A Comparative Study Of 8OW KTP LASER PVP Versus Conventional TURP In the Treatment of BPH.
Journal Title: JOURNAL OF MEDICAL COLLEGE CHANDIGARH - Year 2018, Vol 8, Issue 1
Abstract
ABSTRACT: Background: Although TURP is ‘gold standard’ surgical treatment for BPH, use of lasers is good alternative due to their inherent advantages of good haemostatic property with almost negligible fluid absorption with early recovery and shorter stay in hospital. PVP using 80W KTP laser is new advancement in the treatment of BPH. Aims and Objectives: To analyze the outcome of 80W KTP laser in terms of its efficacy and safety in the treatment of BPH. Material and Methods: A total of hundred patients (n=100) of BPH with IPSS≥12, Qmax≤15ml/sec or urinary retention were randomized into two groups to undergo either TURP or PVP procedure after excluding neurogenic bladder, urethral stricture and prostate cancer. Catheter was removed as per the institution protocol. Observations and Results: In all the patients, various parameters were recorded using standard performa. Any complications related to the procedure were also recorded and all the patients were followed up after discharge for the same. All the patients were comparable with respect to demographics in both the groups. Preoperatively, on digital rectal examination there was no significant difference between two groups regarding the size of prostate. The prostate volume on USG was found to be comparable in both the groups. The mean operative-time was comparable in both groups for different grades of prostate viz; grade-I (24min), grade II (46 v/s 48min) and grade III (72 v/s 77min). Both groups exhibited lower urinary tract symptoms to varying degree of severity post operatively and majority of the patients had only mild symptoms after one year. Quality of life improved after the procedure in both the groups. Maximal urinary flow rate improved from baseline upto one month in both the groups, from 5.39ml/sec to 16.07ml/sec in TURP and 6.44 ml/sec to 16.07 ml/sec in PVP group. The catheter was removed on day-1 and 3 in PVP and TURP group respectively. Prolonged catheterization was required in only one patient in PVP group in view of persisting hematuria (p-value<0.001). While varying degree of post voidal residual volume was observed in TURP group, none of the patient in PVP group had volume > 500 ml after resecting equal volume of prostate. Six patients required blood transfusions in TURP group whereas none of the patients in PVP group required transfusion despite being on anticoagulants (p-value<0.001). Both groups exhibited complications like dysuria, retention, incontinence and retrograde ejaculation, which were slightly more in PVP group. Conclusion: Although, as compared to conventional TURP, KTP laser produces similar improvement in clinical parameters, it is slightly more time consuming. Dysuria persists for longer but length of catheterization and hospital stay is shorter and its use avoids the need of transfusion even in those on anticoagulants. Thus, it may be concluded that PVP is safe and efficacious procedure even in high-risk patients.
Authors and Affiliations
Mahesh Chandra, Seema Wasnik, Tapan Sinha, Shailesh Karan
Keywords
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