Abstract
Background:
To assess the effect of novel surgical techniques (Laser Enucleation of the Prostate (LEP) and Laser Vaporization of the Prostate (LVP)) compared to Transurethral Resection of Prostate (TURP), on post-operative outcomes stratified based on kidney function.
Methods:
The ACS-NSQIP database was reviewed from 2008-2021 for 83020 patients that underwent TURP, LEP, and LVP. Pre-operative variables were compared across kidney function groups: G1(normal/high function); G2-G3(mild/moderate kidney disease); and G4-G5(severe kidney disease). Multivariate logistic regression was performed on 30-day peri-operative complications adjusting for pre-operative variables. Propensity score matching was done between LEP and LVP to TURP.
Results:
In the G1 category, LEP showed significant protective effect against UTI (OR=0.59[0.41-0.84]), shorter hospital stay (OR= 0.72[0.60-0.87]), and longer operative time (OR=5.29[4.50-6.22]). LVP had a significant protective effect against bleeding (OR=0.19[0.11-0.37]), shorter hospital stay (OR=0.18[0.16-0.20]), and decreased return to OR (OR=0.59[0.45-0.78]).
In the G2-G3 category, LEP showed significant protective effect against UTI (OR=0.65[0.50-0.83]), sepsis (OR=0.48[0.26-0.88]), shorter hospital stay (OR=0.64[0.56-0.71]), and longer operative time (OR=5.47[4.90-6.09]). LVP had significant protective effect against bleeding (OR=0.35[0.27-0.45]), shorter hospital stay (OR=0.24[0.23-0.26]), decreased return to OR (OR=0.71[0.60-0.85]), thromboembolic events (OR=0.64[0.42-0.97]), and shorter operative time (OR=0.95[0.90-0.99]).
In the G4-G5 category, LEP lost the protective effect against UTI and sepsis and had longer operative time (OR=5.29[3.02-9.26]). LVP had significant protective effect against cardiac complications (OR=0.27[0.07-0.97]), bleeding (OR=0.49[0.28-0.85]), and shorter hospital stay (OR=0.30[0.24-0.39]).
Conclusion:
LEP and LVP are superior to TURP in terms of post-operative complications. The type of endoscopic surgery technique should be tailored according to patient’s pre-operative kidney status and risk.