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THE EFFICACY AND SAFETY OF PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE(PVP) FOR THE TREATMENT OF BENIGN PROSTATE HYPERPLASIA(BPH) IN MEN WITH LARGE PROSTATES

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Authors
Kim, M.; Park, J. H.; Lee, C. J.; Ko, D. W.; Paick, J.; Son, H.; Yang, S.; Kim, S. W.
Issue Date
2009
Publisher
WILEY-LISS
Citation
NEUROUROLOGY AND URODYNAMICS; Vol.28 7; 723-725
Abstract
Hypothesis / aims of study
Recent studies have shown the photoselective vaporization of the prostate(PVP) is safe and efficacious as possible to alternate
with the standard surgical treatment, transurethral resection of the prostate(TURP). But there are a few reports about the large
prostates. This study was conducted to evaluate the efficacy and safety of PVP for men with a prostate volume greater than
60cc.
Study design, materials and methods
The clinical data of 249 men with symptomatic benign prostatic hyperplasia underwent PVP between January 2006 and June
2008 was retrospectively analyzed. All patients were classified into two groups by their prostate volume (< 60cc; group A, 60cc; group B). The preoperative evaluation included the digital rectal exam, urinanalysis, prostate-specific antigen(PSA) levels,
International Prostate Symptom Score(IPSS), the quality of life (QoL score), the maximal flow rate(Qmax), the postvoid residual
urine volume(PVR) and transrectal ultrasonography(TRUS). The total operative time, used energy(kJ), the urethral Foley
catheter indwelling period and the number of hospital days were recoded after wards. The IPSS, QoL, Qmax and PVR were
evaluated at 1, 3, 6 and 12 months postoperatively.
Results
Of 249 men, 186 men were included in group A, remained 63 men were group B. The mean age was 67.2 (44-87) years in
group A and 69.4 (57-88) years in group B. The mean prostate volume was 38.4 ± 10.8cc in group A and 78.6 ± 15.4cc in group
B. PSA level was 2.06 ± 1.97ng/mL in group A and 5.93 ± 4.66ng/mL in group B (P<0.05). The mean operative time was 46.6 ±
19.1 minutes in group A and 76.0 ± 29.8 minutes in group B(P<0.05). The used energy was 122 ± 80 kJ in group A and 200 ±
89 kJ in group B. The postoperative urethral Foley catheter indwelling period was 24.4 ± 15.2 hrs in group A and 24.6 ± 10.8 hrs
in group B, and almost of the patients(156 men(84%) in group A, 59 men(94%) in group B) were discharged at postoperative 1st
day after urethral catheter removal. IPSS was improved from 20.1 relatively to 13.4, 10.8, 10.5 and 10.7 at 1, 3, 6 and 12
months postoperatively in group A, and improved from 19.1 preoperatively to 11.8, 8.7, 7.0, and 7.6 at 1, 3, 6 and 12 months
postoperatively in group B. QoL was decreased from 4.5 preoperatively to 2.8, 2.3, 2.3 and 2.2 at 1, 3, 6 and 12 months
postoperatively in group A, and decreased from 4.2 preoperatively to 2.9, 2.1, 1.6 and 1.7 at 1, 3, 6 and 12 months
postoperatively in group B. Qmax was increased from 10.2mL/s preoperatively to 17.7, 17.7, 16.9 and 15.7mL/s at 1, 3, 6 and
12 months postoperatively in group A, and increased from 11.1mL/s preoperatively to 18.7, 16.7, 15.6 and 16.0mL/s at 1, 3, 6
and 12 months postoperatively in group B. PVR was decreased from 73.3cc preoperatively to 24.6, 21.3, 20.8 and 21.8cc at 1,
3, 6 and 12 months postoperatively in group A, and from 78.4cc preoperatively to 34.2, 37.3, 40.6 and 51.0cc at 1, 3, 6 and 12
months postoperatively in group B. Parameters such as IPSS, QoL, Qmax, PVR were changed significantly all groups. The
postoperative complications were similar. There were retrograde ejaculation(17.8%), urethral stricture(4.8%), urinary
incontinence(3.8%), urinary tract infection(2.2%), delayed gross hematuria(1.1%), and erectile dysfunction(1.1%) in group A,
and retrograde ejaculation(14.3%), urethral stricture(4.7%), delayed gross hematuria(3.2%), urinary incontinence(1.6%),
urinary tract infection(1.6%), and erectile dysfunction(1.6%) in group B.
Interpretation of results
In both group A and B, significant improvements of the subjective and objective voiding parameters were achieved and these
were sustainable for at least 1 year with minimal complication after PVP.
Concluding message
PVP was safe and efficacious, with durable results for men with symptomatic benign prostatic hyperplasia, regardless of the
prostate volume.
ISSN
0733-2467
Language
English
URI
https://hdl.handle.net/10371/77795
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College of Medicine/School of Medicine (의과대학/대학원)Urology (비뇨기과학전공)Journal Papers (저널논문_비뇨기과학전공)
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