Comparison of Scoring Systems in Predicting Stone Free Rate (SFR) in Patients with Fluoroless Retrograde Intrarenal Surgery (fRIRS)
DOI:
https://doi.org/10.35790/ecl.v13i3.62803Abstract
Abstract: Between March 2022 and October 2023, a prospective study evaluated 216 patients who underwent Fluoroless Retrograde Intrarenal Surgery (fRIRS), including right, left, and bilateral procedures. The study compared the predictive abilities of Guy’s Stone Score (GSS), Seoul National University Renal Stone Complexity Score (S-ReSC), and Resorlu-Unsal Stone Score (RUSS) for stone-free rate (SFR). The patient cohort consisted of 164 men (76.3%) and 52 women (23.7%), with an average age of 57.3 years. The distribution of procedures was 49.07% right fRIRS, 49.5% left fRIRS, and 1.43% bilateral fRIRS. GSS scores were evenly split, with 50% of patients in Grade I and 50% in Grade II. S-ReSC scores were predominantly high (65.3%), with 20.4% moderate and 14.4% low. RUSS scores were distributed as 1 (43 patients), 2 (112 patients), and 3 (61 patients). The overall SFR was 82.1%, indicating a high success rate in eliminating residual stones post-procedure. In conclusion, GSS was the most accurate scoring system for predicting SFR, with an AUC of 75%, compared to S-ReSC (72%) and RUSS (70%). All three scoring systems demonstrated good predictive ability, with AUC values ≥70%. Fluoroless RIRS, a minimally invasive surgical option for kidney stones, has gained popularity due to technological advancements. While GSS showed the highest accuracy, the study highlighted the utility of all three scoring systems in preoperative planning and outcome prediction. These findings underscore the importance of scoring systems in optimizing surgical management and improving patient outcomes in kidney stone treatment.
Keywords: stone free rate; retrograde intrarenal surgery; Resorlu-Unsal score; Guy’stone score; Seoul nation university renal stone complexity score
References
Mayans L. Nephrolithiasis. Prim Care. 2019;46(2):203-12. Doi:10.1016/j.pop.2019.02.001.
Ziemba JB, Matlaga BR. Epidemiology and economics of nephrolithiasis. Investig Clin Urol. 2017;58(5):299-306. Doi:10.4111/icu.2017.58.5.299
Atmoko W, Savira M, Fajriani R, Wistara SS, Asmarinah, Harahap AR, et al. Stone recurrence among Indonesian kidney stone formers: a comprehensive analysis of genetic polymorphism, demographic, and clinical factors. Med J Indones. 2024;33(3):190-7. Doi:10.13181/mjloa.247596.
Schlomer BJ. Urologic treatment of nephrolithiasis. Curr Opin Pediatr. 2020;32(2):288-94. Doi:10.1097/MOP.0000000000000849.
Karsiyakali N, Karabay E, Erkan E, Kadihasanoglu M. Evaluation of nephrolithometric scoring systems to predict outcomes of retrograde intrarenal surgery. Urol J. 2020;17(4):352-7. Doi:10.22037/uj.v0i0.5256
Chatterjee S, Abhishek A, Samanta K, Ghosh A, Mandal SN, Karmakar D. Evaluation of various nephrometric scoring systems for nephrolithiasis to predict stone-free status after percutaneous nephrolithotomy: a comparative study. Urologia. 2022;89(3):418-23. Doi: 10.1177/03915603211030162
Jiang K, Sun F, Zhu J, Luo G, Zhang P, Ban Y, Shan G, Liu C. Evaluation of three stone-scoring systems for predicting SFR and complications after percutaneous nephrolithotomy: a systematic review and meta-analysis. BMC Urol. 2019;19(1):57. Doi: 10.1186/s12894-019-0488-y
Weiss B, Shah O. Evaluation of dusting versus basketing – can new technologies improve stone-free rates? Nat Rev Urol. 2016;13(12):726-33. doi: 10.1038/nrurol.2016.172
Cheungpasitporn W, Rossetti S, Friend K, Erickson SB, Lieske JC. Treatment effect, adherence, and safety of high fluid intake for the prevention of incident and recurrent kidney stones: a systematic review and meta-analysis. J Nephrol. 2016;29(2):211-19. Doi: 10.1007/s40620-015-0210-4
Estrade V, Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Combined approach for the management of kidney and ureteral stones (Endoscopic Combined IntraRenal Surgery, ECIRS). Prog Urol. 2023;33(14):871-4. Doi: 10.1016/j.purol.2023.08.009
Koo K, Matlaga BR. New imaging techniques in the management of stone disease. Urol Clin North Am. 2019 ;46(2):257-63. Doi:10.1016/j.ucl.2018.12.007
Brisbane W, Bailey MR, Sorensen MD. An overview of kidney stone imaging techniques. Nat Rev Urol. 2016;13(11):654-662. Doi:10.1038/nrurol.2016.154
Sfoungaristos S, Gofrit ON, Mykoniatis I, Landau EH, Katafigiotis I, Pode D, et al. External validation of Resorlu-Unsal stone score as predictor of outcomes after retrograde intrarenal surgery. Int Urol Nephrol. 2016;48(8):1247-1252. Doi:10.1007/s11255-016-1311-2
Singla A, Khattar N, Nayyar R, Mehra S, Goel H, Sood R. How practical is the application of percutaneous nephrolithotomy scoring systems? Prospective study comparing Guy's Stone Score, S.T.O.N.E. score and the Clinical Research Office of the Endourological Society (CROES) nomogram. Arab J Urol. 2017 12;15(1):7-16. Doi:10.1016/j.aju.2016.11.005
Mazzon G, Choong S, Celia A. Stone-scoring systems for predicting complications in percutaneous nephrolithotomy: A systematic review of the literature. Asian J Urol. 2023;10(3):226-38. Doi: 10.1016/j.ajur.2023.01.005
Özman O, Akgül HM, Başataç C, Sancak EB, Çınar Ö, Çakır H, Yazıcı CM, Akpınar H, Önal B; RIRSearch Study Group. Recent scoring systems predicting stone-free status after retrograde intrarenal surgery; a systematic review and meta-analysis. Cent European J Urol. 2022;75(1):72-80. Doi:10.5173/ceju.2022.0277
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