Key Points
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The need for standardized outcome reporting following percutaneous nephrolithotomy resulted in the creation of the four major validated scoring systems Guy's stone score, S.T.O.N.E. nephrolithometry, CROES nomogram, and S-ReSC score
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The four scoring systems have similar ability to predict postoperative stone-free rate but their ability to predict complications varies; the Guy's stone score is the only system predictive of both stone-free rate and complications
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The S.T.O.N.E. score provides the best combination of ability to predict stone-free rate, minimal subjectivity when scoring, and simplicity in clinical application
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The S-ReSC score provides similar information to the S.T.O.N.E. score but it was created on the basis of expert opinion and no studies exist that compare S-ReSC with other systems
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The CROES nomogram was created using data from a large multicentre database but its application in daily practice is hindered by the need to know multiple patient characteristics for score calculation
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Increasing use of scoring will provide additional data on factors that are most predictive of stone-free rate and complications following PCNL and might help create an optimum unified system in the future
Abstract
Percutaneous nephrolithotomy has become the preferred treatment modality for patients with large renal calculi. The technique provides excellent stone clearance, but complication rates are higher than those of minimally invasive techniques, such as ureteroscopy and shockwave lithotripsy. Guy's stone score, S.T.O.N.E. nephrolithometry, the CROES nomogram, and S-ReSC are contemporary scoring systems introduced to provide standardized grading of stone complexity and outcomes of percutaneous stone surgery. Guy's stone score is easy to apply and has been validated in multiple studies. The S.T.O.N.E. score is based on factors determined through CT imaging, which is the currently preferred imaging modality for patients with nephrolithiasis. The CROES nomogram was developed from data in a large multicentre database and has high statistical power. Determination of the S-ReSC score relies on stone location only, providing a simple approach to grading disease complexity. Each system has advantages and disadvantages, but several studies suggest that their ability to predict stone-free rate is comparable. The optimal system should have a high predictive ability, should be simple to use and should be widely applicable. Additional studies are required to evaluate patient clinical factors that influence stone complexity and are predictive of outcomes. A future unified scoring system might incorporate the strengths of each currently available system and optimize care of patients with nephrolithiasis.
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Wu, W., Okeke, Z. Current clinical scoring systems of percutaneous nephrolithotomy outcomes. Nat Rev Urol 14, 459–469 (2017). https://doi.org/10.1038/nrurol.2017.71
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DOI: https://doi.org/10.1038/nrurol.2017.71
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