S.T.O.N.E. Nephrolithometry: Novel Surgical Classification System for Kidney Calculi

Okhunov, Zhamshid; Friedlander, Justin I.; George, Arvin; Duty, Brian; Moreira, Daniel M.; Srinivasan, Arun K.; Hillelsohn, Joel; Smith, Arthur D.; Okeke, Zeph

doi:10.1016/j.urology.2012.10.083

Cited by 240 publications

(222 citation statements)

References 13 publications

Supporting

Mentioning

192

Contrasting

Unclassified

Order By: Relevance

“…Patient management protocols were the same at both institutes over the study period and the only notable differences were -SSSIHMS uses a rigid nephroscope and pneumatic lithoclast, while Medanta had additional access to flexible nephroscopes and pneumatic, ultrasonic as well as laser energy sources. [3][4][5]. Thus, considering all factors including duration of the study, a sample size >600 was considered feasible and adequate.…”

Section: Methodsmentioning

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%

See 1 more Smart Citation

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

2016

View full text Add to dashboard Cite

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.

show abstract

Section: Methodsmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…Currently there are three scoring systems; Guy's score [32] described in 2011, S.T.O.N.E. nephrolithometry system [33] and CROES nephrolithometry nomogram [34] in 2013. 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.…”

Section: Ct Beyond the Diagnosis Of Stonementioning

confidence: 99%

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

Ather¹,

Memon²,

Aziz³

et al. 2017

Computed Tomography - Advanced Applications

View full text Add to dashboard Cite

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.

show abstract

“…Using this score the SFRs for low, moderate, and high-risk groups were 94-100, 83-92, and 27-64%, respectively. [8] The most recently reported scoring system is the nephrolithometric nomogram on behalf of the Clinical Research Office of the Endourological Society [2] , which includes patient related factors as well as intravenous pyelography findings, number of cases per year, prior treatments, stone burden and location, staghorn stones and overall number of stones. All of the factors listed are ranked between 0-100, with a total score obtained ranging between 0-350, with a probability of SFR from 30 to 90%, depending on the total sum obtained.…”

Section: Introductionmentioning

confidence: 99%

Rearrangement of the Guy’s stone score improves prediction of stone-free rate after percutaneous nephrolithotomy

Moreno‐Palacios

García-Peña

et al. 2018

Turkish Journal of Urology

View full text Add to dashboard Cite

Objective: We propose a modification of the original Guy´s Stone Score (GSS) to hold on 20 % of prognostic discrimination among groups which makes this score a more reliable resource for risk assessment in patients undergoing percutaneous nephrolithotomy (PCNL). Material and methods:Historical cohort of 126 patients undergoing PCNL from December 2010 to November 2014 was included in the survey. Every patient was classified according to the original GSS. For the new classification of Guy Stone Score (GSS-M) all of the subgroups included in the scale were analyzed individually and then ranked from better to worst according to the postoperative stone-free rates (SFRs). This ranking led us to reclassify all the original subgroups, clustering them in three new categories according to their SFRs as subgroups of good, intermediate and poor prognosis, trying to achieve at least 20% of prognostic discrimination among the groups.Results: Hundred and twenty-six PCNL procedures were evaluated, but only 124 were included for statistical analysis and classified based on SFR according to the GSS as follows: 76% for grade 1, 71% for grade 2, 55% for grade 3 and 20% for grade 4. The SFRs were also assessed for the GSS-M obtaining the following predictive values as 93%, 67% and 44% for the good, intermediate and poor prognostic groups, respectively. The prognostic difference among the GSS-M groups was always >20% (p<0.05). Conclusion:The original GSS has limitations to predict SFR because of its poor discrimination power among prognostic groups. This rearrangement improves prediction of SFR and better discriminates risk groups in PCNL.

show abstract

S.T.O.N.E. Nephrolithometry: Novel Surgical Classification System for Kidney Calculi

Cited by 240 publications

References 13 publications

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

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

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

Rearrangement of the Guy’s stone score improves prediction of stone-free rate after percutaneous nephrolithotomy

Contact Info

Product

Resources

About