Advertisement

Nephrometry Scores are useless for experienced urologists in clinical practice.

Login to Access Video or Poster Abstract: MP08-02
Sources of Funding: none

Introduction

Several nephrometry scores have been proposed to predict perioperative outcomes in partial nephrectomy, but for clinical uses, its been questioned as an instrument for helping in decision-making. Therefore, our objective was to compare the ability of Nephrometry scores (R.E.N.A.L., PADUA and ABC) to subjective evaluation of the image by a group of experienced urologists and a group of first-year general surgery residents in predicting surgical outcomes in patients who underwent Partial Nephrectomy.

Methods

Computerized Tomography or Magnetic Resonance preoperative images of 87 patients who underwent nephron sparing surgery were retrospectively analyzed and classified by experienced Radiologist using nephrometry scores (R.E.N.A.L., PADUA and ABC) and subjective classification of the image in low, medium or high complexity was done by a group of blinded urologists (3) and residents (3) with none experience in renal surgery. The most common classification in each group was chosen or in the case of 3 divergent findings, medium complexity was the selected option. The outcomes were postoperative complication, positive surgical margin, ischemia time, surgery lenght, bleeding, renal functional lost and hospital stay period. Chi-Squared test was used for analyzing qualitative outcomes and a Spermans correlation test was used for continuous variables.

Results

R.E.N.A.L., PADUA and ABC Score can predict surgery time (p=0.004, p= 0.003 and p<0.001) and ischemia time (p<0.001 for all). The evaluation performed by the urologists also statistically predicts surgery time (p=0.001) and ischemia time with a better correlation than the Scores (p<0.001) Table 1. The evaluation performed by the urologists was the only one capable for predicting postoperative complications (p=0.049). Regarding bleeding, positive surgical margins, hospital stay and decrease in renal function, none of the scores or subjective evaluation had statistically significant correlation.

Conclusions

Nephrometry scores can overcome a subjective evaluation done by a non-experienced surgeon. On the other hand, experienced urologists perform better than Nephrometry scores in predicting surgical outcomes when analyzing pre-operative imaging. Therefore, those scores have little utility in clinical decision-making.

Funding

none

Authors
Henrique Nonemacher
Giuliano Guglielmetti
George Lins de Albuquerque
Rafael Coelho
Mauricio Cordeiro
Arnaldo Fazoli
Paulo Afonso Carvalho
Tiago Magalhaes Freire
kayann Kaled R el Hayek
Vitor Pagotto
George Lins de Albuquerque
Mauricio Cordeiro
Bruno Aragao Rocha
Diego Parga Rodrigues
Alexandre Fligelman Kanas
Publio Cesar Cavalcanti Viana
Willian Nahas
back to top