L’adénomectomie selon Millin à l’heure de l’énucléation laser : résultats d’une série de 240 cas

[Outcomes of GreenLight XPS-180W laser photovaporization for BPH larger than 80mL]

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.

A Novel Technique for Post-Prostatectomy Catheter Traction

Background

Prostate traction is one way to control post-prostatectomy bleeding. The most popular method involves traction with a catheter fixed to the thigh with adhesive bands. However, this method has its own drawbacks.

Objectives

We aimed to simplify this traction procedure and to overcome its disadvantages.

Patients and Methods

From 2007 - 2015, a new method was used to control post-prostatectomy bleeding in 152 patients. This technique involved inducing pressure on the prostate neck with an indwelling catheter attached to a partially filled urine bag to control bleeding after a prostatectomy.

Results

The new method effectively controlled post-prostatectomy bleeding. A few patients required surgical intervention.

Conclusions

Post-prostatectomy catheter traction using a semi-filled urine bag was an acceptable alternative to the standard method to control post-operative bleeding.