比較mini-PCNL使用S.T.O.N.E nephrolithometry scoring system, Guy’s

stone score, 和Seoul National University Renal Stone Complexity

(S‐ReSC) 的結石廓清率的預測

陳怡璇^1,2,3,4、阮雍順^2,3,4、黃琮懿²、李香瑩^2,3,4

1高雄市立大同醫院泌尿科

2 高雄醫學大學附設醫院泌尿部

3 高雄醫學大學醫學院泌尿部

4 高雄醫學大學臨床醫學研究所

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

Yi‐Hsuan Chen^1,2,3,4 , Yung‐Shun Juan^2,3,4 , Tsung‐Yi Huang² , Hsiang‐Ying Lee^2,3,4

1 Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan

2 Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

3 Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

4 Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

Purpose:

Percutaneous Nephrolithotomy (PCNL) has been a standard treatment for patients with complex renal stones or upper ureteral stones for a long time and several stone scores pending on the stone characteristic were established to predict the stone free rate. There are studies to compare the efficacy of different 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)). Mini-percutaneous nephrolithotomy (Mini-PCNL), which is a more minimal invasive technique has become more popular with less blood loss, less pain and comparable stone free rate to traditional PCNL. The main goal of the study is to evaluate the three stone scoring systems for mini-PCNL stone free rate prediction.

Materials and Methods:

A total of 72 patients received mini-PCNL from February, 2018 to October, 2020 were retrospectively analyzed. The enrolled patients were divided into stone free and not stone free groups. The clinical characteristics of patients, stone characteristics were compared between two groups. The stone free rate, complication rates, hospitalization days and recurrence rates were analyzed using three stone scoring systems (STONE, GSS and S-ReSC). Post-operation stone free is defined as residual stone <4mm. The predictive accuracy and comparison of the three stone scoring systems was assessed using logistic regression.

Results:

The result showed statistical significance in the association between scoring system and stone-free (STONE: OR 95%C.I. :0.409(0.221-0.759), p = 0.0045; S-ReSC OR 95%C.I. :0.633(0.401-0.999), p=0.0497), but not GSS (OR 95%C.I. :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 were 0.86, 0.78 and 0.81 and akaike information criterion (AIC) of STONE, GSS, and S-ReSC were 64.65, 74.89 and 69.92 respectively. The accuracy rate of STONE, GSS and S-ReSC were 0.81, 0.75, 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.

Conclusion:

Both the STONE and S-ReSC stone scoring systems are viable for predicting the stone free rate following mini-PCNL, especially after variable adjustment with the STONE system demonstrating superiority over S-ReSC. However, the GSS may not be suitable for accurately predicting the mini-PCNL stone free rate even after adjusting the variables.