External Validation and Evaluation of Reliability and Validity of the S-ReSC Scoring System to Predict Stone-Free Status after Percutaneous Nephrolithotomy

Objectives: The Seoul National University Renal Stone Complexity (S-ReSC) scoring system was developed to predict the stone-free rate (SFR) after single-tract percutaneous nephrolithotomy (PCNL). This study is an external validation of this scoring system. Materials and methods: A retrospective review included 327 patients who underwent PCNL at 2 tertiary referral centers. The S-ReSC score was assigned from 1 to 9 based on the number of sites involved. The stone free status was defined as either complete clearance or clinically insignificant residual fragments,4 mm in size at 1 month follow-up imaging. Interobserver and test-retest reliabilities were evaluated. The statistical performance of the prediction model was assessed by its predictive accuracy, predictive probability, and clinical usefulness. Results: The overall SFR was 65.4%. SFRs were 83.9%, 47.6%, and 21.4% in low (1-2), intermediate (3-4), and high (5-9) score groups, respectively, with significant differences (P < 0.001). Inter-observer and test-retest reliabilities revealed almost perfect agreements. External validation of the S-ReSC scoring system revealed an AUC of 0.731 (95% CI 0.675-0.788). The AUC of 3-titered S-ReSC score groups was 0.691 (95% CI, 0.629-0.753). The calibration plot showed that the predicted probability of SFR had a concordance comparable to that of the observed frequency. The Hosmer-Lemeshow goodness-offit statistic revealed an adequate performance of the predictive model (P = 0.10). Inter-observer and test-retest reliability showed a good level of agreement. Conclusions: The S-ReSC scoring system is useful in predicting the post-PCNL SFR and in describing the complexity of renal stones.