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Photoselective vaporization of the prostate: pursuing good indications based on the results of 400 Japanese patients
Author(s) -
Otsuki Hideo,
Kuwahara Yoshitaka,
Tsukamoto Takuji,
Nakamura Kenzo,
Shiroki Ryoichi,
Hoshinaga Kiyotaka
Publication year - 2012
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2011.10525.x
Subject(s) - prostate , medicine , urology , cohort , retrospective cohort study , surgery , cancer
Study Type – Therapy (individual cohort) Level of Evidence 2b What's known on the subject? and What does the study add? Photoselective vaporization of prostate (PVP) with a KTP laser is safer than TURP and has comparable efficacy to TURP. But long‐term durability and suitable amount of vaporization have been unknown. We investigated 400 Japanese patients after PVP regarding prostate volume. The mean reduction rate of prostate size was 43.2% (21.8 mL), which was achieved with 273.5 kj of KTP energy on average. A larger absolute volume reduction in patients with larger prostates was associated with greater improvements of objective urinary function parameters and symptoms score reduction. OBJECTIVE• To investigate good indications of photoselective vaporization of the prostate (PVP) by retrospective evaluation of its efficacy in relation to prostate volume.PATIENTS AND METHODS• A cohort of 400 patients had International Prostate Symptoms Score (IPSS), Quality of Life (QoL) score, urinary peak flow ( Q max ), and prostate volume ( P vol ), assessed before and after surgery. • Changes of outcome variables were compared among four groups classified according to preoperative prostate volume: <30 mL (group A), ≥30 and <50 mL (group B), ≥50 and <70 mL (group C), and >70 mL (group D).RESULTS• Operating times and amounts of energy applied were 44.2 min and 159 kJ, 67.7 min and 268 kJ, 111 min and 409 kJ, and 171 min and 604 kJ in groups A, B, C, and D, respectively. • All variables improved significantly and immediately, and remained for more than 12 months. • Investigation of groups classified by prostate size demonstrated that IPSS and QoL score decreased and improvement rate of Q max rose as prostate volume increased. • Changes of P vol were from 24.5 mL to 13.2 mL (−46.1%), from 39.8 mL to 22.9 mL (−42.4%), from 58.4 mL to 32.8 mL (−43.8%), and from 92.1 mL to 53.8 mL (−41.5%) in groups A, B, C, and D, respectively. Overall the P vol reduction rate was 43.2%, and no significant differences were observed in reduction ratios among the groups. • Complications were minimal, but bladder neck contracture arose in 16 cases with a smaller prostate.CONCLUSION• Whilst the percentage reduction in volume was similar across the groups, the larger absolute volume reduction in patients with larger prostates was associated with greater improvement in objective urinary function variables, and with symptom score reduction.