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Article

Utility and Practicability of Nephrometry Scoring Systems in Contemporary Clinical Practice—An International Multicentre Perspective †

by
Brendan A. Yanada
1,2,*,
David Homewood
1,2,
Brendan H. Dias
1,2,
Niall M. Corcoran
1,2,3,4,
Nathan Lawrentschuk
2,3,4,
Ravindra Sabnis
5,
Jeremy Y. C. Teoh
6 and
Dinesh Agarwal
1,2,3
1
Department of Urology, Western Health, 160 Gordon Street, Footscray, VIC 3011, Australia
2
Department of Surgery, The University of Melbourne, Parkville, VIC 3010, Australia
3
Department of Urology, The Royal Melbourne Hospital, Melbourne, VIC 3000, Australia
4
Victorian Comprehensive Cancer Centre, Melbourne, VIC 3000, Australia
5
Department of Urology, Muljibhai Patel Urological Hospital, Nadiad Gujarat 387001, India
6
S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
*
Author to whom correspondence should be addressed.
This article is a revised and expanded version of a paper entitled “MP51-07 utility and practicability of nephrometry scoring systems in contemporary clinical practice—An international multicentre perspective”, which was presented at the American Urological Association (AUA) Annual Meeting in San Antonio, Texas, on 1 May 2024.
Soc. Int. Urol. J. 2025, 6(1), 7; https://doi.org/10.3390/siuj6010007
Submission received: 10 September 2024 / Revised: 5 December 2024 / Accepted: 10 January 2025 / Published: 12 February 2025

Abstract

:
To conduct a multi-institutional international survey to determine the clinical utility and applicability of nephrometry scoring systems in contemporary clinical practice. Methods: A cross-sectional anonymous 15-item online survey was conducted on REDCap between January 2023 and May 2023. Survey invitations were sent via email within Australia and internationally to urologists who are either members of the Urological Society of Australia and New Zealand (USANZ) or the Urological Association of Asia (UAA) or who have direct professional relationships with their members. The survey underwent a trial run on REDCap with several urologists at our institution to test the technical functionality and comprehension prior to dissemination. Results: First, 158 responses were collected and analysed. Just over half (51%) responded that they use a nephrometry system in clinical practice, and the RENAL nephrometry scoring system is the most commonly used. Amongst respondents who use a nephrometry scoring system, 63% stated that it helps with counselling patients and 54% stated it serves as a decision-making tool on whether to perform a partial or radical nephrectomy. Furthermore, 54% use a nephrometry scoring system in surgical planning meetings, and 67% believe that it is helpful for research purposes. Common concerns included that they are too time-consuming to complete, they are unhelpful for treatment decision-making and they are only useful for research purposes. Conclusions: Nephrometry scoring systems are utilised by roughly one in two urologists in contemporary clinical practice. Further qualitative studies are required to better ascertain perspectives towards them and enhance their clinical applicability.

1. Introduction

With the increase in incidental detection of renal masses on imaging and evidence pointing towards the benefits of nephron-sparing surgery where possible to reduce morbidity and mortality associated with renal insufficiency, surgeons are performing more difficult surgeries on more complex renal masses. Nephrometry scoring was developed to help standardise reporting of surgically relevant anatomical features of solid renal masses and uses of validated quantitative metrics to predict treatment success with surgical resection [1].
The two most widely studied and validated scoring systems are the RENAL [2] and PADUA [3] nephrometry systems. These systems assign a numerical value to a set of morphological parameters that are ascertainable with conventional contrast-enhanced computed tomography (CT). These scores objectify the anatomical surgical complexity of a renal mass, assist in surgical decision-making and facilitate the outcome assessment [4].
Despite widespread support within the literature regarding the usefulness of nephrometry scoring systems in clinical decision-making, their applicability and reproducibility remain controversial [5,6,7]. There are also very limited published data available regarding how frequently these tools are utilised in contemporary clinical practice. The objective of this study therefore was to conduct a multi-institutional international survey to determine the clinical utility and applicability of nephrometry scoring systems in contemporary clinical practice.

2. Materials and Methods

An anonymous cross-sectional online survey was conducted on REDCap between January 2023 and May 2023. Survey invitations were sent via email within Australia and internationally to urologists who are either members of the Urological Society of Australia and New Zealand (USANZ) or the Urological Association of Asia (UAA) or who have direct professional relationships with their members. USANZ is the peak professional and representative body for over 700 urologists in Australia and New Zealand. The UAA aims to promote urological care and training throughout Asia and is a consortium of 25 member associations.
We developed a 15-item survey to ascertain urologists’ views (see the Supplementary File). The survey underwent a trial run on REDCap with several urologists at our institution to test the technical functionality and comprehension prior to dissemination. Data regarding the current management practices of renal masses were collected using radio buttons to obtain single-answer responses. Views towards the clinical utility of nephrometry scoring systems were captured using checkbox fields, allowing for respondents to select as many choices as they considered relevant. Where respondents felt that their specific concern was not included in the checkbox fields list, we allowed them to include this as a free text by selecting “Other”. All submitted responses were automatically assigned a record ID and saved onto REDCap. All responses were exported from REDCap after closure of the survey. Incomplete or duplicate survey responses were excluded. Descriptive statistics were conducted to report responses for each survey question. A subgroup analysis was performed to correlate surgeon experiences, based on the number of partial nephrectomies (PNs) performed, with their use of nephrometry systems using one-way analysis of variance. A p-value of <0.05 was considered statistically significant.

3. Results

Survey responses were collected from urologists across a variety of countries throughout the world. A total of 159 responses were collected, one of which was a duplicate response and was therefore excluded, leaving 158 responses (Table 1). There were no responses that were excluded due to incompleteness. The majority of survey responses originated from Australia (33%), India (25%) and the UK (11%). Most respondents were involved in the management of renal masses (96%), 88% stated that they performed PNs and 54% had performed greater than 50 PNs as the primary surgeon at the time of completing the survey. Just over half responded that they used a nephrometry system in clinical practice (51%), and the RENAL nephrometry scoring system was the most commonly used system (89%).
Amongst respondents who use a nephrometry scoring system, 70% stated that they use it more than half of the time, 63% stated that they use it to help counsel patients and 54% stated it serves as a decision-making tool on whether to perform a partial or radical nephrectomy. Furthermore, 54% use a nephrometry scoring system in surgical planning meetings, and 67% believe that it is helpful for data collection and research purposes. However, some respondents who use nephrometry scoring voiced concerns, such as how they are “time-consuming to complete”, how they can be “unhelpful for treatment decision-making” and how they are “only useful for research and not clinically relevant”.
Thus, 49% of respondents stated that they do not use nephrometry scoring in their clinical practice. The main concerns raised were that they were only helpful for research purposes only and not clinically relevant (47%), unhelpful for treatment decision-making (38%), unhelpful for patient counselling (31%) and too time-consuming (26%).
We performed a subgroup analysis to examine whether surgeon experience, based on the number of PNs performed, affected their use of nephrometry scoring (Table 2). We found that there was no statistically significant difference in the use of nephrometry scoring nor concerns towards these systems amongst surgeons with various levels of operating experience based on the number of PNs performed as the primary surgeon.

4. Discussion

To the best of our knowledge, this is the first study to date to investigate how frequently nephrometry scoring systems are utilised in contemporary clinical practice by urologists managing renal masses. Nephrometry scoring systems arose out of concern regarding high rates of complications with surgical treatment of renal masses. In 2009, Kutikov and Uzzo developed the RENAL nephrometry scoring system following consideration of the anatomical characteristics of renal masses on cross-sectional imaging as they relate to resectability [3]. In the same year, Ficarra et al. developed a separate preoperative classification system integrating the tumour diameter and five anatomical tumour aspects [4]. The goal of both systems was to standardise reporting of the degree of complexity of surgical resection of renal masses using a structured, reproducible and quantitative scoring system. Several authors have attempted to establish correlations between these nephrometry scores and perioperative outcomes in nephron-preserving surgery; however, the literature reveals significant disparities. While certain studies have emphasised the utility of nephrometry systems in forecasting perioperative results [8,9,10,11], others have not established a definitive correlation [12,13,14].
Our study demonstrated that only 51% of urologists, or just over one in two, use a nephrometry scoring system in their surgical practice. The main concerns highlighted are that they are too time-consuming to complete, they are unhelpful for patient counselling, they do not alter clinical decision-making and they are only useful for academic reporting for research purposes. These responses point towards the impractical nature of the current nephrometry scoring systems in a busy clinical setting and limited benefits in predicting tumour complexity and a postoperative course.
Various limitations of nephrometry scoring systems have been reported within the literature, including interobserver reproducibility, incomplete quantification of relevant anatomical features and variable correlation with perioperative outcomes. Furthermore, nephrometry classification may have limited utility in predicting outcomes after percutaneous ablation procedures [15].
Various scoring systems have been proposed by other investigators, such as the Diameter–Axial–Polar (DAP) nephrometry system [16], the Zonal Nephro scoring system [17] and Arterial Based Complexity (ABC) scoring system [18], with the goal of improving the RENAL and PADUA classifications. However, these systems failed to be simpler, more reproducible or effective. In 2019, Ficarra et al. proposed the Simplified PADUA Renal (SPARE) nephrometry scoring system, which consists of four parameters (exophytic/endophytic properties, renal rim, renal sinus relationships and tumour size), with the goal of simplifying all available classification systems to improve their reproducibility and also increase their use in busy clinical environments beyond the academic research setting [19]. Despite emerging evidence in favour of the SPARE score for predicting surgical outcomes post-RAPN so far [20,21], it has yet to be externally validated, and none of our respondents stated that they used this simplified scoring system.
More recently, a three-tiered classification called RPN (Radius, Position of tumour, iNvasion of renal sinus) has been developed to assess the surgical difficulty of robot-assisted PN [22]. Due to its simplicity, memorability and accuracy to correlate with perceived surgical difficulty according to highly experienced surgeons, it has potential to be widely applied by urologists within a busy clinical setting.
Beyond nephrometry scoring, surgeon intuition is considered an important tool in predicting perioperative outcomes of nephron-sparing surgery [23]. In a prospective cohort study, Khene et al. (2020) concluded that a surgeon’s clinical judgement was a better indicator compared to nephrometry scoring to predict perioperative morbidity and the trifecta achievement of robot-assisted PN [6]. The surgeon’s intuition and subjective “gut” feeling to anticipate complications could also be helpful to counsel patients and guide treatment. This view was supported by multiple survey respondents, who stated that a surgeon’s experience and intuition when looking at a renal mass on imaging were important factors that allowed for the measurement of tumour complexity and the optimal surgical approach. This suggests that experienced surgeons can intuitively measure operative risk during the imaging assessment of tumour characteristics, potentially precluding the need for complex scoring systems. Our subgroup analysis, however, did not show a statistically significant difference in the use of nephrometry scoring amongst surgeons with various levels of operating experience based on the number of PNs performed as the primary surgeon, therefore suggesting that experience alone may not be a predictor for the use of nephrometry scoring in clinical practice.
The advantage of scoring systems is that they provide a common language that clinicians can use to communicate and compare the anatomical complexity of renal masses within surgical planning meetings or research settings. However, this survey demonstrates mixed opinions towards the applicability of nephrometry scoring in clinical practice, which echoes concerns raised by multiple investigators regarding the limited abilities of these systems to predict perioperative outcomes for renal masses [6,7]. This highlights the need to build and validate a tool for renal masses that assess individual patient risk for perioperative outcomes and complications.
Our study had several limitations. Despite our efforts to sample urologists from all around the world, there is a selection bias towards those who are members of USANZ and UAA, as can be seen by the greater response rates from urologists practicing in Australia and India. Our survey is lacking representation from urologists practicing in Europe, North and South America and Africa, and so, our conclusions may not be applicable to these groups. Secondly, our survey is cross-sectional, and responses provided regarding concerns towards nephrometry systems are not necessarily causal explanations behind their lack of use. Thirdly, most urologists surveyed had an appointment with an academic teaching centre, and this may have introduced an inclusion bias, as urologists at these centres may favour the use of nephrometry scoring for research and teaching purposes. Furthermore, our study does not reflect changes in attitudes or views towards nephrometry scoring systems over time, which would be an important consideration, as one accumulates greater experience and technical expertise with training.
Given the above limitations, future studies on the practicality of nephrometry scoring systems should firstly focus on diversifying recruitment to incorporate many urological societies around the globe in order to access a broader range of participant urologists and increase the sample size, thus reducing the selection bias and enhancing the generalisability of the survey findings. Next, a longitudinal study design would be helpful in tracking changes in attitudes and views towards nephrometry scoring systems over time, providing insights into the impact of experience and training. Finally, inclusion of a qualitative study design, such as conducting interviews with urologists to gain a deeper understanding of their perspectives, concerns and experiences with nephrometry scoring systems, would add further context to and reasoning for the quantitative findings.

5. Conclusions

The complexity of surgically managing a renal mass is not limited to the nephrometry score only but also depends on surgeon experience and intuition. Our survey demonstrates that nephrometry scoring systems are utilised by around one in two urologists in contemporary clinical practice. Commonly voiced concerns are that they are too time-consuming to complete, they are unhelpful for treatment decision-making and they are only useful for research purposes and not clinically relevant. Despite its widespread use as a standardised method of reporting within the urological literature, its clinical applicability and reproducibility remain controversial. Further qualitative studies are required to better ascertain the perspectives towards these scoring systems to enhance their applicability in real-world clinical practice.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/siuj6010007/s1. Included in the supplementary materials is the 15-item survey conducted on REDCap, aimed at ascertaining urologists’ views towards nephrometry scoring systems.

Author Contributions

B.A.Y.: Protocol/project development, Data collection and management, Data analysis, Manuscript writing/editing. D.H.: Data analysis, Manuscript writing/editing. B.H.D.: Protocol/project development, Data collection and management, Manuscript writing/editing. N.M.C.: Protocol/project development, Manuscript writing/editing, Project supervision. N.L.: Manuscript writing/editing. R.S.: Manuscript writing/editing. J.Y.C.T.: Manuscript writing/editing. D.A.: Protocol/project development, Data collection and management, Manuscript writing/editing, Project supervision. All authors have read and agreed to the published version of the manuscript.

Funding

No funding was sought for this project.

Institutional Review Board Statement

Ethics clearance was not required, because the project did not involve patient subjects. This project did not involve experiments on humans and/or the use of human tissue samples.

Informed Consent Statement

Patient consent was not required for this project, as it did not involve patient subjects.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors on request.

Acknowledgments

This article is a revised and expanded version of a paper entitled “MP51-07 utility and practicability of nephrometry scoring systems in contemporary clinical practice—An international multicentre perspective”, which was presented at the American Urological Association (AUA) Annual Meeting in San Antonio, Texas, on 1 May 2024 [1].

Conflicts of Interest

There are no conflicts of interest or competing interests to be declared.

References

  1. Rosevear, H.M.; Gellhaus, P.T.; Lightfoot, A.J.; Kresowik, T.P.; Joudi, F.N.; Tracy, C.R. Utility of the RENAL nephrometry scoring system in the real world: Predicting surgeon operative preference and complication risk. BJU Int. 2012, 109, 700–705. [Google Scholar] [CrossRef] [PubMed]
  2. Kutikov, A.; Uzzo, R.G. The RENAL nephrometry score: A comprehensive standardized system for quantitating renal tumor size, location and depth. J. Urol. 2009, 182, 844–853. [Google Scholar] [CrossRef] [PubMed]
  3. Ficarra, V.; Novara, G.; Secco, S.; Macchi, V.; Porzionato, A.; De Caro, R.; Artibani, W. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur. Urol. 2009, 56, 786–793. [Google Scholar] [CrossRef] [PubMed]
  4. Joshi, S.S.; Uzzo, R.G. Renal tumor anatomic complexity: Clinical implications for urologists. Urol. Clin. 2017, 44, 179–187. [Google Scholar] [CrossRef] [PubMed]
  5. Yanada, B.A.; Dias, B.H.; Corcoran, N.M.; Lawrentschuk, N.; Sabnis, R.; Teoh, J.Y.; Agarwal, D. MP51-07 UTILITY AND PRACTICABILITY OF NEPHROMETRY SCORING SYSTEMS IN CONTEMPORARY CLINICAL PRACTICE–AN INTERNATIONAL MULTICENTRE PERSPECTIVE. J. Urol. 2024, 211, e844. [Google Scholar] [CrossRef]
  6. Khene, Z.E.; Peyronnet, B.; Freton, L.; Graffeille, V.; Pradere, B.; Robert, C.; Kammerer-Jacquet, S.F.; Verhoest, G.; Rioux-Leclercq, N.; Shariat, S.; et al. What is better for predicting morbidity of robotic partial nephrectomy—A score or your clinical judgement? Eur. Urol. Focus 2020, 6, 313–319. [Google Scholar] [CrossRef] [PubMed]
  7. Kumar, R.M.; Lavallée, L.T.; Desantis, D.; Cnossen, S.; Mallick, R.; Cagiannos, I.; Morash, C.; Breau, R.H. Are renal tumour scoring systems better than clinical judgement at predicting partial nephrectomy complexity? Can. Urol. Assoc. J. 2017, 11, 199. [Google Scholar] [CrossRef] [PubMed]
  8. Veccia, A.; Antonelli, A.; Uzzo, R.G.; Novara, G.; Kutikov, A.; Ficarra, V.; Simeone, C.; Mirone, V.; Hampton, L.J.; Derweesh, I.; et al. Predictive value of nephrometry scores in nephron-sparing surgery: A systematic review and meta-analysis. Eur. Urol. Focus 2020, 6, 490–504. [Google Scholar] [CrossRef] [PubMed]
  9. Schiavina, R.; Novara, G.; Borghesi, M.; Ficarra, V.; Ahlawat, R.; Moon, D.A.; Porpiglia, F.; Challacombe, B.J.; Dasgupta, P.; Brunocilla, E.; et al. PADUA and RENAL nephrometry scores correlate with perioperative outcomes of robot-assisted partial nephrectomy: Analysis of the Vattikuti Global Quality Initiative in Robotic Urologic Surgery (GQI-RUS) database. BJU Int. 2017, 119, 456–463. [Google Scholar] [CrossRef]
  10. Long, J.; Arnoux, V.; Fiard, G.; Autorino, R.; Descotes, J.; Rambeaud, J.; Boillot, B.; Terrier, N.; Arvin-Berod, A.; Moreau-Gaudry, A. External validation of the RENAL nephrometry score in renal tumours treated by partial nephrectomy. BJU Int. 2013, 111, 233–239. [Google Scholar] [CrossRef] [PubMed]
  11. Ficarra, V.; Bhayani, S.; Porter, J.; Buffi, N.; Lee, R.; Cestari, A.; Mottrie, A. Predictors of warm ischemia time and perioperative complications in a multicenter, international series of robot-assisted partial nephrectomy. Eur. Urol. 2012, 61, 395–402. [Google Scholar] [CrossRef]
  12. Ubrig, B.; Roosen, A.; Wagner, C.; Trabs, G.; Schiefelbein, F.; Witt, J.H.; Schoen, G.; Harke, N.N. Tumor complexity and the impact on MIC and trifecta in robot-assisted partial nephrectomy: A multi-center study of over 500 cases. World J. Urol. 2018, 36, 783–788. [Google Scholar] [CrossRef] [PubMed]
  13. Mufarrij, P.W.; Krane, L.S.; Rajamahanty, S.; Hemal, A.K. Does nephrometry scoring of renal tumors predict outcomes in patients selected for robot-assisted partial nephrectomy? J. Endourol. 2011, 25, 1649–1653. [Google Scholar] [CrossRef]
  14. Yeon, J.S.; Son, S.J.; Lee, Y.J.; Cha, W.H.; Choi, W.S.; Chung, J.W.; Lee, B.K.; Lee, S.; Jeong, C.W.; Hong, S.K.; et al. The nephrometry score: Is it effective for predicting perioperative outcome during robot-assisted partial nephrectomy? Korean J. Urol. 2014, 55, 254–259. [Google Scholar] [CrossRef] [PubMed]
  15. Li, S.; Huang, J.; Jang, S.; Schammel, N.C.; Schammel, C.; Som, A.; El Khudari, H.; Devane, A.M.; Gunn, A.J. Utility of the RENAL nephrometry scoring system in predicting adverse events and outcomes of percutaneous microwave ablation of renal tumors. J. Vasc. Interv. Radiol. 2022, 33, 695–701. [Google Scholar] [CrossRef]
  16. Simmons, M.N.; Hillyer, S.P.; Lee, B.H.; Fergany, A.F.; Kaouk, J.; Campbell, S.C. Diameter-axial-polar nephrometry: Integration and optimization of RENAL and centrality index scoring systems. J. Urol. 2012, 188, 384–390. [Google Scholar] [CrossRef]
  17. Hakky, T.S.; Baumgarten, A.S.; Allen, B.; Lin, H.-Y.; Ercole, C.E.; Sexton, W.J.; Spiess, P.E. Zonal NePhRO scoring system: A superior renal tumor complexity classification model. Clin. Genitourin. Cancer 2014, 12, e13–e18. [Google Scholar] [CrossRef] [PubMed]
  18. Spaliviero, M.; Poon, B.Y.; Karlo, C.A.; Guglielmetti, G.B.; Di Paolo, P.L.; Corradi, R.B.; Martin-Malburet, A.G.; Campos-Juanatey, F.; Escudero-Fontano, E.; Sjoberg, D.D.; et al. An arterial based complexity (ABC) scoring system to assess the morbidity profile of partial nephrectomy. Eur. Urol. 2016, 69, 72–79. [Google Scholar] [CrossRef]
  19. Ficarra, V.; Porpiglia, F.; Crestani, A.; Minervini, A.; Antonelli, A.; Longo, N.; Novara, G.; Giannarini, G.; Fiori, C.; Simeone, C.; et al. The S implified PA DUA RE nal (SPARE) nephrometry system: A novel classification of parenchymal renal tumours suitable for partial nephrectomy. BJU Int. 2019, 124, 621–628. [Google Scholar] [CrossRef]
  20. Diana, P.; Lughezzani, G.; Uleri, A.; Casale, P.; Saita, A.; Hurle, R.; Lazzeri, M.; Mottrie, A.; De Naeyer, G.; De Groote, R.; et al. Multi-institutional retrospective validation and comparison of the simplified PADUA REnal Nephrometry System for the prediction of surgical success of robot-assisted partial nephrectomy. Eur. Urol. Focus 2021, 7, 1100–1106. [Google Scholar] [CrossRef] [PubMed]
  21. Weprin, S.; Falagario, U.; Veccia, A.; Nandanan, N.; Emerson, D.; Ovanez, C.; Albuquerque, E.V.; Zukovski, E.B.; Clayton, R.; Hampton, L.; et al. Simplified PADUA Renal (SPARE) nephrometry scoring system: External validation, interobserver variability, and comparison with RENAL and PADUA in a single-center robotic partial nephrectomy series. Eur. Urol. Focus 2021, 7, 591–597. [Google Scholar] [CrossRef] [PubMed]
  22. Agarwal, D.K.; Mulholland, C.; Koye, D.N.; Sathianathen, N.; Yao, H.; Dundee, P.; Moon, D.; Furrer, M.; Giudice, C.; Wang, W.; et al. RPN (Radius, Position of tumour, iNvasion of renal sinus) Classification and Nephrometry Scoring System: An Internationally Developed Clinical Classification To Describe the Surgical Difficulty for Renal Masses for Which Robotic Partial Nephrectomy Is Planned. Eur. Urol. Open Sci. 2023, 54, 33–42. [Google Scholar]
  23. Sharma, A.P.; Mavuduru, R.S.; Bora, G.S.; Devana, S.K.; Singh, S.K.; Mandal, A.K. Predicting trifecta outcomes after robot-assisted nephron-sparing surgery: Beyond the nephrometry score. Investig. Clin. Urol. 2018, 59, 305–312. [Google Scholar] [CrossRef]
Table 1. Survey response totals.
Table 1. Survey response totals.
Survey Questionn%
Country of Practice
-
Australia
-
India
-
UK
-
West Europe (Spain, Belgium, France, Germany, Switzerland, Greece, Italy)
-
South America (Brazil, Argentina, Colombia, Peru, Venezuela)
-
USA
-
Southern Asia and the Middle East (Israel, Morocco, Pakistan, Bangladesh, Turkey, UAE)
-
East Asia (Singapore, Japan, HK)
-
New Zealand
-
Russia

52
41
17
13
11
8
8
5
2
1

33
25
11
8
7
5
5
3
1
<1
Are you involved in the management of renal masses?
        Yes
        No

152
6

96
4
Do you perform partial nephrectomies?
        Yes
        No

139
19

88
12
How many partial nephrectomies have you done so far as primary surgeon?
        1–10
        11–20
        21–50
        51–100
        >100
        No response

8
17
27
30
56
20

5
11
17
19
35
13
Do you use a nephrometry system in clinical practice?
        Yes
        No

81
77

51
49
        Urologists who use a nephrometry scoring system in clinical practice (n = 81)
          Which nephrometry scoring system do you use most often?
            RENAL
            PADUA
            SPARE
            C-index
            SARR
            ABC

72
7
0
0
1
1

89
9
0
0
1
1
          How often do you use this nephrometry scoring system?
            Less than half of the time
            More than half of the time

24
57

30
70
          Who calculates the nephrometry score?
            Primary surgeon
            Trainee assistant

56
25

69
31
          Do you use nephrometry scoring when counselling patients on treatment options?
            Yes
            No

51
30

63
37
          Do you use nephrometry scoring for deciding when to perform a partial vs radial nephrectomy?
            Yes
            No

44
37

54
46
          Do you use nephrometry scoring in your surgical planning meetings when discussing treatment options of a renal mass?
            Yes
            No
            We do not have surgical planning meetings

44
18
19

54
22
23
          In what other context do you use this nephrometry scoring system?
            For data collection for research purposes
            For training the novice surgeon
            Other *

54
39
5

67
48
6
          What are your concerns using existing nephrometry systems?
            Lack of familiarity
            Too complex
            Too time consuming
            Unhelpful for patient counselling
            Unhelpful for treatment decision-making
            Lacks good evidence base
            Useful for research only and not clinically relevant
            Other a
            None

4
7
14
14
17
9
24
8
20

5
9
17
17
21
11
30
10
25
        Urologists who do not use a nephrometry scoring system in clinical practice (n = 77)
          What are your concerns using existing nephrometry systems?
            Lack of familiarity
            Too complex
            Too time consuming
            Unhelpful for patient counselling
            Unhelpful for treatment decision-making
            Lacks good evidence base
            Useful for research only and not clinically relevant
            Other b

10
9
20
24
29
5
36
10

13
12
26
31
38
6
47
13
* Other reasons include perioperative counselling and surgical planning; for communication with other surgeons; decisions about postoperative monitoring (ICU vs ward). a Other reasons include “too complicated for patients to understand”; “does not take into consideration surgeon skill and experience”; “hilar lesions behave differently even if they have same nephrometry scores”; “surgeon’s eye is more than enough to measure complexity”. b Other reasons include “I’m a paediatric urologist”; “use experience to ‘calculate’ own score and assess difficulty”; “I don’t manage renal masses/treat kidney disease”.
Table 2. Subgroup analysis of the responses based on surgeons’ PN case number experience.
Table 2. Subgroup analysis of the responses based on surgeons’ PN case number experience.
Number of Partial Nephrectomies Done as Primary Surgeon (n = 138)
1–20
(n = 25)
21–50
(n = 27)
51–100
(n = 30)
>100
(n = 56)
p-Value
Uses a nephrometry scoring system15 (60) 13 (48)17 (57)31 (55)0.851
        How often do you use?
          Less than half the time
          Greater than half the time

2 (13)
13 (87)

2 (15)
11 (85)

8 (47)
9 (53)

11 (35)
20 (65)
0.088
        Used for patient counselling11 (73)9 (69)11 (65)15 (48)0.394
        Used to decide when to perform a partial         nephrectomy
10 (67)

10 (77)

7 (41)

13 (42)

0.117
        Used in surgical planning meetings8 (53)9 (69)9 (53)15 (48)0.657
Concerns:
        Lack of familiarity3 (12)3 (11)2 (7)5 (9)0.905
        Too complex6 (24)4 (15)1 (3)5 (9)0.095
        Too time consuming7 (28)9 (33)5 (17)10 (18)0.320
        Unhelpful for patient counselling8 (32)6 (22)6 (20)15 (27)0.746
        Unhelpful for treatment decision-making8 (32)4 (15)10 (33)20 (36)0.265
        Lacks good evidence base1 (4)2 (7)6 (20)4 (7)0.156
        Useful for research only9 (36)8 (30)11 (37)28 (50)0.286
One did not provide a response for the number of partial nephrectomies they have performed.
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MDPI and ACS Style

Yanada, B.A.; Homewood, D.; Dias, B.H.; Corcoran, N.M.; Lawrentschuk, N.; Sabnis, R.; Teoh, J.Y.C.; Agarwal, D. Utility and Practicability of Nephrometry Scoring Systems in Contemporary Clinical Practice—An International Multicentre Perspective. Soc. Int. Urol. J. 2025, 6, 7. https://doi.org/10.3390/siuj6010007

AMA Style

Yanada BA, Homewood D, Dias BH, Corcoran NM, Lawrentschuk N, Sabnis R, Teoh JYC, Agarwal D. Utility and Practicability of Nephrometry Scoring Systems in Contemporary Clinical Practice—An International Multicentre Perspective. Société Internationale d’Urologie Journal. 2025; 6(1):7. https://doi.org/10.3390/siuj6010007

Chicago/Turabian Style

Yanada, Brendan A., David Homewood, Brendan H. Dias, Niall M. Corcoran, Nathan Lawrentschuk, Ravindra Sabnis, Jeremy Y. C. Teoh, and Dinesh Agarwal. 2025. "Utility and Practicability of Nephrometry Scoring Systems in Contemporary Clinical Practice—An International Multicentre Perspective" Société Internationale d’Urologie Journal 6, no. 1: 7. https://doi.org/10.3390/siuj6010007

APA Style

Yanada, B. A., Homewood, D., Dias, B. H., Corcoran, N. M., Lawrentschuk, N., Sabnis, R., Teoh, J. Y. C., & Agarwal, D. (2025). Utility and Practicability of Nephrometry Scoring Systems in Contemporary Clinical Practice—An International Multicentre Perspective. Société Internationale d’Urologie Journal, 6(1), 7. https://doi.org/10.3390/siuj6010007

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