Correlation of the S.T.O.N.E. Score with surgical outcomes of Percutaneous Nephrolithotomy in an academic hospital
DOI:
https://doi.org/10.34117/bjdv9n6-125Keywords:
S.T.O.N.E, Percutaneous Nephrolithotomy, complications, lithiasisAbstract
Introduction: Percutaneous nephrolithotomy (PCNL) is the best option for the treatment of patients with large kidney stones. The S.T.O.N.E score system takes measurements of objective parameters from preoperative tomography into account, and aims to provide the surgical team with a preliminary assessment of the complexity of each case, allowing the surgeon to more accurately predict the final results of PCNL. However, adequate studies that confirm its results and effectiveness are so far lacking. Hence, our objective was to correlate the S.T.O.N.E. nephrolithometry scoring system to the actual surgical outcomes achieved in a cohort of patients undergoing PCNL, in an academic hospital.Patients e Methods: We retrospectively reviewed the charts of 277 consecutive patients who underwent percutaneous nephrolithotomy from 2014 to 2019 in our academic hospital. Only those patients with all radiological images available for review were included in this cohort. The S.T.O.N.E nephrolithotomy score was calculated based on the preoperative computed tomography (CT) scans and then correlated with stone-free rate (SFR), postoperative complications (PC) in accordance with the Clavien-Dindo system, length of hospital stay (LHS) and operative time (OT). Results: A total of 193 PCNLs were included. Mean age was 50.7 years (25-82); 56% of patients were female, and the right side was slightly more affected (51.8%). The mean S.T.O.N.E. score for the entire cohort was 8.45, but for patients with residual stone after PCNL, this figure was actually higher, at 9.4 (p <0.01). The overall SFR after an initial procedure was 51.8%, with logistic regression analysis showing that the number of involved calyces and stone size were significantly correlated with stone-free status (p<0.001). Mean LHS (3.47 days) and OT (117.9 mins) also significantly correlated with S.T.O.N.E. score (p<0.001). The overall complication rate after the primary procedure was 16.6% (of which 68.8% were grade I or II), and there were no complications Grades IVb or V. There was no significant correlation between complications and the S.T.O.N.E. score (p=0.37). Conclusion: The S.T.O.N.E nephrolithometry score was significantly associated with stone free status, operative time and length of hospital stay, although not with occurrence of complications.
References
Astolfi RH, Carrera R, Gattas N, Bertolla R, Sepulveda F, Reggio E, et al.: Current scenario of endourological treatment of kidney stones in Brazil: results of a national survey. Int. Braz J Urol. [online]. 2020, 46(3), 400-08.
Scales CD Jr, Smith AC, Hanley J, Saigal CS: Urologic Diseases in America Project. Prevalence of kidneystones in the United States. Eur Urol. 2012; 62:160-165.
Saigal CS, Joyce G, Timilsina AR: Urologic Diseases in America Project. Direct and indirect costs of nephrolithiasis in an employed population: opportunity for disease management? Kidney Int. 2005; 68:1808-14.
Vernez SLOZ, Motamedinia P, Bird V, Okeke Z, Smith A: Nephrolithometric scoring systems to predict outcomes of percutaneous Nephrolithotomy. Rev Urol. 2016; 18(1):15–27.
Maghsoudi R, Etemadian M, Kashi AH, Ranjbaran A: The association of stone opacity in plain radiography with percutaneous nephrolithotomy outcomes and complications. Urol J. 2016; 13:2899902.
Magrill D, Patel U, Anson K: Impact of imaging in urolithiasis treatment planning. Curr Opin Urol. 2013; 23:15863.
De S, Autorino R, Kim FJ, Zargar H, Laydner H, Balsamo R, et al.: Percutaneous nephrolithotomy versus retrograde intrarenal surgery: A systematic review and metaanalysis. Eur Urol. 2015; 67:12537.
Binbay M, Akman T, Ozgor F, et al.: Does pelvicaliceal system anatomy affect success of percutaneous nephrolithotomy? Urology. 2011; 78:733-737.
Resorlu B, Oguz U, Resorlu EB, et al: The impact of pelvicaliceal anatomy on the success of retrograde intrarenal surgery in patients with lower pole renal stones. Urology. 2012; 79:61-66.
Osther PJ, Razvi H, Liatsikos E, Averch T, Crisci A, Garcia JL, Mandal A, de la Rosette J; Croes PCNL Study Group. Percutaneous nephrolithotomy among patients with renal anomalies: patient characteristics and outcomes; a subgroup analysis of the clinical research office of the endourological society global percutaneous nephrolithotomy study. J Endourol. 2011 Oct;25(10):1627-32.
El-Nahas AR, Eraky I, Shokeir AA, Shoma AM, ElAssmy AM, ElTabey NA, et al.: Factors affecting stonefree rate and complications of percutaneous nephrolithotomy for treatment of staghorn stone. Urology. 2012; 79:123641.
Shahrour K, Tomaszewski J, Ortiz T, Scott E, Sternberg KM, Jackman SV, et al.: Predictors of immediate postoperative outcome of singletract percutaneous nephrolithotomy. Urology 2012; 80:1925.
Thomas K, Smith NC, Hegarty N et al.: The Guy’s stone score-grading the complexity of percutaneous nephrolithotomy procedures. Urology. 2011; 78:277–281.
Smith A, Averch TD, Shahrour K et al.: A nephrolithometric nomogram to predict treatment success of percutaneous nephrolithotomy. J Urol. 2013; 190:149–156.
Okhunov Z, Friedlander JI, George AK et al: S.T.O.N.E. Nephrolithometry: novel surgical classification system for kidney calculi. Urology. 2013; 81:1154–1160.
Mishra S, Sabnis RB, Desai M: Staghorn morphometry: a new tool for clinical classification and prediction model for percutaneous nephrolithotomy monotherapy. J Endourol. 2012; 26:6–14.
Tailly T, Razvi H: The S.T.O.N.E. nephrolithometry scoring system: how valid is it? Can Urol Assoc J. 2015; 9:196.
Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13.
Brasil. Ministério da Saúde. Datasus. Morbidade hospitalar do SUS por local de internação - Brasil. 2017. Available at. <http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sih/cnv/niuf.def> [accessed on 2018 October23]. http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sih/cnv/niuf.def.
Netto Jr NR, Toledo Fº JS, Leitão VA: Projeto Diretrizes. Associação Médica Brasileira e Conselho Federal de Medicina. Sociedade Brasileira de Urologia. 2006.
da Silva SFR, da Silva SL, Campos HL, De Francesco Daher E, da Silva CAB: Demographic, clinical and laboratory data of patients with urinary lithiasis in Fortaleza, Ceará. J Bras Nefrol. 2011;33(3):295-299.
Scales CD, Curtis LH, Norris RD, Springhart WP, Sur RL, Schulman KA, et al.: Changing gender prevalence of stone disease. J Urol 2007; 177:979-82.
Amaro CR, Goldberg J, Amaro JL, Padovani CR: Metabolic assessment in patients with urinary lithiasis. Int Braz J Urol. 2005; 31:29-33.
Daudon M, Traxer O, Lechevallier E, Saussine C: Épidemiologie des lithiases urinaires. Prog Urol 2008; 18:802-14.
Shekarriz B, Lu HF, Stoller ML: Correlation of unilateral urolithiasis with sleep posture. J Urol 2001; 165:1085-7.
Soucy F, Ko R, Duvdevani M, et al.: Percutaneous nephrolithotomy for staghorn calculi: a single center's experience over 15 years. J Endourol. 2009; 23(10):1669–73.
