Reporting ureteroscopy complications using the modified clavien classification system

Abstract

Objective:Perioperative complications are one of the surrogate indicators of surgical outcomes. However, reporting these complications need a precise grading system. Our aim is to report and grade the complications of semirigid ureteroscopy in ureteral stone management according to the modified Clavien classification system.Materials and Methods:This is a prospective study conducted From January 2012 to June 2013. All patients with ureteral stones who were indicated for semirigid URS were evaluated. All procedures were performed by the same surgeon. The data recorded including patient demographics, clinical indication, stone size and location, operative time and complications were classified according to the modified Clavien classification system. The patients were followed for 8 weeks postoperatively.Results:148 patients included, Stone distribution was: 89 (60.1%) lower ureteral, 26 (17.6%) mid ureteral, and 33 (22.3%) upper ureteral. the mean stone size was 8.6 mm. Urgent URS done in 23% of patient. The overall stone free rate was 88.5%, the individual stone free rate for the upper, middle and lower ureter were 87.9%, 84.6%, and 89.9%, respectively. The mean operative time was 31.9 min (20-50 min.). Complications occurred in 26.35% of patients. Grade I complications occurred in 32 patients (26.1%), grade II in 9 (6.1%), grade IIIa in 7 (4.7%), grade IIIb in 8 (5.4%), grade IVa in two patient (1.35%), and grade IVb in one patient (0.7%). No grade V complication was encountered.Conclusion:Ureteroscopy becomes the vanguard interventional therapy for ureteral stones with well-established efficacy and safety. It is of paramount importance to adopt a precise structured classification system for reporting surgical complications, that should be flexible and comprehensive in order to accommodate the various and rapidly expanding surgical fields.

Complications associated with ureterorenoscopy (URS) related to treatment of urolithiasis: the Clinical Research Office of Endourological Society URS Global study

“…Another possible limitation is linked to the Clavien–Dindo classifications system, and we may have suffered underreporting in minor self-limiting complications as described by Ibrahim [2]. One of these underreported self-limiting complications may be mucosal damage, and there is some debate whether or not mucosal damage is simply part of the procedure, or a complication worth mentioning and grading [8, 11].…”

“…Most important complications of ureterorenoscopy are up-migration [1, 2] of stones, higher retreatment rates [1] due to incompletely removed stones (specifically in larger stones), and damage to the ureter [1–3] (from minor mucosal damage to avulsion) as a consequence of access sheath placement or difficulties with negotiating the ureter and rarely due to repetitive in and out movement of instruments.…”

Semi-Rigid Ureteroscopy for Proximal Ureteral Stones: Does Adjunctive Tamsulosin Therapy Increase the Chance of Success?

“…Most of the reported complications were minor. However, some investigators [18,28] reported major complications in the form of ureteral perforation and even sepsis that required laparotomy. In our study, no ureteral perforation or avulsion was encountered, and we only had 4 (2.4%) cases of stone migration.…”

Categorization of ureteroscopy complications and investigation of associated factors by using the modified Clavien classification system

“…Sex was detected as an important entity only in grade I complications. In the previous literature, sex-associated complications were not reported according to the grade of the MCCS and there were no significant differences between sex and complication rates (3,24,25). Moreover, the association of sex with hematuria after URS was not investigated before.…”