title: Complications associated with photoselective vaporization of the prostate: categorization by a panel of GreenLight users according to Clavien score and report of a single-center experience.
abstract: OBJECTIVE
  To devise and validate a system to categorize GreenLight photoselective vaporization of prostate (PVP) complications according to Clavien score (CS), to report complications of PVP using this categorization, and to determine risk factors.
  
  
  METHODS
  A survey questionnaire was distributed to all participants of the second meeting of the Group of GreenLight Users. They were asked to grade PVP complications according to CS. We calculated the mode CS for each complication from the survey data to propose a categorization system for complications of PVP. Complications encountered in a large single-center cohort of 370 patients were reported according to this system. We assessed the reproducibility of CS by estimating inter-rater agreement by the Fleiss kappa. We performed univariate and multivariate analyses to determine risk factors for complications.
  
  
  RESULTS
  Of the 67 meeting participants, 42 (62.7%) completed the survey. Overall agreement between urologists was fair (Fleiss kappa = 0.356). Among the 370 patients, 21 (5.7%) had intraoperative complications, 147 (39.7%) had postoperative complications, and 70 (18.9%) had long-term complications. Among the postoperative complications, 125 patients (33.8%) were classified as Clavien grade I, 58 (15.7%) as Clavien grade II, 4 (1.1%) as Clavien grade IIIb, 5 (1.3%) as Clavien grade IVa, 1 (0.3%) as Clavien grade IVb, and 1 (0.3%) as Clavien grade V. In multivariate analysis, the only predictor of overall complications was a polymicrobial preoperative urine culture.
  
  
  CONCLUSIONS
  The grading of PVP complications by CS is fairly reproducible. We are the first to propose a system for the categorization of PVP complications. PVP complications are frequent but most often minor.
authors.affiliation: Department of Urology, CHRU TOURS, Tours, Loire Valley, France. Electronic address: peyronnetbenoit@hotmail.fr.
authors.forename: Benoit
authors.initials: B
authors.lastname: Peyronnet
authors.affiliation: Department of Urology, CHRU TOURS, Tours, Loire Valley, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Pradere
authors.affiliation: Department of Urology, CHRU TOURS, Tours, Loire Valley, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Brichart
authors.affiliation: Department of Urology, CHRU TOURS, Tours, Loire Valley, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bodin
authors.affiliation: Department of Statistics, CHRU TOURS, Tours, Loire Valley, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bertrand
authors.affiliation: Department of Urology, CHRU TOURS, Tours, Loire Valley, France; Université François Rabelais, PRES Center-Tours, Loire Valley, France; Center d'Innovations Technologiques, CHRU TOURS, Tours, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Bruyère
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology; D011467:Prostate / Q000601:surgery*; D011468:Prostatectomy / Q000009:adverse effects; D015203:Reproducibility of Results; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014835:Volatilization