Modified Clavien Classification in Percutaneous Nephrolithotomy: Assessment of Complications in Children

Özden, Ender; Mercimek, Mehmet Necmettin; Yakupoğlu, Yarkın Kamil; Özkaya, Ozan; Sarıkaya, Şaban

doi:10.1016/j.juro.2010.09.023

Cited by 70 publications

(54 citation statements)

References 21 publications

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“…The modified Clavien system focuses mainly on the therapeutic consequences of a complication, emphasizing the level of the required intervention. The system is generally used to report complications occurring up to 90 days postoperatively, although it can also be applied to late complications [24]. We applied this classification system to stratify the recorded complications of URS for ureteral stones with different localizations in our institution.…”

Section: Discussionmentioning

confidence: 99%

“…First, this study is retrospective, which may lead to an inadequate recording of minor, self-limited complications. Ozden et al [24] reported their results in children treated with percutaneous nephrolithotomy and stated that auxiliary procedures such as SWL and second-look percutaneous nephrolithotomy, which were classified as grade III complications, are not complications but rather part of the treatment strategy. When we reviewed our results, we were faced with the same issue.…”

Section: Discussionmentioning

confidence: 99%

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Factors Affecting the Complications of Pneumatic Lithotripsy for the Treatment of Ureteral Stones with Different Localizations: A Multivariate Analysis of Complications

et al. 2013

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Objective: To evaluate the complications of ureterorenoscopy (URS) using the modified Clavien classification system for ureteral stones with different localizations. Patients and Methods: From February 2001 to January 2010, a total of 1,926 patients underwent URS for the treatment of ureteral stones with different localizations. The complications were evaluated according to the modified Clavien system. Univariate and multivariate analyses were conducted to identify risk factors affecting the complication rates. Results: The patient cohort included 1,212 males and 714 females with a mean age of 47.8 ± 14.3 years (range 15-86). The success rate was 95.7%. The overall complication rate was 9.3%. Univariate analysis revealed that solitary kidney, stone burden, bilaterality, stone localization (proximal to the iliac crest) and stone impaction significantly affected the complication rates. Multivariate analysis revealed that preoperative shock wave lithotripsy treatment, stone impaction, multiplicity, proximal localization and stone burden were significant parameters affecting the occurrence of complications (relative risks of 6.5, 4.3, 3.3, 2.4 and 2.0, respectively). Conclusions: URS is a safe and minimally invasive procedure with a high success rate and low-grade, self-limiting complications. Preoperative shock wave lithotripsy treatment, stone impaction, multiplicity, proximal localization and stone burden were independent risk factors for the development of complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors Affecting the Complications of Pneumatic Lithotripsy for the Treatment of Ureteral Stones with Different Localizations: A Multivariate Analysis of Complications

et al. 2013

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“…On the other hand, Kroovand [18] stated that adult-sized instruments are suitable to use in children including infants and toddles. Ozden et al [19] stated that modiWed Clavien system provides a straightforward and validated method to classify postoperative complications in pediatric PNL patients although they did not mention the type of instruments (pediatric vs. adult type) used in their evaluation. In our series, we had 15 complications and due to the modiWed Clavien system 3 were Grade I, 10 were Grade II and 2 were Grade IIIb.…”

Section: Discussionmentioning

confidence: 99%

Efficiency of percutaneous nephrolithotomy in pediatric patients using adult-type instruments

Doğan¹,

Atmaca²,

Canda³

et al. 2011

Urol Res

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To evaluate the efficiency of percutaneous nephrolithotomy using adult-type instruments in children with kidney stones. Between September 2004 and October 2009, 18 children (19 renal units) underwent percutaneous nephrolithotomy using adult-type instruments. Following percutaneous access under fluoroscopy, 20-30F tract dilatation was performed (1,92,427F), and lithotripters were used. Postoperatively, kidney-ureter-bladder X-ray and antegrade pyelography were performed to evaluate residual stones and contrast passage to the bladder. 8 boys and 10 girls with a mean age of 9.8 ± 4.56 years were evaluated. Mean stone burden was 338 ± 196.21 mm². Stones were located in the left and right kidneys in 16 (84.2%) and 3 (16.8%) patients, respectively. Horse-shoe kidney was present in one patient. Mean operation (including cystoscopy) and fluoroscopy times were 106 ± 49.60 and 5.2 ± 2.14 min, respectively. Postoperatively, 10(52.6%) patients were stone free and 4 (21.1%) patients had clinically insignificant stones. Saline extravasation developed in three patients and surgery was aborted in one patient. Stone fragments migrated into the ureter in two patients and managed by additional endourological interventions. Nephrostomy catheters were kept for a mean of 2.6 ± 1.12 days. Four patients required blood transfusion due to bleeding. Postoperative fever of <39°C developed in five patients and >39°C in one patient. Mean hospitalization time was 5.3 ± 3.12 days. Overall, 73.7% of our patients were stone free, including patients with clinically insignificant stones. Particularly in children with a high-stone burden, the use of adult-type instruments might have a positive impact on stone-free rate, operation time and fluoroscopy time without increasing the complication rate.

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“…Intraoperative data included side of operation, location of stone, location and number of tracts, and operative time. Outcome data included SFR at discharge, length of hospital stay, need for second-look nephroscopy, occurrence of complication coded according to the Modified Clavien Classification System [18], and stone composition. SFR was defined as no residual stones !3 mm on postoperative kidney ureter bladder (KUB) radiography, ultrasound, nephrostogram, or computed tomography (CT), according to surgeon preference.…”

Section: Methodsmentioning

confidence: 99%

A comparison of outcomes after percutaneous nephrolithotomy in children and adults: A matched cohort study

Lee

Violette

Tailly

et al. 2015

Journal of Pediatric Urology

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Modified Clavien Classification in Percutaneous Nephrolithotomy: Assessment of Complications in Children

Abstract: Percutaneous nephrolithotomy in children is safe, feasible and effective. Stone burden and operative time are independent risk factors for complications. The modified Clavien system provides a straightforward and validated method to classify postoperative complications.

Cited by 70 publications

References 21 publications

Factors Affecting the Complications of Pneumatic Lithotripsy for the Treatment of Ureteral Stones with Different Localizations: A Multivariate Analysis of Complications

Factors Affecting the Complications of Pneumatic Lithotripsy for the Treatment of Ureteral Stones with Different Localizations: A Multivariate Analysis of Complications

Efficiency of percutaneous nephrolithotomy in pediatric patients using adult-type instruments

A comparison of outcomes after percutaneous nephrolithotomy in children and adults: A matched cohort study

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