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634 Photoselective vaporisation of the prostate using the 180W lithium triborate laser in the treatment of benign prostatic obstruction: An international multicenter experience
634
Photoselective vaporisation of the prostate using the 180W lithium triborate laser in the treatment of benign prostatic obstruction: An international multicenter experience Eur Urol Suppl 2013;12;e634
Chung A.S.1, Bachmann A.2, Collins E.3, Gomez Sancha F.4, Tabatabaei S.5, Woo H.H.1, Henry Woo 1
University of Sydney, Sydney Adventist Hospital Clinical School, Sydney, Australia, 2University Hospital Basel, Dept.
of Urology, Basel, Switzerland, 3University of California San Francisco, Dept. of Urology, San Francisco, United States of America, 4ICUA - Clinica CEMTRO, Dept. of Urology, Madrid, Spain, 5Massachusetts General Hospital, Dept. of Urology, Boston, United States of America INTRODUCTION & OBJECTIVES: Laser prostatectomy has gained popularity in the treatment of benign prostatic obstruction. This study evaluates our international multicenter experience regarding the safety and efficacy of using photoselective vaporisation of the prostate (PVP) with the 180W lithium triborate (LBO) laser in the treatment of men with lower urinary tract symptoms due to benign prostatic obstruction (BPO). MATERIAL & METHODS: Databases of 510 men treated with the 180W LBO laser PVP for BPO in 4 countries by 5 urologists, from 2010 to 2012 inclusive, were collated and analysed. Perioperative and functional outcomes [International Prostate Symptom Score (IPSS), Quality of Life Score (QoL), maximum urinary flow rate (Qmax), postvoid residual urine (PVR)] were assessed at baseline and 3 months post-operation. Statistical analyses were conducted in Microsoft Excel 2011, and comparisons made using Student’s t test. RESULTS: Of the 510 patients (median patient age 70 years, median prostate volume 60 cc), 24% (122/510) men were in urinary retention, and 35% (181/510) men were taking antiplatelet and/or anticoagulant medications. The median operation time was 57 minutes, median laser time 35 minutes, median energy usage 290 kJ, median duration of catheterization 18 hours, and median duration of hospital stay 24 hours. 92% (471/510) of men went home voiding successfully without requiring any catheterisation. There was significant improvement (p<0.01) in all functional outcomes from baseline to 3 months follow up (IPSS 20 to 6, QoL 4 to 1, Qmax 8 to 20 ml/s, PVR 88 to 0 ml). 11% (58/510) of men experienced at least one complication. There were 71 complications in total. The majority of complications were low grade and of minimal consequence to the patient (40 were Clavien-Dindo grade I, 17 were grade II, 9 were grade III). There were 5 grade IV complications, and no grade V complications. CONCLUSIONS: This to our knowledge is the largest multicenter experience reported on the use of the 180W LBO laser. Our large international multicenter experience shows that PVP using the 180W LBO laser is an efficacious and safe treatment for men with lower urinary tract symptoms due to BPO. 92% of treated men went home voiding successfully without a catheter. There was significant improvement in all functional outcomes from baseline to 3 months follow-up, and the majority of complications were low grade.
Photoselective vaporisation of the prostate using the 180W lithium triborate laser in the treatment of benign prostatic obstruction: An international multicenter experience Eur Urol Suppl 2013;12;e634
Chung A.S.1, Bachmann A.2, Collins E.3, Gomez Sancha F.4, Tabatabaei S.5, Woo H.H.1, Henry Woo 1
University of Sydney, Sydney Adventist Hospital Clinical School, Sydney, Australia, 2University Hospital Basel, Dept.
of Urology, Basel, Switzerland, 3University of California San Francisco, Dept. of Urology, San Francisco, United States of America, 4ICUA - Clinica CEMTRO, Dept. of Urology, Madrid, Spain, 5Massachusetts General Hospital, Dept. of Urology, Boston, United States of America INTRODUCTION & OBJECTIVES: Laser prostatectomy has gained popularity in the treatment of benign prostatic obstruction. This study evaluates our international multicenter experience regarding the safety and efficacy of using photoselective vaporisation of the prostate (PVP) with the 180W lithium triborate (LBO) laser in the treatment of men with lower urinary tract symptoms due to benign prostatic obstruction (BPO). MATERIAL & METHODS: Databases of 510 men treated with the 180W LBO laser PVP for BPO in 4 countries by 5 urologists, from 2010 to 2012 inclusive, were collated and analysed. Perioperative and functional outcomes [International Prostate Symptom Score (IPSS), Quality of Life Score (QoL), maximum urinary flow rate (Qmax), postvoid residual urine (PVR)] were assessed at baseline and 3 months post-operation. Statistical analyses were conducted in Microsoft Excel 2011, and comparisons made using Student’s t test. RESULTS: Of the 510 patients (median patient age 70 years, median prostate volume 60 cc), 24% (122/510) men were in urinary retention, and 35% (181/510) men were taking antiplatelet and/or anticoagulant medications. The median operation time was 57 minutes, median laser time 35 minutes, median energy usage 290 kJ, median duration of catheterization 18 hours, and median duration of hospital stay 24 hours. 92% (471/510) of men went home voiding successfully without requiring any catheterisation. There was significant improvement (p<0.01) in all functional outcomes from baseline to 3 months follow up (IPSS 20 to 6, QoL 4 to 1, Qmax 8 to 20 ml/s, PVR 88 to 0 ml). 11% (58/510) of men experienced at least one complication. There were 71 complications in total. The majority of complications were low grade and of minimal consequence to the patient (40 were Clavien-Dindo grade I, 17 were grade II, 9 were grade III). There were 5 grade IV complications, and no grade V complications. CONCLUSIONS: This to our knowledge is the largest multicenter experience reported on the use of the 180W LBO laser. Our large international multicenter experience shows that PVP using the 180W LBO laser is an efficacious and safe treatment for men with lower urinary tract symptoms due to BPO. 92% of treated men went home voiding successfully without a catheter. There was significant improvement in all functional outcomes from baseline to 3 months follow-up, and the majority of complications were low grade.