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Salmivalli A, Boström P, Nurminen P, Kinnala P, Kytö V, Ettala O. National trends of surgery for benign prostatic hyperplasia in Finland. Scand J Urol 2024; 59:70-75. [PMID: 38647246 DOI: 10.2340/sju.v59.32425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/22/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE To investigate national trends of surgical treatment for benign prostatic obstruction (BPO). METHODS The Care Register for Healthcare in Finland was used to investigate the annual numbers and types of surgical procedures, operation incidence and duration of hospital stay between 2004 and 2018 in Finland. Procedures were classified using the Nordic Medico-Statistical Committee Classification of Surgical Procedures coding. Trends in incidence were analyzed with two-sided Cochran-Armitage test. Trends in duration of hospital stay and patient age were analyzed with linear regression. RESULTS Transurethral resection of the prostate (TURP) was the most common operation type during the study period, covering over 70% of operations for BPO. Simultaneous with the implementation of photoselective vaporization of the prostate (PVP), the incidence of TURP, minimally invasive surgical therapies, transurethral vaporization of the prostate (TUVP) and open prostatectomies decreased (p < 0.05). The mean operation incidence rate in the population between 2004 and 2018 was 263 per 100,000. The duration of hospital stay shortened (p < 0.05), and the average age of operated patients increased by 2 years (p < 0.0001). CONCLUSION The implementation of PVP did not challenge the dominating position of TURP in Finland, but it has probably influenced the overall use of other surgical therapies, excluding transurethral incision of the prostate. The results might suggest that the conservative treatment is accentuated, patient selection is more thorough, and surgical intervention might be placed at a later stage of BPO.
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Affiliation(s)
- Alisa Salmivalli
- Doctoral Programme in Clinical Research, University of Turku, Turku, Finland; Department of Urology, Satasairaala Central Hospital, Wellbeing Services County of Satakunta, Pori, Finland; Department of Urology, Turku University and Turku University Hospital, Turku, Finland.
| | - Peter Boström
- Department of Urology, Turku University and Turku University Hospital, Turku, Finland
| | - Pertti Nurminen
- Department of Urology, Turku University and Turku University Hospital, Turku, Finland
| | - Pekka Kinnala
- Department of Urology, Turku University and Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland; Research Services, Wellbeing Services County of Southwest Finland, Turku, Finland
| | - Otto Ettala
- Department of Urology, Turku University and Turku University Hospital, Turku, Finland
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Misrai V, Rijo E, Cottenceau JB, Zorn KC, Enikeev D, Elterman D, Bhojani N, De La Taille A, Herrmann TRW, Robert G, Pradere B. A Standardized Method for Estimating the Carbon Footprint of Disposable Minimally Invasive Surgical Devices: Application in Transurethral Prostate Surgery. ANNALS OF SURGERY OPEN 2021; 2:e094. [PMID: 37635829 PMCID: PMC10455069 DOI: 10.1097/as9.0000000000000094] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/14/2021] [Indexed: 12/13/2022] Open
Abstract
Objective To propose a standardized methodology for estimating the embodied carbon footprint (CF) of disposable minimally-invasive surgical devices (MISDs) and their application in new benign prostatic hyperplasia (BPH) MISDs. Summary of Background Data The estimation of the CO2e emissions of disposable surgical devices is central to empowering the healthcare supply chain. Methods The proposed methodology relied on a partial product lifecycle assessment and was restricted to a specific part of scope 3, which comprised the manufacturing of surgical device- and non-device-associated products (NDAPs), including packaging and user manual. The process-sum inventory method was used, which involves collecting data on all the component processes underpinning disposable MISDs. The seven latest disposable MISDs used worldwide for transurethral prostatic surgery were dismantled, and each piece was categorized, sorted into the appropriate raw material group, and weighed. The CF was estimated according to the following formula: activity data (weight of raw material) × emission factors of the corresponding raw material (kg CO2e/kg). Results The total weights of disposable packaging and user manuals ranged from 0.062 to 1.013 kg. Plastic was the most common and least emissive raw material (2.38 kg CO2e/kg) identified. The estimated embodied CF of MISDs ranged from 0.07 to 3.3 kg CO2e, of which 9% to 86% was attributed to NDAPs. Conclusions This study described a simple and independent calculation method for estimating the embodied CF of MISDs. Using this method, our results showed a wide discrepancy in the estimated CO2 emissions of the most recent disposable MISDs for transurethral BPH surgery. Thus, the lack of CF information should be of major concern in the development of future MISDs.
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Affiliation(s)
- Vincent Misrai
- From the Department of Urology, Clinique Pasteur, Toulouse, France
| | - Enrique Rijo
- Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain
| | | | - Kevin C. Zorn
- Division of Urology, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Naeem Bhojani
- Division of Urology, Department of Surgery, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | | | | | - Gregoire Robert
- Department of Urology, Bordeaux University Hospital, Bordeaux, France
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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John H, Wagner C, Padevit C, Witt JH. From open simple to robotic-assisted simple prostatectomy (RASP) for large benign prostate hyperplasia: the time has come. World J Urol 2021; 39:2329-2336. [PMID: 33575813 DOI: 10.1007/s00345-020-03508-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/23/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Robotic-assisted simple prostatectomy (RASP) has recently been studied as an alternative to open simple prostatectomy or endoscopic treatment options. At present, there is no defined recommendation for a robotic procedure as a standard surgical technique to treat large benign prostate hyperplasia. METHODS Several robotic techniques have been described since 2007. Contemporaneously, multiple endoscopic enucleation techniques have been proposed. Nevertheless, open simple prostatectomy still remains a mainstay of therapy. We aimed to evaluate the development of robotic-assisted prostatectomy for large benign prostatic obstruction, thus comparing the technical aspects and clinical outcomes with open and endoscopic enucleation. RESULTS Robotic-assisted simple prostatectomy provides significantly less blood loss and shorter hospital stay but longer operative time compared to open simple prostatectomy. Compared to endoscopic treatments, robotic approaches have a similar perioperative outcome, but cause less urethral trauma or potential bladder neck strictures. Moreover, concomitant bladder pathologies can be treated within the same setting. CONCLUSION Robotic-assisted simple prostatectomy is an effective and safe technique, and can hence be considered to become the preferred first-line therapy to treat patients with obstructive large prostate glands.
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Affiliation(s)
- H John
- Department of Urology, Kantonsspital Winterthur, 8400, Winterthur, Switzerland.
| | - Ch Wagner
- Department of Urology, St. Antonius Hospital Gronau, Gronau, Germany
| | - Ch Padevit
- Department of Urology, Kantonsspital Winterthur, 8400, Winterthur, Switzerland
| | - J H Witt
- Department of Urology, St. Antonius Hospital Gronau, Gronau, Germany
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Morton A, Williams M, Perera M, Teloken PE, Donato P, Ranasinghe S, Chung E, Bolton D, Yaxley J, Roberts MJ. Management of benign prostatic hyperplasia in the 21st century: temporal trends in Australian population-based data. BJU Int 2020; 126 Suppl 1:18-26. [PMID: 32558340 DOI: 10.1111/bju.15098] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine national trends in the medical and surgical treatment of benign prostatic hyperplasia (BPH) using Australian Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) population data from 2000 to 2018. PATIENTS AND METHODS Annual data was extracted from the MBS, PBS and Australian Institute of Health and Welfare databases for the years 2000-2018. Population-adjusted rates of BPH procedures and medical therapies were calculated and compared in relation to age. Cost analysis was performed to estimate financial burden due to BPH. RESULTS Overall national hospital admissions due to BPH declined between 2000 and 2018, despite an increased proportion of admissions due to private procedures (42% vs 77%). Longitudinal trends in the medical management of BPH showed an increased prescription rate of dutasteride/tamsulosin combined therapy (111 vs 7649 per 100 000 men) and dutasteride monotherapy (149 vs 336 per 100 000 men) since their introduction to the PBS in 2011. Trends in BPH surgery showed an overall progressive increase in rate of total procedures between 2000 and 2018 (92 vs 133 per 100 000 men). Transurethral resection of the prostate (TURP) remained the most commonly performed surgical procedure, despite reduced utilisation since 2009 (118 vs 89 per 100 000 men), offset by a higher uptake of photoselective vaporisation of prostate, holmium:YAG laser enucleation of prostate, and later likely due to minimally invasive surgical therapies including prostatic urethral lift and ablative technologies (including Rezūm™). Financial burden due to BPH surgery has remained steady since 2009, whilst the burden due to medical therapy has risen sharply. CONCLUSION Despite reduced national BPH-related hospitalisations, overall treatment for BPH has increased due to medical therapy and surgical alternatives to TURP. Further exploration into motivators for particular therapies and effect of medical therapy on BPH progression in clinical practice outside of clinical trials is warranted.
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Affiliation(s)
- Andrew Morton
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Michael Williams
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Marlon Perera
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Department of Surgery, Austin Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Patrick E Teloken
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Peter Donato
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sachinka Ranasinghe
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Eric Chung
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Andro Urology Centre, Brisbane, Queensland, Australia
| | - Damien Bolton
- Department of Surgery, Austin Health, The University of Melbourne, Parkville, Victoria, Australia
| | - John Yaxley
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Matthew J Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,Nepean Urology Research Group, Nepean Hospital, Kingswood, New South Wales, Australia.,Centre for Clinical Research, The University of Queensland, Herston, Queensland, Australia
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5
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Abstract
PURPOSE OF REVIEW GreenLight photoselective vaporization (GL-PV) is now established in the treatment of benign prostatic enlargement. The present review outlines the available technical armamentarium and summarizes the current best evidence on functional and safety outcomes. Moreover, future technical developments and refinements are presented. RECENT FINDINGS GL-PV has evolved to be the most commonly performed procedure, second to conventional transurethral resection of the prostate (TURP) for surgical management of benign prostatic obstruction (BPO). On the basis of the data published in the randomized controlled Goliath study, GL-PV with 180-W technology is noninferior in terms of functional outcomes compared with TURP considering short and intermediate follow-up with a complication-free rate of around 80% after 24 months.The ongoing push towards high-power lasers can be explained by their more effective tissue ablative effect, leading to shorter operating times. Comparative analysis between high-power and low-power laser systems demonstrated similar retreatment rates and most institutions are, therefore, now performing 180-W GL-PV.Performed as an outpatient procedure, GL-PV is cost-effective with a low hospital re-admission rate. Plasma kinetic vaporization of the prostate (PKVP) has recently emerged as a potential contender in the field; also GreenLight enucleation of the prostate (GreenLEP) might be even more effective than GL-PV. SUMMARY GL-PV appears to be a well tolerated surgical alternative for patients suffering from BPO. Long-term follow-up data from 120-W and 180-W laser systems are still pending. Potential competitors have recently been brought to the market and further trials and long-term data will show, whether GL-PV will stand the test of time. Regardless of technical specifications, surgeon's experience remains essential to achieve good functional and safety outcomes.
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Moiroud M, Ait Said K, Vaudreuil L, Alharbi F, Leon G, Tillou X. Prostate Laser Photovaporization in Older People With and Without Bladder Catheter. J Am Geriatr Soc 2019; 67:1888-1894. [PMID: 31188479 DOI: 10.1111/jgs.16019] [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: 02/20/2019] [Revised: 05/12/2019] [Accepted: 05/13/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare results of prostate laser photovaporization (PVP) by age groups to evaluate morbidity and functional results. Then, to specifically analyze surgical data for patients with an indwelling bladder catheter. DESIGN Monocentric retrospective study of a prospective maintained database of all laser PVPs performed at our university hospital between December 2012 and June 2017. SETTINGS AND PARTICIPANTS A total of 305 patients (three groups: younger than 70, 70-80, and older than 80 years) were operated on in our hospital center for the treatment of urinary tract disorders related to benign prostatic hyperplasia. RESULTS A difference was found between the three age groups, with a higher rate of complications for patients older than 80 years (45%) (P = .013). Rate of patients with postoperative bladder catheters at 1 year was higher for patients older than 80 years (15%) (P = .004). Postoperative quality-of-life (QoL) score was worse for patients older than 80 years (P = .04). For patients with an indwelling bladder catheter undergoing surgery, morbidity was greater in patients older than 80 years, but the difference was not significant. International Prostate Symptom Score and QoL score were not significantly different between the three groups. Rate of patients with a remaining bladder catheter at 1 year was higher for patients older than 80 years (17.1% vs 7.1% for patients between 70 and 80, and 4.8% for patients under 70.) but with no statistical difference. CONCLUSION PVP had a greater morbidity in octogenarians compared to younger subjects. Functional results were less satisfactory for patients older than 80 years compared to younger ones. For subjects operated on with an indwelling bladder catheter, no significant difference in outcome and morbidity was found between the three groups. J Am Geriatr Soc 67:1888-1894, 2019.
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Affiliation(s)
- Martin Moiroud
- Department of Urology and Transplantation, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Khelifa Ait Said
- Department of Urology and Transplantation, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Lionel Vaudreuil
- Department of Urology and Transplantation, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Feras Alharbi
- Department of Urology and Transplantation, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Gregoire Leon
- Department of Urology and Transplantation, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Xavier Tillou
- Department of Urology and Transplantation, Centre Hospitalier Universitaire de Caen, Caen, France
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7
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Patel RM, Bariol S. National trends in surgical therapy for benign prostatic hyperplasia in Australia. ANZ J Surg 2019; 89:345-349. [PMID: 30706655 DOI: 10.1111/ans.15016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/08/2018] [Accepted: 11/10/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND To determine national trends in the utilization of surgical procedures for the treatment of benign prostatic hyperplasia (BPH) in Australia over the last 20 years. METHODS The Medicare Australia and Australian Institute of Health and Welfare databases were used to determine the annual number of surgical procedures and hospital admissions for BPH. RESULTS From 1998 to 2017, surgical procedures for BPH have increased by 79% which is largely commensurate with population growth. From 1998 to 2008, transurethral resection of the prostate (TURP) was the predominant surgical therapy, accounting for 96% of all surgical treatments. From 2008 to 2017, TURP use reduced to 70% and in the last 5 years has been replaced with photoselective vaporization (16%), UroLift (8%) and holmium laser prostatectomy (6%). UroLift is used significantly more in younger men (P < 0.001). CONCLUSION There has been a substantial increase in surgical treatments for BPH over the last 20 years. In the last 5 years, TURP use has declined due to an increase in laser prostatectomy and UroLift procedures.
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Affiliation(s)
- Rohan M Patel
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Simon Bariol
- Department of Urology, Westmead Hospital and Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia
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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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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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10
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Robert G, de la Taille A, Descazeaud A. [Surgical treatment of BPO: Standard and innovations]. Prog Urol 2018; 28:856-867. [PMID: 30297185 DOI: 10.1016/j.purol.2018.07.287] [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: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND OBJECTIVE Surgical management of benign prostatic hyperplasia has dramatically changed in the recent years towards higher proportion of endoscopic treatment and fewer perioperative complications. Nevertheless the question of urinary and sexual quality of life after surgical treatment remains partially unresolved with a high proportion of retrograde ejaculation after conventional surgical treatments. Therefore mini-invasive alternatives to conventional surgery have been proposed. The objective of this literature review was to provide an overview of the alternatives to monopolar TURP currently available in France. MATERIAL AND METHOD A non-systematic review of the scientific literature was conducted from the PubMed database to retrieve the most relevant scientific publications. A first research was cross-referenced with the results of literature reviews already published and enriched by the authors of this review. A synthesis is proposed for each alternative technique mentioning its level of clinical development, but also its potential advantages and disadvantages compared to conventional surgical techniques. RESULTS The quality of life of patients after surgical or interventional management has become the main priority of urologists since the risks of perioperative complication have been reduced by the use of laser or bipolar endoscopic techniques. Thanks to the development of minimally invasive alternatives that are better and better evaluated by randomized trials versus interventional simulation and conventional surgical treatment, more personalized care is possible. Patients' expectations and their individual risk factors can thus be placed at the center of the therapeutic decision and the preoperative information. CONCLUSION The surgical and interventional management of LUTS due to BPH has evolved to lower perioperative morbidity with the help of numerous technological developments. Mini-invasive alternatives to standard treatment have also been proposed in order to improve the quality of postoperative sexual life. These alternatives provide significant improvement in LUTS that remains lower than after conventional treatments. Somme of these alternative are also not fully supported by clinical trials, which should urge urologists to act with caution when proposing these alternatives in daily clinical practice.
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Affiliation(s)
- G Robert
- Service d'urologie, CHU de Bordeaux, 33000 Bordeaux, France.
| | - A de la Taille
- Service d'urologique, CHU Henri Mondor, AP-HP, 94000 Créteil, France
| | - A Descazeaud
- Service d'urologie, CHU de Limoges, 87042 Limoges, France
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11
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Ajib K, Zgheib J, Salibi N, Zanaty M, Mansour M, Alenizi A, El-Hakim A. Monopolar Transurethral Enucleo-Resection of the Prostate Versus Holmium Laser Enucleation of the Prostate: A Canadian Novel Experience. J Endourol 2018; 32:509-515. [PMID: 29641356 DOI: 10.1089/end.2017.0853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To study the functional outcome of patients undergoing transurethral enucleation and resection of the prostate (TUERP) vs patients undergoing holmium laser enucleation of the prostate (HoLEP) in men with bladder outlet obstruction. MATERIALS AND METHODS We retrospectively analyzed our prospectively collected database of two groups of patients. Twenty-four patients underwent TUERP (group 1), and 27 underwent HoLEP (group 2). Preoperative characteristics, intervention parameters, postoperative functional outcomes, uroflowmetry, and complications were collected. RESULTS Mean prostate size in groups 1 and 2 were 87.2 and 93.5 cc, respectively. The mean duration of surgery was 110 minutes in group 1 and 136 minutes in group 2. In group 1, prostate-specific antigen (PSA) dropped from 4.4 to 1.2 ng/cc after 12 months. International Prostate Symptom Score (IPSS) was 3.75 at 12 months with a preoperative value of 20.9. With respect to maximum urinary flow rate (Qmax), it increased to 21.8 mL/s from a preoperative value of 6.4 mL/s. In group 2, the PSA dropped from 7.6 to 1.3 ng/cc. IPSS dropped from 22.3 to 3.8, Qmax increased from 7.7 to 22.5 mL/s. Hemoglobin, complications, and all studied parameters were not statistically significant between both groups. CONCLUSION In this study, TUERP was safe and efficacious in benign prostatic hyperplasia patients with large glands. Modifications can be implemented on the standard transurethral resection of the prostate technique to treat patients with prostate sizes >70 cc.
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Affiliation(s)
- Khaled Ajib
- 1 Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal , Montréal, Canada .,2 Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Cœur de Montréal , Montreal, Canada
| | - Joseph Zgheib
- 3 Division of Urology, Department of Surgery, Saint George Hospital University Medical Center , Beirut, Lebanon
| | - Noura Salibi
- 4 Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut , Beirut, Lebanon
| | - Marc Zanaty
- 1 Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal , Montréal, Canada .,2 Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Cœur de Montréal , Montreal, Canada
| | - Mila Mansour
- 1 Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal , Montréal, Canada
| | - Abdullah Alenizi
- 5 Division of Urology, Department of Surgery, Security Forces Hospital , Riyadh, Saudi Arabia
| | - Assaad El-Hakim
- 2 Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Cœur de Montréal , Montreal, Canada
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80-W GreenLight Laser Vaporization Versus Transurethral Resection of the Prostate for Treatment of Benign Prostatic Obstruction: 5-Year Outcomes of a Single-center Prospective Randomized Trial. Urology 2018; 116:144-149. [PMID: 29447947 DOI: 10.1016/j.urology.2018.01.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/27/2018] [Accepted: 01/31/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess long term functional and safety follow-up data after 80-W GreenLight photoselective vaporization (GL PV) of the prostate and transurethral resection of the prostate (TURP). MATERIALS AND METHODS Prospective randomized trial at a single tertiary referral center (Geneva, Switzerland). Patients were recruited in the outpatient clinic if they met the criteria for surgical treatment of benign prostatic obstruction. At baseline, 238 patients were treated either with the 80-W GL PV or monopolar TURP. After 5 years, data were available from 105 patients: 44 GL PV patients and 61 TURP patients. The primary outcome measure was the International Prostate Symptom Score (IPSS). Secondary outcome measures included maximum urinary flow rate (Qmax), postvoidal residual (PVR) and reoperation rate. Statistical analyses were performed using Stata 14 (StataCorp). RESULTS After 5 years of follow-up, mean improvements in International Prostate Symptom Score, postvoidal residual and maximum urinary flow rate were similar in both groups. The re-treatment rate was 14.3% in the GL PV group vs 11.9% in the TURP group (P = .9). CONCLUSION Noninferiority of the GL PV to TURP was confirmed in all functional and safety outcomes at 5-year follow-up. GL-PV could be a safe surgical alternative for patients suffering from benign prostatic obstruction.
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13
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Misraï V, Pasquie M, Bordier B, Elman B, Lhez JM, Guillotreau J, Zorn K. Comparison between open simple prostatectomy and green laser enucleation of the prostate for treating large benign prostatic hyperplasia: a single-centre experience. World J Urol 2018; 36:793-799. [PMID: 29368232 DOI: 10.1007/s00345-018-2192-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 01/19/2018] [Indexed: 12/27/2022] Open
Abstract
PURPOSE This study sought to compare perioperative outcomes and morbidities for open simple prostatectomy (OSP) and endoscopic green laser enucleation of the prostate (GreenLEP). METHODS In a single department, all consecutive patients who underwent OSP between January 2005 and December 2010 were retrospectively reviewed, and all consecutive patients undergoing GreenLEP between July 2013 and January 2017 were prospectively enrolled. Perioperative data, information regarding early postoperative complications for up to 6 months and outcomes were collected and retrospectively compared. RESULTS Overall, 204 patients were enrolled in each group. The baseline characteristics of patients in both groups were comparable. Intraoperative time was significantly longer for the OSP group than for the GreenLEP group (67 versus 60 min; p < 0.0001). The OSP group had significantly longer catheterisation (5 versus 2 days; p < 0.0001) and hospitalisation times (7 versus 2 days; p < 0.0001) than the GreenLEP group. The overall rate of complications was significantly higher after OSP than after GreenLEP (37.2 versus 20.6%; p = 0.0003); both Clavien-Dindo grade 3a complications (8.8 versus 0.98%) and Clavien-Dindo grade 3b complications (2.4 versus 3.4%) were observed. The transfusion rate was higher after OSP than after GreenLEP (8.3 versus 0.5%; p = 0.0001). The rehospitalisation rate was similar for both groups (7.8 versus 8.3%; p = 0.99). CONCLUSIONS The results of this single-centre cohort study confirm those of similar prior investigations addressing endoscopic enucleation of the prostate. Compared with OSP, GreenLEP may have a more desirable perioperative profile with lower morbidity. In contrast, GreenLEP and OSP were associated with similar 6-month rehospitalisation rates.
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Affiliation(s)
- Vincent Misraï
- Department of Urology, Clinique Pasteur, 31300, Toulouse, France.
| | - Marie Pasquie
- Department of Urology, Clinique Pasteur, 31300, Toulouse, France
| | - Benoit Bordier
- Department of Urology, Clinique Pasteur, 31300, Toulouse, France
| | - Benjamin Elman
- Department of Urology, Clinique Pasteur, 31300, Toulouse, France
| | - Jean Michel Lhez
- Department of Urology, Clinique Pasteur, 31300, Toulouse, France
| | | | - Kevin Zorn
- CHUM Section of Urology, Department of Surgery, Université de Montréal, Montreal, QC, Canada
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14
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Azizi M, Tholomier C, Meskawi M, Hueber PA, Valdivieso RF, Alenizi AM, Rajih E, Zanaty M, Hai MA, Gonzalez RR, Eure GR, Kriteman LS, Misrai V, Zorn KC. Safety, Perioperative, and Early Functional Outcomes of Vapor Incision Technique Using the GreenLight XPS 180 W System: Direct Comparison with Photoselective Vaporization of the Prostate. J Endourol 2017; 31:43-49. [DOI: 10.1089/end.2016.0474] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Mounsif Azizi
- Section of Urology, Department of Surgery, University of Montreal Health Centre, Montreal, Canada
| | - Côme Tholomier
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Malek Meskawi
- Section of Urology, Department of Surgery, University of Montreal Health Centre, Montreal, Canada
| | - Pierre-Alain Hueber
- Section of Urology, Department of Surgery, University of Montreal Health Centre, Montreal, Canada
| | - Roger F. Valdivieso
- Section of Urology, Department of Surgery, University of Montreal Health Centre, Montreal, Canada
| | | | - Emad Rajih
- Department of Urology, Taibah University, Madina, Saudi Arabia
| | - Marc Zanaty
- Section of Urology, Department of Surgery, University of Montreal Health Centre, Montreal, Canada
| | - Mahmood A. Hai
- Department of Urology, Comprehensive Urology, Westland, Michigan
| | | | - Gregg R. Eure
- Department of Urology, Urology of Virginia, Virginia Beach, Virginia
| | | | | | - Kevin C. Zorn
- Section of Urology, Department of Surgery, University of Montreal Health Centre, Montreal, Canada
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15
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Baron M, Nouhaud FX, Delcourt C, Grise P, Pfister C, Cornu JN, Sibert L. [HoLEP learning curve: Toward a standardised formation and a team strategy]. Prog Urol 2016; 26:492-9. [PMID: 27614386 DOI: 10.1016/j.purol.2016.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 07/02/2016] [Accepted: 08/01/2016] [Indexed: 11/30/2022]
Abstract
AIM Holmium laser enucleation of prostate (HoLEP) is renowned for the difficulty of its learning curve. Our aim was to evaluate the interest of a three-step tutorial in the HoLEP learning curve, in a university center. METHODS It is a retrospective, monocentric study of the 82 first procedures done consecutively by the same operator with a proctoring in early experience and after 40 procedures. For all patients were noted: enucleation efficiency (g/min), morcellation efficiency (g/min), percentage of enucleated tissue (enucleated tissue/adenome weigth evaluated by ultrasonography. g/g), perioperative morbidity (Clavien), length of hospital stay, length of urinary drainage, functional outcomes at short and middle term (Qmax, post-void residual volume [PVR], QOL scores and IPSS at 3 and 6months). RESULTS Enucleation and morcellation efficiency were significantly higher after the second proctoring (0.87 vs 0.44g/min; P<0.0001 and 4.2 vs 3.37g/min, P=0.038, respectively) so as the prostatic volume (43.5 vs 68.1mL, P=0.0001). Percentage of enucleated tissue was higher in the second group, however, the difference was not significant (69.5% vs 80.4%, P=0.03). Per- and postoperative complications, hospital length of stay, urinary drainage length and functional results at 3 and 6months were not significantly different. CONCLUSION The learning curve did not interfere with functional results. The second proctoring was essential to us in order to grasp the technique. These data underlined the necessity of a pedagogic reflexion in order to built a standardized formation technique to the HoLEP. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- M Baron
- Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France
| | - F-X Nouhaud
- Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France
| | - C Delcourt
- Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France
| | - P Grise
- Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France
| | - C Pfister
- Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France
| | - J-N Cornu
- Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France.
| | - L Sibert
- Service d'urologie, université de Rouen, CHU Charles-Nicolle, 1 rue de Germont, 76031 Rouen cedex, France
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16
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Charbonneau H, Pathak A, Albenque JP, Misrai V. Greenlight™ photovaporization of the prostate in patients under rivaroxaban: Lesson learned after the first cases. Prog Urol 2016; 26:273-5. [PMID: 26970929 DOI: 10.1016/j.purol.2016.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 02/06/2016] [Indexed: 11/16/2022]
Affiliation(s)
- H Charbonneau
- EA 4564 "Modélisation de l'agression tissulaire et nociceptive", université Paul-Sabatier, 31000 Toulouse, France; Pôle anesthésie-réanimation, CHU Purpan, place du Dr-Baylac, 31059 Toulouse cedex 9, France.
| | - A Pathak
- Department of cardiovascular medicine, clinique Pasteur, 31300 Toulouse, France
| | - J-P Albenque
- Department of cardiovascular medicine, clinique Pasteur, 31300 Toulouse, France
| | - V Misrai
- Department of urology, clinique Pasteur, 31300 Toulouse, France
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17
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Pradere B, Peyronnet B, Leonard G, Misrai V, Bruyère F. Photovaporisation prostatique au laser Greenlight® : évaluation des pratiques françaises en 2015. Prog Urol 2016; 26:168-75. [DOI: 10.1016/j.purol.2016.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/19/2015] [Accepted: 01/07/2016] [Indexed: 11/29/2022]
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18
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[Evaluation of postoperative symptoms after Greenlight™ photovaporization of the prostate through a dedicated questionnaire]. Prog Urol 2015; 26:108-14. [PMID: 26611569 DOI: 10.1016/j.purol.2015.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 09/17/2015] [Accepted: 10/03/2015] [Indexed: 11/22/2022]
Abstract
AIMS To evaluate postoperative symptoms after Greenlight™ photovaporisation of the prostate (PVP), through a dedicated questionnaire. METHODS A retrospective study has been conducted between 2008 and 2014. The questionnaire had 5 sections about pain while voiding, hematuria, urgency, incontinence and urinary stream, and was filled at one-month postoperative. The main outcome criterion was pain while voiding. Descriptive statistical analyses were done to identify predictive factors for pain while voiding. RESULTS Out of 169 patients, 22% had no pain while voiding, 37% had moderate pain, 30% acceptable pain and 11% intense pain. Patients with pain were significantly older, (P=0.012), had more urgency (P=0.01) and more often hematuria (P=0.0001). Only 7% of patients had no symptoms of urgency, and urgency was painful or bothering in 57% of cases. Hematuria was frequent, with clots in 21% of cases. Ninety three percent felt improvement of urinary stream. CONCLUSIONS Systematic evaluation of symptoms through a dedicated questionnaire one month after PVP has shown that 41% of patients felt pain while voiding, 57% had urgency and 39% significant hematuria. These results should encourage a more accurate patient information and further studies to better understand postoperative healing after PVP.
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19
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[Serious and unexpected complications of benign prostatic obstruction surgery: Results of the LUTS Committee survey from urologists of the French Urological Association]. Prog Urol 2015; 25:583-9. [PMID: 26159052 DOI: 10.1016/j.purol.2015.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/12/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE Rare and severe complications of benign prostatic hyperplasia (BPH) surgery are poorly documented in the literature. Our purpose was to make an inventory of severe and unexpected complications of BPH faced by urologists of the French Association of Urology (AFU). MATERIAL AND METHODS A declarative 13-question survey was sent by e-mail 2 months before the 108th French Congress of Urology to the urologist's members of the AFU. Complications were split in complications due to material and complications directly related to the surgery. RESULTS Overall, 216 (16.2%) urologists surveyed but only 85 forms were usable. Complications related to the material was divided into: excessive temperature of the serum irrigation leading to urethral and bladder burns (n=5), material default leading to interruption of the procedure (n=1) or incomplete hemostasis (n=2) and endoscope rupture (n=1). Peroperative complications related to surgery were divided into surgical complications: haemorrhage (n=7), urethral wounds (n=6), perforation and/or explosion (n=16), rectal wounds (n=11), obstructive renal failure (n=1); and medical complications: TURP syndrome (n=2), cardiovascular (n=5) and septic shock (n=6). CONCLUSION This is the first French declarative study having allowed the identification of severe and unexpected complications of BPH surgery. The recorded occurred complications were very eclectic and secondary to all types of techniques used.
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