Mid term outcomes of initial 250 case experience with GreenLight 120W-HPS photoselective vaporization prostatectomy for benign prostatic hyperplasia: comparison of prostate volumes < 60 cc, 60 cc-100 cc and > 100 cc.

Abstract

INTRODUCTION:

The aim of this study was to compare the efficacy of GreenLight 120W-HPS (American Medical Systems, Minnetonka, Minnesota, USA) laser vaporization for men with obstructive benign prostatic hyperplasia (BPH) according to prostate volumes < 60 cc, 60 cc-100 cc and > 100 cc.

MATERIAL AND METHODS:

The clinical data of 250 men with symptomatic BPH who underwent photoselective vaporization prostatectomy (PVP) by a single surgeon between July 2007 and August 2009 were retrospectively analyzed. Prostate volumes were measured by using transrectal ultrasonography (TRUS). Functional evaluations were performed at 3, 6 and 12 months with a prostate-specific antigen (PSA) obtained at 6 months. All men were stratified into three groups according to TRUS volume.

RESULTS:

Among the 250 consecutive PVP patients, 134, 76 and 40 men had prostate volumes < 60 cc, 60 cc-100 cc and > 100 cc, respectively. Mean laser time and delivered energy were 31, 44 and 59 minutes; 163, 309 and 473 kJ respectively (p < 0.01 for all). At 1 year, mean International Prostate Symptom Score (IPSS) improved by 69%, 63% and 50%, Qmax increased by 194%, 175% and 162% and post void residual (PVR) decreased by 88%, 81% and 71%, respectively (p < 0.01 for all). Mean decrease in preoperative PSA at 6 months was 63%, 52% and 41% (p < 0.01), respectively. Hospital stay, catheterization time and complication rates were comparable between groups, however retreatment rates were significantly higher for prostates >100 cc (1.5% versus 2.6% versus 9%; p = 0.02).

CONCLUSIONS:

Although larger prostates require more time and energy delivery, PVP is safe and efficacious for patients with lower urinary tract symptoms (LUTS) regardless of prostate size. Laser vaporization for glands > 100 cc appears to have a reduced reduction in PSA and a higher 9% rate of retreatment indicating that PVP for larger prostates remains to be optimized.

• Authors: Pierre-Alain Hueber, Tal Ben-Zvi, Daniel Liberman, Naeem Bhojani, Gagan Gautam, Tom Deklaj, Mark Katz, Kevin C Zorn
• Journal: The Canadian journal of urology (Can J Urol) Vol. 19 Issue 5 Pg. 6450-8 (Oct 2012) ISSN: 1195-9479 [Print] Canada
• PMID: 23040627 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Prostate-Specific Antigen

Topics

• Aged
• Color
• Humans
• Lasers, Solid-State (therapeutic use)
• Length of Stay
• Light
• Male
• Middle Aged
• Operative Time
• Organ Size
• Prostate (diagnostic imaging, pathology)
• Prostate-Specific Antigen (blood)
• Prostatectomy
• Prostatic Hyperplasia (blood, pathology, surgery)
• Reoperation
• Retrospective Studies
• Severity of Illness Index
• Ultrasonography
• Urinary Retention (etiology, surgery)