Multicenter External Validation and Comparison of Stone Scoring Systems in Predicting Outcomes After Percutaneous Nephrolithotomy

Tailly, Thomas; Okhunov, Zhamshid; Nadeau, Brandon R; Huynh, Melissa; Labadie, Kevin P.; Akhavein, Arash; Violette, Philippe D.; Olvera‐Posada, Daniel; Alenezi, Husain; Amann, Justin; Bird, Vincent G.; Landman, Jaime; Smith, Arthur D.; Denstedt, John D.; Razvi, Hassan

doi:10.1089/end.2015.0700

Cited by 45 publications

(35 citation statements)

References 33 publications

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“…20 In general, these studies showed a comparable performance of GSS grading (AUC = 0.629-0.821) versus the CROES nomogram (AUC = 0.627-0.820) in predicting post-PCNL SFR. [21][22][23][24][25][26][27] In a systematic review, Withington and colleagues showed that although the validity of GSS is supported by a marginally higher quality of evidence compared with other nomograms, in general, the performance of all systems is similar for stonefree status. However, their questionable efficacy for predicting post-PCNL adverse events called attention to the need for further improvement.…”

Section: Discussionmentioning

confidence: 99%

Predicting the Postoperative Outcome of Percutaneous Nephrolithotomy with Machine Learning System: Software Validation and Comparative Analysis with Guy's Stone Score and the CROES Nomogram

Aminsharifi

Irani

Tayebi

et al. 2020

Journal of Endourology

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Purpose: To validate the output of a machine learning-based software as an intelligible interface for predicting multiple outcomes after percutaneous nephrolithotomy (PCNL). We compared the performance of this system with Guy's stone score (GSS) and the Clinical Research Office of Endourological Society (CROES) nomogram. Patients and Methods: Data from 146 adult patients (87 males, 59%) who underwent PCNL at our institute were used. To validate the system, accuracy of the software for predicting each postoperative outcome was compared with the actual outcome. Similarly, preoperative data were analyzed with GSS and CROES nomograms to determine stone-free status as predicted by these nomograms. A receiver operating characteristic (ROC) curve was generated for each scoring system, and the area under the ROC curve (AUC) was calculated and used to assess the predictive performance of all three models. Results: Overall stone-free rate was 72.6% (106/146). Forty of 146 patients (27.4%) were scheduled for 42 ancillary procedures (extracorporeal shockwave lithotripsy [SWL] [n = 31] or repeat PCNL [n = 11]) to manage residual renal stones. Overall, the machine learning system predicted the PCNL outcomes with an accuracy ranging between 80% and 95.1%. For predicting the stone-free status, the AUC for the software (0.915) was significantly larger than the AUC for GSS (0.615) or CROES nomograms (0.621) (p < 0.001). Conclusion: At the internal institutional level, the machine learning-based software was a promising tool for recording, processing, and predicting outcomes after PCNL. Validation of this system against an external dataset is highly recommended before its widespread application.

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Section: Discussionmentioning

confidence: 99%

Predicting the Postoperative Outcome of Percutaneous Nephrolithotomy with Machine Learning System: Software Validation and Comparative Analysis with Guy's Stone Score and the CROES Nomogram

Aminsharifi

Irani

Tayebi

et al. 2020

Journal of Endourology

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“…In a recent work by Choi et al comparing these three scoring systems for tubeless PCNL, noted that Guy's stone score was the only signiicant predictive factor for stone free and complication rates. However, Tailly et al [35] earlier noted no diference in the ability to predict stone free rate comparing the three scoring systems after PCNL.…”

Section: Ct Beyond the Diagnosis Of Stonementioning

confidence: 96%

Non-contrast CT in the Evaluation of Urinary Tract Stone Obstruction and Haematuria

Ather¹,

Memon²,

Aziz³

et al. 2017

Computed Tomography - Advanced Applications

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Non-contrast computed tomography (CT) abdomen has emerged as a irst line investigation in suspected upper urinary tract obstruction. Underlying causes can usually be ascertained on computed tomography of kidneys, ureters and bladder (CT KUB). However, further investigations may be required to delineate/conirm underlying pathology like ureteropelvic junction obstruction (UPJ), diferentiation between obstruction and residual dilatation. Actual protocol of CT KUB for evaluation of stone disease and haematuria vary on institutional guidelines. CT KUB is not only extremely sensitive and speciic in the diagnosis of stone; it is now used in the pre-operative nomograms in predicting success of various endourological interventions like percutaneous nephrolithotomy (PCNL) and shock wave lithotripsy (SWL). Determination of stone density, stone volume, stone composition, skin to stone distance, presence of ureteral wall oedema, perinephric oedema are highly predictive of stone free rate. CT recognition of various anomalies, presence of retro-renal colon, horse-shoe kidney, malrotation, etc. can help in beter planning to avoid complications. One of the major limitations of CT is the radiation dose, besides cost and availability. Modiication in technique and technological innovation has resulted in signiicant dose reduction from 4.5 to about 1 mSv.

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“…Thus, it is understandable why a model that is designed to optimally statistically predict SFR may not do well when applied to other outcomes. We thus find it not surprising when conflicting data exists for the association of ordinal, as well as the CROES score, with complications (with more favourable data for ordinal scores) [9,10,[13][14][15]19,21]. These conflicting reports can be explained by issues of sample size, variations in expertise, patient-related factors (comorbidities), and surgical approach characteristics.…”

Section: Scoring Systemmentioning

confidence: 99%

“…and CROES scores also found to be associated with complications), although cross-comparative studies have been fewer [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The only systematic review concluded with ambiguity over the clear superiority of any one system and recommended further validation studies [23].…”

Section: Introductionmentioning

confidence: 99%

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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Multicenter External Validation and Comparison of Stone Scoring Systems in Predicting Outcomes After Percutaneous Nephrolithotomy

Cited by 45 publications

References 33 publications

Predicting the Postoperative Outcome of Percutaneous Nephrolithotomy with Machine Learning System: Software Validation and Comparative Analysis with Guy's Stone Score and the CROES Nomogram

Predicting the Postoperative Outcome of Percutaneous Nephrolithotomy with Machine Learning System: Software Validation and Comparative Analysis with Guy's Stone Score and the CROES Nomogram

Non-contrast CT in the Evaluation of Urinary Tract Stone Obstruction and Haematuria

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

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