High Performance System Laser Research Articles

Prostrate-specific antigen level following 120W Green light High Performance System Laser Photoselective Vaporisation Prostatectomy (PVP) & its efficacy and safety of PVP in Benign Prostatic Hyperplasia (BPH)

Prostrate-specific antigen level following 120W Green light High Performance System Laser Photoselective Vaporisation Prostatectomy (PVP) & its efficacy and safety of PVP in Benign Prostatic Hyperplasia (BPH)

Comparison of Penile Cuff Test and Conventional Urodynamic Study Prior to Photoselective Vaporization of Prostate for Benign Prostate Hyperplasia Using a 120 W GreenLight High Performance System Laser.

Background: We compared the utility of the penile cuff test (PCT) and the conventional urodynamic study (UDS) for the preoperative assessment of patients undergoing scheduled photoselective vaporization of the prostate (PVP) for benign prostate hyperplasia (BPH). Methods: Fifty-nine patients with voiding lower urinary tract symptoms (LUTS) underwent a simultaneous PCT and conventional UDS before PVP. The modified International Continence Society (ICS) nomogram was used to confirm bladder outlet obstruction after measuring maximum urinary flow rate and highest pressure at flow interruption. The PCT and UDS results, in terms of modified ICS nomogram predictions, were compared. Their sensitivities, specificities, and positive and negative predictive values were calculated. Results: Thirty-six patients were diagnosed as obstructed and 23 as non-obstructed/equivocal using the modified ICS nomogram during the PCT. All 36 of the first group were confirmed as obstructed by UDS. Of the 23 diagnosed as non-obstructed/equivocal by the PCT, 14 were confirmed to be non-obstructed by UDS, with nine diagnosed as obstructed. The PCT showed a sensitivity of 80% and a specificity of 100%. The positive and negative predictive values were 100% and 60.9%, respectively. Conclusions: In conclusion, despite our small number of patients, the PCT’s high sensitivity and specificity suggest that it may provide diagnostic information about bladder outlet obstruction before PVP for patients with voiding LUTS. Evidently, the PCT has the potential to be used for some patients as a screening alternative to invasive UDS.

Predictors of Improvement in Storage Symptoms at Three Years After 120W GreenLight High Performance System Laser Treatment for Benign Prostate Hyperplasia.

This study was conducted to investigate the indicators of recovery in storage symptoms after GreenLight High Performance System photoselective vaporization of the prostate (HPS-PVP) in men with benign prostate hyperplasia. A total of 155 men with a baseline subtotal storage symptom score of international prostate symptom score (sIPSS) greater than or equal to six, who underwent HPS-PVP and were followed up on for as much as 3 years, were included in this retrospective study. Surgical outcomes were evaluated at 1, 3, 6, 12, 24, and 36 months after surgery. Improvement of storage symptoms was defined as a reduction greater than or equal to 30% of sIPSS after surgery compared to the baseline. The mean age was 67.5 ± 7.8 years and the preoperative median prostate-specific antigen, mean total prostate volume, and sIPSS were 1.95 (0.97-5.27) ng/mL, 52.1 ± 32.5 mL, and 9.6 ± 2.6, respectively. The mean improvement rate of sIPSS after 3 years was 34.4%. Age was only associated with an improvement of sIPSS in the multivariate analysis (odds ratio = 0.889, p = 0.008). The mean improvement rates of sIPSS according to age group (<65 vs ≥65) were 44.7% and 26.0%, respectively. Age can serve as an independent predictor of storage symptom improvement for as much as 3 years. Therefore, we suggest that older patients who are being considered candidates for surgical treatment should be further evaluated.

230 Predictors of Improvement in Storage Symptoms at 3-year after 120W GreenLight High Performance System Laser for Benign Prostate Hyperplasia

230 Predictors of Improvement in Storage Symptoms at 3-year after 120W GreenLight High Performance System Laser for Benign Prostate Hyperplasia

Changes in Erectile Function after Photoselective Vaporization of the Prostate with a 120-W GreenLight High-Performance System Laser: 2-Year Follow-Up.

PurposeTo evaluate the impact of photoselective vaporization of the prostate (PVP) with a 120-W GreenLight high-performance system on erectile function in a 2-year follow-up study.Materials and MethodsOne hundred seventy-seven patients who underwent PVP during 2008 to 2012 were analyzed retrospectively. The patients were divided into 5 groups according to their preoperative 5-item International Index of Erectile Function (IIEF-5) scores: Group I (IIEF-5: 5~7, n=28), II (IIEF-5: 8~11, n=47), III (IIEF-5: 12~16, n=43), IV (IIEF-5: 17~21, n=34), and V (IIEF-5: 22~25, n=25). The patients were assessed before surgery and 6, 12, and 24 months after the PVP. Their International Prostate Symptom Score/quality of life, maximum urinary flow rate/post-void residual urine volume, and IIEF-5 scores were measured at each visit.ResultsThe mean age and presence of hypertension were significantly different among the 5 groups. Perioperative parameters and postoperative complication rates showed no statistical differences. After PVP, voiding parameters were significantly improved in all the groups and sustained during the 2-year follow-up. The postoperative IIEF-5 scores fell slightly overall, while group V showed the largest significant deterioration. In multivariate analysis, body mass index (BMI) was the only independent predictor of decreased erectile function after PVP.ConclusionsErectile function declined in all the groups after PVP, with the most extensive deterioration observed in patients with normal erectile function preoperatively. Preoperative BMI was the only independent risk factor for a meaningful decrease in erectile function after PVP.

P-01-059 Changes in sexual function after photoselective vaporization of the prostate by 120W greenlight high performance system laser: 2-year follow-up

P-01-059 Changes in sexual function after photoselective vaporization of the prostate by 120W greenlight high performance system laser: 2-year follow-up

Risk Factors for Reoperation After Photoselective Vaporization of the Prostate Using a 120 W GreenLight High Performance System Laser for the Treatment of Benign Prostatic Hyperplasia.

We investigated risk factors in a large cohort of patients who underwent reoperation after photoselective vaporization of the prostate using the 120 W GreenLight High Performance System laser for treatment of benign prostatic hyperplasia. Complications such as recurrent/residual adenoma, urethral stricture, or bladder neck might occur after photoselective vaporization of the prostate for treatment of benign prostatic hyperplasia. We reviewed the data of 1040 patients who underwent photoselective vaporization of the prostate between April 2009 and December 2014, and analyzed the clinical data of 630 patients who completed >12 months of follow-up. Patients were evaluated for perioperative and late complications. Reoperation was defined as the necessity for any surgical intervention to resolve recurrent/residual adenoma, urethral stricture, or bladder neck contracture. Patients with recurrent/residual adenoma, urethral stricture, or bladder neck contracture were compared with those without complications to identify the risk factors for reoperation. Logistic regression analysis was conducted to estimate the risk of reoperation. Reoperation was performed in 25 of 630 patients (3.9%) at 35.5 months mean follow-up: 12 had recurrent/residual adenoma, 5 had urethral stricture, and 8 had bladder neck contracture. Multivariate analysis revealed that a higher prostate-specific antigen (PSA) (OR, 1.129; p = 0.023) and longer lasing time (OR, 0.883; p = 0.024) were predictors of recurrent/residual adenoma. Urethral stricture was associated with a history of transurethral surgery (OR, 1.321; p = 0.042). Preoperative small prostate volume was a risk factor for bladder neck contracture (OR, 0.901; p = 0.011). In our study, the significant factors related to recurrent/residual adenoma were a high preoperative PSA and longer lasing time. A history of transurethral surgery was significantly associated with urethral stricture, whereas preoperative small prostate volume was significantly associated with bladder neck contracture.

AB141. Changes of sexual function after photoselective vaporization of the prostate by 120 W GreenLight High Performance System Laser: long-term follow-up

ObjectiveTo evaluate the impact of 120 W GreenLight High Performancer System photoselective vaporization of the prostate (HPS-PVP) on erectile function at long-term follow-up in men with LUTS due to benign prostatic hyperplasia (BPH).MethodsThree hundred and fifty-one consecutive patients who underwent HPS-PVP during 2008-2012 were analyzed retrospectively. We divided all patients into three groups: group I [International Index of Erectile Function (IIEF-5) ≤7, n=202], group II (8≤ IIEF-5 ≤16, n=90) and group III (IIEF-5 ≥17, n=59) according to the preoperative IIEF-5. The patients were assessed before surgery and at 3, 12 and 24 months after HPS-PVP. We measured IPSS, QoL, Qmax, post void residual volume and IIEF-5 at each visit. The risk factors were evaluated for over three IIEF-5 points decrease at postoperative 3 months.ResultsThe mean age, presence of hypertension, prostate volume, IPSS and QoL were significantly different among three groups. Perioperative parameters such as operative time, applied energy, catheterization time and postoperative complication rates showed no statistical differences. In all groups, main parameters following operation such as IPSS, QoL, Qmax, and post void residual volume had significant improved compared to baseline. Whereas, the IIEF-5 was significant decrease in group II and group III. On the contrary, group I was increased. In group II and III, multivariate analysis showed that the age, BMI, and prostate volume were significantly related to a diminution of erectile function after HPS-PVP.ConclusionsSexual function was significantly deceased after HPS-PVP except patients with preoperative severe erectile dysfunction (IIEF-5 ≤7). The age, BMI, and prostate volume were the independent risk factors for erectile function decline after HPS-PVP.

Efficacy of a vaporization-resection of the prostate median lobe enlargement and vaporization of the prostate lateral lobe for benign prostatic hyperplasia using a 120-W GreenLight high-performance system laser: the effect on storage symptoms.

GreenLight laser photoselective vaporization of the prostate (PVP) was established as a minimally invasive procedure to treat patients with benign prostatic hyperplasia (BPH). However, it may be difficult to achieve adequate tissue removal from a large prostate, particularly those with an enlarged median lobe. The purpose of this study was to investigate the feasibility and clinical effect of a 120-W GreenLight high-performance system laser vaporization-resection for an enlarged prostate median lobe compared with those of only vaporization. A total of 126 patients from January 2010 to January 2014 had an enlarged prostate median lobe and were included in this study. Ninety-six patients underwent vaporization only (VP group), and 30 patients underwent vaporization-resection for an enlarged median lobe (VR group). The clinical outcomes were International Prostate Symptoms Score (IPSS), quality of life (QOL), maximum flow rate (Q max), and post-void residual urine volume (PVR) assessed at 1, 3, 6, and 12 months postoperatively between the two groups. The parameters were not significantly different preoperatively between the two groups, except for PVR. Operative time and laser time were shorter in the VR group than those in the VP group. (74.1 vs. 61.9 min and 46.7 vs. 37.8 min; P = 0.020 and 0.013, respectively) and used less energy (218.2 vs. 171.8 kJ, P = 0.025). Improved IPSS values, increased Q max, and a reduced PVR were seen in the two groups. In particular, improved storage IPSS values were higher at 1 and 3 months in the VR group than those in the VP group (P = 0.030 and 0.022, respectively). No significant complications were detected in either group. Median lobe tissue vaporization-resection was complete, and good voiding results were achieved. Although changes in urinary symptoms were similar between patients who received the two techniques, shorter operating time and lower energy were superior with the vaporization-resection technique. In addition, vaporization-resection may have a beneficial effect on storage symptoms.

A Prospective Study on the Effect of Photoselective Vaporization of Prostate by 120-W High-Performance System Laser on Sexual Function

Photoselective vaporization of prostate (PVP) by 120W HPS laser emerged as an efficient, bloodless, and durable first line alternative to transurethral resection of prostate for treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPE). In this study, we assessed effects of PVP by HPS laser on erectile function. Between January 2012 and February 2014, 143 consecutive patients presenting with LUTS secondary to BPE, who underwent PVP by 120W HPS laser, were prospectively enrolled in the study. Patient's (Group A: International Index of Erectile Function-5 (IIEF-5) ≥19; Group B: IIEF <19) preoperative, perioperative and follow-up data were recorded. IIEF-5 was used to assess preoperative and postoperative erectile function at 1, 3, 6, and 12 months. Recorded data was analyzed statistically. Preoperative and perioperative data of the two groups were comparable. Significant improvement in IPSS, Qmax, QoL, and post void residual urine at 1, 3, 6 and 12 months were observed in both groups with no significant difference between them. Although IIEF-5 scores declined in both groups postoperatively (Group A: 21.06±1.21 to 19.84±1.55, P=0.43; Group B: 14.67±2.05 to 12.79±1.42, P=0.53), it was not statistically significant in either group. No significant difference was noted in IIEF-5 score between patients with or without indwelling catheter in either of the two groups. In patients undergoing PVP by 120W HPS laser for LUTS secondary to BPE, no significant effect was observed in sexual function at 1 year follow-up.

Efficacy and safety of 120-W GreenLight High-Performance System laser photo vaporization of the prostate: 3-year results with specific considerations

Purpose:High-Performance System (HPS) laser photo vaporization of the prostate (PVP) is a widely used procedure nowadays. The safety and efficacy of the procedure has been affirmed in general patients with benign prostatic hyperplasia (BPH), but data on the safety and efficacy in specific situations, such as in patients with a large prostate, patients taking anticoagulant or 5-alpha reductase inhibitor (5-ARI) medication, and patients with a history of acute urinary retention (AUR) or previous transurethral resection of the prostate (TURP), is lacking. We investigated the safety and efficacy of HPS laser PVP in these unique patient groups.Methods:The study was conducted from March 2009 to February 2012 among patients for lower urinary tract symptoms. Patients in whom BPH was diagnosed and who were treated with 120-W HPS GreenLight PVP were selected. Patients were divided into groups of prostate size above and below 80, anticoagulant medication, 5-ARI medication, AUR history, and TURP history on the basis of the preoperative history and physical examination.Results:A total of 533 patients observable for a follow-up period of more than 6 months were enrolled as the study population. The patients’ mean preoperative prostate size was 51.0±32.7 mL and their mean prostate-specific antigen was 4.5±27.9 ng/mL. The average operating time was 24.5±12.2 minutes and the average applied energy during surgery was 152,184±89,495 J. Postoperative objective and subjective parameters in all groups were significantly improved compared with preoperative values.Conclusions:Laser resection of the prostate is safe and effective. The results of HPS laser PVP were not influenced by prostate size, the use of anticoagulants, the intake of 5-ARI for BPH management, a history of AUR, a history of TURP, or other factors. Thus, this study was able to reconfirm the efficacy and safety of laser resection of the prostate.

GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: A prospective randomized trial

The most recent advance in laser treatment of benign prostatic hyperplasia (BPH) is the introduction of a high-performance system (HPS) 120-W laser. The HPS laser beam at a wavelength of 532~nm is highly absorbed by oxyhemoglobin in the tissue and maintains focus with negligible divergence up to 3 mm from the fiber and with limited divergence at 5 mm. This study is designed to evaluate the three-year clinical efficacy and safety of photoselective vaporization of the prostate (PVP, n=100 cases) with GreenLight HPS laser compared with transurethral resection of the prostate (TURP, n=100 cases) for treatment of BPH. The results showed that the mean operating time, catheterization time and admission time were significantly shorter in the PVP group, respectively. There were dramatic improvements in International Prostate Symptom Score (IPSS), quality of life (Qol), maximum flow rate (Qmax) and postvoid residual (PVR) compared with preoperative values and the degree of improvements was comparable in both groups. The intraoperative complications were lower in PVP group. In summary, PVP is an effective technique in patients with BPH, when compared to TURP, producing equivalent improvements in IPSS, Qmax, Qol and PVR with the advantages of markedly reduced catheterization time, admission time and adverse events.

120W GreenLight High Performance System Laser for Benign Prostate Hyperplasia: 68 Patients With 3-Year Follow-up and Analysis of Predictors of Response

To investigate 3-year postoperative results of photoselective vaporization of the prostate using the 120W GreenLight High Performance System photoselective vaporization of the prostate (HPS-PVP) for treating benign prostate hyperplasia (BPH) >30 mL. Records of 68 of 85 men who underwent HPS-PVP and were followed up for 3 years were analyzed retrospectively. Patients were older than 50 years with prostate volume >30 mL, International Prostate Symptom Score (IPSS) ≥8, maximum flow rate (Q(max.)) <15 mL/s, and bladder outlet obstruction (BOO) index ≥20. Parameters, including IPSS and Q(max.), were measured at baseline and 6, 12, 24, and 36 months postoperatively. Patients who improved by at least 30% from baseline IPSS scores were considered responders, and logistic regression analysis was done to determine predictors of response. Mean age, prostate volume, IPSS, Q(max.), and operative time were 71.6 ± 7.3 years, 50.0 ± 17.0 mL, 21.7 ± 7.9, 8.7 ± 3.1 mL/s, and 60.6 ± 31.9 minutes, respectively. Six months postoperatively, 50 (73.5%) patients responded with respect to IPSS score, and 40 (58.8%) maintained improvements at 3 years postoperatively. Analysis at 3-year follow-up showed that for IPSS ≥19, the higher the IPSS the greater the functional bladder capacity (FBC) and the lower the frequency of nocturia; and for BOO index ≥40, the higher the BOO index the better the response. HPS-PVP is a safe and effective procedure for treating BPH, having demonstrated that 60% of patients maintained efficacy at 3 years postoperatively. Baseline IPSS, FBC, nocturia, BOO index, and bladder contractility index were valuable for predicting response to surgery.

Comparison of Harmful Gases Produced During GreenLight High-performance System Laser Prostatectomy and Transurethral Resection of the Prostate

To compare the gases generated from GreenLight High-Performance System (HPS) laser prostatectomy with Urosol or normal saline solution and transurethral resection and vaporization of the prostate (TURVP) with Urosol. A total of 36 smoke samples were collected from a continuous irrigation suction system attached to a Tenax absorber during transurethral surgery of the prostate. The gases were qualitatively and quantitatively analyzed by gas chromatography-mass spectrometry equipped with a purge and trap sample injector. The gas produced during TURVP contained propylene, allene, isobutylene, 1,3-butadiene, vinyl acetylene, mercaptomethane, ethyl acetylene, diacetylene, 1-pentene, ethanol, piperylene, propenylacetylene, 1,4-pentadiene, cyclopentadiene, acrylnitrile, and butyrolacton. The types and amount of gas produced during HPS laser prostatectomy were fewer and smaller than during TURVP. However, 1,3-butadiene, a well-known human carcinogen, was also generated by HPS laser prostatectomy. HPS laser prostatectomy with saline produced a greater amount and number of gases than HPS laser prostatectomy with Urosol. The surgical smoke produced from TURVP and HPS laser prostatectomy contains potentially harmful chemical compounds, although HPS laser prostatectomy produced less surgical smoke than TURVP. Urosol produced fewer types and a smaller amount of gas than normal saline during HPS laser prostatectomy.

Influence of Intravesical Prostatic Protrusion on Preoperative Lower Urinary Tract Symptoms and Outcomes after 120 W High Performance System Laser Treatment in Men with Benign Prostatic Hyperplasia

PurposeTo evaluate the efficacy of photoselective vaporization of the prostate (PVP) with the 120 W Greenlight high performance system (HPS) laser for the treatment of benign prostatic hyperplasia (BPH) with intravesical prostatic protrusion (IPP).Materials and MethodsThis study was conducted on 389 BPH patients who underwent PVP with the 120 W HPS laser from April 2009 to August 2011. The patients were divided into groups according to IPP: group I was defined as IPP of 0 to 5 mm (n=216), group II as IPP of 5 to 10 mm (n=135), and group III as IPP above 10 mm (n=38). Prostate volume, prostate-specific antigen, International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), and postvoid residual volume (PVR) were assessed and checked at postoperative 1, 3, 6, and 12 months.ResultsThere was a significant difference in the mean prostate size in each group (p<0.05). The preoperative total IPSS score, IPSS voiding symptom score, and quality of life score were not significantly different. However, the IPSS storage symptom score was significantly different between groups 1 and 2 and group 3. IPSS scores, Qmax, and PVR at postoperative 1, 3, 6, and 12 months showed significant improvement compared with preoperative values.ConclusionsThe degree of IPP can affect storage symptoms. However, there is no significant correlation between the degree of IPP and postoperative results. Also, the degree of IPP does not affect short- and long-term PVP results. Proper elimination of bladder outlet obstruction is important for symptomatic relief.

120-W GreenLight Laser Photoselective Vaporization of Prostate for Benign Prostatic Hyperplasia: Midterm Outcomes

To evaluate the safety and efficacy of 120-W high-performance system (HPS) laser photoselective vaporization of the prostate (PVP) in the treatment of patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. Two experienced surgeons performed 120-W HPS laser PVP. The baseline characteristics, perioperative data, complications, and postoperative outcomes were evaluated at 3, 6, 12, 24, and 36 months postoperatively. A total of 550 consecutive patients, with a mean age of 67.6 years, underwent PVP with a 120-W HPS laser. The mean prostate volume was 72.93 cm3, with a mean prostate-specific antigen level of 3.57 ng/mL. The mean operative duration and the mean applied energy was 61.3 minutes and 164.06 kJ, respectively. No major complication occurred intraoperatively or postoperatively. The mean follow-up was 17.80 months. Significant improvements were observed postoperatively in the mean International Prostate Symptom Score, quality of life score, maximal urinary flow rate, and postvoid residual urine volume. The mean catheterization time was 18.5 hours. The complications included delayed hematuria in 26 (4.8%), recatheterization in 24 (4.4%), reoperation owing to residual prostatic adenoma in 46 (8.5%), urethral stricture in 19 (3.5%), and bladder neck contracture in 6 (1.1%) patients. PVP with a 120-W HPS laser for benign prostatic hyperplasia has been proved to be a safe and effective procedure for our patients, including those treated with oral anticoagulants. The functional outcome in larger prostates was similar to that in smaller glands.

Lithium Triborate Laser Vaporization of the Prostate Using the 120 W, High Performance System Laser: High Performance All the Way?

Technical modifications of the 120 W lithium-triborate laser have been implemented to increase power output, and prevent laser fiber degradation and loss of power output during laser vaporization of the prostate. However, visible alterations at the fiber tip and the subjective impression of decreasing ablative effectiveness during lithium-triborate laser vaporization indicate that delivering constantly high laser power remains a relevant problem. Thus, we evaluated the extent of laser fiber degradation and loss of power output during 120 W lithium-triborate laser vaporization of the prostate. We investigated 46 laser fibers during routine 120 W lithium-triborate laser vaporization in 35 patients with prostatic bladder outflow obstruction. Laser beam power was measured at baseline and after the application of each 25 kJ during laser vaporization. Fiber tips were microscopically examined after the procedure. Mild to moderate degradation at the emission window occurred in all fibers, associated with a loss of power output. A steep decrease to a median power output of 57.3% of baseline was detected after applying the first 25 kJ. Median power output at the end of the defined 275 kJ lifespan of the fibers was 48.8%. Despite technical refinements of the 120 W lithium-triborate laser fiber degradation and significantly decreased power output are still detectable during the procedure. Laser fibers are not fully appropriate for the high power delivery of the new system. There is still potential for further improvement in the laser performance.

120 W Greenlight HPS Laser Photoselective Vaporization of the Prostate for Treatment of Benign Prostatic Hyperplasia in Men with Detrusor Underactivity

PurposeMost men with benign prostatic hyperplasia (BPH) have bothersome lower urinary tract symptoms (LUTS). This study aimed to investigate the safety and efficacy of high-performance system (HPS) laser photoselective vaporization of the prostate (PVP) for the treatment of BPH in men with detrusor underactivity (DU).Materials and MethodsFrom March 2009, 371 patients with BPH were divided into 2 groups according to the findings of preoperative urodynamic study: 239 (64.4%) patients with bladder outlet obstruction (BOO) and 132 (35.6%) patients with bladder outlet obstruction with detrusor underactivity (BOO+DU). 120 W HPS laser PVP was performed to resolve the BOO. The perioperative data and postoperative results at 1 month and 12 months, including the International Prostate Symptom Score (IPSS), maximum urinary flow (Qmax), and postvoid residual urine (PVR) values, were evaluated.ResultsCompared with the preoperative parameters, significant improvements in IPSS, Qmax, and PVR were observed in each group at 1 and 12 months after the operation. In addition, IPSS, Qmax, and PVR were not significantly different between the BOO and BOO+DU groups at 1 and 12 months after the operation.ConclusionsSurgery to relieve BOO in the patients with BPH seems to be an appropriate treatment modality regardless of the existence of DU.

Long-Term Follow-Up Results of Photoselective Vaporization of the Prostate with the 120 W Greenlight HPS Laser for Treatment of Benign Prostatic Hyperplasia

PurposeWith the use of 12 months of follow-up data, this study was conducted to evaluate the efficacy of photoselective vaporization of the prostate (PVP) with the 120 W Greenlight high performance system (HPS) laser for the treatment of symptomatic benign prostatic hyperplasia.Materials and MethodsData were collected from 104 patients who were diagnosed with benign prostatic hyperplasia and who underwent PVP with the 120 W Greenlight HPS Laser. Postoperative parameters, including International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum urinary flow rate (Qmax), and postvoid residual volume (PVR), were assessed and compared with preoperative baseline values.ResultsThe mean age of the patients was 71.1±7.7. The baseline mean prostate-specific antigen level was 3.8±2.7 ng/ml, the mean prostate size was 43.9±20.6 g, the mean preoperative IPSS was 18.4±8.5, the mean QoL score was 4.1±1.0, the mean Qmax was 9.9±5.5 ml/sec, and the mean PVR was 89.6±207.1 ml. During surgery, the mean operation time was 21.8±11.3 minutes, the mean lasing time was 16.9±10.5 minutes, and the mean total applied energy was 170,068±63,181 J. At 1 month, significant improvements were observed in total IPSS (11.5±6.7, p<0.05), voiding symptom score (6.1±5.4, p<0.05), and QoL score (2.2±1.5, p<0.05); however, there were no significant improvements in storage symptom score (4.8±3.8, p=0.06), Qmax (12.6±10.2, p=0.06), and PVR (40.1±30.5, p=0.41). However, 3 months after surgery, all postoperative follow-up parameters showed significant improvements, and the 6- and 12-month data showed sustained improvement of postoperative follow-up parameters.ConclusionsSignificant improvements were observed in subjective and objective voiding parameters, which were evident at 3 months after PVP and were sustained throughout a period of 12 months after PVP.

GreenLight HPS laser 120‐W versus diode laser 200‐W vaporization of the prostate: Comparative clinical experience

We present our clinical experiences of two recently introduced vaporization laser systems: the GreenLight High Performance System (HPS) laser (532 nm, 120 W) and the Diolas LFD diode laser (980 nm, 200 W). Two laser systems were evaluated to compare their clinical results for the treatment of benign prostatic hyperplasia (BPH). Patients were treated using either the GreenLight HPS laser (n = 84) or the diode laser (n = 55) in a prospective randomized study. The data of International Prostate Symptom Score (IPSS), maximum flow rate (Q(max)), post-void residual urine (PVR), and quality of life score (Qols) were recorded at baseline, 1-, 6-, and 12-month follow-ups. The prostate volume and prostate-specific antigen (PSA) level were assessed at baseline and 6-month follow-up. All complications were also recorded. There was a statistically significant difference in IPSS, Q(max), PVR, and QoLs in each laser group at the 1-, 6-, and 12-month follow-ups compared with baseline. There was no statistical significant difference in any of these parameters at any follow-up interval between each group. The diode laser demonstrates superior hemostatic properties compared with the GreenLight HPS laser. Postoperative incontinence and postoperative irritative symptoms are more pronounced (P < 0.05) after diode laser prostatectomy. Higher incidence of dysuria with sloughing tissues and epididymitis (P < 0.05) is noted after diode laser prostatectomy. Other complications were comparable for both procedures. Although both lasers can improve subjective and objective parameters of BPH, both can produce undesired effects. The search for the ideal vaporization laser to treat BPH still continues.