RAMB - Novembro 2017

unes

RLV

930

ssoc

ras

2017; 63(11):929-940

urinary retention and sexual dysfunction, especially

regarding ejaculation function.

In an attempt to reduce morbidity, the development

of new alternative surgical procedures has been encour-

aged, including photoselective vaporization of the pros-

tate (PVP) using laser.

The laser emits light at a wavelength of 532 nm, which

will be absorbed by hemoglobin, leading to heating of the

prostatic tissue. In the beginning, PVP was performed with

potassium-titanyl-phosphate (KTP) laser at 60W and later

at 80 W. Then, laser prostatectomy (PVP) using a high-per-

formance system (HPS) 120W laser or XPS 180W laser was

introduced, aiming at reducing the limitations of KTP, as

well as improving results compared with conventional TURP.

The goal is to reduce hospitalization time, bleeding,

and other complications, but there is some doubt as to the

effectiveness of laser treatment with regard to the replace-

ment of conventional TURP as a first-line treatment.

elected

evidence

results

Patients (> 50 years) with urinary flow (UF) ≤ 15 mL/s; pros-

tate symptoms score (IPSS) ≥ 12; prostatic volume (PV):

15-85 cm

(USG); obstruction (AGnomogram) (N: 76), were

treated with PVP using KTP 80 W laser and star pulse qua-

sicontinuous wave laser (laserscope) emitting green light

at a wavelength of 532 nm (N: 38) compared with trans-

urethral resection of the prostate (conventional TURP)

(N: 38), with the following outcomes being assessed: urinary

flow, international prostate symptoms score (IPSS), qual-

ity of life score (QoL), bother score, postvoid residual vol-

ume (PVRV), surgical time, POHb, length of catheterization

and length of hospitalization after 6 weeks and at 3, 6 and

12-month follow-up. The use of laser leads to significant

increase in UF (mL/s), decline in IPSS, increase in quality

of life (QoL), increase in bother score, increase in postvoid

residual volume (PVRV) (mL), shorter bladder irrigation

time (min) and shorter length of hospitalization (days),

and less decrease in hemoglobin levels (g/dL). There is no

difference in surgical time (min).

(

)

In patients aged 68 years, BPH; PV: 70 to 100 mL; UF <

15mL/s; PVRV > 150mL; IPSS > 7 (N: 76), PVPwithKTP/532

high-power laser emitting green light (80W) (N: 39) was

compared with transurethral resection of the prostate

(conventional TURP) (N: 37), and the following outcomes

were assessed: IPSS and IIEF-5 scores; PV; PVRV; UF; uri-

nary retention; transfusion; re-intervention after 6 months.

There was a significant benefit with the use of PVP laser

in relation to all analyzed outcomes; however, there was

an increased risk of urinary retention (NNH: 8) and re-

intervention (NNH: 6).

(

)

Patients with BPH; IPSS > 16; UF < 15 mL/s; PV < 100

mL; PVRV < 100mL (N: 120) treated with HPS 120-W laser

using lithium triborate (LBO) crystal, producing 532-nm

waves (N: 60) or transurethral resection of the prostate (con-

ventional TURP) (N: 60) were assessed regarding surgical

time; Hb; transfusion; length of catheterization; length of

hospitalization; complications; IPSS; PVRV; PV; UF at 1, 3,

6, 12, 24 and 36 months. The use of laser compared with

conventional TURP significantly increased the outcome of

surgical time, but reduced the outcomes of bleeding, length

of catheterization and length of hospitalization. There is a

decline in the risk of transfusions (NNT: 6) and intraopera-

tive complications (NNT: 5), but also an increase in the num-

ber of early (NNH: 2) and late (NNH: 8) complications.

(

)

PVP treatment using HPS 120-W laser in 50 patients

was compared with transurethral resection of the pros-

tate (conventional TURP) in other 50 patients, the fol-

lowing inclusion criteria being adopted: BPH; IPSS > 15;

PV < 80 cm

; urinary flow < 15 mL/s. At 1, 3, 6, 12 and 24

months, the following outcomes were assessed: IPSS;

urinary flow; surgical time; Hb; transfusion; complications;

length of hospitalization; length of catheterization. The

results of laser intervention reduced blood loss, length of

catheterization and length of hospitalization compared

with conventional TURP. Nevertheless, they increased

surgical time. Regarding catheterization with a probe < 20

Fr, intraoperative and late complications, there is a benefit

to using laser with NNT = 1, 10 and 6, respectively.

(

)

In patients with BPH; > 50 years; IPSS ≥ 12 and both-

er score ≥ 3; Qmax < 12 mL/s; prostatic volume between

25 mL and 80 mL; PVRV < 300 mL (N: 139), two treatment

modalities were compared: PVP HPS 120-W laser (N: 69)

and transurethral resection of the prostate (convention-

al TURP) (N: 70) based on IPSS; length of hospitalization;

Qmax; PVRV; complications; sexual symptoms; quality

of life at 12 months. Only surgical time was shorter using

laser treatment, while none of the other outcomes pre-

sented significant differences, although length of hospi-

talization was shorter with conventional TURP.

(

)

Bleeding (measured by Hb) and length of catheteriza-

tion were less noticeable in 64 patients with BPH (age >

50 years; IPSS > 7; prostatic volume > 20 and < 80 cc;

urinary flow (Q max) < 15 mL/s) treated with PVP (laser

emitting green light at a wavelength of 532 nm, 30 to

80W) compared with 64 patients treated with conven-

tional TURP, at 12-month follow-up. Nevertheless, surgi-

cal time was longer in the group treated with PVP.

(

)

In patients with lower urinary tract symptoms due

to BPH (N: 20) treated with PVP HPS 120-W laser) or

transurethral resection of the prostate (conventional