Construction And Clinical Study Of CUBWAY.E Scoring Scale For Single Establishment Of Cutaneous Renal Channel

Objective:1.Design to evaluate and predict the CUBWAY.E evaluation component of the success rate of establishing a single cutaneous renal channel;2.Through a retrospective study,the clinical verification of the results of establishing a single cutaneous renal channel using a CUBWAY.E evaluation component was carried out to detect the internal consistency of the scoring results.3.The predictive value of the CUBWAY.E scale was studied through a prospective study using preoperative scoring to compare the results of a single intraoperative establishment of a cutaneous renal channel.Materials and methods:1.By searching and reviewing the relevant literature of Pubmed,Web of Science,China Zhiwang and other search platforms,the factors influencing the successful establishment of cutaneous renal work channel during PCNL were determined,and the CUBWAY.E evaluation subscale was established.The scale included 7 variables(C:target nephrolith,U: target renal calycelial degree,B: body mass index,W: working channel length,A: anatomical factor,Y: sagittal puncture needle deviation angle,E:expansion sheath model).2.To retrospectively analyze the clinical data of 178 patients with upper urinary calculi treated with PCNL from June 2017 to November 2019 in the urology department of the second affiliated hospital of Fujian Medical University,and to collect the general situation of the patients,the establishment of working channels and the perioperative period.were rated by two urological attending physicians using the CUBWAY.E rating subscale based on the established percutaneous nephroscopy work channel related parameters.To evaluate the intrinsic consistency of the two physicians using the CUBWAY.E scoring system.to analyze the relationship between the CUBWAY.E rating score and the single successful establishment of work channel status,puncture time,and the average number of days of postoperative hospitalization.The sensitivity and specificity of a single successful working channel were evaluated and the cut-off value was determined.In the same period,50 patients with upper urinary calculi treated with PCNL were rated according to the CUBWAY.E rating subscale by two clinicians who independently completed the work channel >200 and two independent completed work channel <50.Analyze the reliability(Kappa value)of the CUBWAY.E scoring system used by different levels of physicians.contrast the actual results of a single successful establishment of the working channel during the operation,and evaluate the predictive value of the cubway.e evaluation subscale for the single successful establishment of the working channel state during pcnl.Results:1.To successfully establish a CUBWAY.E rating subscale for evaluating and predicting the single successful establishment of working channel status during the operation of PCNL under the prone position;2.178 CUBWAY.E score,hydronephrosis,body mass index,working channel length and anatomical factors were statistically significant in patients with upper urinary tract stones in PCNL(P <0.05).CUBWAY.E score was not correlated with operation time(P=0.83),postoperative hospitalization days(P =0.59),puncture time(P =0.68).The area under the ROC curve(AUC)of the CUBWAY.E score was 0.884.The Cut-off value was 12.5 and the sensitivity and specificity of the CUBWAY.E score for the successful establishment of a single working channel was 72.5% and 87.4%.CUBWAY.E had a higher score and a lower success rate for a single successful working channel.3.The intra-group relationships(ICC)of the two evaluators using CUBWAY.E scores and C,U,B,W,A,Y and E variables scores were0.966,0.884,0.951,0.994,0.887,0.95,0.899,0.997,showing good consistency.4.For the 50 patients included in the same period,the CUBWAY.E score was used to predict the status of a single successful working channel based on general and imaging data before operation,and the results were compared with the actual results of the operation.The Kappa value of CUBWAY.E score was K =0.73 and the junior physician was higher(K =0.67),while the area under the ROC curve of CUBWAY.E score was0.888 and the CUBWAY.E score was defined as 12.5 when the predictive sensitivity was 88.2% and the specificity was 87.9%,which proved that CUBWAY.E evaluation component table had some clinical predictive value for the successful establishment of skin kidney work channel at a single time.Conclusions:1.The successful establishment of a single percutaneous renal pathway is the key to the success or failure of PCNL surgery,and the evaluation of this success status is an important link in the evaluation of surgical effect,so it is necessary to construct a CUBWAY.E evaluation subscale to evaluate the success rate of establishing a single working channel.2.The CUBWAY.E scoring system is constructed by referring to the current literature to select and assign values to factors that affect the establishment of a single percutaneous renal pathway.The preliminary results showed that the results of the two graders were in good agreement,and the sensitivity and specificity of the single successful establishment of the cutaneous renal channel by the CUBWAY.E score evaluation was 72.5% and 87.4%,which basically met the requirements of clinical evaluation.3.Using the CUBWAY.E rating subscale,the patients with proposed PCNL surgery were predicted,and the results were compared with the actual operation.The reliability of CUBWAY.E was higher for senior physicians(K =0.7)than for junior physicians(K=0.67);the CUBWAY.E rating subscale could predict to some extent the success rate of establishing a single successful cutaneous kidney working channel,which could provide a basis for assessing the difficulty of the channel,choosing a reasonable way of operation and communicating with patients before operation.4.There is a lack of standardized,quantifiable methods for evaluating the individual experience of clinicians,so this study failed to include physician levels as a scoring factor;at the same time,limited by sample size and the experience of the raters,we need further multicenter large sample prospective randomized studies to re-verify,and we look forward to having more work-channel-related scoring systems to learn from each other and promote the clinical application of the CUBWAY.E scoring system.