Vol. 43 (x): 2017 May 5.[Ahead of print]
Sumit Kumar 1, Ramaiah Keshavamurthy 1, Vilvapathy Senguttuvan Karthikeyan 1, Ashwin Mallya 1
1 Department of Urology, Institute of Nephrourology, Bangalore, India
Introduction: CROES-Clavien system (CCS) for grading complications in percutaneous nephrolithotomy (PCNL) is a step towards standardization of outcomes. We categorized complications based on CCS and predicted risk factors across the entire cohort and individually for pediatric (P: ≤18 years), adult (A: 19-65 years) and geriatric (G: ≥65 years) subgroups to assess the risk factors in each subset. We assessed association of complications with length of hospitalization (LOH) and operation time (OT).
Materials and Methods: Retrospective record review of unilateral PCNL performed between January 2009-September 2015 at a tertiary care center in India, performing around 150 PCNL per year.
Results: Out of 922 (P=61; A=794; G=67) PCNL, 259 (28.09%) complications occurred with CCS I, II, III and IV constituting 152 (16.49%), 72 (7.81%), 31 (3.36%) and 4 (0.43%) respectively and its distribution was similar across the subsets and majority (224; 24.3%) were minor (CCS-1, 2). Placement of a nephrostomy (47.4%; 18/38) in Group P, supracostal access, ≥2 punctures, higher GSS, nephrostomy, staghorn stones, ≥2 stones, stone size in Group A and hydronephrosis and prolonged OT in Group G were significantly associated with complications. On logistic regression, need of nephrostomy (adj. OR – 4.549), OT (adj. OR – 1.364) and supracostal access (adj. OR – 1.471) significantly contributed to complications in the study population. LOH was found to be significantly associated with complications (p<0.001).
Conclusions: Contrary to the belief that extremes of ages are associated with complications of prone PCNL, we found age does not alter the incidence or grade of complications and LOH.
Keywords: Kidney Calculi; Nephrostomy, Percutaneous; complications [Subheading]