Login to Access Video or Poster Abstract: MP13-09
Sources of Funding: none

Introduction

Photoselective Vaporization of the Prostate (PVP) has been promoted as a valuable alternative to transurethral resection of the Prostate (TURP) and is considered an appropriate and effective treatment in men with moderate to severe LUTS. However the learning curve of this technique has never been evaluated accurately. The objective of this study was to evaluate the learning curve of PVP.

Methods

Multicenter retrospective study was conducted in the first patients treated with PVP by three operators in 3 different centers (Group 1: 152 patients, Group 2: 112 patients, Group 3: 101 patients). The learning curve was analyzed from the progression in time of quantitative variables: operative time (min), ratios vaporisation time (min)/operative time (%) and delivered energy (Joules)/prostate volume. We also compared the rate of complications (Clavien classification). The relationships between variables were modeled using analysis of covariance (software R 2. 14.2).

Results

The patients’ preoperative data differed significantly between each centers in terms of age, prostate volume and IPSS. There was no significate difference in operative time between the three centers (p=0,06). During the initial 50 cases for each center, a significantly increased in vaporisation time (min)/operative time (%) was observed. 75 patients were necessary to reach the goal of 66 to 80%. (Graphic 1) A significantly increased in energy delivery was observed (this increase appeared to plateau beyond the 50th case in group 3, beyond the 75th case in group 1 and beyond the 100th case in group 2) but a significant difference was observed in terms of energy ratio = Energy delivered / prostate volume (Graphic 2) : 3.2kJ / ml [ 2.5 , 4.1kJ] ( Montreal ) vs 2.5kJ / ml [ 1.7-3.0] ( Paris ) vs 4.1kJ / ml [ 2.9-5.2] (Toulouse) (p < 0.0001). (Figure 2) No differences were observed in terms of postoperative complications (17.6% vs. 22.3% vs. 19.8%; p=0.64)_x000D_

Conclusions

This is the first study to support that the outcomes obtained during PVP learning curve may be influenced by patients and surgeons’ characteristics. In this study, 100 Greenlight 180-W XPS PVP procedures were required before to reach a plateau in intraoperative parameters.

Funding

none