Greenlight laser prostatectomy: a safe and effective treatment for bladder outlet obstruction by prostate cancer

Abstract

Level of Evidence 4 What's known on the subject? and What does the study add? Although looked on as standard of care there is little published data on the use of "channel TURP" . Those case series that have been published show significant morbidity (in particular stress incontinence) and relatively long hospitalization compared to standard TURP. The use of vaprorising lasers in this patient group has not been addressed. GreenLight laser is a safe and efficacious treatment for bladder outflow obstruction in men with prostate cancer. Hospitalization is minimal (most were day cases) which we feel is important in men who are often in their last few months. We had no serious complications apart from a few patients with stress incontinence. The stress incontinence rate was dramatically lower than that reported in previous reported series of channel TURP - we are not however able to offer any obvious explanation for that finding. OBJECTIVE To present our experience on photoselective vaporization of the prostate (PVP) in a cohort of men with bladder outlet obstruction (BOO) by prostate cancer. PATIENTS AND METHODS From 2003 to 2008 we identified 43 patients with prostate cancer treated with PVP. The patients' hospital records were comprehensively reviewed to obtain preoperative, intra-operative and postoperative data. Inclusion criteria were patients with BOO or urinary retention with a diagnosis of prostate cancer. RESULTS Mean operating time was 42 min, mean post-operative hospital stay was 9.6 h. 32 out of 43 patients were discharged home within 24 h. Twelve patients (28%) did not need post-operative catheter. Mean and median catheter times were 22 and 21.5 h respectively. Complications were mild: 1 patient needed bladder irrigation, 3 failed initial TWOC, 1 had early stress incontinence. Three had clot retention. At 3 months post-operatively, 41 of 42 evaluable patients were voiding without a catheter. The mean peak flow rate had increased by 80% and a mean residual volume decreased of 49%. Four patients underwent a second laser treatment. Three had developed further retention between 7 and 23 months post-operatively and did not want further surgery. The local failure rate at a mean follow up of 22 months was 7 of 39 patients (18%). CONCLUSION The present study is the first on PVP applied to patients with prostate cancer. It is shown that, for patients with CaP bothered by LUTS or retention, GreenLight laser prostatectomy is very safe and gives excellent relief from symptoms, with a good improvement in peak flow rate.