The Massively Enlarged Prostate: Experience with Photoselective Vaporization of the ≥100 cc Prostate Using the 180 W Lithium Triborate Laser

Objectives: To determine if there is a role for high-powered photoselective vaporization of the prostate (PVP) in large prostates for the management of bladder outlet obstruction. This study aims to evaluate the safety and efficacy of PVP in prostates >= 100 cc. Materials and Methods: A retrospective analysis of a prospectively maintained database (ethics approved), single-surgeon, single-center series, between November 2010 and February 2013 of males with >= 100 cc prostates who underwent PVP. Perioperative and functional outcomes at baseline, 3, and 6 months were evaluated. Results: Thirty-five males were identified, median age 70 (interquartile range [IQR] 66-79) with prostates >= 100 cc (median 132, IQR 118-157). Preoperatively, 11/35 (31%) were in urinary retention and 11/35 (31%) were anticoagulated. Perioperative outcomes showed median laser time 75 minutes, operating time 103 minutes, and energy use 750 kJ. Median postoperative length of stay was 20 hours, catheterization 12 hours, and 33/35 (94%) were discharged catheter free. Twelve adverse events in 11 men were recorded, all Clavien-Dindo Grade I-II with 1 Grade IIIa complication. Paired functional outcomes showed statistically significant (p<0.05) improvements in the median International Prostate Symptom Score (IPSS) (20, 6, 6), quality of life (QoL) Index (4, 1, 1), maximum urinary flow rate (Qmax) (9.5, 20.5, 19.5 mL/s), and postvoid residual (149, 40, 41 mL) (baseline, 3, and 6 months). Conclusion: PVP using the 180 W LBO laser in large prostates appears feasible and efficacious, with short duration of catheterization and postoperative length of stay. Acceptable morbidity was recorded. Enormous energy utilization was delivered within acceptable operating times. Early results indicate excellent functional outcomes at 3 and 6 months following PVP.