NEW YORK (Reuters Health) – High-power laser vaporization is a safe and effective alternative to transurethral resection of the prostate (TURP) for benign prostatic hyperplasia, results of a new study show.
“It provides better intraoperative and early postoperative outcomes,” researchers write in European Urology, “but induces more storage bladder symptoms.”
They don’t recommend the procedure in patients with a prostate of more than 80 ml, though, due to a high re-operation rate in such men.
As reported by Reuters Health on June 9, many urologists already use laser-ablation techniques. But according to the senior author of the new report, Dr. Ahmed Shokeir of Mansoura University in Egypt, laser procedures have evolved so quickly that reproducible results from randomized trials with long-term follow-up do not yet exist. The new study, published online May 27th, is the first randomized controlled trial to compare 120-W laser ablation to TURP with a mid-term follow-up, the researchers say.
They included 120 patients with International Prostate Symptoms Scores greater than 16 (indicating moderate to severe lower urinary tract symptoms); post-void residual urine greater than 100 ml; maximum flow rate less than 15 ml/sec; and prostate volume less than 100 ml. Patients were excluded if they were on permanent anticoagulants, or had urethral strictures, bladder stones or neurogenic bladder.
Half of the patients received standard TURP, while the other half were treated with a GreenLight High Performance System laser. The high energy of the laser, based on a lithium triborate crystal, was presumed to produce faster vaporization and greater penetration than earlier models.
All functional measures improved markedly after surgery, with no significant differences between the two groups. Laser surgery took on average nine minutes longer than TURP, but the average hospital stay was shorter in the laser group (2.3 vs. 4.1 days, p<0.0001) as was catheterization (1.4 vs. 2.7 days, p<0.0001).
Compared with baseline values, only the TURP group showed a decrease in hemoglobin and serum sodium levels; three of these patients developed TUR syndrome, characterized by hyponatremia due to absorption of large volumes of bladder irrigation fluid.
In general, laser surgery had fewer complications than TURP. Twelve TURP patients needed blood transfusions and 10 had capsule perforation; early clot retention was seen in 6 of these patients. None of these problems occurred in the prostate vaporization protocol.
In the first month after the procedure, however, more laser surgery patients had storage bladder symptoms compared to the TURP group (56, or 93%, vs. 19, or 32%; p = 0.001). And six patients in the laser-surgery group required a re-operation during the three-year follow-up, compared to only one in the TURP group; all had a prostate volume of more than 80 ml.
“There is some concern regarding the long-term reoperation rate” with photoselective vaporization, the research team acknowledges. “There are few long-term studies available at present, and none is in the setting of a randomized trial,” the authors said.
They note that the TURP patients had significantly greater percentage reductions in prostate size and prostate specific antigen levels compared to men treated with laser vaporization.
“Notably, the prostate size in all redo cases was >80 g,” they point out. “Therefore, we do not recommend doing (photoselective vaporization) for prostate >80 g at the present time. Nevertheless, with increasing experience it would be expected that more tissue would be vaporized.”
They note that the surgeons in the study had different levels of experience, which could explain part of the high transfusion and perforation rates in the TURP group. Because the study wasn’t blinded, they recommend caution when interpreting the findings.
The researchers did not estimate costs, but say the initial high cost of the laser equipment might be offset by the shorter hospital stay.
Reference:
http://www.europeanurology.com/article/S0302-2838%2810%2900463-X/fulltext
Eur Urol 2010.
