Performing 180-Watt GreenLight® Laser Prostatectomy using Periprostatic Block
Ömer Onur Çakır1, Mehmet Çulha2, Hüseyin Lüleci3, Ahmet Yaser Müslümanoğlu11Department of Urology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkey2Department of Urology, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
3Department of Urology, Istanbul Medistate Hospital, Istanbul, Turkey
INTRODUCTION: GreenLight® photoselective vaporization of the prostate (PVP) is an effective minimally invasive surgical treatment for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH/LUTS). This study aimed to assess the feasibility of using local anesthesia during the 180-Watt GreenLight® PVP procedure in patients who are unsuitable for general or regional anesthesia.
METHODS: The study involved 52 patients who underwent PVP using the 180-Watt GreenLight® system at our institution under periprostatic block between December 2013 and August 2015. All patients completed International Prostate Symptom Score (IPSS) and underwent uroflowmetric evaluation to determine maximum flow rate (Qmax). Post-void residual urine and prostate volumes were measured by transpubic and transrectal ultrasonography, respectively. Before the operation, 20 ml of bupivacaine hydrochloride (5 mg/ml) was injected into the prostate capsule through the perineum using a 22 G Spinocan® needle under the guidance of an index finger inserted into the rectum. Following the procedure, each patient was assessed for pain using the visual analog scale (VAS), and all patients were followed up 3 months after surgery.
RESULTS: Mean patient age was 74.88±7.16 years. All operations were successfully completed without the need to convert to general anesthesia. PVP resulted in a significant improvement in IPSS (28.6±3.83 vs. 10.73±2.62, p<0.0001) and Qmax (6.88±1.1 vs. 23.87±2.8, p<0.0001). Mean operative time, indwelling catheter duration, and length of hospital stay were 57.13±15.32 min, 1.25±0.44 days, and 1.37±0.56 days, respectively. No severe perioperative complications were recorded. The majority of patients did not exhibit any evidence of pain during the procedure (46 of 52 patients had a VAS of 0), and the mean VAS score was 0.40±1.27.
DISCUSSION AND CONCLUSION: Periprostatic block appears to be a feasible and safe alternative to general or regional anesthesia during PVP using a 180-Watt GreenLight® system. This type of anesthesia may be preferred for use in elderly patients with BPH/LUTS who cannot tolerate general and/or regional anesthesia due to comorbidities.
Periprostatik Blok ile 180 Watt GreenLight® Lazer Prostatektomi
Ömer Onur Çakır1, Mehmet Çulha2, Hüseyin Lüleci3, Ahmet Yaser Müslümanoğlu11Sağlık Bilimleri Üniversitesi, Bağcılar Eğitim ve Araştırma Hastanesi, Üroloji Kliniği, İstanbul2Sağlık Bilimleri Üniversitesi, Okmeydanı Eğitim ve Araştırma Hastanesi, Üroloji Kliniği
3Medistate Hastanesi, Üroloji Kliniği, İstanbul
GİRİŞ ve AMAÇ: GreenLight® photoselective vaporisation of the prostate(PVP) is an effective minimally invasive surgical treatment for lower urinary tract symptoms suggestive of benign prostatic hyperplasia(BPH/LUTS).This study aimed to assess the feasibility of using local anaesthesia during the 180 Watts GreenLight® PVP procedure in patients who are unsuitable for general or regional anaesthesia.
YÖNTEM ve GEREÇLER: The study involved 52 patients who underwent PVP using the 180-watt GreenLight® system at our institution under periprostatic block between December 2013 and August 2015.All patients completed International Prostate Symptom Score(IPSS) and underwent uroflowmetric evaluation to determine maximum flow rate(Qmax).Post-void residual urine(PVR) and prostate volumes were measured by transpubic and transrectal ultrasonography, respectively.Prior to the operation, 20 ml of bupivacaine hydrochloride(5 mg/ml) was injected into the prostate capsule via the perineum using a 22 G Spinocan® needle under the guidance of an index finger inserted into the rectum.Following the procedure, each patient was assessed for pain using the visual analogue scale (VAS), and all patients were followed-up 3 months after surgery.
BULGULAR: Mean patient age was 74.88±7.16 years.All operations were successfully completed without the need to convert to general anaesthesia. PVP resulted in a significant improvement in IPSS (28.6±3.83 vs. 10.73±2.62, p<0.0001) and Qmax (6.88±1.1 vs. 23.87±2.8, p<0.0001). Mean operative time, indwelling catheter duration and length of hospital stay were 57.13±15.32 min, 1.25±0.44 days and 1.37±0.56 days, respectively.No severe perioperative complications were recorded.The majority of patients did not exhibit any evidence of pain during the procedure (46 of 52 patients had a VAS of 0), and the mean VAS score was 0.40±1.27.
TARTIŞMA ve SONUÇ: Periprostatic block appears to be a feasible and safe alternative to general or regional anaesthesia during PVP using a 180-watt GreenLight® system. This type of anaesthesia may be preferred for use in elderly patients with BPH/LUTS who cannot tolerate general and/or regional anaesthesia due to comorbidities.
Manuscript Language: English