Bojan Sudarević, Dalibor Šimunović, Hrvoje Kuveždić,
Department of Urology, Osijek University Hospital
Systematic reporting of surgical complications is necessary in making an objective comparison between institutions, in a single institution over time or between surgeons and to evaluate new treatment modality. Clavien-Dindo (CD) is most frequently used such classification in urology. We will present pros and cons of CD specifically for percutaneous nephrolitholapaxy (PCNL) and ureterorenoscopy (URS), followed by results from our institution.
We use CD since January 2013 for 14 urological operations, including PCNL and URS. Initial retrospective dana collecting was later replaced by filling the CD form at patient discharge. Data for the last 45 PCNL and 70 URS patients will be presented. 85% of URS treated ureterolithiasis patients had no deviation from normal postoperative course. 9.4% patients were classified as CD2 and 1 patient as grade 3A, while ureterolithotomy was performed in 1 patient when URS failed. JJ stent was placed intraoperatively in 38% of patients, median stone size was 8 mm and hospital stay 3 days.
69.5% of patients had normal postoperative course after PCNL, 5 patients were classified as CD2 and 5 as grade 3A, while URS as an adjunctive treatment was done in 1 patient. Stones were mostly staghorn calculi and median hospital stay was 7 days. Data will be updated.
While applicable for PCNL, CD classification does not take into account frequently present need for adjunctive treatments like second-look PCNL or URS, classifying them as complications. Because of that CD modifications for specific procedures are being developed. PULS (Postureteroscopic lesion scale) was conceived in a similar fashion for classifying ureteral lesions during URS.Systematic presentation of surgical complications objectifies and upgrades the quality of surgical scientific literature and CD, although not without limitations, currently represents most widely accepted classification of surgical complications.