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Safety of Green Light Laser Vaporization of the Prostate in high risk patients At the IMC

Safety of Green Light Laser Vaporization of the Prostate in high risk patients At the IMC. Anmar Nassir , Mohamed El- Azab , Abdulmalik Tayib. INTRODUCTION. BPH constitutes 20-40% of the whole urology work load in Saudi Arabia . TURP stayed for decades as the gold standard procedure

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Safety of Green Light Laser Vaporization of the Prostate in high risk patients At the IMC

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  1. Safety of Green Light LaserVaporization of the Prostate in high risk patientsAt the IMC Anmar Nassir, Mohamed El-Azab, AbdulmalikTayib

  2. INTRODUCTION • BPH constitutes 20-40% of the whole urology work load in Saudi Arabia . • TURP stayed for decades as the gold standard procedure • failure of medical treatment, • severe symptoms • presence of complications.

  3. INTRODUCTION • Many therapeutic modularities failed to replace TURP wither : • Transurethral microwave thermotherapy (TUNA), • Interstitial laser coagulation of the prostate (ILC) • Holmium laser enucleation of the prostate (HoLEP) proved to be safe and effective alternative for TURP and Open prostatectomy for treating men with symptomatic BPH

  4. The elevated demand on BPH management for better quality of life and safety has determined continuous research into development of less invasive therapies such as laser.

  5. INTRODUCTION • Most new technologies failed to provide safe and effective evaporation of the prostate until the emerge of the powerful green light potassium titanyl-phosphate (KTP) laser.

  6. INTRODUCTION • The laser energy is selectively absorbed by hemoglobin with the possibility of obtaining large cavity with minimal bleeding and negligible fluid absorption.

  7. Objective • To evaluate the short term tolerability and outcome of high power green light (KTP) laser prostatectomy in high risk patient with symptomatic BPH

  8. Material and Methods

  9. PATIENTS • Between May 2007 and Feb 2009 • High anesthesia risk patients were included in this study at IMC

  10. The inclusion criteria in this study were patients with: • high anesthesia risk • multiple systemic diseases • physically in satisfactory performance status. • refractory urinary retention • severely symptomatic BPH

  11. Intervention • Patients enrolled in the study underwent • preoperative and postoperative • cardiac, • anesthesia evaluation, • Ultrasound of urinary tract, • preoperative laboratory investigation,

  12. Peri-operative were conducted as out-patient prior to admission: • Systemic check up • Routine laboratory • Radiological • UDS for all long standing DM patients

  13. High Risk Patients • The American Association of Anesthesia grading risk system has been used to categorize the patients included in this study.

  14. All anticoagulants stopped one week before admission.

  15. Intervention • All patients underwent high power green light laser prostatectomy using the green light photo vaporization system with setting of 120 watts. • Performed by 2 surgeons

  16. Evaluation Perioperativeparameters: • Operation time, • Delivered energy, • Catheterization • Hospitalization time • Intraoperative and postoperative complications. Patients presenting for follow-up … • International Prostate Symptom Score (IPSS) • Maximal flow rate (Qmax) • Post-voiding residual volume (V) • Complications

  17. Result

  18. 14 patients were recruited • Patients' age • varied between 65 and 87 years • average age of 75.5 years.

  19. High Risk Patients • All of the patients had >2 co-morbid illnesses: • DM • HTN • atrial fib • IVC filter, • vocal cord tumor • IHD • mitral valve regurge

  20. Co-morbidities

  21. High Risk Patients • 9 patients were categorized as high risk patients for anesthesia grade III • 5 patients as grade IV • 10 patients were on Acetyl salicylic acid or plavix (Clopidogrel bisulfate). • 6 patients were also on Warfarin

  22. High Risk Patients • Echocardiogram patients prior to surgery showed EF • 13 pts between 35-60% • 1 patient it was 20%.

  23. The size of the prostate by US • 55 -112 cc • average size of 60 cc • One patient had two bladder stones 2.5 cm and 2.3 cm .

  24. 12 patients had uneventful intra and postoperative course without any significant complications • 2 patient who required postoperative admission to the ICU. • Average blood loss was insignificant • only 1 of the patients required blood transfusion.

  25. Complication

  26. Discussion

  27. TURP stood as the gold standard procedure in management of BOO secondary to BPH, • It is not without its disadvantages and limitations especially in patient who are at high risk of developing fluid overload during the procedure • It can be associated with a relatively high rate of complications (15%).

  28. GLL PvsTURP

  29. GLL PvsTURP

  30. Complications (LUTS and AUR)

  31. CONCLUSION • Considering the lower morbidity, shorter catheterisation and hospitalization times, and the degree of effectiveness that was achieved even at the low-power settings used in this study, GLL prostatectomy appears to be a viable and safe alternative to standard TURP.

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