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Destefanis P, Sibona M, Vitiello F, Vercelli E, Micai L, Montefusco G, Mangione C, Bracco F, Colucci F, De Nunzio C, Gontero P. Trans - Perineal laser ablation of the prostate in high surgical risk patients affected by severe lower urinary tract symptoms related to benign prostatic obstruction. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00736-5. [PMID: 37853099 DOI: 10.1038/s41391-023-00736-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/21/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND In our study, we aimed to test the efficacy and safety of Trans-Perineal Laser Ablation of the prostate (TPLA®) in the surgical treatment of high-risk Benign Prostatic Obstruction (BPO) patients. METHODS We defined a high-risk BPO patient as an elderly man affected by severe comorbidities, among which coagulation issues due to pre-existent medications or diseases. From October 2020 to June 2022, we prospectively enrolled high-risk patients affected by a moderate to severe and/or complicated BPO condition. The analysis of the efficacy of the Trans-Perineal Laser Ablation was defined as the primary endpoint of the study. Secondary endpoints were post-operative surgical complications and patient-reported quality of life. RESULTS Globally, 40 consecutive patients were enrolled. Median (IQR) age was 80 (72.5-84) years. Median Charlson Comorbidity Index was 6 (5-7). Median prostate volume was 38 (30.5-73) cc. In all cases, a TPLA® procedure was performed under local anesthesia, and patients being discharged within the same day of the procedure. A progressive reduction of median prostate volumes was reported at 3 and 6 months post-operatively, compared to baseline [38 (30.5-73) vs 35 (26-49) vs 34 (28-49) cc, p < 0.001]. Median International Prostate Symptom Score (IPSS) improved accordingly [25 (19-30) vs 10.5 (7.5-13) vs 8 (6-11.5), p < 0.001]. A permanent bladder catheter was successfully removed in 13 out of 23 (56.5%) cases. Within 90 days from surgery, 19 (47.5%) patients experienced at least one surgical complication. According to the Clavien-Dindo classification, complications were classified as grade I in 16 (40%) cases, grade II in 9 (22.5%), and grade III in 1 (2.5%). We did not observe any grade IV or V complications. CONCLUSIONS The Trans-Perineal Laser Ablation of the Prostate is a feasible, safe, and effective Minimally Invasive Surgical Technique, when offered to elderly, high-risk patients affected by severe Benign Prostatic Obstruction.
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Affiliation(s)
- Paolo Destefanis
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Mattia Sibona
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy.
| | - Federico Vitiello
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Eugenia Vercelli
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Luca Micai
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Gabriele Montefusco
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Carlotta Mangione
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Francesco Bracco
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Fulvia Colucci
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Cosimo De Nunzio
- Urology Unit, Ospedale Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Paolo Gontero
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
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Iqbal J, Mashkoor Y, Nadeem A, Tah S, Sharifa M, Ghani S, Thugu TR, Patel H, Bonner-Reid FT, Shrestha J, Hassen BA. Shifting Trends in Prostate Treatment: A Systematic Review Comparing Transurethral Resection of the Prostate and Holmium Laser Enucleation of the Prostate. Cureus 2023; 15:e46173. [PMID: 37905244 PMCID: PMC10613322 DOI: 10.7759/cureus.46173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Our systematic review aimed to assess the effectiveness and suitability of holmium laser enucleation of the prostate (HoLEP) as a treatment for benign prostatic hyperplasia (BPH) in comparison to transurethral resection of the prostate (TURP). We analyzed 12 studies involving male participants aged 45-85 years, all of whom had BPH. In our analysis, we compared HoLEP and TURP, with a focus on several primary outcomes, including postoperative International Prostate Symptom Score (IPSS), postvoid residual (PVR) volume, maximum flow rate (Qmax), and changes in sexual function post-treatment. HoLEP demonstrated advantages in certain aspects when compared to TURP. HoLEP generally resulted in an improved postoperative IPSS in some studies, but not all studies showed a significant difference when compared to TURP. HoLEP was associated with improved Qmax in most studies, but one study found no significant difference between HoLEP and TURP. Patients who underwent HoLEP showed improvement in the PVR volume in some studies, while others found no significant change in the PVR volume with either HoLEP or TURP. Some studies reported a reduction in orgasm and ejaculatory scores following TURP, while no significant changes were observed in erectile function, intercourse satisfaction, and overall satisfaction scores. It is worth noting that previous reviews and meta-analyses had limited data on the effects of HoLEP and TURP on sexual dysfunction. TURP is associated with a higher risk of morbidity and mortality, which has led to its replacement with HoLEP as the gold standard for treating BPH, particularly due to its size-independent applicability. HoLEP also demonstrated greater efficacy in the postoperative period.
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Affiliation(s)
- Javed Iqbal
- Department of Neurosurgery, Mayo Hospital, Lahore, PAK
| | - Yusra Mashkoor
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Abdullah Nadeem
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Sunanda Tah
- Department of Internal Medicine, Saint James School of Medicine, Arnos Vale, VCT
| | | | - Saroosh Ghani
- Department of Medicine and Allied Sciences, Isra University, Hyderabad, PAK
| | - Thanmai Reddy Thugu
- Department of Internal Medicine, Sri Padmavathi Medical College for Women, Tirupati, IND
| | - Harshkumar Patel
- Department of Internal Medicine, Pandit Deendayal Upadhyay Medical College, Rajkot, IND
| | - Felicia T Bonner-Reid
- Department of Internal Medicine, Universidad de Ciencias Médicas de Granma, Manzanillo, CUB
| | - Jeena Shrestha
- Department of Internal Medicine, Jalalabad Ragib-Rabeya Medical College, Sylhet, BGD
| | - Buure A Hassen
- Department of Internal Medicine, Hayat Medical College, Addis Ababa, ETH
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Ayoub CH, Haber R, Amine R, Mikati D, Mahfoud ZR, El Hajj A. Comparison of Postoperative Outcomes of Trans-urethral Resection of the Prostate, Laser Vaporization, and Laser Enucleation: A Double Propensity Score Matched Analysis. Urology 2023; 177:148-155. [PMID: 37182649 DOI: 10.1016/j.urology.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To compare postoperative outcomes of 3 types of endourologic surgeries (trans-urethral resection of the prostate [TURP], laser vaporization [LVP], and laser enucleation [LEP]) for benign prostatic hypertrophy (BPH) treatment using the ACS-NSQIP database. METHODS The ACS-NSQIP database was queried for men who underwent TURP, PVP, and LEP for treatment of BPH from 2011 till 2019. Demographics, clinical, operative characteristics, and 30-day outcomes were compared. Univariate and multivariate regression models were constructed. Propensity score matching was then performed as a sensitivity analysis. RESULTS A total of 74,273 patients underwent endourologic surgeries for BPH, 65.4% had TURP, 28.6% PVP, and 5.9% LEP. Patients undergoing TURP were more likely to be older with higher ASA class, abnormal labs, and comorbidities (diabetic, congestive heart failure, and bleeding requiring transfusion) (P-value <.001). After adjusting for covariates and propensity score matching, LVP demonstrated shorter hospital stays, shorter operative times, less reoperation rates, decreased DVT/PE risk, with, however, higher odds of urinary tract infection and sepsis as compared to TURP (P-value<.028). Furthermore, LEP was found to have shorter hospital stays, longer operative times, and decreased odds of urinary tract infections and sepsis as compared to TURP (P-value<.006). CONCLUSION LVP and LEP showed better surgical outcomes and characteristics as compared to TURP. Further research is needed to account for longer duration of follow-up and patient-specific urologic outcomes, such as prostate size, urinary incontinence, erectile dysfunction, and retrograde ejaculation.
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Affiliation(s)
- Christian Habib Ayoub
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Rachelle Haber
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Reem Amine
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Diana Mikati
- Salim El-Hoss Bioethics & Professionalism Program, American University of Beirut Medical Center, Beirut, Lebanon.
| | | | - Albert El Hajj
- Department of Surgery, Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon.
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Elshal AM, Ghobrial FK, Laymon M, Elegeezy M, El-Nahas AR. Greenlight laser (XPS TM) 180W prostatectomy for treatment of benign prostate hyperplasia in patients with uncorrectable bleeding tendency. Arab J Urol 2022; 21:129-134. [PMID: 37234681 PMCID: PMC10208207 DOI: 10.1080/2090598x.2022.2156655] [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: 10/21/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives Safety of GreenLight™ laser prostatectomy (GL-LP) in patients with ongoing blood thinners has been proven. Yet, the possibility of drug manipulation makes it a less challenging situation compared to treating patients with uncorrectable bleeding tendency. Herein, we aim at evaluating the outcomes of XPS™-180 W GL-LP for treatment of BPH in patients who had uncorrectable bleeding tendency due to hepatic dysfunction. Methods A prospectively maintained database for all patients who underwent GL-LP for symptomatic BPH was reviewed. Patients were divided into two groups based on the degree of hepatic dysfunction using Fib-4 index: Group 1 (indexed patients; low-risk Fib-4) and Group 2 (non-indexed patients; intermediate-high-risk Fib-4) included those who had chronic liver disease associated with either thrombocytopenia and/or hypoprothrombinemia. Primary outcome was the difference in perioperative bleeding complications between the two groups. Other outcome measures included all perioperative findings and complications as well-functional outcome measures. Results The study included 140 patients (93 indexed patients and 47 non-indexed). There were no significant differences between both groups in operative time, laser time and energy, auxiliary procedures, catheter time, hospital stay, and hemoglobin deficit. The need for blood transfusion was significantly more in group 2 (two patients (4.3%) versus no patients in group 1, P = 0.045). Perioperative and late postoperative complications were comparable for both groups (P = 0.634 and 0.858, respectively). There were no significant differences in the postoperative uroflow, symptoms score, and PSA reduction between the two groups (P = 0.57, 0.87, and 0.05, respectively). Conclusions XPS™-180 W GL-LP is a safe and effective technique for treatment of BPH in patients with uncorrectable bleeding tendency due to hepatic dysfunction.
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Affiliation(s)
- Ahmed M. Elshal
- Urology Department, Urology and Nephrology Center, Mansoura University, Egypt
| | - Fady K. Ghobrial
- Department of Urology, Faculty of Medicine, Damietta University, Egypt
| | - Mahmoud Laymon
- Urology Department, Urology and Nephrology Center, Mansoura University, Egypt
| | - Mohamed Elegeezy
- Department of Internal Medicine, Hepatology Unit, Mansoura University, Al Mansurah, Egypt
| | - Ahmed R. El-Nahas
- Urology Department, Urology and Nephrology Center, Mansoura University, Egypt
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Elterman D, Aubé-Peterkin M, Evans H, Elmansy H, Meskawi M, Zorn KC, Bhojani N. UPDATE - Canadian Urological Association guideline: Male lower urinary tract symptoms/benign prostatic hyperplasia. Can Urol Assoc J 2022; 16:245-256. [PMID: 35905485 PMCID: PMC9343161 DOI: 10.5489/cuaj.7906] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Affiliation(s)
- Dean Elterman
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | | | - Howard Evans
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Hazem Elmansy
- Division of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Malek Meskawi
- Division of Urology, Université de Montréal, Montreal, QC, Canada
| | - Kevin C. Zorn
- Division of Urology, Université de Montréal, Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Université de Montréal, Montreal, QC, Canada
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El-Shaer W, Alhefnawy M, Ebrahim Y, Elshazly A, Abdel-Lateef S. Bipolar Needlescopic Enucleation Versus Bipolar Vapoenucleation of the prostate: A prospective single Centre Randomized Study. J Endourol 2022; 36:1452-1459. [PMID: 35838130 DOI: 10.1089/end.2022.0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Endoscopic enucleation of the prostate (EEP) is a safe and effective interventional option for the management of variable-sized adenomas. PURPOSE To point out the safety and efficacy of needlescopic enucleation of the prostate (BNEP) in comparison with vapoenucleation of the prostate (BVEP). MATERIALS AND METHODS This is a prospective randomized trial. In all, 214 patients with variable size adenoma were randomly assigned (1:1) to either: the BNEP group (108 patients underwent Bipolar-EEP (BEEP) using a needle electrode, or a vapoenucleation one (BVEP) group (106 patients underwent BEEP using vaporization electrodes). Intra & intergroup objective and subjective outcomes were compared at different time points for 1 year. Also, all other procedure's related events and mishaps were registered and compared. RESULTS The median (interquartile range (IQR)) operative time, resected tissue weight, postoperative irrigation time, and Hb drop were: 60 (50-88) Vs 80 (60 - 98) minutes, 67 (56 - 86) Vs 46 (40- 61) grams, 10 (8 - 12) Vs 12 (10 -18) hours, and 1 (0.6 - 1.3) Vs 1.2 (0.88 - 1.9) g/dl, for BNEP and BVEP groups, respectively, (P<0.05). Both subjective and objective parameters were analogously improved in the two groups (P> 0.5). However, the post-operative irritative symptoms and urinary infections were lower in BNEP group (P<0.05). CONCLUSIONS Our results revealed that although both BNEP and BVEP are effective and safe in the management of benign prostatic obstruction, BNEP is superior in terms of less operative time, intra-operative blood loss, irrigation time, irritative symptoms and urinary infections.
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Nguyen DD, Deyirmendjian C, Law K, Bhojani N, Elterman DS, Chughtai B, Bruyère F, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo T, Becher EF, Cash H, Reimann M, Rijo E, Misrai V, Zorn KC. GreenLight photovaporization of the prostate in high-medical-risk patients: an analysis of the Global GreenLight Group (GGG) database. World J Urol 2022; 40:1755-1762. [PMID: 35347413 DOI: 10.1007/s00345-022-03986-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/07/2022] [Indexed: 01/16/2023] Open
Abstract
PURPOSE We sought to characterize the adjusted outcomes of GreenLight photoselective vaporization of the prostate (PVP) in high-medical-risk (HMR) patients using data from the largest international database. METHODS Data were obtained from the Global GreenLight Group (GGG) database which pools data of eight high-volume, experienced surgeons, from a total of seven international centers. Eligible study participants underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019. HMR patients were defined as patients with ASA III or greater and were compared to non-HMR patients. Analyses were adjusted for patient age and prostate volume. RESULTS In the HMR group, patients on average were older and had smaller prostates than the non-HMR control group. Compared to non-HMR patients, transfusions occurred more frequently (2.6% vs. 0.14%, p < 0.01) and the odds of readmission were elevated [OR 2.0, (95% CI 1.4-2.8, p < 0.01)] among HMR patients. Twelve months postoperatively, HMR patients experience greater improvement in QoL than the control group [+ 0.54 (95% CI 0.07-1.0, p = 0.02)]. PVR also decreased 93.1 ml more in HMR than in non-HMR patients after 12 months (95% CI 33.6-152.6, p < 0.01). CONCLUSION We found that GreenLight PVP is safe and effective in improving functional outcomes in higher-risk patients with severe systemic disease compared to their lower-risk counterparts. Though absolute risks remain low, GreenLight PVP is associated with higher odds of transfusion and readmission in the high-risk cohort. The findings of our study reaffirm current guidelines that propose PVP as a viable treatment option for HMR patients.
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Affiliation(s)
- David-Dan Nguyen
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | | | - Kyle Law
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Dean S Elterman
- Division of Urology, University Health Network, Toronto, ON, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Franck Bruyère
- Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Centre-Val de Loire, France
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, "Cure Group", Modena, Italy
| | - Giovanni Ferrari
- Department of Urology, Hesperia Hospital, "Cure Group", Modena, Italy
| | | | | | | | - Hannes Cash
- Prouro, Urology Berlin, Berlin, Germany
- Department of Urology, University of Magdeburg, Magdeburg, Germany
| | | | - Enrique Rijo
- Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
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Deyirmendjian C, Elterman D, Chughtai B, Zorn KC, Bhojani N. Surgical treatment options for benign prostatic obstruction: beyond prostate volume. Curr Opin Urol 2022; 32:102-108. [PMID: 34669611 DOI: 10.1097/mou.0000000000000937] [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 Many surgical treatment options are available for patients who present with benign prostatic obstruction (BPO). This article reviews the current treatment options available and distinguishes them based on five clinical considerations: antithrombotic therapy, sexual function preservation, ambulatory procedures, anesthesia-related risks and duration of catheterization. RECENT FINDINGS A comprehensive review of the literature was performed on 10 BPO procedures. Laser enucleation of the prostate (LEP), bipolar plasma transurethral vaporization of the prostate and photoselective vaporization (PVP) of the prostate reduces the risk of bleeding, which is recommended for anticoagulated men. Ejaculatory function is more likely to be preserved following transurethral incision of the prostate, Rezūm, Aquablation, UroLift and iTind. Same-day discharge is possible for LEP, PVP and prostatic arterial embolization (PAE). For patients with high anesthesia-related risks, procedures compatible with local anesthesia (UroLift, Rezūm, iTind and PAE) should be favored. Catheterization duration is shorter with UroLift, PVP and LEP. SUMMARY BPO treatment options are growing rapidly. The optimal procedure for a given patient is based on factors such as associated risks, recovery and expected outcomes. Besides prostate volume, the clinical considerations in the present article can help elucidate the best surgical BPO treatment option for each patient based on their values, preferences, and risk tolerance.
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Affiliation(s)
| | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
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Mesnard B, Drillaud N, Sigaud M, Hakim G, Chelly S, Ternisien C, Fouassier M, Chelghaf I, De Vergie S, Perrouin Verbe MA, Rigaud J, David A, Trossaërt M, Branchereau J. Prostate interventions in patients with mild haemophilia: Safe and feasible. Haemophilia 2021; 27:e659-e666. [PMID: 34342928 DOI: 10.1111/hae.14388] [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: 04/26/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To date, there is no specific recommendation or evaluation of the morbidity of prostate surgery in patients with haemophilia (PWH) although this surgery is common and at high risk of bleeding. AIM To assess the post-operative morbidity of benign prostate hyperplasia (BPH) surgeries and of oncological prostate interventions in patients with mild haemophilia A or B. METHODS We performed a monocentre, epidemiological, in real life study. Data were collected between 1 January, 1997 and 1 September, 2020 and focused on prostate biopsy, radical prostatectomy, prostate radiotherapy, simple prostatectomy, transurethral resection of prostate (TURP) and laser-vaporisation in patients with mild haemophilia A or B. RESULTS Between 1 January, 1997 and 1 September, 2020, 51 interventions were performed on 30 patients with mild haemophilia. Haemophilia A represented 93.33% of the population and haemophilia B 6.67%. For prostate biopsies (n = 24), median length of hospitalisation was 4 days and only one patient needed a blood transfusion. No patient needed re-admission. For prostatectomy (n = 10), one patient presented with intra-operative and post-operative bleeding. Two patients required re-admission. The other patients did not present any significant haemorrhagic symptoms. For radiotherapy (n = 4), two patients presented a grade II complication (radiocystitis and radiorectitis). For BPH surgeries, during hospitalisation, laser-vaporisation (n = 5) was less haemorrhagic than TURP (n = 5) but after hospital discharge, 60% of patients presented a haemorrhagic complication with two readmissions and one surgical re-explorations. CONCLUSION Performed in a specialised centre, prostate surgeries and interventions in patients with mild haemophilia is feasible with acceptable morbidity.
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Affiliation(s)
- Benoit Mesnard
- Department of Urology and Transplantation Surgery, Nantes University Hospital, Nantes, France
| | | | - Marianne Sigaud
- Haemophilia Centre, Nantes University Hospital, Nantes, France
| | - Gabriella Hakim
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Samuel Chelly
- Department of Urology, Angers University Hospital, Angers, France
| | | | - Marc Fouassier
- Haemophilia Centre, Nantes University Hospital, Nantes, France
| | - Ismaël Chelghaf
- Department of Urology and Transplantation Surgery, Nantes University Hospital, Nantes, France
| | - Stéphane De Vergie
- Department of Urology and Transplantation Surgery, Nantes University Hospital, Nantes, France
| | | | - Jérôme Rigaud
- Department of Urology and Transplantation Surgery, Nantes University Hospital, Nantes, France
| | - Arthur David
- Department of Radiology, Nantes University Hospital, Nantes, France
| | - Marc Trossaërt
- Haemophilia Centre, Nantes University Hospital, Nantes, France
| | - Julien Branchereau
- Department of Urology and Transplantation Surgery, Nantes University Hospital, Nantes, France.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.,Centre de Recherche en Transplantation et Immunologie CRTI Inserm, Nantes University, Nantes, France
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10
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Law KW, Tholomier C, Nguyen DD, Sadri I, Couture F, Zakaria AS, Bouhadana D, Bruyère F, Cash H, Reimann M, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo TJ, Becher EF, Misrai V, Elterman D, Bhojani N, Zorn KC. Global Greenlight Group: largest international Greenlight experience for benign prostatic hyperplasia to assess efficacy and safety. World J Urol 2021; 39:4389-4395. [PMID: 33837819 DOI: 10.1007/s00345-021-03688-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/26/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Greenlight photo-selective vaporization of the prostate (GL-PVP) has gained international acceptance as a safe and effective alternative procedure for the treatment of benign prostatic hyperplasia (BPH), especially in anticoagulated men. This descriptive analysis aims to characterize the current state of GL-PVP, pooling data from international centers. METHODS Data from 3627 patients who underwent GL-PVP with the XPS-180 W system in seven international centers performed by eight expert surgeons between 2011 and 2019 were retrospectively analyzed. Demographic, perioperative, and postoperative data were collected, including IPSS, QoL, Qmax, PVR, and PSA, and complications. RESULTS At baseline, median age, prostate volume, PSA, and IPSS were 70 years (interquartile range 64-77), 64 (47-90), 3.1 ng/mL (1.8-6), and 22 (19-27), respectively. Median lasing and operative time were 34 (23-48) and 62 min (46-85), respectively. Median energy use was 250.0 kJ (168.4-367.9), with 92.6% of procedures being completed with one laser fiber. In 60.1% of cases, catheter was removed on postoperative day 1 with median length of 2 days. All-cause mortality within 30 days was 0.3%. Median PSA reduction at 3 months and 60 months compared to baseline was 43.9 and 46.4%, respectively (p < 0.001). All functional outcomes (IPSS, QoL, Qmax, and PVR) were significantly improved across study period when compared to baseline (p < 0.001). For those men with longer follow-up available, the observed surgical BPH retreatment rate was 1.5% CONCLUSION: Using the largest multi-user, international database of GL-PVP, Greenlight XPS laser treatment in experienced hands is a safe, effective, and durable BPH treatment option.
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Affiliation(s)
- Kyle W Law
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Côme Tholomier
- Department of Surgery, Division of Urology, McGill University, Montreal, QC, Canada
| | | | - Iman Sadri
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Félix Couture
- Department of Surgery, Division of Urology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Ahmed S Zakaria
- Department of Urology, University of Montreal Hospital Center CHUM, Montreal, QC, Canada
| | - David Bouhadana
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Franck Bruyère
- Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Centre-Val de Loire, France
| | - Hannes Cash
- Department of Urology, Charité-Universitaetsmedizin Berlin, Berlin, Germany.,PROURO, Berlin, Germany.,Department of Urology, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
| | - Maximilian Reimann
- Department of Urology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy
| | - Giovanni Ferrari
- Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy
| | | | | | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, Midi-Pyrenees, France
| | - Dean Elterman
- Division of Urology, Department of Surgery, University. Health Network, University of Toronto, Toronto, ON, Canada
| | - Naeem Bhojani
- Department of Urology, University of Montreal Hospital Center CHUM, Montreal, QC, Canada
| | - Kevin C Zorn
- Department of Urology, University of Montreal Hospital Center CHUM, Montreal, QC, Canada.
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11
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Xu X, Jiang D, Liu G, Mu L, Zeng J, Yang L, He D. In vitro evaluation of the safety and efficacy of a high-power 450-nm semiconductor blue laser in the treatment of benign prostate hyperplasia. Lasers Med Sci 2021; 37:555-561. [PMID: 33770281 DOI: 10.1007/s10103-021-03297-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/22/2021] [Indexed: 01/17/2023]
Abstract
A 450-nm blue laser may be suitable to treat benign prostate hyperplasia (BPH) due to its haemoglobin absorption characteristic. The present study compared a novel high-power 450-nm semiconductor blue laser with other lasers marketed for in vitro soft tissue ablation, to evaluate the safety and efficacy of the 450-nm laser in BPH surgery. With the in vitro tissues on an experimental platform in water, the vaporization efficiency and coagulation layer thickness of the novel 450-nm laser and commercially available 532-nm, 980-nm, and 1470-nm lasers were measured at the same power (120 W). The damage to the adjacent tissue and the working noise were also measured. The vaporization efficiency was proved to be 450-nm laser > 532-nm laser > 1470-nm laser > 980-nm laser. Comparison of coagulation layer thickness was as follow: 980-nm laser > 1470-nm laser > 532-nm laser > 450-nm laser. The degree of tissue damage caused by the 450-nm and 532-nm lasers increased with the decrease in distance and increase in time (these are safe when a sufficient distance and short irradiation time are maintained). The heating ability of 980-nm and 1470-nm lasers was much greater than that of 450-nm and 532-nm lasers. The working noise was lower in 450-nm and 1470-nm lasers. The novel 450-nm laser has the advantages of highly efficient tissue vaporization, creating a thin coagulation layer, and low working noise. These characteristics suggest that the novel 450-nm laser may be a promising choice for the surgical treatment of BPH.
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Affiliation(s)
- Xiaofeng Xu
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
- Department of Urology, Xianyang Central Hospital, Xianyang, 710061, Shaanxi, China
| | - Dali Jiang
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Guoxiong Liu
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
- Department of Urology, Xianyang Central Hospital, Xianyang, 710061, Shaanxi, China
| | - Liyue Mu
- Xi'an Lanji Medical Electronic Technology Co., Ltd., Xi'an, 710003, Shaanxi, China
| | - Jin Zeng
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Lin Yang
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| | - Dalin He
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
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12
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Laine-Caroff P, Pradere B, Ruffion A, Bruyere F. Greenlight laser photoselective vaporization vs open simple prostatectomy: long-term functional outcomes after treatment of large volume prostates (> 80 cc). Int Urol Nephrol 2021; 53:1289-1295. [PMID: 33725292 DOI: 10.1007/s11255-021-02839-1] [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: 11/29/2020] [Accepted: 03/06/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare long-term outcomes between photoselective vaporization (PVP) and Open simple prostatectomy (OSP) for prostates > 80 cc. METHODS Men operated either by PVP or OSP for BPH > 80 cc were included in two expert centres. Functional and uroflowmetric outcomes were assessed pre- and postoperatively. Data were collected prospectively in the PVP group and retrospectively in the OSP group and compared at long-term follow-up. Complications and re-intervention rates were used as main outcomes. RESULTS 332 men underwent surgery: 132 PVP were performed in a fist expert-centre and 200 OSP were performed in a second one with a median follow-up of 54 and 48 months, respectively. Mean Prostate volume was similar between OSP and PVP group (119 vs 116 cc). Major complications were more common in the OSP group (12.5 vs 1.5%, p < 0.001). At long-term follow-up, Qmax was higher and PVR was lower (p < 0.05) in the OSP group. IPSS score was similar between groups (p = 0.45) but the Qol was better in the OSP group (0.9 vs. 1.6; p < 0.05). There were more re-interventions in the PVP group compared to OSP (15.2 vs. 0%, p < 0.005). CONCLUSION PVP is a good alternative for prostates > 80 cc particularly for fragile patients as it is associated with a lower complication rate. At long-term follow-up, IPSS was similar between groups, but Qol was better in the OSP group. Patients treated by PVP should be informed that they could require reoperation in 15% of the cases.
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Affiliation(s)
- Paul Laine-Caroff
- Department of Urology, CHRU de Tours, Loire Valley, 2, Boulevard Tonnelle, 37044, Tours cedex 9, France.
| | - Benjamin Pradere
- Department of Urology, CHRU de Tours, Loire Valley, 2, Boulevard Tonnelle, 37044, Tours cedex 9, France.,Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Alain Ruffion
- Department of Urology, GH Lyon-Sud, hospices civils de Lyon, Claude-Bernard Université Lyon-1, 69495, Pierre-Bénite cedex, France
| | - Franck Bruyere
- Department of Urology, CHRU de Tours, Loire Valley, 2, Boulevard Tonnelle, 37044, Tours cedex 9, France.,PRES Centre Val-de-Loire, Université François-Rabelais, 37000, Tours, France
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13
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Schwartz RN, Couture F, Sadri I, Arezki A, Nguyen DD, Zakaria AS, Law K, Elterman D, Rieken M, Cash H, Zorn KC. Reasons to believe in vaporization: a review of the benefits of photo-selective and transurethral vaporization. World J Urol 2020; 39:2263-2268. [PMID: 32930847 DOI: 10.1007/s00345-020-03447-x] [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: 04/21/2020] [Accepted: 09/05/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE In the current review, we will discuss the state of the literature of vaporization of the prostate for the treatment of benign prostatic enlargement (BPE). We discuss two methods of vaporization of the prostate: Transurethral Vaporization of the Prostate (TUVP) and Greenlight Photo-selective Vaporization of the Prostate (PVP). METHODS A comprehensive review of the literature was performed on TUVP and PVP. The literature on transurethral resection of the prostate (TURP) was also extensively reviewed as a comparative surgical method. RESULTS The evidence shows that TUVP appears to be the safer choice, as compared to TURP due to less intra- and peri-operative complications. PVP was associated with less bleeding complications than TURP with outpatient discharge. Importantly, PVP was not associated with serious bleeding events requiring blood transfusions or medical treatment in patients under anticoagulation or antiplatelet therapies. PVP was also shown to be a cost-effective option compared to TURP. CONCLUSION Prostate vaporization for the treatment of BPE appears to be an efficient and safer alternative to TURP. Vaporization techniques, particularly Greenlight PVP, should be offered to most men, especially those under anticoagulation therapy, as well as patients at risk of bleeding complications.
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Affiliation(s)
| | - Felix Couture
- Département d'Urologie, Centre Hospitalier de l'Université de Sherbrooke, Montreal, Canada
| | - Iman Sadri
- McGill University, Faculty of Medicine, Montreal, Canada
| | - Adel Arezki
- McGill University, Faculty of Medicine, Montreal, Canada
| | | | - Ahmed S Zakaria
- Département d'Urologie, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Kyle Law
- McGill University, Faculty of Medicine, Montreal, Canada
| | - Dean Elterman
- Division of Urology, University of Toronto, Toronto, Canada
| | - Malte Rieken
- alta uro AG, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Hannes Cash
- Department of Urology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kevin C Zorn
- Département d'Urologie, Centre Hospitalier de l'Université de Montréal, Montreal, Canada.
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14
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Dornbier R, Pahouja G, Branch J, McVary KT. The New American Urological Association Benign Prostatic Hyperplasia Clinical Guidelines: 2019 Update. Curr Urol Rep 2020; 21:32. [PMID: 32607874 DOI: 10.1007/s11934-020-00985-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW The goal of this paper was to analyze the efficacy of the current modalities available to surgically treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). RECENT FINDINGS There have been significant surgical advancements for the treatment of BPH, including an increasing development and utilization of minimally invasive surgical techniques (MISTs). These procedures have varying outcomes that are critical to understand. In addition, MISTs have important adverse effects, though have minimized effects on sexual function when compared to more invasive surgical techniques. It is important for all urologists to be familiar with the surgical techniques available to treat BPH and the updated American Urological Association (AUA) Guidelines. Further studies evaluating efficacy, safety, and sexual functioning will help guide care in the future and evolve practice.
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Affiliation(s)
- Ryan Dornbier
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA.
| | - Gaurav Pahouja
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
| | - Jeffrey Branch
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
| | - Kevin T McVary
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
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15
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Morton S, McGuiness L, Harding C, Thorpe A. A review of surgery and new technology procedures for the management of benign prostatic obstruction. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415819879667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Level of evidence: Not applicable for this review article.
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Affiliation(s)
- Simon Morton
- Department of Urology Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Luke McGuiness
- Department of Urology Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Christopher Harding
- Department of Urology Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - Andrew Thorpe
- Department of Urology Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
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16
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Bausch K, Motzer J, Roth JA, Dangel M, Seifert HH, Widmer AF. High incidence of urinary tract infections after photoselective laser vaporisation of the prostate: a risk factor analysis of 665 patients. World J Urol 2019; 38:1787-1794. [PMID: 31578631 DOI: 10.1007/s00345-019-02969-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/20/2019] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Although photoselective laser vaporisation of the prostate (PVP) is a recognised alternative to transurethral resection in treating benign prostatic obstruction, there is limited data on the incidence and determinants of postoperative urinary tract infections (UTI). We assessed patients subjected to PVP, evaluating incidence and potential determinants of postoperative UTIs. MATERIALS AND METHODS Consecutive patients undergoing PVP between April 2010 and August 2018 were candidates for this retrospective cohort study. The primary outcome measure was microbiologically confirmed postoperative UTI. We fitted uni- and multi-variable Cox models to identify potential risk factors. RESULTS Among the 665 included patients, 20% developed postoperative UTIs. The overall incidence rate per 100 patient-days was 0.65 (95% confidence interval [CI] 0.55-0.77). Risk factors for postoperative UTIs were end-stage renal failure (adjusted hazard ratio [aHR] = 14.10, 95% CI 2.08-64.58; p = 0.001) and presence of at least one of the following factors in the 3 months preceding PVP: (i) placement of urinary catheter, (ii) bacteriuria, (iii) UTI, or (iv) antimicrobial treatment (composite aHR = 1.99, 95% CI 1.22-3.24; p < 0.001). There was no apparent association between choice or duration of antimicrobial prophylaxis and incident UTIs. CONCLUSIONS Our analysis revealed a high incidence of UTIs after PVP and served to identify certain preoperative risk factors. Neither the choice of antimicrobial regimen nor its duration affected the incidence of UTIs. Prolonged antimicrobials proved to be disproportionately high, warranting further scrutiny in randomised controlled trials.
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Affiliation(s)
- Kathrin Bausch
- Department of Urology, University Hospital Basel, Spitalstrasse 21, Basel, 4056, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Jan A Roth
- University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Marc Dangel
- University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Hans-Helge Seifert
- Department of Urology, University Hospital Basel, Spitalstrasse 21, Basel, 4056, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Andreas F Widmer
- University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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17
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Abstract
This review provides a brief overview of and commentary on currently available technology for the surgical treatment of obstructive benign prostatic hyperplasia causing lower urinary tract symptoms. This review provides references relevant to review and understand current technology that is clinically available.
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Affiliation(s)
- Alexis E Te
- Weill Medical College of Cornell University, Ithaca, NY, USA.,Urology Program, Iris Cantor Men's Health Center, 425 East 61st Street, 12th Floor, New York, NY, 10065, USA.,Brady Prostate Center and Urodynamics Laboratory, 525 East 68th Street, 9th Floor, New York, NY, 10065, USA
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18
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Outcome of Photoselective Vaporization of the Prostate with the GreenLight-XPS 180 Watt System Compared to Transurethral Resection of the Prostate. J Clin Med 2019; 8:jcm8071004. [PMID: 31295846 PMCID: PMC6678790 DOI: 10.3390/jcm8071004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 06/30/2019] [Accepted: 07/07/2019] [Indexed: 11/17/2022] Open
Abstract
The aim of this paper was to compare the perioperative and postoperative results of photoselective vaporization of the prostate with the GreenLight-XPS 180 Watt System (PVP) and transurethral resection of the prostate (TURP). This retrospective study included 140 men who underwent PVP and 114 men who underwent TURP for symptomatic benign prostate enlargement (BPE) between June 2010 and February 2015. The primary outcome measures were the patient reported outcome, operative results, International Prostate Symptom Score-Quality of Life (IPSS-QoL), complication rates, catheterization time, and length of hospital stay. The median follow-up times were 27 months (range 14-44) for the PVP group and 36 months (range 25-47) for the TURP group. The patient characteristics were well balanced in both groups with a median age of 71 years (PVP group) vs. 70 years (TURP group) and a comparable prostate volume (median 50 mL in the PVP group vs. 45 mL in the TURP group). The IPSS-QoL was significantly higher in the PVP group than in the TURP group (median 22 + 4; range 16-27 + 3-5 vs. median 19 + 3; range 15-23 + 3-4; p = 0.02). Men undergoing PVP were more likely to be on anticoagulants (PVP group n = 23; 16% vs. TURP group n = 2; 2%, p < 0.001). The median operation time (OT; min) for both procedures was comparable with 68 min (PVP group; range 53-91) vs. 67 min (TURP group; range 46-85). The rate of severe intraoperative bleeding was significantly lower in the PVP group than in the TURP group (n = 7; 5% vs. n = 16; 14%; p = 0.01). The postoperative catheterization time and length of hospital stay was significantly lower in the PVP group (median 1-2 days; range 1-4) vs. the TURP group (median 2-4 days; range 2-5; both p < 0.001). Complication rates (Clavien-Dindo classification ≥III) based on the follow-up data showed no statistically significant difference between the PVP group and the TURP group (n = 6; 4% vs. n = 6; 5%; p = 0.28). The IPSS on follow-up showed an equivalent reduction in symptoms for both treatment modalities (IPSS-QoL of 5 + 1; range 2-11 + 0-2 for both). There were no differences concerning urge (PVP group n = 3; 2% vs. TURP group n = 3; 3%; p = 0.90) and men were similarly satisfied with the postoperative outcome (PVP group 92% vs. TURP group 87%; p = 0.43). The PVP group was associated with a shorter hospitalization time and showed a reduced risk of bleeding, despite patients remaining on anticoagulants, without increasing the overall operative time. There was no difference in the patient reported outcome for both procedures.
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19
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Rieken M, Herrmann TRW, Füllhase C. Operative Therapie des benignen Prostatasyndroms – resezieren, vaporisieren oder enukleieren? Urologe A 2019; 58:263-270. [DOI: 10.1007/s00120-019-0891-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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20
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Becker B, Netsch C, Hansen J, Böhme A, Gross AJ, Zacharias M, Lehrich K. Perioperative Safety in Patient Under Oral Anticoagulation During Holmium Laser Enucleation of the Prostate. J Endourol 2019; 33:219-224. [PMID: 30516393 DOI: 10.1089/end.2018.0693] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the safety of holmium laser enucleation of the prostate (HoLEP) in patients on oral anticoagulation (OA) with respect to intra- and postoperative bleeding complications. METHODS Between January 2013 and October 2016, 2178 patients were included in this study, of whom 94 received direct oral anticoagulants (DOACs) and 151 received vitamin K antagonists (VKAs) before HoLEP. All patients either ceased OA (DOACs) or were bridged subtherapeutically (VKAs, international normalized ratio <2) during surgery. These patients were compared to a sample size of 1933 nonanticoagulated patients. RESULTS A significant longer postoperative stay was noted for the patients on DOACs (5.2 [4-6] days) and VKAs (5.3 [4-5] days) compared to the control group (4.5 [4-4] days). The mean drop in hemoglobin was significantly higher in the VKA group compared to the DOAC and control group. There was a significantly higher rate of postoperative bladder tamponades/secondary coagulation in patients on OA with 6 (7.9%)/3 (3.9%) patients in the DOAC group, 10 (7.4%)/6 (4.4%) patients in the VKA group compared to 37 (2.2%)/21 (2.1%) patients in the control group, respectively (p < 0.001). Eight patients required blood transfusions with a distribution of 1 (1.3%), 3 (2.2%), and 4 (0.2%) patients in the DOAC, VKA, and control group, respectively (p < 0.001). CONCLUSIONS Our findings indicate that bridged patients who's DOACs and VKAs were ceased before HoLEP are at higher risk of intra- and postoperative bleeding complications. Nonetheless, HoLEP appears to be a safe and effective procedure in those patients.
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Affiliation(s)
- Benedikt Becker
- 1 Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
| | | | - Jens Hansen
- 2 Department of Urology, Auguste Viktoria Hospital, Berlin, Germany
| | - Axel Böhme
- 2 Department of Urology, Auguste Viktoria Hospital, Berlin, Germany
| | - Andreas J Gross
- 1 Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Mario Zacharias
- 2 Department of Urology, Auguste Viktoria Hospital, Berlin, Germany
| | - Karin Lehrich
- 2 Department of Urology, Auguste Viktoria Hospital, Berlin, Germany
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21
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Charbonneau H, Pasquié M, Peyronnet B, Descazeaud A, Barry-Delongchamps N, Della Negra E, Mathieu R, Karsenty G, Long JA, Ballereau C, Azzouzi AR, Pradère B, Bruyère F, Fournier G, Lebdai S, Calves J, Corbel L, Vincendeau S, Fiard G, Thuillier C, Descotes JL, Colin P, Culty T, Hesbois A, Fuzier V, Savy N, Pathak A, Albaladejo P, Samama CM, Guerrero F, Misraï V. Stopping or maintaining oral anticoagulation in patients undergoing photoselective vaporization of the prostate (SOAP) surgery for benign prostate obstruction: study protocol for a multicentre randomized controlled trial. Trials 2018; 19:705. [PMID: 30587221 PMCID: PMC6307178 DOI: 10.1186/s13063-018-3066-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 11/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lower urinary tract symptoms related to benign prostatic obstruction (BPO) are frequent in men aged > 50 years. Based on the use of innovative medical devices, a number of transurethral ablative techniques have recently been developed for the surgical treatment of BPO. In recent years, GreenLight photoselective vaporization of the prostate (PVP) has been considered as a non-inferior alternative to transurethral resection of the prostate. The GreenLight PVP is usually considered as an interesting surgical option for patients treated via oral anticoagulants (OACs) with regard to its haemostatic properties. The aim of this study was to assess the impact of maintaining OAC treatment in patients undergoing PVP. METHODS This study is a multicentre, open-label, randomized controlled trial (RCT) designed to show the non-inferiority of PVP surgery in patients with BPO treated with OACs. This study is designed to enrol 386 OAC-treated patients (treated with vitamin K antagonists and direct oral anticoagulants) who are undergoing PVP for BPO. Patients will be randomized (1:1) to either maintain or stop OAC treatment during the perioperative course. The intervention group will maintain OAC treatment until the day before surgery and resume OAC treatment the day after surgery, whereas the control group will stop OAC treatment (with or without low-molecular-weight heparin bridging therapy) according to the anaesthesia guidelines. The primary outcome of interest to be assessed is the 30-day complications rate according to the Clavien-Dindo classification. The secondary endpoint will examine the 30-day rate of haemorrhagic and thrombotic events. This study will provide 80% power to show non-inferiority, defined as not worse than a 10% (non-inferiority margin) inferior change in the proportion of patients with good outcomes (Clavien-Dindo score < 2), using two-tailed 95% confidence intervals. DISCUSSION This first multicentre RCT in the field is underway to evaluate the safety and efficacy of PVP in patients with ongoing OAC therapy. The study results could influence the perioperative management of OACs in BPO surgery with a high level of evidence. TRIAL REGISTRATION ClinicalTrials.gov, NCT03297281 . Registered on 29 September 2017.
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Affiliation(s)
| | - Marie Pasquié
- Department of Urology, Clinique Pasteur, 45 avenue de Lombez, BP 27 617, 31076, Toulouse Cedex 3, France
| | - Benoit Peyronnet
- Department of Urology, Rennes University Hospital , Rennes, France
| | - Aurélien Descazeaud
- Department of Urology, Limoges University Hospital, Dupuytren Hospital, Limoges, France
| | | | | | - Romain Mathieu
- Department of Urology, Rennes University Hospital , Rennes, France
| | - Gilles Karsenty
- Department of Urology, Conception Hospital, Marseille, France
| | - Jean-Alexandre Long
- Department of Urology, Grenoble University Hospital , Michallon Hospital, La Tronche, France
| | | | | | - Benjamin Pradère
- Department of Urology, Tours University Hospital , Tours, France
| | - Franck Bruyère
- Department of Urology, Tours University Hospital , Tours, France
| | - Georges Fournier
- Department of Urology, Brest University Hospital, Cavale Blanche Hospital, Brest, France
| | - Souhil Lebdai
- Department of Urology, Angers University Hospital , Angers, France
| | - Jehanne Calves
- Department of Urology, Brest University Hospital, Cavale Blanche Hospital, Brest, France
| | - Luc Corbel
- Department of Urology, Cochin University Hospital, Paris, France
| | | | - Gaelle Fiard
- Department of Urology, Grenoble University Hospital , Michallon Hospital, La Tronche, France
| | - Caroline Thuillier
- Department of Urology, Grenoble University Hospital , Michallon Hospital, La Tronche, France
| | - Jean-Luc Descotes
- Department of Urology, Grenoble University Hospital , Michallon Hospital, La Tronche, France
| | - Pierre Colin
- Department of Urology, Hopital Privée la Louviere, Lille, France
| | - Thibaut Culty
- Department of Urology, Angers University Hospital , Angers, France
| | - Audrey Hesbois
- Department of Anesthesia, Clinique Pasteur, Toulouse, France
| | - Valerie Fuzier
- Department of Anesthesia, Clinique Pasteur, Toulouse, France
| | - Nicolas Savy
- Institute of mathematics, Paul Sabatier University, CNRS, Toulouse, France
| | - Atul Pathak
- Department of Cardiovascular Medicine, Clinique Pasteur, Toulouse, France
| | - Pierre Albaladejo
- Department of Anaesthesia and Intensive Care, Grenoble University Hospital, Avenue Maquis-du-Grésivaudan, 38700, La Tronche, France.,Clinical Investigation Centre, Grenoble University Hospital, ThEMAS, TIMC, UMR-CNRS 5525, University Grenoble-Alpes, 38700, La Tronche, France
| | - Charles Marc Samama
- Department of Anaesthesiology and Intensive Care, Assistance publique-Hôpitaux de Paris, Cochin University Hospital, 75014, Paris, France
| | - Felipe Guerrero
- Department of Haematology, Toulouse University Hospital , Rangueil, France
| | - Vincent Misraï
- Department of Urology, Clinique Pasteur, 45 avenue de Lombez, BP 27 617, 31076, Toulouse Cedex 3, France.
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Complications and functional outcomes of high-risk patient with cardiovascular disease on antithrombotic medication treated with the 532-nm-laser photo-vaporization Greenlight XPS-180 W for benign prostate hyperplasia. World J Urol 2018; 37:1671-1678. [PMID: 30478499 DOI: 10.1007/s00345-018-2560-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 11/03/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To examine the complications and functional outcomes of high-risk patients on antithrombotic therapy (ATT) treated with photoselective vaporization of the prostate (PVP) using the Greenlight (GL) XPS-180 system. METHODS A retrospective analysis of prospectively maintained institutional database was performed. Men with symptomatic LUTS related to BPH were treated with 523-nm GL PVP using the XPS-180 W system. They were stratified according to ATT status: group 1 (control group), group 2 (acetylsalicylic acid), group 3 (antiplatelet agents other than acetylsalicylic acid) and group 4 (anticoagulation agents). Postoperative adverse events at 30- and 90-days were prospectively recorded. Complications were stratified according to the Clavien-Dindo classification. Additionally, functional outcomes (IPSS, Qmax and PVR) were analyzed up to 48 months of follow-up after surgery. Multivariable logistic regression analyses were used to predict the effect of ATT on serious bleeding-associated complications that was defined as the sum of patients with hematuria Clavien grade ≥ 2, patients requiring transfusions and patient with postoperative hemoglobin drop ≥ 15 g/dl. RESULTS 274 (63%), 87 (21%), 24 (6%) and 37 (9%) patients were included in groups 1, 2, 3 and 4, respectively. Patients on antiplatelet (group 3) and anticoagulant medication (group 4) were older (median age 60 vs. 68 vs. 77 vs. 76 years, p < 0.001) and had more comorbidities (ASA 3-4: 9.5 vs. 27.6 vs. 66.7 vs. 64.9%; p < 0.001) than their counterparts. The overall 30-day complications rates were 31, 28.7, 45.8 and 45.9% of patients included in groups 1, 2, 3 and 4, respectively (p = 0.4). Hematuria Clavien 1 events (p < 0.001), readmissions rates (p = 0.02), length of post-operative hospital stay (p < 0.001) and catheterization time (p < 0.001) were significantly higher in patients on antiplatelet and anticoagulation medication. In multivariable analyses, ATT status was not a predictor of serious bleeding events after surgery (p > 0.5). Finally, functional outcomes were significantly improved accross the four groups. CONCLUSION GL PVP is safe and effective in treating high-risk patients on ATT. Although serious bleeding complications are rare and equivalent with non-high-risk patients, patients on antiplatelet and anticoagulation medication should be counseled on the increased risk of minor bleeding events and readmissions rates at 30 days after surgery.
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Photoselective vaporization has comparative efficacy and safety among high-risk benign prostate hyperplasia patients on or off systematic anticoagulation: a meta-analysis. World J Urol 2018; 37:1377-1387. [PMID: 30390127 DOI: 10.1007/s00345-018-2530-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/11/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The necessity to cease anticoagulation before photoselective vaporization (PVP) surgery remains nonconsensual. We aimed at assessing the efficacy and safety of PVP among high-risk benign prostate hyperplasia (BPH) patients on or off anticoagulation. METHODS We systematically searched Pubmed, Embase, and Cochrane Library Central Register of Controlled Trials (CENTRAL). 2299 patients from 11 studies were eventually included. Newcastle-Ottawa Scale (NOS) was employed to assess the quality and risk of bias of each study. All statistical analyses were conducted with Review Manager v.5.3 software. RESULTS Ten parameters (operation time, laser time, blood transfusion, urethral stricture, urinary tract infection, reoperation, dysuria, capsule perforation, catheterization time, and re-catheterization) from patients on or off anticoagulant therapy were collected. The patients without anticoagulants performed better at catheterization time [MD - 0.54, 95% CI (- 0.82, - 0.26), P = 0.96, I2 = 0] with a reduction of 0.54 day than those on anticoagulants. Significant statistical difference was not observed from other parameters. Subgroup analysis, grouped by the power output of PVP systems (80 W, 120 W and 180 W), consistently showed no statistical significant difference except at catheterization time in the 180-W PVP subgroup. CONCLUSION PVP, a safe and effective option for high-risk BPH patients, work comparably regardless of anticoagulant therapy, despite non-anticoagulant patients have shorter catheterization time. It is implied that the use of anticoagulants might be unnecessary to stop for high-risk BPH patients undergoing PVP for the sake of safety, which certainly requires further investigations to confirm.
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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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25
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Caicedo JI, Taborda A, Robledo D, Bravo-Balado A, Domínguez C, Trujillo CG, Cataño JG, Campos Hernández J, Londoño Trujillo D, Plata M. Photovaporization of the prostate with GreenLight™ laser 180 W XPS versus transurethral resection of the prostate with monopolar energy for the treatment of benign prostatic enlargement: a cost-utility analysis from a healthcare perspective. World J Urol 2018; 37:861-866. [PMID: 30116964 DOI: 10.1007/s00345-018-2425-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To assess the cost-utility of the photovaporization of the prostate (PVP) with GreenLight™ laser 180 W XPS compared to transurethral resection of the prostate with monopolar energy (M-TURP) for lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) from a healthcare perspective in Colombia. METHODS We designed a Markov model to compare four health states following treatment with either PVP or M-TURP to estimate expected costs and outcomes. We used the results of the only randomized clinical trial published to date comparing PVP versus M-TURP to estimate surgical outcomes, complications, re-operation and re-intervention rates. Time horizon was defined at 2 years with four cycles of 6 months each. Resource-use estimation involved a random selection of clinical records from a local institution and cost list from public healthcare system. Costs were obtained in Colombian pesos and converted to US dollars. Threshold was defined at three-times the Colombian gross domestic product (GDP) per capita. Quality-adjusted-life-years (QALYs) were used based on the utilities of the available literature. Uncertainty was analyzed with deterministic and probabilistic models using a Monte Carlo simulation. RESULTS Patients who underwent PVP gained 1.81 QALYs compared to 1.59 with M-TURP. Costs were US$6797.98 and US$7777.59 for M-TURP and PVP, respectively. Incremental cost-effectiveness ratio was US$4452.81 per QALY, favoring PVP as a cost-effective alternative in our context. CONCLUSIONS In Colombia, with current prices, PVP is cost-effective when compared to M-TURP for LUTS due to BPE for a 2-year time horizon.
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Affiliation(s)
- Juan Ignacio Caicedo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09 Piso 3, Clínicas Urológicas, Bogotá D.C., 110111, Colombia.
| | - Alejandra Taborda
- Department of Public Health and Health Economics, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia
| | - Daniela Robledo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09 Piso 3, Clínicas Urológicas, Bogotá D.C., 110111, Colombia
| | - Alejandra Bravo-Balado
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09 Piso 3, Clínicas Urológicas, Bogotá D.C., 110111, Colombia
| | - Cristina Domínguez
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09 Piso 3, Clínicas Urológicas, Bogotá D.C., 110111, Colombia
| | - Carlos Gustavo Trujillo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09 Piso 3, Clínicas Urológicas, Bogotá D.C., 110111, Colombia
| | - Juan Guillermo Cataño
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09 Piso 3, Clínicas Urológicas, Bogotá D.C., 110111, Colombia
| | - Jonathan Campos Hernández
- Department of Public Health and Health Economics, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia
| | - Darío Londoño Trujillo
- Department of Public Health and Health Economics, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia
| | - Mauricio Plata
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09 Piso 3, Clínicas Urológicas, Bogotá D.C., 110111, Colombia
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26
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Foster HE, Barry MJ, Dahm P, Gandhi MC, Kaplan SA, Kohler TS, Lerner LB, Lightner DJ, Parsons JK, Roehrborn CG, Welliver C, Wilt TJ, McVary KT. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline. J Urol 2018; 200:612-619. [PMID: 29775639 DOI: 10.1016/j.juro.2018.05.048] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Male lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is common in men and can have negative effects on quality of life (QoL). It is the hope that this Guideline becomes a reference on the effective evidence-based surgical management of LUTS/BPH. MATERIALS AND METHODS The evidence team searched Ovid MEDLINE, the Cochrane Library, and the Agency for Healthcare Research and Quality (AHRQ) database to identify studies indexed between January 2007 and September 2017. When sufficient evidence existed, the body of evidence was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions (table 1 in supplementary unabridged guideline, http://jurology.com/). RESULTS This Guideline provides updated, evidence-based recommendations regarding management of LUTS/BPH utilizing surgery and minimally invasive surgical therapies; additional statements are made regarding diagnostic and pre-operative tests. Clinical statements are made in comparison to what is generally accepted as the gold standard (i.e. transurethral resection of the prostate [TURP]-monopolar and/or bipolar). This guideline is designed to be used in conjunction with the associated treatment algorithm. CONCLUSIONS The prevalence and the severity of LUTS increases as men age and is an important diagnosis in the healthcare of patients and the welfare of society. This document will undergo additional literature reviews and updating as the knowledge regarding current treatments and future surgical options continues to expand.
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Affiliation(s)
- Harris E Foster
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Michael J Barry
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Philipp Dahm
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Manhar C Gandhi
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Steven A Kaplan
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Tobias S Kohler
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Lori B Lerner
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Deborah J Lightner
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - J Kellogg Parsons
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Claus G Roehrborn
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Charles Welliver
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Timothy J Wilt
- American Urological Association Education and Research, Inc., Linthicum, Maryland
| | - Kevin T McVary
- American Urological Association Education and Research, Inc., Linthicum, Maryland
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27
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Rieken M, Kaplan SA. Enucleation, Vaporization, and Resection: How To Choose the Best Surgical Treatment Option for a Patient with Male Lower Urinary Tract Symptoms. Eur Urol Focus 2018; 4:8-10. [PMID: 29754809 DOI: 10.1016/j.euf.2018.04.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/23/2018] [Accepted: 04/30/2018] [Indexed: 11/29/2022]
Abstract
Transurethral resection of the prostate remains the reference technique for patients with a prostate <100ml. Endoscopic enucleation is a safe and effective alternative, while photoselective vaporization of the prostate appears to be the treatment of choice for patients on anticoagulation medication.
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Affiliation(s)
- Malte Rieken
- alta uro AG, Basel, Switzerland; University Basel, Basel, Switzerland.
| | - Stephen A Kaplan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Green Light photoselective vaporization of the prostate: a safe and effective treatment for elderly high-risk benign prostate hyperplasia patients with gland over 80 ml. Lasers Med Sci 2018; 33:1693-1698. [DOI: 10.1007/s10103-018-2521-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 04/19/2018] [Indexed: 01/09/2023]
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29
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Zambrano N, Palma C. Tratamiento de la hiperplasia prostática benigna y de la disfunción eréctil por el médico general. REVISTA MÉDICA CLÍNICA LAS CONDES 2018. [DOI: 10.1016/j.rmclc.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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30
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Xu H, Cai Z, Chen Y, Gu M, Chen Q, Wang Z. Benign prostatic hyperplasia surgical scoring (BPHSS): an novel scoring system for the perioperative outcomes of holmium laser enucleation of the prostate. Lasers Med Sci 2018; 33:589-595. [PMID: 29313161 DOI: 10.1007/s10103-017-2425-1] [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: 10/19/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
To develop a standardized scoring system, the BPH surgical scoring (BPHSS) system, to quantify the ability to predict the perioperative outcomes resulting from an enlarged prostate. There are two parts included in this study: the retrospective observational study (875 patients treated with holmium laser enucleation of the prostate, HoLEP) and the prospective observational study (111 patient underwent HoLEP). All the outcome data included the following: the basic patient preoperative characteristics, operation time (OT), pre- and post- surgery hemoglobin decrease, Na+ variation, hospital stay duration, duration of bladder irrigation, catheterization time, and hospitalization time. The BPHSS, consisting of prostatic volume (PV), prostate-specific antigen (PSA), bladder stones, intravesical prostatic protrusion (IPP), and metabolic syndrome (MetS), was observed regarding the perioperative outcomes. In the retrospective study, patients in high BPHSS group (6-8 points) showed significant increase in the OT (74.61, 95%CI = 16.98-327.84, P < 0.001), hemochrome reduction (416.50, 95%CI = 35.48-4889.88, P < 0.001), hospital stay (1.80, 95%CI = 1.35-2.41, P < 0.001), and bladder irrigation duration (4.04, 95%CI = 1.35-12.10, P = 0.013) compared with the low BPHSS group (0-2 points). In the prospective study, there also existed significant differences between the three scoring grades (P < 0.01) in OT, hemochrome decrease, and the hospital stay. The BPHSS is suitable to predict the perioperative outcomes in patients undergoing HoLEP. It may help urologist to prepare more before surgery to treat the enlarged prostates. Further studies are needed to validate this scoring system in BPH patients in multiple centers.
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Affiliation(s)
- Huan Xu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Zhikang Cai
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Yanbo Chen
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Meng Gu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Qi Chen
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Zhong Wang
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
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31
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[Anticoagulation impact on bleeding risk during HoLEP: Monocentric study of 156 patients]. Prog Urol 2017; 28:128-134. [PMID: 29203157 DOI: 10.1016/j.purol.2017.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 10/18/2017] [Accepted: 10/20/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Compare the length of hospital stay and the complications after HoLEP between three groups of patients: a control group, a group with antiplatelet therapy, a group with anticoagulation therapy. MATERIALS Retrospective cohort study that included all consecutive patients who underwent HoLEP for prostatic hyperplasia in our center from may 2013 to may 2016. Anticoagulated patients and patients under clopidogrel had respectively a relay with heparine and aspirine. Patients were seen after surgery at 1 and 3 months. RESULTS A hundred and fifty six patients were analysed, mean age was 70.7 years (DS 6.8), mean prostate volume 88.8g (DS 34.1). 106 patients were in the control group, 34 had antiplatelet therapy and 16 had anticoagulation therapy. There were no difference between the 3 groups for mean age, mean prostatic volume, PSA. There was also no difference for length of intervention, irrigated volume and length of morcellation between the three groups. There were no difference between patients in the control group and patients with antiplatelet therapy for length of hospital stay (2.1 days vs 2.0 days), lenght of urethral catheterization (1.6 days vs 1.5 days). There was a statistical difference between patients in the control group and patients with anticoagulation therapy for lenght of hospital stay (2.0 days vs 4.4 days; P=0.01), length of bladder irrigation (0.9 day vs 1.8 days; P=0.01), lenght of urethral catheterization (1.6 days vs 3.5 days; P=0.01). Transfusion rate was 18.75% (n=3) for patients with anticoagulation, 2.9% (n=1) for patients under antiplatelet therapy and 0.9% (n=1) for patients in the control group. CONCLUSION Anticoagulation during HoLEP is a valid option but need to be proceed with carefully management. LEVEL OF PROOF 4.
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El-Shaer W, Abou-Taleb A, Kandeel W. Transurethral bipolar plasmakinetic vapo-enucleation of the prostate: Is it safe for patients on chronic oral anticoagulants and/or platelet aggregation inhibitors? Arab J Urol 2017; 15:347-354. [PMID: 29234539 PMCID: PMC5717451 DOI: 10.1016/j.aju.2017.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/20/2017] [Accepted: 09/16/2017] [Indexed: 02/02/2023] Open
Abstract
Objectives To assess the safety and efficacy of bipolar plasmakinetic enucleation and resection of the prostate (PKERP) for the management of benign prostatic hyperplasia (BPH) in patients on oral anticoagulant (OAC) therapy and/or platelet aggregation inhibitors (PAIs). Patients and methods In all, 91 patients were recruited and underwent PKERP whilst they were receiving PAIs (aspirin, 56 patients; clopidogrel, three; aspirin and clopidogrel, 11). In all, 15 patients were receiving an OAC drug perioperatively, whilst another six patients were on dual PAIs and OACs. The primary outcomes were the perioperative morbidity and mortality rates. The secondary outcomes were functional outcomes including maximum urinary flow rate (Qmax), International Prostate Symptoms Score (IPSS), and post-void residual urine volume (PVR). Results The mean (SD) age of the patients was 65 (5.9) years, preoperative adenoma volume was 80.9 (30.4) mL, and the operative time was 67 (23) min. No patient developed serious perioperative cardiovascular complications. The mean (SD) duration of hospital stay was 1.79 (1) days and the postoperative catheterisation time was 1.14 (0.76) days. The mean (SD) haemoglobin drop was 0.74 (0.61) g/dL, blood transfusion rate was 2.2%, and the clot retention rate was 2.2%. The mean (SD) postoperative Qmax was 18.6 (4.37) mL/s as compared to 7.2 (3.2) mL/s preoperatively (P < 0.001), and the preoperative IPSS was reduced from 24.3 (6.1) to 5.7 (2.3) postoperatively (P < 0.05). Prostate volume measured by transrectal ultrasonography was significantly reduced from a mean (SD) of 80.9 (30.4) mL preoperatively to 29.5 (10.6) mL postoperatively (P < 0.001). Conclusion Minimally invasive PKERP may be considered as a safe and effective treatment option for managing patients with BPH receiving OAC/PAI drugs.
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Key Words
- Anticoagulant
- BPH
- Hb, haemoglobin
- HoLEP, holmium laser enucleation of the prostate
- INR, international normalised ratio
- LUTS
- M-TURP, monopolar TURP
- OA, oral anticoagulant
- PAI, platelet aggregation inhibitor
- PKERP
- PKERP, plasmakinetic enucleation and resection of the prostate
- PVR, post-void residual urine volume
- Qmax, maximum urinary flow rate
- ThuVARP, thulium vaporesection of the prostate
- ThuVEP, thulium vapoenucleation of the prostate
- UI, urinary incontinence
- US, ultrasonography
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Affiliation(s)
- Waleed El-Shaer
- Department of Urology, Banha University Hospital, Banha, Egypt
| | | | - Wael Kandeel
- Department of Urology, Banha University Hospital, Banha, Egypt
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Pascoe C, Ow D, Perera M, Woo HH, Jack G, Lawrentschuk N. Optimising patient outcomes with photoselective vaporization of the prostate (PVP): a review. Transl Androl Urol 2017; 6:S133-S141. [PMID: 28791232 PMCID: PMC5522804 DOI: 10.21037/tau.2017.05.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Benign prostatic hyperplasia (BPH) is a common pathology causing lower urinary tract symptoms (LUTS) and may significantly impact quality of life. While transurethral resection of the prostate (TURP) remains the gold standard treatment, there are many evolving technologies that are gaining popularity. Photoselective vaporization of the prostate (PVP) is one such therapy which has been shown to be non-inferior to TURP. We aimed to review the literature and discuss factors to optimise patient outcomes in the setting of PVP for BPH. A comprehensive search of the electronic databases, including MEDLINE, Embase, Web of Science and The Cochrane Library was performed on articles published after the year 2000. After exclusion, a total of 38 papers were included for review. The evolution of higher powered device has enabled men with larger prostates and those on oral anticoagulation to undergo safely and successfully PVP. Despite continued oral anticoagulation in patients undergoing PVP, the risk of bleeding may be minimised with 5-Alpha Reductase Inhibitor (5-ARI) therapy however further studies are required. Pre-treatment with 5-ARI’s does not hinder the procedure however more studies are required to demonstrate a reliable benefit. Current data suggests that success and complication rate is largely influenced by the experience of the operator. Post-operative erectile dysfunction is reported in patients with previously normal function following PVP, however those with a degree of erectile dysfunction pre-operatively may see improvement with alleviation of LUTS.
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Affiliation(s)
- Claire Pascoe
- University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia.,Young Urology Researchers Organisation (YURO), Melbourne, Australia
| | - Darren Ow
- University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia.,Young Urology Researchers Organisation (YURO), Melbourne, Australia
| | - Marlon Perera
- University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia.,Young Urology Researchers Organisation (YURO), Melbourne, Australia
| | - Henry H Woo
- Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, Australia
| | - Greg Jack
- University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia
| | - Nathan Lawrentschuk
- University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Rajih E, Tholomier C, Hueber PA, Alenizi AM, Valdivieso R, Azizi M, Gonzalez RR, Eure G, Kriteman L, Hai M, Zorn KC. Evaluation of Surgical Outcomes with Photoselective GreenLight XPS Laser Vaporization of the Prostate in High Medical Risk Men with Benign Prostatic Enlargement: A Multicenter Study. J Endourol 2017; 31:686-693. [DOI: 10.1089/end.2016.0782] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Emad Rajih
- Section of Urology, Department of Surgery, University of Montreal Hospital Center—HSL Site, Montreal, Canada
- Department of Urology, Taibah University, Madinah, Saudi Arabia
| | - Come Tholomier
- Section of Urology, Department of Surgery, University of Montreal Hospital Center—HSL Site, Montreal, Canada
| | - Pierre-Alain Hueber
- Section of Urology, Department of Surgery, University of Montreal Hospital Center—HSL Site, Montreal, Canada
| | - Abdullah M. Alenizi
- Section of Urology, Department of Surgery, University of Montreal Hospital Center—HSL Site, Montreal, Canada
| | - Roger Valdivieso
- Section of Urology, Department of Surgery, University of Montreal Hospital Center—HSL Site, Montreal, Canada
| | - Mounsif Azizi
- Section of Urology, Department of Surgery, University of Montreal Hospital Center—HSL Site, Montreal, Canada
| | | | - Gregg Eure
- Department of Urology, Urology of Virginia, PLLC, Virginia Beach, Virginia
| | - Lewis Kriteman
- North Fulton Urology PC, Georgia Urology, Roswell, Georgia
| | - Mahmood Hai
- Comprehensive Urology, The Surgical Institute of Michigan, Westland, Michigan
| | - Kevin C. Zorn
- Section of Urology, Department of Surgery, University of Montreal Hospital Center—HSL Site, Montreal, Canada
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35
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Knapp GL, Chalasani V, Woo HH. Perioperative adverse events in patients on continued anticoagulation undergoing photoselective vaporisation of the prostate with the 180-W Greenlight lithium triborate laser. BJU Int 2017; 119 Suppl 5:33-38. [DOI: 10.1111/bju.13822] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Venu Chalasani
- Sydney Adventist Hospital Clinical School; University of Sydney; Wahroonga NSW Australia
| | - Henry H. Woo
- Sydney Adventist Hospital Clinical School; University of Sydney; Wahroonga NSW Australia
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