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Xu M, Sun C, Zang Y, Zhu J, Xue B, Tao W. The feasibility and safety of photoselective vaporization for prostate using a 180-W XPS Greenlight laser in day-surgery pattern in China. Lasers Med Sci 2020; 36:1421-1426. [PMID: 33118126 DOI: 10.1007/s10103-020-03174-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/23/2020] [Indexed: 12/14/2022]
Abstract
To evaluate the feasibility and safety of photoselective vaporization for prostate (PVP) with a 180-W XPS Greenlight laser as day surgery in the Chinese population. We retrospectively collected 114 cases undergoing the day surgery PVP and 198 cases undergoing conventional inpatient surgery PVP from April 2017 to March 2020. All patients' data including baseline characteristics, peri-operative data, post-operative outcomes, and complications were recorded and evaluated. The day-surgery procedures were successful in 110 patients. There were no significant differences in baseline characteristics in both groups. The catheterization time and hospitalization time were much shorter and economic cost was much lower in the day-surgery group than in the conventional inpatient surgery group. As for the post-operative complications, the incidence rate of the urinary retention is higher in the day-surgery group than in conventional inpatient surgery group. During the follow-up periods, the International Prostate Symptom Score (IPSS), quality of life (QoL), maximal urinary flow rate (Qmax), and post-void residual urine (PVR) improved significantly in both groups, and no differences were observed between the two groups. Compared to the conventional inpatient surgery, the day-surgery PVP is feasible and safe, which can reduce the hospitalization time and economic cost.
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Affiliation(s)
- Ming Xu
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chuanyang Sun
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yachen Zang
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jin Zhu
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Boxin Xue
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China.
| | - Wei Tao
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China.
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Tao W, Sun C, Yang D, Zang Y, Zhu J, Zhang Y, Wang G, Xue B. Application of 180W XPS GreenLight laser vaporization of the prostate for treatment of benign prostatic hyperplasia. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:1121-1129. [PMID: 31498146 DOI: 10.3233/xst-190550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To evaluate safety, efficacy and clinical outcomes after photovaporization of the prostate with the 180W-XPS Greenlight laser in patients with low urinary tracts symptom secondary to benign prostatic hyperplasia (BPH). MATERIALS AND METHODS All 102 patients with lower urinary tract symptoms who underwent 180W XPS laser vaporization of the prostate from April 2017 to April 2018 were enrolled. The preoperative parameters, postoperative functional, uroflowmetry outcomes and complications were collected. RESULTS All patients were successfully treated with 180W XPS laser vaporization. Mean preoperative prostate volume was 81±28.7 ml and mean laser time was 28.2±12.5 minutes. No major complications intraoperatively or postoperatively were observed and no blood transfusions were required. Comparing to preoperative characteristics, International Prostate Symptom Score (IPSS), maximum flow rate (Qmax) and post-void residual (PVR) parameters were improved significantly and sustained during the follow-up period. At 3, 6 and 12-month follow-ups, mean urinary peak flow increased from 6.2±2.1 ml per second to 19.8±4.6, 19.4±4.7 and 19.6±4.9 ml per second, respectively. Mean International Prostate Symptom Scores decreased over time, from 28.9±4.5 to 8.2±1.6, 6.2±1.22 and 5.88±1.15 at 3, 6, 12 months, respectively. CONCLUSIONS 180W XPS Greenlight laser vaporization is a safe and effective treatment option for patients with lower urinary tract symptoms secondary to BPH.
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Affiliation(s)
- Wei Tao
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Chuanyang Sun
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Dongrong Yang
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yachen Zang
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jin Zhu
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yuanyuan Zhang
- Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Gang Wang
- Department of Urology, Ningbo Urology and Nephrology Hospital, Ningbo, Zhejiang, China
| | - Boxin Xue
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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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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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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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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Plata M, Trujillo CG, Domínguez C, Caicedo JI, Carreño GL, Mariño Alvarez AM, Hernandez N, Cataño JG. Photoselective Vaporization with KTP 180-W Green Laser for the Treatment of Lower Urinary Symptoms Secondary to Benign Prostatic Enlargement: Effectiveness and Safety at Midterm Follow-Up. J Endourol 2015; 29:1253-7. [DOI: 10.1089/end.2015.0200] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mauricio Plata
- Department of Urology and Universidad de Los Andes School of Medicine, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Carlos G. Trujillo
- Department of Urology and Universidad de Los Andes School of Medicine, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Cristina Domínguez
- Department of Urology and Universidad de Los Andes School of Medicine, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Juan Ignacio Caicedo
- Department of Urology and Universidad de Los Andes School of Medicine, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Gabriel Leonardo Carreño
- Department of Urology and Universidad de Los Andes School of Medicine, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Angela M. Mariño Alvarez
- Department of Urology and Universidad de Los Andes School of Medicine, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Natalia Hernandez
- Department of Urology and Universidad de Los Andes School of Medicine, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Juan G. Cataño
- Department of Urology and Universidad de Los Andes School of Medicine, Fundación Santa Fe de Bogotá, Bogotá, Colombia
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