The role of the prostatic median lobe in urinary symptoms following photoselective vaporization of the prostate (PVP)

摘要

Introduction and Objective: Photoselective vaporization of the prostate (PVP) remains a relatively new addition to our armamentarium of minimally invasive surgical treatments for symptomatic benign prostatic hypertrophy/enlargement. Early favorable reports of the safety and efficacy of PVP do not alleviate the need to investigate factors that may further improve the safety margin and efficacy outcomes of PVP in the management of symptomatic benign prostatic enlargement (BPE). Consequently, we investigated the role of enlarged or prominent intravesical median/middle lobe of the prostate in mediating urinary symptoms following PVP. Materials and Methods: Forty-one non-consecutive patients diagnosed with BPE were enrolled under an Institutional Review Board approved multi-center protocol at the Hunter McGuire Veterans Administration Medical Center, Richmond, Virginia, for PVP treatment using the 80W quasi-continuous wave KTP laser. Perioperative and postoperative complications/adverse events were assessed. Urodynamic parameters: AUA-SI, QOL, Qmax and PVR; and PSA were assessed at baseline, 1, 3, 6 and 12 months postoperatively. Results: The forty-one patients were sub-stratified based on cystoscopic evidence of prominent median/middle lobe (n=17)(Study Group), and absence of median lobe (n = 24). Seven of seventeen (41.1%) patients with and 10/24 (41.7%) patients without median lobes experienced adverse urinary symptoms, which resolved within 7-8 months. All 41 patients have demonstrated significant improvements in urodynamic, that is, flow rates, post void residual volumes and clinical (QOL) outcome measures. Conclusion: Niagara Green Light PVP procedure did not result in heightened severity of voiding symptoms in those BPE patients with prominent intravesical median lobes.