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Spirito L, Capra M, Sciorio C, Romano L, Morelli M, Valtorta A, Arcaniolo D, Mirto BF, Manfredi C, Sicignano E, Capone F, Giampaglia G, Iaconis S, Napolitano L, Machiella F, Quattrone C, Imperatore V, Crocetto F. Long-term functional outcomes and predictors of efficacy in thulium laser enucleation of the prostate (ThuLEP) for benign prostatic hyperplasia (BPH): a retrospective observational study. J Basic Clin Physiol Pharmacol 2024; 35:169-174. [PMID: 38915209 DOI: 10.1515/jbcpp-2024-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 06/26/2024]
Abstract
OBJECTIVES Benign prostatic hyperplasia (BPH) is a common urological condition affecting aging men worldwide. Among the treatment options available for BPH, transurethral resection of the prostate (TURP) is the gold-standard invasive intervention. To reduce the TURP-related non-negligible morbidity, loss-of-ejaculation rate, hospitalization, blood loss and catheterization time several laser techniques have been developed, such as the Thulium Laser Enucleation of the Prostate (ThuLEP). To investigate the efficacy outcomes of the ThuLEP as a treatment option for benign prostatic hyperplasia (BPH) we performed a retrospective observational study at Moriggia Pelascini Hospital (Como, Italy) between January 2015 and September 2018. METHODS We included 265 patients who underwent ThuLEP at a specific hospital between defined dates. Data on various parameters, including post-void residue volume, peak urinary flow rate (Qmax), International Prostate Symptom Score (IPSS) for urinary symptoms, IPSS Quality of Life (QoL) score, and International Index of Erectile Function (IIEF) score for erectile dysfunction, were collected at baseline and follow-up. RESULTS The analysis revealed significant improvements in voiding efficiency, urinary flow, urinary symptoms, quality of life, and erectile function following ThuLEP. Furthermore, certain baseline characteristics, such as post-void residue, peak urinary flow rate, age, prostate volume, and aspirin usage, were found to influence treatment outcomes. CONCLUSIONS Despite the study's limitations, these findings contribute to understanding ThuLEP's effectiveness in managing BPH and can aid in making informed clinical decisions for patient care. Prospective studies with longer follow-up periods are recommended to validate and extend these results.
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Affiliation(s)
- Lorenzo Spirito
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli" Naples, Italy
| | - Massimo Capra
- Urology Unit, 9337 Alessandro Manzoni Hospital , Lecco, Italy
| | - Carmine Sciorio
- Urology Unit, 9337 Alessandro Manzoni Hospital , Lecco, Italy
| | - Lorenzo Romano
- Urology Unit, 9337 Alessandro Manzoni Hospital , Lecco, Italy
| | - Michele Morelli
- Urology Unit, 9337 Alessandro Manzoni Hospital , Lecco, Italy
| | - Adelio Valtorta
- Urology Unit, 89497 Moriggia Pelascini Hospital , Como, Italy
| | - Davide Arcaniolo
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli" Naples, Italy
| | - Benito Fabio Mirto
- Department of Neurosciences, Science of Reproduction and Odontostomatology, 9307 University of Naples Federico II Naples, Italy
| | - Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli" Naples, Italy
| | - Enrico Sicignano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, 9307 University of Naples Federico II Naples, Italy
| | - Federico Capone
- Department of Neurosciences, Science of Reproduction and Odontostomatology, 9307 University of Naples Federico II Naples, Italy
| | - Gaetano Giampaglia
- Department of Neurosciences, Science of Reproduction and Odontostomatology, 9307 University of Naples Federico II Naples, Italy
| | - Salvatore Iaconis
- Department of Neurosciences, Science of Reproduction and Odontostomatology, 9307 University of Naples Federico II Naples, Italy
| | - Luigi Napolitano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, 9307 University of Naples Federico II Naples, Italy
| | - Fabio Machiella
- Department of Neurosciences, Science of Reproduction and Odontostomatology, 9307 University of Naples Federico II Naples, Italy
| | - Carmelo Quattrone
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli" Naples, Italy
| | | | - Felice Crocetto
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli" Naples, Italy
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Tung JY, Aslim EJ, Ho HS, Chen C. A cost-effectiveness analysis of pharmacotherapy versus prostatic urethral lift as initial therapy for patients with moderate benign prostatic hyperplasia. Expert Rev Pharmacoecon Outcomes Res 2023; 23:63-68. [PMID: 36342223 DOI: 10.1080/14737167.2023.2144237] [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: 11/09/2022]
Abstract
AIM The objective of this study was to evaluate the cost-effectiveness of an upfront minimally invasive surgical procedure, the prostatic urethral lift (PUL), as an initial treatment for patients with moderate benign prostatic hyperplasia (BPH), against current first-line pharmacotherapy with combination medical therapy. METHOD A micro-simulation model was developed using TreeAge Pro to compare two treatment strategies - initial treatment with combination medical therapy (alpha-blocker + 5-ARI) versus an upfront prostatic urethral lift procedure. The impact on disease progression, costs, and quality-adjusted life-years (QALYs) was analyzed. A Markov model and probabilistic sensitivity analysis were used to estimate the costs and effects of the different strategies. The cost-effectiveness of the strategies at different willingness-to-pay (WTP) thresholds was then examined. RESULTS Incremental costs (versus no prostatic urethral lift) were S$13,600 (1 year) and S$8,700 (5 years). Incremental QALYs were 0.07 (1 year) and 0.22 (5 years). An upfront PUL procedure was more expensive but also more effective than pharmacotherapy, with an incremental cost per QALY gain of approximately S$39,400. It is a cost-effective treatment option at the willingness-to-pay threshold of S$50,000. CONCLUSION Prostatic urethral lift is a cost-effective initial treatment option for men with moderate symptoms of benign prostatic hyperplasia.
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Affiliation(s)
- Joshua Ym Tung
- Department of Urology, Singapore General Hospital, Singapore
| | - Edwin J Aslim
- Department of Urology, Singapore General Hospital, Singapore
| | - Henry Ss Ho
- Department of Urology, Singapore General Hospital, Singapore
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Bilhim T, Costa NV, Torres D, Pinheiro LC, Spaepen E. Long-Term Outcome of Prostatic Artery Embolization for Patients with Benign Prostatic Hyperplasia: Single-Centre Retrospective Study in 1072 Patients Over a 10-Year Period. Cardiovasc Intervent Radiol 2022; 45:1324-1336. [PMID: 35778579 DOI: 10.1007/s00270-022-03199-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/04/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Assess long-term outcomes of prostatic artery embolization (PAE) for patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS Single centre retrospective study from 2009-2019 including 1072 patients who received PAE and had available follow-up. Patients were evaluated yearly at 1-10 years post PAE using the International Prostate Symptom Score (IPSS) and quality of life (QoL), prostate volume (PV), prostate-specific antigen (PSA), peak urinary flow rate (Qmax) and postvoid residual (PVR) volume. The need for prostatic medication, re-intervention rates, repeat PAE and prostatectomy rates were assessed with Kaplan-Meier survival analysis and compared between different embolic agents using Cox regression analysis. RESULTS Mean follow-up time was 4.39 ± 2.37 years. At last follow-up visit, mean IPSS and QoL improvements were - 10.14 ± 8.34 (p < .0001) and - 1.87 ± 1.48 (p < .0001) points, mean PV reduction was - 6.82 ± 41.11 cm3 (p = 0.7779), mean PSA reduction was - 1.12 ± 4.60 ng/mL (p = 0.9713), mean Qmax increase was 2.72 ± 6.38 mL/s (p = 0.0005), mean PVR reduction was - 8.35 ± 135.75 mL (p = 0.6786). There were 335 patients (31.3%) needing prostatic medication after PAE. Re-intervention rates were 3.4% at 1 year, 21.1% at 5 years and 58.1% at 10 years. Repeat-PAE rates were 2.3% at 1 year, 9.5% at 5 years and 23.1% at 10 years. Prostatectomy rates were 1.1% at 1 year, 11.6% at 5 years and 35.0% at 10 years. No significant differences were found between polyvinyl alcohol particles, Bead Block, Embospheres and Embozenes. CONCLUSION PAE induces durable long-term LUTS relief, with re-intervention rates of 20% in the first 5 years and 30%-60% > 5 years post-PAE.
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Affiliation(s)
- Tiago Bilhim
- Interventional Radiologist, Interventional Radiology Unit, Saint Louis Hospital, R. Luz Soriano 182, 1200-249, Lisbon, Portugal. .,NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa, Lisbon, Portugal. .,Urology Department, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal.
| | - Nuno Vasco Costa
- Interventional Radiologist, Interventional Radiology Unit, Saint Louis Hospital, R. Luz Soriano 182, 1200-249, Lisbon, Portugal.,NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa, Lisbon, Portugal.,Urology Department, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal
| | - Daniel Torres
- Interventional Radiologist, Interventional Radiology Unit, Saint Louis Hospital, R. Luz Soriano 182, 1200-249, Lisbon, Portugal.,NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa, Lisbon, Portugal.,Urology Department, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal
| | - Luís Campos Pinheiro
- NOVA Medical School
- Faculdade de Ciências Médicas, NMS
- FCM, Universidade Nova de Lisboa, Lisbon, Portugal.,Urology Department, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal
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Nottingham CU, Large T, Agarwal DK, Rivera ME, Krambeck A. Comparison of Newly-Optimized Moses Technology Versus Standard Holmium:YAG for Endoscopic Laser Enucleation of the Prostate. J Endourol 2021; 35:1393-1399. [PMID: 33813861 DOI: 10.1089/end.2020.0996] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The purpose of this study was to describe our initial experience of using a newly-optimized Moses technology that is part of the second generation Moses platform specifically designed for holmium laser enucleation of the prostate M2-HoLEP, and compare it to patients undergoing holmium laser enucleation of the prostate (HoLEP) using standard holmium:YAG technology (S-HoLEP). METHODS We retrospectively collected data on patients who underwent M2-HoLEP and compared it to the last 50 patients in whom we performed S-HoLEP. Specifically, we compared preoperative symptom scores for lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), preoperative objective voiding metrics, as well as intraoperative characteristics, perioperative characteristics, postoperative complications, postoperative symptom scores for LUTS and ED, and postoperative objective voiding metrics. Additionally we evaluated the ability for same day discharge following surgery in the M2-HoLEP group. RESULTS We included 104 total patients for analysis. We compared the first 54 patients undergoing M2-HoLEP to 50 patients undergoing S-HoLEP. Both groups had similar age, BMI, use of anticoagulation medication, LUTS and ED scores, and objective voiding metrics. Operations performed with M2-HoLEP had faster mean hemostasis time (8.7 vs 10.6 ± 6 minutes, p=0.03) as well as hemostasis rate (0.13 vs 0.30 grams/minute, p=0.01). Same day discharge was successful in 69.4% of patients in the M2-HoLEP group. Postoperatively, both groups also had similar and low rates of urinary retention and complications. At follow-up, both groups had similar symptom scores for LUTS and ED, as well as similar objective voiding metrics. CONCLUSION The newly optimized Moses pulse modulation technology is safe and efficient for the treatment of BPH. Such technologic improvements in the laser have greatly enhanced the feasibility of same day discharge of patients undergoing HoLEP.
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Affiliation(s)
- Charles Upshur Nottingham
- Washington University in St Louis School of Medicine, 12275, Urology, St Louis, Missouri, United States;
| | - Tim Large
- Indiana University School of Medicine, 12250, Urology, Indianapolis, Indiana, United States;
| | - Deepak Kumar Agarwal
- Indiana University School of Medicine, Urology, Indianapolis, Indiana, United States;
| | - Marcelino E Rivera
- Indiana University Health Methodist Hospital, 22535, Urology, 1801 Senate Blvd, Ste 220, Indianapolis, Indiana, United States, 46202;
| | - Amy Krambeck
- Northwestern University Feinberg School of Medicine, 12244, Urology, Chicago, Illinois, United States;
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Nottingham CU, Agarwal DK, Valadon C, Large T, Rivera ME, Krambeck AE. Correlating Patient Anxiety with Urinary Symptoms Before and After Holmium Laser Enucleation of the Prostate. J Endourol 2020; 34:782-787. [PMID: 32394722 DOI: 10.1089/end.2020.0114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction and Objective: Preoperative anxiety has been shown to correlate with certain urinary symptoms in patients with certain types of voiding dysfunction, particularly overactive bladder. The purpose of this study was to evaluate if patient-reported anxiety correlates with pathologic characteristics, voiding symptoms, and objective metrics of bladder emptying in male patients undergoing holmium laser enucleation of the prostate (HoLEP). Patients and Methods: We began collecting patient-reported anxiety scores (generalized anxiety disorder 7-item or GAD-7) in addition to patient-reported scores of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) starting in November 2018 for men with LUTS due to benign prostate hyperplasia (BPH). We retrospectively evaluated the relationship between preoperative GAD-7 score with preoperative age, body mass index (BMI), preoperative urine flow metrics, preoperative postvoid residual (PVR), and preoperative symptom scores for LUTS (American Urological Association, BPH impact index [BII], and Michigan incontinence symptom index [MISI]) and ED (sexual health inventory for men and male sexual health questionnaire for ejaculatory dysfunction [MSHQ-EjD]). We then compared preoperative GAD-7 score with enucleated prostate weight, postoperative GAD-7 scores, postoperative urine flow metrics, postoperative PVR, and postoperative symptom scores for LUTS and ED. Results: We included 139 patients for analysis. The preoperative GAD-7 score positively correlated with preoperative BII scores (rs = 0.202, p = 0.019), MISI total (rs = 0.260, p = 0.002), and MISI bother (rs = 0.345, p < 0.001) scores. Preoperative GAD-7 negatively correlated with preoperative MSHQ-EjD (rs = -0.191, p = 0.031). Following HoLEP, all four of these correlations disappear. The GAD-7 score did not correlate with age, BMI, preoperative urine flow metrics, preoperative PVR, or other preoperative LUTS and ED symptom scores. In addition, preoperative GAD-7 score showed no correlation with enucleated prostate weight, postoperative urine flow metrics, postoperative PVR, and postoperative LUTS and ED symptom scores. Conclusions: Higher preoperative anxiety correlated with more severe preoperative urinary LUTS, particularly incontinence symptoms, in patients undergoing HoLEP. Following HoLEP, these symptoms improve regardless of patient anxiety level.
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Affiliation(s)
- Charles U Nottingham
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Deepak K Agarwal
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Crystal Valadon
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tim Large
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Marcelino E Rivera
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amy E Krambeck
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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De S. EDITORIAL COMMENT. Urology 2019; 131:19-20. [PMID: 31451160 DOI: 10.1016/j.urology.2019.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 03/21/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Smita De
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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Abstract
PURPOSE OF REVIEW GreenLight photoselective vaporization (GL-PV) is now established in the treatment of benign prostatic enlargement. The present review outlines the available technical armamentarium and summarizes the current best evidence on functional and safety outcomes. Moreover, future technical developments and refinements are presented. RECENT FINDINGS GL-PV has evolved to be the most commonly performed procedure, second to conventional transurethral resection of the prostate (TURP) for surgical management of benign prostatic obstruction (BPO). On the basis of the data published in the randomized controlled Goliath study, GL-PV with 180-W technology is noninferior in terms of functional outcomes compared with TURP considering short and intermediate follow-up with a complication-free rate of around 80% after 24 months.The ongoing push towards high-power lasers can be explained by their more effective tissue ablative effect, leading to shorter operating times. Comparative analysis between high-power and low-power laser systems demonstrated similar retreatment rates and most institutions are, therefore, now performing 180-W GL-PV.Performed as an outpatient procedure, GL-PV is cost-effective with a low hospital re-admission rate. Plasma kinetic vaporization of the prostate (PKVP) has recently emerged as a potential contender in the field; also GreenLight enucleation of the prostate (GreenLEP) might be even more effective than GL-PV. SUMMARY GL-PV appears to be a well tolerated surgical alternative for patients suffering from BPO. Long-term follow-up data from 120-W and 180-W laser systems are still pending. Potential competitors have recently been brought to the market and further trials and long-term data will show, whether GL-PV will stand the test of time. Regardless of technical specifications, surgeon's experience remains essential to achieve good functional and safety outcomes.
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Sjöström C, Bergkvist M, Thulin H, Kjellman A, Thorstenson A. Reduced bleeding with DRY CUT ® transurethral resection of the prostate (TURP) compared to standard TURP. Scand J Urol 2019; 53:235-239. [PMID: 31328609 DOI: 10.1080/21681805.2019.1637376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To compare bleeding and transfusion rate between patients who undergo standard transurethral resection of the prostate (TURP) and patients who undergo DRY CUT® TURP.Materials and methods: A retrospective comparison was made of 626 patients who underwent a standard monopolar TURP during 2004-2007 at the Karolinska University Hospital Huddinge with 620 patients who underwent monopolar DRY CUT® TURP during 2011-2014 at the same clinic. Transfusion rate, perioperative bleeding, prostate volume, resection weight, use of anticoagulation therapy, presence of prostate cancer, whether the operation was performed by a specialist doctor in urology or a resident and length of hospital stay were evaluated.Results: The median bleeding was 300 ml (IQR = 100-645 ml) in the group of patients who underwent standard TURP compared to 75 ml (IQR 30-268 ml) in the DRY CUT® TURP group. The bleeding quotient for standard TURP was 2.3-times the perioperative bleeding for DRY CUT® TURP. In a logistic regression model the patients who underwent standard TURP were more likely to undergo blood transfusion compared to DRY CUT® TURP (OR = 3.18, 95% CI = 1.72-5.88). The results were not affected by adjustment for patient age, presence of prostate cancer, anticoagulation therapy or operation performed by a specialist in urology. However, the resection weight did influence the bleeding quotient.Conclusions: The shift from standard TURP to DRY CUT® TURP has decreased the perioperative bleeding and need for blood transfusion at our hospital.
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Affiliation(s)
- Carin Sjöström
- Section of Urology, Department of Surgery, Capio S:t Göran's Hospital, Stockholm, Sweden.,Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Bergkvist
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
| | - Helena Thulin
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
| | - Anders Kjellman
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden
| | - Andreas Thorstenson
- Section of Urology, Department of Surgery, Capio S:t Göran's Hospital, Stockholm, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
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Urethra and Ejaculation Preserving Robot-assisted Simple Prostatectomy: Near-infrared Fluorescence Imaging-guided Madigan Technique. Eur Urol 2019; 75:492-497. [DOI: 10.1016/j.eururo.2018.11.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/28/2018] [Indexed: 12/27/2022]
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Hermanns T, Gross O, Fankhauser CD, Wettstein MS, Grossmann NC, Keller EX, Eberli D, Kozomara M, Sulser T, Poyet C, Kranzbühler B. Pure Bipolar Plasma Vaporization of the Prostate: Results from a Prospective 3D Ultrasound Volumetry Study with Clinical Outcome After 3 Years. J Endourol 2019; 33:107-112. [PMID: 30612441 DOI: 10.1089/end.2018.0700] [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 Bipolar plasma vaporization (BPV) has been shown to be a low-morbidity alternative to conventional transurethral resection of the prostate (TURP). Improved functional short-term outcome and a postoperative prostate volume reduction comparable to TURP have been reported. However, comprehensive mid- or long-term results following BPV are still lacking. METHODS A consecutive series of men who underwent pure BPV in a tertiary care academic center was prospectively investigated. Clinical parameters [International Prostate Symptom Score with Quality-of-Life domain, peak urinary flow rate (Qmax), postvoid residual volume, and prostate-specific antigen] as well as prostate volume (assessed by planimetric volumetry following transrectal 3D-ultrasound) were recorded preoperatively and regularly after BPV (after catheter removal, 6 weeks, 6 months, 1 year, and 3 years). Statistical analysis was performed using the Wilcoxon signed-rank test. All p-values ≤0.05 were considered significant. RESULTS Seventy-five men were included in this prospective investigation. Their median (interquartile range) prostate volume was 41.0 mL (30.6-57.4 mL). In the first year after BPV, the prostate volume continuously decreased over time and the relative volume reduction was 52.2% after 12 months. Subsequently, the volume reduction remained stable with 50.7% after 3 years. All investigated outcome parameters improved significantly after the procedure and remained so after 3 years. Reoperations due to persistent or regrown adenoma were not necessary. Six (8.0%) and five patients (6.6%) developed a de novo urethral stricture or bladder neck contracture, respectively. CONCLUSIONS Three years after pure BPV of the prostate, a durable prostate volume reduction in combination with a stable improvement of functional outcome parameters was detectable in our prospective study. The low morbidity of the procedure and the possibility to perform BPV under ongoing platelet aggregation inhibition confirms its role as minimally invasive alternative to conventional TURP.
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Affiliation(s)
- Thomas Hermanns
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich Switzerland
| | - Oliver Gross
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich Switzerland
| | - Christian D Fankhauser
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich Switzerland
| | - Marian S Wettstein
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich Switzerland
| | - Nico C Grossmann
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich Switzerland
| | - Etienne X Keller
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich Switzerland
| | - Marko Kozomara
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich Switzerland
| | - Tullio Sulser
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich Switzerland
| | - Benedikt Kranzbühler
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich Switzerland
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Davis NF, Jack GS, Witjes WP, Bjartell A, Caris C, Patel A, de la Taille A, Lawrentschuk N, Bolton DM, Tubaro A. Medical therapy versus transurethral resection of the prostate (TURP) for the treatment of symptomatic benign prostatic enlargement (BPE): a cost minimisation analysis. World J Urol 2018; 37:873-878. [PMID: 30145778 DOI: 10.1007/s00345-018-2454-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 08/14/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE A cost minimisation analysis compares the costs of different interventions' to ascertain the least expensive over time. We compared different prostate targeted drug treatments with TURP to identify the optimal cost saving duration of a medical therapy for symptomatic benign prostatic enlargement (BPE). METHODS The Evolution registry is a prospective, multicentre registry, conducted by the European Association of Urology Research Foundation (EAUrf) for 24 months in 5 European countries. Evolution was designed to register the management of symptomatic BPE in clinical practice settings in 5 European countries. Direct cost evaluation associated with prostate targeted medical therapies and TURP was also recorded and analysed. RESULTS In total, 1838 men were enrolled with 1246 evaluable at 24 months. Medical therapies were more cost saving than TURP for treatment durations ranging from 2.9 to 70.4 years. Cost saving depended on both medication class and individual country assessed. Daily tamsulosin monotherapy was more cost saving than TURP for ≤ 13.9 years in Germany compared to ≤ 32.7 years in Italy. Daily finasteride monotherapy was more cost saving for ≤ 5.9 years in France compared to ≤ 36.9 years in Spain. Combination therapy was more cost saving for ≤ 5.9 years for Italian patients versus ≤ 13.8 years in Germany. CONCLUSIONS BPE medical management was more cost saving than TURP for different specific treatment durations. Information from this study will allow clinicians to convey medical and surgical costs over time, to both patients and payors alike, when considering BPE treatment.
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Affiliation(s)
- Niall F Davis
- Department of Urology, The Austin Hospital, Heidelberg, Melbourne, 3084, Australia.
| | - G S Jack
- Department of Urology, The Austin Hospital, Heidelberg, Melbourne, 3084, Australia
| | - W P Witjes
- EAU Research Foundation, P.O. Box 30016, 6803 AA, Arnhem, The Netherlands
| | - A Bjartell
- EAU Research Foundation, P.O. Box 30016, 6803 AA, Arnhem, The Netherlands.,Department of Urology, Lund University, Skane Hospital, Malmö, Sweden
| | - C Caris
- EAU Research Foundation, P.O. Box 30016, 6803 AA, Arnhem, The Netherlands
| | - A Patel
- Department of Urology, Spire London East Hospital, Roding Lane South, Redbridge, Essex, Ilford, IG4 5PZ, UK
| | - A de la Taille
- Department of Urology, Assistance Publique des Hopitaux de Paris, 54 av du Mal de Lattre de Tassigny, 94000, Créteil, France
| | - N Lawrentschuk
- Department of Urology, The Austin Hospital, Heidelberg, Melbourne, 3084, Australia
| | - D M Bolton
- Department of Urology, The Austin Hospital, Heidelberg, Melbourne, 3084, Australia
| | - A Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Enikeev D, Glybochko P, Rapoport L, Gahan J, Gazimiev M, Spivak L, Enikeev M, Taratkin M. A Randomized Trial Comparing The Learning Curve of 3 Endoscopic Enucleation Techniques (HoLEP, ThuFLEP, and MEP) for BPH Using Mentoring Approach-Initial Results. Urology 2018; 121:51-57. [PMID: 30053397 DOI: 10.1016/j.urology.2018.06.045] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 05/30/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess the differences in the learning curve associated with different techniques of endoscopic enucleation of the prostate. MATERIALS AND METHODS Ninety patients were randomly assigned into 3 groups (30 patients in each): HoLEP, ThuFLEP or MEP. Inclusion criteria for the study included prostate volume <80 cc, IPSS > 20, or Qmax < 10. The EEPs were performed by 3 surgeons experienced in transurethral resection of the prostate. Assignment of surgeons to surgical technique was also randomized. None of the surgeons had prior experience in EEP. RESULTS ThuFLEP was slightly superior (with no significant difference [P > .05]) to HoLEP and MEP in terms of overall enucleation rate-1.0 g/min vs 0.8 g/min and 0.7 g/min, respectively. We observed similar enucleation rates at the initial stages of training (first 20 surgeries) with insignificant increase in ThuFLEP efficiency. At next 10 surgeries ThuFLEP and HoLEP efficiency were higher than of MEP (P < .001) without significant difference between techniques of laser EEP (P = .07). CONCLUSION Endoscopic enucleation of the prostate can be adopted safely and effectively within 30 surgeries if the technique is learned with a mentoring approach. EEP is shown to be safe and effective even in the initial stages of learning. Laser EEP (HoLEP, ThuFLEP) appears to lend itself to quicker adaptation compared MEP.
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Affiliation(s)
- Dmitry Enikeev
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation.
| | - Petr Glybochko
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
| | - Leonid Rapoport
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
| | - Jeffrey Gahan
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
| | - Magomed Gazimiev
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
| | - Leonid Spivak
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
| | - Mikhail Enikeev
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
| | - Mark Taratkin
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
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Is loss of power output due to laser fiber degradation still an issue during prostate vaporization using the 180 W GreenLight XPS laser? World J Urol 2018; 37:181-187. [PMID: 29923013 DOI: 10.1007/s00345-018-2377-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 06/12/2018] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To investigate whether heat-induced fiber degradation and loss of power output, which occurred during GreenLight laser vaporization (LV) of the prostate using the first- and second-generation 80 and 120 W laser, are still an issue during LV using the upgraded third generation 180 W GreenLight XPS™ laser. METHODS Laser beam power output of 53 laser fibers was measured at baseline and after every 25 kJ of delivered energy during routine 180 W GreenLight XPS™ LV in 47 patients with prostatic bladder outflow obstruction. After the procedures, the fiber tips were microscopically examined. RESULTS The median applied energy per patient was 178 kJ [interquartile range (IQR): 106-247]. Loss of power output during the procedure was detectable in all fibers. After the application of 25, 150, and 250 kJ, the median power output decreased to 77% (IQR 59-87), 57% (IQR 32-71), and 51% (IQR 37-64) of the baseline value. Nine fibers (17%) remained on a relatively high power output level (> 80% of the initial output), while 13 fibers (25%) showed an end-of-procedure power output of less than 20%. Microscopy of the fiber tip revealed mild-to-moderate overall degradation and increasing degradation with higher energy delivered. CONCLUSION Despite changes in fiber design, heat-induced fiber damage and loss of power output remain an issue during 180 W GreenLight XPS™ LV. Whether modifications of the surgical technique can prevent impairment of fiber performance needs to be further evaluated.
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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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80-W GreenLight Laser Vaporization Versus Transurethral Resection of the Prostate for Treatment of Benign Prostatic Obstruction: 5-Year Outcomes of a Single-center Prospective Randomized Trial. Urology 2018; 116:144-149. [PMID: 29447947 DOI: 10.1016/j.urology.2018.01.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/27/2018] [Accepted: 01/31/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess long term functional and safety follow-up data after 80-W GreenLight photoselective vaporization (GL PV) of the prostate and transurethral resection of the prostate (TURP). MATERIALS AND METHODS Prospective randomized trial at a single tertiary referral center (Geneva, Switzerland). Patients were recruited in the outpatient clinic if they met the criteria for surgical treatment of benign prostatic obstruction. At baseline, 238 patients were treated either with the 80-W GL PV or monopolar TURP. After 5 years, data were available from 105 patients: 44 GL PV patients and 61 TURP patients. The primary outcome measure was the International Prostate Symptom Score (IPSS). Secondary outcome measures included maximum urinary flow rate (Qmax), postvoidal residual (PVR) and reoperation rate. Statistical analyses were performed using Stata 14 (StataCorp). RESULTS After 5 years of follow-up, mean improvements in International Prostate Symptom Score, postvoidal residual and maximum urinary flow rate were similar in both groups. The re-treatment rate was 14.3% in the GL PV group vs 11.9% in the TURP group (P = .9). CONCLUSION Noninferiority of the GL PV to TURP was confirmed in all functional and safety outcomes at 5-year follow-up. GL-PV could be a safe surgical alternative for patients suffering from benign prostatic obstruction.
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Baten E, van Renterghem K. The Advantages of Transurethral Resection of the Prostate in Patients with an Elevated or Rising Prostate Specific Antigen, Mild or Moderate Lower Urinary Tract Symptoms, Bladder Outlet Obstruction and Negative Prostate Cancer Imaging or Prostate Biopsies: A Prospective Analysis in 105 Consecutive Patients. Curr Urol 2017; 10:140-144. [PMID: 28878597 DOI: 10.1159/000447168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/05/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate elevated or rising prostate specific antigen (PSA) as a marker for bladder outlet obstruction (BOO) in patients with minor lower urinary tract symptoms (LUTS) and without prostate cancer. MATERIALS AND METHODS One hundred and five consecutive patients were prospectively analyzed between 2005 and 2013. All patients were referred to the principal investigator by their general practitioner as a result of an elevated and/or rising PSA. Only patients with minor LUTS [International Prostate Symptom Score (I-PSS) 0-19] and without suspicion for prostate cancer were included. All patients had BOO, shown by full urodynamics, and underwent transurethral resection of the prostate. The resected tissue was histologically examined and PSA and I-PSS were evaluated after 3, 6 and 12 months and later on yearly. RESULTS Mean pre-operative PSA and I-PSS values were 8.8 ng/ml and 11.1, respectively. The mean detrusor pressure at maximum flow was 93.6 cmH2O. The mean resected volume was 52 g and the mean prostate biopsy rate was 1.8. Eighty-three of 105 patients (79%) had no malignancy and were diagnosed with BOO due to benign prostate hyperplasia (subgroup 1). Their mean PSA decreased from 9.2 to 0.7 ng/ml and 0.9 ng/ml after 6 and 12 months post-operation, respectively. The mean I-PSS declined from 11 to 3 after 6 and 12 months. Sixteen of 105 patients (15%) were treated for prostate cancer (subgroup 2). Radical prostatectomy was performed in 11 patients, brachytherapy in 3 patients and external beam radiotherapy in 2 patients. Six of 105 patients (5.7%) had active surveillance (subgroup 3). CONCLUSION BOO can cause an elevated or rising PSA in patients with minor LUTS and negative screening for prostate cancer. Transurethral resection of the prostate is an adequate treatment for these patients.
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Qian X, Liu H, Xu D, Xu L, Huang F, He W, Qi J, Zhu Y, Xu D. Functional outcomes and complications following B-TURP versus HoLEP for the treatment of benign prostatic hyperplasia: a review of the literature and Meta-analysis. Aging Male 2017; 20:184-191. [PMID: 28368238 DOI: 10.1080/13685538.2017.1295436] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To conduct a systematic review and Meta-analysis of the literature on the efficacy and safety of B-TURP versus HoLEP for the treatment of benign prostatic hyperplasia (BPH) in terms of demographic and clinical baseline characteristics, peri-operative variables, and postoperative outcomes and complications. METHODS Trials comparing B-TURP and HoLEP were identified systematically using Pubmed, Embase, CNKI, Web of Science and the Cochrane Library. Primary outcomes were the peak urinary flow rate (Qmax), post-void residual volume (PVR) and international prostate symptom score (IPSS). Secondary outcomes were operation time, irrigation duration, catheterization duration, resected tissue and complications. RESULTS Four trials assessing B-TURP and HoLEP were considered eligible for Meta-analysis, including three randomized controlled trials (RCTs) and one retrospective study. There was no statistically significant difference between B-TURP and HoLEP in terms of Qmax, IPSS, PVR at 3-6 months follow-up, operation duration, catheterization duration, resected tissue and complications (p > 0.05). HoLEP was associated with a significantly shorter irrigation time as compared with B-TURP (p < 0.05). CONCLUSION Both B-TURP and HoLEP are safe and minimally invasive techniques that are similar in terms of symptomatic relief, although these findings need further validation in larger RCTs involving larger numbers of patients and over a longer follow-up duration for B-TURP or HoLEP before a new gold standard procedure emerges for surgical treatment of BPH.
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Affiliation(s)
- Xiaoqiang Qian
- a Urology Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , P.R. China and
| | - Hailong Liu
- b Urology Department, Xinhua Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , P.R. China
| | - Ding Xu
- b Urology Department, Xinhua Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , P.R. China
| | - Le Xu
- a Urology Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , P.R. China and
| | - Fang Huang
- a Urology Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , P.R. China and
| | - Wei He
- a Urology Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , P.R. China and
| | - Jun Qi
- b Urology Department, Xinhua Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , P.R. China
| | - Yu Zhu
- a Urology Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , P.R. China and
| | - Danfeng Xu
- a Urology Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , P.R. China and
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Greenlight® users should move from photoselective vaporization to endoscopic enucleation in larger prostates. World J Urol 2017; 35:1635-1636. [DOI: 10.1007/s00345-017-2042-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/19/2017] [Indexed: 10/19/2022] Open
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Learning curves and perioperative outcomes after endoscopic enucleation of the prostate: a comparison between GreenLight 532-nm and holmium lasers. World J Urol 2016; 35:973-983. [PMID: 27766387 DOI: 10.1007/s00345-016-1957-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/14/2016] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To compare the learning curves, perioperative and early functional outcomes after HoLEP and GreenLEP. METHODS Data from the first 100 consecutive cases treated by GreenLEP and HoLEP by two surgeons were prospectively collected from dedicated databases and analysed retrospectively. En-bloc GreenLEP and two-lobar HoLEP enucleations were conducted using the GreenLight HPS™ 2090 laser and Lumenis™ holmium laser. Patients' characteristics, perioperative outcomes and functional outcomes after 1, 3 and 6 months were compared between groups. RESULTS Total energy delivered and operative times were significantly shorter for GreenLEP (58 vs. 110 kJ, p < 0.0001; 60 vs. 90 min, p < 0.0001). Operative time reached a plateau after 30 procedures in each group. Length of catheterization and hospital stay were significantly shorter in the HoLEP group (2 vs. 1 day, p < 0.0001; 2 vs. 1 day, p < 0.0001). Postoperative complications were comparable between GreenLEP and HoLEP (19 vs. 25 %; p = 0.13). There was a greater increase of Q max at 3 months and a greater IPSS decrease at 1 month for GreenLEP, whereas decreases in IPSS and IPSS-Q8 at 6 months were greater for HoLEP. Transient stress urinary incontinence was comparable between both groups (6 vs. 9 % at 3 months; p = 0.42). Pentafecta was achieved in four consecutive patients after the 18th and the 40th procedure in the GreenLEP and HoLEP group, respectively. Learning curves ranged from 14 to 30 cases for GreenLEP and 22 to 40 cases for HoLEP. CONCLUSION Learning curves of GreenLEP and HoLEP provided roughly similar peri-operative and short-term functional outcomes.
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Kranzbühler B, Gross O, Fankhauser CD, Wettstein MS, Grossmann NC, Hefermehl LJ, Zimmermann M, Müller A, Eberli D, Sulser T, Poyet C, Hermanns T. Prostate volume reduction following pure transurethral bipolar plasma vaporization and conventional transurethral resection of the prostate: a prospective investigation using transrectal 3D ultrasound volumetry. World J Urol 2016; 35:429-435. [PMID: 27339623 DOI: 10.1007/s00345-016-1876-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/03/2016] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To evaluate and compare postoperative changes in prostate volume and clinical outcome after bipolar plasma vaporization (BPV) and conventional transurethral resection of the prostate (TURP). PATIENTS AND METHODS Consecutive series of patients undergoing BPV or TURP were included in this prospective, nonrandomized study. Planimetric volumetry after transrectal three-dimensional ultrasound of the prostate was performed preoperatively and postoperatively after 6 weeks, 6 months and 12 months. Additionally, changes in clinical outcome parameters were assessed and compared between the groups. The reduction ratio and analysis of covariance were used to compare volume changes between BPV and TURP. Multiple regression analysis was performed to assess a possible interaction between preoperative prostate volume and effect of therapy. RESULTS A total of 157 patients were included (BPV: n = 68, TURP: n = 89). Median preoperative prostate volume was 43.1 ml in the BPV group and 45.9 ml in the TURP group (p = 0.43). Postoperatively, the prostate volumes decreased significantly in both groups. After catheter removal, the relative residual prostate volume was significantly higher in the BPV group (66.6 vs. 60.8 %; p = 0.02). Thereafter, significant differences were not detectable anymore (12 months: 46.6 vs. 47.1 %; p = 0.82). Regression analysis revealed that tissue ablation after BPV was superior to TURP in prostates <45 ml but inferior in prostates >45 ml. All clinical outcome parameters improved significantly and were not significantly different between the groups. CONCLUSIONS Volume reduction and short-term clinical outcome following pure BPV was excellent and comparable to conventional TURP. However, volume reduction seems to be limited in patients with larger prostates.
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Affiliation(s)
- Benedikt Kranzbühler
- Department of Urology, University Hospital Zürich, University of Zürich, Frauenklinikstr. 10, 8091, Zurich, Switzerland
| | - Oliver Gross
- Department of Urology, University Hospital Zürich, University of Zürich, Frauenklinikstr. 10, 8091, Zurich, Switzerland
| | - Christian D Fankhauser
- Department of Urology, University Hospital Zürich, University of Zürich, Frauenklinikstr. 10, 8091, Zurich, Switzerland
| | - Marian S Wettstein
- Department of Urology, University Hospital Zürich, University of Zürich, Frauenklinikstr. 10, 8091, Zurich, Switzerland
| | - Nico C Grossmann
- Department of Urology, University Hospital Zürich, University of Zürich, Frauenklinikstr. 10, 8091, Zurich, Switzerland
| | - Lukas J Hefermehl
- Department of Urology, University Hospital Zürich, University of Zürich, Frauenklinikstr. 10, 8091, Zurich, Switzerland
| | - Matthias Zimmermann
- Department of Urology, University Hospital Zürich, University of Zürich, Frauenklinikstr. 10, 8091, Zurich, Switzerland
| | - Alexander Müller
- Department of Urology, University Hospital Zürich, University of Zürich, Frauenklinikstr. 10, 8091, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zürich, University of Zürich, Frauenklinikstr. 10, 8091, Zurich, Switzerland
| | - Tullio Sulser
- Department of Urology, University Hospital Zürich, University of Zürich, Frauenklinikstr. 10, 8091, Zurich, Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital Zürich, University of Zürich, Frauenklinikstr. 10, 8091, Zurich, Switzerland
| | - Thomas Hermanns
- Department of Urology, University Hospital Zürich, University of Zürich, Frauenklinikstr. 10, 8091, Zurich, Switzerland.
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