13 / 102
B
enign
prostatic
hyperplasia
:
laser
prostatectomy
(PVP)
R
ev
A
ssoc
M
ed
B
ras
2017; 63(11):929-940
929
GUIDELINES IN FOCUS
Benign prostatic hyperplasia: laser prostatectomy (PVP)
H
iperplasia
prostática
benigna
:
prostatectomia
por
vaporização
a
laser
(PVP)
Authorship:
Brazilian Society of Urology
Participants:
Nunes RLV
1
, Oliveira RRM
1
, Carneiro A
1
, Neto AM
1
, Antunes AA
1
,
Wanderley Marques Bernardo
2
, Antônio Silvinato
2
Final draft:
September 3
rd
, 2016
1
Sociedade Brasileira de Urologia (SBU)
2
Associação Médica Brasileira (AMB)
http://dx.doi.org/10.1590/1806-9282.63.11.929The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize
procedures to assist the reasoning and decision-making of doctors.
The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending
on the conditions and the clinical status of each patient.
G
rades
of
recommendation
and
levels
of
evidence
•
•
A: Experimental or observational studies of higher
consistency.
•
•
B: Experimental or observational studies of lower
consistency.
•
•
C: Cases reports (non-controlled studies).
•
•
D: Opinion without critical evaluation, based on con-
sensus, physiological studies or animal models.
O
bjective
The objective of this guideline is to present the main avail-
able evidence comparing transurethral resection of the
prostate with laser prostatectomy (PVP) in patients with
benign prostatic hyperplasia (BPH) in relation to the main
peri- or postoperative outcomes, allowing the formalization
of recommendations directly supported by such evidence.
D
escription
of
evidence
collection method
This guideline followed the standard of a systematic review
with evidence retrieval based on the EBM (evidence-based
medicine), so that clinical experience is integrated with
the ability to critically analyze and apply scientific infor-
mation rationally, thus improving the quality of medical
care. EBM uses existing and currently available scientific
evidence, with good internal and external validity for the
application of its results in clinical practice.
1,2
Systematic reviews are currently considered the level
I of evidence for any clinical question by systematically
summarizing information on a particular topic through
primary studies (clinical trials, cohort studies, case-control
or cross-sectional studies) using a reproducible method-
ology, in addition to integrating information on effective-
ness, efficiency, efficacy and safety.
1,2
We use the structured mode of formulating the ques-
tion synthesized by the acronym PICO, where P stands
for patient or population presenting prostatic hyperpla-
sia, I stands for intervention with laser prostatectomy
(PVP), C stands for comparison with transurethral resec-
tion of the prostate and O stands for the outcome of
efficacy and harm. Based on the structured question, we
identified the descriptors that formed the basis of the
search for evidence in the following databases: Medline,
Embase, Central Cochrane, Cochrane Library. Thus, 367
studies were retrieved, and, after applying the eligibility
criteria (inclusion and exclusion), 11 were selected to
answer the clinical question (Annex I).
C
linical
question
What is the effectiveness of laser prostatectomy (PVP) in
patients with benign prostatic hyperplasia?
I
ntroduction
Benign prostatic hyperplasia (BPH) is a common disease
with high morbidity in the elderly. Patients with urinary
symptoms, mainly obstructive, may require surgical
treatment, which is usually performed through trans-
urethral resection of the prostate (conventional TURP).
Complications of the procedure include bleeding, TURP
syndrome (water intoxication), urinary incontinence,