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Heidenberg DJ, Nethery E, Wymer KM, Judge N, Cheney SM, Stern KL, Humphreys MR. Are adverse events during surgery for benign prostatic hyperplasia device related? A review of the MAUDE database. Urologia 2024; 91:249-255. [PMID: 38520298 DOI: 10.1177/03915603241240646] [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: 03/25/2024]
Abstract
PURPOSE The Manufacturer and User Facility Device Experience database contains anonymous, voluntary medical device reports. A review of device-related adverse events associated with Benign Prostatic Hyperplasia surgeries was completed. The objective was to evaluate the occurrence and contributing factors to clinically significant complications in a cohort of patients electing to undergo surgical intervention for Benign Prostatic Hyperplasia. METHODS The Manufacturer and User Facility Device Experience database was queried for "Aquablation, Greenlight Laser, Holmium Laser, Morcellator, Water Vapor Thermal Therapy, Loop Resection, and Prostatic Urethral Lift" from 2018 through 2021. A complication classification system (Level I-IV) based on the Clavien-Dindo system was used to categorize events. These events were then correlated with procedural technology malfunctions and classified as "device related" and "non-device related." Chi squared analysis was performed to identify associations between procedural technology and complication classification distribution. RESULTS A total of 873 adverse events were identified. The adverse events were classified into level I (minimal harm) versus levels II-IV (clinically significant). Aquablation (p < 0.017) and Water Vapor Thermal Therapy (p < 0.012) were associated with a higher proportion of reports with Level II-IV complications compared with other procedure types. Level II-IV complications were not associated with a reported device related malfunction. CONCLUSIONS Aquablation and water vapor thermal therapy demonstrated noteworthy clinically significant complications which were not driven by device-related malfunctions.
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Affiliation(s)
| | - Ethan Nethery
- Virginia Tech Carilion School of Medicine and Research Institute, Roanoke, VA, USA
| | - Kevin M Wymer
- Department of Urology, Mayo Clinic, Phoenix, AZ, USA
| | | | | | - Karen L Stern
- Department of Urology, Mayo Clinic, Phoenix, AZ, USA
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Heidenberg DJ, Choudry MM, Wymer K, Stagg J, Parker N, Campagna J, Narang G, Humphreys MR, Cheney SM. The Impact of Standard vs Early Apical Release Holmium Laser Enucleation of the Prostate Technique on Postoperative Incontinence and Quality of Life. Urology 2024:S0090-4295(24)00156-0. [PMID: 38492757 DOI: 10.1016/j.urology.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/11/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To investigate the difference in postoperative incontinence and quality of life comparing standard vs early apical release (EAR) Holmium Laser Enucleation of the Prostate (HoLEP). METHODS A retrospective review was performed to identify patients who underwent HoLEP from December 2021 to December 2022 at a single tertiary referral center with two participating consultant urologists. Patients were assessed with questionnaires and evaluated clinically. We performed propensity score matching with a logistic regression and a 1:1 matching method. A propensity score-adjusted logistic regression (PSRM) was performed to compare the pads per day between surgical techniques controlling for age, prostate size, preoperative survey data, uroflow, and postvoid residual. RESULTS One hundred fourteen patients underwent HoLEP, of which 60 patients were treated with EAR and 54 patients with standard technique. EAR technique demonstrated shorter operative times (P = .046). The EAR cohort demonstrated improved AUASS (P = .034, P = .001), QOL (P = .001, P <.001), and continence rates (P <.001, P <.001) at 6 and 12weeks postoperatively. PSRM showed that the standard HoLEP increased the risk of requiring ≥2 pads per day 4.2x (P = .031, HR 95%, CI=1.16, 15.35) and 8.3x (P <.001, HR 95% CI 3.17, 21.6) at 6 and 12weeks postoperatively. CONCLUSION EAR technique promoted earlier return of continence and improved quality of life within 6weeks of surgery.
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Affiliation(s)
| | | | - Kevin Wymer
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | | | | | - Gopal Narang
- Department of Urology, University of North Carolina, Chapel Hill, NC
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Morin A, Boulet S, Lagabrielle S. Ambulatory surgery for Moses™ holmium laser enucleation of the prostate A prospective, real-practice study from a single center. Can Urol Assoc J 2023; 17:E228-E235. [PMID: 37581561 PMCID: PMC10426413 DOI: 10.5489/cuaj.8229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Use of ambulatory holmium laser enucleation of the prostate (HoLEP) is uncommon among Canadian urologists. Our objectives were to determine the feasibility (ambulatory success rate) and safety (early complication rate) of ambulatory HoLEP in a Canadian population. METHODS We prospectively evaluated consecutive patients from June 2020 to May 2022 presenting for ambulatory HoLEP using Moses™ technology at our institution (MoLEP). Ambulatory success was defined as no hospital admission within 48 hours following the procedure. Thirty-day adverse events were also identified and graded according to the Clavien-Dindo (CD) classification. All procedures were planned to be ambulatory regardless of prostate size or anticoagulant treatment. We generated a logistic regression model to identify factors associated with ambulatory failure. RESULTS A total of 61 patients underwent MoLEP, 52 of whom met the eligibility criteria. The mean age was 71.0 years (standard deviation 6.2). Most patients (67%, 35/52) were catheter or self-catheterization-dependent. The ambulatory success rate was 87% (45/52); 6/52 (11.5%) required hospitalization following MoLEP and one patient (2%) was re-admitted within 48 hours of the procedure. Hematuria was the sole cause of ambulatory failure. Thirty-day major complication rate (CD ≥3) was 6% (3/52) and the minor complication rate (CD <3) was 37% (19/52). The identified adverse events included hematuria (10/52), urinary retention (6/52), and cystitis (4/52). Based on univariate analysis, we did not identify factors significantly associated with ambulatory failure. CONCLUSIONS The MoLEP ambulatory success rate is high, and the 30-day major adverse event rate is low. In this small, Canadian cohort, ambulatory MoLEP seems feasible and safe.
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Affiliation(s)
- Alexandre Morin
- Department of Urology, Sherbrooke University Hospital Center (CHUS), Sherbrooke, QC, Canada
| | - Stéphanie Boulet
- Department of Urology, Sherbrooke University Hospital Center (CHUS), Sherbrooke, QC, Canada
| | - Samuel Lagabrielle
- Department of Urology, Sherbrooke University Hospital Center (CHUS), Sherbrooke, QC, Canada
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Mostafa MM, Khallaf A, Khalil M, Elgammal MA, Mahdy A. Efficacy and safety of TURP, HoLEP, and PVP in the management of OAB symptoms complicating BPH in patients with moderately enlarged prostates: A comparative study. Can Urol Assoc J 2023; 17:E1-E7. [PMID: 36121889 PMCID: PMC9872828 DOI: 10.5489/cuaj.7905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION We aimed to compare the effectiveness and safety of transurethral resection of the prostate (TURP), holmium laser enucleation of the prostate (HoLEP), and photoselective vaporization of the prostate (PVP) in management of storage and overactive bladder (OAB) symptoms complicating benign prostatic hyperplasia (BPH) in patients with moderately enlarged prostates. METHODS The charts of patients with moderately enlarged prostates and BPH complicated by storage and OAB symptoms who were treated by TURP, HoLEP, and PVP at University of Cincinnati hospitals between March 2012 and December 2020 were retrospectively reviewed and analyzed for changes in storage and OAB symptomatology, International Prostate Symptom Score (IPSS), peak flow rates (Qmax), presence of detrusor overactivity (DO), and postvoid residual (PVR) from baseline to up to six months postoperatively. RESULTS A total of 204 patients with moderately enlarged prostates and BPH complicated by storage and OAB symptoms were divided into three groups: group 1 (patients who underwent TURP, 89 patients), group 2 (those who underwent HoLEP, 64 patients), and group 3 (those who underwent PVP, 51 patients). TURP, HoLEP, and PVP were associated with significant improvement in urodynamics study (UDS) parameters, patient storage and OAB symptomatology, and IPSS from preoperatively to both three and six months postoperatively in BPH patients with moderately enlarged prostates, with relatively low procedure complication rate and postoperative need for either anticholinergic or procedure. CONCLUSIONS TURP, HoLEP, and PVP are effective and reliable surgical procedures that can be relied upon for BPH patients with moderately enlarged prostates and storage or OAB symptoms, with comparable efficacy and relatively low procedure complication rate and postoperative need for anticholinergic or additional procedure.
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Affiliation(s)
- Mostafa M. Mostafa
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States,Asiut University Hospitals, Asiut, Egypt
| | - Ashraf Khallaf
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | | | | | - Ayman Mahdy
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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Prostatic Artery Embolization for Benign Prostatic Hyperplasia: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2021; 21:1-139. [PMID: 34188733 PMCID: PMC8202600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) is a noncancerous enlargement of the prostate that commonly affects older people with prostates and may lead to obstructive urinary symptoms. Symptoms may initially be mild but tend to worsen over time. Prostatic artery embolization (PAE) is an endovascular procedure to treat BPH, wherein an interventional radiologist inserts a catheter into the patient to inject tiny particles intended to reduce blood flow to the enlarged prostate, causing it to shrink in size. We conducted a health technology assessment on PAE for people with BPH, which included an evaluation of effectiveness, safety, cost-effectiveness, the budget impact of publicly funding PAE, and patient preferences and values. METHODS We performed a systematic literature search of the clinical evidence. We assessed the risk of bias of each included study using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the Risk of Bias in Nonrandomized Studies-of Interventions (ROBINS-I) tool for observational studies. We assessed the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic review of the economic literature. We then assessed the cost-effectiveness of PAE compared with alternative treatments (i.e., transurethral resection of the prostate [TURP] or open simple prostatectomy [OSP]) using a Markov microsimulation model. The analysis was conducted from the Ontario Ministry of Health perspective over a time horizon of 6.5 years. We also analyzed the budget impact of publicly funding PAE in people with moderate to severe BPH in Ontario. RESULTS We included six studies in our systematic review. Four RCTs and one observational study compared PAE with TURP, and one observational study compared PAE with OSP. All studies had considerable risk-of-bias concerns. PAE may improve BPH symptoms and urodynamic measures, but we are uncertain whether PAE achieves better results than TURP (GRADE: Very low to Low). Compared with TURP, PAE may result in higher patient satisfaction and fewer adverse events (GRADE: Not assessed). Compared with OSP, PAE may result in smaller improvements in BPH symptoms and urodynamic measures and may lead to fewer adverse events, but the evidence is very uncertain (GRADE: Very low).We did not find any published cost-effectiveness studies in the economic literature review. Our primary economic evaluation showed that, compared with TURP, PAE has an incremental cost of $328 (95% CrI: -$686 to $1,423) and a very small incremental quality-adjusted life-year (QALY) of 0.007 (95% CrI: -0.004 to 0.018). The resulting incremental cost-effectiveness ratio (ICER) of PAE versus TURP is $44,930 per QALY gained. At the commonly used willingness-to-pay values of $50,000 and $100,000 per QALY, the cost-effectiveness of PAE is uncertain (52% and 68% probability, respectively, of being cost-effective compared with TURP). In a scenario analysis, we compared PAE with OSP for individuals with large prostates (who may be ineligible for TURP). We found that PAE is less costly (-$1,231; 95% CrI: -$2,457 to $69) and less effective (-0.12 QALYs; 95% CrI: -0.18 to -0.04). The resulting ICER of PAE versus OSP is $10,241 saved per QALY lost. At the commonly used willingness-to-pay value of $50,000 per QALY, PAE is unlikely to be cost-effective (2% probability of being cost-effective compared with OSP). Assuming a low uptake (i.e., an additional 10 to 50 procedures per year in years 1 to 5), we estimated that publicly funding PAE in Ontario would lead to an additional cost of about $11,400 over the next 5 years.People we spoke with who have lived experience with BPH reported on the negative impact it can have on their quality of life. Those who had received PAE reported a positive experience with the procedure and meaningful improvement in their symptoms. CONCLUSIONS Prostatic artery embolization may improve BPH symptoms and urodynamic measures, but we are uncertain if the procedure results in similar outcomes to those of TURP. Based on one observational study, PAE may result in smaller improvements compared with OSP, but we are very uncertain of the evidence. Compared with TURP and OSP, PAE may result in fewer adverse events. Longer-term comparative studies are needed to assess the durability and long-term adverse events of PAE, the potential need for reintervention after PAE, and how PAE compares with other available BPH treatment options.We found the cost-effectiveness of PAE compared with TURP to be uncertain. Also, PAE is unlikely to be cost-effective compared with OSP. If PAE is publicly funded in Ontario, the budget impact is estimated to be small over the next 5 years.People who have lived experience with BPH reported that PAE improves quality of life and reduces negative symptoms of BPH.
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Al Khayal AM, Balaraj FK, Alferayan TA, Alrabeeah KA, Abumelha SM. Current surgical procedures for benign prostatic hyperplasia and impression of new surgical modalities. Urol Ann 2021; 13:95-100. [PMID: 34194132 PMCID: PMC8210715 DOI: 10.4103/ua.ua_75_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/09/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Surgery is considered the most effective treatment for Benign prostatic hyperplasia (BPH) and Transurethral resection of prostat (TURP) is considered the gold standard. The goal of this study is to assess the surgical interventions used in Saudi Arabia, the difference in surgical procedures done depending on age and years of experience and the participant's impression on the new modalities in the management of BPH. Methodology: An online survey using Google Forms was sent to the participants. The data were collected during Saudi Urological Association Annual Meeting February 2019. Additional data were gathered 2 months later. The study was closed in May 2019. No incentives were provided to participants. Results: A total of 65 (54.1% response rate) urologist participated in the survey, of whom 41.5% of respondents were aged <40 years, while 40% of them aged between 40 and 60 years. Forty-seven (72.3%) out of 65 were consultants. The essential investigations used by most participants prior to surgical interventions are prostate specific antigen, urine culture, urinalysis, and abdominal ultrasound. The most used surgical interventions are unipolar transurethral resection (TURP), Bipolar TURP, and open prostatectomy. About 50% of respondents preferred open prostatectomy for prostate size above 100 g. In general, 40%–50% of participants believe that urethral lift, Rezum, Aquablation, prostate artery embolization, and robotic simple prostatectomy are useful options. Conclusion: TURP continues to be the main intervention for prostate sizes <100 g. Open prostatectomy is widely used intervention for prostate sizes more than 100 g. New modalities gained little acceptance among urologist practicing in Saudi Arabia. Hands on workshops may help in educating urologists and introduce these new modalities for the future use.
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Affiliation(s)
- Abdullah M Al Khayal
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Urology, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Ministry of the National Guard- Health Affairs, Riyadh, Saudi Arabia
| | - Faisal K Balaraj
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Urology, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Ministry of the National Guard- Health Affairs, Riyadh, Saudi Arabia
| | - Turki A Alferayan
- Department of Urology, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Khalid A Alrabeeah
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Urology, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Ministry of the National Guard- Health Affairs, Riyadh, Saudi Arabia
| | - Saad M Abumelha
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Urology, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Ministry of the National Guard- Health Affairs, Riyadh, Saudi Arabia
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Comparison of 532-nm GreenLight HPS laser with 980-nm diode laser vaporization of the prostate in treating patients with lower urinary tract symptom secondary to benign prostatic hyperplasia: a meta-analysis. Lasers Med Sci 2021; 36:1897-1907. [PMID: 33507432 DOI: 10.1007/s10103-021-03255-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/14/2021] [Indexed: 01/08/2023]
Abstract
To evaluate the efficacy and safety of 532-nm GreenLight HPS laser (PVP) vs 980-nm diode laser vaporization of the prostate (DVP) in treating patients with lower urinary tract symptom (LUTS) secondary to benign prostatic hyperplasia (BPH). PubMed, Cochrane Library databases, EMBASE (until Jun 2020), and original references of the included articles were searched. PRISMA checklist was followed. A total of four articles including 521 patients were studied. There was no significant difference in total operating time and lasering time of the two laser surgeries; however, a higher amount of total applied laser energy was delivered with DVP (P < 0.00001). The catheterization time after surgery in the PVP group was significantly longer than that in the DVP group (P = 0.0008), whereas the hospitalization time was significantly shorter than that in the DVP group (P = 0.02). Compared with baseline, there were significant improvements in the voiding variables over the observation period after surgery in both groups. PVP had a significant improvement in total international prostate symptom score (IPSS) (P = 0.0002) and quality of life (QoL) index (P = 0.003) compared with DVP after ≥12 months of postoperative follow-up. For complications after surgery, PVP had a larger number in needing for electrocautery to control bleeding (P = 0.02). Besides, the application of DVP resulted in a higher incidence of bladder neck contracture (P = 0.0007), dysuria (≥1 month) (P = 0.002), transient incontinence (P = 0.003), postoperative recatheterization (P = 0.02), and reoperation (P < 0.0001). The voiding parameters and micturition symptoms of patients with BPH after two kinds of laser surgery were significantly improved. However, PVP was more beneficial than DVP in terms of total IPSS, QoL index, and hospitalization time. Moreover, PVP showed a lower incidence of postoperative adverse events, but a higher risk of postoperative bleeding. PROSPERO registration number: CRD42020203222.
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Jones P, Hawary A. Resident exposure to open simple prostatectomy in the United Kingdom: Going, going, gone? (Re: National discrepancies in residency training of open simple prostatectomy for benign prostatic enlargement: Redefining our gold standard, CUAJ, June 2020). Can Urol Assoc J 2020; 14:358-359. [PMID: 33275554 DOI: 10.5489/cuaj.6794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Patrick Jones
- Department of Urology, Great Western Hospital Swindon, United Kingdom
| | - Amr Hawary
- Department of Urology, Great Western Hospital Swindon, United Kingdom
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Shamout S, Carlson K, Brotherhood HL, Crump T, Baverstock R. Incidence and predictors of early and late hospital readmission after transurethral resection of the prostate: a population-based cohort study. BJU Int 2020; 127:238-246. [PMID: 32790101 DOI: 10.1111/bju.15191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the incidence and predictors of hospital readmission and emergency department (ED) visits in patients with benign prostatic hyperplasia treated by transurethral resection of the prostate (TURP). PATIENTS AND METHODS We conducted a retrospective cohort study using a linked administrative dataset from Calgary, Canada. Participants were men who underwent their first TURP procedure between 2015 and 2017. We examined patient demographics, and type of surgery (elective or urgent). Comorbidities were scored using the Charlson comorbidity index (CCI). The primary outcomes were unplanned hospital readmissions and ED visits at 30, 60 and 90 days after TURP. The secondary aim was to identify potential predictors across these groups. RESULTS We identified 3059 men, most of whom underwent elective TURP (83%). The mean (sd) patient age was 71.0 (10.0) years. A total of 224 patients (7.4%) were readmitted to the hospital within 30 days, 290 (9.5%) within 60 days, and 339 (11.1%) within 90 days of discharge. The frequency of return visits within 30, 60 and 90 days of TURP were 21.4%, 26% and 28.6%, respectively. The most responsible diagnoses for ED visit within 90 days were haematuria (15.4%) and retention of urine (12.8%). Multivariable analysis showed that age (odds ratio [OR] 1.61, P < 0.001), surgery type (OR 2.20, P < 0.001), and CCI score (OR 2.03, P < 0.001) were independently associated with odds of readmission and ED visits at all time points. CONCLUSION Older age, poorer health and urgent surgery predicted return to ED or readmission after TURP; efforts should be made to improve selection, counselling and preoperative optimization based on these risks.
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Affiliation(s)
- Samer Shamout
- Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada.,Vesia [Alberta Bladder Centre], Calgary, AB, Canada
| | - Kevin Carlson
- Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada.,Vesia [Alberta Bladder Centre], Calgary, AB, Canada
| | - Hilary L Brotherhood
- Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Trafford Crump
- Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Richard Baverstock
- Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada.,Vesia [Alberta Bladder Centre], Calgary, AB, Canada
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Wroclawski ML, Teles SB, Carneiro A. Anatomical endoscopic enucleation of the prostate: The next gold standard? No! (or not yet!). Andrologia 2020; 52:e13707. [PMID: 32559344 DOI: 10.1111/and.13707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/15/2020] [Indexed: 12/13/2022] Open
Abstract
Most cases of lower urinary tract symptoms due to benign prostatic hyperplasia are initially managed through medical therapy. In cases that surgery is indicated, the anatomical endoscopic enucleation of the prostate (aEEP), first described in 1983, allegedly presents the same safety profile as the best endoscopic non-enucleating procedures and the same long-term functional outcomes as simple prostatectomy. Thus, why aEEP has not yet been consolidated as the gold-standard BPH surgical treatment? The main reasons are as follows: (a) Multiple energy sources and techniques; (b) High costs; (c) Steep learning curve; (d) Rare in-residency training; (e) Reimbursement issues; (f) Outcomes and (g) Complications. We do believe aEEP is an important advance and a "practice-changing" procedure that will play an important role in the BPH surgical options arsenal, especially for larger prostates. However, there is a need to start an in-residency training program, with a mentor guidance, and, over time, the cost will likely be reduced due to greater competition between companies and greater support from health insurers. Considering these points, in the future, EEP may be considered the gold-standard treatment for BPH… but not yet.
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Affiliation(s)
- Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, São Paulo, Brazil.,BP - a Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | | | - Arie Carneiro
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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11
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LaBossiere JR, Wallis CJD, Herschorn S, Carr L, Saskin R, Nam R. Surgical management of benign prostatic obstruction: 20-year population-level trends. Can Urol Assoc J 2020; 14:252-257. [PMID: 32209211 DOI: 10.5489/cuaj.6224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Benign prostatic obstruction (BPO) due to histological benign prostatic hyperplasia is highly prevalent among older men. Despite widespread use of medical therapy, surgical treatment remains a mainstay in the management of BPO. We sought to characterize trends in the surgical management of BPO in Ontario, Canada. METHODS We performed an interrupted time-series analysis using segmented regression among men aged 18 years and older undergoing surgical treatment for BPO between January 1, 1994 and December 31, 2014 in Ontario, Canada. The passage of time was considered the primary exposure. The primary outcome was the proportion of all BPO surgeries performed using each of the following modalities: transurethral resection of the prostate (TURP), endoscopic laser prostatectomy, open/laparoscopic prostatectomy, and others. RESULTS We identified 136 459 men who underwent BPO surgery between 1994 and 2014. The annual age-adjusted rate of BPO surgery declined significantly over time (24 to 10 per 10 000 population in 1994 and 2014, respectively). From 1994-2001, there were no significant changes in the distribution of BPO surgical modalities, with TURP the most common throughout (97.2% and 97% in 1994 and 2001, respectively). From 2002-2014, there was a significant decline in the use of TURP (92.1% to 76.9%; p=0.027) with a corresponding increase in the use of endoscopic laser prostatectomy (3.5% to 21.9%; p=0.0008). CONCLUSIONS This study demonstrates a shift in the management of BPO, with increasing use of endoscopic laser prostatectomy, beginning in 2002. However, TURP remains the most common treatment modality.
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Affiliation(s)
- Joseph R LaBossiere
- Division of Urology, Department of Surgery, Northern Alberta Urology Institute, University of Alberta, Edmonton, AB, Canada
| | - Christopher J D Wallis
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Sender Herschorn
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Lesley Carr
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Refik Saskin
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Robert Nam
- Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Levasseur-Fortin P, Law KW, Nguyen DD, Zakaria A, Misrai V, Elterman D, Bhojani N, Rijo E, Zorn KC. National discrepancies in residency training of open simple prostatectomy for benign prostatic enlargement: Redefining our gold standard. Can Urol Assoc J 2020; 14:182-186. [PMID: 31977302 DOI: 10.5489/cuaj.6242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In light of the recent Canadian Urological Association (CUA) and other urological associations' (America Urological Association, European Association of Urology) recommendations for the treatment of benign prostate hyperplasia (BPH) with lower urinary tract symptoms (LUTS), open simple prostatectomy (OSP) remains the recommended approach for large prostates with measured volumes over 80 cc. We sought to assess the current state of OSP and other BPH surgical training across Canadian urology residency programs and the use of guideline-recommended imagery prior to BPH surgery. METHODS A survey was distributed among Canadian urology program directors in June 2019. We identified the various surgical modalities available for the treatment of BPH offered by each program and obtained the annual number of OSP performed at each academic residency program. Additionally, we evaluated if preoperative transrectal ultrasound (TRUS) of the prostate was routinely performed to obtain the prostate volume during patient counselling, as recommended by 2018 CUA guidelines. RESULTS All 13 program directors from the Canadian urology programs responded to our survey. OSP and monopolar transurethral resection of the prostate (TURP) remain the most common across programs and are practiced in all centers. Greenlight photo-vaporization, bipolar TURP, holmium laser enucleation of the prostate, and robot-assisted simple prostatectomy were practiced in 76.8%, 69.2%, 23.1%, and 23.1% of centers, respectively. The mean number of OSP per academic training program was 4.7 cases annually. Moreover, only five (38%) academic centers routinely performed a preoperative TRUS to evaluate prostate volume for BPH counselling. CONCLUSIONS Although recognized and referenced as the BPH gold standard for the treatment of prostates over 80 cc, Canadian urology trainees' annual OSP exposure remains extremely limited. Considering the degree of importance given (category A) to the direct observation (of a minimum of five) of this intervention during residency training in the new Royal College's practice guidelines, it may be unrealistic to reach these national standards considering the annual case OSP volumes in Canadian academic urology faculties.
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Affiliation(s)
| | - Kyle W Law
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | | | - Ahmed Zakaria
- Division of Urology, Centre hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Dean Elterman
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Naeem Bhojani
- Division of Urology, Centre hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Enrique Rijo
- Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain
| | - Kevin C Zorn
- Division of Urology, Centre hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada
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13
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Sun I, Yoo S, Park J, Cho SY, Jeong H, Son H, Oh SJ, Paick JS, Cho MC. Quality of life after photo-selective vaporization and holmium-laser enucleation of the prostate: 5-year outcomes. Sci Rep 2019; 9:8261. [PMID: 31164686 PMCID: PMC6547661 DOI: 10.1038/s41598-019-44686-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/22/2019] [Indexed: 11/26/2022] Open
Abstract
This study was aimed to compare serial long-term postoperative changes in quality-of-life (QoL) between photoselective-vaporization (PVP) using 120W-High-Performance-System and holmium-laser-enucleation (HoLEP) in benign-prostatic-hyperplasia (BPH) patients and to identify factors influencing the QoL improvement at the short-term, mid-term and long-term follow-up visits after surgery. We analyzed 1,193 patients with a baseline QoL-index ≥2 who underwent PVP (n = 439) or HoLEP (n = 754). Surgical outcomes were serially compared between the two groups at up to 60-months using the International-Prostatic-Symptom-Score (I-PSS), uroflowmetry, and serum PSA. We used logistic regression analysis to identify predictors of QoL improvement (a reduction in the QoL-index ≥50% compared with baseline) at the short-term (12-months), mid-term (36-months), and long term (60-months) follow-up after surgery. In both groups, the QoL-index was decreased throughout the entire follow-up period compared with that at baseline. There were no significant differences in postoperative changes from the baseline QoL-index between the two groups during the 48-month follow-up, except at 60-months. The degree of improvement in QoL at 60-months after HoLEP was greater than that after PVP. A lower baseline storage-symptom-subscore and a higher bladder-outlet-obstruction-index (BOOI) were independent factors influencing QoL improvement at the short-term. No independent factor influences QoL improvement at the mid- or long-term.
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Affiliation(s)
- Inyoung Sun
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Sangjun Yoo
- Department of Urology, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, 07061, Republic of Korea
| | - Juhyun Park
- Department of Urology, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, 07061, Republic of Korea
| | - Sung Yong Cho
- Department of Urology, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, 07061, Republic of Korea
| | - Hyeon Jeong
- Department of Urology, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, 07061, Republic of Korea
| | - Hwancheol Son
- Department of Urology, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, 07061, Republic of Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Jae-Seung Paick
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Min Chul Cho
- Department of Urology, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, 07061, Republic of Korea.
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Analysis of Present Status for Surgery of Benign Prostatic Hyperplasia in Korea Using Nationwide Healthcare System Data. Int Neurourol J 2019; 23:22-29. [PMID: 30943691 PMCID: PMC6449663 DOI: 10.5213/inj.1836198.099] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/01/2019] [Indexed: 11/08/2022] Open
Abstract
Purpose There are no established statistical data available for the comparison of different surgical methods adopted for the resection of benign prostatic hyperplasia (BPH). This study investigates the present status related to BPH surgery in Korea for the past 8 years. Methods National-level data from the National Health Insurance Service and National Statistical Office were analyzed in this study. From 2010 to 2017, the trends of surgeries for BPH were reviewed according to the procedure code including transurethral resection of the prostate (TURP), holmium laser enucleation of the prostate (HoLEP), or high-power potassium titanyl phosphate (KTP), and this trend also analyzed by age, geographic distribution, and hospital type. Results Over the past 8 years, there was not much change in the total number of BPH-related surgeries (range, 10,393– 11,072). Although there was not much alteration in the number of conventional TURP (from 6,801 in 2010 to 6,645 in 2017), the number of HoLEP has dramatically increased (from 278 in 2010 to 3,805 in 2017). The number of HoLEP surgeries after 2011 exceeded the number of surgeries using KTP, and the gap is anticipated to rise. The number of surgeries by age group was most common in the 70s and the total number of surgeries is decreasing in all age groups; for HoLEP, the trend is steadily increasing over the age of 60 years. Most of the BPH surgeries were performed in metropolitan areas, such as Seoul, Gyeonggi-do, and Busan, and in larger hospitals compared to smaller hospital settings. Conclusions Through the data of the National Health Insurance Service, we could apprehend the present status of BPH-related surgery in Korea. Then, we could know about the trend according to several factors and we think these results will be valuable as academic references as well.
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Brown AD, Stella SF, Simons ME. Minimally Invasive Treatment for Benign Prostatic Hyperplasia: Economic Evaluation from a Standardized Hospital Case Costing System. Cardiovasc Intervent Radiol 2018; 42:520-527. [PMID: 30506168 DOI: 10.1007/s00270-018-2132-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/22/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Minimally invasive alternatives to transurethral resection of the prostate (TURP) such as prostate arterial embolization (PAE) and photoselective vaporization of the prostate (PVP) are being explored as adjuncts in the care of patients with benign prostatic hyperplasia. However, there are conflicting reports of the costs of these procedures. The purpose of this study was to compare the direct and indirect hospital costs of TURP, PAE and PVP. MATERIALS AND METHODS A chart review was performed in patients who underwent TURP, PVP and PAE from April 2015 to March 2017. All hospital costs were collected in accordance with the Ontario Case Costing Initiative, a standardized medical case costing system. Costs were characterized as direct or indirect and fixed or variable. Probabilistic sensitivity analysis was conducted to study cost uncertainty. RESULTS During the study period, a total of 209 men underwent TURP, 28 PVP and 21 PAE. Mean age (years) was as follows: TURP 71.43; PVP 73.66; PAE 70.77 (p = 0.366). Mean length of stay (days) was as follows: TURP 1.63; PVP 1.55; PAE 1 (p = 0.076). Total costs of the PAE group ($3829, SD $1582) were less than both PVP ($5719, SD $1515) and TURP groups ($5034, SD $1997, p < 0.001). There was no significant difference in direct costs between the groups. Monte Carlo simulation demonstrated that PAE was the least costly alternative majority of the time. CONCLUSIONS The total hospital costs of PAE at our institution are significantly lower than those of PVP and TURP.
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Affiliation(s)
- Andrew D Brown
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada.
| | - Steffan F Stella
- Division of Vascular and Interventional Radiology, Department of Radiology, Hamilton Health Sciences, McMaster University Medical Centre, McMaster University, Hamilton, ON, Canada
| | - Martin E Simons
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, Toronto, ON, M5G 2N2, Canada
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Zorn KC, Goldenberg SL, Paterson R, So A, Elterman D, Bhojani N. Aquablation among novice users in Canada: A WATER II subpopulation analysis. Can Urol Assoc J 2018; 13:E113-E118. [PMID: 30332589 DOI: 10.5489/cuaj.5501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Surgical management options for lower urinary tract symptoms/benign prostatic hyperplasia (LUTS/BPH) associated with prostates of small to moderate volume (<80 cc) are numerous; however, for men with enlarged prostates (>80 cc), many of these options are neither safe nor effective. Recently, Aquablation (PROCEPT BioRobotics, Inc., U.S.), a precise ultrasound-guided, robotically executed prostatic ablative procedure, has become available with U.S. Food and Drug Administration approval. Herein, we present three-month safety and efficacy data from the cohort of Canadian men included in the WATER II trial. METHODS WATER II is a prospective clinical trial of the Aquablation system for the treatment of BPH in men with prostate volumes between 80 and 150 cc. Only patients from Canada were included for this analysis. At baseline, subjects completed International Prostate Symptom Score (IPSS), as well as several validated questionnaires, uroflowmetry and post-void residual volume measurements, and underwent standard laboratory blood assessment. These were repeated at one and three months post-Aquablation. RESULTS A total of 19 subjects who met inclusion and exclusion criteria were enrolled at three Canadian academic sites. Mean pre-, one-month, and three-month post-treatment IPSS scores were 21.2±5.5, 9.9±6.9 (p<0.0001), and 5.0±4.5 (p<0.0001), respectively. Mean pre-, one-month, and three-month post-treatment maximum urinary flow rates (Qmax) were 6.6±3.1 ml/s, 19.5±6.1 ml/s (p<0.0001), and 23.1±9.2 ml/s (p<0.0001), respectively. The Clavien-Dindo grade 2 or higher event rate at three months was 31.6% (six events). CONCLUSIONS In this short-term, three-month analysis of Canadian men, Aquablation appears to provide a strong surgical alternative in patients with LUTS/BPH due to larger prostate volumes, with impressive functional outcomes, relatively short operative time and length of hospital stay, and acceptable complication and low transfusion rates.
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Affiliation(s)
- Kevin C Zorn
- Division of Urology, University of Montreal Hospital Centre, Université de Montréal, Montreal, QC, Canada
| | - S Larry Goldenberg
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ryan Paterson
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Alan So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Dean Elterman
- Department of Urology, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Naeem Bhojani
- Division of Urology, University of Montreal Hospital Centre, Université de Montréal, Montreal, QC, Canada
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Erman A, Masucci L, Krahn MD, Elterman DS. Pharmacotherapy vs surgery as initial therapy for patients with moderate-to-severe benign prostate hyperplasia: a cost-effectiveness analysis. BJU Int 2018; 122:879-888. [PMID: 30113127 DOI: 10.1111/bju.14520] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of using a surgery, such as transurethral resection of the prostate (TURP) or photoselective vaporisation of the prostate using greenlight laser (GL-PVP), as initial treatment for men with moderate-to-severe benign prostate hyperplasia (BPH) compared to the standard practice of using pharmacotherapy as initial treatment followed by surgery if symptoms do not resolve. PATIENTS AND METHODS We compared a combination of eight strategies involving upfront pharmacotherapy (i.e., α-blocker, 5α-reductase inhibitor, or combination) followed by surgery (e.g. TURP or GL-PVP) upon failure vs TURP or GL-PVP as initial treatment, for a target population of men with moderate-to-severe BPH symptoms, with a mean age of 65 years and no contraindications for treatment. A microsimulation decision-analytic model was developed to project the costs and quality-adjusted life years (QALYs) of the target population over the lifetime. The model was populated and validated using published literature. Incremental cost-effectiveness ratios (ICERs) were determined. Cost-effectiveness was evaluated using a public payer perspective, a lifetime horizon, a discount rate of 1.5%, and a cost-effectiveness threshold of $50 000 (Canadian dollars)/QALY. Sensitivity and probabilistic analyses were performed. RESULTS All options involving an upfront pharmacotherapy followed by TURP for those who fail were economically unattractive compared to strategies involving a GL-PVP for those who fail, and compared to using either BPH surgery as initial treatment. Overall, upfront TURP was the most costly and effective option, followed closely by upfront GL-PVP. On average, upfront TURP costs $1015 more and resulted in a small gain of 0.03 QALYs compared to upfront GL-PVP, translating to an incremental cost per QALY gained of $29 066. Results were robust to probabilistic analysis. CONCLUSIONS Surgery is cost-effective as initial therapy for BPH. However, the health and economic evidence should be considered concurrently with patient preferences and risk attitudes towards different therapy options.
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Affiliation(s)
- Aysegul Erman
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University of Toronto, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Lisa Masucci
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Murray D Krahn
- Toronto Health Economics and Technology Assessment Collaborative (THETA), University of Toronto, Toronto, ON, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Dean S Elterman
- Division of Urology, University of Toronto, Toronto, ON, Canada.,Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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18
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Lee YJ, Oh SA, Kim SH, Oh SJ. Patient satisfaction after holmium laser enucleation of the prostate (HoLEP): A prospective cohort study. PLoS One 2017; 12:e0182230. [PMID: 28793314 PMCID: PMC5549990 DOI: 10.1371/journal.pone.0182230] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 07/16/2017] [Indexed: 12/20/2022] Open
Abstract
Objective To investigate patient satisfaction after holmium laser enucleation of the prostate (HoLEP) in a prospective study. Subjects and methods From May 2012 to December 2014, 397 patients underwent HoLEP by a single surgeon and enrolled in our prospective registry. Baseline data included age, PSA, transrectal ultrasonography, the international prostate symptom score (IPSS), and overactive bladder symptom score (OABSS). Subjective assessment of surgical outcomes was performed at 6 months postoperatively using self-administered questionnaires consisting of ‘satisfaction with treatment question’ (STQ), ‘overall response assessment’ (ORA), and ‘willingness to undergo surgery question’ (WSQ). Results A total of 331 patients (mean age 69.6±7.0 years) were included in the analysis. Mean total prostate volume was 69.5 (±42.2) ml. Mean preoperative IPSS score was 18.5 (±7.8). The STQ showed that most patients (91.8%) were satisfied after the surgery. Only 11 (3.3%) patients responded with ‘dissatisfied’, and no patients replied with ‘very dissatisfied’. The WSQ showed that 311 (94.0%) patients were willing to undergo the surgery again if they had to reconsider the surgical decision. The ORA showed that all patients (99.4%) experienced an improvement. When compared with satisfied patients, neutral/dissatisfied patients had lower IPSS quality of life scores (2.7 vs. 0.9, p<0.001), higher IPSS voiding symptom scores (7.0 vs. 1.4, p<0.001), and more frequent episodes of urgency urinary incontinence in OABSS (1.0 vs. 0.3, p = 0.017) at 6 months postoperatively. Conclusions The overall level of satisfaction after HoLEP was high. The most common reason for dissatisfaction was the occurrence of urgency urinary incontinence after the surgery.
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Affiliation(s)
- Young Ju Lee
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
| | - Shin Ah Oh
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
| | - Sung Han Kim
- Department of Urology, Prostate Cancer Center, Research Institute and National Cancer Center, Goyang, South Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
- * E-mail:
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Skinner TAA, Leslie RJ, Steele SS, Nickel JC. Randomized, controlled trial of laser vs. bipolar plasma vaporization treatment of benign prostatic hyperplasia. Can Urol Assoc J 2017; 11:194-198. [PMID: 28652878 DOI: 10.5489/cuaj.4213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Prostate vaporization technology is becoming a standard of care for treatment of moderate, symptomatic benign prostatic hyperplasia (BPH). We compared two transurethral prostate vaporization technologies with respect to cost, efficiency, efficacy, safety, and surgical team satisfaction. METHODS Fifty-five patients meeting standardized symptom criteria for BPH were randomized to either Olympus Plasma ButtonTM or Biolitec EVOLVE® diode laser vaporization. Primary outcome of cost with secondary outcomes of clinical efficacy, resection time, surgical team satisfaction, and safety were analyzed. Followup was carried out at six and 12 weeks. Patient factors included baseline, as well as six- and 12-week International Prostate Symptom Score (IPSS) with quality of life (QoL) scores. We recorded surgical team satisfaction with a Likert-style survey investigating ease of set-up, reliability, efficiency, and ability to reach desired endpoint. All complications or side effects detected within three months and the resulting management were included in the cost analysis. RESULTS Mean cost per patient was $3418 for the Olympus group and $4564 for Biolitec (p<0.05). Surgical vaporization time was significantly less for the Olympus group, 24.3 vs. 33.5 minutes (p<0.05). Surgical and nursing staff preferred the Olympus device (p<0.05). IPPS symptom improvement and complication rates were similar between groups. Patients in the Biolitec arm had more intraoperative bleeding episodes requiring conversion to monopolar transurethral resection of the prostate (TURP) (three vs. none). CONCLUSIONS In a head-to-head randomized trial, Olympus Plasma Button transurethral vaporization was more cost-effective, faster, and preferred by surgical staff when compared to Biolitetec Diode Laser vaporization. Both devices showed similar safety and efficacy.
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Affiliation(s)
| | - Robert J Leslie
- Department of Urology, Queen's University, Kingston, ON, Canada
| | | | - J Curtis Nickel
- Department of Urology, Queen's University, Kingston, ON, Canada
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20
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Takamori H, Masumori N, Kamoto T. Surgical procedures for benign prostatic hyperplasia: A nationwide survey in Japan, 2014 update. Int J Urol 2017; 24:476-477. [PMID: 28429834 DOI: 10.1111/iju.13344] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hiroki Takamori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshiyuki Kamoto
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Ow D, Papa N, Perera M, Liodakis P, Sengupta S, Clarke S, Bolton DM, Lawrentschuk N. Trends in the surgical treatment of benign prostatic hyperplasia in a tertiary hospital. ANZ J Surg 2017; 88:95-99. [PMID: 28317227 DOI: 10.1111/ans.13904] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/06/2016] [Accepted: 12/09/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND To assess current treatment trends and perioperative outcomes of transurethral resection of the prostate (TURP) and photoselective vaporization of the prostate (PVP) in a tertiary institution. METHODS We prospectively collected a database of all patients undergoing TURP and PVP for benign prostatic hyperplasia (BPH) at a tertiary hospital between January 2011 and December 2013. Patient characteristics such as length of stay, readmission, anticoagulation status, American Society of Anesthesiologists (ASA) score and need for blood transfusion were recorded and analysed. RESULTS In total, 560 cases were included: 204 (36.4%) underwent TURP and 356 (63.6%) PVP. Patients undergoing PVP had higher ASA scores (P < 0.001) and were more frequently on continuing anticoagulant therapy (P < 0.001). With regards to non-aspirin/asasantin coagulation therapy, 61 (17.1%) patients underwent PVP with their anticoagulants continued while no patients who received TURP continued anticoagulation. Blood transfusion percentages were similar at 1.0% for TURP and 1.7% for PVP but readmission proportions were higher after PVP (32 patients, 9.0%) compared to TURP (10 patients, 4.9%). These differences were attenuated when excluding patients continuing anticoagulation during the procedure. CONCLUSION At our institution, the use of PVP has been increasing on a year-by-year basis. The results of the current study demonstrated that PVP is safe in patients with increased anaesthetic risk or on active anticoagulation when compared to traditional TURP. While this makes PVP an attractive alternative to TURP in high-risk anticoagulated patients, these patients may have complex post-discharge issues that should be addressed during the informed consent process.
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Affiliation(s)
- Darren Ow
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nathan Papa
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marlon Perera
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Liodakis
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shomik Sengupta
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.,Olivia Newton-John for Cancer Research Institute, Heidelberg Branch, Austin Health, Melbourne, Victoria, Australia
| | - Stephen Clarke
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Damien M Bolton
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.,Olivia Newton-John for Cancer Research Institute, Heidelberg Branch, Austin Health, Melbourne, Victoria, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.,Olivia Newton-John for Cancer Research Institute, Heidelberg Branch, Austin Health, Melbourne, Victoria, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Azizi M, Tholomier C, Meskawi M, Hueber PA, Valdivieso RF, Alenizi AM, Rajih E, Zanaty M, Hai MA, Gonzalez RR, Eure GR, Kriteman LS, Misrai V, Zorn KC. Safety, Perioperative, and Early Functional Outcomes of Vapor Incision Technique Using the GreenLight XPS 180 W System: Direct Comparison with Photoselective Vaporization of the Prostate. J Endourol 2017; 31:43-49. [DOI: 10.1089/end.2016.0474] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Mounsif Azizi
- Section of Urology, Department of Surgery, University of Montreal Health Centre, Montreal, Canada
| | - Côme Tholomier
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Malek Meskawi
- Section of Urology, Department of Surgery, University of Montreal Health Centre, Montreal, Canada
| | - Pierre-Alain Hueber
- Section of Urology, Department of Surgery, University of Montreal Health Centre, Montreal, Canada
| | - Roger F. Valdivieso
- Section of Urology, Department of Surgery, University of Montreal Health Centre, Montreal, Canada
| | | | - Emad Rajih
- Department of Urology, Taibah University, Madina, Saudi Arabia
| | - Marc Zanaty
- Section of Urology, Department of Surgery, University of Montreal Health Centre, Montreal, Canada
| | - Mahmood A. Hai
- Department of Urology, Comprehensive Urology, Westland, Michigan
| | | | - Gregg R. Eure
- Department of Urology, Urology of Virginia, Virginia Beach, Virginia
| | | | | | - Kevin C. Zorn
- Section of Urology, Department of Surgery, University of Montreal Health Centre, Montreal, Canada
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23
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Parsons JK, Rangarajan SS, Palazzi K, Chang D. A National, Comparative Analysis of Perioperative Outcomes of Open and Minimally Invasive Simple Prostatectomy. J Endourol 2015; 29:919-24. [DOI: 10.1089/end.2014.0879] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- J. Kellogg Parsons
- Department of Urology, UC San Diego Health System, La Jolla, California
- Urologic Cancer, UC San Diego Moores Cancer Center, La Jolla, California
- Section of Surgery, VA San Diego Healthcare System, San Diego, California
- Department of Surgery, UC San Diego Health System, San Diego, California
| | | | - Kerrin Palazzi
- Department of Urology, UC San Diego Health System, La Jolla, California
| | - David Chang
- Department of Surgery, UC San Diego Health System, San Diego, California
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Geavlete B, Bulai C, Ene C, Checherita I, Geavlete P. Bipolar Vaporization, Resection, and Enucleation Versus Open Prostatectomy: Optimal Treatment Alternatives in Large Prostate Cases? J Endourol 2015; 29:323-31. [DOI: 10.1089/end.2014.0493] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bogdan Geavlete
- Department of Urology, “Saint John” Emergency Clinical Hospital, Bucharest, Romania
| | - Catalin Bulai
- Department of Urology, “Saint John” Emergency Clinical Hospital, Bucharest, Romania
| | - Cosmin Ene
- Department of Urology, “Saint John” Emergency Clinical Hospital, Bucharest, Romania
| | - Ionel Checherita
- Department of Nephrology and Dialysis, “Saint John” Emergency Clinical Hospital, Bucharest, Romania
| | - Petrisor Geavlete
- Department of Urology, “Saint John” Emergency Clinical Hospital, Bucharest, Romania
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Chughtai BI, Simma-Chiang V, Lee R, Isaacs A, Te AE, Kaplan SA, Sedrakyan A. Trends and Utilization of Laser Prostatectomy in Ambulatory Surgical Procedures for the Treatment of Benign Prostatic Hyperplasia in New York State (2000-2011). J Endourol 2014; 29:700-6. [PMID: 25353692 DOI: 10.1089/end.2014.0692] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION There has been a significant change in surgical treatment of benign prostatic hypertrophy (BPH) over the last two decades. Most importantly, laser surgery (coagulation, vaporization, or enucleation) has been growing in popularity as an alternative to standard transurethral prostatectomy (TURP) or other procedures. Our goal was to analyze the trends of BPH surgeries and compare outcomes of laser surgery to TURP, the two most common alternative surgeries. MATERIALS AND METHODS We used the New York Statewide Planning and Research Cooperation System (SPARCS) data to identify patients diagnosed as having BPH who underwent BPH-related surgery from October 2000 to December 2011. Age, insurance, individual comorbidities, and average hospital volumes were assessed. Bivariate and multivariate regression models were used to analyze predictors of laser use. In-hospital outcomes were then compared between laser and TURP in a balanced propensity-matched cohort. RESULTS Ninety thousand six hundred seventy patients underwent BPH surgery. Laser surgery usage increased from 6.4% to 44.5% over 10 years (p<0.0001). TURP declined significantly from 72.2% to 48.3% (p<0.0001). Patients with Medicaid were less likely to undergo laser therapy than those with private insurance (odds ratio [OR]: 0.58, 95% confidence interval [CI]: 0.48, 0.69). Mid- and high-volume institutions were more likely to use laser treatment than low-volume centers (OR: 2.26, 95% CI: 1.22, 4.2; OR: 4.07, 95% CI: 1.75, 9.46, respectively). In the matched cohort, both laser and TURP patients had similar complication rates with more frequent electrolyte disorders in TURP patients (2.9% vs 2.3%, p=0.001). CONCLUSIONS TURP remains the most common procedure. However, the rate of use has declined over time. In contrast, laser use has significantly increased. Laser treatment was utilized more in younger patients, in those privately insured, in hospitals with high volumes of BPH procedures, and in patients with fewer comorbid conditions. Both surgeries are safe with no differences in terms of occurrences of morbidity and complications.
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Affiliation(s)
- Bilal I Chughtai
- 1 Department of Urology, Weill Medical College of Cornell University , New York, New York
| | - Vannita Simma-Chiang
- 1 Department of Urology, Weill Medical College of Cornell University , New York, New York
| | - Richard Lee
- 1 Department of Urology, Weill Medical College of Cornell University , New York, New York
| | - Abby Isaacs
- 2 Department of Healthcare Policy and Research, Weill Medical College of Cornell University , New York, New York
| | - Alexis E Te
- 1 Department of Urology, Weill Medical College of Cornell University , New York, New York
| | - Steven A Kaplan
- 1 Department of Urology, Weill Medical College of Cornell University , New York, New York
| | - Art Sedrakyan
- 2 Department of Healthcare Policy and Research, Weill Medical College of Cornell University , New York, New York
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Ben-Zvi T, Hueber PA, Valdivieso R, Azizi M, Azzizi M, Tholomier C, Bienz M, Bhojani N, Trinh QD, Zorn KC. Urological resident exposure to transurethral surgical options for BPH management in 2012-2013: A pan-Canadian survey. Can Urol Assoc J 2014; 8:54-60. [PMID: 24578746 DOI: 10.5489/cuaj.1647] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Tal Ben-Zvi
- Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Laval, Québec, QC
| | - Pierre-Alain Hueber
- Section of Urology Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC
| | - Roger Valdivieso
- Section of Urology Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC
| | - Mounsif Azizi
- Section of Urology Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC
| | | | | | - Marc Bienz
- Faculty of Medicine, McGill University, Montréal, QC
| | - Naeem Bhojani
- Faculty of Medicine, McGill University, Montréal, QC
| | - Quoc-Dien Trinh
- Division of Urology at Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School Center for Surgery and Public Health, Boston, MA
| | - Kevin C Zorn
- Section of Urology Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montréal, QC
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