Login to Access Video or Poster Abstract: MP02-01
Sources of Funding: None

Introduction

Laser therapy has gained increasing acceptance as a relatively less invasive treatment for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPE). The potassium-titanyl-phosphate (KTP) laser, as well known as GreenLight laser (PVP) has been recently tested in a numbers of clinical studies. However, clinical outcomes have been different and not always the same. Recently, it has been tested the BPH6 score as a reliable patient reported outcome (PROM) for the evaluation of patients who underwent BPE surgery. _x000D_ In this study we aimed to compare PVP vs. TURP regarding BPH6 outcomes at 12 months of follow-up in a matched pair analysis. _x000D_

Methods

From January 2014 to January 2016, we conducted a matched pair analysis on 220 patients to compare the efficacy and safety of PVP laser and bipolar TURP in terms of the composite BHP6 endpoint at 12 mo. A propensity score matching was performed to adjust for preoperative prostate volume, peak flow and international prostate symptoms score (IPSS). _x000D_ Patients with LUTS secondary to BPE and refractory to medical therapy underwent TURP of 180 W PVP. The BPH6 primary study endpoint is a composite of six elements that assess overall outcome including LUTS relief, recovery experience, erectile function, ejaculatory function, continence and safety. The final BPH6 responder endpoint is achieved if a participant meets all six of the criteria defined as follow: LUTS relief: reduction of >=30% in IPSS at 12 mo compared to baseline, Recovery experience: QoR VAS >=70 by 1 mo, reduction of <6 points for SHIM (Sexual Health Inventory For Men) compared to baseline during 12-mo follow-up, response to MSHQ-EjD (Male Sexual Health Questionnaire Short Form for assessing ejaculatory dysfunction) question 3 indicating emission of semen during 12-mo follow-up, ISI (Incontinence score index) of ?4 points at all follow-up intervals, no treatment-related adverse event greater than grade I on the Clavien-Dindo classification system at any time during the procedure or follow up. _x000D_ All data presented are given as mean ± standard deviation (SD). Statistical analysis was performed using the SPSS 19.0 statistical software package (SPSS Inc., Chicago, IL, USA). _x000D_

Results

After the matched paired-analysis, a total of 123 (55 TURP and 68 PVP) were analyzed. Participants were well matched between the study arms, with no statistically significant differences of prostate volume, peak flow and IPSS. When comparing both groups, the proportion of patients achieving the BPH6 recovery endpoint by 12 mo was 45.6% in the PVP group, which was significantly better than the rate in the TURP group (18.2%) (p=0.001). In particular, PVP group showed better BPH6 outcomes vs. regarding TURP regarding recovery (82.4% vs. 58.2%; p<0.05), ejaculatory function (58.8% vs. 34.5; p<0.05) and safety (94.1% vs. 78.2%; p<0.05). The TURP group showed greater catheterization time (4.67 vs. 1.25; p<0.01) while PVP showed greater recovery experience (77.35 vs. 68.73; <0.01). Postoperative Ejaculatory dysfunctions were observed in both groups, 58.8% in TURP and 34.5% in PVP group. _x000D_ No difference regarding LUTS reduction, erectile function and continence. In both groups surgery did not cause any adverse events that required surgical intervention or revision and reintervention for failure to cure did not occurred in 12mo follow up. The multivariate logistic regression analysis, adjusted for pre-operative variables, showed that PVP was independently associated with BPH6 recovery endpoint (odds ratio= 3.77 [95%CI 1.64-8.70]; p<0.01). _x000D_

Conclusions

This study sheds some light in support of PVP technology. The results prove that PVP of the prostate represents an effective and safe technique, combining minimal morbidity and significant advantages compared to TURP regarding BPH6 outcomes. In fact, this is the first study comparing those two techniques in terms of the composite BHP6 endpoint, a reliable tool that can easily applied to compare BPE surgery procedures.

Funding

None