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Huang J, Fan Y, Wang K, Ding H, Mao D, Zhao L, Tai S. Transurethral 1470 nm diode laser vaporization versus plasma kinetic enucleation of the prostate for the treatment of benign prostatic hyperplasia: A retrospective study. Medicine (Baltimore) 2023; 102:e35031. [PMID: 37653733 PMCID: PMC10470672 DOI: 10.1097/md.0000000000035031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/26/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023] Open
Abstract
To compare the efficacy, safety, and complications of transurethral 1470 nm diode laser vaporization and plasma kinetic enucleation of prostate (PKEP) in benign prostatic hyperplasia treatment. A retrospective matched-paired comparison of patients treated using transurethral 1470 nm diode laser vaporization (n = 40) or PKEP (n = 40) was conducted. Baseline characteristics, preoperative data, and postoperative outcomes at the 24-month follow-up of the patients were recorded. The present study found no significant preoperative differences between the 2 treatment groups. Compared with PKEP, 1470 nm diode laser vaporization had a significantly shorter operation time and less intraoperative blood loss, but there were no marked differences between the 2 groups in terms of postoperative bladder irrigation time, catheterization time, and hospital stay. Moreover, at the 24-month follow-up postoperatively, there were no marked differences in the International Prostatic Symptomatic Score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax), and post-void residual urine volume (PVR) between the 2 groups. IPSS, QOL, Qmax, and PVR had improved significantly compared to preoperative assessment at 24-month follow-up in both groups and there was no significant difference in the variation of IPSS, QOL, Qmax and PVR before and after the operation. Furthermore, complications were comparable between the 2 treatment groups. Transurethral 1470 nm diode laser vaporization and PKEP are effective strategies in the treatment of benign prostatic hyperplasia. However, 1470 nm diode laser vaporization offers advantages over PKEP in terms of shortening operation time and reducing intraoperative bleeding. Nonetheless, further research with a larger number of patients and long-term follow-up is necessary to confirm and validate these findings.
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Affiliation(s)
- Jiaguo Huang
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yi Fan
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Kai Wang
- Department of Urology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hongxiang Ding
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Dikai Mao
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Liwei Zhao
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Shengcheng Tai
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, Zhejiang, China
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Mithani MH, Khalid SE, Khan SA, Sharif I, Awan AS, Mithani S, Majeed I. Outcome of 980 nm diode laser vaporization for benign prostatic hyperplasia: A prospective study. Investig Clin Urol 2018; 59:392-398. [PMID: 30402572 PMCID: PMC6215781 DOI: 10.4111/icu.2018.59.6.392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 10/01/2018] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate the initial experience and outcome of photo-selective vaporization of the prostate (PVP) for benign prostatic hyperplasia (BPH) in Pakistan with the use of a 980 nm diode laser. Materials and Methods A prospective study was performed from November 2016 to December 2017. A total of 100 patients diagnosed with bladder outlet obstruction secondary to BPH who planned for PVP were enrolled in the study. PVP was carried out with a diode laser at 980 nm (Biolitec Diode 180W laser) in a continuous wave with a 600 nm (twister) fiber. Baseline characteristics and perioperative data were compared. Postoperative outcomes were evaluated by International Prostate Symptom Score (IPSS), post void residual (PVR) and maximum urinary flow rate (Qmax) at 3 and 6 months after surgery. Results The mean age was 65.82±10.42, mean prostate size was 67.35±16.42, operative time was 55.85±18.01 and total energy was 198.68±49.12 kJ. At 3 months and 6 months, significant improvements were noted (p<0.001) in IPSS 7.04±1.69 (−18.92), Qmax 19.22±4.75 mL/s (+13.09) and and PVR 18.89±5.39 mL (−112.80). Most frequent problems were burning micturition (35%) and terminal dysuria (29%). No significant difference in postoperative hemoglobin was seen in patients who were on anti-platelet drugs. Conclusions PVP with a diode laser is a safe and effective procedure for the treatment of BPH and is also safe in patients who are on anti-platelet agents.
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Affiliation(s)
- M Hammad Mithani
- Department of Urology, The Kidney Centre Post Graduate Training Institute, Karachi, Sindh, Pakistan
| | - Salman El Khalid
- Department of Urology, The Kidney Centre Post Graduate Training Institute, Karachi, Sindh, Pakistan
| | - Shariq Anis Khan
- Department of Urology, The Kidney Centre Post Graduate Training Institute, Karachi, Sindh, Pakistan
| | - Imran Sharif
- Department of Urology, The Kidney Centre Post Graduate Training Institute, Karachi, Sindh, Pakistan
| | - Adnan Siddiq Awan
- Department of Urology, The Kidney Centre Post Graduate Training Institute, Karachi, Sindh, Pakistan
| | - Shoaib Mithani
- Department of Urology, The Kidney Centre Post Graduate Training Institute, Karachi, Sindh, Pakistan
| | - Irfan Majeed
- Department of Urology, The Kidney Centre Post Graduate Training Institute, Karachi, Sindh, Pakistan
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Razzaghi MR, Mazloomfard MM, Mokhtarpour H, Moeini A. Diode laser (980 nm) vaporization in comparison with transurethral resection of the prostate for benign prostatic hyperplasia: randomized clinical trial with 2-year follow-up. Urology 2014; 84:526-32. [PMID: 25168526 DOI: 10.1016/j.urology.2014.05.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/19/2014] [Accepted: 05/21/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare outcomes of diode laser vaporization of prostate with transurethral resection of the prostate (TURP) as a gold-standard treatment. MATERIALS AND METHODS A total number of 115 patients with benign prostatic hyperplasia underwent TURP and 980-nm diode vaporization of prostate in a balanced randomization (1:1) from 2010 to 2012 and were followed up for 24 months. Baseline characteristics of the patients, perioperative data, and postoperative outcomes were compared. The primary end point of the study was assessing the values of International Prostate Symptom Score (IPSS), and maximum flow rate (Qmax) to predict the functional improvement of each group. The trial is registered at http://www.irct.ir (number IRCT201202138146N3). RESULT The mean age (± standard deviation) of the patients was 68.2 ± 7.8 years in TURP and 68.5 ± 8.8 in diode groups. In TURP and diode groups, the operation time was 54.9 ± 15.3 vs 60.6 ± 22.6 minutes (P = .14), Foley catheterization time was 88.9 ± 22.5 vs 20.1 ± 4.6 hours (P = .0001) and postoperative hospital stay was 59.9 ± 14.4 vs 25.8 ± 9.2 hours (P = .0001) respectively. Outcome with regard to increase in Qmax, decrease in IPSS, and decrease in postvoid residual urine volume showed a dramatic improvement in both groups during the first 6 months. In the TURP group, the values of IPSS and Qmax were respectively lower and higher than diode patients at 12 and 24 months of follow-up. CONCLUSION According to our study, diode laser vaporization (980 nm) offers a safe and feasible procedure in the management of patients with symptomatic benign prostatic hypertrophy; however, at longer follow-up the functional outcome of diode laser vaporization has been less efficient than TURP.
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Affiliation(s)
- Mohammad Reza Razzaghi
- Department of Urology, Laser Application in Medical Sciences Research Center, Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mohsen Mazloomfard
- Department of Urology, Laser Application in Medical Sciences Research Center, Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Hooman Mokhtarpour
- Department of Urology, Laser Application in Medical Sciences Research Center, Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aida Moeini
- Department of Urology, Laser Application in Medical Sciences Research Center, Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Peng B, Yao MH, Wu R, Xie J, Xu HX. The clinical value of sonourethrography after bipolar transurethral plasmakinetic prostatectomy. MINIM INVASIV THER 2012; 22:122-6. [PMID: 22924472 DOI: 10.3109/13645706.2012.713365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Bo Peng
- Department of Urology, Shanghai tenth People's Hospital, Tongji University School of Medicine,
Shanghai, China
| | - Ming-Hua Yao
- Department of Ultrasound in Medicine, Shanghai tenth People's Hospital, Tongji University School of Medicine,
Shanghai, China
| | - Rong Wu
- Department of Ultrasound in Medicine, Shanghai tenth People's Hospital, Tongji University School of Medicine,
Shanghai, China
| | - Juan Xie
- Department of Ultrasound in Medicine, Shanghai tenth People's Hospital, Tongji University School of Medicine,
Shanghai, China
| | - Hui-Xiong Xu
- Department of Ultrasound in Medicine, Shanghai tenth People's Hospital, Tongji University School of Medicine,
Shanghai, China
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Seitz M, Bayer T, Ruszat R, Tilki D, Bachmann A, Gratzke C, Schlenker B, Stief C, Sroka R, Reich O. Preliminary evaluation of a novel side-fire diode laser emitting light at 940 nm, for the potential treatment of benign prostatic hyperplasia: ex-vivo and in-vivo investigations. BJU Int 2009; 103:770-5. [DOI: 10.1111/j.1464-410x.2008.08066.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ex vivo and in vivo investigations of the novel 1,470 nm diode laser for potential treatment of benign prostatic enlargement. Lasers Med Sci 2008; 24:419-24. [DOI: 10.1007/s10103-008-0591-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2008] [Accepted: 06/11/2008] [Indexed: 10/21/2022]
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Pfitzenmaier J, Gilfrich C, Pritsch M, Herrmann D, Buse S, Haferkamp A, Djakovic N, Pahernik S, Hohenfellner M. Vaporization of prostates of 80mL using a potassium-titanyl-phosphate laser: midterm-results and comparison with prostates of <80mL. BJU Int 2008; 102:322-7. [DOI: 10.1111/j.1464-410x.2008.07563.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Seitz M, Ackermann A, Gratzke C, Schlenker B, Ruszat R, Bachmann A, Stief C, Reich O, Sroka R. [Diode laser. Ex vivo studies on vaporization and coagulation characteristics]. Urologe A 2008; 46:1242-7. [PMID: 17665162 DOI: 10.1007/s00120-007-1490-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES Laser therapy of symptomatic benign prostatic hyperplasia (BPH) remains a challenge for most urologic surgeons. The main goal of laser surgery is to achieve a marked volume reduction and to decrease bladder outlet obstruction and lower urinary tract symptoms with minimal morbidity. Laser therapy encompasses a variety of techniques using different laser wavelengths, application systems, and surgical techniques to achieve contrasting tissue effects. In an in vitro animal model we compared the vaporization and coagulation effects of the potassium-titanyl-phosphate (KTP) laser, holmium:yttrium-aluminum-garnet (Ho:YAG) laser, and diode laser (980 nm). MATERIAL AND METHODS In an in vitro model using isolated perfused porcine kidneys we investigated the vaporization, the coagulation effect, and the bleeding rate of the KTP, Ho:YAG, and diode lasers on five porcine kidneys each. The application of each laser type was standardized. The area of laser application was 1 cm x 1 cm. The KTP group received an application with 80 W, the Ho:YAG group an application with 10-30 W, and the diode group an application with 30, 60, and 100 W. Hemostasis was measured semiquantitatively. Ablation and coagulation were investigated macro- and microscopically. RESULTS Concerning the ablation capacity, the diode laser is most effective (more than fivefold) compared to the KTP and Ho:YAG lasers but demonstrated a rather large coagulation zone of up to tenfold in comparison to the KTP and Ho:YAG lasers. Semiquantitatively, in terms of bleeding rate, all lasers were equivalent in this ex vivo model. CONCLUSIONS Our very early and limited experience indicates that KTP (80 W) and Ho:YAG (30 W) laser application are equivalent in terms of tissue ablation capacity and coagulation in an experimental setting. The diode laser at 980 nm is superior in terms of ablation capacity but has a large coagulation zone. Concerning the bleeding rate all tested lasers are equivalent in this ex vivo model.
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Affiliation(s)
- M Seitz
- Urologische Klinik und Poliklinik, Klinikum der Universität, Campus Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistrasse 15, 81377 München.
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10
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High-power diode laser at 980 nm for the treatment of benign prostatic hyperplasia: ex vivo investigations on porcine kidneys and human cadaver prostates. Lasers Med Sci 2008; 24:172-8. [DOI: 10.1007/s10103-008-0543-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 01/14/2008] [Indexed: 10/22/2022]
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Sroka R, Ackermann A, Tilki D, Reich O, Steinbrecher V, Hofstetter A, Stief CG, Seitz M. In-vitro comparison of the tissue vaporisation capabilities of different lasers. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.mla.2007.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Seitz M, Reich O, Karl A, Bachmann A, Gratzke C, Steinbrecher V, Stanislaus P, Stief C, Sroka R. Diode laser treatment of human prostates – Clinical 6-month experience. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.mla.2007.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Seitz M, Sroka R, Gratzke C, Schlenker B, Steinbrecher V, Khoder W, Tilki D, Bachmann A, Stief C, Reich O. The Diode Laser: A Novel Side-Firing Approach for Laser Vaporisation of the Human Prostate—Immediate Efficacy and 1-Year Follow-Up. Eur Urol 2007; 52:1717-22. [PMID: 17628326 DOI: 10.1016/j.eururo.2007.06.028] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2007] [Accepted: 06/18/2007] [Indexed: 02/07/2023]
Abstract
OBJECTIVES A prototype diode laser was used to evaluate the feasibility and postoperative outcome of diode laser vaporisation of the prostate in patients with bladder outlet obstruction (BOO) necessitating interventional desobstruction. METHODS Ten patients were included in this pilot study. The prostate was vaporised via a side-fire laser fibre (diode laser at 1470 nm, 50 W; Biolitec-AG, Jena, Germany). IPSS, quality of life, Q(max), and PVR volume were measured pre- and postoperatively and 1 yr after the intervention. RESULTS Prostate volumes were 35-78 ml. A mean 121 kJ (61-200 kJ) of energy was delivered. No patient had significant blood loss or fluid absorption. Three-way catheters were removed after a median of 33 h. Q(max) increased from 8.9 ml/s (3.6-13.2 ml/s) preoperatively to 15.7 ml/s (10.5-22 ml/s) (p<0.01) postoperatively. After the 12-mo follow-up, Q(max) increased to 22.35 ml/s (+/-4.32 ml/s; p<0.001). PVR volume changed from a baseline of 243 ml to 26.9 ml (p<0.001) after 12 mo. Volume reduction was estimated by transrectal ultrasound postoperatively (15 cc+/-6.39), and by PSA levels before surgery (3.8 ng/ml+/-2.3) and after 6 mo (2.64 ng/ml+/-1.51). No patient is incontinent. Two patients required recatheterisation postoperatively on days 1 and 2, respectively. Two patients required TURP within 2 mo. All patients without reintervention have presented for the 1-yr follow-up examination and are satisfied with the outcome. CONCLUSIONS Our preliminary findings indicate that 50-W diode laser vaporisation prostatectomy at 1470 nm is feasible and appears to be effective for acutely relieving BOO.
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Affiliation(s)
- Michael Seitz
- Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Germany.
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Reich O. Editorial Comment on: A Prospective Randomized Study Comparing Monopolar and Bipolar Transurethral Resection of Prostate Using Transurethral Resection in Saline (TURIS) System. Eur Urol 2007; 52:523-4. [PMID: 17416451 DOI: 10.1016/j.eururo.2007.03.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Oliver Reich
- Department of Urology, Ludwig-Maximilians-University Hospital, Campus Grosshadern, 81377 Munich, Germany.
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