Introduction: Since the introduction of percutaneous nephrolithotomy (PCNL), it has been
well acknowledged that PCNL has varying grades of complexities that affect stone clearance
and post-operative complications. There is, thus, a need to standardize the success and the
perioperative complexity associated with the procedure. Such a purpose can be achieved
using scoring system which can generalize the criteria for stratification of the complexity of
PCNL. The ""Guy's Stone Score"" (GSS) which was validated in 2011 by Thomas et al. is a
valuable tool that can be used in the stratification of the complexity of PCNL into four grades
depending on the stone burden along with the anatomy of both the patient and the renal tract.
Objective: The objective of the study was to evaluate GSS in patients undergoing PCNL in
predicting the complexity of the procedure.
Materials and Methods: The study design was a
prospective observational study which was conducted on 80 patients who underwent PCNL
at Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, between November
2018 and October 2019. The GSS was determined preoperatively for each patient using intravenous urography (IVU). All patients underwent PCNL as per the standard protocol.
Stone-free status was determined using X-ray kidneys, ureters, and bladder on the 2nd postoperative
day.
Results: Out of 80 patients, 37 patients (46.3%) belonged to Grade I, 26
patients (32.5%) belonged to Grade II, eight patients (10%) belong to Grade III, and nine
patients (11.3%) belonged to Grade IV. Overall Stone-free status was accomplished in in
73 patients (91.25%). A complete stone-free rate (100%) was achieved among patients
belonging to Grades I and II, while 7 (87.5%) out of eight patients belonging to Grade III
had a complete stone-free status and only three patients (33.3%) belonging to Grade IV had
complete stone-free status.
Conclusion: GSS based on IVP is a simple and useful tool which
can stratify the complexity of PCNL preoperatively and can help in counseling of patients
preoperatively regarding the outcome of PCNL.
KEY WORDS: GSS, PCNL, IVU
How to cite this article: Sahay BK, Seth S, Agarwal R.
Grading the complexity of
percutaneous nephrolithotomy
using the guy's stone score based on
intravenous pyelogram. Int J Adv
Integ Med Sci 2020;5(2):57-61.
Source of Support: Nil,
Conflicts of Interest: None declared.
Received: 11-03-2020
Accepted: 15-04-2020
Published: 29-05-2020