AB174. Clinical analysis of transurethral end-fire greenlight PVRP-ST for the treatment of elderly and high-risk patients with

Objective: Analyzing the features of transurethral end-fire greenlight photoselective vaporesection of prostate-shovel technique (PVRP-ST) and evaluating the safety and efficacy of transurethral end-fire greenlight PVRP-ST for high-risk and elderly patients with benign prostatic hyperplasia (BPH) by comparing with TURP.

Methods: We analyzed a total of 93 high-risk and elderly patients with BPH underwent PVRP-ST (50 cases) and TURP (43 cases) from September 2013 to March 2015 in Guangdong NO. 2 Provincial People’s Hospital prospectively. We collected their generally information (including age, duration of oral drug finasteride time, prostate volume, past medical history, PSA situation and complications etc.), and recorded operative time, blood loss, the number of intraoperative flushing fluid bag, postoperative bladder irrigation time, postoperative catheter indwelling time, the postoperative hospitalization days, intraoperative complications and postoperative complications. The variables such as sodium (Na+) concentration, potassiumions (K+) concentration, hemoglobin (Hb) concentration, and hematocrit (HCT) were compared before and after operation. Detecting the maximum urinary flow rate (Qmax), residual urine volume (RUV), fill in the International Prostate Symptom (IPSS) score sheet, quality of life (QoL) score sheet before the surgery. Following up the IPSS, QoL, Qmax and RUV after 3 months of operation. The IPSS, QoL, Qmax and RUV were compared between preoperation and 3 months after operation. Using relevant statistical methods to compare the data between preoperation and postoperation with SPSS 17.0 software.

Results: All patients were successfully performed surgery with no serious complications, no deaths, no case turn to open surgery and no capsular perforation. (I) There were not significant differences in values of preoperative general information between two the groups of patients (P>0.05); (II) the average operative time of group PVRP-ST was (68.2±23.8) min, and the average operative time of group TURP was (61.8±22.3) min, there were not significant differences between the two groups (P>0.05); (III) group PVRP-ST: the average blood loss was(4.5±1.9)ml, average flushing fluid were (3.1±1.3) bags, mean bladder irrigation time was (17.6±8.3) h, mean catheter indwelling time was (38.6±8.1) h and the mean postoperative hospitalization days were (3.3±1.7) days. Group TURP: the average blood loss was (25.9±8.7) mL, average flushing fluid were (4.3±1.3) bags, mean bladder irrigation time was (58.0±19.7) h, mean catheter indwelling time was (85.9±24.6) h and the mean postoperative hospitalization days were (4.6±1.0) days. There were significant differences of the parameters above between the two groups (P<0.05); (IV) group PVRP-ST: there was no case of intraoperative blood transfusions, obturator nerve reflex or transurethral resection syndrome. There were two cases of hyponatremia, one case of hypokalemia, two cases of induce or aggravate existing medical conditions. Group TURP: one case of intraoperative blood transfusion, five cases of obturator nerve reflex, four cases transurethral resection syndrome, ten cases of hyponatremia, six cases of hypokalemia syndrome, eight cases induce or aggravate existing medical conditions. There was no significant difference of conversion to open surgery and capsular perforation and intraoperative blood transfusion index between the two groups (P>0.05). There were differences of the other intraoperative complications between the two groups (P>0.05); (V) There was not postoperative urethral stricture or bladder neck contracture and urinary incontinence in two groups of patients. Group PVRP-ST: no blood transfusion patients, four cases of catheter blockage occurs in, one case of hematuria, one case of dysuria, three cases of urinary tract infection, three cases transient dysuria, no case of original system diseases was induced or aggravated. Group TURP: one case of blood transfusion, three cases catheter blockage, four cases of hematuria after catheter removal, one case of dysuria, three cases of transient dysuria, three cases of urinary tract infection, two cases of original system diseases was induced or aggravated and one case of bleeding was performed second surgery to electric coagulation hemostasis. The incidence of postoperative hematuria in Group PVRP-ST was lower than the group TURP, there was differences between the two groups (P<0.05), there was no significant difference between the two groups in other postoperative complication indexes (P>0.05); (VI) The postoperative Hb concentration, HCT, Na+ concentration, K+ concentration of group PVRP-ST decreased less than group TURP., there was no significant difference between preoperation and postoperation (P>0.05). The postoperative Hb concentration, HCT, Na+ concentration, K+ concentration of group TURP fell more, there was significant difference between preoperation and postoperation (P<0.05); (VII) group PVRP-ST: Qmax, RUV, IPSS, QoL was significantly improved after three months. There were significant statistically differences between preoperation and 3 months after operation (P<0.01). Group TURP: Qmax, RUV, IPSS, QoL was significantly improved after three months. There were significant differences between preoperation and 3 months after operation (P<0.01). While there were no significant difference of the indexes between the two groups (P>0.05).

Conclusions: (I) PVRP-ST is effective for the treatment of BPH, the short-term efficacy is similar to TURP; (II) PVRP-ST is effective in improving the traditional surgery of side fire greenlight PVP, the operative time became shorter and it is similar to TURP. More importantly, a postoperative pathological specimens is available; (III) compared with TURP, the patients can be underwent PVRP-ST without stopping taking anticoagulants and there was less blood loss, less impact on blood electrolyte concentration perioperative; (IV) there is lower intraoperative complication rate, surgical risk and higher security for elderly patients at high risk; (V) compared with TURP, the patients underwent PVRP-ST can recovery quicker and the hospital stay days are shorter. There is lower incidence of postoperative hematuria. But there was no significant difference between the other complications.

Keywords: Prostatic; laser therapy; high-risk