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.