The Percutaneous Nephrolithotomy Global Study: Classification of Complications

Labate, Gaston; Modi, Pranjal; Timoney, Anthony G.; Cormio, Luigi; Zhang, Xiaochun; Louie, Michael K.; Grabe, Magnus

doi:10.1089/end.2011.0067

Cited by 196 publications

(148 citation statements)

References 33 publications

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“…15,16,20 However, in other studies, positive urine culture had no significant effect on the mean Clavien score, grade ≥IIIa or complications in multivariate analysis. 3,8,21 In our experience, age, gender, BMI, hypertension, DM, IHD, previous stone surgery and ESWL, preoperative hemoglobin, preoperative UTI and kidney side did not affect MCC. Positive preoperative urine culture does not predict urosepsis and systemic inflammatory response syndrome in PCNL.…”

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confidence: 53%

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confidence: 79%

“…In multiple studies, stone burden had no significant effect on the mean Clavien score, risk of grade ≥IIIa, major complications, or complication rate. 8,15,16,20,21 In other studies, stone surface area or stone size significantly affected complications and mean Clavien score.3,17 Moreover, stone location, staghorn and complex stones had a significant influence on mean Clavien score, Clavien grades, or complications in some studies. 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: 88%

“…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%. 4 PCNL complications may occur during puncturing, access, or stone removal.…”

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: 53%

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confidence: 79%

mentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

mentioning

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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Bowel and Other Organ Injuries with Percutaneous Nephrolithotomy

Knoedler

Gettman

Fleming

2018

Smith's Textbook of Endourology

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Super‐stiff guidewire or loach guidewire during percutaneous nephrolithotomy?

et al. 2023

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ObjectivesThe objectives of this work are to compare the outcomes between loach guidewire and super‐stiff guidewire during percutaneous nephrolithotomy (PCNL) and find potential indications of different guidewires.Patients and methodsWe retrospectively reviewed our institutional PCNL database from 2017 to 2021. Patients who underwent PCNL guided by loach guidewire were assigned to group A (489 patients); patients who received super‐stiff guidewire were assigned to group B (269 patients). Preoperative demographic data, intraoperative parameters, and postoperative complications were compared. The conditions and reasons of failed placement of guidewire needed readjustment were evaluated as well.ResultsPreoperative demographic data and most intraoperative parameters were not statistically different between the groups. Postoperative Clavien–Dindo complications were also comparable, with low rate of complications. However, failed placement of guidewire more occurred in group A (8.2% vs. 4.0%, respectively, p = 0.03). Compared with the super‐stiff guidewire, the loach guidewire was easier pass/slip into any place either it be perinephric or blood vessels. In most failed group A cases and all failed group B cases, the guidewire was placed in the perirenal fat. Six patients (15%) in group A, the guidewires entered into vessels.ConclusionsOur results support that the faulty placement of loach guidewire is significantly more common compared with super‐stiff guidewire. Double confirmation is needed to prevent a major complication out of wrong dilatation whenever there is doubt about the wrong location of the guidewire.

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The Percutaneous Nephrolithotomy Global Study: Classification of Complications

Abstract: The majority of complications after PCNL are minor. Longer operative time and higher ASA scores are associated with the risk of more severe postoperative complications in PCNL.

Cited by 196 publications

References 33 publications

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

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

Bowel and Other Organ Injuries with Percutaneous Nephrolithotomy

Super‐stiff guidewire or loach guidewire during percutaneous nephrolithotomy?

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