KLİNİĞİMİZDE UYGULANAN PERKÜTAN NEFROLİTOTOMİ AMELİYATLARINA AİT KOMPLİKASYONLARIN MODİFİYE CLAVİEN SINIFLAMA SİSTEMİNE GÖRE DEĞERLENDİRİLMESİ

Amaç: Kliniğimizde uygulanan standart perkütan nefrolitotomi operasyonu sonrasında gelişenkomplikasyonları modifiye Clavien sınıflamasına göre sınıflandırarak sonuçlarımızı sunmayıamaçladık.Gereç ve Yöntem: 2011 ve 2016 yılları arasında Adıyaman Üniversitesi Tıp Fakültesi Üroloji kliniğindestandart perkütan nefrolitotomi uygulanan 341 olguya ait postoperatif komplikasyonlarmodifiye Clavien sınıflama sistemine göre değerlendirildi.Bulgular: Hastaların ortalama yaşları 44,6±12,4 yıl (12-82), 225’i (%65,9) erkek, 116’sı (%34,1)kadın idi. Ortalama operasyon süresi 86,42±14,37 (17-174) dakika idi. Hastaların 85’inde(%24,9) postoperatif dönemde komplikasyon gerçekleşti. Bu komplikasyonlar Modifiye Claviensınıflama sistemine göre grade 1, 2, 3A, 3B, 4A, 4B için sırasıyla %6.7, %13.4, %1.7, %2.3, %0.29,%0.29 idi. Hiçbir hastada grade 5 komplikasyon izlenmedi.Sonuç: Modifiye Clavien sınıflama sistemi perkütan nefrolitotomi sonrası gelişen komplikasyonlarınsınıflanmasında standardizasyon getiren, kullanımı uygun, güncel bir sınıflama sistemidir.

Evaluation of Complications of Percutaneous Nephrolithotomy Operations Performed at our Clinic Using Modified Clavien Classification System

Introduction and Purpose: Our aim was to present complications of percutaneous nephrolithotomy operations performed at our clinic using modified Clavien classification and to compare our results with the literature. Material and Methods: We evaluated postoperative complications of 341 cases who had percutaneous nephrolithotomy at our clinic between 2011 and 2016 using modified Clavien classification. Findings: Mean age of the patients was 44,6±12,4 years (12-82), 225 (65,9%) were males, and 116 (34%) were females. Mean operation duration was 86,42±14,37 (range: 17-174) minutes. Postoperative complications occurred in 85 (24,9%) patients. Rate of these complications according to modified Clavien classification grade 1, 2, 3A, 3B, 4A, and 4B were 6.7%, 13.4%, 1.7%, 2.3%, 0.29%, and 0.29% respectively. None of the patients had a grade 5 complication. Discussion: Modified Clavien classification system is a feasible and up-to-date classification system which enables standardization for complications that occur after percutaneous nephrolithotomy.

PDF

___

Tefekli A, Karadag MA, Tepeler K, Sari E, Berberoglu Y, Baykal M et al. Classification of percutaneous nephrolithotomy complications using the modified Clavien grading system: Looking for a standard. Eur Urol 2008;53(1):184-90.
Akman T, Binbay M, Akcay M, Tekinarslan E, Kezer C, Ozgor F, et al. Variables that influence operative time during percutaneous nephrolithotomy: An analysis of 1897 cases. J Endourol 2011;25:1269-73.
de la Rosette JJ, Zuazu JR, Tsakiris P, Elsakka AM, Zudaire JJ, Laguna MP, et al. Prognostic factors and percutaneous nephrolithot omy morbidity: A multivariate analysis of a contemporary series using the Clavien classification. J Urol 2008;180:2489-93.
Netto NR Jr, Ikonomidis J, Ikari O, Claro JA. Comparative study of percutaneous access for staghorn calculi. Urology 2005;65:659-62.
Hegarty NJ, Desai MM. Percutaneous nephrolithotomy requiring multiple tracts: Comparison of morbidity with single-tract procedures. J Endourol 2006;20:753-60.
Osther PJ, Razvi H, Liatsikos E, Averch T, Crisci A, Garcia JL, et al. Percutaneous nephrolithotomy among patients with renal anomalies: Patient characteristics and outcomes; a subgroup analysis of the clinical research office of the endourological society global percutaneous nephrolithotomy study. J Endourol 2011;25:1627-32.
Falahatkar S, Moghaddam KG, Kazemnezhad E, Farzan A, Aval HB, Ghasemi A, et al. Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy. Can Urol Assoc J 2015;9:83-92
Sairam K, Scoffone CM, Alken P, Turna B, Sodha HS, Rioja J, et al. Percutaneous nephrolithotomy and chronic kidney disease: Results from the CROES PCNL Global Study. J Urol 2012;188:1195-2000.
Yaycioglu O, Egilmez T, Gul U, Turunc T, Ozkardes H. Percutaneous nephrolithotomy in patients with normal versus impaired renal function. Urol Res 2007;35:101-5.
Yuruk E, Tefekli A, Sari E, Karadag MA, Tepeler A, Binbay M, et al. Does previous extracorporeal shock wave lithotripsy affect the performance and outcome of percutaneous nephrolithotomy? J Urol 2009;181:663-7.
Duvdevani M, Nott L, Ray AA, Ko R, Denstedt JD, Razvi H. Percutaneous nephrolithotripsy in patients with diabetes mellitus. J Endourol 2009;23:21-6.
Olbert PJ, Hegele A, Schrader AJ, Scherag A, Hofmann R. Preand perioperative predictors of short-term clinical outcomes in patients undergoing percutaneous nephrolitholapaxy. Urol Res 2007;35:225-30.
Palmero JL, Nu-o de la Rosa I, Miralles J, Amorós A, Pastor JC, Benedicto A, et al. Study of predictive factors for complications after percutaneous nephrolithotomy according to the Clavien classification. Actas Urol Esp 2013;37:412-8.
El-Nahas AR, Eraky I, Shokeir AA, Shoma AM, El-Assmy AM, ElTabey NA, et al. Factors affecting stone-free rate and complications of percutaneous nephrolithotomy for treatment of staghorn stone. Urology 2012;79:1236-41.
Shin TS, Cho HJ, Hong SH, Lee JY, Kim SW, Hwang TK, 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;52:769-75.
de la Rosette JJ, Opondo D, Daels FP, Giusti G, Serrano A, Kandasami SV et al. Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy. Eur Urol 2012;62(2):246-55.
Aktaş BG, Gökkaya CS, Bulut S, Öztekin ÇV, Erbay G, Özden C ve ark. Perkütan Nefrolitotomi Komplikasyonlarımızın Modifiye Clavien Sınıflaması. J Clin Anal Med 2015;6:46-9
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240: 205-13
Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 1992;111:518-26
Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur Urol 2007; 51(4):899-906
Labate G, Modi P, Timoney A, Cormio L, Zhang X, Louie M, et al. The percutaneous nephrolithotomy global study: classification of complications. J Endourol 2011; 25(8): 1275-80
Matlaga BR, Assimos DG. Changing indications of open stone surgery. Urology 2002; 59(4): 490-3
Noga A, Szkodny A, Prajsner A, Bar K, Szkodny G. Percutaneous nephrolithotripsy indications for the procedure and its technique. Przegl Lek 1992; 49(4):131-2
Schuster TK, Smaldone MC, Averch TD, Ost MC. Percutaneous nephrolithotomy in children. J Endourol 2009; 23 (10) 1699-705.