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Liu Z, Chen Z, Yan D, Jiang T, Fu J, Zheng J, Zhou Y, Zhou Z, Shen W. Photoselective sharp enucleation of the prostate with a front-firing 532-nm laser versus photoselective vaporization of the prostate in the treatment of benign prostatic hyperplasia: a randomised controlled trial with 1-year followup results. BMC Urol 2022; 22:173. [PMID: 36344969 PMCID: PMC9639323 DOI: 10.1186/s12894-022-01129-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We designed a new surgical procedure to treat benign prostatic hyperplasia(BPH). In order to verify its effectiveness and safety, we constructed this randomized controlled trial to compare the efficacy of our innovative enucleation technique- photoselective sharp enucleation of the prostate (PSEP), with a front-firing 532-nm laser and the traditional technique-photoselective vaporization of the prostate (PVP) in the treatment of BPH. METHODS A total of 154 consecutive patients diagnosed with bladder outlet obstruction secondary to BPH in our center from June 2018 to April 2019 were randomly divided into the PSEP group (n = 77) and the PVP group (n = 77) and were treated surgically with either PSEP or PVP. All patients were assessed preoperatively and followed up at 1, 6, and 12 months postoperatively. The international prostate symptom score,quality-of-life score, postvoid residual urine volume, maximum urine flow rate, prostate volume, prostate-specific antigen, and adverse events were compared. RESULTS The lower urinary tract symptoms in both groups were significantly improved compared with the baseline at 1, 6, and 12 months postoperatively. The PSEP and PVP groups had an equivalent International Prostate Symptom Score, quality-of-life score, postvoid residual urine volume, maximum urine flow rate, prostate-specific antigen at each follow-up (P > 0.05). The median operative time in the PSEP group was significantly shorter than that in the PVP group (35 min vs. 47 min, P < 0.001). At 6 and 12 months after surgery, the median PV in the PSEP group was smaller than that in the PVP group (P < 0.05). Complication rates were comparable between the groups. CONCLUSION Both PSEP and PVP can achieve good efficacy and safety in the treatment of BPH. PSEP can remove more tissue than PVP and is associated with higher efficiency. In addition, PSEP eliminates the problem of lack of tissue samples associated with PVP. TRIAL REGISTRATION Chinese Clinical Trial Registry, identifie:ChiCTR1800015867, date:25/04/2018.
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Affiliation(s)
- Zhengchao Liu
- grid.410570.70000 0004 1760 6682Urological institution of the People’s Liberation Army, First Affiliated Hospital to Army Medical University, Third Military Medical University), 400037 Chongqing, China
- grid.410570.70000 0004 1760 6682Department of Anesthesiology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Zhipeng Chen
- grid.410570.70000 0004 1760 6682Urological institution of the People’s Liberation Army, First Affiliated Hospital to Army Medical University, Third Military Medical University), 400037 Chongqing, China
| | - Dishi Yan
- grid.410570.70000 0004 1760 6682Urological institution of the People’s Liberation Army, First Affiliated Hospital to Army Medical University, Third Military Medical University), 400037 Chongqing, China
| | - Tao Jiang
- grid.410570.70000 0004 1760 6682Urological institution of the People’s Liberation Army, First Affiliated Hospital to Army Medical University, Third Military Medical University), 400037 Chongqing, China
| | - Jian Fu
- grid.410570.70000 0004 1760 6682Urological institution of the People’s Liberation Army, First Affiliated Hospital to Army Medical University, Third Military Medical University), 400037 Chongqing, China
| | - Jun Zheng
- grid.410570.70000 0004 1760 6682Urological institution of the People’s Liberation Army, First Affiliated Hospital to Army Medical University, Third Military Medical University), 400037 Chongqing, China
| | - Yuanxiu Zhou
- grid.410570.70000 0004 1760 6682Urological institution of the People’s Liberation Army, First Affiliated Hospital to Army Medical University, Third Military Medical University), 400037 Chongqing, China
| | - Zhansong Zhou
- grid.410570.70000 0004 1760 6682Urological institution of the People’s Liberation Army, First Affiliated Hospital to Army Medical University, Third Military Medical University), 400037 Chongqing, China
| | - Wenhao Shen
- grid.410570.70000 0004 1760 6682Urological institution of the People’s Liberation Army, First Affiliated Hospital to Army Medical University, Third Military Medical University), 400037 Chongqing, China
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Hout M, Gurayah A, Arbelaez MCS, Blachman-Braun R, Shah K, Herrmann TRW, Shah HN. Incidence and risk factors for postoperative urinary incontinence after various prostate enucleation procedures: systemic review and meta-analysis of PubMed literature from 2000 to 2021. World J Urol 2022; 40:2731-2745. [PMID: 36194286 DOI: 10.1007/s00345-022-04174-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the risk of urinary incontinence (UI) after various prostate enucleation procedures (PEP). METHODS PubMed was searched from January 2000 to July 2021 for studies investigating UI after PEP. The articles were divided into 5 subgroups: holmium, thulium, greenlight laser, electrocautery, and simple prostatectomy. Meta-analysis was performed to examine rate of stress (SUI), urge (UUI) or unspecified UI at short (< 3 months), intermediate (3-6 months), and long-term (> 6 months). The impact of age, prostate size, surgery time, laser time, postoperative nadir PSA level and technical modifications on UI was analyzed. RESULTS Most (69.4%) of 49 articles included employed holmium laser. There was no significant difference in incidence of short-, intermediate-, and long-term UI, SUI and UUI between five sub-groups and within different technical modifications. Although not statistically significant, the incidence of UI was higher (15%) at short-term with green-light and simple prostatectomy (95% CI 9-23 and 1-84), and higher (4%) at intermediate-term with holmium laser (95% CI 2-8). SUI was more prevalent at short-term with holmium laser (4%; 95% CI 2-5%), and at intermediate term with simple prostatectomy (3%; 95% CI 1-14). UUI was higher in the thulium group (10%, 95% CI 7-16). Increased age, surgery time, laser time and prostate size up to 80 cc were associated with higher UI. There was no correlation between postoperative PSA and UI. CONCLUSIONS There is no significant difference in incidence of UI, SUI and UUI after various PEP. Patients age, prostate size, surgery and laser time are linearly associated with UI.
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Affiliation(s)
- Mohammad Hout
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | - Aaron Gurayah
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | - Maria Camila Suarez Arbelaez
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | - Ruben Blachman-Braun
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | - Khushi Shah
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | | | - Hemendra N Shah
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA.
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Paladini A, Benamran D, Pinar U, Duquesne I, Benarroche D, Parra J, Vaessen C, Chartier-Kastler E, Seisen T, Roupret M. Mid-term functional outcomes of extraperitoneal robot-assisted simple prostatectomy: a single centre experience. J Robot Surg 2022; 16:1355-1360. [PMID: 35107710 DOI: 10.1007/s11701-021-01360-y] [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: 10/09/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
For large prostate volume, open simple prostatectomy (OSP) or holmium laser enucleation are the gold standard surgical treatment medical therapy failure. Robot-assisted simple prostatectomy (RASP) has recently been proposed as an alternative to OSP and endoscopic techniques. Our objective was to describe our extraperitoneal RASP technique for patients with benign prostate obstruction (BPO), and to report on perioperative and mid-term functional outcomes. Data were collected prospectively for all consecutive patients who underwent RASP in our high-volume tertiary hospital over a 6-year period. International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5) and uroflow findings were compared before and after surgery. Intraoperative and postoperative outcomes were also assessed. Forty-seven patients were included in the study. There was no intraoperative incident and no blood transfusion was needed after surgery. Median time to bladder catheter removal was 4 days and patients were discharged the day after. Within 90 postoperative days, 6 patients (12%) experienced at least one complication, all low-grade except one (2.1%) which was Clavien IIIa grade. By univariate analysis, the only risk factor for postoperative complications was the Charlson comorbidity index (OR = 2.1, 95% CI = [1.1-4.7], p = 0.04). At 12 months, a significant improvement IPSS and uroflow rate was observed. No patient reported stress urinary incontinence. Extraperitoneal RASP appears to be a safe and effective technique for men with LUTS related to large BPO. RASP is less invasive than OSP and wide diffusion of the robot-system could lead to the rapid implementation of RASP as a treatment for large prostate.
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Affiliation(s)
- Alessio Paladini
- Division of Urology, APHP, Pitié-Salpêtrière Hôpital, Urology, Sorbonne University, GRC 5, 75013, Paris, France.,Division of Urology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Daniel Benamran
- Division of Urology, Geneva University Hospitals, Geneva, Switzerland
| | - Ugo Pinar
- Division of Urology, APHP, Pitié-Salpêtrière Hôpital, Urology, Sorbonne University, GRC 5, 75013, Paris, France
| | - Igor Duquesne
- Division of Urology, APHP, Hôpital Cochin, Université de Paris, 75014, Paris, France
| | - Davy Benarroche
- Division of Urology, APHP, Pitié-Salpêtrière Hôpital, Urology, Sorbonne University, GRC 5, 75013, Paris, France
| | - Jerome Parra
- Division of Urology, APHP, Pitié-Salpêtrière Hôpital, Urology, Sorbonne University, GRC 5, 75013, Paris, France
| | - Christophe Vaessen
- Division of Urology, APHP, Pitié-Salpêtrière Hôpital, Urology, Sorbonne University, GRC 5, 75013, Paris, France
| | - Emmanuel Chartier-Kastler
- Division of Urology, APHP, Pitié-Salpêtrière Hôpital, Urology, Sorbonne University, GRC 5, 75013, Paris, France
| | - Thomas Seisen
- Division of Urology, APHP, Pitié-Salpêtrière Hôpital, Urology, Sorbonne University, GRC 5, 75013, Paris, France
| | - Morgan Roupret
- Division of Urology, APHP, Pitié-Salpêtrière Hôpital, Urology, Sorbonne University, GRC 5, 75013, Paris, France.
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Taratkin M, Shpikina A, Morozov A, Novikov A, Fokin I, Petov V, Rw Herrmann T, Misrai V, Lusuardi L, Teoh JY, McFARLAND J, Kozlov V, Enikeev D. Enucleation vs vaporization of benign prostatic hyperplasia: a head-to-head comparison of the various outcomes and complications. A systematic review and meta-analysis. Minerva Urol Nephrol 2021; 74:559-569. [PMID: 34791865 DOI: 10.23736/s2724-6051.21.04639-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Vaporization of the prostate (VP) and endoscopic enucleation of the prostate (EEP) are reliable and frequently used methods for BPO relief. Both surgeries utilize lasers and EAU recommends them in similar patient cohorts. Our objective was to compare intra- and perioperative results of patients who had undergone VP and EEP. EVIDENCE ACQUISITION A systematic literature search was performed in three databases (MEDLINE, Web of Science and Scopus). The detailed search strategy is available at Prospero, CRD42020204739. Primary outcomes were functional results (IPSS, QoL, PVR, Qmax), and secondary outcomes were intraoperative results, postoperative PSA and prostate volume, complications, and recurrence rate. EVIDENCE SYNTHESIS VP required less operative time compared to EEP, mean difference=-5.51 (95%CI -7.52; -3.50). IPSS and Qmax for VP were worse after 12-month follow-up, mean difference=0.89 (95%CI 0.52; 1.27) and -3.7 (95%CI -4.56; -2.85), respectively, while QoL did not differ significantly. Postoperative PSA level was higher in the VP group, mean difference=2.28 (95%CI 2.00; 2.55). VP was associated with reduced Clavien-Dindo grade I (OR=4.16; 95%CI 2.96; 5.84) and grade II (OR=3.79; 95%CI 2.25; 6.39) complication rate, especially in terms of the percentage of blood transfusion and transient urinary incontinence. The rate of complications grade IIIa and higher was similar (3 - 6%). Reoperation rate was only estimated in one study and was significantly higher in the PVP group at 60 months of follow-up, 2.7% vs 0%, p<0.05. CONCLUSIONS EEP and VP share the efficacy and safety in BPH management. Our meta-analysis shows comparable complication rate in Clavien-Dindo III, VP superiority in operation time, and EEP superiority in long-term functional outcomes and PSA reduction.
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Affiliation(s)
- Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Anastasia Shpikina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Alexey Novikov
- Moscow state clinical hospital named after Yudin, Moscow, Russia
| | - Igor Fokin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Vladislav Petov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Thomas Rw Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland.,Department of Urology, Hannover Medical School, Hannover, Germany
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Lukas Lusuardi
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Jeremy Y Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Jonathan McFARLAND
- Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia.,Faculty of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Vasiliy Kozlov
- Department of Public Health and Healthcare, Sechenov University, Moscow, Russia
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia -
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Taratkin M, Azilgareeva C, Taratkina D, Goryacheva E, Rapoport L, Enikeev D. Laser endoscopic procedures on the prostate: it is the small details that count. Curr Opin Urol 2021; 31:468-472. [PMID: 34231543 DOI: 10.1097/mou.0000000000000919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review aims to highlight the pros and cons of each laser device and to consider additional possible milestones for the development of laser technologies in the surgical treatment of benign prostate hyperplasia. RECENT FINDINGS Over the last three decades, lasers' role in endourology has gone from strength to strength. Specifically, the primary techniques where laser surgery for BPO relief is concerned are vaporization and enucleation. The idea behind vaporization is that lasers are able to vaporize substantial amounts of tissue due to deep ablation depth and increased power. The most efficient devices for vaporization are those affecting hemoglobin as primary chromophore and/or using a continuous firing mode (KTP/LBO:YAG, diode lasers, Tm:YAG). As for enucleation, multiple devices have been suggested for the adequate anatomical enucleation of the prostate (EEP). As it is a skill-dependent technique, the EEP is effective irrespective of which device the surgeon uses. However, some devices have shown significant advances where enucleation is concerned. SUMMARY The choice of device should be based primarily on the technique the surgeon prefers. Although the most suitable lasers for vaporization are hemoglobin-targeting and/or continuous wave devices, the EEP may be done with any enough powered laser, yet some provides specific effects which you should be aware before the surgery.
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Recent evidence for anatomic endoscopic enucleation of the prostate (AEEP) in patients with benign prostatic obstruction on antiplatelet or anticoagulant therapy. World J Urol 2021; 39:3187-3196. [PMID: 33721062 DOI: 10.1007/s00345-021-03647-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/19/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Due to demographic changes in today's society, the number of patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) is increasing. Similarly, the proportion of patients with cardiovascular risk factors undergoing antiplatelet (AP) or anticoagulation (AC) therapy is growing as well. METHODS This review discusses the current literature on various techniques used for anatomic endoscopic enucleation of the prostate (AEEP) in patients on AC/AP therapy. RESULTS The large number of energy sources used for AEEP makes it difficult to compare them. Overall, fewer bleeding-associated complications arise in patients under AP compared to AC or bridging therapy with low molecular weight heparin. However, perioperatively both AP and AC therapy lead to a higher risk of bleeding complications compared to patients not taking anticoagulants. CONCLUSIONS The literature shows that AEEP is possible and efficacious in patients under AC/AP therapy, with only slight differences compared to patients not taking AC/AP drugs, on a short and long-term basis. Nevertheless, the sparse data, the retrospective nature of many studies and the inclusion of prostate sizes between 50 and 110 ml only, make it difficult to come to strong conclusions.
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Gasmi A, Khene ZE, Guérin S, Bensalah K, Peyronnet B, Mathieu R, Roupret M, Rijo E, Pradère B, Misrai V. Propensity-score analysis comparing perioperative and functional outcomes between XPS 180 W-photovaporization and GreenLight laser enucleation of the prostate: reasons to discard vaporization and move to enucleation. World J Urol 2021; 39:2269-2276. [PMID: 33590278 DOI: 10.1007/s00345-021-03590-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/06/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To compare the perioperative and functional outcomes between 180_W XPS GreenLight photoselective vaporization (PVP) and 532-nm GreenLight laser enucleation of the prostate (GreenLEP) in the surgical management of benign prostatic obstruction (BPO). METHODS Retrospective review of a prospectively maintained international database of patients managed with GreenLight laser surgery (PVP or GreenLEP) was performed. To adjust for potential baseline confounders, propensity-score matching (PSM) was applied at a ratio of 1:1 to compare the perioperative and functional outcomes between the groups. RESULTS A total of 2,420 patients were included. 1,491 (61.6%) underwent PVP and 929 (38.4%) underwent GreenLEP. Before PSM analysis, patients in the vaporization group were older (p < 0.001), had a lower PSA and prostate volume at baseline (p < 0.001). Using estimated propensity scores, 78 patients in the PVP group were matched 1:1 to the patients in the GreenLEP group. The incidence of overall postoperative complications was comparable between the two groups (19 vs. 16%, p = 0.06). However, after PSM, PVP was found to be associated with a higher rate of overall complications (33 vs. 11%, p = 0.001). At 3 months and at last follow-up the I-PSS, Qmax and PSA had similarly decreased in the two groups with a greater improvement in the GreenLEP group (all p < 0.05). CONCLUSIONS PVP and GreenLEP are two efficient and safe techniques for treating BPO. However, PVP was associated with longer operative time and higher risk of reoperation on a midterm follow-up compared to GreenLEP.
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Affiliation(s)
- Anis Gasmi
- Department of Urology, Rennes University Hospital, Rennes, France
| | | | - Sonia Guérin
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Karim Bensalah
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Benoit Peyronnet
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Romain Mathieu
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Morgan Roupret
- Academic Department of Urology, La Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6, Paris, France
| | - Enrique Rijo
- Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain
| | - Benjamin Pradère
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, 45 Avenue de Lombez, 31300, Toulouse, France.
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Wang Y, Liu Z, Jiang T, Zhou X, Chen Z, Zheng J, Yan D, Zhou Y, Zhou Z, Shen W. Photoselective sharp enucleation of the prostate with a front-firing 532-nm laser: an innovative surgical technique for benign prostatic hyperplasia-a single-center study of 475 cases. World J Urol 2021; 39:3025-3033. [PMID: 33388914 DOI: 10.1007/s00345-020-03547-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 11/30/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To describe the novel technique of photoselective sharp enucleation of the prostate (PSEP) with a front-firing 532-nm laser and evaluate its efficacy and safety. METHODS A seven-step standardized surgical procedure was established, and PSEP was performed in an en bloc or lobulate manner according to the size of the middle lobe of the prostate. The following clinical data of 583 patients who underwent PSEP in our center from November 2016 to May 2018 were retrospectively reviewed: maximum flow rate (Qmax), International Prostate Symptom Score (IPSS), quality of life score (Qols), post-void residual volume (PVR), prostate volume, operation time, serum prostate-specific antigen (PSA) concentration, and complications at 1, 6, and 12 months postoperatively. RESULTS Of the 583 patients, 475 had complete clinical information and were included in the study. The median operation time was 39 min. There were significant improvements in the Qmax, IPSS, Qols, PVR and PSA concentration at each follow-up time point postoperatively. Postoperative hemorrhage occurred in 22 patients (4.6%), urinary retention in 29 (6.1%), urinary tract infection in 55 (11.6%), bladder neck contracture in 8 (1.7%), urethral strictures in 11 (2.3%), and stress urinary incontinence in 9 (1.9%). CONCLUSIONS PSEP is effective and safe for the treatment of benign prostatic hyperplasia. The innovative technique integrates the excellent hemostatic property of the 532-nm laser and the high efficiency of enucleation. It decreases the occurrence of postoperative incontinence associated with "blunt" enucleation of 532-nm laser and eliminates the lack of tissue samples problem associated with photoselective vaporization of the prostate.
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Affiliation(s)
- Yongquan Wang
- Urological Institution of the People's Liberation Army, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Zhengchao Liu
- Urological Institution of the People's Liberation Army, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Tao Jiang
- Urological Institution of the People's Liberation Army, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Xiaozhou Zhou
- Urological Institution of the People's Liberation Army, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Zhipeng Chen
- Urological Institution of the People's Liberation Army, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Jun Zheng
- Urological Institution of the People's Liberation Army, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Dishi Yan
- Urological Institution of the People's Liberation Army, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Yuanxiu Zhou
- Urological Institution of the People's Liberation Army, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China
| | - Zhansong Zhou
- Urological Institution of the People's Liberation Army, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China.
| | - Wenhao Shen
- Urological Institution of the People's Liberation Army, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China.
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Yin X, Chen J, Sun H, Liu M, Wang Z, Shi B, Zheng X. Endoscopic enucleation vs endoscopic vaporization procedures for benign prostatic hyperplasia: how should we choose: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22882. [PMID: 33181656 PMCID: PMC7668528 DOI: 10.1097/md.0000000000022882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/27/2020] [Accepted: 09/23/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To assess the safety and efficacy of different endoscopic procedures of the prostate techniques, by comparing endoscopic enucleation (EEP) and endoscopic vaporization procedures (EVP) of the prostate; and laser enucleation procedures (L-EEP) vs laser vaporization procedures (L-EVP) surgeries for benign prostatic hyperplasia. METHODS A systematic literature review was performed in December 2019 using PubMed, Embase and the Cochrane Library to identify relevant studies. Two analyses were carried out: (1) EEP vs EVP; and (2) L-EEP vs L-EVP. Efficacy and safety were evaluated using perioperative data, functional outcomes, including maximum urinary flow rate (Qmax), quality of life (QoL), international prostate symptom score (IPSS), postvoiding residual urine volume (PRV), and rate of complications. Meta-analyses were conducted using RevMan5.3. RESULTS Sixteen studies (4907 patients) evaluated EEP vs EVP, and 12 of them (4392 patients) evaluated L-EEP vs L-EVP. EEP showed improved functional outcomes compared with EVP. EEP was always presented a better Qmax at various follow-up times. EEP also associated with a reduced PRV and IPSS at 12 months postsurgery, an increased Qmax, and reduced IPSS and QoL score at both 24 and 36 months postsurgery. In addition, EEP was associated with less total energy utilized and retreatment for residual adenoma, but a longer catheterization time. Among other outcomes, there was no significant difference. L-EEP favors total energy used, retreatment for residual adenoma, and functional outcomes. L-EEP was associated with reduced PRV at 1, 6, and 12 months postsurgery, a greater Qmax at 6 and 12 months postsurgery, a lower IPSS at 12 months postsurgery, and higher Qmax and lower IPSS and QoL scores at 24 and 36 months postsurgery. However, there was no difference at 3 months postsurgery. No significant differences were observed for other perioperative data and complications. CONCLUSIONS Both EEP and EVP displayed sufficient efficacy and safety for treating benign prostatic hyperplasia. EEP and L-EEP were favored in perioperative data, rate of complications, and functional outcomes. However, the clinical significance of those statistical differences was unclear. Hence, higher-quality randomized controlled trials may be needed to provide a clear algorithm.
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Affiliation(s)
- Xinbao Yin
- Department of Urology, Qilu Hospital of Shandong University
| | - Jun Chen
- Department of Urology, Qilu Hospital of Shandong University
| | - Hui Sun
- Department of Urology, Qilu Hospital of Shandong University
| | - Ming Liu
- Department of Urology, Qilu Hospital of Shandong University
| | - Zehua Wang
- Department of Urology, Qilu Hospital of Shandong University
| | - Benkang Shi
- Department of Urology, Qilu Hospital of Shandong University
| | - Xueping Zheng
- Department of Geriatrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Rijo E, Misrai V. En bloc GreenLight laser enucleation of the prostate (GreenLEP): An in-depth look at the anatomical endoscopic enucleation of the prostate using a 532-nm lithium triborate laser. Andrologia 2020; 52:e13729. [PMID: 32662906 DOI: 10.1111/and.13729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 12/12/2022] Open
Abstract
GreenLight laser enucleation of the prostate (GreenLEP) is an alternative endoscopic enucleation of the prostate (EEP) technique for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). GreenLEP is an 'en bloc' EEP technique to remove the transitional zone tissue in one piece. The procedure is a combination of laser enucleation and blunt gentle mechanical dissection using the tip of the resectoscope. The advantage of mechanical dissection is that it allows for better visualisation of the capsule and in some cases makes the dissection a little faster. This procedure is performed with a 532-nm lithium triborate laser (GreenLight™ XPS 180 W generator, AMS), a 2090 side-firing fibre and a Piranha™ morcellator (Richard Wolf GmbH). We offer a review of the evolution of the technique including the most important technical aspects, complications, advantages/disadvantages, tips and tricks and a visual step by step guide to perform the GreenLEP technique. GreenLEP is one of the latest energy sources reported in the armamentarium of EEP techniques for the treatment of BPO. GreenLEP has previously demonstrated its feasibility, safety and similar short- to mid-term functional outcomes compared to surgical gold standards in the literature.
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Affiliation(s)
- Enrique Rijo
- Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain
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11
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Reddy SK, Utley V, Gilling PJ. The Evolution of Endoscopic Prostate Enucleation: A historical perspective. Andrologia 2020; 52:e13673. [PMID: 32557842 DOI: 10.1111/and.13673] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/25/2020] [Accepted: 05/04/2020] [Indexed: 01/05/2023] Open
Abstract
Here, we review the evolution of prostate enucleation in chronological order based on energy technology starting first with holmium laser, then bipolar electrocautery, followed by thulium laser and finally greenlight and diode laser enucleation of the prostate.
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Affiliation(s)
- Sumeet K Reddy
- Department of Urology, Tauranga Hospital, Tauranga, New Zealand
| | - Victoria Utley
- Department of Urology, Tauranga Hospital, Tauranga, New Zealand
| | - Peter J Gilling
- Department of Urology, Tauranga Hospital, Tauranga, New Zealand.,Tauranga Urology Research, Tauranga, New Zealand
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12
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Cheng X, Qiu Z, Dong J, Liu G, Xie Y, Xu W, Ji Z. GreenLight Laser photoselective vapo-enucleation of the prostate with front-firing emission versus plasmakinetic resection of the prostate for benign prostate hyperplasia. Transl Androl Urol 2020; 9:544-552. [PMID: 32420160 PMCID: PMC7215003 DOI: 10.21037/tau.2020.02.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Although the conventional, monopolar transurethral resection of the prostate (TURP) has proven to be an effective and relatively safe treatment for patients with benign prostatic hyperplasia (BPH), many new endoscopic technologies have been introduced to treat BPH. With the development of laser, there are several alternative transurethral procedures embracing laser therapies. Herein, this study sought to explore the efficacy, safety and follow-up of GreenLight laser photoselective vapo-enucleation of the prostate (PVEP) with front-firing emission compared with plasmakinetic resection of the prostate (PKRP) used to surgically manage BPH. Methods Data from patients who underwent either GreenLight laser PVEP or PKRP were retrospectively collected from March 2013 to May 2018. Perioperative data from both groups were compared. Results Totally, 43 and 45 patients were included in the PVEP and PKRP groups, respectively. No significant difference was observed in excision efficiency ratio (resected prostate weight/operation time) between the two groups (P=0.372). The efficiency ratio of the first 20 PVEP procedures (0.36±0.09 g/min) was significantly lower than that of the second 23 PVEP procedures (0.45±0.18 g/min) (P=0.042). The PVEP group experienced a shorter duration of catheterization, postoperative hospital stay and irrigation time than the PKRP group (P<0.001, P=0.001 and P<0.001, respectively). There was no statistically significant difference between the two groups (P=0.937) in terms of overall postoperative complications. Three months after surgery, the international prostate symptoms (IPSS) score, quality of life (QOL) score, postvoid residual (PVR) volume and maximum urinary flow rate (Qmax) were decreased in both groups (P<0.001 for all) and were comparable between both groups (P=0.635, 0.662, 0.671 and 0.924, respectively). Conclusions GreenLight laser PVEP with front-firing emission was safe and effective modality in treating patients with BPH with short-term follow-up. PVEP was associated with shorter catheterization and postoperative hospital stay time compared with PKRP.
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Affiliation(s)
- Xiangming Cheng
- Department of Urology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing 210029, China.,Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China
| | - Zikai Qiu
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China
| | - Jie Dong
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China
| | - Guanghua Liu
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China
| | - Yi Xie
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China
| | - Weifeng Xu
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China
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13
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Herrmann TR, Gravas S, de la Rosette JJMCH, Wolters M, Anastasiadis AG, Giannakis I. Lasers in Transurethral Enucleation of the Prostate-Do We Really Need Them. J Clin Med 2020; 9:E1412. [PMID: 32397634 PMCID: PMC7290840 DOI: 10.3390/jcm9051412] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 12/21/2022] Open
Abstract
The acronym EEP, coding for transurethral Endoscopic Enucleation of the Prostate, was introduced in 2016 by the European Association of Urology (EAU) guidelines panel on management of non-neurogenic male lower urinary tract symptoms (LUTS) and benign prostatic obstruction (BPO). Since then, a laser-based treatment, Holmium Laser Enucleation of the Prostate (HoLEP), and the current-based treatment of bipolar enucleation of the prostate (BipoLEP) are equally appreciated as valuable options for the management of benign prostatic obstruction (BPO). This was mainly inspired by the results of two meta-analyses on randomized controlled trials, comparing open prostatectomy with either Holmium Laser Enucleation of the Prostate (HoLEP) or bipolar enucleation of the prostate (BipoLEP). Prior to that, HoLEP was embraced as the only valid option for transurethral enucleation, although evidence for equivalence existed as early as 2006, but was not recognized due to a plethora of acronyms for bipolar energy-based treatments and practiced HoLEP-centrism. On the other hand, the academic discourse focused on different (other) laser approaches that came up, led by Thulium:Yttrium-Aluminum-Garnet (Tm:YAG) Vapoenucleation (ThuVEP) in 2009 and, finally, transurethral anatomical enucleation with Tm:YAG support (thulium laser enucleation of the prostate, ThuLEP) in 2010. Initially, the discourse on lasers focused on the different properties of lasers rather than technique or surgical anatomy, respectively. In and after 2016, the discussion ultimately moved towards surgical technique and accepting anatomical preparation as the common of all EEP techniques (AEEP). Since then, the unspoken question has been raised, whether lasers are still necessary to perform EEP in light of existing evidence, given the total cost of ownership (TCO) for these generators. This article weighs the current evidence and comes to the conclusion that no evidence of superiority of one modality over another exists with regard to any endpoint. Therefore, in the sense of critical importance, AEEP can be safely and effectively performed without laser technologies and without compromise.
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Affiliation(s)
- Thomas R.W. Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, 8569 Münsterlingen, Switzerland; (A.G.A.); (I.G.)
- Department of Urology, Hannover Medical School, 30625 Hannover, Germany;
| | - Stavros Gravas
- Department of Urology, University Hospital of Larisa, 41500 Larisa, Greece;
| | | | - Mathias Wolters
- Department of Urology, Hannover Medical School, 30625 Hannover, Germany;
| | | | - Ioannis Giannakis
- Department of Urology, Spital Thurgau AG, Frauenfeld, 8569 Münsterlingen, Switzerland; (A.G.A.); (I.G.)
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14
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Heidar NA, Labban M, Misrai V, Mailhac A, Tamim H, El-Hajj A. Laser enucleation of the prostate versus transurethral resection of the prostate: perioperative outcomes from the ACS NSQIP database. World J Urol 2020; 38:2891-2897. [PMID: 32036397 DOI: 10.1007/s00345-020-03100-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/19/2020] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To compare the perioperative outcomes associated with laser enucleation of the prostate (LEP) and transurethral resection of the prostate (TURP) using a national database. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for patients who underwent TURP or LEP from 2008 to 2016. Baseline demographics, comorbidities, and predisposition to bleeding were compared between TURP and LEP. The 30-day perioperative outcomes including operative time, length of hospital stay (LOS), return to the operating room (OR), bleeding requiring transfusion, and organ system-specific complications were compared between the procedures. A multivariate logistic regression analysis was performed, adjusting for the type of surgery and other covariates. RESULTS The series included 37,577 TURP and 2869 LEP procedures. While TURP was associated with a shorter operative time (55.20 ± 37.80 min) than LEP (102.80 ± 62.30 min), the latter was associated with a shorter hospital stay (1.29 ± 2.73 days) than TURP (2.05 ± 5.20 days). Compared to TURP, LEP had 0.52 (0.47-0.58) times the odds of a LOS > 1 day and 0.67 (0.54-0.83) times the odds of developing urinary tract infections. Nevertheless, no difference was found for other postoperative complications, need for transfusion, and return to OR. CONCLUSION Real-life data from a large national database confirmed that LEP is a safe and reproducible procedure to treat benign prostatic obstruction. Compared to TURP, LEP was associated with a lower rate of infectious complications and a shorter LOS at the expense of an increased operative time.
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Affiliation(s)
- Nassib Abou Heidar
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Muhieddine Labban
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Aurelie Mailhac
- American University of Beirut Medical Center, Clinical Research Institute, Beirut, Lebanon
| | - Hani Tamim
- American University of Beirut Medical Center, Clinical Research Institute, Beirut, Lebanon
| | - Albert El-Hajj
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, Lebanon.
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15
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Tuccio A, Sessa F, Campi R, Grosso AA, Viola L, Muto G, Scoffone C, Cracco CM, Gómez-Sancha F, Misrai V, Muto G, Mari A, Di Maida F, Tellini R, Figueiredo F, Carini M, Oriti R, Amparore D, Fiori C, Porpiglia F, Minervini A. En-bloc endoscopic enucleation of the prostate: a systematic review of the literature. MINERVA UROL NEFROL 2020; 72:292-312. [PMID: 32026670 DOI: 10.23736/s0393-2249.20.03706-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Transurethral resection of the prostate (TURP) remains the gold standard for treatment of benign prostatic hyperplasia (BPH). Yet, the introduction of lasers for the treatment of LUTS due to BPO has dramatically changed the surgical landscape of benign prostatic obstruction (BPO) treatment. Recently, "en-bloc" techniques have shown to prove advantageous in terms of better visualization, more prompt identification of the surgical capsule and the correct plane to dissect. Herein we provide a comprehensive overview of available series of en-bloc enucleation of the prostate, focusing on surgical techniques, perioperative and functional outcomes. EVIDENCE ACQUISITION A systematic review of the literature was performed according to PRISMA recommendations and was conducted on surgical techniques and perioperative outcomes of minimally invasive en-bloc surgery for prostate adenoma detachment. EVIDENCE SYNTHESIS Overall, 16 studies with 2750 patients between 2003 and 2019 were included. Specific technical nuances have been described to maximize perioperative outcomes of en-bloc prostatic enucleation, including early apical release, horse-shape incisions, inverted U-shape tractions and low power. Overall, regardless of the energy employed, en-bloc prostatic enucleation achieved favorable outcomes including low risk of major complications and quality of life improvement. However, a great heterogeneity of study design, patients' inclusion criteria, prostate volume and en-bloc surgical strategy was found. CONCLUSIONS En-bloc endoscopic enucleation of the prostate has been shown to be technically feasible and safe, with potential technical advantages over the classic three-lobe technique. Larger comparative studies are needed to evaluate the ultimate impact of the en-bloc approach on postoperative outcomes, in light of the surgeon's learning curve.
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Affiliation(s)
- Agostino Tuccio
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy -
| | - Francesco Sessa
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Campi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Antonio A Grosso
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Lorenzo Viola
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Gianluca Muto
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | | | | | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Giovanni Muto
- Department of Urology, Humanitas Gradenigo University, Turin, Italy
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Fabrizio Di Maida
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Tellini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Marco Carini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rino Oriti
- Department of Urology, Ulivella e Glicini Clinic, Florence, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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16
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Campobasso D, Marchioni M, Altieri V, Greco F, De Nunzio C, Destefanis P, Ricciardulli S, Bergamaschi F, Fasolis G, Varvello F, Voce S, Palmieri F, Divan C, Malossini G, Oriti R, Tuccio A, Ruggera L, Tubaro A, Delicato G, Laganà A, Dadone C, De Rienzo G, Frattini A, Pucci L, Carrino M, Montefiore F, Germani S, Miano R, Schips L, Rabito S, Ferrari G, Cindolo L. GreenLight Photoselective Vaporization of the Prostate: One Laser for Different Prostate Sizes. J Endourol 2020; 34:54-62. [DOI: 10.1089/end.2019.0478] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Davide Campobasso
- Department of Urology, Ospedale Civile di Guastalla and Ospedale Ercole Franchini di Montecchio Emilia, Azienda USL-IRCCS di Reggio Emilia, Guastalla, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, “G. D'Annunzio” University of Chieti, Chieti, Italy
| | | | | | - Cosimo De Nunzio
- Department of Urology, “Sant'Andrea” Hospital, Sapienza University, Roma, Italy
| | - Paolo Destefanis
- Department of Urology, Azienda Ospedaliera Città della Salute e della Scienza di Torino—Sede Molinette, Torino, Italy
| | | | - Franco Bergamaschi
- Department of Urology, “Arcispedale Santa Maria Nuova,” Reggio Emilia, Italy
| | | | | | - Salvatore Voce
- Department of Urology, “Santa Maria delle Croci Hospital,” Ravenna, Italy
| | - Fabiano Palmieri
- Department of Urology, “Santa Maria delle Croci Hospital,” Ravenna, Italy
| | - Claudio Divan
- Department of Urology, “Rovereto Hospital,” Rovereto, Italy
| | | | - Rino Oriti
- Department of Urology, “Ulivella e Glicini Clinic,” Florence, Italy
| | - Agostino Tuccio
- Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Lorenzo Ruggera
- Department of Urology, Clinica urologica azienda ospedaliera, University of Padova, Padova, Italy
| | - Andrea Tubaro
- Department of Urology, “Sant'Andrea” Hospital, Sapienza University, Roma, Italy
| | - Giampaolo Delicato
- Department of Urology, “S. Giovanni Evangelista” Hospital, Tivoli, Italy
| | - Antonino Laganà
- Department of Urology, “S. Giovanni Evangelista” Hospital, Tivoli, Italy
| | - Claudio Dadone
- Department of Urology, “Santa Croce e Carle” Hospital, Cuneo, Italy
| | - Gaetano De Rienzo
- Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari, Bari, Italy
| | - Antonio Frattini
- Department of Urology, Ospedale Civile di Guastalla and Ospedale Ercole Franchini di Montecchio Emilia, Azienda USL-IRCCS di Reggio Emilia, Guastalla, Italy
| | - Lugi Pucci
- Department of Urology, AORN “Antonio Cardarelli,” Naples, Italy
| | | | | | - Stefano Germani
- UOSD Urologia, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Roberto Miano
- UOSD Urologia, Dipartimento di Scienze Chirurgiche, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Luigi Schips
- Department of Urology, ASL Abruzzo 2, Chieti, Italy
| | | | | | - Luca Cindolo
- Department of Urology, “Villa Stuart” Private Hospital, Rome, Italy
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17
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Stoddard MD, Zorn KC, Elterman D, Cash H, Rijo E, Misrai V, Te A, Chughtai B. Standardization of 532 nm Laser Terminology for Surgery in Benign Prostatic Hyperplasia: A Systematic Review. J Endourol 2019; 34:121-127. [PMID: 31880953 DOI: 10.1089/end.2019.0756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction: The use of GreenLight™ laser technology to remove the prostatic transitional zone transurethrally has grown considerably in recent years. This increased utilization has resulted in an increase in the number of terms that are used to describe various laser techniques. Variable terminology complicates literature analysis and publication, which can cause confusion when performing reviews and comparisons of the techniques in the available literature. It has therefore become necessary to simplify and standardize terminology used to describe transurethral prostate debulking procedures using the 532 nm laser to simplify communication on these techniques. Materials and Methods: We conducted a search on September 17, 2019, in the following databases: Ovid MEDLINE®, Ovid EMBASE, and PubMed. Results: Of the 1115 unique records found in our database search, a total of 27 articles were selected for inclusion. Of the 16 search terms used, we found that 4 terms could be used to describe the fundamental technique associated with each search term. These terms include "vaporization," "vaporesection," "vapoenucleation," and "enucleation." Conclusions: Standardizing terminology leads to an efficient consolidation of terms based on the above outcomes. This will streamline the literature search process for future publications and facilitate comparison of varying techniques.
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Affiliation(s)
- Michelina D Stoddard
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, New York
| | - Kevin C Zorn
- Section of Urology, Department of Surgery, University of Montreal Hospital Center, Montreal, Canada
| | - Dean Elterman
- University of Toronto-University Health Network, Toronto, Canada
| | - Hannes Cash
- Department of Urology, Charité University Medicine Berlin, Berlin, Germany
| | - Enrique Rijo
- Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Alexis Te
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, New York
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, New York
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18
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Prudhomme T, Marquette T, Péré M, Patard PM, Michiels C, Sallusto F, Rigaud J, Glémain P, Kamar N, Blancho G, Soulié M, Rischmann P, Karam G, Gamé X, Robert G, Branchereau J. Benign Prostatic Hyperplasia Endoscopic Surgical Procedures in Kidney Transplant Recipients: A Comparison Between Holmium Laser Enucleation of the Prostate, GreenLight Photoselective Vaporization of the Prostate, and Transurethral Resection of the Prostate. J Endourol 2019; 34:184-191. [PMID: 31588793 DOI: 10.1089/end.2019.0430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose: The main objective of this multicentric retrospective pilot study was to evaluate the 1-year follow-up safety (i.e., minor [Clavien-Dindo I-II] and major [Clavien-Dindo ≥III] complications) of holmium laser enucleation of the prostate (HoLEP), GreenLight photoselective vaporization of the prostate (GL PVP), and transurethral resection of the prostate (TURP) performed after kidney transplantation (KT). The secondary objectives were to evaluate the efficacy and to assess the impact of these procedures on graft function. Materials and Methods: We retrospectively included all KT recipients who underwent a HoLEP or GL PVP or TURP for benign prostatic hyperplasia (BPH) in three French university centers. Results: From January 2013 to April 2018, 60 BPH endoscopic surgical procedures in KT recipients were performed: 17 HoLEP (HoLEP group), 9 GL PVP (GL PVP group), and 34 TURP (TURP group). Age, body mass index, preoperative serum creatinine, preoperative International Prostatic Symptom Score, preoperative Qmax, preoperative prostate-specific antigen, medical history of acute urinary retention (AUR), urinary tract infection (UTI), and indwelling urethral catheter were similar in all study groups. Mean preoperative prostate volume was higher in HoLEP group. The rate of overall postoperative complications was statistically higher in the HoLEP group (11/17 [64.7%] vs 1/9 [11.1%] vs 12/34 [35.3%] in HoLEP group, GL PVP group, and TURP group, respectively, p = 0.02), with higher rate of long-term UTI and AUR. Qmax improved in all groups after operation. Delta postoperative month 12-preoperative serum creatinine was similar in the all groups. Conclusions: Although our study is underpowered, the rate of postoperative complications is higher with HoLEP procedure, in comparison with GL PVP, for the treatment of BPH after KT. One-year efficacy is similar in HoLEP, GL PVP, and TURP groups. Further prospective randomized controlled trials are needed to confirm our results.
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Affiliation(s)
- Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Thibault Marquette
- Department of Urology, Kidney Transplantation and Andrology, Bordeaux University Hospital, Bordeaux, France
| | - Morgane Péré
- Biostatistics Unit, Research Board, Nantes University Hospital, Nantes, France
| | - Pierre-Marie Patard
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Clément Michiels
- Department of Urology, Kidney Transplantation and Andrology, Bordeaux University Hospital, Bordeaux, France
| | - Federico Sallusto
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Jérôme Rigaud
- Institut de Transplantation Urologie Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Pascal Glémain
- Institut de Transplantation Urologie Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Gilles Blancho
- Institut de Transplantation Urologie Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Michel Soulié
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Pascal Rischmann
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Georges Karam
- Institut de Transplantation Urologie Néphrologie (ITUN), Nantes University Hospital, Nantes, France
| | - Xavier Gamé
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Grégoire Robert
- Department of Urology, Kidney Transplantation and Andrology, Bordeaux University Hospital, Bordeaux, France
| | - Julien Branchereau
- Institut de Transplantation Urologie Néphrologie (ITUN), Nantes University Hospital, Nantes, France
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19
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Khene Z, Peyronnet B, Vincendeau S, Huet R, Gasmi A, Pradere B, Pasquie M, Tabatabaei S, Ferrari G, Roupret M, Mathieu R, Rijo E, Gomez‐Sancha F, Misrai V. The surgical learning curve for endoscopic GreenLight™ laser enucleation of the prostate: an international multicentre study. BJU Int 2019; 125:153-159. [DOI: 10.1111/bju.14904] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | | | - Romain Huet
- Department of Urology Rennes University Hospital Rennes France
| | - Anis Gasmi
- Department of Urology Rennes University Hospital Rennes France
| | | | - Marie Pasquie
- Department of Urology Clinique Pasteur Toulouse France
| | | | | | - Morgan Roupret
- Department of Urology La Pitié‐Salpétrière Hospital Assistance‐Publique Hôpitaux de Paris Paris France
| | - Romain Mathieu
- Department of Urology Rennes University Hospital Rennes France
| | - Enrique Rijo
- Department of Urology Hospital Quiron Barcelona Barcelona Spain
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Bajic P, Noriega N, Gorbonos A, Karpman E. GreenLight Laser Enucleation of the Prostate (GreenLEP): Initial Experience with a Simplified Technique. Urology 2019; 131:250-254. [DOI: 10.1016/j.urology.2019.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/03/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
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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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Huet R, Peyronnet B, Khene ZE, Freton L, Verhoest G, Manunta A, Bensalah K, Vincendeau S, Mathieu R. Prospective Assessment of the Sexual Function After Greenlight Endoscopic Enucleation and Greenlight 180W XPS Photoselective Vaporization of the Prostate. Urology 2019; 131:184-189. [PMID: 31254569 DOI: 10.1016/j.urology.2019.06.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the impact of Greenlight 180W photoselective vaporization of the prostate (PVP) and endoscopic enucleation of the prostate (GreenLEP) on ejaculatory and erectile functions. MATERIALS AND METHODS Between January 2014 and September 2016, 440 men with low urinary tract symptoms or complications related to benign prostate obstruction with prostate >80 g and sexually active, underwent a PVP or GreenLEP performed by experienced surgeons at a single institution. Patients were matched in a 1:1 fashion according to preoperative transrectal ultrasonography prostatic volume and cardiovascular risk factors (smoking, diabetes, and hypertension). RESULTS One hundred patients in each group were included. Mean prostatic volume were 110 g (95%CI: 101-118) and 107 g (95%CI: 99-115) in the GreenLEP and PVP groups, respectively (P = .68). Mean total energy delivered in the PVP group was 4.42 kJ/g (4.2-4.6). Surgical retreatment was required in 9 patients (10.1%) in the PVP group and none in the GreenLEP group (log rank test: P = .002). Mean prostate specific antigen level and International Prostate Symptom Score score were significantly lower in the GreenLEP group than in the PVP group at 3, 12, and 24 months (P <.001). Preserved antegrade ejaculation was reported in 24 patients (26.9%) in the PVP group vs 1 patient (1.2%) in the GreenLEP group at 12 months (P <.001). In multivariate analysis, age, history of coronary artery disease, and surgical treatment with PVP were independent factors of IIEF-5 decline. CONCLUSION Despite a poor rate of preserved antegrade ejaculation, GreenLEP was associated with better erectile function outcomes possibly due to greater improvement of low urinary tract symptoms.
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Affiliation(s)
- Romain Huet
- Department of Urology, Rennes University Hospital, University of Rennes 1, Rennes, France
| | - Benoit Peyronnet
- Department of Urology, Rennes University Hospital, University of Rennes 1, Rennes, France.
| | - Zine-Eddine Khene
- Department of Urology, Rennes University Hospital, University of Rennes 1, Rennes, France
| | - Lucas Freton
- Department of Urology, Rennes University Hospital, University of Rennes 1, Rennes, France
| | - Grégory Verhoest
- Department of Urology, Rennes University Hospital, University of Rennes 1, Rennes, France
| | - Andréa Manunta
- Department of Urology, Rennes University Hospital, University of Rennes 1, Rennes, France
| | - Karim Bensalah
- Department of Urology, Rennes University Hospital, University of Rennes 1, Rennes, France
| | - Sébastien Vincendeau
- Department of Urology, Rennes University Hospital, University of Rennes 1, Rennes, France
| | - Romain Mathieu
- Department of Urology, Rennes University Hospital, University of Rennes 1, Rennes, France
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Kaplan SA. Re: Learning Curves and Perioperative Outcomes after Endoscopic Enucleation of the Prostate: A Comparison between GreenLight 532-nm and Holmium Lasers. J Urol 2019; 200:1139. [PMID: 30835613 DOI: 10.1016/j.juro.2018.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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En Bloc Thulium Laser Enucleation of the Prostate: A Step-by-Step Guide to Improve Enucleation Time and Efficiency for Endoscopic Enucleation of Prostatic Adenoma. Urology 2019; 124:307. [DOI: 10.1016/j.urology.2018.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 10/03/2018] [Accepted: 11/05/2018] [Indexed: 12/22/2022]
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Kreydin EI, Chyu J, Lerner L. Laser prostate ablation and enucleation: Analysis of a national cohort. Int J Urol 2018; 25:549-553. [PMID: 29633359 DOI: 10.1111/iju.13560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 02/15/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare characteristics and outcomes of benign prostatic hyperplasia patients undergoing prostate laser ablation with those undergoing laser enucleation using a nationwide cohort. METHODS Men who underwent prostate laser ablation (n=10054) or laser enucleation (n=1705) between 2011 and 2015 were identified by the common procedural terminology code as recorded in the National Surgical Quality Improvement Program database. Preoperative, intraoperative and postoperative parameters were compared between the groups using univariate and multivariate analysis. RESULTS Prostate laser ablation patients were older, had more comorbidities and were more likely to have abnormal laboratory values. Enucleations were significantly longer and more likely to result in a hospital stay >1day. Enucleation patients were also more likely to require a blood transfusion postoperatively, but less likely to experience urinary tract infection and sepsis on both univariate and multivariate analysis adjusted for preoperative and intraoperative factors. CONCLUSIONS Although laser enucleation and prostate laser ablation are both considered minimally invasive techniques, significant differences in patient selection, intraoperative factors and postoperative complications are identified in this national cohort. The present study shows that despite similar outcomes in prospective single-center studies, prostate laser ablation and laser enucleation have distinct practice patterns in a broader national context.
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Affiliation(s)
- Evgeniy I Kreydin
- Institute of Urology, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Jennifer Chyu
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Lori Lerner
- Department of Urology, Boston University School of Medicine, Boston, Massachusetts, USA
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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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Marquette T, Comat V, Robert G. [Endoscopic enucleation of the prostate: Indication, technique and results]. Prog Urol 2017; 27:836-840. [PMID: 28965711 DOI: 10.1016/j.purol.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Laser prostatic enucleation is an increasingly popular technique among surgical urology. It is now gradually becoming a contender for gold standard surgical treatments, trans-urethral resection of the prostate (TURP) and open prostatectomy (OP). MATERIALS AND METHODS This study is based on data collected from sources published between June 1995 and June 2017. Medline and Embase database have been used to research the following keywords: Holmium; Thulium; Greenlight; Laser; Prostate; Enucleation; Benign prostatic obstruction; Surgical technique. RESULTS With HoLEP process, catheterization time varies from 17,7hrs to 46,4hrs with 2 to 2.5 hospitalization days. With ThuLEP process, catheterization time varies from 2 to 2.5 days with 2.15 to 6.5 hospitalization days. With GreenLEP process, catheterization and hospitalization times are both 2 days. IPSS score after a year varies from 12.7 to 19.1 points in different publications. CONCLUSION Convincing results of Laser prostatic enucleation make it a valid alternative to existing treatments.
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Affiliation(s)
- T Marquette
- Service de chirurgie urologique, CHU de Bordeaux, 33000 Bordeaux, France.
| | - V Comat
- Service de chirurgie urologique, CHU de Bordeaux, 33000 Bordeaux, France.
| | - G Robert
- Service de chirurgie urologique, CHU de Bordeaux, 33000 Bordeaux, France.
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Yoo S, Park J, Cho SY, Cho MC, Jeong H, Son H. A novel vaporization-enucleation technique for benign prostate hyperplasia using 120-W HPS GreenLight™ laser: Seoul technique II in comparison with vaporization and previously reported modified vaporization-resection technique. World J Urol 2017; 35:1923-1931. [PMID: 28942591 DOI: 10.1007/s00345-017-2091-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 09/19/2017] [Indexed: 02/07/2023] Open
Abstract
PURPOSE We developed a novel vaporization-enucleation technique (Seoul II), which consists of vaporization-enucleation of the prostate using 120-W HPS GreenLight laser, and enucleated prostate resection using bipolar devices for tissue removal. We compared the outcomes of the Seoul II with vaporization and a previously reported modified vaporization-resection technique (Seoul I). METHODS Among patients with benign prostate hyperplasia who underwent transurethral surgery using GreenLight laser at our institute, 347 patients with prostate volume ≥ 40 ml were included. The impact of surgical techniques on efficacy and postoperative functional outcomes was compared. RESULTS No difference was found in baseline characteristics, although the prostate volume was marginally greater in Seoul II (p = 0.051). Prostate volume reduction per operation time (p < 0.001) and lasing time (p = 0.016) were greater in Seoul II. At postoperative 12 months, the International Prostate Symptom Score (I-PSS) was lower (p = 0.011), and the decrement in I-PSS was greater in Seoul II (p = 0.001) than other techniques. In multivariate analysis, postoperative 12-month I-PSS for Seoul II was significantly superior to vaporization (p < 0.001), although it was similar to Seoul I. The maintenance of immediate postoperative I-PSS decrement, until postoperative 12 months was superior in Seoul II compared with vaporization (p = 0.014) and Seoul I (p = 0.048). CONCLUSIONS Seoul II showed improved efficacy and voiding functional maintenance over postoperative 12 months in patients with prostate volume ≥ 40 ml compared with vaporization and Seoul I. This technique could be easily accepted by clinicians who are familiar with GreenLight lasers and add flexibility to surgery without additional equipment.
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Affiliation(s)
- Sangjun Yoo
- Department of Urology, Seoul National University College of Medicine, Boramae Medical Center, Sindaebang 2(i)-dong, Dongjak-gu, Seoul, 07061, Korea
| | - Juhyun Park
- Department of Urology, Seoul National University College of Medicine, Boramae Medical Center, Sindaebang 2(i)-dong, Dongjak-gu, Seoul, 07061, Korea
| | - Sung Yong Cho
- Department of Urology, Seoul National University College of Medicine, Boramae Medical Center, Sindaebang 2(i)-dong, Dongjak-gu, Seoul, 07061, Korea
| | - Min Chul Cho
- Department of Urology, Seoul National University College of Medicine, Boramae Medical Center, Sindaebang 2(i)-dong, Dongjak-gu, Seoul, 07061, Korea
| | - Hyeon Jeong
- Department of Urology, Seoul National University College of Medicine, Boramae Medical Center, Sindaebang 2(i)-dong, Dongjak-gu, Seoul, 07061, Korea
| | - Hwancheol Son
- Department of Urology, Seoul National University College of Medicine, Boramae Medical Center, Sindaebang 2(i)-dong, Dongjak-gu, Seoul, 07061, Korea.
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Thoulouzan M, Perrouin-Verbe MA, Calves J, Deruelle C, Joulin V, Valeri A, Fournier G. [Outcomes of GreenLight XPS-180W laser photovaporization for BPH larger than 80mL]. Prog Urol 2017; 27:489-496. [PMID: 28483481 DOI: 10.1016/j.purol.2017.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 03/13/2017] [Accepted: 04/02/2017] [Indexed: 10/19/2022]
Abstract
AIM To evaluate the results of GreenLight XPS photovaporization (PVP/XPS) with intraoperative transrectal ultrasonographic monitoring for the treatment of large Benign Prostatic Hyperplasia (BPH) (>80mL). PATIENTS AND METHODS Operative and perioperative data of 82 patients were collected prospectively. Complications and functional outcomes (IPSS, quality of life (QoL) score, maximal flow rate and post-void residual (PVR)) were evaluated at 1, 3, 12 months post-operatively prostate volume and PSA were assessed at 3 and 12 months post-operatively. RESULTS Median patient age was 68.5years (50-85). Twenty percent had an indwelling catheter and 5%/22% were on anticoagulant/antiplatelet therapy. Median prostate volume and PSA were 103mL (80-220) and 6.4ng/mL (0.66-44.0). Median operative time and energy delivered were 107min (46-219) and 581kJ (212-1193). Energy delivered/prostate volume was 5.4kJ/mL (1.6-10.5). Transurethral catheter was removed at day 1 or 2 in 96% of cases. Patients were discharged as outpatient, p.o. day 1 or day 2 in 4%, 55% and 21% of cases, respectively. Transfusion and Clavien≥3 complication rates were 1.2% and 3.7%. Significant improvement of IPSS (4 vs 19.5), QoL (1 vs 5), maximum flow rate (19.1 vs 8.2mL/s) and PVR (26 vs 100mL) was observed (P<0.001) at 12-months evaluation. PSA and prostate volume were decreased by 61 and 62%. Late complications were urethral strictures (6%), stress incontinence (1.2%). Eighty-five percent of patients had no antegrade ejaculation. CONCLUSION The treatment of large BPH with PVP/XPS is safe and effective, with a long operative time. The functional outcomes are good and stable at mid-term evaluation. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- M Thoulouzan
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France.
| | - M-A Perrouin-Verbe
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France
| | - J Calves
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France
| | - C Deruelle
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France
| | - V Joulin
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France
| | - A Valeri
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France
| | - G Fournier
- Service de chirurgie urologique et de transplantation rénale, hôpital de la Cavale-Blanche, centre hospitalier régional universitaire de Brest, 29200 Brest, France
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Multicenter international experience of 532 nm-laser photo-vaporization with Greenlight XPS in men with large prostates (prostate volume > 100 cc). World J Urol 2017; 35:1603-1609. [PMID: 28229211 DOI: 10.1007/s00345-017-2007-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 01/19/2017] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate the outcomes and durability of photoselective vaporization of the prostate (PVP) using the XPS-180 system in patients with a large prostate volume (PV) > 100 cc at 4 years of follow-up in a large, multicenter experience. METHODS 438 men with pre-operative transrectal ultrasound (TRUS) PV > 100 cc were treated in eight experienced centers in Canada, USA, and in France with the Greenlight XPS laser using PVP for the treatment of symptomatic BPH. IPSS, Qmax, postvoid residual (PVR), and prostate-specific antigen (PSA) were measured at 6, 12, 24, 36, and 48 months. Durability was evaluated using BPH retreatment rate at 12, 24, and 36 months. RESULTS Median PV and PSA were 121 cc and 6.3 ng/dl. Indwelling catheter at the time of surgery was observed in 37% of men. Median operative, laser time, and energy applied were 90 min, 55 min, and 422 kJ, respectively. Median energy delivery was 3.4 kJ/cc of prostate per case. Outpatient surgery was feasible with median length of stay at 24 h. IPSS, Qmax and PVR were significantly improved at all endpoints including at 48 months. Moreover, surgical BPH retreatment rates were 5.4 and 9.3% at 24 and 36 months. Interestingly, characteristics of retreated men include: energy delivery 2.4 vs. 3.4 kJ/cc of prostate (p = 0.02) and PSA reduction at 12 months 26 vs. 51% (p = 0.02). CONCLUSIONS PVP using Greenlight XPS-180W can potentially provide durable improvements with regard to functional outcomes at 4 years. However, rising retreatment rates after 3 years is of concern. This highlights the imperative need of utilizing a standardized surgical technique (enucleation-like-defect) and an optimal energy density >3KJ/cc.
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Cindolo L, Ruggera L, Destefanis P, Dadone C, Ferrari G. Vaporize, anatomically vaporize or enucleate the prostate? The flexible use of the GreenLight laser. Int Urol Nephrol 2017; 49:405-411. [DOI: 10.1007/s11255-016-1494-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 12/23/2016] [Indexed: 10/20/2022]
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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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Misrai V, Bordier B, Guillotreau J. Analyse de la courbe d’apprentissage de la morcellation intravésicale réalisée avec le système Piranha© au cours de l’énucléation endoscopique. Prog Urol 2017; 27:33-37. [DOI: 10.1016/j.purol.2016.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/17/2016] [Accepted: 10/21/2016] [Indexed: 12/22/2022]
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Learning curves and perioperative outcomes after endoscopic enucleation of the prostate: a comparison between GreenLight 532-nm and holmium lasers. World J Urol 2016; 35:973-983. [PMID: 27766387 DOI: 10.1007/s00345-016-1957-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/14/2016] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To compare the learning curves, perioperative and early functional outcomes after HoLEP and GreenLEP. METHODS Data from the first 100 consecutive cases treated by GreenLEP and HoLEP by two surgeons were prospectively collected from dedicated databases and analysed retrospectively. En-bloc GreenLEP and two-lobar HoLEP enucleations were conducted using the GreenLight HPS™ 2090 laser and Lumenis™ holmium laser. Patients' characteristics, perioperative outcomes and functional outcomes after 1, 3 and 6 months were compared between groups. RESULTS Total energy delivered and operative times were significantly shorter for GreenLEP (58 vs. 110 kJ, p < 0.0001; 60 vs. 90 min, p < 0.0001). Operative time reached a plateau after 30 procedures in each group. Length of catheterization and hospital stay were significantly shorter in the HoLEP group (2 vs. 1 day, p < 0.0001; 2 vs. 1 day, p < 0.0001). Postoperative complications were comparable between GreenLEP and HoLEP (19 vs. 25 %; p = 0.13). There was a greater increase of Q max at 3 months and a greater IPSS decrease at 1 month for GreenLEP, whereas decreases in IPSS and IPSS-Q8 at 6 months were greater for HoLEP. Transient stress urinary incontinence was comparable between both groups (6 vs. 9 % at 3 months; p = 0.42). Pentafecta was achieved in four consecutive patients after the 18th and the 40th procedure in the GreenLEP and HoLEP group, respectively. Learning curves ranged from 14 to 30 cases for GreenLEP and 22 to 40 cases for HoLEP. CONCLUSION Learning curves of GreenLEP and HoLEP provided roughly similar peri-operative and short-term functional outcomes.
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