Prognostic Factors and Percutaneous Nephrolithotomy Morbidity: A Multivariate Analysis of a Contemporary Series Using the Clavien Classification

Rosette, Jean J.M.C.H. de la; Zuazu, J. Rioja; Tsakiris, Peter; Elsakka, Ahmed M.; Zudaire, J.J.; Laguna, M. Pilar; Reijke, T.M. De

doi:10.1016/j.juro.2008.08.025

Cited by 117 publications

(78 citation statements)

References 19 publications

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“…3,15,31,32 Pre-existent hydronephrosis did not predict major complications in the Olbert study. 20 Renal morphology (including hydronephrosis) had no significant effect on complications in staghorn stones.…”

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confidence: 66%

“…3,10,16,21,34 In other studies, stone distribution and staghorn stone had no significant effect on complications or grade ≥IIIa.…”

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confidence: 76%

“…[1][2][3][4][5][6][7] An increase in PCNL has been accompanied by variations in positions, techniques, and instruments, and these may have led to increased complications.…”

Section: Introductionmentioning

confidence: 99%

“…4 A standardized classification allow us to compare complications among different instruments, techniques, and centres. 3,4,7,9 In 2004, the modified Clavien system (MCC) was introduced and allowed us to classify complications based on life-threatening conditions, interventions required, and disability. 9 In recent years, this classification has been used to report PCNL complications instead of using simply "minor" and "major" distinctions.…”

Section: Introductionmentioning

confidence: 99%

“…9 In recent years, this classification has been used to report PCNL complications instead of using simply "minor" and "major" distinctions. [3][4][5][6][7][8][10][11][12] In this study, we reported on the PCNL complications according to the MCC and identified the parameters affecting the severity of complications based on this classification. …”

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confidence: 99%

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Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy

Falahatkar¹,

Moghaddam

Kazemnezhad³

et al. 2015

CUAJ

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Cite as: Can Urol Assoc J 2015;9(1-2):e83-92. http://dx.doi.org/10.5489/cuaj.2248 Published online February 9, 2015. AbstractIntroduction: An increase in percutaneous nephrolithotomy (PCNL) has been accompanied by an increase in complications. We identified the parameters affecting the severity of complications using the modified Clavien classification (MCC). Methods: From 2008 to 2013, 330 patients underwent complete supine PCNL using subcostal access, one-shot dilation, rigid nephroscopy, and pneumatic lithotripsy. We assessed the impact of the following factors on complication severity based on the MCC: age, gender, body mass index, hypertension, diabetes, previous stone surgery and extracorporeal shock wave lithotripsy, preoperative hemoglobin, renal dysfunction (creatinine >1.4 mg/dL), preoperative urinary tract infection, anatomic upper urinary tract abnormality (AUUTA), significant (moderate-severe) hydronephrosis, stonerelated parameters (opacity, number, burden, location, staghorn, complex stones), anesthesia type, kidney side, imaging and calyx for access, tract number, tubeless approach, operative time, postoperative hemoglobin, and hemoglobin drop and stone-free results. Results: The complication rate was 19.7% (MCC: 0=80.3%, I=6.4%, II=11.2%, ≥III=2.1%). On univariate analyses, only the following factors affected MCC: gender, preoperative hemoglobin, AUUTA, significant hydronephrosis, imaging for access, calyx for access, tract number, postoperative hemoglobin, hemoglobin drop and stone-free result. Renal dysfunction was accompanied by higher complications, yet the results were not statistically significant. Multivariate logistic regression analysis demonstrated renal dysfunction, absence of significant hydronephrosis, AUUTA, multiple tracts, lower postoperative hemoglobin, and higher postoperative hemoglobin drop as the significant parameters which affected MCC and predicted higher grades. The paper's limitations include a low number of cases in the higher Clavien grades and some subgroups of variables, and not applying some techniques due to surgeon preference. Interpretation: Many of the complete supine PCNL complications were in the lower Clavien grades and major complications were uncommon. Renal dysfunction, AUUTA, significant hydronephrosis, tract number, postoperative hemoglobin, and hemoglobin drop were the only factors affecting MCC. IntroductionPresently, percutaneous nephrolithotomy (PCNL) is preferred as a safe and effective way to remove large or multiple upper urinary tract calculi. [1][2][3][4][5][6][7] An increase in PCNL has been accompanied by variations in positions, techniques, and instruments, and these may have led to increased complications.1,2,4,5 Following PCNL, 79.5% of patients may experience an uncomplicated postoperative period, 5,8 although there are reports of an early complication rate of 50.8%. 4PCNL complications may occur during puncturing, access, or stone removal. 4 A standardized classification allow us to compare complications among different instruments, te...

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confidence: 66%

“…3,10,16,21,34 In other studies, stone distribution and staghorn stone had no significant effect on complications or grade ≥IIIa.…”

mentioning

confidence: 76%

“…[1][2][3][4][5][6][7] An increase in PCNL has been accompanied by variations in positions, techniques, and instruments, and these may have led to increased complications.…”

Section: Introductionmentioning

confidence: 99%