Objectives:
The ideal amount of energy delivery during photo-selective vaporization of the prostate (PVP) for optimal treatment of benign prostate hyperplasia (BPH) has not been established. The aim of this study is to assess the effect of energy density (kJ/cc) applied on adenoma during treatment on functional outcomes, PSA reduction and complications.
Subjects/Patients and methods:
After exclusions, a total of 440 patients that underwent Greenlight laser XPS 180W LBO PVP for the treatment of BPH were retrospectively reviewed. Data was collected from seven different international centers (Canada, the United States, the United Kingdom and France). Patients were stratified into four energy density groups (kJ/cc) according to intraoperative energy delivered and prostate volume as determined by pre-operative trans-rectal ultrasound (TRUS): group 1: <3 kJ/cc, group 2: 3 to 5 kJ/cc, group 3: 5 to 7 kJ/cc and group 4: ≥7kJ/cc. Energy density groups were chosen arbitrarily. PSA reduction and functional outcomes (IPSS, QoL, PVR, Qmax) were compared at 6, 12 and 24 months. Moreover, perioperative complications and retreatment rates were also compared between groups.
Results:
PSA reduction at 24 months post procedure was 51%, 61%, 79% and 83% for an energy density groups of <3, 3-5, 5-7 and ≥7 kJ/g respectively (p≤0.01). This held true after accounting for baseline confounders. Energy density was not associated with increased complication rates, including hematuria, stricture formation, incontinence, refractory urinary retention, urinary tract infection and conversion to TURP. Functional outcomes at 2 years of follow-up were equivalent between groups (p>0.05 for all) and comparable re-treatment rates were observed (p=0.36).
Conclusion:
Increased energy usage per cc of prostate is associated with a more significant PSA reduction (>50%) at 6,12 and 24 months suggesting increased vaporization of adenoma tissue. However this did not translate into differences in functional outcomes at two years of follow-up. This article is protected by copyright. All rights reserved.
