Abstract: Objective To compare the incidences of complications associated with 3 different endoscopic procedures, namely
transurethral resection of prostate (TURP), bipolar plasmakinetic resection of the prostate (PKRP), and holmium laser
enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) and assess the clinical value of the
Clavien-Dindo classification system for standardizing the evaluation of the complications. Methods Between January 2010 and
December 2013, a total of 625 patients with BPH scheduled for endoscopic surgery underwent TURP (214 cases), PKRP (207
cases), or HoLEP (204 cases). The complications were recorded in each group and analyzed using the Clavien-Dindo
classification system. Results There was no significant difference in the baseline data among the 3 groups (P>0.05). TURP was
associated with a higher total incidence rate of complications than PKRP and HoLEP, and the incidences of electrolyte
disturbance, massive intraoperative hemorrhage, urinary irritation symptom, urinary blockage, transurethral resection
syndrome (TRUS), and erectile dysfunction (ED) differed significantly among the 3 groups (P<0.05). According to
Clavien-Dindo classification, the incidence of grade II complications was significantly higher in TURP group than in PKRP and
HoLEP groups (P<0.05), and that of grades III and IV complications was significantly higher in TURP group than in HoLEP
group (P<0.05); no significant difference was found in grade I or V complications among the 3 groups (P>0.05). Conclusion
According to the results of Clavien-Dindo classification analysis, PKRP and HoLEP are associated with fewer complications
with a better safety profile in the treatment of BPH. The current Clavien-Dindo classification system can contribute to
standardized evaluation of surgical complications but still needs further modifications for better performance.