An 18-month Audit of TURP Complications using the Clavien-Dindo Classification System

Rapid Communication

Austin J Urol. 2014;1(3): 3.

An 18-month Audit of TURP Complications using the Clavien-Dindo Classification System

Stroman L1*, Ellis D1, Toomey R1, Mazaris E1

1Department of Urology, St Mary’s Hospital, Imperial College NHS Trust, UK

*Corresponding author: Stroman L, Department of Urology, St Mary’s Hospital, Imperial College NHS Trust, Praed Street, Paddington, London W2 1NY

Received: September 03, 2014; Accepted: October 23, 2014; Published: October 28, 2014

Abstract

Transurethral resection of the prostate (TURP) is the gold standard for management of medical treatment for benign prostatic obstruction (BPO) resistant to medical therapy. Complications can be classified intovarious systems. The Clavien-Dindo Classification System has been ‘highly recommended’ for grading urological complications.

This paper aims to retrospectively analyse complications of TURP over an 18-month period at St Mary’s Hospital, London.

Sixty-six patients underwent TURP for benign prostatic disease from 1st May 2012 until 30th November 2013. Eight complications were seen in six (9.1%) patients. Complications ranged from Clavien-Dindo I to III-b.

TURP has been a safe method of managing benign prostatic disease in our centre. Urological complications can be easily classified using the Clavien- Dindo Classification System.

Keywords: TURP, prostate, resection, complications, Clavien-Dindo

Abbreviations

TURP: Trans-urethral Resection of the Prostate; BPO: Benign Prostatic Obstruction; UTI: Urinary Tract Infection

Introduction

Trans-urethral resection of the prostate (TURP) is gold standard for the treatment of lower urinary tract symptoms such as frequency, nocturia, hesitancy and incomplete voiding in men with benign prostatic obstruction (BPO) resistant to medical treatment in prostates 30-80 mL. TURP is also indicated in BPO related haematuria and UTI, recurrent urinary retention, upper urinary tract dilatation secondary to BPO and bladder stones [1]. TURP has been shown to improve urine flow by 120% and has been associated with an increase in Qmax by 9.7 ml/s. Improvements have been seen in both terms of quality of life indicators and IPSS score which improve by 70.6% following TURP [2].

Complications of TURP can be divided into intraoperative,perioperative and postoperative complications. Intraoperative complications include bleeding, of which 8.6% require postoperative transfusion and TUR syndrome, a dilutional hyponatraemia, which has decreased to less than 1% of cases due to the introduction of bipolar diathermy and intravesical fluid management [3]. Perioperative complications include UTI (4-20%), retention (3-9%) and bladder tamponade (1-5%) [3]. Urinary incontinence can occur in 30-40% of cases in the weeks following procedure, likely due to detrusor overactivity. However, long-term iatrogenic stress incontinence occurs in <0.5% [3]. Other post-operative complications include urethral stricture (2-9%) and bladder neck stenosis (0.3-9%) [3]. Retrograde ejaculation is seen in >90% but there is debate over whether this should be classified as a complication or consequence of TURP. Complications can be classified into various systems. Mitropoulos et al. completed a systematic review of urological complications and deemed the Clavien-Dindo Classification System (Table 1) ‘highly recommended’ for grading of urological complications [4].

Citation: Stroman L, Ellis D, Toomey R, Mazaris E. An 18-month Audit of TURP Complications using the Clavien- Dindo Classification System. Austin J Urol. 2014;1(3): 3. ISSN:2472-3606