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Photoselective vaporization of the prostate (PVP): feasibility and safety as an office based modality
FRIDAY, SEPTEMBER 30
FRIDAY, SEPTEMBER 30, 2005 Poster Display LUTS, BPO, Prostatitis
100
Photoselective vaporization of the prostate (PVP): feasibility and safety as an office based modality Hai M Department of Urology, Oakwood Annapolis Hospital, Wayne, MI Introduction: The surgical treatment of benign prostatic hyperplasia (BPH) has never been introduced outside the confines of a hospital operating room. The risks of intraoperative and postoperative complications, especially hemorrhage and anesthesia, have prevented established treatments such as TURP and open prostatectomy to be performed in office based environments or well equipped ambulatory surgical centers (ASC). Recently, a relatively new surgical modality known as photoselective vaporization of the prostate (PVP) has been introduced with clinical efficacy and safety data that rivals the traditional therapies. More importantly, recent clinical evidence suggests that this therapy can be offered in the well equipped office based setting with little to no complications. We report our initial results on 154 male subjects diagnosed with bladder outlet obstruction secondary to BPH treated in a well equipped office based setting. Methods: From December 2002 to present, 154 patients with a mean age of 65.3 ⫾ 4.6 years (61-85) and a mean preoperative TRUS volume of 60.3 ⫾ 38.5 cc (17.2-275) clinically diagnosed with lower urinary tract symptoms (LUTS) secondary to obstructive BPH were surgically treated in an outpatient office based surgical suite with only L-MAC anesthesia and pudendal prostate block. Patients were included in the evaluation with an ASA ⬎ 2 and physical weight of ⬍ 250lbs. All patients were evaluated and monitored pre, intra and postoperatively by a board certified anesthesiologist. Blood pressure, oxygen saturation, blood chemistry, EKG monitoring and conscious sedation were evaluated. Efficacy outcome data was evaluated using standard parameters including AUASI, Q-max and PVR. Results: All patients were successfully treated with no significant intraoperative or postoperative complications. There were no intubations required or anesthesia complications observed during surgery. All patients experienced no significant changes in hematocrit, hemoglobin, serum sodium, blood pressure, 02 saturation or cardiac arrhythmia. All patients were sent home under outpatient status 2-4 hours after surgery with no postoperative hospitalizations required. Mean
UROLOGY 66 (Supplement 3A), September 2005
treatment time was 37.3 ⫾ 14.6 min (7-86) and mean postoperative catheterization was 8.1 ⫾ 10.2 hours (0-24). Absolute improvements in AUASI, Q-Max and PVR at 12 months follow-up were 74%, 156% and 75%, respectively. Minor postoperative complications related to surgery include UTI in 5%, transient post-operative urinary retention in 3% (⬍ 5 days post treatment), bladder neck contracture in 2% and mildmoderate transient dysuria in 10%. Conclusions: Photoselective vaporization of the prostate with a high-power potassium-titanyl-phosphate (KTP) laser is a safe and effective outpatient office based modality that offers all of the objective outcomes of a TURP while maintaining less morbidity and providing a more expedient recovery.
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Factors influencing efficacy outcomes in photoselective vaporization prostatectomy (PVP): results and analysis of ongoing prospective multicenter study at 3 years Stein BS1, Te AE2, Malloy TR3, Ulchaker JC4, Nseyo UO5, Hai MA6 1 Brown University, Providence, RI, 2Cornell University, New York, NY, 3University of PA, Philadelphia, PA, 4Cleveland Clinic, Cleveland, OH, 5Commonwealth of VA, Richmond, VA, 6Oakwood Annapolis Hospital, Wayne, MI Introduction: The high-power KTP laser prostatectomy or PVP with its unique 532 nm laser wavelength, pulsing regime and absorption characteristics has previously demonstrated that it can safely and efficiently vaporize prostatic adenoma with minimal bleeding and morbidity in the ongoing multicenter study. This study will report 3 year results and review the factors that influence durability of clinical efficacy of PVP for treatment of obstructive benign prostatic disease. Methods: One hundred thirty nine male subjects, mean age of 67.7 ⫾ 8.7 years, diagnosed with obstructive lower urinary tract symptoms (LUTS) secondary to BPH underwent PVP with an average 80W KTP laser at six sites. The preoperative mean ultrasound volume of the prostate was 55.1. Preoperative evaluation included AUA symptom index, QOL score, peak urinary flow rate, post-void residual and TRUS prostate volume measurement. Biochemical assessment included PSA, serum sodium and creatinine measurements. Ongoing follow-up evaluations included 1, 3, 6, 12, 24 and 36 month assessment of preoperative parameters. Analysis was also per-
17
FRIDAY, SEPTEMBER 30, 2005 Poster Display LUTS, BPO, Prostatitis
100
Photoselective vaporization of the prostate (PVP): feasibility and safety as an office based modality Hai M Department of Urology, Oakwood Annapolis Hospital, Wayne, MI Introduction: The surgical treatment of benign prostatic hyperplasia (BPH) has never been introduced outside the confines of a hospital operating room. The risks of intraoperative and postoperative complications, especially hemorrhage and anesthesia, have prevented established treatments such as TURP and open prostatectomy to be performed in office based environments or well equipped ambulatory surgical centers (ASC). Recently, a relatively new surgical modality known as photoselective vaporization of the prostate (PVP) has been introduced with clinical efficacy and safety data that rivals the traditional therapies. More importantly, recent clinical evidence suggests that this therapy can be offered in the well equipped office based setting with little to no complications. We report our initial results on 154 male subjects diagnosed with bladder outlet obstruction secondary to BPH treated in a well equipped office based setting. Methods: From December 2002 to present, 154 patients with a mean age of 65.3 ⫾ 4.6 years (61-85) and a mean preoperative TRUS volume of 60.3 ⫾ 38.5 cc (17.2-275) clinically diagnosed with lower urinary tract symptoms (LUTS) secondary to obstructive BPH were surgically treated in an outpatient office based surgical suite with only L-MAC anesthesia and pudendal prostate block. Patients were included in the evaluation with an ASA ⬎ 2 and physical weight of ⬍ 250lbs. All patients were evaluated and monitored pre, intra and postoperatively by a board certified anesthesiologist. Blood pressure, oxygen saturation, blood chemistry, EKG monitoring and conscious sedation were evaluated. Efficacy outcome data was evaluated using standard parameters including AUASI, Q-max and PVR. Results: All patients were successfully treated with no significant intraoperative or postoperative complications. There were no intubations required or anesthesia complications observed during surgery. All patients experienced no significant changes in hematocrit, hemoglobin, serum sodium, blood pressure, 02 saturation or cardiac arrhythmia. All patients were sent home under outpatient status 2-4 hours after surgery with no postoperative hospitalizations required. Mean
UROLOGY 66 (Supplement 3A), September 2005
treatment time was 37.3 ⫾ 14.6 min (7-86) and mean postoperative catheterization was 8.1 ⫾ 10.2 hours (0-24). Absolute improvements in AUASI, Q-Max and PVR at 12 months follow-up were 74%, 156% and 75%, respectively. Minor postoperative complications related to surgery include UTI in 5%, transient post-operative urinary retention in 3% (⬍ 5 days post treatment), bladder neck contracture in 2% and mildmoderate transient dysuria in 10%. Conclusions: Photoselective vaporization of the prostate with a high-power potassium-titanyl-phosphate (KTP) laser is a safe and effective outpatient office based modality that offers all of the objective outcomes of a TURP while maintaining less morbidity and providing a more expedient recovery.
101
Factors influencing efficacy outcomes in photoselective vaporization prostatectomy (PVP): results and analysis of ongoing prospective multicenter study at 3 years Stein BS1, Te AE2, Malloy TR3, Ulchaker JC4, Nseyo UO5, Hai MA6 1 Brown University, Providence, RI, 2Cornell University, New York, NY, 3University of PA, Philadelphia, PA, 4Cleveland Clinic, Cleveland, OH, 5Commonwealth of VA, Richmond, VA, 6Oakwood Annapolis Hospital, Wayne, MI Introduction: The high-power KTP laser prostatectomy or PVP with its unique 532 nm laser wavelength, pulsing regime and absorption characteristics has previously demonstrated that it can safely and efficiently vaporize prostatic adenoma with minimal bleeding and morbidity in the ongoing multicenter study. This study will report 3 year results and review the factors that influence durability of clinical efficacy of PVP for treatment of obstructive benign prostatic disease. Methods: One hundred thirty nine male subjects, mean age of 67.7 ⫾ 8.7 years, diagnosed with obstructive lower urinary tract symptoms (LUTS) secondary to BPH underwent PVP with an average 80W KTP laser at six sites. The preoperative mean ultrasound volume of the prostate was 55.1. Preoperative evaluation included AUA symptom index, QOL score, peak urinary flow rate, post-void residual and TRUS prostate volume measurement. Biochemical assessment included PSA, serum sodium and creatinine measurements. Ongoing follow-up evaluations included 1, 3, 6, 12, 24 and 36 month assessment of preoperative parameters. Analysis was also per-
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