Comparison of complication rates for unilateral and bilateral percutaneous nephrolithotomy (PCNL) using a modified Clavien grading system Journal Article

Authors: Kadlec, A. O.; Greco, K. A.; Fridirici, Z. C.; Hart, S. T.; Vellos, T. G.; Turk, T. M.
Article Title: Comparison of complication rates for unilateral and bilateral percutaneous nephrolithotomy (PCNL) using a modified Clavien grading system
Abstract: OBJECTIVE: To compare complication rates of unilateral vs bilateral percutaneous nephrolithotomy (PCNL) using the modified Clavien grading system. PATIENTS AND METHODS: Single-institution retrospective chart review. Identified patients who had synchronous bilateral PCNL (B-PCNL) over an 11-year period (2000-2011). B-PCNL patients were matched by age, gender, and stone burden per renal unit with patients who underwent unilateral PCNL (U-PCNL) over the same period. Complications were recorded and classified using the modified Clavien classification system, and then compared with a two-sided chi-square test of proportions. RESULTS: In all, 47 B-PCNL patients [mean (range) age 54 (14-84) years] and 78 U-PCNL patients [mean (range) age 54 (17-91 years] were compared. The mean (range) stone burden per renal unit was 2.8 (0.7-7.0) cm and 2.9 (0.7-9.0) cm, respectively. The overall complication rate was higher for B-PCNL (53.2% vs 30.8%, P = 0.013). Rates of Grade I and Grade II complications trended toward being higher in the B-PCNL group. Low-grade complications (Grade I and II combined) occurred more often in the B-PCNL group (P = 0.011); the most common low-grade complication was fever. Two procedures terminated for poor visualisation due to bleeding were successfully completed in delayed fashion with no transfusion and were classified as Grade I complications. There were equivalently low rates of Grade III complications. There were no Grade IV or V complications. CONCLUSIONS: B-PCNL carries a higher overall complication rate than U-PCNL when the modified Clavien system is used for classification. Patients undergoing U-PCNL who have more than one tract dilatation have a higher complication rate than those who have only one tract dilatation. High-grade complications are uncommon for both procedures.
Keywords: Adult; Aged; Aged, 80 and over; Female; Humans; Middle Aged; Young Adult; Male; Severity of Illness Index; Retrospective Studies; Adolescent; Urology; Follow-Up Studies; Kidney Calculi/surgery; Nephrostomy, Percutaneous/adverse effects/methods; Postoperative Complications/classification/diagnosis
Journal Title: BJU international
Volume: 111
Issue: 4 Pt B
ISSN: 1464-410X; 1464-4096
Journal Place: England
Date Published: 2013
Start Page: E243
End Page: 8
Language: eng
Notes: ID: 13154; CI: (c) 2012 THE AUTHORS. BJU INTERNATIONAL (c) 2012; JID: 100886721; 2012/10/29 [aheadofprint]; ppublish