Complication rates of open transvesical prostatectomy according to the Clavien–Dindo classification system

Abstract

Background: Traditional open prostatectomies either transvesical or retropubic remains the reference standard for managing benign prostatic enlargement in some centers, especially in developing countries. The comparison of complication rates between the various types of open prostatectomies is usually a source of significant debate among urologists, most times with conflicting results. The Clavien–Dindo classification system is an excellent attempt at standardization of reporting complications associated with surgeries. Materials and Methods: We reviewed retrospectively the records of patients who had open transvesical prostatectomy (TVP) in three specialist urology centers in Anambra state, Southeast Nigeria, over a period of 5 years (January 2004–December 2009), with the aim of documenting medical and surgical complications arising from open TVP. These complications were then categorized according to the Clavien–Dindo system. Results: A total of 362 patients had open TVP over the period under review. Of this number, 145 had documented evidence of complications. The mean age of the patients was 66.3 years (SD 9.4 years; range 49–96 years). The mean follow‑up period was 27.8 months (SD 12.6 months; range 6–33 months). The overall complication rate for open TVP in this study was 40.1% (145/362). Complication rates for grades i, id, ii, iiia, and iiib were 0.8%, 0.6%, 35.1%, 0.6%, and 3.0%, respectively. Most complications of open TVP occur in the early postoperative period. Conclusion: Open TVP still remains a valid surgical option in contemporary environment where advanced techniques for transurethral resection of the prostate and laparoscopic prostatectomy are unavailable. Most complications occur in the early postoperative period, with bleeding requiring several units of blood transfusion accounting for the commonest complication. This should be explained to patients during the preoperative counselling.

Keywords: Classification, postoperative complications, reference standard, suprapubic prostatectomy

Nigerian Journal of Clinical Practice •Jan-Mar 2012 • Vol 15 • Issue 1