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Janeczek M, Rybak Z, Lipińska A, Bujok J, Czerski A, Szymonowicz M, Dobrzyński M, Świderski J, Żywicka B. Local Effects of a 1940 nm Thulium-Doped Fiber Laser and a 1470 nm Diode Laser on the Pulmonary Parenchyma: An Experimental Study in a Pig Model. MATERIALS 2021; 14:ma14185457. [PMID: 34576681 PMCID: PMC8471385 DOI: 10.3390/ma14185457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
The lungs are a common site of metastases from malignant tumors. Their removal with a minimal but safe tissue margin is essential for the long-term survival of patients. The aim of this study was to evaluate the usefulness of a 1940 nm thulium-doped fiber laser (TDFL) and a 1470 nm diode laser (DL) in a pig model of lung surgery that involved the incision and excision of lung tissue. Histopathological analysis was performed on days 0 and 7 after surgery. Neither TDFL nor DL caused significant perioperative or postoperative bleeding. Histological analysis revealed the presence of carbonized necrotic tissue, mixed fibrin-cellular exudate in the superficial zone of thermal damage and bands of deeper thermal changes. The mean total width of thermal damage on day 0 was 499.46 ± 61.44 and 937.39 ± 109.65 µm for TDFL and DL, respectively. On day 7, cell activation and repair processes were visible. The total width of thermal damage was 2615.74 ± 487.17 µm for TDFL vs. 6500.34 ±1118.02 µm for DL. The superficial zone of thermal damage was narrower for TDFL on both days 0 and 7. The results confirm the effectiveness of both types of laser in cutting and providing hemostasis in the lungs. TDFL caused less thermal damage to the lung parenchyma than DL.
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Affiliation(s)
- Maciej Janeczek
- Department of Animal Physiology and Biostructure, Division of Anatomy, Wroclaw University of Environmental and Life Sciences, Kożuchowska 1, 51-631 Wroclaw, Poland; (M.J.); (A.L.)
| | - Zbigniew Rybak
- Department of Experimental Surgery and Biomaterial Research, Wroclaw Medical University, Bujwida 44, 50-368 Wroclaw, Poland; (Z.R.); (M.S.); (B.Ż.)
| | - Anna Lipińska
- Department of Animal Physiology and Biostructure, Division of Anatomy, Wroclaw University of Environmental and Life Sciences, Kożuchowska 1, 51-631 Wroclaw, Poland; (M.J.); (A.L.)
| | - Jolanta Bujok
- Department of Animal Physiology and Biostructure, Division of Animal Physiology, Wroclaw University of Environmental and Life Sciences, C.K. Norwida 31, 50-375 Wroclaw, Poland;
- Correspondence:
| | - Albert Czerski
- Department of Animal Physiology and Biostructure, Division of Animal Physiology, Wroclaw University of Environmental and Life Sciences, C.K. Norwida 31, 50-375 Wroclaw, Poland;
| | - Maria Szymonowicz
- Department of Experimental Surgery and Biomaterial Research, Wroclaw Medical University, Bujwida 44, 50-368 Wroclaw, Poland; (Z.R.); (M.S.); (B.Ż.)
| | - Maciej Dobrzyński
- Department of Pediatric Dentistry and Preclinical Dentistry, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland;
| | - Jacek Świderski
- Institute of Optoelectronics, Military University of Technology, Kaliskiego 2, 00-908 Warsaw, Poland;
| | - Bogusława Żywicka
- Department of Experimental Surgery and Biomaterial Research, Wroclaw Medical University, Bujwida 44, 50-368 Wroclaw, Poland; (Z.R.); (M.S.); (B.Ż.)
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Maruccia S, Fulgheri I, Montanari E, Casellato S, Boeri L. Nomenclature in thulium laser treatment of benign prostatic hyperplasia: it's time to pull the rabbit out of the hat. Lasers Med Sci 2021; 36:1355-1367. [PMID: 33389305 DOI: 10.1007/s10103-020-03227-4] [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: 09/02/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022]
Abstract
We performed a narrative review with the focus on laser settings and surgical procedure with thulium laser. Our primary goal was to define the most valid settings of each surgical procedure to overcome the inconsistency about nomenclature of thulium surgery and to ensure comparability of future publications. A literature search of articles on thulium laser treatment of benign prostatic hyperplasia (BPH) was conducted between 2009 and 2019. We proposed a new classification standard for laser settings and associated surgical procedure. Each article was analyzed and categorized as concordant or discordant referring to the new classification. In total, 74 papers were included in this narrative review. Overall, 43% and 42% of included studies reported discordant laser parameters and surgical description, respectively. Most of the studies on vaporization were categorized as discordant because they reported a medium/low laser setting instead of high power. Conversely, 93.3% of studies on enucleation were deemed as discordant for laser setting because they reported high power parameters instead of medium-low power setting. Most of the studies on laser enucleation and vapo/enucleation were considered discordant for surgical procedure since authors did not mention the use of mechanical vs. laser method for enucleation. The current literature lacks a uniform definition and standardization of the terminology of thulium laser settings and surgical techniques to guarantee comparability between different approaches. We found a huge heterogeneity in 10 years of surgery with thulium laser. We proposed a new classification of laser setting and procedural description for categorization of thulium laser surgery for BPH.
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Affiliation(s)
- Serena Maruccia
- Department of Urology, Istituti Clinici Zucchi, Monza, Italy
| | - Irene Fulgheri
- Department of Pharmacy, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | | | - Luca Boeri
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.
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Cacciamani GE, Cuhna F, Tafuri A, Shakir A, Cocci A, Gill K, Gómez Rivas J, Dourado A, Veneziano D, Okhunov Z, Capogrosso P, Hueber PA, Alberseen M, Abreu A, Migliorini F, Fiori C, Porcaro AB, Porpiglia F, Desai M, Russo GI. Anterograde ejaculation preservation after endoscopic treatments in patients with bladder outlet obstruction: systematic review and pooled-analysis of randomized clinical trials. MINERVA UROL NEFROL 2019; 71:427-434. [PMID: 31487977 DOI: 10.23736/s0393-2249.19.03588-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Despite the high rate of resolution, ejaculatory dysfunction still is the most common side effect related to surgical treatment of bladder outlet obstruction (BOO). The aim of the present systematic review was to compare several technological treatment modalities for the management of lower urinary tract symptoms/BOO in terms of functional and sexual outcomes. EVIDENCE ACQUISITION All English language randomized controlled trials assessing the impact of different endoscopic treatments for BOO were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement to evaluate PubMed®, Scopus®, and Web of Science™ databases (up to June 2019). EVIDENCE SYNTHESIS Our electronic search identified a total of 2221 papers in PubMed, Scopus, and Web of Science. Of these, 142 publications were identified for detailed review, which yielded 21 included in the present systematic review. All groups appeared similar with regards to preoperative IPSS/AUA Score, Qmax, and prostate volume (cc). Patients undergoing endoscopic treatments using ThuLEP, Greenlight or Prostate Artery Embolization techniques had lower-but not statistically significant- relative risk (RR) of retrograde ejaculation compared with conventional transurethral resection of the prostate (TURP) (RR: 0.90; P=0.35; RR: 0.71; P=0.1; RR0.73; P=0.11). Efficacy of those techniques was equal to TURP. CONCLUSIONS Data reporting anterograde ejaculation preservation after endoscopic treatment in patients with benign prostatic enlargement are sparse and heterogeneous. Pooled analyses suggest that new technological alternatives to conventional TURP might improve sexual outcomes, especially for non-ablative treatments.
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Affiliation(s)
- Giovanni E Cacciamani
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA -
| | - Frederico Cuhna
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | - Alessandro Tafuri
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA.,Department of Urology, University of Verona, Verona, Italy
| | - Aliasger Shakir
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | - Andrea Cocci
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Karanvir Gill
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | | | - Aurus Dourado
- Department of Urology, São Marcos Hospital, Piauí, Brazil
| | - Domenico Veneziano
- Department of Urology and Renal Transplantation, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, CA, USA
| | | | - Pierre A Hueber
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | - Marteen Alberseen
- Department of Urology and Pediatric Urology, Medicine University Mainz, Mainz, Germany
| | - Andre Abreu
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | | | - Cristian Fiori
- Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy
| | | | - Francesco Porpiglia
- Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy
| | - Mihir Desai
- USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | - Giorgio I Russo
- Department of Urology, University of Catania, Catania, Italy
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Sun F, Sun X, Shi Q, Zhai Y. Transurethral procedures in the treatment of benign prostatic hyperplasia: A systematic review and meta-analysis of effectiveness and complications. Medicine (Baltimore) 2018; 97:e13360. [PMID: 30572440 PMCID: PMC6320039 DOI: 10.1097/md.0000000000013360] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND With the progress of surgical techniques and instruments, various minimally invasive surgical therapies were developed to treat benign prostatic hyperplasisa (BPH). However, the efficacy and safety of different transurethral procedures for the treatment of BPH are still undefined. METHOD A systematic search was performed for all randomized controlled trials (RCTs), which compared the transurethral procedures for BPH from 1995 to 2016. The clinical baseline characteristics, International Prostate Symptom Score (IPSS), quality of life (QoL), postvoid residual (PVR), maximum flow rate (Qmax), short-term and long-term complications were analyzed using RevMan and ADDIS software. RESULT Eighty-eight randomly controlled trials and fifteen procedures were included in the network meta-analysis. HoLEP greatly inproved PVR. TmLRP had the best efficacy in improving QoL score. Diode laser vaporization of prostate was superior in improving IPSS and Qmax. Diode laser through vaporization required the shortest time in catheterization, while Nd:YAG was the longest procedure. For the hospitalization time, TUR was the longest and HoLEP was the shortest. TmLRP was related to the lowest postoperative hemoglobin decrease. TmLEP had the least rates of occurrence of hematuria, reoperation and erectile dysfunction. HoLEP was the best choice to reduce the incidence of recatheterization, urinary retention, urinary tract infection, stress urinary incontinence and retrograde ejaculation. The complications such as blood transfusion, urethral stricture, bladder neck contracture were relatively rare in the patients who underwent diode laser vaporization of prostate. CONCLUSION Compared with other transurethral procedures, thulium, holmium and diode lasers were associated with better efficacy and fewer complications.
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Thulium laser VapoResection of the prostate versus traditional transurethral resection of the prostate or transurethral plasmakinetic resection of prostate for benign prostatic obstruction: a systematic review and meta-analysis. World J Urol 2018; 36:1355-1364. [DOI: 10.1007/s00345-018-2287-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/28/2018] [Indexed: 02/03/2023] Open
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Investigations of initial airtightness after non-anatomic resection of lung parenchyma using a thulium-doped laser with different optical fibres. Lasers Med Sci 2016; 31:1097-103. [DOI: 10.1007/s10103-016-1952-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 04/27/2016] [Indexed: 11/26/2022]
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Zhang X, Shen P, He Q, Yin X, Chen Z, Gui H, Shu K, Tang Q, Yang Y, Pan X, Wang J, Chen N, Zeng H. Different lasers in the treatment of benign prostatic hyperplasia: a network meta-analysis. Sci Rep 2016; 6:23503. [PMID: 27009501 PMCID: PMC4806333 DOI: 10.1038/srep23503] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 03/09/2016] [Indexed: 02/05/2023] Open
Abstract
All available surgical treatments for benign prostatic hyperplasia (BPH) have their individual advantages or disadvantages. However, the lack of head-to-head studies comparing different surgeries makes it unavailable to conduct direct analysis. To compare the efficacy and safety among different lasers and transurethral resection of prostate (TURP) for BPH, randomized controlled trials were searched in MEDLINE, EMBASE, Cochrane library, WHO International Clinical Trial Registration Platform, and Clinical Trial.gov by 2015.5; and the effectiveness-, perioperation- and complication-related outcomes were assessed by network meta-analysis. 36 studies involving 3831 patients were included. Holmium laser through resection and enucleation had the best efficacy in maximum flow rate. Thulium laser through vapo-resection was superior in improving international prostate symptom score and holmium laser through enucleation was the best for post-voiding residual volume improvement. Diode laser through vaporization was the rapidest in removing postoperative indwelling catheter, while TURP was the longest. TURP required the longest hospitalization and thulium laser through vapo-resection was relatively shorter. Holmium and thulium lasers seem to be relatively better in surgical efficacy and safety, so that these two lasers might be preferred in selection of optimal laser surgery. Actually, more large-scale and high quality head-to-head RCTs are suggested to validate the conclusions.
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Affiliation(s)
- Xingming Zhang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Pengfei Shen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Qiying He
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Xiaoxue Yin
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Zhibin Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Haojun Gui
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Kunpeng Shu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Qidun Tang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Yaojing Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Xiuyi Pan
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Jia Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Ni Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China, 610041
| | - Hao Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China, 610041
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Comparison between thulium laser resection of prostate and transurethral plasmakinetic resection of prostate or transurethral resection of prostate. Sci Rep 2015; 5:14542. [PMID: 26444930 PMCID: PMC4595764 DOI: 10.1038/srep14542] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 03/30/2015] [Indexed: 02/05/2023] Open
Abstract
Benign prostatic hyperplasia (BPH) is one of the most common diseases in middle-aged and elderly men. In the present study, we aimed to compare the efficacy and safety of thulium laser resection of the prostate (TMLRP) with either transurethral plasmakinetic resection of the prostate (TUPKP) or transurethral resection of the prostate (TURP). A literature search was performed, eventually, 14 studies involving 1587 patients were included. Forest plots were produced by using Revman 5.2.0 software. Our meta-analysis showed that operation time, decrease in hemoglobin level, length of hospital stay, catheterization time, and development of urethral stricture significantly differed, whereas the transitory urge incontinence rate, urinary tract infection rate, and recatheterization rate did not significantly differ between TMLRP and either TURP or TUPKP. The blood transfusion rate was significantly different between TMLRP and TURP, but not between TMLRP and TUPKP. In addition, the retrograde ejaculation rate between TMLRP and TURP did not significantly differ. At 1, 3, 6, and 12 months of postoperative follow-up, the maximum flow rate, post-void residual, quality of life, and International Prostate Symptom Score did not significantly differ among the procedures. Thus, the findings of this study indicate that TMLRP may be a safe and feasible alternative.
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Marra G, Sturch P, Oderda M, Tabatabaei S, Muir G, Gontero P. Systematic review of lower urinary tract symptoms/benign prostatic hyperplasia surgical treatments on men's ejaculatory function: Time for a bespoke approach? Int J Urol 2015; 23:22-35. [DOI: 10.1111/iju.12866] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/08/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Giancarlo Marra
- Urology Clinic; Città della Salute e della Scienza; University of Turin; Turin Italy
| | - Paul Sturch
- Department of Urology; King's College Hospital; London UK
| | - Marco Oderda
- Urology Clinic; Città della Salute e della Scienza; University of Turin; Turin Italy
| | - Shahin Tabatabaei
- Department of Urology; Massachusetts General Hospital; Boston MA USA
| | - Gordon Muir
- Department of Urology; King's College Hospital; London UK
| | - Paolo Gontero
- Urology Clinic; Città della Salute e della Scienza; University of Turin; Turin Italy
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Jiang H, Zhou Y. Safety and Efficacy of Thulium Laser Prostatectomy Versus Transurethral Resection of Prostate for Treatment of Benign Prostate Hyperplasia: A Meta-Analysis. Low Urin Tract Symptoms 2015; 8:165-70. [PMID: 27619781 DOI: 10.1111/luts.12092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/03/2014] [Accepted: 12/16/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of the present study was to objectively evaluate the safety and efficacy of Thulium laser prostatectmy (TmLRP) versus transurethral resection of prostate (TURP) in treating benign prostate hyperplasia (BPH). METHODS Online databases such as Cochrane Library, PubMed, Embase, and Chinese biomedicine literature database were searched by randomized control trial (RCT), quasi-randomized control trial (Q-RCT) and case control study (CCSs) about TmLRP versus TURP for the treatment of BPH. After study selection, assessment and data extraction conducted, Meta-analyses were performed by using the RevMan 5.2 software. RESULTS Six studies involving 640 patients were included and the results of follow-up time was 1 year. The results of meta-analyses showed that: (i) safety indicators: compared with TURP, TmLRP was associated with less decrease of serum sodium salt, less blood transfusion, shorter catheterization time hospital time and more operation time. No differences were noted in the TUR syndrome, recatheterization rate, transitory urge incontinence, stress incontinence urethral stricture and retrograde ejaculation. (ii) Efficacy indicators (International Prostate Symptom Score [IPSS], post-void residual [PVR], Qmax, quality of life [QoL]): Compared with the baseline, significant improvement in IPSS, QoL, Qmax and PVR were obvious improvement before and after surgery in both groups. There were statistical differences in IPSS at 12 months, QoL at 1, 6 months and Qmax 1, 6 months between the two groups. CONCLUSIONS TmLRP is a safe and effective procedure for treatment of benign prostatic hyperplasia. Compared with TURP, TmLRP was not only associated with less decrease of serum sodium salt, less blood transfusion, shorter catheterization time and hospital time, but also may be superior to TURP in efficacy.
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Affiliation(s)
- HongJing Jiang
- Department of Urology, Chongqing Dongnan Hospital, Chongqing, China
| | - Yu Zhou
- Department of Urology, Chongqing Dongnan Hospital, Chongqing, China.
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Zhu Y, Zhuo J, Xu D, Xia S, Herrmann TRW. Thulium laser versus standard transurethral resection of the prostate for benign prostatic obstruction: a systematic review and meta-analysis. World J Urol 2014; 33:509-15. [PMID: 25298242 DOI: 10.1007/s00345-014-1410-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 07/31/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To assess the efficacy and safety of thulium laser versus standard transurethral resection of the prostate (TURP) for treating patients with benign prostatic obstruction. METHODS A systematic search of the electronic databases, including Medline, Embase, Web of Science, and The Cochrane Library, was performed up to February 1, 2014. The pooled estimates of demographic and clinical baseline characteristics, perioperative variables, complications, and postoperative efficacy including International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and postvoid residual (PVR) were calculated. RESULTS Seven trials assessing thulium laser versus standard TURP were considered suitable for meta-analysis including four randomized controlled trials (RCTs) and three non-RCTs. Compared with TURP, although thulium laser prostatectomy (TmLRP) needed a longer operative time [weighted mean difference (WMD) 8.18 min; 95 % confidence interval (CI) 1.60-14.75; P = 0.01], patients having TmLRP might benefit from significantly less serum sodium decreased (-3.73 mmol/L; 95 % CI -4.41 to -3.05; P < 0.001), shorter time of catheterization (WMD -1.29 days; 95 % CI -1.95 to -0.63; P < 0.001), shorter length of hospital stay (WMD -1.83 days; 95 % CI -3.10 to -0.57; P = 0.005), and less transfusion (odds ratio 0.09; 95 % CI 0.02-0.41; P = 0.002). During the 1, 3, and, 12 months of postoperative follow-up, the procedures did not demonstrate a significant difference in IPSS, QoL, Qmax, and PVR. CONCLUSIONS TmLRP had a similar efficacy to standard TURP in terms of IPSS, QoL, Qmax, and PVR, and offered several advantages over TURP in terms of blood transfusion, serum sodium decreased, catheterization time, and hospital stay, while TURP was superior in terms of operation duration. Well-designed multicentric/international RCTs with long-term follow-up are still needed.
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Affiliation(s)
- Yiping Zhu
- Department of Urology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, No.100, Haining Road, Shanghai, 200080, People's Republic of China
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Pariser JJ, Famakinwa OJ, Pearce SM, Chung DE. High-power thulium laser vaporization of the prostate: short-term outcomes of safety and effectiveness. J Endourol 2014; 28:1357-62. [PMID: 24936718 DOI: 10.1089/end.2014.0336] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The thulium laser was introduced in 2005 for the treatment of benign prostatic hyperplasia (BPH). Enucleation studies from outside North America show comparable efficacy and lower morbidity to transurethral resection of the prostate. A few studies exist describing outcomes of vaporization, the most commonly used technique for urologists. We present our 3-month outcomes of thulium laser vaporization of the prostate (ThuVP). MATERIALS AND METHODS From December 2010 to October 2013, 68 men underwent ThuVP using the 150 W CyberTM(®). Data were collected on demographics, comorbidities, intraoperative measures, complications, serum parameters, maximum flow rate (Qmax), postvoid residual (PVR), International Prostate Symptom Score (IPSS), quality-of-life (QoL) score, and prostate-specific antigen. Patients were evaluated at 1 week, 1 month, and 3 months postoperatively. Nine patients were excluded for known prostate cancer. RESULTS The mean age was 66±10 years, with a mean prostate size of 57±30 mL. At baseline, the mean IPSS was 19.9±8.0, QoL score was 4.5±1.1, Qmax was 5.2±4.5 mL/sec, and PVR was 220±397 mL. The mean laser time was 35±18 minutes, and energy used was 234±139 kJ. Forty-seven (78%) patients were discharged the day of surgery. No blood transfusions were administered with a mean drop in hemoglobin of 0.7±0.8 g/dL (p<0.05). There were no Clavien grade≥III complications within 30 days of surgery. Six (10%) patients were diagnosed with urinary tract infection. Significant improvements from baseline were seen in Qmax, PVR, IPSS, and QoL score. All 15 patients who were in retention were voiding at the last follow-up. CONCLUSIONS Thulium laser vaporization of the prostate appears to be a safe and effective outpatient technique for the treatment of BPH with durable outcomes at 3 months.
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Chung JS, Kang PM, Seo WI, Oh CK, Kim SC, Park SH, Choi JH, Yoon JH, Kang DI, Chung JI. Thulium laser (RevoLix) vaporesection versus vapoenucleation with morcellator (Piranha) for the treatment of benign prostatic obstruction: a propensity-matched multicenter analysis. Int J Urol 2014; 21:1156-61. [PMID: 25040293 DOI: 10.1111/iju.12547] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To compare the efficacy and safety of vaporesection without a morcellator, and vapoenucleation with a morcellator in thulium laser prostatectomy for the treatment of benign prostatic obstruction. METHODS Between March 2010 and January 2013, 405 patients underwent thulium:yttrium-aluminium-garnet laser prostatectomy. Among these patients, 150 patients who underwent thulium:yttrium-aluminium-garnet laser prostatectomy without a morcellator (n = 75) or with a morcellator (n = 75) were analyzed in a propensity matching study. Outcome measures included International Prostate Symptom Score, quality of life score, maximum flow rate, postvoid residual, total operating time, laser time and resected tissue weight. RESULTS No significant differences were noted between the thulium:yttrium-aluminium-garnet laser prostatectomy without a morcellator and thulium:yttrium-aluminium-garnet laser prostatectomy with a morcellator groups, including the prostate volume (50.3 vs 51.9 mL) and postoperative prostate volume (22.4 vs 18.7 mL). However, there were differences between the groups in total operating time (72.8 vs 61.0 min, P = 0.023) and laser activating time (24.5 vs 19.9 min, P = 0.037). Thulium:yttrium-aluminium-garnet laser prostatectomy with a morcellator showed greater resected tissue volume than thulium:yttrium-aluminium-garnet laser prostatectomy without a morcellator (9.0 vs 18.2 g, P = 0.029). There were also significant differences in total retrieval efficiency (1.14 vs 1.67 g/min, P = 0.031). There were no significant differences in improvement of International Prostate Symptom Score, quality of life scores and urodynamic findings between the two groups, except for the International Prostate Symptom Score (11.2 vs 7.3, P = 0.028) at 6 weeks after surgery. CONCLUSION Thulium:yttrium-aluminium-garnet laser prostatectomy with a morcellator provides superior reduction of prostate volume and better short-term clinical outcomes than thulium:yttrium-aluminium-garnet laser prostatectomy without a morcellator in the treatment of patients with benign prostatic obstruction. Furthermore, thulium:yttrium-aluminium-garnet laser prostatectomy with a morcellator can offer a shorter operative time.
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Affiliation(s)
- Jae Seung Chung
- Department of Urology, Haeundae Paik Hospital, Inje University, Busan, Korea
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Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, McVary K, Novara G, Woo H, Madersbacher S. A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update. Eur Urol 2014; 67:1066-1096. [PMID: 24972732 DOI: 10.1016/j.eururo.2014.06.017] [Citation(s) in RCA: 514] [Impact Index Per Article: 51.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/12/2014] [Indexed: 10/25/2022]
Abstract
CONTEXT A number of transurethral ablative techniques based on the use of innovative medical devices have been introduced in the recent past for the surgical treatment of benign prostatic obstruction (BPO). OBJECTIVE To conduct a systematic review of the literature and a meta-analysis of available randomized controlled trials (RCTs), and to evaluate the efficacy and safety of transurethral ablative procedures for BPO. EVIDENCE ACQUISITION A systematic literature search was performed for all RCTs comparing any transurethral surgical technique for BPO to another between 1992 and 2013. Efficacy was evaluated after a minimum follow-up of 1 yr based on International Prostate Symptom Score, maximum flow rate, and postvoid residual volume. Efficacy at midterm follow-up, prostate volume, perioperative data, and short-term and long-term complications were also assessed. Data were analyzed using RevMan software. EVIDENCE SYNTHESIS A total of 69 RCTs (8517 enrolled patients) were included. No significant difference was found in terms of short-term efficacy between bipolar transurethral resection of the prostate (B-TURP) and monopolar transurethral resection of the prostate (M-TURP). However, B-TURP was associated with a lower rate of perioperative complications. Better short-term efficacy outcomes, fewer immediate complications, and a shorter hospital stay were found after holmium laser enucleation of the prostate (HoLEP) compared with M-TURP. Compared with M-TURP, GreenLight photoselective vaporization of the prostate (PVP) was associated with a shorter hospital stay and fewer complications but no different short-term efficacy outcomes. CONCLUSIONS This meta-analysis shows that HoLEP is associated with more favorable outcomes than M-TURP in published RCTs. B-TURP and PVP have resulted in better perioperative outcomes without significant differences regarding efficacy parameters after short-term follow-up compared with M-TURP. Further studies are needed to provide long-term comparative data and head-to head comparisons of emerging techniques. PATIENT SUMMARY Bipolar transurethral resection of the prostate, photovaporization of the prostate, and holmium laser enucleation of the prostate have shown efficacy outcomes comparable with conventional techniques yet reduce the complication rate. The respective role of these new options in the surgical armamentarium needs to be refined to propose tailored surgical treatment for benign prostatic obstruction relief.
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Affiliation(s)
- Jean-Nicolas Cornu
- Department of Urology, Tenon Hospital, University Paris 6, Assistance Publique-Hopitaux de Paris, Paris, France.
| | - Sascha Ahyai
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Jean de la Rosette
- Department of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - Peter Gilling
- Department of Urology, Tauranga Hospital, Tauranga, New Zealand
| | - Christian Gratzke
- Department of Urology, Urologische Klinik und Poliklinik, Klinikum der Universität München-Großhadern, Munich, Germany
| | - Kevin McVary
- Department of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology-Urology Clinic, University of Padua, Padua, Italy
| | - Henry Woo
- Department of Urology, Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, Australia
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Tang K, Xu Z, Xia D, Ma X, Guo X, Guan W, Hu Z, Zhang X, Ye Z, Xu H. Early outcomes of thulium laser versus transurethral resection of the prostate for managing benign prostatic hyperplasia: a systematic review and meta-analysis of comparative studies. J Endourol 2013; 28:65-72. [PMID: 23980542 DOI: 10.1089/end.2013.0404] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess the efficacy and safety of thulium laser resection of the prostate (TmLRP) vs transurethral resection of the prostate (TURP) for treating patients with benign prostatic hyperplasia (BPH). METHODS A systematic search of the electronic databases, including Medline, Scopus, China National Knowledge Infrastructure, and the Cochrane Library was performed up to May 1, 2013. The pooled outcomes of interest assessing the two techniques included demographic and clinical baseline characteristics, perioperative variables, complications, and postoperative efficacy including maximum flow rate (Qmax), postvoid residual (PVR), quality of life (QoL) and International Prostate Symptom Score (IPSS). RESULTS Nine trials assessing TmLRP vs. TURP were considered suitable for meta-analysis including three randomized controlled trials (RCTs), two prospective, and four retrospective studies. Compared with TURP, although TmLRP needed a longer operative time (weighted mean difference [WMD]: 9.00 min; 95% confidence interval [CI], 2.53-15.47; P=0.006), patients having TmLRP might benefit from significantly less serum sodium decreased (-3.58 mmol/L; 95% CI, -4.04 to -3.12; P<0.001), less serum hemoglobin decreased (WMD: -0.94 mmol/L; 95% CI, -1.44 to -0.44; P<0.001), shorter time of catheterization (WMD: -2.07 days; 95% CI, -2.66 to -1.49; P<0.001), shorter length of hospital stay (WMD: -1.87 days; 95% CI, -2.41 to -1.33; P<0.001), and fewer total complications (odds ratio [OR]: 0.29; 95% CI, 0.20-0.41; P<0.001). During the 1, 3, 6, and 12 months of postoperative follow-up, the procedures did not demonstrate a significant difference in Qmax, IPSS, PVR, and QoL. CONCLUSIONS Our data suggest that as a promising minimally invasive technique, TmLRP appears to be a safe, feasible, and efficient alternative to TURP for treating patients with BPH with reliable perioperative safety, fewer complications, and comparable efficacy in relation to Qmax, PVR, QoL, and IPSS. Because of the inherent limitations of the included studies, further large sample prospective, multicentric, long-term follow-up studies and RCTs should be undertaken to confirm our findings.
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Affiliation(s)
- Kun Tang
- 1 Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China
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