Comparison And Upgrade Of Renal Stone Scoring System In Predicting The Stone-free-rate (SFR) After Flexible Ureteroscopic Lithotripsy(FURL)

Objective: To compare the value of S.T.O.N.E.Score systems,Guy's grading systems and RUSS score systems in predicting SFR after flexible ureteroscopic lithotripsy(FURL),and to improve and upgrade the traditional RUSS score systems.Methods: A retrospective statistical analysis was performed in 88 patients with Kidney treated with FURL from February 2016 to September 2016,Department of Urology,the First Affiliated Hospital of Xiamen University.By collecting the general clinical data of patients such as age,sex,body mass index(BMI),preoperative laboratory examination,with ipsilateral surgery,renal malformations,spinal deformity,hydronephrosis,whether staghorn calculus,whether caliceal diverticular calculi,according to the characteristics of single stone,unilateral stone,stone location,size,and average CT value,we calculated the postoperative stone-free-rate(SFR)and screened the logistic regression model for statistically significant factors of postoperative SFR analysis.The RUSS,S.T.O.N.E.,and Guy's scoring systems were used to evaluate the value in terms of the predictive value of the postoperative SFR..Results: All the 88 cases completed FURL,the SFR was 62.5%(55/88).Multivariate analysis of different types of variables found that: 1,the renal pelvis and ureteral minimum angle(IPA),whether caliceal diverticular calculi,calculus average CT value(E),involving the number of calyces(N),stone size classification,(S)and RUSS,STONE,and Guy's score of the final scoring system for the impact of a clear postoperative SFR was statistically significant(p <0.05);2,By comparing the area under the ROC curve(AUC),we found that RUSS,STONE,and Guy's were 0.810,0.772 and 0.617,respectively,which indicated that RUSS was superior to STONE and Guy's grading system in predicting the SFR of the first stage of FURL;3,Logistic regression analysis was used to evaluate the RUSS calculus score by the logistic regression model of three variables,ie,the IPA,the number of the calyx(N),and the size of the stone,And whether or not the caliceal diverticular calculi and stone average CT value(E)of two score items,obtained improved RUSS score system,of the final scoring system for the impact of a clear postoperative SFR was statistically significant(p <0.05)and calculate the area under the ROC curve is 0.822(>0.810),Suggesting that improved RUSS stone score system than the traditional RUSS stone scoring system can better predict the SFR after FURL.Conclusion:The RUSS calculus score system is superior to STONE and Guy's calculus grading system in predicting the SFR of first-stage stone removal after FURL;(2)By adding whether caliceal diverticular calculi and Calculus CT value of the two score items to derived improved RUSS scoring system,can better predict the SFR after FURL.