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Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma
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Can factors affecting complication rates for ureteric re-implantation be predicted? Use of the modified Clavien

Evren Suer1, Cihat Ozcan, Murat Mermerkaya

  • 1Department of Urology, Ibn-i Sina Hospital, Ankara University, Ankara, Turkey.

BJU International
|March 25, 2014
PubMed

Insights

Ureteric re-implantation is effective for VUR treatment. Key predictors of complications include voiding dysfunction, megaureters, and duplex systems, identified using the modified Clavien classification system.

Area of Science:

  • Pediatric Urology
  • Surgical Complications
  • Reconstructive Surgery

Background:

  • Ureteric re-implantation is a surgical procedure for vesico-ureteric reflux (VUR) and other conditions.
  • Assessing postoperative complications is crucial for patient outcomes.
  • The modified Clavien classification system (MCCS) offers a standardized method for grading surgical complications.

Purpose of the Study:

  • To identify preoperative factors predicting postoperative complications after ureteric re-implantation in children.
  • To utilize the modified Clavien classification system (MCCS) for complication assessment.

Main Methods:

  • A retrospective study of 383 children undergoing ureteric re-implantation between 2002 and 2011.
  • Complications were classified using the MCCS.
  • Univariate and multivariate analyses were performed to identify predictive factors for complications.

Main Results:

  • Complications occurred in 19.8% of patients, with MCCS grades I, II, and III reported.
  • Univariate analysis identified hydronephrosis, obstructing megaureters, tailoring-tapering-folding procedures, voiding dysfunction, and duplex systems as significant predictors.
  • Multivariate analysis confirmed refractory voiding dysfunction, tailoring-tapering-folding procedures, obstructing megaureters (>9mm), and duplex systems as significant predictors of complications.

Conclusions:

  • Ureteric re-implantation is a viable treatment for select VUR patients.
  • Refractory voiding dysfunction, specific surgical techniques (tailoring-tapering-folding), obstructing megaureters, and duplex systems are key predictors of postoperative complications.
  • Standardized complication grading systems like MCCS are essential for comparing surgical outcomes.
Abstract

Keywords:
postoperative complicationsuretervesico-ureteric reflux (VUR)

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