Comparison of percutaneous nephrolithotomy complications according to the modified clavien classification during and after the learning curve

Abstract

Objectives: The aim of the study was to compare the percutaneous nephrolithotomy (PCNL) complications according to the modified clavien classification during and after the learning curve.

Methods: In our study, PCNL procedures applied to 275 patients between May 2010 and June 2014. The complications were retrospectively compared according to the Modified Clavien Classification during and after the learning curve. The first 50 cases were defined as the learning curve and referred to as Group-1 and the following cases as Group-2.

Results: We performed 294 PCNL applications on a total of 275 patients. The average duration of surgery was 120 (65-230 min.-max.) minutes and 80.2 (20-140 min.-max.) minutes in Group-1 and in Group-2, respectively (p<0.05).  When complications, following PCNL, were evalauted according to the modified Clavien classification, grade I, II, IIIa, IIIb, IVa, IVb, and V complications were observed in 12 (%), 54 (%), 10 (%), 4 (%), 0 (0.9%), 0 (0%), and 0 (0%) patients of group 1, respectively. When group 2 was evaluated, grade I, II, IIIa, IIIb, IVa, IVb, and V complications were observed  in 24 (%), 132 (%), 30 (%), 6 (%), 1 (0.%), 1 (0%), and 0 (0%) patients, respectively. Grade-5 complication was not observed in any of our patients.

Conclusions:  The Modified Clavien Classification may be useful for the comparison of PCNL complications during and after the learning curve for reporting outcomes.

Keywords

• Percutaneous nephrolithotomy, Modified-Clavien, Complications, learning curve

References

1. Constantinides CA, Tyritzis SI, Skolarikos A, et al. Short- and long-term complications of open radical prostatectomy according to the Clavien classification system. BJU Int 2009; 103:336-340.
2. Shin TS, Cho HJ, Hong SH, et al. Complications of Percutaneous Nephrolithotomy Classified by the Modified Clavien Grading System: A Single Center's Experience over 16 Years. Korean J Urol 2011; 52: 769-775.
3. De la Rosette JJ, Rioja Zuazu J, Tsakiris P. Prognostic factors on percutaneous nephrolithotomy morbidity: a multivariate analysis of a contemporary series using the Clavien classification. J Urol 2008; 180: 2489- 2493.
4. Novara G, Ficarra V, D’Elia C, et al. Prospective evaluation with standardised criteria for postoperative complications after robotic-assisted laparoscopic radical prostatectomy Eur Urol 2010; 57: 363-370.
5. Michel MS, Trojan L, Rassweiler JJ. Complications in Percutaneous Nephrolithotomy. Eur Urol 2007; 51: 899-906.
6. Mandal S, Goel A, Kathpalia R, et al. Prospective evaluation of complications using the modified Clavien grading system, and of success rates of percutaneous nephrolithotomy using Guy's Stone Score: A single-center experience. Indian J Urol 2012; 28: 392-398.
7. Kessaris D, Bellman G, Pardalidis N, Smith AG. Management of hemorrhage after percutaneous renal surgery. J Urol 1995; 153: 604-608.
8. El-Nahas AR, Shokeir AA, El-Assmy AM, et al. Post- percutaneous nephrolithotomy extensive hemorrhage: a study of risk factors. J Urol 2007; 177: 576-579.

9. Srivastava A, Singh KJ, Suri A, et al. Vascular complications after percutaneous nephrolithotomy: are there any predictive factors? Urology 2005; 66: 38-40.
10. Kukreja R, Desai M, Patel S, Bapat S, Desai M. Factors affecting blood loss during percutaneous nephrolithotomy: Prospective study. J Endourol 2004; 18: 715-722.
11. AslZare M, Darabi MR, Shakiba B, Gholami-Mahtaj L. Colonic perforation during nephrolithotomy: An 18-year experience. Can Urol Assoc J 2014; 8: 323-326. percutaneous
12. Labate G, Modi P, Timoney A, et al. study: The percutaneous classification of complications. On Behalf of The Croes PCNL Study Group J. J Endourol 2011; 25: 1275-1280.
13. Segura JW. Percutaneous Nephrolithotomy: Technique, indications, and complications; AUA Guidelines 1993; 12: 154.