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Coman R, Anract J, Pinar U, Sibony M, Peyromaure M, Delongchamps B. Is the systematic histological analysis of benign prostatic hyperplasia surgical specimen always necessary? Int Urol Nephrol 2022; 54:1485-1489. [PMID: 35536389 DOI: 10.1007/s11255-022-03220-6] [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: 11/22/2021] [Accepted: 04/23/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION After most surgical management of benign prostatic hyperplasia (BPH), the resected tissue undergoes a histological examination. This examination is performed for the risk of finding an incidental prostate cancer (iPCa). The improvement of prostate cancer detection in the past few years decreased the global iPCa rate. This raises the question of the real benefit for all patients of a systematic histological analysis. The aim of our study was to evaluate the iPCa detection rate on a large contemporary cohort of patients treated for BPH, and to define predictive factors of iPCa detection. PATIENTS AND METHODS We retrospectively analyzed the medical charts of all consecutive patients who underwent surgical treatment for BPH in our academic center from 2012 to 2018. Patients with prostate cancer diagnosed before surgery were not included. All the resected tissue underwent standard histopathological examination. iPCa was defined by any grade or stage of prostate cancer identified on the resected tissue by the histological examination. The following variables were analyzed using an uni- and multi-variable logistic regression as potential risk factors of iPCa: age, total PSA, PSA density (PSAd), prostate volume, technique used, weight of resected tissue and use of 5ARI medication. RESULTS 1045 patients were included in the study. Of them, 439 (42.0%), 206 (19.7%) and 400 (38.3%) underwent HoLEP, OP and TURP, respectively. iPCa was diagnosed in 94 (9.0%) of the 1045. Among them 15 (1.4%) were clinically significant (ISUP score ≥ 2). The multivariable logistic regression analysis identified age (p = 0.03) and PSA density (p < 0.001) as independent predictive factors for the detection of iPCa. Using the median of age and PSAd, we identified a population with 0% of iPCa in our cohort (age < 70 year-old and PSAd < 0.05 ng/mL/mL). CONCLUSION The global iPCa rate was 9% in this contemporary large cohort of patients who underwent surgical treatment for BPH, with 1.4% of clinically significant cancer. Age and PSAd were independent predictive factors to find iPCa. Patients younger than 70 with a PSAd < 0.05 ng/mL/mL had 0% of iPCA in our cohort. In this specific population, we could probably avoid a systematical histological examination of the resected tissue.
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Affiliation(s)
- R Coman
- Urology Department, Cochin Hospital, Paris, France.,Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - J Anract
- Urology Department, Cochin Hospital, Paris, France. .,Institut Necker Enfants Malades (INEM), INSERM U1151, Université de Paris, Paris, France.
| | - U Pinar
- Urology Department, Pitié-Salpétrière Hospital, Paris, France
| | - M Sibony
- Pathology Department, Cochin Hospital, Paris, France
| | - M Peyromaure
- Urology Department, Cochin Hospital, Paris, France.,Institut Necker Enfants Malades (INEM), INSERM U1151, Université de Paris, Paris, France
| | - Barry Delongchamps
- Urology Department, Cochin Hospital, Paris, France.,Institut Necker Enfants Malades (INEM), INSERM U1151, Université de Paris, Paris, France
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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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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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Castellan P, Marchioni M, Rizzoli A, Di Nicola M, Porfilio I, Ghahhari J, Greco F, Schips L, Cindolo L. The Surgical Experience Influences the Safety and Efficacy of Photovaporization of Prostate with 180-W XPS GreenLight Laser: Comparison Between Novices vs Expert Surgeons Learning Curves. J Endourol 2018; 32:1071-1077. [PMID: 30226409 DOI: 10.1089/end.2018.0437] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To assess the extent to which surgical experience can affect perioperative and functional outcomes after photoselective vaporization of the prostate (PVP) with 180W XPX GreenLight laser in patients with lower urinary tract symptoms secondary to benign prostatic obstruction (BPO). MATERIALS AND METHODS Data from 291 consecutive patients with symptomatic BPO (median follow-up 12 m) were collected and analyzed. Patients were treated at 2 different institutions by 2 expert (G1, n = 182) and 2 novice (G2, n = 109) transurethral prostate surgeons (February 2013 - March 2017) and underwent standard or anatomical PVP depending on surgeons' preferences. Patients' characteristics, perioperative and functional outcomes were compared using the chi-square and Mann-Whitney U tests. Patients' satisfaction was measured using the Patient Global Impression of Improvement (PGI-I) score. Learning curves were analyzed based on changes in quantitative parameters: surgery time, lasing/operative time, and energy delivered (kJ). RESULTS Patients' baseline characteristics, perioperative data and PGI-I score were similar. Overall the complication rates showed better trends for G1. Serum prostate-specific antigen levels, maximum flow rate, and International Prostatic Symptoms Score improved in both groups, with perceived improvements greater in G2 (p < 0.006). Lasing time/operative time ratio showed greater evolution for G1 than G2 (0.50:IQR 0.38-0.60 vs 0.46:IQR 0.34-0.58, respectively)(p = 0.201). A major increase in energy delivery for G2 was achieved within the first 50 procedures, whereas more than 100 iterations were needed for G1 to reach LT/OT >60%. CONCLUSION Surgeons' background and expertise appear to affect outcomes over the learning curve, with roughly similar perioperative and functional results.
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Affiliation(s)
| | | | - Ambra Rizzoli
- 2 Department of Urology, University "G. d'Annunzio" , Chieti, Italy
| | - Marta Di Nicola
- 3 Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, University "G.d'Annunzio," Chieti, Italy
| | - Italo Porfilio
- 4 Division of Hygiene, Epidemiology and Public Health, Department of Medicine and Science of Aging, University "G. d'Annunzio," Chieti, Italy
| | - Jamil Ghahhari
- 2 Department of Urology, University "G. d'Annunzio" , Chieti, Italy
| | - Francesco Greco
- 5 Department of Urology, Humanitas Gavazzeni , Bergamo, Italy
| | - Luigi Schips
- 1 Department of Urology, ASL02 Abruzzo , Chieti, Italy .,2 Department of Urology, University "G. d'Annunzio" , Chieti, Italy
| | - Luca Cindolo
- 1 Department of Urology, ASL02 Abruzzo , Chieti, Italy
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Cindolo L, De Nunzio C, Greco F, Destefanis P, Bergamaschi F, Ferrari G, Fasolis G, Palmieri F, Divan C, Oriti R, Ruggera L, Tubaro A, Dadone C, De Rienzo G, Frattini A, Mirone V, Schips L. Standard vs. anatomical 180-W GreenLight laser photoselective vaporization of the prostate: a propensity score analysis. World J Urol 2017; 36:91-97. [DOI: 10.1007/s00345-017-2106-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/20/2017] [Indexed: 11/30/2022] Open
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