17.9 minutes. Complete stone clearance was observed in 30 (75%) patients. In conclusion, study data confirmed that Master Lithoclast provides faster stone clearance and is unaffected by the composition of stones, ease of usability, and improved tissue safety with reduced chances of fragments blocking are key factors.

Is Guy’s stone score useful for predicting outcomes in percutaneous nephrolithotomy?

IntroductionPercutaneous Nephrolithotomy (PCNL) is currently the treatment of choice in large kidney stones. Guy’s stone score was developed to predict treatment outcomes. The aim of this study was to evaluate the relationship between Guy’s score and outcomes in our institution. Materials and MethodsThe medical records of patients diagnosed with urolithiasis and treated by PCNL were retrospectively evaluated between January 2017 and December 2018. Analyzed data included: age, sex, Guy's score based on preoperative findings, transfusion, stone-free rate and requirement of auxiliary procedures. Chi-square test was used for the comparison of proportions. Odds ratios (OR) with confidence intervals (CIs) of 95% were calculated by logistic regression. ResultsA total of 386 patients, 53.89% female, mean age of 45.59 ± 15 years were analyzed. Guy’s score was as follows: 112 patients (29.04%) were classified as Guy I, 92 patients (23.82%) as Guy II, 94 patients (24.34%) as Guy III, and 88 patients (22.80%) as Guy IV. There were no differences between groups in terms of blood transfusions. Stone-free rate was 96.43% (n = 108) for patients Guy I; 84.78% (n = 72) for Guy II; 76.59% (n = 72) for Guy III and 50% (n = 44) for Guy IV categories (p < 0.0001). Taking as a reference Guy I group, the OR to require new treatment for residual stones were: Guy II 4.85 (CI = 0.95 to 24.60, P = 0.05) to Guy III 8.25 (CI = 1.73 to 39.44, P = 0.008) and Guy IV 27 (CI = 5.84 to 124.70; p < 0.0001). ConclusionThere was a statistically significant association between Guy’s Score and stone-free rates following PCNL. Guy’s score was useful to predict results of PCNL in our group.

Evaluation and comparison of S.T.O.N.E. and Guy's scoring systems for predicting percutaneous nephrolithotomy outcomes in supine position.

Percutaneous nephrolithotomy (PCNL) was applied in the prone position until recently. But also, in recent years supine positions was applied in patients with kidney stones. Predicting how much renal stones can be cleared after surgery and possibility of complications is an important question for both surgeons and patients. Therefore different scoring systems are used to evaluate outcomes of PCNL before surgery. Between 2018 and 2020, 80 patients with renal stone who underwent PCNL in the supine position were evaluated preoperatively by S.T.O.N.E. and Guy's scoring systems (GSS). The predictions of both scoring systems for stone-free and complication rates in patients who underwent PCNL in the supine position were evaluated. Also, these scoring systems were compared among themselves for reliability. In both scoring systems, there was a statistically significant difference between postoperative stone-free (SF) and residual stone (RS) of patients and in predicting the likelihood of complications in patients. No statistically significant difference was found between the two scoring systems in predicting the stone-free rate. Our findings revealed that S.T.O.N.E. nephrolithometry and Guy's score systems can be used effectively to predict stone-free rate, complications, and operation duration in supine position PCNL for renal stones.

¿Es útil la puntuación de Guy para predecir resultados en la nefrolitotomía percutánea?

IntroductionPercutaneous Nephrolithotomy (PCNL) is currently the treatment of choice in large kidney stones. Guýs stone score was developed to predict treatment outcomes. The aim of this study was to evaluate the relationship between Guýs score and outcomes in our institution. Materials and MethodsThe medical records of patients diagnosed with urolithiasis and treated by PCNL were retrospectively evaluated between January 2017 and December 2018. Analyzed data included: age, sex, Guy's score based on preoperative findings, transfusion, stone-free rate and requirement of auxiliary procedures. Chi-square test was used for the comparison of proportions. Odds ratios (OR) with confidence intervals (CIs) of 95% were calculated by logistic regression. ResultsA total of 386 patients, 53.89% female, mean age of 45.59±15 years were analyzed. Guy's score was as follows: 112 patients (29.04%) were classified as Guy I, 92 patients (23.82%) as Guy II, 94 patients (24.34%) as Guy III, and 88 patients (22.80%) as Guy IV. There were no differences between groups in terms of blood transfusions. Stone-free rate was 96.43% (n=108) for patients Guy I; 84.78% (n=72) for Guy II; 76.59% (n=72) for Guy III and 50% (n=44) for Guy IV categories (p <0.0001). Taking as a reference Guy I group, the OR to require new treatment for residual stones were: Guy II 4.85 (CI=0.95 to 24.60, P=0.05) to Guy III 8.25 (CI=1.73 to 39.44, P=0.008) and Guy IV 27 (CI=5.84 to 124.70; p <0.0001). ConclusionThere was a statistically significant association between Guýs Score and stone-free rates following PCNL. Guy's score was useful to predict results of PCNL in our group.

Comparison of percutaneous nephrolithotomy and retrograde intrarenal surgery outcomes for kidney stones larger than 2cm from Guy's stone scoring system perspective.

To compare surgical outcomes of percutaneous nephrolithotomy (PNL) and retrograde intrarenal surgeries (RIRS) as a result of kidney stones larger than 2cm, together with Guy's stone scores (GSS). The data of 811 patients with stone sizes 2-6cm were operated using PNL (n=361) and RIRS (n=450) reviewed retrospectively. GSS were graded 1, 2, 3 or 4 according to the computed tomography findings. Stone-free rate (SFR), operation times, length of hospital stay (LOHS) and Clavien complications (CC) were recorded. Although mean operative times were significantly longer in the RIRS group than the PNL group in GSS grades 1, 2 and 3 (P<.001), it was similar between the two groups in GSS grade 4 (P=.186). SFRs in the PNL and RIRS group were 90.3% and 58.4% on post-operative 10th day (P<.001), and it raised up to 95.3% and 81.6% after secondary interventions (P<.001). Significantly higher SFRs observed in the PNL group in GSS grades 1, 2 and 3 categories. On postoperative 10th day, the SFRs were similar in both GSS grade 4 categories (P=.06). LOHS was longer in the PNL group (P<.001). Although LOHS was significantly longer only in GSS grade 3 (P=.043) and GSS grade 4 (P<.001) in the PNL group, it was similar in GSS grade 1 and 2 between groups. Clavien complications increased in line with GSS in the PNL group (P<.001), but the difference did not differ between GSS grade 3 and 4. SF of PNL in a single session and short operation time seems to be significant especially in GSS grades 1, 2 and 3 category stones. Although the number of patients in the GSS 4 group is very small to claim this, RIRS might be considered as an alternative to PNL in a special group of patients such as GSS grade 4 because of its lower complication rates and shorter LOHS.

Comparison of Guy's, S.T.O.N.E. and CROES Scoring Systems for Predicting Percutaneous Nephrolithotomy Outcomes in Eldery Patients.

To evaluate the efficacy and reliability of Guy's (GSS), S.T.O.N.E., and CROES scoring systems developed to predict percutaneous nephrolithotomy (PCNL) outcomes in aged patients. StudyDesign: Descriptive study. Department of Urology, Ministry of Health University Izmir Bozyaka Training and Research Hospital and Department of Urology, Faculty of Medicine, Amasya University, Turkey, from April 2011 to January 2020. Patients aged 65 years and over, who underwent PCNL for kidney stones, were retrospectively analysed. The patients' clinical and perioperative characteristics and the radiological features of the stones were obtained from the prospectively recorded data. GSS, S.T.O.N.E. and CROES nephrolithometry scores were calculated for each patient and their relation with stone-free status, complications, and perioperative findings were analysed. A total of 147 patients were included in the study. Stone-free status was achieved in 76.0% of the patients, and complications developed in 27.2%. All three scoring systems were associated with stone-free status and complication development. GSS (OR=0.213,p=0.005) and S.T.O.N.E. (OR=0.601, p=0.042) scores were detected as independent markers for stone-free status, while the CROES score was not an independent marker. Only diabetes mellitus was determined to be an independent marker for the development of complications (OR=2.375, p=0.045). PCNL is an effective and safe treatment method with high stone-free rates in the treatment of large renal stones, but care should be taken in terms of cardiac risks. The results of this study showed that GSS and S.T.O.N.E. scoring systems were effective and reliable in predicting stone-free status. Key Words: Aged, Nephrolithotomy, Percutaneous, Comorbidity, Stone-free status, Treatment outcome, Complications, Scoring systems.

Bilateral simultaneous percutaneous nephrolithotomy versus staged approach: a critical analysis of complications and renal function.

Patients with bilateral kidney stones and burdened by large stones are challenging cases for endourologists. Simultaneous bilateral percutaneous nephrolithotomy (sbPCNL) is an option; however, it may be accompanied by important morbidity. An alternative is a staged PCNL, operating one side each time. Herein, we compare the impact of sbPCNL and staged PCNL on complication rates and renal function. Patients who underwent sbPCNL or staged bilateral PCNL with a frame time of 6 months were searched in our prospectively collected kidney stone database. Groups were compared for age, gender, body mass index (BMI), comorbidities (classification by the American Society of Anesthesiology - ASA), stone size, Guy's score, stone-free status, renal function, blood loss, blood transfusion rate, complication rate, and length of hospital stay. Twenty-six patients and 52 kidney units were enrolled. The mean operative time was 134.7 min. Only 11.3% of cases had complications, all of them minor (Clavien ≤ 2). Overall, the stone-free rate was 61.50%. Comparing the groups, there was a significantly longer operative time in the sbPCNL group (172.5 vs. 126.3 min; p=0.016), as well as a higher transfusion rate (12.5% vs. 5.6%; p=0.036). There was no statistically significant difference in creatinine levels between the groups. Regarding the stone-free rate, there was a significantly higher proportion of patients in the staged PCNL group (64.9% vs. 43.8%; p=0.012). sbPCNL is a safe procedure; however, when compared to staged procedures it has a higher transfusion and lower stone-free rate.

Preoperative risk factors for complications of percutaneous nephrolithotomy.

This study was conducted to evaluate preoperative risk factors for development of complications of percutaneous nephrolithotomy (PCNL). All consecutive patients aged ≥ 16years who underwent PCNL during 2015 were retrospectively reviewed. Non-contrast CT (NCCT) was performed for all patients to evaluate stone complexity. The technique of PCNL was the same for all patients. Intra-operative and postoperative complications were recorded and classified based on modified Clavien system. The differences in preoperative data (patients, renal and stone characteristics including Guy's and STONE scores) between complicated and uncomplicated cases were compared using univariate and multivariate statistical analyses for detection of independent risk factors. The study included 1178 patients (61% were males). Mean age was 50 ± 12years, and mean BMI was 30.7 ± 5.7kg/m2. Complicated group included 166 patients (14.1%). Independent risk factors on multivariate analysis were infected preoperative urine culture (RR: 2.098, P 0.001, 95%CI: 1.380-3.189), largest stones diameter 30mm or more (RR: 2.481, P > 0.001, 95%CI: 1.697-3.627) and number of calyces affected by the stones (RR: 2.431, P 0.002, 95%CI: 1.400-4.222 for affection of two calyces and RR: 2.778, P 0.005, 95%CI: 1.357-5.684 for affection of three calyces). While two scoring systems (Guy's and STONE) were not predictive of complications after PCNL, preoperative risk factors were infected preoperative urine culture, distribution of the stones or stone branches in two or three calyceal groups and stone size 30mm or more.