Risk Factors for Reoperation after Photoselective Vaporization of the Prostate Using a 120 W GreenLight High Performance System Laser for the Treatment of Benign Prostatic Hyperplasia

Objective: We investigated risk factors in a large cohort of patients who underwent reoperation after photoselective vaporization of the prostate using the 120 W GreenLight High Performance System laser for treatment of benign prostatic hyperplasia. Background data: Complications such as recurrent/residual adenoma, urethral stricture, or bladder neck might occur after photoselective vaporization of the prostate for treatment of benign prostatic hyperplasia. Materials and methods: We reviewed the data of 1040 patients who underwent photoselective vaporization of the prostate between April 2009 and December 2014, and analyzed the clinical data of 630 patients who completed >12 months of follow-up. Patients were evaluated for perioperative and late complications. Reoperation was defined as the necessity for any surgical intervention to resolve recurrent/residual adenoma, urethral stricture, or bladder neck contracture. Patients with recurrent/residual adenoma, urethral stricture, or bladder neck contracture were compared with those without complications to identify the risk factors for reoperation. Logistic regression analysis was conducted to estimate the risk of reoperation. Results: Reoperation was performed in 25 of 630 patients (3.9%) at 35.5 months mean follow-up: 12 had recurrent/residual adenoma, 5 had urethral stricture, and 8 had bladder neck contracture. Multivariate analysis revealed that a higher prostate-specific antigen (PSA) (OR, 1.129; p = 0.023) and longer lasing time (OR, 0.883; p = 0.024) were predictors of recurrent/residual adenoma. Urethral stricture was associated with a history of transurethral surgery (OR, 1.321; p = 0.042). Preoperative small prostate volume was a risk factor for bladder neck contracture (OR, 0.901; p = 0.011). Conclusions: In our study, the significant factors related to recurrent/residual adenoma were a high preoperative PSA and longer lasing time. A history of transurethral surgery was significantly associated with urethral stricture, whereas preoperative small prostate volume was significantly associated with bladder neck contracture.