Category: Clinical Stones: PCNL

MP26-1 - The Outcomes of More Than One Thousand of Percutaneous Nephrolithotomies in a Large Indonesian National Referral Hospital and Validation of Guy’s Stone Score

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective :

Currently there are several scoring system used to grade the complexity of percutaneous nephrolithotomy (PCNL). From the latest study, one of the most commonly used scoring systems is The Guy’s Stone Score. Several studies try to use Guy’s Stone Score to predict the outcome of PNCL, but there are still no study regarding the usage of Guy’s Stone Score in Indonesia. This study was conducted to present the experience with PCNL at a high-volume center, externally validate the Guy’s stone score system in our Center and estimate its predictive accuracy.


Methods :

We retrospectively evaluated 1199 patients who underwent PCNL between June 2000 until December 2016 in our Cipto Mangunkusumo National Referral Hospital, Indonesia. Indication for PCNL was renal stone with size of > 2 cm in stone burden. All patients underwent a complete preoperative procedure, including imaging studies, laboratory examination, and complete clinical examination. Stone complexity was assessed using Guy’s Stone Score (GSS). Stone free was defined as absence of fragments with size ≥ 4 mm on imaging studies on day 1 of postoperative. Postoperative complications were classified using Modified Clavien Grading system.


Results :

Total of 1199 PCNLs were performed, in all 27.9% classified as 27.9% GSS 1, 35.9% classified as GSS 2, 21.9% as GSS 3, and 14.2% as GSS 4. Mean operating time was 72.4 (31.9) minutes, with 228 (19%) patients underwent general anesthesia and 971 (81%) patients underwent spinal anesthesia. Overall stone free/ immediate success rate in our Center was 69.6%, with complications emerged in 5.6% of all patients regardless the stone free or not. After classifying patients with GSS, stone free was proportional to the complexity that was measured by Guy’s Stone Score. Patients with GSS1 had a stone free of 79.7%, GSS2 68.2%, GSS 3 61.5%, GSS 4 60.9% (p<0.001). Higher GSS were significantly correlated with number of puncture tracts (p<0.001), operating time (p<0.001), bleeding (p=0.007), and complication (p<0.001). Higher GSS were not correlated with open conversion (p=0.247) and postoperative length of stay (p=0.564). The AUC prediction of stone free of GSS was 0.58 (95%CI 0.54-0.614; p<0.001) and for prediction of complication, the AUC was 0.427 (95%CI 0.36-0.493;p=0.04)


Conclusions :

In our Center, PCNL was a commonly used technique and a reliable one, with low morbidity and higher stone free rate. GSS was confirmed as a useful tool for predicting the stone free of PNCL, and its used should be encouraged on daily basis. GSS was not useful as the predictor of complication of PCNL.

Adhitama ALAM. Soeroto

Residence
Cipto Mangunkusumo Hospital/ Faculty of Medicine Universitas Indonesia
South Jakarta, Jakarta Raya, Indonesia

Nur Rasyid

Medical Staff
Cipto Mangunkusumo Hospital/ Faculty of Medicine Universitas Indonesia
Central Jakarta, Jakarta Raya, Indonesia

Widi Atmoko

Medical Staff
Cipto Mangunkusumo Hospital/ Faculty of Medicine Universitas Indonesia
Central Jakarta, Jakarta Raya, Indonesia

Ponco Birowo

Medical Staff
Cipto Mangunkusumo Hospital/ Faculty of Medicine Universitas Indonesia
Central Jakarta, Jakarta Raya, Indonesia