Exploring the competency of the comprehensive complication index over the clavien-dindo classification in standard percutaneous nephrolithotomy: a call for better complication reporting.

PURPOSE: The Comprehensive Complication Index (CCI) was introduced in 2013 to overcome the limitations of the Clavien-Dindo Classification (CDC) in grading postoperative complications. The objective of this study to assess the predictive value of the CDC and the CCI for postoperative course in patients undergoing standard adult percutaneous nephrolithotomy (PCNL). METHODS: A retrospective analysis of 320 renal units that underwent standard PCNL between July 2021 - April 2023 was conducted. The CDC and CCI systems assessed complications occurring within the first 30 days after surgery. A second CCI score was calculated only on the highest CDC grade, and this score was referred to as the noncumulative CCI. A comparative analysis was conducted to determine the predictive efficacy of both evaluation methods regarding the postoperative course. RESULTS: The postoperative complication rate was 23.1% (74/320). Eight patients (2.5%) experienced multiple complications, resulting in a higher total CCI score than the noncumulative CCI (p = 0.010). Correlation analysis revealed that the CCI correlated with the length of hospital stay (LOS) more precisely than the noncumulative CCI (CCI: r = 0.335; p = 0.004 vs. noncumulative CCI: r = 0.325; p = 0.005). Compared with patients with a single complication, those with multiple complications had similar demographics, preoperative stone characteristics, and intraoperative features. CONCLUSION: Cumulative CCI proves to be a more effective predictor of LOS and complication burden in standard PCNL than CDC. Hence, using CCI to evaluate complications after PCNL may be a more appropriate approach.

Is There Any Effect of Retrograde Intrarenal Stone Surgery on Renal Functions in Childhood?

Purpose In this study, we aimed to demonstrate whether retrograde intrarenal stone surgery (RIRS) performed due to renal stones during the childhood period has any detrimental impact on renal functions. Materials and methods We retrospectively analyzed 121 patients aged 2 to 16 years who underwent RIRS for renal stones between March 2018 and February 2023. Data were available for 41 patients. The estimated glomerular filtration rate (eGFR) was computed using the modification of diet in renal disease (MDRD) formula on the day preceding the surgery and the third month after the surgery. We employed the National Kidney Foundation's chronic kidney disease (CKD) classification to categorize the glomerular filtration rate (GFR) into five groups. Preoperative and postoperative eGFR values of pediatric patients were compared by analyzing changes in CKD groups. Results Of the patients included in the study, 21 (51.2%) were male, while 20 (48.8%) were female children. No significant difference was found between the preoperative median eGFR and the postoperative median eGFR values (p=0.958). In the 3rd month after surgery, it was observed that 5 (12.1%) patients showed an improvement in their CKD stage, while deterioration was noted in 1 (2.4%) patient. Although a negative correlation was observed between the median eGFR change and both the operation time and the stone volume in Pearson correlation analysis, it was determined that this change did not create a significant difference (p=0.213 and p=0.295, respectively). Conclusion Stone surgery conducted with RIRS appears to yield positive outcomes on kidney function in the pediatric population. Nevertheless, being particularly attentive to patients with prolonged operation times and larger stone volumes is essential.