Cai Fangzhen, Chen Chaohong, Zhnag Jianyu
Department of Urology, Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China.E-mail:
Nan Fang Yi Ke Da Xue Xue Bao. 2015 Aug;35(9):1344-8.
To compare the incidences of complications associated with 3 different endoscopic procedures, namely transurethral resection of prostate (TURP), bipolar plasmakinetic resection of the prostate (PKRP), and holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) and assess the clinical value of the Clavien-Dindo classification system for standardizing the evaluation of the complications.
Between January 2010 and December 2013, a total of 625 patients with BPH scheduled for endoscopic surgery underwent TURP (214 cases), PKRP (207 cases), or HoLEP (204 cases). The complications were recorded in each group and analyzed using the Clavien-Dindo classification system.
There was no significant difference in the baseline data among the 3 groups (P>0.05). TURP was associated with a higher total incidence rate of complications than PKRP and HoLEP, and the incidences of electrolyte disturbance, massive intraoperative hemorrhage, urinary irritation symptom, urinary blockage, transurethral resection syndrome (TRUS), and erectile dysfunction (ED) differed significantly among the 3 groups (P<0.05). According to Clavien-Dindo classification, the incidence of grade II complications was significantly higher in TURP group than in PKRP and HoLEP groups (P<0.05), and that of grades III and IV complications was significantly higher in TURP group than in HoLEP group (P<0.05); no significant difference was found in grade I or V complications among the 3 groups (P>0.05).
According to the results of Clavien-Dindo classification analysis, PKRP and HoLEP are associated with fewer complications with a better safety profile in the treatment of BPH. The current Clavien-Dindo classification system can contribute to standardized evaluation of surgical complications but still needs further modifications for better performance.
比较经尿道前列腺电切术（TURP）、双极等离子前列腺切除术（PKRP）和钬激光前列腺剜除术（HoLEP）这三种不同内镜手术治疗良性前列腺增生（BPH）相关并发症的发生率，并评估Clavien-Dindo分类系统在规范并发症评估方面的临床价值。
2010年1月至2013年12月期间，共有625例计划行内镜手术的BPH患者接受了TURP（214例）、PKRP（207例）或HoLEP（204例）治疗。记录每组的并发症情况，并使用Clavien-Dindo分类系统进行分析。
三组患者的基线数据无显著差异（P>0.05）。TURP组并发症总发生率高于PKRP组和HoLEP组，三组间电解质紊乱、术中大量出血、尿路刺激症状、尿路梗阻、经尿道电切综合征（TRUS）和勃起功能障碍（ED）的发生率差异有统计学意义（P<0.05）。根据Clavien-Dindo分类，TURP组Ⅱ级并发症发生率显著高于PKRP组和HoLEP组（P<0.05），TURP组Ⅲ级和Ⅳ级并发症发生率显著高于HoLEP组（P<0.05）；三组间Ⅰ级或Ⅴ级并发症发生率无显著差异（P>0.05）。
根据Clavien-Dindo分类分析结果，PKRP和HoLEP在治疗BPH时并发症较少，安全性更好。目前的Clavien-Dindo分类系统有助于手术并发症的标准化评估，但仍需进一步改进以提高性能。
