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European UrologyVolume 54, issue 4, pages 709-970, October 2008
Benign Prostatic Obstruction
GreenLight Laser Vaporization of the Prostate: Single-Center Experience and Long-Term Results After 500 Procedures
Accepted 22 April 2008, Published online 30 April 2008, pages 893 - 901
Long-term data of photoselective vaporization of the prostate (PVP) for treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is scanty.
Evaluate the long-term efficacy and the complication rate in 80-watt (W) PVP.
Design, Setting, and Participants
500 consecutive patients with LUTS secondary to BPH underwent PVP between September 2002 and April 2007. The mean follow-up was 30.6 ± 16.6 (5.2–60.6) mo.
All patients underwent 80-W PVP performed by seven surgeons.
We evaluated perioperative parameters, including operation time, delivered energy, changes of hemoglobin and serum sodium, catheterization, and hospitalization time as well as intraoperative and postoperative complications. Patients presenting for follow-up had data assessed on the International Prostate Symptom Score and quality-of-life questionnaire (IPPS-QoL), maximal flow rate (Qmax), and post-voiding residual volume (Vres).
Results and Limitations
Mean patient age was 71.4 ± 9.6 (46–96) yr, with a mean preoperative prostate volume of 56.1 ± 25.3 (10–180) ml. Mean operation time was 66.4 ± 26.8 (10–160) min, and mean energy delivery was 206 ± 94 (2.4–619.0) kJ. Despite ongoing oral anticoagulation in 45% of the patients (n = 225), no severe intraoperative complications were observed. Mean catheterization and postoperative hospitalization time was 1.8 ± 1.2 (0–10) and 3.7 ± 2.9 (0–35) d, respectively. The mean IPSS after 3 yr was 8.0 ± 6.2, the QoL score was 1.3 ± 1.3, the Qmax was 18.4 ± 8.0 ml/s, and the Vres was 28 ± 42 ml. The retreatment rate was 6.8%. Urethral and bladder neck strictures were observed in 4.4% and 3.6% of the patients, respectively. Localized prostate cancer was diagnosed during follow-up in six patients.
PVP is a safe and effective procedure for treatment of LUTS secondary to BPH. Patients on ongoing oral anticoagulation can be safely operated on. PVP leads to an immediate and sustained improvement of subjective and objective voiding parameters. The late complication rate is comparable to that of transurethral electroresection of the prostate.
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