2-year followup pressure flow studies of prostate photoselective vaporization using local anesthesia with sedation

We report 2-year pressure flow studies and other clinical outcomes of photoselective prostate vaporization with the patient under general or spinal anesthesia vs local anesthesia with sedation.

The study included 150 unselected patients with an average age of 73 years (range 51 to 92) and a mean American Society of Anesthesiologists score of 2.4 (median 2.0), of whom 33% were medicated with acetylsalicylic acid and 5% were on anticoagulation with warfarin. Photoselective prostate vaporization was performed under general or spinal anesthesia in the first 67 patients and under local anesthesia with light sedation in the remaining 83.

No patient who received local anesthesia required conversion to general anesthesia. The median preoperative to postoperative decrease in hemoglobin was 0.55 gm/dl and no patient required blood transfusion. The median postoperative catheterization requirement was 2 hours after local anesthesia and 9 hours after general or spinal anesthesia. Median time from operation to hospital discharge was 12 hours in the local anesthesia group and 24 hours in the general or spinal anesthesia group (p <0.001). At 12 and 24 months postoperatively significant and stable improvements were found in certain measures, including prostate specific antigen, transrectal ultrasound measurement, post-void residual urine volume, International Prostate Symptom Score, quality of life score, maximum and average flow, and the bladder outlet obstruction index.

Photoselective prostate vaporization using local anesthesia with sedation provides excellent intraoperative safety and expedient postoperative recovery. Compared to photoselective prostate vaporization performed with the patient under general or spinal anesthesia it leads to equally significant symptom relief and stable improvement in pressure flow outcomes at 1 and 2 years of followup.