G Hibon1, G Léonard2, A Franceschi3, V Misrai4, F Bruyère5. 1. Department of urology, CHRU de Tours, Loire Valley, 2, boulevard Tonnelle, 37000 Tours, France. Electronic address: guillaume.r.hibon@gmail.com. 2. Department of urology, CHRU de Tours, Loire Valley, 2, boulevard Tonnelle, 37000 Tours, France. Electronic address: gregoireleonard@hotmail.com. 3. Department of public health university of Tours, hospital of Tours, 37000 Tours, France. Electronic address: arnaudfranceschi@gmail.com. 4. Department of urology, clinic Pasteur, 31300 Toulouse, France. Electronic address: vmisrai@clinique-pasteur.com. 5. Department of urology, CHRU de Tours, Loire Valley, 2, boulevard Tonnelle, 37000 Tours, France; PRES centre Val-de-Loire, université Francois-Rabelais, 37000 Tours, France. Electronic address: F.BRUYERE@chu-tours.fr.
Abstract
OBJECTIVE: Long-term outcome after prostate photovaporization (PVP) remains largely unknown, especially when performed on enlarged prostates. However, new vaporisation techniques (e.g., laser enucleation) are increasingly used. Our aim was to compare postoperative results after standard PVP to those of an anatomical technique. MATERIALS AND METHODS: This bicentric prospective study included males treated for enlarged prostate caused by benign prostatic hyperplasia using a GreenLight laser. Patients were preoperatively assessed according to prostate volume, post-void residual volume (PVR), maximum urinary-flow rate (Qmax), prostatic specific antigens, and International prostate symptom score (IPSS). Peroperative data included vaporization time, energy delivered, and operative length. Postoperative data at 1, 3, 6 and 12 months were compared with initial data; all complications were recorded. Comparisons were made between the conventional vaporization technique versus anatomical vaporization, which initially differentiated the peripheral zone of the prostate using an enucleation technique but no morcellation. RESULTS: Records from 106 surgical patients between December 2012 and December 2013 were analyzed. Operative length, vaporisation time, and energy used were greater in the anatomical PVP group. The average length of hospital stay (2.0 vs. 2.5 days), time with a catheter (1.3 vs. 1.9 days), IPSS (5.0 vs. 6.4), PVR (15.5 vs. 11.7mL), and Qmax (19.9 vs. 19.7mL/s) were comparable between the two groups. However, more complications occurred (27% vs. 37%), including stress urinary incontinence (0% vs. 8%) when using anatomic vaporization. CONCLUSION: Despite comparable groups and similar functional results, anatomical PVP caused more stress incontinence. However, the learning curve between the two techniques may explain this difference. LEVEL OF EVIDENCE: 4.
OBJECTIVE: Long-term outcome after prostate photovaporization (PVP) remains largely unknown, especially when performed on enlarged prostates. However, new vaporisation techniques (e.g., laser enucleation) are increasingly used. Our aim was to compare postoperative results after standard PVP to those of an anatomical technique. MATERIALS AND METHODS: This bicentric prospective study included males treated for enlarged prostate caused by benign prostatic hyperplasia using a GreenLight laser. Patients were preoperatively assessed according to prostate volume, post-void residual volume (PVR), maximum urinary-flow rate (Qmax), prostatic specific antigens, and International prostate symptom score (IPSS). Peroperative data included vaporization time, energy delivered, and operative length. Postoperative data at 1, 3, 6 and 12 months were compared with initial data; all complications were recorded. Comparisons were made between the conventional vaporization technique versus anatomical vaporization, which initially differentiated the peripheral zone of the prostate using an enucleation technique but no morcellation. RESULTS: Records from 106 surgical patients between December 2012 and December 2013 were analyzed. Operative length, vaporisation time, and energy used were greater in the anatomical PVP group. The average length of hospital stay (2.0 vs. 2.5 days), time with a catheter (1.3 vs. 1.9 days), IPSS (5.0 vs. 6.4), PVR (15.5 vs. 11.7mL), and Qmax (19.9 vs. 19.7mL/s) were comparable between the two groups. However, more complications occurred (27% vs. 37%), including stress urinary incontinence (0% vs. 8%) when using anatomic vaporization. CONCLUSION: Despite comparable groups and similar functional results, anatomical PVP caused more stress incontinence. However, the learning curve between the two techniques may explain this difference. LEVEL OF EVIDENCE: 4.
Authors: Luca Cindolo; Cosimo De Nunzio; Francesco Greco; Paolo Destefanis; Franco Bergamaschi; Giovanni Ferrari; Giuseppe Fasolis; Fabiano Palmieri; Claudio Divan; Rino Oriti; Lorenzo Ruggera; Andrea Tubaro; Claudio Dadone; Gaetano De Rienzo; Antonio Frattini; Vincenzo Mirone; Luigi Schips Journal: World J Urol Date: 2017-11-01 Impact factor: 4.226