RAMB - Novembro 2017

enign

prostatic

hyperplasia

laser

prostatectomy

(PVP)

ssoc

ras

2017; 63(11):929-940

931

TURP), there is no difference between the two treatment

modalities regarding outcomes expressed by IPSS, IIEF-5

and ICIQ-SF scores, or the following measures: PVRV and

Qmax, at 12-month follow-up.

(

)

In patients with BPH, IPSS > 15, treatment failure, Qmax

< 15 mL/s and prostatic volume < 100 mL (N: 200), com-

parison between PVP (HPS with 80-W KTP laser) (N: 100)

and transurethral resection of the prostate (conventional

TURP) (N: 100) made it possible to assess the outcomes of

length of catheterization, length of hospitalization, peri-

and postoperative complications, IPSS and QoL, Qmax,

PVRV and prostatic volume, at 1, 3, 6, 12, 24 and 36-month

follow-up. The outcomes measured at 24 months did not

present significant difference between the two treatment

modalities in relation to the scores: quality of life (QoL),

IPSS, urinary flow, PVRV and PO Hb. But there was sig-

nificant benefit in favor of the laser in the following out-

comes: prostatic volume, length of catheterization and

length of hospitalization. Conventional TURP yielded a

shorter surgical time. Regarding complications, there was

a decline in the rate of transfusion and perforation of the

prostatic capsule with the use of the laser.

(

)

Patients with BPH andmoderate or severe lower urinary

tract symptoms (IPSS >16), therapeutic failure, maximum

flow rate (Qmax) < 15 mL/s, PVRV > 100 mL and prostatic

volume < 100 mL (N: 62) were treated comparatively with

PVP (HPS 180-W laser) (N: 31) and transurethral resection

of the prostate (conventional TURP) (N: 31). At the 12-month

follow-up, surgical time was longer using laser, but the

lengths of hospitalization and catheterization were shorter,

with lower rates of transfusion (NNT: 5) and perforation

(NNT: 6). The other outcomes did not differ: hemoglobin

and transfusion, other peri- and postoperative complications,

IPSS, QoL, Qmax, PVRV and prostatic volume.

(

)

Except for a shorter length of hospitalization, the

treatment of patients with symptoms of BPH obstruc-

tion; 64 years; IPSS > 7; Qmax < 15 mL/s; prostatic vol-

ume < 80 mL; PVRV > 150 mL (N: 124) with PVP 120-W

laser (N: 60), compared with transurethral resection of

the prostate (conventional TURP) (N: 64), failed to dem-

onstrate superiority or inferiority when analyzed in rela-

tion to the following outcomes: IPSS; length of hospital-

ization; Qmax; PVRV; complications; sexual symptoms;

re-intervention or transfusion at 24 months.

(

)

In patients with lower urinary tract symptoms due

to BPH with obstruction; aged 40 to 80 years; IPSS ≥ 12;

Qmax < 15 mL/s; prostatic volume ≤ 100 mL (N: 281),

there was no difference between treatment with transure-

thral resection of the prostate (conventional TURP) (N:

142) and PVP with 180-W XPS laser vaporization (N: 139),

at 24 months, regarding the following outcomes: quality

of life (QoL); IPSS; urinary flow (mL/s); PVRV; prostatic

volume; re-treatment and complications.

(

)

vidence

summary

There is evidence, with high risk of bias, of the benefit of

laser prostatectomy (PVP) in patients with BPH compared

to conventional TURP regarding UF, IPSS, QoL, bother score,

IIEF-5 score, postvoid residual volume (PVRV), bladder ir-

rigation/length of catheterization, length of hospitalization

(days), Hb decline, prostatic volume, urinary retention, trans-

fusion (NNT: 6), re-intervention (?), intraoperative compli-

cations (NNT: 5), early (NNT: 10) and late (NNT: 6) com-

plications at different times, from 6 to 24 months.

There is evidence, with the same high risk of bias, of

lower PVP benefit compared to conventional TURP regard-

ing risk of urinary retention (NNH: 8), re-intervention

(NNH: 6), surgical time, number of early (NNH: 2) and late

(NNH: 8) complications, as well as length of hospitalization.

There is no difference between the two treatment mo-

dalities in relation to the outcomes expressed by the scores:

IPSS, IIEF-5 and ICIQ-SF, or the following measurements:

urinary flow, PVRV, prostatic volume and Qmax, length of

hospitalization, complications, sexual symptoms, re-inter-

vention, need for transfusion or re-treatment at 12 to 24

months of follow-up.

ecommendation

Due to controversies regarding the superiority or inferior-

ity of treatment of benign prostatic hyperplasia using

laser PVP compared to transurethral resection, it is not

possible to recommend treatment with PVP instead of

conventional TURP. (

)

onflict

interest

The authors declare no conflict of interest.

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