A retrospective review of office-based 532-nm GreenLight laser prostatectomy in men with symptomatic benign prostatic hyperplasia.

OBJECTIVE: To evaluate the feasibility, safety, and outcomes of men with symptomatic benign prostatic hyperplasia undergoing 532-nm GreenLight laser prostatectomy in the office-based setting. MATERIALS AND METHODS: From September 2007 to October 2011, 47 patients underwent office-based 532-nm GreenLight laser prostatectomy by a single surgeon. Patients were enrolled prospectively and preoperative, intraoperative, and postoperative parameters were then reviewed retrospectively. Statistical analysis was performed with Wilcoxon rank sum test with a P value ≤.05 being considered statistically significant. RESULTS: The mean patient age was 66 (range, 49-89); 91% of men were on an alpha-blocker preoperatively; mean (standard deviation; SD) prostate volume by transrectal ultrasound was 35.8 mL (14.5); mean (SD) American Society of Anesthesiologists score was 2.33 (0.77); mean (SD) operative time was 36.73 minutes (18); mean (SD) lasing time was 19.1 minutes (8.31); mean (SD) total laser kiloJoules used was 85,387 kJ (38,885); and mean (SD) follow-up time was 8.48 months (8.24). The 1-year decrease in mean (SD) American Urologic Association Symptom Score and quality of life were 17.7 (8.3)-7 (7.3) and 4.1 (1.4)-2.27 (2) respectively. The maximal urinary flow increased from 8.1 (3.8) to 10.7 (6). Patients' postvoid residual improved from 130 mL (147) to 27 mL (55) over a 1-year period. (P <.01 for all). There were no reoperations for refractory lower urinary tract symptoms or hospital admissions. CONCLUSION: For men with small but symptomatic benign prostatic enlargement, office-based GreenLight laser prostatectomy is safe and feasible.

Evaluation of continence following 532 nm laser prostatectomy for patients previously treated with radiation therapy or brachytherapy.

INTRODUCTION/OBJECTIVE: Urinary complications such as bladder outlet obstruction or urinary retention following radiation therapy or brachytherapy have been reported in up to 15% of men. When conservative therapy has failed, surgical intervention with transurethral resection of the prostate (TURP) may be performed, but carries a significant risk of incontinence, ranging from 18% to 70% in reported literature. We reviewed a cohort of men previously treated with radiation or brachytherapy, who underwent laser prostatectomy. METHODS: From February 2004 to October 2011, 12 patients (Six = brachytherapy and Six = external beam radiation) underwent 532 nm GreenLight™ laser prostatectomy by a single surgeon (BBC) for chronic retention or debilitating obstructive symptoms. Preoperative, intraoperative, and postoperative parameters were collected prospectively and reviewed retrospectively. Statistical analysis was performed with a Wilcox Rank sum test with significance defined as P < 0.05. RESULTS: The median patient age was 77.4 (Interquartile range (IQR) 73.9, 79.1). Prior to surgery, five patients were catheter dependent. Intraopertively, the median operative time was 48 minutes (IQR 35, 67); median lasing time was 28 minutes (IQR 23, 44); median Joules used was 126,873 (IQR 95,030, 222,336) J. Postoperative median follow up was 22.9 (IQR 13.4, 41.7) months. Significant improvements were noted in IPSS, QoL scores, PVR, and Qmax after PVP treatment. At 12 months, the median decrease in IPSS, QoL scores, and PVR was 15 (IQR 14.5, 22) to 10 (IQR 5.5, 13.5), 5 (IQR 3.5, 5) to 2 (IQR 1, 3.5), 200 (IQR 171, 327.5) to 5 (IQR 1.25, 8), respectively (P < 0.05 for all). Similarly, at 12 months, the median increase in Qmax (ml/second) was 4 (IQR 3, 10) to 15.9 (IQR 11, 16) (P = 0.04). There were no reportable complications at 12 months. None of the 12 patients that underwent 532 nm GreenLight™ laser prostatectomy developed stress urinary incontinence. One patient developed metastatic prostate cancer and the remaining patients had no evidence of biochemical recurrence. CONCLUSION: In this pilot study, 532 nm GreenLight™ laser prostatectomy is feasible and safe in patients who have undergone prior radiotherapy for prostate cancer. Laser prostatectomy provides a durable response while maintaining continence in this cohort suffering from severe lower urinary tract symptoms (LUTS) or retention. Larger, randomized trials comparing GreenLight™ laser prostatectomy to traditional TURP are necessary to confirm non-inferiority.