BACKGROUND: The clinical outcome of 105 consecutive patients undergoing Photoselective Vaporization of the Prostate (PVP) by Greenlight Laser was presented at the 2006 New England Section Annual Meeting of the American Urological Association (AUA). These results revealed decreased AUA Symptom Scores, decreased AUA Bother Scores, increased Peak Flow Rates, decreased Post Void Residual Urines, and maintainence of Sexual Potency. The present report discusses the postoperative care of these patients concentrating upon catheter use, complications, and concomitant urologic procedures.
METHODS: An IRB approved prospective case series of 105 consecutive men underwent PVP between September 2004 and March 2006. The men were divided into three groups based upon preoperative bladder management: Group N-catheter free (86 men), Group Y-indwelling Foley catheter (8 men), and Group CIC-clean intermittent catheterization (11 men).Data points included voiding trial post surgery, reason for hospital admission, postoperative complications, and concomitant urologic procedures during PVP.
RESULTS: Of the 105 men 82 went home on the day of surgery and 23 were admitted to the hospital. Reasons for hospital admission included postoperative bleeding (17), mental retardation (1),physician preference (1), breathing problems (2), myocardial infarction (1), and burn from anesthesia warmer (1). 36 patients tried to void after short catheter drainage (<2 hours) in the recovery room with 19 (53%) able to void and 17 (47%) required catheter reinsertion. 69 patients had delayed voiding trial (post operative day number 1) and 61 (88%) were able to void and 8 (12%) were unable to void. Postoperative complications in the first year included early postoperative bleeding (17), late bleeding (>7 days postop) ( 2,),prolonged burning (>10 days postop) (14), urge incontinence (19), stress incontinence (2), urethral stricture (3), bladder neck contracture (3), and TURP performed within first postop year (5).Concomitant urological procedures were TURP (2), TURBT (2), prostate biopsy (2), ESWL (1), cystolithalopaxy (1), and TUR fulguration bladder diverticula (1).Final voiding status of the 86 patients in Group N revealed all voiding spontaneously, in Group Y, 7 void on own and 1 performs CIC, and of Group CIC, 9 void on own and 2 perform CIC.
CONCLUSIONS: PVP improves all voiding parameters in men at 6 and 12 months.There is a significant problem with voiding on the same day of surgery so we reccommend patients to go home with an indwelling cahtheter and remove it on postop day 1. There are some significant possible postoperative complications and these should be discussed with patients.