Eighteen-month results of a randomized prospective study comparing transurethral photoselective vaporization with transvesical open enucleation for prostatic adenomas greater than 80 cc.
BACKGROUND
None Take Home Message: This is a prospective randomized study showing that for large prostatic adenomas, photoselective vaporization of the prostate requires less blood transfusions, shorter catheterization time and shorter hospital stay compared to open prostatectomy, while achieving similar functional results at the same time.


OBJECTIVE
The effectiveness and the safety of photoselective vaporization of the prostate (PVP) was compared to that of open prostatectomy (OP) for the surgical treatment of large prostatic adenomas.


METHODS
125 patients with prostate glands>80 ml, were randomly allocated to PVP (n=65) or OP (n=60) and prospectively evaluated at 1, 3, 6, 12, and 18 months postoperatively. International prostate symptom score (IPSS) and peak urinary flow rate (Qmax) were chosen as primary treatment-related endpoints.


RESULTS
Longer length of operation time, shorter length of catheterization and hospital stay were experienced by patients who underwent PVP. Although patients who underwent OP showed a higher transfusion rate, adverse events in general were minor and of similar profile in both groups. All functional parameters improved significantly compared to baseline values in both groups. There was no difference in IPSS between the two groups at 3, 6, 12, and 18 months postoperatively. Patients who underwent OP scored better in the IPSS-Quality of life score at 18 months postoperatively. At 18 months there were no significant differences between the two groups in the Qmax, post void residual urine volume and in the International Index for Erectile function-5 questionnaire. At three months prostate volume was significantly lower in the OP group and remained as such throughout follow-up.


CONCLUSIONS
Our results indicate that for an 18 month period photoselective vaporization of the prostate is a highly acceptable treatment alternative to open prostatectomy.
Skolarikos
Andreas
A
Athens Medical School, 2nd Department of Urology, Sismanoglio Hospital, Athens Greece. andskol@yahoo.com
Papachristou
Christos
C
Athanasiadis
G
G
Chalikopoulos
Dimitrios
D
Deliveliotis
Charalambos
C
Alivizatos
Gerasimos
G
D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D053844:Lasers, Solid-State; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D019990:Perioperative Care; D011182:Postoperative Care; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000473:pathology* / Q000601:surgery*; D011788:Quality of Life; D013997:Time Factors; D020728:Transurethral Resection of Prostate / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome