Functional outcomes and safety of GreenLight photovaporization of the prostate in the high‐risk patient with lower urinary tract symptoms due to benign prostatic enlargement

Abstract

Aims: Photovaporization of the prostate (PVP) with GreenLight Laser is a surgical treatment for lower urinary tract symptoms. It is considered safe in elderly patients with comorbidities, however, the evidence is inconclusive. The objective of this study is to evaluate the efficacy and safety outcomes of PVP according to the American Society of Anesthesiologists Physical Status (ASAPS). Methods: A cohort of 675 patients who underwent PVP between 2012 and 2018 was evaluated. Patients were classified according to their ASAPS as low (I and II) and high risk (III and IV). Surgical characteristics and improvement of symptoms and Quality of Life (QoL) were evaluated.Results: The median age of high-risk group was higher than low-risk group. The high-risk group had more history of anticoagulation, antiaggregation, urinary catheterization, urinary retention and urethral stricture. Longer times of hospitalization ] vs 21.8 hours , P = .008) and catheterization .57] vs 17.67 hours [IQR = 14.76-22.5], P = .004) were found in the high-risk group. Conversion and bleeding control were not different between groups. In the follow-up

Impact of American Society of Anesthesiologists score on postoperative holmium enucleation of the prostate outcomes and complications

“…Lower urinary tract symptoms (LUTS) measured by IPSS in the high‐risk group significantly improved at a similar rate in low‐risk patients. Barco‐Castillo et al., 11 however, found that patients with higher ASA scores had less improvement than the lower score group. There was no difference in groups that had IPSS improvement.…”

“…In addition to the benign prostatic hyperplasia (BPH) prevalence in the aging population, there has been an increase in age and medical comorbidities in patients requiring BPH surgery 8 . Multiple studies have attempted to use these risk stratification to predict outcomes from surgery 9–11 . Additionally, there has been increased interest in newer technologies that do not require general anesthesia in those who are felt to be unfit for anesthesia, such as transurethral bipolar radiofrequency thermotherapy (Bipolar‐RF) and water vapor thermal therapy (WVTT) 12,13 …”

“…8 Multiple studies have attempted to use these risk stratification to predict outcomes from surgery. [9][10][11] Additionally, there has been increased interest in newer technologies that do not require general anesthesia in those who are felt to be unfit for anesthesia, such as transurethral bipolar radiofrequency thermotherapy (Bipolar-RF) and water vapor thermal therapy (WVTT). 12,13 Holmium laser enucleation of the prostate (HoLEP) is a sizeindependent BPH surgical treatment that can be done in medically complicated patients, including those on anticoagulation 14,15 and those who are older, including patients >80 years old.…”

Efficacy and Safety of Prostatic Artery Embolization in the Treatment of High Risk Benign Prostatic Hyperplasia and its Influence on Postoperative Life Quality of Patients

“…BPH is the most common disease in elderly men. When the disease progresses to a certain stage, patients often suffer from chronic urinary retention due to obstruction of lower urinary tract, causing lower abdominal pain, repeated urinary tract infection, hematuria, which easily lead to serious coplications such as bladder dysfunction, renal insufficiency, electrolyte disturbance, etc., and poses a serious threat to the health of elderly men ( 11 – 13 ). Although BPH high-risk patients have obvious symptoms of lower urinary tract obstruction and their quality of life declines, their tolerance to anesthesia and surgical intervention is poor due to physical factors.…”

Comparison of PKRP and TUVP in the treatment of high-risk BPH and analysis of postoperative influencing factors

“…High-risk patients with BPH are often accompanied by basic diseases such as hypertension and diabetes. In addition, they are elderly and have poor body resistance, which greatly increases the difficulty of treatment ( 3 , 4 ). At present, surgical treatment is commonly used in clinical practice.…”