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Helman TA, Browne BM. Advances in Outpatient Therapies and Treatment of Benign Prostatic Hyperplasia: A Comprehensive Review for Men's Health. Med Clin North Am 2024; 108:981-991. [PMID: 39084845 DOI: 10.1016/j.mcna.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Benign prostate hyperplasia (BPH) affects a large number of men and can be treated with behavioral, medical, or surgical treatments. The newest addition to medical therapy is β3-agonists for overactive lower urinary tract symptoms. Multiple new surgical treatments have become available in the past decade, including several clinic-based minimally invasive surgical techniques (eg, UroLift, Rezum, Optilume BPH), OR treatments (eg, Aquablation, single port robotics), and prostate artery embolization. The growth of options allows providers to better tailor BPH treatment to the specific disease factors and patient preferences.
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Affiliation(s)
- Talia A Helman
- Division of Urology, Department of Surgery, Emory University, 1365 Clifton Road NorthEast, Building B 1st Floor, Suite 1400, Atlanta, GA 30322, USA.
| | - Brendan M Browne
- Division of Urology, Department of Surgery, Emory University, 1365 Clifton Road NorthEast, Building B 1st Floor, Suite 1400, Atlanta, GA 30322, USA
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Bourgi A, Bruyère F. Delayed hematuria after prostatic photovaporization: risk factors to know. World J Urol 2024; 42:422. [PMID: 39033469 DOI: 10.1007/s00345-024-05128-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/14/2024] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVE characterize delayed hematuria (DH) after photoselective vaporization of the prostate (PVP) and identify its associated risk factors. METHODS 1014 patients who underwent PVP at an expert center, from September 2005 through December 2021, were prospectively enrolled in a database registry. Risk factors of DH included age, prostate volume, ASA score, history of BPH surgery, history of prostate cancer, use of anticoagulation or 5ARIs, concomitant procedure, operative factors, and the duration of follow-up. RESULTS The median operating time was 60 ± 11 min. The median specific applied energy was 318,500 Joules ± 101,347. After PVP, the mean catheterization duration was 1.6 days with a postoperative hospitalization time of 1.8 days. The median follow-up was 52 months (range 2-95 months). Hematuria occurred in 206 patients (20.3%), with 10% requiring an ER visit and 8.3% requiring hospital admission, transfusion or endoscopic clot removal. Almost 80% of hematuria episodes occurred within the first 3 months. The overall retreatment rate for clot retention was 3.7% after a mean time of 50 months. Hematuria-free survival was 97.2% after 1 year, and 89.3% after 4 years. Delayed hematuria occurred in 32 patients (3.1%). In the multivariate analysis, age, preoperative prostate volume, anticoagulant use, total applied energy, lasing time and operative time were identified as risk factors for delayed hematuria after PVP. CONCLUSION Larger prostate volume, longer operative time, longer lasing time, and use of oral anticoagulation increase the odds of delayed hematuria after PVP, while older age is protective.
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Affiliation(s)
- Ali Bourgi
- Department of Urology, University Hospital of Tours, 2 Boulevard Tonnellé, Tours, Loire Valley, France.
| | - Franck Bruyère
- Department of Urology, University Hospital of Tours, 2 Boulevard Tonnellé, Tours, Loire Valley, France
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Gill BC, Miller LE, Bhattacharyya S, Cash H, Eure GR. Complications of GreenLight Laser vs Transurethral Resection of the Prostate for Treatment of Lower Urinary Tract Symptoms: Meta-analysis of Randomized Trials. Urology 2024; 184:259-265. [PMID: 38176618 DOI: 10.1016/j.urology.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/14/2023] [Accepted: 12/26/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE To compare perioperative outcomes and complications between GreenLight and transurethral resection of the prostate (TURP) for benign prostatic hyperplasia. METHODS A systematic review and random effects meta-analysis of randomized trials comparing GreenLight with TURP was completed. Primary outcomes included periprocedural milestones, 12 predefined complications, Clavien-Dindo class III-V complications, reoperations (all-cause), and a composite of reoperations and readmissions. Metaregression assessed the relationship between patient- and study-level factors with periprocedural outcomes and reoperation rates. RESULTS The review included 13 randomized trials with 1757 patients (839 GreenLight; 918 TURP). Procedure time was 10 minutes (95% CI: 5 to 15; P < .001) longer with GreenLight, while catheterization time (mean difference=-1.3days; 95% CI: -1.7 to -0.9; P<.001) and hospital stay (mean difference=-2.1days; 95% CI: -2.5 to -1.7; P<.001) were shorter. Bleeding-related complications, including clot retention (risk ratio [RR]=0.12; 95% CI: 0.05 to 0.32; P<.001) and transfusion (RR=0.26; 95% CI: 0.12 to 0.58; P = .001), as well as sexual dysfunction (RR=0.66; 95% CI: 0.45 to 0.98; P = .04), were less frequent with GreenLight. All other complications occurred at similar frequencies between groups. The risks of reoperation (RR: 1.17; 95% CI: 0.82 to 1.66; P = .38) and reoperation or readmission (RR: 1.05; 95% CI: 0.76 to 1.44; P = .79) did not differ. CONCLUSION GreenLight achieved shorter catheterization times and hospital stays with lower rates of sexual dysfunction and bleeding-related complications compared to TURP.
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Affiliation(s)
- Bradley C Gill
- Department of Urology, Cleveland Clinic Foundation, Cleveland, OH
| | | | | | - Hannes Cash
- Department of Urology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
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Kaltsas A, Kratiras Z, Zachariou A, Dimitriadis F, Sofikitis N, Chrisofos M. Evaluating the Impact of Benign Prostatic Hyperplasia Surgical Treatments on Sexual Health. Biomedicines 2024; 12:110. [PMID: 38255215 PMCID: PMC10813562 DOI: 10.3390/biomedicines12010110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Benign prostatic hyperplasia (BPH), a prevalent condition in older men, is often managed through various surgical interventions. This narrative review aims to explore the impact of these surgical treatments on sexual function, a critical aspect of patient quality of life often overlooked in BPH management. The methodology encompassed a thorough review of contemporary surgical techniques for BPH, including prostate resection, enucleation, vaporization, and minimally invasive therapies such as UroLift, Rezum, and Aquablation. Additionally, the focus was on patient-centered outcomes, with a special emphasis on sexual health following surgery. Findings reveal that, while surgical interventions effectively alleviate BPH symptoms, they often have significant repercussions in sexual function, including erectile and ejaculatory dysfunction. However, emerging techniques demonstrate potential in preserving sexual function, underscoring the need for patient-centric treatment approaches. The study highlights the complex interplay between BPH surgery and sexual health, with minimally invasive treatments showing promise in balancing symptom relief and sexual function preservation. In conclusion, the study advocates for an integrated, interdisciplinary approach to BPH treatment, emphasizing the importance of considering sexual health in therapeutic decision-making. This narrative review suggests a paradigm shift towards minimally invasive techniques could optimize patient outcomes, marrying symptom relief with quality-of-life considerations. The need for further research in this domain is evident, particularly in understanding long-term sexual health outcomes following different surgical interventions for BPH.
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Affiliation(s)
- Aris Kaltsas
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.)
| | - Zisis Kratiras
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.)
| | - Athanasios Zachariou
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.Z.); (N.S.)
| | - Fotios Dimitriadis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Nikolaos Sofikitis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.Z.); (N.S.)
| | - Michael Chrisofos
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.)
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Salmivalli A, Ettala O, Nurminen P, Kinnala P, Boström PJ, Kytö V. Short- and long-term risks of photoselective laser vaporization of the prostate: a population-based comparison with transurethral resection of the prostate. Ann Med 2023; 55:1287-1294. [PMID: 36974584 PMCID: PMC10054157 DOI: 10.1080/07853890.2023.2192046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Transurethral resection of the prostate (TURP) is the standard surgical treatment for benign prostate enlargement (BPE). Photoselective vaporization of the prostate (PVP) is an alternative, but there is limited real-life evidence of PVP risks. OBJECTIVE To compare short- and long-term risks of PVP to those of TURP in the treatment of BPE. MATERIALS AND METHODS Consecutive patients who underwent elective PVP or TURP between 2006 and 2018 in 20 hospitals in Finland were retrospectively studied using a combination of national registries (n = 27,408; mean age 71 years). Short-term risks were postoperative mortality, major adverse cardiovascular events (MACE), and reoperations for bleeding. Long-term risks were reoperations for BPE or any urethral operations within 12 years. Differences between treatment groups were balanced by inverse probability of treatment weighting. Risks were analyzed using the Kaplan-Meier method and Cox regression. RESULTS There were no differences in postoperative mortality or MACE between the study groups. Reoperations for bleeding were less frequent after PVP (0.9%, HR: 0.72, p = 0.042). Bleeding was more likely in patients with atrial fibrillation (number needed to treat [NNT] for PVP vs TURP: 61). Cumulative incidence for reoperation was higher after PVP (23.5%) than after TURP in long-term follow-up (17.8%; HR: 1.20, p < 0.0001, NNT: -31.7). CONCLUSIONS PVP is associated with lower postoperative bleeding risk but higher long-term reoperation risk than TURP. Patients with high bleeding risk and a low likelihood of needing reoperation appear most suitable for laser vaporization.KEY MESSAGEPVP is associated with lower postoperative bleeding risk but higher long-term reoperation risk than TURP. PVP appears an attractive treatment option, especially for patients with high bleeding risk and a low likelihood of needing a reoperation.
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Affiliation(s)
- Alisa Salmivalli
- Department of Clinical Research, University of Turku, Turku, Finland
- Department of Urology, Satasairaala Central Hospital, Wellbeing Services County of Satakunta, Pori, Finland
| | - Otto Ettala
- Department of Urology, Turku University, Turku University Hospital, Turku, Finland
| | - Pertti Nurminen
- Department of Urology, Turku University, Turku University Hospital, Turku, Finland
| | - Pekka Kinnala
- Department of Urology, Turku University, Turku University Hospital, Turku, Finland
| | - Peter J. Boström
- Department of Urology, Turku University, Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
- Turku Clinical Research Center, Turku University Hospital, Turku, Finland
- Research Services, Wellbeing Services County of Southwest Finland, Turku, Finland
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He W, Ding T, Niu Z, Hao C, Li C, Xu Z, Jing Y, Qin W. Reoperation after surgical treatment for benign prostatic hyperplasia: a systematic review. Front Endocrinol (Lausanne) 2023; 14:1287212. [PMID: 38027158 PMCID: PMC10665564 DOI: 10.3389/fendo.2023.1287212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Context Surgical treatment is important for male lower urinary tract symptom (LUTS) management, but there are few reviews of the risks of reoperation. Objective To systematically evaluate the current evidence regarding the reoperation rates of surgical treatment for LUTS in accordance with current recommendations and guidelines. Evidence acquisition Eligible studies published up to July 2023, were searched for in the PubMed® (National Library of Medicine, Bethesda, MD, USA), Embase® (Elsevier, Amsterdam, the Netherlands), and Web of Science™ (Clarivate™, Philadelphia, PA, USA) databases. STATA® (StataCorp LP, College Station, TX, USA) software was used to conduct the meta-analysis. Random-effects models were used to calculate the pooled incidences (PIs) of reoperation and the 95% confidence intervals (CIs). Evidence synthesis A total of 119 studies with 130,106 patients were included. The reoperation rate of transurethral resection of the prostate (TURP) at 1, 2, 3, and 5 years was 4.0%, 5.0%, 6.0%, and 7.7%, respectively. The reoperation rate of plasma kinetic loop resection of the prostate (PKRP) at 1, 2, 3, and 5 years was 3.5%, 3.6%, 5.7%, and 6.6%, respectively. The reoperation rate of holmium laser enucleation of the prostate (HoLEP) at 1, 2, 3, and 5 years was 2.4%, 3.3%, 5.4%, and 6.6%, respectively. The reoperation rate of photoselective vaporization of the prostate (PVP) at 1, 2, 3, and 5 years was 3.3%, 4.1%, 6.7%, and 7.1%, respectively. The reoperation rate of surgery with AquaBeam® at 1, 2, 3, and 5 years was 2.6%, 3.1%, 3.0%, and 4.1%, respectively. The reoperation rate of prostatic artery embolization (PAE) at 1, 2, 3, and 5 years was 12.2%, 20.0%, 26.4%, and 23.8%, respectively. The reoperation rate of transurethral microwave thermotherapy (TUMT) at 1, 2, 3, and 5 years was 9.9%, 19.9%, 23.3%, and 31.2%, respectively. The reoperation rate of transurethral incision of the prostate (TUIP) at 5 years was 13.4%. The reoperation rate of open prostatectomy (OP) at 1 and 5 years was 1.3% and 4.4%, respectively. The reoperation rate of thulium laser enucleation of the prostate (ThuLEP) at 1, 2, and 5 years was 3.7%, 7.7%, and 8.4%, respectively. Conclusion Our results summarized the reoperation rates of 10 surgical procedures over follow-up durations of 1, 2, 3, and 5 years, which could provide reference for urologists and LUTS patients. Systematic review registration https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023445780.
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Affiliation(s)
- Weixiang He
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Ting Ding
- Department of Clinical Laboratory Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Zhiping Niu
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Chunlin Hao
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Chengbin Li
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Zhicheng Xu
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Yuming Jing
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Weijun Qin
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
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Hughes T, Harper P, Somani BK. Treatment Algorithm for Management of Benign Prostatic Obstruction: An Overview of Current Techniques. Life (Basel) 2023; 13:2077. [PMID: 37895457 PMCID: PMC10608556 DOI: 10.3390/life13102077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
The management of benign prostatic obstruction (BPO) should involve a treatment algorithm that takes into account prostate size, and patient's symptoms and preference with the aim of helping with urinary symptoms and enhance quality of life. The diagnostic assessment for men with lower urinary tract symptoms (LUTS) should be comprehensive to help choose the best management strategy. Strategies from lifestyle modifications to medical treatment with alpha blockers and/or 5-alpha-reductase inhibitors to surgical procedures can all be used in the management algorithm. Surgical management ranges from transurethral resection of prostate (TURP) to minimally invasive surgical therapies (MIST) including laser therapies such as Holmium laser enucleation (HoLEP) and photoselective vaporisation (PVP), aquablation, Rezūm system, prostate artery embolisation (PAE), prostatic urethral lift (PUL), temporary implantable nitinol device (iTind) and Optilume BPH catheter system. BPO is a common urological condition that has a significant impact on quality of life and economic burden globally and is likely to become increasingly prevalent with an ageing population. Selecting the most appropriate treatment modality will depend on the individual patient preferences, availability of resources, cost, anatomical factors and the goals of treatment.
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Affiliation(s)
- Thomas Hughes
- Department of Urology, South Warwickshire University Hospital NHS Foundation Trust, Warwick CV34 5BW, UK;
| | - Philip Harper
- Department of Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
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Smetana GW, Smith CC, Singla A, Libman H. How Would You Manage This Patient With Benign Prostatic Hyperplasia? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med 2023; 176:545-555. [PMID: 37037036 DOI: 10.7326/m23-0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
Lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) are common in older patients assigned male sex at birth, regardless of gender identity, and treatment of these symptoms is therefore common in primary care practice. In 2021, the American Urological Association published guidelines for management of BPH. They recommend using a standardized scoring system such as the International Prostate Symptom Score to help establish a diagnosis and to monitor the efficacy of interventions, α-blockers as the first-choice pharmacotherapy option, and 5α-reductase inhibitors for patients with prostate size estimated to be at least 30 cc. Tadalafil is another option regardless of erectile dysfunction. Combination therapies with α-blockers and 5α-reductase inhibitors, anticholinergic agents, or β3-agonists are effective options. A surgical referral is warranted if the BPH results in chronic kidney disease, refractory urinary retention, or recurrent urinary tract infections; if there is concern for bladder or prostate cancer; or if symptoms do not respond to medical therapy. In this article, a general internal medicine physician and a urologist discuss the treatment options and how they would apply their recommendations to a patient who wishes to learn more about his options.
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Affiliation(s)
- Gerald W Smetana
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (G.W.S., C.C.S., A.S., H.L.)
| | - C Christopher Smith
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (G.W.S., C.C.S., A.S., H.L.)
| | - Ajay Singla
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (G.W.S., C.C.S., A.S., H.L.)
| | - Howard Libman
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (G.W.S., C.C.S., A.S., H.L.)
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Fallahi F, Fallahi M, Brauckmann R, Brandt S, Horstmann J, Wiedemann A. [Complications of the 180 Watt XPS™ GreenLight laser-results of 1283 procedures]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:376-382. [PMID: 36513771 PMCID: PMC10073166 DOI: 10.1007/s00120-022-01988-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 04/12/2023]
Abstract
BACKGROUND The aim of this study was to classify and analyze postoperative complications under a new inspection method. This study assessed all patients who presented to the urologic ward within the first 3 months after their surgery. METHODS A total of 170 patients suffered from complications due to the surgery; 29 patients experienced complications that were not directly correlated with the surgery. Age, American Society of Anesthesiologists (ASA) score, the emitted laser energy of the 180 Watt XPS™ GreenLight laser measured in joules, and the complications which led to the renewed hospitalization such as hematuria, urinary retention, and infection were analyzed and compared in the two groups of patients. RESULTS Most complications that occurred were urinary retention and hematuria (50.6% and 49.4% of all patients, respectively). Of the patients with hematuria, 86.75% were under anticoagulant therapy medication. CONCLUSION Compared with the reference approval study (Goliath trial) that included 135 multicentric patients (14.07% of patients presented with a complication classified as Clavien-Dindo II), the rate of complications was similar. This outcome is surprising because the patients treated with the GreenLight laser in the present study were classified as geriatric patients not only according to their age but also in their ASA score which is an indication of multiple other pathologies and administered medications. To achieve long-term postoperative success for these patients, the interface between the ambulatory and the hospital care should be optimized.
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Affiliation(s)
- F Fallahi
- Urologische Klinik, Ev. Krankenhaus Witten gGmbH, Pferdebachstr. 27, 58455, Witten, Deutschland.
- Lehrstuhl für Geriatrie, Lehrstuhl für Urologie, Universität Witten/Herdecke, Witten, Deutschland.
| | - M Fallahi
- Urologische Praxisklinik/Zentrum Euregio Franziskushospital Aachen, Aachen, Deutschland
| | - R Brauckmann
- Chrestos Institut, Concept GmbH & Co. KG, Essen, Deutschland
| | - S Brandt
- Urologische Praxisklinik/Zentrum Euregio Franziskushospital Aachen, Aachen, Deutschland
| | - J Horstmann
- Urologische Praxisklinik/Zentrum Euregio Franziskushospital Aachen, Aachen, Deutschland
| | - A Wiedemann
- Urologische Klinik, Ev. Krankenhaus Witten gGmbH, Pferdebachstr. 27, 58455, Witten, Deutschland
- Lehrstuhl für Geriatrie, Lehrstuhl für Urologie, Universität Witten/Herdecke, Witten, Deutschland
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De la Cuadra-Grande A, Rioja-Zuazu J, Domínguez-Esteban M, Torres E, Blissett R, Woodward E, Oyagüez I, Fernández-Arjona M. Budget impact analysis of transurethral water vapor therapy for treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia in the Spanish national healthcare system. Expert Rev Pharmacoecon Outcomes Res 2023; 23:499-510. [PMID: 36897833 DOI: 10.1080/14737167.2023.2189591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND Several surgical treatments are available for managing lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH). Water vapor thermal therapy (WVTT) is a new minimally invasive therapy. This study estimates the budget impact of introducing WVTT for LUTS/BPH into the Spanish health care system. METHODS A model simulated the evolution of men over 45 years of age with moderate-severe LUTS/BPH after surgical treatment, over a 4-year time horizon, from the Spanish public health care service´s perspective. The technologies in scope included those most used in Spain: WVTT, transurethral resection (TURP), photoselective laser vapourization (PVP) and holmium laser enucleation (HoLEP). Transition probabilities, adverse events and costs were identified from the scientific literature and validated by a panel of experts. Sensitivity analyses were performed by varying the most uncertain parameters. RESULTS Per intervention, WVTT resulted in savings of €3,317, €1,933 and €2,661 compared to TURP, PVP and HoLEP. Over a 4-year time horizon, when performed in 10% of the cohort of 109,603 Spanish males with LUTS/BPH, WVTT saved €28,770,125 against the scenario without WVTT availability. CONCLUSIONS WVTT could reduce the cost of managing LUTS/BPH, increase the quality of health care and reduce the length of procedure and hospital stay.
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Affiliation(s)
| | - Jorge Rioja-Zuazu
- Urology Department, Clínica Universitaria de Navarra, Navarra, Spain
| | | | - Esperanza Torres
- Health Economics & Market Access, Boston Scientific Inc, Madrid, Spain
| | - Rob Blissett
- Health Economics & Economic Evaluation, MedTech Economics Ltd, Winchester, UK
| | - Emily Woodward
- Health Economics & Market Access, Boston Scientific AG, Solothurn, Switzerland
| | - Itziar Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
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Deyirmendjian C, Nguyen DD, Law KW, Nguyen ALV, Sadri I, Arezki A, Bouhadana D, Ibrahim A, Bhojani N, Elterman DS, Chughtai B, Bruyère F, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo T, Becher EF, Cash H, Reimann M, Rijo E, Misrai V, Zorn KC. Safety and efficacy of GreenLight PVP in octogenarians: evaluation of the Global GreenLight Group database. World J Urol 2023; 41:1133-1140. [PMID: 36821011 DOI: 10.1007/s00345-023-04334-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/09/2023] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION The present study analyzes the largest international GreenLight database, the Global GreenLight Group (GGG), to evaluate the functional and safety profile of GreenLight photoselective vaporization of the prostate (PVP) in octogenarians. METHODS The GGG is a database comprised of patients that underwent GreenLight PVP from 2011 to 2019 performed by 8 experienced urologists at 7 international hospitals. Patients 80 years or older at the time of surgery were categorized as octogenarians. They were compared to a similar group of PVP patients below the age of 80. RESULTS Among 3,648 patients, 586 men were above the age of 80. Compared to patients under the age of 80, octogenarians had larger prostates (76.0 vs 71.9 ml, p = 0.02) and a lower BMI (25.6 vs 26.7, p = 0.045). Operative time was not significantly longer in octogenarians. The improvement in functional outcomes between 80-year-old patients and control patients was not significantly different at one-year follow-up, with the exception of maximum urinary flow (Qmax) that favoured younger patients (10.3 vs 12.6 ml/s, p = 0.02). The odds of transfusion were greater for older patients [OR 8.2 (95% CI 3.6-18.9, p < 0.01)], but they were not at increased risk of hematuria. Octogenarians had higher readmission rates (23.0 vs 11.9%, p < 0.01). CONCLUSIONS GreenLight PVP is a safe option in well-selected octogenarians in a cohort of patients treated by surgeons experienced with the technology. The odds of transfusion were higher in patients over 80, but the absolute risk remains low. The 30-day hospital readmission rate was higher in octogenarians.
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Affiliation(s)
| | | | - Kyle W Law
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Anna-Lisa V Nguyen
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Iman Sadri
- Division of Urology, McGill University, Montreal, QC, Canada
| | - Adel Arezki
- Division of Urology, McGill University, Montreal, QC, Canada
| | - David Bouhadana
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Ahmed Ibrahim
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Dean S Elterman
- Division of Urology, University Health Network, Toronto, ON, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Franck Bruyère
- Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Centre-Val de Loire, France
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, "Cure Group", Modena, Italy
| | - Giovanni Ferrari
- Department of Urology, Hesperia Hospital, "Cure Group", Modena, Italy
| | | | | | | | - Hannes Cash
- Prouro, Urology Berlin, Berlin, Germany.,Department of Urology, University of Magdeburg, Magdeburg, Germany
| | - Maximillian Reimann
- Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Enrique Rijo
- Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
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12
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Functional outcomes of GreenLight 180-W photoselective vaporization in patients with large (≥ 80 cc) prostates: an analysis of over 3000 men in the Global Greenlight Group (GGG) database. World J Urol 2023; 41:529-536. [PMID: 36534154 DOI: 10.1007/s00345-022-04260-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION GreenLight photoselective vaporization of the prostate (PVP) has gained widespread adoption as an option to traditional transurethral resection of the prostate. Prior reports expressed concern with the use of PVP in large prostates. The aim of this study was to investigate the adjusted outcomes of GreenLight PVP in men with large (≥ 80 cc) vs. small prostates (< 80 cc). METHODS Data were obtained from the Global Greenlight Group which pools data from 7 high volume centers. Men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019 were eligible and assigned into two groups based on their prostate size (≥ 80 and < 80 cc). 11 functional and perioperative covariates were collected. Analyses were adjusted for patient age and presence of median lobe. RESULTS 3426 men met the inclusion criteria. 34.6% (n = 1187) of patients had a large prostate size. Baseline age and prostate volume were significantly different between the groups. The magnitude of absolute improvement in unadjusted international prostate symptom score was significantly greater in the large (≥ 80 cc) prostate group at 12 months, with an absolute change of 19.17 points (95% CI 18.46-19.88; p < 0.01). There was also a significant drop in PVR at both 6- (p = 0.007) and 12 months (p = 0.005). There were no significant differences in transfusion (p = 0.42), hematuria (p = 0.80), or 30-day readmission rates (p = 0.28). CONCLUSIONS Greenlight PVP is a safe and effective alternative for patients with prostate sizes ≥ 80 cc, with durable outcomes relatively independent from prostate size.
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13
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Liu Z, Chen Z, Yan D, Jiang T, Fu J, Zheng J, Zhou Y, Zhou Z, Shen W. Photoselective sharp enucleation of the prostate with a front-firing 532-nm laser versus photoselective vaporization of the prostate in the treatment of benign prostatic hyperplasia: a randomised controlled trial with 1-year followup results. BMC Urol 2022; 22:173. [PMID: 36344969 PMCID: PMC9639323 DOI: 10.1186/s12894-022-01129-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We designed a new surgical procedure to treat benign prostatic hyperplasia(BPH). In order to verify its effectiveness and safety, we constructed this randomized controlled trial to compare the efficacy of our innovative enucleation technique- photoselective sharp enucleation of the prostate (PSEP), with a front-firing 532-nm laser and the traditional technique-photoselective vaporization of the prostate (PVP) in the treatment of BPH. METHODS A total of 154 consecutive patients diagnosed with bladder outlet obstruction secondary to BPH in our center from June 2018 to April 2019 were randomly divided into the PSEP group (n = 77) and the PVP group (n = 77) and were treated surgically with either PSEP or PVP. All patients were assessed preoperatively and followed up at 1, 6, and 12 months postoperatively. The international prostate symptom score,quality-of-life score, postvoid residual urine volume, maximum urine flow rate, prostate volume, prostate-specific antigen, and adverse events were compared. RESULTS The lower urinary tract symptoms in both groups were significantly improved compared with the baseline at 1, 6, and 12 months postoperatively. The PSEP and PVP groups had an equivalent International Prostate Symptom Score, quality-of-life score, postvoid residual urine volume, maximum urine flow rate, prostate-specific antigen at each follow-up (P > 0.05). The median operative time in the PSEP group was significantly shorter than that in the PVP group (35 min vs. 47 min, P < 0.001). At 6 and 12 months after surgery, the median PV in the PSEP group was smaller than that in the PVP group (P < 0.05). Complication rates were comparable between the groups. CONCLUSION Both PSEP and PVP can achieve good efficacy and safety in the treatment of BPH. PSEP can remove more tissue than PVP and is associated with higher efficiency. In addition, PSEP eliminates the problem of lack of tissue samples associated with PVP. TRIAL REGISTRATION Chinese Clinical Trial Registry, identifie:ChiCTR1800015867, date:25/04/2018.
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Affiliation(s)
- Zhengchao Liu
- grid.410570.70000 0004 1760 6682Urological institution of the People’s Liberation Army, First Affiliated Hospital to Army Medical University, Third Military Medical University), 400037 Chongqing, China
- grid.410570.70000 0004 1760 6682Department of Anesthesiology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Zhipeng Chen
- grid.410570.70000 0004 1760 6682Urological institution of the People’s Liberation Army, First Affiliated Hospital to Army Medical University, Third Military Medical University), 400037 Chongqing, China
| | - Dishi Yan
- grid.410570.70000 0004 1760 6682Urological institution of the People’s Liberation Army, First Affiliated Hospital to Army Medical University, Third Military Medical University), 400037 Chongqing, China
| | - Tao Jiang
- grid.410570.70000 0004 1760 6682Urological institution of the People’s Liberation Army, First Affiliated Hospital to Army Medical University, Third Military Medical University), 400037 Chongqing, China
| | - Jian Fu
- grid.410570.70000 0004 1760 6682Urological institution of the People’s Liberation Army, First Affiliated Hospital to Army Medical University, Third Military Medical University), 400037 Chongqing, China
| | - Jun Zheng
- grid.410570.70000 0004 1760 6682Urological institution of the People’s Liberation Army, First Affiliated Hospital to Army Medical University, Third Military Medical University), 400037 Chongqing, China
| | - Yuanxiu Zhou
- grid.410570.70000 0004 1760 6682Urological institution of the People’s Liberation Army, First Affiliated Hospital to Army Medical University, Third Military Medical University), 400037 Chongqing, China
| | - Zhansong Zhou
- grid.410570.70000 0004 1760 6682Urological institution of the People’s Liberation Army, First Affiliated Hospital to Army Medical University, Third Military Medical University), 400037 Chongqing, China
| | - Wenhao Shen
- grid.410570.70000 0004 1760 6682Urological institution of the People’s Liberation Army, First Affiliated Hospital to Army Medical University, Third Military Medical University), 400037 Chongqing, China
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14
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Garbens A, Kominsky H, Dai J, Steinberg RL, Trivedi H, Kusin S, Roehrborn C, Gahan J. Evaluating Surgical Outcomes of Robot Assisted Simple Prostatectomy in the Retreatment Setting. Urology 2022; 170:111-116. [PMID: 35988733 DOI: 10.1016/j.urology.2022.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/20/2022] [Accepted: 07/27/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To report perioperative and postoperative outcomes in men who undergo salvage RASP (sRASP) following some other endoscopic outlet procedure for benign prostate enlargement (BPE) compared to those undergoing RASP for primary treatment (pRASP). METHODS A prospectively maintained database consisting of all RASP surgeries (December 2014 - October 2019) performed at our institution by three different urologists was used. Patients who had received an endoscopic procedure for BPE prior to their RASP (sRASP) were compared to those who had not had a prior outlet procedure (pRASP). RESULTS In total, 310 men underwent RASP during the study period. Of those, 30 (9.7%) had undergone an endoscopic procedure prior to surgery. There were no significant differences in age, race, ASA, BMI, prostate volume, PSA or rates of preoperative retention (p>0.05 for all). Men who were treatment-naive had significantly higher preoperative International Prostate Symptom Scores (IPSS) than men who had a prior procedure (18.3 ±7.7 vs. 13.6 ±6.2, p=0.008). However, there were no significant differences in functional or quality of life outcomes between the two groups (p>0.05 for all). There were no significant differences in perioperative or post-operative outcomes between the two groups. Furthermore, rates of post-operative complications and incontinence were similar between groups (11% vs. 10%, p=0.9 and 2% vs. 0%, p=1 respectively). CONCLUSION Performing a RASP after prior endoscopic procedure for BPE was found to be safe and effective. Success and complication rates were similar to patients with no prior procedures.
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Affiliation(s)
- Alaina Garbens
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Hal Kominsky
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Jessica Dai
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Ryan L Steinberg
- University of Iowa, Department of Urology, Iowa City, Iowa, USA.
| | - Hersh Trivedi
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Sam Kusin
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Claus Roehrborn
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
| | - Jeffrey Gahan
- University of Texas Southwestern Medical Center, Department of Urology, Dallas, TX, USA.
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15
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Kobayashi Y, Arai H, Honda M. Influence of transurethral enucleation with bipolar of the prostate on erectile function: Prospective analysis of 51 patients at 12-month follow-up. PLoS One 2022; 17:e0272652. [PMID: 35951591 PMCID: PMC9371260 DOI: 10.1371/journal.pone.0272652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 07/25/2022] [Indexed: 11/20/2022] Open
Abstract
Background Transurethral enucleation with bipolar (TUEB) is a safe and effective surgery for benign prostatic obstruction (BPO). However, few data exist concerning the influence of TUEB on erectile function (EF) in patients with BPO. Objective To evaluate the influence of TUEB on EF in patients with BPO at 3- and 12-month follow-up. Material and methods We prospectively enrolled 51 patients who underwent TUEB from June 2016 to April 2020. We evaluated maximum urinary flow rate (Qmax), postvoid residual urine (PVR), International Prostate Symptom Score (IPSS), quality of life (QoL), and International Index of Erectile Function-5 (IIEF-5) preoperatively and at 3- and 12-month follow-up. We classified the patients according to their preoperative IIEF-5 score into group 1 (IIEF-5 ≥10; n = 24) and group 2 (IIEF-5 <10; n = 27), and for further evaluation of EF, into subgroups a: severe (IIEF-5 5–7), b: moderate (8–11), c: mild to moderate (12–16), d: mild (17–21), and e: no erectile dysfunction (22–25). Data are displayed as median or median (interquartile range). Results The study comprised 51 patients with a median age of 75 (70.5–79.5) years. Median prostate and transition zone volumes were 69.5 (46.5–78.8) mL and 30.5 (19–43) mL, respectively. Urinary function improved significantly when comparing respective preoperative, 3-month, and 12-month follow-up values: Qmax (7.6, 12.9, 15.2 mL/s), PVR (50, 0, 0 mL), IPSS (20.5, 9, 6), and QoL (5, 2, 2), respectively. There was no significant change in IIEF-5 score across the three time points: 9, 7, 8. The IIEF-5 score slightly but significantly increased between the preoperative and 12-month follow-up values in group 2 (5, 5, 6) and subgroup a (5, 5, 5). Conclusion TUEB was effective and safe surgery for patients with BPO and showed no significant influence on EF at 12-month follow-up after TUEB in patients with BPO.
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Affiliation(s)
- Yasuyuki Kobayashi
- Department of Urology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan
- * E-mail:
| | - Hiroki Arai
- Department of Urology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan
| | - Masahito Honda
- Department of Urology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan
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16
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Elterman D, Aubé-Peterkin M, Evans H, Elmansy H, Meskawi M, Zorn KC, Bhojani N. UPDATE - Canadian Urological Association guideline: Male lower urinary tract symptoms/benign prostatic hyperplasia. Can Urol Assoc J 2022; 16:245-256. [PMID: 35905485 PMCID: PMC9343161 DOI: 10.5489/cuaj.7906] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Affiliation(s)
- Dean Elterman
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | | | - Howard Evans
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Hazem Elmansy
- Division of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Malek Meskawi
- Division of Urology, Université de Montréal, Montreal, QC, Canada
| | - Kevin C. Zorn
- Division of Urology, Université de Montréal, Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Université de Montréal, Montreal, QC, Canada
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17
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Fu Y, Wen X, Yin Y, Wang C, Mai J. Comparison of effectiveness and postoperative complications of different surgical methods in the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis based on randomized controlled trials. Transl Androl Urol 2022; 11:842-858. [PMID: 35812205 PMCID: PMC9262744 DOI: 10.21037/tau-22-377] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/20/2022] [Indexed: 12/13/2022] Open
Abstract
Background More and more new surgical procedures for the treatment of benign prostate hyperplasia (BPH) are proposed creatively. However, the existing clinical evidence shows that the effectiveness and safety of various procedures exist inconsistent. Methods The randomized controlled trials comparing the international prostate score, length of hospital stay, maximum urinary flow rate, operation time, and complication rates of prostatic artery embolization (PAE), Greenlight-XPS Laser prostate vaporization procedure (GLL PVP), diode laser enucleation of prostate (DILEP) and plasmakinetic resection of the prostate (PKRP), transurethral resection of the prostate (TURP) in patients with BPH were screened out in databases. The primary outcome was pooled using a restricted maximum likelihood-based random-effect model and inverse variance-based fixed-effect model. Cochrane Q statistics and I2 statistics were computed to quantify between-study heterogeneity. The risk of bias of each included study was assessed using the revised Cochrane risk of bias tool. Results This meta-analysis ultimately included 14 original research papers, with 1,940 participants enrolled. Eight studies were considered to be at moderate risk of bias, while the others were at mild risk of bias. Although the improvement in functional outcome of the DILEP procedure was equivalent to that of the PKRP procedure, the DILEP procedure group had fewer hospital stays than the PKRP group (P=0.01). In addition, even though the performance of the GLL PVP procedure in the improvement of functional outcome was inferior to the counterpart of TURP (P=0.64), it had a much fewer hospital stays (P=0.01). Moreover, there is still insufficient evidence for the improvement of subjective functional indicators of postoperative patients with PAE compared with TURP [international prostate symptom score (IPSS): P=0.73; IPSS QoL: P=0.91], but achieved less satisfactory objective functional outcomes (Qmax: P=0.06; PVR: P=0.00). Discussion New surgical procedures such as GLL PVP, PAE, and DILEP were safer than traditional TURP procedures. However, it is not superior to traditional surgery in the improvement of clinical symptoms. In clinical practice, the pros and cons of the new operation and the traditional operation should be carefully weighed, and the operation that is most suitable for the patient's condition should be selected.
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Affiliation(s)
- Yujia Fu
- Department of Nuclear Medicine, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Xiaomiao Wen
- Department of Urology, Danzhou People's Hospital, DanZhou, China
| | - Yanhai Yin
- Department of Nuclear Medicine, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Chaoqun Wang
- Department of Nuclear Medicine, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Jiren Mai
- Department of Urology, Sanya People's Hospital/West China (Sanya) Hospital, Sichuan University, Sanya, China
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18
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Lichy I, Law K, Tholomier C, Nguyen DD, Sadri I, Bouhadana D, Couture F, Zakaria AS, Bhojani N, Zorn KC, Bruyère F, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo TJ, Becher EF, Misrai V, Elterman D, Reimann M, Cash H. Global experience and progress in GreenLight-XPS 180-Watt photoselective vaporization of the prostate. World J Urol 2022; 40:1513-1522. [PMID: 35499590 PMCID: PMC9166849 DOI: 10.1007/s00345-022-03997-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/18/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate changes in global perioperative data of GreenLight-XPS 180-Watt photo-selective vaporization of the prostate (GL-XPS) of the Global Greenlight Group (GGG) database. METHODS 3441 men, who underwent GL-XPS for symptomatic BPH between 2011 and 2019 at seven high volume international centers, were included. Primary outcome measurements were operative time (OT; min), effective laser time (LT; min of OT), as well as intraoperative and postoperative adverse events (AEs), all analyzed by year of surgery (2011-2019) and prostate volume (PV) group (< 80 ml vs. 80-150 ml vs. > 150 ml). RESULTS The median age was 70 years (interquartile range 64-77), the median PV was 64 ml (IQR 47-90). The OT and LT slightly increased but stayed highly efficient all in all. Median OT was 60 min (IQR 45-83) and LT was 33 min (IQR 23-46). Median energy use was 253 kJ (IQR 170-375) with an energy density of 3.94 kJ/ml (IQR 2.94-5.02). The relative probability of perioperative AEs decreased by 17% each year (p < 0.001). The relative probability of perioperative transfusion dropped significantly from 2% in 2011 to 0% in 2019 (p = 0.007). The early postoperative complications (within 30 days after surgery) decreased significantly from 48.8% (n = 106) in 2011 to 24.7% (n = 20) in 2019 (p > 0.001). CONCLUSION These findings from the GGG demonstrate significant improvement secondary to growing experience with GL-XPS between 2011 and 2019 in intraoperative AEs, including transfusions, and postoperative AEs. While staying highly efficient in OT and LT of GL-XPS within a 9-year period of experience.
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Affiliation(s)
- Isabel Lichy
- Department of Urology, Charité–University Medicine Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Kyle Law
- Department of Urology, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Côme Tholomier
- Division of Urology, Department of Surgery, McGill University, Montreal, QC Canada
| | - David-Dan Nguyen
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Iman Sadri
- Division of Urology, Department of Surgery, McGill University, Montreal, QC Canada
| | - David Bouhadana
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Félix Couture
- Department of Urology, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Ahmed S. Zakaria
- Division of Urology, Department of Surgery, Northern Ontario School of Medicine, Thunder Bay, ON Canada
| | - Naeem Bhojani
- Department of Urology, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Kevin C. Zorn
- Department of Urology, University of Montreal Hospital Center (CHUM), Montreal, Canada
| | - Franck Bruyère
- Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Centre-Val de Loire, France
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy
| | - Giovanni Ferrari
- Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy
| | | | | | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, Midi-Pyrenees France
| | - Dean Elterman
- Division of Urology, Dept. of Surgery, University Health Network, University of Toronto, Toronto, ON Canada
| | - Maximilian Reimann
- Department of Urology, Charité–University Medicine Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Hannes Cash
- Prouro, Urology Berlin, Berlin, Germany
- Department of Urology, University of Magdeburg, Magdeburg, Germany
- Department of Urology, University Hospital Magdeburg, Magdeburg, Germany
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19
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Chughtai B, Rojanasarot S, Neeser K, Gultyaev D, Fu S, Bhattacharyya SK, El-Arabi AM, Cutone BJ, McVary KT. A comprehensive analysis of clinical, quality of life, and cost-effectiveness outcomes of key treatment options for benign prostatic hyperplasia. PLoS One 2022; 17:e0266824. [PMID: 35427376 PMCID: PMC9012364 DOI: 10.1371/journal.pone.0266824] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Treatment options for men with moderate-to-severe lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) have variable efficacy, safety, and retreatment profiles, contributing to variations in patient quality of life and healthcare costs. This study examined the long-term cost-effectiveness of generic combination therapy (CT), prostatic urethral lift (PUL), water vapor thermal therapy (WVTT), photoselective vaporization of the prostate (PVP), and transurethral resection of the prostate (TURP) for the treatment of BPH. A systematic literature review was performed to identify clinical trials of CT, PUL, WVTT, PVP, and TURP that reported change in International Prostate Symptom Score (IPSS) for men with BPH and a prostate volume ≤80 cm3. A random-effects network meta‐analysis was used to account for the differences in patient baseline clinical characteristics between trials. An Excel-based Markov model was developed with a cohort of males with a mean age of 63 and an average IPSS of 22 to assess the cost-effectiveness of these treatment options at 1 and 5 years from a US Medicare perspective. Procedural and adverse event (AE)-related costs were based on 2021 Medicare reimbursement rates. Total Medicare costs at 5 years were highest for PUL ($9,580), followed by generic CT ($8,223), TURP ($6,328), PVP ($6,152), and WVTT ($2,655). The total cost of PUL was driven by procedural ($7,258) and retreatment ($1,168) costs. At 5 years, CT and PUL were associated with fewer quality-adjusted life years (QALYs) than WVTT, PVP, and TURP. Compared to WVTT, the incremental cost-effectiveness ratios (ICERs) for both TURP and PVP were above a willingness-to-pay threshold of $50,000/QALY (TURP: $64,409/QALY; PVP: $87,483/QALY). This study provides long-term cost-effectiveness evidence for several common treatment options for men with BPH. WVTT is an effective and economically viable treatment in resource-constrained environments.
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Affiliation(s)
- Bilal Chughtai
- Department of Urology, Weill Cornell Medicine, New York, New York, United States of America
| | | | - Kurt Neeser
- Certara Evidence & Access, Lörrach, BW, Germany
| | | | - Shuai Fu
- Certara Evidence & Access, Lörrach, BW, Germany
| | | | - Ahmad M. El-Arabi
- Center for Male Health, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, United States of America
| | - Ben J. Cutone
- Boston Scientific, Marlborough, MA, United States of America
| | - Kevin T. McVary
- Center for Male Health, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, United States of America
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Bhatia S, Acharya V, Jalaeian H, Kumar J, Bryant E, Richardson A, Malkova K, Harward S, Sinha V, Kably I, Kava BR. Effect of Prostate Artery Embolization on Erectile Function - A Single Center Experience of 167 Patients. J Sex Med 2022; 19:594-602. [PMID: 35184995 DOI: 10.1016/j.jsxm.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prostate artery embolization (PAE) is an emerging therapy for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). AIM This retrospective study was conducted to assess the effect of prostate artery embolization (PAE) on erectile function in a cohort of patients with LUTS attributable to BPH at 3-months after the procedure. METHODS A retrospective review was performed on 167 patients who underwent PAE. Data collected included Sexual Health Inventory in Men (SHIM) scores at 3, 6, and 12 months post-PAE, in conjunction with the International Prostate Symptom Scores (IPSS), Quality of Life (QoL) scores, and prostate volumes. Primary outcome was erectile function as assessed by SHIM scores at 3 months after PAE. An analysis was performed to identify patients with a ±5-point SHIM change to group them according to this minimum clinically significant difference in erectile function. Adverse events were recorded using the Clavien-Dindo (CD) classification. OUTCOMES At 3 months following PAE, median IPSS decreased by 16.0 [IQR, 9.0-22.0] points, median QOL decreased by 4.0 [IQR, 2.0-5.0] points, and median prostate volume decreased by 33 g [IQR, 14-55]. RESULTS Median SHIM score was 17.0 [IQR, 12.0-22.0] at baseline, 18.0 [IQR, 14.0-23.0] at 3 months [P = .031], 19.0 [IQR, 14.5-21.5] at 6 months [P = .106] and 20 [IQR, 16.0-24.0] at 12 months [P = .010] following PAE. In patients with no erectile dysfunction (ED) at baseline, 21% (n = 9) reported some degree of decline in erectile function post-PAE. However, 38% (n = 40) of patients who presented with mild-to-moderate ED reported improvement in their erectile function 3 months following PAE. Overall, the changes in baseline SHIM score were relatively small; 82% (n = 137) of patients did not have more than 5 points of change in their SHIM scores at 3 months following PAE. CLINICAL IMPLICATIONS Our findings suggest PAE has no adverse impact on erectile function for most patients. STRENGTHS & LIMITATIONS The study was performed at a single center with 1 operator's experience, and is retrospective with no control group. CONCLUSION Findings suggest that prostate artery embolization has no adverse effect on erectile function in the majority of patients with LUTS attributable to BPH at 3 months after the procedure. Bhatia S, Acharya V, Jalaeian H, et al., Effect of Prostate Artery Embolization on Erectile Function - A Single Center Experience of 167 Patients. J Sex Med 2022;19:594-602.
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Affiliation(s)
- Shivank Bhatia
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Vedant Acharya
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Hamed Jalaeian
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Jessica Kumar
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA.
| | - Evan Bryant
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Andrew Richardson
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Kseniia Malkova
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Sardis Harward
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Vishal Sinha
- Weill Cornell Department of Radiology, New York, NY, USA
| | - Issam Kably
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Bruce R Kava
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
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Ejaculations and Benign Prostatic Hyperplasia: An Impossible Compromise? A Comprehensive Review. J Clin Med 2021; 10:jcm10245788. [PMID: 34945084 PMCID: PMC8704358 DOI: 10.3390/jcm10245788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 01/23/2023] Open
Abstract
Background: Benign prostatic hyperplasia (BPH) is commonly responsible for lower urinary tract symptoms (LUTS) in men aged 50 or over. Sexual dysfunctions, such as ejaculatory disorders (EjD), go along with LUTS but are frequently overlooked in the initial evaluation. This review aimed to detail BPH-related EjD, as well as their modifications by medical, surgical, and interventional treatments. Methods: We conducted a narrative review looking for publications between 1990 and 2020, regarding physiopathology, epidemiology, evaluation, and therapeutic management (medical, surgical, and interventional) of BPH-related EjD. Results: Sixty-five articles were included in our final analysis. Forty-six percent of men presenting with LUTS reported EjD. If the prevalence increases with age and LUTS severity, the functional impairment is not correlated with age. Several self-questionnaires evaluated the sexual function, but only four approaches are specific to EjD. Medical therapies were exposed to anejaculation, rather than retrograde ejaculation (RE) (4–30% (alpha-blockers), 4–18% (5-alpha-reductase inhibitors)). Regarding surgical therapies, trans-urethral resection of the prostate (TURP) and incision of the prostate (TUIP) are associated with 50–70% and 21–35% of RE. The RE rate is important after open simple prostatectomy but can be reduced with robotic approaches and urethral sparing techniques (19%). Anatomic endoscopic enucleation of the prostate (AEEP) with or without a laser source is associated with an 11–36% RE rate, according to supramontanal preservation. Recent surgical techniques (Rezum©, Aquablation©, or Urolift©) were developed to preserve antegrade ejaculation with promising short-term results. Regardless of the surgical approach, anatomic studies suggest that the preservation of peri-montanal tissue (7.5 mm laterally; 10 mm proximally) is primordial to avoid post-operative RE. Finally, prostate artery embolization (PAE) limits the RE rate but exposes it to a 12 months 10% re-intervention rate. Conclusion: EjD concerns almost half of the patients presenting BPH-related LUTS. Initial evaluation of EjD impairment is primordial before medical or surgical therapy. Peri-montanal tissue preservation represents a key point for antegrade ejaculation preservation, regardless of the surgical option.
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22
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Waters DK, Khalid R, Mustafa F, Omeire F, Jones BJ. Safety profile of GreenLight XPS laser photoselective vaporisation of the prostate in patients at high risk of bleeding. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211041896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study aimed to assess the utility and safety profile of the GreenLight Xcelerated Performance System (XPS) photoselective vaporisation of the prostate (PVP) to treat benign prostatic hyperplasia (BPH) in high-risk patients. Patients and methods: A retrospective study of a prospectively managed database was carried out. The study reviewed a single surgeon’s experience of treating high-risk patients with GreenLight XPS PVP between two sites over a four-year period. Patients considered to be high risk were those who were at an increased risk of bleeding, those who had a prostate size >80 mL, those with preoperative urinary retention and/or those aged >80 years. Results: In total, 374 patients were identified as being high risk for GreenLight PVP. Patient age ranged from 44 to 96 years ( Mage=71 years). Of the 374 patients, 103 were aged >80 years. All 374 patients were considered to be at an increased risk of bleeding, as they underwent GreenLight PVP while taking antiplatelet agents (not including aspirin), anticoagulant agents or both. Ninety-one patients had preoperative urinary retention and indwelling urinary catheter. Fifty-four patients had a prostate size >80 mL. Length of stay varied from 1 to 14 days. Most patients ( n=270) were discharged on postoperative day 1. There were no perioperative blood transfusions. One patient developed acute coronary syndrome on postoperative day 4, requiring percutaneous coronary intervention. Twenty-two patients required readmission: 12 due to urinary retention with or without haematuria, and 10 due to haematuria without associated acute retention. Two patients required cystoscopy and bladder washout. There were two blood transfusions in the ‘readmission due to haematuria’ group. Outcomes for patients aged >80 years were favourable. The average length of stay was 2.7 days (range 1–14 days). This group was responsible for 12 of the 22 readmissions. There were no perioperative cardiovascular events. Conclusion: We conclude that GreenLight XPS PVP is a safe procedure in patients with one or more high-risk factors. The ability to proceed without the need to stop antiplatelets or anticoagulant agents also allows for high-risk medical patients to be treated without the additional risks of cardiovascular events. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
| | - Raihan Khalid
- Department of Surgery, Hermitage Medical Clinic, Ireland
| | | | | | - Barry J Jones
- Department of Surgery, Hermitage Medical Clinic, Ireland
- Department of Surgery, Aut Even Hospital, Ireland
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23
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Pirola GM, Maggi M, Castellani D, Sciarra A, Rubilotta E, Gubbiotti M. A Cost-Benefit Analysis of Bipolar TURP for the Treatment of Bladder Outflow Obstruction. Res Rep Urol 2021; 13:487-494. [PMID: 34268258 PMCID: PMC8276822 DOI: 10.2147/rru.s277480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/30/2021] [Indexed: 02/01/2023] Open
Abstract
Transurethral resection of the prostate (TURP) is the gold standard surgical technique for endoscopic treatment of benign prostatic hyperplasia (BPH). Introduced in 2001, the bipolar energy appeared to be a valid alternative to the classical monopolar one with reduced risk of complication related to the use of saline irrigation and to the increased hemostatic efficacy. More recently, raising attention has been given to laser enucleation and vaporization techniques, which appear to achieve further advantages in terms of reduced hospital stay and complications compared to the resection ones. Few studies have investigated the cost/benefit ratio related to these techniques. The aim of this systematic review was to analyze the cost/benefit ratio of bipolar TURP (B-TURP) compared with other endoscopic procedures.
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Affiliation(s)
| | - Martina Maggi
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Daniele Castellani
- Department of Urology, Ospedali Riuniti di Ancona, Le Marche Polytechnic University, Ancona, Italy
| | - Alessandro Sciarra
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
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Safety and efficacy of TURP vs. laser prostatectomy for the treatment of benign prostatic hyperplasia in multi-morbid and elderly individuals aged ≥ 75. World J Urol 2021; 39:4405-4412. [PMID: 34232353 DOI: 10.1007/s00345-021-03779-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To compare the safety and durability of transurethral resection of the prostate (TURP) and Laser prostatectomy (LP) among multi-morbid and elderly patients. METHODS Using data retrieved from the New York State Department of Health Statewide Planning and Research Cooperative System and the California Office of Statewide Health Planning and Development, we selected cohorts of 1) multi-morbid (Charlson comorbidity index ≥ 3) and 2) elderly (aged ≥ 75) patients with benign prostatic hyperplasia who underwent laser coagulation, vaporization, enucleation, or TURP between January 2005 and December 2016. We assessed the post-operative incidence of hospital readmission and ER visit at 30 days and 90 days, complications at 90 days, and reoperation and the development of urethral stricture at 6 months or longer. RESULTS We found 12,815 and 29,806 patients in the multi-morbid and elderly cohort, respectively. Compared to LP, TURP was associated with lower odds of 90-day hospital readmission and ER visit in the multi-morbid cohort (OR 0.92, 95% CI 0.85-1.00) and higher odds in the elderly cohort (OR 1.07, 95% CI 1.01-1.14). The multi-morbid cohort showed lower odds of urinary tract infections (Ref: LP, OR 0.83, 95% CI 0.73-0.93). The elderly cohort showed higher odds of experiencing hematuria (OR 1.28, 95% CI 1.03-1.59) post TURP. TURP was associated with a 19% (95% CI 0.66-1.00) and 20% (95% CI 0.71-0.91) reduced hazard of reoperation at 6 months or longer for multi-morbid and elderly cohorts, respectively. CONCLUSION Compared to LP, TURP was associated with higher complication rates for the multi-morbid and elderly cohorts overall but a lower hazard of reoperation, supporting its durability.
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25
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Light A, Jabarkhyl D, Gilling P, George G, Van Hemelrijck M, Challacombe B, Malde S, Popert R, Dasgupta P, Elhage O. Erectile Function Following Surgery for Benign Prostatic Obstruction: A Systematic Review and Network Meta-analysis of Randomised Controlled Trials. Eur Urol 2021; 80:174-187. [PMID: 34127315 DOI: 10.1016/j.eururo.2021.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 04/12/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT Benign prostatic obstruction (BPO) is associated with sexual dysfunction. Furthermore, numerous BPO interventions may themselves impact sexual function. OBJECTIVE To perform a systematic review with network meta-analysis to evaluate how BPO interventions affect erectile function. EVIDENCE ACQUISITION Three databases were searched for randomised controlled trials (RCTs) comparing surgical interventions for BPO. The primary outcome was postoperative International Index of Erectile Function-5 (IIEF-5) score at ten time points up to 72 mo. A random-effects Bayesian network meta-analysis with meta-regression was performed. In comparison to monopolar transurethral resection (mTURP), the mean difference (MD) with 95% credible interval (CrI) and rank probability (rank p) were calculated for interventions. The mean baseline score was studied in meta-regression. τ2 values were used to quantify heterogeneity. EVIDENCE SYNTHESIS A total of 48 papers (33 RCTs, 5159 patients, 16 interventions) were included. Prostatic urethral lift (PUL) ranked highest at 1 mo (MD 3.88, 95% CrI -0.47 to 8.25; rank p = 0.742), 6 mo (MD 2.43, 95% CrI -0.72 to 5.62; rank p = 0.581), 12 mo (MD 2.94, 95% CrI -0.26 to 6.12, rank p = 0.782), and 24 mo (MD 3.63, 95% CrI 0.14 to 7.11; rank p = 0.948), at which point statistical significance was reached. At time points up to 60 mo, there were no statistically significant comparisons for other interventions. Analyses were not possible at 18, 48, or 72 mo. β did not reach statistical significance in meta-regression. τ2 was highest at 1 mo (0.56) and 60 mo (0.55). CONCLUSIONS PUL ranked highly and resulted in erectile function improvement at 24 mo compared to mTURP, but direct evidence is lacking. We did not observe significant differences in erectile function following other interventions up to 60 mo. Owing to heterogeneity, our conclusions are weakest at 1 and 60 mo. Further RCTs comparing sexual function outcomes are recommended, such as PUL versus holmium laser or bipolar enucleation. PATIENT SUMMARY Different surgical treatments can be used to treat benign enlargement of the prostate causing urinary problems. We compared the effects of various treatments on erectile function at time points up to 5 years after surgery. Compared to surgical removal of some of the prostate gland (transurethral resection of the prostate, TURP), a technique called prostatic urethral lift resulted in better erectile function scores at 24 months. However, other treatments did not differ in their effect on erectile function.
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Affiliation(s)
- Alexander Light
- Department of Surgery, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Dost Jabarkhyl
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Peter Gilling
- Department of Urology, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand
| | - Gincy George
- Translational Oncology & Urology Research, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Mieke Van Hemelrijck
- Translational Oncology & Urology Research, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Ben Challacombe
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rick Popert
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Prokar Dasgupta
- Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Oussama Elhage
- Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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26
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Castellani D, Pirola GM, Rubilotta E, Gubbiotti M, Scarcella S, Maggi M, Gauhar V, Teoh JYC, Galosi AB. GreenLight Laser™ Photovaporization versus Transurethral Resection of the Prostate: A Systematic Review and Meta-Analysis. Res Rep Urol 2021; 13:263-271. [PMID: 34295844 PMCID: PMC8290851 DOI: 10.2147/rru.s277482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/05/2021] [Indexed: 11/23/2022] Open
Abstract
GreenLight laser™ photovaporization of the prostate (GLL-PVP) has become a valid alternative to traditional transurethral resection of the prostate (TURP) in men requiring surgery for benign prostatic hyperplasia. We aimed to review systematically the safety and efficacy of studies comparing GLL PVP and TURP in the medium-term. A comprehensive literature search was performed. Twelve studies were identified for meta-analysis. Meta-analyses showed a longer postoperative catheterization time (risk ratio (RR): 1.12, 95% CI:1.09–1.14, p<0.00001) and length of stay (RR: 1.16, 95% CI:1.12–1.19, p<0.00001) in the TURP group; higher risk of transfusion in the TURP group (RR: 6.51, 95% CI: 2,90–14,64 p<0.00001); no difference in the risk of urinary tract infections (RR: 0.83, 95% CI: 0.58–1.18, p=0.30) and transient re-catheterization (RR: 1.11, 95% CI: 0.76–1.60, p=0.60). Regarding reoperation rate, no difference was found in term of postoperative urethral stricture (RR: 1.13, 95% CI: 0.73–1.75, p=0.59) and bladder neck contracture (RR: 0.66, 95% CI: 0.31–1.40, p=0.28). A significantly higher incidence in reoperation for persistent/regrowth adenoma was present in the GLLL-PVP (RR: 0.64, 95% CI: 0.41–0.99, p=0.05). Data at 2-year follow-up showed significant better post-voiding residual (PVR) (MD: -1.42, 95% CI: -2.01, -0.82, p<0.00001) and International Prostate Symptom Score (IPSS) (MD: -0.35, 95% CI: -0.50, -0.20, p<0.00001) after TURP. No difference was found in the mean PVR at 2 years after TURP, in the mean maximum flow rate (Qmax) (MD: 0.30, 95% CI: -0.02–0.61, p=0.06) and quality of life QoL score (MD: 0.05, 95% CI: -0.02–0.42, p=0.13). At 5-year follow-up, data showed better IPSS (MD: -1.70, 95% CI: -2.45,-0.95, p<0.00001), QoL scores (MD: -0.35, 95% CI: -0.69, -0.02, p=0.04) and Qmax (MD: 3.29, 95% CI: 0.19–6.38, p=0.04) after TURP. Data of PVR showed no significant difference (MD: -11.54, 95% CI: -29.55–6.46, p=0.21). In conclusion, our analysis shows that GLL-PVP is a safer and more efficacious procedure than standard TURP in the early and medium-term. However, in the long term period GLL-PVP showed a higher incidence of reoperation rate due to incomplete vaporization/regrowth of prostatic adenoma.
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Affiliation(s)
- Daniele Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of Le Marche, Ancona, Italy
| | | | | | | | - Simone Scarcella
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of Le Marche, Ancona, Italy
| | - Martina Maggi
- Urology Division, La Sapienza University, Rome, Italy
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital (NUHS), Singapore
| | - Jeremy Yuen-Chun Teoh
- S.H.Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Andrea Benedetto Galosi
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Polytechnic University of Le Marche, Ancona, Italy
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Gautier B, Chaker K, Schneider M, Obringer L, Jung JL. [Assessment of energy density during laser photoselective vaporisation of the prostate: A retrospective monocentric study]. Prog Urol 2021; 31:584-590. [PMID: 33941459 DOI: 10.1016/j.purol.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/02/2020] [Accepted: 10/30/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Greenlight XPS-180W® (AMS, San José, USA) photoselective vaporisation of the prostate (PVP) is considered as an alternative to transurethral resection of the prostate. The objective of this study was to assess the effect of energy density applied on adenoma during PVP treatment for benign prostate hyperplasia (BPH) on postoperative outcomes. METHODS A single-centre retrospective study has been conducted in the department of Urology of Colmar Hospital, in patients with symptomatic BPH, treated by PVP, between January 2016 and January 2019. Patients were stratified into two groups according to energy delivered and prostate volume as determined preoperatively: Low density (<4kJ/mL) and high density (>4kJ/mL). Perioperative complications, PSA evolution and functional outcomes (International Prostate Symptom Score, quality of life, maximum urinary flow rate, post-void residual urine volume) were compared with a minimal delay of 6 months. The retreatment rate was similar in the two groups. RESULTS A total of 215 patients were included with median follow-up of 25 months. High energy density was associated with less glandular volume. There were no statistically significant differences between the two groups concerning the perioperative complications and the functional outcomes. The postoperative reduction of the PSA level was more significant in the high-energy group (41% vs. 28%, P=0.03). CONCLUSION The perioperative complications and functional outcomes of PVP with Greenlight XPS-180W® laser are equivalent depending on the energy density delivered. The greater decrease in postoperative PSA for high-energy density could nevertheless suggest better quality tissue destruction. LEVEL OF PROOF 3.
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Affiliation(s)
- B Gautier
- Service d'urologie, hôpitaux civils de Colmar, 39, avenue de la Liberté 68024 Colmar, France.
| | - K Chaker
- Service d'urologie, hôpitaux civils de Colmar, 39, avenue de la Liberté 68024 Colmar, France
| | - M Schneider
- Service d'urologie, hôpitaux civils de Colmar, 39, avenue de la Liberté 68024 Colmar, France
| | - L Obringer
- Service d'urologie, hôpitaux civils de Colmar, 39, avenue de la Liberté 68024 Colmar, France
| | - J L Jung
- Service d'urologie, hôpitaux civils de Colmar, 39, avenue de la Liberté 68024 Colmar, France
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Law KW, Tholomier C, Nguyen DD, Sadri I, Couture F, Zakaria AS, Bouhadana D, Bruyère F, Cash H, Reimann M, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo TJ, Becher EF, Misrai V, Elterman D, Bhojani N, Zorn KC. Global Greenlight Group: largest international Greenlight experience for benign prostatic hyperplasia to assess efficacy and safety. World J Urol 2021; 39:4389-4395. [PMID: 33837819 DOI: 10.1007/s00345-021-03688-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/26/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Greenlight photo-selective vaporization of the prostate (GL-PVP) has gained international acceptance as a safe and effective alternative procedure for the treatment of benign prostatic hyperplasia (BPH), especially in anticoagulated men. This descriptive analysis aims to characterize the current state of GL-PVP, pooling data from international centers. METHODS Data from 3627 patients who underwent GL-PVP with the XPS-180 W system in seven international centers performed by eight expert surgeons between 2011 and 2019 were retrospectively analyzed. Demographic, perioperative, and postoperative data were collected, including IPSS, QoL, Qmax, PVR, and PSA, and complications. RESULTS At baseline, median age, prostate volume, PSA, and IPSS were 70 years (interquartile range 64-77), 64 (47-90), 3.1 ng/mL (1.8-6), and 22 (19-27), respectively. Median lasing and operative time were 34 (23-48) and 62 min (46-85), respectively. Median energy use was 250.0 kJ (168.4-367.9), with 92.6% of procedures being completed with one laser fiber. In 60.1% of cases, catheter was removed on postoperative day 1 with median length of 2 days. All-cause mortality within 30 days was 0.3%. Median PSA reduction at 3 months and 60 months compared to baseline was 43.9 and 46.4%, respectively (p < 0.001). All functional outcomes (IPSS, QoL, Qmax, and PVR) were significantly improved across study period when compared to baseline (p < 0.001). For those men with longer follow-up available, the observed surgical BPH retreatment rate was 1.5% CONCLUSION: Using the largest multi-user, international database of GL-PVP, Greenlight XPS laser treatment in experienced hands is a safe, effective, and durable BPH treatment option.
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Affiliation(s)
- Kyle W Law
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Côme Tholomier
- Department of Surgery, Division of Urology, McGill University, Montreal, QC, Canada
| | | | - Iman Sadri
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Félix Couture
- Department of Surgery, Division of Urology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Ahmed S Zakaria
- Department of Urology, University of Montreal Hospital Center CHUM, Montreal, QC, Canada
| | - David Bouhadana
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Franck Bruyère
- Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Centre-Val de Loire, France
| | - Hannes Cash
- Department of Urology, Charité-Universitaetsmedizin Berlin, Berlin, Germany.,PROURO, Berlin, Germany.,Department of Urology, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
| | - Maximilian Reimann
- Department of Urology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy
| | - Giovanni Ferrari
- Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy
| | | | | | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, Midi-Pyrenees, France
| | - Dean Elterman
- Division of Urology, Department of Surgery, University. Health Network, University of Toronto, Toronto, ON, Canada
| | - Naeem Bhojani
- Department of Urology, University of Montreal Hospital Center CHUM, Montreal, QC, Canada
| | - Kevin C Zorn
- Department of Urology, University of Montreal Hospital Center CHUM, Montreal, QC, Canada.
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Tanneru K, Jazayeri SB, Alam MU, Kumar J, Bazargani S, Kuntz G, Palayapalayam Ganapathi H, Bandyk M, Marino R, Koochekpour S, Gautam S, Balaji KC, Costa J. An Indirect Comparison of Newer Minimally Invasive Treatments for Benign Prostatic Hyperplasia: A Network Meta-Analysis Model. J Endourol 2021; 35:409-416. [PMID: 32962442 DOI: 10.1089/end.2020.0739] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: This study was designed to provide an indirect comparison of the urinary and sexual domain outcomes and complications after newer minimally invasive surgical therapy (MIST) of Aquablation, Rezum, and UroLift for benign prostatic hyperplasia (BPH) for transurethral resection of prostate (TURP). Methods: We searched Embase, Medline, and Cochrane in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, in December 2019. Only randomized clinical trials (RCTs) that reported outcomes after treatment of BPH for prostate less than 80 g with Aquablation, Rezum, or UroLift were included in the analysis. Results: A total of four RCTs reporting the outcomes after treatment with newer MIST for BPH were identified. Patients undergoing the resective procedures, that is, TURP and Aquablation, had greater improvement in urinary domain outcomes: International Prostate Symptom Score, quality of life, peak flow rate, and postvoiding residual compared to patients undergoing nonresective procedures: UroLift and Rezum. Patients in UroLift group maintained a higher sexual function domain score compared to TURP, but not Aquablation. Our multiple comparison analysis did not reveal a significant difference in urinary and sexual domain scores between patients undergoing UroLift and Rezum at 24 months of follow-up. Conclusions: Aquablation and TURP necessitate general or regional anesthesia and both produced significantly better urinary domain scores compared to Rezum and UroLift. On the other hand, UroLift demonstrated better sexual function domain scores compared to TURP, but not Aquablation. There was no significant difference in urinary domain scores between UroLift and Rezum at 24 months of follow-up.
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Affiliation(s)
- Karthik Tanneru
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | | | - Muhammad Umar Alam
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - Jatinder Kumar
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - Soroush Bazargani
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - Gretchen Kuntz
- Borland Library, University of Florida, Jacksonville, Florida, USA
| | | | - Mark Bandyk
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - Robert Marino
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | | | - Shiva Gautam
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - K C Balaji
- Department of Urology, University of Florida, Jacksonville, Florida, USA
| | - Joseph Costa
- Department of Urology, University of Florida, Jacksonville, Florida, USA
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Elterman D, Li W, Hatiboglu G, Relle J, Zorn KC, Bhojani N, Chin J. Relief of Lower Urinary Tract Symptoms After MRI-Guided Transurethral Ultrasound Ablation for Localized Prostate Cancer: Subgroup Analyses in Patients with Concurrent Cancer and Benign Prostatic Hyperplasia. J Endourol 2021; 35:497-505. [PMID: 32935575 DOI: 10.1089/end.2020.0511] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: MRI-guided transurethral ultrasound ablation (TULSA) offers minimally invasive thermal ablation of benign and malignant prostate tissue, using directional high-intensity ultrasound and real-time, magnetic resonance thermometry feedback control. Feasibility of TULSA for alleviating lower urinary tract symptoms (LUTSs) associated with benign prostatic hyperplasia (BPH) is retrospectively assessed in a subgroup of men from a localized prostate cancer study who also had LUTSs. Patients and Methods: TULSA was used to ablate 90% of the prostate gland in 30 men with localized prostate cancer, without plans to spare ejaculatory ducts. Mean ± standard deviation treatment time was 37 ± 10 minutes. Retrospective analysis was conducted on a subpopulation of nine patients who also suffered from LUTSs (International Prostate Symptom Score [IPSS] ≥ 12 at baseline) as well as a smaller subgroup of five patients with IPSS >12 and peak urinary flow (Qmax) <15 mL/second. Urinary symptom relief, continence, and erectile function were assessed using IPSS, International Index of Erectile Function (IIEF), and uroflowmetry. Results: At 12 months post-TULSA, IPSS improved significantly by 58% to 6.3 ± 5.0 (p = 0.003), with at least a moderate (≥6 points) reduction in eight of nine patients. IPSS quality of life improved in eight of nine patients. Erectile function (IIEF-EF) remained stable from 14.6 ± 9.3 at baseline to 15.7 ± 9.0 at 12 months. The proportion of patients with erections sufficient for penetration (IIEF Q2 ≥2) was unchanged. Full urinary continence (pad free and leak free) was achieved at 12 months in all patients. In five men who suffered from more severe symptoms, Qmax increased from 11.6 ± 2.6 mL/second to 22.5 ± 14.2 mL/second at 12 months (p = 0.126). Perfused prostate volume, measured on MRI, decreased 70% to 13.6 ± 4.6 mL (p = 0.003) at 12 months. All adverse events were mild to moderate (Common Terminology Criteria for Adverse Events [CTCAE] Grade 1-2) with no serious events reported. Conclusions: This retrospective analysis demonstrates promising safety and feasibility of TULSA to relieve LUTSs, with improvement in IPSS comparable with modern, minimally invasive surgical therapies. Larger controlled studies with BPH-specific ablation plans in men seeking treatment for LUTSs are warranted.
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Affiliation(s)
- Dean Elterman
- University Health Network, University of Toronto, Toronto, Canada
| | | | - Gencay Hatiboglu
- Department of Urology, University of Heidelberg, Heidelberg, Germany
| | - James Relle
- Beaumont Health System, Royal Oak, Michigan, USA
| | - Kevin C Zorn
- Department of Urology, University of Montreal, Montreal, Canada
| | - Naeem Bhojani
- Department of Urology, University of Montreal, Montreal, Canada
| | - Joseph Chin
- London Health Sciences Center, Western University, London, Canada
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Which Anatomic Structures Should Be Preserved During Aquablation Contour Planning to Optimize Ejaculatory Function? A Case-control Study Using Ultrasound Video Recordings to Identify Surgical Predictors of Postoperative Anejaculation. Urology 2021; 153:250-255. [PMID: 33482130 DOI: 10.1016/j.urology.2021.01.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To identify key anatomic structures that should be preserved to decrease postoperative anejaculation after Aquablation. METHODS We conducted a case-control study design using patient data and operative video logs from Aquablation clinical trials. Cases were sexually active participants with functional baseline ejaculation and postoperative anejaculation. Controls were sexually active participants with functional baseline ejaculation and no postoperative decline in sexual function. Each case was matched to 1 or 2 controls. Video logs from the procedure were scored for: verumontanum cut coverage, penetration of ejaculatory ducts, depth of cut below the verumontanum, angle offset of verumontanum to centerline of protection zone, number of passes, and intraprostatic calcifications. Conditional logistic regression was used to calculate univariate odds ratios relating anatomic findings to case/control status. RESULTS We identified 24 cases and 27 controls. In univariate analysis, predictors of postoperative anejaculation were: penetration of the ejaculatory ducts (odds ratio [OR] 8.6 [95% CI 1.09-67.5], P = .041) and depth below the verumontanum (OR 1.92 [1.1-3.3], P = .015). CONCLUSION Violation of anatomic structures involved in ejaculation during the Aquablation procedure increases the risk of postoperative anejaculation. More careful attention to these structures during contour planning may further improve ejaculatory function after Aquablation.
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Lebdai S, Chevrot A, Doizi S, Pradère B, Barry Delongchamps N, Baumert H, Benchikh A, Della Negra E, Fourmarier M, Gas J, Misraï V, Rouscoff Y, Theveniaud PE, Vincendeau S, Wilisch J, Descazeaud A, Robert G. [Surgical and interventional management of benign prostatic obstruction: Guidelines from the Committee for Male Voiding Disorders of the French Urology Association]. Prog Urol 2021; 31:249-265. [PMID: 33478868 DOI: 10.1016/j.purol.2020.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/24/2020] [Accepted: 12/04/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of the Male Lower Urinary Tract Symptoms Committee (CTMH) of the French Urology Association was to propose an update of the guidelines for surgical and interventional management of benign prostatic obstruction (BPO). METHODS All available data published on PubMed® between 2018 and 2020 were systematically searched and reviewed. All papers assessing surgical and interventional management of adult patients with benign prostatic obstruction (BPO) were included for analysis. After studies critical analysis, conclusions with level of evidence and French guidelines were elaborated in order to answer the predefined clinical questions. RESULTS/GUIDELINES Offer a trans-uretral incision of the prostate to treat patients with moderate to severe lower urinary tract symptoms (LUTS) with a prostate volume<30cm3, without a middle lobe. TUIP increases the chances of preserving ejaculation. Propose mono- or bipolar trans-urethral resection of the prostate (TURP) to treat patients with moderate to severe LUTS with a prostate volume between 30 and 80cm3. Vaporization by Greenlight™ or by bipolar energy can be offered as an alternative to TURP. Offer a Greenlight™ laser vaporization to patients at risk of bleeding. Offer endoscopic prostate enucleation to surgically treat patients with moderate to severe LUTS as an alternative to TURP and open prostatectomy (OP). Minimally invasive prostatectomy is an alternative to OP in centers without access to adequate endoscopic procedures. Embolization of the prostatic arteries may be offered in the event of a contraindication or refusal of surgery for prostates with a volume>80cm3. Prostatic uretral lift is an alternative in patients interested in preserving their ejaculatory function and with a prostate volume<70cm3 without a middle lobe. Aquablation and Rezum™ are under evaluation and should be offered in research protocols. CONCLUSION Major changes in surgical management of BPO have occurred and aim at reducing morbidity and improving quality of life of patients.
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Affiliation(s)
- S Lebdai
- Service d'urologie, CHU d'Angers, Angers, France.
| | - A Chevrot
- Service d'urologie, CHU de Nîmes, Nîmes, France
| | - S Doizi
- Service d'urologie, hôpital européen Georges-Pompidou, Paris, France
| | - B Pradère
- Service d'urologie, CHU de Tours, Tours, France
| | | | - H Baumert
- Service d'urologie, hôpital Ambroise-Paré, Paris, France
| | - A Benchikh
- Service d'urologie, Clinique les Martinets, Versailles, France
| | - E Della Negra
- Service d'urologie, hôpital des Côtes d'Armor, Saint-Brieuc, France
| | - M Fourmarier
- Service d'urologie, hôpital Aix-en-Provence, Aix-en-Provence, France
| | - J Gas
- Service d'urologie, CHU de Toulouse, Toulouse, France
| | - V Misraï
- Service d'urologie, clinique Pasteur, Toulouse, France
| | - Y Rouscoff
- Service d'urologie, polyclinique Saint-Georges, Nice, France
| | - P E Theveniaud
- Service d'urologie, CHR de Metz Thionville, Metz, France
| | - S Vincendeau
- Service d'urologie, CHU de Rennes, Rennes, France
| | - J Wilisch
- Service d'urologie, hôpital privé Natecia, Lyon, France
| | - A Descazeaud
- Service d'urologie, CHU de Limoges, Limoges, France
| | - G Robert
- Service d'urologie, CHU de Bordeaux, Bordeaux, France
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Kim M, Truong VG, Kim S, Kim H, Hasenberg T, Kang HW. In Vivo Investigation of Noncontact Rapid Photothermal Hemostasis on Venous and Arterial Bleeding. IEEE Trans Biomed Eng 2021; 68:2689-2697. [PMID: 33406035 DOI: 10.1109/tbme.2021.3049483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Endoscopic surgical procedures rigorously underscore the significance of rapid hemostasis for unavoidable intraoperative bleeding, requiring advancement of the immediate hemostatic interventions for favorable clinical outcomes. Here, we report the efficacy of a new optical treatment with dual-wavelengths to develop an endoscopic hemostasis method. METHODS we combine visible (20-W 532 nm at 1.1 kW/cm2) and near-infrared (40-W 980 nm at 2.2 kW/cm2) wavelengths for facilitating noncontact thermal hemostasis on venous and arterial bleeders in in vivo leporine models. RESULTS Simultaneous irradiation of 60-W dual-wavelengths allows for an increased irradiance of 3.3 kW/cm2, involving both rapid light absorption by hemoglobin and deep thermal penetration. The collective thermal effects from the combined wavelengths contribute to a significant reduction in coagulation time and a high success rate of complete hemostasis for both venous and arterial bleeders. The enhanced hemostatic potential of the dual-wavelengths treatment accompanies minimal hemorrhage, reduces inflammatory responses, and facilitates re-epithelialization. CONCLUSION The proposed dual-wavelengths method can achieve rapid and complete hemostasis for endoscopic procedures. SIGNIFICANCE We present the high-irradiance photothermal treatment using the dual-wavelengths as a novel method to regulate venous and arterial bleeding and potentially as a rapid noncontact hemostasis option to mitigate the risk associated with significant blood loss.
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Nguyen DD, Sadri I, Law K, Bhojani N, Elterman DS, Zakaria AS, Arezki A, Bruyère F, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo T, Becher EF, Cash H, Reimann M, Rijo E, Misrai V, Zorn KC. Impact of the presence of a median lobe on functional outcomes of greenlight photovaporization of the prostate (PVP): an analysis of the Global Greenlight Group (GGG) Database. World J Urol 2021; 39:3881-3889. [PMID: 33388918 DOI: 10.1007/s00345-020-03529-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Previous analyses of the impact of median lobe presence on Greenlight photoselective vaporization of the prostate (PVP) outcomes were limited by their small sample size and the ability to adjust for important confounders. As such, we sought to investigate the impact of prostate median lobe presence on the operative outcomes of 180 W XPS GreenLight PVP using a large international database. METHODS Data were obtained from the Global GreenLight Group (GGG) database which pools data of eight high-volume, experienced surgeons, from a total of seven international centers. All men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019 were eligible for the study. Patients were assigned to two groups based on presence or absence of median lobes. Analyses were adjusted for patient age, prostate volume, body mass index, and American Society of Anesthesia (ASA) score. RESULTS A total of 1650 men met the inclusion criteria. A median lobe was identified in 621 (37.6%) patients. Baseline prostate volume, patient age, and ASA score varied considerably between the two groups. In adjusted analyses, the operative and lasing time of patients with median lobes was 6.72 (95% CI 3.22-10.23; p < 0.01) minutes and 2.90 (95% CI 1.02-4.78; p < 0.01) minutes longer than the control group. Men with median lobes had similar postoperative functional outcomes to those without a median lobe except for a 1.59-point greater drop in the 12-month IPSS score compared to baseline (95% CI 0.11-3.08; p = 0.04) in the median lobe group, and a decrease in PVR after 6 months which was 46.51 ml (95% CI 4.65-88.36; p = 0.03) greater in patients with median lobes compared to men without median lobes. CONCLUSIONS Our findings suggest that the presence of a median lobe has no clinically significant impact on procedural or postoperative outcomes for patients undergoing Greenlight PVP using the XPS-180 W system.
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Affiliation(s)
| | - Iman Sadri
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Kyle Law
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Dean S Elterman
- Division of Urology, University Health Network, Toronto, ON, Canada
| | - Ahmed S Zakaria
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Adel Arezki
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Franck Bruyère
- Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Tours, Centre-Val de Loire, France
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, Modena, Italy
| | | | | | | | | | - Hannes Cash
- Department of Urology, Charite-Universitaetsmedizin Berlin, Berlin, Germany
| | | | - Enrique Rijo
- Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
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Whiting D, Ng KL, Barber N. Initial single centre experience of Aquablation of the prostate using the AquaBeam system with athermal haemostasis for the treatment of benign prostatic hyperplasia: 1-year outcomes. World J Urol 2021; 39:3019-3024. [PMID: 33392647 DOI: 10.1007/s00345-020-03534-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Aquablation using the AquaBeam system combines real-time image guidance and robotics to enable precise and heat-free removal of prostatic tissue with a high velocity water jet. The aim of this study is to report the outcomes of Aquablation up to 1 year in a single centre within the UK employing an athermal approach to haemostasis. METHODS Fifty-five consecutive men underwent Aquablation between September 2017 and December 2018 (as part of OPEN WATER trial). Standard Aquablation was performed with the AquaBeam system (PROCEPT® BioRobotics) with 2 passes of Aquablation followed by bladder washout with application of continuous bladder irrigation via a catheter on a continuous traction device. Patients were followed up at 3 and 12 months. The data were prospectively collected on patient demographics, uroflowmetry, prostate volume, International Prostate Symptom Score (IPSS), Male Sexual Health Questionnaire for Ejaculatory Dysfunction (MSHQ-EjD) and International Index of Erectile Function (IIEF-15). RESULTS The mean age was 64.1 ± 7.9 years. Operating time was 26.9 ± 9.2 min. Mean prostate volume decreased from 58.2 ± 23.9 cc to 33.2 ± 12.9 cc (p < 0.0001). There were significant improvements at the 12 month follow-up in maximum urinary flow rate (9.9 ± 5.1 ml/s vs. 23.9 ± 11.6 ml/s), IPSS (21.7 ± 7.4 vs. 6.1 ± 4.2) and quality of life score (4.8 ± 1.1 vs. 1.4 ± 1.4) (p < 0.0001). There was no significant change in IIEF-15 and MSHQ-EjD scores. There were 8 (14.5%) Clavien grade 2 or higher complications. CONCLUSION Our single centre experience suggests Aquablation using an entirely athermal approach is a safe cavitating procedure resulting in significant LUTS improvement comparable to standard cavitating procedures with greater preservation of sexual function.
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Affiliation(s)
- Danielle Whiting
- Department of Urology, Frimley Park Hospital, Portsmouth Road, Frimley, Camberley, GU167UJ, UK
| | - Keng Lim Ng
- Department of Urology, Frimley Park Hospital, Portsmouth Road, Frimley, Camberley, GU167UJ, UK
| | - Neil Barber
- Department of Urology, Frimley Park Hospital, Portsmouth Road, Frimley, Camberley, GU167UJ, UK.
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Kiba K, Akashi Y, Yoshikawa M, Yamamoto Y, Hirayama A, Fujimoto K, Uemura H. Comparison of the Safety and Efficacy of Photoselective Vaporization of the Prostate (PVP) and Transurethral Enucleation with a Bipolar System (TUEB): A Single-Center Retrospective Study. Res Rep Urol 2020; 12:569-575. [PMID: 33235881 PMCID: PMC7680144 DOI: 10.2147/rru.s280113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/02/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to compare the safety and efficacy of photoselective vaporization of the prostate (PVP) and transurethral enucleation with a bipolar system (TUEB). Patients and Methods Patients who underwent PVP or TUEB surgery for lower urinary tract symptoms due to bladder outlet obstruction at our institution from September 2015 to May 2019 were retrospectively reviewed. A total of 83 patients (PVP: n=45, TUEB: n=38) who were available for follow-up at least 12 months after surgery were included. Preoperative characteristics, perioperative parameters, and postoperative outcomes-such as International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), and complications-at 3, 6, and 12 months after surgery were compared between the two groups. Results Although differences in age, IPSS, and QoL were not significant, a significantly greater prostate volume, lower Qmax, and greater PVR were noted in the TUEB group. In perioperative parameters, a significantly shorter operation time, less change in serum hemoglobin, fewer days of catheterization, and shorter length of stay were observed in the PVP group. As for postoperative outcomes, the IPSS storage subscore and PVR were significantly improved in the TUEB group. As complications, stress urinary incontinence was more frequently observed in the TUEB group, and urethral stricture was more common in the PVP group. Conclusion The present data suggest that PVP and TUEB are efficient and safe surgical treatment options. Management of patients undergoing PVP in the perioperative period appears easy. Improvements of subjective and objective parameters were superior after TUEB than after PVP.
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Affiliation(s)
- Keisuke Kiba
- Department of Urology, Kindai University Nara Hospital, Ikoma-City, Nara, Japan
| | - Yasunori Akashi
- Department of Urology, Kindai University Nara Hospital, Ikoma-City, Nara, Japan
| | - Motokiyo Yoshikawa
- Department of Urology, Kindai University Nara Hospital, Ikoma-City, Nara, Japan
| | - Yutaka Yamamoto
- Department of Urology, Kindai University Nara Hospital, Ikoma-City, Nara, Japan
| | - Akihide Hirayama
- Department of Urology, Kindai University Nara Hospital, Ikoma-City, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara-City, Nara, Japan
| | - Hirotsugu Uemura
- Department of Urology, Kindai University Faculty of Medicine, Sayama-City, Osaka, Japan
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Xu M, Sun C, Zang Y, Zhu J, Xue B, Tao W. The feasibility and safety of photoselective vaporization for prostate using a 180-W XPS Greenlight laser in day-surgery pattern in China. Lasers Med Sci 2020; 36:1421-1426. [PMID: 33118126 DOI: 10.1007/s10103-020-03174-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/23/2020] [Indexed: 12/14/2022]
Abstract
To evaluate the feasibility and safety of photoselective vaporization for prostate (PVP) with a 180-W XPS Greenlight laser as day surgery in the Chinese population. We retrospectively collected 114 cases undergoing the day surgery PVP and 198 cases undergoing conventional inpatient surgery PVP from April 2017 to March 2020. All patients' data including baseline characteristics, peri-operative data, post-operative outcomes, and complications were recorded and evaluated. The day-surgery procedures were successful in 110 patients. There were no significant differences in baseline characteristics in both groups. The catheterization time and hospitalization time were much shorter and economic cost was much lower in the day-surgery group than in the conventional inpatient surgery group. As for the post-operative complications, the incidence rate of the urinary retention is higher in the day-surgery group than in conventional inpatient surgery group. During the follow-up periods, the International Prostate Symptom Score (IPSS), quality of life (QoL), maximal urinary flow rate (Qmax), and post-void residual urine (PVR) improved significantly in both groups, and no differences were observed between the two groups. Compared to the conventional inpatient surgery, the day-surgery PVP is feasible and safe, which can reduce the hospitalization time and economic cost.
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Affiliation(s)
- Ming Xu
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chuanyang Sun
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yachen Zang
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jin Zhu
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Boxin Xue
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China.
| | - Wei Tao
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China.
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Wong T, Tembelis M, Acharya V, Hoffmann JC. Prostatic Artery Embolization and Sexual Function: Literature Review and Comparison to Other Urologic Interventions. Tech Vasc Interv Radiol 2020; 23:100693. [PMID: 33308525 DOI: 10.1016/j.tvir.2020.100693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many interventions to treat men with benign prostatic hyperplasia (BPH) associated lower urinary tract symptoms (LUTS) are associated with sexual side effects or complications, such as hematospermia, erectile dysfunction, or ejaculatory dysfunction. As loss of sexual function can significantly impact quality of life, an optimal treatment for BPH associated LUTS would be one without any sexual dysfunction side effects. Prostatic artery embolization is a minimally invasive treatment for men with BPH associated LUTS. The aim of this paper is to review the effects of prostatic artery embolization on sexual function and compare the sexual side effect profile to the other available BPH procedures.
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Affiliation(s)
- Thomas Wong
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN
| | | | - Vedant Acharya
- University of Miami Miller School of Medicine, Miami, FL
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Manov JJ, Mohan PP, Kava B, Bhatia S. Benign Prostatic Hyperplasia: A Brief Overview of Pathogenesis, Diagnosis, and Current State of Therapy. Tech Vasc Interv Radiol 2020; 23:100687. [PMID: 33308528 DOI: 10.1016/j.tvir.2020.100687] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
As prostatic artery embolization is assuming an increasingly important role in the management of benign prostatic hyperplasia, it is important for the practicing interventional radiologist to have a deep understanding of all aspects of the disease process and the available treatment options. This paper provides a comprehensive overview of the pathophysiology, diagnosis and management options for benign prostatic hyperplasia with an emphasis on the surgical and medical treatments.
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Affiliation(s)
- John J Manov
- Department of Radiology, University of Miami, Miller School of Medicine, FL.
| | - Prasoon P Mohan
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, FL
| | - Bruce Kava
- Department of Urology, University of Miami, Miller School of Medicine, FL
| | - Shivank Bhatia
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, FL
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Reasons to overthrow TURP: bring on Aquablation. World J Urol 2020; 39:2291-2299. [PMID: 32740805 DOI: 10.1007/s00345-020-03390-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE In this review, we will discuss the state of the literature regarding Aquablation, its limitations, and opportunities for its application in the treatment of benign prostatic enlargement (BPE). METHODS A comprehensive review of original research on Aquablation was conducted. Articles related to transurethral resection of the prostate, holmium laser enucleation of the prostate, greenlight photoselective vaporization of the prostate, and simple prostatectomy were reviewed for discussion. RESULTS For small-medium prostates (30-80 mL), Aquablation's main advantages include better ejaculatory function and similar functional outcomes compared to TURP. For large prostates (80-150 mL), Aquablation demonstrates shorter operative time and superior ejaculatory function when compared to simple prostatectomy, HoLEP, and Greenlight PVP. In addition, Aquablation displays shorter hospital stays than simple prostatectomy. The integration of software programming and semi-automatic technology increases the reproducibility of the procedure and helps standardize overall outcomes, while also accelerating the learning curve. Its ability to preserve antegrade ejaculation makes Aquablation a very compelling option for sexually active patients. However cost and postoperative bleeding risks remain a concern. CONCLUSION The current evidence suggests that Aquablation is a safe and effective alternative for BPE for small to large prostates. Further prospective clinical trials, with comparisons to other BPE modalities, and data from longer follow-up periods are still required.
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Park S, Kang HW. Temporal modulation of optical energy for enhanced photothermal hemostasis of intraoperative bleeding during laser treatment. JOURNAL OF BIOPHOTONICS 2020; 13:e202000086. [PMID: 32406184 DOI: 10.1002/jbio.202000086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/22/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
Intraoperative bleeding during laser treatment of benign prostate hyperplasia (BPH) often impedes cystoscopic vision, necessitating the use of conventional hemostatic devices. This study proposes an optical technique to improve the efficacy of photothermal hemostasis of bleeders during laser prostatectomy by temporally modulating a 532 nm laser beam. A perfused porcine kidney model is established to quantitatively investigate various optical pulse patterns and irradiation modes. Thermal simulations demonstrate a high success rate of complete hemostasis achieved by the modulated 532 nm pulse pattern. In comparison to the irradiation modes typically employed for hemostasis, the modulated 532 nm mode exhibits a short coagulation time and minimal thermal injury. ex vivo and in vivo cystoscopic observations validate the clinical feasibility of the proposed optical energy modulation method to regulate intraoperative bleeding.
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Affiliation(s)
- Suhyun Park
- School of Electrical and Electronics Engineering, Chung-Ang University, Seoul, Republic of Korea
| | - Hyun Wook Kang
- Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology (BK21 Plus), Pukyong National University, Busan, Republic of Korea
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Xiang P, Wang M, Guan D, Liu D, Wang Y, Hao Y, Li S, Liu Y, Ping H. A Systematic Review and Meta-analysis of Prostatic Urethral Lift for Male Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. EUR UROL SUPPL 2020; 19:3-15. [PMID: 34337448 PMCID: PMC8317884 DOI: 10.1016/j.euros.2020.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2020] [Indexed: 02/03/2023] Open
Abstract
CONTEXT Recently, prostatic urethral lift (PUL) is being used to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Although preliminary clinical studies on PUL are increasing, the long-term efficacy and safety of this procedure are still not well evaluated. OBJECTIVE The objective of our study is to synthesize the existing literature evidence, and make a comprehensive and long-term systematic review for the PUL procedure. EVIDENCE ACQUISITION A systematic search was performed from the electronic databases including PubMed, Embase, and OVID. The search period was up to January 1, 2020. Comprehensive retrospective and prospective studies on PUL were collected in accordance with specific inclusion and exclusion criteria. Pooled prostatic symptom scores, sexual health scores, and functional outcomes were calculated by using a fixed or random-effect model. EVIDENCE SYNTHESIS Nineteen articles meet our determined inclusion and exclusion criteria, and 11 independent patient series were included in the final analysis. Meta-analysis results indicated improvement after the PUL procedure, including International Prostate Symptom Score improvement of 9.73-12.16 points, BPH Impact Index improvement of 3.74-4.50 points, maximum flow rate improvement of 3.44-4.26 ml/s, and quality of life improvement of 2.20-2.55 points. Postvoid residual volume at most of the intervals was not significantly variable. Data regarding sexual function remained stable or improved slightly during the 24-mo follow-up period. Pooled estimates were largely heterogeneous except for sexual function. CONCLUSIONS PUL can continue to relieve prostatic symptoms for 24 mo without causing serious complications. The extremely important advantage of the PUL procedure is that it can preserve or slightly improve sexual function. Longer-term and more comprehensive clinical trials are still needed to further clarify the functional outcomes and cost effectiveness of PUL. PATIENT SUMMARY Prostatic urethral lift is an attractive option for selected patients who seek rapid and durable relief of lower urinary tract symptoms with complete preservation of sexual function.
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Affiliation(s)
- Peng Xiang
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Mingdong Wang
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Di Guan
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Dan Liu
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yonghui Wang
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yongxiu Hao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Shuang Li
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuexin Liu
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hao Ping
- Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Liu X, Yuan F, Xue Md B. GreenLight XPS 180-W Laser Vaporization of Prostate in High-Risk Elderly Patients: A Single-Center Experience. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2020; 38:380-384. [PMID: 32456546 DOI: 10.1089/photob.2019.4735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Purpose: To evaluate the safety and efficacy of GreenLight XPS 180-W laser photoselective vaporization of the prostate (PVP) in high-risk elderly patients with benign prostatic hyperplasia. Materials and methods: This retrospective study included 150 elderly patients with enlarged prostate glands (>40 mL) receiving 180-W photoselective vaporization at our department between January 2016 and October 2018. All patients were of advanced age (>80 years) and included those at higher risk of bleeding and cardiopulmonary disease. Perioperative data were collected and analyzed. Results: All operations were completed uneventfully without conversion to open surgery, and nobody died due to postoperative complications. The mean preoperative prostate volume was 65 ± 12.5 mL, mean operative time was 63 ± 12.5 min, mean laser working time was 51 ± 9.2 min, and mean catheterization time was 2.7 ± 1.8 days. There were significant improvements in International Prostate Symptom Scores, quality of life, maximum flow rate, and postvoid residual volume compared with preoperative values. Intraoperative as well as short- and long-term postoperative complication rates were 0.7%, 29.8%, and 13.3%, respectively. Three patients required rehospitalization for postoperative complications, one needed reoperation, and the others recovered after conservative treatment. Conclusions: PVP with a GreenLight XPS 180-W laser in high-risk elderly patients is safe and feasible. It provides a dramatic improvement in both short- and long-term functional outcomes and deserves promotion.
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Affiliation(s)
- Xiaolong Liu
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, China
| | - Feng Yuan
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, China
| | - Boxin Xue Md
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, China
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44
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Franz PL, Wang H. Development of hypothermia measurable fiber radiometric thermometer for thermotherapy. JOURNAL OF BIOPHOTONICS 2020; 13:e201960205. [PMID: 32077211 DOI: 10.1002/jbio.201960205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 05/11/2023]
Abstract
Temperature monitoring is extremely important during thermotherapy. Fiber-optic temperature sensors are preferred because of their flexibility and immunity to electromagnetic interference. Although many types of fiber-optic sensors have been developed, clinically adopting them remains challenging. Here, we report a silica fiber-based radiometric thermometer using a low-cost extended InGaAs detector to detect black body radiation between 1.7 and 2.4 μm. For the first time, this silica fiber-based thermometer is capable of measuring temperatures down to 35°C, making it suitable for monitoring hyperthermia during surgery. In particular, the thermometer has potential for seamless integration with current silica fiber catheters, which are widely used in laser interstitial thermotherapy. The feasibility, capability and sensitivity of tracking tissue temperature variation were proved through ex vivo tissue studies. After further improvement, the technology has the potential to be translated into clinics for monitoring tissue temperature.
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Affiliation(s)
- Paris L Franz
- Department of Chemical, Paper and Biomedical Engineering, Miami University, Oxford, Ohio, USA
- Currently associated with the Department of Applied Physics, Stanford University, Stanford, California, USA
| | - Hui Wang
- Department of Chemical, Paper and Biomedical Engineering, Miami University, Oxford, Ohio, USA
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45
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Reale G, Marchioni M, Altieri V, Greco F, De Nunzio C, Destefanis P, Ricciardulli S, Bergamaschi F, Fasolis G, Varvello F, Voce S, Palmieri F, Divan C, Malossini G, Oriti R, Tuccio A, Ruggera L, Tubaro A, Delicato G, Laganà A, Dadone C, De Rienzo G, Ditonno A, Frattini A, Pucci L, Carrino M, Montefiore F, Germani S, Miano R, Schips L, Rabito S, Ferrari G, Cindolo L. Operative profile, safety and functional outcomes after GreenLight laser prostate surgery: results from a 12 months follow-up multicenter Italian cohort analyses. MINERVA UROL NEFROL 2020; 72:622-628. [PMID: 32284526 DOI: 10.23736/s0393-2249.20.03597-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Over the two past decades, GreenLight laser therapy has been considered a valid alternative for the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia/benign prostatic obstruction (BPH/BPO). However, the debate on the effectiveness of laser therapy compared to conventional techniques is still open. The aim of our study is to analyze and describe the use of GreenLight laser prostate surgery in Italy, with regard to the surgical techniques performed and the surgical and functional outcomes at mid-term follow-up. METHODS From March 2012 to July 2018, patients who underwent GreenLight laser prostate surgery for LUTS due to BPH/BPO from 19 Italian centers were included. The following parameters were evaluated in the population: age, prostate volume, prostate adenoma volume, PSA tot, Q<inf>max</inf> at uroflowmetry (UFM), International Prostatic Symptoms Score (IPSS), previous therapy for LUTS, use of anticoagulants and antiplatelet drugs. We recorded also the kind of anesthesia, mean laser time (min), mean irradiation time (min), TURP conversion/completion rate, postoperative day of catheter removal, postoperative acute urinary retention (AUR), hospital stay, variation of hematocrit (Ht) and hemoglobin levels (Hb). Early complications were classified according to the Clavien-Dindo classification, the re-operation rate within 30 days and after 30 days, the late complications and the Patient Global Impression of Improvement were also collected. Changes over time in terms of blood loss and functional outcomes (IPSS and Q<inf>max</inf> at the UFM at 6 and 12 months) were tested with Student's test for paired samples. We assumed P≤0.05 as level of statistical significance. RESULTS Overall, 1077 were enrolled in the study, 554 (56.4%) were treated with standard vaporization and 523 (48.6%) with anatomical vaporization. Student's t-test for paired samples showed no statistically significant differences in terms of reduction of Ht preoperative vs. Ht postoperative (42.80±3.91 vs. 39.93±5.35 95% CI P=0.3) and preintervention and postintervention Hb levels (14.28±1.46 vs. 13.72 P=0.35). Compared with the preoperative Q<inf>max</inf> (8.60±2.64), the 6- and 12-month UFM showed a significant improvement [19.56±6.29, P<0.01 and 19.99±5.92 P<0.01]. In terms of IPSS variation, compared to the baseline level (22±5.51) the 6- and 12-month follow-up confirmed a significant reduction (8.01±4.41 P<0.01 and 5.81±4.12 P<0.01 respectively). Postoperative complications were CD0, CD1, CD2, CD3, CD4 in 33.0%,35.3%, 2.9%, 0.3%, and 0.6%. CONCLUSIONS To the best of our knowledge, this is one of the most numerous surgical series of GreenLight laser vaporization and with the longest follow-up. This technique should be considered as a safe and effective alternative in the treatment of secondary LUTS to BPH.
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Affiliation(s)
- Giulio Reale
- Department of Urology, S. Maria delle Croci Hospital, Azienda AUSL Romagna, Ravenna, Italy -
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti, Italy
| | | | | | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Paolo Destefanis
- Departement of Urology, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | | | - Franco Bergamaschi
- Department of Urology, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | | | | | - Salvatore Voce
- Department of Urology, S. Maria delle Croci Hospital, Azienda AUSL Romagna, Ravenna, Italy
| | - Fabiano Palmieri
- Department of Urology, S. Maria delle Croci Hospital, Azienda AUSL Romagna, Ravenna, Italy
| | - Claudio Divan
- Department of Urology, Hospital of Rovereto, Rovereto, Milan, Italy
| | - Gianni Malossini
- Department of Urology, Hospital of Rovereto, Rovereto, Milan, Italy
| | - Rino Oriti
- Department of Urology, Ulivella e Glicini Clinic, Florence, Italy
| | - Agostino Tuccio
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Lorenzo Ruggera
- Department of Urology, Urologic Clinic, University of Padua, Padua, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Giampaolo Delicato
- Department of Urology, S.Giovanni Evangelista Hospital, Tivoli, Rome, Italy
| | - Antonino Laganà
- Department of Urology, S.Giovanni Evangelista Hospital, Tivoli, Rome, Italy
| | - Claudio Dadone
- Department of Urology, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Gaetano De Rienzo
- Urology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Andrea Ditonno
- Urology and Andrology Unit II, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Antonio Frattini
- Department of Urology, Ospedale Civile di Guastalla, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Ercole Franchini di Montecchio Emilia Hospital, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Pucci
- Department of Urology, AORN Antonio Cardarelli, Naples, Italy
| | | | - Franco Montefiore
- Department of Urology, San Giacomo Hospital, Novi Ligure, Alessandria, Italy
| | - Stefano Germani
- Unit of Urology, Department of Surgery, Tor Vergata Polyclinic Foundation, Tor Vergata University, Rome, Italy
| | - Roberto Miano
- Unit of Urology, Department of Surgery, Tor Vergata Polyclinic Foundation, Tor Vergata University, Rome, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, G. D'Annunzio University, Chieti, Italy
| | | | | | - Luca Cindolo
- Department of Urology, Villa Stuart Private Hospital, Rome, Italy
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46
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Franz P, Wang X, Zhu H, Chia R, Hasenberg T, Wang H. Detection of blackbody radiation during fiber guided laser-tissue vaporization. BIOMEDICAL OPTICS EXPRESS 2020; 11:791-800. [PMID: 32206396 PMCID: PMC7041439 DOI: 10.1364/boe.376141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/29/2019] [Accepted: 01/03/2020] [Indexed: 06/10/2023]
Abstract
Laser-tissue vaporization through a fiber catheter is evolving into a major category of surgical operations to remove diseased tissue. Currently, during a surgery, the surgeon still relies on personal experience to optimize surgical techniques. Monitoring tissue temperature during laser-tissue vaporization would provide important feedback to the surgeon; however, simple and low-cost temperature sensing technology, which can be seamlessly integrated with a fiber catheter, is not available. We propose to monitor tissue temperature during laser-tissue vaporization by detecting blackbody radiation (BBR) between 1.6 µm-1.8 µm, a relatively transparent window for both water and silica fiber. We could detect BBR after passing through a 2-meter silica fiber down to ∼70°C using lock-in detection. We further proved the feasibility of the technology through ex vivo tissue studies. We found that the BBR can be correlated to different tissue vaporization levels. The results suggest that this simple and low-cost technology could be used to provide objective feedback for surgeons to maximize laser-tissue vaporization efficiency and ensure the best clinical outcomes.
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Affiliation(s)
- Paris Franz
- Department of Chemical, Paper and Biomedical Engineering, Miami University, OH 45056, USA
- Currently with Department of Applied Physics, Stanford University, CA, USA
| | - Xiaomei Wang
- Department of Computer Science, Shanghai Normal University, China
| | - Hui Zhu
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, OH 44125, USA
| | - Ray Chia
- Boston Scientific, MA 01752, USA
| | | | - Hui Wang
- Department of Chemical, Paper and Biomedical Engineering, Miami University, OH 45056, USA
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47
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Tuccio A, Sessa F, Campi R, Grosso AA, Viola L, Muto G, Scoffone C, Cracco CM, Gómez-Sancha F, Misrai V, Muto G, Mari A, Di Maida F, Tellini R, Figueiredo F, Carini M, Oriti R, Amparore D, Fiori C, Porpiglia F, Minervini A. En-bloc endoscopic enucleation of the prostate: a systematic review of the literature. MINERVA UROL NEFROL 2020; 72:292-312. [PMID: 32026670 DOI: 10.23736/s0393-2249.20.03706-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Transurethral resection of the prostate (TURP) remains the gold standard for treatment of benign prostatic hyperplasia (BPH). Yet, the introduction of lasers for the treatment of LUTS due to BPO has dramatically changed the surgical landscape of benign prostatic obstruction (BPO) treatment. Recently, "en-bloc" techniques have shown to prove advantageous in terms of better visualization, more prompt identification of the surgical capsule and the correct plane to dissect. Herein we provide a comprehensive overview of available series of en-bloc enucleation of the prostate, focusing on surgical techniques, perioperative and functional outcomes. EVIDENCE ACQUISITION A systematic review of the literature was performed according to PRISMA recommendations and was conducted on surgical techniques and perioperative outcomes of minimally invasive en-bloc surgery for prostate adenoma detachment. EVIDENCE SYNTHESIS Overall, 16 studies with 2750 patients between 2003 and 2019 were included. Specific technical nuances have been described to maximize perioperative outcomes of en-bloc prostatic enucleation, including early apical release, horse-shape incisions, inverted U-shape tractions and low power. Overall, regardless of the energy employed, en-bloc prostatic enucleation achieved favorable outcomes including low risk of major complications and quality of life improvement. However, a great heterogeneity of study design, patients' inclusion criteria, prostate volume and en-bloc surgical strategy was found. CONCLUSIONS En-bloc endoscopic enucleation of the prostate has been shown to be technically feasible and safe, with potential technical advantages over the classic three-lobe technique. Larger comparative studies are needed to evaluate the ultimate impact of the en-bloc approach on postoperative outcomes, in light of the surgeon's learning curve.
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Affiliation(s)
- Agostino Tuccio
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy -
| | - Francesco Sessa
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Campi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Antonio A Grosso
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Lorenzo Viola
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Gianluca Muto
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | | | | | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Giovanni Muto
- Department of Urology, Humanitas Gradenigo University, Turin, Italy
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Fabrizio Di Maida
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Tellini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rino Oriti
- Department of Urology, Ulivella e Glicini Clinic, Florence, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Exploration of day-surgery photoselective vaporization of the prostate (PVP) in Chinese population. Lasers Med Sci 2019; 35:1503-1507. [PMID: 31858348 DOI: 10.1007/s10103-019-02938-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 11/21/2019] [Indexed: 01/16/2023]
Abstract
To explore the surgical effect and cost-effectiveness of day surgery versus inpatient surgery for photoselective vaporization of the prostate (PVP) in Chinese population. We retrospectively collected 240 patients undergoing day-surgery PVP (April 2016 to March 2018) and 156 patients undergoing inpatient-surgery PVP (May 2014 to March 2016). Differences between groups in demographics, perioperative outcomes, complications, and postoperative changes were calculated. Economical results in terms of hospital stay and relevant preoperative, intraoperative, and postoperative cost were evaluated. There was no significant difference in operative time, incidence of postoperative complications, and other functional outcomes between two groups (P > 0.05), but the waiting time for admission and the hospital cost including the drug charges, bed fee, nursing fee, laboratory test, and imaging fee of day-surgery group were significantly lower than that of inpatient-surgery group (P < 0.05). Day surgery of PVP has firm and well accepted position in ambulatory surgery of urology. It could significantly reduce the waiting time for admission and hospitalization costs in BPH patients.
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49
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Davis C, Golzarian J, White S, Fischman A, Rastinehad A, Isaacson A, Carnevale FC, Foster H, Findeiss L, Sapoval M, Borofsky M, Ayyagari R, Salem R, Bhatia S, Caridi T. Development of Research Agenda in Prostate Artery Embolization: Summary of Society of Interventional Radiology Consensus Panel. J Vasc Interv Radiol 2019; 31:108-113. [PMID: 31771895 DOI: 10.1016/j.jvir.2019.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To summarize the Society of Interventional Radiology Foundation's Research Consensus Panel development of a research agenda on prostate artery embolization (PAE). MATERIALS AND METHODS PAE for the treatment of lower urinary tract symptoms has been shown to be safe and effective in decreasing symptoms and prostate size. Lack of randomized controlled trials (RCTs) on PAE in the United States has prevented inclusion in American Urologic Association guideline recommendations for treatment of lower urinary tract symptoms resulting from benign prostatic hyperplasia. Recognizing the need for well-designed trials, the SIR Foundation funded a Research Consensus Panel to prioritize a research agenda. The panel included interventional radiologists, urologists, SIR Foundation leadership, and industry representatives. The goal of the meeting was to discuss weaknesses with current data and study design for development of US trials to report long-term outcomes data. RESULTS Final consensus on a research design could not be made because the group was split on 3 research designs: (i) RCT of PAE versus sham with crossover of the sham group. (ii) RCT of PAE versus simple prostatectomy. (iii) RCT of PAE versus holmium laser enucleation of the prostate/thulium laser enucleation of the prostate. The panel recommended a nonindustry-funded registry to obtain real-world data. CONCLUSIONS Level 1 data are required to be included in the American Urologic Association guidelines for treatment of benign prostatic hyperplasia. Because of concerns with all 3 study designs, the panel did not reach a consensus. Further meetings are planned with the panel to select among these research designs.
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Affiliation(s)
- Clifford Davis
- College of Medicine and Radiology, University of South Florida, Tampa, Florida.
| | - Jafar Golzarian
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Sarah White
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aaron Fischman
- Department of Radiology and Surgery, Icahn School of Medicine at Mount Sinai, New York New York
| | - Ardeshir Rastinehad
- Department of Urology and Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ari Isaacson
- Department of Vascular and Interventional Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Harris Foster
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
| | - Laura Findeiss
- Department of Radiology and Imaging Services, Emory University School of Medicine, Atlanta, Georgia
| | - Marc Sapoval
- Vascular and Oncological Interventional Radiology, Hôpital Européen Georges-Pompidou, Paris, France
| | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - Raj Ayyagari
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Riad Salem
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Shivank Bhatia
- Department of Radiology, University of Miami, Miami, Florida
| | - Theresa Caridi
- Department of Radiology, MedStar Georgetown University, Washington, DC
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50
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Ghobrial FK, Shoma A, Elshal AM, Laymon M, El-Tabey N, Nabeeh A, Shokeir AA. A randomized trial comparing bipolar transurethral vaporization of the prostate with GreenLight laser (xps-180watt) photoselective vaporization of the prostate for treatment of small to moderate benign prostatic obstruction: outcomes after 2 years. BJU Int 2019; 125:144-152. [PMID: 31621175 DOI: 10.1111/bju.14926] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To test the non-inferiority of bipolar transurethral vaporization of the prostate (TUVP) compared to GreenLight laser (GL) photoselective vaporization of the prostate (PVP) for reduction of benign prostatic hyperplasia-related lower urinary tract symptoms in a randomized trial. METHODS Eligible patients with prostate volumes of 30-80 mL were randomly allocated to GL-PVP (n = 58) or bipolar TUVP (n = 61). Non-inferiority of symptom score (International Prostate Symptom Score [IPSS]) at 24 months was evaluated. All peri-operative variables were recorded and compared. Urinary (IPSS, maximum urinary flow rate and post-void residual urine volume) and sexual (International Index of Erectile Function-15) outcome measures were evaluated at 1, 4, 12 and 24 months. Need for retreatment and complications, change in PSA level and health resources-related costs of both procedures were recorded and compared. RESULTS Baseline and peri-operative variables were similar in the two groups. At 1, 4, 12 and 24 months, 117, 116, 99 and 96 patients, respectively, were evaluable. Regarding urinary outcome measures, there was no significant difference between the groups. The mean ± sd IPSS at 1 and 2 years was 7.1 ± 3 and 7.9 ± 2.9 (P = 0.8), respectively, after GL-PVP and 6.3 ± 3.1 and 7.2 ± 2.8, respectively, after bipolar TUVP (P = 0.31). At 24 months, the mean difference in IPSS was 0.7 (95% confidence interval -0.6 to 2.3; P = 0.6). The median (range) postoperative PSA reduction was 64.7 (25-99)% and 65.9 (50-99)% (P = 0.006) after GL-PVP, and 32.1 (28.6-89.7)% and 39.3 (68.8-90.5)% (P = 0.005) after bipolar TUVP, at 1 and 2 years, respectively. After 2 years, retreatment for recurrent bladder outlet obstruction was reported in eight (13.8%) and 10 (16.4%) patients in the GL-PVP and bipolar TUVP groups, respectively (P = 0.8). The mean estimated cost per bipolar TUVP procedure was significantly lower than per GL-PVP procedure after 24 months (P = 0.01). CONCLUSIONS In terms of symptom control, bipolar TUVP was not inferior to GL-PVP at 2 years. Durability of the outcome needs to be tracked. The greater cost of GL-PVP compared with bipolar TUVP is an important concern.
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Affiliation(s)
- Fady K Ghobrial
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Shoma
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed M Elshal
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mahmoud Laymon
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Nasr El-Tabey
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Adel Nabeeh
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed A Shokeir
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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