Articles

Benign Prostatic Obstruction

GreenLight Laser Vaporization of the Prostate: Single-Center Experience and Long-Term Results After 500 Procedures

By: Robin Ruszata lowast , Michael Seitzb, Stephen F. Wylera, Constanze Abea, Malte Riekena, Oliver Reichb, Thomas C. Gassera and Alexander Bachmanna b

European Urology, Volume 54 Issue 1, October 2008, Pages 893-901

Published online: 01 October 2008

Keywords: Benign prostatic hyperplasia, KTP laser, Photoselective vaporization, PVP, Long-term, GreenLight, BPH

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Abstract

Background

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.

Objective

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.

Intervention

All patients underwent 80-W PVP performed by seven surgeons.

Measurements

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±8.0ml/s, and the Vres was 28±42ml. 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.

Conclusion

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.

Take Home Message

Photoselective vaporization of the prostate offers low perioperative morbidity. Even patients on ongoing oral anticoagulation can be treated safely. The improvement of subjective and objective voiding parameters is confirmed in long-term follow-up.

Keywords: Benign prostatic hyperplasia, KTP laser, Photoselective vaporization, PVP, Long-term, GreenLight, BPH.

Footnotes

a Department of Urology, Basel University Hospital, Basel, Switzerland

b Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany

lowast Corresponding author. Department of Urology, Basel University Hospital, Spitalstr. 21, CH-4031 Basel, Switzerland. Tel. +41 61 265 7119; Fax: +41 61 265 7273.

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