Establishment Of Preoperative Scoring System For Flexible Ureteroscopic Lithotripsy And It’s Clinical Significance

Objective:By analyzing the relevant factors affecting the stone free rate after flexible ureteroscopic lithotripsy,to establish a simple scoring system to preoperatively predict the stone free rate after flexible ureteroscopic lithotripsy and to verify its predictive value.Methods :A retrospective analysis was made of 481 cases of renal calculi treated by flexible ureteroscopic lithotripsy in urology department of our hospital from April 2013 to December 2018.Patients were divided into stone free group and stone residual group according to whether there are residual stones after operation.The general data,stone characteristics,anatomical characteristics of the affected kidney,operative data and perioperative data of the two groups were compared.After binary logistic analysis,independent risk factors affecting the stone free rate after flexible ureteroscopic lithotripsy were screened out.After quantifying these factors,a scoring system was established,and the predictive value of the scoring system was evaluated by the receiver operating characteristic curve.Results: The total stone free rate was 76.1%(366/481),the complication rate was 9.8%(47/481),the average hospitalization days were 2.8±1.7days,and the average operative time was 52.9±22.0 minutes.There was no significant differences in general data between the two groups(P > 0.05).There were significant differences in the cumulative stone diameter,the number of stones,the angle between the infundibulum and renal pelvis,the length of infundibular neck,and the CT value of stones between the two groups.The number of stones was excluded by binary logistic regression analysis.B.A.L.D.scoring system was established with the above fourindicators.Each patient was scored with the scoring system and the relationship between the total score and the stone free rate and complications after operation was analysed.The total score was correlated with stone free rate,operation time and hospitalization days,but not with complications.The area under the receiver opetative characteristic curve of total score was 0.705,which was higher than any other single index.Conclusion: The higher the total score,the lower the stone clearance rate,the longer the operation time,and the longer the hospital stay,but it has no correlation with the postoperative complications.When the total score is greater than 6 points,other surgical methods like Percutaneous nephrolithotomy or staged surgical treatment should be adopted to achieve the best effect of lithotripsy.