EAU 2018: Ejaculation-preserving Greenlight Photovaporization: Short and Long Term Results
Dr. Dozi from Tenon Hospital from the Department of Urology at Assistance-Publiquie Hopitaux de Paris presents a prospective study of ejaculation-preserving Greenlight photovaporization both immediately right after surgery and long-term.
65 patients undergoing surgical treatment for benign prostatic obstruction from January 2010 through December 2013 were included in the study. The primary investigators utilized a modified technique designed to preserve ejaculatory function and patients were informed of the risk of failure. 6 follow-up timepoints were utilized, of which primary endpoint was a change in the post-void residual and International Prostate Symptom Score (IPSS).
Overall, antegrade ejaculation was preserved in 59 of 65 (90.7%) of patients at 1-3 months. This rate remained constant until 24-36 months, as also seen in regards to improvements in maximum flow rate and peak flow rates. Ultimately, no serious adverse events were reported, although seven (10.8%) patients received a secondary ejaculation-reserving Greenlight photovaporization due to the recurrence in symptoms.
In discussion, Dr. Dozi noted that the volume of ejaculation was not assessed in a continuous fashion. Rather, there were no shifts in categorical changes in volume of ejaculation (i.e. low volume, mid-volume, and high-volume).
Further, in response to an inquiry from a member of the audience, Dr. Dozi also emphasized the physiology of ejaculation and the lack of bladder neck involvement in the trajectory of ejaculation. Echoed by the Drs. Hermann, Woo, and Zorn, chairs of the session, Dr. Dozi clarifies that ejaculation is a phenomenon of the muscular pelvic floor and musculature-centric techniques are suggested to preserve ejaculation. As such, the Greenlight photovaporization technique yields excellent outcomes for the treatment of BPO and functional outcomes were comparable to the conventional TURP.
Authors: Doizi S., Lukacs B.
Written by: Linda M. Huynh, B.S., University of California-Irvine, at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark