Gelmis Mucahit, Bulut Berk, Kose Mustafa Gokhan, Gonultas Serkan, Ayten Ali, Arslan Burak
Department of Urology, Gaziosmanpasa Training and Research Hospital, Karayolları Mahallesi, Osmanbey Caddesi, 621 Sokak, Gaziosmanpaşa, Istanbul, Turkey.
Urolithiasis. 2025 Jan 7;53(1):20. doi: 10.1007/s00240-024-01689-7.
Percutaneous nephrolithotomy (PCNL) is a widely preferred method for treating complex kidney stones, particularly in patients with larger or more complicated stones. Despite its advantages, such as minimal invasiveness and a shorter recovery time, postoperative complications can occur, thereby necessitating effective risk assessment tools to identify at-risk patients. This study evaluated the Estimation of Physiologic Ability and Surgical Stress (E-PASS) scoring system's utility in predicting postoperative complications following standard PCNL. This retrospective study included 218 patients who underwent standard PCNL from June 2020 to August 2024 at our institution. Data on demographics, comorbidities, and perioperative factors were collected and analyzed. Postoperative complications were classified using the modified Clavien-Dindo system. The E-PASS scoring system, which incorporates the Preoperative Risk Score (PRS), Surgical Stress Score (SSS), and Comprehensive Risk Score (CRS), was applied to stratify risk. Postoperative complications occurred in 38 patients (17.4%). Significant predictors included advanced age, higher American Society of Anesthesiologists (ASA) scores, and comorbidities like diabetes and coronary artery disease. Intraoperative factors, such as prolonged operative times, number of access and greater blood loss, were also associated with complications. Multivariate analysis identified higher CRS and greater stone burden as independent predictors (p = 0.012 and p = 0.037, respectively). The CRS demonstrated moderate discrimination, with an area under the curve (AUC) of 0.747. The E-PASS scoring system effectively predicts postoperative complications in PCNL, underscoring the importance of thorough preoperative and intraoperative evaluation. Future studies should explore its broader applicability across other urological procedures.
经皮肾镜取石术（PCNL）是治疗复杂性肾结石广泛首选的方法，尤其适用于结石较大或更为复杂的患者。尽管它具有诸如微创性和恢复时间较短等优点，但术后仍可能发生并发症，因此需要有效的风险评估工具来识别高危患者。本研究评估了生理能力与手术应激评估（E-PASS）评分系统在预测标准PCNL术后并发症方面的效用。这项回顾性研究纳入了2020年6月至2024年8月在我们机构接受标准PCNL的218例患者。收集并分析了人口统计学、合并症和围手术期因素的数据。术后并发症采用改良的Clavien-Dindo系统进行分类。应用包含术前风险评分（PRS）、手术应激评分（SSS）和综合风险评分（CRS）的E-PASS评分系统进行风险分层。38例患者（17.4%）发生了术后并发症。显著的预测因素包括高龄、较高的美国麻醉医师协会（ASA）评分以及糖尿病和冠状动脉疾病等合并症。术中因素，如手术时间延长、穿刺通道数量和出血量增加，也与并发症有关。多因素分析确定较高的CRS和更大的结石负荷为独立预测因素（分别为p = 0.012和p = 0.037）。CRS显示出中等的辨别力，曲线下面积（AUC）为0.747。E-PASS评分系统可有效预测PCNL术后并发症，强调了全面的术前和术中评估的重要性。未来的研究应探索其在其他泌尿外科手术中的更广泛适用性。
