External Validation and Comparison of Current Scoring Systems in Encrusted Ure-teral Stent Management: a Multicenter...

Area of Science:

• Urology
• Medical Device Management
• Nephrolithiasis Research

Background:

• Encrusted ureteral stents (EUS) pose significant management challenges in urology.
• Existing scoring systems for EUS require external validation to assess their clinical utility.
• Understanding the relationship between EUS characteristics and surgical outcomes is crucial for patient care.

Purpose of the Study:

• To externally validate four scoring systems for encrusted ureteral stents (EUS): ESB, FECal, KUB, and V-GUES.
• To evaluate the association of these scoring systems with stent indwelling time, stone-free rates, and surgical complexity.
• To identify predictors for outcomes including multiple surgery sessions and prolonged operation times.

Main Methods:

• Retrospective review of 208 patients undergoing surgery for EUS.
• Evaluation of EUS using four scoring systems: ESB (encrusted stone burden), FECal (forgotten, encrusted, calcified), KUB (kidney, ureter and bladder), and V-GUES (visual grading for ureteral stone burden).
• Multivariate logistic regression and ROC curve analysis to assess predictive values.

Main Results:

• All four scoring systems (ESB, FECal, KUB, V-GUES) showed significant increases with prolonged stent indwelling time (p<0.001).
• V-GUES and stent indwelling time predicted stone-free rates; FECal predicted multimodal procedure requirements.
• FECal and V-GUES predicted multiple surgery sessions, while stent indwelling time and KUB predicted prolonged operation times.

Conclusions:

• Current scoring systems for EUS, while varying, are valuable tools for guiding patient management.
• The KUB and FECal scoring systems demonstrated superior predictive performance for specific complex outcomes.
• Stent indwelling time is a critical factor influencing EUS encrustation and subsequent surgical outcomes.