The use of a novel complication reporting system: the comprehensive complication index in thulium laser enucleation of the prostate.

Objectives: To evaluate the application of the comprehensive complication index (CCI) in the assessment of postoperative complications after thulium laser prostate enucleation (ThuLEP) and compare it with the Clavien‒Dindo classification (CDC) grading system.

Methods: A retrospective analysis of the clinical data of 467 patients hospitalized for benign prostatic hyperplasia treated with ThuLEP surgery from August 2019 to October 2023 was conducted. The postoperative complications of patients were assessed via both the CDC and CCI complication evaluation systems, and the correlation between both systems and the postoperative length of stay (LOS) was analyzed. Sample size estimations for randomized controlled trials (RCTs) were also performed on the basis of complication rates and CCI scores.

Results: Ninety-nine (21.20%) of the patients had a total of 121 complications. Eighteen patients experienced ≥ 2 types of complications, and their cumulative CCI scores exceeded the score corresponding to the highest CDC grade. Both the CDC and CCI were significantly and positively correlated with the postoperative LOS, with the cumulative CCI score showing a stronger correlation than the highest CDC grade (r = 0.429, p < 0.001 vs. r = 0.383, p < 0.001). Furthermore, the use of the CCI for evaluating postoperative complications was found to reduce the required sample size for RCTs (305 per group vs. 90 per group).

Conclusions: Compared with the CDC, the CCI more accurately reflects short-term postoperative complications after ThuLEP and shows a stronger correlation with LOS while enabling smaller sample sizes in RCTs. Future studies should integrate the CCI into standardized reporting for laser-based BPH surgery to improve consistency and benchmarking.