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Ortner G, Güven S, Somani BK, Nicklas A, Scoffone CM, Gracco C, Goumas IK, Bach T, Sancha FG, Figueredo FCA, Krambeck A, Bozzini G, Lehrich K, Liatsikos E, Kallidonis P, Roche JB, Miernik A, Enikeev D, Tunc L, Bhojani N, Gilling P, Otero JR, Porreca A, Ahyai S, Netsch C, Gözen AS, Nagele U, Herrmann TRW, Tokas T. Experts' recommendations in laser use for the endoscopic treatment of prostate hypertrophy: a comprehensive guide by the European Section of Uro-Technology (ESUT) and Training-Research in Urological Surgery and Technology (T.R.U.S.T.)-Group. World J Urol 2023; 41:3277-3285. [PMID: 37632557 DOI: 10.1007/s00345-023-04565-y] [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: 07/02/2023] [Accepted: 08/01/2023] [Indexed: 08/28/2023] Open
Abstract
PURPOSE To identify expert laser settings for BPH treatment and evaluate the application of preventive measures to reduce complications. METHODS A survey was conducted after narrative literature research to identify relevant questions regarding laser use for BPH treatment (59 questions). Experts were asked for laser settings during specific clinical scenarios. Settings were compared for the reported laser types, and common settings and preventive measures were identified. RESULTS Twenty-two experts completed the survey with a mean filling time of 12.9 min. Ho:YAG, Thulium fiber laser (TFL), continuous wave (cw) Tm:YAG, pulsed Tm:YAG and Greenlight™ lasers are used by 73% (16/22), 50% (11/22), 23% (5/22), 13.6% (3/22) and 9.1% (2/22) of experts, respectively. All experts use anatomical enucleation of the prostate (EEP), preferentially in one- or two-lobe technique. Laser settings differ significantly between laser types, with median laser power for apical/main gland EEP of 75/94 W, 60/60 W, 100/100 W, 100/100 W, and 80/80 W for Ho:YAG, TFL, cwTm:YAG, pulsed Tm:YAG and Greenlight™ lasers, respectively (p = 0.02 and p = 0.005). However, power settings within the same laser source are similar. Pulse shapes for main gland EEP significantly differ between lasers with long and pulse shape modified (e.g., Moses, Virtual Basket) modes preferred for Ho:YAG and short pulse modes for TFL (p = 0.031). CONCLUSION Ho:YAG lasers no longer seem to be the mainstay of EEP. TFL lasers are generally used in pulsed mode though clinical applicability for quasi-continuous settings has recently been demonstrated. One and two-lobe techniques are beneficial regarding operative time and are used by most experts.
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Affiliation(s)
- Gernot Ortner
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria.
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
| | - Selcuk Güven
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andre Nicklas
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | | | - Cecilia Gracco
- Department of Urology, Cottolengo Hospital of Torino, Turin, Italy
| | | | - Thorsten Bach
- Department of Urology, Asklepios Westklinikum Rissen, Hamburg, Germany
| | | | | | - Amy Krambeck
- Department of Urology, Northwestern Medicine, Chicago, IL, USA
| | | | - Karin Lehrich
- Department of Urology, Urological Laser Center, Vivantes Auguste-Viktoria-Hospital Berlin, Berlin, Germany
| | | | | | | | | | - Dmitry Enikeev
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Karl Landstainer Institute of Urology and Andrology, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Lutfi Tunc
- Department of Urology, Acibadem Hospital, Ankara, Turkey
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Peter Gilling
- Department of Urology, Tauranga Hospital, University of Auckland, Auckland, New Zealand
| | - Javier Romero Otero
- ROC Clinic and HM Urological Department, Fundación Investigación HM Hospitales, HM Hospitales, Madrid, Spain
| | - Angelo Porreca
- Department of Oncological Urology, Veneto Institute of Oncology (IOV)-IRCCS, Padua, Italy
| | - Sasha Ahyai
- Department of Urology, Medical University of Graz, Graz, Austria
| | | | - Ali Serdar Gözen
- Department of Urology, Medius Kliniken, Ruit, Baden-Württemberg, Germany
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | - Thomas R W Herrmann
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Theodoros Tokas
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Greece
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Hines L, Doersch KM, Ninomiya M, Jain R, Quarrier SO. Redefining Clinically Significant Hematuria After Holmium Enucleation of the Prostate. J Endourol 2023; 37:1216-1220. [PMID: 37725558 DOI: 10.1089/end.2023.0317] [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] [Indexed: 09/21/2023] Open
Abstract
Introduction and Objective: Holmium laser enucleation of the prostate (HoLEP) is often offered for symptomatic prostatic enlargement at high risk for bleeding. However, prior studies define clinically significant hematuria (CSH) narrowly as the need for blood transfusion or significant decrease in hemoglobin. We sought to evaluate risk factors contributing to a broader definition of CSH, which may contribute to alteration of clinical course. Methods: We analyzed 164 patients in a prospectively maintained database who underwent HoLEP at a single institution across two surgeons from November 2020 to April 2023. HoLEP was performed using Moses 2.0 (Boston Scientific) laser and the Piranha enucleation system (Richard Wolf). We defined CSH broadly as follows: clot retention, return to operating room, perioperative management variation due to hematuria, or continued gross hematuria past 1 month postoperatively. Univariable and multivariable ANOVAs were used. Multivariable analysis of CSH risk based on the use of antiplatelet (AP) agents or anticoagulants included correction for age, enucleation time (surrogate for case difficulty), and prostate volume. Results: 17.7% (29/164) of our patients developed CSH after HoLEP. Longer enucleation time was a mild risk factor for developing CSH (multivariate odds ratio [OR] 1.01, p = 0.02). The strongest predictor of CSH was the use of anticoagulation or AP agents (OR 2.71 p < 0.02 on univariable analysis, OR 2.34 p < 0.02 on multivariable analysis), even when aspirin 81 mg was excluded. Conclusion: With a broadened definition, 18% of patients developed CSH following HoLEP, which impacted the clinical course. Our data suggest that the current definition of significant hematuria is too narrow and does not capture many patients whose clinical course is affected by hematuria. While safe, anticoagulants and APs significantly predicted an increased CSH risk, and patients should be counseled accordingly.
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Affiliation(s)
- Laena Hines
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Karen M Doersch
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Mark Ninomiya
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Rajat Jain
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
| | - Scott O Quarrier
- Department of Urology, University of Rochester Medical Center, Rochester, New York, USA
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Destefanis P, Sibona M, Vitiello F, Vercelli E, Micai L, Montefusco G, Mangione C, Bracco F, Colucci F, De Nunzio C, Gontero P. Trans - Perineal laser ablation of the prostate in high surgical risk patients affected by severe lower urinary tract symptoms related to benign prostatic obstruction. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00736-5. [PMID: 37853099 DOI: 10.1038/s41391-023-00736-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/21/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND In our study, we aimed to test the efficacy and safety of Trans-Perineal Laser Ablation of the prostate (TPLA®) in the surgical treatment of high-risk Benign Prostatic Obstruction (BPO) patients. METHODS We defined a high-risk BPO patient as an elderly man affected by severe comorbidities, among which coagulation issues due to pre-existent medications or diseases. From October 2020 to June 2022, we prospectively enrolled high-risk patients affected by a moderate to severe and/or complicated BPO condition. The analysis of the efficacy of the Trans-Perineal Laser Ablation was defined as the primary endpoint of the study. Secondary endpoints were post-operative surgical complications and patient-reported quality of life. RESULTS Globally, 40 consecutive patients were enrolled. Median (IQR) age was 80 (72.5-84) years. Median Charlson Comorbidity Index was 6 (5-7). Median prostate volume was 38 (30.5-73) cc. In all cases, a TPLA® procedure was performed under local anesthesia, and patients being discharged within the same day of the procedure. A progressive reduction of median prostate volumes was reported at 3 and 6 months post-operatively, compared to baseline [38 (30.5-73) vs 35 (26-49) vs 34 (28-49) cc, p < 0.001]. Median International Prostate Symptom Score (IPSS) improved accordingly [25 (19-30) vs 10.5 (7.5-13) vs 8 (6-11.5), p < 0.001]. A permanent bladder catheter was successfully removed in 13 out of 23 (56.5%) cases. Within 90 days from surgery, 19 (47.5%) patients experienced at least one surgical complication. According to the Clavien-Dindo classification, complications were classified as grade I in 16 (40%) cases, grade II in 9 (22.5%), and grade III in 1 (2.5%). We did not observe any grade IV or V complications. CONCLUSIONS The Trans-Perineal Laser Ablation of the Prostate is a feasible, safe, and effective Minimally Invasive Surgical Technique, when offered to elderly, high-risk patients affected by severe Benign Prostatic Obstruction.
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Affiliation(s)
- Paolo Destefanis
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Mattia Sibona
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy.
| | - Federico Vitiello
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Eugenia Vercelli
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Luca Micai
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Gabriele Montefusco
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Carlotta Mangione
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Francesco Bracco
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Fulvia Colucci
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
| | - Cosimo De Nunzio
- Urology Unit, Ospedale Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Paolo Gontero
- Urology Clinic, Department of Surgical Sciences, AOU Città della Salute e della Scienza - Molinette Hospital, University of Turin, Turin, Italy
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Elshal AM, Ghobrial FK, Laymon M, Elegeezy M, El-Nahas AR. Greenlight laser (XPS TM) 180W prostatectomy for treatment of benign prostate hyperplasia in patients with uncorrectable bleeding tendency. Arab J Urol 2022; 21:129-134. [PMID: 37234681 PMCID: PMC10208207 DOI: 10.1080/2090598x.2022.2156655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives Safety of GreenLight™ laser prostatectomy (GL-LP) in patients with ongoing blood thinners has been proven. Yet, the possibility of drug manipulation makes it a less challenging situation compared to treating patients with uncorrectable bleeding tendency. Herein, we aim at evaluating the outcomes of XPS™-180 W GL-LP for treatment of BPH in patients who had uncorrectable bleeding tendency due to hepatic dysfunction. Methods A prospectively maintained database for all patients who underwent GL-LP for symptomatic BPH was reviewed. Patients were divided into two groups based on the degree of hepatic dysfunction using Fib-4 index: Group 1 (indexed patients; low-risk Fib-4) and Group 2 (non-indexed patients; intermediate-high-risk Fib-4) included those who had chronic liver disease associated with either thrombocytopenia and/or hypoprothrombinemia. Primary outcome was the difference in perioperative bleeding complications between the two groups. Other outcome measures included all perioperative findings and complications as well-functional outcome measures. Results The study included 140 patients (93 indexed patients and 47 non-indexed). There were no significant differences between both groups in operative time, laser time and energy, auxiliary procedures, catheter time, hospital stay, and hemoglobin deficit. The need for blood transfusion was significantly more in group 2 (two patients (4.3%) versus no patients in group 1, P = 0.045). Perioperative and late postoperative complications were comparable for both groups (P = 0.634 and 0.858, respectively). There were no significant differences in the postoperative uroflow, symptoms score, and PSA reduction between the two groups (P = 0.57, 0.87, and 0.05, respectively). Conclusions XPS™-180 W GL-LP is a safe and effective technique for treatment of BPH in patients with uncorrectable bleeding tendency due to hepatic dysfunction.
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Affiliation(s)
- Ahmed M. Elshal
- Urology Department, Urology and Nephrology Center, Mansoura University, Egypt
| | - Fady K. Ghobrial
- Department of Urology, Faculty of Medicine, Damietta University, Egypt
| | - Mahmoud Laymon
- Urology Department, Urology and Nephrology Center, Mansoura University, Egypt
| | - Mohamed Elegeezy
- Department of Internal Medicine, Hepatology Unit, Mansoura University, Al Mansurah, Egypt
| | - Ahmed R. El-Nahas
- Urology Department, Urology and Nephrology Center, Mansoura University, Egypt
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Ji X, Zhao Y, Zhang L, Liu Y. Benign prostatic hyperplasia wound after surgical removal in subjects on anticoagulant or antiplatelet therapy: A meta-analysis. Int Wound J 2022; 19:1990-1999. [PMID: 35419950 DOI: 10.1111/iwj.13799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Abstract
We performed a meta-analysis to evaluate the safety of benign prostatic hyperplasia wound after surgical removal in subjects on anticoagulant or antiplatelet therapy. A systematic literature search up to December 2021 was done and 19 studies included 5715 benign prostatic hyperplasia subjects at the start of the study; 1501 of them were on anticoagulant/antiplatelet therapy, and 4214 were control. We calculated the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to evaluate the safety of benign prostatic hyperplasia wound after surgical removal in subjects on anticoagulant or antiplatelet therapy by the dichotomous or continuous methods with a random or fixed-influence model. Anticoagulant/antiplatelet therapy had significantly higher bleeding complication (OR, 1.88; 95% CI, 1.36-2.60, P < .001), higher blood transfusion (OR, 2.15; 95% CI, 1.63-2.83, P < .001), lower operation time (MD, -3.53; 95% CI, -6.80-0.27, P = .03), higher catheterization time (MD, 0.30 95% CI, 0.06-0.53, P = .01), longer length of hospital stay (MD, 0.82; 95% CI, 0.37-1.26, P < .001) and higher thromboembolic events (OR, 2.88; 95% CI, 1.26-6.62, P = .01) compared to control in benign prostatic hyperplasia subjects. Anticoagulant/antiplatelet therapy had a significantly higher bleeding complication, higher blood transfusion, lower operation time, higher catheterization time, longer length of hospital stay and higher thromboembolic events compared to control in benign prostatic hyperplasia subjects. Further studies are required.
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Affiliation(s)
- Xuhui Ji
- Department of Urology, Jincheng People's Hospital, Jincheng, Shanxi, China
| | - Yali Zhao
- Department of Respiratory and Critical Care, Jincheng People's Hospital, Jincheng, Shanxi, China
| | - Luxia Zhang
- Department of Dermato-Venereology, Jincheng People's Hospital, Jincheng, Shanxi, China
| | - Yunbo Liu
- Department of Urology, Jincheng People's Hospital, Jincheng, Shanxi, China
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6
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Erazo J, Suso D, Sejnaui J, Aluma L, Mendoza L, Ramirez G, Morales C, Usubillaga F, Mendoza S, Rivera F, Mendoza A, Usubillaga MC, Erazo S, Chavarriaga J. Outpatient 180 W XPS GreenLight™ Laser Photoselective Vaporization of the Prostate: Seven Year Experience. J Endourol 2021; 36:548-553. [PMID: 34779677 DOI: 10.1089/end.2021.0618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE GreenLight XPS Laser System (GL-XPS) photoselective vaporization of the prostate (PVP) is not only non-inferior to Transurethral resection of the prostate (TURP), but with shorter rates of hospital stay and length of catheterization. Scarce literature has been published about the feasibility and safety of performing GL-XPS PVP in an outpatient setting. Our aim is to report our seven-year experience with outpatient GL-XPS PVP. METHODS Medical charts of all patients that underwent GL-XPS PVP between 2013 and 2020 were reviewed. Patients were discharged after careful monitoring in the recovery room and the catheter was removed either at home or at a schedule hospital visit. We used the Shapiro-Wilk test to assess for normal distribution, and the evaluation of homoscedasticity was performed with the SD Test. For qualitative variables, the comparison between groups was carried using the Chi-Square test and for the quantitative variables we used the non-parametric Mann Whitney U test. RESULTS A total of 537 patients were treated, 517 in an outpatient basis. Median age was 68 years (IQR 62-76), median prostate volume 50 cc (IQR 40-70). 22.8% were on anticoagulants or antiplatelet therapy. Median operative time was 100 minutes (IQR 75-125), length of hospital stay 5 hours (IQR 4-6.45), mean length of catheterization 48 hours (SD 14.92). Readmission rate within 90 days of surgery was 11.7%, 58 (10.8%) for surgical-related complications. Median time for readmission was 4 days (IQR 2-24). Immediate readmission (within 10 days) was recorded in 7.6% of patients, urinary retention was the main cause. No significant differences were found trying to find perioperative predictors for readmission. CONCLUSIONS Our experience suggests that outpatient GL-XPS PVP could be performed safely with a predefined outpatient pathway. With a low readmission and complication rate.
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Affiliation(s)
- Juan Erazo
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Daniel Suso
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Jorge Sejnaui
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Luis Aluma
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Lupi Mendoza
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - German Ramirez
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Carlos Morales
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | | | - Sergio Mendoza
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Fabio Rivera
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Alexandra Mendoza
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Maria C Usubillaga
- Pontificia Universidad Javeriana Facultad de Medicina, 89654, Urology, Bogota, Colombia;
| | - Santiago Erazo
- Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
| | - Julian Chavarriaga
- Pontificia Universidad Javeriana Facultad de Medicina, 89654, Urology, Bogota, Colombia.,Imbanaco Medical Centre, 173050, Urology, Cali, Valle del Cauca, Colombia;
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Waters DK, Khalid R, Mustafa F, Omeire F, Jones BJ. Safety profile of GreenLight XPS laser photoselective vaporisation of the prostate in patients at high risk of bleeding. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211041896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study aimed to assess the utility and safety profile of the GreenLight Xcelerated Performance System (XPS) photoselective vaporisation of the prostate (PVP) to treat benign prostatic hyperplasia (BPH) in high-risk patients. Patients and methods: A retrospective study of a prospectively managed database was carried out. The study reviewed a single surgeon’s experience of treating high-risk patients with GreenLight XPS PVP between two sites over a four-year period. Patients considered to be high risk were those who were at an increased risk of bleeding, those who had a prostate size >80 mL, those with preoperative urinary retention and/or those aged >80 years. Results: In total, 374 patients were identified as being high risk for GreenLight PVP. Patient age ranged from 44 to 96 years ( Mage=71 years). Of the 374 patients, 103 were aged >80 years. All 374 patients were considered to be at an increased risk of bleeding, as they underwent GreenLight PVP while taking antiplatelet agents (not including aspirin), anticoagulant agents or both. Ninety-one patients had preoperative urinary retention and indwelling urinary catheter. Fifty-four patients had a prostate size >80 mL. Length of stay varied from 1 to 14 days. Most patients ( n=270) were discharged on postoperative day 1. There were no perioperative blood transfusions. One patient developed acute coronary syndrome on postoperative day 4, requiring percutaneous coronary intervention. Twenty-two patients required readmission: 12 due to urinary retention with or without haematuria, and 10 due to haematuria without associated acute retention. Two patients required cystoscopy and bladder washout. There were two blood transfusions in the ‘readmission due to haematuria’ group. Outcomes for patients aged >80 years were favourable. The average length of stay was 2.7 days (range 1–14 days). This group was responsible for 12 of the 22 readmissions. There were no perioperative cardiovascular events. Conclusion: We conclude that GreenLight XPS PVP is a safe procedure in patients with one or more high-risk factors. The ability to proceed without the need to stop antiplatelets or anticoagulant agents also allows for high-risk medical patients to be treated without the additional risks of cardiovascular events. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
| | - Raihan Khalid
- Department of Surgery, Hermitage Medical Clinic, Ireland
| | | | | | - Barry J Jones
- Department of Surgery, Hermitage Medical Clinic, Ireland
- Department of Surgery, Aut Even Hospital, Ireland
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Law KW, Tholomier C, Nguyen DD, Sadri I, Couture F, Zakaria AS, Bouhadana D, Bruyère F, Cash H, Reimann M, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo TJ, Becher EF, Misrai V, Elterman D, Bhojani N, Zorn KC. Global Greenlight Group: largest international Greenlight experience for benign prostatic hyperplasia to assess efficacy and safety. World J Urol 2021; 39:4389-4395. [PMID: 33837819 DOI: 10.1007/s00345-021-03688-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/26/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Greenlight photo-selective vaporization of the prostate (GL-PVP) has gained international acceptance as a safe and effective alternative procedure for the treatment of benign prostatic hyperplasia (BPH), especially in anticoagulated men. This descriptive analysis aims to characterize the current state of GL-PVP, pooling data from international centers. METHODS Data from 3627 patients who underwent GL-PVP with the XPS-180 W system in seven international centers performed by eight expert surgeons between 2011 and 2019 were retrospectively analyzed. Demographic, perioperative, and postoperative data were collected, including IPSS, QoL, Qmax, PVR, and PSA, and complications. RESULTS At baseline, median age, prostate volume, PSA, and IPSS were 70 years (interquartile range 64-77), 64 (47-90), 3.1 ng/mL (1.8-6), and 22 (19-27), respectively. Median lasing and operative time were 34 (23-48) and 62 min (46-85), respectively. Median energy use was 250.0 kJ (168.4-367.9), with 92.6% of procedures being completed with one laser fiber. In 60.1% of cases, catheter was removed on postoperative day 1 with median length of 2 days. All-cause mortality within 30 days was 0.3%. Median PSA reduction at 3 months and 60 months compared to baseline was 43.9 and 46.4%, respectively (p < 0.001). All functional outcomes (IPSS, QoL, Qmax, and PVR) were significantly improved across study period when compared to baseline (p < 0.001). For those men with longer follow-up available, the observed surgical BPH retreatment rate was 1.5% CONCLUSION: Using the largest multi-user, international database of GL-PVP, Greenlight XPS laser treatment in experienced hands is a safe, effective, and durable BPH treatment option.
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Affiliation(s)
- Kyle W Law
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Côme Tholomier
- Department of Surgery, Division of Urology, McGill University, Montreal, QC, Canada
| | | | - Iman Sadri
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Félix Couture
- Department of Surgery, Division of Urology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Ahmed S Zakaria
- Department of Urology, University of Montreal Hospital Center CHUM, Montreal, QC, Canada
| | - David Bouhadana
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Franck Bruyère
- Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Centre-Val de Loire, France
| | - Hannes Cash
- Department of Urology, Charité-Universitaetsmedizin Berlin, Berlin, Germany.,PROURO, Berlin, Germany.,Department of Urology, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
| | - Maximilian Reimann
- Department of Urology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy
| | - Giovanni Ferrari
- Department of Urology, Hesperia Hospital, Cure Group, Modena, Italy
| | | | | | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, Midi-Pyrenees, France
| | - Dean Elterman
- Division of Urology, Department of Surgery, University. Health Network, University of Toronto, Toronto, ON, Canada
| | - Naeem Bhojani
- Department of Urology, University of Montreal Hospital Center CHUM, Montreal, QC, Canada
| | - Kevin C Zorn
- Department of Urology, University of Montreal Hospital Center CHUM, Montreal, QC, Canada.
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9
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Sachs B, Misrai V, Tabatabaei S, Woo HH. Multicenter experience with photoselective vaporization of the prostate on men taking novel oral anticoagulants. Asian J Urol 2020; 7:340-344. [PMID: 32995278 PMCID: PMC7498936 DOI: 10.1016/j.ajur.2019.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/16/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022] Open
Abstract
Objective Photoselective vaporization of the prostate (PVP) is a widely performed surgical procedure for benign prostatic obstruction. This approach has become particular favoured for men on anti-platelet and anticoagulation agents such as clopidogrel and warfarin but there is minimal published experience in the setting of novel oral anticoagulants (NOACs). This study was to examine the perioperative outcomes in men on NOACs undergoing PVP, with particular reference to perioperative morbidity. Methods A retrospective analysis of PVP datasets was undertaken from three centres in Sydney (Australia), Toulouse (France) and Boston (USA). Subjects who had been treated whilst on NOACs without discontinuation or bridging were identified. Perioperative outcomes and treatment parameters were examined and morbidity recorded according to Clavien-Dindo (CD) classification. Results There were a total of 20 subjects who had undergone PVP whilst NOACs had been continued during the perioperative period. The mean age was 77±6.5 years. The mean prostate volume, energy utilization and vaporisation time was 94±56 mL, 301±211 kJ, and 35±21 min respectively. The mean postoperative duration of catheterization and duration of hospitalization was 2.2±2.4 days and 2.4±2.4 days respectively. There was a single episode of urinary tract infection and four subjects required re-catheterisation for non-hematuric retentions. Conclusions This study supports the safety of men on NOACs undergoing PVP. Whilst this study represents the largest experience of PVP in these men, larger studies are necessary to confirm the safety of PVP in this group of men undergoing BPH-related surgery.
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Affiliation(s)
| | | | | | - Henry H Woo
- The Chris O'Brien Lifehouse Hospital, Sydney, Australia
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10
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He Q, Yu Y, Gao F. Meta-analysis of the effect of antithrombotic drugs on perioperative bleeding in BPH surgery. Exp Ther Med 2020; 20:3807-3815. [PMID: 32855730 PMCID: PMC7444423 DOI: 10.3892/etm.2020.9102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/23/2020] [Indexed: 01/11/2023] Open
Abstract
Effects of antithrombotic agents on the bleeding risk after transurethral resection of the prostate (TURP) were assessed in patients with benign prostatic hyperplasia (BPH). Controlled clinical trials on the effects of perioperative anticoagulant therapy on postoperative bleeding in BPH patients published during January 1990 and February 2019 were searched in PubMed, Embase and the Cochrane Library. Two independent reviewers screened the studies according to the inclusion and exclusion criteria, extracted the data, evaluated the quality, and conducted a meta-analysis using the RevMan 5.3 software. A total of 20 studies were included. Analysis of these studies found that compared with interrupted use of antithrombotic agents, continuous use of antithrombotic drugs led to more frequent post-TURP bleeding (OR=4.34, 95% CI=2.29-8.23), and higher transfusion rate (2.96, 1.19-7.36). Compared with patients who never used antithrombotic agents, those who used antithrombotic agents continuously had higher bleeding risk (5.52, 1.64-18.66). Those who continued using antithrombotic agents during laser treatment had higher transfusion rate than those who stopped using them before the operation (5.39, 1.49-19.53), but it had no significant difference in clot retention, blood transfusion rate, intraoperative hemoglobin decrease and postoperative catheter-indwelling time compared with those who never used antithrombotic agents (P>0.05). Those who continued using antithrombotic agents during TURP showed less intraoperative hemoglobin decrease (-0.46, -0.58-0.35) than the patients who underwent low molecular weight heparin substitution. Interruption of antithrombotic agents during TURP can prevent the risk of postoperative bleeding; continuous use of antithrombotic agents is safe and feasible during laser treatment of BPH; whether low molecular weight heparin substitution is necessary during the discontinuation of antithrombotic agents is controversial.
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Affiliation(s)
- Qian He
- Department of Urology, Sir Run-Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Yanlan Yu
- Department of Urology, Sir Run-Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Fengbin Gao
- Department of Urology, Sir Run-Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
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11
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Dornbier R, Pahouja G, Branch J, McVary KT. The New American Urological Association Benign Prostatic Hyperplasia Clinical Guidelines: 2019 Update. Curr Urol Rep 2020; 21:32. [PMID: 32607874 DOI: 10.1007/s11934-020-00985-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW The goal of this paper was to analyze the efficacy of the current modalities available to surgically treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). RECENT FINDINGS There have been significant surgical advancements for the treatment of BPH, including an increasing development and utilization of minimally invasive surgical techniques (MISTs). These procedures have varying outcomes that are critical to understand. In addition, MISTs have important adverse effects, though have minimized effects on sexual function when compared to more invasive surgical techniques. It is important for all urologists to be familiar with the surgical techniques available to treat BPH and the updated American Urological Association (AUA) Guidelines. Further studies evaluating efficacy, safety, and sexual functioning will help guide care in the future and evolve practice.
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Affiliation(s)
- Ryan Dornbier
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA.
| | - Gaurav Pahouja
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
| | - Jeffrey Branch
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
| | - Kevin T McVary
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
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12
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Holmium laser technologies versus photoselective greenlight vaporization for patients with benign prostatichyperplasia: a meta-analysis. Lasers Med Sci 2020; 35:1441-1450. [PMID: 31939037 DOI: 10.1007/s10103-020-02953-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/02/2020] [Indexed: 02/05/2023]
Abstract
This study aims to compare the efficacy and safety of holmium laser technologies (HoL-Ts) and photoselective greenlight vaporization (PVP) for the treatment of benign prostatic hyperplasia (BPH), and to perform a meta-analysis according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines on PubMed, EMBASE, ClinicalTrial.gov, and the Cochrane Central Register of Controlled Trials up to August 2019. Functional outcomes, perioperative parameters, and complications were included and analyzed. Review Manager 5.3 (Cochrane Collaboration, Oxford, UK) was used to perform all analyses. A total of six articles composed of 2014 patients were included in this review. In comparison with PVP, HoL-Ts had a better performance in 1-, 3-, and 6-month Qmax (P = 0.02, but I2 = 81%), with less postvoid residual urine volume (PVR) (MD = -33.85, 95% CI -52.13 to -15.57, P = 0.0003) and less total energy used (MD = -31.66, 95% CI -58.99 to -4.33, P = 0.02). Moreover, HoL-Ts had a relatively lower risk of conversion rate (OR = 0.08, 95% CI 0.01 to 0.60, P = 0.01) associated with enough enucleation and less intraoperative bleeding. Subgroup analysis of holmium laser enucleation of prostate (HoLEP) versus PVP suggested that HoLEP presented better results in 1-, 3-, 6-month and 1-year Qmax with less PVR, less energy consumption, and lower conversion rate. Compared with PVP, HoL-Ts had higher 1-, 3-, and 6-month Qmax, less PVR, and less total energy consumption with a relatively lower risk of conversion rate. In subgroup analyses, HoLEP had shown better results in accordance with all HoL-Ts. Nevertheless, well-designed RCTs including overall functional indicators are required to confirm our findings.
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13
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Diri MA, Gul M. Effect of bipolar radiofrequency thermotherapy on benign prostate hyperplasia. Andrologia 2019; 52:e13467. [PMID: 31692009 DOI: 10.1111/and.13467] [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: 06/08/2019] [Revised: 09/29/2019] [Accepted: 10/11/2019] [Indexed: 12/25/2022] Open
Abstract
This study aims to evaluate the safety and efficacy of the new bipolar radiofrequency thermotherapy device (TEMPRO) in treating patients with benign prostate hyperplasia (BPH). Between December 2017 and November 2018, 72 male patients with BPH were included. All patients completed the International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5) questionnaires. Physical examinations were performed, and prostate volume, prostatic urethral length and post-voiding residual urine (PVR) were measured using ultrasound. Uroflowmetry was used to calculate the maximum flow rate of urination (Qmax). Bipolar radiofrequency thermotherapy was applied with TEMPRO system containing a 16Fr applicator. All patients were re-evaluated at 6 months post-operatively. The mean age of the patients was 63.22 ± 6.68 years. All patients were treated with local anaesthesia, and three patients were unable to complete the procedure. The median (IQR) visual analogue scale score was 1 (0-3) at 6 hr post-operatively. After 6 months, significant improvements were observed in the IPSS, QoL, Qmax and PVR values of the patients (p < .001 for Qmax, IPSS and QoL; p = .03 for PMR). The success rate of the procedure was similar between patients with prostate volumes <70 and >70 ml. Due to its low rate of complication, the TEMPRO© treatment is effective in treating BPH, especially among aged patients and those with serious symptoms.
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Affiliation(s)
- Mehmet Akif Diri
- Department of Urology, School of Medicine, Aksaray University, Aksaray, Turkey
| | - Murat Gul
- Department of Urology, School of Medicine, Aksaray University, Aksaray, Turkey.,Laboratory of Reproductive Biology, University of Copenhagen, Copenhagen, Denmark
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14
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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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15
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Rieken M, Herrmann TRW, Füllhase C. Operative Therapie des benignen Prostatasyndroms – resezieren, vaporisieren oder enukleieren? Urologe A 2019; 58:263-270. [DOI: 10.1007/s00120-019-0891-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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16
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Becker B, Netsch C, Hansen J, Böhme A, Gross AJ, Zacharias M, Lehrich K. Perioperative Safety in Patient Under Oral Anticoagulation During Holmium Laser Enucleation of the Prostate. J Endourol 2019; 33:219-224. [PMID: 30516393 DOI: 10.1089/end.2018.0693] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the safety of holmium laser enucleation of the prostate (HoLEP) in patients on oral anticoagulation (OA) with respect to intra- and postoperative bleeding complications. METHODS Between January 2013 and October 2016, 2178 patients were included in this study, of whom 94 received direct oral anticoagulants (DOACs) and 151 received vitamin K antagonists (VKAs) before HoLEP. All patients either ceased OA (DOACs) or were bridged subtherapeutically (VKAs, international normalized ratio <2) during surgery. These patients were compared to a sample size of 1933 nonanticoagulated patients. RESULTS A significant longer postoperative stay was noted for the patients on DOACs (5.2 [4-6] days) and VKAs (5.3 [4-5] days) compared to the control group (4.5 [4-4] days). The mean drop in hemoglobin was significantly higher in the VKA group compared to the DOAC and control group. There was a significantly higher rate of postoperative bladder tamponades/secondary coagulation in patients on OA with 6 (7.9%)/3 (3.9%) patients in the DOAC group, 10 (7.4%)/6 (4.4%) patients in the VKA group compared to 37 (2.2%)/21 (2.1%) patients in the control group, respectively (p < 0.001). Eight patients required blood transfusions with a distribution of 1 (1.3%), 3 (2.2%), and 4 (0.2%) patients in the DOAC, VKA, and control group, respectively (p < 0.001). CONCLUSIONS Our findings indicate that bridged patients who's DOACs and VKAs were ceased before HoLEP are at higher risk of intra- and postoperative bleeding complications. Nonetheless, HoLEP appears to be a safe and effective procedure in those patients.
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Affiliation(s)
- Benedikt Becker
- 1 Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
| | | | - Jens Hansen
- 2 Department of Urology, Auguste Viktoria Hospital, Berlin, Germany
| | - Axel Böhme
- 2 Department of Urology, Auguste Viktoria Hospital, Berlin, Germany
| | - Andreas J Gross
- 1 Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Mario Zacharias
- 2 Department of Urology, Auguste Viktoria Hospital, Berlin, Germany
| | - Karin Lehrich
- 2 Department of Urology, Auguste Viktoria Hospital, Berlin, Germany
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17
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Charbonneau H, Pasquié M, Peyronnet B, Descazeaud A, Barry-Delongchamps N, Della Negra E, Mathieu R, Karsenty G, Long JA, Ballereau C, Azzouzi AR, Pradère B, Bruyère F, Fournier G, Lebdai S, Calves J, Corbel L, Vincendeau S, Fiard G, Thuillier C, Descotes JL, Colin P, Culty T, Hesbois A, Fuzier V, Savy N, Pathak A, Albaladejo P, Samama CM, Guerrero F, Misraï V. Stopping or maintaining oral anticoagulation in patients undergoing photoselective vaporization of the prostate (SOAP) surgery for benign prostate obstruction: study protocol for a multicentre randomized controlled trial. Trials 2018; 19:705. [PMID: 30587221 PMCID: PMC6307178 DOI: 10.1186/s13063-018-3066-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 11/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lower urinary tract symptoms related to benign prostatic obstruction (BPO) are frequent in men aged > 50 years. Based on the use of innovative medical devices, a number of transurethral ablative techniques have recently been developed for the surgical treatment of BPO. In recent years, GreenLight photoselective vaporization of the prostate (PVP) has been considered as a non-inferior alternative to transurethral resection of the prostate. The GreenLight PVP is usually considered as an interesting surgical option for patients treated via oral anticoagulants (OACs) with regard to its haemostatic properties. The aim of this study was to assess the impact of maintaining OAC treatment in patients undergoing PVP. METHODS This study is a multicentre, open-label, randomized controlled trial (RCT) designed to show the non-inferiority of PVP surgery in patients with BPO treated with OACs. This study is designed to enrol 386 OAC-treated patients (treated with vitamin K antagonists and direct oral anticoagulants) who are undergoing PVP for BPO. Patients will be randomized (1:1) to either maintain or stop OAC treatment during the perioperative course. The intervention group will maintain OAC treatment until the day before surgery and resume OAC treatment the day after surgery, whereas the control group will stop OAC treatment (with or without low-molecular-weight heparin bridging therapy) according to the anaesthesia guidelines. The primary outcome of interest to be assessed is the 30-day complications rate according to the Clavien-Dindo classification. The secondary endpoint will examine the 30-day rate of haemorrhagic and thrombotic events. This study will provide 80% power to show non-inferiority, defined as not worse than a 10% (non-inferiority margin) inferior change in the proportion of patients with good outcomes (Clavien-Dindo score < 2), using two-tailed 95% confidence intervals. DISCUSSION This first multicentre RCT in the field is underway to evaluate the safety and efficacy of PVP in patients with ongoing OAC therapy. The study results could influence the perioperative management of OACs in BPO surgery with a high level of evidence. TRIAL REGISTRATION ClinicalTrials.gov, NCT03297281 . Registered on 29 September 2017.
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Affiliation(s)
| | - Marie Pasquié
- Department of Urology, Clinique Pasteur, 45 avenue de Lombez, BP 27 617, 31076, Toulouse Cedex 3, France
| | - Benoit Peyronnet
- Department of Urology, Rennes University Hospital , Rennes, France
| | - Aurélien Descazeaud
- Department of Urology, Limoges University Hospital, Dupuytren Hospital, Limoges, France
| | | | | | - Romain Mathieu
- Department of Urology, Rennes University Hospital , Rennes, France
| | - Gilles Karsenty
- Department of Urology, Conception Hospital, Marseille, France
| | - Jean-Alexandre Long
- Department of Urology, Grenoble University Hospital , Michallon Hospital, La Tronche, France
| | | | | | - Benjamin Pradère
- Department of Urology, Tours University Hospital , Tours, France
| | - Franck Bruyère
- Department of Urology, Tours University Hospital , Tours, France
| | - Georges Fournier
- Department of Urology, Brest University Hospital, Cavale Blanche Hospital, Brest, France
| | - Souhil Lebdai
- Department of Urology, Angers University Hospital , Angers, France
| | - Jehanne Calves
- Department of Urology, Brest University Hospital, Cavale Blanche Hospital, Brest, France
| | - Luc Corbel
- Department of Urology, Cochin University Hospital, Paris, France
| | | | - Gaelle Fiard
- Department of Urology, Grenoble University Hospital , Michallon Hospital, La Tronche, France
| | - Caroline Thuillier
- Department of Urology, Grenoble University Hospital , Michallon Hospital, La Tronche, France
| | - Jean-Luc Descotes
- Department of Urology, Grenoble University Hospital , Michallon Hospital, La Tronche, France
| | - Pierre Colin
- Department of Urology, Hopital Privée la Louviere, Lille, France
| | - Thibaut Culty
- Department of Urology, Angers University Hospital , Angers, France
| | - Audrey Hesbois
- Department of Anesthesia, Clinique Pasteur, Toulouse, France
| | - Valerie Fuzier
- Department of Anesthesia, Clinique Pasteur, Toulouse, France
| | - Nicolas Savy
- Institute of mathematics, Paul Sabatier University, CNRS, Toulouse, France
| | - Atul Pathak
- Department of Cardiovascular Medicine, Clinique Pasteur, Toulouse, France
| | - Pierre Albaladejo
- Department of Anaesthesia and Intensive Care, Grenoble University Hospital, Avenue Maquis-du-Grésivaudan, 38700, La Tronche, France.,Clinical Investigation Centre, Grenoble University Hospital, ThEMAS, TIMC, UMR-CNRS 5525, University Grenoble-Alpes, 38700, La Tronche, France
| | - Charles Marc Samama
- Department of Anaesthesiology and Intensive Care, Assistance publique-Hôpitaux de Paris, Cochin University Hospital, 75014, Paris, France
| | - Felipe Guerrero
- Department of Haematology, Toulouse University Hospital , Rangueil, France
| | - Vincent Misraï
- Department of Urology, Clinique Pasteur, 45 avenue de Lombez, BP 27 617, 31076, Toulouse Cedex 3, France.
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Heiman J, Large T, Krambeck A. Best practice in the management of benign prostatic hyperplasia in the patients requiring anticoagulation. Ther Adv Urol 2018; 10:431-436. [PMID: 30574203 PMCID: PMC6295789 DOI: 10.1177/1756287218807591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 09/24/2018] [Indexed: 11/16/2022] Open
Abstract
In today’s aging population, urologists are often treating older patients with multiple comorbidities. Lower urinary tract symptoms from benign prostate hyperplasia (LUTS/BPH) is a common condition that affects men, with increasing prevalence as men age. In a subset of patients, the symptoms are too severe or refractory to medical therapy and, therefore, surgical therapy is required to improve their LUTS. The use of medical therapy often delays the need to intervene surgically in men with LUTS/BPH and with advances in the management of cardiovascular disease, urologists are increasingly encountering more men requiring BPH surgery on chronic anticoagulation therapy. The decision of when to offer surgical intervention and how to manage anticoagulation medication in the perioperative setting is a dilemma with which surgeons are dealing with increasing frequency. The purpose of this review is to clarify the optimal approach to the surgical patient with LUTS/ BPH requiring anticoagulation therapy.
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Affiliation(s)
| | - Tim Large
- Indiana University, Indianapolis, USA
| | - Amy Krambeck
- Indiana University School of Medicine, IU Health Physicians Urology, 1801 N. Senate Blvd., Indianapolis, IN 46202-5114, USA
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Complications and functional outcomes of high-risk patient with cardiovascular disease on antithrombotic medication treated with the 532-nm-laser photo-vaporization Greenlight XPS-180 W for benign prostate hyperplasia. World J Urol 2018; 37:1671-1678. [PMID: 30478499 DOI: 10.1007/s00345-018-2560-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 11/03/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To examine the complications and functional outcomes of high-risk patients on antithrombotic therapy (ATT) treated with photoselective vaporization of the prostate (PVP) using the Greenlight (GL) XPS-180 system. METHODS A retrospective analysis of prospectively maintained institutional database was performed. Men with symptomatic LUTS related to BPH were treated with 523-nm GL PVP using the XPS-180 W system. They were stratified according to ATT status: group 1 (control group), group 2 (acetylsalicylic acid), group 3 (antiplatelet agents other than acetylsalicylic acid) and group 4 (anticoagulation agents). Postoperative adverse events at 30- and 90-days were prospectively recorded. Complications were stratified according to the Clavien-Dindo classification. Additionally, functional outcomes (IPSS, Qmax and PVR) were analyzed up to 48 months of follow-up after surgery. Multivariable logistic regression analyses were used to predict the effect of ATT on serious bleeding-associated complications that was defined as the sum of patients with hematuria Clavien grade ≥ 2, patients requiring transfusions and patient with postoperative hemoglobin drop ≥ 15 g/dl. RESULTS 274 (63%), 87 (21%), 24 (6%) and 37 (9%) patients were included in groups 1, 2, 3 and 4, respectively. Patients on antiplatelet (group 3) and anticoagulant medication (group 4) were older (median age 60 vs. 68 vs. 77 vs. 76 years, p < 0.001) and had more comorbidities (ASA 3-4: 9.5 vs. 27.6 vs. 66.7 vs. 64.9%; p < 0.001) than their counterparts. The overall 30-day complications rates were 31, 28.7, 45.8 and 45.9% of patients included in groups 1, 2, 3 and 4, respectively (p = 0.4). Hematuria Clavien 1 events (p < 0.001), readmissions rates (p = 0.02), length of post-operative hospital stay (p < 0.001) and catheterization time (p < 0.001) were significantly higher in patients on antiplatelet and anticoagulation medication. In multivariable analyses, ATT status was not a predictor of serious bleeding events after surgery (p > 0.5). Finally, functional outcomes were significantly improved accross the four groups. CONCLUSION GL PVP is safe and effective in treating high-risk patients on ATT. Although serious bleeding complications are rare and equivalent with non-high-risk patients, patients on antiplatelet and anticoagulation medication should be counseled on the increased risk of minor bleeding events and readmissions rates at 30 days after surgery.
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20
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Photoselective vaporization has comparative efficacy and safety among high-risk benign prostate hyperplasia patients on or off systematic anticoagulation: a meta-analysis. World J Urol 2018; 37:1377-1387. [PMID: 30390127 DOI: 10.1007/s00345-018-2530-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/11/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The necessity to cease anticoagulation before photoselective vaporization (PVP) surgery remains nonconsensual. We aimed at assessing the efficacy and safety of PVP among high-risk benign prostate hyperplasia (BPH) patients on or off anticoagulation. METHODS We systematically searched Pubmed, Embase, and Cochrane Library Central Register of Controlled Trials (CENTRAL). 2299 patients from 11 studies were eventually included. Newcastle-Ottawa Scale (NOS) was employed to assess the quality and risk of bias of each study. All statistical analyses were conducted with Review Manager v.5.3 software. RESULTS Ten parameters (operation time, laser time, blood transfusion, urethral stricture, urinary tract infection, reoperation, dysuria, capsule perforation, catheterization time, and re-catheterization) from patients on or off anticoagulant therapy were collected. The patients without anticoagulants performed better at catheterization time [MD - 0.54, 95% CI (- 0.82, - 0.26), P = 0.96, I2 = 0] with a reduction of 0.54 day than those on anticoagulants. Significant statistical difference was not observed from other parameters. Subgroup analysis, grouped by the power output of PVP systems (80 W, 120 W and 180 W), consistently showed no statistical significant difference except at catheterization time in the 180-W PVP subgroup. CONCLUSION PVP, a safe and effective option for high-risk BPH patients, work comparably regardless of anticoagulant therapy, despite non-anticoagulant patients have shorter catheterization time. It is implied that the use of anticoagulants might be unnecessary to stop for high-risk BPH patients undergoing PVP for the sake of safety, which certainly requires further investigations to confirm.
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Brown N, Walker D, McBean R, Pokorny M, Kua B, Gianduzzo T, Dunglison N, Esler R, Yaxley J. Prostate artery Embolisation Assessment of Safety and feasibilitY (P-EASY): a potential alternative to long-term medical therapy for benign prostate hyperplasia. BJU Int 2018; 122 Suppl 5:27-34. [DOI: 10.1111/bju.14504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Nicholas Brown
- Wesley Medical Imaging; The Wesley Hospital; Auchenflower Queensland Australia
| | - Duncan Walker
- Wesley Medical Imaging; The Wesley Hospital; Auchenflower Queensland Australia
| | - Rhiannon McBean
- Wesley Medical Imaging; The Wesley Hospital; Auchenflower Queensland Australia
| | - Morgan Pokorny
- Department of Urology; The Wesley Hospital; Auchenflower Queensland Australia
| | - Boon Kua
- Department of Urology; The Wesley Hospital; Auchenflower Queensland Australia
| | - Troy Gianduzzo
- Department of Urology; The Wesley Hospital; Auchenflower Queensland Australia
| | - Nigel Dunglison
- Department of Urology; The Wesley Hospital; Auchenflower Queensland Australia
| | - Rachel Esler
- Department of Urology; The Wesley Hospital; Auchenflower Queensland Australia
| | - John Yaxley
- Department of Urology; The Wesley Hospital; Auchenflower Queensland Australia
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22
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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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