1557

PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE (PVP): PROSPECTIVE EVALUATION IN 85 HIGH RISK PATIENTS

Oliver Reich*, Alexander Bachmann, Dirk Zaak, Alfons Hofstetter, Muenchen, Germany; Tullio Sulser, Basel, Switzerland; Christian G Stief, Muenchen, Germany

INTRODUCTION AND OBJECTIVE: High power (80W) Photoselective Vaporization of the Prostate (PVP) is a novel technique, in which instant hemostatic tissue ablation is achieved. The objective of this study was to evaluate this procedure in patients with lower urinary tract symptoms (LUTS) at high risk and/or long-term anticoagulation, which are commonly denied surgical treatment.

METHODS: Between September 2002 and August 2004, 85 patients at high cardiopulmonary risk (presenting with an American Society of Anesthesiology (ASA) - Score = 3) with LUTS were enrolled in a prospective multicenter trial and underwent PVP Potassium-Titanyl-Phosphate (KTP) - laser vaporization of the prostate. In addition, 41 patients received ongoing oral anticoagulant therapy (n=37) or suffered from severe bleeding disorders (n=4). Mean follow-up was 12.8 months.

RESULTS: In all 85 patients the procedure could be performed without major complication intra- and postoperatively; no blood transfusion was required. Mean operating time was 55±20 min, mean preoperative prostate volume was 54±37 ml. Three patients had to be re-operated due to recurrent urinary retention (2 TURP, 1 PVP). Catheterization time averaged 1.9±2 days. At 1, 3, 6 and 12 months the IPSS decreased from 20.0±7 to 11.9±7, 8.2±7, 7.9±6 and 7.0±7, respectively. The urinary peak flow increased from 7.2±5 ml/s preoperative to 17.9±8 ml/s, 18.1±9 ml/s, 18.3±7 ml/s and 19.1±9 ml/s, respectively.

CONCLUSIONS: Based on our experience, we believe that photoselective vaporization of the prostate (PVP) is a hemostatic, therefore safe but efficient option for critically ill patients and patients on oral anticoagulation.

Session Info: Moderated Poster - Wednesday, May 25, 2005, 10:00 AM - 12:00 PM

1558

PROSPECTIVE COMPARISON OF PHOTOSELECTIVE LASER VAPORIZATION (PVP) AND TRANSURETHRAL RESECTION OF THE PROSTATE (TURP)

Tullio Sulser*, Basel, Switzerland; Leander Schürch, Baden, Switzerland; Robin Ruszat, Basel, Switzerland; Oliver Reich, Munich, Germany; Kurt Lehmann, Baden, Switzerland; Alexander Bachmann, Basel, Switzerland

INTRODUCTION AND OBJECTIVE: To evaluate the clinical efficacy and early complication rate of photoselective laser vaporisation of the prostate in comparison to standard TURP in a prospective bi-center study.

METHODS: Since Dezember 2003 all consecutive patients with obstructive BPS of two institutions have been included in this study prospectively. PVP and TURP were performed at different institutions. PVP was performed at the 80 power setting. Data of 61 patients after PVPand 38 patients after TURP with at least 6 months of follow-up are available.

RESULTS: Mean age was 72 (55-90) years in the PVP and 69 (50-83) years in the TURP-group. Mean prostate size was 63 (20-130) ml and 57 (18-90) ml in the PVP and TURP-group, respectively. Mean operation time was 53 (15-120) min for PVP and 55 (25-90) min for TURP (ns.). An average of 27 g of prostate tissue was resected in the TURP-group. Mean intraoperative irrigation volume was highly different (7.1 l (PVP) vs. 23.2 l (TURP); p<0.001). Postoperative bladder irrigation was not performed in the PVP-group routinely. For the PVP group, the transurethral catheter was removed after 1.7 (0-6) days and for TURP after 2.9 (2-9) days (p<0.001). Decrease in hemoglobin was significant lower in the PVP-group (?-0.9 g/dl) compared to TURP (?-2.6 g/dl) (p<0.001). Sodium was significant lower after TURP (136 U/l (127-146)) one hour postoperatively (PVP 138 U/l (134-142); p<0.03). Hospitalisation time was significant shorter in the PVP-group (p<0.002). Mean urinary peak flow was as follows (preoperative; discharge; 4 weeks; 3 months; 6 months; PVP vs. TURP): 6 vs. 7 ml/s; 16 vs. 18 ml/s (ns.); 14 vs. 22 ml/s (p<0.02); 20 vs. 19 (ns.) and 19 vs. 20 ml/s (ns.). IPSS follow-up was as follows: 17 vs. 18 (ns); 9 vs. 10 (ns); 9 vs. 12 (ns); 8 vs. 7 and 6 vs. 6 (ns.). Post-void residual volume was not different between both groups within the follow-up. Intraoperative bleeding was observed in 7 (18%) and perforation in 2 (5%) pts. for TURP. No transfusion was necessary in either group. Clot retention was observed in 2 (5%) pts. after TURP. Urinary retention was seen in 2 (3%) pts. after PVP. Incidence of urethral strictures and urinary tract infection was similar in both groups within the follow-up of 6 months.

CONCLUSIONS: PVP provides immediate relief from obstructive voiding comparable to TURP. Because of the excellent hemostyptic properties, PVP seems to be superior in terms of intraoperative complications to TURP. Early postoperative complication rate is comparable between both techniques.

Session Info: Moderated Poster - Wednesday, May 25, 2005, 10:00 AM - 12:00 PM

1562

PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE (PVP) IN ANTICOAGULATED PATIENTS: A MULTICENTER RETROSPECTIVE EVALUATION OF FEASIBILITY

Terrence R Malloy*, Philadelphia, PA; Jaspreet S Sandhu, New York, NY; Ariana L Smith, Philadelphia, PA; Balaji Reddy, New York, NY; Joseph F Harryhill, Philadelphia, PA; Steven A Kaplan, Alexis E Te, New York, NY

INTRODUCTION AND OBJECTIVE: Peri-operative bleeding is a complication of conventional transurethral resection of the prostate (TURP). Warfarin, clopidogrel or aspirin therapy is considered to be a contraindication to TURP. PVP laser prostatectomy utilizing an 80W quasi-continuous potassium-titanyl-phosphate (KTP) laser provides a safe, effective and highly hemostatic modality for surgical treatment of benign prostatic hypertrophy (BPH). This study assessed the safety and efficacy of the PVP laser prostatectomy in the high-risk anticoagulated patient.

METHODS: Eighty-three men with a mean age of 70.9 ± 7.9 years and a mean American Society of Anesthesiology (ASA) score of 2.4 ± 0.5 underwent PVP surgery. All patients presented with significant subjective and objective indicators of prostatic obstruction including 13 patients in urinary retention as well as 2 with bladder carcinoma and 1 with prostate cancer. All patients were on either dicumarol, warfarin, dipyridamole, enoxaparin, heparin, ticlopidine, clopidogrel, tirofiban, and/or eptifibatide and continued their medication throughout the preoperative period. Mean prostate volume was 87.9 ± 41.8 cc and mean total prostate-specific antigen (PSA) was 3.6 ± 3.5 ng/mL. Of the total 83 men treated, 81 had some measurable hematologic deficiency at the time of surgery. Follow-up ranged from 1-24 months.

RESULTS: Immediate postoperative serum sodium, hemoglobin, and hematocrit showed no significant changes from baseline, while intraoperative blood loss ranged from 0 to 50 cc. No patients required blood transfusion perioperatively, and there were no thromboembolic events. Mean duration of bladder irrigation in the postoperative period was 3.3 ± 8.3 hours while the mean duration of postoperative catheterization was 2.1 ± 1.3 days. Mean length of stay was 1.3 ± 1.5 days. Five patients experienced retention in the immediate postoperative period. Four patients experienced clot retention during follow-up. Four patients required a second operation, two for clot evacuation, and one for excessive bleeding and one for a bladder neck contracture.

CONCLUSIONS: Our initial experience indicates that the PVP treatment may be a useful tool for hemophiliacs, patients that are considered high cardiopulmonary surgical risks, patients with platelet disorders or patients managed by oral anticoagulant therapy.

Session Info: Moderated Poster - Wednesday, May 25, 2005, 10:00 AM - 12:00 PM

Read BPH Selected Abstracts - Part 5

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