Frequency of grading of complications using modified clavien classification system after transurethral resection of prostate.

Objective: To determine the frequency of post-operative complications of transurethral resection of prostate (TURP), in benign prostatic hyperplasia (BPH) patients, using the Modified Clavien Classification System (MCCS). Study Design: Descriptive study. Setting: Urology Department, Sindh Institute of Urology and Transplantation, Karachi. Period: 26th May, 2019 to 25th Nov, 2019. Material & Methods: A total number of 162 patients with benign prostatic hyperplasia planned for TURP were included in this study and Post-operative complications data was collected, and classified according to the Modified Clavien Classification System (MCCS). Patient’s demographics and other parameters like prostate volume, operative time, mean prostatic tissue resected and hospital stay was collected. Results: Mean age was 63.32±8.36 years. Mean prostate volume was 56.99±13.25 grams. Mean operative time was 26.55±9.46 mins. Mean prostate tissue resected was 16.75±12.09 grams. Mean hospital stay was 1.27±0.60 mins. Grade I complication was occurred in 06 (3.70%) patients, grade II in 03 (1.85%) patients, grade III in 00 patients, grade IV in 01 (0.62%) patients and grade V in no patient. While there were no complications in remaining 152 (93.83%) patients. Conclusion: Clavien–Dindo classification system can be easily applied by urologists to grade the post-operative transurethral resection of prostate (TURP) complications. We observed that TURP is a very safe procedure for surgical management of benign prostatic hyperplasia, and is having low morbidity and mortality.

The effect of the American Society of Anesthesiology classification scores on complications associated with percutaneous nephrolithotomy

Objectives: We aimed to evaluate the effect of American Society of Anesthesiology (ASA) classification scoring and age on complications and surgical outcomes during and after percutaneous nephrolithotomy (PCNL) operation. Material and methods: The records of 263 patients, above the age of 18 years, that underwent PCNL surgery between October 2014 and May 2017 were evaluated retrospectively. The patients were divided into three groups based on their ASA risk scores (ASA 1, 2, 3) and into two groups based on their age (younger and older than 65 years). Postoperative complications were assessed according to the ASA groups and age and according to the Clavien classification system. Results: The number of patients in the ASA 1, 2, and 3 groups were 97 (36.8%), 131 (49.8%) and 35 (13.3%), respectively. Four patients in ASA4 were not included in the study. There was no significant difference in ASA 1, 2, 3 groups in terms of changes in Hgb values, mean duration of operation, and mean hospital stay. When ASA1 was compared to ASA3 and ASA2 was compared to ASA3, there was no significant difference in the incidence of all complication rates. There were 159 (60.4%) patients in the young group and 104 (39.5%) patients in the elderly group. Postoperative PCNL complications of these 2 groups were compared according to Clavien classification system and no significant difference was found in incidence of complications.Conclusions: We believe that PCNL operation can be performed effectively and safely in both ASA3 patients and patients above the age of 65 years.

Using the Modified Clavien Grading System to Classify Complications of Percutaneous Nephrolithotomy

Purpose: A modified Clavien classification system has been proposed to grade perioperative complications. We share our experience in grading the complications of percutaneous nephrolithotomy (PNL), according to this new classification. Methods: A total of 809 PNLs performed between 2010 and 2014 were reviewed retrospectively. The modified Clavien classification system, which classifies the perioperative complications into 5 grades, was applied. Grade wise comparison of complications between the patients with simple and complex calculi was done. We also carried out a univariate analysis of different predictors of complications after surgery. Results: A total of 253 perioperative complications were observed in 237 (29.29%) patients. Most complications were related to bleeding and urinary leakage. Patients with complex calculi had significantly more number of complications across all Clavien groups. In a univariate analysis, positive preoperative urine culture and multiple access for stone clearance were identified to be the independent predictors of complications. Conclusion: The modified Clavien system is a simplistic grading system for classification of postoperative complications. However, it suffers from various shortcomings. Therefore, till the proposition of a more comprehensive classification system, the modified Clavien system is useful for reporting the complications and short-term outcomes of PNL.

Correlating complications of transurethral complications of prostate using the Charlson’s Comorbidity Index

Introduction: Ageing is a continuous, universal and progressive process associated with an increasing incidence of comorbidities. Benign Enlargement of Prostate (BEP) is major cause of morbidity in the ageing men. Transurethral Resection of Prostate (TURP) is the Gold Standard for patients with BEP and delivers durable outcomes, however, is associated with morbidity and mortality.This study was conducted to analyze the correlation of these comorbidities in ageing men with the incidence of complications of TURP.Objective: To report and grade operative complications of TURP using Modified Clavien Classification System (MCCS) and analyze whether Charlson Comorbidity Index (CCI) predicts complications after TURP.Methods: This is a prospective analytical study of 77 patients diagnosed as Benign Prostatic Hyperplasia (BPH) undergoing TURP over one year at Tribhuvan University Teaching Hospital. Preoperative morbidity was classified using Charlsons Comorbidity and postoperative complications were graded according to Modified Clavien Classification System (MCCS) into five grades (Grades I, II, IIIa, IIIb, IVa, IVb and V) according to severity followed till 90 days after TURP.Results: Fourteen out of seventy seven (18.2%) patients developed postoperative complications. CCI Scores of <1 were observed in 73 (94.8%) and >2 in 4 (5.2%) patients, constituting the bulk of 93%, Grade IV complications were 7% and no mortality was observed. Patients with higher CCI scores showed statistically significant increase in the grade of postoperative complication and positively correlated to MCCS (ρ of .295; p value <0.009).Conclusion: Men with higher CCI scores have significantly higher grade of postoperative complications.