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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. Materials and 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. Conclusion 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.

Resume Introduction Un antigene specifique de la prostate (PSA) eleve et une biopsie prostatique (BP) negative peut relever soit d’un faux negatif de la BP qui meconnait un cancer de la prostate (CaP) soit d’un faux positif du PSA dont l’augmentation ne serait pas en rapport avec un CaP. L’objectif de cette etude etait d’evaluer le role de biopsies iteratives dans ce contexte. Methodes Il s’agit d’une analyse retrospective monocentrique d’une cohorte de patients ayant eu une premiere BP negative pour un PSA superieur a 4 ng/mL et au moins une BP supplementaire. Ces cas ont ete comparee a une population temoin constituee d’un groupe de patients biopsies dans le meme centre, dans la meme periode et ayant eu le diagnostic de CaP des la premiere BP. Les comparaisons cas-temoins ont ete faites a l’aide des tests de Mann-Whitney (valeurs quantitatives) et des tests de Fisher (valeurs qualitatives). Les analyses multivariees ont utilise la regression logistique. Resultats Les 63 cas etaient significativement plus jeunes que les 75 temoins et avaient plus souvent un toucher rectal normal. Le volume prostatique etait plus important chez les cas et leur premier PSA plus bas d’ou une densite du PSA plus faible chez les cas. La proportion de PSA libre etait significativement plus elevee chez les cas. Parmi les 63 cas, 17 (27 %) ont eu une BP positive lors de la deuxieme (7/64), troisieme (6/31), quatrieme (3/9) et sixieme (1/1) BP. Parmi ces 17 cas avec CaP, la longueur de cancer par carotte envahie et la longueur cumulee de cancer sur l’ensemble de la BP etaient plus petites que chez les temoins. Dans 76 % des cas, le score de Gleason chez les cas etait de 6 ou moins. Conclusion Pres d’un quart des patients ayant une premiere BP negative et un PSA augmente ont eu un diagnostic de CaP sur des biopsies iteratives. Ce cancer decouvert sur les BP iteratives avait certaines caracteristiques de meilleur pronostic que ceux des temoins. Nous proposons un algorithme de prise en charge des patients avec PSA eleve et premiere BP negative en fonction de notre travail et de la litterature.

An elevated PSA and a negative prostate biopsy (PB) can be a false negative PB that ignores a prostate cancer (PCa) or a false positive PSA not related to PCa. The objective of this study was to analyze a group of patients who had a negative first BP for a PSA superior to 4 ng/mL and at least one additional PB and to compare these cases with controls who had the diagnosis PCa from the first PB.Retrospective single-center study comparing patients with an elevated PSA and repeat biopsy following a first negative PB and patients with PCa diagnosed from the first PB.The 63 cases were younger than the 75 controls and had more often a normal digital rectal examination. Their prostate volume was larger and their number of PSA before the first PB lower: this corresponded to a lower PSA in the second (7/64), third (6/31), fourth (3/9) and sixth (1/1) PB. Among these cases with PCa, the length of core invaded by cancer and the total length of cancer of the entire PB were smaller than controls. In 76% of cases, the Gleason score among cases was 6 or less.PCa discovered on repeat biopsy had features of better prognosis than those of controls. We propose an algorithm for management of patients with elevated PSA and negative first PB.