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Feiertag JH, Kane JA, Clark JY. Incidence of Surgical Reintervention for Benign Prostatic Hyperplasia Following Prostatic Urethral Lift, Transurethral Resection of the Prostate, and Photoselective Vaporization of the Prostate: A TriNetX Analysis. EUR UROL SUPPL 2024; 59:63-70. [PMID: 38298771 PMCID: PMC10829608 DOI: 10.1016/j.euros.2023.11.009] [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] [Accepted: 11/24/2023] [Indexed: 02/02/2024] Open
Abstract
Background Prostatic urethral lift, or UroLift, has gained popularity as a treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). Surgical reintervention rates are a reliable indicator for treatment durability. Objective The objective of this study was to utilize TriNetX, a third-party database, to investigate the incidence of surgical reintervention following UroLift, transurethral resection of the prostate (TURP), and photoselective vaporization of the prostate (PVP) procedures for BPH from 2015 to 2018. Design setting and participants Male patients aged 18-100 yr diagnosed with BPH were identified in the TriNetX Diamond Network database between January 2015 and December 2018. Cohorts of individuals undergoing their first UroLift procedure were built using Current Procedural Terminology and International Classification of Diseases 10th Revision codes. TURP and PVP cohorts were built as comparison groups. The cohorts were then queried for subsequent BPH-related procedures. Outcome measurements and statistical analysis Reprocedure rates were assessed and descriptive statistics were used. Results and limitations The mean age at first-time UroLift was 70.1 ± 9.4 yr (n = 14 343). Cumulative reprocedure rates collected after first-time UroLift included 1 yr after UroLift (5.1%, n = 14 343) and 4 yr after UroLift (16.1%, n = 710), with an average annual increase of +3.6% per year following 1 yr after the procedure. Comparatively, TURP (n = 22 071) and PVP (n = 14 110) had 4-yr reprocedure rates of 7.5% and 7.8%, respectively, during the same timeframe. Limitations include a lack of clinical data and loss of follow-up data outside the Diamond Network. Conclusions The reprocedure rate of UroLift at 4 yr is double the rate of TURP and PVP. In appropriately selected patients, UroLift might be a suitable option for those who desire symptomatic relief from BPH with minimal erectile and ejaculatory side effects. However, the risk of secondary surgical intervention should be considered when considering BPH treatments. Patient summary We compared the reintervention rates of prostatic urethral lift (PUL), transurethral resection of the prostate (TURP), and photoselective vaporization of the prostate (PVP) using the TriNetX database, and have found that the highest reintervention rates were for PUL of 16% at 4 yr of follow-up, compared with about 8% for those who had TURP and PVP. Interestingly, the most common reintervention was the same operation at 1 yr. This has important implications when counseling patients about the durability of these various outlet procedures for BPH.
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Affiliation(s)
| | - Jennifer A. Kane
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Joseph Y. Clark
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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Cheng X, Qin C, Xu P, Li Y, Peng M, Wu S, Ren D, Zhou L, Wang Y. Comparison of bipolar plasmakinetic resection of prostate versus photoselective vaporization of prostate by a three year retrospective observational study. Sci Rep 2021; 11:10142. [PMID: 33980942 PMCID: PMC8115102 DOI: 10.1038/s41598-021-89623-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 04/28/2021] [Indexed: 01/07/2023] Open
Abstract
Comprehensive evaluation of photoselective vaporization of the prostate (PVP) versus plasmakinetic resection of the prostate (PKRP) in treating benign prostatic hyperplasia (BPH) is inadequate. This single-centre, retrospective observational study was designed to compare their efficacy, complications and sexual function. A total of 215 patients under PVP or PKRP were included in the study, propensity score matching (PSM) was performed to match the baseline characteristics of the two groups, and perioperative and three-year follow-up data were compared between them. Finally, 120 patients (60 for PVP and 60 for PKRP) were matched after PSM. Compared with the PKRP group, the intraoperative haemoglobin loss was lower (9.08 vs 13.75 g/L, P < 0.001) and the duration of catheterization and postoperative hospital stay were shorter (2.97 vs 4.10 day, P < 0.001; 3.95 vs 5.13 day, P < 0.001, respectively), but the operation time was longer (56.72 vs 49, 90 min, P < 0.001) in the PVP group. Urination measurements were improved for both groups after surgery, although no significant differences were found between them during follow-up. Sexual function after surgery was partly increased; however, frequent retrograde and discomfortable ejaculation occurred in both groups. In addition, dysuria incidence and retreatment were higher in the PVP group at 12 months. In conclusion, PVP is safe and effective in relieving BPH-related lower urinary tract symptoms with less perioperative blood loss and earlier recovery without inferior sexual function effects. However, the study is potentially affected by residual unmeasured confounding.
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Affiliation(s)
- Xu Cheng
- Department of Urology, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139, Changsha, 410011, China
| | - Chuying Qin
- Department of Urology, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139, Changsha, 410011, China
| | - Peng Xu
- Department of Urology, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139, Changsha, 410011, China
| | - Yijian Li
- Department of Urology, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139, Changsha, 410011, China
| | - Mou Peng
- Department of Urology, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139, Changsha, 410011, China
| | - Shuiqing Wu
- Department of Urology, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139, Changsha, 410011, China
| | - Da Ren
- Department of Urology, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139, Changsha, 410011, China
| | - Lizhi Zhou
- Department of Urology, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139, Changsha, 410011, China
| | - Yinhuai Wang
- Department of Urology, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139, Changsha, 410011, China.
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Bipolar vaporization of the prostate may cause higher complication rates compared to bipolar loop resection: a randomized prospective trial. Int Urol Nephrol 2019; 51:2143-2148. [PMID: 31522378 DOI: 10.1007/s11255-019-02280-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/09/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Transurethral resection of the prostate (TURP) by resection loop or vaporization button is becoming a standard of care due to its better safety profile (less bleeding and less incidence of TUR syndrome). However, there are published data showing bipolar vaporization may be associated with increased late complications. In this study, we compared results of bipolar TURP using the resection loop versus vaporization button for treatment of benign prostatic hyperplasia (BPH) to determine the relative safety profile. PATIENTS AND METHODS Between January 2013 and March 2014, 89 patients with BPH were randomized to surgical intervention either by Olympus (Gyrus) Bipolar loop TURP or Olympus (Gyrus) Bipolar button vaporization. Inclusion criteria were; BPH with Q-max < 10 ml/s, IPSS > 18 and prostate volume > 40 g. All patients were evaluated preoperatively and at 1, 3 and 9 months. Evaluation included IPSS, uroflowmetry, prostate volume by ultrasound. Clavien complications and operative time were recorded. Statistical analysis was done using Statistical Package of Social Science (SPSS) version 17 software. RESULTS 44 patients were included in bipolar TURP and 45 patients in vaporization arm. Preoperative mean prostate volume (59 g versus 58 g, p = 0.52) and mean IPSS (19 versus 20, p = 0.38) were equivalent in both groups. Vaporization was associated with a significant increase in operative time (mean of 81 ± 15 min range 40-110 versus 55 ± 10 min range 30-70 min, p < 0.001), less blood loss (0.8% versus 2.0% drop in hemoglobin, p < 0.001) but increased postoperative urinary frequency (80% versus 50%, p < 0.001), hematuria with clots up to 4 weeks post surgery (20% versus 2%, p < 0.001) and postoperative urethral stricture (11% versus 0%, p < 0.001). Both techniques improved urine flow with Q-max (17 ml/s versus 18 ml/s p = 0.22). Prostate volume (32 g versus 31 g, p = 0.31) and IPSS (6 versus 5, p = 0.22), were comparable in both treatment arms. CONCLUSIONS Bipolar vaporization of the prostate, despite being a technically robust, speedy and with less intraoperative bleeding, appears to be associated with increased postoperative irritative symptoms, increased late-onset postoperative bleeding and high urethral stricture rates.
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Aboutaleb H, Ali TA, Zaghloul A, Amin MM. Efficacy of bipolar ‘button’ plasma vaporisation of the prostate compared to green laser vaporisation for benign prostatic obstruction. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415817752855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Our objectives were to evaluate the efficiency of transurethral bipolar plasma vaporisation of the prostate (BPVP) using the button electrode and compare it to green laser vaporisation of the prostate (GLVP). Patients and methods: During the period March 2012 to January 2017, 155 patients with benign prostatic obstruction (BPO) were enrolled in our study. Overall, 80 patients underwent BPVP and 75 GLVP. All International Prostate Symptom Scores (IPSS), quality of life (QOL), uroflow Qmax, Qave and post-void residual (PVR) urine samples were evaluated 24 hours preoperatively and at three months postoperatively. Operative time, hospital stay, catheterisation time, and complications were reported. Mean serum haemoglobin, haematocrit and serum sodium changes were reported preoperatively and within 24 hours postoperatively in both groups. Statistical analysis was performed using the SPSS program version 20 for Windows. Results: Mean age at surgery was 62.8 ± 4 (53–82) years and 63 ± 6.6 (54–86) years for the BPVP and GLVP groups respectively. Mean prostatic volume was 45 ± 10 (36–90) and 43 ± 9 (32–85) in each group, respectively. Patients from both series had similar preoperative characteristics. The mean operative duration was 58 ± 21 (range: 20–70) minutes and 57 ± 13 (range: 24–75) minutes, hospital stay was 12.2 ± 6.4 (12–60) hours vs 7 ± 3.3 (6–48) hours ( p = 0.01), and catheterisation period was 48 ± 1.28 (24–72) hours vs 6 ± 6.2 (6–7) hours ( p = 0.001). Conclusions: Both BPVP and GLVP offer good options for management of BPO with less bleeding, one-day surgery, less catheterisation time with significant improvement of IPSS, QOL score and uroflow postoperatively. However, more studies comparing the cost of both techniques are needed for a solid conclusion. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
| | - Tamer A Ali
- Urology Department Al-Azhar University Hospitals, Cairo, Egypt; Gulf Medical University, United Arab Emirates
| | - Ahmed Zaghloul
- Department of Urology, NMC Hospital, Dubai, United Arab Emirates
| | - Moamen M Amin
- Department of Urology, NMC Hospital, Dubai, United Arab Emirates
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Aboutaleb H, Ali TA, Zaghloul A, Amin MM. Efficacy of bipolar ‘button’ plasma vaporisation of the prostate compared to green laser vaporisation for benign prostatic obstruction. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: http://journal of clinical urology.com/.doi: 10.1177/2051415817752855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: Our objectives were to evaluate the efficiency of transurethral bipolar plasma vaporisation of the prostate (BPVP) using the button electrode and compare it to green laser vaporisation of the prostate (GLVP). Patients and methods: During the period March 2012 to January 2017, 155 patients with benign prostatic obstruction (BPO) were enrolled in our study. Overall, 80 patients underwent BPVP and 75 GLVP. All International Prostate Symptom Scores (IPSS), quality of life (QOL), uroflow Qmax, Qave and post-void residual (PVR) urine samples were evaluated 24 hours preoperatively and at three months postoperatively. Operative time, hospital stay, catheterisation time, and complications were reported. Mean serum haemoglobin, haematocrit and serum sodium changes were reported preoperatively and within 24 hours postoperatively in both groups. Statistical analysis was performed using the SPSS program version 20 for Windows. Results: Mean age at surgery was 62.8 ± 4 (53–82) years and 63 ± 6.6 (54–86) years for the BPVP and GLVP groups respectively. Mean prostatic volume was 45 ± 10 (36–90) and 43 ± 9 (32–85) in each group, respectively. Patients from both series had similar preoperative characteristics. The mean operative duration was 58 ± 21 (range: 20–70) minutes and 57 ± 13 (range: 24–75) minutes, hospital stay was 12.2 ± 6.4 (12–60) hours vs 7 ± 3.3 (6–48) hours ( p = 0.01), and catheterisation period was 48 ± 1.28 (24–72) hours vs 6 ± 6.2 (6–7) hours ( p = 0.001). Conclusions: Both BPVP and GLVP offer good options for management of BPO with less bleeding, one-day surgery, less catheterisation time with significant improvement of IPSS, QOL score and uroflow postoperatively. However, more studies comparing the cost of both techniques are needed for a solid conclusion. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
| | - Tamer A Ali
- Urology Department Al-Azhar University Hospitals, Cairo, Egypt; Gulf Medical University, United Arab Emirates
| | - Ahmed Zaghloul
- Department of Urology, NMC Hospital, Dubai, United Arab Emirates
| | - Moamen M Amin
- Department of Urology, NMC Hospital, Dubai, United Arab Emirates
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Nair SM, Pimentel MA, Gilling PJ. A Review of Laser Treatment for Symptomatic BPH (Benign Prostatic Hyperplasia). Curr Urol Rep 2016; 17:45. [DOI: 10.1007/s11934-016-0603-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Zang YC, Deng XX, Yang DR, Xue BX, Xu LJ, Liu XL, Zhou YB, Shan YX. Photoselective vaporization of the prostate with GreenLight 120-W laser versus transurethral resection of the prostate for benign prostatic hyperplasia: a systematic review with meta-analysis of randomized controlled trials. Lasers Med Sci 2015; 31:235-40. [DOI: 10.1007/s10103-015-1843-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 11/30/2015] [Indexed: 11/30/2022]
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Falahatkar S, Mokhtari G, Moghaddam KG, Asadollahzade A, Farzan A, Shahab E, Ghasemi A, Allahkhah A, Esmaeili S. Bipolar transurethral vaporization: a superior procedure in benign prostatic hyperplasia: a prospective randomized comparison with bipolar TURP. Int Braz J Urol 2015; 40:346-55. [PMID: 25010300 DOI: 10.1590/s1677-5538.ibju.2014.03.08] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 11/04/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the outcomes of bipolar transurethral vaporization of the prostate (TUVP) with bipolar transurethral resection of the prostate (TURP). MATERIALS AND METHODS In a prospective randomized trial, 88 patients with moderate to severe lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) underwent bipolar TUVP (N = 39) or bipolar TURP (N = 49) from October 2010 to November 2011. The inclusion criteria were age > 50 years, prostate volume of 30-80 mL, serum PSA < 4 ng/mL, IPSS ≥ 20, Qmax ≤ 10 mL/s and failed medical therapy. The perioperative and postoperative outcomes were evaluated and the IPSS and Qmax were assessed preoperatively and 3 months after procedure in all cases. RESULTS Both groups were similar in patient age, prostate volume, preoperative IPSS and Qmax. The TUVP group had significantly lower mean values of operative time, hospital stay, catheterization period, irrigation fluid volume and serum hemoglobin, creatinine, sodium and potassium changes compared with TURP group. No significant differences were seen between two groups regarding complications (TUVP = 10.3%; TURP = 12.2%) and modified Clavien classification of complications. No TUR syndrome, obturator reflex or epididymitis occurred in both groups. Re-hospitalization and transfusion due to clot retention (N = 2) and urethral stricture (N = 1) were reported only in the TURP group. Three patients experienced urinary retention after catheter removal in the TUVP group. Two patients were re-catheterized temporarily and one patient required repeat bipolar TUVP. Three months after surgery, two groups had significant improvement in IPSS and Qmax. But the TUVP group had significantly lower IPSS and higher Qmax than TURP group. CONCLUSIONS Bipolar TUVP is a safe, effective and low cost procedure among minimally invasive surgeries of BPH. Compared with bipolar TURP, the bipolar TUVP had similar complications, better perioperative and postoperative outcomes, superior hemostasis and higher efficacy.
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Affiliation(s)
- Siavash Falahatkar
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | - Gholamreza Mokhtari
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | | | - Ahmad Asadollahzade
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | - Alireza Farzan
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | - Elaheh Shahab
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | - Ali Ghasemi
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | - Aliakbar Allahkhah
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
| | - Samaneh Esmaeili
- Urology Research Center, Razi Hospital, Guilan University of Medical Sciences
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Comparison of patients undergoing laser vaporization of the prostate versus TURP using the ACS-NSQIP database. Prostate Cancer Prostatic Dis 2014; 18:18-24. [DOI: 10.1038/pcan.2014.39] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/11/2014] [Accepted: 08/18/2014] [Indexed: 11/08/2022]
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Yang SL, Tang KQ, Bai WK, Zhao YW, Shen E, Tao JJ, Hu B. Combined low-frequency ultrasound and microbubble contrast agent for the treatment of benign prostatic hyperplasia. J Endourol 2014; 27:1020-6. [PMID: 23607285 DOI: 10.1089/end.2012.0637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Benign prostatic hyperplasia is one of the most common conditions in middle-aged and elderly men. The aim of the study was to investigate the treatment effects of low-frequency ultrasound combined with a microbubbles agent on benign prostatic hyperplasia. METHODS Eighteen 7-year-old male beagles with prostatic hyperplasia were randomly divided into six groups (n=3): Control group, 21 kHz ultrasound group, 21 kHz ultrasound and microbubble contrast agent group, 1 MHz ultrasound group, 1 MHz ultrasound and microbubble contrast agent group, and microbubble contrast agent group. The histopathologic damage to prostate cells was assessed via transmission electron microscopy and optical microscopy. The protein expressions of prostate-specific antigen (PSA), inducible nitric oxide synthase (iNOS), and super oxidase dimutase (SOD) were detected by enzyme-linked immunosorbent assay. Levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), and creatinine (Cr) were detected by the Biochemistry Automatic Analyzer. RESULTS Significant tissue injury, mitochondria injury, and cell apoptosis were observed in 21 kHz ultrasound and the microbubble contrast agent group. Compared with the control and microbubbles contrast agent groups, the decrease in levels of PSA or increase in levels of iNOs and SOD in the other four groups were statistically significant (P<0.05). The lowest level of PSA and the highest levels of iNOs and SOD were observed in the 21 kHz ultrasound and microbubbles contrast agent group. No significant changes in levels of AST, ALT, BUN, and Cr were observed between the six groups. CONCLUSIONS Our results suggest that lower frequency ultrasound may have a better effect on benign prostatic hyperplasia, and microbubble contrast agent application further strengthens this biological effect.
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Affiliation(s)
- Shao-ling Yang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, China
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Vargas C, García-Larrosa A, Capdevila S, Laborda A. Vaporization of the prostate with 150-w thulium laser: complications with 6-month follow-up. J Endourol 2014; 28:841-5. [PMID: 24521152 DOI: 10.1089/end.2013.0715] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
UNLABELLED Purpose: To analyze the efficacy and safety of vaporization of the prostate (VP) with the 150-W thulium:yttrium-aluminum-garnet (Tm:YAG) laser. PATIENTS AND METHODS In a prospective series of 55 patients with small- and medium-size prostates undergoing major outpatient surgery (MOS), the primary objectives were to analyze changes in maximum flow (Qmax) and International Prostate Symptom Score (IPSS) after 6 months. Immediate (<30 days) and late (>30 days) complications were subsequently recorded. RESULTS An increase in mean Qmax of 9.33 mL/s (95% confidence interval [CI] of the mean difference 6.73-11.93; P<0.001) was recorded, and mean IPSS was reduced by 16.88 points (95% CI 14.22-19.54; P<0.001). The immediate complications recorded were acute urinary retention (one patient), urinary tract infection without fever (two patients), and macroscopic hematuria (two patients). The only late complication observed was bladder neck sclerosis (one patient). CONCLUSION After 6 months, VP with 150-W Tm:YAG presents promising results in the clinical improvement of patients with small- and medium-size prostates. Its complication rate is low and it offers excellent hemostasis. The data from our study provide the basis for the design of clinical trials to compare this technique with other procedures.
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Affiliation(s)
- César Vargas
- Department of Urology, Hospital de Viladecans , Viladecans, Barcelona, Spain
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Yang SL, Tang KQ, Bai WK, Shen E, Zhao YW, Lin YD, Nan SL, Bing H. Effects of low-frequency ultrasound combined with microbubbles on benign prostate hyperplasia. Can Urol Assoc J 2013; 7:E681-6. [PMID: 24282457 DOI: 10.5489/cuaj.354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Our objective is to assess the effects of low-frequency ultrasound combined with microbubbles on benign prostate hyperplasia (BPH). METHODS Sixteen Beagle dogs with BPH were randomly assigned into 4 groups (n = 4): control group (without treatment), G1 group (injection with 2 mL of microbubble contrast agent); G2 group (21 kHz ultrasound); and G3 group (injection with 2 mL of micro-bubble contrast agent +21 kHz ultrasound). The histopathological damage to prostate cells was assessed via transmission electron microscopy and optical microscopy. The protein expressions of prostate-specific antigen (PSA), inducible nitric oxide synthase (iNOS), superoxide dismutase (SOD) of vessels were detected by enzyme-linked immunosorbent assay (ELISA). RESULTS Histopathologically, the prostate cells exhibited nuclear chromatin contraction, mitochondrial swelling, degranulation of rough endoplasmic reticulum, basement membrane rupture and cell apoptosis in the G2 and G3 groups; it was especially obvious in the G3 group, while no changes were observed in the control and G1 groups. Although prostate volume using imaging was not significantly changed in all groups after treatment, PSA was significantly reduced in the G2 and G3 groups, and especially obvious in the G3 group (p < 0.05). The iNOS and SOD, which are important oxidative stress factors, significantly increased after treatment in the G2 and G3 groups, but not in the control and G1 groups (p < 0.05). CONCLUSIONS Low-frequency ultrasound is effective in treating BPH; low-frequency ultrasound combined with microbubbles improves the treatment efficacy.
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Affiliation(s)
- Shao-Ling Yang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated 6th People's Hospital, Shanghai Institute of Ultrasound in Medicine, Shanghai, PR China; ; Department of Ultrasound in Medicine, Branch Hospital in Fengxian of Shanghai 6th People's Hospital, Shanghai, PR China
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Kumar A, Vasudeva P, Kumar N, Nanda B, Jha SK, Mohanty N. A Prospective Randomized Comparative Study of Monopolar and Bipolar Transurethral Resection of the Prostate and Photoselective Vaporization of the Prostate in Patients Who Present with Benign Prostatic Obstruction: A Single Center Experience. J Endourol 2013; 27:1245-53. [DOI: 10.1089/end.2013.0216] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Anup Kumar
- Department of Urology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Pawan Vasudeva
- Department of Urology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Niraj Kumar
- Department of Urology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Biswajit Nanda
- Department of Urology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Sanjeev K. Jha
- Department of Urology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Nayhan Mohanty
- Department of Urology, VMMC and Safdarjung Hospital, New Delhi, India
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Kim MS, Park KK, Chung BH, Lee SH. Effect of photoselective vaporization prostatectomy on lower urinary tract symptoms in benign prostatic hyperplasia with or without intravesical prostatic protrusion. Korean J Urol 2013; 54:36-41. [PMID: 23362446 PMCID: PMC3556552 DOI: 10.4111/kju.2013.54.1.36] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 10/20/2012] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Intravesical protrusion of the prostate (IPP) can affect voiding. We evaluated the improvement in lower urinary tract symptoms and patient satisfaction after laser prostate photovaporization in benign prostatic hyperplasia (BPH) patients with or without IPP. MATERIALS AND METHODS This prospective study included 134 patients who underwent GreenLight HPS laser photoselective vaporization prostatectomy (PVP) between January 2010 and July 2011 patient. Preoperative IPP was evaluated by using the retroflexed view from flexible cystoscopy. evaluation included complete medical history, International Prostate Symptom Scores (IPSS), maximum flow rate (Qmax), postvoid residual (PVR), serum prostate-specific antigen (PSA), and transrectal ultrasonogram. Changes from baseline in Qmax, PVR, total IPSS, and IPSS subscores (voiding and storage) were analyzed at postoperative months 1, 3, and 6. RESULTS The patients' mean age was 66.6±7.8 years. Mean serum PSA and prostate volume were 1.7±1.5 ng/mL and 42.9±16.7 g, respectively. No significant differences existed between the IPP and no IPP groups in preoperative prostate volume, total IPSS, PSA, or lasing time and energy. The mean follow-up duration was 6.2±1.9 months. IPP patients showed significant improvements in total IPSS and voiding subscores at months 1 and 3. Improvements in the quality of life score and storage subscore were not significantly different between the groups. Qmax was significantly improved at 6 months postoperatively in the IPP group versus the no IPP group. CONCLUSIONS Among patients who underwent PVP for BPH, the IPP group showed more symptom improvement, especially in voiding symptoms, than did the no IPP group. Preoperative cystoscopy is helpful for evaluating IPP and for anticipating postoperative outcome.
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Affiliation(s)
- Myung Soo Kim
- Department of Urology, Gangnam Severance Hospital, Uological Science Institute, Seoul, Korea
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