Stone Score Research Articles

Construction and performance of a clinical prediction rule for ureteral stone without the use of race or ethnicity: A new STONE score.

The original STONE score was designed to predict the presence of uncomplicated renal colic and the corresponding absence of alternate serious etiologies. It was retrospectively derived and prospectively validated and resulted in five variables: Sex (male gender), Timing (acute onset of pain), "Origin" (non-Black race), Nausea/vomiting (present), and Erythrocytes (microscopic hematuria). With recent increased awareness of the potential adverse impacts of including race (a socially constructed identity) in clinical prediction rules, we sought to determine if a revised STONE score without race could be constructed with similar diagnostic accuracy. We used data from the original STONE score that utilized retrospective data on patients with confirmed kidney stone by computed tomography (CT) to derive a clinical prediction rule as well as prospective data to validate the score. These data were used to construct a revised STONE score after removing race as a variable. We performed univariate and multivariable logistic regression and compared the old and new STONE scores (including multivariable, integral, and three-level risk) using the area under the receiver operating characteristic curve (AUC) and misclassification rates. After the elimination of race, multivariable logistic regression revealed that gross hematuria was the next strongest feasible variable for the prediction of ureteral stone. This was incorporated into a revised STONE score by substituting "obvious hematuria" for "origin" (formerly race). The revised STONE score had similar predictive accuracy to the original STONE score: AUC 0.85 versus 0.86 (95% confidence interval [CI]: 0.82-0.87 and 0.79-0.93); misclassification rates were also unchanged, 0.23 versus 0.23 (95% CI: 0.20-0.25 and 0.20-0.25). We modified the STONE score to remove race and include "obvious hematuria" without losing clinical accuracy. Considering the potential adverse effects of propagating racial bias in clinical algorithms, we recommend using the revised STONE score. Future research could investigate the potential contributions of social drivers of health (SDOH) to the diagnosis of kidney stone.

Predictive factors of stone-free rate and complications in patients with proximal impacted ureteral stones undergoing percutaneous nephrolithotomy: based on a new scoring standard.

To evaluate the predictive factors affecting the stone-free rate (SFR) and complications of percutaneous nephrolithotomy (PCN) in the treatment of proximal impacted ureteral stones (PIUS) based on a new scoring standard. The data of 90 patients with PIUS were collected in this retrospective study between January 2015 and June 2023. Univariate and multivariate logistic regression analyses were used to determine factors affecting treatment outcome in terms of SFR and complications. The scoring standard for patients with PIUS was developed based on the univariate logistic regression analyses. In the univariate analysis, stone density (P = 0.015), and stone diameter (P = 0.032) significantly were associated with lower SFR. And degree of hydronephrosis (P = 0.014), Preoperative infection (P = 0.002), and history of lithotripsy (P = 0.045) were associated with occurrence of complications. Multivariate analysis indicated that stone density (P = 0.020), and stone diameter (P < 0.001) were associated with lower SFR; independent risk factors for development of complications were history of lithotripsy (P = 0.024), and preoperative infection (P < 0.001). Additionally, score ≥ 3 was the independent risk factor for both SFR (P < 0.001) and complication rate (P < 0.001). Subgroup analysis shown that there were statistically significant differences between the two groups in terms of stone-free rate (P = 0.032) and complications (P = 0.015). According to the findings of this study, the stone score ≥ 3 was determined as a critical predictive factor of SFR and complications in PIUS patients undergoing PCN based on a new scoring standard. Additionally, PCN has high initial SFR and low complications when dealing with score < 3 PIUS.

Efficacy of flexible ureterorenoscopy in treating multiple renal stones: a cohort study.

While the efficacy of flexibleureterorenoscopy (URS) in managing solitary kidney stones (KSs) is widely acknowledged, its effectiveness intreating multiple stones has scarcely been investigated. This study aims to assess the effectiveness and safety of retrogradeintrarenal surgery (RIRS) utilizing flexible URS and laser lithotripsy in the management of multiple KSs. Methods: This study was a single-group cohort study conducted on patients with multiple KSs who underwent treatment withRIRS using flexible URS and laser lithotripsy. Stone-free status was considered as the lack of residual stone fragments or anyresidual stone of any size. The first follow-up appointment was arranged 3-4 weeks following the procedure. If significant residualstones were present, patients underwent reintervention within 2-4 weeks. A total of 110 patients with multiple KSs were included. The mean stone burden was 27.5 ± 7.9 mm, and the mean duration of the operation was 54.9 ± 19.7 minutes. Seven cases(6.3%) experienced intraoperative complications, while postoperative complications were found in eight cases (7.3%). Afterfour weeks, a stone-free rate (SFR) was documented in 80.9% of the cases, and this rate increased to 93.6% after three months.The SFR after three months was significant with Guy's stone score (p < 0.001); however, it did not reach a significant level with any other parameters. Conclusions: The RIRS with flexible URS may be an effective and potentially safe procedure for treating multiple KSs. It mayyield a favorable SFR with an acceptable complication rate.

Comparison of Scoring Systems in Predicting Stone-Free Rate in Flourless Retrograde Intrarenal Surgery

Abstract: Thus far, there is no standardised method for predicting outcomes from fluoro-less retrograde intrarenal surgery (RIRS) procedure. This study aimed to compare scoring systems in predicting stone-free rate (SFR) in RIRS patients This was an observational and analytical study with a retrospective cohort design. Samples were obtained from medical records of Dr. J. H. Awaloei Hospital from March 2022 to October 2023. This study only analyzed three scoring systems: Guy's Stone Score (GSS), Resorlu-Unsal Stone Score (RUSS), and Seoul National University Renal Stone Complexity Score (S-ReSC). The results obtained 219 patients with an average age of 55 years, GSS grade I in 108 patients, and grade II in 50 patients. Related to RUSS score, 43 patients got a score of 1, 108 got a score of 2, and 60 got a score of 60. Meanwhile, S-ReSC score was at a high level with a percentage of 65.3%, 20.4% at the medium level, and 14.4% at the low level. Moreover, GSS sensitivity 76%, specificity 75%, PPV 93.2%, NPV 41.1%, AUC 75%; RUSS score sensitivity 75.4%, specificity 62.2%, PPV 90%, NPV 36.2%, AUC 70%; S-ReSC score sensitivity 71%, specificity 77.5%, PPV 93.4%, NPV 37.3%, AUC 72%. In conclusion, Guy's Stone Score, Resorlu-Unsal Stone Score, and Seoul National University Renal Stone Complexity Score have similar abilities in predicting stone-free rate. Further research is needed with a larger sample size or population to confirm the findings of this study. Keywords: nephrolithiasis; stone-free rate; scoring system; retrograde intrarenal surgery

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.

Comparative analysis of scoring systems for patients undergoing retrograde intrarenal surgery with isolated lower calyx stones.

It is critical to provide patients with accurate information on potential surgical outcomes during the preoperative phase. Several scoring systems have been developed for this specific purpose. This study aimed to examine the predicted efficacy of scoring systems in patients with isolated lower calyx stones who underwent retrograde intrarenal surgery (RIRS). We performed a retrospective analysis of 85 patients who underwent RIRS for lower calyx stones between 2016 and 2023. The study computed each participant's Resorlu-Unsal Stone score (RUSS), R.I.R.S. scoring system score, Modified Seoul National University Renal Stone Complexity (S-ReSC) score, S.T.O.N.E. score, Ito's nomogram, and T.O.HO score. Residual stones less than 4mm were classified as clinically insignificant residual fragments (CIRFs) and regarded as successful. Following that, we used receiver-operating characteristic (ROC) curves to compare various scoring systems' success predictions. The median scores for RUSS, R.I.R.S. scoring system, Modified S-ReSC, S.T.O.N.E., Ito's nomogram, and T.O.HO score were 1 (1), 7 (2), 2 (0), 11 (1), 18 (4), and 7 (1), respectively. When CIRF cases were included, the stone-free rate increased to 80%. Only Ito's nomogram from scoring systems has a statistically significant cut-off value for success in ROC analysis (p = 0.021). In multivariate analysis, stone volume and preoperative hydronephrosis were associated with success (p = 0.004 and p = 0.035, respectively). In the multivariate analysis, none of the scoring systems were significantly associated with success. Hence, a new scoring system must be developed exclusively for patients with isolated lower pole stones undergoing RIRS.

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.

The Association between S.T.O.N.E. Nephrolithometry Score and Hemoglobin Drop in Patients Undergoing Percutaneous Nephrolithotomy

Nephrolithiasis is a very common condition with significant burden to patients. Percutaneous nephrolithotomy (PCNL) is safe procedure considered as gold standard for large renal stones. The most common complication of PCNL is bleeding which can require blood transfusion to angioembolization and may even need nephrectomy. The purpose of this study is to assess if STONE Nephrolithometry Score can predict hemoglobin drop in PCNL procedure. A total of 104 patients who underwent PCNL during one year period from October of 2022 to September of 2023 were taken using consecutive sampling method. All patients with renal stones underwent routine blood tests including complete blood counts, renal function and electrolytes. CT scans were then done and STONE nephrolithometry Score was evaluated. PCNL was performed and hemoglobin investigation was sent at 24 hours postoperatively. The two data were compared with the STONE nephrolithometry Score and other factors. More than three-fourths (78.8%) of the patients had comorbidities with hypertension being the commonest (76.9%). There was a significant association of drop of hemoglobin more than 1 g/dl with age &lt;30 years (p &lt;0.034), higher preoperative hemoglobin (p &lt;0.046), larger stone size (p &lt;0.001), shorter tract length (p=0.017) and STONE Score greater than 10 (p&lt;0.001). On correlation study only STONE score (p = 0.015) and larger stone size (p = 0.002) were associated with hemoglobin drops of more than 1 g/dl. STONE Nephrolithometry score is a good predictor of bleeding complications during PCNL and higher score is associated with more drop in hemoglobin levels.

Assessment of Factors Responsible for Stone-Free Status After Retrograde Intrarenal Surgery.

Aim The study aimed to evaluate the predictive factors that determined stone-free rate (SFR) after retrograde intrarenal surgery (RIRS). Materials and methods This prospective study was conducted on 183 patients undergoing RIRS for renal stones. Patients were categorized into two groups, depending on stone-free status one month following the procedure. SFRwas defined as the complete absence of stones or stones <4 mm. The parameters studied included patient demographics, presence of hydronephrosis, presence of preoperative double J-stent, abnormal renal anatomy, and stone characteristics (stone burden, stone number, stone density, stone location, lower pole infundibulopelvic angle, and lower pole renal infundibular length (RIL)). Univariate and multivariate analyses were performed to identify risk factors for residual stones. We assessed the predictive ability of the RIRS score and Resorlu-Unsal stone score (RUSS) for evaluating SFR utilizing receiver operating characteristic (ROC) analysis. Results 183 patients were included inthe study with a median age of 51 years. 131 (71.6%) patients were declared stone-free after the procedure. The mean stone size and density were 16.9 SD±7.5 mm and 1038 SD±342 Hounsfield units (HU) respectively. Stone-free patients had lower stone size (14.3 mm vs. 23.6 mm, p<0.01) and stone density (970 HU vs. 1211 HU, p<0.01) compared to non-stone-free patients. Patients with residual stones had steeper lower pole renal infundibulopelvic angle (RIPA) (31.3° vs. 40.7°, p<0.01) and longer RIL(26.6 mm vs. 21.1 mm, p<0.01). Stone multiplicity (p<0.01), lower pole stone location (p<0.01), and renal malformations (p<0.01)were significant influencing factors for residual renal stones after RIRS. Multivariate analysis revealed stone size, stone density (HU), and stone location as independent predictors for SFR after RIRS. Among the scoring systems, the RIRS score had the highest diagnostic accuracy for SFR (area under the curve (AUC): -0.882, 95% CI-0.828-0.936). Conclusion Stone size, stone density (HU), and stone number are important predictors of SFR after RIRS. Lower pole stone location and abnormal renal anatomy play a substantial role in determining SFR after RIRS. In lower pole stones, a long RIL and acute RIPA negatively influence SFR. Additionally, the RIRS score was found to be a better predictor for SFR than the RUSS score.

Endoscopic combined intrarenal surgery versus percutaneuos nephrolithotomy for complex pediatric stone disease: A comparative analysis of efficacy and safety

INTRODUCTIONDecision-making for complex pediatric urinary system stone disease is still a challenge for pediatric urologists. The interest in supine percutaneous nephrolithotomy (PCNL) is increasing among centers to achieve high surgical success rates with less morbidity. Despite advanced retrograde intrarenal surgery armamentarium, percutaneous approaches remain the first-line surgical treatment modality for >2 cm and complex renal stones. There are no comparative studies yet in the literature for pediatric endoscopic combined intrarenal surgery (ECIRS) OBJECTIVEIn this study, we aimed to contribute to the literature by evaluating the safety and efficacy of ECIRS by comparing it with PCNL. STUDY DESIGNPatients under 18 years of age who underwent PCNL and ECIRS for urinary tract stone disease at our Pediatric Urology department between 2012 and 2024 were included. Preoperative (demographic characteristics, stone characteristics, biochemical parameters), perioperative (duration of surgery, number of accesses, lasing and fluoroscopy times, endoscopic and fluoroscopic stone-free rates) and postoperative (hospital stay, urinary tract infection, complication and radiological stone-free rates) parameters were retrospectively evaluated. RESULTSA total of 68 children [28 (41%) girls and 40 (59%) boys] aged 5 (0-17) years were included in the study. ECIRS was performed in 19 (28%), supine in 28 (41%) and prone PCNL in 21 (30%) patients. Age (p = 0.029), Guy's stone score (p<0.001), S.T.O.N.E. (p<0.001), and Seoul National University Renal Stone Complexity (S-ReSC) scores (p=0.001) for preoperative parameters were found to be higher in ECIRS group over both PCNL methods (Summary Table). However, Clinical Research Office of the Endourological Society (CROES) score was seen lower for ECIRS group patients compared to other groups (p=0.028).Surgery time (in favor of supine over prone PCNL), fluoroscopy time (in favor of ECIRS and Supine PCNL over Prone PCNL), preferred laser type (prone PCNL group was mostly performed with holmium laser, whereas other groups were balanced between Holmium and Thulium Fiber Laser) and exit strategy (the preferred exit strategy was DJ Stent in most of the ECIRS patients, whereas nephrostomy tube was used in some of the PCNL group) showed significant difference among the groups as perioperative parameters (p=0.042, <0.001, <0.001, <0.001, respectively). Surgery time was lower for supine PCNL compared to prone PCNL. For postoperative parameters, stone-free rates, complication rates and urinary tract infections were similar between the 3 groups, while a difference was detected in terms of length of hospital stay in favor of ECIRS over both supine and prone PCNL (p = 0.006). DISCUSSIONThe current trial suggests that stone-free and complication rates of ECIRS and supine PCNL were similar in the pediatric complex stone patients. Although, the stones in the ECIRS group we found to be more complex. Also, ECIRS was superior to PCNL in terms of fluoroscopy exposure and hospital stay. CONCLUSIONWith the widespread use of new generation ureteral access sheaths and flexible ureterorenoscopes, ECIRS may have an important role in treatment of complex pediatric kidney stones.

STONE Score: A Predictor for Need of Blood Transfusion in Percutaneous Nephrolithotomy.

To determine if the STONE score is a predictor of blood transfusion and if patient-related factors, i.e., the presence of comorbidities such as urinary tract infection and obesity, can predict blood transfusion post-percutaneous nephrolithotomy. A cross-sectional descriptive study. Place and Duration of the Study: Department of Urology, The Aga Khan University Hospital, Karachi, Pakistan, between March 2022 and 2023. All patients admitted for percutaneous nephrolithotomy (PNCL) were included in the study. STONE score and patient related factors were assessed. Chi-square or Fisher's exact test was applied to check the association between the dependent variables (blood transfusion) and the independent variables. Logistic regression analysis was applied to compare the variables responsible for the outcome. Results: During the study period, 150 patients underwent PCNL. After exclusion, 89 patients were included in the study. The mean STONE score was 7.87, and the total number of transfusions was 8 (8.9%). BMI (body mass index) >25kg/m2 and STONE score were found to be significant factors predicting the need for transfusion with p-values of 0.02 and 0.03, respectively. On multivariate analysis, only BMI was found to be a significant contributing factor for blood transfusion. High BMI and STONE score are significant predictive factors for blood transfusion post-PCNL. Blood product arrangements should be restricted to obese patients. STONE score, Body mass index, Blood transfusion.

Cone Beam Computed Tomography-Assisted Percutaneous Nephrolithotomy in a Hybrid Operating Room: Optimization of Patient Selection.

Background: Cone beam computed tomography (CBCT) enables intraoperative cross-sectional and three-dimensional imaging of the urinary tract. CBCT in a hybrid operating room can be used for intraoperative detection of residual stones and potential additional stone extraction at the end of percutaneous nephrolithotomy (PCNL). This study describes our initial experience with intraoperative CBCT during PCNL and analyzes its role in potentially improving its outcomes. Methods: We conducted a single-center retrospective cohort study at a tertiary referral hospital between 2018 and 2021. The study aimed to evaluate the outcome of patients who underwent intraoperative noncontrast CBCT scan during PCNL. The CBCT scan was performed when the urologist determined the kidney to be endoscopically stone-free. In case any residual fragments were imaged, an additional effort was made to extract them. Patients were divided into three groups based on treatment outcome: stone-free upon CBCT, not stone-free with additional stone extraction after CBCT, and not stone-free without additional stone extraction. Procedure and patient characteristics were recorded to identify factors associated with additional stone extraction during CBCT-assisted PCNL. Results: A total of 102 procedures were included in this study. Intraoperative CBCT scans showed residual calcifications in 58 (57%) cases. In 39 cases, which is 38% of the total population and 61% of the cases with residual calcifications, one or more residual fragments imaged on the intraoperative CBCT-scan were extracted additionally within the same procedure. A higher Guy's Stone Score was associated with a higher likelihood of additionally extracting stones as a result of the CBCT. Conclusions: CBCT-assisted PCNL in a hybrid operating room can lead to additional stone extraction in the same procedure in 37% of all cases and in over 60% of the cases in which residual fragments are imaged. The value of CBCT-assisted PCNL appears to increase in the case of more complex stone surgery cases.

Determinants of Partial Stone Clearance after Mini-PCNL in the Pediatric Population

Abstract: Background: The prevalence of renal stones in pediatric population is increasing in Pakistan, to minimize the adverse outcomes of renal stone disease accurate diagnosis and proper management is necessary. Objective: This study aim to evaluate the risk factors of partial stone clearance after mini-PCNL in the pediatric population of Pakistan. Materials and Methods: This is a retrospective, cross-sectional study conducted at Godhra Hospital, Karachi, during 2021, patients diagnosed with single or multiple renal stones requiring PCNL were enrolled in the study, Guy’s stone score was used as a prediction method for complete clearance. SPSS version 22 was used to analyze the data, chi-square test was used to assess the significance of the data keeping a p-value ≤0.05 as significant. The risk estimation was analyzed with the help of the odds ratio test. Result: A total of 234 participants with mean age of 6.4 ± 4.8 years were enrolled. Stone clearance was reported 203 (86.7%) and 31 (13.2%) residual fragments. 09 (3.8%) out of the residual stone group needed intervention for complete clearance while the remaining were reported as stone free after 4 weeks with METs. The mean residual stone size was 0.7 ± 0.3, upon assessing the determinants maximum patients had Staghorn (&gt; 4) cms stone size with 7 (2.9%) of patients out of 13 (5.5%). The odds of having partial clearance were reportedly positive with 2.34 in staghorn ≥ 4cms stone size and 1.62 in Grade IV Guy’s stone score. Conclusion: Stone size ≥ 4.0 cm and staghorn calculi present in all calyces are independent risk factors for partial stone clearance after Mini-PCNL.

Comparison of lithotripsy methods during mini-PNL: is there a role for ballistic lithotripsy in the era of high-power lasers

BackgroundFor renal stones > 20 mm, percutaneous nephrolithotomy (PNL) offers the best stone clearance rates with acceptable complication rates. This study aimed to compare the efficiency of high-power holmium YAG laser and ballistic lithotripsy during mini-PNL.MethodsData from 880 patients who underwent mini-PNL for renal stones was investigated retrospectively. The study utilized propensity score matching to create two groups: laser lithotripsy (n = 440) and ballistic lithotripsy (n = 440). The groups were matched based on stone size, Guy’s stone score, and stone density. The main objectives of the study were to assess the stone-free rate (SFR), duration of surgery, and complication rates.ResultsThe average age of the population was 51.4 ± 7.1 years, with a mean stone size of 28.6 ± 8.3 mm and a mean stone density of 1205 ± 159 HU. There were no significant differences between the groups. The SFRs of the laser lithotripsy and ballistic lithotripsy were 92.5% and 90.2%, respectively (p = 0.23). The laser lithotripsy group had a notably shorter surgery time (40.1 ± 6.3 min) compared to the ballistic lithotripsy group (55.6 ± 9.9 min) (p = 0.03). Complication rates were similar (p = 0.67).ConclusionsOur study shows that a high-power holmium YAG laser provides quicker operation time compared to ballistic lithotripsy. However, ballistic lithotripsy is still an effective and safe option for stone fragmentation during mini-PNL. In places where a high-power holmium YAG laser is not available, ballistic lithotripters are still a safe, effective, and affordable option for mini-PNL.

Predictors for emergency readmission in patients with ureteral calculi: a focus on pain management and stone location.

The management of patients with ureteral calculi in the emergency department (ED) remains challenging due to high revisit rates. To identify predictors of revisits among patients with ureteral calculi in the ED. Data from patients who presented at a tertiary academic hospital in Seoul, Republic of Korea, between February 2018 and December 2019, were analyzed retrospectively. Variables, including the respiratory rate (RR), estimated glomerular filtration rate (eGFR), duration of pain, number of analgesic doses, location of ureteral calculi, and ED length of stay (LOS) were examined using logistic regression. We also examined some additional variables included in the STONE and CHOKAI scoring systems to examine their association with revisit. Significant predictors of revisits included the number of analgesic doses and the location of ureteral calculi. Patients who required multiple analgesic doses or those with proximal or mid-ureteral calculi were more likely to revisit the ED. Although the STONE and CHOKAI scores could predict uncomplicated ureteral calculi, we found that the CHOKAI score is a valuable tool for predicting the likelihood of patient revisits (p = 0.021). Effective pain management and consideration of calculi location are important for predicting patient revisits. More research is required to validate findings, develop precise predictive models, and empower tailored care for high-risk patients. In patients with ureteral calculi in the ED, the number of analgesics given and stone location predict return visits. Proximal ureteral calculi on CT may require early urologic intervention to prevent pain-related revisits.

Comparison of STONE Score, Guy's Stone Score, CROES Nomogram, and Seoul National University Renal Stone Complexity Score in Prognosticating Outcomes of Multiple-Tract Mini-Percutaneous Nephrolithotomy: A Retrospective Study.

Objective The objective of this study was to compare the STONE score (Size of the stone, Topography or location, degree of Obstruction of the urinary system, Number of stones, and Evaluation of Hounsfield units), Guy's stone score (GSS), Clinical Research Office of the Endourological Society (CROES) nomogram, and Seoul National University Renal Stone Complexity Score (RSCS) in prognosticating multiple tract mini-percutaneous nephrolithotomy (mPCNL) outcome. Methodology Thisdescriptive retrospective analysis was carried out at the Urology Department, Lady Reading Hospital, Peshawar, Pakistan. Male and female patients in the age range of 18-70 years who underwent multiple tract mPCNL for renal stones from July 1, 2021, to June 30, 2023, were included in the analysis. Results A total of 110 patients were registered. Stone-free status (SFS) was achieved in 78.2% (n=86), and complications were observed in 13.6% (n=15) patients. The odds ratio for STONE score, GSS, CROES scoring system, and RSCS for predicting the SFS was 7.093 (95%CI 2.40-20.89), 9.333 (95%CI 2.92-29.81), 11.70 (95%CI 2.56-53.38) and 3.450 (95%CI 1.25-9.53), respectively. Conclusion Multiple tract mPCNL is a safe and effective technique for the management of renal stones, producing a high stone-free rate. This study demonstrated adequate efficacy and dependability of the four scoring systems in predicting SFS.

The Outcome of the Miniaturized Percutaneous Nephrolithotomy in Lateral Position with Guidance of Non-Rotational C-Arm.

Evaluation of the outcome of the miniaturized percutaneous nephrolithotomy in the treatment of nephrolithiasis with a lateral position based on the principle of a right triangle under the guidance of a C-Arm without contrast fluid. Sixty-nine cases of Mini-PCNL with the assistance of a vacuum-assisted sheath in the lateral position were performed at Central Hospital from March 2021 to August 2022. Percutaneous renal access was under the guidance of a non-rotational C-arm without contrast medium, and we determined the puncture location and depth of the needle based on the principle of right triangles. The median age was 51.6 ± 12.5 years, and males accounted for 68.1% of the cases. 60.9% of all patients had normal weight. The median stone surface area was 361.1mm2, and 59.4% of all cases were graded as 2 regarding Guy's stone score. The successful renal access rate was 100%. The tunnel access from the middle and lower calyx accounted for 94.2%. The median access duration, fluoroscopy duration, and hospital length of stay were 271.7 seconds, 14.79 seconds, and 6.3 days, respectively. The complete stone clearance rate was 78.3%. Bleeding complications occurred in 2 patients without mortality. Three patients required an additional procedure. The puncture technique into the renal calyxes based on the principle of the right triangle under the guidance of a non-rotational C-Arm without contrast medium in PCNL is a fast, exact, and safe technique.

A comparison of S.T.O.N.E nephrolithometry scoring system, Guy's stone score, and Seoul National University Renal Stone Complexity (S-ReSC) in predicting mini-PCNL stone-free rate.

The main goal of the study is to evaluate the three stone scoring systems (S.T.O.N.E nephrolithometry scoring system (STONE), Guy's stone score (GSS) and Seoul National University Renal Stone Complexity (S-ReSC)) for the stone-free rate (SFR) of mini-PCNL. We retrospectively analyzed 72 patients who received mini-PCNL from February 2018 to October 2020. The SFR, complication rates, hospitalization days and recurrence rates were analyzed using three stone scoring systems. The result showed statistical significance in the association between scoring system and stone-free (STONE: OR 95%CI 0.409 (0.221-0.759), p = 0.0045; S-ReSC OR 95%CI 0.633 (0.401-0.999), p = 0.0497), but not GSS (OR 95%CI 0.776 (0.397-1.516), p = 0.4581). After adjusting the potential confounding factors, the area under curve (AUC) of STONE, GSS, and S-ReSC was 0.86, 0.78, and 0.81, respectively, and Akaike information criterion (AIC) of STONE, GSS, and S-ReSC was 64.65, 74.89, and 69.92, respectively. The accuracy rate of STONE, GSS, and S-ReSC was 0.81, 0.75, and 0.79, respectively. There was no statistically difference of predicting stone recurrence (p = 0.46, 0.53, 0.86), complications (p = 0.74, 0.51, 0.16) and hospitalization days (p = 0.77, 0.86, 0.87) in STONE, GSS, and S-ReSC, respectively. In conclusion, both the STONE and S-ReSC stone scoring systems are viable for predicting the SFR following mini-PCNL, especially after variable adjustment with the STONE system demonstrating superiority over S-ReSC.

Renal colic in the emergency department, clinical features and diagnosis

A study was conducted by reviewing the literature regarding renal colic (RC) in emergency department (ED) to determine the diagnostic value of the physical examination, patient history, imaging results, and laboratory test, either alone or in conjunction with one another. The PRISMA statement was followed in the course of this systematic review investigation. A comprehensive search was performed from 2018 to 2023 using MEDLINE, Google Scholar, and EMBASE to find published English-language studies assessing the diagnostic value of clinical symptoms and signs, clinical examination, Imaging, and laboratory investigations for RC diagnosis. The study was limited to adult patients suspected of having renal colic and presenting with severe pain of unknown cause. It was found that Acupuncture is safe, quick, and significantly less painful than sham acupuncture for patients with renal colic when combined with an intramuscular injection of diclofenac. A diagnostic approach that excludes ureteric calculi solely based on the lack of hydronephrosis, hematuria, or both might miss a very small number of stones. By using the straightforward and helpful STONE score at the emergency room, patients with renal colic can avoid needless CT scans in addition to saving money and ionizing radiation exposure. It was concluded that the CHOKAI score performs better in terms of diagnostic performance than the STONE score.

S.T.O.N.E Score versus Guy’s Stone Score in the Prediction of Stone Clearance in Percutaneous Nephrolithotomy: A Cross-sectional Study

Introduction: Percutaneous Nephrolithotomy (PCNL) has become the standard of care for large renal calculi. The aim of the surgery is to achieve maximum stone clearance with minimal postoperative complications. Various scoring systems have been described to predict both of these outcomes. S.T.O.N.E. Score and Guy's Stone Score (GSS) are two of the most widely used scoring systems. S.T.O.N.E. Score comprises of Size of the stone, Tract length, degree of Obstruction of the urinary system, Number of stones, and Essence. Aim: To compare the predictive power for stone clearance and postoperative complications of the two scoring systems, namely S.T.O.N.E. Score and GSS. Materials and Methods: This cross-sectional study was conducted at the Department of Genitourinary Surgery at Government Medical College, Kottayam, Kerala, India from March 2019 to August 2020. All patients above 18 years undergoing PCNL were included. A total of 122 patients were studied by calculating the preoperative S.T.O.N.E. Score and GSS and comparing them with post-PCNL stone clearance and complications. The association of both S.T.O.N.E. Score and GSS with stone clearance was estimated by plotting the Receiver Operating Curve (ROC) curve using Statistical Package for Social Sciences (SPSS) version 20, International Business Machines (IBM) SPSS Statistics windows, version 20.0 (Armonk, NY: IBM Corp.). A p-value &lt;0.05 was considered statistically significant. Results: The mean age of the subjects was 49.8±12.47 years. A total of 76 males and 46 females were included in the present study. The mean S.T.O.N.E. Score among the study subjects was 7.12±1.57, and the mean GSS was 2.09±0.48. Complete stone clearance was achieved in 96 (78.7%) patients. A total of 22 (18%) patients had postoperative complications. Both scores had a significant association with stone clearance (p&lt;0.001 for both) and postoperative complications (p-value for S.T.O.N.E. Score was 0.019 and GSS was 0.007). Conclusion: Both the S.T.O.N.E. Score and GSS can predict post-PCNL stone clearance and complications with comparable efficacy