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Ventimiglia E, Orecchia L, Bevilacqua L, Tondelli E, Oliva I, Cindolo L, Goumas IK. Anatomic endoscopic enucleation of the prostate using a novel hybrid thulium:yttrium-aluminium-garnet laser generator: surgical technique and clinical outcomes. World J Urol 2024; 42:498. [PMID: 39214884 DOI: 10.1007/s00345-024-05207-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024] Open
Abstract
PURPOSE We aim to report here the first clinical series of patients treated with AEEP using a novel hybrid thulium:yttrium-aluminium-garnet (Tm:YAG) laser generator (RevoLix HTL, LISA Laser Products, Germany), i.e. capable of emitting both in pulsated and continuous-wave. METHODS We included 39 consecutive patients who underwent hybrid Tm:YAG AEEP (hybrid ThuLEP) at a single center starting from July 2022 and were followed-up until 3 months after surgery. Complete baseline, intraoperative, and follow-up demographic and clinical data were collected. The International Prostatic Symptoms Score (IPSS) questionnaire was used to quantify urinary symptoms at baseline and during follow-up. Post-operative follow-up further included a PSA test, uroflowmetry with post-void residual volume (PVR) measurement. Clavien-Dindo classification was used to classify complications. RESULTS Median (IQR) age at surgery and prostate volume were 68 (IQR 63-74) years and 85 (60-105) cc. Both en-bloc or two-lobes technique enucleation were performed according to the intraoperative and endoscopic anatomy, with a median operative time of 85 (63-108) minutes. Bladder catheter was removed in all cases on postoperative day two. Intraoperative bleeding requiring conversion to bipolar enucleation was observed in two patients. After discharge, one patient developed arm phlebitis which was treated with anticoagulants leading to new onset haematuria requiring short term catheterisation (Clavien-Dindo grade II) and two more patients had a single episode of acute urinary retention (Clavien-Dindo grade I). Median pre- vs postoperative Qmax and IPSS were 8.0 (7.0-9.4) vs. 25.0 (22.5-32.5) ml/s and 22 (20-28) vs. 1 (0-2), whereas PVR decreased from 70 (50-115) to 0 (0-26) ml. CONCLUSIONS Hybrid ThuLEP is a feasible and effective surgical procedure for the management of benign prostatic obstruction.
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Affiliation(s)
- Eugenio Ventimiglia
- Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Orecchia
- Department of Urology, Istituto Clinico Beato Matteo, Corso Pavia 84, 27029, Vigevano, Italy
- Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Luigi Bevilacqua
- Department of Urology, Istituto Clinico Beato Matteo, Corso Pavia 84, 27029, Vigevano, Italy
| | - Elena Tondelli
- Department of Urology, Istituto Clinico Beato Matteo, Corso Pavia 84, 27029, Vigevano, Italy
| | - Isabella Oliva
- Department of Urology, Istituto Clinico Beato Matteo, Corso Pavia 84, 27029, Vigevano, Italy
| | - Luca Cindolo
- Dept of Urology, "Villa Stuart" Private Hospital, Rome,and Centro Urologico Europeo, Modena, Italy
| | - Ioannis Kartalas Goumas
- Department of Urology, Istituto Clinico Beato Matteo, Corso Pavia 84, 27029, Vigevano, Italy.
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Coman RA, Coman RT, Popescu RI, Leucuta DC, Couți R, Coman I, Al Hajjar N. Multimodal Approach Combining Thulium Laser Vaporization, Bipolar Transurethral Resection of the Prostate, and Bipolar Plasma Vaporization versus Bipolar Transurethral Resection of the Prostate: A Matched-Pair Analysis. J Clin Med 2024; 13:4863. [PMID: 39201005 PMCID: PMC11355674 DOI: 10.3390/jcm13164863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 09/02/2024] Open
Abstract
Background/Objectives: The aim of our study is to compare the perioperative and functional outcomes of a multimodal approach combining thulium laser vaporization, bipolar TURP, and bipolar plasma vaporization (TLP) with bipolar TURP in a matched-pair analysis. Methods: A nonrandomized, observational, retrospective, and matched-pair analysis was performed on two homogeneous groups of 60 patients who underwent TLP versus bipolar TURP at our center between March 2018 and December 2021. The American Society of Anesthesiologists (ASA) score and prostate volume (PV) were the main parameters used to match patients between the two groups. Follow-up was evaluated at 3, 6, 12, and 24 months after surgery. Results: There was a shorter operative time in favor of TLP (42 versus 45 min, p = 0.402). Median hemoglobin drop (-0.3 versus -0.6, p < 0.001) and median sodium drop (-0.3 versus -0.7, p < 0.001) after surgery were statistically significantly lower in TLP compared to bipolar TURP. The International Prostate Symptom Score (IPSS) and Quality of Life (QoL) scores were significantly lower, and the maximum urinary flow rate was higher in the TLP group. The median PSA decrease 2 years after surgery was 73.92% in the TLP group versus 76.17% in the bipolar TURP group (p = 0.578). The complication rate was lower in the TLP group (20% versus 21.67%, p = 1). Conclusions: The results show that both procedures are equally effective and safe in the treatment of symptomatic BPH with some advantages regarding the TLP technique.
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Affiliation(s)
- Roxana Andra Coman
- Department of Urology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.A.C.)
- Department of Urology, Endoplus Clinic, 400165 Cluj-Napoca, Romania
| | - Radu Tudor Coman
- Department of Epidemiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Răzvan-Ionuț Popescu
- Department of Urology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Urology, “Prof. Dr. Th. Burghele” Clinical Hospital, 061344 Bucharest, Romania
| | - Daniel Corneliu Leucuta
- Department of Medical Informatics and Biostatistics, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Răzvan Couți
- Bistrita County Emergency Hospital, 420016 Bistrita, Romania
| | - Ioan Coman
- Department of Urology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (R.A.C.)
- Department of Urology, Endoplus Clinic, 400165 Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Department of Surgery, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Surgery, Regional Institute of Gastroenterology and Hepatology “Octavian Fodor”, 400394 Cluj-Napoca, Romania
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Coman RA, Leucuta DC, Coman RT, Lapusan C, Stanca DV, Coman I, Al Hajjar N. Long-term results of multimodal treatment of the prostate using the Thulium Laser. Med Pharm Rep 2024; 97:338-346. [PMID: 39234455 PMCID: PMC11370861 DOI: 10.15386/mpr-2760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 06/13/2024] [Accepted: 07/01/2024] [Indexed: 09/06/2024] Open
Abstract
Background and aims To evaluate a novel multimodal treatment (TLP) that integrates the use of a thulium laser, bipolar transurethral resection of the prostate (TURP), and "button-type" bipolar plasma vaporization for the endoscopic treatment of benign prostatic hyperplasia (BPH). Methods From March 2018 to December 2021, we prospectively evaluated 220 patients with symptomatic BPH who underwent TLP. Patients were assessed based on the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), and postvoid residual urine (PVR). Perioperative and postoperative follow-up data were analyzed. Results The mean age at surgery was 66.74 years (SD 8.21). The median prostate size was 80 (IQR 70 - 110). The median operative time was 45 (IQR 35 - 55) minutes and the hospital stay was 2 (IQR 1 - 2) days. Patients were discharged with the urinary catheter in place, which was removed approximately 7 days after surgery when the histopathological result was discussed with the patient. Postoperatively, IPSS, QoL, Qmax and PVR showed a significant improvement starting at 3 months and continued through the postoperative follow-up visits (6-12-24-36-48-60 months). Urethral stricture and bladder neck contracture occurred in 1 (0.45%) and 2 (0.91%) patients, respectively. Recurrence of BPH occurred in 2 patients (0.91%) who underwent a second procedure. Conclusions In conclusion, we report that the multimodal surgical treatment of BPH consisting of combining Thulium laser vaporization, bipolar TURP and plasma vaporization (TLP) represents an efficient and durable therapeutic method for BPH patients with low a complication rate at 5-year follow-up.
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Affiliation(s)
- Roxana Andra Coman
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Endoplus Clinic, Cluj-Napoca, Romania
| | - Daniel Corneliu Leucuta
- Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu Tudor Coman
- Department of Epidemiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Dan Vasile Stanca
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioan Coman
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Endoplus Clinic, Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
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Dalton DC, Shelton TM, Rivera M. Laser Technology Advancements in the Treatment of Benign Prostatic Hypertrophy. Curr Urol Rep 2024; 25:71-78. [PMID: 38349464 DOI: 10.1007/s11934-024-01197-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE OF REVIEW Lasers have had a significant impact on the treatment of benign prostatic hypertrophy. This article attempts to distill the advancements in laser technology for the treatment of benign prostatic hypertrophy (BPH) into key and understandable points to help make this topic more accessible to urologists. RECENT FINDINGS The holmium:yttrium-aluminum-garnet (YAG) laser, one of the most significant lasers in the field of urology, has recently been improved with pulse modulating technology (Moses™ technology). New thulium:YAG technology allows both pulsed and continuous wave modes. The thulium fiber laser is one of the newer lasers to come to market and has been shown to have effective and safe outcomes. GreenLight™ lasers are predominantly used in photovaporization procedures and have also been studied extensively, although less in recent years. The modern urologist is fortunate to have many high-quality lasers and a wide variety of surgical techniques to choose from when treating BPH. Understanding the basic laser principles and applications will help urologists to select the best treatment options for their patients with BPH.
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Affiliation(s)
- David C Dalton
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
| | - T Max Shelton
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Marcelino Rivera
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
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Kosiba M, Filzmayer M, Welte MN, Hügenell L, Keller AC, Traumann MI, Müller MJ, Kluth LA, Mandel PC, Chun FKH, Becker A. Thulium fiber laser vs. holmium laser enucleation of the prostate: results of a prospective randomized non-inferiority trial. World J Urol 2024; 42:49. [PMID: 38244076 PMCID: PMC10799774 DOI: 10.1007/s00345-023-04748-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/24/2023] [Indexed: 01/22/2024] Open
Abstract
PURPOSE Holmium laser enucleation of the prostate (HoLEP) represents the current standard procedure for size-independent surgical therapy of benign prostatic obstruction (BPO). With advent of the novel laser technology thulium fiber laser (TFL), we hypothesized that the functional outcome of TFL enucleation of the prostate (ThuFLEP) is non-inferior compared to HoLEP. METHODS From October 2021 to October 2022, 150 patients with BPO were recruited for the prospective randomized trial in accordance with CONSORT. Stratified randomization into the arms ThuFLEP (n = 74) or HoLEP (n = 76) was carried out. The primary endpoint was non-inferior international prostate symptom score (IPSS) and quality of life (QoL) at three months after treatment. Secondary endpoints were rates of complications, peak flow, residual urine and operation times. RESULTS Preoperative characteristics showed no significant differences. Overall IPSS and QoL improved from 21 to 8 and 4 to 1.5, respectively, after three months of follow-up. No statistically significant differences between ThuFLEP and HoLEP were observed regarding median postoperative IPSS (8.5 vs. 7, p > 0.9), QoL (1 vs. 2, p = 0.6), residual urine (48 vs. 30ml, p = 0.065) and peak flow (19 vs. 17ml/s, p > 0.9). Similarly, safety profile was comparable with no statistically significant differences regarding rate of major complications (5.3 vs. 5.4%, p = 0.5), laser hemostasis time (3 vs. 2min, p = 0.2), use of additive electric coagulation (74 vs. 87%, p = 0.06) or electric coagulation time (8 vs. 8min, p = 0.4). CONCLUSIONS In this prospective, randomized trial ThuFLEP showed non-inferior results compared to HoLEP in terms of functional outcomes measured by IPSS and QoL as primary endpoint. TRIAL REGISTRATION NUMBER DRKS00032699 (18.09.2023, retrospectively registered).
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Affiliation(s)
- Marina Kosiba
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Maximilian Filzmayer
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany.
| | - Maria N Welte
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Leonie Hügenell
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Anna C Keller
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Miriam I Traumann
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Matthias J Müller
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Luis A Kluth
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Philipp C Mandel
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Felix K-H Chun
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
| | - Andreas Becker
- Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany
- Urological Center at Boxberg, Neunkirchen, Germany
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Fan Y, Xu L, Liu S, Li J, Xia J, Qin X, Li Y, Gao T, Tang X. The State-of-the-Art and Perspectives of Laser Ablation for Tumor Treatment. CYBORG AND BIONIC SYSTEMS 2024; 5:0062. [PMID: 38188984 PMCID: PMC10769065 DOI: 10.34133/cbsystems.0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/21/2023] [Indexed: 01/09/2024] Open
Abstract
Tumors significantly impact individuals' physical well-being and quality of life. With the ongoing advancements in optical technology, information technology, robotic technology, etc., laser technology is being increasingly utilized in the field of tumor treatment, and laser ablation (LA) of tumors remains a prominent area of research interest. This paper presents an overview of the recent progress in tumor LA therapy, with a focus on the mechanisms and biological effects of LA, commonly used ablation lasers, image-guided LA, and robotic-assisted LA. Further insights and future prospects are discussed in relation to these aspects, and the paper proposed potential future directions for the development of tumor LA techniques.
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Affiliation(s)
- Yingwei Fan
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Liancheng Xu
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Shuai Liu
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Jinhua Li
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Jialu Xia
- School of Materials Science and Engineering, Hefei University of Technology, Hefei 230009, China
| | - Xingping Qin
- John B. Little Center for Radiation Sciences, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - Yafeng Li
- China Electronics Harvest Technology Co. Ltd., China
| | - Tianxin Gao
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
| | - Xiaoying Tang
- School of Medical Technology, Beijing Institute of Technology, Beijing 100081, China
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