FACTORS AFFECTING THE COMPLICATION RATES OF PEDIATRIC PERCUTANEOUS NEPHROLITHOTOMY USING THE MODIFIED CLAVIEN CLASSIFICATION SYSTEM  

Sarwar Noori Mahmood a, Hazhar Muhammad Rasul band Hewa Mahmood Tawfeeq b



a Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq. 
b Urology Department, Sulaimani General Teaching Hospital, Sulaimani, Kurdistan Region, Iraq.



Submitted: 21/9/2019; Accepted: 18/2/2020; Published: 21/3/2020
ABSTRACT


Background 

Percutaneous nephrolithotomy (PCNL) is effective and safe in children, with a high success rate and a low rate of major complications. The significant factors identified should be considered by clinicians to decrease associated complication rates.


Objectives 

To evaluate factors affecting the complications using the modified Clavien scoring system (MCCS) in children undergoing PCNL.


Patients and Methods

We performed prospective data analysis of 109 consecutive patients under the age of 17 years who underwent PCNL from September 2009 to January 2018. Stone complexity was determined according to certified Guy’s stone score (GSS). All PCNL procedures performed by a single experienced urologist under general anaesthesia and fluoroscopic guidance in a prone position. Complications recorded according to the MCCS.


Results

The study comprises 109 patients who underwent 115 PCNL (six patients had bilateral PCNL), (65 boys and 44 girls), with a mean (range) age 6.57±4.51 (1-17) years and mean (range) stone burden was 2.341±1.105 (0.6-6) cm. The Stone-free rate after PCNL monotherapy was 93%, which heightened to 96.5% after shock wave lithotripsy. Thirty-nine children (33.9%) had operative complications; 95% were minor, Clavien grade I in 19(16.5%) patients, grade II in 18 (15.7%) patients, all were managed conservatively, while two (1.7%) patients have Grade IIIb Complications requiring surgical intervention. The Degree of hydronephrosis (moderate and severe), GSS, and operation duration were significantly associated with perioperative complications (P <0.05). 


Conclusions

PCNL in children is effective and safe for handling simple as well as complex renal calculi. Assignment of the modified clavien classification to all possible PCNL complications is a reproducible system for the improvement in reporting of detail perioperative complications. The distinguishing factors should be considered to reduce associated complication rates.



KEYWORDS

Renal stone, Pediatric percutaneous nephrolithotomy, Stone-free rate, Modified clavien classification system.