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Complications of retrograde intrarenal surgery classified by the modified Clavien grading system

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Abstract

The increase in the retrograde intrarenal surgery (RIRS) has been accompanied by the increase in complications. This study identified the factors that affected the severity of the complications using the modified Clavien classification system (MCCS). Three hundred and twenty-two consecutive RIRS performed by a single surgeon were analyzed. Data collection included demographics, clinical parameters, and perioperative and postoperative complications. The rate of adverse events for each of the Clavien grades was calculated, and statistical comparisons were made. The impact of each of the factors on the severity of the complications, based on the MCCS, was investigated using the univariate and multivariate analyses. The total complication rate was 26.1% (MCCS: I = 67.7%, II = 22.7%, IIIb = 7.2%, IVb = 2.4%). On the univariate analyses, the following factors affected complication: positive preoperative urine culture, operative time, irrigation rate, and stone burden. Multivariate logistic regression analysis demonstrated that positive preoperative urine culture, irrigation rate, and operative time were the significant factors affecting the complications. Most of the RIRS complications were in the lower Clavien grades and major complications were uncommon. Positive preoperative urine culture, irrigation rate, and operative time were the factors that affected complications.

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References

  1. Zheng C, Xiong B, Wang H, Luo J, Zhang C, Wei W et al (2014) Retrograde intrarenal surgery versus percutaneous nephrolithotomy for treatment of renal stones > 2 cm: a meta-analysis. Urol Int 93:417–424

    Article  PubMed  Google Scholar 

  2. Giusti G, Proietti S, Luciani L (2014) Is retrograde intrarenal surgery for the treatment of renal stones with diameters exceeding 2 cm still a hazard? Can J Urol 21:7207–7212

    PubMed  Google Scholar 

  3. Au V, Feit J, Barasch J, Sladen RN, Wagener G (2016) Urinary neutrophil gelatinase-associated lipocalin (NGAL) distinguishes sustained from transient acute kidney injury after general surgery. KI Rep 1:3–9

    PubMed  PubMed Central  Google Scholar 

  4. Lin KJ, Lin PH, Chu SH, Chen HW, Wang TM, Chiang YJ et al (2014) The impact of climate factors on the prevalence of urolithiasis in Northern Taiwan. Biomed J 37:24–30

    Article  PubMed  Google Scholar 

  5. Ramon de Fata F, Garcia-Tello A, Andres G, Redondo C, Meilan E, Gimbernat H et al (2014) Comparative study of retrograde intrarenal surgery and micropercutaneous nephrolithotomy in the treatment of intermediate-sized kidney stones. Actas Urol Esp 38:576–583

    Article  CAS  PubMed  Google Scholar 

  6. Gao X, Peng Y, Shi X, Li L, Zhou T, Xu B et al (2014) Safety and efficacy of retrograde intrarenal surgery for renal stones in patients with a solitary kidney: a single-center experience. J Endourol 28:1290–1294

    Article  PubMed  Google Scholar 

  7. Traxer O, Thomas A (2013) Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 189:580–584

    Article  PubMed  Google Scholar 

  8. Alkan E, Avci E, Ozkanli AO, Acar O, Balbay MD (2014) Same-session bilateral retrograde intrarenal surgery for upper urinary system stones: safety and efficacy. J Endourol 28:757–762

    Article  PubMed  Google Scholar 

  9. Oguz U, Resorlu B, Ozyuvali E, Bozkurt OF, Senocak C, Unsal A (2014) Categorizing intraoperative complications of retrograde intrarenal surgery. Urol Int 92:164–168

    Article  PubMed  Google Scholar 

  10. Breda A, Angerri O (2014) Retrograde intrarenal surgery for kidney stones larger than 2.5 cm. Curr Opin Urol 24:179–183

    Article  PubMed  Google Scholar 

  11. Sabnis RB, Ganesamoni R, Doshi A, Ganpule AP, Jagtap J, Desai MR (2013) Micropercutaneous nephrolithotomy (microperc) vs retrograde intrarenal surgery for the management of small renal calculi: a randomized controlled trial. BJU Int 112:355–361

    Article  PubMed  Google Scholar 

  12. Miranda-Utrera N, Pamplona Casamayor M, Borruel Nacenta S, Villar Esnal R, Diaz Gonzalez R (2014) Grade 3a Clavien grade complication following percutaneous nephrolithotomy. Related factors and review of the literature. Arch Esp Urol 67:206–209

    PubMed  Google Scholar 

  13. Karakoyunlu N, Ekici M, Yesil S, Zengin K, Goktug G, Ozok U (2014) Comparison of complications associated with standard and totally tubeless percutaneous nephrolithotomy according to modified Clavien grading: a multicenter retrospective study. Kaohsiung J Med Sci 30:613–618

    Article  PubMed  Google Scholar 

  14. Resorlu B, Unsal A, Ziypak T, Diri A, Atis G, Guven S et al (2013) Comparison of retrograde intrarenal surgery, shockwave lithotripsy, and percutaneous nephrolithotomy for treatment of medium-sized radiolucent renal stones. World J Urol 31:1581–1586

    Article  PubMed  Google Scholar 

  15. Koras O, Bozkurt IH, Yonguc T, Degirmenci T, Arslan B, Gunlusoy B et al (2015) Risk factors for postoperative infectious complications following percutaneous nephrolithotomy: a prospective clinical study. Urolithiasis 43:55–60

    Article  PubMed  Google Scholar 

  16. Cockerill PA, Rivera ME, Krambeck AE (2014) Analysis of the utility of stone gram stain in urolithiasis treated with percutaneous nephrolithotomy. Urology 83:1254–1257

    Article  PubMed  Google Scholar 

  17. Jung H, Osther P (2015) Intraluminal pressure profiles during flexible ureterorenoscopy. Springerplus 24:373

    Article  Google Scholar 

  18. Suh LK, Rothberg M, Landman J (2010) Intrarenal pressures generated during deployment of various antiretropulsion devices in an ex vivo porcine model. J Endourol 24:1165–1168

    Article  PubMed  Google Scholar 

  19. Kreydin EI, Eisner BH (2013) Risk factors for sepsis after percutaneous renal stone surgery. Nat Rev Urol 10:598–605

    Article  PubMed  Google Scholar 

  20. Wang Y, Jiang F, Wang Y, Hou Y, Zhang H, Chen Q et al (2012) Post-percutaneous nephrolithotomy septic shock and severe hemorrhage: a study of risk factors. Urol Int 88:307–310

    Article  CAS  PubMed  Google Scholar 

  21. Shah K, Kurien A, Mishra S, Ganpule A, Muthu V, Sabnis RB (2010) Predicting effectiveness of extracorporeal shockwave lithotripsy by stone attenuation value. J Endourol 24:1169–1173

    Article  PubMed  Google Scholar 

  22. Kijvikai K, de la Rosette JJ (2011) Assessment of stone composition in the management of urinary stones. Nat Rev Urol 8:81–85

    Article  PubMed  Google Scholar 

  23. Shoshany O, Margel D, Finz C (2015) Percutaneous nephrolithotomy for infection stones: what is the risk for postoperative sepsis? A retrospective cohort study. Urolithiasis 43:237–242

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This work was financed by a Grant from foundation of Health and Family Planning Commision of Hunan province (No. B2016171).

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Authors and Affiliations

  1. Department of Urology, Zhuzhou Central Hospital, 116# South Changjiang Road, Tianyuan district, Zhuzhou, 412007, Hunan, China

    Yong Xu, Haibo Nie & Guangjun Duan

  2. Department of Radiology, Shaanxi Provincial People’s Hospital, No. 256 Youyi Road, Xi’an, 710068, Shaanxi, China

    Zhiqian Min

  3. Department of Urology, First People’s Hospital of Xiaoshan, 199# Xinnan Road, Xiaoshan district, Hangzhou, 311200, Zhejiang, China

    Shaw P. Wan

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  1. Yong Xu
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Correspondence to Yong Xu.

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Xu, Y., Min, Z., Wan, S.P. et al. Complications of retrograde intrarenal surgery classified by the modified Clavien grading system. Urolithiasis 46, 197–202 (2018). https://doi.org/10.1007/s00240-017-0961-6

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  • DOI: https://doi.org/10.1007/s00240-017-0961-6

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