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Salmivalli A, Boström P, Nurminen P, Kinnala P, Kytö V, Ettala O. National trends of surgery for benign prostatic hyperplasia in Finland. Scand J Urol 2024; 59:70-75. [PMID: 38647246 DOI: 10.2340/sju.v59.32425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/22/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE To investigate national trends of surgical treatment for benign prostatic obstruction (BPO). METHODS The Care Register for Healthcare in Finland was used to investigate the annual numbers and types of surgical procedures, operation incidence and duration of hospital stay between 2004 and 2018 in Finland. Procedures were classified using the Nordic Medico-Statistical Committee Classification of Surgical Procedures coding. Trends in incidence were analyzed with two-sided Cochran-Armitage test. Trends in duration of hospital stay and patient age were analyzed with linear regression. RESULTS Transurethral resection of the prostate (TURP) was the most common operation type during the study period, covering over 70% of operations for BPO. Simultaneous with the implementation of photoselective vaporization of the prostate (PVP), the incidence of TURP, minimally invasive surgical therapies, transurethral vaporization of the prostate (TUVP) and open prostatectomies decreased (p < 0.05). The mean operation incidence rate in the population between 2004 and 2018 was 263 per 100,000. The duration of hospital stay shortened (p < 0.05), and the average age of operated patients increased by 2 years (p < 0.0001). CONCLUSION The implementation of PVP did not challenge the dominating position of TURP in Finland, but it has probably influenced the overall use of other surgical therapies, excluding transurethral incision of the prostate. The results might suggest that the conservative treatment is accentuated, patient selection is more thorough, and surgical intervention might be placed at a later stage of BPO.
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Affiliation(s)
- Alisa Salmivalli
- Doctoral Programme in Clinical Research, University of Turku, Turku, Finland; Department of Urology, Satasairaala Central Hospital, Wellbeing Services County of Satakunta, Pori, Finland; Department of Urology, Turku University and Turku University Hospital, Turku, Finland.
| | - Peter Boström
- Department of Urology, Turku University and Turku University Hospital, Turku, Finland
| | - Pertti Nurminen
- Department of Urology, Turku University and Turku University Hospital, Turku, Finland
| | - Pekka Kinnala
- Department of Urology, Turku University and Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland; Research Services, Wellbeing Services County of Southwest Finland, Turku, Finland
| | - Otto Ettala
- Department of Urology, Turku University and Turku University Hospital, Turku, Finland
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Salmivalli A, Ettala O, Nurminen P, Kinnala P, Boström PJ, Kytö V. Short- and long-term risks of photoselective laser vaporization of the prostate: a population-based comparison with transurethral resection of the prostate. Ann Med 2023; 55:1287-1294. [PMID: 36974584 PMCID: PMC10054157 DOI: 10.1080/07853890.2023.2192046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Transurethral resection of the prostate (TURP) is the standard surgical treatment for benign prostate enlargement (BPE). Photoselective vaporization of the prostate (PVP) is an alternative, but there is limited real-life evidence of PVP risks. OBJECTIVE To compare short- and long-term risks of PVP to those of TURP in the treatment of BPE. MATERIALS AND METHODS Consecutive patients who underwent elective PVP or TURP between 2006 and 2018 in 20 hospitals in Finland were retrospectively studied using a combination of national registries (n = 27,408; mean age 71 years). Short-term risks were postoperative mortality, major adverse cardiovascular events (MACE), and reoperations for bleeding. Long-term risks were reoperations for BPE or any urethral operations within 12 years. Differences between treatment groups were balanced by inverse probability of treatment weighting. Risks were analyzed using the Kaplan-Meier method and Cox regression. RESULTS There were no differences in postoperative mortality or MACE between the study groups. Reoperations for bleeding were less frequent after PVP (0.9%, HR: 0.72, p = 0.042). Bleeding was more likely in patients with atrial fibrillation (number needed to treat [NNT] for PVP vs TURP: 61). Cumulative incidence for reoperation was higher after PVP (23.5%) than after TURP in long-term follow-up (17.8%; HR: 1.20, p < 0.0001, NNT: -31.7). CONCLUSIONS PVP is associated with lower postoperative bleeding risk but higher long-term reoperation risk than TURP. Patients with high bleeding risk and a low likelihood of needing reoperation appear most suitable for laser vaporization.KEY MESSAGEPVP is associated with lower postoperative bleeding risk but higher long-term reoperation risk than TURP. PVP appears an attractive treatment option, especially for patients with high bleeding risk and a low likelihood of needing a reoperation.
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Affiliation(s)
- Alisa Salmivalli
- Department of Clinical Research, University of Turku, Turku, Finland
- Department of Urology, Satasairaala Central Hospital, Wellbeing Services County of Satakunta, Pori, Finland
| | - Otto Ettala
- Department of Urology, Turku University, Turku University Hospital, Turku, Finland
| | - Pertti Nurminen
- Department of Urology, Turku University, Turku University Hospital, Turku, Finland
| | - Pekka Kinnala
- Department of Urology, Turku University, Turku University Hospital, Turku, Finland
| | - Peter J. Boström
- Department of Urology, Turku University, Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
- Turku Clinical Research Center, Turku University Hospital, Turku, Finland
- Research Services, Wellbeing Services County of Southwest Finland, Turku, Finland
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3
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Ghobrial FK, Laymon M, El-Tabey N, Elshal AM. Greenlight laser (XPS-180watt) prostatectomy for treatment of benign prostate obstruction, Pursuit of durability. Arab J Urol 2023; 22:24-30. [PMID: 38205390 PMCID: PMC10776041 DOI: 10.1080/2090598x.2023.2220631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/29/2023] [Indexed: 01/12/2024] Open
Abstract
Objectives To report 5-year outcomes, need and predictors of retreatment post greenlight laser photoselective vaporization (GL.PVP) and vapo-enucleation (GL.PVEP), as long-term data on safety and efficacy of GL.PVP and GL.PVEP and on the prostate using XPSTM system are still pending. Patients and methods Primary outcome was the need for retreatment (medical treatment and reintervention) for recurrent BOO. Time-to-event (retreatment) analysis, perioperative events, change in the urinary outcome measures at different follow-up visits, early and late complications and PSA kinetics were reported. Results Between September 2014 and April 2017, 248 patients underwent GL/XPS procedures. GL.PVP and GL.PVEP were carried out for 157 (63.3%) and 91 (36.7%) patients with mean prostate sizes of 60 ± 18 and 100 ± 22 cc, respectively. After a mean duration of 62 ± 9-month follow-up, overall retreatment rate (medical and interventional) was 23% (57 patients). It was comparable between both GL.PVP and GL.PVEP cases: 38 (24.2%) and 19 (20.9%) patients, P = 0.5, respectively. Significantly more surgical reintervention rate was reported after GL.PVP compared to GL.PVEP (P = 0.03). In retreatment group, more intraoperative bleeding (P = 0.02), early postoperative hematuria (P = 0.03), higher median preoperative PSA (P = 0.02) and less postoperative one-year percent PSA reduction (P = 0.02) were detected. Lower postoperative one-year percent PSA reduction independently predicts retreatment with a cut-off point of 64.2% (58.2% sensitivity, 73.4% specificity, AUC 0.647, 95% CI 0.52-0.76).Median (range in months) time to event was 20 (1-60) for all cases and 13.5 (1-42) and 30 (18-60), P = 0.7, for GL.PVP and GL.PVEP groups, respectively. Conclusion Greenlight laser XPS is an effective, durable and versatile tool in treating benign prostatic obstruction. Durability of the outcome is predictable with more postoperative PSA reduction.
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Affiliation(s)
- Fady K. Ghobrial
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
- Department of Urology, Faculty of Medicine, Damietta University, New Damietta, Egypt
| | - Mahmoud Laymon
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Nasr El-Tabey
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed M. Elshal
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Luu T, Gonzalez RR. Residency Surgical BPH Training Paradigms from MIST to HOLEP. Curr Urol Rep 2023; 24:261-269. [PMID: 36947390 DOI: 10.1007/s11934-023-01153-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE OF REVIEW Benign prostatic hyperplasia (BPH) is a common medical condition of older men that often requires medical or surgical therapy. Surgical options for BPH have grown exponentially over the last two decades. The numerous options and/or lack of access to them can make it challenging for new trainees to gain proficiency. We examine the literature for available BPH surgical simulators, learning curves, and training pathways. RECENT FINDINGS Each BPH surgical therapy has a learning curve which must be overcome. There is an abundance of TURP simulators which have shown face, content, and construct validity in the literature. Similarly, laser therapies have validated simulators. Newer technologies do have available simulators, but they have not been validated. There are strategies to improve learning and outcomes, such as having a structured training program. Simulators are available for BPH surgical procedures and some have been implemented in urology residencies. It is likely that such simulation may make urologists more facile on their learning curves for newer technologies. Further studies are needed. Future directions may include integration of simulator technology into training pathways that include surgical observation and proctorship.
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Affiliation(s)
- Thaiphi Luu
- Department of Urology, Scurlock Tower, Houston Methodist Hospital, Suite 2100, 6560 Fannin St, Houston, TX, 77030, USA.
| | - Ricardo R Gonzalez
- Department of Urology, Scurlock Tower, Houston Methodist Hospital, Suite 2100, 6560 Fannin St, Houston, TX, 77030, USA
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5
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Meta-analysis of prognostic factors related to early urinary incontinence following new transurethral procedures dominated by laser therapy for benign prostatic hyperplasia. Lasers Med Sci 2022; 37:2937-2946. [DOI: 10.1007/s10103-022-03563-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
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6
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Kumar S, Panaiyadiyan S, Singh P, Dogra P. Safety, efficacy and functional outcomes of photoselective vaporisation of the prostate: A single-centre experience. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221078471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The objective of this study was to report the safety, efficacy and functional outcomes following photoselective vaporisation of prostate (PVP) with GreenLight laser for benign prostatic enlargement (BPE). Material and methods: We retrospectively analysed men who underwent PVP from April 2011 to August 2019 for BPE. Preoperative, intraoperative and postoperative details were retrieved from electronic data software. The perioperative and functional outcomes were analysed. Results: A total of 147 patients, with a mean age of 65.4 years, underwent PVP (51 patients – high performance system (HPS), 120 Watts; 96 patients – xcelerated performance system (XPS), 180 Watts). In 20 (13.6%) patients, antiplatelet or anticoagulant were continued in the perioperative period. The mean operative time, lasing time, catheterization time and hospital stay were 54.4 minutes, 38.0 minutes, 48.7 hours and 2.73 days, respectively. Postoperatively, all the functional outcomes IPSS (international prostate symptom score), QOL (quality of life), Qmax (maximum flow rate) and PVR (postvoid residue) were significantly improved from the baseline. The most common complication was dysuria (36.7%). There was no significant perioperative bleeding complications in high-risk men who were on antiplatelet or anticoagulant therapy. Conclusion: PVP is a safe, efficacious and durable surgical option in BPE including patients on antiplatelet or anticoagulant therapy. Level of evidence: Level 4
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Affiliation(s)
- Sanjay Kumar
- Department of Urology, All India Institute of Medical Sciences (AIIMS), India
| | | | - Prashant Singh
- Department of Urology, All India Institute of Medical Sciences (AIIMS), India
| | - Premnath Dogra
- Department of Urology, All India Institute of Medical Sciences (AIIMS), India
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Jibara G, Sjoberg DD, Stearns GL, Stabholz Y, Fathollahi A, Leddy LS, Benfante N, Ehdaie B, Coleman JA, Eastham JA, Sandhu JS. Photoselective Vaporization of the Prostate in the Management of Lower Urinary Tract Symptoms in Prostate Cancer Patients on Active Surveillance. Urology 2021; 156:225-230. [PMID: 33539897 DOI: 10.1016/j.urology.2021.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To demonstrate the safety and efficacy of photoselective vaporization of the prostate in alleviating refractory lower urinary tract symptoms in prostate cancer patients who are managed with active surveillance and to explore the association of this procedure with prostate specific antigen (PSA) levels and cancer progression rates. METHODS Between 2008-2018, active surveillance patients who had refractory symptoms and needed surgery were studied. Perioperative functional variables were collected and analyzed. Disease progression was defined as an upgrade or upstage on surveillance biopsies or multiparametric prostate magnetic resonance imaging. Mean postop scores were estimated using locally-weighted methods. The risk of progression was reported using Kaplan-Meier's method. RESULTS Seventy-one patients were included in the study. The median age was 68 years and the median surveillance time before surgery was 4 years. At 12 months, there were substantial improvements in the mean International Prostate Symptom Score (18-5.9), maximum flow rate (6.8-14 mL/s), postvoid residual (240-73mL), PSA (8.1-5.2 ng/mL), and prostate volume (85-57mL). At 30-days, only 2 patients with grade-III complications. Late consequences included tissue regrowth in 4 and urethral stricture (requiring a single dilation) in 3 patients. PSA levels decreased by 36% at 12 months postoperatively. With a median follow-up of 3.7 years, 7 men progressed and received radical treatment. At 3 years, the probability of remaining on surveillance was 93% (95% CI 87%- 100%). CONCLUSION Photoselective vaporization of the prostate offers substantial relief of symptoms in active surveillance patients with refractory symptoms, without adverse effects on disease progression rates.
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Affiliation(s)
- Ghalib Jibara
- Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics; Memorial Sloan Kettering Cancer Center, NY
| | | | - Yariv Stabholz
- Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY
| | - Ali Fathollahi
- Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY
| | - Laura S Leddy
- Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY
| | - Nicole Benfante
- Department of Epidemiology and Biostatistics; Memorial Sloan Kettering Cancer Center, NY
| | - Behfar Ehdaie
- Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY
| | - Jonathan A Coleman
- Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY
| | - James A Eastham
- Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY
| | - Jaspreet S Sandhu
- Urology Service, Department of Surgery; Memorial Sloan Kettering Cancer Center, NY
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Nguyen DD, Sadri I, Law K, Bhojani N, Elterman DS, Zakaria AS, Arezki A, Bruyère F, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo T, Becher EF, Cash H, Reimann M, Rijo E, Misrai V, Zorn KC. Impact of the presence of a median lobe on functional outcomes of greenlight photovaporization of the prostate (PVP): an analysis of the Global Greenlight Group (GGG) Database. World J Urol 2021; 39:3881-3889. [PMID: 33388918 DOI: 10.1007/s00345-020-03529-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/13/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Previous analyses of the impact of median lobe presence on Greenlight photoselective vaporization of the prostate (PVP) outcomes were limited by their small sample size and the ability to adjust for important confounders. As such, we sought to investigate the impact of prostate median lobe presence on the operative outcomes of 180 W XPS GreenLight PVP using a large international database. METHODS Data were obtained from the Global GreenLight Group (GGG) database which pools data of eight high-volume, experienced surgeons, from a total of seven international centers. All men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180 W system between 2011 and 2019 were eligible for the study. Patients were assigned to two groups based on presence or absence of median lobes. Analyses were adjusted for patient age, prostate volume, body mass index, and American Society of Anesthesia (ASA) score. RESULTS A total of 1650 men met the inclusion criteria. A median lobe was identified in 621 (37.6%) patients. Baseline prostate volume, patient age, and ASA score varied considerably between the two groups. In adjusted analyses, the operative and lasing time of patients with median lobes was 6.72 (95% CI 3.22-10.23; p < 0.01) minutes and 2.90 (95% CI 1.02-4.78; p < 0.01) minutes longer than the control group. Men with median lobes had similar postoperative functional outcomes to those without a median lobe except for a 1.59-point greater drop in the 12-month IPSS score compared to baseline (95% CI 0.11-3.08; p = 0.04) in the median lobe group, and a decrease in PVR after 6 months which was 46.51 ml (95% CI 4.65-88.36; p = 0.03) greater in patients with median lobes compared to men without median lobes. CONCLUSIONS Our findings suggest that the presence of a median lobe has no clinically significant impact on procedural or postoperative outcomes for patients undergoing Greenlight PVP using the XPS-180 W system.
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Affiliation(s)
| | - Iman Sadri
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Kyle Law
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Dean S Elterman
- Division of Urology, University Health Network, Toronto, ON, Canada
| | - Ahmed S Zakaria
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Adel Arezki
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Franck Bruyère
- Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Tours, Centre-Val de Loire, France
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, Modena, Italy
| | | | | | | | | | - Hannes Cash
- Department of Urology, Charite-Universitaetsmedizin Berlin, Berlin, Germany
| | | | - Enrique Rijo
- Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
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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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Herrmann TR, Gravas S, de la Rosette JJMCH, Wolters M, Anastasiadis AG, Giannakis I. Lasers in Transurethral Enucleation of the Prostate-Do We Really Need Them. J Clin Med 2020; 9:E1412. [PMID: 32397634 PMCID: PMC7290840 DOI: 10.3390/jcm9051412] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 12/21/2022] Open
Abstract
The acronym EEP, coding for transurethral Endoscopic Enucleation of the Prostate, was introduced in 2016 by the European Association of Urology (EAU) guidelines panel on management of non-neurogenic male lower urinary tract symptoms (LUTS) and benign prostatic obstruction (BPO). Since then, a laser-based treatment, Holmium Laser Enucleation of the Prostate (HoLEP), and the current-based treatment of bipolar enucleation of the prostate (BipoLEP) are equally appreciated as valuable options for the management of benign prostatic obstruction (BPO). This was mainly inspired by the results of two meta-analyses on randomized controlled trials, comparing open prostatectomy with either Holmium Laser Enucleation of the Prostate (HoLEP) or bipolar enucleation of the prostate (BipoLEP). Prior to that, HoLEP was embraced as the only valid option for transurethral enucleation, although evidence for equivalence existed as early as 2006, but was not recognized due to a plethora of acronyms for bipolar energy-based treatments and practiced HoLEP-centrism. On the other hand, the academic discourse focused on different (other) laser approaches that came up, led by Thulium:Yttrium-Aluminum-Garnet (Tm:YAG) Vapoenucleation (ThuVEP) in 2009 and, finally, transurethral anatomical enucleation with Tm:YAG support (thulium laser enucleation of the prostate, ThuLEP) in 2010. Initially, the discourse on lasers focused on the different properties of lasers rather than technique or surgical anatomy, respectively. In and after 2016, the discussion ultimately moved towards surgical technique and accepting anatomical preparation as the common of all EEP techniques (AEEP). Since then, the unspoken question has been raised, whether lasers are still necessary to perform EEP in light of existing evidence, given the total cost of ownership (TCO) for these generators. This article weighs the current evidence and comes to the conclusion that no evidence of superiority of one modality over another exists with regard to any endpoint. Therefore, in the sense of critical importance, AEEP can be safely and effectively performed without laser technologies and without compromise.
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Affiliation(s)
- Thomas R.W. Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, 8569 Münsterlingen, Switzerland; (A.G.A.); (I.G.)
- Department of Urology, Hannover Medical School, 30625 Hannover, Germany;
| | - Stavros Gravas
- Department of Urology, University Hospital of Larisa, 41500 Larisa, Greece;
| | | | - Mathias Wolters
- Department of Urology, Hannover Medical School, 30625 Hannover, Germany;
| | | | - Ioannis Giannakis
- Department of Urology, Spital Thurgau AG, Frauenfeld, 8569 Münsterlingen, Switzerland; (A.G.A.); (I.G.)
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Campobasso D, Marchioni M, Altieri V, Greco F, De Nunzio C, Destefanis P, Ricciardulli S, Bergamaschi F, Fasolis G, Varvello F, Voce S, Palmieri F, Divan C, Malossini G, Oriti R, Tuccio A, Ruggera L, Tubaro A, Delicato G, Laganà A, Dadone C, De Rienzo G, Frattini A, Pucci L, Carrino M, Montefiore F, Germani S, Miano R, Schips L, Rabito S, Ferrari G, Cindolo L. GreenLight Photoselective Vaporization of the Prostate: One Laser for Different Prostate Sizes. J Endourol 2020; 34:54-62. [DOI: 10.1089/end.2019.0478] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Davide Campobasso
- Department of Urology, Ospedale Civile di Guastalla and Ospedale Ercole Franchini di Montecchio Emilia, Azienda USL-IRCCS di Reggio Emilia, Guastalla, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, “G. D'Annunzio” University of Chieti, Chieti, Italy
| | | | | | - Cosimo De Nunzio
- Department of Urology, “Sant'Andrea” Hospital, Sapienza University, Roma, Italy
| | - Paolo Destefanis
- Department of Urology, Azienda Ospedaliera Città della Salute e della Scienza di Torino—Sede Molinette, Torino, Italy
| | | | - Franco Bergamaschi
- Department of Urology, “Arcispedale Santa Maria Nuova,” Reggio Emilia, Italy
| | | | | | - Salvatore Voce
- Department of Urology, “Santa Maria delle Croci Hospital,” Ravenna, Italy
| | - Fabiano Palmieri
- Department of Urology, “Santa Maria delle Croci Hospital,” Ravenna, Italy
| | - Claudio Divan
- Department of Urology, “Rovereto Hospital,” Rovereto, Italy
| | | | - Rino Oriti
- Department of Urology, “Ulivella e Glicini Clinic,” Florence, Italy
| | - Agostino Tuccio
- Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Lorenzo Ruggera
- Department of Urology, Clinica urologica azienda ospedaliera, University of Padova, Padova, Italy
| | - Andrea Tubaro
- Department of Urology, “Sant'Andrea” Hospital, Sapienza University, Roma, Italy
| | - Giampaolo Delicato
- Department of Urology, “S. Giovanni Evangelista” Hospital, Tivoli, Italy
| | - Antonino Laganà
- Department of Urology, “S. Giovanni Evangelista” Hospital, Tivoli, Italy
| | - Claudio Dadone
- Department of Urology, “Santa Croce e Carle” Hospital, Cuneo, Italy
| | - Gaetano De Rienzo
- Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari, Bari, Italy
| | - Antonio Frattini
- Department of Urology, Ospedale Civile di Guastalla and Ospedale Ercole Franchini di Montecchio Emilia, Azienda USL-IRCCS di Reggio Emilia, Guastalla, Italy
| | - Lugi Pucci
- Department of Urology, AORN “Antonio Cardarelli,” Naples, Italy
| | | | | | - Stefano Germani
- UOSD Urologia, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Roberto Miano
- UOSD Urologia, Dipartimento di Scienze Chirurgiche, Fondazione Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Luigi Schips
- Department of Urology, ASL Abruzzo 2, Chieti, Italy
| | | | | | - Luca Cindolo
- Department of Urology, “Villa Stuart” Private Hospital, Rome, Italy
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12
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Exploration of day-surgery photoselective vaporization of the prostate (PVP) in Chinese population. Lasers Med Sci 2019; 35:1503-1507. [PMID: 31858348 DOI: 10.1007/s10103-019-02938-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 11/21/2019] [Indexed: 01/16/2023]
Abstract
To explore the surgical effect and cost-effectiveness of day surgery versus inpatient surgery for photoselective vaporization of the prostate (PVP) in Chinese population. We retrospectively collected 240 patients undergoing day-surgery PVP (April 2016 to March 2018) and 156 patients undergoing inpatient-surgery PVP (May 2014 to March 2016). Differences between groups in demographics, perioperative outcomes, complications, and postoperative changes were calculated. Economical results in terms of hospital stay and relevant preoperative, intraoperative, and postoperative cost were evaluated. There was no significant difference in operative time, incidence of postoperative complications, and other functional outcomes between two groups (P > 0.05), but the waiting time for admission and the hospital cost including the drug charges, bed fee, nursing fee, laboratory test, and imaging fee of day-surgery group were significantly lower than that of inpatient-surgery group (P < 0.05). Day surgery of PVP has firm and well accepted position in ambulatory surgery of urology. It could significantly reduce the waiting time for admission and hospitalization costs in BPH patients.
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13
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Korn SM, Hübner NA, Seitz C, Shariat SF, Fajkovic H. Role of lasers in urology. Photochem Photobiol Sci 2019; 18:295-303. [PMID: 30640321 DOI: 10.1039/c8pp00409a] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Laser technology has long been a standard treatment for many diseases. In particular, laser treatment is considered the standard of care in various urological diseases. While originally primarily restricted to stone treatment, lasers have since evolved to play an important role even in the treatment of malignant diseases. In this review, we take a closer look at the history of lasers in urology and some implications for treatments today.
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Affiliation(s)
- Stephan M Korn
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Nicolai A Hübner
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Christian Seitz
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Institute of Urology and Andrology, Karl Landsteiner Society, Krems an der Donau, Austria
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Institute of Urology and Andrology, Karl Landsteiner Society, Krems an der Donau, Austria.,Department of Urology, University of Texas Southwestern Medical Centre, Dallas, Texas, USA.,Department of Urology, Weill Cornell Medical College, New York, USA
| | - Harun Fajkovic
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. .,Institute of Urology and Andrology, Karl Landsteiner Society, Krems an der Donau, Austria.
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14
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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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15
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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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16
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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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17
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Reimann M, Fishman N, Almedom Z, Lichy I, Buckendahl J, Steiner U, Friedersdorff F, Busch J, Fuller TF, Miller K, Hinz S, Cash H. Perioperative Changes and Progress in Photoselective Vaporization of the Prostate with GreenLight XPS 180 W System: A Single Center Experience. Urol Int 2018; 100:463-469. [PMID: 29621785 DOI: 10.1159/000487958] [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: 11/20/2017] [Accepted: 02/23/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE The study aimed to evaluate progression of GreenLight-XPS 180 W photoselective vaporization of the prostate (GL-XPS) with respect to effectiveness, efficacy, and safety over time at a tertiary referral high volume center. METHODS The retrospective study included 375 men who underwent GL-XPS for symptomatic benign prostate obstruction (BPO) between June 2010 and February 2015. Primary outcome measurements were operation time (OT; min) and effective laser time (LT; min of OT) analyzed with regard to prostatic volume (PV; mL) (group 1 <40 mL up to 4 >80 mL in 20 mL steps) and the year of surgery (2010-2015). RESULTS The median age was 72 years (range 64-79), the median PV was 58 mL (range 33-98) and the median PV increased from 42 mL in 2012 to 80 mL in 2015. The OT and LT clearly correlated with the PV, being doubled for glands of median 95 mL compared to median 30 mL while the applied laser energy per LT likewise steadily increased. Overall, both OT and LT could be significantly reduced each year by 37% (OT; p < 0.05) and 36% (LT; p < 0.05) within 5 years. The hospital stay (days) and catheterization time (days) remained constant, without any changes over time. The overall complication rate (Clavien-Dindo >2) ranged from 36 to 15% between 2010 and 2015. The pre (median 22 + 4) and postoperative International Prostate Symptom Score-Quality of Life (median 5 + 1) showed a sufficient reduction in symptomatic BPO. CONCLUSION GL-XPS is a safe and effective surgical method for symptomatic BPO. Our single center experience showed a significant improvement of both OT and effective LT within 5 years whilst maintaining stable low complication rate and high patient satisfaction.
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Affiliation(s)
- Maximilian Reimann
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Nikita Fishman
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Zenai Almedom
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Isabel Lichy
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - John Buckendahl
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Ursula Steiner
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Jonas Busch
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Tom Florian Fuller
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
| | - Stefan Hinz
- Department of Urology, Vivantes Klinikum am Urban, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Charité - University Medicine Berlin, Berlin, Germany
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18
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Ajib K, Mansour M, Zanaty M, Alnazari M, Hueber PA, Meskawi M, Valdivieso R, Tholomier C, Pradere B, Misrai V, Elterman D, Zorn KC. Photoselective vaporization of the prostate with the 180-W XPS-Greenlight laser: Five-year experience of safety, efficiency, and functional outcomes. Can Urol Assoc J 2018; 12:E318-E324. [PMID: 29603912 DOI: 10.5489/cuaj.4895] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Transurethral resection of the prostate (TURP) is still considered the gold standard surgical treatment for symptomatic benign prostatic hyperplasia (BPH). However, photoselective vaporization of the prostate (PVP) has gained widespread global acceptance in national guidelines as a safe and effective alternative option. Nevertheless, further evidence is required to assess the durability of Greenlight PVP. Herein, we report our five years of PVP experience with the Greenlight 180W XPS laser system. METHODS A retrospective analysis was conducted on a prospectively gathered database of 370 consecutively included patients who underwent PVP using Greenlight XPS-180 W laser system (Boston Scientific, Boston, MA, U.S.) performed by a single experienced laser surgeon between 2011 and 2016. Preoperative characteristics, intervention parameters, postoperative functional, uroflowmetry outcomes, and complications were collected. Outcomes are reported over a period of five years. RESULTS Mean age was 68 years, with a mean prostate volume of 78.8 cc (95% confidence interval [CI] 70.9-78.7]). The mean followup was 59.4 months (55.4-63.5). Mean energy, operative time, and energy/cc were 270.2 kJ (255.2-285.2), 62.7 minutes (59.6-65.7), and 3.7 kJ/cc (3.6-3.9), respectively. Compared to preoperative values, International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and post-void residual (PVR) parameters were significantly improved and sustained over the five postoperative years. Of note, only 66 patients (out of 370) had a complete five-year followup. Prostate-specific antigen (PSA) reached nadir at one year, with a drop of 67% from the mean preoperative value of 6.2 ng/mL. Mean IPSS nadir was reached at three years, with a drop of 80.4% (-21.1 points). Similarly, mean quality of life (QoL) score dropped by 82.8% after three years (preoperative mean of 4.7). With respect to mean Qmax, there was an increase by 72.7% (+14.7 mL/s) at one year, reaching the value of 19.9 mL/s. Moreover, mean PVR was 32.8 mL at four years compared to 345 mL preoperatively. At five years followup, PSA, IPSS, QoL, and PVR dropped by 59.7% (3.7 ng/mL), 75.2% (19.7 points), 78.72% (3.7 points), and 84.4% (291.3 mL), respectively. Qmax increased by 12.9 mL/s. Clavien complication rates were low, with bladder neck stenosis observed in seven (1.6%) men. During the five-year followup, only four patients (1%) required BPH surgical re-intervention. CONCLUSIONS This is the first long-term reporting of Greenlight XPS-180W laser system. In experienced hands, the observed outcomes appear to demonstrate that Greenlight XPS-180 W laser system is safe, efficacious, and durable for the treatment of bladder outlet obstruction (BOO) secondary to BPH.
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Affiliation(s)
- Khaled Ajib
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Mila Mansour
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Marc Zanaty
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Mansour Alnazari
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Pierre-Alain Hueber
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Malek Meskawi
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Roger Valdivieso
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Come Tholomier
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Department of Urology, McGill University, Montreal, QC, Canada
| | - Benjamin Pradere
- Department of Urology, Centre Hospitalier Universitaire, Tours, France
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Dean Elterman
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Kevin C Zorn
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
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19
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Calves J, Thoulouzan M, Perrouin-Verbe MA, Joulin V, Valeri A, Fournier G. Long-term Patient-reported Clinical Outcomes and Reoperation Rate after Photovaporization with the XPS-180W GreenLight Laser. Eur Urol Focus 2017; 5:676-680. [PMID: 29102672 DOI: 10.1016/j.euf.2017.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/13/2017] [Accepted: 10/16/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the long-term reported clinical outcomes after photovaporization of the prostate (PVP) with the XPS-GreenLight laser in patients with symptomatic benign prostatic enlargement (BPE). DESIGN, SETTING, AND PARTICIPANTS A prospective longitudinal study was performed for all consecutive patients with BPE who underwent PVP at our institution between 2010 and 2012. Patient-reported clinical outcomes were assessed at 1 mo, 3 mo, 12 mo, and 57 mo using International Prostate Symptoms Score, International Continence Society, and International Index of Erectile Function short-form questionnaires. Maximum flow rate (Qmax), postvoid residual urine measurements were assessed at 3 mo and 12 mo. Long-term satisfaction, complications, and reoperation rates were assessed by questionnaires. Prostate-specific antigen was measured at 3 mo, 12 mo, and 57 mo. INTERVENTION A single surgeon (GF) has practiced photovaporization with a Moxy fiber, under transrectal ultrasonography monitoring. Long-term clinical outcomes were evaluated using questionnaires. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary measurement was the reoperation. RESULTS AND LIMITATIONS Eighty-four patients of 102 answered the long-term questionnaire. The mean age was 68±7.2 yr. The mean follow-up was 57.4±6.8 mo. The mean prostate volume was 73±38ml. After treatment, the mean International Prostate Symptoms Score decreased significantly from 19.9±6.4 to 6.1±5.6, 3.9±3.4, and 5.9±5.8, respectively, at 3 mo, 12 mo, and 57 mo. The mean prostate-specific antigen level decreased significantly (-56%) from 4.5±4.3ng/ml preoperatively to 2.0±2.0ng/ml and 2.6±2.2ng/ml, respectively, at 12 mo and 57 mo. The mean Qmax increased from 9.6±3.8ml/s preoperatively to 23.9±11.5ml/s and 25.2±9.2ml/s, respectively, at 3 mo and 12 mo. Overall reoperation rate was 4.8%(4/84). Limitations include the single surgeon single center design study and the lack of long-term objectives data such as urodynamic parameters (postvoid residual urine and Qmax). CONCLUSIONS Photovaporization of the prostate with the XPS-GreenLight laser is an effective technique able to durably improve reported clinical outcomes in patients with BPE. PATIENT SUMMARY In this study we looked at the long-term outcomes after laser therapy with XPS-GreenLight laser for benign prostatic enlargement. We found a few reoperation rates and good stable reported clinical outcomes after a mean follow-up of 57 mo. We conclude that this laser technique can offer durably good reported clinical outcomes.
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Affiliation(s)
- Jehanne Calves
- Department of Urology, Centre Hospitalier Universitaire Régional de Brest, Brest, France.
| | - Maxime Thoulouzan
- Department of Urology, Centre Hospitalier Universitaire Régional de Brest, Brest, France
| | | | - Vincent Joulin
- Department of Urology, Centre Hospitalier Universitaire Régional de Brest, Brest, France
| | - Antoine Valeri
- Department of Urology, Centre Hospitalier Universitaire Régional de Brest, Brest, France
| | - Georges Fournier
- Department of Urology, Centre Hospitalier Universitaire Régional de Brest, Brest, France
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20
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Bastard C, Zorn K, Peyronnet B, Hueber PA, Pradère B, Rouprêt M, Misrai V. Assessment of Learning Curves for 180-W GreenLight XPS Photoselective Vaporisation of the Prostate: A Multicentre Study. Eur Urol Focus 2017; 5:266-272. [PMID: 28951116 DOI: 10.1016/j.euf.2017.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/15/2017] [Accepted: 09/14/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The learning curve for photoselective vaporisation of the prostate (PVP) has never been assessed accurately. OBJECTIVE To compare 180-W GreenLight XPS PVP learning curves for three surgeons with different levels of surgical experience and different institutional backgrounds. DESIGN, SETTING, AND PARTICIPANTS A multicentre retrospective study of the first patients treated with PVP by three operators in three different centres (n=152 in group 1, n=112 in group 2, n=101 in group 3) was conducted. Surgeon 1 had performed >600 PVP procedures (120-W GreenLight HPS laser) since 2007, while surgeons 2 and 3 had no previous experience with GreenLight PVP. Surgeon 1 mainly treats both benign prostatic hyperplasia (BPH) and urologic oncology, surgeon 2 primarily focuses on urologic oncology, and surgeon 3 mostly treats BPH. Surgeon experience was analysed as a continuous variable in terms of consecutive procedures performed. INTERVENTION PVP using a 180-W GreenLight XPS laser. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The learning curve was analysed in terms of changes over time for the following variables: operative time, the vaporisation time/operative time ratio, and the energy delivered/prostate volume ratio. The primary endpoint was a trifecta of (1) energy delivered >5kJ/ml of prostate, (2) vaporisation time/operative time ratio of 66-80%, and (3) no postoperative complications. RESULTS AND LIMITATIONS Patient baseline characteristics differed significantly among the centres in terms of age, prostate volume, and International Prostate Symptom Score (IPSS). Most perioperative outcomes favoured group 1 over group 3 over group 2. Functional outcomes, such as a decrease in IPSS at 1 mo for the first 50 patients (-15 vs -13.6 vs -13.3; p<0.0001) and an increase in maximum flow at 1 mo for the first 50 patients (+14.2 vs. +7 vs. +9.4; p<0.0001), favoured group 1 over group 3 over group 2. The trifecta achievement rate was significantly higher in group 3 over group 1 over group 2 (26.7% vs 14.4% vs 5.4%; p<0.0001). In multivariate analysis adjusting for age, American Society of Anesthesiologists score, and preoperative prostate volume, the only factors predictive of trifecta achievement were surgeon experience (p<0.0001) and surgeon identity (p<0.0001). The study limitations include selection bias, short follow-up, and a lack of consensus regarding learning curve assessment and definition. CONCLUSIONS More than 100 PVP procedures were required to reach an intraoperative parameter plateau regardless of surgeon expertise and institutional background. Both surgeon background and expertise seemed to influence perioperative outcomes during the GreenLight XPS PVP learning curve. PATIENT SUMMARY Both surgeon background and expertise seem to influence perioperative outcomes during the learning curve when using a GreenLight XPS laser for photoselective vaporisation of the prostate.
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Affiliation(s)
- Claire Bastard
- Academic Department of Urology, La Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6, Paris, France
| | - Kevin Zorn
- Urology Section, Department of Surgery, University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Benoit Peyronnet
- Academic Department of Urology, La Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6, Paris, France
| | - Pierre Alain Hueber
- Urology Section, Department of Surgery, University of Montreal Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | | | - Morgan Rouprêt
- Academic Department of Urology, La Pitié-Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris 6, Paris, France
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France.
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Multicenter international experience of 532 nm-laser photo-vaporization with Greenlight XPS in men with large prostates (prostate volume > 100 cc). World J Urol 2017; 35:1603-1609. [PMID: 28229211 DOI: 10.1007/s00345-017-2007-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 01/19/2017] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To evaluate the outcomes and durability of photoselective vaporization of the prostate (PVP) using the XPS-180 system in patients with a large prostate volume (PV) > 100 cc at 4 years of follow-up in a large, multicenter experience. METHODS 438 men with pre-operative transrectal ultrasound (TRUS) PV > 100 cc were treated in eight experienced centers in Canada, USA, and in France with the Greenlight XPS laser using PVP for the treatment of symptomatic BPH. IPSS, Qmax, postvoid residual (PVR), and prostate-specific antigen (PSA) were measured at 6, 12, 24, 36, and 48 months. Durability was evaluated using BPH retreatment rate at 12, 24, and 36 months. RESULTS Median PV and PSA were 121 cc and 6.3 ng/dl. Indwelling catheter at the time of surgery was observed in 37% of men. Median operative, laser time, and energy applied were 90 min, 55 min, and 422 kJ, respectively. Median energy delivery was 3.4 kJ/cc of prostate per case. Outpatient surgery was feasible with median length of stay at 24 h. IPSS, Qmax and PVR were significantly improved at all endpoints including at 48 months. Moreover, surgical BPH retreatment rates were 5.4 and 9.3% at 24 and 36 months. Interestingly, characteristics of retreated men include: energy delivery 2.4 vs. 3.4 kJ/cc of prostate (p = 0.02) and PSA reduction at 12 months 26 vs. 51% (p = 0.02). CONCLUSIONS PVP using Greenlight XPS-180W can potentially provide durable improvements with regard to functional outcomes at 4 years. However, rising retreatment rates after 3 years is of concern. This highlights the imperative need of utilizing a standardized surgical technique (enucleation-like-defect) and an optimal energy density >3KJ/cc.
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Evolving treatment of prostate diseases – A never ending journey. UROLOGICAL SCIENCE 2016. [DOI: 10.1016/j.urols.2016.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Han JL, Gandhi S, Bockoven CG, Narayan VM, Dahm P. The landscape of systematic reviews in urology (1998 to 2015): an assessment of methodological quality. BJU Int 2016; 119:638-649. [DOI: 10.1111/bju.13653] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Julia L. Han
- Department of Urology; University of Florida; Gainesville FL USA
| | | | | | - Vikram M. Narayan
- Department of Urology; University of Minnesota and Minneapolis VA Health Care System; Minneapolis MN USA
| | - Philipp Dahm
- Department of Urology; University of Minnesota and Minneapolis VA Health Care System; Minneapolis MN USA
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Cornu JN, Herrmann T, Traxer O, Matlaga B. Prevention and Management Following Complications from Endourology Procedures. Eur Urol Focus 2016; 2:49-59. [DOI: 10.1016/j.euf.2016.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 01/10/2023]
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Oh J, Nam SY, Lee YW, Kang HW. Effect of multiple-sweeping on ablation performance during ex vivo laser nephrectomy. Lasers Surg Med 2016; 48:616-23. [PMID: 26990980 DOI: 10.1002/lsm.22505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Fiber-assisted laser surgery has been employed as a minimally invasive method in various medical fields. In spite of multiple sweeping on tissue during laser treatments, the rate of tissue removal gradually decreases and eventually leads to longer irradiation times as well as deeper thermal injury. The objective of the current study was to quantitatively investigate the effect of multiple fiber sweeps on ablation performance during ex vivo 532-nm laser nephrectomy. MATERIALS AND METHODS Porcine kidney tissue was used to evaluate variations in tissue ablation and coagulative necrosis after pre- and multiple-sweeping with a 532 nm wavelength at various fiber speeds (2, 4, and 6 mm/second). The distance between a fiber tip and tissue surface was initially set at 1.5 mm, and no further distance change was performed. Double-integrating spheres in conjunction with an adding-doubling method were employed to measure variations in optical properties of the tested tissue. The extent of ablation and coagulation was quantified to identify the role of multiple-sweeping at various fiber conditions. RESULTS Optical property measurements showed a 30% decrease in light absorption but a more than threefold increase in light scattering after irreversible thermal denaturation. Pre-sweeping yielded insignificant effects on tissue coagulation due to almost consistent coagulation depths with numbers of pre-sweeps. Ablation depths increased with more numbers of fiber sweeps and slower fiber speeds whereas coagulation depths thickened primarily with the slower speeds. Multiple-sweeping induced saturation in ablation volume with the increasing numbers of multiple-sweeps irrespective of the fiber speed. CONCLUSION A combination of coagulation barriers, spatial distribution of power, and temporal interplay of optical energy could attribute to continuously lessen the amount of the ablated tissue with the multiple sweeps. Optical power modulation with varying fiber conditions (speed and distance) will be examined to optimize surgical parameters and to sustain the equivalent ablation performance of the first sweep with the multiple sweeping for laser nephrectomy. Lasers Surg. Med. 48:616-623, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Junghwan Oh
- Department of Biomedical Engineering, Pukyong National University, Nam-gu, Busan, South Korea.,Center for Marine-Integrated Biomedical Technology (BK21 Plus), Pukyong National University, Nam-gu, Busan, South Korea
| | - Seung Yun Nam
- Department of Biomedical Engineering, Pukyong National University, Nam-gu, Busan, South Korea
| | - Yong Wook Lee
- Center for Marine-Integrated Biomedical Technology (BK21 Plus), Pukyong National University, Nam-gu, Busan, South Korea.,School of Electrical Engineering, Pukyong National University, Nam-gu, Busan, South Korea
| | - Hyun Wook Kang
- Department of Biomedical Engineering, Pukyong National University, Nam-gu, Busan, South Korea.,Center for Marine-Integrated Biomedical Technology (BK21 Plus), Pukyong National University, Nam-gu, Busan, South Korea
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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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