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Garman T, Cho A, Stoddard MD, Kilemnik I, Malka V, Elterman D, Chughtai B. The Mechanism of Action of cTIND for Minimally Invasive Ischemic Incision of the Prostate: In Vivo Study. Urology 2021; 157:217-221. [PMID: 34058242 DOI: 10.1016/j.urology.2021.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To understand the histologic changes of prostate tissue induced by temporary implantable nitinol device (cTIND) in a canine model. METHODS The cTIND is a small, symmetric device comprised of nitinol wire loops welded together on an axis, which exert radial force on the tissue to induce a targeted ischemic effect. The cTIND was implanted in three live canine models, which were monitored for 14 days post-index procedure. Device placement was monitored via serial fluoroscopy and biologic effects of cTIND were studied via histopathology. RESULTS The cTIND was successfully placed in the canine models and remained securely in position until the animal was sacrificed on postoperative day 14. The cTIND treated tissue demonstrated an abrupt transition from normal, viable prostatic glandular tissue to an area of shrunken necrosis and fibrosis between the two. CONCLUSION In the canine models, the cTIND created focal areas of ischemic necrosis resulting in incisions in the peri-urethral prostate with minimal inflammation.
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Affiliation(s)
- Tyler Garman
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY
| | - Ahra Cho
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY
| | - Michelina D Stoddard
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY
| | | | | | - Dean Elterman
- Department of Urology, University Health Network, Toronto, Ontario, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY.
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Comparison of Penile Cuff Test and Conventional Urodynamic Study Prior to Photoselective Vaporization of Prostate for Benign Prostate Hyperplasia Using a 120 W GreenLight High Performance System Laser. J Clin Med 2020; 9:jcm9041189. [PMID: 32326373 PMCID: PMC7231057 DOI: 10.3390/jcm9041189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/17/2020] [Accepted: 04/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background: We compared the utility of the penile cuff test (PCT) and the conventional urodynamic study (UDS) for the preoperative assessment of patients undergoing scheduled photoselective vaporization of the prostate (PVP) for benign prostate hyperplasia (BPH). Methods: Fifty-nine patients with voiding lower urinary tract symptoms (LUTS) underwent a simultaneous PCT and conventional UDS before PVP. The modified International Continence Society (ICS) nomogram was used to confirm bladder outlet obstruction after measuring maximum urinary flow rate and highest pressure at flow interruption. The PCT and UDS results, in terms of modified ICS nomogram predictions, were compared. Their sensitivities, specificities, and positive and negative predictive values were calculated. Results: Thirty-six patients were diagnosed as obstructed and 23 as non-obstructed/equivocal using the modified ICS nomogram during the PCT. All 36 of the first group were confirmed as obstructed by UDS. Of the 23 diagnosed as non-obstructed/equivocal by the PCT, 14 were confirmed to be non-obstructed by UDS, with nine diagnosed as obstructed. The PCT showed a sensitivity of 80% and a specificity of 100%. The positive and negative predictive values were 100% and 60.9%, respectively. Conclusions: In conclusion, despite our small number of patients, the PCT’s high sensitivity and specificity suggest that it may provide diagnostic information about bladder outlet obstruction before PVP for patients with voiding LUTS. Evidently, the PCT has the potential to be used for some patients as a screening alternative to invasive UDS.
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Ren XL, Xia HB. Development of Medical Lasers for Treatment on Benign Prostatic Hyperplasia. Chin Med J (Engl) 2018; 131:2265-2268. [PMID: 30203813 PMCID: PMC6144847 DOI: 10.4103/0366-6999.240804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Xiao-Lei Ren
- Department of Urology, The Second Affiliated Hospital of Chifeng College, Chifeng, Inner Mongolia Autonomous Region 024000, China
| | - Hai-Bo Xia
- Department of Urology, The Second Affiliated Hospital of Chifeng College, Chifeng, Inner Mongolia Autonomous Region 024000, China
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Abstract
The study is aiming to evaluate the treatment safety and efficacy of greenlight laser photovaporization of the prostate (PVP) combined with transurethral electrovaporization resection (TUVP) for elderly (≥ 70 years) men with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH/LUTS) with a large prostate volume (≥ 80 mL). One hundred twelve BPH/LUTS patients treated with PVP were divided into 2 groups according to prostate volume (PV), the outcomes of the 2 groups were assessed at 12 months after the operation. Patients in the PV ≥ 80 group (n = 51) had a higher level of maximum detrusor pressure (Pdet.max) than those in the PV < 80 group (n = 61) (97.14 ± 36.68 vs 70.70 ± 32.55, P < .001). Pdet.max level of the 2 groups was significantly decreased at the end of follow-up. International Prostate Symptom Score questionnaires (IPSS) score, maximum flow rate (Qmax), and residual urine volume (PVR) were significantly improved in comparison to the preoperative status (P < .001). PVP combined with TUVP can significantly improve outcomes (IPSS, Qmax, PVR) and is a safe and effective technique for elderly BPH/LUTS patients with a large prostate volume.
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Ajib K, Mansour M, Zanaty M, Alnazari M, Hueber PA, Meskawi M, Valdivieso R, Tholomier C, Pradere B, Misrai V, Elterman D, Zorn KC. Photoselective vaporization of the prostate with the 180-W XPS-Greenlight laser: Five-year experience of safety, efficiency, and functional outcomes. Can Urol Assoc J 2018; 12:E318-E324. [PMID: 29603912 DOI: 10.5489/cuaj.4895] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Transurethral resection of the prostate (TURP) is still considered the gold standard surgical treatment for symptomatic benign prostatic hyperplasia (BPH). However, photoselective vaporization of the prostate (PVP) has gained widespread global acceptance in national guidelines as a safe and effective alternative option. Nevertheless, further evidence is required to assess the durability of Greenlight PVP. Herein, we report our five years of PVP experience with the Greenlight 180W XPS laser system. METHODS A retrospective analysis was conducted on a prospectively gathered database of 370 consecutively included patients who underwent PVP using Greenlight XPS-180 W laser system (Boston Scientific, Boston, MA, U.S.) performed by a single experienced laser surgeon between 2011 and 2016. Preoperative characteristics, intervention parameters, postoperative functional, uroflowmetry outcomes, and complications were collected. Outcomes are reported over a period of five years. RESULTS Mean age was 68 years, with a mean prostate volume of 78.8 cc (95% confidence interval [CI] 70.9-78.7]). The mean followup was 59.4 months (55.4-63.5). Mean energy, operative time, and energy/cc were 270.2 kJ (255.2-285.2), 62.7 minutes (59.6-65.7), and 3.7 kJ/cc (3.6-3.9), respectively. Compared to preoperative values, International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and post-void residual (PVR) parameters were significantly improved and sustained over the five postoperative years. Of note, only 66 patients (out of 370) had a complete five-year followup. Prostate-specific antigen (PSA) reached nadir at one year, with a drop of 67% from the mean preoperative value of 6.2 ng/mL. Mean IPSS nadir was reached at three years, with a drop of 80.4% (-21.1 points). Similarly, mean quality of life (QoL) score dropped by 82.8% after three years (preoperative mean of 4.7). With respect to mean Qmax, there was an increase by 72.7% (+14.7 mL/s) at one year, reaching the value of 19.9 mL/s. Moreover, mean PVR was 32.8 mL at four years compared to 345 mL preoperatively. At five years followup, PSA, IPSS, QoL, and PVR dropped by 59.7% (3.7 ng/mL), 75.2% (19.7 points), 78.72% (3.7 points), and 84.4% (291.3 mL), respectively. Qmax increased by 12.9 mL/s. Clavien complication rates were low, with bladder neck stenosis observed in seven (1.6%) men. During the five-year followup, only four patients (1%) required BPH surgical re-intervention. CONCLUSIONS This is the first long-term reporting of Greenlight XPS-180W laser system. In experienced hands, the observed outcomes appear to demonstrate that Greenlight XPS-180 W laser system is safe, efficacious, and durable for the treatment of bladder outlet obstruction (BOO) secondary to BPH.
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Affiliation(s)
- Khaled Ajib
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Mila Mansour
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Marc Zanaty
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Mansour Alnazari
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Pierre-Alain Hueber
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Malek Meskawi
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Roger Valdivieso
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Come Tholomier
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.,Department of Urology, McGill University, Montreal, QC, Canada
| | - Benjamin Pradere
- Department of Urology, Centre Hospitalier Universitaire, Tours, France
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Dean Elterman
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Kevin C Zorn
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
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