GreenLight Photoselective Vaporization Of The Prostate Research Articles

Complications and functional outcomes of high-risk patient with cardiovascular disease on antithrombotic medication treated with the 532-nm-laser photo-vaporization Greenlight XPS-180 W for benign prostate hyperplasia.

To examine the complications and functional outcomes of high-risk patients on antithrombotic therapy (ATT) treated with photoselective vaporization of the prostate (PVP) using the Greenlight (GL) XPS-180 system. A retrospective analysis of prospectively maintained institutional database was performed. Men with symptomatic LUTS related to BPH were treated with 523-nm GL PVP using the XPS-180W system. They were stratified according to ATT status: group 1 (control group), group 2 (acetylsalicylic acid), group 3 (antiplatelet agents other than acetylsalicylic acid) and group 4 (anticoagulation agents). Postoperative adverse events at 30- and 90-days were prospectively recorded. Complications were stratified according to the Clavien-Dindo classification. Additionally, functional outcomes (IPSS, Qmax and PVR) were analyzed up to 48months of follow-up after surgery. Multivariable logistic regression analyses were used to predict the effect of ATT on serious bleeding-associated complications that was defined as the sum of patients with hematuria Clavien grade ≥ 2, patients requiring transfusions and patient with postoperative hemoglobin drop ≥ 15g/dl. 274 (63%), 87 (21%), 24 (6%) and 37 (9%) patients were included in groups 1, 2, 3 and 4, respectively. Patients on antiplatelet (group 3) and anticoagulant medication (group 4) were older (median age 60 vs. 68 vs. 77 vs. 76years, p < 0.001) and had more comorbidities (ASA 3-4: 9.5 vs. 27.6 vs. 66.7 vs. 64.9%; p < 0.001) than their counterparts. The overall 30-day complications rates were 31, 28.7, 45.8 and 45.9% of patients included in groups 1, 2, 3 and 4, respectively (p = 0.4). Hematuria Clavien 1 events (p < 0.001), readmissions rates (p = 0.02), length of post-operative hospital stay (p < 0.001) and catheterization time (p < 0.001) were significantly higher in patients on antiplatelet and anticoagulation medication. In multivariable analyses, ATT status was not a predictor of serious bleeding events after surgery (p > 0.5). Finally, functional outcomes were significantly improved accross the four groups. GL PVP is safe and effective in treating high-risk patients on ATT. Although serious bleeding complications are rare and equivalent with non-high-risk patients, patients on antiplatelet and anticoagulation medication should be counseled on the increased risk of minor bleeding events and readmissions rates at 30days after surgery.

Cost analysis of Greenlight photoselective vaporization of the prostate compared to transurethral resection of the prostate for benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland, which results in the development of lower urinary tract symptoms that can interfere with a patient's daily activities and negatively impact their quality of life. The gold standard treatment for moderate to severe BPH has been transurethral resection of the prostate (TURP), however, this procedure is associated with prolonged hospitalizations and increased complications. An alternative to TURP is Greenlight photoselective vaporization of the prostate (PVP), which is associated with better perioperative safety. The objectives of the research were to 1) assess the cost of Greenlight PVP compared to TURP and bipolar TURP; and 2) assess the predictors of total cost. We conducted a descriptive costing study from the hospital perspective. We evaluated perioperative costs of patients who underwent each procedure from 2013-2015 at a tertiary academic medical centre. A multiple linear regression was performed to identify predictors of total cost. The variables included in regression analysis were patient age, type of procedure, Charlson Comorbidity Index, and distance to clinic. A total of 202 patients received one of the three procedures over the study period. The total cost of Greenlight PVP was $3836 per patient compared to $4963 for TURP and $4978 for bipolar TURP. The linear regression showed that the Charlson Comorbidity Index and type of procedure were independent predictors of total cost. The procedure costs and readmission rates are lower for Greenlight PVP compared to TURP and bipolar TURP, making it a preferable option for hospitals.

Photoselective vaporization of the prostate with the 180-W XPS-Greenlight laser: Five-year experience of safety, efficiency, and functional outcomes.

Transurethral resection of the prostate (TURP) is still considered the gold standard surgical treatment for symptomatic benign prostatic hyperplasia (BPH). However, photoselective vaporization of the prostate (PVP) has gained widespread global acceptance in national guidelines as a safe and effective alternative option. Nevertheless, further evidence is required to assess the durability of Greenlight PVP. Herein, we report our five years of PVP experience with the Greenlight 180W XPS laser system. A retrospective analysis was conducted on a prospectively gathered database of 370 consecutively included patients who underwent PVP using Greenlight XPS-180 W laser system (Boston Scientific, Boston, MA, U.S.) performed by a single experienced laser surgeon between 2011 and 2016. Preoperative characteristics, intervention parameters, postoperative functional, uroflowmetry outcomes, and complications were collected. Outcomes are reported over a period of five years. Mean age was 68 years, with a mean prostate volume of 78.8 cc (95% confidence interval [CI] 70.9-78.7]). The mean followup was 59.4 months (55.4-63.5). Mean energy, operative time, and energy/cc were 270.2 kJ (255.2-285.2), 62.7 minutes (59.6-65.7), and 3.7 kJ/cc (3.6-3.9), respectively. Compared to preoperative values, International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and post-void residual (PVR) parameters were significantly improved and sustained over the five postoperative years. Of note, only 66 patients (out of 370) had a complete five-year followup. Prostate-specific antigen (PSA) reached nadir at one year, with a drop of 67% from the mean preoperative value of 6.2 ng/mL. Mean IPSS nadir was reached at three years, with a drop of 80.4% (-21.1 points). Similarly, mean quality of life (QoL) score dropped by 82.8% after three years (preoperative mean of 4.7). With respect to mean Qmax, there was an increase by 72.7% (+14.7 mL/s) at one year, reaching the value of 19.9 mL/s. Moreover, mean PVR was 32.8 mL at four years compared to 345 mL preoperatively. At five years followup, PSA, IPSS, QoL, and PVR dropped by 59.7% (3.7 ng/mL), 75.2% (19.7 points), 78.72% (3.7 points), and 84.4% (291.3 mL), respectively. Qmax increased by 12.9 mL/s. Clavien complication rates were low, with bladder neck stenosis observed in seven (1.6%) men. During the five-year followup, only four patients (1%) required BPH surgical re-intervention. This is the first long-term reporting of Greenlight XPS-180W laser system. In experienced hands, the observed outcomes appear to demonstrate that Greenlight XPS-180 W laser system is safe, efficacious, and durable for the treatment of bladder outlet obstruction (BOO) secondary to BPH.

Dolor por rotura uterina durante trabajo de parto bajo analgesia epidural. Reporte de un caso

A number of transurethral ablative techniques based on the use of innovative medical devices have been introduced in the recent past for the surgical treatment of benign prostatic obstruction (BPO).To conduct a systematic review of the literature and a meta-analysis of available randomized controlled trials (RCTs), and to evaluate the efficacy and safety of transurethral ablative procedures for BPO.A systematic literature search was performed for all RCTs comparing any transurethral surgical technique for BPO to another between 1992 and 2013. Efficacy was evaluated after a minimum follow-up of 1 yr based on International Prostate Symptom Score, maximum flow rate, and postvoid residual volume. Efficacy at midterm follow-up, prostate volume, perioperative data, and short-term and long-term complications were also assessed. Data were analyzed using RevMan software.A total of 69 RCTs (8517 enrolled patients) were included. No significant difference was found in terms of short-term efficacy between bipolar transurethral resection of the prostate (B-TURP) and monopolar transurethral resection of the prostate (M-TURP). However, B-TURP was associated with a lower rate of perioperative complications. Better short-term efficacy outcomes, fewer immediate complications, and a shorter hospital stay were found after holmium laser enucleation of the prostate (HoLEP) compared with M-TURP. Compared with M-TURP, GreenLight photoselective vaporization of the prostate (PVP) was associated with a shorter hospital stay and fewer complications but no different short-term efficacy outcomes.This meta-analysis shows that HoLEP is associated with more favorable outcomes than M-TURP in published RCTs. B-TURP and PVP have resulted in better perioperative outcomes without significant differences regarding efficacy parameters after short-term follow-up compared with M-TURP. Further studies are needed to provide long-term comparative data and head-to head comparisons of emerging techniques.Bipolar transurethral resection of the prostate, photovaporization of the prostate, and holmium laser enucleation of the prostate have shown efficacy outcomes comparable with conventional techniques yet reduce the complication rate. The respective role of these new options in the surgical armamentarium needs to be refined to propose tailored surgical treatment for benign prostatic obstruction relief.

AB074. 180-W XPS GreenLight laser vaporization versus transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: 2 months safety and efficacy results of Korean

ObjectiveTo compare short-term outcomes of 180W-XPS GreenLight photoselective vaporization of the prostate (XPS PVP) to transurethral resection of prostate (TURP) on uroflowmetry and IPSS at two months in patients with benign prostatic hyperplasia (BPH)MethodsA retrospective chart review was performed of 40 patients with BPH who underwent XPS PVP. Controls were configured with 40 patients who underwent TURP with similar prostate size of XPS PVP group. All parameters were collected retrospectively including maximum urinary flow rate (Qmax), postvoid residual (PVR), prostate specific antigen, IPSS, and complication.ResultsXPS PVP and TURP were similar in preoperative parameters such as mean age, prostate volume, Qmax, PVR, IPSS and QoL score respectively. The median operative time for XPS PVP was significantly longer than TURP (49.1±19.5 min TURP and 69.9±38.6 min XPS PVP, P=0.001). XPS PVP showed significantly shorter hospital stay (4.5±1.0 vs. 3.0±1.4, P<0.001). Postoperative Qmax, PVR, IPSS all improved compared to baseline at two months of follow-up in XPS PVP. There was no statistically significant difference between XPS PVP and TURP for each of these parameters. No patient needed transfusion and re-operation in XPS PVP and two patients had re-operation in TURP.ConclusionsPVP treatment using XPS-180 is safe and effective procedure for treating BPH comparing TURP.

GreenLight laser for prostates over 100 ml: what is the evidence?

GreenLight photoselective vaporization of the prostate (PVP) has emerged as a minimally invasive, well tolerated, efficacious alternative to transurethral resection of the prostate (TURP) or simple prostatectomy for the treatment of benign prostatic hyperplasia. However, some authors have expressed concern with the use of PVP in large prostates. In this review, we present the most relevant recent literature regarding PVP for treatment of benign prostatic hyperplasia in prostates over 100 ml. Recent studies have found that the subjective and objective outcomes of GreenLight PVP, including International Prostate Symptom Score, quality of lifescore, maximum urinary flow rate, and postvoid residual are comparable in large and small prostates. Though larger glands require increased operative time, energy delivery, and fiber use, the short duration of hospitalization and catheterization does not vary with prostate size. The overall complication rates do not increase with prostate size, though some studies have reported increased conversion to electrocautery TURP hemostasis. The trend toward increased retreatment rates in some studies of PVP in large prostates may be because of inadequate energy density delivered. GreenLight photoselective PVP is a well tolerated and efficacious procedure regardless of prostate size, and should therefore be considered as a viable alternative to TURP, holmium laser enucleation of the prostate, or simple prostatectomy in large prostates.

Long-Term Outcomes of 80-Watt KTP and 120-Watt HPS GreenLight Photoselective Vaporization of the Prostate

Objective: Photoselective vaporization of the prostate (PVP) is becoming a surgical treatment alternative of transurethral resection of the prostate for male lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). We evaluated the outcome and postoperative complications of PVP performed by 80-W KTP and 120-W HPS GreenLight lasers (AMS®) over a 4-year period. Materials and Methods: This is a prospective monocentric study that included all patients who underwent PVP. They had routine follow-up at 1 month, 3 months, 6 months and every year until the fourth postoperative year. Listed data were maximum urinary flow rate (Q_max), International Prostate Symptom Score (IPSS), post-void residual (PVR) volume, prostate-specific antigen (PSA) and prostate volume. We collected the postoperative complications. Results: From September 2005 to May 2008, 77 patients out of a 409 patients cohort underwent surgery and were followed during 4 years. At 4 years mean Q_max increase was 82.5%; mean IPSS, PVR volume, PSA and prostate volume decreases were 79.1, 69.8, 43.8 and 22.9%, respectively. The main side effects observed were storage LUTS. A urinary catheter was replaced after a first withdrawal failure in 10 patients (15.6%) after surgery. Conclusions: PVP showed a sustainable efficacy and an appealing tolerance profile during a 4-year period in patients with LUTS secondary to BPO.

A prospective trial of GreenLight PVP (HPS120) versus transurethral resection of the prostate in the treatment of lower urinary tract symptoms in Ontario, Canada.

Photoselective vaporization of the prostate (PVP) is a bloodless, relatively painless alternative to transurethral resection of the prostate (TURP) for relief of lower urinary tract symptoms (LUTS) in benign prostatic hyperplasia (BPH). We compare the effectiveness, safety and cost-effectiveness of Greenlight Laser PVP (HPS-120) and TURP. We conducted a prospective, non-randomized trial in 3 Ontario centres from March 2008 to February 2011. Assessments were completed at baseline, 1 and 6 months following surgery at the physicians' offices and at 12 and 24 months by phone. The primary outcome was the change in International Prostate Symptoms Score (IPSS) score at 6 months versus baseline. Secondary outcomes were changes in flow rate, postvoid residual (PVR), prostate-specific antigen (PSA) and sexual health inventory for men (SHIM) scores. Adverse events, health-related quality of life (HRQoL), resource utilization and productivity losses were collected. Although the IPSS decreased in both arms (n = 140 for PVP and n = 24 for TURP) between baseline and 6 months, the difference in change over time between the groups was not statistically significant (p = 0.718). Other outcomes improved equally from baseline and 6 months (Qmax, SHIM, PSA and HRQoL), with only changes in PVR favouring PVP (p = 0.018). There were no statistical differences in serious adverse events. In total, 130 of 140 PVP patients were outpatients, all TURP subjects were inpatients. PVP was less costly than TURP ($3891 vs. $4863; p < 0.001) with similar quality-adjusted life years (0.448 vs. 0.441; p = 0.658). Greenlight Laser PVP (HPS-120) is a safe and cost-effective alternative to TURP for outpatient treatment of LUTS and can be completed as an outpatient with minimal blood loss.

Holmium:YAG Transurethral Incision Versus Laser Photoselective Vaporization for Benign Prostatic Hyperplasia in a Small Prostate

We assess the perioperative, short-term and long-term functional outcomes of treating bladder outlet obstruction secondary to a small prostate by 1 of 2 laser techniques. A retrospective review using a prospectively maintained database was performed of patients treated for bladder outlet obstruction secondary to a prostate smaller than 40 ml. Patients who were treated with GreenLight™ photoselective vaporization of the prostate or holmium laser transurethral incision of the prostate were included in the study. From January 2002 through December 2010, 191 cases of 1,682 laser prostate surgeries were described. GreenLight photoselective vaporization of the prostate was performed in 144 (75.4%) cases and holmium laser transurethral incision of the prostate was performed in 47 (24.6%) cases. A significantly shorter mean operating time, hospital stay and catheter duration were observed in the holmium laser transurethral incision of the prostate group (30.3 ± 16 minutes, 0.8 ± 0.8 days and 1.3 ± 1.9 days, respectively) than in the photoselective vaporization of the prostate group (45.8 ± 22 minutes, 0.3 ± 0.4 days and 0.4 ± 0.6 days, respectively, p <0.05). At 1 and 5 years after photoselective vaporization of the prostate there were reductions in mean International Prostate Symptom Score, quality of life score and residual urine with improvement in mean maximal flow rate of 57.7% and 62.8%, 58.3% and 57.2%, 65.4% and 73%, and 127.6% and 167.1%, respectively. At 1 and 5 years after holmium laser transurethral incision of the prostate there were reductions in mean International Prostate Symptom Score, quality of life score and residual urine with improvement of mean maximal flow rate of 55.3% and 52.8%, 49.2% and 49%, 45% and 78.1%, and 67.4% and 35.4%, respectively. Subjective and objective urine flow parameters were comparable at different followup points. There was no significant difference between the 2 groups in terms of early and late complications (p >0.05). Reoperation rates were 10.4% and 6.4% in the photoselective vaporization of the prostate and holmium laser transurethral incision of the prostate groups, respectively (p >0.05). The mean estimated cost per holmium laser transurethral incision of the prostate procedure was significantly lower than per photoselective vaporization of the prostate procedure (509.34CAD vs 1,765.92CAD, p = 0.002). Holmium laser transurethral incision of the prostate and GreenLight photoselective vaporization of the prostate seem to be equally effective, safe and durable surgical treatment options for small prostates even in high risk patients.

Editorial Comment

The authors deserve to be congratulated for their present work. They investigated the long-term outcome in a randomized trial comparing 2 widely available lasers for prostate ablation to treat symptomatic benign prostatic obstruction. The data are presented genuinely, are open minded, and aimed to capture all the pros and cons. However, we believe that a critical editorial comment is appropriate. Two Laser Ablation Techniques for a Prostate Less Than 60 mL: Lessons Learned 70 Months After a Randomized Controlled TrialUrologyVol. 82Issue 2PreviewTo report lessons learned and predictors of long-term outcome after a randomized trial comparing 2 widely available lasers (2123 nm and 532 nm) in prostate ablation as treatment of symptomatic benign prostatic hyperplasia. Full-Text PDF ReplyUrologyVol. 82Issue 2PreviewWe appreciate the editorial comments and would like to address some of the concerns. First, regarding the prostate size included in this trial, we agree that larger glands presented for surgery is one of the main driving forces for laser surgery for benign prostatic hyperplasia (BPH) in the current era. However, in a tertiary referral prostate center, many of our patients have mild to moderate BPH and are not infrequently on ongoing anticoagulation therapy. Among almost 1700 laser prostate surgeries that were done in our center using holmium laser enucleation of the prostate (HOLEP), GreenLight photoselective vaporization of the prostate (PVP), holmium transurethral incision of the prostate, or holmium laser ablation of the prostate (HOLAP), 37% of the prostates were sized less than 60 mL. Full-Text PDF

Reply

We appreciate the editorial comments and would like to address some of the concerns. First, regarding the prostate size included in this trial, we agree that larger glands presented for surgery is one of the main driving forces for laser surgery for benign prostatic hyperplasia (BPH) in the current era. However, in a tertiary referral prostate center, many of our patients have mild to moderate BPH and are not infrequently on ongoing anticoagulation therapy. Among almost 1700 laser prostate surgeries that were done in our center using holmium laser enucleation of the prostate (HOLEP), GreenLight photoselective vaporization of the prostate (PVP), holmium transurethral incision of the prostate, or holmium laser ablation of the prostate (HOLAP), 37% of the prostates were sized less than 60 mL. We believe this study gives valuable information that would be useful for this cohort of patients. Editorial CommentUrologyVol. 82Issue 2PreviewThe authors deserve to be congratulated for their present work. They investigated the long-term outcome in a randomized trial comparing 2 widely available lasers for prostate ablation to treat symptomatic benign prostatic obstruction. The data are presented genuinely, are open minded, and aimed to capture all the pros and cons. However, we believe that a critical editorial comment is appropriate. Full-Text PDF

2004 GREENLIGHT HPS-120W VS GREENLIGHT XPS-180W LASER VAPORIZATION OF THE PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA: A GLOBAL, MULTI-CENTER, AND PROSPECTIVE COMPARATIVE ANALYSIS ACCORDING TO PROSTATE SIZE

INTRODUCTION AND OBJECTIVES: The aim was to evaluate the surgical performance and impact of prostate volume (PV) of the new Greenlight XPS-180W laser system (AMS, Minnetonka, MI, USA) in comparison with the former generation HPS-120W system for the treatment of BPH by photo-selective vaporization of the prostate (PVP). METHODS: From July 2007 to March 2012, a total of 1809 patients underwent Greenlight PVP for the treatment of BPH performed at 7 international centers. 1187 cases were performed using HPS120W and 622 cases using XPS-180W laser system. Data were all collected prospectively. Comparative analysis was performed between XPS and HPS and according to PV 80 and 80 cc. RESULTS: The XPS compared to HPS, allowed significantly reduced laser and operative time with a mean lasing time of 29.6 min vs. 65.8 min and total operative time of 53 min vs. 80 min respectively (p 0.01 for both). The number of fiber used during procedures was significantly reduced with the XPS system 1.11 vs. 2.28 fiber (p 0.01) while total energy delivered was 250.2 vs. 267.7 kJ (p 0.043) respectively. Overall using XPS and HPS systems, the mean operative time (104.3 vs 55.6 min), mean laser time (86.5 vs 37.3 min) and mean energy usages (400 vs 197 kJ) were all significantly increased according to PV 80 cc vs 80cc. However, when stratified according to PV, XPS demonstrates significant advantages compared to HPS regardless of prostate size in all operative parameters (p 0.01) but energy; total energy delivery was equivalent between the two systems (p 0.05). CONCLUSIONS: The XPS-180W system exhibits reduced operative time and laser time with similar total energy delivery per given PV suggesting a significant increased efficiency compared to the HPS-120W system. Overall, both with XPS-180W and HPS-120W mean operative time, laser time and energy usage increased according to prostate size. This suggests evaluation of PV should be a mandatory assessment as part of pre-operative evaluation of Greenlight PVP because it has direct implications for the operating parameters. Source of Funding: None

Photoselective Vaporization of the Prostate with GreenLight 120-W Laser Compared with Monopolar Transurethral Resection of the Prostate: A Multicenter Randomized Controlled Trial

BackgroundEvidence supporting the widespread use of GreenLight High Performance System (HPS) 120-W photoselective vaporization of the prostate (PVP) is lacking. ObjectiveTo assess the noninferiority of PVP compared with transurethral resection of the prostate (TURP) on urinary symptoms and the superiority of PVP over TURP on length of hospital stay. Design, setting, and participantsA multicenter randomized controlled trial was conducted. InterventionPatients underwent monopolar TURP or PVP with the GreenLight HPS 120-W laser. MeasurementsInternational Prostate Symptom Score (IPSS), Euro-QOL questionnaire, uroflowmetry, Danish Prostate Symptom Score Sexual Function Questionnaire, sexual satisfaction, and adverse events were collected at 1, 3, 6, and 12 mo. The two groups were compared using the 95% confidence interval (CI) of median difference for testing noninferiority of the IPSS at 12 mo and the student t test for testing the difference in length of hospital stay. Results and limitationsA total of 139 patients (70 vs 69 men in each group) were randomized. Median IPSS scores at 12-mo follow-up were 5 (interquartile range [IQR]: 3–8) for TURP versus 6 (IQR: 3–9) for PVP, and the 95% CI of the difference of the median was equal to −2 to 3. Because the upper limit of the 95% CI was >2 (the noninferiority margin), the hypothesis of noninferiority could not be considered demonstrated. Median length of stay was significantly shorter in the PVP group than in the TURP group, with a median of 1 (IQR: 1–2) versus 2.5 (IQR: 2–3.5), respectively (p<0.0001). Uroflowmetry parameters and complications were comparable in both groups. Sexual outcomes were slightly better in the PVP group without reaching statistical significance. ConclusionsThe present study failed to demonstrate the noninferiority of 120-W GreenLight PVP versus TURP on prostate symptoms at 1 yr but showed that PVP was associated with a shorter length of stay in the hospital. Trial registrationNCT01043588.

Photoselective vaporization of the prostate for treating benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) commonly occurs in older men. Traditionally, the gold standard for treatment of BPH has been the electrocautery-based transurethral resection of the prostate (TURP). However, TURP is associated with several complications and side effects. Therefore, there is an interest in a number of emerging minimally invasive therapies as alterative treatment options. Advancements in laser technology have led to the introduction of photoselective vaporization of the prostate (PVP) using the GreenLight™ laser (American Medical Systems, MN, USA). PVP uses a 532-nm laser to remove obstructive prostatic tissue. The laser energy is selectively absorbed by hemoglobin in the prostate tissue and results in tissue destruction. The GreenLight PVP laser system has gone through several evolutions from the original 60-W laser to the most recent 180-W GreenLight XPS™ system with MoXy™ Fiber. With the increasing use of GreenLight to treat BPH, there is a need to review the evidence regarding its use. We review the clinical implications of using GreenLight laser therapy for the treatment of BPH.

The Role of PCA3 Testing in Patients with a Raised Prostate-Specific Antigen Level After Greenlight Photoselective Vaporization of the Prostate

Greenlight(®) photoselective vaporization of the prostate (PVP) is an effective method for treating men with lower urinary tract symptoms. A rise in prostate specific antigen (PSA) levels, however, may be noticed in some patients during follow-up. The aim of this study was to determine whether the prostate cancer gene 3 (PCA3) urinary test would help identify patients who were in need of a prostate biopsy. The PSA of all patients undergoing PVP were analyzed. Patients with an elevated (above reference range) or rising PSA level (defined as > 0.75 ng/mL/year if the PSA was between 4.1 and 10 or a doubling time of less than 2 years) were offered a transrectal ultrasonography (TRUS) guided prostate biopsy. Before the biopsy procedure, all patients had a PCA3 test. The relationships between PSA, PCA3, and TRUS prostate biopsy findings were analyzed to determine sensitivity and specificity for the PCA3 test in this setting. 50 patients were identified. The mean age was 69.97 (range 57-83) years. The mean PSA level was 10.1 ng/mL (range 3.03-44.2 ng/mL). Six patients were found to have prostate cancer. Of those, five patients had a positive PCA3 test. One patient had a negative PCA3 test but positive biopsy findings. This gives a sensitivity of 83.3%, and a positive predictive value of 21.7%. The negative predictive value was 96%. The results suggest that a negative PCA3 test in our group of patients is a good predictor of negative biopsy results. The low positive predictive value may be an artefact of the group size. This will need further investigation and greater patient numbers to determine.

The Effect of Dutasteride on the Efficacy of Photoselective Vaporization of the Prostate: Results of a Randomized, Placebo-controlled, Double-blind Study (DOP Trial)

To study the effect of Dutasteride on the efficacy of GreenLight photoselective vaporization of the prostate (PV). Some investigators have suggested that 5 alpha-reductase inhibitors may interfere with PV by reducing intraprostatic blood flow. Dutasteride offers the most complete blockade of the 5 alpha-reductase inhibitors, with minimal increase in side effects. This is a prospective, placebo-controlled, randomized, double-blind study. A total of 59 patients were randomized to either dutasteride 0.5 mg or placebo for 3 months before and 12 months after PV. Surgical time, joules used, estimated blood loss, and ease of the procedure were compared. Other clinical end points investigated include postsurgical catheter time, hematuria, dysuria, urinary flow parameters, American Urological Association symptom score, benign prostatic hyperplasia quality of life score, prostate volume, and prostate-specific antigen level. Average surgical time and joules used were 12% (P = .24) and 16% (P = .15) less, respectively, for dutasteride patients compared with placebo. Estimated blood loss was also lower in the treatment group (P = .14). However, these results were not statistically significant. Surgeon-rated ease of the procedure was comparable between the 2 groups. There were no significant differences in catheter time, dysuria, quality of life scores, or urinary flow parameters. Quality of life and urinary parameters markedly improved after PV. Compared with patients randomized to placebo, patients randomized to dutasteride experienced a trend toward decreased time, joules used, and blood loss during surgery. Although we could not convincingly prove an operative benefit of treatment with dutasteride before surgery, we have demonstrated the efficacy of PV in men receiving dutasteride.

Evaluation of greenlight photoselective vaporization of the prostate for the treatment of high-risk patients with benign prostatic hyperplasia

To explore the feasibility and safety of greenlight photoselective vaporization of the prostate (PVP) on high-risk patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH) and to evaluate their clinical and voiding outcome. A total of 85 high-risk patients with obstructive BPH underwent PVP with an 80 W potassium-titanyl-phosphate laser, which was delivered through a side-deflecting fiber with a 23 Fr continuous flow cystoscope. Operative time, blood loss, indwelling catheterzation, international prostate symptom score (IPSS), quality of life score (QoL), uroflowmetry, postvoid residual urine volume and short-term complication rates were evaluated for all patients. All patients got through the perioperative period safely. The chief advantages of PVP were: short operative time (25.6 +/- 7.6 min), little bleeding loss (56.8 +/- 14.3 mL) and short indwelling catheterization (1.6 +/- 0.8 d). The IPSS and QoL decreased from (29.6 +/- 5.4) and (5.4 +/- 0.6) to (9.5 +/- 2.6) and (1.3 +/- 0.6), respectively. The vast majority of patients were satisfied with voiding outcome. The mean maximal urinary flow rate increased to 17.8 mL/s and postvoid residual urine volume decreased to 55.6 mL. These results are significantly different from preoperative data (P < 0.05). No patient required blood transfusion or fluid absorption. There were few complications and very high patient satisfaction after operation. PVP has a short operative time and high tolerance, and is safe, effective and minimally invasive for high-risk patients, therefore it might be considered as a good alternative treatment for high-risk patients with obstructive urinary symptoms as a result of BPH.

Greenlight photoselective vaporization of the prostate: the 21st century prostatectomy

Greenlight photoselective vaporization of the prostate: the 21st century prostatectomy

Greenlight photoselective vaporization of the prostate: the 21st century prostatectomy

Greenlight photoselective vaporization of the prostate: the 21st century prostatectomy