THE ROLE OF SYSTEMATIZATION OF POSTOPERATIVE COMPLICATIONS IN ASSESSING THE EFFICIENCY AND SAFETY OF SURGICAL METHODS FOR THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Aim. Adaptation of the Clavien-Dindo classification to the assessment of postoperative complications of surgical treatment of benign prostatic hyperplasia (BPH) and assessment of the efficacy and safety of various surgical methods for treating BPH by systematizing postoperative complications. Materials and methods. Patients with BPH were divided into three groups depending on the method of surgical treatment. In group I (n=40; 26.7%) HoLEP was performed, while in group II (n=50; 33.3%) and III (n=60; 40%) TURP and open transvesical simple prostatectomy (SP) were done. The Clavien-Dindo classification system was used to adapt to the assessment of postoperative complications of surgical treatment of BPH. Results. To determine the normal and complicated postoperative period, the respective were developed. According to the adapted Clavien-Dindo classification, postoperative complications were systematized. In group I, there were 28 (70%) complications, including 8 of I grade (28.6%), 16 of II grade (57.1%), 3 of IIIa grade (10.7%) and 1 of IIIb grade (3.6%). There were no complications of IVa, IVb and V grade. In group II, a total of 41 (82.0%) complications were observed, including 16 (39%), 17 (41.5%), 1 (2.4%) and 7 (17.1%) of grade I, II, IIIa and IIIb, respectively. There were also no complications of IVa, IVb and V grade. In group III there were 154 complications in total and 89 (57.8%), 48 (31.2%), 9 (5.8%), 3 (1.96%), 3 (1.96%), 0 and 2 (1.3%) of grade I, II, IIIa, IIIb, IV and V, respectively. Conclusions. To objectively assess the quality of surgical procedures and systematize complications using the Clavien-Dindo classification, it needs to be adapted, taking into account the specifics of the methods and the postoperative period. OP is characterized as an effective method of eliminating bladder outlet obstruction, but it is associated with significantly longer lengths of stay compared to TURP and HoLEP, more severe complications, and significantly more often requires additional interventions. In terms of morbidity, blood transfusion rate and the length of hospital stay, the results of TURP are comparable to HoLEP, but TURP is inferior in terms of the frequency of long-term complications.

Full Text

Restricted Access

About the authors

Sh. I Giyasov

State Institution “Republican Specialized Scientific and Practical Medical Center of Urology”; Tashkent Medical Academy

Email: dr.sh.giyasov@gmail.com
Ph.D., professor at the Department of Urology of Tashkent Medical Academy, consultant at Republican Specialized Scientific and Practical Medical Center of Pediatrics Tashkent, Uzbekistan

R. R Gafarov

Samarkand State Medical University

Email: rushen.gafarov@bk.ru
assistant at the Department of Urology Samarkand, Uzbekistan

Z. R Shodmonova

Samarkand State Medical University

Email: zebuniso.shodmonova@mail.ru
Ph.D., associate professor, Head of the Department of Urology Samarkand, Uzbekistan

Sh. T Mukhtarov

State Institution “Republican Specialized Scientific and Practical Medical Center of Urology”; Tashkent Medical Academy

Email: msht_doc@mail.ru
Ph.D., MD, director of Republican Specialized Scientific and Practical Medical Center of Pediatrics, professor at the Department of Urology of Tashkent Medical Academy Tashkent, Uzbekistan

F. A Akilov

State Institution “Republican Specialized Scientific and Practical Medical Center of Urology”; Tashkent Medical Academy

Email: akilovmd@gmail.com
Ph.D., MD, professor, Head of the Department of Urology of Tashkent Medical Academy, Tashkent, Uzbekistan, consultant at Republican Specialized Scientific and Practical Medical Center of Pediatrics Tashkent, Uzbekistan

References

  1. Pham H., Sharma P. Emerging, newly-approved treatments for lower urinary tract symptoms secondary to benign prostatic hypertrophy. Can J Urol. 2018 Apr;25(2):9228-9237. PMID: 29679999.
  2. Freyer P.G. A new method ofperforming prostatectomy. Lancet: 1900;1:774.
  3. EAU Guidelines. Edn. presented at the EAU Annual Congress Milan 2021. ISBN 978-94-92671-13-4.
  4. Reich O., Gratzke C., Bachmann A., Seitz M., Schlenker B., Hermanek P., Lack N., Stief C.G. Urology Section of the Bavarian Working Group for Quality Assurance. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol. 2008 Jul;180(1):246-249. doi: 10.1016/j.juro.2008.03.058. Epub 2008 May 21. PMID: 18499179.
  5. Gilling P.J., Fraundorfer M.R. (1998). Holmium laser prostatectomy: a technique in evolution. Current opinion in. urology, 8(1), 11-15.
  6. Michalak J., Tzou D, Funk J. HoLEP: the gold standard for the surgical management of BPH in the 21(st) Century. Am J Clin Exp Urol. 2015 Apr 25;3(1):36-42. PMID: 26069886; PMCID: PMC4446381.
  7. Enikeev D., Okhunov Z., Rapoport L., Taratkin M., Enikeev M., Snurnitsyna O., Capretz T., Inoyatov J., Glybochko P. Novel Thulium Fiber Laser for Enucleation of Prostate: A Retrospective Comparison with Open Simple Prostatectomy. J Endourol. 2019 Jan;33(1):16-21. Doi: 10.1089/ end.2018.0791. PMID: 30489154.
  8. Peshekhonov K.S., Shpilenia E.S., Komyakov B.K., Burlaka O.O., Sargsyan M.S. Endoscopic treatment of prostatic hyperplasia in elderly patients: a comparative analysis of resection and enucleation technique. Urology Herald. 2020;8(1):25-38. (In Russ.). https://doi.org/10.21886/2308-6424-2020-8-1-25-38
  9. Dindo D., Demartines N., Clavien P.A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of Surgery. 2004;240:205-213. doi: 10.1097/01.sla.0000133083.54934.ae.
  10. Clavien P.A., Barkun J., de Oliveira M.L., Vauthey J.N., Dindo D., Schulick R.D., de Santibanes E., Pekolj J., Slankamenac K., Bassi C., Graf R., Vonlanthen R., Padbury R., Cameron J.L., Makuuchi M. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009 Aug;250(2):187-196. doi: 10.1097/SLA.0b013e3181b13ca2. PMID: 19638912.
  11. Dindo D., Demartines N., Clavien P.A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of Surgery. 2004; 240:205-213. doi: 10.1097/01.sla.0000133083.54934.ae.
  12. De Cassai A., Boscolo A., Tonetti T., Ban I., Ori C. Assignment of ASAphysical status relates to anesthesiologists’ experience: a survey-based national-study. Korean J Anesthesiol. 2019 Feb;72(1):53-59.
  13. Laguna M.P., Beemster P., Kumar P. et al. (2009) Perioperative morbidity of laparoscopic cryoablation of small renal masses with ultrathin probes: a European multicentre experience. Eur Urol 56:355-361.
  14. Mamoulakis C., Efthimiou I., Kazoulis S., Christoulakis I., Sofras F. The modified Clavien classification system: a standardized platform for reporting complications in transurethral resection of the prostate. World J Urol. 2011 Apr;29(2):205-210. doi: 10.1007/s00345-010-0566-y. Epub 2010 May 12. PMID: 20461386; PMCID: PMC3062770.
  15. Sagen E., Namnuan R.O., Hedelin H., Nelzén O., Peeker R. The morbidity associated with a TURP procedure in routine clinical practice, as graded by the modified Clavien-Dindo system. Scand J Urol. 2019 Aug;53(4):240- 245. doi: 10.1080/21681805.2019.1623312.
  16. Omar M.I., Lam T.B., Alexander C.E., Graham J., Mamoulakis C., Imamura M., et al. Systematic review and meta-analysis of the clinical effectiveness of bipolar compared with monopolar transurethral resection of the prostate (TURP). BJU Int. 2014;113:24-35.
  17. Rabbani F., Yunis L.H., Pinochet R., Nogueira L., Vora K.C., Eastham J.A., et al.Comprehensive standardized report of complications of retropubic and laparoscopic radical prostatectomy. Eur Urol 2010;57:371-386.
  18. Loppenberg B., Noldus J., Holz A., Palisaar R.J. Reporting complications after open radical retropubic prostatectomy using the Martin criteria. J Urol 2010;184:944-948.
  19. Mamoulakis C., Ubbink D.T., de la Rosette JJMCH. Bipolar versus monopolar transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. Eur Urol. 2009;56:798-809.
  20. Tang Y., Li J., Pu C., Bai Y., Yuan H., Wei Q., et al. Bipolar transurethral resection versus monopolar transurethral resection for benign prostatic hypertrophy: a systematic review and meta-analysis. J Endourol. 2014;28:1107-1114.
  21. Michalak J., Tzou D., Funk J. HoLEP: the gold standard for the surgical management of BPH in the 21(st) Century. Am J Clin Exp Urol. 2015 Apr 25;3(1):36-42. PMID: 26069886; PMCID: PMC4446381.
  22. Yalçin S., Yilmaz S., Gazel E., Kaya E., Aydogan T.B., Aybal H.Ç., Tunç L. Holmium laser enucleation of the Mitr prostate for the treatment of size-independent BPH: A single-center experience of 600 cases. Turk J Urol. 2020 Jan 17;46(3):219-225. doi: 10.5152/tud.2020.19235. PMID: 32053095; PMCID: PMC7219966.
  23. Акилов Ф.А., Гиясов Ш.И., Мухтаров Ш.Т., Насыров Ф.Р., Мирхамидов Д.Х. Оценка осложнений эндоскопической хирургии нефролитиаза с позиций классификации Clavien-Dindo // ЭКУ. 2012. № 3.
  24. Гиясов Ш.И., Акилов Ф.А. Трудности в систематизации послеоперацонных осложнений эндоскопического лечения уролитиаза и пути их решения. Вестник урологии. 2018;6(1):5-17. https://doi.org/10.21886/2308-6424-2018-6-1-5-17
  25. Foster H.E., Dahm P., Kohler T.S., Lerner L.B., Parsons J.K., Wilt T.J., McVary K.T. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline Amendment 2019. J Urol. 2019 Sep;202(3):592-598. doi: 10.1097/JU.0000000000000319. Epub 2019 Aug 8. PMID: 31059668.
  26. Rassweiler J., Teber D., Kuntz R., Hofmann R.Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. Eur Urol. 2006 Nov;50(5):969-979; discussion 980. doi: 10.1016/j.eururo.2005.12.042. Epub 2006 Jan 30. PMID: 16469429.
  27. Ahyai S.A., Gilling P., Kaplan S.A., Kuntz R.M., Madersbacher S., Montorsi F., Speakman M.J., Stief C.G. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010 Sep;58(3):384-397. doi: 10.1016/j.eururo.2010.06.005. Epub 2010 Jun 11. PMID: 20825758.
  28. Glybochko P.V., Alyaev Y.G., Rapoport L.M., Enikeev D.V., Okhunov Z., Netsch C., Spivak L.G., Taratkin M.S. [Endoscopic enucleation of the prostate: a short term trend or a new treatment standard?]. Urologiia. 2018 May;(2):130-133.Russian. PMID: 29901308.
  29. Bozzini G., Berti L., Aydogan T.B., Maltagliati M., Roche J.B., Bove P., Besana U., Calori A., Pastore A.L., Müller A., Micali S., Sighinolfi M.C., Rocco B., Buizza C. A prospective multicenter randomized comparison between Holmium Laser Enucleation of the Prostate (HoLEP) and Thulium Laser Enucleation of the Prostate (ThuLEP). World J Urol. 2021 Jul;39(7):2375-2382. doi: 10.1007/s00345-020-03468-6. Epub 2020 Sep 30. PMID: 32997262.
  30. Li M., Qiu J., Hou Q., Wang D., Huang W., Hu C., Li K., Gao X. Endoscopic enucleation versus open prostatectomy for treating large benign prostatic hyperplasia: a meta-analysis of randomized controlled trials. PLoS One. 2015 Mar 31;10(3):e0121265. doi: 10.1371/journal.pone.0121265. PMID: 5826453; PMCID: PMC4380430.
  31. Ahyai S.A., Chun F.K., Lehrich K., Dahlem R., Zacharias M.S., Fisch M.M., Kuntz R.M. Transurethral holmium laser enucleation versus transurethral resection of the prostate and simple open prostatectomy--which procedure is faster? J Urol. 2012 May;187(5):1608-1613. Doi: 10.1016/j. juro.2011.12.107. Epub 2012 Mar 14. PMID: 22425091.
  32. Gratzke C., Schlenker B., Seitz M., Karl A., Hermanek P., Lack N., Stief C.G., Reich O.Complications and early postoperative outcome after open prostatectomy in patients with benign prostatic enlargement: results of a prospective multicenter study. J Urol. 2007 Apr;177(4):1419-1422. doi: 10.1016/j.juro.2006.11.062. PMID: 17382744.
  33. Biktimirov R.G., Martov A.G., Biktimirov T.R., Kaputovskij A.A. [The current status of surgical treatment of benign prostatic hyperplasia with volume over 80.]. Urologiia. 2019 Jul;(3):128-133.Russian. PMID: 31356026.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies