Correlation of the S.T.O.N.E. Score with surgical outcomes of Percutaneous Nephrolithotomy in an academic hospital

• Autor(a) principal: Diaz, Ana Maria
• Data de Publicação: 2023
• Outros Autores: Kawano, Paulo Roberto, Mourão, Ioana Bittencourt, Yamamoto, Hamilto Akihissa, Guerra, Rodrigo, Moraes, Bruno de Matos, Amaro, João Luiz, Fugita, Oscar Eduardo Hidetoshi
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Revista Veras
• Texto Completo: https://ojs.brazilianjournals.com.br/ojs/index.php/BRJD/article/view/60921
• topic: S.T.O.N.E; Percutaneous Nephrolithotomy; complications; lithiasis

Introduction: Percutaneous nephrolithotomy (PCNL) is the best option for the treatment of patients with large kidney stones. The S.T.O.N.E score system takes measurements of objective parameters from preoperative tomography into account, and aims to provide the surgical team with a preliminary assessment of the complexity of each case, allowing the surgeon to more accurately predict the final results of PCNL. However, adequate studies that confirm its results and effectiveness are so far lacking. Hence, our objective was to correlate the S.T.O.N.E. nephrolithometry scoring system to the actual surgical outcomes achieved in a cohort of patients undergoing PCNL, in an academic hospital.Patients e Methods: We retrospectively reviewed the charts of 277 consecutive patients who underwent percutaneous nephrolithotomy from 2014 to 2019 in our academic hospital. Only those patients with all radiological images available for review were included in this cohort. The S.T.O.N.E nephrolithotomy score was calculated based on the preoperative computed tomography (CT) scans and then correlated with stone-free rate (SFR), postoperative complications (PC) in accordance with the Clavien-Dindo system, length of hospital stay (LHS) and operative time (OT). Results: A total of 193 PCNLs were included. Mean age was 50.7 years (25-82); 56% of patients were female, and the right side was slightly more affected (51.8%).  The mean S.T.O.N.E. score for the entire cohort was 8.45, but for patients with residual stone after PCNL, this figure was actually higher, at 9.4 (p <0.01).  The overall SFR after an initial procedure was 51.8%, with logistic regression analysis showing that the number of involved calyces and stone size were significantly correlated with stone-free status (p<0.001). Mean LHS (3.47 days) and OT (117.9 mins) also significantly correlated with S.T.O.N.E. score (p<0.001). The overall complication rate after the primary procedure was 16.6% (of which 68.8% were grade I or II), and there were no complications Grades IVb or V. There was no significant correlation between complications and the S.T.O.N.E. score (p=0.37). Conclusion: The S.T.O.N.E nephrolithometry score was significantly associated with stone free status, operative time and length of hospital stay, although not with occurrence of complications.