title: Complications of radical cysto-urethrectomy using modified Clavien grading system: prepubic versus perineal urethrectomy.
abstract: OBJECTIVE
  • To assess the impact of both prepubic and perineal urethrectomy on the complication rate and grade when cysto-urethrectomy is planned. • To review the perioperative complications of radical cysto-urethrectomy and grade them according to the modified Clavien classification system.
  
  
  METHODS
  • A total of 186 radical cysto-urethrectomies were performed between 1984 and 2008 • Patients' charts were retrospectively reviewed, focusing on operation duration, hospital stay and complications arising. • According to this new classification, perioperative complications were stratified into five grades.
  
  
  RESULTS
  • Prepubic urethrectomy was done in 71 patients (group I) while perineal urethrectomy was done in 115 patients (group II). • The mean operation duration was significantly lower in group I than in group II (173.8 and 208.9 min in groups I and II, respectively; P= 0.003). • There were a total of 46 perioperative complications in 186 (24.7%) patients, 21 (29.5%) in the prepubic group and 25 (21.1%) in the perineal group. • There were 19 (90.5%) and 18 (72%) low-grade (G1-3) complications in the prepubic and perineal groups, respectively, and two (9.5%) and seven (28%) high-grade (G4-5) complications in the prepubic and perineal groups, respectively (P= 0.033). • The mean hospital stay was significantly lower in group I than in group II (14.5 and 17.6 days in groups I and II, respectively; P= 0.047).
  
  
  CONCLUSIONS
  • The prepubic approach has a lower incidence of serious complications with shorter operation duration and shorter hospital stay.
authors.affiliation: Mansoura Urology and Nephrology Centre, Mansoura, Egypt. elshalam@hotmail.com
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Elshal
authors.forename: Tamer S
authors.initials: TS
authors.lastname: Barakat
authors.forename: Ahmed
authors.initials: A
authors.lastname: Mosbah
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Latif
authors.forename: Hassan
authors.initials: H
authors.lastname: Abol-Enein
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period / Q000009:adverse effects; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D014521:Urethra / Q000601:surgery; D014523:Urethral Neoplasms / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods