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A Prospective Evaluation of a Single Centers Experience with the Greenlight Laser for Photoselective Vaporization of the Prostate
Parviz K Kavoussi*
Texas A&M Health Sciences Center, Scott and White Memorial Hospital, Temple, TX
Introduction: Photoselective vaporization of the prostate (PVP) has become an alternative to transurethral resection of the prostate (TURP). Our results are presented.
Methods: 105 consecutive PVP patients were divided into 3 groups depending on pre-operative bladder management: Group N- catheter free (86), Group Y- indwelling catheters (8), and Group CIC- performing clean intermittent catheterization (11).
Results:
Data summarized in table. (ND=No data available)
| Timing | Group | AUA | Bother | SHIM | Flow Rate | Post-void Residual |
| Pre-op | N | 21.2 | 4 | 11.1 | 8.5 | 124 |
| Y | 20.6 | 5.2 | 7.6 | 7.6 | 1077 |
| CIC | 23 | 4.3 | 8 | 7.8 | 401 |
| 6 month post-op | N | 7.2 | 1.4 | 10.9 | 16.5 | 41.4 |
| Y | 8.7 | 1.7 | 22 | 7.9 | 139.8 |
| CIC | 8 | 2 | 3 | 11.5 | 127 |
| 12 month post-op | N | 8.3 | 1.6 | 9.8 | 17.1 | 64.6 |
| Y | 8 | 1 | 23 | ND | ND |
| CIC | 15.5 | 2.5 | 4.4 | 16 | 331 |
There were 65 complications. 17 required admission and CBI. 2 had significant bleeding over a week after their catheters were removed. 14 had dysuria for > 10 days after catheter removal. 19 had urge incontinence, 2 had stress incontinence, 3 developed strictures, 3 developed bladder neck contractures, and 5 required TURP within 1 year following PVP.
None required indwelling catheters up to 1 year after surgery. Of the 86 patients in group N, all were voiding spontaneously. Of the 8 in group Y, 7 (87.5%) void spontaneously, and 1 (12.5%) does CIC. Of the 11 in group CIC, 9 (81.8%) void spontaneously, and 2 (18.1%) continue to perform CIC.
Overall, 19 (52.8%) attempting immediate post-operative voiding trial were successful. 61 (88.4%) who waited until post-operative day 1 voided on first attempt.
Conclusions: All voiding parameters improved at 6 and 12 months post-operatively. Sexual function was maintained and improved for men in group Y. We recommend removal of catheters on post-operative day one.
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