PVP laser enabling BPH treatment for more patients

New Orleans-Laser photoselective vaporization prostatectomy (PVP) is permitting surgical intervention for BPH in a widening array of patients, many of whom harbor comorbidities that would ordinarily exclude them from invasive procedures, according to a new multinational report.

Dr. WongCo-author Carson Wong, MD, told Urology Times on behalf of the Clinical Research Office of the Endourological Society (CROES) that the paper presented at the 2013 World Congress of Endourology and SWL in New Orleans was a baseline report that detailed characteristics of the patient cohort in the study. Patients underwent PVP (GreenLight [American Medical Systems, Minnetonka, MN]) at one of three powers using the potassium-titanyl-phosphate (KTP) or lithium triborate (LBO) laser. Information concerning PVP outcomes, adverse events, and related clinical findings is to be presented at a later date following careful analysis of data derived from 25 centers around the globe.

“What can be said is that the procedure can be offered to select patients with lower urinary tract symptoms secondary to BPH who have cardiac and/or other comorbidities, including those on anticoagulation therapy. Many of these patients might otherwise be excluded from surgical intervention,” said Dr. Wong, chief of urology at University Hospitals Ahuja Medical Center, Beachwood, OH. He also holds positions at the Center for Minimally Invasive and Robotic Surgery at Parma Community General Hospital, Parma, OH and Southwest Urology, LLC, Cleveland.

The baseline data in the report show that 370 (52.3%) of the 713 patients in the study had a history of cardiac disease and 239 (33.7%) were receiving anticoagulation therapy at the time of their procedure. Ninety-six (13.5%) of the patients had diabetes mellitus and 177 (36.7%) reported some degree of erectile dysfunction.

Dr. Wong, a member of the study’s CROES steering committee, said he could not speak in detail about the outcomes until the study’s clinical findings were released. Based on prior publications, he noted that the laser technology offered several advantages over transurethral resection of the prostate (TURP), the current gold standard. Compared to TURP, the laser procedure engenders minimal bleeding, and the risk of hypotonic fluid absorption is also minimal. These characteristics permit the procedure to be conducted on patients with comorbidities that otherwise would mitigate against surgical intervention.

The CROES study collected prospective data from GreenLight laser PVP procedures conducted in 713 consecutive patients at 25 centers internationally between April 2010 and April 2012. The men had a mean age of 69.4 years and were divided into three groups according to the power of the laser being employed: 80-W, 247 patients; 120-W, 356 patients; and 180-W, 110 patients.

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Power choice likely related to availability

Dr. Wong said the choice of laser power was not necessarily a clinical decision but was more likely a reflection of the availability of the specific laser at a specific institution. The 80-W KTP laser became available a little over 10 years ago. The more powerful 120-W HPS laser appeared in 2006 and the 180-W XPS laser is the most recent model.

“There are a number of surgeons around the world still using the 80-W laser, but it is our impression that the 120-W and 180-W lasers are the most prevalent,” Dr. Wong said.

The CROES report stated that the 120-W technology was the most commonly used in the study and that the 180-W model was used in patients with higher prostate volumes.

The cohort’s overall mean preoperative maximum flow rate was 8.2 mL/s, and median post-void residual volume was 80 mL. The median International Prostate Symptom Score was 21 (severe) and median quality of life score was 4 (mostly dissatisfied).

American Medical Systems provided support for the study.UT

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