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Objective <p>This study aims to evaluate and compare the predictive performance of three widely used nephrolithometry scoring systems—S.T.O.N.E., CROES, and Guy’s Stone Score—in determining stone-free outcomes following percutaneous nephrolithotomy (PCNL) in patients with horseshoe kidney (HSK), a population in which the utility of these models remains uncertain.</p> Methods <p>In this retrospective single-center study, 64 adult patients with HSK who underwent unilateral PCNL between January 2017 and December 2024 were included. Preoperative non-contrast CT images were used to assess S.T.O.N.E., CROES, and Guy’s scores by two blinded endourologists. The primary outcome was stone-free rate (SFR), defined as complete clearance or residual fragments &lt; 4&#xa0;mm at 1-month postoperative CT. Predictive performance was evaluated via univariate/multivariate logistic regression and ROC curve analysis.</p> Results <p>The overall SFR was 65.6%. All three scoring systems were significantly associated with SFR in univariate analysis. However, in multivariate analysis, only the CROES score remained an independent predictor of SFR (OR: 1.07; 95% CI: 1.02–1.13; <i>p</i> = 0.005). ROC analysis demonstrated the highest predictive accuracy for the CROES score (AUC: 0.81), followed by the S.T.O.N.E. score (AUC: 0.71) and Guy’s score (AUC: 0.55).</p> Conclusion <p>Among the evaluated scoring systems, the CROES nomogram achieved the best predictive performance; however, all three tools were developed for standard renal anatomy and demonstrated limited applicability in horseshoe kidney. These findings highlight the need for scoring models specifically adapted to this population.</p>

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Limitations of standard scoring systems in predicting PCNL outcomes for horseshoe kidney patients

  • 期刊论文

  • 发表日期：

    2026年1月18日

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  • Ibrahim Hacibey,
  • Ismail Ulus,
  • Ahmet Halis,
  • Yusuf Sahin,
  • Aykut Colakerol

摘要

Objective

This study aims to evaluate and compare the predictive performance of three widely used nephrolithometry scoring systems—S.T.O.N.E., CROES, and Guy’s Stone Score—in determining stone-free outcomes following percutaneous nephrolithotomy (PCNL) in patients with horseshoe kidney (HSK), a population in which the utility of these models remains uncertain.

Methods

In this retrospective single-center study, 64 adult patients with HSK who underwent unilateral PCNL between January 2017 and December 2024 were included. Preoperative non-contrast CT images were used to assess S.T.O.N.E., CROES, and Guy’s scores by two blinded endourologists. The primary outcome was stone-free rate (SFR), defined as complete clearance or residual fragments < 4 mm at 1-month postoperative CT. Predictive performance was evaluated via univariate/multivariate logistic regression and ROC curve analysis.

Results

The overall SFR was 65.6%. All three scoring systems were significantly associated with SFR in univariate analysis. However, in multivariate analysis, only the CROES score remained an independent predictor of SFR (OR: 1.07; 95% CI: 1.02–1.13; p = 0.005). ROC analysis demonstrated the highest predictive accuracy for the CROES score (AUC: 0.81), followed by the S.T.O.N.E. score (AUC: 0.71) and Guy’s score (AUC: 0.55).

Conclusion

Among the evaluated scoring systems, the CROES nomogram achieved the best predictive performance; however, all three tools were developed for standard renal anatomy and demonstrated limited applicability in horseshoe kidney. These findings highlight the need for scoring models specifically adapted to this population.