Prediction of pediatric PCNL outcomes using contemporary scoring systems

Purpose: To evaluate the applicability of contemporary percutaneous nephrolithotomy (PCNL) scoring systems in pediatric patients and to compare their predictive power for postoperative outcomes. Materials and methods: The records of 125 pediatric patients who were diagnosed with renal calculi and managed with PCNL between March 2011 and April 2016 were retrospectively analyzed. The predictive scoring systems; The Guy’s Stone Score (GSS), S.T.O.N.E. nephrolithometry and, Clinical Research Office of the Endourological Society (CROES) were calculated for all patients included in the study. Patient demographics, stone free rate (SFR), and complications were all reported and analyzed. Results: In patients with residual stones (group I) vs those who were (group II) stone free the median (IQR) of GSS was 2 (2-3) and 2 (1-2), CROES nomogram score was 215 (210-235) and 257 (240-264), and S.T.O.N.E. nephrolithometry score was 8 (7-9) and 5 (5-6), respectively (each <p0.0001). S.T.O.N.E. nephrolithometry score revealed the highest accuracy in predicting SFR. GSS was significantly correlated with complications but the CROES nomogram and S.T.O.N.E nephrolithometry were not significantly correlated with complications. Conclusion: The scoring systems could be used in predicting PCNL success in pediatric setting. However, further studies are required to make modifications in the scoring systems in pediatrics. The main variables in the scoring systems as stone burden, tract length and case volume were measured using records from adult patients. Besides these variables, the relatively small pelvicalyceal system and the higher incidence of anatomic malformations in pediatrics could potentially affect PCNL outcomes

Prediction of pediatric PCNL outcomes using contemporary scoring systems

Purpose: To evaluate the applicability of contemporary percutaneous nephrolithotomy (PCNL) scoring systems in pediatric patients and to compare their predictive power for postoperative outcomes. Materials and methods: The records of 125 pediatric patients who were diagnosed with renal calculi and managed with PCNL between March 2011 and April 2016 were retrospectively analyzed. The predictive scoring systems; The Guy’s Stone Score (GSS), S.T.O.N.E. nephrolithometry and, Clinical Research Office of the Endourological Society (CROES) were calculated for all patients included in the study. Patient demographics, stone free rate (SFR), and complications were all reported and analyzed. Results: In patients with residual stones (group I) vs those who were (group II) stone free the median (IQR) of GSS was 2 (2-3) and 2 (1-2), CROES nomogram score was 215 (210-235) and 257 (240-264), and S.T.O.N.E. nephrolithometry score was 8 (7-9) and 5 (5-6), respectively (each <p0.0001). S.T.O.N.E. nephrolithometry score revealed the highest accuracy in predicting SFR. GSS was significantly correlated with complications but the CROES nomogram and S.T.O.N.E nephrolithometry were not significantly correlated with complications. Conclusion: The scoring systems could be used in predicting PCNL success in pediatric setting. However, further studies are required to make modifications in the scoring systems in pediatrics. The main variables in the scoring systems as stone burden, tract length and case volume were measured using records from adult patients. Besides these variables, the relatively small pelvicalyceal system and the higher incidence of anatomic malformations in pediatrics could potentially affect PCNL outcomes

Medical expulsive therapy for ureteral stones: where do we go from here?

Despite two decades of clinical use, the effectiveness of medical expulsive therapy (MET) for the noninvasive management of patients with ureteral stones has, in the past year, been called into in question. The primary aim of MET is to expedite stone passage, although it has also shown effectiveness in reducing time to stone passage, thus reducing the incidence of colic episodes, improving stone clearance and improving patients' quality of life. At least 11 systematic reviews and meta-analyses have been published showing clinical benefits of MET; however, the results of these analyses have been challenged by data from two randomized controlled, multicentre trials with large patient cohorts, thus providing higher quality evidence that MET is ineffective in patients with ureteral stones. Results of the various systematic reviews and meta-analyses have suggested that MET is effective, however, such analyses incorporate the biases and limitations of smaller cohort studies, resulting in their conclusions being based upon lower-quality evidence. Evidence for the use of MET for small (&lt;5 mm) distal ureteral stones has weakened based on clinical trial data published in 2015. However, MET might remain effective in the management of larger ureteral stones (&gt;5 mm).</p