Korean J Urol.  2013 Jan;54(1):36-41.

Effect of Photoselective Vaporization Prostatectomy on Lower Urinary Tract Symptoms in Benign Prostatic Hyperplasia With or Without Intravesical Prostatic Protrusion

• Kim MS
• Park KK
• Chung BH
• Lee SH

Abstract

PURPOSE
Intravesical protrusion of the prostate (IPP) can affect voiding. We evaluated the improvement in lower urinary tract symptoms and patient satisfaction after laser prostate photovaporization in benign prostatic hyperplasia (BPH) patients with or without IPP.
MATERIALS AND METHODS
This prospective study included 134 patients who underwent GreenLight HPS laser photoselective vaporization prostatectomy (PVP) between January 2010 and July 2011 patient. Preoperative IPP was evaluated by using the retroflexed view from flexible cystoscopy. evaluation included complete medical history, International Prostate Symptom Scores (IPSS), maximum flow rate (Qmax), postvoid residual (PVR), serum prostate-specific antigen (PSA), and transrectal ultrasonogram. Changes from baseline in Qmax, PVR, total IPSS, and IPSS subscores (voiding and storage) were analyzed at postoperative months 1, 3, and 6.
RESULTS
The patients' mean age was 66.6+/-7.8 years. Mean serum PSA and prostate volume were 1.7+/-1.5 ng/mL and 42.9+/-16.7 g, respectively. No significant differences existed between the IPP and no IPP groups in preoperative prostate volume, total IPSS, PSA, or lasing time and energy. The mean follow-up duration was 6.2+/-1.9 months. IPP patients showed significant improvements in total IPSS and voiding subscores at months 1 and 3. Improvements in the quality of life score and storage subscore were not significantly different between the groups. Qmax was significantly improved at 6 months postoperatively in the IPP group versus the no IPP group.
CONCLUSIONS
Among patients who underwent PVP for BPH, the IPP group showed more symptom improvement, especially in voiding symptoms, than did the no IPP group. Preoperative cystoscopy is helpful for evaluating IPP and for anticipating postoperative outcome.

Keyword

Lasers; Prostate; Prostatic hyperplasia; Transurethral resection of prostate; Urinary bladder neck obstruction

MeSH Terms

Cystoscopy
Follow-Up Studies
Humans
Indoles
Lower Urinary Tract Symptoms
Patient Satisfaction
Prospective Studies
Prostate
Prostate-Specific Antigen
Prostatectomy
Prostatic Hyperplasia
Quality of Life
Transurethral Resection of Prostate
Urinary Bladder Neck Obstruction
Volatilization
Indoles
Prostate-Specific Antigen

Figure

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  FIG. 1 Changes in the total International Prostate Symptom Score (IPSS) score with time in the intravesical prostatic protrusion (IPP) and no IPP groups. a:Significant difference between the IPP and no IPP groups, p<0.05.

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  FIG. 2 Changes in the voiding subscore with time in the intravesical prostatic protrusion (IPP) and no IPP groups. a:Significant difference between the IPP and no IPP groups, p<0.05.

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  FIG. 3 Changes in the storage subscore with time in the intravesical prostatic protrusion (IPP) and no IPP groups.

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  FIG. 4 Improved maximal uroflow rate for up to 6 months after photoselective vaporization of the prostate. Qmax, maximum flow rate. a:Significant difference between the intravesical prostatic protrusion (IPP) and no IPP groups (t-test); p=0.821 at month 1, p=0.558 at month 3, p=0.047 at month 6.

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