Photoselective vaporization of the prostate: pursuing good indications based on the results of 400 Japanese patients.

Abstract

To investigate good indications of photoselective vaporization of the prostate (PVP) by retrospective evaluation of its efficacy in relation to prostate volume. A cohort of 400 patients had International Prostate Symptoms Score (IPSS), Quality of Life (QoL) score, urinary peak flow (Q(max) ), and prostate volume (P(vol) ), assessed before and after surgery. Changes of outcome variables were compared among four groups classified according to preoperative prostate volume: <30 mL (group A), ≥30 and <50 mL (group B), ≥50 and <70 mL (group C), and >70 mL (group D). Operating times and amounts of energy applied were 44.2 min and 159 kJ, 67.7 min and 268 kJ, 111 min and 409 kJ, and 171 min and 604 kJ in groups A, B, C, and D, respectively. All variables improved significantly and immediately, and remained for more than 12 months. Investigation of groups classified by prostate size demonstrated that IPSS and QoL score decreased and improvement rate of Q(max) rose as prostate volume increased. Changes of P(vol) were from 24.5 mL to 13.2 mL (-46.1%), from 39.8 mL to 22.9 mL (-42.4%), from 58.4 mL to 32.8 mL (-43.8%), and from 92.1 mL to 53.8 mL (-41.5%) in groups A, B, C, and D, respectively. Overall the P(vol) reduction rate was 43.2%, and no significant differences were observed in reduction ratios among the groups. Complications were minimal, but bladder neck contracture arose in 16 cases with a smaller prostate. Whilst the percentage reduction in volume was similar across the groups, the larger absolute volume reduction in patients with larger prostates was associated with greater improvement in objective urinary function variables, and with symptom score reduction.