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Urolithiasis
DOI 10.1007/s00240-016-0935-0
ORIGINAL PAPER
Comparison of S.T.O.N.E and CROES nephrolithometry scoring
systems for predicting stone-free status and complication rates
after percutaneous nephrolithotomy: a single center study
with 262 cases
Serkan Yarimoglu
1
· Salih Polat
1
· Ibrahim Halil Bozkurt
1
· Tarık Yonguc
1
·
Ozgu Aydogdu
1
· Erhan Aydın
1
· Tansu Degirmenci
1
Received: 29 April 2016 / Accepted: 2 November 2016
© Springer-Verlag Berlin Heidelberg 2016
and operation time. We demonstrated that S.T.O.N.E. and
CROES scoring systems were useful for predicting post-
PCNL stone-free status. But both scoring systems were not
useful for predicting post-PCNL complications.
Keywords CROES nephrolithometry score · S.T.O.N.E.
nephrolithometry · Modified Clavien classification
Introduction
Percutaneous nephrolithotomy (PNL) has been recom-
mended as the first-line treatment option for kidney stones
that are either refractory to extracorporeal shock wave lith-
otripsy (ESWL) or are >2 cm in diameter according to the
guidelines of the European Association of Urology (EAU)
[1]. The number of PCNLs has been increasing over the
last decade and use of PCNL is expected to continue in the
future. Differences in reporting of PCNL outcomes among
the authors have recently lead to the invention of nephro-
lithometry scoring systems using preoperative parameters
to improved patient counseling, surgical planning, and
evaluation of outcomes and uniform academic reporting
[2]. The CROES nephrolithometric nomogram and the
S.T.O.N.E. nephrolithometry scoring system have been
described as predictors of stone-free status after PCNL by
Smith and Okhunov, respectively [3, 4]. The CROES neph-
rolithometric nomogram is a scoring system, which gives
an estimated success rate in a range 30–90% depending
on the stone burden, annual case volume, and prior stone
treatment, presence of staghorn stone, stone location and
stone count [4]. The S.T.O.N.E. nephrolithometry scoring
system assesses PCNL complexity according to stone size,
tract length, obstruction, number of involved calyces, and
Hounsfield units calculated from the CT. According to the
Abstract The aim of this study was to compare the accu-
racy of the CROES nephrolithometric nomogram and
S.T.O.N.E. scoring system in predicting PCNL outcomes
in terms of stone-free rate, estimated blood loss (EBL),
operative time (OR), length of hospital stay (LOS), and
complications. Patients who underwent PCNL for renal
stones between May 2012 and January 2015 were analyzed
retrospectively. The patients’ demographic characteristics
and operational features were recorded prospectively in all
patients postoperatively. S.T.O.N.E. and CROES nephro-
lithometry scores’ correlation with stone-free status, opera-
tion and fluoroscopy time, length of hospital stay (LOS) and
blood loss (BL) was evaluated. Patients were categorized
according to S.T.O.N.E. nephrolithometry and CROES
nephrolithometry scores. Postoperative complications were
graded according to modified Clavien classification (Dindo
et al. in Ann Surg 240:205–213, 2004) and the correlation
of both scoring systems with postoperative complications
was also evaluated. We identified 437 patients who under-
went PCNL between May 2012 and January 2015. A total
of 262 patients who are available data for the CROES and
S.T.O.N.E. scoring systems were included in the recent
study. The mean S.T.O.N.E score was 7.65 ± 1.56 and
the mean CROES score was 191.13 ± 64.39. The overall
stone-free rate was 71.4%. Of the 262 patients, 89 expe-
rienced postoperative complications. Stone-free patients
had significantly lower BMI (<0.001) and stone burden
(p < 0.001). Regression analysis showed that both scoring
systems were significantly associated with stone-free rates
* Salih Polat
salihpolat@gmail.com
1
Department of Urology, Izmir Bozyaka Training
and Research Hospital, Karabaglar, Izmir, Turkey