| Objective: To analyze the risk factors influencing stone-free rate after RIRS,evaluate and compare the predictive value of RUSS and modified S-Re SC score system for stone clearance rate in the RIRS,and investigate the relationship between the score systems and operation time,hospitalization time and postoperative complications.Methods: Retrospective analysis of clinical data of 100 patients with kidney stones who treated by RIRS in the Department of Urology of First Affiliated Hospital of Guangxi Medical University from June 2017 to June 2018 was made in the study.Logistic regression analysis was performed to determine the influence of the potential role of preoperative as predictive factors on the stonefree rate after RIRS.The RUSS and modified S-Re SC scores of each patient were calculated by the same researcher according to the clinical data.This research analyzed and compared the specificity and sensitivity of RUSS and modified S-Re SC score system in predicting stone-free rate through drawing their ROC curves,and investigate the relationship between the score systems and operation time,hospitalization time and postoperative complications.Results: A total of 100 patients with a mean age of 49.34±12.94(rang: 22-81)years and a mean BMI of 23.79±3.51(rang: 16.72-31.89)were included in this study.The mean stone size was 23.52±9.86(rang: 6.00-56.78)mm,and the mean number of stones was1.67±1.17(rang: 1-7).The mean of infundibulopelvic angle(IPA)was 38.32±8.25(rang: 16-63)°.There were 45(45%)patients with multiple kidney stones and 55(55%)patients had a single stone(31 cases of lower calix calculi,5 cases of middle calix calculi,3 cases of upper calix calculi and 16 cases of pelvis calculi).The overall stone-free rate was 59%(59/100)one month after operation.Logistic regression analysis showed that the main factors affecting stone-free status were stone size(P = 0.000,OR: 1.371,95% CI: 1.175-1.600)and stone location(P = 0.035,OR: 7.305,95% CI: 1.148-46.475).According to the ROC curves,area under curve(AUC)of RUSS is 0.867,and its maximum Youden index is 0.625 when scoring = 2.5;AUC of modified SRe SC score system is 0.918,and its maximum Yoden index is 0.716 when scoring = 3.5.The mean operation time and hospitalization time were 81.12±33.65 minutes and 5.77±2.29 day,and postoperative complications occurred in 23 patients in the study.In the RUSS and modified S-Re SC score system,there were statistically significant differences in operation time and hospitalization time among the scoring groups(P=0.017,P=0.006;P=0.002,P=0.020),but there was no significant difference in postoperative complications among the scoring groups(P=0.687;P=0.371).Conclusion: The size and location of stones were important factors for the stone-free rate after RIRS.RUSS and the modified S-Re SC score system are simple and easy to operate in clinical practice,which can not only accurately predict the postoperative stone clearance status of RIRS,but also have certain predictive value for RIRS operation time and patient hospitalization time.In addition,the accuracy of the modified S-Re SC score system in this study in predicting the stone-free rate after RIRS was higher than that of RUSS. |
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