title: Contemporary monopolar and bipolar transurethral resection of the prostate: prospective assessment of complications using the Clavien system.
abstract: OBJECTIVE
  A modified version of the Clavien system has been recently suggested to allow a standardized assessment of complications associated with transurethral resection of the prostate (TURP). Aim of this multicentre study was to validate the use of this assessment tool in a contemporary cohort of patients undergoing monopolar or bipolar TURP.
  
  
  METHODS
  Consecutive patients undergoing TURP in five Italian institutions from April 2011 to March 2012 were prospectively included in this study. Complications occurring within first postoperative month were recorded and graded according to the modified Clavien system. Univariate and binary logistic regression analysis were used for statistical analysis.
  
  
  RESULTS
  Two hundred and ninety-five patients were included in the study. Overall, 47 complications were recorded in 44 patients. There was no difference in terms of postoperative complications between those who underwent monopolar TURP (27 pts; 9.2 %) versus those who underwent bipolar TURP (17 pts; 5.2 %, p = 0.142). Overall perioperative morbidity rate was 15.5 %. Most of the complications were Clavien type I (37 cases; 78 %) and II (6 cases; 12 %). High-grade complications were few as follows: Clavien type IIIb in two cases (4 %) and IV in two cases (4 %). No TURP-related deaths were reported. In the monopolar TURP group, a longer-operative time (OR 1.024; 95 % CI 1.007-1.040, p = 0.004) is an independent predictors of postoperative complications.
  
  
  CONCLUSIONS
  A modified Clavien system can be considered a practical and easily applicable tool in grading postoperative complications in patients undergoing TURP. Our findings confirm that TURP is a safe procedure associated with minimal perioperative morbidity.
authors.affiliation: Department of Urology, Ospedale Sant'Andrea, University La Sapienza, Rome, Italy. cosimodenunzio@virgilio.it
authors.forename: Cosimo
authors.initials: C
authors.lastname: De Nunzio
authors.forename: Riccardo
authors.initials: R
authors.lastname: Lombardo
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.forename: Antonio
authors.initials: A
authors.lastname: Cicione
authors.forename: Luca
authors.initials: L
authors.lastname: Cindolo
authors.forename: Rocco
authors.initials: R
authors.lastname: Damiano
authors.forename: Marco
authors.initials: M
authors.lastname: De Sio
authors.forename: Mario
authors.initials: M
authors.lastname: Falsaperla
authors.forename: Giorgio
authors.initials: G
authors.lastname: Franco
authors.forename: Mauro
authors.initials: M
authors.lastname: Gacci
authors.forename: Costantino
authors.initials: C
authors.lastname: Leonardo
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Presicce
authors.forename: Andrea
authors.initials: A
authors.lastname: Tubaro
mesh_terms: D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy; D016015:Logistic Models; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000145:classification* / Q000175:diagnosis / Q000453:epidemiology; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000473:pathology / Q000601:surgery*; D015203:Reproducibility of Results; D018570:Risk Assessment; D012720:Severity of Illness Index; D020728:Transurethral Resection of Prostate / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome