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Study Type – Therapy (cohort) Level of Evidence 2b OBJECTIVE • To evaluate the safety and efficacy of laser vaporization of the prostate (LVP) with several different wavelengths for urinary retention. PATIENTS AND METHODS • A cohort study of patients undergoing LVP from 2005 to 2009 at a single institution was performed. • Outcomes were compared in those patients with urinary retention versus those without, using t-tests, Mann–Whitney U-test, chi-squared test and Fisher’s exact test as appropriate. RESULTS • During the study period, 122 patients underwent LVP, of which 39 (32%) presented with refractory urinary retention requiring indwelling or intermittent catheterization. • The mean ± SD period of postoperative follow-up was 11.2 ± 9.6 months. Comparing patients with and without urinary retention, there were no significant preoperative differences in median body mass index (25.6 versus 26.4 kg/m2; P= 0.40) or prostate-specific antigen (2.3 versus 2 ng/mL; P= 0.27). • Patients with urinary retention were significantly more likely to be diabetic (33% versus 12%; P= 0.01), have heart disease (36% versus 15%; P= 0.01) and be taking anticoagulants (61% versus 31%; P= 0.003). • Following LVP, retention patients were more likely than non-retention patients to fail an initial voiding trial (28.2% versus 7.2%; P= 0.002). • In total, 36 of 39 (92%) retention patients no longer required catheterization after postoperative recovery. No patients required perioperative transfusion. • Compared to those without preoperative retention, retention patients had a longer median duration of postoperative catheterization (3 versus 1 days; P= 0.01). • There were similar rates of low- and high-grade complications (P= 0.275 and 1.000, respectively) and no significant difference in median hospital stay (1 versus 0 days; P= 0.212). CONCLUSIONS • In the present study cohort, LVP was an effective and safe therapy for urinary retention. • Compared to patients without retention, those with retention had a higher prevalence of heart disease, diabetes and anticoagulant use. • Because the morbidity of LVP is low, and the prevalence of co-morbid disease high, LVP should be considered for the surgical management of refractory urinary retention. |
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