Incidence, Management, and Prevention of Perioperative Complications of GreenLight HPSTM Laser Photoselective Vaporization Prostatectomy: Experience in the First 70 Patients

Abstract

We report the incidence, prevention, and management of perioperative adverse events in patients treated with GreenLight HPS laser photoselective vaporization prostatectomy (PVP). A side-firing GreenLight HPS laser system was used to perform transurethral PVP. American Urological Association Symptom Score, Quality of Life score, Sexual Health Inventory for Men score, serum prostate-specific antigen (PSA), maximum flow rate (Qmax), and postvoid residual were assessed preoperatively and at 1, 4, 12, 24, and 52 weeks postsurgery. Preoperative and 3-month postsurgery volumetric prostate measurements with transrectal ultrasonography, operative times (laser and total), and energy usage were recorded. Serum PSA was obtained at the 12- and 52-week visit. Adverse events were recorded perioperatively and at each follow-up interval. Seventy consecutive patients with a median age of 67 (45-87) years, median prostate volume of 61.6 (20.9-263.0) mL, and median PSA of 1.4 (0.1-10.1) ng/mL underwent GreenLight HPS laser PVP from July 2006 through March 2008. All procedures were performed in an outpatient setting, with a mean laser time of 13 (3-34) minutes, mean total operative time of 30 (6-100) minutes, and mean energy usage of 85 (11-235) kJ. Perioperative complications included intraoperative bleeding (1.4%), postoperative clinically nonsignificant hematuria (78.5%), hematuria requiring clot evacuation (1.4%), urinary retention requiring recatheterization (2.8%), urinary tract infection (4.3%), and prostatitis (1.4%). No urethral strictures, bladder neck contracture, or urinary incontinence were noted. GreenLight HPS laser PVP appears to have a low incidence of perioperative adverse events.