Adaptation of the Assessment of Complications of Endoscopic Surgery of Nephrolithiasis According to the Clavien-Dindo Classification

Most urologists use endoscopic methods in the treatment of patients with urolithiasis. The objective: adaptation of the Clavien-Dindo classification for the generalization and systematization of complications of endoscopic surgery of nephrolithiasis and the formation of treatment tactics. Materials and methods. Retrospective analysis of disease histories of patients with urolithiasis from 2017 to 2023 who were treated in the urolithiasis clinic of the DU «Institute of Urology named after Academic O. F. Vozianov» of the National Academy of Medical Sciences of Ukraine» was held. The number of patients is 986: men – 506 (58%), women – 480 (42%), the age of patients is 5–80 years. Patients were divided into two groups. The Group I included 470 (43%) patients with simple stones (single kidney and ureteral stones of various localizations). Group II included 516 (57%) patients with complex kidney stones (coral stones of various sizes, multiple stones, kidney and pelvis stones, kidney and ureteral stones). Results. Our analysis of complications during endoscopic surgery for nephrolithiasis according to the Сlavien-Dindo classification in 986 patients with urolithiasis showed that the frequency of intraoperative complications reaches 1.5%, postoperative complications – 25.9%, at the same time, the severity of intraoperative complications according to the Clavien-Dindo classification was not considered due to the subjectivity of its assessment. The adapted classification of Сlavien-Dindo in the systematization of postoperative complications of endoscopic surgery for nephrolithiasis established the degree and frequency of complications: I degree – 17.2%, II degree – 10.5%, IIIa degree – 3.2%, IIIb degree – 5.5%, IV–V degree – 0.3%. Residual kidney stones, after their endoscopic removal were considered only in operations for simple stones (I group), and they must be included in the number of complications (IIIc – degree) that require additional treatment under general anesthesia. Large coral-shaped and multiple kidney stones (II group – complex stones) under the condition of continuing the planned stage treatment should be interpreted as one stage of endoscopic surgery. Remaining stones after the transfer of this category of patients to outpatient treatment can be legitimately considered as residual. Conclusions. The universal classification of surgical complications according to Clavien-Dindo is easily adapted in endoscopic surgery of urolithiasis and can be used in clinical practice, that spreads the opportunities of objectively assessing the severity of postoperative complications and applying adequate treatment in time.