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ANALYSIS OF AUGMENTATION CYSTOPLASTY COMPLICATION RATES USING
CLAVIEN-DINDO GRADING SYSTEM
Ali Cansu BOZACI, Burak CITAMAK, Mesut ALTAN, Hasan Serkan DOGAN and Serdar TEKGUL
Hacettepe University, Urology, Ankara, TURKEY
PURPOSE
Application of Clavien-Dindo grading system for augmentation cystoplasty procedures in 200 children.
MATERIAL AND METHODS
Two hundred patients (103 male, 97 female) who underwent augmentation cystoplasty between 1991-2015 were
analyzed retrospectively. Complications were evaluated according to the Clavien-Dindo grading system and grouped as
minor(Clavien 1-2) and major(Clavien 3-4-5). Gender, age, indications, preoperative renal function, VUR, augmentation
technique, associated procedures (apendicovesicostomy, sling-bladder neck reconstruction, ureteral reimplantation)
were studied to predict complications.
RESULTS
The mean age at the time of surgery was 10.8±2.3 years. Cystoplasty indications were neurogenic bladder, bladder
extrophy, PUV and others (74.5%,12.5%,5.5%,7.5% respectively). Augmentation procedures were 116(58%)
ileocystoplasty, 63(31.5%) autoaugmentation, 8(4%) ureteral augmentation, 8(%4) colocystoplasty, 5(2.5%)
gastrocystoplasty. 30 (%15) patients had chronic renal failure (CRF) preoperatively and 9 of them underwent renal
transplantation in the long-term. Complications occurred in 69(34.5%) patients (23 grade 1, 31 grade 2, 14 grade 3B,
1 grade 4A) during follow up. One patient died from ileus and gastric perforation at 12 months postoperatively.
Preoperative CRF, bladder extrophy, ileocystoplasty surgery and techniques other than autoaugmentation were are
significant predictor of major complications on univariate analysis where multivariate analysis revealed preoperative
CRF, bladder neck procedures, bladder extrophy were significant factors of major complications respectively (p=0.004,
0.020, 0.020).
CONCLUSIONS
Use of this Clavien-Dindo reporting system objectively evaluates the complications and allow surgeons to stratify
complications and properly inform parents.