title: Prostate laser vaporization in men with urinary retention.
abstract: OBJECTIVE
  • To evaluate the safety and efficacy of laser vaporization of the prostate (LVP) with several different wavelengths for urinary retention.
  
  
  METHODS
  • A cohort study of patients undergoing LVP from 2005 to 2009 at a single institution was performed. • Outcomes were compared in those patients with urinary retention versus those without, using t-tests, Mann-Whitney U-test, chi-squared test and Fisher's exact test as appropriate.
  
  
  RESULTS
  • During the study period, 122 patients underwent LVP, of which 39 (32%) presented with refractory urinary retention requiring indwelling or intermittent catheterization. • The mean ± SD period of postoperative follow-up was 11.2 ± 9.6 months. Comparing patients with and without urinary retention, there were no significant preoperative differences in median body mass index (25.6 versus 26.4 kg/m(2) ; P= 0.40) or prostate-specific antigen (2.3 versus 2 ng/mL; P= 0.27). • Patients with urinary retention were significantly more likely to be diabetic (33% versus 12%; P= 0.01), have heart disease (36% versus 15%; P= 0.01) and be taking anticoagulants (61% versus 31%; P= 0.003). • Following LVP, retention patients were more likely than non-retention patients to fail an initial voiding trial (28.2% versus 7.2%; P= 0.002). • In total, 36 of 39 (92%) retention patients no longer required catheterization after postoperative recovery. No patients required perioperative transfusion. • Compared to those without preoperative retention, retention patients had a longer median duration of postoperative catheterization (3 versus 1 days; P= 0.01). • There were similar rates of low- and high-grade complications (P= 0.275 and 1.000, respectively) and no significant difference in median hospital stay (1 versus 0 days; P= 0.212).
  
  
  CONCLUSIONS
  • In the present study cohort, LVP was an effective and safe therapy for urinary retention. • Compared to patients without retention, those with retention had a higher prevalence of heart disease, diabetes and anticoagulant use. • Because the morbidity of LVP is low, and the prevalence of co-morbid disease high, LVP should be considered for the surgical management of refractory urinary retention.
authors.affiliation: Division of Urology, University of California San Diego Medical Center, San Diego, CA, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Woldrich
authors.forename: Kerrin
authors.initials: K
authors.lastname: Palazzi-Churas
authors.forename: Charles
authors.initials: C
authors.lastname: Lakin
authors.forename: Michael
authors.initials: M
authors.lastname: Albo
authors.forename: J Kellogg
authors.initials: JK
authors.lastname: Parsons
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D053448:Prostatism / Q000601:surgery*; D016896:Treatment Outcome; D014546:Urinary Catheterization; D016055:Urinary Retention / Q000209:etiology / Q000601:surgery*