Purpose: To review our intraoperative complications of retrograde intrarenal surgery (RIRS) for kidney calculi and stratify these complications according to the modified Satava classification system (SCS). Patients and Methods: 230 patients (119 males, 111 females) who underwent RIRS because of kidney calculi were analyzed. We documented and stratified the intraoperative complications according to the modified SCS. There are four grades for this classification: grade 1 complications include events without consequences for patients; grade 2a complications include events that could be treated with endoscopic surgery intraoperatively; grade 2b complications include events which were treated with endoscopic treatment in another session, and grade 3 describes the events requiring laparoscopic or open surgery. Results: Mean age was 39.1 years (range 1-78). The stone-free rate after one session was 81%. Intraoperative complications were recorded in 30.4% of the patients. According to the modified SCS, grade 1 complications were documented in 15.9%, grade 2a complications were documented in 5.6%, and grade 2b complications were documented in 8.9% of the patients. Grade 3 complications were not detected in any of the patients. Conclusion: In our opinion, the modified SCS can facilitate patients to understand the safety of this surgery and can make it easier to compare the results of different institutes and surgeons.

Keywords:
Intraoperative complications, Retrograde intrarenal surgery, Satava classification system
1.
Abe R, Etori K, Kato T, Sato K: Experience with transurethral uretero-nephrolithotripsy using flexible nephro-ureteroscope. Nihon Hinyokika Gakkai Zasshi 1990;81:1667-1674.
2.
Puppo P, Bottino P, Germinale F, Caviglia C, Ricciotti G, Giuliani L: Flexible antegrade and retrograde nephroscopy: review of 50 cases. Eur Urol 1990;17:193-199.
3.
Fuchs GJ, Fuchs AM: Flexible endoscopy of the upper urinary tract. A new minimally invasive method for diagnosis and treatment. Urologe A 1990;29:313-320.
4.
Wendt-Nordahl G, Mut T, Krombach P, Michel MS, Knoll T: Do new generation flexible ureterorenoscopes offer a higher treatment success than their predecessors? Urol Res 2011;39:185-188.
5.
Rajamahanty S, Grasso M: Flexible ureteroscopy update: indications, instrumentation and technical advances. Indian J Urol 2008;24:532-537.
6.
Lim SH, Jeong BC, Seo SI, Jeon SS, Han DH: Treatment outcomes of retrograde intrarenal surgery for renal stones and predictive factors of stone-free. Korean J Urol 2010;51:777-782.
7.
Cansino Alcaide JR, Reinoso Elbers J, López Sánchez D, Pérez González S, Rodriguez, Aguilera Bazán A, Rando Tous A, Hidalgo Togores L, De La Peña Barthel J: Flexible ureterorenoscopy: technique and results. Arch Esp Urol 2010;63:862-870.
8.
Resorlu B, Unsal A, Gulec H, Oztuna D: A new scoring system for predicting stone-free rate after retrograde intrarenal surgery: the ‘Resorlu-Unsal stone score'. Urology 2012;80:512-518.
9.
Schoenthaler M, Wilhelm K, Katzenwadel A, Ardelt P, Wetterauer U, Traxer O, Miernik A: Retrograde intrarenal surgery in treatment of nephrolithiasis: is a 100% stone-free rate achievable? J Endourol 2012;26:489-493.
10.
Geavlete P, Georgescu D, Niţă G, Mirciulescu V, Cauni V: Complications of 2,735 retrograde semirigid ureteroscopy procedures: a single-center experience. J Endourol 2006;20:179-185.
11.
Tanriverdi O, Silay MS, Kadihasanoglu M, Aydin M, Kendirci M, Miroglu C: Revisiting the predictive factors for intraoperative complications of rigid ureteroscopy: a 15-year experience. Urol J 2012;9:457-464.
12.
Tepeler A, Resorlu B, Sahin T, Sarikaya S, Bayindir M, Oguz U, Armagan A, Unsal A: Categorization of intraoperative ureteroscopy complications using modified Satava classification system. World J Urol 2013 (E-pub ahead of print).
13.
Resorlu B, Unsal A, Tepeler A, Atis G, Tokatli Z, Oztuna D, Armagan A, Gurbuz C, Caskurlu T, Saglam R: Comparison of retrograde intrarenal surgery and mini-percutaneous nephrolithotomy in children with moderate-size kidney stones: results of multi-institutional analysis. Urology 2012;80:519-523.
14.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 2004;240:205-213.
15.
Mandal S, Goel A, Singh MK, Kathpalia R, Nagathan DS, Sankhwar SN, Singh V, Singh BP, Sinha RJ, Dalela D: Clavien classification of semirigid ureteroscopy complications: a prospective study. Urology 2012;80:995-1001.
16.
Subrt Z, Ferko A, Cečka F, Jon B, Orhalmi J: Classification of surgical complications: analysis of the group of consecutive patients. Rozhl Chir 2012;91:666-669.
17.
Rassweiler JJ, Teber D, Frede T: Complications of laparoscopic pyeloplasty. World J Urol 2008;26:539-547.
18.
Nerli RB, Reddy M, Prabha V, Koura A, Patne P, Ganesh MK: Complications of laparoscopic pyeloplasty in children. Pediatr Surg Int 2009;25:343-347.
19.
Dogan HS, Onal B, Satar N: Factors affecting complication rates of ureteroscopic lithotripsy in children: results of multi-institutional retrospective analysis by Pediatric Stone Disease Study Group of Turkish Pediatric Urology Society. J Urol 2011;186:1035-1040.
20.
Traxer O, Thomas A: Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 2013;189:580-584.
21.
Al-Qahtani SM, Gil-Deiz-de-Medina S, Traxer O: Predictors of clinical outcomes of flexible ureterorenoscopy with holmium laser for renal stone greater than 2 cm. Adv Urol 2012;2012:543537.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.