Wednesday, May 16, 2012

Photoselective vaporization of the prostate using GreenLight 120-W lithium triborate laser to treat symptomatic benign prostatic hyperplasia: A single-centre prospective study


Abstract
Introduction: We evaluated the safety and efficacy of photoselective vaporization of the prostate (PVP) using GreenLight 120-W lithium triborate (LBO) laser to treat symptomatic small-to-medium sized benign prostatic hyperplasia (BPH).

Methods: This prospective non-controlled observational study included symptomatic BPH men .50 years with international prostate symptom score (IPSS) .14, prostate volume (PV) .80 cc and maximum flow rate (Q-max) .15 mL/s. PVP was performed using the GreenLight 120-W LBO laser machine. Patients were assessed at baseline and postoperatively at discharge, 2 weeks, and 3, 6 and 12 months. We measured changes in IPSS, PV, PSA, Q-max,
post-void residual (PVR), hemoglobin (Hb), serum sodium (Na+) and reported complications. Statistical significance was p < 0.05.

Results: The study included 103 men with mean age of 67 (±standard deviation)�±9.7 years. Thirty patients were on indwelling urethral catheters for refractory urinary retention and 12 on ongoing anticoagulants. The mean baseline IPSS, PV, PSA, Q-max and PVR parameters significantly improved at follow-up (p < 0.001; each). Mean measurements at baseline versus at six months were: IPSS 25.6±4.2 vs. 7.4�±2.3; PV 44.6±9.2 vs. 21.6±6.3 cc (51.6% reduction); Q-max 5.8±3.4 vs. 20.4±4.8 mL/s; PVR 110±40 vs. 35±9 cc. Mean baseline Hb and serum Na+ declined nonsignificantly (p > 0.05) at discharge and at 2 weeks. No patient needed a blood transfusion. Secondary procedures were needed in 2 patients for urethral and bladder neck strictures. The re-treatment rate for residual adenoma was 0.97%.

Conclusion: PVP using the GreenLight 120-W LBO laser to treat small-to-medium sized symptomatic BPH demonstrated significant improvements in efficacy parameters and high safety profile within 12 months of follow-up. The procedure entails good hemostasis with minimal blood loss even in patients receiving ongoing anticoagulants.

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