External validation of the S.T.O.N.E. nephrolithometry scoring system

Abstract

Introduction: We perform external validation of the S.T.O.N.E. nephrolithometry scoring system for the preoperative assessment of percutaneous nephrolithotomy (PCNL) outcomes.

Methods: After obtaining institutional review board approval, all PCNLs performed from 2009 to 2013 at a tertiary referral centre were reviewed. The S.T.O.N.E. score was calculated and correlated with stone-free status, estimated blood loss (EBL), operative time, length of hospital stay (LOS), and postoperative complications.

Results: A total of 155 PCNLs were included, with 100 (64.5%) males and 55 (35.5%) females. The mean age was 54.9 ± 1.2 years (range: 17-85), with a mean body mass index of 26.9 ± 0.5 kg/m(2) (range: 17.2-51). The mean S.T.O.N.E. score was 7.67 ± 0.1 (range: 5-12), with a mean stone size of 609.8 ± 48.4 mm(2) (range: 250-4030), a mean Hounsfield unit of 887.7 ± 25.3 (range: 222-1766), a mean tract length of 97.3 ± 1.9 mm (range: 53-175), a mean operative time of 100.1 ± 2.8 min (range: 60-240), and a mean LOS of 4.2 ± 0.3 days (range: 1-18). The overall stone-free rate after the primary procedure was 71.6%. The S.T.O.N.E. score significantly affected stone-free status (p = 0.001) and EBL (p = 0.003). There was significant correlation between the S.T.O.N.E. score and operative time (r = 0.4; p < 0.001) and LOS (r = 0.3; p = 0.001). Therefore, the higher the S.T.O.N.E. score, the longer the operative time, the higher the EBL, the longer the LOS, and the lower the chance of being stone-free. The overall complication rate after the primary procedure was 15.5%, which did not correlate with the S.T.O.N.E. score (p = 0.9).

Conclusion: Although this study externally validates the S.T.O.N.E. scoring system, its accuracy is comparable to stone size and number of involved calyces in predicting stone-free status post-PCNL.

Fig. 1.

Demonstrates the effect of S.T.O.N.E. nephrolithometry score on the stone-free status.

Fig. 2.

Receiver operator characteristic curve demonstrating accuracy of the S.T.O.N.E nephrolithometry score, stone size, and number of involved calyces on preoperative prediction of stone-free status.