373 MODIFIED CLAVIEN CLASSIFICATION FOR COMPLICATIONS OF PERCUTANEOUS NEPHROLITHOTOMY (PCNL) IN PEDIATRIC PATIENTS: A COMPARATIVE STUDY

Abstract

INTRODUCTION AND OBJECTIVES: To assess the morbidity and outcome of PCNL in pediatric patients using modified Clavien scale. METHODS: We retrospectively reviewed the computerized records of pediatric patients (ageiU 14 years) who underwent PCNL for treatment of renal stones between 1994 and 2010. All cases were performed by experienced endourologist. The patients were divided into two groups, group I; Simple stones (isolated renal pelvis or isolated calyceal stone) and group II; Complex stones (partial or complete staghorn stones, renal pelvis stones accompanied by calyceal stone). Modified Clavien complication scale was used to grade and compare the perioperative complications between both groups. Success rate of PCNL monotherapy and the need of secondary procedures were compared. RESULTS: During the study period, 122 PCNL procedures were performed for 97 children (61 males, 36 females) with mean age 7.1 (0.5–14) years. Group I included 57 procedures while group II included 65 procedures. There were no statistically significant differences between both groups with regard to age, gender, BMI, indications of the procedure, renal characteristics. Also, a comparable data were found for operative details such as number of PCNL sessions and mini-Perc procedures. However, multiple puncture tracts were created in 4 (7%) procedures in group I and in 21 (32%) procedures in group II (P-value 0.001). Perioperative complications were 35 (28.7%) in 122 procedures. Low grade complications (G1–G3a) were 33 (27%) and high grade complications (G3b-G5) were 2 (1.6%). Table 1 shows the sort and distribution of complications. 2nd session PCNL was needed in 6 and 13 procedures in group I &II respectively (P-value 0.21). Stone free rate for PCNL monotherapy was 94.7% and 72.3% in group I &II respectively (Pvalue 0.013). Secondary procedures were needed once (1.7%) in group I and in 10 procedures (15.3%) in group II (P-value 0.017). CONCLUSIONS: High grade complications during PCNL in pediatric patients were seldom occurring. Complexity of the stone is not a risk of complications as long as the procedure is done by experienced surgeon Table 1. Perioperative complications according to modified Clavien scale. Grades Types of complications Group 1 Group 2 Grade 1 fever for antipyretics 5 2 haematuria 2 3 Grade 2 bleeding or haematuria requiring blood transfusion 2 1