Mittal V et al, 2016: Standardized Grading of Shock Wave Lithotripsy Complications with Modified Clavien System.
Mittal V, Srivastava A, Kappor R, Ansari MS, Patidar N, Arora S, Kumar M, Kudchadkar S, Raj A.
Department of Kidney Transplant and Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, India.
Abstract
INTRODUCTION: Definitive consensus on grading of complications of shock wave lithotripsy (SWL) does not exist. The objective of this study was to grade complications of SWL in relation to different stone and shock wave parameters, according to the modified Clavien system.
MATERIALS AND METHODS: Complications observed in 2,648 patients who underwent SWL between January 2003 and May 2014 were evaluated statistically and stratified into 5 grades by the modified Clavien system focusing on stone and shock wave parameters.
RESULTS: Statistically significant association (p ≤ 0.05) was found between SWL outcome, Clavien grade of complications and stone and shock wave parameters. According to the modified Clavien system, grades I, II, IIIa, IIIb, IV and V complications were observed in 1,811 (68.39%), 619 (23.37%), 183 (6.91%), 34 (1.28%), nil (0.00%) and 1 (0.03%) patients, respectively. The overall success rate at 3 months was 87.72%.
CONCLUSIONS: The modified Clavien system provides a standardized grading of SWL complications and can be used to standardize procedural errors and maintain quality, thereby preventing associated complications and improving the overall management and hence outcome of SWL.
Urol Int. 2016 Aug 10. [Epub ahead of print]
Comments 1
This is an interesting paper on a large series with good data on success and failure rates with an overall success rate at 3 months of 87.72%. BUT: The total percentage of complications after ESWL - the least-invasive form of stone therapy - in this report is 100,31 %. This figure will make it into the literature! But it should also stimulate others to think about adaptation of the Clavien-System to ESWL. To get a realistic view on real complications the interested reader should have a look at those listed e.g. for PNL (Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy. de la Rosette JJ et al. Eur Urol. 2012 Aug;62(2):246-55.).
Sequelae of a procedure are inherent effects of that procedure and should not be regarded and listed as complications.
For information of the reader the Clavien Grades and the authors’ definitions are listed in the table:
Clavien PA, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250:187–96.