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Role of Debulking Procedures in Men with Prostates less than 40 grams.

Login to Access Video or Poster Abstract: MP27-10
Sources of Funding: None

Introduction

There is a dearth of evidence showing a long-term benefit of performing debulking procedure in small volume prostates (<40grams), with no evidence in using 180-W XPS-greenlight system in this population. Our objective was to characterize the long term clinical and symptomatic benefit of the 180-W XPS-Greenlight laser in patients with small volume prostates.

Methods

A retrospective analysis of 58 patients who underwent 180-W XPS-laser PVP vaporization of the prostate between 2012 and 2016 at three tertiary medical centers. We included all comers with prostates less than 40 grams with clinical evidence of bladder outlet obstruction.

Results

The average age of men who underwent PVP of the prostate was 67.8±10.9 years old, with an average BMI of 29.7±3.9. The average prostate volume was 29±6.7mL, five patients were found to have a significant intravesicular median lobe. Three patients had pre-operative retention requiring catheterization, 45 patients were using an alpha blocker and 41 were using a 5-alpha reductase inhibitor. The average operative time was 45.1±22.1 minutes, laser time of 20.9± 13 minutes, and energy of 146±96.8 kilojoules. All patients were discharged from the hospital within 48 hours of the procedure, five patients were discharged with a catheter. The median follow up time was 6 months (IQR 3-22.5), there were 12 complications within 30 days, including 2 patients with persistent retention, 4 patients had urinary tract infections, 4 patients had severe urgency requiring medications, one patient had intermittent hematuria and 1 patient had a paraphimosis. There was no incidence of stricture or bladder neck up to four years of follow up. The IPSS score improved from was 22.8±7 at baseline 0.7±7 (p<0.01) and 6.31±4.4 (p<0.01) at 30 and 180 days, respectively. The maximal flow rate improved from 7.7±4.6 ml/sec at baseline to 17.25±9.3 mL/sec (p<0.01) and 19.14±7.19 (p<0.001) at 30 and 180 days, respectively, while the PVR improved from 216±271 mL pre-operatively to 32.8±45.3 (p<0.01) and 26.23±46 (p<0.01) at 30 and 180 days, respectively. The PSA drop from 1.97±1.76 ng/mL pre-operatively to 0.74±0.63 ng/mL 180 days, respectively.

Conclusions

Photovaporzation of prostates smaller than 40 grams with the 180-W XPS-laser has been shown to have a durable improvement in symptomatic and clinical parameters.

Funding

None

Authors
Ramy Goueli
Lesa Deonarine
Dominique Thomas
Kristina Navrazhina
Kelsey Lawson
Malek Meskawi
Marc Zanaty
Vincent Misrai
Roger Valdivieso
Pierre-Alain Hueber
Kevin Zorn
Alexis Te
Bilal Chughtai
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