Fayoum Faculty of Medicine, Fayoum, Egypt.
Cairo Faculty of Medicine, Cairo, Egypt.
J Urol. 2017 Nov;198(5):1146-1152. doi: 10.1016/j.juro.2017.04.084. Epub 2017 Apr 24.
We evaluate the applicability of contemporary percutaneous nephrolithotomy scoring systems in pediatric patients and compare their predictive power regarding postoperative outcomes.
We retrospectively analyzed the records of 125 children who were diagnosed with renal calculi and underwent percutaneous nephrolithotomy between March 2011 and April 2016. Predictive scores, which consisted of Guy's Stone Score, S.T.O.N.E. (stone size, tract length, obstruction, number of involved calyces and essence/stone density) nephrolithometry and CROES (Clinical Research Office of the Endourological Society) nomogram, were calculated for all patients included in the study. Patient demographics, stone-free rate and complications were all analyzed and are reported.
Median Guy's Stone Score was 2 (IQR 2 to 3) in patients with residual stones (group 1) and 2 (1 to 2) in those who were stone-free (group 2). Median respective CROES nomogram scores were 215 (IQR 210 to 235) and 257 (240 to 264), and S.T.O.N.E. nephrolithometry scores were 8 (7 to 9) and 5 (5 to 6, all p <0.0001). S.T.O.N.E. score demonstrated the greatest accuracy in predicting stone-free rate. Guy's Stone Score was significantly correlated with complications but the CROES and S.T.O.N.E. scores were not significantly correlated with complications.
The scoring systems analyzed could be used to predict success of percutaneous nephrolithotomy in the pediatric setting. However, further studies are needed to formulate modifications for use in children. The main variables in the scoring systems, ie stone burden, tract length and case volume, were measured using records from adult patients. Besides these variables, the relatively small pelvicalyceal system and higher incidence of anatomical malformations in children could potentially affect percutaneous nephrolithotomy outcomes.
我们评估了当代经皮肾镜取石术评分系统在儿科患者中的适用性，并比较了它们在术后结果方面的预测能力。
我们回顾性分析了 2011 年 3 月至 2016 年 4 月期间接受经皮肾镜取石术的 125 例肾结石患儿的病历。对所有纳入研究的患者计算了预测评分，包括 Guy's 结石评分、S.T.O.N.E.（结石大小、通道长度、梗阻、受累肾盂数量和实质/结石密度）结石测量和 CROES（内镜学会临床研究办公室）列线图。分析并报告了患者的人口统计学资料、无结石率和并发症。
有残留结石的患者（组 1）的中位 Guy's 结石评分中位数为 2（IQR 2 至 3），无结石的患者（组 2）为 2（1 至 2）。各自的 CROES 列线图评分中位数分别为 215（IQR 210 至 235）和 257（240 至 264），S.T.O.N.E. 结石测量评分中位数分别为 8（7 至 9）和 5（5 至 6，均 p<0.0001）。S.T.O.N.E. 评分在预测无结石率方面具有最高的准确性。Guy's 结石评分与并发症显著相关，但 CROES 和 S.T.O.N.E. 评分与并发症无显著相关性。
分析的评分系统可用于预测儿科经皮肾镜取石术的成功率。然而，需要进一步的研究来制定适用于儿童的修改方案。评分系统中的主要变量，即结石负荷、通道长度和病例量，是使用成人患者的记录来测量的。除了这些变量外，儿童相对较小的肾盂系统和更高的解剖畸形发生率可能会影响经皮肾镜取石术的结果。
