Category: Clinical Stones: PCNL

MP12-7 - Complications of Percutaneous Nephrolithotomy Using The Modified Clavien Grading System: Results From a Large Indonesian National Referral Hospital’s Experience Over 16 Years

Fri, Sep 21
2:00 PM - 4:00 PM

Introduction & Objective : Indonesia is known as one of world stone belt area in Asia. It is shown from an increase in the number of kidney stone patients in Indonesia who undergone stone procedures from year to year, especially percutaneous nephrolithotomy (PCNL). The aim of this study is to evaluate the complications of PCNL procedure in an Indonesian national referral hospital according to modified Clavien grading system.


Methods :

A total of 1199 percutaneous nephrolithotomy procedures were performed at Cipto Mangunkusumo National Referral Hospital, Indonesia. Indication of PCNL was renal stone with the size of > 20 mm in stone burden. All patient underwent a complete preoperative examination, including clinical examination, clinical laboratory tests and imaging studies. We collected data from medical record between January 2000 and December 2016. The demographic data, stone parameters, intraoperative data, PCNL complications, and stone-free rate were evaluated. We retrospectively reviewed and analyzed all patients for complications rates using the Modified Clavien Grading System.


Results : From 1199 procedures, the average stone burden was 40 ± 26.6 mm. Staghorn stone patients accounted for 35.3% (423 patients). Initial stone-free rates were 69.6%. A total of 56 complications were documented. According to the modified Clavien classification, grade I, II, IIIa, IIIb, IVa, IVb, and V complications were observed in 1 (0.1%), 44 (3.7%), 8 (0.7%), 0 (0%), 3 (0.3%), 0 (0%), and 0 (0%) patients, respectively. Blood transfusion 3.4% (41 patients) was the most common complication. There was a significant difference between the complication group based on modified clavien system in terms of mean operation time (P < 0.05), mean age (P <  0.01), mean preoperative haemoglobin (P < 0.05), and mean stone burden (P < 0.005). Stone burden is one of determinant factor for bleeding require transfusion (p < 0.05), while hydronephrosis, multipuncture, staghorn stone, and age are not significantly contributing factor for bleeding require transfusion.


Conclusions : The majority of complications after PCNL are bleeding require blood tranfusion. Some factors, such as operation time, age, preoperative haemoglobin, and stone burden, are associated significantly with complications of PCNL. Stone burden is one of determinant factor for bleeding require transfusion. PCNL as a treatment method offers an economic and effective option in the management of renal stone disease with acceptable stone clearance rates.

Ali Husein

Residence
Universitas Indonesia, Cipto Mangunkusumo National Referral Hosppital
Surakarta, Jawa Tengah, Indonesia

Nur Rasyid

Medical Staff
Cipto Mangunkusumo Hospital/ Faculty of Medicine Universitas Indonesia
Central Jakarta, Jakarta Raya, Indonesia

Widi Atmoko

Medical Staff
Cipto Mangunkusumo Hospital/ Faculty of Medicine Universitas Indonesia
Central Jakarta, Jakarta Raya, Indonesia

Ponco Birowo

Medical Staff
Cipto Mangunkusumo Hospital/ Faculty of Medicine Universitas Indonesia
Central Jakarta, Jakarta Raya, Indonesia