Laser transurethral resection of the prostate: Safety study of a novel system of photoselective vaporization with high power diode laser in prostates larger than 80mL.
OBJECTIVE
To present the feasibility of photoselective vaporization of the prostate (PVP) with of a new diode laser-resection system. Surgical treatment of benign prostatic hyperplasia (BPH) is constantly evolving. Laser techniques are increasingly used in prostates of large size.


METHODS
A prospective study was performed to evaluate operative data and patient outcomes with PVP using high-power diode laser (HPD) and a novel quartz-head fiber with shovel shape in patients with prostate>80mL. Demographic data, operative time, hemoglobin loss, operative results (IPSS, quality of life (QoL), Qmax, post void residue (PVR), IIEF-5 and micturition diary) and complications following Clavien-Dindo classification are described.


RESULTS
Thirty-one patients were included in the study. Sixteen (51.6%) were on active antiplatelet treatment and 12 (38.7%) had received anticoagulants before surgery. All cases were followed at least 6mo. No intraoperative or postoperative major complications occurred. Three patients (9.7%) had minor complications according to Clavien-Dindo classification. Twenty-seven (87.1%) were discharged on postoperative day one without catheter. There were significant improvements in IPSS, QoL, Qmax and PVR, both at 3 and 6mo (P<.0001), but sexual function according to IIEF-5 showed no differences. Urgency (any grade) increased at 3mo (48.4%; P=.002) and considerably decreased at 6mo (9.7%; P<.0001).


CONCLUSIONS
This pilot experience with shovel shape fiber and HPD is encouraging. It shows that laser-resection is a safe procedure, achieving excellent results in terms of IPSS, QoL and Qmax in large prostates even in high-risk patients. Longer follow-up, comparative and randomized controlled studies are needed to widespread these results.
Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate International Universities, Madrid, España.
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Andrés
Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate International Universities, Madrid, España.
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Arance
Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate International Universities, Madrid, España.
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Gimbernat
Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate International Universities, Madrid, España.
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Redondo
Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate International Universities, Madrid, España.
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García-Tello
Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate International Universities, Madrid, España. Electronic address: jangulo@futurnet.es.
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JC
Angulo
D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D004867:Equipment Design; D007172:Erectile Dysfunction / Q000209:etiology; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D054023:Lasers, Semiconductor; D059411:Lower Urinary Tract Symptoms / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011183:Postoperative Complications; D011446:Prospective Studies; D011467:Prostate / Q000473:pathology*; D011470:Prostatic Hyperplasia / Q000150:complications / Q000473:pathology / Q000601:surgery*; D011788:Quality of Life; D020728:Transurethral Resection of Prostate / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D014835:Volatilization
Benign prostatic hyperplasia; High power diode laser; Hiperplasia prostática benigna; Laser-resection of the prostate; Láser diodo de alta potencia; Láser-resección transuretral prostática; Photoselective vaporization of the prostate; Vaporización fotoselectiva de la próstata