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S23-7
(P)
PERIOPERATIVE RISK FACTORS PREDICTING COMPLICATIONS RATES OF
AUGMENTATION CYSTOPLASTY USING THE MODIFIED CLAVIEN CLASSIFICATION
SYSTEM IN PEDIATRIC POPULATION
Onur TELLI
1
, Cihat OZCAN
2
, Mucahit KABAR
3
, Tolga KARAKAN
3
, Ahmet Metin HASCICEK
3
, Tarkan SOYGUR
1
and Berk
BURGU
1
1) Ankara University, Pediatric Urology, Ankara, TURKEY - 2) Ankara University, Ankara, TURKEY - 3) Ankara Training
and Research Hospital, Urology, Ankara, TURKEY
PURPOSE
To evaluate preoperative predictive factors for postoperative complications of augmentation cystoplasty in children by
using the modified Clavien classification system (MCCS), which has been widely used for complication rating of surgical
procedures.
MATERIAL AND METHODS
A retrospective review of medical records between 1994 and 2014 identified 117 children (64 males and 53 females)
who underwent augmentation cystoplasty at two major institutions. Complications were evaluated according to the
MCCS. Univariate and multivariate analyses were used to determine predictive factors affecting complication rates.
RESULTS
The mean (SD) age was 9.3 (1.9) years and the mean (SD) follow-up was 5.4 (1.1) years. The mean (SD)
hospitalization time was 9.7 (3.6) days. Complications occurred in 29 (24.7%) children; 13 (11.1%) were MCCS grade I,
8 (5.1%) were grade II, 5 (4.2%) were grade III and 3 (2.5%) were grade IV.
Anti-reflux surgery, outlet resistance increasing procedures (sling, bladder neck reconstruction), Society of Fetal Urology
(SFU) grade 3–4 hydronephrosis, posterior urethral valves, scoliosis and serum creatinine greater than 1.0 mg/dl were
statistically significant predictors of complications on univariate analysis. Prior Botox injection history, Mitrofonof
Procedure, previous surgery, gender and age were not significant predictors of complications. In the multivariate
analysis Society of Fetal Urology (SFU) grade 3–4 hydronephrosis, bladder neck reconstruction and serum creatinine
greater than 1.0 mg/dl were statistically significant independent predictors of complications.
CONCLUSIONS
Augmentation cystoplasty remains a valid method of treating severe bladder dysfunction in children. Society of Fetal
Urology (SFU) grade 3–4 hydronephrosis, bladder neck reconstruction and serum creatinine greater than 1.0 mg/dl were
the main predictive factors for postoperative complications. Use of a standardized complication grading system, such as
the MCCS, should be encouraged to allow the valid comparison of complication rates between series.