MP42-15 TREATMENT OF SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA IN PATIENTS OVER 80 YEARS OLD USING 180W HIGH POWER 532NM LASER VAPORIZATION-ENUCLEATION TECHNIQUE

Abstract

INTRODUCTION AND OBJECTIVES: GreenLight Laser is a safe and efficacious treatment for benign prostatic hyperplasia (BPH). There is limited evidence on its use in very large prostates, for which simple prostatectomy is the traditional procedure. The objective of this study is to demonstrate the safety and efficacy of 180W high power 532 nm laser vaporization-enucleation prostatectomy in prostates measuring over 150cc. METHODS: We performed a retrospective chart analysis of all patients treated with the GreenLight XPS-180W system (AMS, MN, USA) in our institution from Sep 2011 to Oct 2015 with a prostate measuring over 150 cc on transrectal ultrasound preoperatively. Data collected include prostate volume, IPSS and quality of life (QoL) scores, maximum urinary flow rate (Qmax), postvoid residual (PVR), prostate specific antigen (PSA), complications, and reintervention rates. Statistical analysis was performed using SPSS (version 21). All procedures were performed by the same surgeon using a vaporization-enucleation technique that provides tissue for histologic analysis. RESULTS: We included 70 male patients with a total of 72 procedures. The median prostate size was 203 cc (152-376cc). There were 42 patients (58%) with an indwelling catheter preoperatively. Using the ASA physical status classification system, 37 patients were ASA class 2 and 33 were ASA class 3. Median operative time was 180 minutes, laser time 97 minutes, energy utilization 674kJ, and energy density 3.3kJ/cc, with a median 3 fibers used per case. Median length of stay and length of catheterization were both one day. IPSS and QoL scores demonstrated significant improvements at 6, 12, and 24 months postoperatively. Qmax and PVR, measured at 6 and 12 months postoperatively, were also significantly improved (Table 1). All patients had prostate tissue resected with BPH present in all specimens. One patient required a long-term indwelling catheter for refractory urinary retention. Two patients (2.9%) required retreatment with a second PVP procedure. CONCLUSIONS: In our experience, high-power 532 nm laser vaporization-enucleation prostatectomy provides excellent and durable subjective and objective improvements in symptoms and voiding parameters, regardless of prostate size.