Photoselective vaporisation of the prostate (PVP)-patient selection and outcome optimisation.

Abstract

Introduction: 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 vaporisation 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.

Methods: 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. MESH terms included; photoselective vaporisation of the prostate OR PVP, GreenLight laser, erectile function OR erectile dysfunction, BPH OR benign prostatic hyperplasia, outcome*, anti‐coagula* was performed. Search results were limited to those published in English, involving humans and published after the year 2000.

Results: A total of 38 papers were included for review. It was found that the evolution of a higher powered device has enabled men with larger prostates and those on oral anticoagulation to undergo PVP safely and successfully. 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.

Conclusion: There are multiple factors that may affect complication rate and patient outcomes following PVP, one of the largest being operator experience, however the procedure is safe and continues to evolve as a promising technology for BPH.