Assessing the Impact of the PVP With Greenlight Laser Using Prostatic MRI and Contrast-enhanced Ultrasound

The laser PVP with an optical fiber firing side carries out a vaporization of next prostatic tissue and a necrosis of underlying prostatic tissue which corresponds to a postoperative inflammatory area.

One of the side effects of this technique is the irritative syndrome which may involve urinary frequency, urgency or burning urination in approximately 10 to 20% at 1 month.

The current literature does report neither the analysis of the underlying inflammatory necrotic area in prostatic vaporized tissue, nor the analysis of the urinary irritative signs post-laser PVP.

Progresses in the field of functional ultrasound imaging allow us to consider a study of evolution of the underlying necrotic area devoid of micro-vascularisation under effect of PVP laser. The parallel with results of MRI (radiological technique most referenced) during the same period would help to support the experimental results of prostatic contrast-enhanced ultrasound.

Inclusion criteria

• Patient over 40 years old without an upper age limit
• Informed orally and in writing, having signed a consent which match to the research
• Patient with a benign prostatic hypertrophy requiring surgical treatment by PVP
• Person affiliated to a social security system

Exclusion criteria

• Contraindications to MRI for patients with:

• ocular metallic foreign object
• any electronic medical device implanted by irremovable way (pacemakers, neuro-stimulator, cochlear implants ...)
• metallic heart valve, old heart valves are specially an absolute contraindication because of risk of dysfunction
• vascular clips implanted formerly on brain aneurysm
• Allergy to Gadolinium
• Contraindications to the contrast medium Sonovue:

• Hypersensitivity to hexafluorinated sulphur or any other components of Sonovue
• Recent acute coronary syndrome (within 6 months before the intervention)
• Unstable ischemic heart disease (myocardial infarction being formed or evolving, typical angina of rest in the previous month)
• Significant worsening of cardiac symptoms between the pre anaesthesia consultation and intervention
• Recent intervention (less than 6 months) on coronary arteries or other factor suggesting clinical instability (changes in ECG, changes in clinical or biological parameters)
• Acute heart failure or heart failure stage III or IV
• Severe arrhythmias
• Right-left shunt
• Acute endocarditis
• Valve prothesis
• Severe pulmonary hypertension (pulmonary artery pressure > 90mmHg)
• Systemic hypertension uncontrolled
• Respiratory distress syndrome
• Prostatic biopsy < 30 days or anal pathology
• Patient with prostate cancer
• Patient with a urinary infection
• Patient with preoperative urinary catheter
• Patient with a contraindication for surgery
• Adult patient with a legal protection measure