The evolution of KTP laser vaporization of the prostate

The Long-Pulse Potassium-Titanyl-Phosphate Laser: Promising Treatment for Resistant Port-Wine Stains

Port-wine stains (PWSs), or port-wine birthmarks, are congenital vascular malformations that manifest as erythematous to pink patches at birth. At present, lasers are the preferred method for treating PWSs, with pulsed dye laser (PDL) being regarded as the gold standard because of its superior efficacy compared to alternative procedures. Despite the progress made in laser therapy, a subset of patients continue to experience PWSs that cannot be resolved effectively even with PDL. A new long-pulse potassium-titanyl-phosphate (KTP) laser with a trail of sub-pulses (Derma V, Lutronic, Seoul, South Korea) is a promising treatment for PWSs resistant to PDL therapies. This is a case of a female patient with PDL-resistance PWSs that was treated successfully with a long-pulse KTP laser. Long-pulse KTP appears to be not just more effective in treating PDL-resistant PWSs but also less costly as less number of sessions are needed, with no significant side effects reported such as purpura.

A PEDOT nano-composite for hyperthermia and elimination of urological bacteria

Novel modalities for overcoming recurrent urinary tract infections associated with indwelling urinary catheters are needed, and rapidly induced hyperthermia is one potential solution. PEDOT nanotubes are a class of photothermal particles that can easily be incorporated into silicone to produce thin, uniform coating on medical grade silicone catheters; subsequent laser stimulation therein imparts temperature elevations that can eliminate bacteria and biofilms. PEDOT silicone coatings are stable following thermal sterilization and repeated heating and cooling cycles. Laser stimulation can induce temperature increases of up to 55 °C in 300 s, but only 45 s was needed for ablation of UTI inducing E. coli biofilms in vitro. This work also demonstrates that mild hyperthermia of 50 °C, applied for only 31 s in the presence of antibiotics could eliminate E. coli biofilm as effectively as high temperatures. This work culminates in the evaluation of the PEDOT NTs for photothermal elimination of E. coli in an in vivo model to demonstrate the safety and effectiveness of a photothermal nanocomposite (16 s treatment time) for rapid clearance of E. coli.

En bloc resection of bladder tumors: challenges and unmet needs in 2021

Non-muscle invasive bladder cancer accounts for the majority of new bladder cancer diagnoses, and endoscopic transurethral resection of bladder tumor (TURBT) represents the standard-of-care. Although a relatively safe and common procedure, TURBT is often hampered by the questionable quality of resection. The evolution of surgical techniques has brought en bloc resection of bladder tumor (ERBT) to the forefront. ERBT has emerged as an alternative to conventional TURBT, incorporating a more delicate en bloc sculpting and tumor excision, in contrast to 'piecemeal' resection by conventional TURBT. ERBT appears safe, feasible and effective with demonstrably higher rates of detrusor muscle in the pathologic specimen, all while providing better staging and obviating the need for a re-TURBT in selected patients. However, the method's adoption in the field is still limited. This review summarizes the recent evidence relevant to ERBT while further highlighting the technique's limitations and unmet needs.

The safety and feasibility of the simultaneous use of 180-W GreenLight laser for prostate vaporization during concomitant surgery

OBJECTIVES

To explore the safety and feasibility of photo-selective vaporization of the prostate (PVP) with GreenLight XPS 180 Watt laser (GL-180- W XPS) combined with other surgical procedures.

MATERIAL AND METHODS

Data on patients in whom GL-180-W XPS was performed to relieve lower urinary tract symptoms/ benign prostatic hyperplasia (LUTS/BPH) symptoms were extracted from a multi-institutional database (2011-2016). Patients were stratified into two groups. In the first all patients who had GL-180-W XPS with a concomitant procedure during the same surgical session were included as cases while those who underwent GL-180-W XPS PVP only were included as control.

RESULTS

A total of 487 patients were included. Fifty-eight (11.9%) patients underwent concomitant procedures. Multivariable linear regression models failed to find an association between concomitant procedures and longer laser time (p = 0.4). Similarly, multivariable linear regression models failed to find an association between concomitant procedures and laser time even when the analyses were repeated and stratified into endoscopic (p = 0.6) and open/laparoscopic (p = 0.4) procedures. Multivariable logistic regression models failed to demonstrate any association between concomitant procedures and early complications (OR:1.39, CI: 0.379-2.44, p = 0.2), late complications (OR:1.84, CI:0.78-3.98; p = 0.1) and acute urinary retention (OR:1.84, CI:0.78-3.98; p = 0.1). When the analyses were repeated and the concomitant procedures stratified into endoscopic and open/laparoscopic ones, they yielded virtually the same results.

CONCLUSIONS

GL-180-W XPS PVP could be safely performed in concomitant endoscopic or open/laparoscopic surgery. These results should be taken into consideration in the counseling of the patient who might choose to undergo simultaneous procedures.

Lasers in the surgical treatment of canine prostatic neoplasia and selected tumours of the male reproductive system

Light-based technologies are applied in various fields of medicine: for example optical diagnostics, light-activated therapy and surgery. Although light-based surgical procedures had hardly been a novelty, the revolutionizing moment for surgery came with the first use of light to cut tissue. Nowadays, surgical lasers are routinely used across numerous medical specialties, including gynaecology and urology. They are a part of the surgical treatment of benign prostatic hyperplasia, prostate carcinoma, penis carcinoma, genital skin lesions and orchidectomy. While in human urology lasers continue to establish their position as one of the standard surgical tools, veterinary patients are rarely treated with what here is still considered a technical innovation. However, through research on laser treatment of the prostate hyperplasia conducted on a canine model, veterinary medicine has gained a massive portion of data. It may prove beneficial for our clinical patients. In this review, we introduce the very principles of laser surgery as well as its current and future applications in oncologic surgery of the canine prostate gland and the male reproductive system.

Comparison of vaporization using 120-W GreenLight laser versus 2-micrometer continuous laser for treating benign prostatic hyperplasia: A 24-month follow-up study of a single center

OBJECTIVE

To evaluate safety, efficacy, and long-term outcomes of photoselective vaporization of prostate using 120-W HPS GreenLight KTP laser and compare the results with those obtained with 2-micrometer continuous-wave (2 um CW) laser for treatment of patients with benign prostatic hyperplasia (BPH).

MATERIALS AND METHODS

One group of 216 patients diagnosed with BPH underwent 120-W KTP laser vaporization of the prostate, while another group of 198 BPH patients underwent 2 um CW laser vaporization. The relevant pre-, peri-, and post-operative parameters were compared between the two therapy groups. Functional results in terms of improvement of International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and post-void residual (PVR) urine were assessed at 3, 6, 12, and 24 months.

RESULTS

BPH was successfully treated with 120-W HPS KTP laser and 2 um CW laser in all patients. There were no significant difference between two patient groups in the baseline characteristics (such as PSA, IPSS, QoL, and Qmax). No major complications occurred intraoperatively (capsule perforation and TUR syndrome) or postoperatively (electric unbalance), and no blood transfusions were required in both groups. Average catheterization time was 1.9±1.3 days for the 120-W PVP and 2.2±1.9 days for the 2 um CW laser treatment. In addition, the hospitalization times were 3.8±1.2days (120-W PVP) and 4.8±1.5 days (2 um CW laser), respectively. The incidence of dysuria and urge incontinence was higher in the 2 um CW laser group (35/198, 24/198) than in the 120 W PVP group (15/216, 10/216). Dramatic improvement was observed in Qmax, IPSS, Qol, and PVR as compared with the respective pre-operative values. The degree of improvement during the follow-up period was comparable in both groups. No significant differences were observed in terms of re-operation rates, bladder neck stricture, and urethral stricture.

CONCLUSIONS

Both 120-W HPS laser and 2 um CW laser vaporization present effective treatment options in patients with BPH, but 120-W PVP provides safer therapy with less post-operative complications within the 2-year follow-up period.

Bladder Neck Contracture After Endoscopic Surgery for Benign Prostatic Obstruction: Incidence, Treatment, and Outcomes

PURPOSE OF REVIEW

In recent years, new endoscopic techniques have been developed to reduce the morbidity of transurethral resection of the prostate. Nonetheless, complications are still frequently encountered and bladder neck contracture (BNC) is a well-described complication after endoscopic surgery for benign prostatic obstruction (BPO). Our aim is to review and discuss the contemporary incidence, the relevant treatment strategies, and their outcomes.

RECENT FINDINGS

Findings suggest that BNC is a common complication with an acceptably low incidence but can range in complexity. Most contractures were usually managed successfully with conservative measures; nevertheless, in patients with refractory BNC, various valuable management strategies were employed with different kinds of success and re-treatment rates. In consideration of these challenging possibilities, the treatment of BNC requires a tailored approach with patient-specific management that can range from simple procedures to complex surgical reconstruction.

Safety, efficacy and reliability of 180-W GreenLight laser technology for prostate vaporization: review of the literature

PURPOSE

The aim of this study is to investigate the efficacy and safety of 180-W XPS GreenLight laser technology for photoselective prostate vaporization.

PATIENTS AND METHODS

A systematic search of the electronic databases was performed. Inclusion criteria were: full-text peer-reviewed journal article, with original data analysis that evaluates the feasibility and the outcome only of 180-W XPS GL laser system. Data at baseline and during follow-up have been taken into account. Intra-operative and postoperative (functional results and complications) data were collected and analyzed.

RESULTS

We found 165 articles in our research, among which only nine articles were selected (total 991 patients). A certain grade of variability is present in all the studies in terms of scientific design, sample size and methods of reporting functional results and complications. Nevertheless, a homogenous benefit for patients in terms of symptom score improvement, post-void residual volume reduction and urinary max flow rate improvement was shown. According to Clavien-Dindo classification, 292 (83.7%) adverse events were recorded ≤ grade 2. Adverse events ≥ grade 3 were 57 (16.3%), among which bleeding, urinary retention and residual obstructive tissue represented the wide majority. No mortality was reported. Male sexual function was poorly investigated.

CONCLUSIONS

The 180-W XPS GL laser technique is feasible and safe, with a remarkable clinical benefit. Long-term evidence on outcomes and complications are suitable even in the sphere of male sexuality.

[History of laser in BPH therapy]

Laser technology has been used in the treatment of BPH for more than 15-20 years in order to challenge transurethral resection of the prostate. The aim of this review article is to analyze the evolution of laser in BPH therapy, from early coagulative techniques - progressively abandoned for their elevated postoperative morbidity and unfavorable outcomes - to the newer techniques of vaporization, resection and enucleation of the prostate. A better comprehension of tissue-laser interactions, the improvement of laser technology and a growing clinical experience have lead to the development of different laser systems (Holmium, KTP, Thulium laser) that challenge TURP. Today, HoLEP and, secondarily, PVP are the laser techniques supported by more clinical evidences and represent valid alternatives to TURP.

[Prostate laser photovaporisation in patients at high risk of bleeding]

Introduction

Les patients sous traitement anticoagulant sont à risque élevé de saignement lors de la résection transurétrale de la prostate ou de l'adénomectomie par taille vésicale et ils se voient souvent récuser pour la chirurgie de l'hyperplasie bénigne de la prostate symptomatique. En Utilisant la photovaporisation de la prostate, les patients à haut risque peuvent subir en toute sécurité la chirurgie. Nous avons évalué l'innocuité et l'efficacité de la photovaporisation de la prostate (PVP) chez les patients sous anticoagulants en cours avec les dérivés de la coumarine, l'aspirine ou le clopidogrel, se plaignant de symptômes d'hypertrophie bénigne de la prostate.

Méthodes

Entre janvier 2009 et mai 2010, 47 hommes sous anticoagulation systémique ont subi une photovaporisation de la prostate. Les données ont été recueillies sur les caractéristiques démographiques, les comorbidités, les complications, la natrémie, l'hémoglobine, le débit urinaire maximal, le résidu post-mictionnel, l'IPSS et les complications.

Résultats

L'âge moyen était de 78 ans, le volume prostatique moyen était de 44g et le PSA était de 3.4ng/ml. Parmi les 10 patients (21.2%) étaient sous AVK, 27 (57.4%) étaient sous aspirine, 2 (4.2%) étaient sous clopidogrel, un sous fondaparinux et 6 (12.7%) étaient sous 2 anticoagulants ou plus. Le score ASA moyen était de 3. La durée moyenne de fonctionnement de l'appareil était de 38 minutes, l'énergie moyenne utilisée était de 200kJ. La durée moyenne d'hospitalisation était de 2 jours. Les complications survenant dans les 30 jours comprenaient une infection urinaire chez 5 patients (10.6%), une dysurie chez 4 patients et une hémorragie retardée chez 4 autres (8.5%). Un seul de ces patients a nécessité une transfusion sanguine et aucun patient n'a nécessité une réintervention. En 3 mois de suivi un seul patient a nécessité une incision du col vésical pour sclérose du col. Aucune incontinence ou sténose urétrale n'a été rapportée. Des améliorations significatives ont été notées dans l'IPSS, le débit urinaire maximal et le résidu post-mictionnel.

Conclusion

La PVP est caractérisé par d'excellentes propriétés hémostatiques et taux très faible de complications peropératoires même chez les patients sous 2 ou plusieurs agents anticoagulants. Sur la base de nos résultats péri-opératoires, nous recommandons la PVP comme traitement chirurgical de première intention chez les patients à haut risque de hémorragique souffrant de symptômes d'hypertrophie bénigne de la prostate.

The application of 120-W high-performance system GreenLight laser vaporization of the prostate in high-risk patients

The purpose of this study is to evaluate the safety and efficacy of 120-W potassium titanyl phosphate (KTP) laser vaporization in patients with benign prostatic hyperplasia (BPH) who also had cardiopulmonary diseases who were taking long-term anticoagulants and were at high risk of bleeding complications. The prospective study included 188 patients with severe lower urinary tract symptoms who underwent 120-W KTP laser vaporization of the prostate. All patients were at high cardiopulmonary risk, having presented with an American Society of Anesthesiology score of 3 or greater. Of those, 45 patients were taking oral anticoagulants, and 1 had a severe bleeding disorder. BPH was successfully treated with 120-W KTP laser vaporization in all patients. Mean preoperative prostate volume ± SD was 66 ± 23.1 ml, and mean operative time was 50.8 ± 15.5 min. There were no major complications intraoperatively or postoperatively, and no blood transfusions were required. Postoperatively, only 14 patients (7.4 %) required bladder irrigation. Average catheterization time was 1.9 ± 1.5 days (range, 1-5 days). Three patients required reoperation due to enlarged prostates from residual adenoma. At 3-, 6,- 12-, and 24-month follow-ups, mean urinary peak flow increased from 8.0 ± 3.6 ml/s to 19.1 ± 5.6, 19.2 ± 4.7, 19.1 ± 4.65, and 19.2 ± 4.34 ml/s, respectively. Mean International Prostate Symptom Scores decreased over time, from 25.6 ± 5.1 (3 months) to 9.4 ± 2.8, 7.05 ± 1.46, 6.24 ± 1.36, and 6.20 ± 1.32 (24 months), respectively. 120-W HPS KTP laser vaporization is a safe and effective treatment option in BPH patients at high risk and those on anticoagulation therapy who have severe LUTS secondary to BPH.

Does age affect the efficacy and safety of GreenLight HPS™ laser photoselective vaporization prostatectomy?

BACKGROUND

To evaluate the efficacy and safety of GreenLight HPS(™) (High Performance System) laser photoselective vaporization prostatectomy (PVP) for the treatment of benign prostatic hyperplasia (BPH) in patients of different age groups.

METHODS

164 consecutive patients were stratified into two groups: age <70 (group I, n = 93) and age ≥70 (group II, n = 71) years. Transurethral PVP was performed using a GreenLight HPS™ side-firing laser system. Voiding parameters were measured preoperatively and at 1 and 4 weeks and 3, 6, 12, 18, 24 and 36 months postoperatively.

RESULTS

Among the preoperative parameters evaluated, there were significant differences (p < 0.05) in prostate volume (I: 58.7; II: 73.6 mL) and serum prostate-specific antigen (I: 1.9; II: 2.9 ng/mL), while American Urological Association Symptom Score (AUASS), Quality of Life (QoL), maximum flow rate (Qmax), Sexual Health Inventory for Men (SHIM) and post void residual (PVR) were similar (p > 0.05) between groups. No significant differences in laser utilization, energy usage and operating time were noted. Clinical outcomes (AUASS, QoL, Qmax, PVR) showed immediate and stable improvement from baseline (p < 0.05) within each group, but no significant differences between the two groups were observed during the follow-up period. The incidence of adverse events was low and similar in both groups.

CONCLUSIONS

The results suggest that age has little effect on the efficacy and safety of GreenLight HPS™ laser PVP.

Panurethral stricture after photovaporization of the prostate for benign prostatic hyperplasia

PURPOSE

To report the development of panurethral stricture disease and other lower urinary tract abnormalities as a complication of photovaporization of the prostate (PVP).

PATIENTS AND METHODS

We evaluated three patients who were referred for the treatment of urethral stricture disease after PVP. Evaluation included antegrade cystoscopy, urethroscopy, retrograde urethrography, and cystourethrography.

RESULTS

All three patients had panurethral stricture disease, and a low capacity bladder with bilateral vesicoureteral reflux had developed in one patient as a complication of PVP.

CONCLUSIONS

Although not previously reported, a potential complication of PVP is devastating panurethral stricture disease.

GreenLight™ laser in the treatment of lower urinary tract symptoms due to benign prostatic enlargement

For more than a decade, laser technology has facilitated a minimally invasive surgical method to treat patients with bladder outlet obstruction caused by benign prostatic hyperplasia. This article critically assesses the features of the GreenLight™ laser and its potential use in the treatment of lower urinary tract symptoms in benign prostatic hyperplasia patients. Recently, a significant body of evidence in the literature on good clinical outcomes in 1-year follow-up periods has been enriched with the findings from a few randomized trials, in which this device is compared with other minimally invasive or standard approaches. In turn, very few patients in the GreenLight laser study groups reach the end point of a 3- or 5-year follow-up time. However, most patients who underwent GreenLight laser treatment were treated successfully with a good clinical outcome and a minor rate of peri- and post-operative complications. Furthermore, it can be implemented in high-risk patients who are undergoing anticoagulation therapy. Bearing in mind the inherent characteristics of using a laser for treatment, one obvious consequence is that no pathological specimen remains for further study. This implies the necessity of suitable patient selection in whom the risk of prostate cancer should be minimal. In terms of cost-effectiveness, one should consider applying this method when dealing with patients who have a moderately enlarged prostate volume.

Tunable plasmonic nanoprobes for theranostics of prostate cancer

Theranostic applications require coupling of diagnosis and therapy, a high degree of specificity and adaptability to delivery methods compatible with clinical practice. The tunable physical and biological effects of selective targeting and activation of plasmonic nanobubbles (PNB) were studied in a heterogeneous biological microenvironment of prostate cancer and stromal cells. All cells were targeted with conjugates of gold nanoparticles (NPs) through an antibody-receptor-endocytosis-nanocluster mechanism that produced NP clusters. The simultaneous pulsed optical activation of intracellular NP clusters at several wavelengths resulted in higher optical contrast and therapeutic selectivity of PNBs compared with those of gold NPs alone. The developed mechanism was termed "rainbow plasmonic nanobubbles." The cellular effect of rainbow PNBs was tuned in situ in target cells, thus supporting a theranostic algorithm of prostate cancer cell detection and follow-up guided destruction without damage to collateral cells. The specificity and tunability of PNBs is promising for theranostic applications and we discuss a fiber optic platform that will capitalize on these features to bring theranostic tools to the clinic.

Korean urologist's view of practice patterns in diagnosis and management of benign prostatic hyperplasia: a nationwide survey

PURPOSE

In Korea, there was no specific guidelines for the management of benign prostatic hyperplasia (BPH). We reviewed the practice patterns of Korean urologists in the management of BPH and aimed to describe the need to develop specific guidelines.

MATERIALS AND METHODS

A probability sample was taken from the Korean Urological Association Registry of Physicians, and a structured questionnaire, that explored practice patterns in the management of BPH, was mailed to a random sample of 251 Korean urologists.

RESULTS

For the initial evaluation of BPH, most urologists routinely performed prostatic specific antigen (PSA) (96.4%), digital rectal exam (94.4%), international prostate symptom score (IPSS) (83.2%) and transrectal ultrasound (79.2%). Symptom assessment (36.4%) followed by transrectal ultrasound of prostate (TRUS) (20.0%) was considered as the most important diagnostic examination affecting the decision about individual treatment options. Almost all urologists (92.2%) chose medical treatment as the first-line treatment option for uncomplicated BPH with moderate symptoms. Of the respondents, 57.2% had prescribed alpha blocker and 41.6% alpha blocker plus 5-alpha reductase inhibitors as the medical treatment option for BPH. The prescription of 5-ARIs was dependent on the size of the prostate and the severity of symptoms.

CONCLUSION

The results of our current survey provide useful insight into variations in the clinical practice of Korean urologists. They also indicate the need to develop further practical guidelines based on solid clinical data and to ensure that these guidelines are widely promoted and accepted by the urological community.