MP3-20 PREDICTORS OF PERIOPERATIVE COMPLICATIONS AND REOPERATION IN PATIENTS TREATED WITH PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I1 Apr 2015MP3-20 PREDICTORS OF PERIOPERATIVE COMPLICATIONS AND REOPERATION IN PATIENTS TREATED WITH PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE Malte Rieken, Sanwei Guo, Georg Müller, Gernot Bonkat, Jan Ebbing, Thomas Gasser, and Alexander Bachmann Malte RiekenMalte Rieken More articles by this author , Sanwei GuoSanwei Guo More articles by this author , Georg MüllerGeorg Müller More articles by this author , Gernot BonkatGernot Bonkat More articles by this author , Jan EbbingJan Ebbing More articles by this author , Thomas GasserThomas Gasser More articles by this author , and Alexander BachmannAlexander Bachmann More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.123AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We aimed to characterize predictors of perioperative complications and surgical reintervention within the first two years after photoselective vaporization of the prostate (PVP) for symptomatic prostate enlargement (BPE). METHODS Retrospective analysis of a single center cohort of 771 patients who underwent PVP with the 80-W KTP, 120-W HPS, and 180-W XPS GreenLight laser between 2002 and 2013. Binominal logistic regression analyses addressed factors associated with intra- and perioperative complications. Uni- and multivariable Cox regression analyses assessed the association of various clinical and surgical parameters with reoperation. RESULTS Of 771 patients, 370 (48.0%), 187 (24.3) and 214 (27.8%) underwent PVP with the 80-W KTP, 120-W HPS, and 180-W XPS-laser, respectively. Median age was 68 years (Interquartile range (IQR): 12), median PSA 2.5 ng/ml (IQR: 3.4), and median prostate volume 45 ml (IQR: 25). Of the patients, 199 (25.8%) were in retention at time of surgery. Intraoperative bleeding was noted in 70 (9.1%) patients. Use of the 120-W laser (OR: 6.65, 95% CI 3.48-12.70, p<0.0001) and 180-W laser (OR: 2.19, 95% CI 1.04-4.63, p=0.04) was associated with increased risk of intraoperative bleeding compared to the 80-W laser. Ongoing platelet aggregation therapy or oral anticoagulation was not associated with increased risk of intraoperative bleeding (p>0.05). Retention during hospitalization with the need for catheterization occurred in 67 (8.7%) patients. Preoperative catheterization (OR: 2.34, 95% CI 1.37-4.01, p=0.002) was associated with increased risk of postoperative retention. During 2-years follow-up, 49 (6.4%), 10 (1.3%), and 17 (2.2) patients has to undergo reoperation due to persistent or recurrent adenoma, urethral stricture, and bladder neck stricture, respectively. No significant association of clinical and surgical parameters or laser generation with risk of reoperation due to recurrent or persistent adenoma or urethral stricture could be detected. In contrast, incidence of bladder neck sclerosis was significantly associated with prostate volume < 40 ml (HR 3.65, 95% CI 1.41-9.47, p=0.008). CONCLUSIONS Reoperation within the first 2 years after PVP does not seem to be associated with laser type. Prostate volume < 40 ml is significantly associated with increased risk of reoperation due to bladder neck sclerosis. Our results may help patients counseling and treatment decision-making regarding the choice of technique for BPE surgery. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e26 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Malte Rieken More articles by this author Sanwei Guo More articles by this author Georg Müller More articles by this author Gernot Bonkat More articles by this author Jan Ebbing More articles by this author Thomas Gasser More articles by this author Alexander Bachmann More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...