Presented by: Bora Özveren MD, FEBU
Acıbadem University, School of Medicine

Introduction

The purpose of this study was to assess the incidence, risk factors, and timing of specific causes of surgical reinterventions required after PVP due to bladder neck contracture (BNC), urethral stricture (US), or persistent/recurrent prostate adenoma in patients who were treated and followed up in the same department. We also investigated the impact of different PVP laser device models and specific perioperative clinical parameters on each cause of reoperations.   

Materials

This is a retrospective observational analysis of prospectively collected data on consecutive men undergoing PVP with the Greenlight KTP, HPS, and XPS laser devices between 2004 and 2019 in a single center.

Results

,

The overall rate of reoperations was 13.8% during a 61-month median follow-up of 377 patients. Reoperations were due to BNC, US, and adenoma in 7.7%, 5.6%, and 4.8% of cases, respectively. The median interval until reoperation for US (11 months) was significantly shorter.

None of the risk factors had any relevance to US.

In patients who underwent reoperation for BNC, lasing time and energy were significantly lower, and the prostate volume was smaller; however, the multivariate analysis only identified shorter lasing time as a predictor.

In patients who had reoperation for persistent/recurrent adenoma, the PSA was increased, while the prostate volume was non-significantly high, and performance by less-experienced surgeons was associated with a higher rate of reoperations (p<0.05). A longer lasing time predicted an increased risk of reoperation for adenoma in multivariate analysis.

Conclusion

An unselective utilization of Greenlight PVP in the treatment of BPH patients may result in a relatively high rate of reoperations. The correlation of BNC with shorter lasing time may imply a higher risk after PVP of smaller prostates. A longer lasing time predicts an increased risk of reoperation due to persistent/recurrent adenoma, which may be related to higher prostate volumes and inefficient PVP by less-experienced surgeons.

Funding

None

Co-Authors

Nejdet Karşıyakalı, MD
Acıbadem University, School of Medicine

Levent Türkeri, MD
Acıbadem University, School of Medicine