The Comparison Of The Scoring Systems(Guy's,S.T.O.N.E,CROES)for Application In Percutaneous Nephrolithotomy For Staghorn

Objective:The aim of this study was comparison of Guy's,S.T.O.N.E and CROES scoring systems which used to predict postoperative stone-free rate and complications for staghorn stones after percutaneous nephrolithotomy?PCNL?.Methods:We retrospectively reviewed patients of staghorn stones undergoing single-tract PCNL from January 2014 to December 2016 at our center.All PCNL were finished by the same urologist.On the basis of computed tomography?CT?scan images,the stone scoring systems and Clavien-Dindo classification system,we calculated Guy's,S.T.O.N.E and CROES score for each patient and divided the patients into groups.Finally,the difference of stone-free rate and complications in the stone scoring systems were compared.Results:Data of 45 patients were collected and analyzed.Study data consisted of 26?57.78%?males and 19?42.22%?females with a mean age of 49.56± 10.56 and a mean BMI of 23.87±3.50 kg/m2.21?46.67%?stones were located in the left kidney and 24?53.33%?stones were located in the right kidney.Staghorn stones were classified as 28?62.22%?partial staghorn stones and 17?37.78%?complete staghorn stones.The mean stone burden was 1022.31 ±552.50 mm2.The overall stone-free rate was 60%and the overall complication rates was 20%.The mean Guy's,S.T.O.N.E and CROES scores were 3.38±0.49,8.89±1.21,121.66±26.47 respectively.In univariate analysis,partial or complete staghorn stones type?p=0.001?,PCNL operative time?p=0.010?,stone size?p=0.021?,calices?p=0.003?,stone burden?p=0.003?and three stone scoring systems were significantly associated with postoperative stone-free status.In addition,puncture depth?p=0.037?and postoperative hospitalization days?p=0.001?were significantly associated with complication status.In logistic analysis,S.T.O.N.E scoring system?OR=2.899,p=0.003?was the only significant independent predictor for stone-free status.All three stone scoring systems failed to predict complication rates.According to ROC analysis,the estimated AUC for S.T.O.N.E scoring system was 0.775?p=0.002,95%CI 0.639-0.911?showing higher predictive accuracy compared to Guy's scoring system?AUC=0.741,p=0₀07,95%CI 0.585-0.896?and CROES scoring system?AUC=0.762,p=0.003,95%CI 0.621-0.904?respectively.Conclusion:From this study,S.T.O.N.E scoring system was proved to be the better predictor for stone-free rate for staghorn stones patients after PCNL compared to Guy's and CROES scoring system.However,all three scoring system failed to predict complication rates.