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Gill BC, Miller LE, Bhattacharyya S, Cash H, Eure GR. Complications of GreenLight Laser vs Transurethral Resection of the Prostate for Treatment of Lower Urinary Tract Symptoms: Meta-analysis of Randomized Trials. Urology 2024; 184:259-265. [PMID: 38176618 DOI: 10.1016/j.urology.2023.12.018] [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: 10/19/2023] [Revised: 12/14/2023] [Accepted: 12/26/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE To compare perioperative outcomes and complications between GreenLight and transurethral resection of the prostate (TURP) for benign prostatic hyperplasia. METHODS A systematic review and random effects meta-analysis of randomized trials comparing GreenLight with TURP was completed. Primary outcomes included periprocedural milestones, 12 predefined complications, Clavien-Dindo class III-V complications, reoperations (all-cause), and a composite of reoperations and readmissions. Metaregression assessed the relationship between patient- and study-level factors with periprocedural outcomes and reoperation rates. RESULTS The review included 13 randomized trials with 1757 patients (839 GreenLight; 918 TURP). Procedure time was 10 minutes (95% CI: 5 to 15; P < .001) longer with GreenLight, while catheterization time (mean difference=-1.3days; 95% CI: -1.7 to -0.9; P<.001) and hospital stay (mean difference=-2.1days; 95% CI: -2.5 to -1.7; P<.001) were shorter. Bleeding-related complications, including clot retention (risk ratio [RR]=0.12; 95% CI: 0.05 to 0.32; P<.001) and transfusion (RR=0.26; 95% CI: 0.12 to 0.58; P = .001), as well as sexual dysfunction (RR=0.66; 95% CI: 0.45 to 0.98; P = .04), were less frequent with GreenLight. All other complications occurred at similar frequencies between groups. The risks of reoperation (RR: 1.17; 95% CI: 0.82 to 1.66; P = .38) and reoperation or readmission (RR: 1.05; 95% CI: 0.76 to 1.44; P = .79) did not differ. CONCLUSION GreenLight achieved shorter catheterization times and hospital stays with lower rates of sexual dysfunction and bleeding-related complications compared to TURP.
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Affiliation(s)
- Bradley C Gill
- Department of Urology, Cleveland Clinic Foundation, Cleveland, OH
| | | | | | - Hannes Cash
- Department of Urology, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
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Kitahara R, Hiragata S, Matsumoto Y, Kinebuchi Y. [EXPERIENCES OF CONTACT LASER VAPORIZATION OF THE PROSTATE (CVP) FOR TREATING BENIGN PROSTATIC HYPERPLASIA IN THE LOCAL HOSPITAL]. Nihon Hinyokika Gakkai Zasshi 2023; 114:53-56. [PMID: 38644186 DOI: 10.5980/jpnjurol.114.53] [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: 04/23/2024]
Abstract
(Objective) We started contact laser vaporization of the prostate (CVP) for treating benign prostatic hyperplasia at our hospital in July 2019. Forty-five patients were treated with CVP from July 2019 to April 2021. (Methods) Patients were assessed preoperatively and at one and three months after CVP treatment by using the International Prostate Symptom Score (IPSS), quality of life index (QOL index), peak urinary flow rate (Qmax), and postvoid residual urine volume (PVR). (Results) IPSS, QOL index, Qmax, and PVR significantly improved three months after CVP (p<0.05). Regarding adverse events, five patients developed early external urinary meatus strictures, two had postoperative bleeding, and three had temporary urinary retention. (Conclusions) In our hospital, elderly patients and patients who cannot discontinue an antithrombotic drug were treated by CVP for benign prostatic hyperplasia relatively safely.
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Affiliation(s)
| | | | - Yuki Matsumoto
- National Hospital Organization Shinshu Ueda Medical Center
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Manfredi C, García-Gómez B, Arcaniolo D, García-Rojo E, Crocerossa F, Autorino R, Gratzke C, De Sio M, Romero-Otero J. Impact of Surgery for Benign Prostatic Hyperplasia on Sexual Function: A Systematic Review and Meta-analysis of Erectile Function and Ejaculatory Function. Eur Urol Focus 2022; 8:1711-1732. [PMID: 35803852 DOI: 10.1016/j.euf.2022.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/17/2022] [Indexed: 01/25/2023]
Abstract
CONTEXT Several sexual side effects, including erectile, ejaculatory, and orgasmic dysfunction, were reported with the majority of surgical procedures for benign prostatic obstruction (BPO). OBJECTIVE To systematically review current evidence regarding the impact of benign prostatic hyperplasia (BPH) surgery on sexual function. EVIDENCE ACQUISITION A comprehensive bibliographic search on the MEDLINE, Cochrane Library, Embase, Web of Science, and Google Scholar databases was conducted in July 2021. The population, intervention, comparator, and outcome (PICO) model was used to define study eligibility. Studies were Included if they assessed patients with BPO and related lower urinary tract symptoms (P) undergoing BPH surgery (I) with or without a comparison between surgical treatments (C) evaluating the impact on sexual function (O). Retrospective and prospective primary studies were included. A pooled analysis was conducted on studies including the postoperative assessment of International Index of Erectile Function (IIEF)-5, Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD; Function and/or Bother), or retrograde ejaculation (RE) rate (PROSPERO database ID: CRD42020177907). EVIDENCE SYNTHESIS A total of 151 studies investigating 20 531 patients were included. Forty-eight randomized controlled trials evaluating 5045 individuals were eligible for the meta-analysis. In most studies (122, 80.8%), only erectile and/or ejaculatory function was evaluated. A substantial number of articles (67, 44.4%) also used nonvalidated tools to evaluate erectile and/or ejaculatory function. The pooled analysis showed no statistically significant changes in IIEF-5 score compared with baseline for the transurethral resection of the prostate (TURP; weighted mean difference [WMD] 0.76 pts; 95% confidence interval [CI] -0.1, 1.62; p = 0.08), laser procedure (WMD 0.33 pts; 95% CI -0.1, 0.77; p = 0.13), and minimally invasive treatment (WMD -1.37 pts; 95% CI -3.19, 0.44; p = 0.14) groups. A statistically significantly higher rate of RE was found after TURP (risk ratio [RR] 13.31; 95% CI 8.37, 21.17; p < 0.00001), other electrosurgical procedures (RR 34.77; 95% CI 10.58, 127.82; p < 0.00001), and the entire laser group (RR 17.37; 95% CI 5.93, 50.81; p < 0.00001). No statistically significant increase in RE rate was described after most of the minimally invasive procedures (p > 0.05). The pooled analysis of MSHQ-EjD scores was possible only for prostatic urethral lift, showing no statistically significant difference between baseline and post-treatment MSHQ-EjD Function scores (WMD -0.80 pts; 95% CI -2.41, 0.81; p = 0.33), but postoperative MSHQ-EjD Bother scores were significantly higher (WMD 0.76 pts; 95% CI 0.22, 1.30; p = 0.006). CONCLUSIONS Erectile function appears to be unaffected by most surgical procedures for BPO. RE is a very common adverse event of BPH surgery, although emerging minimally invasive surgical procedures could be associated with a lower risk. PATIENT SUMMARY Benign prostatic hyperplasia surgery can have an impact on sexual function, mainly involving ejaculatory function.
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Affiliation(s)
- Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Borja García-Gómez
- Department of Urology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain
| | - Davide Arcaniolo
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Esther García-Rojo
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain
| | - Fabio Crocerossa
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Christian Gratzke
- Department of Urology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Marco De Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Javier Romero-Otero
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain.
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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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Furusawa J, Yamada Y, Soga N, Kuromatsu I. Optimal Monitoring of Prostate-Specific Antigen Detects Prostate Cancer at the Localized Stage after Photoselective Vaporization for Benign Prostatic Hyperplasia. Curr Urol 2019; 12:147-152. [PMID: 31316323 DOI: 10.1159/000489433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/24/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction Photoselective vaporization of the prostate (PVP) does not provide prostate tissue for pathologic analysis. Here, we carried out early monitoring for prostate cancer by measuring prostate-specific antigen (PSA) levels and assessing clinicopathological features after PVP. Materials and Methods Patients (n = 800) who underwent PVP and were followed-up for more than 12 months were analyzed retrospectively. After PVP, PSA levels were measured at 3 and 12 months and each year thereafter. Prostate biopsies were performed when PSA levels increased continuously. We assessed the characteristics of patients diagnosed with prostate cancer. Results The mean follow-up period was 49 months. After PVP, 54 patients underwent biopsies, and 23 patients were diagnosed with prostate cancer. Overall, 10, 10, and 3 patients had clinical stage T1c, T2a, and T2b disease, respectively, and there were no cases of stage T2c disease or greater. Conclusions We found that it was possible to diagnose prostate cancer at a localized stage under our optimal PSA monitoring schedule before and after PVP.
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Affiliation(s)
- Jun Furusawa
- Department of Urology, Nagoya Central Hospital, Aichi Cancer Center Hospital, Nagoya, Japan.,Department of Urology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yasushi Yamada
- Department of Urology, Nagoya Central Hospital, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Norihito Soga
- Department of Urology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Isao Kuromatsu
- Department of Urology, Nagoya Central Hospital, Aichi Cancer Center Hospital, Nagoya, Japan
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Ulchaker JC, Martinson MS. Cost-effectiveness analysis of six therapies for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 10:29-43. [PMID: 29343977 PMCID: PMC5749396 DOI: 10.2147/ceor.s148195] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To conduct a cost-effectiveness analysis from payers' perspectives of six treatments for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) and to examine positioning of these modalities in the marketplace for the best use of health care funds and quality-of-life benefits for patients. METHODS The economic analysis was conducted with a Markov model to compare combination prescription drug therapy (ComboRx), minimally invasive therapies (MITs) including convective radiofrequency (RF) water vapor thermal therapy (Rezūm®), conductive RF thermal therapy (Prostiva®), and prostatic urethral lift (UroLift®), and invasive surgical procedures including photovaporization of the prostate (Greenlight® PVP) and transurethral resection of the prostate (TURP). Effects assessed with International Prostate Symptom Score, adverse events, and re-treatment rates were estimated from medical literature; treatments effects were modeled using a common baseline score. Starting with each therapy, patients' transitions to more intensive therapies when symptoms returned were simulated in 6-month cycles over 2 years. Incremental cost-effectiveness ratios (ICERs) were calculated for pairs of treatments; uncertainty in ICERs was estimated with probabilistic sensitivity analyses. RESULTS ComboRx was least effective and provided one-third of the symptom relief achieved with MITs. UroLift was similar in effectiveness to Prostiva and Rezūm but costs more than twice as much. The cheaper MITs were ~$900 more expensive than the cost of ComboRx generic drugs over 2 years. TURP and PVP provided slightly greater relief of LUTS than MITs at approximately twice the cost over 2 years; typically, they are reserved for treatment of more severe LUTS. CONCLUSION The analysis evaluated the costs and symptom relief of six treatment options in the continuum of care from a common baseline of LUTS severity. Identification of treatments for LUTS/BPH that demonstrate cost-effectiveness and provide appreciable symptom relief is paramount as reimbursement for patient care moves from volume-based services to value-based services.
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Cimino S, Voce S, Palmieri F, Favilla V, Castelli T, Privitera S, Giardina R, Reale G, Russo GI, Morgia G. Transurethral resection of the prostate (TURP) vs GreenLight photoselective vaporization of benign prostatic hyperplasia: analysis of BPH6 outcomes after 1 year of follow-up. Int J Impot Res 2017; 29:240-243. [PMID: 28814812 DOI: 10.1038/ijir.2017.30] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/23/2017] [Accepted: 07/14/2017] [Indexed: 11/09/2022]
Abstract
The surgical treatment of benign prostatic obstruction is changing over the time, thanks the increase evidence about the successful role of laser techniques in this surgery. We aimed to compare prostatic GreenLight photovaporization (PVP) to bipolar transurethral resection of the prostate (TURP) with regard to lower urinary tract symptoms (LUTS) improvement through the evaluation of BPH6. We enrolled 220 consecutive subjects affected by LUTS. We performed a propensity score matching using prostate volume, peak flow and International Prostate Symptoms Score (IPSS). A total of 110 (55 TURP and 55 PVP) were analyzed. We found after 1 year of follow-up that the rate of subjects resulting in greater BPH6 recovery in the PVP group vs TURP (45.6% vs 18.2%; P=0.001). The TURP treatment showed greater catheterization time (4.67 vs 1.25; P<0.01) while PVP showed greater recovery experience (82.4 vs 58.2; <0.01). Postoperative ejaculatory dysfunctions were observed in both groups, 58.8% in TURP and 34.5% in PVP group. The multivariate logistic regression analysis, adjusted for preoperative variables, showed that PVP was independently associated with BPH6 recovery end point (odds ratio=3.77; P<0.01). This study showed data in favor of PVP. Although IPSS and peak flow improvements were similar, PVP showed better clinical outcomes.
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Affiliation(s)
- S Cimino
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - S Voce
- Urology Division, Lugo of Romagna Hospital, Ravenna, Italy
| | - F Palmieri
- Urology Division, Lugo of Romagna Hospital, Ravenna, Italy
| | - V Favilla
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - T Castelli
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - S Privitera
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - R Giardina
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - G Reale
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - G I Russo
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - G Morgia
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
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Noureldin YA, Elkoushy MA, Aloosh M, Carrier S, Elhilali MM, Andonian S. Objective Structured Assessment of Technical Skills for the Photoselective Vaporization of the Prostate Procedure: A Pilot Study. J Endourol 2016; 30:923-9. [DOI: 10.1089/end.2016.0270] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yasser A. Noureldin
- Division of Urology, McGill University, Montréal, Canada
- Urology Department, Benha University Hospital, Benha University, Benha, Egypt
| | - Mohamed A. Elkoushy
- Division of Urology, McGill University, Montréal, Canada
- Urology Department, Suez Canal University, Ismailia, Egypt
| | - Mehdi Aloosh
- Division of Urology, McGill University, Montréal, Canada
| | - Serge Carrier
- Division of Urology, McGill University, Montréal, Canada
| | | | - Sero Andonian
- Division of Urology, McGill University, Montréal, Canada
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Valdivieso R, Meyer CP, Hueber PA, Meskawi M, Alenizi AM, Azizi M, Trinh QD, Misrai V, Rutman M, Te AE, Chughtai B, Barber NJ, Emara AM, Munver R, Zorn KC. Assessment of energy density usage during 180W lithium triborate laser photoselective vaporization of the prostate for benign prostatic hyperplasia. Is there an optimum amount of kilo-Joules per gram of prostate? BJU Int 2016; 118:633-40. [DOI: 10.1111/bju.13479] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Roger Valdivieso
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
| | - Christian P Meyer
- Division of Urologic Surgery and Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Pierre-Alain Hueber
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
| | - Malek Meskawi
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
| | - Abdullah M. Alenizi
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
| | - Mounsif Azizi
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
| | - Quoc-Dien Trinh
- Division of Urologic Surgery and Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School; Boston MA USA
| | - Vincent Misrai
- Department of Urology; Clinique Pasteur Toulouse; Toulouse France
| | - Matthew Rutman
- Department of Urology; Columbia University; New York NY USA
| | - Alexis E. Te
- Department of Urology; Cornell University; New York NY USA
| | - Bilal Chughtai
- Department of Urology; Cornell University; New York NY USA
| | - Neil J. Barber
- Department of Urology; Frimley Park Hospital; Frimley Surrey UK
| | - Amr M. Emara
- Department of Urology; Frimley Park Hospital; Frimley Surrey UK
| | - Ravi Munver
- Department of Urology; Hackensack University Medical Center; Hackensack NJ USA
| | - Kevin C. Zorn
- Division of Urology; Centre Hospitalier de l'Université de Montréal (CHUM); Montreal QC Canada
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