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646 Can factors affecting complication rates for urethral reimplantation be predicted? Use of Clavien classification system in pediatric population
646
Can factors affecting complication rates for urethral reimplantation be predicted? Use of Clavien classification system in pediatric population Eur Urol Suppl 2013;12;e646
Süer E., Özcan C., Mermerkaya M., Öztürk E., Gülpınar Ö., Burgu B., Soygür T. Ankara University School of Medicine, Dept. of Urology, Ankara, Turkey INTRODUCTION & OBJECTIVES: Clavien classification (CC) of postoperative complications is widely used in surgical procedures. We aimed to determine predictive factors on postoperative complications of ureteroneocystostomy(UNC) in children by utilizing this standardized system. MATERIAL & METHODS: We reached the data of 383 children who underwent ureteral reimplantation (UR) for vesicoureteral reflux (VUR)& obstructing megaureters (OM) between 2002-2011. Intravesical and extravesical URs were performed in 338-45 patients, respectively. Complications were evaluated according to the Clavien Classification systems (CCS). Univariate and multivariate analyses were performed to determine predictive factors for complications. RESULTS: 246 females & 136 males were studied. Mean patient age was 46,59±25,03 months and the mean followup period was 49,42±27,85 months. 44(11,5%) children had OM:Bilateral VUR and SFU grade 3-4 hydronephrosis were detected in 125(36,9%) and (84%) of the patients, respectively. Mean hospitalization time was 4,7 ±1,6days. Complications occurred in 76(19,8%) of patients. Of these complications 34(8,8%) was clavien grade 1, 22(5,7%) was clavien grade 2 and 20(5,2%) was clavien grade 3. The duration of the surgical procedure, SFU grade3-4 hydronephrosis, ureteral diameter >9mm, tailoring-tapering, refractory LUTS and duplex system were statistically significant on univariate analysis.Prior injection history, paraureteral diverticula, stenting, gender, age, operation technique(intra vs extravesical) were not significant predictors of complications. In the multivariate analysis refractory LUTS, tailoring-tapering, diameter >9mm and duplex system reached statistical significance. CONCLUSIONS: UNC still remains as a valid option for treatment of certain VUR patients. Refractory LUTS, tailoringtapering procedure, diameter >9mm and associated duplex systems are the outstanding predictive factors for postoperative complications. Use of standardized complication grading systems should be encouraged to determine the valid complication rates between different series.
Can factors affecting complication rates for urethral reimplantation be predicted? Use of Clavien classification system in pediatric population Eur Urol Suppl 2013;12;e646
Süer E., Özcan C., Mermerkaya M., Öztürk E., Gülpınar Ö., Burgu B., Soygür T. Ankara University School of Medicine, Dept. of Urology, Ankara, Turkey INTRODUCTION & OBJECTIVES: Clavien classification (CC) of postoperative complications is widely used in surgical procedures. We aimed to determine predictive factors on postoperative complications of ureteroneocystostomy(UNC) in children by utilizing this standardized system. MATERIAL & METHODS: We reached the data of 383 children who underwent ureteral reimplantation (UR) for vesicoureteral reflux (VUR)& obstructing megaureters (OM) between 2002-2011. Intravesical and extravesical URs were performed in 338-45 patients, respectively. Complications were evaluated according to the Clavien Classification systems (CCS). Univariate and multivariate analyses were performed to determine predictive factors for complications. RESULTS: 246 females & 136 males were studied. Mean patient age was 46,59±25,03 months and the mean followup period was 49,42±27,85 months. 44(11,5%) children had OM:Bilateral VUR and SFU grade 3-4 hydronephrosis were detected in 125(36,9%) and (84%) of the patients, respectively. Mean hospitalization time was 4,7 ±1,6days. Complications occurred in 76(19,8%) of patients. Of these complications 34(8,8%) was clavien grade 1, 22(5,7%) was clavien grade 2 and 20(5,2%) was clavien grade 3. The duration of the surgical procedure, SFU grade3-4 hydronephrosis, ureteral diameter >9mm, tailoring-tapering, refractory LUTS and duplex system were statistically significant on univariate analysis.Prior injection history, paraureteral diverticula, stenting, gender, age, operation technique(intra vs extravesical) were not significant predictors of complications. In the multivariate analysis refractory LUTS, tailoring-tapering, diameter >9mm and duplex system reached statistical significance. CONCLUSIONS: UNC still remains as a valid option for treatment of certain VUR patients. Refractory LUTS, tailoringtapering procedure, diameter >9mm and associated duplex systems are the outstanding predictive factors for postoperative complications. Use of standardized complication grading systems should be encouraged to determine the valid complication rates between different series.