Photoselective vaporization prostatectomy

A group at the University of Oklahoma has reported the incidence, prevention, and management of perioperative adverse events in patients treated with transurethral photoselective vaporization prostatectomy (PVP) using the side-firing GreenLight HPS laser.

In patients treated (in an outpatient setting) using this technique, Spaliviero et al. assessed the AUA Symptom Score, Quality of Life score, Sexual Health Inventory for Men score, maximum flow rate (Qmax), and post-void residual urine preoperatively and at 1, 4, 12, 24, and 52 weeks post-surgery. Preoperative and 3-month post-surgery volumetric prostate measurements, operative times (laser and total), and energy usage were also recorded. Serum PSA levels were obtained preoperatively and at the 12- and 52-week post-treatment visits. Adverse events were recorded perioperatively and at each follow-up interval.

The authors report the following outcome data, based on treatment of 70 consecutive patients between July 2006 and March 2008:

  • Median age of patients was 67 years (range 45-87 years).
  • Median prostate volume was 61.6 ml (range 20.9-263.0 ml).
  • Median preoperative PSA was 1.4 ng/ml (range 0.1-10.1 ng/ml) underwent GreenLight HPS laser PVP from July 2006 through March 2008.
  • The mean laser time was 13 min (range 3-34 min) and the mean energy usage was 85 kJ (range 11-235 kJ).
  • The mean total operative time was 30 min (range 6-100 min).
  • Perioperative complications included intraoperative bleeding in 1/70 patients (1.4 percent).
  • Postoperative adverse events included clinically non-significant hematuria in 55/70 patients (78.5 percent), hematuria requiring clot evacuation in 1/70 patients (1.4 percent), urinary retention requiring recatheterization in 2/70 patients (2.8 percent), urinary tract infection in 3/70 patients (4.3 percent), and prostatitis in 1/70 patients (1.4 percent).
  • No urethral strictures, bladder neck contracture, or urinary incontinence were noted.

The authors conclude that, on the basis of these data, GreenLight HPS laser PVP appears to have a low incidence of perioperative adverse events.

What is not clear from this abstract is what these men were being treated for — although we probably should assume it was benign prostatic hyperplasia since there is no mention of pre- or post-surgical prostate biopsy data. However, these data also support the concept that Greenlight laser PVP could be used with considerable safety for the treatment of prostate cancer — if the surgery can clearly be shown to eliminate the cancer, either as whole gland therapy or focally.

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