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Barco-Castillo C, Plata M, Zuluaga L, Santander J, Trujillo CG, Caicedo JI, Serrano A, Fernández N, Azuero J. Functional outcomes and safety of GreenLight photovaporization of the prostate in the high-risk patient with lower urinary tract symptoms due to benign prostatic enlargement. Neurourol Urodyn 2019; 39:303-309. [PMID: 31677209 DOI: 10.1002/nau.24195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/13/2019] [Indexed: 01/08/2023]
Abstract
AIMS Photovaporization of the prostate (PVP) with GreenLight Laser is a surgical treatment for lower urinary tract symptoms. It is considered safe in elderly patients with comorbidities, however, the evidence is inconclusive. The objective of this study is to evaluate the efficacy and safety outcomes of PVP according to the American Society of Anesthesiologists Physical Status (ASAPS). METHODS A cohort of 675 patients who underwent PVP between 2012 and 2018 was evaluated. Patients were classified according to their ASAPS as low (I and II) and high risk (III and IV). Surgical characteristics and improvement of symptoms and Quality of Life (QoL) were evaluated. RESULTS The median age of high-risk group was higher than low-risk group. The high-risk group had more history of anticoagulation, antiaggregation, urinary catheterization, urinary retention and urethral stricture. Longer times of hospitalization (23.7 [interquartile range {IQR} = 18.9-41.35] vs 21.8 hours [IQR = 18.7-26.6], P = .008) and catheterization (19.55 [IQR = 15.6-35.57] vs 17.67 hours [IQR = 14.76-22.5], P = .004) were found in the high-risk group. Conversion and bleeding control were not different between groups. In the follow-up, improvement of International Prostate Symptoms Score (IPSS) and QoL was significant in all patients when compared before and after surgery scores (P < .001). There were no difference between groups for QoL, however, IPSS was lower for the low-risk group (8 [IQR = 4-14.5] vs 5 [2-12], P = .001). CONCLUSION PVP with GreenLight Laser is a safe and efficient procedure for all patients despite their comorbidities, with comparable middle-term outcomes which makes it a standard treatment for the entire aging population, improving their QoL.
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Affiliation(s)
- Catalina Barco-Castillo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad de los Andes School of Medicine, Bogotá D.C, Colombia
| | - Mauricio Plata
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad de los Andes School of Medicine, Bogotá D.C, Colombia
| | - Laura Zuluaga
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad de los Andes School of Medicine, Bogotá D.C, Colombia
| | - Jessica Santander
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad de los Andes School of Medicine, Bogotá D.C, Colombia
| | - Carlos Gustavo Trujillo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad de los Andes School of Medicine, Bogotá D.C, Colombia
| | - Juan Ignacio Caicedo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad de los Andes School of Medicine, Bogotá D.C, Colombia
| | - Adolfo Serrano
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad de los Andes School of Medicine, Bogotá D.C, Colombia
| | - Nicolás Fernández
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad de los Andes School of Medicine, Bogotá D.C, Colombia
| | - Julián Azuero
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá, Universidad de los Andes School of Medicine, Bogotá D.C, Colombia
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Kim SW, Hwang J, Xuan J, Hasenberg T, Kang HW. Enhanced photothermal hemostasis using dual wavelengths in an in vivo leporine kidney model. BIOMEDICAL OPTICS EXPRESS 2019; 10:5198-5206. [PMID: 31646041 PMCID: PMC6788610 DOI: 10.1364/boe.10.005198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/03/2019] [Accepted: 09/10/2019] [Indexed: 06/10/2023]
Abstract
The current study investigated the hemostatic effect of dual wavelengths on in vivo leporine kidney tissue using 532-nm and 980-nm laser systems. Three irradiation modes, 532 nm, 980 nm, and dual (532 and 980 nm) modes, were compared to test non-contact photothermal hemostasis on 36 bleeders in the kidney models. Each bleeder was flushed with saline during the irradiation. The dual mode achieved complete hemostasis more rapidly than the single modes (4.0 ± 1.4 s for dual vs. no hemostasis for 532 nm and 10.0 ± 1.3 s for 980 nm; p < 0.001). Application of 60 W from the dual wavelengths expanded the surface area of the thermal lesion (up to 60%). In vivo dual-wavelength irradiation achieved more rapid and complete hemostasis with ∼2 mm coagulation depth than the single-wavelength irradiation.
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Affiliation(s)
- Sung won Kim
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, South Korea
| | - Jieun Hwang
- Interdisciplinary Program of Marine-Bio, Electrical & Mechanical Engineering, Pukyong National University, Busan, South Korea
| | - Jason Xuan
- UroPH R&D, Boston Scientific Corp., San Jose, CA 95134, USA
| | | | - Hyun Wook Kang
- Interdisciplinary Program of Marine-Bio, Electrical & Mechanical Engineering, Pukyong National University, Busan, South Korea
- Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology (BK21 Plus), Pukyong, National University, Busan, South Korea
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Bausch K, Motzer J, Roth JA, Dangel M, Seifert HH, Widmer AF. High incidence of urinary tract infections after photoselective laser vaporisation of the prostate: a risk factor analysis of 665 patients. World J Urol 2019; 38:1787-1794. [PMID: 31578631 DOI: 10.1007/s00345-019-02969-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/20/2019] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Although photoselective laser vaporisation of the prostate (PVP) is a recognised alternative to transurethral resection in treating benign prostatic obstruction, there is limited data on the incidence and determinants of postoperative urinary tract infections (UTI). We assessed patients subjected to PVP, evaluating incidence and potential determinants of postoperative UTIs. MATERIALS AND METHODS Consecutive patients undergoing PVP between April 2010 and August 2018 were candidates for this retrospective cohort study. The primary outcome measure was microbiologically confirmed postoperative UTI. We fitted uni- and multi-variable Cox models to identify potential risk factors. RESULTS Among the 665 included patients, 20% developed postoperative UTIs. The overall incidence rate per 100 patient-days was 0.65 (95% confidence interval [CI] 0.55-0.77). Risk factors for postoperative UTIs were end-stage renal failure (adjusted hazard ratio [aHR] = 14.10, 95% CI 2.08-64.58; p = 0.001) and presence of at least one of the following factors in the 3 months preceding PVP: (i) placement of urinary catheter, (ii) bacteriuria, (iii) UTI, or (iv) antimicrobial treatment (composite aHR = 1.99, 95% CI 1.22-3.24; p < 0.001). There was no apparent association between choice or duration of antimicrobial prophylaxis and incident UTIs. CONCLUSIONS Our analysis revealed a high incidence of UTIs after PVP and served to identify certain preoperative risk factors. Neither the choice of antimicrobial regimen nor its duration affected the incidence of UTIs. Prolonged antimicrobials proved to be disproportionately high, warranting further scrutiny in randomised controlled trials.
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Affiliation(s)
- Kathrin Bausch
- Department of Urology, University Hospital Basel, Spitalstrasse 21, Basel, 4056, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Jan A Roth
- University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Marc Dangel
- University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Hans-Helge Seifert
- Department of Urology, University Hospital Basel, Spitalstrasse 21, Basel, 4056, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Andreas F Widmer
- University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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The role of photovaporization of the prostate in small volume benign prostatic hyperplasia and review of the literature. Asian J Urol 2019; 6:353-358. [PMID: 31768321 PMCID: PMC6872824 DOI: 10.1016/j.ajur.2019.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/23/2018] [Accepted: 10/17/2018] [Indexed: 11/24/2022] Open
Abstract
Objective Our objective was to characterize the safety and efficacy of the 180 W XPS-GreenLight laser in men with lower urinary tract symptoms secondary to a small volume benign prostatic hyperplasia (BPH). Methods A retrospective analysis was performed for all patients who underwent 180 W XPS-laser photoselective vaporization of the prostate (PVP) vaporization of the prostate between 2012 and 2016 at two-tertiary medical centers. Data collection included baseline comorbidities, disease-specific quality of life scores, maximum urinary flow rate (Qmax), postvoid residual (PVR), complications, prostate volume and prostate-specific antigen (PSA). The secondary endpoints were the incidence of intraoperative and postoperative adverse events. Complications were stratified using the Clavien-Dindo grading system up to 90 days after surgery. Results Mean age of men was 67.8 years old, with a mean body mass index of 29.7 kg/m2. Mean prostate volume as measured by transrectal ultrasound was 29 mL. Anticoagulation use was 47% and urinary retention with catheter at time of surgery was 17%. Mean hospital stay and catheter time were 0.5 days. Median follow-up time was 6 months with the longest duration of follow-up being 22.5 months (interquartile range, 3–22.5 months). The International Prostate Symptom Score improved from 22.8 ± 7.0 at baseline to 10.7 ± 7.4 (p < 0.01) and 6.3 ± 4.4 (p < 0.01) at 1 and 6 months, respectively. The Qmax improved from 7.70 ± 4.46 mL/s at baseline to 17.25 ± 9.30 mL/s (p < 0.01) and 19.14 ± 7.19 mL/s (p < 0.001) at 1 and 6 months, respectively, while the PVR improved from 216.0 ± 271.0 mL preoperatively to 32.8 ± 45.3 mL (p < 0.01) and 26.2 ± 46.0 mL (p < 0.01) at 1 and 6 months, respectively. The PSA dropped from 1.97 ± 1.76 ng/mL preoperatively to 0.71 ± 0.61 ng/mL (p < 0.01) and 0.74 ± 0.63 ng/mL at 1 and 6 months, respectively. No patient had a bladder neck contracture postoperatively and no capsular perforations were noted intraoperatively. Conclusion The 180 W GreenLight XPS system is safe and effective for men with small volume BPH. PVP produced improvements in symptomatic and clinical parameters without any safety concern. It represents a safe surgical option in this under studied population.
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Wu B, Li J, Xu Q, Hou R, Jia W, Chen Q. Vaporization of Prostate by 160W GreenLight Laser on Postoperative Erectile Function. Urology 2019; 132:164-169. [DOI: 10.1016/j.urology.2019.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/21/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022]
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Cacciamani GE, Cuhna F, Tafuri A, Shakir A, Cocci A, Gill K, Gómez Rivas J, Dourado A, Veneziano D, Okhunov Z, Capogrosso P, Hueber PA, Alberseen M, Abreu A, Migliorini F, Fiori C, Porcaro AB, Porpiglia F, Desai M, Russo GI. Anterograde ejaculation preservation after endoscopic treatments in patients with bladder outlet obstruction: systematic review and pooled-analysis of randomized clinical trials. MINERVA UROL NEFROL 2019; 71:427-434. [PMID: 31487977 DOI: 10.23736/s0393-2249.19.03588-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Despite the high rate of resolution, ejaculatory dysfunction still is the most common side effect related to surgical treatment of bladder outlet obstruction (BOO). The aim of the present systematic review was to compare several technological treatment modalities for the management of lower urinary tract symptoms/BOO in terms of functional and sexual outcomes. EVIDENCE ACQUISITION All English language randomized controlled trials assessing the impact of different endoscopic treatments for BOO were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement to evaluate PubMed®, Scopus®, and Web of Science™ databases (up to June 2019). EVIDENCE SYNTHESIS Our electronic search identified a total of 2221 papers in PubMed, Scopus, and Web of Science. Of these, 142 publications were identified for detailed review, which yielded 21 included in the present systematic review. All groups appeared similar with regards to preoperative IPSS/AUA Score, Qmax, and prostate volume (cc). Patients undergoing endoscopic treatments using ThuLEP, Greenlight or Prostate Artery Embolization techniques had lower-but not statistically significant- relative risk (RR) of retrograde ejaculation compared with conventional transurethral resection of the prostate (TURP) (RR: 0.90; P=0.35; RR: 0.71; P=0.1; RR0.73; P=0.11). Efficacy of those techniques was equal to TURP. CONCLUSIONS Data reporting anterograde ejaculation preservation after endoscopic treatment in patients with benign prostatic enlargement are sparse and heterogeneous. Pooled analyses suggest that new technological alternatives to conventional TURP might improve sexual outcomes, especially for non-ablative treatments.
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Affiliation(s)
- Giovanni E Cacciamani
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA -
| | - Frederico Cuhna
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | - Alessandro Tafuri
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA.,Department of Urology, University of Verona, Verona, Italy
| | - Aliasger Shakir
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | - Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Karanvir Gill
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | | | - Aurus Dourado
- Department of Urology, São Marcos Hospital, Piauí, Brazil
| | - Domenico Veneziano
- Department of Urology and Renal Transplantation, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, CA, USA
| | | | - Pierre A Hueber
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | - Marteen Alberseen
- Department of Urology and Pediatric Urology, Medicine University Mainz, Mainz, Germany
| | - Andre Abreu
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | | | - Cristian Fiori
- Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy
| | | | - Francesco Porpiglia
- Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy
| | - Mihir Desai
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | - Giorgio I Russo
- Department of Urology, University of Catania, Catania, Italy
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Lai S, Peng P, Diao T, Hou H, Wang X, Zhang W, Liu M, Zhang Y, Seery S, Wang J. Comparison of photoselective green light laser vaporisation versus traditional transurethral resection for benign prostate hyperplasia: an updated systematic review and meta-analysis of randomised controlled trials and prospective studies. BMJ Open 2019; 9:e028855. [PMID: 31439603 PMCID: PMC6707662 DOI: 10.1136/bmjopen-2018-028855] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess the efficacy and safety of green-light laser photoselective vaporisation of the prostate (PVP) compared with transurethral resection of the prostate (TURP) for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). DESIGN Systematic review and meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. DATA SOURCES PubMed, EMBASE, the Cochrane Library until October 2018. ELIGIBILITY CRITERIA Randomised controlled trials and prospective studies comparing the safety and efficacy of PVP versus TURP for LUTS manifesting through BPH. DATA EXTRACTION AND SYNTHESIS Perioperative parameters, complications rates and functional outcomes including treatment-related adverse events such as International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), postvoid residual (PVR), quality of life (QoL) and International Index of Erectile Function (IIEF). RESULTS 22 publications consisting of 2665 patients were analysed. Pooled analysis revealed PVP is associated with reduced blood loss, transfusion, clot retention, TUR syndrome, capsular perforation, catheterisation time and hospitalisation, but also with a higher reintervention rate and longer intervention duration (all p<0.05). No significant difference in IPSS, Qmax, QoL, PVR or IIEF at 3, 24, 36 or 60 months was identified. There was a significant difference in QoL at 6 months (MD=-0.08; 95% CI -0.13 to -0.02; p=0.007), and IPSS (MD = -0.10; 95% CI -0.15 to -0.05; p<0.0001) and Qmax (MD=0.62; 95% CI 0.06 to 1.19; p=0.03) at 12 months, although these differences were not clinically relevant. CONCLUSION PVP is an effective alternative, holding additional safety benefits. PVP has equivalent long-term IPSS, Qmax, QoL, PVR, IIEF efficacy and fewer complications. The main drawbacks are dysuria and reintervention, although both can be managed with non-invasive techniques. The additional shortcoming is that PVP does not acquire histological tissue examination which removes an opportunity to identify prostate cancer.
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Affiliation(s)
- Shicong Lai
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Panxin Peng
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Tongxiang Diao
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Peking university fifth school of clinical medicine, Beijing, China
| | - Huimin Hou
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xuan Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Wei Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Peking university fifth school of clinical medicine, Beijing, China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Yaoguang Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Samuel Seery
- School of Humanities and Social Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianye Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
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González Salas M. Green Light Láser XPS Tratamiento de HPB para Pacientes Tratados en un solo Centro por un solo Cirujano del 2015 al 2017: Descripción de técnica Quirúrgica y Experiencia Inical. REVISTA GUATEMALTECA DE UROLOGÍA 2019; 7:5-8. [DOI: 10.54212/27068048.v7i1.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Propósito: Valorar la eficacia postoperatoria del tratamiento en pacientes con antecedente de HPB con el sistema Green Light Láser XPS (GL XPS)a 180 watts y describir nuestra técnica operatoria del GL XPS.
Justificación: La hiperplasia prostática benigna (HPB) es la causa más común de sintomatología del tracto urinario inferior (STUI) en hombres con edades posteriores a los 40 años. Siendo la cirugía un arma fundamental para el tratamiento definitivo de este padecimiento (1,3).
Metodología: Revisión retrospectiva de los expedientes de pacientes intervenidos con diagnóstico de HPB mediante foto vaporización de próstata (PVP) Green Light Láser XPS (GL XPS) por el Dr. Mario González en el Hospital La California. La revisión comprendió todos los expedientes de pacientes desde enero del año 2015 hasta diciembre de 2017.
Resultados: De los 250 casos realizados hasta el momento, en total se incluyeron 146 en el estudio, cuya media de edad fue de 66.3 años (rango de 44-86). Se demostró una diminución significativa en cuanto a al international prostate symptom score (IPSS) pre operatorio y post operatorio en todos los pacientes (tabla 1). La media post operatorio fue de 17.6 IPSS y post operatorio 3.3 puntos respectivamente. El promedio de disminución del tamaño de la glándula post operatorio fue de 34.2 gramos. Los resultados de las complicaciones y reintervenciones están en periodo de recopilación de información.
Conclusiones: La PVP con GL XPS con vaporización a 180 watts resultó ser un método seguro y reproducible con una curva de aprendizaje corta. Presenta una tasa de complicaciones y re intervenciones no superior al ser comparada a RTUP bipolar (2).
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Leong JY, Patel AS, Ramasamy R. Minimizing Sexual Dysfunction in BPH Surgery. CURRENT SEXUAL HEALTH REPORTS 2019; 11:190-200. [PMID: 31467497 DOI: 10.1007/s11930-019-00210-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose of Review To review the prevalence and risks of sexual dysfunction associated with current treatment options for benign prostatic hyperplasia and to characterize techniques and methods to manage postoperative sexual dysfunction-related side effects. Recent Findings Current surgical therapies available for the treatment of benign prostatic hyperplasia are associated with a substantial risk of both ejaculatory and erectile function. However, many of the novel minimally invasive treatment alternatives have demonstrated the ability to preserve postoperative sexual function to a better degree, all while providing significant relief of lower urinary tract symptoms in an equally safe and efficacious manner. Summary Benign prostatic hyperplasia remains a highly prevalent disease among the aging population. While surgical treatments are often necessary to relieve bothersome urinary symptoms, these procedures are associated with an increased risk of sexual dysfunction. As such, there has been an increased interest in the development of minimally invasive therapies, such as the UroLift®, Rezum®, and Aquablation®, with the hopes of achieving similar symptomatic relief while maintaining sexual function. Aside from reporting lower rates of sexual dysfunction, these procedures have also demonstrated comparable safety, durability, and efficacy to current gold standard therapies. Some procedures can even be performed in an outpatient setting, avoiding the need for general anesthesia altogether. Overall, an individualized, shared decision-making approach is necessary to determine the ideal treatment option for each patient.
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Affiliation(s)
- Joon Yau Leong
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street, College Building, Suite 1112, Philadelphia, PA 19107, USA
| | - Amir S Patel
- Department of Urology, Oregon Health and Science University, Portland, OR, USA
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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Outcome of Photoselective Vaporization of the Prostate with the GreenLight-XPS 180 Watt System Compared to Transurethral Resection of the Prostate. J Clin Med 2019; 8:jcm8071004. [PMID: 31295846 PMCID: PMC6678790 DOI: 10.3390/jcm8071004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 06/30/2019] [Accepted: 07/07/2019] [Indexed: 11/17/2022] Open
Abstract
The aim of this paper was to compare the perioperative and postoperative results of photoselective vaporization of the prostate with the GreenLight-XPS 180 Watt System (PVP) and transurethral resection of the prostate (TURP). This retrospective study included 140 men who underwent PVP and 114 men who underwent TURP for symptomatic benign prostate enlargement (BPE) between June 2010 and February 2015. The primary outcome measures were the patient reported outcome, operative results, International Prostate Symptom Score-Quality of Life (IPSS-QoL), complication rates, catheterization time, and length of hospital stay. The median follow-up times were 27 months (range 14-44) for the PVP group and 36 months (range 25-47) for the TURP group. The patient characteristics were well balanced in both groups with a median age of 71 years (PVP group) vs. 70 years (TURP group) and a comparable prostate volume (median 50 mL in the PVP group vs. 45 mL in the TURP group). The IPSS-QoL was significantly higher in the PVP group than in the TURP group (median 22 + 4; range 16-27 + 3-5 vs. median 19 + 3; range 15-23 + 3-4; p = 0.02). Men undergoing PVP were more likely to be on anticoagulants (PVP group n = 23; 16% vs. TURP group n = 2; 2%, p < 0.001). The median operation time (OT; min) for both procedures was comparable with 68 min (PVP group; range 53-91) vs. 67 min (TURP group; range 46-85). The rate of severe intraoperative bleeding was significantly lower in the PVP group than in the TURP group (n = 7; 5% vs. n = 16; 14%; p = 0.01). The postoperative catheterization time and length of hospital stay was significantly lower in the PVP group (median 1-2 days; range 1-4) vs. the TURP group (median 2-4 days; range 2-5; both p < 0.001). Complication rates (Clavien-Dindo classification ≥III) based on the follow-up data showed no statistically significant difference between the PVP group and the TURP group (n = 6; 4% vs. n = 6; 5%; p = 0.28). The IPSS on follow-up showed an equivalent reduction in symptoms for both treatment modalities (IPSS-QoL of 5 + 1; range 2-11 + 0-2 for both). There were no differences concerning urge (PVP group n = 3; 2% vs. TURP group n = 3; 3%; p = 0.90) and men were similarly satisfied with the postoperative outcome (PVP group 92% vs. TURP group 87%; p = 0.43). The PVP group was associated with a shorter hospitalization time and showed a reduced risk of bleeding, despite patients remaining on anticoagulants, without increasing the overall operative time. There was no difference in the patient reported outcome for both procedures.
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Two-Year Outcomes After Aquablation Compared to TURP: Efficacy and Ejaculatory Improvements Sustained. Adv Ther 2019; 36:1326-1336. [PMID: 31028614 PMCID: PMC6824383 DOI: 10.1007/s12325-019-00952-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Indexed: 11/06/2022]
Abstract
Introduction To compare 2-year safety and efficacy outcomes after Aquablation or transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms related to benign prostate hyperplasia (BPH). Methods One hundred eighty-one patients with BPH were assigned at random (2:1 ratio) to either Aquablation or TURP. Patients and follow-up assessors were blinded to treatment. Assessments included the International Prostate Symptom Score (IPSS), Male Sexual Health Questionnaire (MSHQ), International Index of Erectile Function and uroflow. The focus of analysis was 2-year outcomes. Results At 2 years, IPSS scores improved by 14.7 points in the Aquablation group and 14.9 points in TURP (p = .8304, 95% CI for difference − 2.1 to 2.6 points). Two-year improvements in maximum flow rate (Qmax) were large in both groups at 11.2 and 8.6 cc/s for Aquablation and TURP, respectively (p = 0.1880, 95% CI for difference − 1.3 to 6.4). Sexual function as assessed by MSHQ was stable in the Aquablation group and decreased slightly in the TURP group. At 2 years, PSA was reduced significantly in both groups by 0.7 and 1.2 points, respectively; the reduction was similar across groups (p = 0.1816). Surgical retreatment rates after 12 months for Aquablation were 1.7% and 0% for TURP. Over 2 years, surgical BPH retreatment rates were 4.3% and 1.5% (p = 0.4219), respectively. Conclusion Two-year efficacy outcomes after TURP and Aquablation were similar, and the rate of surgical retreatment was low and similar to TURP. Trial Registration ClinicalTrials.gov no. NCT02505919. Funding PROCEPT BioRobotics. Electronic supplementary material The online version of this article (10.1007/s12325-019-00952-3) contains supplementary material, which is available to authorized users.
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Photoselective vaporization of the prostate: study outcomes as a function of risk of bias, conflicts of interest, and industrial sponsorship. World J Urol 2019; 38:741-746. [DOI: 10.1007/s00345-019-02799-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/03/2019] [Indexed: 01/20/2023] Open
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McWilliams JP, Bilhim TA, Carnevale FC, Bhatia S, Isaacson AJ, Bagla S, Sapoval MR, Golzarian J, Salem R, McClure TD, Kava BR, Spies JB, Sabharwal T, McCafferty I, Tam AL. Society of Interventional Radiology Multisociety Consensus Position Statement on Prostatic Artery Embolization for Treatment of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: From the Society of Interventional Radiology, the Cardiovascular and Interventional Radiological Society of Europe, Société Française de Radiologie, and the British Society of Interventional Radiology: Endorsed by the Asia Pacific Society of Cardiovascular and Interventional Radiology, Canadian Association for Interventional Radiology, Chinese College of Interventionalists, Interventional Radiology Society of Australasia, Japanese Society of Interventional Radiology, and Korean Society of Interventional Radiology. J Vasc Interv Radiol 2019; 30:627-637.e1. [PMID: 30926185 DOI: 10.1016/j.jvir.2019.02.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Justin P McWilliams
- Department of Radiology, Division of Interventional Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Tiago A Bilhim
- Interventional Radiology Department, St. Louis Hospital, Lisbon, Portugal
| | - Francisco C Carnevale
- Department of Interventional Radiology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Shivank Bhatia
- Department of Radiology and Division of Vascular Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Ari J Isaacson
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - Sandeep Bagla
- Vascular Institute of Virginia, Woodbridge, Virginia
| | - Marc R Sapoval
- Department of Vascular and Oncologic Interventional Radiology, Hôpital Européen Georges Pompidou, Paris, France
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology and Vascular Imaging, University of Minnesota, Minneapolis, Minnesota
| | - Riad Salem
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Timothy D McClure
- Department of Urology, Weill Cornell Medicine, Lefrak Center for Robotic Surgery, New York, New York
| | - Bruce R Kava
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - James B Spies
- Department of Radiology, Georgetown University Medical Center, Washington, DC
| | - Tarun Sabharwal
- Department of Radiology, Guys and St Thomas' Hospital, London, United Kingdom
| | - Ian McCafferty
- Department of Clinical Radiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Alda L Tam
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
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Rieken M, Herrmann TRW, Füllhase C. Operative Therapie des benignen Prostatasyndroms – resezieren, vaporisieren oder enukleieren? Urologe A 2019; 58:263-270. [DOI: 10.1007/s00120-019-0891-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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The efficacy of green light laser prostatectomy in the management of urinary retention due to prostate hyperplasia. Lasers Med Sci 2019; 34:1201-1205. [PMID: 30604348 DOI: 10.1007/s10103-018-02712-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
Abstract
To evaluate the efficacy and safety of 120 W potassium titanyl phosphate (KTP) in the treatment of urinary retention (UR) due to benign prostate hyperplasia in high-risk patients. Forty-six male patients with mean age of 73.78 ± 9.82 years who اhad UR and underwent 120 W KTP laser vaporization of the prostate between January 2015 and June 2017 were included. We evaluated perioperative parameters including serum prostate specific antigen, prostate volume, period of postoperative catheterization, vaporization time, delivered energy, hospitalization period, as well as intraoperative and postoperative complications. In the follow-up protocols, International Prostate Symptom Score and quality-of-life questionnaire (IPPS-QoL) and postvoid residual volume (PVR) were also assessed. The mean follow-up period was 15.57 ± 9.26 (1-42) months. All patients get rid of UR, except 1 patient (2.1%) remained on Foley catheter and standard TURP was done. Mean vaporization time was 8.57 ± 4.19 min, and mean energy delivered was 51.7 ± 29.9 kJ. No intraoperative complications were observed and no blood transfusion was done. The mean postoperative IPSS at the last follow-up was 9.64 ± 6.65 and the QoL score was 1.61 ± 1.31. Green light laser prostatectomy is a safe, simple, and effective procedure for the treatment of UR secondary to BPH in high-risk patients. Short hospitalization, low rate of intra operative and postoperative complications with rapid improvements in the objective, and subjective voiding parameters are important considerations of this procedure.
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Anderson BB, Heiman J, Large T, Lingeman J, Krambeck A. Trends and Perioperative Outcomes Across Major Benign Prostatic Hyperplasia Procedures from the ACS-NSQIP 2011–2015. J Endourol 2019; 33:62-68. [DOI: 10.1089/end.2018.0266] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Joshua Heiman
- Department of Urology, IU Health Methodist Hospital, Indiana University School of Medicine, Indianapolis, Indiana
| | - Tim Large
- Department of Urology, IU Health Methodist Hospital, Indiana University School of Medicine, Indianapolis, Indiana
| | - James Lingeman
- Department of Urology, IU Health Methodist Hospital, Indiana University School of Medicine, Indianapolis, Indiana
| | - Amy Krambeck
- Department of Urology, IU Health Methodist Hospital, Indiana University School of Medicine, Indianapolis, Indiana
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Tao W, Sun C, Yang D, Zang Y, Zhu J, Zhang Y, Wang G, Xue B. Application of 180W XPS GreenLight laser vaporization of the prostate for treatment of benign prostatic hyperplasia. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:1121-1129. [PMID: 31498146 DOI: 10.3233/xst-190550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To evaluate safety, efficacy and clinical outcomes after photovaporization of the prostate with the 180W-XPS Greenlight laser in patients with low urinary tracts symptom secondary to benign prostatic hyperplasia (BPH). MATERIALS AND METHODS All 102 patients with lower urinary tract symptoms who underwent 180W XPS laser vaporization of the prostate from April 2017 to April 2018 were enrolled. The preoperative parameters, postoperative functional, uroflowmetry outcomes and complications were collected. RESULTS All patients were successfully treated with 180W XPS laser vaporization. Mean preoperative prostate volume was 81±28.7 ml and mean laser time was 28.2±12.5 minutes. No major complications intraoperatively or postoperatively were observed and no blood transfusions were required. Comparing to preoperative characteristics, International Prostate Symptom Score (IPSS), maximum flow rate (Qmax) and post-void residual (PVR) parameters were improved significantly and sustained during the follow-up period. At 3, 6 and 12-month follow-ups, mean urinary peak flow increased from 6.2±2.1 ml per second to 19.8±4.6, 19.4±4.7 and 19.6±4.9 ml per second, respectively. Mean International Prostate Symptom Scores decreased over time, from 28.9±4.5 to 8.2±1.6, 6.2±1.22 and 5.88±1.15 at 3, 6, 12 months, respectively. CONCLUSIONS 180W XPS Greenlight laser vaporization is a safe and effective treatment option for patients with lower urinary tract symptoms secondary to BPH.
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Affiliation(s)
- Wei Tao
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Chuanyang Sun
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Dongrong Yang
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yachen Zang
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jin Zhu
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yuanyuan Zhang
- Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Gang Wang
- Department of Urology, Ningbo Urology and Nephrology Hospital, Ningbo, Zhejiang, China
| | - Boxin Xue
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Charbonneau H, Pasquié M, Peyronnet B, Descazeaud A, Barry-Delongchamps N, Della Negra E, Mathieu R, Karsenty G, Long JA, Ballereau C, Azzouzi AR, Pradère B, Bruyère F, Fournier G, Lebdai S, Calves J, Corbel L, Vincendeau S, Fiard G, Thuillier C, Descotes JL, Colin P, Culty T, Hesbois A, Fuzier V, Savy N, Pathak A, Albaladejo P, Samama CM, Guerrero F, Misraï V. Stopping or maintaining oral anticoagulation in patients undergoing photoselective vaporization of the prostate (SOAP) surgery for benign prostate obstruction: study protocol for a multicentre randomized controlled trial. Trials 2018; 19:705. [PMID: 30587221 PMCID: PMC6307178 DOI: 10.1186/s13063-018-3066-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 11/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lower urinary tract symptoms related to benign prostatic obstruction (BPO) are frequent in men aged > 50 years. Based on the use of innovative medical devices, a number of transurethral ablative techniques have recently been developed for the surgical treatment of BPO. In recent years, GreenLight photoselective vaporization of the prostate (PVP) has been considered as a non-inferior alternative to transurethral resection of the prostate. The GreenLight PVP is usually considered as an interesting surgical option for patients treated via oral anticoagulants (OACs) with regard to its haemostatic properties. The aim of this study was to assess the impact of maintaining OAC treatment in patients undergoing PVP. METHODS This study is a multicentre, open-label, randomized controlled trial (RCT) designed to show the non-inferiority of PVP surgery in patients with BPO treated with OACs. This study is designed to enrol 386 OAC-treated patients (treated with vitamin K antagonists and direct oral anticoagulants) who are undergoing PVP for BPO. Patients will be randomized (1:1) to either maintain or stop OAC treatment during the perioperative course. The intervention group will maintain OAC treatment until the day before surgery and resume OAC treatment the day after surgery, whereas the control group will stop OAC treatment (with or without low-molecular-weight heparin bridging therapy) according to the anaesthesia guidelines. The primary outcome of interest to be assessed is the 30-day complications rate according to the Clavien-Dindo classification. The secondary endpoint will examine the 30-day rate of haemorrhagic and thrombotic events. This study will provide 80% power to show non-inferiority, defined as not worse than a 10% (non-inferiority margin) inferior change in the proportion of patients with good outcomes (Clavien-Dindo score < 2), using two-tailed 95% confidence intervals. DISCUSSION This first multicentre RCT in the field is underway to evaluate the safety and efficacy of PVP in patients with ongoing OAC therapy. The study results could influence the perioperative management of OACs in BPO surgery with a high level of evidence. TRIAL REGISTRATION ClinicalTrials.gov, NCT03297281 . Registered on 29 September 2017.
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Affiliation(s)
| | - Marie Pasquié
- Department of Urology, Clinique Pasteur, 45 avenue de Lombez, BP 27 617, 31076, Toulouse Cedex 3, France
| | - Benoit Peyronnet
- Department of Urology, Rennes University Hospital , Rennes, France
| | - Aurélien Descazeaud
- Department of Urology, Limoges University Hospital, Dupuytren Hospital, Limoges, France
| | | | | | - Romain Mathieu
- Department of Urology, Rennes University Hospital , Rennes, France
| | - Gilles Karsenty
- Department of Urology, Conception Hospital, Marseille, France
| | - Jean-Alexandre Long
- Department of Urology, Grenoble University Hospital , Michallon Hospital, La Tronche, France
| | | | | | - Benjamin Pradère
- Department of Urology, Tours University Hospital , Tours, France
| | - Franck Bruyère
- Department of Urology, Tours University Hospital , Tours, France
| | - Georges Fournier
- Department of Urology, Brest University Hospital, Cavale Blanche Hospital, Brest, France
| | - Souhil Lebdai
- Department of Urology, Angers University Hospital , Angers, France
| | - Jehanne Calves
- Department of Urology, Brest University Hospital, Cavale Blanche Hospital, Brest, France
| | - Luc Corbel
- Department of Urology, Cochin University Hospital, Paris, France
| | | | - Gaelle Fiard
- Department of Urology, Grenoble University Hospital , Michallon Hospital, La Tronche, France
| | - Caroline Thuillier
- Department of Urology, Grenoble University Hospital , Michallon Hospital, La Tronche, France
| | - Jean-Luc Descotes
- Department of Urology, Grenoble University Hospital , Michallon Hospital, La Tronche, France
| | - Pierre Colin
- Department of Urology, Hopital Privée la Louviere, Lille, France
| | - Thibaut Culty
- Department of Urology, Angers University Hospital , Angers, France
| | - Audrey Hesbois
- Department of Anesthesia, Clinique Pasteur, Toulouse, France
| | - Valerie Fuzier
- Department of Anesthesia, Clinique Pasteur, Toulouse, France
| | - Nicolas Savy
- Institute of mathematics, Paul Sabatier University, CNRS, Toulouse, France
| | - Atul Pathak
- Department of Cardiovascular Medicine, Clinique Pasteur, Toulouse, France
| | - Pierre Albaladejo
- Department of Anaesthesia and Intensive Care, Grenoble University Hospital, Avenue Maquis-du-Grésivaudan, 38700, La Tronche, France.,Clinical Investigation Centre, Grenoble University Hospital, ThEMAS, TIMC, UMR-CNRS 5525, University Grenoble-Alpes, 38700, La Tronche, France
| | - Charles Marc Samama
- Department of Anaesthesiology and Intensive Care, Assistance publique-Hôpitaux de Paris, Cochin University Hospital, 75014, Paris, France
| | - Felipe Guerrero
- Department of Haematology, Toulouse University Hospital , Rangueil, France
| | - Vincent Misraï
- Department of Urology, Clinique Pasteur, 45 avenue de Lombez, BP 27 617, 31076, Toulouse Cedex 3, France.
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Gilling PJ, Barber N, Bidair M, Anderson P, Sutton M, Aho T, Kramolowsky E, Thomas A, Cowan B, Roehrborn C. Randomized Controlled Trial of Aquablation versus Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia: One-year Outcomes. Urology 2018; 125:169-173. [PMID: 30552937 DOI: 10.1016/j.urology.2018.12.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/21/2018] [Accepted: 12/03/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report 1-year safety and efficacy outcomes after either Aquablation or transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia (BPH) METHODS: This double-blinded, multicenter prospective randomized controlled trial assigned 181 patients with BPH-related moderate-to-severe lower urinary tract symptoms to either electrocautery-based prostate resection (TURP) or Aquablation. Efficacy endpoints included reduction in International Prostate Symptom Score and improvement in uroflow parameters. The primary safety endpoint was the occurrence of Clavien-Dindo persistent grade 1 or grade 2 or higher complications. RESULTS BPH symptom score improvements were similar across groups with 12-month reduction of 15.1 points after TURP or Aquablation. In both groups, mean maximum urinary flow rates increased markedly postoperatively, with mean improvements of 10.3 cc/s for Aquablation versus 10.6 cc/s for TURP (P = .8632). At 1 year, Prostate-specific antigen (PSA) was reduced significantly (P < .01) in both groups by 1 point; the reduction was similar across groups (P = .9125). Surgical retreatment for BPH rates for TURP were 1.5% and Aquablation 2.6% within 1 year from the study procedure (P = not significant (NS)). The rate of late complications was low, with no procedure-related adverse events after month 6. CONCLUSION The 1-year outcomes after TURP and Aquablation were similar and the rate of late procedure-related complications was low. (ClinicalTrials.gov number, NCT02505919).
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Affiliation(s)
| | - Neil Barber
- Frimley Park Hospital, Frimley Health Foundation Trust, Surrey, UK
| | | | | | | | - Tev Aho
- Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK
| | | | | | | | - Claus Roehrborn
- UT Southwestern Medical Center, Department of Urology, University of Texas Southwestern, Dallas, TX
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Sun F, Sun X, Shi Q, Zhai Y. Transurethral procedures in the treatment of benign prostatic hyperplasia: A systematic review and meta-analysis of effectiveness and complications. Medicine (Baltimore) 2018; 97:e13360. [PMID: 30572440 PMCID: PMC6320039 DOI: 10.1097/md.0000000000013360] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND With the progress of surgical techniques and instruments, various minimally invasive surgical therapies were developed to treat benign prostatic hyperplasisa (BPH). However, the efficacy and safety of different transurethral procedures for the treatment of BPH are still undefined. METHOD A systematic search was performed for all randomized controlled trials (RCTs), which compared the transurethral procedures for BPH from 1995 to 2016. The clinical baseline characteristics, International Prostate Symptom Score (IPSS), quality of life (QoL), postvoid residual (PVR), maximum flow rate (Qmax), short-term and long-term complications were analyzed using RevMan and ADDIS software. RESULT Eighty-eight randomly controlled trials and fifteen procedures were included in the network meta-analysis. HoLEP greatly inproved PVR. TmLRP had the best efficacy in improving QoL score. Diode laser vaporization of prostate was superior in improving IPSS and Qmax. Diode laser through vaporization required the shortest time in catheterization, while Nd:YAG was the longest procedure. For the hospitalization time, TUR was the longest and HoLEP was the shortest. TmLRP was related to the lowest postoperative hemoglobin decrease. TmLEP had the least rates of occurrence of hematuria, reoperation and erectile dysfunction. HoLEP was the best choice to reduce the incidence of recatheterization, urinary retention, urinary tract infection, stress urinary incontinence and retrograde ejaculation. The complications such as blood transfusion, urethral stricture, bladder neck contracture were relatively rare in the patients who underwent diode laser vaporization of prostate. CONCLUSION Compared with other transurethral procedures, thulium, holmium and diode lasers were associated with better efficacy and fewer complications.
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Photoselective vaporization has comparative efficacy and safety among high-risk benign prostate hyperplasia patients on or off systematic anticoagulation: a meta-analysis. World J Urol 2018; 37:1377-1387. [PMID: 30390127 DOI: 10.1007/s00345-018-2530-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/11/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The necessity to cease anticoagulation before photoselective vaporization (PVP) surgery remains nonconsensual. We aimed at assessing the efficacy and safety of PVP among high-risk benign prostate hyperplasia (BPH) patients on or off anticoagulation. METHODS We systematically searched Pubmed, Embase, and Cochrane Library Central Register of Controlled Trials (CENTRAL). 2299 patients from 11 studies were eventually included. Newcastle-Ottawa Scale (NOS) was employed to assess the quality and risk of bias of each study. All statistical analyses were conducted with Review Manager v.5.3 software. RESULTS Ten parameters (operation time, laser time, blood transfusion, urethral stricture, urinary tract infection, reoperation, dysuria, capsule perforation, catheterization time, and re-catheterization) from patients on or off anticoagulant therapy were collected. The patients without anticoagulants performed better at catheterization time [MD - 0.54, 95% CI (- 0.82, - 0.26), P = 0.96, I2 = 0] with a reduction of 0.54 day than those on anticoagulants. Significant statistical difference was not observed from other parameters. Subgroup analysis, grouped by the power output of PVP systems (80 W, 120 W and 180 W), consistently showed no statistical significant difference except at catheterization time in the 180-W PVP subgroup. CONCLUSION PVP, a safe and effective option for high-risk BPH patients, work comparably regardless of anticoagulant therapy, despite non-anticoagulant patients have shorter catheterization time. It is implied that the use of anticoagulants might be unnecessary to stop for high-risk BPH patients undergoing PVP for the sake of safety, which certainly requires further investigations to confirm.
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Impact of different color fiber sleeves on beam hazards of 532-nm laser and vaporization efficiency. Lasers Med Sci 2018; 34:801-805. [PMID: 30353478 DOI: 10.1007/s10103-018-2666-7] [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: 05/11/2018] [Accepted: 10/16/2018] [Indexed: 10/28/2022]
Abstract
The 532-nm laser has become increasingly popular for the treatment of urologic diseases. However, laser beam will pose significant hazards for the health of surgeons. In order to reduce beam hazards during surgery, we compared the beam hazards of laser fiber with black sleeves to the traditional fiber with transparent sleeves, and the vaporization efficiency. A total of 18 porcine kidney specimens were vaporized in normal saline at a room temperature under 532-nm laser delivered through a 760-μm core diameter side firing fiber. Two groups were divided according to the color of fiber sleeves: the transparent and the black. Each group was then divided into another three subgroups by laser power: the 80 W group, the 120 W group, and the 160 W group. The beam hazard was evaluated by light intensity measured in a sector area at a distance of 0 m, 0.5 m, and 1 m from the irradiation center. The vaporization efficiency was measured by the vaporization groove depth under the working power of 80 W, 120 W, and 160 W with a working distance of 5 mm and irradiation time of 10 s. The light intensity measured in the black fiber sleeve group is significantly lower than that in the transparent one (P < 0.01), regardless of the measuring distance (0 m, 0.5 m, and 1.0 m) and laser power (80 W, 120 W, and 160 W). No statistical difference was found on the vaporization efficiency between the groups protected by fiber sleeves of different colors (transparent/black, p > 0.05). Compared to the traditional transparent fiber sleeves, more beam hazards will be reduced in the operative region with the protection of black fiber sleeves, especially those from the irradiation center. The vaporization efficiency is not affected by the color of fiber sleeves. Such findings may offer a completely new idea for the protection of surgeons in surgeries with 532-nm lasers.
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Does mechanical morcellation of large glands compromise incidental prostate cancer detection on specimen analysis? A pathological comparison with open simple prostatectomy. World J Urol 2018; 37:1315-1320. [PMID: 30350017 DOI: 10.1007/s00345-018-2532-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/15/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE This study sought to compare the incidental prostate cancer (iPCa) detection rate between pathological specimens from green laser enucleation of the prostate (GreenLEP) and open simple prostatectomy (OSP). MATERIALS AND METHODS In two institutions, the charts of all consecutive patients who underwent OSP between January 2005 and December 2010 were retrospectively reviewed, and the data of all consecutive patients who underwent GreenLEP with tissue morcellation between July 2013 and January 2018 were also collected. Preoperative demographics and pathological findings were recorded. iPCa detection rate was retrospectively compared between the GreenLEP and OSP groups in a propensity score model, including all predetermined variables: Age, preoperative PSA level and prostate volume. RESULTS Of 738 patients, 402 were included in the propensity-score matching analysis, and they were equally distributed among groups. The overall iPCa detection rates were similar in both groups (9.9% vs. 8.5%; p = 0.73), and there were no statistically significant differences in terms of tumour stage, Gleason score or the rate of clinically significant iPCa, although the number of cassettes analysed was significantly higher in the morcellation group than in the OSP group. No predictive factors for iPCa were identified. CONCLUSIONS The results of the present study suggest that the mechanical morcellation of large glands had no influence on iPCa detection. Compared with a specimen from standard OSP, a large morcellated tissue sample allows adequate pathological evaluation and does not alter a pathologist's ability to detect iPCa.
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Bodokh Y, Treacy PJ, Imbert de la Phalecque L, Durand M. Does Prostate Median Lobe Really Matter for GreenLight HPS Laser Photovaporization of the Prostate. J Endourol Case Rep 2018; 4:169-172. [PMID: 30426077 PMCID: PMC6225076 DOI: 10.1089/cren.2018.0053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Benign prostatic hyperplasia (BPH) is a common pathology in elderly patients, inducing lower urinary tract symptoms. The treatment of BPH is first a medical option, then a surgical treatment, either by endoscopy or open surgery. We here report a case of GreenLight HPS™ laser photovaporization (PV) with an impaired maintenance of median lobe postoperatively, unimportant on functional results. Case Presentation: A 68-year-old man presented with lower urinary tract symptoms in the last 2 years, treated first by medicine with good response. On digital rectal examination, the enlarged prostate was homogeneous and regular. International Prostate Symptom Score (IPSS) was 30/35, Incontinence Quality of Life (iQol) 6/6, and International Index of Erectile Function 5 14/25 with regular sexual activity. Transrectal ultrasound (TRUS) reported BPH of 62 g with a median lobe of 6 g protruding into the bladder. At uroflowmetry, maximum urinary flow rate (Qmax) was 8 mL/s for 90 cc void volume and 20 cc postvoid residual. After failure of medical treatment, we offered a surgical treatment option by laser therapy using the 180W XPS GreenLight™. At 1-month follow-up, functional outcomes were improved with a Qmax of 11 mL/s, postvoiding residual volume 0 cc, IPSS 12/35, and iQol 2/6. At 3-month follow-up, outcomes still improved, although the TRUS reported a prostate volume of 30 g with a persistent median lobe. Conclusion: Impaired maintenance of median lobe after GreenLight laser PV does not seem to affect functional results. This case report opens the way for a new therapeutic strategy for patients according to their prostate anatomy. A randomized clinical trial could be done about surgical treatment for patient BPH according to prostate volume and anatomy.
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Affiliation(s)
- Yohan Bodokh
- Department of Urology, Hôpital Pasteur 2, Nice Sophia-Antipolis University, Nice, France
| | - Patrick Julien Treacy
- Department of Urology, Hôpital Pasteur 2, Nice Sophia-Antipolis University, Nice, France
| | | | - Matthieu Durand
- Department of Urology, Hôpital Pasteur 2, Nice Sophia-Antipolis University, Nice, France.,Department of Urology MSSM, New York City, New York.,INSERM, U1189, ONCO-THAI, Lille, France
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Plante M, Gilling P, Barber N, Bidair M, Anderson P, Sutton M, Aho T, Kramolowsky E, Thomas A, Cowan B, Kaufman RP, Trainer A, Arther A, Badlani G, Desai M, Doumanian L, Te AE, DeGuenther M, Roehrborn C. Symptom relief and anejaculation after aquablation or transurethral resection of the prostate: subgroup analysis from a blinded randomized trial. BJU Int 2018; 123:651-660. [DOI: 10.1111/bju.14426] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mark Plante
- University of Vermont Medical Center; Burlington VT USA
| | | | - Neil Barber
- Frimley Park Hospital; Frimley Health Foundation Trust; Surrey UK
| | | | | | | | - Tev Aho
- Addenbrooke's Hospital; Cambridge University Hospitals; Cambridge UK
| | | | | | | | | | - Andrew Trainer
- Adult Pediatric Urology and Urogynecology, P.C.; Omaha NE USA
| | - Andrew Arther
- Adult Pediatric Urology and Urogynecology, P.C.; Omaha NE USA
| | - Gopal Badlani
- Wake Forest School of Medicine; Winston-Salem NC USA
| | - Mihir Desai
- Institute of Urology; University of Southern California; Los Angeles CA USA
| | - Leo Doumanian
- Institute of Urology; University of Southern California; Los Angeles CA USA
| | | | | | - Claus Roehrborn
- Department of Urology; UT Southwestern Medical Center; University of Texas Southwestern; Dallas TX USA
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Aquablation outcomes for the U.S. cohort of men with LUTS due to BPH in large prostates (80-150 cc). Int J Impot Res 2018; 30:209-214. [PMID: 30046163 DOI: 10.1038/s41443-018-0045-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/19/2018] [Indexed: 11/08/2022]
Abstract
Between September and December 2017, 82 men with moderate-to-severe lower urinary tract symptoms due to benign prostatic hyperplasia LUTS/BPH and prostate volume of 80-150 cc underwent Aquablation in a prospective multicenter clinical trial in the United States. Baseline patient and clinical demographics and standardized postoperative parameters were collected and tabulated in a central independently monitored database. Adverse events through 3 months were adjudicated by an independent clinical events committee. Mean pre-treatment prostate volume was 108 ± 21.1 cc. Mean operative time was 38.2 ± 14.4 min and mean Aquablation resection time was 7.7 ± 3.3 min. Additional electrocautery for hemostasis was not needed in any patient following Aquablation. The average length of stay following the procedure was 1.6 ± 1.0 days. Mean pre- and 3 months post-treatment IPSS scores were 23.7 ± 6.4 and 7.1 ± 5.1, -16.6, p < 0.01. Mean pre- and 3 months post-treatment Qmax were 9.2 ± 3.3 ml/s and 19.5 ± 13 ml/s, + 10.8 ml/s, p < 0.01. Mean pre- and 3 months post-treatment post-void residuals were 120.6 ± 119.1 cc and 50.6 ± 61.6 cc, -72.0 cc, p < 0.01. The observed Clavien-Dindo grade 2 or higher event rate at 3 months was 34.1%. Aquablation is a safe and effective treatment option for men with large prostates (80-150 cc) suffering from LUTS/BPH.
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79
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Zou Z, Xu A, Zheng S, Chen B, Xu Y, Li H, Duan C, Zheng J, Chen J, Li C, Wang Y, Gao Y, Liang C, Liu C. Dual-centre randomized-controlled trial comparing transurethral endoscopic enucleation of the prostate using diode laser vs. bipolar plasmakinetic for the treatment of LUTS secondary of benign prostate obstruction: 1-year follow-up results. World J Urol 2018; 36:1117-1126. [PMID: 29459994 DOI: 10.1007/s00345-018-2229-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/07/2018] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Bipolar endoscopic enucleation of the prostate (BEEP) was recommended by the 2016 EAU guidelines as the first choice of surgical treatment in men with a substantially enlarged prostate and moderate-to-severe lower urinary tract symptoms. The main aim of this study was to compare a modified diode laser enucleation of the prostate (DiLEP) to BEEP. METHODS A total of 114 patients with prostate (20-160 mL) were randomized 1:1 into either DiLEP or BEEP in a dual-centre, non-inferiority-design randomized-controlled trial. The primary outcomes included Qmax and IPSS at 12 months. Non-inferiority was evaluated by comparing the two-sided 95% CI for the mean differences of Qmax and IPSS. Secondary endpoints included other perioperative parameters, postoperative micturition variables, and complication rate. RESULTS A total of 111 patients (97%) had completed the intent-to-treat analysis, The results showed that DiLEP was comparable to BEEP regarding Qmax (28.0 ± 7.0 vs. 28.1 ± 7.2 mL/s) and IPSS (3.0 ± 2.2 vs. 2.9 ± 2.6) at 12 months, the non-inferiority was met for both Qmax and IPSS. There were also no significant difference between two groups regarding tissue removal rate (71.8 vs. 73.8%), hemoglobin decrease (0.33 ± 0.66 vs. 0.36 ± 0.75 g/dL), sodium decrease (1.0 ± 2.7 vs. 0.3 ± 2.9 mmol/L), and Clavien III complications (5.3 vs. 1.8%) at 12 months. CONCLUSIONS This DiLEP is an anatomical endoscopic enucleation technique for the treatment of benign prostatic hyperplasia, it is non-inferior to BEEP regarding Qmax and IPSS at 12 months postoperatively.
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Affiliation(s)
- Zhihui Zou
- Department of Urology, Zhujiang Hospital of Southern Medical University, 253 Middle Gongye Avenue Road, Guangzhou, 510280, Guangdong, China
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Abai Xu
- Department of Urology, Zhujiang Hospital of Southern Medical University, 253 Middle Gongye Avenue Road, Guangzhou, 510280, Guangdong, China
| | - Shaobo Zheng
- Department of Urology, Zhujiang Hospital of Southern Medical University, 253 Middle Gongye Avenue Road, Guangzhou, 510280, Guangdong, China
| | - Binshen Chen
- Department of Urology, Zhujiang Hospital of Southern Medical University, 253 Middle Gongye Avenue Road, Guangzhou, 510280, Guangdong, China
| | - Yawen Xu
- Department of Urology, Zhujiang Hospital of Southern Medical University, 253 Middle Gongye Avenue Road, Guangzhou, 510280, Guangdong, China
| | - Hulin Li
- Department of Urology, Zhujiang Hospital of Southern Medical University, 253 Middle Gongye Avenue Road, Guangzhou, 510280, Guangdong, China
| | - Chongyang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, Guangdong, China
- State Key Laboratory of Organ Failure Research, National Clinical Research Centre for Kidney Disease, Guangzhou, Guangdong, China
| | - Junhong Zheng
- Department of Urology, The Second Affiliate Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jiasheng Chen
- Department of Urology, Zhujiang Hospital of Southern Medical University, 253 Middle Gongye Avenue Road, Guangzhou, 510280, Guangdong, China
| | - Chaoming Li
- Department of Urology, Zhujiang Hospital of Southern Medical University, 253 Middle Gongye Avenue Road, Guangzhou, 510280, Guangdong, China
| | - Yiming Wang
- Department of Urology, Zhujiang Hospital of Southern Medical University, 253 Middle Gongye Avenue Road, Guangzhou, 510280, Guangdong, China
- Department of Urology, Ludwig-Maximilians University, Munich, Germany
| | - Yubo Gao
- Department of Urology, Zhujiang Hospital of Southern Medical University, 253 Middle Gongye Avenue Road, Guangzhou, 510280, Guangdong, China
| | - Chaozhao Liang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Chunxiao Liu
- Department of Urology, Zhujiang Hospital of Southern Medical University, 253 Middle Gongye Avenue Road, Guangzhou, 510280, Guangdong, China.
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Foster HE, Barry MJ, Dahm P, Gandhi MC, Kaplan SA, Kohler TS, Lerner LB, Lightner DJ, Parsons JK, Roehrborn CG, Welliver C, Wilt TJ, McVary KT. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline. J Urol 2018; 200:612-619. [PMID: 29775639 DOI: 10.1016/j.juro.2018.05.048] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Male lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is common in men and can have negative effects on quality of life (QoL). It is the hope that this Guideline becomes a reference on the effective evidence-based surgical management of LUTS/BPH. MATERIALS AND METHODS The evidence team searched Ovid MEDLINE, the Cochrane Library, and the Agency for Healthcare Research and Quality (AHRQ) database to identify studies indexed between January 2007 and September 2017. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions (table 1 in supplementary unabridged guideline, http://jurology.com/). RESULTS This Guideline provides updated, evidence-based recommendations regarding management of LUTS/BPH utilizing surgery and minimally invasive surgical therapies; additional statements are made regarding diagnostic and pre-operative tests. Clinical statements are made in comparison to what is generally accepted as the gold standard (i.e. transurethral resection of the prostate [TURP]-monopolar and/or bipolar). This guideline is designed to be used in conjunction with the associated treatment algorithm. CONCLUSIONS The prevalence and the severity of LUTS increases as men age and is an important diagnosis in the healthcare of patients and the welfare of society. This document will undergo additional literature reviews and updating as the knowledge regarding current treatments and future surgical options continues to expand.
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Affiliation(s)
- Harris E Foster
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Michael J Barry
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Philipp Dahm
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Manhar C Gandhi
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Steven A Kaplan
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Tobias S Kohler
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Lori B Lerner
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Deborah J Lightner
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - J Kellogg Parsons
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Claus G Roehrborn
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Charles Welliver
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Timothy J Wilt
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Kevin T McVary
- American Urological Association Education and Research, Inc., Linthicum, Maryland
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81
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Green Light photoselective vaporization of the prostate: a safe and effective treatment for elderly high-risk benign prostate hyperplasia patients with gland over 80 ml. Lasers Med Sci 2018; 33:1693-1698. [DOI: 10.1007/s10103-018-2521-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 04/19/2018] [Indexed: 01/09/2023]
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Valdivieso R, Hueber PA, Meskawi M, Belleville E, Ajib K, Bruyere F, Te AE, Chughtai B, Elterman D, Misrai V, Zorn KC. Multicentre international experience of 532-nm laser photoselective vaporization with GreenLight XPS in men with very large prostates. BJU Int 2018; 122:873-878. [PMID: 29570929 DOI: 10.1111/bju.14208] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe peri-operative results, functional outcomes and complications of laser photoselective vaporization, using the GreenLight system, of prostate glands ≥200 mL in volume. METHODS Retrospective analysis of a prospectively maintained multicentre database was performed to select a subgroup of patients with very large prostates (volume ≥200 mL) treated with the GreenLight XPS laser. A subgroup of patients with prostate volumes 100-200 mL was used for comparison. International Prostate Symptom Score, maximum urinary flow rate, postvoid residual urine volume and prostate-specific antigen levels were measured at 6, 12, 24, 36 and 48 months. Durability was evaluated using benign prostatic hyperplasia re-treatment rate at 12, 24 and 36 months. Additionally, complications were recorded using Clavien-Dindo classification. RESULTS A total of 33 patients (38%) had prostates ≥200 mL. Baseline characteristics were similar between patients with prostates ≥200 mL and those with prostates 100-200 mL. Patients with very large prostates (≥200 mL) had longer operating times (129 vs 93 min), less energy delivered, a greater number of fibres used (3 vs 2) and a higher conversion rate to transurethral resection of the prostate (16% vs 4%). In terms of complications and functional outcomes, we did not find any differences between the groups. Retreatment rate was also comparable. CONCLUSIONS Our results show that PVP GreenLight XPS-180W is an acceptable technique for very large prostates (≥200 mL); however, operating times, energy delivery, fibres used and conversion to TURP are a concern in this particular subgroup. This should be used for patient counselling and surgery planning.
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Affiliation(s)
- Roger Valdivieso
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Pierre-Alain Hueber
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Malek Meskawi
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Eric Belleville
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Khaled Ajib
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | | | - Alexis E Te
- Department of Urology, Cornell University, New York, NY, USA
| | - Bilal Chughtai
- Department of Urology, Cornell University, New York, NY, USA
| | - Dean Elterman
- Department of Urology, University of Toronto, Toronto, ON, Canada
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulousse, France
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
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Reimann M, Fishman N, Almedom Z, Lichy I, Buckendahl J, Steiner U, Friedersdorff F, Busch J, Fuller TF, Miller K, Hinz S, Cash H. Perioperative Changes and Progress in Photoselective Vaporization of the Prostate with GreenLight XPS 180 W System: A Single Center Experience. Urol Int 2018; 100:463-469. [PMID: 29621785 DOI: 10.1159/000487958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/23/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE The study aimed to evaluate progression of GreenLight-XPS 180 W photoselective vaporization of the prostate (GL-XPS) with respect to effectiveness, efficacy, and safety over time at a tertiary referral high volume center. METHODS The retrospective study included 375 men who underwent GL-XPS for symptomatic benign prostate obstruction (BPO) between June 2010 and February 2015. Primary outcome measurements were operation time (OT; min) and effective laser time (LT; min of OT) analyzed with regard to prostatic volume (PV; mL) (group 1 <40 mL up to 4 >80 mL in 20 mL steps) and the year of surgery (2010-2015). RESULTS The median age was 72 years (range 64-79), the median PV was 58 mL (range 33-98) and the median PV increased from 42 mL in 2012 to 80 mL in 2015. The OT and LT clearly correlated with the PV, being doubled for glands of median 95 mL compared to median 30 mL while the applied laser energy per LT likewise steadily increased. Overall, both OT and LT could be significantly reduced each year by 37% (OT; p < 0.05) and 36% (LT; p < 0.05) within 5 years. The hospital stay (days) and catheterization time (days) remained constant, without any changes over time. The overall complication rate (Clavien-Dindo >2) ranged from 36 to 15% between 2010 and 2015. The pre (median 22 + 4) and postoperative International Prostate Symptom Score-Quality of Life (median 5 + 1) showed a sufficient reduction in symptomatic BPO. CONCLUSION GL-XPS is a safe and effective surgical method for symptomatic BPO. Our single center experience showed a significant improvement of both OT and effective LT within 5 years whilst maintaining stable low complication rate and high patient satisfaction.
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Affiliation(s)
- Maximilian Reimann
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Nikita Fishman
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Zenai Almedom
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Isabel Lichy
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - John Buckendahl
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Ursula Steiner
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Jonas Busch
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Tom Florian Fuller
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Stefan Hinz
- Department of Urology, Vivantes Klinikum am Urban, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
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Hwang J, Kim H, Truong GV, Xuan J, Hasenberg T, Kang HW. Dual-wavelength-assisted thermal hemostasis for treatment of benign prostate hyperplasia. JOURNAL OF BIOPHOTONICS 2018; 11:e201700192. [PMID: 28926200 DOI: 10.1002/jbio.201700192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/10/2017] [Accepted: 09/15/2017] [Indexed: 06/07/2023]
Abstract
Laser treatment on a large size of prostate gland often encounters significant bleeding that can prolong the entire procedure and cause urinary complications. The current study investigates the feasibility of dual-wavelength (532 and 980 nm) application to achieve rapid hemostasis for 532-nm laser prostatectomy. Porcine kidney and bleeding phantom models were tested to quantify the degree of the irreversible tissue coagulation and to estimate the time for the complete hemostasis, respectively. The ex vivo kidney testing verifies that the dual-wavelength created up to 40% deeper and 25% wider coagulation regions than a single wavelength does. The bleeding phantom testing demonstrates that due to the enhanced thermal effects, the simultaneous irradiation yields the complete photocoagulation (~11 seconds) whereas 532 or 980 nm hardly stops bleeders. Numerical simulations validate that the combined optical-thermal characteristics of both the wavelengths account for the augmented thermal coagulation. The dual-wavelength-assisted coagulation can be a feasible treatment to entail the rapid hemostasis and to facilitate the laser prostatectomy in an effective manner.
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Affiliation(s)
- Jieun Hwang
- Interdisciplinary Program of Biomedical Mechanical & Electrical Engineering, Pukyong National University, Busan, South Korea
| | - Hyejin Kim
- Interdisciplinary Program of Biomedical Mechanical & Electrical Engineering, Pukyong National University, Busan, South Korea
| | - Gia V Truong
- Interdisciplinary Program of Biomedical Mechanical & Electrical Engineering, Pukyong National University, Busan, South Korea
| | - Jason Xuan
- Boston Scientific, Corp, San Jose, California
| | | | - Hyun Wook Kang
- Interdisciplinary Program of Biomedical Mechanical & Electrical Engineering, Pukyong National University, Busan, South Korea
- Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology, Pukyong National University, Busan, South Korea
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85
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Helo S, Holland B, McVary KT. Convective Radiofrequency Water Vapor Thermal Therapy with Rezūm System. Curr Urol Rep 2018; 18:78. [PMID: 28780635 DOI: 10.1007/s11934-017-0728-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are amongst the most commonly treated conditions by urologists. Minimally invasive therapies for the treatment of BPH/LUTS have garnered increased interest as new technology has emerged, improving durability, efficacy, and safety. This paper reviews the most recent literature regarding water vapor therapy, a convective thermal therapy that ablates prostatic tissue. RECENT FINDINGS The current literature includes a pilot study of 65 men and a randomized controlled trial (RCT) of 197 men investigating the efficacy and safety profile of water vapor therapy up to 2 years. Subjects treated with water vapor therapy demonstrated a 51% reduction in IPSS from baseline, sustained at 24 months (p < 0.0001). Durable improvements in max flow rate (Qmax) and quality of life (QoL) were also achieved, while no changes in sexual function were observed. Reporting of adverse events (AEs) reveals predominantly Clavien grade I complications that were self-limited. The clinical efficacy and safety of water vapor therapy are durable to 24 months making it an attractive alternative for patients seeking a minimally invasive treatment for LUTS due to BPH.
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Affiliation(s)
- Sevann Helo
- Division of Urology, Southern Illinois University School of Medicine, St. John's Pavilion, 301 North Eighth St., P.O. Box 19665, Springfield, IL, 62794-9665, USA
| | - Bradley Holland
- Division of Urology, Southern Illinois University School of Medicine, St. John's Pavilion, 301 North Eighth St., P.O. Box 19665, Springfield, IL, 62794-9665, USA
| | - Kevin T McVary
- Division of Urology, Southern Illinois University School of Medicine, St. John's Pavilion, 301 North Eighth St., P.O. Box 19665, Springfield, IL, 62794-9665, USA.
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Lanchon C, Fiard G, Long JA, Arnoux V, Carnicelli D, Franquet Q, Poncet D, Bey E, Lefrancq JB, Grisard S, Peilleron N, Terrier N, Boillot B, Rambeaud JJ, Descotes JL, Thuillier C. Open prostatectomy versus 180-W XPS GreenLight laser vaporization: Long-term functional outcome for prostatic adenomas > 80 g. Prog Urol 2018; 28:180-187. [DOI: 10.1016/j.purol.2017.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/24/2017] [Accepted: 12/13/2017] [Indexed: 11/15/2022]
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Combined prostatic urethral lift and remodeling of the prostate and bladder neck: a modified transurethral approach in the treatment of symptomatic lower urinary tract obstruction. World J Urol 2018; 36:1111-1116. [PMID: 29450732 DOI: 10.1007/s00345-018-2232-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 02/07/2018] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The aim of the study was to evaluate the feasibility and safety of combining prostatic urethral lift (PUL) and a limited resection of the prostatic middle lobe or bladder neck incision in the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). METHODS Twenty-eight patients were treated at two tertiary centers and followed prospectively. Patient evaluations included patient characteristics, relief of LUTS symptoms, erectile and ejaculatory function, continence, operative time and adverse events. Patients were followed for a mean of 10.9 months. RESULTS Patient characteristics were as follows: age 66 years (46-85), prostate volume 39.6 cc (22-66), preoperative IPSS/AUASI 20 (6-35)/QoL 3.9 (1-6)/peak flow 10.5 mL/s (4.0-19)/post-void residual volume (PVR) 123 mL (0-500). Mean operating time was 31 min (9-55). Postoperative complications were minor except for the surgical retreatment of one patient for blood clot retention (Clavien 3b). One patient required catheterization due to urinary retention. Reduction of symptoms (IPSS - 59.6%), increase in QoL (+ 49.0%), increase in flow (+ 111.5%), and reduction of PVR (- 66.8%) were significant. Antegrade ejaculation was always maintained. CONCLUSION Our data suggest that a combination of PUL and transurethral surgical techniques is feasible, safe, and effective. This approach may be offered to patients with moderate size prostates including those with unfavorable anatomic conditions for PUL. This procedure is still 'minimally invasive' and preserves sexual function. In addition, it may add to a higher functional efficacy compared to PUL alone. STUDY REGISTER NUMBER DRKS00008970.
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Desai MM, Singh A, Abhishek S, Laddha A, Pandya H, Ashrafi AN, Ganpule AP, Roehrborn CG, Thomas AJ, Desai M, Sabnis RB. Aquablation therapy for symptomatic benign prostatic hyperplasia: a single-centre experience in 47 patients. BJU Int 2018; 121:945-951. [PMID: 29319914 DOI: 10.1111/bju.14126] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report procedure process improvements and confirm the preserved safety and short-term effectiveness of a second-generation Aquablation device for the treatment of lower urinary tract symptoms (LUTS) attributable to benign prostatic hyperplasia (BPH) in 47 consecutive patients at a single institution. PATIENTS AND METHODS Aquablation was performed in 47 patients with symptomatic BPH at a single institution. Baseline, peri-operative and 3-month urinary function data were collected. RESULTS The mean (range) patient age was 66 (50-79) years, and transrectal ultrasonography-measured prostate volume was 48 (20-118) mL. A median lobe was present in 25 patients (53%) and eight patients had catheter-dependent urinary retention. The mean (range) total procedure time was 35 (13-128) min and the tissue resection time was 4 (1-10) min. Five Clavien-Dindo grade I/II and five Clavien-Dindo grade III complications were recorded in eight patients. The mean (range) hospital stay was 3.1 (1-8) days and the mean (range) duration of urethral catheterization was 1.9 (1-11) days. The mean International Prostate Symptom Score (IPSS) decreased from 24.4 at baseline to 5 at 3 months; IPSS quality-of-life score decreased from 4.5 to 0.3 points; peak urinary flow rate increased from 7.1 to 16.5 mL/s and post-void residual urine volume decreased from 119 to 43 mL (all P < 0.01). CONCLUSIONS This study confirmed procedure process improvements resulting from system enhancements, with preservation of safety and effectiveness during use of a second-generation device for the treatment of LUTS attibutable to BPH in the largest single-institution study conducted to date.
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Affiliation(s)
- Mihir M Desai
- USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Abhishek Singh
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Shashank Abhishek
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Abhishek Laddha
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Harshad Pandya
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Akbar N Ashrafi
- USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Arvind P Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Claus G Roehrborn
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Andrew J Thomas
- Department of Urology, Princess of Wales Hospital, Bridgend, UK
| | - Mahesh Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Ravindra B Sabnis
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
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89
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Gilling P, Barber N, Bidair M, Anderson P, Sutton M, Aho T, Kramolowsky E, Thomas A, Cowan B, Kaufman RP, Trainer A, Arther A, Badlani G, Plante M, Desai M, Doumanian L, Te AE, DeGuenther M, Roehrborn C. WATER: A Double-Blind, Randomized, Controlled Trial of Aquablation ® vs Transurethral Resection of the Prostate in Benign Prostatic Hyperplasia. J Urol 2018; 199:1252-1261. [PMID: 29360529 DOI: 10.1016/j.juro.2017.12.065] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE We compared the safety and efficacy of Aquablation and transurethral prostate resection for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia. MATERIALS AND METHODS In a double-blind, multicenter, prospective, randomized, controlled trial 181 patients with moderate to severe lower urinary tract symptoms related to benign prostatic hyperplasia underwent transurethral prostate resection or Aquablation. The primary efficacy end point was the reduction in International Prostate Symptom Score at 6 months. The primary safety end point was the development of Clavien-Dindo persistent grade 1, or 2 or higher operative complications. RESULTS Mean total operative time was similar for Aquablation and transurethral prostate resection (33 vs 36 minutes, p = 0.2752) but resection time was lower for Aquablation (4 vs 27 minutes, p <0.0001). At month 6 patients treated with Aquablation and transurethral prostate resection experienced large I-PSS improvements. The prespecified study noninferiority hypothesis was satisfied (p <0.0001). Of the patients who underwent Aquablation and transurethral prostate resection 26% and 42%, respectively, experienced a primary safety end point, which met the study primary noninferiority safety hypothesis and subsequently demonstrated superiority (p = 0.0149). Among sexually active men the rate of anejaculation was lower in those treated with Aquablation (10% vs 36%, p = 0.0003). CONCLUSIONS Surgical prostate resection using Aquablation showed noninferior symptom relief compared to transurethral prostate resection but with a lower risk of sexual dysfunction. Larger prostates (50 to 80 ml) demonstrated a more pronounced superior safety and efficacy benefit. Longer term followup would help assess the clinical value of Aquablation.
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Affiliation(s)
| | - Neil Barber
- Frimley Park Hospital, Frimley Health Foundation Trust, Surrey, United Kingdom
| | | | | | | | - Tev Aho
- Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom
| | | | - Andrew Thomas
- Princess of Wales Hospital, Bridgend, Wales, United Kingdom
| | | | | | - Andrew Trainer
- Adult Pediatric Urology and Urogynecology, P.C., Omaha, Nebraska
| | - Andrew Arther
- Adult Pediatric Urology and Urogynecology, P.C., Omaha, Nebraska
| | - Gopal Badlani
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mark Plante
- University of Vermont Medical Center, Burlington, Vermont
| | - Mihir Desai
- Institute of Urology, University of Southern California, Los Angeles, California
| | - Leo Doumanian
- Institute of Urology, University of Southern California, Los Angeles, California
| | - Alexis E Te
- Weill Cornell Medical College, New York, New York
| | | | - Claus Roehrborn
- Department of Urology, Southwestern Medical Center, University of Texas Southwestern, Dallas, Texas.
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90
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Eken A, Soyupak B. Safety and efficacy of photoselective vaporization of the prostate using the 180-W GreenLight XPS laser system in patients taking oral anticoagulants. J Int Med Res 2018; 46:1230-1237. [PMID: 29332492 PMCID: PMC5972269 DOI: 10.1177/0300060517747489] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To evaluate the safety and efficacy of the 180-W GreenLight XPS laser system for the treatment of benign prostatic hyperplasia in patients taking oral anticoagulants. Methods All consecutive patients admitted for lower urinary tract symptoms associated with benign prostatic hyperplasia from November 2012 to October 2016 and who underwent photoselective vaporization of the prostate with the 180-W GreenLight XPS laser were included in the study. The perioperative outcomes examined were the operating time, laser time, energy usage, and duration of postoperative catheterization. Functional parameters (International Prostate Symptom Score, maximum urinary flow rate, and post-void residual urine volume), prostate volume, and serum prostate-specific antigen concentration were examined at baseline and 3 months. Perioperative complications, if any, were noted. Results All functional parameters (International Prostate Symptom Score, maximum urinary flow rate, and post-void residual urine volume) significantly improved from baseline to 3 months. A small number of patients experienced at least one minor adverse event. There was no difference in the rate of adverse events between patients who were and were not taking anticoagulants. Conclusions Photoselective vaporization with a 180-W laser is an efficacious and safe treatment for benign prostatic hyperplasia, even in patients taking anticoagulant medications.
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Affiliation(s)
- Alper Eken
- 1 Vocational School of Health Services, Acıbadem University, Istanbul, Turkey.,2 Urology Department, Acıbadem Adana Hospital, Adana, Turkey
| | - Bülent Soyupak
- 2 Urology Department, Acıbadem Adana Hospital, Adana, Turkey
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91
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Wilhelm K, Cazana IM, Schoenthaler M, Katzenwadel A, Spaeth J, Miernik A. Low-pressure monopolar electroresection of the prostate for glands sized > 70 vs. < 70 cc performed with continuous irrigation and suprapubic suction: perioperative and long-term outcome. World J Urol 2018; 36:449-457. [PMID: 29307091 PMCID: PMC5846831 DOI: 10.1007/s00345-017-2162-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 12/20/2017] [Indexed: 01/27/2023] Open
Abstract
Purpose To evaluate long-term efficacy and safety of low-pressure transurethral resection of the prostate for prostates < 70 cc (group 1) vs. > 70 cc (group 2). Patients and methods In this study patients operated with monopolar TURP between 2009 and 2012 were evaluated retrospectively. During surgery a specially designed trocar (18 Fr) was placed suprapubically and connected to a suction pump to maintain stable low-pressure conditions. After sample size calculations, long-term follow-up was completed for 70 invited patients in each group up to 9/2015. Results Follow-up period was 57 vs. 56 months for group 1 and 2, respectively (p = 0.56). At baseline there was no significant difference in age, IPSS, peak flow, and post void residual (PVR). Mean prostate volume was 47 cc (15–65) vs. 100 cc (70–163). Mean operating time was 55.4 vs. 82.6 min (p = 0.00). Blood transfusion was necessary in 0.0 vs. 2.9% (p = 0.16), and 0.0 vs. 1.4% developed TUR syndrome (p = 0.32). At follow-up mean relative improvement in IPSS was 63 vs. 57% (p = 0.29), QoL 64 vs. 64% (p = 0.93), peak flow 139 vs. 130% (p = 0.85), and PVR 58 vs. 63% (p = 0.80). Long-term complications included recurring adenoma in 1.4 vs. 4.3% (p = 0.31), and stricture in 7.2 vs. 5.8% (p = 0.73). 1 patient in each group reported worsening incontinence symptoms. Conclusions In terms of safety and efficacy, the aforementioned modality of standardized monopolar TURP using suprapubic suction was non-inferior for prostates > 70 cc compared to the same procedure for prostates < 70 cc. This technique is a potential low-cost alternative for clinics that cannot afford modern laser approaches. Study register number DRKS00006527.
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Affiliation(s)
- Konrad Wilhelm
- Department of Urology, University Medical Center, Hugstetterstr. 55, 79106, Freiburg, Germany.
| | - Ioana Maria Cazana
- Department of Urology, University Medical Center, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Martin Schoenthaler
- Department of Urology, University Medical Center, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Arndt Katzenwadel
- Department of Urology, University Medical Center, Hugstetterstr. 55, 79106, Freiburg, Germany
| | - Johannes Spaeth
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Medical Centre-University of Freiburg, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, University Medical Center, Hugstetterstr. 55, 79106, Freiburg, Germany
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92
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Ulchaker JC, Martinson MS. Cost-effectiveness analysis of six therapies for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 10:29-43. [PMID: 29343977 PMCID: PMC5749396 DOI: 10.2147/ceor.s148195] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To conduct a cost-effectiveness analysis from payers' perspectives of six treatments for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and to examine positioning of these modalities in the marketplace for the best use of health care funds and quality-of-life benefits for patients. METHODS The economic analysis was conducted with a Markov model to compare combination prescription drug therapy (ComboRx), minimally invasive therapies (MITs) including convective radiofrequency (RF) water vapor thermal therapy (Rezūm®), conductive RF thermal therapy (Prostiva®), and prostatic urethral lift (UroLift®), and invasive surgical procedures including photovaporization of the prostate (Greenlight® PVP) and transurethral resection of the prostate (TURP). Effects assessed with International Prostate Symptom Score, adverse events, and re-treatment rates were estimated from medical literature; treatments effects were modeled using a common baseline score. Starting with each therapy, patients' transitions to more intensive therapies when symptoms returned were simulated in 6-month cycles over 2 years. Incremental cost-effectiveness ratios (ICERs) were calculated for pairs of treatments; uncertainty in ICERs was estimated with probabilistic sensitivity analyses. RESULTS ComboRx was least effective and provided one-third of the symptom relief achieved with MITs. UroLift was similar in effectiveness to Prostiva and Rezūm but costs more than twice as much. The cheaper MITs were ~$900 more expensive than the cost of ComboRx generic drugs over 2 years. TURP and PVP provided slightly greater relief of LUTS than MITs at approximately twice the cost over 2 years; typically, they are reserved for treatment of more severe LUTS. CONCLUSION The analysis evaluated the costs and symptom relief of six treatment options in the continuum of care from a common baseline of LUTS severity. Identification of treatments for LUTS/BPH that demonstrate cost-effectiveness and provide appreciable symptom relief is paramount as reimbursement for patient care moves from volume-based services to value-based services.
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93
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Mazeaud C, Le Clerc QC, Robine E, Madec FX, Perrouin-Verbe MA, Nedelec M, Rigaud J, Branchereau J. [Post operative fistula after photovaporisation (PVP) laser green light XPS 180W: About two cases]. Prog Urol 2017; 28:71-73. [PMID: 29239750 DOI: 10.1016/j.purol.2017.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/18/2017] [Accepted: 10/20/2017] [Indexed: 11/13/2022]
Affiliation(s)
- C Mazeaud
- CHU de Nancy, 5, rue du Morvan, 54500 Vandoeuvres-les-Nancy, France
| | - Q-C Le Clerc
- CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - E Robine
- CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - F-X Madec
- CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | | | - M Nedelec
- CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - J Rigaud
- CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - J Branchereau
- CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
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94
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Piotrowicz G, Syryło T, Jedynak R, Zieliński H. Efficacy and Safety of Photoselective Vaporization of the Prostate with 120 W 532 nm Laser in Patients with Benign Prostatic Hyperplasia on Anticoagulation or Antiplatelet Therapy: Observations on Long-Term Outcomes. Photomed Laser Surg 2017; 36:273-283. [PMID: 29227749 DOI: 10.1089/pho.2017.4367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the safety and effectiveness of photoselective vaporization of the prostate (PVP) in the treatment of patients with benign prostatic hyperplasia (BPH) on anticoagulant or antiplatelet therapy. BACKGROUND The "gold standard" of surgical treatment of BPH is transurethral resection of the prostate (TURP). Since the risk of complications associated with TURP is still significant, there is a continuous search for safer and equally effective procedures. One of them is PVP with a 532 nm potassium-titanyl-phosphate/lithium triborate (KTP/LBO) laser. MATERIALS AND METHODS A total of 109 patients underwent PVP with the use of the GreenLight HPS 120 W laser. Sixty-five (59.6%) of the patients were on anticoagulants or antiplatelet drugs, whereas 44 (40.4%) patients were not. Various objective and subjective parameters were evaluated intra- and postoperatively along with a 5-year follow-up to compare the results and safety of PVP in these two groups of patients. RESULTS No difference between the groups was found in intraoperative parameters, including operation and lasing time, as well as laser energy used. Also, no intraoperative complications were observed. There was no significant bleeding in any of the groups, and none of the patients required a blood transfusion. Catheterization and hospitalization time did not differ between both groups, and during the 5-year follow-up period, good objective and subjective results were observed, and the complication rates were comparable between the groups. CONCLUSIONS Our results demonstrate that PVP for patients with BPH is an effective and safe procedure with satisfactory long-term outcomes. Anticoagulant and antiplatelet drugs did not significantly influence the results, or the complication rates.
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Affiliation(s)
| | - Tomasz Syryło
- Department of Urology, Military Institute of Medicine , Warsaw, Poland
| | - Rafał Jedynak
- Department of Urology, Military Institute of Medicine , Warsaw, Poland
| | - Henryk Zieliński
- Department of Urology, Military Institute of Medicine , Warsaw, Poland
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95
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Gordon A, Skarecky D, Babaian KN, Dhaliwal H, Ahlering TE. Diminished long-term recovery of peak flow rate (PFR) after robotic prostatectomy in men with baseline PFR <10 mL/s and incidental association with high-risk prostate cancer. Low Urin Tract Symptoms 2017; 11:78-84. [PMID: 29193833 DOI: 10.1111/luts.12199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/18/2017] [Accepted: 08/03/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of robot-assisted radical prostatectomy (RARP) on uroflowmetry (UF) parameters among men with baseline peak flow rates (PFR) <10 mL/s. METHODS A single-surgeon RARP database of 1082 men who underwent prospective UF testing was analyzed. Men filled out International Prostate Symptom Score questionnaires and underwent uroflowmetry and post-void bladder ultrasound before surgery and at each follow-up visit. Patients were divided into 2 groups based on preoperative PFR: those with PFR <10 mL/s (n = 158) and those with PFR ≥10 mL/s (n = 924). Univariate and multivariate regression models tested the association of preoperative characteristics in predicting postoperative PFR improvement. Within the PFR <10 mL/s group, preoperative variables were analyzed to predict pathologic outcomes. RESULTS Three months after RARP, men with baseline PFR <10 mL/s had a 3-fold improvement in PFR (from mean of 7.0 to 24.2 mL/s), whereas in men with PFR ≥10 mL/s there was a 50% improvement (from mean of 19.7 to 28.9 mL/s; P < .001). Improvement in PFR remained stable for >5 years, but mean postoperative PFR was 20% lower in men with baseline PFR <10 mL/s. Preoperative prostate-specific antigen (odds ratio [OR] 0.75; 95% confidence interval [CI] 0.59-0.95) and PFR (OR 0.52; 95% CI 0.34-0.80) were independent predictors of the percentage improvement in men with baseline PFR <10 mL/s. Preoperative PFR ≤7 mL/s was an independent predictor of Gleason score ≥8 (P = .016), seminal vesicle invasion (P = .010), and lymph node invasion (0.029). CONCLUSIONS After RARP, PFR improved significantly, with the improvement persisting over long-term follow-up. However, men with baseline PFR <10 mL/s had a 20% lower postoperative PFR over 5 years, suggesting permanent damage to the bladder and the need for early treatment to maintain bladder health. There appears to be an association between baseline PFR ≤7 mL/s and adverse pathologic features.
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Affiliation(s)
- Adam Gordon
- Department of Urology, University of California Irvine, Orange, California.,Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Douglas Skarecky
- Department of Urology, University of California Irvine, Orange, California
| | - Kara N Babaian
- Department of Urology, University of California Irvine, Orange, California
| | - Harleen Dhaliwal
- Department of Urology, University of California Irvine, Orange, California
| | - Thomas E Ahlering
- Department of Urology, University of California Irvine, Orange, California
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96
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Pascoe C, Ow D, Perera M, Woo HH, Jack G, Lawrentschuk N. Optimising patient outcomes with photoselective vaporization of the prostate (PVP): a review. Transl Androl Urol 2017; 6:S133-S141. [PMID: 28791232 PMCID: PMC5522804 DOI: 10.21037/tau.2017.05.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Benign prostatic hyperplasia (BPH) is a common pathology causing lower urinary tract symptoms (LUTS) and may significantly impact quality of life. While transurethral resection of the prostate (TURP) remains the gold standard treatment, there are many evolving technologies that are gaining popularity. Photoselective vaporization of the prostate (PVP) is one such therapy which has been shown to be non-inferior to TURP. We aimed to review the literature and discuss factors to optimise patient outcomes in the setting of PVP for BPH. A comprehensive search of the electronic databases, including MEDLINE, Embase, Web of Science and The Cochrane Library was performed on articles published after the year 2000. After exclusion, a total of 38 papers were included for review. The evolution of higher powered device has enabled men with larger prostates and those on oral anticoagulation to undergo safely and successfully PVP. Despite continued oral anticoagulation in patients undergoing PVP, the risk of bleeding may be minimised with 5-Alpha Reductase Inhibitor (5-ARI) therapy however further studies are required. Pre-treatment with 5-ARI’s does not hinder the procedure however more studies are required to demonstrate a reliable benefit. Current data suggests that success and complication rate is largely influenced by the experience of the operator. Post-operative erectile dysfunction is reported in patients with previously normal function following PVP, however those with a degree of erectile dysfunction pre-operatively may see improvement with alleviation of LUTS.
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Affiliation(s)
- Claire Pascoe
- University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia.,Young Urology Researchers Organisation (YURO), Melbourne, Australia
| | - Darren Ow
- University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia.,Young Urology Researchers Organisation (YURO), Melbourne, Australia
| | - Marlon Perera
- University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia.,Young Urology Researchers Organisation (YURO), Melbourne, Australia
| | - Henry H Woo
- Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, Australia
| | - Greg Jack
- University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia
| | - Nathan Lawrentschuk
- University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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97
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Jiang YH, Kuo HC. Recent research on the role of urodynamic study in the diagnosis and treatment of male lower urinary tract symptoms and urinary incontinence. CI JI YI XUE ZA ZHI = TZU-CHI MEDICAL JOURNAL 2017; 29:72-78. [PMID: 28757770 PMCID: PMC5509199 DOI: 10.4103/tcmj.tcmj_19_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although evidence shows that urodynamic study may not improve outcomes, it can be used to evaluate men with lower urinary tract symptoms (LUTSs) which have not been adequately delineated and treated. In young men with LUTS not responding to treatment based on clinical examination, or elderly men with LUTS and incontinence, a complete urodynamic evaluation is mandatory to understand the pathophysiology underlying LUTS, such as bladder outlet obstruction (BOO), detrusor overactivity, and detrusor underactivity. Preoperative urodynamic study-proven BOO is a predictor of a successful surgical outcome. An urodynamic study should be performed when patients with LUTS are planning to undergo surgical treatment for benign prostatic obstruction.
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Affiliation(s)
- Yuan-Hong Jiang
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
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98
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Welliver C, Helo S, McVary KT. Technique considerations and complication management in transurethral resection of the prostate and photoselective vaporization of the prostate. Transl Androl Urol 2017; 6:695-703. [PMID: 28904902 PMCID: PMC5583058 DOI: 10.21037/tau.2017.07.30] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The prevalence of lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) increases with age. While a variety of treatments are available for these men, endoscopic treatments are generally preferred for men with small to moderate size glands. Novel treatment options are continually introduced into this large market. However, the practicing urologist should have a well tested surgical option in regular practice that is applicable to a wide range of patients. Herein we discuss two well recognized surgical options that can be used for the majority of men with LUTS due to BPH who have failed medical management.
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Affiliation(s)
- Charles Welliver
- Division of Urology, Albany Medical Center, Albany, New York, USA.,Albany Stratton Veterans Affairs Medical Center, Albany, New York, USA
| | - Sevann Helo
- Division of Urology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Kevin T McVary
- Division of Urology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
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99
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Knapp GL, Chalasani V, Woo HH. Perioperative adverse events in patients on continued anticoagulation undergoing photoselective vaporisation of the prostate with the 180-W Greenlight lithium triborate laser. BJU Int 2017; 119 Suppl 5:33-38. [DOI: 10.1111/bju.13822] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Venu Chalasani
- Sydney Adventist Hospital Clinical School; University of Sydney; Wahroonga NSW Australia
| | - Henry H. Woo
- Sydney Adventist Hospital Clinical School; University of Sydney; Wahroonga NSW Australia
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100
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Thoulouzan M, Perrouin-Verbe MA, Calves J, Deruelle C, Joulin V, Valeri A, Fournier G. [Outcomes of GreenLight XPS-180W laser photovaporization for BPH larger than 80mL]. Prog Urol 2017; 27:489-496. [PMID: 28483481 DOI: 10.1016/j.purol.2017.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 03/13/2017] [Accepted: 04/02/2017] [Indexed: 10/19/2022]
Abstract
AIM To evaluate the results of GreenLight XPS photovaporization (PVP/XPS) with intraoperative transrectal ultrasonographic monitoring for the treatment of large Benign Prostatic Hyperplasia (BPH) (>80mL). PATIENTS AND METHODS Operative and perioperative data of 82 patients were collected prospectively. Complications and functional outcomes (IPSS, quality of life (QoL) score, maximal flow rate and post-void residual (PVR)) were evaluated at 1, 3, 12 months post-operatively prostate volume and PSA were assessed at 3 and 12 months post-operatively. RESULTS Median patient age was 68.5years (50-85). Twenty percent had an indwelling catheter and 5%/22% were on anticoagulant/antiplatelet therapy. Median prostate volume and PSA were 103mL (80-220) and 6.4ng/mL (0.66-44.0). Median operative time and energy delivered were 107min (46-219) and 581kJ (212-1193). Energy delivered/prostate volume was 5.4kJ/mL (1.6-10.5). Transurethral catheter was removed at day 1 or 2 in 96% of cases. Patients were discharged as outpatient, p.o. day 1 or day 2 in 4%, 55% and 21% of cases, respectively. Transfusion and Clavien≥3 complication rates were 1.2% and 3.7%. Significant improvement of IPSS (4 vs 19.5), QoL (1 vs 5), maximum flow rate (19.1 vs 8.2mL/s) and PVR (26 vs 100mL) was observed (P<0.001) at 12-months evaluation. PSA and prostate volume were decreased by 61 and 62%. Late complications were urethral strictures (6%), stress incontinence (1.2%). Eighty-five percent of patients had no antegrade ejaculation. CONCLUSION The treatment of large BPH with PVP/XPS is safe and effective, with a long operative time. The functional outcomes are good and stable at mid-term evaluation. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- M Thoulouzan
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France.
| | - M-A Perrouin-Verbe
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France
| | - J Calves
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France
| | - C Deruelle
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France
| | - V Joulin
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France
| | - A Valeri
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France
| | - G Fournier
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France
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