International Urology and Nephrology

, Volume 49, Issue 9, pp 1569–1575 | Cite as

Comparison of CROES, S.T.O.N.E, and Guy’s scoring systems for the prediction of stone-free status and complication rates following percutaneous nephrolithotomy in patients with chronic kidney disease

  • Fatih Yanaral
  • Faruk Ozgor
  • Metin Savun
  • Murat Sahan
  • Omer Sarilar
  • Murat Binbay
Urology - Original Paper



To evaluate and compare the accuracy of S.T.O.N.E, Clinical Research Office of the Endourological Society (CROES), and Guy’s stone score in patients with chronic kidney disease (CKD) following percutaneous nephrolithotomy (PNL).


The charts of patients who had undergone a prone percutaneous nephrolithotomy from June 2006 to June 2016 were retrospectively analyzed. Patients accepted as stage 3 and higher according to chronic kidney disease epidemiology collaboration formula, were enrolled into the study. Calculation of the CROES, S.T.O.N.E, and Guy’s scoring system (SS) was made as defined in original papers. Patients were categorized into four scores according to CROES, into nine scores according to S.T.O.N.E, and into four scores according to Guy’s SS.


A total of 303 patients fulfilled the study inclusion criteria. The mean preoperative eGFR and creatinine levels were 47 mL/min and 1.55 mg/dL, respectively. In patients who were stone free and those with residual stones, the mean CROES SS was 179 and 137 (p < 0.001), the mean S.T.O.N.E score was 8.8 and 9.9 (p < 0.001), and the mean Guy’s SS was 1.8 and 2.4 (p < 0.001), respectively. Multivariate regression analysis revealed CROES SS was the only scoring system, which had a predictive value for PNL outcome in patients with CKD (p = 0.011) and any of three SS were not useful for predicting PNL complications in patients with CKD.


Our study demonstrated the CROES SS was the only independent factor in the prediction of PNL outcome in CKD patients. Furthermore, three of the NSSs were not useful for predicting PNL complications in patients with CKD.


Kidney Lithotripsy Nephrostomy, percutaneous Nephrolithiasis Nomograms Prognosis Renal insufficiency, chronic 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.


  1. 1.
    Türk C, Knoll T, Petrik A et al (2015) European association of urology, guidelines on urolithiasis. Eur Urol 69:468CrossRefPubMedGoogle Scholar
  2. 2.
    Kuzgunbay B, Turunc T, Yaycioglu O et al (2011) Percutaneous nephrolithotomy for staghorn kidney stones in elderly patients. Int Urol Nephrol 43:639–643CrossRefPubMedGoogle Scholar
  3. 3.
    Levey AS, Coresh J, Balk E et al (2003) National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 139:137–147CrossRefPubMedGoogle Scholar
  4. 4.
    Fox CS, Matsushita K, Woodward M et al (2012) Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis. Lancet 380:1662–1673CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Smith A, Averch TD, Shahrour K et al (2013) A nephrolithometric nomogram to predict treatment success of percutaneous nephrolithotomy. J Urol 190:149–156CrossRefPubMedGoogle Scholar
  6. 6.
    Okhunov Z, Friedlander JI, George AK et al (2013) STONE nephrolithometry: novel surgical classification system for kidney calculi. Urology 81:1154–1159CrossRefPubMedGoogle Scholar
  7. 7.
    Thomas K, Smith NC, Hegarty N, Glass JM (2011) The Guy’s stone score—grading the complexity of percutaneous nephrolithotomy procedures. Urology 78:277–281CrossRefPubMedGoogle Scholar
  8. 8.
    National Kidney Foundation (2013) Estimated glomerular filtration rate formula developed by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Accessed 7 Nov 2013
  9. 9.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Jungers P, Joly D, Barbey F, Choukroun G, Daudon M (2004) ESRD caused by nephrolithiasis: prevalence, mechanisms, and prevention. Am J Kidney Dis 44:799–805CrossRefPubMedGoogle Scholar
  11. 11.
    Gupta M, Bolton DM, Gupta PN, Stoller ML (1994) Improved renal function following aggressive treatment of urolithiasis and concurrent mild to moderate renal insufficiency. J Urol 152:1086–1090CrossRefPubMedGoogle Scholar
  12. 12.
    Lukaszyk E, Lukaszyk M, Koc-Zorawska E, Bodzenta-Lukaszyk A, Malyszko J (2016) GDF-15, iron, and inflammation in early chronic kidney disease among elderly patients. Int Urol Nephrol 48:839–844CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Cader RA, Ibrahim OA, Paul S, Gafor HA, Mohd R (2014) Left ventricular hypertrophy and chronic fluid overload in peritoneal dialysis patients. Int Urol Nephrol 46:1209–1215CrossRefPubMedGoogle Scholar
  14. 14.
    Sfoungaristos S, Gofrit ON, Yutkin V, Landau EH, Pode D, Duvdevani M (2016) External validation of CROES nephrolithometry as a preoperative predictive system for percutaneous nephrolithotomy outcomes. J Urol 195:372–376CrossRefPubMedGoogle Scholar
  15. 15.
    Akhavein A, Henriksen C, Syed J, Bird VG (2015) Prediction of single procedure success rate using S.T.O.N.E nephrolithometry surgical classification system with strict criteria for surgical outcome. Urology 85:69–73CrossRefPubMedGoogle Scholar
  16. 16.
    Mandal S, Goel A, Kathpalia R et al (2012) Prospective evaluation of complications using the modified Clavien grading system, and of success rates of percutaneous nephrolithotomy using Guy’s Stone Score: a single-center experience. Indian J Urol 28:392–398CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Labadie K, Okhunov Z, Akhavein A et al (2015) Evaluation and comparison of urolithiasis scoring systems used in percutaneous kidney stone surgery. J Urol 193:154–159CrossRefPubMedGoogle Scholar
  18. 18.
    Tailly TO, Okhunov Z, Nadeau BR et al (2016) Multicenter external validation and comparison of stone scoring systems in predicting outcomes after percutaneous nephrolithotomy. J Endourol 30:594–601CrossRefPubMedGoogle Scholar
  19. 19.
    Sfoungaristos S, Gofrit ON, Pode D, Landau EH, Duvdevani M (2016) Percutaneous nephrolithotomy for staghorn stones: which nomogram can better predict postoperative outcomes? World J Urol 34:1163–1168CrossRefPubMedGoogle Scholar
  20. 20.
    Choi SW, Bae WJ, Ha US et al (2017) Prediction of stone-free status and complication rates after tubeless percutaneous nephrolithotomy: a comparative and retrospective study using three stone-scoring systems and preoperative parameters. World J Urol 35:449–457CrossRefPubMedGoogle Scholar
  21. 21.
    Yarimoglu S, Polat S, Bozkurt IH et al (2016) Comparison of S.T.O.N.E and CROES nephrolithometry scoring systems for predicting stone-free status and complication rates after percutaneous nephrolithotomy: a single center study with 262 cases. Urolithiasis. doi: 10.1007/s00240-016-0935-0 PubMedGoogle Scholar
  22. 22.
    Kumar S, Sreenivas J, Karthikeyan VS, Mallya A, Keshavamurthy R (2016) Evaluation of CROES nephrolithometry nomogram as a preoperative predictive system for percutaneous nephrolithotomy outcomes. J Endourol 30:1079–1083CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Department of UrologyHaseki Teaching and Research HospitalIstanbulTurkey

Personalised recommendations