1. Anmar Nassir, Mohamed El-Azab, Abdulmalik Tayib
Safety of Green Light Laser Vaporization of the Prostate in high risk patients At the IMC
Anmar Nassir, Mohamed El-Azab, Abdulmalik Tayib

2. INTRODUCTION
BPH constitutes 20-40% of the whole urology work load in Saudi Arabia .
TURP stayed for decades as the gold standard procedure
failure of medical treatment,
severe symptoms
presence of complications.

3. INTRODUCTION
Many therapeutic modularities failed to replace TURP wither :
Transurethral microwave thermotherapy (TUNA),
Interstitial laser coagulation of the prostate (ILC)
Holmium laser enucleation of the prostate (HoLEP) proved to be safe and effective alternative for TURP and Open prostatectomy for treating men with symptomatic BPH

4. The elevated demand on BPH management for better quality of life and safety has determined continuous research into development of less invasive therapies such as laser.

5. INTRODUCTION
Most new technologies failed to provide safe and effective evaporation of the prostate until the emerge of the powerful green light potassium titanyl-phosphate (KTP) laser.

6. INTRODUCTION
The laser energy is selectively absorbed by hemoglobin with the possibility of obtaining large cavity with minimal bleeding and negligible fluid absorption.

7. Objective
To evaluate the short term tolerability and outcome of high power green light (KTP) laser prostatectomy in high risk patient with symptomatic BPH

8. Material and Methods

9. PATIENTS Between May 2007 and Feb 2009
High anesthesia risk patients were included in this study at IMC

10. The inclusion criteria in this study were patients with:
high anesthesia risk
multiple systemic diseases
physically in satisfactory performance status.
refractory urinary retention
severely symptomatic BPH

11. Intervention Patients enrolled in the study underwent
preoperative and postoperative
cardiac,
anesthesia evaluation,
Ultrasound of urinary tract,
preoperative laboratory investigation,

12. Peri-operative were conducted as out-patient prior to admission:
Systemic check up
Routine laboratory
Radiological
UDS for all long standing DM patients

13. High Risk Patients
The American Association of Anesthesia grading risk system has been used to categorize the patients included in this study.

14. All anticoagulants stopped one week before admission.

15. Intervention
All patients underwent high power green light laser prostatectomy using the green light photo vaporization system with setting of 120 watts.
Performed by 2 surgeons

16. Patients presenting for follow-up …
Evaluation
Perioperative parameters:
Operation time,
Delivered energy,
Catheterization
Hospitalization time
Intraoperative and postoperative complications.
Patients presenting for follow-up …
International Prostate Symptom Score (IPSS)
Maximal flow rate (Qmax)
Post-voiding residual volume (V)
Complications

17. Result

18. 14 patients were recruited Patients' age
varied between 65 and 87 years
average age of 75.5 years.

19. High Risk Patients All of the patients had >2 co-morbid illnesses:DM
HTN
atrial fib
IVC filter,
vocal cord tumor
IHD
mitral valve regurge

20. Co-morbidities

21. High Risk Patients
9 patients were categorized as high risk patients for anesthesia grade III
5 patients as grade IV
10 patients were on Acetyl salicylic acid or plavix (Clopidogrel bisulfate).
6 patients were also on Warfarin

22. High Risk Patients Echocardiogram patients prior to surgery showed EF
13 pts between 35-60%
1 patient it was 20%.

23. The size of the prostate by UScc
average size of 60 cc
One patient had two bladder stones 2.5 cm and 2.3 cm .

24. 2 patient who required postoperative admission to the ICU.
12 patients had uneventful intra and postoperative course without any significant complications
2 patient who required postoperative admission to the ICU.
Average blood loss was insignificant
only 1 of the patients required blood transfusion.

26. Complication

27. Discussion

28. TURP stood as the gold standard procedure in management of BOO secondary to BPH,
It is not without its disadvantages and limitations especially in patient who are at high risk of developing fluid overload during the procedure
It can be associated with a relatively high rate of complications (15%).

29. GLL P vs TURP Prolonged resection time
No risk of dilutional hyponatremia
Risk of TURP syndrome
Catheterization time
1 - 0
≥ 2-3 days
Hospital stay
(day case -1)
Longer
Retrograde ejaculation
( %)
( %)

30. GLL P vs TURP Procedure time Lengthier - slower vaporization speed
(～0.5 gr/min)
Shorter - higher resection speed (up to 1 gr/min)
Histological evaluation
Absence of prostatic tissue
Ability to detect (incidental) prostate cancer
Re-operation rates
? Higher
More durable

31. Complications (LUTS and AUR)

32. CONCLUSION
Considering the lower morbidity, shorter catheterisation and hospitalization times, and the degree of effectiveness that was achieved even at the low-power settings used in this study, GLL prostatectomy appears to be a viable and safe alternative to standard TURP.