目的:在术前阶段为患者提供有关潜在手术结果的准确信息至关重要。已经为此特定目的开发了几种评分系统。这项研究旨在检查评分系统在接受逆行肾内手术(RIRS)的孤立性下萼结石患者中的预测疗效。
方法:我们对2016年至2023年期间因下萼结石接受RIRS治疗的85例患者进行了回顾性分析。该研究计算了每个参与者的Resorlu-UnsalStone评分(RUSS),R.I.R.S.评分系统评分,改良首尔国立大学肾结石复杂性(S-ReSC)评分,S.T.O.N.E.得分,伊藤的列线图,和T.O.HO得分。小于4毫米的残余结石被归类为临床上微不足道的残余碎片(CIRFs),并被认为是成功的。在此之后,我们使用受试者工作特征(ROC)曲线来比较各种评分系统的成功预测。
结果:RUSS的中位数得分,R.I.R.S.评分系统,修改后的S-ReSC,S.T.O.N.E.,伊藤的列线图,T.O.HO得分为1(1),7(2)、2(0),11(1)、18(4)、7(1)分别。当包括CIRF病例时,无石率提高到80%。只有来自评分系统的Ito列线图在ROC分析中具有统计学上显著的成功截断值(p=0.021)。在多变量分析中,结石体积和术前肾积水与成功相关(分别为p=0.004和p=0.035).
结论:在多变量分析中,没有一个评分系统与成功显著相关.因此,必须专门为接受RIRS的孤立性下极结石患者开发新的评分系统。
OBJECTIVE: It is critical to provide patients with accurate information on potential surgical outcomes during the preoperative phase. Several scoring systems have been developed for this specific purpose. This study aimed to examine the predicted efficacy of scoring systems in patients with isolated lower calyx stones who underwent retrograde intrarenal surgery (RIRS).
METHODS: We performed a retrospective analysis of 85 patients who underwent RIRS for lower calyx stones between 2016 and 2023. The study computed each participant\'s Resorlu-Unsal Stone score (RUSS), R.I.R.S. scoring system score, Modified Seoul National University Renal Stone Complexity (S-ReSC) score, S.T.O.N.E. score, Ito\'s nomogram, and T.O.HO score. Residual stones less than 4 mm were classified as clinically insignificant residual fragments (CIRFs) and regarded as successful. Following that, we used receiver-operating characteristic (ROC) curves to compare various scoring systems\' success predictions.
RESULTS: The median scores for RUSS, R.I.R.S. scoring system, Modified S-ReSC, S.T.O.N.E., Ito\'s nomogram, and T.O.HO score were 1 (1), 7 (2), 2 (0), 11 (1), 18 (4), and 7 (1), respectively. When CIRF cases were included, the stone-free rate increased to 80%. Only Ito\'s nomogram from scoring systems has a statistically significant cut-off value for success in ROC analysis (p = 0.021). In multivariate analysis, stone volume and preoperative hydronephrosis were associated with success (p = 0.004 and p = 0.035, respectively).
CONCLUSIONS: In the multivariate analysis, none of the scoring systems were significantly associated with success. Hence, a new scoring system must be developed exclusively for patients with isolated lower pole stones undergoing RIRS.