Greenlight XPS laser photoselective vapourization of prostate (PVP) in high risk patients
BAUS ePoster online library. Waters D. 06/27/18; 211372; P8-11
Darragh Waters
Darragh Waters
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Introduction: Recent NICE guidance supports greenlight XPS P.V.P. as being at least as effective as TURP in non-high risk patients but notices there is insufficient high quality comparative evidence to support the routine adoption of XPS laser P.V.P. in high-risk patients.
NICE identifies high-risk patients as:

• High risk of bleeding,
• Prostate > 100 mls,
• Urinary retention.

Methods: This retrospective study reviews a single surgeon's experience of treating high risk patients with XPS PVP. All patients had laser PVP while taking anti-coagulants, anti-platelet agents or both.

n= 374 were treated.
n = 91 had urinary retention (AUR)
n = 103 age > 80 years
n = 54 had prostates > 80mls

Mean age = 71 years (44-96 yrs)
Haematuria from BPH = 40
Troublesome L.U.T.S. = 243
54% were classed ASA III
5.4% were classed ASA IV

There were no perioperative blood transfusions.
n = 301 were managed with Bananno supra-pubic catheter (SPC) (proxy for no haematuria)
n = 40 Bananno SPC & temporary haematuria (UC 1-2 hours).
n = 25 U.C. on irrigation overnight.
n = 270 Discharged Day 1 post-op.
n = 10 Re-admitted with clot retention.
n = 12 Re-admitted with recurrent retention.

Conclusion: This retrospective study shows that in experienced hands XPS laser PVP is a safe and effective treatment in patients with one or more high-risk factors. Despite all patients having significant co-morbidities the incidence of cardiovascular and haematological complications were less than those reported for TURP in non- high-risk patients.
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