A Comparison of 120 W Laser Photoselective Vaporization versus Transurethral Resection of the Prostate for Bladder Outlet Obstruction by Prostate Cancer

Abstract

Objective: To compare the mid-term outcomes of photoselective vaporization of prostate (PVP) with GreenLight HPS 120 W laser and transurethral resection of the prostate (TURP) for obstructive lower urinary tract symptoms (LUTS) in men with prostate cancer (CaP). Patients and Methods: Seventy four patients with locally advanced (T3/T4) CaP with severe LUTS or acute urinary retention (AUR) were allocated to TURP (n = 36) or PVP (n = 38). International Prostate Symptom Scores (IPSS), maximum flow rates (Qmax) and post-void residual volumes (Vres), PSA levels, prostate volumes, complications, catheter removal and hospitalization periods were recorded. Patients were reassessed at 3, 6, and 12 months. Results: The catheter removal time was significantly longer in the TURP group (3.8 ± 1.1 vs. 1.2 ± 0.7 days, p = 0.02), whereas failure of initial voiding trial was higher in PVP (2.7 vs. 13.1%, p = 0.01). No significant difference in IPSS, Qmax and Vres values was observed within the follow-up period between two groups. A significant difference in urethral stricture rate (8.3 vs. 0%), catheter removal time (3.8 ± 11 vs. 1.2 ± 0.7 days) and hospital stay (2.9 ± 0.6 vs. 1.1 ± 0.5 days) was observed in favor of PVP. Conclusions: Palliative PVP is very safe and effective by means of symptomatic relief in patients with locally advanced CaP.

Impact of Thulium Laser Enucleation of the Prostate on Erectile, Ejaculatory and Urinary Functions

“…Therefore, in recent years, new procedures have been developed in order to guarantee reduced morbidity, reduced catheterization time and hospitalization. Recent literature has shown that laser surgery, by means of Green Light photoselective vaporization, Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP) is considered an effective surgical alternative [4,5,6,7]. The purpose of this study is to test the andrological impact of ThuLEP in terms of erectile and ejaculatory functions, on lower urinary tract symptoms (LUTS) modifications and on improvements of QoL.…”

Optimal Monitoring of Prostate-Specific Antigen Detects Prostate Cancer at the Localized Stage after Photoselective Vaporization for Benign Prostatic Hyperplasia

“…In contrast, Liberale et al [26] presented their experience with PVP in 43 patients with prostate cancer and showed that for patients with prostate cancer, PVP is safe and provides excellent relief from symptoms. Altay et al [27] compared PVP and TURP for bladder outlet obstruction by locally advanced (cT3/T4) prostate cancer. In their study, there were no significant differences in adverse events and primary functional outcomes between the 2 groups of 34 patients who underwent TURP and 35 patients who underwent PVP and completed 12 months of follow-up.…”

Photoselective Vaporization of the Prostate in Men With Refractory Urinary Retention

“…We also acknowledged that our management of patients with elevated PSA level (ie, prostate biopsy during PVP) could be questionable, as one can argue that diagnosing prostate cancer preoperatively would be preferable and could have changed the management of No Complication n ¼ 132 (86.9) Acute urinary retention due to clusters of necrotic deposits removed at fibroscopy or cystoscopy n ¼ 3 (2) Clusters of necrotic deposits requiring a new resection n ¼ 2 (1.3) Erectile dysfunction n ¼ 2 (1.3) Uretral stenosis n ¼ 2 (1.3) Urgency with sterile urine culture not treated n ¼ 1 (0.6) Urgency with sterile urine culture treated by antimuscarinic or non steroid anti-inflammatory n ¼ 1 (0.6) Urinary incontinence not requiring pads n ¼ 6 (4) Urinary incontinence requiring at least 1 pad n ¼ 3 (2) these patients. However, several series have recently assessed the reliability of PVP in patients with prostate cancer, 18,19 and to our knowledge, the appropriate timing to perform prostate biopsy in the setting of PVP has not been addressed in current guidelines. Another potential limitation is that 3 different types of fibers were used (XPS, HPS, KTP-80W), which could have biased the results observed as it has been hypothesized that the higher energy application and higher speed of tissue vaporization with the XPS fiber could lead to increased tissue vaporization compared with the former 120-W and 80-W laser systems.…”