Modified Clavien Grading System Research Articles

Clinical Utility of S.T.O.N.E, Guy's Scoring System, and Renal Stone Complexity Scoring in Predicting Outcome of Single-Tract Percutaneous Nephrolithotomy.

Several imaging-basedscores have been developed to predict postoperative stone-free state (SFS) and complications. This study aimed to assess the accuracyof the S.T.O.N.E., Guy Scoring System (GSS), and Seoul National University Renal Stone Complexity (S-ReSCS) scores inpredicting theoutcomes of single-tract percutaneous nephrolithotomy (ST-PCNL). This scoring system holds paramount importance for low-incomeand low-middle-income countries (LMICs), as it is inexpensive and cost-effective for the healthcare system. This retrospective study was carried out with 147 participants. Based on the preoperative computerized tomographic (CT) scan, each patient's S.T.O.N.E. score, GSS, and S-ReSCS were recorded. The modified Clavien grading system was used to document intra- and postoperative complications. The mean age of the sample population was 45 years. SFS was achieved in 110 (74.8%) patients. The number of calyces involved (p = 0.008), S.T.O.N.E. scoring (p = 0.001), GSS (p = 0.008), and S-ReSCS (0.001) correlated well with the SFS. Forty-nine (33.33%) patients developed complications. The most common complications fell within Clavien grade II. No statistical significance was noted between the S.T.O.N.E. score, GSS, and S-ReSCS with the modified Clavien grading system. The S.T.O.N.E. scoring, GSS, and S-ReSCS have a high predictive value for achieving SFS in ST-PCNL. In addition, findings from LMICs are comparable with those from the rest of the world.

Is Percutaneous Nephrolithotomy (PCNL) as Safe and Effective in Children as Adults?

Background: Percutaneous Nephrolithotomy (PCNL) is an endoscopic procedure of choice for the larger renal stones in both adult and children. Adequate literature is present regarding the efficacy of PCNL in clearing the adult kidney stones but limited data in our part of world is available to show noticeable renal stone clearance after PCNL with minimal complications in pediatric group. We set out to compare the outcomes of PCNL in both groups so we can recommend its efficacy and safety in pediatric group. Methods: The prospective cross-sectional comparative study conducted in 86 patients who underwent PCNL for Renal Calculi. Patients were divided into two groups. Thirty patients were in the pediatric group and 56 patients in the adult group. Both groups were compared for the safety and efficacy of PCNL. Safety will be assessed through post-operative complications and graded according to Modified Clavien grading system. Efficacy was assessed through stone clearance. The aim of study is to determine the safety and efficacy of percutaneous nephrolithotomy in children so it can be done frequently and confidently without fear of complications and incomplete clearance of stones. Results: When we compare children with adults for safety and efficacy of PCNL, no statistical significance was observed in both groups in terms of stone clearance and postoperative complications. Conclusion: Percutaneous nephrolithotomy is as safe and effective in pediatric age as adult age. Keywords: Percutaneous Nephrolithotomy, Renal Stones, modified Clavien grading system.

USING THE MODIFIED CLAVIEN GARDING SYSTEM TO CLASSIFY COMPLICATIONS OF BIPOLAR TURP

introduction: TURP is considered gold standard treatment for BPH. TURP was first introduced in 1929 by Maximilian Stern. Complications in TURP are less but not absolute. Modified Clavien Dindo Grading System is well-established classification for post-operative complications. Objective of this study is to assess complications of BIPOLAR TURP by using the modified Clavien grading system. Objective: To assess the evaluation of complications after bipolar transurethral resection of prostate using the Modified Clavien grading system. Materials And Methods: 110 BIPOLAR TURP performed between April 2019 and March 2021 at Meenakshi mission hospital Madurai Tamilnadu India were reviewed retrospectively. All patients with various complications were graded using Modified Clavien grading system in 5 grades. Results: 110 cases were enrolled in our study out of them 21 (19.9%) patients developed complications there was no mortality. Out of 21; 11 (52.4%) grade I, 5 (23.8%) grade II, 2 (9.5%) grade IIIa, 1 ( 4.8%) grade IIIb, 1 (4.8%) in each grade IVa and IVb. Conclusion: Modified Clavien Grading System is an easy and feasible classification system for postoperative complications. In spite of various shortcomings, it is very useful to grade end-urological procedure BIPOLAR TURP short-term complications.

Comparison of stone scoring systems as predictive tools for percutaneous nephrolithotomy outcome in kidneys with anatomical abnormalities: A retrospective study

Background/Aim: European urology guidelines recommend percutaneous nephrolithotomy (PNL) as a treatment modality to remove complex kidney stones over 2 cm in size. Aim of this study was to compare stone scoring systems in predicting stone-free status and complications rate after percutaneous nephrolithotomy (PNL) in abnormal kidneys. Methods: Retrospective analysis of data from 94 patients with anatomical abnormalities who underwent PNL for the kidney stones in the Clinic between January 2017 and January 2022 was performed. Sixty-four patients with renal anomalies who underwent PNL were included in the study. Guy, S.T.O.N.E. and CROES nephrolitometry scores were evaluated for each patient by the same researcher using non-contrast computed tomography. The modified Clavien grading system was used to evaluate complications. Results: The mean age and body mass index (BMI) of the patients were 46 ± 11.7 and 28 ± 6 kg/m2, respectively. There was no differences between the groups in terms of operative parameters, renal anomaly categorisation and complications. Compared with the residual stone group, GSS (2.49 vs 3.03; p = 0.001) and S.T.O.N.E. scores (7.26 vs 8.38; p = 0.021) in the stone free group were statistically significantly lower, while the CROES score was lower in the group with residual stones (172 vs 245; p < 0.001). In the Chi-square analysis performed between Clavien complication rating and stone scoring systems, no success was found in predicting the presence of complications in any scoring system. Conclusion: Although nomograms were successful in predicting postoperative stone-free status (SFS) after PNL in abnormal kidneys, they may not predict postoperative complications.

Supine versus prone percutaneous nephrolithotomy: A comparison of efficacy and safety in obese patients

Objective: To compare prone and supine percutaneous nephrolithotomy (PNL) in obese patients with respect to efficacy and safety.Material and Methods: Individuals with kidney stones larger than 2 cm undergoing either prone or supine position PNL were included in the study based on the World Health Organization (WHO) classification of body mass index (BMI) ≥30 kg/m2 between January 2011 and September 2020 retrospectively. Demographic characteristics, intraoperative, postoperative data, and complications according to Modified Clavien Grading System were listed. Patients were followed for 3 months, documenting their stone-free status. Results: Out of the total 156 obese patients, 74(47.4%) underwent supine PNL (group 1), and 82 (52.6%) were prone to PNL (group 2). There was no statistically significant difference between the groups concerning hemoglobin drop, the number of pelvicalyceal access, blood transfusion, length of hospital stay, complications rates, and stone-free status (p>0.05). The location of pelvicalyceal access (upper, middle, lower calyces) was significantly different (18.9%, 32.4%, 42.6% in group 1, 3.2%, 19.3%, 77.5% in group 2, respectively) (p<0.001). Mean operative times were statistically different between the groups (97.2 ± 18.1 minutes in group 1, 119.5 ± 18.9 minutes in group 2, respectively) (p<0.001).Conclusion: In the prone or supine position, PNL is a safe and effective method for managing kidney stones in obese patients. Access through the upper calyx may be favored in the supine position considering to patient’s characteristics. Additionally, the supine position has the greatest advantage over the prone position due to shorter operative times.

What is the best approach for pediatric kidney stones of moderate-sized between shock wave lithotripsy, ultramini percutaneous nephrolithotomy and retrograde intrarenal surgery?

This study aimed to compare the results of ultramini percutaneous nephrolithotomy (UMP), shock wave lithotripsy (SWL) and retrograde intrarenal surgery (RIRS) in pediatric patients with kidney stones 10-20mm size. The files of 159 pediatric patients (36 RIRS, 39 SWL, 84 UMP) with kidney stones were reviewed retrospectively. Preoperative age, sex, stone size and location were evaluated. The three methods were compared in terms of operation and fluoroscopy duration, complications with the modified Clavien grading system, and stone-free rate (SFR) in the postoperative first month. The stone burdens of the groups were similar (P = 0.102). At the end of the first month, SFR was higher in the RIRS and UMP groups compared to the SWL group (88.9%, 92.9% and 69.2%, respectively, P = 0.002). UMP had higher SFR for lower pole stones than the other two methods (P = 0.042). There was no difference in complications between the three methods (P = 0.758). SFR was similar for all three methods in all localizations, apart from lower pole stones. UMP had higher SFR for lower pole stones than the other two methods. There was no difference in terms of complications between the three methods.

Is there a place for extracorporeal shockwave lithotripsy (ESWL) in the endoscopic era?

This retrospective study aimed to evaluate whether there was still a place for ESWL therapy in the endourological era. From 1988 to 2018, ESWL therapy was performed with 3 successive types of lithotripters in our hospital. From 1988 to 1998, the electrohydraulic lithotripter NS-15 was used, and the electromagnetic lithotripter HK-V was put to use in 1999. Since 2010, the electromagnetic lithotripter HK-Vm has been used. Over the 30-year period, 16,969 urolithiasis patients underwent ESWL therapy, including 124 paediatric cases and 178 special cases. The stone clearance rate (SCR) and postoperative complications in the 3 lithotripter groups were recorded and analysed. The SCR was estimated by ultrasonography or plain X-ray, while the complications were recorded by the modified Clavien grading system. The primary stone clearance rate (pSCR) of ureteral and renal stones was significantly improved in the HK-Vm group compared with the NS-15 and HK-V groups. The final stone clearance rate (fSCR) of lower calyx stones was considerably higher in the HK-Vm group (55.9%) than in the NS-15 (41.1%) and HK-V (44.1%) groups. Most complications were grade I and II, while the incidence of grade III and above complications was less than 3%. Additionally, the fSCR in paediatric and special cases ranged from 66.5% to 83.5%, with no record of severe complications. As our data showed, ESWL was effective and safe for most urolithiasis patients, including paediatric patients and special cases. Therefore, ESWL is still the major treatment option in the current endourological era.

Percutaneous nephrolithotomy in previously operated patients: A prospective study

Purpose:To determine the effect of previous renal stone surgery on result and complications of percutaneous nephrolithotomy (PCNL).Materials and Methods:Total 300 patients were enrolled in the study. We enrolled 100 surgery-naive cases (those with no history of any renal surgery) as control and labeled them as Group A. Group B comprised 100 cases who had PCNL in the past. Group C constituted 100 patients who had open renal stone surgery in the past. Stones were classified using Guy's stone score. PCNL was performed by standard technique in prone position and technical features encountered during operation and outcomes were compared between groups. Complications were graded using modified Clavien grading system.Results:There were no differences between the three groups in age, gender, body mass index, stone burden, and stone opacity. Multiple calyceal stones and distorted pelvicalyceal system anatomy were more in Group C, but stone score showed no statistically significant difference from other groups. The mean operative time (68.91 ± 21.27 min) and fluoroscopy time (264.40 ± 74.90 s) were longer in Group C, but there was no statistically significant difference between the groups. Multiple access was significantly more common in Group C compared to the other two groups (P < 0.001). Access location too did not show any statistically significant difference between the groups. Postoperative complications were more in previous stone surgery patients, but did not show statistically significant difference.Conclusion:PCNL is a safe and effective treatment modality for patients with renal stones regardless of history of previous PCNL or open renal surgery.

Clinical study of the puncture success rate during ultrasound-guided percutaneous nephrolithotomy

Objective To evaluate the success rate during ultrasound-guided percutaneous nephrolithotomy (PCNL) and analyze the reasons of puncture failure. Methods A retrospective analysis was performed based on the data of 58 patients who underwent ultrasound-guided PCNL by 4 experienced urologists(10 years' experience of PCNL and more than 80 cases per year)in our center from August 2018 to November 2018. Of all the 58 patients, there were 36 males and 22 females (aged from 22 to 73 years) with the mean age of 51 years. The calculi ranged from 9 mm to 93 mm, with the average of 26.5 mm. The separation of renal collecting system ranged from 5 mm to 30 mm, with the average of 15.1 mm. All of the 58 patients underwent one-stage PCNL and the numbers of punctures, the numbers of percutaneous tubes and the reasons for failure were recorded. Results All percutaneous tubes and surgeries were established and done successfully. Of all the 118 punctures, 74 punctures succeeded by detecting the urine and 68 surgery tracts were established (6 punctures failed because of the dilation). The total puncture success rate was 62.7%(74/118). Of the total 74 successful punctures, 56.8%(42/74)succeeded at the first puncture, 28.4%(21/74)succeeded at the second puncture and 14.9%(11/74)succeeded at least after three punctures. The success puncture rate of the 4 urologists were 59.2%(29/49), 64.1%(25/39), 66.7%(16/24), 66.7%(4/6)respectively, and there were no statistical differences between the puncture success rates of the urologists (P=0.679). Each channel needed 1.7 punctures on average. Fouty-four punctures failed without detecting the urine, including 20 failed punctures because of the puncture tract deviation, 17 punctures without seeing the urine after the core needle being removed, 7 punctures no display on the ultrasound imagine. There were 33 punctures to be tubeless while other 35 indwelling the nephrostomy tubes. Five nephrostomy tubes' position were different with the preoperationally predicted position which means the discrepancy rate was 14.3%(5/35). One patient had complications and classified as Grade II or above on the modified Clavien Grading System of aerothorax. Conclusions The puncture success rate during ultrasound-guided PCNL is not satisfied. The main reasons of puncture failure are the deviation of puncture tract, unclear imaging of puncture tract and other unclear reasons( puncture needle went too deep or superficially or tip of the needle embedded into the stone). Key words: Kidney calculi; Percutaneous nephrolithotomy; Puncture; Success rate

Retrograde intrarenal surgery versus mini-percutaneous nephrolithotripsy to treat renal stones 20 mm or larger in diameter using holmium:YAG laser

Objective To evaluate the efficacy and safety of mini-percutaneous nephrolithotripsy (mini-PCNL) and retrograde intrarenal surgery (RIRS) in the treatment of renal stones 20 mm or larger in the longest diameter using holmium:YAG laser. Patients and methods This was a prospective randomized study that included 40 patients who were divided into two groups, with 20 patients each. Group A underwent mini-PCNL using holmium:YAG laser lithotripsy for renal pelvic and calyceal stones. Group B underwent RIRS in which flexible ureteroscopy was used for pelvic and calyceal stones, and semi-rigid ureteroscope was used for only renal pelvic and upper calyceal stones using holmium:YAG laser. In both groups, the procedure outcomes in terms of operative time, blood loss, hospital stay, complications using modified Clavien grading system, the need of auxiliary procedures, and stone-free rates (SFRs) after 3 weeks by using CTUT were evaluated statistically. Results Statistical analysis of the data showed that there was significant difference in the operative time, which was higher in RIRS group compared with mini-PCNL group, whereas the blood loss in terms of mean±SD change in pre-treatment and post-treatment hemoglobin levels and the hospital stay were significantly higher in mini-PCNL group compared with RIRS group. The complications using modified Clavien grading system were higher in mini-PCNL group compared with RIRS group. The SFR was higher in mini-PCNL group. Conclusion In patients with renal stones 20 mm or larger, results showed that mini-PNCL has significantly shorter operative time with higher blood loss and longer hospital stay compared with RIRS. In both groups, the SFR and the need of the auxiliary procedures were comparable.

Assessment of lower calyceal single-access percutaneous nephrolithotomy for staghorn stones: A single-surgeon and a single-center experience at KAMC, Riyadh.

Introduction:Percutaneous nephrolithotomy (PCNL) is still the mainstay and the treatment of choice for most complex renal stones. The success of PCNL is defined by achieving a stone-free rate (SFR). Lower calyceal access PCNL is established to be the safest percutaneous access to the renal system, but controversy is present when it comes to SFR in comparison to upper calyceal and middle calyceal accesses.Aim:We aim to prove that lower calyceal access PCNL is the safest PCNL access and has the same efficacy as upper calyceal access PCNL for staghorn stones.Methodology:All lower calyceal access PCNLs done from May 2012 to August 2017 were included in the study. Postoperative complications were reported using the modified Clavien Grading System.Results:Sixty-seven patients were included in the study. The mean age was found to be 49.39 years; most (36 [53.73%]) patients were male. The prevalence of diabetes, hypertension, dyslipidemia, and chronic kidney disease was 40.91%, 47.76%, 37.31%, and 20.00%, respectively. The mean hospital stay was 7.9 days; mean operative time was 138.52 min. The mean staghorn stone burden was 476.34 mm2. About 80.59% (n = 54) of patients had complete stone resolution after the first session. Only 3 (4.47%) patients had complications and classified as Grade 2 on the modified Clavien Grading System and the remainder were classified as Grade 1, two patients needed postoperative blood transfusion, and one had a renal pelvis perforation.Conclusion:When it comes to safety and efficacy, the use of lower calyceal single-access PCNL has a very low complication rate compared to upper calyceal access PCNL, especially pneumothorax and bleeding.

STONE score versus Guy's Stone Score - prospective comparative evaluation for success rate and complications in percutaneous nephrolithotomy.

Purpose:The aim of the current study was to compare Guy's score and STONE score in predicting the success and complication rate of percutaneous nephrolithotomy (PCNL).Materials and Methods:A total of 445 patients were included in the study between July 2015 and December 2016. The patients were given STONE score and Guy's Stone Score (GSS) grades based on CT scan done preoperatively and intra- and post-operative complications were graded using the modified Clavien grading system. The PCNL were done by a standard technique in prone positions.Results:The success rate in our study was 86.29% and both the GSS and STONE score were significantly associated with a success rate of the procedure. Both the scoring systems correlated with operative time and postoperative hospital stay. Of the total cases, 102 patients (22.92%) experienced complications. A correlation between STONE score stratified into low, moderate, and high nephrolithometry score risk groups (low scores 4–5, moderate scores 6–8, high scores 9–13), and complication was also found (P = 0.04) but not between the GSS and complication rate (P = 0.054).Conclusion:Both GSS and STONE scores are equally effective in predicting success rate of the procedure.

Analysis of the etiology and prognosis of severe complications after percutaneous nephrolithotomy

Objective To analyze the etiology and prognosis of severe complications of percutaneous nephrolithotomy (PCNL). Methods The clinical data of patients with severe complications after PCNL from December 2004 to December 2015 were retrospectively analyzed. Age of the patients ranged from 25 to 69 years old, with an average of 41 years. There were 64 cases with 29 male and 35 female. Fifty-five cases were diagnosed as renal calculi, including 21 cases of left renal calculi, 19 cases of right renal calculi; 15 cases of bilateral renal calculi; 2 cases of the patients were bilateral upper ureteral calculi; 7 patients were renal calculi upper ureteral calculi on the other side. In all cases, the maximum diameter of calculus was 1.8-4.3 cm (mean 2.6 cm) and hydronephrosis depth was 0-5.9 cm (mean 2.3 cm); 15 cases were previously treated with nephrolithotomy. The modified Clavien grading system was used to evaluate surgical complications, and ≥grade Ⅲ complications were considered as serious complications. Results Among the 64 cases, 28 cases were classified as Clavien Ⅲ class. There were 2 cases of bleeding in operation due to renal parenchyma laceration or multiple access, patients were treated with later open surgery. Postoperative bleeding were revealed in 22 cases, 16 of which were hemorrhage from the nephrostomy tubes, 4 of which complained of discontinuity gross hematuria and 2 postoperative bleeding were encountered during the nephrostomy tube remove. All the cases received renal arteriography and were diagnosed with pseudoaneurysm, bleeding were stopped after embolization. 3 cases of pleural injury were treated with closed thoracic drainage, 1 colon injury was treated with open colostomy. There were 32 cases of urinary sepsis considered as Clavien Ⅳ complications, and these patients were transferred to the Intensive Care Unit. Clavien Ⅴ class 4 cases: 1 died of hemorrhagic shock due to pleural injury, 2 cases died of urinary sepsis and multiple organ failure and another case died of pulmonary embolism. Conclusions PCNL has high risk of serious complications, which should be always strictly follow the principles. Adequate preoperative preparation, appropriate surgery access, carefully and gently operate, appropriate antibiotic use and postoperative management are the key measures to reduce the incidence of complications. Key words: Percutaneous nephrolithotomy (PCNL); Severe complications; Etiology; Prognosis

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

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.

To stratify complications of percutaneousnephrolithotomy (PCNL) in a single hospital by use of the modified Clavien grading system

Introduction: PCNL is relatively safe but evaluating its complication can be of importance so that we can betteranticipate and act on it.Purpose: To evaluate the complications of percutaneous nephrolithotomy (PCNL).Materials and methods: We prospectively analyzed the patients who underwent conventional PCNL at KMCTH from March 2013 to July 2015. Eighty five cases with renal stones more than 1cm and upper ureteric stones were included in the study. Patients with coagulation disorder were not included in this study. Ten patients who had PCNL converted to open procedures were excluded in the study. Patients underwent PCNL in prone position. Pre-operative complete blood count, urine, ultrasound(USG), intravenous Urography (IVU) was done. CT IVU was also done in few cases. During the period of which Demographic data, stone free rate, hospital stay and complications were assessed.Results: A total of 95 cases were enrolled for the study. Ten cases were excluded. There were 47 (55.29%) were female and 38 (44.71%) were male.Most of the patients had unilateral kidney stones(78.82%).Mean size of the was 1.85cm.There were 38(44.70%) renal pelvi-ureteric junction(PUJ) stones out of 85 cases. Sub-costal approach for PCNL was carried out in 78 (91.77%) patients. Mean operative time was 59.29 minutes with blood loss of 72.58 ml and three patients needed blood transfusion. Twelve patients (14.11%) experienced PCNL related complication. There was 1 mortality. Stone free rate was 91.76% (n-78).Conclusion: PCNL is safe with acceptable complication rate and has an acceptable high stone free rate.

Prospective Evaluation of Learning Curve of Urology Residents for Percutaneous Nephrolithotomy

IntroductionWe studied the learning curve for percutaneous nephrolithotomy of urology residents according to stone complexity. MethodsThe learning curve of 8 residents with no previous experience of solo percutaneous nephrolithotomy was studied. Stones were classified according to complexity using the Guy stone score. Competence was reviewed using 4 markers, namely operative time, fluoroscopic time, complication rate using the modified Clavien grading system and success rate. Analysis was done in 3-month cohorts to determine how and when competence and excellence were achieved during 1 year of training for various grades of stone. The results of resident surgeons were compared with those of experienced endourologist. ResultsResident surgeons achieved a plateau in mean operative time and fluoroscopic time for grade I stones after 30 to 35 cases but not for more complex stones. Similarly complications were decreased significantly only in grade I stone cases. Resident surgeons also achieved an almost excellent success rate of 87% for grade I stones only. ConclusionsThis study of the learning curve of residents suggests that competence and near excellence is reached after 30 to 35 cases for grade I stones. However the learning curve for complex stones (grades II to IV) is steeper and requires more experience.

Predicting Outcomes after Minimally Percutaneous Nephrolithotomy with the Aid of a Patented System by Using the Guy's Stone Score

Objectives: At present, there is no report on the application of Guy's stone (GS) score in minimally invasive percutaneous nephrolithotomy (MPCNL). We therefore investigate the clinical effect of MPCNL by using a patented irrigation and clearance system according to the GS. Methods: A total of 222 consecutive patients were divided into 2 groups that were treated with MPCNL using the patented system or standard PCNL using Electro Medical System (EMS) ultrasound/ballistic trajectory lithotripsy and clearance system, respectively (124 patients in patented system group, 98 patients in EMS system group). The stone complexity and severity of complications were stratified by GS and Modified Clavien grading system in this study, respectively. The success and complication rates between MPCNL and PCNL were compared. Results: The patented system group had a significantly higher success rate (GS3: 95 vs. 43% and GS4: 67 vs. 31%) and a significantly less complications rate (GS3: 12 vs. 27% and GS4: 21 vs. 46%) in GS3 and GS4 compared with the EMS system group. Also, the patented system had significant lower complication rates in Clavien grades II-IV than that of the EMS system. Conclusion: The MPCNL using the patented irrigation and clearance system was more efficient in dealing with renal stones of high complexity (GS3-4).

Efficacy and safety of percutaneous nephrolithotomy with adult standard size instruments in children under 3 years of age: a 10 years single-center experience.

Using percutaneous nephrolitotomy (PCNL) with large adult instruments in treatment of pediatricurolithiasis is still in debate. This study was conducted to evaluate the efficacy and safety of PCNL with adult's instrument in treatment of patients less than 3 years old. Data on patient characteristics and outcomes for 261 consecutive children undergoing PCNL at a Labbafinejad University Hospital were collected prospectively from September 2006 to February 2016. Thirty-two children, with 34 renal units, who were treated with PCNL were enrolled in the study. All PCNL procedures were performed via subcostal approach with one access tract in all of them. Postoperative complications were evaluated according to the modified Clavien grading system. The mean age of patients was 19.4 ± 6.2 months. Two patients had bilateral stones; thus, PCNL was performed on 34 kidney units. The mean size of the largest stone diameter was 17.5 ± 7.8 mm. The mean duration of procedures was 121.52 ± 29.05 minutes, ranging from 60 to 180 minutes. The most common complication was fever (n = 9, 26.4%), and hemorrhage that needs transfusion was the second one (n = 4, 11.7%). Seventeen patients with complications were in the first degree of Clavien complication system and five of them were in the second degree. Due to our experience, utilizing PCNL with adult-sized instruments in management of urolithiasis in less than 3 years old children appeared to be effective and relatively safe.

Obesity in Percutaneous Nephrolithotomy. Is Body Mass Index Really Important?

To evaluate the influence of obesity in the results of percutaneous nephrolithotomy (PCNL) in terms of efficacy and safety and to evaluate other aspects such as fluoroscopy time, radiation exposure, total operative time, hemoglobin loss, hospital stay, and the need of auxiliary procedures. We evaluated prospectively all the PCNLs performed at our institution between 2011 and 2012. A series of perioperative and postoperative details were recorded in our database. The patients were distributed in 4 groups using World Health Organization's classification of body mass index (BMI): normal weight, ≤ 25 kg/m(2); overweight, 25-29.9 kg/m(2); obese, 30-39.9 kg/m(2); and morbidly obese, ≥ 40 kg/m(2). Modified Clavien classification was used for reporting the complications. Results were compared between the groups using the chi square and multivariate logistic regression tests. A total of 255 procedures were performed between January 2011 and December 2012. Overall stone clearance was 76.3% and complication rate using the modified Clavien grading system was 31.4%. No statistical differences in terms of complication rate and stone free rate were noted between the 4 groups. Total operative time and radiation doses increase along with BMI. No difference was found in fluoroscopy time, failure to gain access, hospital stay, or need for auxiliary procedures. Obesity does not increase complications in PCNL, and the efficacy of the technique is similar to normal weight patients with appropriate expertise. Total operative time and radiation exposure increase along with BMI, putting patients at risk.

The Clinical Research Office of the Endourological Society Ureteroscopy Global Study: Indications, Complications, and Outcomes in 11,885 Patients

To assess the current indications for ureteroscopy (URS) treatment, outcome in terms of stone-free rate, and intra- and postoperative complications using the modified Clavien grading system. The Clinical Research Office of the Endourological Society collected prospective data as part of the URS Global Study for consecutive patients treated with URS at centers around the world for 1 year. URS was performed according to study protocol and local clinical practice guidelines. The stone size and location were recorded and postoperative outcome and complications, graded according to the modified Clavien grading system, reported. Between January 2010 and October 2012, 11,885 patients received URS at 114 centers in 32 countries; 1852 had only renal stones, 8676 had only ureteral stones, and 1145 patients had both types of stone. Fragmentation was performed principally using a laser device (49.0%) or a pneumatic device (30.3%); no device was used in 17.9% of the patients. A high stone-free rate (85.6%) was achieved. The large majority of patients did not receive any further treatment for renal or ureter stones (89.4%). The postoperative complication rate was low (3.5%). The most frequent complication was fever (1.8%); a blood transfusion was required in 0.2% of patients. The majority of complications were Clavien grade I or II (2.8% of patients). URS is an established minimal invasive treatment for urinary stones with a high success rate and low morbidity. Recent advances have expanded the indication for urinary stones, which now ranges from treatment of smaller sized distal ureter stones by semirigid URS to larger sized renal pelvis stones treated by flexible URS.