MP25-03 DIABETES MAY COMPROMISE THE FUNCTIONAL OUTCOMES OF GREENLIGHT LASER XPS-180W PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE

Abstract

INTRODUCTION AND OBJECTIVE: To compare the perioperative and functional outcomes of diabetic vs. non-diabetic patients after photoselective vaporization of the prostate (PVP) for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). METHODS: The data of all patients who underwent GreenLight® XPS 180-W Laser PVP Between January 2012 and December 2015 at a tertiary referral center were collected prospectively. Out of 1070 patients, 120 patients had type 2 diabetes. They were matched in 1:1 fashion with 120 patients without diabetes (control group) according to the age, the ultrasound prostate volume and the preoperative IPSS. The functional and perioperative outcomes were compared between the two groups. The continuous and categorical datas were compared using the Kruskall-Wallis and Chi2 tests respectively. RESULTS: Diabetic patients had more comorbidities (ASA score 3: 44.3% vs. 6.2%; p<0.001). They were more commonly under oral anticoagulants (21.7% vs. 4.2%; p<0.001) or under antiplatelets (39.2% vs. 19.2%; p<0.001). There was a higher rate of patients with refractory urinary retention/indwelling urethral catheter preoperatively in the diabetic group (55.8% vs. 20%; p<0.001). The duration of bladder irrigation (0.4 vs. 0.08 days; p<0.001), duration of bladder catheterization (1.9 vs. 1.6 days; p=0.009), length of hospital stay (2.6 vs. 1.1 days; p<0.001) were all significantly longer in the diabetic group. The proportion of day-case surgery was smaller in the diabetic group (12.5% vs. 42.5%; p<0.001) and the failures of postoperative trial without catheter were more common in the diabetic group (23.3% vs. 11.7%; p=0.03). At 3 months diabetics patients tended to have more urgency (IPPS-Q4: 1.6 vs. 0.9; p=0.10), had significantly worse nocturia (IPSS-Q7: 2.1 vs. 1.3; p=0.003), significantly more urgency incontinence (27.3% vs. 11.4%; p=0.01) and stress urinary incontinence (15.7% vs. 0%; p<0.001) according to the ICS score. Postoperative IPPS, maximum flow rate, post void residual and PSA were comparable in both groups at 3, 6, 12 and 24 months. CONCLUSIONS: GreenLight Laser PVP may not increase the risk of postoperative complications and may provide satisfactory functional outcomes for diabetic patients. However, the slightly less favorable perioperative profile and impact on overactive bladder symptoms and the higher rate of early postoperative urinary incontinence calls out for caution in this population, underscoring that these patients might have an underlying diabetic cystopathy unlikely to be improved by BPH surgery.