The Percutaneous Nephrolithotomy Global Study: Classification of Complications

Purpose: This study evaluated postoperative complications of percutaneous nephrolithotomy (PCNL) and the influence of selected factors on the risk of complications using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database.

Patients And Methods: The CROES PCNL Global Study collected prospective data for consecutive patients who were treated with PCNL at centers around the world for 1 year. Complications were evaluated by the modified Clavien classification system.

Results: Of 5724 patients with Clavien scores, 1175 (20.5%) patients experienced one or more complications. The most frequent complications were fever and bleeding. Urinary leakage, hydrothorax, hematuria, urinary tract infection, pelvic perforation, and urinary fistula also occurred in ≥20 patients in each group. The majority of complications (n=634, 54.0%) were classified as Clavien grade I. Two patients died in the postoperative period. The largest absolute increases in mean Clavien score were associated with American Society of Anesthesiologists (ASA) physical status classification IV (0.75) or III (0.34), anticoagulant medication use (0.29), positive microbiologic culture from urine (0.24), and the presence of concurrent cardiovascular disease (0.15). Multivariate regression analysis revealed that operative time and ASA score were significant predictors of higher mean Clavien scores.

Conclusion: The majority of complications after PCNL are minor. Longer operative time and higher ASA scores are associated with the risk of more severe postoperative complications in PCNL.