Predictive value of scoring systems for stone free status and complications before percutaneous nephrolithotomy in...

PCNL, a minimally invasive surgical technique for kidney stone removal, relies on achieving stone-free status, which various scoring systems aim to predict. This study assesses the predictive accuracy of the Clinical Research Office of the Endourological Society (CROES) and Guy's Stone Score (GSS) systems in determining stone-free rates following percutaneous nephrolithotomy (PCNL) in pediatric patients. A retrospective analysis was conducted on 580 pediatric patients who underwent PCNL at Çukurova University Urology Clinic between January 2007 and March 2024. Patients were categorized into two groups based on postoperative stone status: Group 1 and Group 2. CROES and GSS scores were calculated for each patient. The association between these scores and stone-free status, as well as postoperative complications, was statistically analyzed. Additionally, subgroup analyses were performed based on age groups. The study showed that 83.7% of patients achieved a stone-free condition postoperatively. Significant differences were found between the stone-free and residual stone groups regarding stone burden and operative time (p < 0.001). CROES had high accuracy for predicting stone-free outcomes (p < 0.001), while GSS was also effective in predicting both stone-free rates and complications. CROES was less effective in predicting complications. Both CROES and GSS are valuable for predicting PCNL outcomes in pediatric patients. While CROES is more reliable for stone-free rates, GSS better predicts complications. However, their limitations highlight the need for pediatric-specific scoring models. Until such models are developed, these systems should be used with caution alongside individualized clinical assessments.