Photoselective Vaporization Prostatectomy with 120 W Greenlight HPS on Bleeding Tendency Patients—Vaporization Incision Technique

Abstract

Objectives:

Photoselective laser vaporization prostatectomy (PVP) is a hemostatic procedure for men with benign prostatic hyperplasia. The study demonstrates that the modified vaporization incision technique can improve irrigation flow in men receiving anticoagulants.

Patients and Methods:

Men treated with PVP for benign prostatic hyperplasia in North District Hospital between January 2007 to April 2009 who were receiving anticoagulants (n = 18) were reviewed retrospectively. Their mean age was 74 years (range 62–83 years), the mean prostate volume was 47.46 cc (range 24–91 cc). Of these men, 12 were on Aspirin, 4 on Aspirin + Persantin/Plavix, 1 on Warfarin, 1 was Thrombocytopenic. The PVP was performed with 120 W high power system (HPS) side-firing laser through a 22.5 Fr continuous-flow cystoscope with normal saline as the irrigant. The vaporization incision technique is described in detail in the video.

Results:

The mean operative time was 62.4 min (range 25–110 min). Only one man had hemoglobin drop of more than 1 g/dL. His prostate volume was 91 cc. No transfusion was required. Fourteen (77.8%) men were discharged without a catheter. Sixteen (88.9%) were catheter-free 2 weeks after operation. The last two were catheter-free in 2 months. One man had prolonged hematuria for more than 2 weeks. One man had secondary hemorrhage. No ancillary procedure was required.

Conclusion:

PVP is a good treatment option in men on anticoagulants, who are at risk of significant bleeding. Vaporization incision technique can improve channel visibility and fasten the treatment procedure.

The authors have nothing to disclose

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Runtime of video: 5 min 1 sec