Resorlu-Unsal 结石评分对逆行肾内手术治疗结局预测的外部验证：单中心经验。
External validation of Resorlu-Unsal stone score in predicting outcomes after retrograde intrarenal surgery. Experience from a single institution.
机构信息
Department of Maternal-Infant and Urological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome.
"Cristo Re" Hospital, Rome.
出版信息
Arch Ital Urol Androl. 2022 Sep 26;94(3):311-314. doi: 10.4081/aiua.2022.3.311.
OBJECTIVE
Pre-operative assessment of renal stones is essential in selecting treatment options and achieving high success rates for retrograde intrarenal surgery (RIRS). Several nephrolithometric scoring systems have been developed using pre-operative clinical data and stone characteristics. Resorlu-Unsal stone score (RUSS) is composed of four different parameters, and each of them adds 1 point to the final score. One point is added in patients with stone size > 20 mm, lower calyceal stones and infundibulo-pelvic angle < 45°, stone number > 1, and abnormal anatomy, respec-tively. RUSS categorizes patients into four distinct groups and aims to predict stone-free rates (SFR) after RIRS. We externally validated RUSS and evaluated its predictive accuracy.
MATERIALS AND METHODS
We performed a retrospective analysis of patients who underwent RIRS for renal stones between January 2020 and December 2021. Patient age, pre-operative hydronephrosis, stone size, stone density as Hounsfield Unit (HU), operative time and RUSS were investigated as potential preoperative predictive factors for stone-free status. RUSS was applied to all patients, and the nomogram was externally vali-dated. Area under the curve (AUC) was used for clinical validity assessment.
RESULTS
The present study included a total of 79 patients. Mean patient age was 55.1 ± 15.4 years with a mean stone size was 14.2 ± 4.4 mm. Overall, 62/79 (78.4%) patients were stone free after the initial treatment. After applying RUSS, 36 (45.6%), 29 (36.7%), 10 (12.6%), and 4 (5.1%) patients had a score of 0, 1, 2, and 3, respectively. On multivariate logistic regression RUSS (OR = 0.220; 95%CI: 0.086-0.567; p = 0.002) was identified as the only predictor of postoperative stone-free status.
CONCLUSIONS
RUSS is a user-friendly scoring system that may predict postoperative stone-free rate after RIRS with great effi-cacy and accuracy.
目的
术前评估肾结石对于选择治疗方案和实现逆行肾内手术（RIRS）的高成功率至关重要。已经开发了几种基于术前临床数据和结石特征的肾石计量评分系统。Resorlu-Unsal 结石评分（RUSS）由四个不同的参数组成，每个参数为最终评分增加 1 分。如果结石大小>20mm、下盏结石和漏斗肾盂角<45°、结石数量>1 以及存在异常解剖结构，则分别增加 1 分。RUSS 将患者分为四个不同的组，旨在预测 RIRS 后的结石清除率（SFR）。我们对外验证了 RUSS 并评估了其预测准确性。
材料和方法
我们对 2020 年 1 月至 2021 年 12 月期间接受 RIRS 治疗肾结石的患者进行了回顾性分析。研究了患者年龄、术前肾积水、结石大小、结石密度（以亨氏单位[HU]表示）、手术时间和 RUSS 等作为结石清除状态的潜在术前预测因素。对所有患者应用 RUSS，并对外验证了列线图。曲线下面积（AUC）用于评估临床有效性。
结果
本研究共纳入 79 例患者。患者平均年龄为 55.1±15.4 岁，平均结石大小为 14.2±4.4mm。总体而言，79 例患者中有 62 例（78.4%）在初次治疗后结石清除。应用 RUSS 后，36 例（45.6%）、29 例（36.7%）、10 例（12.6%）和 4 例（5.1%）患者的评分分别为 0、1、2 和 3。多变量逻辑回归显示，RUSS（OR=0.220；95%CI：0.086-0.567；p=0.002）是术后结石清除状态的唯一预测因素。
结论
RUSS 是一种用户友好的评分系统，可有效地、准确地预测 RIRS 术后结石清除率。
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