Predictors of surgical complications of nephrectomy for urolithiasis

Abstract

Objectives: Nephrectomy due to stone disease may be a challenging procedure owing to the presence of significant inflammation and infection, involving high complication rate. The objective of our study was to identify predictors for complications of nephrectomy for urolithiasis. Patients and Methods: A retrospective review of 149 consecutive patients > 18y submitted to simple nephrectomy for urolithiasis from January 2006 to July 2012 was performed. Clinical data, computed tomography findings and pathology report were analyzed. Postoperative complications were categorized based on Clavien - Dindo classification. Logistic multivariate regression models assessed the predictors for surgical complications of nephrectomy for urolithiasis. Results: Eighty-three (55.7%) patients were submitted to laparoscopic nephrectomy and 66 (44.2%) to open procedure. Conversion to open surgery was necessary in 19.2% (16 / 83). On univariable analysis, higher preoperative chronic kidney stage (p = 0.02), Charlson comorbidity index ≥ 2 (p = 0.04), higher ASA score (p = 0.001), urgency due to sepsis (p = 0.01), kidney size ≥ 12 cm (p = 0.006), renal and perirenal abscess (p = 0.004 and 0.002 respectively) and visceral adhesion (p = 0.04) were associated with Clavien - Dindo score > 1. On multivariate analysis, higher ASA score (p = 0.01), urgency due to sepsis (p = 0.03), kidney size ≥ 12 cm (p = 0.04) and preoperative abscess (p = 0.04) remained significantly associated with complications. End - stage renal disease with dialysis was needed post - operatively in 3.4% (5 / 144) of patients. Conclusions: We identified that higher ASA score, urgency due to sepsis, kidney size ≥ 12 cm and preoperative abscess were associated with Clavien - Dindo score > 1.

Laparoscopic retroperitoneal approach for urinary tract surgery. Predictive factors of complications and conversion to open surgery

“…No unnoticed intestinal lesion was reported in this series, as compared to other revised studies. (3,9,15) In this study, grade II complications prevailed, as in other investigations that report a prevalence of minor complications (grade I, II). (3,15,20) Al-Otaibi et al (18) reported two grade V (0.48%) complications, one as the result of the perforation of the duodenum complicated with septic shock and another due to pulmonary thromboembolism.…”

“…However, when performing the lumboscopic approach in adulthood in patients who underwent open surgery during childhood, we have observed that access to the retroperitoneum is easier, the perirenal tissue is laxer and an appropriate workspace can be created. (9,10) Renal percutaneous surgery also causes adhesions from the renal unit to the perirenal, which can extend up to the renal hilum. This is the reason some authors recommend the transperitoneal approach in patients with a past history of this surgery.…”

Estimation of functional reserves of the body and risk of cardiovascular events in patients with myocardial infarction with comorbid pathology undergoing rehabilitation

“…Approaches to the rehabilitation process in comorbid patients should be different from standard rehab programs, since the body's response to the standard load in such patients may be inadequate, hence the need for an active search of highly specific markers and valid methods of risk stratification for cardiovascular events (CVE) in the presence of multimorbid conditions. This requires a weighted integrated approach with an estimate of total risk [22][23][24]. In this plan, the Charlson comorbidity index and the six-minute walking test seem promising as rather universal combinations of assessment of degree of comorbidity and exercise tolerance.…”

Comparing public interest on stone disease between developed and underdeveloped nations: are search patterns on google trends similar?

“…The prevalence of urinary stone disease has signifi cantly increased worldwide in the last decades, with an overall prevalence of 7% to 12% (1)(2)(3)(4). In Brazil, the number of stone-related hospitalizations increased from 58.165 in 1998 to 67.306 in 2012 (5,6). As the disease becomes more prevalent, there is an increase in patient's interest which is translated in a rise on the volume of search for information regarding the matter globally (7).…”