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The comparison study of anatomic vapor-incision technique (AVIT) using the 180W-XPS Greenlight laser and photoselective vaporization of the prostate(PVP) for the treatment of benign prostatic hyperplasia. Urology 2022; 167:191-197. [DOI: 10.1016/j.urology.2022.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/17/2022] [Accepted: 03/31/2022] [Indexed: 11/18/2022]
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Law KW, Zakaria AS, Elterman DS, Rijo E, Misrai V, Nguyen DD, Lai C, Byrne E, Tarasidis J, Baker J, Langan R, Fedas N, Mejia AM, O'Neill P, Hasenberg T, Zorn KC. A Novel Method for GreenLight MoXy Laser Fiber Irrigation System to Improve Performance and Durability: A New Standard of Care? J Endourol 2021; 35:1378-1385. [PMID: 33397193 DOI: 10.1089/end.2020.0860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction and Objectives: The GreenLight™ MoXy® laser fiber has been used since 2010 for benign prostatic hyperplasia procedures. We tested a novel principle to increase the saline irrigation flow rates beyond the current standard of gravity drip (∼22 cc/minutes) within the fiber-attached cooling system to potentially prevent excessive tissue adherence and to eliminate the likelihood of degradation due to abnormal overheating. The objective was to assess differences between the ordinary and active pumping methods with ≥2 times flow rate after conditioning of the laser fiber. Materials and Methods: A controllable full, tissue-contact system was utilized for conditioning in a porcine model, applying 180 W of vaporization mode of GreenLight XPS console for 30 continuous minutes. Four groups were evaluated using different saline flow rates; the nominal flow rate (control group, 22 mL/minute), digital pump set (35 mL and 50 mL/minute), and a manual pressure cuff with hand pump set using a 3-L saline bag with pressure of 300 mmHg (35-80 mL/minute). At the end of the conditioning process, a mechanical pull force test was executed on the fiber metal cap to evaluate the bonding strength. A failed event was defined as the natural detachment of the metal cap during the conditioning process or a cap pull force smaller than 22.24 N resulting in detachment. Additional physical parameters, including fiber tip temperature information and laser beam power transmission efficiency, were analyzed. Results: Detachment of the cap occurred less frequently when using the 300 mmHg pressure cuff saline bag compared to the nominal flow rate (6.67% vs 50%, respectively). The average operating fiber tip temperatures were lower in the higher flow rate groups compared to nominal, measured at 315°C and 305°C. compared to 442°C. Moreover, a significantly lower FiberLife Event count and an ∼5% increase of the average final laser transmission efficiency were observed in the higher flow rate groups. Conclusions: Our study demonstrates superior results when using active pumping or high-pressure systems to increase saline flow rates in terms of laser fiber durability without any additional cost. More specifically, use of a manual pressure cuff with starting pressure at 300 mmHg, a system that is readily available in most operating rooms, increases MoXy fiber durability. Further studies are required to assess if this technique will improve user experience, clinical outcomes, and procedure costs.
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Affiliation(s)
- Kyle W Law
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ahmed S Zakaria
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Dean S Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Enrique Rijo
- Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - David-Dan Nguyen
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Changyi Lai
- Division of Urology and Pelvic Health, Boston Scientific Corporation, Marlborough, Massachusetts, USA
| | - Earol Byrne
- Division of Urology and Pelvic Health, Boston Scientific Corporation, Marlborough, Massachusetts, USA
| | - John Tarasidis
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - James Baker
- Division of Urology and Pelvic Health, Boston Scientific Corporation, San Jose, California, USA
| | - Ray Langan
- Division of Urology and Pelvic Health, Boston Scientific Corporation, San Jose, California, USA
| | - Nick Fedas
- Division of Urology and Pelvic Health, Boston Scientific Corporation, Marlborough, Massachusetts, USA
| | - Ana Maria Mejia
- Division of Urology and Pelvic Health, Boston Scientific Corporation, San Jose, California, USA
| | - Paul O'Neill
- Division of Urology and Pelvic Health, Boston Scientific Corporation, San Jose, California, USA
| | - Thomas Hasenberg
- Division of Urology and Pelvic Health, Boston Scientific Corporation, San Jose, California, USA
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
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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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Operative time comparison of aquablation, greenlight PVP, ThuLEP, GreenLEP, and HoLEP. World J Urol 2020; 38:3227-3233. [PMID: 32124018 DOI: 10.1007/s00345-020-03137-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 02/12/2020] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION The BPH surgical armamentarium is composed of a rapidly expanding number of technologies and techniques. These include greenlight photovaporization of the prostate (PVP), greenlight enucleation of the prostate (GreenLEP), holmium laser enucleation of the prostate (HoLEP), thulium laser enucleation of the prostate (ThuLEP) and, more recently, the aquablation procedure. To the best of our knowledge, no direct comparison in operative time has been performed. METHODS Data for this study were pooled from five sources. For aquablation, patient-level data from four studies of the aquablation procedure were provided by the device manufacturer as well as from a high-volume commercial user. PVP, GreenLEP, HoLEP, and ThuLEP were performed by high-volume, experienced experts. Endpoints included total operative time, resection time, and proportion of total operative time for resection. General linear models were used to evaluate the relationship between prostate volume (or other continuous predictors) and procedure time. RESULTS Total procedure time was related to prostate size. Except for the small prostate size range (size < 40 cc), at any given prostate volume, procedure time was highest for PVP, intermediate for LEPs, and lowest for Aquablation. The relationship between procedure time and prostate size (i.e., slope of the fitted lines) was 0.16 min/g for aquablation, 0.32 min/g, 0.28 min/g and 0.32 min/g for GreenLEP, HoLEP and ThuLEP, respectively, and 0.63 min/g for PVP. CONCLUSION In our analysis of pooled data of multi-surgical techniques and technologies, aquablation provided the lowest operative time across all prostate volumes. PVP had the longest procedure time for prostates > 40 cc.
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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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