Moderated Poster

Poster, Podium & Video Sessions

MP08-02: Nephrometry Scores are useless for experienced urologists in clinical practice.

Friday, May 12
9:30 AM - 11:30 AM
Location: BCEC: Room 160

Presentation Authors: Henrique Nonemacher*, Giuliano Guglielmetti, George Lins de Albuquerque, Rafael Coelho, Mauricio Cordeiro, Arnaldo Fazoli, Paulo Afonso Carvalho, Tiago Magalhaes Freire, kayann Kaled R el Hayek, Vitor Pagotto, George Lins de Albuquerque, Mauricio Cordeiro, Bruno Aragao Rocha, Diego Parga Rodrigues, Alexandre Fligelman Kanas, Publio Cesar Cavalcanti Viana, Willian Nahas, Sao Paulo, Brazil

Introduction: Several nephrometry scores have been proposed to predict perioperative outcomes in partial nephrectomy, but for clinical uses, its been questioned as an instrument for helping in decision-making. Therefore, our objective was to compare the ability of Nephrometry scores (R.E.N.A.L., PADUA and ABC) to subjective evaluation of the image by a group of experienced urologists and a group of first-year general surgery residents in predicting surgical outcomes in patients who underwent Partial Nephrectomy.

Methods: Computerized Tomography or Magnetic Resonance preoperative images of 87 patients who underwent nephron sparing surgery were retrospectively analyzed and classified by experienced Radiologist using nephrometry scores (R.E.N.A.L., PADUA and ABC) and subjective classification of the image in low, medium or high complexity was done by a group of blinded urologists (3) and residents (3) with none experience in renal surgery. The most common classification in each group was chosen or in the case of 3 divergent findings, medium complexity was the selected option. The outcomes were postoperative complication, positive surgical margin, ischemia time, surgery lenght, bleeding, renal functional lost and hospital stay period. Chi-Squared test was used for analyzing qualitative outcomes and a Spermans correlation test was used for continuous variables.

Results: R.E.N.A.L., PADUA and ABC Score can predict surgery time (p=0.004, p= 0.003 and p<0.001) and ischemia time (p<0.001 for all). The evaluation performed by the urologists also statistically predicts surgery time (p=0.001) and ischemia time with a better correlation than the Scores (p<0.001) Table 1. The evaluation performed by the urologists was the only one capable for predicting postoperative complications (p=0.049). Regarding bleeding, positive surgical margins, hospital stay and decrease in renal function, none of the scores or subjective evaluation had statistically significant correlation.

Conclusions: Nephrometry scores can overcome a subjective evaluation done by a non-experienced surgeon. On the other hand, experienced urologists perform better than Nephrometry scores in predicting surgical outcomes when analyzing pre-operative imaging. Therefore, those scores have little utility in clinical decision-making.

Source Of Funding: none

Henrique Nonemacher

FMUSP/ICESP

Medical School at Universidade de Caxias do Sul (CAXIAS DO SUL/RS/BRAZIL) finished in 2010
General Surgery Residency at Hospital Conceição (PORTO ALEGRE/RS/BRAZIL) finished in 2013
Urology Residency at Hospital Conceição (PORTO ALEGRE/RS/BRAZIL) finished in 2016
Currently performing Urologic-oncology fellowship at FMUSP/ICESP (SAO PAULO/SP/BRAZIL)

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MP08-02: Nephrometry Scores are useless for experienced urologists in clinical practice.



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