The PVP procedure for BPH: Long-term outcomes

Laser technology for prostatectomy has steadily gained clinical utility, potentially replacing TURP. Multiple clinical studies demonstrate that its unique features of minimal invasiveness with minimal morbidity are combined in a desirable, safe, efficacious procedure to treat BPH. However, the question is whether its long-term outcomes are comparable to those of TURP, especially in light of decreased morbidity with the laser.

The rationale for treatment with TURP has been based on surgical debulking of obstructive prostatic tissue, which is considered to be the etiology of lower urinary tract symptoms and the cause of complete prostatic bladder outlet obstruction leading to urinary retention. Among generally accepted advantages are a 100% improvement in urinary flow rates with greater than 50% palliation in symptoms or, in the case of urinary retention, the return of spontaneous voiding. In terms of durability, the re-treatment rate associated with TURP procedures is 10% to 15% at 10 years. In many studies, these traditional therapies achieve excellent results due to efficient debulking that attains a surgical endpoint described as an adequate TUR defect. This defect properly removes the prostatic bladder outlet obstruction causing the pathology, but the defect is only as good as the surgeon's skill and persistence to achieve it.

What, then, is the comparable quantitative standard by which these traditional therapies can be assessed in terms of adequate resection resulting in long-term durability, and how does laser treatment compare to this standard?

PVP involves a hemostatic, high-powered vaporizing laser with a 532-nm wavelength selectively absorbed by hemoglobin (Urology 1996; 48:575-83). High-powered laser energy is delivered into the cells through an aqueous medium such as saline, where it is absorbed by hemoglobin, which acts as an intracellular chromophore, rapidly heating the cells and vaporizing tissue. The wavelength's short, high-powered optical penetration combined with continuous-flow cooling irrigation leads to rapid vaporization and a confined energy effect, producing a clinically optimal 1- to 2-mm rim of hemostatic coagulated tissue.