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Photoselective Vaporization of the Prostate (PVP) with GreenLight 180Watt-XPS is Effective in Patients with Urinary Retention
Gregg Eure1, Ricardo Gonzalez2, Mahmood Hai3, Lewis Kriteman4, Kevin Zorn5 1Urology of Virginia, Virginia Beach, VA;2Houston Metro Urology, Houston, TX;3Comprehensive Urology, Westland, MI;4Georgia Urology, Roswell, GA;5University of Montreal Health Center, Montreal, QC, Canada
INTRODUCTION: Men with BPH can present with urinary retention. The use of GreenLight 180W-XPS, a minimally invasive procedure has not been evaluated for its effectiveness in men presenting with urinary retention. We interrogated a large retrospective database to compare outcomes for men in urinary retention. MATERIALS & METHODS: Data on 928 patients with clinical BPH treated with GreenLight 180W-XPS were collected retrospectively from 5 centers. 204 men presented in urinary retention. Several clinical factors were ascertained to document efficacy and safety in men including: procedure time, energy applied in joules, postop catheterization time, IPSS, QOL, PVR and reoperation rates. RESULTS: The total procedure time and amount of energy used were greater in the retention group. However, postoperative IPSS, QOL, length of catheterization, reoperation rate, and proportion with adverse events were all similar between the two groups. PVR in the urinary retention group difference of 24 cc is not clinically meaningful CONCLUSIONS: PVP with GreenLight 180W-XPS is a safe, effective method of treating patients with BPH who present with catheter dependent urinary retention. There was a low reoperation rate and very few adverse events. The results show excellent outcomes with PVP in patients with advanced BPH who present with urinary retention.
TABLE 1 | Group | | | Variable | Retention (N = 204) | No (N = 724) | Total (N = 928) | p-value | Procedure time, min | 70.7 ± 32.4 (12.0, 64.0, 193.0) n = 195 | 52.8 ± 26.1 ( 15.0, 47.0, 210.0 ) n = 684 | 56.8 ± 28.5 ( 12.0, 50.0, 210.0 ) n = 879 | < 0.001 | Energy applied, kJ | 344.5 ± 208.0 ( 20.0, 303.5, 1103.6 ) n = 204 | 250.8 ± 161.2 ( 14.5, 205.3, 1006.2 ) n = 722 | 271.5 ± 176.8 ( 14.5, 225.0, 1103.6 ) n = 926 | < 0.001 | Length of catheterization, days | 1.4 ± 1.4 ( 0.3, 1.0, 14.0 ) n = 180 | 1.1 ± 0.9 ( 0.1, 1.0, 10.0 ) n = 502 | 1.2 ± 1.1 ( 0.1, 1.0, 14.0 ) n = 682 | 0.209 | IPSS, post-op | 5.6 ± 4.7 ( 0.0, 5.0, 28.0 ) n = 129 | 6.5 ± 5.8 ( 0.0, 5.0, 32.0 ) n = 423 | 6.3 ± 5.5 ( 0.0, 5.0, 32.0 ) n = 552 | 0.409 | IPSS, post-op <=8 9 to 21 greater than 21 | 82.2% ( 106) 16.3% ( 21) 1.6% ( 2) n = 129 | 74.8% (320) 22.0% ( 94) 3.3% (14) n = 428 | 76.5% (426) 20.6% ( 115) 2.9% ( 16) n = 557 | 0.218 | IPSS-QoL, post-op | 1.1 ± 1.1 ( 0.0, 1.0, 6.0 ) n = 124 | 1.4 ± 1.3 ( 0.0, 1.0, 6.0 ) n = 403 | 1.3 ± 1.3 ( 0.0, 1.0, 6.0 ) n = 527 | 0.079 | Post void residual, post-op | 65.4 ± 120.1 ( 0.0, 26.5, 999.0 ) n = 118 | 41.8 ± 88.4 ( 0.0, 15.0, 954.0 ) n = 450 | 46.7 ± 96.2 ( 0.0, 15.5, 999.0 ) n = 568 | < 0.001 | *Results are presented as percentage (count) or mean ± standard deviation (min, median, max). p-value is from statistical test of difference between groups. |
TABLE 2 | Group* | | | Event | Time Point (days) | Retention† | No† | Total† | Group Difference** | Urinary tract infection | 90 | 4.5% (9) [ 2.4% to 8.4% ] | 2.4% (17) [ 1.5% to 3.8% ] | 2.8% (26) [1.9% to 4.2% ] | 2.1% [ -1.0% to 5.2% ] | Stricture or BNC | 365 | 1.0% (2) [ 0.3% to 4.1% ] | 2.0% (13) [ 1.2% to 3.5% ] | 1.8% (15) [ 1.1% to 3.0% ] | -1.0% [ -2.8% to 0.8% ] | Retention | 90 | 6.4% (13) [ 3.8% to 10.8% ] | 3.4% (24) [ 2.3% to 5.0% ] | 4.0% (37) [ 2.9% to 5.5% ] | 3.0% [ -0.6% to 6.7% ] | Surgical retreatment | 365 | 2.8% (5) [ 1.2% to 6.5% ] | 2.1% (14) [ 1.3% to 3.6% ] | 2.3% (19) [ 1.5% to 3.6% ] | 0.6% [ -2.0% to 3.2% ] | * Results presented are Kaplan-Meier estimate for proportion of subjects with event (number of subjects) [95% confidence interval] † Complementary log-log confidence interval presented ** Linear confidence interval presented |
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