Observation of complications assessed by Clavien-Dindo classification in different endoscopic procedures of benign prostatic hyperplasia: An observational study

Abstract

The Clavien-Dindo classification (CDC) was widely used in the assessment of surgical complications, but some inconsistencies always existed in urological literature. This study was aimed to report complications of the transurethral resection of the prostate (TURP), plasmakinetic resection of the prostate (PKRP), and holmium laser enucleation of the prostate (HoLEP) by using a more detailed way under the framework of CDC. A total of 623 eligible cases underwent endoscopic procedures from January 2018 and December 2020 were divided into the TURP group (212 cases), the PKRP group (208 cases), and the HoLEP group (203 cases) according to the surgical type. Patients’ surgical complications assessed by the CDC were compared among the 3 groups. The operation time, intraoperative irrigation volume, postoperative irrigation time and volume, decrease in hemoglobin and sodium, postoperative catheterization time, visual analogue scale, hospital stay of the PKEP group and the HoLEP group were significantly less than those of the TURP group, and the decrease in hemoglobin and visual analogue scale in the HoLEP group were significantly lower than those in the PKEP group (all P < .05). The electrolyte disturbance, urinary tract irritation, and patients with grade II of CDC in the PKRP group were significantly lower than those in the TURP group; The electrolyte disturbance, lower abdominal pain, urinary tract irritation, intraoperative hemorrhage, secondary hemorrhage, clot retention, patients with grade I, II, III of CDC in the HoLEP group were significantly lower than those in the TURP group, and the urinary tract irritation, grade I, II of CDC in the HoLEP group was significantly lower than that in the PKRP group (all P < .05). The CDC should be recommended because of the enhanced insight into surgical complications, and the HoLEP should be given a priority for Benign prostatic hyperplasia (BPH) surgical treatment in terms of the merits in surgical characteristics and complications.

Avaliação das complicações pós-operatórias em pacientes submetidos à Ressecção Transuretral de Próstata e à Enucleação Prostática por Holmium Laser em um hospital universitário

“…Ao avaliarem a queixa de dor pela escola visual analógica (EVA) indicaram relatos menores das duas técnicas comparadas à RTUp. A RTUp oferece relatos mais frequentes de sangramento e menor hemostasia gerando maiores volumes de coágulos e consequente retenção urinária impactando nos relatos de dor (Pan et al, 2023).…”

“…As possíveis complicações pós-operatórias na RTU de próstata incluem: hematúria, risco de hemorragia com necessidade de transfusão, retenção urinária aguda, síndrome pós-RTUp ou intoxicação hídrica (devido à absorção intravascular de líquidos da irrigação hiperosmolar), infecção urinária, disfunção erétil, ejaculação retrógrada, incontinência urinária, estenose uretral ou de colo vesical, o que condiciona a taxa de retratamento de 7% a 12% em oito anos (Barboza et al, 2015;Geremew et al, 2022;Pan et al, 2023).…”