Optimising patient outcomes with photoselective vaporization of the prostate (PVP): a review

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Abstract

Benign prostatic hyperplasia (BPH) is a common pathology causing lower urinary tract symptoms (LUTS) and may significantly impact quality of life. While transurethral resection of the prostate (TURP) remains the gold standard treatment, there are many evolving technologies that are gaining popularity. Photoselective vaporization of the prostate (PVP) is one such therapy which has been shown to be non-inferior to TURP. We aimed to review the literature and discuss factors to optimise patient outcomes in the setting of PVP for BPH. A comprehensive search of the electronic databases, including MEDLINE, Embase, Web of Science and The Cochrane Library was performed on articles published after the year 2000. After exclusion, a total of 38 papers were included for review. The evolution of higher powered device has enabled men with larger prostates and those on oral anticoagulation to undergo safely and successfully PVP. Despite continued oral anticoagulation in patients undergoing PVP, the risk of bleeding may be minimised with 5-Alpha Reductase Inhibitor (5-ARI) therapy however further studies are required. Pre-treatment with 5-ARI’s does not hinder the procedure however more studies are required to demonstrate a reliable benefit. Current data suggests that success and complication rate is largely influenced by the experience of the operator. Post-operative erectile dysfunction is reported in patients with previously normal function following PVP, however those with a degree of erectile dysfunction pre-operatively may see improvement with alleviation of LUTS.

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Update on AUA guideline on the management of benign prostatic hyperplasia.

Kevin T. McVary, Claus Roehrborn, Andrew Avins … (2011)

To revise the 2003 version of the American Urological Association's (AUA) Guideline on the management of benign prostatic hyperplasia (BPH). From MEDLINE® searches of English language publications (January 1999 through February 2008) using relevant MeSH terms, articles concerning the management of the index patient, a male ≥45 years of age who is consulting a healthcare provider for lower urinary tract symptoms (LUTS) were identified. Qualitative analysis of the evidence was performed. Selected studies were stratified by design, comparator, follow-up interval, and intensity of intervention, and meta-analyses (quantitative synthesis) of outcomes of randomized controlled trials were planned. Guideline statements were drafted by an appointed expert Panel based on the evidence. The studies varied as to patient selection; randomization; blinding mechanism; run-in periods; patient demographics, comorbidities, prostate characteristics and symptoms; drug doses; other intervention characteristics; comparators; rigor and intervals of follow-up; trial duration and timing; suspected lack of applicability to current US practice; and techniques of outcomes measurement. These variations affected the quality of the evidence reviewed making formal meta-analysis impractical or futile. Instead, the Panel and extractors reviewed the data in a systematic fashion and without statistical rigor. Diagnosis and treatment algorithms were adopted from the 2005 International Consultation of Urologic Diseases. Guideline statements concerning pharmacotherapies, watchful waiting, surgical options and minimally invasive procedures were either updated or newly drafted, peer reviewed and approved by AUA Board of Directors. New pharmacotherapies and technologies have emerged which have impacted treatment algorithms. The management of LUTS/BPH continues to evolve. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

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180-W XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European Multicentre Randomised Trial--the GOLIATH study.

Alexander Bachmann, Andrea Tubaro, Neil J Barber … (2014)

The comparative outcome with GreenLight (GL) photoselective vaporisation of the prostate and transurethral resection of the prostate (TURP) in men with lower urinary tract symptoms due to benign prostatic obstruction (BPO) has been questioned.

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The impact of lower urinary tract symptoms and comorbidities on quality of life: the BACH and UREPIK studies.

R Fourcade, James McKinlay, Chris Robertson … (2007)

To investigate the effect of lower urinary tract symptoms (LUTS) on quality of life (QoL) and to determine its extent across a variety of cultures, and the confounding effects of self-reported comorbidities and demographics. Data were obtained from two population-based studies in five cities: UREPIK (Boxmeer, the Netherlands; Auxerre, France; Birmingham, UK; and Seoul, Korea) and the Boston Area Community Health (BACH) study (Boston, USA). UREPIK used stratified random samples of men aged 40-79 years. BACH used a multistage stratified cluster sample to randomly select adults aged 40-79 years. QoL was assessed using a standard Medical Outcomes Study-Short Form 12 (SF-12, mental and physical health component scores); LUTS was assessed using the International Prostate Symptom Score (IPSS). The association between QoL and IPSS, associated illnesses, and lifestyle factors was investigated using weighted regression. The UREPIK studied 4800 men aged 40-79 years; BACH recruited 1686 men aged 40-79 years. The prevalence of LUTS, defined as an IPSS of > or =8, varied by city (P or =20, affected approximately 3.3% of the age group; this was roughly similar to stroke (2.2%), cancer (4.5%), or heart attack (4.5%) and less than half as much as diabetes (8.6%). A 10-point increase in IPSS was associated with a 3.3 (0.3)-point reduction in SF-12 physical health component score, with the same effect in all cities (P = 0.682 for the interaction test). This was more than the physical health component score reduction caused by cancer, diabetes, or high blood pressure (2 points each), but less than stroke or heart attack (6 points). The comorbidities had no significant impact on SF-12 mental health component score (other than a heart attack, that had a 1.8-point reduction). A 10-point increase in IPSS was associated with a 3.4 (0.6)-point reduction of the mental health component score in the four western cities and a 1.4 (0.3)-point reduction in Seoul. Increasingly severe LUTS is associated with a lower QoL. The effect of moderate LUTS on QoL physical health component score is similar to that of having diabetes, high blood pressure or cancer, while the effect of severe LUTS is similar to a heart attack or stroke. These changes were consistent across cultures. This analysis shows the magnitude and consistency of the effects of LUTS on QoL. While these patients might be seen by several types of practitioners, it is likely that urologists will be in the best position to recognize the true impact of LUTS on a patient's QoL, to be aware of the effects of therapies for LUTS on QoL, and to ensure that colleagues in other disciplines recognize the importance of these symptoms and their treatment.

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Author and article information

Journal

Journal ID (nlm-ta): Transl Androl Urol

Journal ID (iso-abbrev): Transl Androl Urol

Journal ID (publisher-id): TAU

Title: Translational Andrology and Urology

Publisher: AME Publishing Company

ISSN (Electronic): 2223-4691

Publication date (Print and electronic): July 2017

Publication date (Print): July 2017

Volume: 6

Issue: Suppl 2

Pages: S133-S141

Affiliations

[1 ]University of Melbourne, Department of Surgery, Austin Hospital , Melbourne, Australia;

[2 ]Young Urology Researchers Organisation (YURO) , Melbourne, Australia;

[3 ]Sydney Adventist Hospital Clinical School, University of Sydney , Sydney, Australia;

[4 ]Olivia Newton-John Cancer Research Institute , Melbourne, Australia;

[5 ]Department of Surgical Oncology, Peter MacCallum Cancer Centre , Melbourne, Australia

Author notes

Contributions: (I) Conception and design: C Pascoe, D Ow, N Lawrentschuk; (II) Administrative support: C Pascoe; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: C Pascoe, D Ow; (V) Data analysis and interpretation: C Pascoe, D Ow; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Claire Pascoe. Department of Urology, Austin Hospital, Melbourne, Australia. Email: cea.pascoe@ 123456gmail.com .

Article

Publisher ID: tau-06-S2-S133

DOI: 10.21037/tau.2017.05.14

PMC ID: 5522804

SO-VID: 0469e93b-780d-466f-b1d1-450265b4d4a8

History

Date received : 06 January 2017

Date accepted : 26 March 2017

Optimising patient outcomes with photoselective vaporization of the prostate (PVP): a review

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Most cited references 47

Update on AUA guideline on the management of benign prostatic hyperplasia.

180-W XPS GreenLight laser vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a European Multicentre Randomised Trial--the GOLIATH study.

The impact of lower urinary tract symptoms and comorbidities on quality of life: the BACH and UREPIK studies.

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