Does mayo adhesive probability score affect mini-PCNL outcomes? Evidence from a prospective study

Objectives This study aims to prospectively evaluate the utility of Mayo Adhesive Probability (MAP) score, for determining stone-free status and post-operative complications in patients undergoing mini-Percutaneous Nephrolithotomy (PCNL).Methods A prospective cohort study of 154 patients undergoing mini-PCNL at a single tertiary care centre in eastern India was conducted. Patients were stratified into two groups based on their preoperative MAP score: group 1 (MAP score < 3, n = 103) and group 2 (MAP score ≥ 3, n = 51). Preoperative patient and stone characteristics were recorded. Postoperative outcomes, including stone-free rate, complications, haemoglobin drop, need for transfusion, fever, operative time and hospital stay were compared between the two groups. MAP score and complications according to Clavien-Dindo grade were correlated using Spearman’s rank correlation coefficient (r). ROC curves were generated to evaluate the diagnostic performance of MAP score in predicting binary outcomes (blood transfusion, fever, stone-free status).Results Patients in group 2 had lower stone-free rate (70.6% vs. 89.3%, p = 0.003), higher complications (39.21% vs. 21.3%, p = 0.007) including post operative fever and greater haemoglobin drop (1.25 vs. 0.369 g/dL, p < 0.001) with higher transfusions. Higher MAP score correlated with increasing severity of complications (r = 0.285, p < 0.001). ROC analysis demonstrated the MAP score’s ability to predict stone-free rate, need for transfusion and postoperative fever.Conclusions Higher MAP score (≥3) is significantly associated with lower stone-free rates, higher incidence of complications and greater blood loss in patients undergoing mini PCNL. Thus, incorporating the MAP score into preoperative assessment can aid clinicians in identifying high-risk patients, informed patient counselling, better surgical planning and aggressive infection control measures.