Impact of Photoselective Vaporization of the Prostate on Renal Function: A Pressure Flow Study-Based Analysis

This study assessed changes in renal function from baseline to 6 months after photoselective vaporization of the prostate (PVP).

Among 117 consecutive patients who underwent PVP at our institution between November 2020 and September 2024, 88 patients with complete baseline and 6-month postoperative blood sampling and pressure flow study (PFS) data were included in the analysis. The primary endpoints were the changes in serum creatinine (sCr) and the estimated glomerular filtration rate (eGFR) from baseline to 6 months postoperatively. Secondary endpoints included changes in urodynamic parameters and clinical outcomes from baseline to 6 months postoperatively. An exploratory group comparison was performed between patients with and without an increase in eGFR of ≥ 5 mL/min/1.73 m².

Overall, median sCr and eGFR showed no significant changes, with sCr remaining at 0.93-0.92 mg/dL and eGFR unchanged at 61.7 mL/min/1.73 m² (p = 0.59 and p = 0.29, respectively). Clinical and urodynamic outcomes improved significantly, including a decrease in median Bladder Outlet Obstruction Index (BOOI) from 54.4 to 13.4 (p < 0.001). Eleven patients (12.5%) met the exploratory eGFR improvement criterion. Compared with the remaining patients, they had a lower baseline eGFR and higher proportions of CKD stage ≥ 3, preoperative catheterization or clean intermittent catheterization, and phasic detrusor overactivity (p = 0.015, p = 0.0027, p = 0.033, and p = 0.0019, respectively).

Overall renal function did not significantly change at 6 months after PVP. The exploratory findings may provide preliminary support for considering PVP in patients with impaired renal function who otherwise meet established indications for surgery; however, they do not establish a renal protective effect and require prospective validation.