CROES nefrolitometri nomogramı perkütan nefrolitotomi sonuçlarını tahmin edebilir mi?

Amaç: Çalışmamızda CROES nefrolitometri nomogramının perkütan nefrolitotomi sonuçlarını tahmin etmedeki değeri ve PNL komplikasyonlarımızın modifiye clavien sisteme göre değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Merkezimizde opere edilen toplam 220 hasta çalışmaya alındı. Tüm hastaların klinik özellikleri, taş özellikleri (yeri, lokalizasyonu, alanı), geçirilmiş cerrahi operasyona ait özellikler (kan kaybı, operasyon süresi, diversiyon çeşidi) taşsızlık oranı ve komplikasyonlar değerlendirildi. Her bir hastanın verileri CROES nomogramı ile skorlandı ve hastaların öngürülen taşsızlık oranı belirlendi. Cerrahi sonuçlarımız ile standart CROES nomogramından elde edilen sonuçlar karşılaştırılarak CROES nomogramının etkinliği değerlendirildi. Bulgular: Body mass index Vücut kitle indeksi ortalaması 26.7±3.3 kg/m2 olan hastalarımızın yaş ortalaması 45.8±15.2 yıl idi ve erkek hasta sayımız daha fazlaydı (%60% vs %40%). Hastalarımızın %36.8'inde daha önce taşa yönelik geçirilmiş bir girişim öyküsü vardı. Staghorn taş oranı %12.7, ortalama taş alanı 452.8±213.4 mm2 olarak bulundu ve %57.3 hastada aynı böbrekte multiple taş vardı. Taşsızlık oranımız %78.2 olarak bulundu. CROES skoruna göre tahmini taşsızlık şansı oranımız %80 idi. Bu tahmini oran ile gerçek başarımız arasındaki fark ise sadece %1.8 idi.Sonuç: CROES nomogramı ile PNL öncesinde taşsızlık oranı işlem öncesinde başarılı bir şekilde tahmin edilebilir. İlk başta kullanımı zor gibi olsa da kullandıkça basitleşen, anlaşılması kolay, parametleri objektif ve sonuçları akla yatkın olan bu nomogram klinisyenlere oldukça yol göstericidir.

Can CROES nephrolithometric nomogram predict postoperative outcomes of percutaneous nephrolithotomy?

Objectives: To assess the prediction of stone clearance of percutaneous nephrolithotomy using the 'CROES' nephrolithometric score, and analyze complications of using modified Clavien classification system.Materials and Methods: A total of 220 operated patients were included in the study. Overall patient characteristics, stone localization, stone burden, prior stone surgery, urine analysis, blood loss, operative duration, postoperative JJ stent and/or nephrostomy tube, stone-free status, and complications were analyzed. Data from each patient were scored with CROES nomogram, and the predicted stone-free rate of patients was determined. The efficacy of CROES nomogram was evaluated by comparing our results with standard CROES nomogram. Results: The average age of our patients with the mean body mass index of 26.7±3.3 kg/m2 was 45.8±15.2, and the number of our male patients was higher (60% vs 40%). 36.8% of our patients had of previous stone surgery history. Staghorn stone rate was found 12.7%, the average stone area was 452.8±213.4 mm2, and multiple stones in the same kidney was 57.3%. Our stone-free rate was found as 78.2%, and estimated chance of stone free rate was 80% according to the CROES score. The difference between estimated rate and our real success was only 1.8%. Conclusions: CROES nomogram has been considered as a simple and easy way for prediction of SF rate prior PNL. to reach more reliable outcomes, a greater number of randomized controlled trials are needed. However, it may still deserve to be use in the daily practice because it gives an idea for success after PNL. Even though this study is a retrospective setting, our results may help to guide for clinicians.

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