Photoselective vaporization of the prostate with the 120W lithium triborate laser for the treatment of acute urinary retention

Amanda SJ Chung, Henry H Woo
Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, New South Wales, Australia

Purpose: Whilst photoselective vaporization of the prostate (PVP) is used to treat benign prostatic hyperplasia, there is little reported about its performance in urinary retention. The objective of this study is to evaluate the efficacy and safety of GreenLight™ high performance system 120W lithium triborate laser (American Medical Systems, Inc, Minnetonka, MN) PVP in men with urinary retention.
Patients and methods: Retrospective analysis of data of all men in urinary retention who underwent treatment with the 120W lithium triborate laser PVP by a single surgeon from November 2006 to July 2010 was performed (n = 78), median age 71 years (interquartile range, 64–80), median prostate volume 91 mL (interquartile range, 58–121). Perioperative outcomes and functional outcomes at baseline, and at 3 and 12 months post-operation were examined.
Results: Patients managed preoperatively by urethral catheterization (n = 61) and suprapubic catheterization (n = 5) were of greater age (by 8.2 years, P < 0.05) and higher American Society of Anesthesiologists scores (P = 0.000, Fisher’s exact test mid P) than patients managed by intermittent self-catheterization (n = 12), but there was no difference in outcomes. There were three Clavien grade III, two Clavien grade IV, and no Clavien grade V complications. There were also no blood transfusions. Fifty-three men (68%) voided successfully post-PVP and went home catheter-free within 24 hours. At 3 months, 62 out of 64 evaluable men (97%) were voiding well without needing any form of catheterization. At 3 months and 12 months, median International Prostate Symptom Score was 7 and 6; International Prostate Symptom Score Quality of Life Index 1 and 1; peak urinary flow 19 and 22 mL/sec; and post-void ultrasound measured residual urine volume 52 and 60 mL, respectively.
Conclusion: PVP for urinary retention is an efficacious and safe treatment modality.

Keywords: benign prostatic hyperplasia, laser prostatectomy