title: Risk factors for long-term outcome in photoselective vaporization of the prostate.
abstract: OBJECTIVE
  The aim of this retrospective cohort study was to investigate long-term risk factors for reintervention after photoselective vaporization of the prostate (PVP).
  
  
  METHODS
  In total, 566 consecutive patients with benign prostatic hyperplasia (BPH) underwent PVP between February 2005 and April 2011. Mean follow-up was 36.42 ± 21.4 months. Perioperative parameters were evaluated, including surgery time, delivered energy, catheterization and duration of hospitalization, intraoperative and postoperative complications, as well as reintervention rates in manifest reobstruction. Follow-up comprised the International Prostate Symptom Score and quality of life questionnaire (IPPS-QoL), maximal flow rate (Qmax) and postvoiding residual volume (PVR).
  
  
  RESULTS
  Mean operation time was 69.8 ± 29.3 min. Mean catheterization and hospitalization times were 1.49 ± 1.19 days and 2.67 ± 2.19 days, respectively. There was ongoing oral anticoagulation for 20.1% of the patients (n = 114). The overall retreatment rate was 17.6% (101 out of 566 patients) after a mean time of 9.21 months (range 0-64 months). Of these, 88 patients (15.55%) had a reobstruction and 13 (2.3%) had urethral strictures. In multivariate analysis, age, prostate volume, total applied energy, specific laser energy usage, preoperative symptomatic (IPSS/QoL) and functional obstruction grade (Qmax/PVR) were not identified as risk factors for reintervention. A poor postoperative Qmax (< 15 ml/s) measured immediately after removal of the transurethral catheter was identified as a risk factor for undergoing a reintervention (p = 0.005).
  
  
  CONCLUSIONS
  PVP is an effective method for BPH treatment, allowing for sustained long-term improvement of the voiding function. Poor immediate postoperative urinary flow after removal of the transurethral catheter (Qmax < 15 ml/s) is a significant risk factor for reintervention.
authors.affiliation: a Department of Urology , University of Heidelberg , Heidelberg , Germany.
authors.forename: Ionel Valentin
authors.initials: IV
authors.lastname: Popeneciu
authors.affiliation: a Department of Urology , University of Heidelberg , Heidelberg , Germany.
authors.forename: Gencay
authors.initials: G
authors.lastname: Hatiboglu
authors.affiliation: a Department of Urology , University of Heidelberg , Heidelberg , Germany.
authors.forename: Timur Hassan
authors.initials: TH
authors.lastname: Kuru
authors.affiliation: a Department of Urology , University of Heidelberg , Heidelberg , Germany.
authors.forename: Sandra
authors.initials: S
authors.lastname: Milakovic
authors.affiliation: a Department of Urology , University of Heidelberg , Heidelberg , Germany.
authors.forename: Gerald
authors.initials: G
authors.lastname: Freier
authors.affiliation: a Department of Urology , University of Heidelberg , Heidelberg , Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Hadaschik
authors.affiliation: a Department of Urology , University of Heidelberg , Heidelberg , Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Hohenfellner
authors.affiliation: a Department of Urology , University of Heidelberg , Heidelberg , Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Pahernik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011470:Prostatic Hyperplasia / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D020728:Transurethral Resection of Prostate; D016896:Treatment Outcome
keywords: Benign prostatic obstruction; GreenLight laser; long-term follow-up; lower urinary tract symptoms; photoselective vaporization of the prostate; prostate vaporization; reintervention; risk factors