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.

1.
Shock Wave Lithotripsy Task Force: Current Perspective on Adverse Effects in Shock Wave Lithotripsy. Clinical Guidelines. Linthicum, American Urological Association, 2009.
2.
Gupta NP, Ansari MS, Kesarvani P, Kapoor A, Mukhopadhyay S: Role of computed tomography with no contrast medium enhancement in predicting the outcome of extracorporeal shock wave lithotripsy for urinary calculi. BJU Int 2005;95:1285-1288.
3.
Cakiroglu B, Eyyupoglu SE, Tas T, Balci MC, Hazar I, Aksoy SH, et al: Are Hounsfield densities of ureteral stones a predictive factor for effectiveness of extracorporeal shock wave lithotripsy? Int J Clin Exp Med 2014;7:1276-1283.
4.
Evan AP, Willis LR: Extracorporeal shock wave lithotripsy: complications; in Smith AD, Badlani GH, Bagley DH, Clayman RV, Docimo SG (eds): Smith's Textbook on Endourology. Hamilton, Decker, Inc., 2007, chapter 41, pp 353-365.
5.
McAteer JA, Evan AP, Williams JC Jr, Lingeman JE: Treatment protocols to reduce renal injury during shock wave lithotripsy. Curr Opin Urol 2009;19:192-195.
6.
Skuginna V, Nguyen DP, Seiler R, Kiss B, Thalmann GN, Roth B: Does stepwise voltage ramping protect the kidney from injury during extracorporeal shockwave lithotripsy? Results of a prospective randomized trial. Eur Urol 2016;69:267-273.
7.
Clavien PA, Barkun J, de Oliveira ML, et al: The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250:187-196.
8.
Mitropoulos D, Artibani W, Graefen M, Remzi M, Rouprêt M, Truss M: [Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations]. Eur Urol 2012;61:341-349.
9.
de la Rosette JJ, Opondo D, Daels FP, et al: Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy. Eur Urol 2012;62:246-255.
10.
Krishnamurthi V, Streem SB: Long-term radiographic and functional outcome of extracorporeal shock wave lithotripsy induced perirenal hematomas. J Urol 1995;154:1673-1675.
11.
Sulaiman MN, Buchholz NP, Clark PB: The role of ureteral stent placement in the prevention of steinstrasse. J Endourol 1999;13:151-155.
12.
Soyupek S, Armağan A, Koşar A, Serel TA, Hoşcan MB, Perk H, Oksay T: Risk factors for the formation of a steinstrasse after shock wave lithotripsy. Urol Int 2005;74:323-325.
13.
Pearle MS, Roehrborn CG: Antimicrobial prophylaxis prior to shock wave lithotripsy in patients with sterile urine before treatment: a meta-analysis and cost-effectiveness analysis. Urology 1997;49:679-686.
14.
Mariappan P, Loong CW: Midstream urine culture and sensitivity test is a poor predictor of infected urine proximal to the obstructing ureteral stone or infected stones: a prospective clinical study. J Urol 2004;171(6 pt 1):2142-2145.
15.
Rashid P, Steele D, Hunt J: Splenic rupture after extracorporeal shock wave lithotripsy. J Urol 1996;156:1756-1757.
16.
Abe H, Nisimura T, Osawa S, et al: Acute pancreatitis caused by extracorporeal shock wave lithotripsy for bilateral renal pelvic calculi. Int J Urol 2000;7:65-68.
17.
Maker V, Layke J: Gastrointestinal injury secondary to extracorporeal shock wave lithotripsy: a review of the literature since its inception. J Am Coll Surg 2004;198:128-135.
18.
Malhotra V, Rosen RJ, Slepian RL: Life-threatening hypoxemia after lithotripsy in an adult due to shock-wave-induced pulmonary contusion. Anesthesiology 1991;75:529-531.
19.
Tiede JM, Lumpkin EN, Wass CT, Long TR: Hemoptysis following extracorporeal shock wave lithotripsy: a case of lithotripsy-induced pulmonary contusion in a pediatric patient. J Clin Anesth 2003;15:530-533.
20.
Kobayashi K, Ishizuka E, Iwasaki A, Saito R: [Subcapsular hematoma of the liver after extracorporeal shock wave lithotripsy]. Nihon Hinyokika Gakkai Zasshi 1998;89:445-448.
21.
Srinivasan A, Mowad JJ: Pyelocutaneous fistula after SWL of xanthogranulomatous pyelonephritic kidney: case report. J Endourol 1998;12:13-14.
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