Greenlight photoselective vaporisation of the prostate in high-risk patients: outcomes from a single-centre series.
BAUS ePoster online library. Trail M. Jun 25, 2019; 259594; P9-8
Mr. Matthew Trail
Mr. Matthew Trail
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Abstract
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INTRODUCTION

Greenlight laser photoselective vaporisation of the prostate (GL-PVP) has emerged in recent years as an alternative to TURP in the surgical management of LUTS secondary to BPE, with RCTs reporting similar efficacy with fewer adverse outcomes. As a consequence, NICE recommends GL-PVP for patients with LUTS secondary to BPE but cites insufficient evidence to advocate its use in higher risk patients.

The aim of this study was to assess the safety and efficacy of GL-PVP as a treatment option in 'high-risk' groups - specifically patients on anticoagulation and those with large prostates, in urinary retention or with significant co-morbidity.

METHODS

All patients who underwent GL-PVP at a single centre over a seven-year period (2010-2017) were identified using a prospectively-collected operating theatre database. Retrospectively, demographics and various pre-operative clinical data were collected to identify patients fulfilling the 'high-risk' criteria. Surgical and functional outcomes were compared in patients with and without high-risk parameters.

RESULTS

From preliminary analysis of over 900 patients, 31.7% of patients were anticoagulated or taking antiplatelet therapy, 34.7% had urinary retention and 8.1% had prostate volume >100cc. The incidence of major perioperative adverse events in high-risk patients was low. Median length of stay was one day, with 25% of patients treated as a day-case. Functional outcomes in 'high-risk' patients were comparable with the published literature for TURP.

Conclusions
From this cohort, GL-PVP can be considered a safe and efficacious procedure in 'high-risk' patients. There is potential to optimise health service efficiency by offering day-case GL-PVP in selected patients.
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