Lessons learned from the CROES percutaneous nephrolithotomy global study

Kamphuis, Guido; Baard, Joyce; Westendarp, Matías; Rosette, Jean J.M.C.H. de la

doi:10.1007/s00345-014-1367-5

Cited by 83 publications

(56 citation statements)

References 60 publications

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“…Description of complication Trainee literature is controversial as to whether outcomes are equally inferior for all types of abnormal anatomy, or indeed that for some types might not be inferior at all [1,29]. Similarly, the literature is conflicting on whether the skin-to-stone distance really matters and external validation studies of the S.T.O.N.E.…”

Section: Clavien-dindo Groupmentioning

confidence: 99%

“…Percutaneous nephrolithotomy (PCNL) is the 'gold standard' treatment for large and/or complex renal stones, and data show that while overall stone-free rate (SFR) is 76%; complications may have increased with time [1]. However, stone complexity is a confounder influencing both outcomes and lowering the validity of conclusions if not properly assessed [2].…”

Section: Introductionmentioning

confidence: 99%

“…Among these, the Guy's Stone Score (GSS) was the first in 2011, and assigns calculi into four grades based on elements of number, location, and presence or absence of abnormality in the renal unit [3]. The Seoul National University Renal Stone Complexity (S-ReSC, described in 2013) scoring system considers the distributional complexity of calculi and assigns a score (range [1][2][3][4][5][6][7][8][9] relative to the presence of calculus across nine stations in the kidney with 1 point assigned for each station [4]. The S.T.O.N.E.…”

Section: Introductionmentioning

confidence: 99%

“…While standardising for the experience level of the surgeon, variation in the institution-specific sophistication of instrumentation [24], and the difference in surgical approach (in terms of access tract location, tract size, and a number of punctures) [1,25].…”

Section: Introductionmentioning

confidence: 99%

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Comparative testing of reliability and audit utility of ordinal objective calculus complexity scores. Can we make an informed choice yet?

2016

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Objectives To assess the reliability of the Guy's Stone Score, the Seoul National University Renal Stone Complexity (S‐ReSC) score and the S.T.O.N.E. scores in percutaneous nephrolithotomy (PCNL), and assess their utility in discriminating outcomes [stone free rate (SFR), complications, need for multiple PCNL sessions, and auxiliary procedures] valid across parameters of experience of surgeon, independence from surgical approach, and variations in institution‐specific instrumentation. Patients and methods A prospectively maintained database of two tertiary institutions was analysed (606 cases). Institutes differed in instrumentation, while the overall surgical team comprised: two trainees (experience <100 cases), two junior consultants (experience 100–200 cases), and two senior surgeons (experience >1000 cases). Scores were assigned and re‐assigned after 4 months by one trainee and an expert surgeon. Inter‐rater and test‐retest agreement were analysed by Cohen's κ and intraclass correlation coefficient. Multivariate logistic regression models were created adjusting outcomes for the institution, comorbidity, Amplatz size, access tract location, the number of punctures, the experience level of the surgeon, and individual scoring system, and receiver operating curves were analysed for comparison. Results Despite some areas of inconsistencies, individually all scores had excellent inter‐rater and test‐retest concordance. On multivariable analyses, while the experience of the surgeon and surgical approach characteristics (such as access tract location, Amplatz size, and number of punctures) remained independently associated with different outcomes in varying combinations, calculus complexity scores were found consistently to be independently associated with all outcomes. The S‐ReSC score had a superior association with SFR, the need for multiple PCNL sessions, and auxiliary procedures. Conclusion Individually all scoring systems performed well. On cross comparison, the S‐ReSC score consistently emerged to be more superiorly associated with all outcomes, signifying the importance of the distributional complexity of the calculus (which also indirectly amalgamates the influence of stone number, size, and anatomical location) in discriminating outcomes. Our study proves the utility of scoring systems in prognosticating multiple outcomes and also clarifies important aspects of their practical application including future roles such as benchmarking, audit, training, and objective assessment of surgical technique modifications.

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Section: Clavien-dindo Groupmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparative testing of reliability and audit utility of ordinal objective calculus complexity scores. Can we make an informed choice yet?

2016

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“…However, results of studies investigating the effect of ORSS on PNL outcomes are controversial. 4 When we analyzed previous studies on the effect of ORSS on PNL, we found that open pyelolithotomy, open nephrolithotomy, open nephropyelolithotomy, and partial nephrectomy for a non-functional part of the kidney were all grouped as ORSS. For the first time, our study categorizes patients who have undergone PNL procedure according to the types of previous ORSS.…”

Section: Introductionmentioning

confidence: 99%

The effects of previous open renal stone surgery types on PNL outcomes

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et al. 2016

CUAJ

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E246Cite as: Can Urol Assoc J 2016;10(7-8) Patients who had a history of ORSS with parenchymal insicion, such as radial nephrotomies, anatrophic nephrolithotomy, lower pole resection, and partial nephrectomy, were included in Group 1. Other patients with a history of open pyelolithotomy were enrolled in Group 2. Preoperative characteristics, perioperative data, stone-free status, and complications were compared between the groups. Stone-free status was defined as complete clearance of stone(s) or presence of residual fragments smaller than 4 mm. The retrospective nature of our study, different experience level of surgeons, and lack of the evaluation of anesthetic agents and cost of procedures were limitations of our study. Results: 123 and 111 patients were enrolled in Groups 1 and 2, respectively. Preoperative characteristics were similar between groups. In Group 1, the mean operative time was statistically longer than in Group 2 (p=0.013). Stone-free status was significantly higher in Group 2 than in Group 1 (p=0.027). Complication rates were similar between groups. Hemorrhage requiring blood transfusion was the most common complication in both groups (10.5% vs. 9.9%). Conclusions: Our study demonstrated that a history of previous ORSS with parenchymal insicion significantly reduces the success rates of PNL procedure.

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