Complications of radical cysto-urethrectomy using modified Clavien grading system: prepubic versus perineal urethrectomy

OBJECTIVES 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. PATIENTS AND 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). CONCLUSION The prepubic approach has a lower incidence of serious complications with shorter operation duration and shorter hospital stay.