Patients with symptomatic benign prostatic hyperplasia (BPH) may be effectively treated with the surgical technology of straight beam lithium triborate laser (LBO), with shorter duration for catheterization and hospital stay after surgery, according to researchers at Shandong Provincial Hospital Affiliated to Shandong University in China.
The study, “Transurethral 160-W straight beam green laser vaporesection of the prostate: initial experience after 180 procedures,” published in Springerplus, describes a prospective study where the benefits of LBO photoselective vaporesection of the prostate (PVRP) for the surgical treatment of BPH were assessed.
Photoselective vaporization of the prostate (PVP) has recently emerged as equally effective for the treatment of BPH as the gold standard transurethral resection of the prostate (TURP). Some studies even report benefits of PVP over TURP, such as shorter catheterization and hospital stay periods.
But compared to TURP, traditional PVP surgery also bears some disadvantages, including unclear visualization due to wash water circulation, slow speed of vaporization, difficulty in stopping bleeding during surgery, and an increased likelihood of having a residual gland in the apex of the prostate.
Recently, a new technique of photoselective vaporesection of the prostate (PVRP) with a front-firing lithium triborate (LBO) laser has been described, showing shorter operation times and higher tissue removal rates compared to PVP.
PVRP also included the ability to collect postoperative tissue samples and to handle bleeding during surgery.
In this study, the researchers used a new form of PVRP, called photoselective retrograde stripping-vaporization of the prostate (PRSVP), in patients with BPH who had failed previous medical therapy, and assessed its efficacy. The main innovations of their technique included the use of a trans-urethral plasma kinetic resection instrument, which improved the rinse water and allowed for a clearer vision, the use of a straight beam LBO laser fiber, whose power could be lowered from 160 W to 30-60 W to stop bleedings, and the possibility of acquisition of a pathological specimen to exclude prostate cancer.
The study enrolled 180 patients who were assessed preoperatively and at month 1, 3, 6, and 12 following surgery. Results revealed that PVRP resulted in a significant improvement of International Prostate Symptom Score (IPSS), which assesses the severity of BPH symptoms; maximum flow rate (Qmax), which assesses the pressure that the prostate puts on the urethra; and post-void residual urine (PVR), which measures the amount of urine left in the bladder after urination, which is helpful in detecting an enlarged prostate.
In addition, the modified PVRP showed a significant improvement in catheter times and hospital stays.
Patients did not report severe perioperative complications and did not require blood transfusions. Four patients had capsule perforation, four patients experienced bladder neck contracture, and another four patients had urethral stricture, but all were effectively treated.
These findings suggest that 160-W straight beam LBO laser PVRP is a feasible and safe alternative to PVP in the treatment of symptomatic BPH patients.