BERKELEY, CA (UroToday.com) - In the online issue of European Urology, Dr. Robin Ruszat and associates report a single institution experience of GreenLight laser vaporization of the prostate. The investigators used the technique of photoselective vaporization of the prostate (PVP) with the 80-W GreenLight laser system.

Beginning in 2002, 500 consecutive men with BPH underwent standard evaluation and treatment with PVP. Elevated PSA had appropriate work-up and other causes of LUTS were excluded from the dataset. Seven surgeons performed the PVP at their clinic.

Among their patients, 45% (225) were on some sort of anticoagulation. While mean applied energy rose significantly with prostate size, the mean energy applied per ml prostate tissue decreased. Operative time and postoperative hospitalization time were significantly longer for larger prostates. Mean catheter time was 1.8 days and mean hospitalization time was 3.7 days.

Mean follow-up was 30.6 months. Subjective and objective voiding parameters showed a significant improvement for up to 5 years. Overall maximum urinary flow rates doubled at 60 months (from 8.4cc/sec to 17.5cc/sec) and IPSS decreased from 18.3 to 7.6. No intraoperative complications were observed and despite 45% of patients continuing active anticoagulation during the procedure, none required blood transfusion. A second fiber we needed in 27 (5.4%) of patients. During the early postoperative period, 2 patients required blood transfusion and needed surgical revision. Both had intrinsic coagulation disorders. Surprisingly, 3 patients developed transient acute renal failure of whom 2 needed hemodialysis. All recovered their baseline renal function. Bladder neck contractures occurred in 3.6% and urethral strictures in 4.4%. Persistent stress urinary incontinence was reported in 6 men after 12 months.

Ruszat R, Seitz M, Wyler SF, Abe C, Rieken M, Reich O, Gasser TC, Bachmann A.

Eur Urol. 2008 Apr 30.(Epub ahead of print)
doi:10.1016/j.eururo.2008.04.053

PubMed Abstract
PMID: 18486311

UroToday.com Prostate Cancer Section

Written by Christopher P. Evans, MD, a Contributing Editor with UroToday.

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