Correlation between S.T.O.N.E score and channel size selection in percutaneous nephrolithotomy.

Area of Science:

• Urology
• Nephrology
• Surgical Innovation

Background:

• Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone removal.
• Access tract size selection impacts PCNL outcomes.
• The S.T.O.N.E. nephrolithiasis scoring system aims to predict stone complexity.

Purpose of the Study:

• To assess the predictive value of the S.T.O.N.E. score for guiding PCNL access tract size.
• To evaluate the influence of S.T.O.N.E. score-based tract selection on stone-free rates and complications.

Main Methods:

• Retrospective analysis of 323 PCNL patients.
• Classification into high (9-13) and low (5-8) S.T.O.N.E. score groups.
• Comparison of standard-tract PCNL (SPCNL) vs. mini-tract PCNL (MPCNL) outcomes (stone-free rate, complications).

Main Results:

• High S.T.O.N.E. score group: SPCNL showed higher stone-free rates (72.6% vs. 33.3%) and shorter operative times than MPCNL, with similar severe complication rates.
• Low S.T.O.N.E. score group: SPCNL and MPCNL had comparable stone-free rates and operative times, but MPCNL had significantly fewer severe complications (12.7% vs. 28.7%).
• Multivariate analysis identified S.T.O.N.E. score and operative time as risk factors for residual stones, while larger tract size was protective.

Conclusions:

• The S.T.O.N.E. score is a significant factor in PCNL access tract selection.
• Standard tracts are recommended for high S.T.O.N.E. score patients for improved efficacy.
• Mini-tracts are associated with fewer complications in low S.T.O.N.E. score patients, suggesting personalized approach.
• The S.T.O.N.E. score aids in tailoring PCNL procedures for optimal outcomes.