Abstract: PD27-12
Sources of Funding: none

Introduction

According to EAU and AUA guidelines on management of male non-neurogenic lower urinary tract symptoms (LUTS), PVP XPS is superior to TURP with regard to intra-operative safety and postoperative complication rates such as bleeding. The experience of the GL system with very large glands (>200mL) is very limited. In the present study, we aimed to describe perioperative results as well as functional outcomes and complications of photo-vaporization of prostate glands bigger than 200 cc using the GL system.

Methods

Retrospective analysis of prospectively maintained multi center database was performed to select subgroup of men having very large prostates (>200mL) treated with the Greenlight-XPS laser using PVP for the treatment of symptomatic BPH. IPSS, Qmax, PVR and PSA were measured at 6, 12, 24, 36 and 48 months. Durability was evaluated using BPH re-treatment rate at 12, 24 and 36 months. Additionally complications were recorded using the Clavien-Dindo classification.

Results

A total of 38 (9%) men had prostates larger than 200mL. Men with very large prostates were older (76 vs 72 years, p=0.05), had higher PSA levels (9.9 vs 6.2 ng/dL, p=0.005) and had more indwelling catheters (55.6 vs 41.3, p=0.001). Patients with very large prostates had longer OR lasing times (94 vs 52 min), less energy density delivered (2.8 vs 3.4 kJ/mL) and longer time to removal of catheter (48 vs 24 hours). In terms of complications men with very large prostates had more LUTS at 6 months and the re-treatment rate were the same at 2 years (4.9 vs 5%). Finally, functional outcomes were similar however very large prostates had a smaller PSA drop in comparison (28 vs 50%).

Conclusions

PVP Greenlight XPS-180W is an acceptable technique for very large prostates (>200mL). However, OR times, energy density delivery, PSA drop at two years of follow up, catheterization time and LUTS are a concern in this particular subgroup. This should be used for patient counseling and surgery planning.

Funding

none