2270 PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE (PVP) USING GREEN LIGHT HPS: IS OUTCOME SIZE DEPENDENT?

Abstract

INTRODUCTION AND OBJECTIVES: The aim of our work was to compare the efficacy of HPS in the treatment of symptomatic BPH, for prostate glands below and above 60 grams. METHODS: A retrospective analysis of 134 patients treated by HPS was done. Nine patients were converted to other procedure due to bleeding and were excluded from the analysis. The remaining 125 cases included 89 and 36 patients with prostate size less and more than 60 grams respectively. International Prostate Symptom score (IPSS), International Index of Erectile Function (IIEF-5), Maximum Flow Rate (Qmax), Post void Residual Urine (PVR) and serum PSA were recorded. Operative data and number of fibers used and complication rates were also recorded. Patients were evaluated at 1, 3,6 months, and 1 year follow up. RESULTS: The mean age of the patients was 73 years,the mean preoperative TRUS volume was 53.6 (15.5-129) grams. The mean energy, operative time and the number of laser fibers were significantly higher in patients with prostate 60 grams. Functional outcomes; including IPSS, QOL, PVR and Qmax were comparable in both groups.One(1.1%)and 8(18%) patients were converted intraoperatively to other procedure (p 0.0001),in patients with prostate gland below and above 60 grams respectively. Postoperative complications including stricture,bladder neck obstruction, urge and stress incontinence were 1.6%, 2.4%, 18.4% and 3.2% for the whole cohort.Table(1) CONCLUSIONS: Due to our intent to reach the prostatic capsule during vaporization, the functional results following HPS management for BPH seems to be comparable for patients with prostate volume less and more than 60 grams. However; patients with prostate volume more than 60 grams significantly required longer operative time and nearly 1/3 of the cases required more than 1 fiber. Also the rate of conversion and redo surgery was significantly higher with prostate volume more than 60 grams,making HPS, although effective, probably not the first choice with larger prostate glands.