A prospective comparative evaluation of preoperative stone scoring systems with respect to stone free rate and complications in percutaneous nephrolithotomy.

BACKGROUND: PCNL outcomes among urologists are different because of the vast heterogeneity in the methods for clinical, academic characterisation and evaluation of surgical outcomes of nephrolithiasis. So assessing the preoperative factors that affect SFR (Stone Free Rate) and complications is critical. Heterogeneity in reporting of PCNL outcomes among different centres has led to the invention of nephrolithotomy scoring systems based on preoperative parameters to better counsel patients contemplating PCNL. The Guy's stone score, CROES nomogram and the S.T.O.N.E score are seen as predictors of stone-free status (SFS) and complications after PCNL. No universally accepted stone scoring system for predicting SFR and complications after PCNL exists. This is a prospective observational study to compare and analyse the existing stone scoring systems (SSS) and to assess the best parameters to predict PCNL outcomes concerning SFR and complications. METHODS: This study is done in a tertiary level institute in eastern India which included 200 patients who underwent PCNL from November 2019 to November 2021. The relevant operative parameters were documented and compared to the preoperative factors with the help of nephrolithotomy scoring systems. RESULTS: The Guy score, CROES nomogram and S.T.O.N.E. score were accurate in predicting the SFR in patients undergoing PCNL. A new IPGMER preoperative stone scoring system based on the most relevant parameters could be used as an alternative to predict SFR and complications in PCNL. CONCLUSION: The Nephrolithometry scoring systems are simple, straightforward and easily reproducible systems to classify the severity of nephrolithiasis and to stratify the complexity of PCNL.

Spectrum of lower urinary tract symptoms after renal transplant among adult non-urologic anuric patients and their management in a tertiary care center.

INTRODUCTION: Lower urinary tract symptoms (LUTS) in a post-transplant patient can lead to several complications including recurrent UTI and deterioration of the graft kidney function. The aim of this study is to investigate the spectrum of LUTS, possible complications resulting from it and its management after renal transplant in pre-transplant anuric patients operated in our tertiary care institute. MATERIALS AND METHODS: It was a retro-prospective observational study done on post-transplant patients operated in this institute from December 2016 to December 2020. Among 165 patients operated during this period 50 male and 21 female patients were finally included in this study. Urinary symptoms were evaluated using the IPSS Questionnaire. Pre and post-surgery Uroflowmetry findings were compared. Urodynamic assessment was done at least 6 months after surgery to determine the cause behind such symptoms. The data was analyzed with the help of standard statistical methods and SPSS 21 software. RESULTS: The most common LUTS among the post renal transplant patients were frequency and nocturia. There was a marked improvement in voided volume and urinary flow in most of the patients. In 11 male and 7 female patients LUTS symptoms were moderate to severe and were seldom associated with recurrent UTI and graft compromise. A cautious approach in these patients helped in early diagnosis of the etiology behind LUTS, which were treated accordingly. CONCLUSION: LUTS should be carefully evaluated before renal transplantation. Postoperatively moderate to severe LUTS symptoms should be thoroughly investigated so that graft compromise and related complications can be prevented by early intervention.