Effect Of Straight Light Beam Greenlight PVP For The Treatment Of Benign Prostatic Hyperplasia

Objective:Benign prostate hyperplasia (BPH) is one of the most common diseases seen in elder men,the incidence of BPH increased with the age.The common goals of surgical treatment for lower urinary tract symptoms (LUTS) related to BPH are to reduce subjective and objective symptoms,improve quality of life,decrease the risk of postoperative complications,and shorten hospitalization.For decades,transurethral resection of the prostate (TURP) is respected as the most effective surgical method for treatment of symptomatic BPH. Because of its significant and durable improvement in LUTS,TURP is a widely accepted reference standard in surgical treatment options.However,despite various technical and anesthetic improvements,certain significant morbidities such as severe bleeding and transurethral resection (TUR) syndrome still occur,Incidence of intraoperative and postoperative complications still high.Therefore,there is an interest in a number of emerging minimally invasive therapies including photoselective vaporization of the prostate (PVP) as alterative treatment options.However,The beam of the traditional PVP is a side light beam,It has the disadvantage of long operationing time,high incidence of postoperative urinary infection,and a lager residual gland compare with TURP,Therefore,It limits the application of PVP in a certain extent.In order to further improve the efficiency of vaporization of the PVP,this study use160W straight light beam PVP for the treatment of BPH,and compare with TURP, aim to evaluate the efficiency of160W straight light beam PVP.Methods:A total of58patients with lower urinary tract symptoms secondary to BPH from March2011to December2011in Shandong Provincial Hospital were randomly divided into two groups,28patients underwent160W straight light beam greenlight PVP and30patients underwent TURP.The significant therapeutic results and markers were recorded and assessed using the folloowing variables:residual urine volume(RUV),International Prostatic Symptom Score(IPSS),Quality of life (QOL),maxmium flow rates (Qmax),operative time,hemorrhage volume during surgery,catheter indwelling time,hospital stay time,and postoperative complications before and1、3、6months after surgical therapy.Results:All operations were successfully completed,and no severe complicaton occured. 1. There was no significant difference between the two groups in terms of the preoperative factors(P>0.05).2. No severe intraoperative complications were recorded,No one needed blood transfusion caused by massive bleeding or developed capsule perforation/TURS in both of the two groups.3. The mean time of operation for straight light beam PVP was (56.2+25.3)min,while the TURP was (55.7+23.2) min;There was no difference between the two groups.4. The hemorrhage volume during surgery was (25.6±12.4) ml in straight light beam PVP group,while the TURP group was (83.5±21.4) ml.The time of bladder irrigating after surgical therapy was (24.0±12.0) h in straight light beam PVP group,while the TURP group was (48.0±24.5) h. The time of catheter indwelling was (2.2+1.1) d in straight light beam PVP group,(7.5±2.3) d in TURP group.Hospital stay time was (7.3±1.6) days in straight light beam PVP group,significantly shorter than (11.3±2.5) d in TURP group. A apparent difference between the two groups was found in the above four markers (P<0.05).5. All patients were reevaluated at1,3, and6moths after operation.The IPSS,QOL,Qmax and RUV were significantly improved in both groups after operations(P<0.05),no significant differrence in the improvement of the subjective symptom and objective signs were found between the2groups(P>0.05)..6. During the early postoperative course, gross hematuria was observed in1patients (3.33%)in the TURP group and in none of the patients in the PVP group.Transient mild to moderate urinary frequency and urgency was seen in8patients (26.7%) in the TURP group and7patients(25.0%) in the PVP group,dysuria was seen in4patients(13.3%) in the TURP group and3patients(10.7%) in the PVP group.dysuria was seen in2patients (7.14%) in the TURP group and3patients(10.0%) in the PVP group,1patient(3.57%) in the TURP group experienced urethral stricture that was solved by urethral dilatation.Sexual dysfunction was recorded in2patients (6.67%) treated by TURP and1patient(3.33%)treated by PVP.No significant difference between the two groups was found(P>0.05). Conclusion:1. Straight light beam PVP for the treatment of lower urinary tract symptoms (LUTS) related to BPH is as effective as TURP.2. The straight light beam PVP has the following advantages:①Use26Fr resectoscope sheath,overcoming the shortages of poor circulating water flushing effect that the traditional side light beam PVP has;②The energy of the laser do not have to refract through the side-out light device,it reduces the energy loss, increases the output power, so that the vaporization efficiency is greatly improved, and further shorten the operation time;③Laser emission direction of the optical fiber parallel to the longitudinal axis,Therefore,The incidence of reflection, scattering, specular and mirror sheath damage is greatly reduced.3.160W straight light beam greenlight PVP for the treatment of BPH has the advantage of few blood loss,safe surgical procedures and short hospital stay time;It provides an ideal operation method for the treatment of BPH.