• BJU international · Apr 2013

    Comparative Study

    Comparison of complication rates for unilateral and bilateral percutaneous nephrolithotomy (PCNL) using a modified Clavien grading system.

    • Adam O Kadlec, Kristin A Greco, Zachary C Fridirici, Spencer T Hart, Ted G Vellos, and Thomas M Turk.
    • Department of Urology, Loyola University Medical Center, Maywood, IL 60153, USA. akadlec@lumc.edu
    • BJU Int. 2013 Apr 1; 111 (4 Pt B): E243-8.

    ObjectiveTo compare complication rates of unilateral vs bilateral percutaneous nephrolithotomy (PCNL) using the modified Clavien grading system.Patients And MethodsSingle-institution retrospective chart review. Identified patients who had synchronous bilateral PCNL (B-PCNL) over an 11-year period (2000-2011). B-PCNL patients were matched by age, gender, and stone burden per renal unit with patients who underwent unilateral PCNL (U-PCNL) over the same period. Complications were recorded and classified using the modified Clavien classification system, and then compared with a two-sided chi-square test of proportions.ResultsIn all, 47 B-PCNL patients [mean (range) age 54 (14-84) years] and 78 U-PCNL patients [mean (range) age 54 (17-91 years] were compared. The mean (range) stone burden per renal unit was 2.8 (0.7-7.0) cm and 2.9 (0.7-9.0) cm, respectively. The overall complication rate was higher for B-PCNL (53.2% vs 30.8%, P = 0.013). Rates of Grade I and Grade II complications trended toward being higher in the B-PCNL group. Low-grade complications (Grade I and II combined) occurred more often in the B-PCNL group (P = 0.011); the most common low-grade complication was fever. Two procedures terminated for poor visualisation due to bleeding were successfully completed in delayed fashion with no transfusion and were classified as Grade I complications. There were equivalently low rates of Grade III complications. There were no Grade IV or V complications.ConclusionsB-PCNL carries a higher overall complication rate than U-PCNL when the modified Clavien system is used for classification. Patients undergoing U-PCNL who have more than one tract dilatation have a higher complication rate than those who have only one tract dilatation. High-grade complications are uncommon for both procedures.© 2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL.

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