Photoselective vaporization of the prostate compared to transurethral resection of the prostate in patients who develop prostatic obstruction following brachytherapy.

Abstract

187 Background: Patients who undergo brachytherapy are at risk of developing prostatic obstruction, and a subset of these patients requires prostate reduction surgery. These patients pose a challenge to urologists who seek to determine the appropriate form of intervention given the reduced healing capacity of irradiated tissue. Given our observation that certain patients suffer recalcitrant prostatic obstruction following photoselective vaporization of the prostate (PVP), we evaluated outcomes after TURP compared to PVP for patients who experienced bladder outlet obstruction after brachytherapy. Methods: Cleveland Clinic’s prostate cancer database includes 3,600 patients who have undergone prostate brachytherapy since 1996. We cross-referenced these patients with the EMR to identify patients who required prostate reduction surgery following brachytherapy. We reviewed operative notes for these patients to identify the type of intervention completed, and we used the EMR to identify post-PVP/TURP complications requiring intervention. Clinical and demographic characteristics were obtained from the prospective database. Results: Sixty of the 3,600 patients developed urinary retention requiring prostate reduction surgery. The average age of these patients was 69 and the average prostate size was 52 grams. Forty patients underwent TURP and 20 patients were treated with PVP. Of the TURP patients, 19/40 (47.5%) required subsequent TURP, dilation, incision or permanent diversion, including 9 patients (22.5%) who required at least 2 further procedures. Of the PVP-treated patients, 10/20 (50%) required subsequent instrumentation including 4 (20%) who underwent at least 2 procedures. Conclusions: Half of the patients who require prostate reduction surgery for urinary retention following brachytherapy may require further procedures regardless of whether TURP or PVP is performed. Neither procedure confers less morbidity. [Table: see text]