Introduction

1. No. 115 Early Experience Photoselective Vaporisation of the Prostate Using the 180W Lithium Triborate and Comparison with the 120W Lithium Triborate Laser Nicholas A Campbell#, Amanda SJ Chung*, Peter D Yoon*, Isaac Thangasamy*, Henry H Woo* #Department of Urology, Westmead Hospital, Sydney, NSW, Australia *Sydney Adventist Hospital Clinical School, University of Sydney, Wahroonga, NSW, Australia • Introduction • Photoselective vaporisation of the prostate (PVP) has become an established form of treatment for benign prostatic obstruction and to date has demonstrated equivalence to transurethral resection of the prostate (TURP) in RCTs 12-4. • The impact of the transition of the new laser to an experienced PVP surgeon has not previously been reported. • Results • The 180W cases had a larger median TRUS prostate volume (68cc versus 51cc, p<0.05). For the 180W and 120W LBO lasers, total operating time was 64.2 and 72.5 minutes (NS, p=0.22), lasering time 49.6 and 54.6 minutes (NS, p=0.30) and energy utilisation 477.6kJ and 377.9kJ (p<0.05) respectively. • There was similar utilisation of power relative to prostate volume between the two laser powers. The laser and operating time relative to the total transrectal ultrasound measured prostate volume was significantly decreased. • Complications using the Clavien-Dindo classification included 5 grade 1 complications and 3 grade 3b (bladder neck contractures) with the 180W LBO laser. The 120 W LBO laser had 4 grade 1 complications and 1 grade 2. • One major complication of capsular perforation occurred using the180W LBO laser. This had not previously been observed in the 120W LBO experience. It is a technically related complication due to the failure to recognise excessive depth of vaporisation, particularly at the region of the bladder neck. • Aim • There is little information on the clinical efficacy and safety of PVP using the 180W lithium triborate (LBO) laser. • We report on initial outcomes of PVP with the 180W laser, comparing the first 50 cases with the last 50 cases performed with the 120W LBO laser. Table 1 : Baseline patient variables • Methods • All 100 cases were performed by a single surgeon (HHW) and have been prospectively maintained from December 2009 to June 2011. Patient variables were recorded preoperatively and at 3 months postoperatively (table 1). • The surgical technique was the same for both types of laser and was consistent with the technique previously described by the International Greenlight Users Group5. A working channel was created at 80W power setting and this was immediately increased to 120W and/or 180W power once there was sufficient working space created. • The inclusion criteria were all men undergoing PVP for indications consistent with established guidelines for surgery for benign prostatic hyperplasia 6,7. Men with a history of prostate cancer were excluded from analysis. • Preoperative and postoperative parameters at 3 months were compared and included the International Prostate Symptom Score (IPSS) Quality of Life Index (QL), peak urinary flow (Qmax), post void residual (PVR) urine as measured by transabdominal ultrasound. Table 2 : Peri operative Parameters Table 3 : Paired analysis of results NB: IPSS – international prostate symptom score, QL – quality of life, PVR – post void residual, IIEF – International index of erectile function, AUR – acute urinary retention, References 1.Burke N WJ, Whelan JP, Goeree L, et al. Systematic review and meta-analysis of transurethral resection of the prostate versus minimally invasive procedures for the treatment of benign prostatic obstruction. Urology. 2010. 75: 1015-22. 2. Al-Ansari A, Younes N, Sampige VP, et al. GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: a randomized clinical trial with midterm follow-up. 2010. Eur Urol. 2010. 58(3): 349-55 3.Malek RS, Kuntzman KR, Barrett DM. Photoselective potassium-titanyl-phosphate laser vaporization of the benign obstructive prostate: observations on long-term outcomes. J Urol. 2005. 174: 1344-8. 4. Woo HH, Hossack T. Photoselective vaporization for prostatic obstruction with the 120-W lithium triborate laser: 1-year clinical outcomes. Int J Urol. 2011. 18(2): 162-5. 5.Muir G, Gomez-Sancha F, Bachmann A, et al. Techniques and Training with GreenLight HPS 120-W Laser Therapy of the Prostate: Position Paper. Eur Urol Suppl. 2008. 7: 370-7. 6. McVary KT, Roehrborn CG, Alvins A, et al. American Urological Association Guideline: Management of Benign Prostatic Hyperplasia (BPH). American Urological Association. 2010. 7.Woo HH, Gillman MP, Gardiner R et al. A practical approach to the management of lower urinary tract symptoms among men. Med J Aust. 2011. 195 (1): 34-9. • Conclusions • There is little change in clinical outcomes with the transition from 120W to 180W LBO PVP with an already experienced PVP surgeon. • The 180W LBO laser appears to have impacted upon patient selection with significantly increased prostate size and associated with increased energy utilisation. There is a trend toward shorter laser times. Acknowledgements Henry H Woo is a consultant to American Medical Systems. Poster presentation sponsor