Application of modified Clavien classification system to 120W GreenLight HPS laser for BPH

Abstract

Introduction: To evaluate the accuracy and applicability of the modified Clavien classification system (CCS) in evaluating complications following modified vaporization-resection for photoselective vaporization of the prostate using 120W GreenLight high performance system (HPS-PVP)

Methods: Medical records of 342 men who underwent HPS-PVP were retrospectively analyzed. Patients were older than 40 years of age with prostate volume >30mL and IPSS ≥8. Patients with prostatic malignancy, neurogenic bladder, urethral stricture, large postvoid residual volume (>250 mL), previous prostatic surgery and urinary tract infection were excluded. All operations were done by a single surgeon, and patients were followed up for uroflowmetry and IPSS postoperatively. All complications were recorded and classified according to the modified CCS, and methods of management were also recorded.

Results: Mean age was 71.6 ± 7.3 years, and mean prostate volume was 50.0 ± 17.0 mL, and 95 cases (27.7%) had volumes greater than 70 mL. Mean total IPSS score was 21.7 ± 7.9 preoperatively and 12.3 ± 8.1 at the first month postoperatively. Total 59 patients (17.3%) had postoperative complications ultil the first month after the surgery. Among them, 49 patients (14.3%) showed grade I complications, 9 patients (2.6%) showed grade II complications, and 1 patient (0.3%) showed grade IIIb complication. No one had complications graded higher than IIIb. Conclusions: Although the modified CCS is a useful tool for communication among clinicians in allowing comparison of surgical outcomes, this classification need to be revised to acquire higher accuracy and applicability in the evaluation of postoperative complications of HPS-PVP.