Basic Science: BPH/LUTS

Moderated Poster Session

MP3-7 - The role of the photovaporization of the prostate (PVP) with GreenLight 180W XPS in patients with large prostates: Is it time to change the standard of treatment?

Presenting Author(s)

• 

  Carlos Trujillo

  Urologist
  Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine

Author(s)

• AB

  Alejandra Bravo-Balado

  Research Assistant
  Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine
• JC

  Juan Ignacio Caicedo

  Urologist
  Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine
• TH

  Tatiana Higuera

  Medical student
  Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine
• LZ

  Laura Zuluaga

  Research Assistant
  Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine
• MP

  Mauricio Plata

  Chairman Department of Urology
  Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine

Introduction & Objective :

According to several guidelines, PVP is as effective as TURP in prostates 80mL.However, with the availability of the Moxy fiber and the 180W power, some authors have stated this technique may have a role in the management of larger prostates. We aim to determine effectiveness and safety of PVP in patients with prostates >80mL.

Methods :

An observational retrospective study was conducted in patients who underwent PVP between 2012 and 2017. Prostate volume was divided into 2 categories: ≤80mL and >80mL. Intra and postoperative complications, symptomatic improvement (VAS), IPSS and quality of life (QoL) were recorded. Descriptive and inferential statistics were employed.

Results :

We included 533 patients, 65.8% with prostates ≤80 mL and 34.2% >80 mL. Table 1 shows preoperative characteristics. Median follow-up was 21 months (IQR 8-38). IPSS and QoL improved from 17 to 5 and 4 to 1, respectively, in patients with prostates >80 mL. Compared to smaller prostates, no significant differences were found. The complication rates according to the Clavien-Dindo classification in prostates >80mL were 24% (I-II) and 9.9% (III-IV), which are slightly greater compared to smaller prostates (Table 2). A multivariate logistic regression analysis showed that prostate volume was associated with moderate-to-severe bleeding (OR 3.4, 95% CI 1.2-9.5), the need for bleeding control (OR 2.2, 95% CI 1.0-4.7), conversion (OR 19.1, 95% CI 2.3-157) and blood transfusion (BT) (OR 28.4 95% CI 2-404).

Conclusions : PVP with GreenLight 180W XPS is safe and effective in patients with prostates >80 mL. As expected, bleeding, conversion and the need for BT was greater in larger prostates, but these rates are notably lower compared to TURP (BT>5%) and open prostatectomy (BT 8-19%). Given the increasing evidence supporting the use of PVP in large prostates, we believe it could become a standard of care in the near future.