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Pirola GM, Maggi M, Castellani D, Sciarra A, Rubilotta E, Gubbiotti M. A Cost-Benefit Analysis of Bipolar TURP for the Treatment of Bladder Outflow Obstruction. Res Rep Urol 2021; 13:487-494. [PMID: 34268258 PMCID: PMC8276822 DOI: 10.2147/rru.s277480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/30/2021] [Indexed: 02/01/2023] Open
Abstract
Transurethral resection of the prostate (TURP) is the gold standard surgical technique for endoscopic treatment of benign prostatic hyperplasia (BPH). Introduced in 2001, the bipolar energy appeared to be a valid alternative to the classical monopolar one with reduced risk of complication related to the use of saline irrigation and to the increased hemostatic efficacy. More recently, raising attention has been given to laser enucleation and vaporization techniques, which appear to achieve further advantages in terms of reduced hospital stay and complications compared to the resection ones. Few studies have investigated the cost/benefit ratio related to these techniques. The aim of this systematic review was to analyze the cost/benefit ratio of bipolar TURP (B-TURP) compared with other endoscopic procedures.
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Affiliation(s)
| | - Martina Maggi
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Daniele Castellani
- Department of Urology, Ospedali Riuniti di Ancona, Le Marche Polytechnic University, Ancona, Italy
| | - Alessandro Sciarra
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
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2
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Richard C, Robert G, Pradère B, Wilisch J, Doizi S, Le Calvez S, Negra ED. [Cost analysis of GreenLight photoselective vaporization of the prostate versus standard transurethral resection of the prostate: Benefit of ambulatory care]. Prog Urol 2021; 31:275-281. [PMID: 33461866 DOI: 10.1016/j.purol.2020.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/26/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare the costs associated with GreenLight XPS 180W photoselective vaporization of the prostate (PVP) for an outpatient versus standard transurethral resection of the prostate (TURP) with a three nights hospitalization in a French private hospital. MATERIAL AND METHODS A retrospective cost minimization analysis was performed between 2017 and 2019 in a French private hospital for the hospital stays associated with TURP and PVP procedures for benign prostatic hyperplasia (BPH). The peri-operative cost-benefit assessment of the two procedures was analyzed from the establishment's point of view according to the micro-costing method. RESULTS 871 surgical treatment for BPH had been performed during the period of the study, including 743 photoselective laser vaporization (85%). The average length of stay of patients undergoing TURP was 3,7 days versus 0,9 days for PVP including 64,7% ambulatory. The cost-benefit was more of 500€ per patient in favor of ambulatory PVP compared with TURP in conventional three nights hospitalization for level 1 hospital stays. CONCLUSION In this private hospital center, ambulatory PVP seemed more cost-effective than TURP with a three nights hospitalization for a severity level 1 patient. The financial profit for the establishment was mostly due to reduction of the main length of stay and ambulatory care. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- C Richard
- Service d'urologie, CHU de Rennes, Rennes, France.
| | - G Robert
- Service d'urologie, CHU de Bordeaux, Bordeaux, France
| | - B Pradère
- Service d'urologie, CHU Tours, Tours, France; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - J Wilisch
- Service d'urologie, Hôpital Privé Natecia, Lyon, France
| | - S Doizi
- Service d'urologie, Hôpital Thenon, Paris, France
| | - S Le Calvez
- Département d'information médicale, hôpital privé des côtes d'armor, Plérin, France
| | - E D Negra
- Centre briochin d'urologie, hôpital privé des côtes d'armor, Plérin, France
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3
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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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Caicedo JI, Taborda A, Robledo D, Bravo-Balado A, Domínguez C, Trujillo CG, Cataño JG, Campos Hernández J, Londoño Trujillo D, Plata M. Photovaporization of the prostate with GreenLight™ laser 180 W XPS versus transurethral resection of the prostate with monopolar energy for the treatment of benign prostatic enlargement: a cost-utility analysis from a healthcare perspective. World J Urol 2018; 37:861-866. [PMID: 30116964 DOI: 10.1007/s00345-018-2425-1] [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: 05/08/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To assess the cost-utility of the photovaporization of the prostate (PVP) with GreenLight™ laser 180 W XPS compared to transurethral resection of the prostate with monopolar energy (M-TURP) for lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) from a healthcare perspective in Colombia. METHODS We designed a Markov model to compare four health states following treatment with either PVP or M-TURP to estimate expected costs and outcomes. We used the results of the only randomized clinical trial published to date comparing PVP versus M-TURP to estimate surgical outcomes, complications, re-operation and re-intervention rates. Time horizon was defined at 2 years with four cycles of 6 months each. Resource-use estimation involved a random selection of clinical records from a local institution and cost list from public healthcare system. Costs were obtained in Colombian pesos and converted to US dollars. Threshold was defined at three-times the Colombian gross domestic product (GDP) per capita. Quality-adjusted-life-years (QALYs) were used based on the utilities of the available literature. Uncertainty was analyzed with deterministic and probabilistic models using a Monte Carlo simulation. RESULTS Patients who underwent PVP gained 1.81 QALYs compared to 1.59 with M-TURP. Costs were US$6797.98 and US$7777.59 for M-TURP and PVP, respectively. Incremental cost-effectiveness ratio was US$4452.81 per QALY, favoring PVP as a cost-effective alternative in our context. CONCLUSIONS In Colombia, with current prices, PVP is cost-effective when compared to M-TURP for LUTS due to BPE for a 2-year time horizon.
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Affiliation(s)
- Juan Ignacio Caicedo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09 Piso 3, Clínicas Urológicas, Bogotá D.C., 110111, Colombia.
| | - Alejandra Taborda
- Department of Public Health and Health Economics, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia
| | - Daniela Robledo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09 Piso 3, Clínicas Urológicas, Bogotá D.C., 110111, Colombia
| | - Alejandra Bravo-Balado
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09 Piso 3, Clínicas Urológicas, Bogotá D.C., 110111, Colombia
| | - Cristina Domínguez
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09 Piso 3, Clínicas Urológicas, Bogotá D.C., 110111, Colombia
| | - Carlos Gustavo Trujillo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09 Piso 3, Clínicas Urológicas, Bogotá D.C., 110111, Colombia
| | - Juan Guillermo Cataño
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09 Piso 3, Clínicas Urológicas, Bogotá D.C., 110111, Colombia
| | - Jonathan Campos Hernández
- Department of Public Health and Health Economics, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia
| | - Darío Londoño Trujillo
- Department of Public Health and Health Economics, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia
| | - Mauricio Plata
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09 Piso 3, Clínicas Urológicas, Bogotá D.C., 110111, Colombia
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Abstract
PURPOSE OF REVIEW To review the costs associated with benign prostatic hyperplasia (BPH) management. Specifically, to compare the costs of medical therapy, office-based procedures, and surgical management from a payer perspective. RECENT FINDINGS The American Urological Association released updated guidelines in 2018 for the surgical management of BPH. Over recent years, analyses investigating the cost-effectiveness of the modalities included in these guidelines have been completed. These show relatively newer, minimally-invasive office-based therapies can provide cost-effective alternatives to medical therapy. Likewise, surgical therapies provide a cost-effective means of BPH management, if performed well with low complication rates. However, comparisons of these studies are limited by the biases they contain. Minimally-invasive office-based therapies and well performed surgical therapies for BPH can achieve cost equivalence to combination medical therapy within a few years. Factors such as age, gland size, patient compliance, and surgeon skill should be considered when personalizing treatment recommendations for each patient.
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6
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Masucci L, Erman A, Krahn MD, Elterman D. Cost analysis of Greenlight photoselective vaporization of the prostate compared to transurethral resection of the prostate for benign prostatic hyperplasia. Can Urol Assoc J 2018; 12:382-387. [PMID: 29940137 DOI: 10.5489/cuaj.5267] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland, which results in the development of lower urinary tract symptoms that can interfere with a patient's daily activities and negatively impact their quality of life. The gold standard treatment for moderate to severe BPH has been transurethral resection of the prostate (TURP), however, this procedure is associated with prolonged hospitalizations and increased complications. An alternative to TURP is Greenlight photoselective vaporization of the prostate (PVP), which is associated with better perioperative safety. The objectives of the research were to 1) assess the cost of Greenlight PVP compared to TURP and bipolar TURP; and 2) assess the predictors of total cost. METHODS We conducted a descriptive costing study from the hospital perspective. We evaluated perioperative costs of patients who underwent each procedure from 2013-2015 at a tertiary academic medical centre. A multiple linear regression was performed to identify predictors of total cost. The variables included in regression analysis were patient age, type of procedure, Charlson Comorbidity Index, and distance to clinic. RESULTS A total of 202 patients received one of the three procedures over the study period. The total cost of Greenlight PVP was $3836 per patient compared to $4963 for TURP and $4978 for bipolar TURP. The linear regression showed that the Charlson Comorbidity Index and type of procedure were independent predictors of total cost. CONCLUSIONS The procedure costs and readmission rates are lower for Greenlight PVP compared to TURP and bipolar TURP, making it a preferable option for hospitals.
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Affiliation(s)
- Lisa Masucci
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University of Toronto.,Institute of Health Policy, Management, and Evaluation
| | - Aysegul Erman
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University of Toronto.,Leslie Dan Faculty of Pharmacy, University of Toronto
| | - Murray D Krahn
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University of Toronto.,Institute of Health Policy, Management, and Evaluation.,Leslie Dan Faculty of Pharmacy, University of Toronto
| | - Dean Elterman
- Division of Urology, University of Toronto.,Krembil Research Institute, Toronto Western Hospital, University Health Network; Toronto, ON, Canada
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7
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Rai P, Srivastava A, Dhayal IR, Singh S. Comparison of Safety, Efficacy and Cost Effectiveness of Photoselective Vaporization with Bipolar Vaporization of Prostate in Benign Prostatic Hyperplasia. Curr Urol 2017; 11:103-109. [PMID: 29593470 DOI: 10.1159/000447202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/23/2017] [Indexed: 11/19/2022] Open
Abstract
Objectives To compare bipolar vaporization of prostate (BPVP) with photoselective vaporization (PVP) of prostate in the surgical management of benign prostatic hyperplasia in terms of safety, efficacy and cost effectiveness. Methods Data was analyzed retrospectively for patients who underwent either PVP or BPVP between August 2012 to July 2014 for prostate size ≤ 80 ml. Preoperative and postoperative period values along with details like operative time, blood loss, hospitalization days, catheter removal time, blood transfusion and etc., were noted down. International prostatic symptom score, quality of life scores, post void residue, and maximum flow rate were recorded preoperatively and postoperatively at each follow-up visit. Follow-up was performed at 1, 3, 6, 12 and 18 months. Results Similar preoperative characteristics were observed in all the study arms. Hemoglobin drop, transfusion rate, catheter time and hospital days were similar in both the groups. The follow-up data indicates sustainable significant improvement in international prostatic symptom score, quality of life, post void residue and maximum flow rate in both the groups. As expected the cost of the procedure was significantly more in PVP group as compared to BPVP group (p < 0.01). Neither group had severe perioperative complications and no blood transfusion was required in both the groups. Conclusion Both PVP and BPVP were safe and effective alternatives in men requiring surgery for benign prostatic hyperplasia including patients who were on anticoagulants. Additionally, BPVP has the advantage of being significantly cheaper and therefore it can be more useful in developing countries.
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Affiliation(s)
- Priyanka Rai
- Department of Surgery, Dr. Ram Manohar Lohia Institute of Medical Sciences, Gomtinagar, Lucknow, India
| | - Alok Srivastava
- Department of Urology and Renal Transplant, Dr. Ram Manohar Lohia Institute of Medical Sciences, Gomtinagar, Lucknow, India
| | - Ishwar R Dhayal
- Department of Urology and Renal Transplant, Dr. Ram Manohar Lohia Institute of Medical Sciences, Gomtinagar, Lucknow, India
| | - Sanjeet Singh
- Department of Urology and Renal Transplant, Dr. Ram Manohar Lohia Institute of Medical Sciences, Gomtinagar, Lucknow, India
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Patelli G, Ranieri A, Paganelli A, Mauri G, Pacella CM. Transperineal Laser Ablation for Percutaneous Treatment of Benign Prostatic Hyperplasia: A Feasibility Study. Cardiovasc Intervent Radiol 2017; 40:1440-1446. [PMID: 28474112 DOI: 10.1007/s00270-017-1662-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 04/21/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE To assess the feasibility and safety of transperineal laser ablation (TPLA) for treating benign prostatic hyperplasia (BPH). MATERIALS AND METHODS Institutional review board approval was obtained for this prospective non-randomized trial. Eightteen patients (age 71.7 ± 9.4 years) with urinary symptoms secondary to BPH underwent TPLA under local anesthesia. Under US guidance, up to four 21G applicators were inserted in the prostatic tissue. Each treatment was performed with diode laser operating at 1064 nm changing the illumination time according to prostate size. Primary endpoints were technical success and safety of TPLA. Secondary endpoints included operation time, ablation time, energy deployed, hospitalization time, catheterization time, and change in International Prostate Symptom Score (IPSS), Quality of Life (QoL), peak urinary flow rate (Q max), post-void residual (PVR), and prostatic volume at 3 months. χ 2 and Fisher exact tests were used. RESULTS All procedures were technically successful. No complications occurred. Mean operation time was 43.3 ± 8.7 min, mean ablation time 15.9 ± 3.9 min, mean energy deployed 10,522 ± 3290.5 J, mean hospital stay 1.5 ± 0.4 days, and mean catheterization time 17.3 ± 10.0 days. At 3 months, IPSS improved from 21.9 to 10.7 (P < 0.001), QoL from 4.7 ± 0.6 to 2.1 ± 1.2 (P < 0.001), Q max from 7.6 to 13.3 mL/s (P = 0.001), PVR from 199.9 ± 147.3 to 81.5 ± 97.8 (P < 0.001), and mean prostate volume from 69.8 to 54.8 mL (P < 0.001). CONCLUSIONS TPLA is feasible and safe in the treatment of BPH, providing significant clinical results at 3 months. LEVEL OF EVIDENCE Case series, Level IV.
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Affiliation(s)
- Gianluigi Patelli
- Department of Interventional Radiology, Pesenti-Fenaroli Hospital-ASST Bergamo Est, 24022, Alzano Lombardo, Italy
| | - Antonio Ranieri
- Department of Urology, Pesenti-Fenaroli Hospital-ASST Bergamo Est, 24022, Alzano Lombardo, Italy
| | - Aurelio Paganelli
- Department of Urology, Pesenti-Fenaroli Hospital-ASST Bergamo Est, 24022, Alzano Lombardo, Italy
| | - Giovanni Mauri
- Department of Interventional Radiology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
| | - Claudio Maurizio Pacella
- Department of Diagnostic Imaging and Interventional Radiology, "Regina Apostolorum" Hospital, 00041, Alzano Lombardo, Italy
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Mathieu R, Lebdai S, Cornu J, Benchikh A, Azzouzi A, Delongchamps N, Dumonceau O, Faix A, Fourmarier M, Haillot O, Lukacs B, Misrai V, de La Taille A, Robert G, Descazeaud A. Perioperative and economic analysis of surgical treatments for benign prostatic hyperplasia: A study of the French committee on LUT. Prog Urol 2017; 27:362-368. [DOI: 10.1016/j.purol.2017.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 10/02/2016] [Accepted: 03/30/2017] [Indexed: 11/26/2022]
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10
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Smith C, Craig P, Taleb S, Young S, Golzarian J. Comparison of Traditional and Emerging Surgical Therapies for Lower Urinary Tract Symptoms in Men: A Review. Cardiovasc Intervent Radiol 2017; 40:1176-1184. [DOI: 10.1007/s00270-017-1575-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
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12
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Abstract
Transurethral resection of the prostate (TURP) and photoselective vaporization of the prostate (PVP) are currently the two most commonly performed procedures for the treatment of benign prostatic hyperplasia (BPH). While each procedure has been shown to be efficacious, TURP or PVP may be preferred in certain clinical scenarios. A number of factors may influence the choice of which patients undergo PVP or TURP. This decision may take into account patient characteristics, such as age, co-morbidities, predominance of irritative symptoms, and/or ongoing anticoagulation. Additionally, balancing desired outcomes with possible risks is critical. Considerations should include possible effects on sexual function, rates of reoperation, cost, and need for tissue specimen in those at risk for prostate cancer. The primary objective of this article is to summarize the comparative research of PVP and TURP and the implications on differences between patients who undergo either procedure.
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13
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Zhou Y, Xue B, Mohammad NA, Chen D, Sun X, Yang J, Dai G. Greenlight high-performance system (HPS) 120-W laser vaporization versus transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: a meta-analysis of the published results of randomized controlled trials. Lasers Med Sci 2016; 31:485-95. [PMID: 26868032 DOI: 10.1007/s10103-016-1895-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 01/26/2016] [Indexed: 12/20/2022]
Abstract
To assess the efficacy and the safety of Greenlight(TM) high-performance system (HPS) 120-W laser photoselective vaporization of the prostate (PVP) compared with transurethral resection of the prostate (TURP) for treatment of benign prostatic hyperplasia (BPH). The related original studies only including randomized controlled trials were searched by databases MEDLINE, EMBASE, Google Scholar, and the Cochrane Controlled Trial Register. The databases were updated till July 2014. The risk ratio, mean difference, and their corresponding 95% confidence intervals were calculated. Risk of bias of the enrolled trials were assessed according to Cochrane Handbook. A total of four trials involving 559 patients were enrolled. Statistical analysis was performed by software Review Manager (V5.3.3). There was no significant difference in International Prostate Symptom Score (IPSS) and maximum flow rate (Qmax) between PVP and TURP at 6-, 12-, and 24-month follow-up. Patients in the PVP group were associated with significantly lower risk of capsule perforation (risk ratio (RR) = 0.06, 95% confidence interval (95%CI) = 0.01 to 0.46; p = 0.007), significantly lower transfusion requirements (RR = 0.12, 95%CI = 0.03 to 0.43; p = 0.001), a shorter catheterization time (mean difference (MD) = -41.93, 95%CI = -54.87 to -28.99; p < 0.00001), and a shorter duration of hospital stay (MD = -2.09, 95%CI = -2.58 to -1.59; p < 0.00001) than that in the TURP group. In the TURP group, the patients were associated with a lower risk of re-operation (RR = 3.68, 95%CI = 1.04 to 13.00; p = 0.04) and a shorter operative time (MD = 9.28, 95%CI = 2.80 to 15.75; p = 0.005) than those in the PVP group. In addition, no statistically significant differences were detected between groups in terms of the rates of transurethral resection syndrome, urethral stricture, bladder neck contracture, incontinence, and infection. Greenlight(TM) 120-W laser PVP is as effective as TURP for symptom reduction and improvement of the quality of life. Laser PVP shows advantages over TURP in terms of intraoperative safety, whereas TURP is found to have a shorter operative time and lower re-operative risk.
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Affiliation(s)
- Yan Zhou
- Department of Urology, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Suzhou, Jiangsu, China
| | - Boxin Xue
- Department of Urology, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Suzhou, Jiangsu, China.
| | - Nadeem Ahmed Mohammad
- Department of Urology, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Suzhou, Jiangsu, China
| | - Dong Chen
- Department of Urology, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Suzhou, Jiangsu, China
| | - Xiaofei Sun
- Department of Urology, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Suzhou, Jiangsu, China
| | - Jinhui Yang
- Department of Urology, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Suzhou, Jiangsu, China
| | - Guangcheng Dai
- Department of Urology, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Suzhou, Jiangsu, China
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Hsu YC, Lin YH, Chou CY, Hou CP, Chen CL, Chang PL, Tsui KH. Economic Evaluation Study (Cheer Compliant) Laser Prostatectomy for Benign Prostatic Hyperplasia: Outcomes and Cost-effectiveness. Medicine (Baltimore) 2016; 95:e2644. [PMID: 26844483 PMCID: PMC4748900 DOI: 10.1097/md.0000000000002644] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To determine which surgical treatment for lower urinary tract symptoms, which is suggestive of benign prostatic hyperplasia (BPH), is more cost-effective and yields a better patient's preference. Treatment outcome, cost, and perioperative complications to assess the treatment effectiveness of using laser prostatectomy as a treatment for BPH were investigated in this study.This retrospective study included 100 patients who underwent transurethral resection of prostate (TUR-P) and another 100 patients who received high-powered 120 W (GreenLight HPS) laser prostatectomy between 2005 and 2011.International Prostate Symptom Score and uroflow parameters were collected before the surgery and the uroflow and postvoiding residual volumes were evaluated before treatment and at 3, 6, 12, and 24 months after treatment. The results of 100 treatments after HPS laser prostatectomy were compared with the results of 100 patients who received TUR-P from the same surgeon. Complication rates and admission costs were analyzed.From 2005 to 2011, 200 consecutive patients underwent endoscopic surgery. Study participants were men with BPH with mean age of 71.3 years old. The peak flow rate went from 8.47 to 15.83 mL/s for 3 months after laser prostatectomy. Laser therapy groups showed better improvement in symptom score, shortened length of stay, and quality of life score when compared with those of TUR-P procedures. The estimated cost for laser prostatectomy was high when compared with cost of any other TUR-P procedural option at Chang Gung Hospital (P = 0.001). All admission charges were similar except for the cost of the laser equipment and accessories (mainly the laser fiber) (P = 0.001). Due to this cost of equipment, it increased the total admission charges for the laser group and therefore made the cost for the laser group higher than that of the TUR-P group.Perioperative complications, such as the need for checking for bleeding, urinary retention rate or urosepsis rate within 30 days after the surgery, held no significant differences between both groups.Compared with alternative treatment options, laser prostatectomy of the prostate is clinically effective but yields a high cost of treatment for symptomatic BPH.
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Affiliation(s)
- Yu-Chao Hsu
- From the Department of Urology and Medicine, Prostate Health Laser Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan (Y-CH, Y-HL, C-PH, C-YC, C-LC, P-LC, K-HT) and Department of Urology, Show Chwan Memorial Hospital, Changhua, Taiwan (C-YC)
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15
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McCahy PJ, Cheng K, Paul E, Gleeson J. The cost of photoselective vaporization of the prostate compared to transurethral resection of the prostate: Experience in a large public Australian teaching centre. JOURNAL OF CLINICAL UROLOGY 2014. [DOI: 10.1177/2051415814526391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The purpose of this study was to compare the cost of photoselective vaporization of the prostate (PVP) with transurethral resection of the prostate (TURP) in the treatment of men with bladder outflow obstruction (BOO). Patients and methods: Men underwent PVP or TURP for clinical BOO or urinary retention. We developed a cost framework to calculate the costs of theatre, recovery and ward time in our publically funded institution and calculated a cost for each procedure including the initial stay and any associated admissions over the first 60 days. These costs were statistically analyzed. Results: A total of 99 men underwent PVP and 97 had TURP. Groups were well matched for age and operative indication. The American Society of Anesthesia (ASA) grade was higher for the PVP group with more taking anticoagulants (36% versus 3.1%). PVP was 74% more expensive (median AUD$4243 vs AUD$2439, p<0.001) than TURP, even in a sub-set analysis excluding the anticoagulated patients. This was because of longer operating time and unavoidable disposable costs. Conclusions: Previous cost studies have all had significant flaws. Using our “bottom up” cost framework suggests that the unavoidable costs of purchasing a laser, single use laser fibers and other paraphernalia will almost always exceed the costs associated with in-patient stay. We caution against establishing a PVP service in a public hospital setting.
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Affiliation(s)
- PJ McCahy
- Monash University, Victoria, Australia
- Department of Urology, Monash Health, Australia
| | - K Cheng
- Department of Urology, Monash Health, Australia
| | - E Paul
- School of Public Health and Preventive Medicine, Monash University, Australia
| | - J Gleeson
- Department of Urology, Monash Health, Australia
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16
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Roberts WW, Teofilovic D, Jahnke RC, Patri J, Risdahl JM, Bertolina JA. Histotripsy of the Prostate Using a Commercial System in a Canine Model. J Urol 2014; 191:860-5. [DOI: 10.1016/j.juro.2013.08.077] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
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17
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Chughtai B, Te A. Photoselective vaporization of the prostate for treating benign prostatic hyperplasia. Expert Rev Med Devices 2014; 8:591-5. [DOI: 10.1586/erd.11.25] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Abstract
Lasers have come a long way in the management of benign prostatic hyperplasia. Over last nearly two decades, various different lasers have been utilized for prostatectomy. Neodymium: yttrium-aluminum-garnet laser that started this journey, is no longer used for prostatectomy. Holmium laser can achieve transurethral enucleation of the prostatic adenoma producing a fossa that can be compared with the fossa after Freyer's prostatectomy. Green light laser has a short learning curve, is nearly blood-less with good immediate results. Thulium laser is a faster cutting laser while diode laser is a portable laser device. Often laser prostatectomy is considered as a replacement for the standard transurethral resection of prostate (TURP). To be comparable, laser should reduce or avoid the immediate and long-term complications of TURP, especially bleeding and need for blood transfusion. It should also be safe in the ever increasing patient population on antiplatelet and anticoagulant drugs. We need to take stock of the situation and identify, which among the present day lasers has stood the test of time. A review of the literature was performed to see if any of these lasers could be called the “best laser for prostatectomy in 2013.”
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Affiliation(s)
- Pankaj N Maheshwari
- Department of Urology, Aditya Birla Memorial Hospital, Chinchwad, Pune, Maharashtra, India
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19
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Osterberg EC, Choi BB. Review of current laser therapies for the treatment of benign prostatic hyperplasia. Korean J Urol 2013; 54:351-8. [PMID: 23789041 PMCID: PMC3685632 DOI: 10.4111/kju.2013.54.6.351] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 05/20/2013] [Indexed: 12/11/2022] Open
Abstract
The gold standard for symptomatic relief of bladder outlet obstruction secondary to benign prostatic hyperplasia has traditionally been a transurethral resection of the prostate (TURP). Over the past decade, however, novel laser technologies that rival the conventional TURP have multiplied. As part of the ongoing quest to minimize complications, shorten hospitalization, improve resection time, and most importantly reduce mortality, laser prostatectomy has continually evolved. Today, there are more variations of laser prostatectomy, each with several differing surgical techniques. Although abundant data are available confirming the safety and feasibility of the various laser systems, future randomized-controlled trials will be necessary to verify which technique is superior. In this review, we describe the most common modalities used to perform a laser prostatectomy, mainly, the holmium laser and the potassium-titanyl-phosphate lasers. We also highlight the physical and clinical characteristics of each technology with a review of the most current and highest-quality literature.
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Whitty JA, Crosland P, Hewson K, Narula R, Nathan TR, Campbell PA, Keller A, Scuffham PA. A cost-minimisation analysis comparing photoselective vaporisation (PVP) and transurethral resection of the prostate (TURP) for the management of symptomatic benign prostatic hyperplasia (BPH) in Queensland, Australia. BJU Int 2013; 113 Suppl 2:21-8. [PMID: 23574626 DOI: 10.1111/bju.12051] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare the costs of photoselective vaporisation (PVP) and transurethral resection of the prostate (TURP) for management of symptomatic benign prostatic hyperplasia (BPH) from the perspective of a Queensland public hospital provider. PATIENTS AND METHODS A decision-analytic model was used to compare the costs of PVP and TURP. Cost inputs were sourced from an audit of patients undergoing PVP or TURP across three hospitals. The probability of re-intervention was obtained from secondary literature sources. Probabilistic and multi-way sensitivity analyses were used to account for uncertainty and test the impact of varying key assumptions. RESULTS In the base case analysis, which included equipment, training and re-intervention costs, PVP was AU$ 739 (95% credible interval [CrI] -12 187 to 14 516) more costly per patient than TURP. The estimate was most sensitive to changes in procedural costs, fibre costs and the probability of re-intervention. Sensitivity analyses based on data from the most favourable site or excluding equipment and training costs reduced the point estimate to favour PVP (incremental cost AU$ -684, 95% CrI -8319 to 5796 and AU$ -100, 95% CrI -13 026 to 13 678, respectively). However, CrIs were wide for all analyses. CONCLUSIONS In this cost minimisation analysis, there was no significant cost difference between PVP and TURP, after accounting for equipment, training and re-intervention costs. However, PVP was associated with a shorter length of stay and lower procedural costs during audit, indicating PVP potentially provides comparatively good value for money once the technology is established.
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Affiliation(s)
- Jennifer A Whitty
- Centre for Applied Health Economics, School of Medicine, and Population and Social Health Research Program, Griffith Health Institute, Griffith University, Meadowbrook, Queensland, Australia
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21
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Bae WJ, Ahn SG, Bang JH, Bae JH, Choi YS, Kim SJ, Cho HJ, Hong SH, Lee JY, Hwang TK, Kim SW. Risk Factors for Failure of Early Catheter Removal After Greenlight HPS Laser Photoselective Vaporization Prostatectomy in Men With Benign Prostatic Hyperplasia. Korean J Urol 2013; 54:31-5. [PMID: 23362445 PMCID: PMC3556551 DOI: 10.4111/kju.2013.54.1.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 06/04/2012] [Indexed: 12/03/2022] Open
Abstract
Purpose To assess the risk factors for developing urinary retention after removal of the urethral catheter on postoperative day 1 in benign prostatic hyperplasia patients who underwent Greenlight HPS laser photoselective vaporization prostatectomy (PVP). Materials and Methods The study included 427 men who underwent Greenlight HPS laser PVP between 2009 and 2012, excluding patients in whom a catheter was maintained for more than 1 day because of urethral procedures. In all patients, a voiding trial was performed on postoperative day 1; if patients were unable to urinate, the urethral catheter was replaced before hospital discharge. The patients were divided into two groups: early catheter removal (postoperative day 1) and late catheter removal (urethral catheter reinsertion). Preoperative and perioperative parameters were compared between the groups. Results Catheters were successfully removed in 378 (88.6%) patients on postoperative day 1. In 49 patients, the catheters were reinserted and removed a mean of 6.45±0.39 days after surgery. In a multivariate analysis, a history of diabetes was the most significant predictor (p=0.028) of failure of early catheter removal, followed by operative time (p=0.039). There were no significant differences in age, prostate volume, International Prostate Symptom Score, or urodynamic parameters between the two groups. Conclusions It is feasible, safe, and cost-effective to remove the urethral catheter on postoperative day 1 after Greenlight HPS laser PVP, but the procedure should be done carefully in patients who have history of diabetes or an extended operative time.
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Affiliation(s)
- Woong Jin Bae
- Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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Rollin G, Soler P, Rischmann P, Fabre D, Malavaud B, Soulié M, Molinier L. [Transurethral resection (TUR) in saline plasma vaporization of the prostate versus standard TUR of the prostate: an economic evaluation]. Prog Urol 2012; 22:963-9. [PMID: 23102019 DOI: 10.1016/j.purol.2012.08.270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 08/16/2012] [Accepted: 08/17/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate and compare the hospital costs of the transurethral resection in saline plasma vaporization of the prostate (TURis-PVP) and the standard TUR of the prostate (TURP). BACKGROUND their efficiency and short terms outcomes are similar. PATIENTS AND METHODS In an observational retrospective and monocentric study, 86 consecutive patients with benign prostatic enlargement (BPE) secondary to benign prostatic hyperplasia (BPH) were enrolled in two non randomized groups. TURP was performed in 44 cases and TURis-PVP in 42 cases. Patients with prostate cancer, urethral stenosis or bladder neck stenosis were not included. Hospital costs with a 3-month follow-up were measured using the database and hospital cost accounting system of the Medical Information Department. RESULTS Patients from both series had similar preoperative characteristics concerning the age, ASA score, urologic history, and antithrombosis treatments. Catheterization period, complications and rehospitalisation rates were similar. With TURis-PVP, prostatic volume was larger (60±24mL vs. 42±16mL; P<0.05), hospital stay was shorter (4.0±2.8days vs. 4.4±2.1days; P<0.05), single-used materials costs were higher (332±64€ vs. 40±18€; P<0.05). The costs of the first hospitalization were 3721±843€ with TURis-PVP and were 3712±880€ with TURP (P=0.14). Global costs with a 3-month follow-up were 3867±1104€ with TURis-PVP and were 4074±1624€ with TURP (P=0.53). CONCLUSION In this study, the costs for the hospital are lightly higher in TURis-PVP, due to single use systems, but there is no significant difference for global costs between TURP and TURis-PVP with a 3-month follow-up difference for the health care system.
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Affiliation(s)
- G Rollin
- Service d'urologie, CHU de Toulouse, Toulouse cedex, France.
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Ding H, Du W, Lu ZP, Zhai ZX, Wang HZ, Wang ZP. Photoselective green-light laser vaporisation vs. TURP for BPH: meta-analysis. Asian J Androl 2012; 14:720-5. [PMID: 22902908 DOI: 10.1038/aja.2012.56] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This study sought to evaluate the efficacy and safety of photoselective vaporisation (PVP) vs. transurethral resection of the prostate (TURP) for patients with benign prostatic hyperplasia (BPH). Eligible studies were identified from electronic databases (Cochrane Library, PubMed and EMBASE). The database search, quality assessment and data extraction were performed independently by two reviewers. Efficacy (primary outcomes: maximum urinary flow rate (Q(max)), international prostate symptom score (IPSS), postvoid residual urine (PVR) and quality of life (QoL); secondary outcomes: operative time, hospital time and catheter removal time) and safety (complications, such as transfusion and capsular perforation) were explored by using Review Manager 5.0. Six randomized controlled trials (RCTs) and five case-controlled studies of 1398 patients met the inclusion criteria. A meta-analysis of the extractable data showed that there were no differences in IPSS, Q(max), QoL or PVR between PVP and TURP (mean difference (MD): prostate sizes <70 ml, Q(max) at 24 months, MD=0.01, P=0.97; IPSS at 12 months, MD=0.18, P=0.64; QoL at 12 months, MD=-0.00, P=0.96; PVR at 12 months, MD=0.52, P=0.43; prostate sizes >70 ml, Q(max) at 6 months, MD=-3.46, P=0.33; IPSS at 6 months, MD=3.11, P=0.36; PVR at 6 months, MD=25.50, P=0.39). PVP was associated with a shorter hospital time and catheter removal time than TURP, whereas PVP resulted in a longer operative time than TURP. For prostate sizes <70 ml, there were fewer transfusions, capsular perforations, incidences of TUR syndrome and clot retentions following PVP compared with TURP. These results indicate that PVP is as effective and safe as TURP for BPH at the mid-term patient follow-up, in particular for prostate sizes <70 ml. Due to the different energy settings available for green-light laser sources and the higher efficiency and performance of higher-quality lasers, large-sample, long-term RCTs are required to verify whether different energy settings affect outcomes.
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Affiliation(s)
- Hui Ding
- Institute of Urology, Key Laboratory of Urological Diseases in Gansu Province, Gansu Nephro-Urological Clinical Center, The Second Hospital of Lanzhou University, Lanzhou 730000, China
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Malaeb BS, Yu X, McBean AM, Elliott SP. National trends in surgical therapy for benign prostatic hyperplasia in the United States (2000-2008). Urology 2012; 79:1111-6. [PMID: 22546389 DOI: 10.1016/j.urology.2011.11.084] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 11/19/2011] [Accepted: 11/22/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report an update of the change in usage trends for different surgical treatments of benign prostatic hyperplasia (BPH) among the United States Medicare population data from 2000-2008. The rate of usage of thermotherapy and laser therapy in the surgical treatment of BPH has been changing over the past decade in conjunction with a steady decrease of transurethral resection of the prostate (TURP). METHODS Using the 100% Medicare carrier file for the years 2000-2008, we calculated counts and population-adjusted rates of BPH surgery. Rates of TURP, thermotherapy, and laser-using modalities were calculated and compared in relation to age, race, clinical setting, and reimbursement. RESULTS After years of a steady rise, the total rate of all BPH procedures peaked in 2005 at 1078/100,000 and then declined by 15.4% to 912/100,000 in 2008. TURP rates continued to decline from 670 in 2000 to 351/100,000 in 2008. Rates of microwave thermoablation peaked in 2006 at 266/100,000 and then declined 26% in 2008. Laser vaporization almost completely replaced laser coagulation and in 2008 was the most commonly performed procedure second to TURP, with the majority performed as outpatient procedures (70%) and an increasing percentage in the office (12%). Men between ages 70 and 75 had the highest rate of procedures. Reimbursement rates correlate using some but not all procedures. Racial disparities reported previously appear to have resolved. CONCLUSION Surgical treatment of BPH continues to change rapidly. TURP continues to decline and laser vaporization is the fastest growing modality. There is a big shift toward outpatient/office procedures. Reimbursement rates do not appear to have a consistent effect on usage.
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Affiliation(s)
- Bahaa S Malaeb
- Department of Urology, University of Minnesota, Minneapolis, Minnesota 55455, USA
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Does prostate configuration affect the efficacy and safety of GreenLight HPS™ laser photoselective vaporization prostatectomy (PVP)? Lasers Med Sci 2012; 28:473-8. [PMID: 22460737 DOI: 10.1007/s10103-012-1085-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 03/13/2012] [Indexed: 12/19/2022]
Abstract
We evaluate the efficacy and safety of GreenLight HPS™ laser photoselective vaporization prostatectomy (PVP) for the treatment of benign prostatic hyperplasia (BPH) with different prostate configuration. Patients were stratified into two groups: bilobe (group I) and trilobe (group II) BPH. Transurethral PVP was performed using a 120 W GreenLight HPS™ side-firing laser system. American Urological Association Symptom Score (AUASS), Quality of Life (QoL) score, maximum flow rate (Q max), and postvoid residual (PVR) were measured preoperatively and at 1 and 4 weeks and 3, 6, 12, 18, 24 and 36 months postoperatively. A number of 160 consecutive patients were identified (I: 86, II: 74). Among the preoperative parameters, there were significant differences (p < 0.05) in prostate volume (I: 46.0 ± 19.8; II: 87.5 ± 39.6 ml), Q max (I: 9.9 ± 3.9; II: 8.7 ± 3.5 ml/sec), PVR (I: 59.2 ± 124.6; II: 97.7 ± 119.1 ml) and PSA (I: 1.4 ± 1.4; II: 3.6 ± 2.6 ng/ml), while AUASS and QoL were similar (p > 0.05). Significant differences (p < 0.05) in laser utilization (I: 9.5 ± 6.6; II: 19.5 ± 11.6 min) and energy usage (I: 63.1 ± 43.9; II: 132.5 ± 81.1 kJ) were noted. Clinical outcomes (AUASS, QoL, Q max, and PVR) showed immediate and stable improvement from baseline (p < 0.05) within each group, but no significant differences between the two groups were observed during the follow-up period (p > 0.05). The incidences of adverse events were low and similar in both groups. Our experience suggests that BPH configuration has little effect on the efficacy and safety of GreenLight HPS™ laser PVP.
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Gu X, Strom K, Spaliviero M, Wong C. Does age affect the efficacy and safety of GreenLight HPS™ laser photoselective vaporization prostatectomy? Aging Male 2012; 15:63-7. [PMID: 22129103 DOI: 10.3109/13685538.2011.632452] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To evaluate the efficacy and safety of GreenLight HPS(™) (High Performance System) laser photoselective vaporization prostatectomy (PVP) for the treatment of benign prostatic hyperplasia (BPH) in patients of different age groups. METHODS 164 consecutive patients were stratified into two groups: age <70 (group I, n = 93) and age ≥70 (group II, n = 71) years. Transurethral PVP was performed using a GreenLight HPS™ side-firing laser system. Voiding parameters were measured preoperatively and at 1 and 4 weeks and 3, 6, 12, 18, 24 and 36 months postoperatively. RESULTS Among the preoperative parameters evaluated, there were significant differences (p < 0.05) in prostate volume (I: 58.7; II: 73.6 mL) and serum prostate-specific antigen (I: 1.9; II: 2.9 ng/mL), while American Urological Association Symptom Score (AUASS), Quality of Life (QoL), maximum flow rate (Qmax), Sexual Health Inventory for Men (SHIM) and post void residual (PVR) were similar (p > 0.05) between groups. No significant differences in laser utilization, energy usage and operating time were noted. Clinical outcomes (AUASS, QoL, Qmax, PVR) showed immediate and stable improvement from baseline (p < 0.05) within each group, but no significant differences between the two groups were observed during the follow-up period. The incidence of adverse events was low and similar in both groups. CONCLUSIONS The results suggest that age has little effect on the efficacy and safety of GreenLight HPS™ laser PVP.
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Affiliation(s)
- Xiao Gu
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, USA
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27
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Liatsikos E, Kyriazis I, Kallidonis P, Sakellaropoulos G, Maniadakis N. Photoselective GreenLight™ laser vaporization versus transurethral resection of the prostate in Greece: a comparative cost analysis. J Endourol 2011; 26:168-73. [PMID: 22050499 DOI: 10.1089/end.2011.0089] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To compare photoselective vaporization of the prostate (PVP) using the 120W GreenLight™ laser with transurethral resection of the prostate (TURP) in terms of their cost to the Greek National Health Service (NHS) or to the Public Insurance Sickness Funds (PISF). PATIENTS AND METHODS A prospective cost evaluation with 1-year follow-up of 60 patients with infravesical obstruction of benign prostatic hyperplasia origin who underwent o either TURP (n=30) or PVP (n=30). The cost of equipment, consumables, anesthesia, drugs, inpatient hospitalization, and complication management within 1 year postoperatively were used to calculate the cost for the NHS. PISF reimbursements to hospitals and PISF opportunity cost from the lost days of work were used to calculate PISF perspective. RESULTS From the NHS perspective, the average cost was €1722 ($2371) for PVP and €2132 ($2935) for TURP. From the PISF perspective, the average cost for hospital reimbursement was €1348 ($1856) in the case of PVP and €938 ($1291) in the case of TURP. Nevertheless, in the case of patients still working, total PISF reimbursement cost was €2038 ($2806) for PVP and €2666 ($3671) for TURP. CONCLUSIONS PVP for 40 to 70 cc prostates is preferable from the perspective of the NHS. From the perspective of PISF, PVP is less costly only in the case of patients who are still working, because patients who undergo PVP stay much less out of work. Further investigation in larger populations as well as in different protocols of PVP hospitalization and return to work times is deemed necessary to reinforce the conclusions of this study.
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Liatsikos E, Kyriazis I, Kallidonis P, Stolzenburg JU. Bloodless management of benign prostatic hyperplasia: medical and minimally invasive treatment options. Aging Male 2011; 14:141-9. [PMID: 21247241 DOI: 10.3109/13685538.2010.548881] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is a medical condition affecting a wide range of the aging male population resulting in various degrees of lower urinary tract symptoms (LUTS). Today, a variety of medical therapies and minimally invasive BPH treatment modalities are available. Medical therapy includes α(1) blockers, 5()α reductase inhibitors and combination therapy. When these options fail, surgery is indicated. Transurethral resection of the prostate (TURP) is still considered the gold standard surgical treatment for BPH. Nevertheless, numerous minimally invasive treatment alternatives are available that are comparable in effectiveness to TURP, with significantly less morbidity. In this article, current treatment options for BPH are reviewed with respect to their indications, long-term safety and efficacy in relieving BPH related LUTS. The selection of the type of BPH treatment should be based on the physician's experience, patient's co-morbidities as well as the prostate size and clinical disease progression.
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29
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Sexual function outcome following photoselective vaporisation of the prostate. Int Urol Nephrol 2011; 44:359-64. [DOI: 10.1007/s11255-011-0029-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Accepted: 06/24/2011] [Indexed: 10/18/2022]
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Gu X, Strom K, Spaliviero M, Wong C. Intermediate Outcomes of GreenLight HPS™ Laser Photoselective Vaporization Prostatectomy for Symptomatic Benign Prostatic Hyperplasia. J Endourol 2011; 25:1037-41. [DOI: 10.1089/end.2010.0512] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Xiao Gu
- Department of Urology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- Department of Urology, The First Clinical Medical College at Yangzhou University, Yangzhou, China
| | - Kurt Strom
- Department of Urology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Massimiliano Spaliviero
- Department of Urology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Carson Wong
- Department of Urology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Gravas S, Bachmann A, Reich O, Roehrborn CG, Gilling PJ, De La Rosette J. Critical review of lasers in benign prostatic hyperplasia (BPH). BJU Int 2011; 107:1030-43. [DOI: 10.1111/j.1464-410x.2010.09954.x] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Antoniewicz AA, Alivizatos G, Zapała Ł, de Reijke TM. GreenLight™ laser in the treatment of lower urinary tract symptoms due to benign prostatic enlargement. Expert Rev Med Devices 2011; 8:139-47. [PMID: 21381906 DOI: 10.1586/erd.10.91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
For more than a decade, laser technology has facilitated a minimally invasive surgical method to treat patients with bladder outlet obstruction caused by benign prostatic hyperplasia. This article critically assesses the features of the GreenLight™ laser and its potential use in the treatment of lower urinary tract symptoms in benign prostatic hyperplasia patients. Recently, a significant body of evidence in the literature on good clinical outcomes in 1-year follow-up periods has been enriched with the findings from a few randomized trials, in which this device is compared with other minimally invasive or standard approaches. In turn, very few patients in the GreenLight laser study groups reach the end point of a 3- or 5-year follow-up time. However, most patients who underwent GreenLight laser treatment were treated successfully with a good clinical outcome and a minor rate of peri- and post-operative complications. Furthermore, it can be implemented in high-risk patients who are undergoing anticoagulation therapy. Bearing in mind the inherent characteristics of using a laser for treatment, one obvious consequence is that no pathological specimen remains for further study. This implies the necessity of suitable patient selection in whom the risk of prostate cancer should be minimal. In terms of cost-effectiveness, one should consider applying this method when dealing with patients who have a moderately enlarged prostate volume.
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Affiliation(s)
- Artur A Antoniewicz
- Clinic of Urology, The Medical Centre of Postgraduate Education, Department of Urology, Multidisciplinary Hospital Warsaw-Miedzylesie, 2 Bursztynowa Str., 04-749 Warsaw, Poland
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Schwartz J, Renard J, Wolf JP, Moret M, Iselin CE. High-power potassium-titanyl-phosphate laser fibres for endovaporization of benign prostatic hyperplasia: how much do they deteriorate during the procedure? BJU Int 2010; 107:1938-42. [DOI: 10.1111/j.1464-410x.2010.09760.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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De Nunzio C, Miano R, Trucchi A, Miano L, Franco G, Squillacciotti S, Tubaro A. Photoselective Prostatic Vaporization for Bladder Outlet Obstruction: 12-Month Evaluation of Storage and Voiding Symptoms. J Urol 2010; 183:1098-103. [DOI: 10.1016/j.juro.2009.11.050] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Cosimo De Nunzio
- Departments of Urology, Sant'Andrea Hospital, University “La Sapienza” and Policlinico Tor Vergata, University “Tor Vergata” (RM), Rome, Italy
| | - Roberto Miano
- Departments of Urology, Sant'Andrea Hospital, University “La Sapienza” and Policlinico Tor Vergata, University “Tor Vergata” (RM), Rome, Italy
| | - Alberto Trucchi
- Departments of Urology, Sant'Andrea Hospital, University “La Sapienza” and Policlinico Tor Vergata, University “Tor Vergata” (RM), Rome, Italy
| | - Lucio Miano
- Departments of Urology, Sant'Andrea Hospital, University “La Sapienza” and Policlinico Tor Vergata, University “Tor Vergata” (RM), Rome, Italy
| | - Giorgio Franco
- Departments of Urology, Sant'Andrea Hospital, University “La Sapienza” and Policlinico Tor Vergata, University “Tor Vergata” (RM), Rome, Italy
| | - Stefano Squillacciotti
- Departments of Urology, Sant'Andrea Hospital, University “La Sapienza” and Policlinico Tor Vergata, University “Tor Vergata” (RM), Rome, Italy
| | - Andrea Tubaro
- Departments of Urology, Sant'Andrea Hospital, University “La Sapienza” and Policlinico Tor Vergata, University “Tor Vergata” (RM), Rome, Italy
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Goh AC, Gonzalez RR. Photoselective laser vaporization prostatectomy versus transurethral prostate resection: a cost analysis. J Urol 2010; 183:1469-73. [PMID: 20172555 DOI: 10.1016/j.juro.2009.12.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE Laser procedures to treat symptomatic benign prostatic hyperplasia are becoming more common despite concern for potentially increasing cost burdens often associated with new technologies. MATERIALS AND METHODS Actual costs associated with photoselective laser vaporization prostatectomy and transurethral prostate resection were measured using the EPSi and TSI (Eclipsys) hospital cost accounting systems at 2 large tertiary referral centers for the first 12 months that GreenLight HPS was performed. Only patients who presented for photoselective laser vaporization prostatectomy or transurethral prostate resection as the principal treatment during the hospital visit were included in study. RESULTS A total of 250 men underwent transurethral prostate resection and 220 underwent photoselective laser vaporization prostatectomy, including 194 (78%) and 209 (95%), respectively, treated on an outpatient basis with less than 23 hours of hospitalization. Overall costs of laser vaporization were lower than those of transurethral prostate resection ($4,266 +/- $1,182 vs $5,097 +/- $5,003, p = 0.01). Average inpatient length of stay was also longer in the resection group. CONCLUSIONS The actual costs of photoselective laser vaporization prostatectomy at our affiliated hospitals are lower than those of transurethral prostate resection. The primary reason is likely that most patients who undergo laser vaporization are treated on an outpatient basis compared to those who undergo resection. While significant complications are uncommon, those that prolong inpatient hospitalization such as hyponatremia (transurethral resection syndrome), which is associated with transurethral prostate resection but not with photoselective laser vaporization prostatectomy, can add substantial expense. Further studies are warranted to investigate these findings on a broader scale.
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Affiliation(s)
- Alvin C Goh
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA
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Benejam Gual J, Díez-Caballero Alonso F, García-Miralles Grávalos R, Servera Ruiz de Velasco A. Fotovaporización prostática láser Greenlight HPS en régimen de cirugía mayor ambulatoria. Actas Urol Esp 2010. [DOI: 10.1016/s0210-4806(10)70035-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Capitán Manjón C, de la Morena Gallego JM, de la Peña Zarzuelo E, Gómez dos Santos V, Llorente Abarca C. [Photoselective vaporization of the prostate with Laser Greenlight HPS: current role, technical aspects and review of the literature]. Actas Urol Esp 2009; 33:771-7. [PMID: 19757663 DOI: 10.1016/s0210-4806(09)74230-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Photoselective vaporization of the prostate with 120W HPS Greenlight laser is one of the most attractive modalities of surgical treatment for benign prostatic hyperplasia at present. The specific physical characteristics of this laser provides an excellent safety and effectiveness profile, making it the ideal technique for high-risk patients or patients ongoing oral anticoagulation. Moreover, the undeniable reduction of urethral catheterization time and hospital stay compared to transurethral resection of prostate (TURP) involves a much more comfortable postoperative period for patients. We have conducted a Medline/Pubmed search, presenting in this review the outcomes and current surgical techniques described in recent studies. We have also reviewed the controversial aspects and limitations attributed to this technique.
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A Review of the Recent Evidence (2006–2008) for 532-nm Photoselective Laser Vaporisation and Holmium Laser Enucleation of the Prostate. Eur Urol 2009; 55:1345-57. [DOI: 10.1016/j.eururo.2009.03.070] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 03/16/2009] [Indexed: 01/18/2023]
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Armstrong N, Vale L, Deverill M, Nabi G, McClinton S, N'Dow J, Pickard R. Surgical treatments for men with benign prostatic enlargement: cost effectiveness study. BMJ 2009; 338:b1288. [PMID: 19372131 PMCID: PMC2669854 DOI: 10.1136/bmj.b1288] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine which surgical treatment for lower urinary tract symptoms suggestive of benign prostate enlargement is cost effective. DESIGN Care pathways describing credible treatment strategies were decided by consensus. Cost-utility analysis used Markov modelling and Monte Carlo simulation. DATA SOURCES Clinical effectiveness data came from a systematic review and an individual level dataset. Utility values came from previous economic evaluations. Costs were calculated from National Health Service (NHS) and commercial sources. METHODS The Markov model included parameters with associated measures of uncertainty describing health states between which individuals might move at three monthly intervals over 10 years. Successive annual cohorts of 25,000 men were entered into the model and the probability that treatment strategies were cost effective was assessed with Monte Carlo simulation with 10,000 iterations. RESULTS A treatment strategy of initial diathermy vaporisation of the prostate followed by endoscopic holmium laser enucleation of the prostate in case of failure to benefit or subsequent relapse had an 85% probability of being cost effective at a willingness to pay value of pound20,000 (euro21,595, $28,686)/quality adjusted life year (QALY) gained. Other strategies with diathermy vaporisation as the initial treatment were generally cheaper and more effective than the current standard of transurethral resection repeated once if necessary. The use of potassium titanyl phosphate laser vaporisation incurred higher costs and was less effective than transurethral resection, and strategies involving initial minimally invasive treatment with microwave thermotherapy were not cost effective. Findings were unchanged by wide ranging sensitivity analyses. CONCLUSION The outcome of this economic model should be interpreted cautiously because of the limitations of the data used. The finding that initial vaporisation followed by holmium laser enucleation for failure or relapse might be advantageous both to men with lower urinary tract symptoms and to healthcare providers requires confirmation in a good quality prospective clinical trial before any change in current practice. Potassium titanyl phosphate laser vaporisation was unlikely to be cost effective in our model, which argues against its unrestricted use until further evidence of effectiveness and cost reduction is obtained.
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Affiliation(s)
- Nigel Armstrong
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne NE2 4AA
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Hai MA. Photoselective Vaporization of Prostate: Five-year Outcomes of Entire Clinic Patient Population. Urology 2009; 73:807-10. [DOI: 10.1016/j.urology.2008.08.502] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 08/06/2008] [Accepted: 08/12/2008] [Indexed: 11/29/2022]
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Jeon GS, Won JH, Lee BM, Kim JH, Ahn HS, Lee EJ, Park SI, Park SW. The Effect of Transarterial Prostate Embolization in Hormone-induced Benign Prostatic Hyperplasia in Dogs: A Pilot Study. J Vasc Interv Radiol 2009; 20:384-90. [DOI: 10.1016/j.jvir.2008.11.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 11/05/2008] [Accepted: 11/10/2008] [Indexed: 12/17/2022] Open
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Spaliviero M, Araki M, Wong C. Short-term outcomes of Greenlight HPS laser photoselective vaporization prostatectomy (PVP) for benign prostatic hyperplasia (BPH). J Endourol 2008; 22:2341-7. [PMID: 18937595 DOI: 10.1089/end.2008.9708] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We evaluated our initial experience with the GreenLight HPS laser, a technologically improved version of the potassium-titanyl-phosphate (KTP) laser for PVP. MATERIALS AND METHODS Transurethral PVP was performed using a GreenLight HPS side-firing laser system. Patients had American Urological Association Symptom Score (AUASS), Quality of Life (QoL) score, Sexual Health Inventory for Men (SHIM) score, serum prostate specific antigen (PSA), maximum flow rate (Qmax) and post void residual (PVR) determinations and volumetric prostate measurements with transrectal ultrasonography (TRUS). Laser and operative times and energy usage were recorded. AUASS, QoL, SHIM, Qmax and PVR were evaluated 1, 4, 12, 24, and 52 weeks post-surgery. Serum PSA and TRUS were obtained at 12 weeks and serum PSA was repeated at 52 weeks. RESULTS Seventy consecutive patients with a median age of 67 (45-86) years underwent GreenLight HPS laser PVP from July 2006 through March 2008. Median prostate volume was 61.6 (20.9-263.0) mL with a median PSA of 1.4 (0.1 -10.1) ng/mL. Mean laser and operative times and energy usage were 13 (3-34) minutes, 30 (6-100) minutes and 85 (11-235) kJ, respectively. All were outpatient procedures with 49 (70%) patients catheter-free at discharge. No urethral strictures or urinary incontinence were noted. Median AUASS decreased from 22 to 8, 6, 5, 5, and 4 (p<0.001) while the median Qmax increased from 9.4 to 20.4, 20.3, 21.2, 18.8, and 20.0 mL/s (p<0.001) during the follow-up period. CONCLUSIONS At one year, our experience suggests that GreenLight HPS laser PVP is safe and effective for treating lower urinary tract symptoms secondary to BPH.
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Affiliation(s)
- Massimiliano Spaliviero
- Department of Urology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
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Laser vaporization of bovine prostate: a quantitative comparison of potassium-titanyl-phosphate and lithium triborate lasers. J Urol 2008; 180:2675-80. [PMID: 18951570 DOI: 10.1016/j.juro.2008.08.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Indexed: 11/22/2022]
Abstract
PURPOSE We compared the outcomes of in vitro vaporization of bovine prostate using the lithium triborate GreenLight HPS and the GreenLight KTP PV photoselective vaporization laser. MATERIALS AND METHODS A total of 96 specimens of bovine prostate tissue in saline at 20C were vaporized with a 2-dimensional scanning system using a side firing fiber emitting a 532 nm wavelength at 80 W using the KTP laser, and at 80 and 120 W using the HPS laser at a working distance of 0.5 to 5 mm and a treatment speed of 2 to 8 mm per second. Dimensions of the vaporized tissue and resultant lesions were assessed. RESULTS At a minimum working distance of 0.5 mm and a treatment speed of 4 mm per second (determined by optimum vaporization volume/energy use) the HPS laser at 80 and 120 W vaporized 50% and 100% more tissue, respectively, than the KTP laser at the customary 80 W. At the same treatment speed the HPS laser vaporized equally efficiently at up to 3 mm working distance at each power level, whereas the KTP laser lost efficiency at working distances beyond 0.5 mm. The 2 lasers vaporized more tissue at slower (longer lasing) treatment speeds but even at the slowest treatment speed mean thickness of the coagulation zone with the HPS laser at 80 and 120 W was comparable to that of the 80 W KTP laser (0.80 and 1.07 mm, respectively, vs 0.81). CONCLUSIONS In vitro the lithium triborate GreenLight HPS 120 W laser vaporizes bovine prostate far more efficiently than the KTP photoselective vaporization laser but coagulates it equally well. These favorable outcomes must be validated in vivo.
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Bartoletti R, Cai T, Tinacci G, Longo I, Ricci A, Massaro MP, Tosoratti N, Zini E, Pinzi N. Transperineal microwave thermoablation in patients with obstructive benign prostatic hyperplasia: a phase I clinical study with a new mini-choked microwave applicator. J Endourol 2008; 22:1509-17. [PMID: 18613779 DOI: 10.1089/end.2007.0329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To evaluate the tolerability and safety of a newly designed probe for trans-perineal microwave thermoablation (TPMT) of the prostate in patients with benign prostatic hyperplasia (BPH), and the in vivo microwave effects on prostatic tissue. PATIENTS AND METHODS Nine patients with obstructive BPH who were candidates for open prostatectomy were selected for this study. Under local anesthesia and transrectal ultrasound monitoring, all patients underwent a single standardized application of TPMT. The visual analog scale (VAS) and Short Form-36 health survey (SF-36) questionnaire were administered to each patient prior to, during, and 1 month after TPMT in order to evaluate pain and quality of life. Then the International Index of Erectile Function (IIEF-5) and International Prostate Symptom Score (IPSS) questionnaires were administered to each patient at baseline and 1 month after prostatectomy in order to evaluate sexual and urinary function, respectively. Then all patients were divided into three groups and underwent open prostatectomy 7, 15, and 30 days after TPMT, respectively. The prostatic adenomas were then evaluated by a pathologist. RESULTS No adverse events from TPMT treatment were noted. In particular, no patients reported local, pelvic, or abdominal pain during the procedure or subsequent alterations of defecation rhythm, ano-rectal/intestinal problems, or hematuria. No differences in quality of life or in sexual function were reported. The diameters of the lesions obtained with TPMT treatment ranged from 16 to 18.1 mm in all patients. Quasi-spheroid lesions with a well-defined area of complete coagulative necrosis were documented in all removed adenomas 7, 15, and 30 days after TMPT. CONCLUSIONS The AMICA-PROBE is a safe, well-tolerated, and repeatable method to treat BPH with microwave thermotherapy. The spheroid lesions obtained demonstrated the maximal control over the radial and longitudinal coagulative effects of the therapy. Phase II studies are needed to further evaluate the efficacy of this new probe.
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Surgical management of benign prostatic hyperplasia: current evidence. ACTA ACUST UNITED AC 2008; 5:540-9. [DOI: 10.1038/ncpuro1214] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Accepted: 08/15/2008] [Indexed: 11/08/2022]
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47
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Spaliviero M, Araki M, Page JB, Wong C. Catheter-Free 120W lithium triborate (LBO) laser photoselective vaporization prostatectomy (PVP) for benign prostatic hyperplasia (BPH). Lasers Surg Med 2008; 40:529-34. [DOI: 10.1002/lsm.20678] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Alivizatos G, Skolarikos A. Photoselective Vaporization of the Prostate to Manage Benign Prostatic Hyperplasia. J Endourol 2008; 22:2117-9. [DOI: 10.1089/end.2008.9731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gerasimos Alivizatos
- Second Urology Department, Athens Medical School, Sismanoglio Hospital, Athens, Greece
| | - Andreas Skolarikos
- Second Urology Department, Athens Medical School, Sismanoglio Hospital, Athens, Greece
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de la Rosette JJ, Gravas S, Fitzpatrick JM. Minimally Invasive Treatment of Male Lower Urinary Tract Symptoms. Urol Clin North Am 2008; 35:505-18, ix. [DOI: 10.1016/j.ucl.2008.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Magno C, Mucciardi G, Galì A, Anastasi G, Inferrera A, Morgia G. Transurethral ethanol ablation of the prostate (TEAP): an effective minimally invasive treatment alternative to traditional surgery for symptomatic benign prostatic hyperplasia (BPH) in high-risk comorbidity patients. Int Urol Nephrol 2008; 40:941-6. [DOI: 10.1007/s11255-008-9394-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Accepted: 04/16/2008] [Indexed: 11/30/2022]
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