Evaluation and comparison of scoring systems for predicting stone-free status after flexible ureteroscopy for renal and ureteral stones

Richard, François; Marguin, Jonathan; Frontczak, A.; Barkatz, Johann; Balssa, L.; Bernardini, S.; Chabannes, É.; Guichard, G.; Bittard, Hugues; Kleinclauss, F.

doi:10.1371/journal.pone.0237068

Cited by 18 publications

(22 citation statements)

References 33 publications

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“…RUS score. Eight studies reported AUCs for RUS score [ 4 , 5 , 16 , 20 , 21 , 22 , 25 , 26 ]. Meta-analysis yielded a pooled AUC of 0.711 (95% CI 0.668 to 0.754).…”

Section: Resultsmentioning

confidence: 99%

Recent scoring systems predicting stone-free status after retrograde intrarenal surgery; a systematic review and meta-analysis

Özman

Akgül

Başataç

et al. 2022

Cent european J Urol

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Introduction Several scoring systems and nomograms have been developed to predict the success of retrograde intrarenal surgery. But no meta-analysis for the performance of scoring systems has yet been performed. The aim of this study was to compare predictive ability of recent scoring systems for stone-free rate of retrograde intrarenal surgery. Material and methods PubMed and Web of Science databases were searched systematically between April and May 2021. The scoring systems which were validated externally or studied at least by two different researcher groups were selected for further analysis. Of 59 records, 14 studies met the inclusion criteria (n = 4137). Area under curve (AUC) values of selected scoring systems were pooled in random or fixed effects. The I 2 test was used to quantify heterogeneity. Results Eight, 5, 8, 4 and 3 studies included in meta-analyses for the modified Seoul National University Renal Stone Complexity Score (S-ReSC), R.I.R.S., Resorlu-Unsal Score (RUS), S.T.O.N.E., and Ito’s Nomogram, respectively. We found pooled AUC values 0.709 (95% CI 0.670–0.748), 0.704 (95% CI 0.668–0.739), 0.669 (95% CI 0.646 to 0.692), and 0.771 (95% CI 0.724 to 0.818), for first four of them, respectively. Heterogeneity was very high to pool AUC values for Ito’s nomogram. Conclusions Although S.T.O.N.E. score showed higer pooled AUC value, this systematic review and meta-analysis has not revealed superiority of any scoring system. High heterogeneity between studies and dependencies between scoring systems make it difficult to design a comparative statistical model to generalize the findings. Also, limitations aside, neither scoring system has demonstrated good predictive/discriminative performance.

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“…RUS score. Eight studies reported AUCs for RUS score [ 4 , 5 , 16 , 20 , 21 , 22 , 25 , 26 ]. Meta-analysis yielded a pooled AUC of 0.711 (95% CI 0.668 to 0.754).…”

Section: Resultsmentioning

confidence: 99%

Recent scoring systems predicting stone-free status after retrograde intrarenal surgery; a systematic review and meta-analysis

Özman

Akgül

Başataç

et al. 2022

Cent european J Urol

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“…And the AUC values were not satisfactory in terms of nomogram’s predictive accuracy (0.655 and 0.596 for RUSS and modified S‐ReSC, respectively). In another recent study by Richard et al RUSS, modified S‐ReSC, S.T.O.N.E., and Ito’s nomogram were compared 11 . The major limitation of that study was evaluation of the stone‐free status that they made it via visual inspection using ureterorenoscope and fluoroscopy at the end of the procedure in the absence of clinical complications.…”

Section: Resultsmentioning

confidence: 99%

“…10 And the AUC values were Ito's nomogram were compared. 11 The major limitation of that study was evaluation of the stone-free status that they made it via visual inspection using ureterorenoscope and fluoroscopy at the end of the procedure in the absence of clinical complications. They concluded that all scoring systems were predicted the stone-free status but none of them were predictive of complications after RIRS.…”

Section: Commentmentioning

confidence: 99%

External validation and comparison of current scoring systems in retrograde intrarenal surgery: Multi‐institutional study with 949 patients

Bozkurt

Karakoyunlu

Koraş

et al. 2021

Int J Clinical Practice

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Objectives To externally validate and compare Resorlu‐Unsal stone score (RUSS), modified Seoul National University Renal Stone Complexity Score(S‐ReSC), Ito’s nomogram, and Retrograde Intra‐Renal Surgery (R.I.R.S.) scoring systems for predicting capabilities of both the stone‐free status and complications in a multi‐institutional study. Materials and Methods We performed a retrospective analysis of 949 patients who underwent flexible ureterorenoscopy (f‐URS) and laser lithotripsy for renal stones in two institutions between March‐2015 and June‐2020. The RUSS, modified S‐ReSC, Ito’s nomogram, and R.I.R.S. scores were calculated for each patient by the same surgeon on imaging methods. Results were compared for their predictive capability of stone‐free status and complications. Results Of 949 patients 603 were male and 346 were female with a mean age of 47.2 ± 14.3 (range 2‐84 years). Mean stone burden was 102.6 ± 42.2 (48‐270 mm2). All nomograms predicted stone‐free status (Area Under Curve (AUC) were 0.689, 0.657, 0.303, and 0.690, respectively). All four scoring systems predicted complications with AUC values of 0.689, 0.646, 0.286, and 0.664 for RUSS, modified S‐ReSC, Ito’s nomogram, and R.I.R.S., respectively. Although all scoring systems were able to predict complications only Ito’s nomogram was able to predict Clavien ≥2 complications. Conclusion All four scoring systems (RUSS, modified S‐ReSC, Ito’s nomogram, and R.I.R.S.) could predict stone‐free status after f‐URS, however, the AUC values are not satisfactory in our large patient cohort. Although these scoring systems were not developed for predicting post‐operative complications, they were associated with complications in our study. However, these four scoring systems have some significant limitations. The ideal scoring system is yet to be developed.

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“…score for SFR following retrograde intrarenal surgery. Richard et al 27 28 reported the stone burden and S. T.O.N.E. score were statistically significantly higher in patients with a residual stone (p < 0.001, for both).…”

Section: Discussionmentioning

confidence: 95%

“…score for SFR following retrograde intrarenal surgery. Richard et al 27 retrospectively reviewed 800 flexible URS procedures and demonstrated that the AUC for the ROC of the S.T.O.N.E score exhibited an intermediate level of prediction; 0.644 [95% CI: 0.609–0.680]. Karsiyakali et al 28 reported the stone burden and S.T.O.N.E.…”

Section: Discussionmentioning

confidence: 99%

External Validation of the S.T.O.N.E. Score in Predicting Stone-Free Status After Rigid Ureteroscopic Lithotripsy

Sirirak

Sangkum

Phengsalae

et al. 2021

RRU

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Background: The Size, Topography, Obstruction, Number, and Evaluation of Hounsfield units (S.T.O.N.E.) scoring system has been proposed as a novel prognostic surgical classification for urolithiasis in predicting success rate and complications. Objective: We carried out an externally validated S.T.O.N.E. score on rigid ureteroscopic lithotripsy (rURS). Materials and Methods: The data of patients who had undergone rURS between 2012 and 2019 at a tertiary referral center were audited retrospectively. The S.T.O.N.E. score was calculated based on factors determined through preoperative computed tomography images and was analyzed in association with stone-free rate (SFR), operating time, surgical complications, and length of stay (LOS). Results: A total of 155 patients were included in the study with a median stone size of 10 mm (7-12) and a median S.T.O.N.E. score of 9 (8-10). The overall SFR was 89.68%. SFRs were 100.0%, 97.83%, and 77.42% in low (5), moderate (6-9), and high (10-13) score groups, respectively. The S.T.O.N.E. score (p = 0.002) and stone size (p = 0.037) were predictive factors for SFR in multivariate analysis. Moreover, there was a significant correlation between the S.T.O.N.E. score and operative time, LOS, and presence of complications (r = 0.22, p = 0.006; r = 0.30, p < 0.001; and r = 0.27, p < 0.001, respectively). The area under the curve of the receiving operator characteristics' curve for the S.T.O.N.E. score was 0.815. Conclusion: The S.T.O.N.E. scoring system is simple and effective in predicting postoperative outcomes; therefore, this score would be a valuable tool in clinical planning for every patient who undergoes rURS.

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Evaluation and comparison of scoring systems for predicting stone-free status after flexible ureteroscopy for renal and ureteral stones

Cited by 18 publications

References 33 publications

Recent scoring systems predicting stone-free status after retrograde intrarenal surgery; a systematic review and meta-analysis

Recent scoring systems predicting stone-free status after retrograde intrarenal surgery; a systematic review and meta-analysis

External validation and comparison of current scoring systems in retrograde intrarenal surgery: Multi‐institutional study with 949 patients

External Validation of the S.T.O.N.E. Score in Predicting Stone-Free Status After Rigid Ureteroscopic Lithotripsy

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