Transurethral resection of the prostate (TURP) is the gold standard of surgical treatment of the BPH.
Alternative surgical techniques have been developed for patients with blood coagulation disorders secondary to anticoagulants or antiplatelet intake. The photoselective vaporization of the prostate (PVP) by Green Laser is a technique used with the aim of obtaining tissue ablation with instantaneous hemostasis. In our experience we sensed the feeling of some differences between the two technologies. For each patient, we calculated the difference (delta) between Qmax, Qmed, PMR to 6 months after surgery compared with preoperative measurements (deltaQmax, deltaQmed, deltaPMR). In the comparison between PVP and TURP the differences between the results, in terms of deltaQmax (11.04 vs. 8.9 ml/sec), deltaQmed (5.87 vs. 3.64 ml/sec), deltaPMR, are not statistically significant, therefore it is clear that if we consider the average of the results, significant differences do not come out between the two techniques. Instead, the real differences emerge from consideration of standard deviations: the higher standard deviations of Qmax and Qmed of PVP compared to TURP (8.29 vs 5.01; 5,51 vs 1.64) indicate that the final result of an intervention being performed by TURP is nearest to the expected preoperatively result; on the contrary the final result of an operation being performed by PVP shows a significantly higher variability. As regards for our clinical decision it follows that the proposal of a surgical procedure which shows the "risk" of a higher variability of the final result is justified only in cases of high cardiovascular or blood coagulation "risk".
Written by:
Albino G, Marucco EC. Are you the author?
U.O. di Urologia, Ospedale L. Bonomo, Andria, ASL BAT, Italy.
Reference: Arch Ital Urol Androl. 2012 Dec;84(4):220-3.
PubMed Abstract
PMID: 23427748
