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OBJECTIVES: We evaluated the therapeutic efficacy and safety of photo-selective vaporization of the prostate
(PVP) under local anaesthesia in patients suffering from lower urinary tract symptoms (LUTS) secondary to
prostatic obstruction. MATERIAL & METHODS: 150 patients at the average age of 73 (range 51-92) and a
mean/median ASA-score of 2.4/2.0 were included. PVP was performed under either general or spinal
anaesthesia in the first 67 patients and under local anaesthesia (peri-prostatic infiltration with 0.25%
bupivacain-adrenalin 20 ml) and light sedation in the remaining 83 patients. Surgical variables including asa-score,
operative-time, blood-pressure, oxygen saturation, pre- and post-op haemoglobin (Hgb) were recorded.
Post operative need for pain medication, catheter-time, and time to pts. hospital discharge were also recorded.
RESULTS: No patient with local anaesthesia required conversion to general anaesthesia. The median Hgb fall
from pre-op. to post-op. was 0.55g/dl. The median requirement for post-op. catheterization was 2 hrs after local
anaesthesia and 9 hrs after general or spinal anaesthesia. The median time from operation to hospital discharge
was 12 hrs in local anaesthesia and 24 hrs for general or spinal anaesthesia (p<0.001). At 12 and 18 months
postoperatively, the following factors were significantly (p<0.001) improved: trans-rectal ultrasound,
international prostate symptom score, quality of life score, post-void residual urine volume, flow max/average.
At 12 months urodynamic studies revealed significant improvement (p<0.001) for opening pressure, pressure @
flow-max, micturation resistance and bladder outlet obstruction index. CONCLUSION: PVP under local
anaesthesia and light sedation provides excellent intraoperative safety, expedient post operative recovery,
significant symptom relief as well as improvement in uro-dynamic outcomes.
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