HPS Laser Research Articles

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.

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.

Assessment of Learning Curves for 180-W GreenLight XPS Photoselective Vaporisation of the Prostate: A Multicentre Study

BackgroundThe learning curve for photoselective vaporisation of the prostate (PVP) has never been assessed accurately. ObjectiveTo compare 180-W GreenLight XPS PVP learning curves for three surgeons with different levels of surgical experience and different institutional backgrounds. Design, setting, and participantsA multicentre retrospective study of the first patients treated with PVP by three operators in three different centres (n=152 in group 1, n=112 in group 2, n=101 in group 3) was conducted. Surgeon 1 had performed >600 PVP procedures (120-W GreenLight HPS laser) since 2007, while surgeons 2 and 3 had no previous experience with GreenLight PVP. Surgeon 1 mainly treats both benign prostatic hyperplasia (BPH) and urologic oncology, surgeon 2 primarily focuses on urologic oncology, and surgeon 3 mostly treats BPH. Surgeon experience was analysed as a continuous variable in terms of consecutive procedures performed. InterventionPVP using a 180-W GreenLight XPS laser. Outcome measurements and statistical analysisThe learning curve was analysed in terms of changes over time for the following variables: operative time, the vaporisation time/operative time ratio, and the energy delivered/prostate volume ratio. The primary endpoint was a trifecta of (1) energy delivered >5kJ/ml of prostate, (2) vaporisation time/operative time ratio of 66–80%, and (3) no postoperative complications. Results and limitationsPatient baseline characteristics differed significantly among the centres in terms of age, prostate volume, and International Prostate Symptom Score (IPSS). Most perioperative outcomes favoured group 1 over group 3 over group 2. Functional outcomes, such as a decrease in IPSS at 1 mo for the first 50 patients (−15 vs −13.6 vs −13.3; p<0.0001) and an increase in maximum flow at 1 mo for the first 50 patients (+14.2 vs. +7 vs. +9.4; p<0.0001), favoured group 1 over group 3 over group 2. The trifecta achievement rate was significantly higher in group 3 over group 1 over group 2 (26.7% vs 14.4% vs 5.4%; p<0.0001). In multivariate analysis adjusting for age, American Society of Anesthesiologists score, and preoperative prostate volume, the only factors predictive of trifecta achievement were surgeon experience (p<0.0001) and surgeon identity (p<0.0001). The study limitations include selection bias, short follow-up, and a lack of consensus regarding learning curve assessment and definition. ConclusionsMore than 100 PVP procedures were required to reach an intraoperative parameter plateau regardless of surgeon expertise and institutional background. Both surgeon background and expertise seemed to influence perioperative outcomes during the GreenLight XPS PVP learning curve. Patient summaryBoth surgeon background and expertise seem to influence perioperative outcomes during the learning curve when using a GreenLight XPS laser for photoselective vaporisation of the prostate.

GreenLight 180-W XPS laser versus 120-W HPS laser for the treatment of benign prostate hyperplasia by a single experienced urologist

ObjectiveThis study aims to evaluate the operative efficacy and safety of the GreenLight 180-W XPS laser system in comparison to the GreenLight 120-W HPS system used by a single experienced surgeon for the treatment of bladder outlet obstruction caused by an enlarged prostate. Materials and methodsWe retrospectively compared the patients undergoing GreenLight 180-W XPS (September 2014–September 2015) and GreenLight 120-W HPS (August 2008–September 2009) for lower urinary tract symptoms secondary to benign prostatic hyperplasia by a single experienced surgeon. The patient baseline characteristics, perioperative parameters, and complications were recorded. Prostate size and prostate-specific antigen were also assessed. Functional parameters, including International Prostate Symptom Score, maximum uroflow rate, postvoid residual, and quality of life score, were analyzed in different follow-up periods. ResultsA total of 130 patients (65 in the HPS and 65 in the XPS group) were included in this study. Intraoperative lasing time was significantly shorter in the XPS group, but the postoperative length of catheterization and hospital stay were comparable in both groups. The number of fibers used during vaporization was significantly less, and only one case required two fibers for prostate vaporization in the XPS group (p=0.03). During the follow-up period, there was statistically significant improvement compared with baseline in all functional parameters in each group. However, no significant difference was observed in these parameters between the two groups. The mean percentages of prostate volume reduction were 57% and 41% and those of prostate-specific antigen reduction were 60% and 49%, respectively, in the XPS and HPS groups. Complications were comparable between the two groups. ConclusionThe 180-W XPS system displays a shorter lasing time, less laser fiber use, more volume reduction, and a comparable safety profile in comparison with the 120-W HPS system for the treatment of bladder outlet obstruction caused by an enlarged prostate.

Economic Evaluation Study (Cheer Compliant) Laser Prostatectomy for Benign Prostatic Hyperplasia

To determine which surgical treatment for lower urinary tract symptoms, which is suggestive of benign prostatic hyperplasia (BPH), is more cost-effective and yields a better patient's preference. Treatment outcome, cost, and perioperative complications to assess the treatment effectiveness of using laser prostatectomy as a treatment for BPH were investigated in this study.This retrospective study included 100 patients who underwent transurethral resection of prostate (TUR-P) and another 100 patients who received high-powered 120 W (GreenLight HPS) laser prostatectomy between 2005 and 2011.International Prostate Symptom Score and uroflow parameters were collected before the surgery and the uroflow and postvoiding residual volumes were evaluated before treatment and at 3, 6, 12, and 24 months after treatment. The results of 100 treatments after HPS laser prostatectomy were compared with the results of 100 patients who received TUR-P from the same surgeon. Complication rates and admission costs were analyzed.From 2005 to 2011, 200 consecutive patients underwent endoscopic surgery. Study participants were men with BPH with mean age of 71.3 years old. The peak flow rate went from 8.47 to 15.83 mL/s for 3 months after laser prostatectomy. Laser therapy groups showed better improvement in symptom score, shortened length of stay, and quality of life score when compared with those of TUR-P procedures. The estimated cost for laser prostatectomy was high when compared with cost of any other TUR-P procedural option at Chang Gung Hospital (P = 0.001). All admission charges were similar except for the cost of the laser equipment and accessories (mainly the laser fiber) (P = 0.001). Due to this cost of equipment, it increased the total admission charges for the laser group and therefore made the cost for the laser group higher than that of the TUR-P group.Perioperative complications, such as the need for checking for bleeding, urinary retention rate or urosepsis rate within 30 days after the surgery, held no significant differences between both groups.Compared with alternative treatment options, laser prostatectomy of the prostate is clinically effective but yields a high cost of treatment for symptomatic BPH.

MP3-20 PREDICTORS OF PERIOPERATIVE COMPLICATIONS AND REOPERATION IN PATIENTS TREATED WITH PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I1 Apr 2015MP3-20 PREDICTORS OF PERIOPERATIVE COMPLICATIONS AND REOPERATION IN PATIENTS TREATED WITH PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE Malte Rieken, Sanwei Guo, Georg Müller, Gernot Bonkat, Jan Ebbing, Thomas Gasser, and Alexander Bachmann Malte RiekenMalte Rieken More articles by this author , Sanwei GuoSanwei Guo More articles by this author , Georg MüllerGeorg Müller More articles by this author , Gernot BonkatGernot Bonkat More articles by this author , Jan EbbingJan Ebbing More articles by this author , Thomas GasserThomas Gasser More articles by this author , and Alexander BachmannAlexander Bachmann More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.123AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We aimed to characterize predictors of perioperative complications and surgical reintervention within the first two years after photoselective vaporization of the prostate (PVP) for symptomatic prostate enlargement (BPE). METHODS Retrospective analysis of a single center cohort of 771 patients who underwent PVP with the 80-W KTP, 120-W HPS, and 180-W XPS GreenLight laser between 2002 and 2013. Binominal logistic regression analyses addressed factors associated with intra- and perioperative complications. Uni- and multivariable Cox regression analyses assessed the association of various clinical and surgical parameters with reoperation. RESULTS Of 771 patients, 370 (48.0%), 187 (24.3) and 214 (27.8%) underwent PVP with the 80-W KTP, 120-W HPS, and 180-W XPS-laser, respectively. Median age was 68 years (Interquartile range (IQR): 12), median PSA 2.5 ng/ml (IQR: 3.4), and median prostate volume 45 ml (IQR: 25). Of the patients, 199 (25.8%) were in retention at time of surgery. Intraoperative bleeding was noted in 70 (9.1%) patients. Use of the 120-W laser (OR: 6.65, 95% CI 3.48-12.70, p<0.0001) and 180-W laser (OR: 2.19, 95% CI 1.04-4.63, p=0.04) was associated with increased risk of intraoperative bleeding compared to the 80-W laser. Ongoing platelet aggregation therapy or oral anticoagulation was not associated with increased risk of intraoperative bleeding (p>0.05). Retention during hospitalization with the need for catheterization occurred in 67 (8.7%) patients. Preoperative catheterization (OR: 2.34, 95% CI 1.37-4.01, p=0.002) was associated with increased risk of postoperative retention. During 2-years follow-up, 49 (6.4%), 10 (1.3%), and 17 (2.2) patients has to undergo reoperation due to persistent or recurrent adenoma, urethral stricture, and bladder neck stricture, respectively. No significant association of clinical and surgical parameters or laser generation with risk of reoperation due to recurrent or persistent adenoma or urethral stricture could be detected. In contrast, incidence of bladder neck sclerosis was significantly associated with prostate volume < 40 ml (HR 3.65, 95% CI 1.41-9.47, p=0.008). CONCLUSIONS Reoperation within the first 2 years after PVP does not seem to be associated with laser type. Prostate volume < 40 ml is significantly associated with increased risk of reoperation due to bladder neck sclerosis. Our results may help patients counseling and treatment decision-making regarding the choice of technique for BPE surgery. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e26 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Malte Rieken More articles by this author Sanwei Guo More articles by this author Georg Müller More articles by this author Gernot Bonkat More articles by this author Jan Ebbing More articles by this author Thomas Gasser More articles by this author Alexander Bachmann More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

C183: A prospective, randomized comparison of greenlight 120 W HPS laser vaporization and thulium laser 120 W vaporesection of the prostate

C183: A prospective, randomized comparison of greenlight 120 W HPS laser vaporization and thulium laser 120 W vaporesection of the prostate

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.

Reply

We appreciate the editorial commentary by the authors highlighting a paradigm shift, whereby many urologists will perform transurethral resection of the prostate procedures in an outpatient or office-based setting. In appropriately selected patients, the benefits for office-based procedures are numerous, including improved patient compliance, time, and cost-effectiveness. In our study, we found that in men with relatively small prostate sizes <60 mL, office-based 120-W KTP laser prostatectomy is a safe, feasible, and efficacious option. Editorial CommentUrologyVol. 82Issue 3PreviewOsterberg et al1 from Cornell University report their experience with photoselective vaporization of the prostate (PVP) using the 120-Watt HPS laser system in an outpatient setting. The authors are to be commended for conducting this study, which shows excellent functional results 8.5 months after surgery; no major complications were noticed. Study inclusion criteria limited prostate sizes to 60 mL. What does this study add to existing published reports? We believe it is an important contribution to the field, showing the feasibility of PVP in an ambulatory setting when choosing the right patient at the right time. Full-Text PDF

Effect of Photoselective Vaporization Prostatectomy on Lower Urinary Tract Symptoms in Benign Prostatic Hyperplasia With or Without Intravesical Prostatic Protrusion

PurposeIntravesical protrusion of the prostate (IPP) can affect voiding. We evaluated the improvement in lower urinary tract symptoms and patient satisfaction after laser prostate photovaporization in benign prostatic hyperplasia (BPH) patients with or without IPP.Materials and MethodsThis prospective study included 134 patients who underwent GreenLight HPS laser photoselective vaporization prostatectomy (PVP) between January 2010 and July 2011 patient. Preoperative IPP was evaluated by using the retroflexed view from flexible cystoscopy. evaluation included complete medical history, International Prostate Symptom Scores (IPSS), maximum flow rate (Qmax), postvoid residual (PVR), serum prostate-specific antigen (PSA), and transrectal ultrasonogram. Changes from baseline in Qmax, PVR, total IPSS, and IPSS subscores (voiding and storage) were analyzed at postoperative months 1, 3, and 6.ResultsThe patients' mean age was 66.6±7.8 years. Mean serum PSA and prostate volume were 1.7±1.5 ng/mL and 42.9±16.7 g, respectively. No significant differences existed between the IPP and no IPP groups in preoperative prostate volume, total IPSS, PSA, or lasing time and energy. The mean follow-up duration was 6.2±1.9 months. IPP patients showed significant improvements in total IPSS and voiding subscores at months 1 and 3. Improvements in the quality of life score and storage subscore were not significantly different between the groups. Qmax was significantly improved at 6 months postoperatively in the IPP group versus the no IPP group.ConclusionsAmong patients who underwent PVP for BPH, the IPP group showed more symptom improvement, especially in voiding symptoms, than did the no IPP group. Preoperative cystoscopy is helpful for evaluating IPP and for anticipating postoperative outcome.

Risk Factors for Failure of Early Catheter Removal After Greenlight HPS Laser Photoselective Vaporization Prostatectomy in Men With Benign Prostatic Hyperplasia

PurposeTo assess the risk factors for developing urinary retention after removal of the urethral catheter on postoperative day 1 in benign prostatic hyperplasia patients who underwent Greenlight HPS laser photoselective vaporization prostatectomy (PVP).Materials and MethodsThe study included 427 men who underwent Greenlight HPS laser PVP between 2009 and 2012, excluding patients in whom a catheter was maintained for more than 1 day because of urethral procedures. In all patients, a voiding trial was performed on postoperative day 1; if patients were unable to urinate, the urethral catheter was replaced before hospital discharge. The patients were divided into two groups: early catheter removal (postoperative day 1) and late catheter removal (urethral catheter reinsertion). Preoperative and perioperative parameters were compared between the groups.ResultsCatheters were successfully removed in 378 (88.6%) patients on postoperative day 1. In 49 patients, the catheters were reinserted and removed a mean of 6.45±0.39 days after surgery. In a multivariate analysis, a history of diabetes was the most significant predictor (p=0.028) of failure of early catheter removal, followed by operative time (p=0.039). There were no significant differences in age, prostate volume, International Prostate Symptom Score, or urodynamic parameters between the two groups.ConclusionsIt is feasible, safe, and cost-effective to remove the urethral catheter on postoperative day 1 after Greenlight HPS laser PVP, but the procedure should be done carefully in patients who have history of diabetes or an extended operative time.

Outcome of GreenLight HPS laser therapy in surgically high-risk patients

The aims of this study are to present our experience with GreenLight HPS laser in the treatment of benign prostatic hyperplasia (BPH) and evaluate the outcomes of laser therapy in surgically high-risk patients. This study included a total of 132 patients who were treated for BPH by using GreenLight HPS laser between August 2008 and December 2010 by the same operator. These patients were further divided into five subgroups: group A (age ≧ 80years), group B (prostate volume ≧ 80ml), group C (American Society of Anesthesiologists score = 3), group D (anticoagulant use), and group E (non-A, non-B, non-C, and non-D patients). Data on International Prostate Symptom Score, maximum flow rate (Q max), post-void residual urine, and quality-of-life score were evaluated at baseline and at 1, 12, and 24months after surgery. The result showed that group B patients required a longer lasing time during surgery. In addition, longer post-operative catheterization time and hospital stay were noted in groups B, C, and D patients. Statistically significant improvements were noted post-operatively for all functional parameters in all groups. The proportion of secondary surgery was significantly higher in group B patients. No major complication was observed in all groups. This suggested that GreenLight HPS laser is safe and effective in the treatment of surgically high-risk patients.

Photoselective Vaporization of the Prostate with GreenLight HPS 120-W Laser for Benign Prostatic Hyperplasia: 36 Months’ Follow-Up

Objective: To evaluate the 3-year clinical outcomes and durability of photoselective vaporization of the prostate (PVP) with the GreenLight HPS laser in the treatment of symptomatic and obstructive benign prostatic hyperplasia (BPH). Methods: A total of 78 patients underwent PVP with the GreenLight HPS laser from October 2007 to November 2008. The baseline and treatment outcomes after surgery were evaluated 3 years later with the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Q_max), postvoid residual rate (PVR), and transrectal ultrasound-determined prostate volume. These parameters were assessed at 1, 3, 6, 12, 24, and 36 months. Results: Patients’ urinary symptoms and QoL significantly improved after surgery. The functional outcomes showed immediate and stable improvements during the entire follow-up period. At 36 months, the average percentage of improvements compared with baseline was as follows: IPSS, 60.2%; QoL, 80.9%; Q_max, 138.7%, and PVR, 82.6%. The median prostate volume, evaluated by transrectal ultrasonography, showed a 50.4% reduction when compared to preoperative volume. Overall, complications from surgery were low; only 6.7% of the 75 patients required reoperation during the 3-year follow-up. Conclusion: PVP using the GreenLight HPS laser showed a safe and effective treatment outcome for the treatment of symptomatic and obstructive BPH.

Reply

Surgical procedures make and release many toxic gases, including carcinogens. Surgical personnel might ignore the environmental risk factors, although these gases can threaten their health and even their life. Ascertaining how to best investigate the hazards of surgical procedures is crucial. Continuous inhalation of toxic gases for a prolonged period can cause severe disease in surgical personnel, especially operators and assistants. Editorial CommentUrologyVol. 79Issue 5PreviewThe authors present a comparison of harmful gases produced during GreenLight HPS laser prostatectomy operating at 120 W and TURVP. Overall, their report is well written, and the method used is correct; however, one might criticize their study, because they chose to perform the 2 procedures (TURVP followed by HPS laser prostatectomy) in the same patient. Others would have chosen to create 2 distinct groups, 1 for TURVP and 1 for HPS laser prostatectomy. Full-Text PDF

Editorial Comment

The authors present a comparison of harmful gases produced during GreenLight HPS laser prostatectomy operating at 120 W and TURVP. Overall, their report is well written, and the method used is correct; however, one might criticize their study, because they chose to perform the 2 procedures (TURVP followed by HPS laser prostatectomy) in the same patient. Others would have chosen to create 2 distinct groups, 1 for TURVP and 1 for HPS laser prostatectomy.

GREENLIGHT HPS™ 120‐W LASER VAPORIZATION VS TRANSURETHRAL RESECTION OF THE PROSTATE (&lt;60 ML): A 2‐YEAR RANDOMIZED DOUBLE‐BLIND PROSPECTIVE URODYNAMIC INVESTIGATION

The major point of concern relates to the retrospective power analysis and extremely low patient numbers. With only 10 patients per arm, the study power was subsequently calculated by the authors to average ≈ 26%. In our calculations, this mean power is in keeping with an effect size (theta) of 1.0. Using the generally accepted study power of 80%, 50 patients are required per arm if we are to keep the same 99% confi dence; if the effect size is indeed lower, say 0.5, then 95 patients per arm would be required. The papers ’ conclusions are thus unfortunately unable to be supported by the data presented. Further concerns arise from incongruence between IPSS results as described in the body and those present in Table 2. Lastly, the Greenlight HPS laser used in the study is repeatedly described as potassium-titanyl-phosphate (KTP), the HPS uses lithium triborate and not KTP. Nevertheless, this paper presents an interesting point regarding preand postoperative urodynamic studies, and could serve as a pilot for future work.

V1024 STEP BY STEP TECHNIQUE OF PHOTOSELECTIVE VAPORIZATION WITH THE GREENLIGHT XPS 180 W LASER FOR PROSTATIC ADENOMAS > 80 CC

You have accessJournal of UrologyMale Voiding Dysfunction (BPH & Incontinence) & Infection1 Apr 2012V1024 STEP BY STEP TECHNIQUE OF PHOTOSELECTIVE VAPORIZATION WITH THE GREENLIGHT XPS 180 W LASER FOR PROSTATIC ADENOMAS > 80 CC Marie Aimee Perrouin Verbe, Maxime Thoulouzan, Francky Delage, and Georges Fournier Marie Aimee Perrouin VerbeMarie Aimee Perrouin Verbe Brest, France More articles by this author , Maxime ThoulouzanMaxime Thoulouzan Brest, France More articles by this author , Francky DelageFrancky Delage Brest, France More articles by this author , and Georges FournierGeorges Fournier Brest, France More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1128AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Greenlight XPS 180W laser and the MoXy liquid-cooled fiber provide up to 180W lasing energy and increase the surface of tissue treated with the laser beam. When compared with the Greenlight HPS 120W laser, this device increases the vaporization speed and allows the management of prostatic adenomas larger than 80 cc. METHODS For all procedures we used real time transrectal ultrasonography navigation, and a 23 Fr cystoscope with a 30° lens. Vaporization starts at the bladder neck. The first step is the creation of a central channel at the lower power of 120W to create a working space and improve irrigation, then the power can be increased up to 180W and the lateral lobes are lasered from the bladder neck to the veru montanum. Maximal efficiency of vaporization, assessed by bubbles generation, is obtained with a working distance of the laser from the tissue between 1 and 3 mm. At the end of the procedure, lasing energy must be decreased under 100W at the level of bladder neck and near the prostate capsule. RESULTS The Greenlight 180W XPS laser provides a faster vaporization when compared with the Greenlight 120W HPS laser. CONCLUSIONS This device allows the management of patients with prostatic adenomas larger than 80cc, which usually undergo open prostatectomy, in a safe manner and with an acceptable operative time. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e417 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marie Aimee Perrouin Verbe Brest, France More articles by this author Maxime Thoulouzan Brest, France More articles by this author Francky Delage Brest, France More articles by this author Georges Fournier Brest, France More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

2015 CHANGES IN ERECTILE FUNCTION AFTER PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology II1 Apr 20122015 CHANGES IN ERECTILE FUNCTION AFTER PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA Piotr Zareba, Alym Abdulla, Jim Bowen, Rob Hopkins, Jean-Eric Tarride, and John Paul Whelan Piotr ZarebaPiotr Zareba Hamilton, Canada More articles by this author , Alym AbdullaAlym Abdulla Hamilton, Canada More articles by this author , Jim BowenJim Bowen Hamilton, Canada More articles by this author , Rob HopkinsRob Hopkins Hamilton, Canada More articles by this author , Jean-Eric TarrideJean-Eric Tarride Hamilton, Canada More articles by this author , and John Paul WhelanJohn Paul Whelan Hamilton, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2178AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although photoselective vaporization of the prostate (PVP) has been shown to significantly improve voiding function in men with benign prostatic hyperplasia (BPH), its effect on erectile function is unknown. The purpose of this study was to characterize changes in erectile function in a large cohort of men undergoing PVP. METHODS The present analysis was conducted on the PVP arm of a non-randomized clinical trial comparing PVP and transurethral resection of the prostate (TURP). All procedures were performed by a single surgeon using a 120 W GreenLight HPS laser. Subjects completed the Sexual Healthy Inventory for Men (SHIM) and International Prostate Symptom Score (IPSS) questionnaires prior to surgery and at six months postoperatively. All data were collected prospectively and there was no loss to follow-up. Associations between change in SHIM score and other clinical variables were tested using the Spearman rank correlation coefficient for continuous variables and the Wilcoxon-Mann-Whitney or Kruskal-Wallis tests for categorical variables. All tests of association were two-sided and performed at a level of significance of 0.05. RESULTS A total of 140 men with a mean age of 67.4 (range 47.8-85.2) years were included in the analysis. Preoperatively, 20 patients (14.3%) had no ED (SHIM≥22), 30 (21.4%) had mild ED (SHIM=17-21), 26 (18.6%) had mild to moderate ED (SHIM=12-16), 18 (12.9%) had moderate ED (SHIM=8-11), and 46 (32.9%) had severe ED (SHIM=1-7). Preoperative SHIM score was negatively correlated with age (Spearman's r=−0.33, p<0.001) but not preoperative IPSS or any other clinical variables. Mean SHIM score decreased by 0.9 points after PVP. However, wide variation was seen, with 54 patients (38.6%) showing an increase, 23 (16.4%) showing no change, and 63 (45.0%) showing a decrease in SHIM score after PVP. The only significant predictor of change in SHIM score was change in IPSS (Spearman's r=−0.18, p=0.03), with men experiencing a greater improvement in voiding symptoms also reporting better postoperative erectile function. There was no significant correlation between change in SHIM score and age (p=0.62), duration of voiding symptoms (p=0.31), preoperative BPH medical therapy (p=0.96), PDE5-inhibitor therapy (p=0.80), or total energy used (p=0.55). CONCLUSIONS Erectile function outcomes following PVP are highly variable but correlate positively with the degree of improvement in voiding function. The biologic mechanisms linking erectile and voiding function are still poorly understood and deserve further study. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e813-e814 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Piotr Zareba Hamilton, Canada More articles by this author Alym Abdulla Hamilton, Canada More articles by this author Jim Bowen Hamilton, Canada More articles by this author Rob Hopkins Hamilton, Canada More articles by this author Jean-Eric Tarride Hamilton, Canada More articles by this author John Paul Whelan Hamilton, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Does Size Really Matter? The Impact of Prostate Volume on the Efficacy and Safety of GreenLight HPS™ Laser Photoselective Vaporization of the Prostate

To evaluate the efficacy and safety of GreenLight HPS™ laser photoselective vaporization of the prostate (PVP) for the treatment of benign prostatic hyperplasia (BPH) in patients with different prostate volumes. Between July 2006 and February 2011, 207 consecutive patients were identified from a prospectively maintained urologic database. Based on preoperative prostate volume measured by transrectal ultrasonography, patients were stratified into two groups: ≥ 80 cc (group 1, n=57) and < 80 cc (group 2, n=150). Transurethral PVP was performed using a 120W GreenLight HPS side-firing laser system. American Urological Association Symptom Score (AUASS), quality-of-life (QoL) score, maximum flow rate (Qmax), and postvoid residual (PVR) volume were measured preoperatively and at 1 and 4 weeks and 3, 6, 12, 18, 24, and 36 months postoperatively. Among the preoperative parameters evaluated, there were significant differences (P<0.05) in the incidence of preoperative urinary retention (1: 24.6%; 2: 7.3%), serum prostate-specific antigen level (1: 4.5 ± 2.7; 2: 1.8 ± 1.9 ng/mL), QoL (1: 4.2 ± 1.1; 2: 4.7 ± 0.9), and mean prostate volume (1: 118.1 ± 37.9; 2: 48.5 ± 15.5 cc), while AUASS, Qmax, and PVR were similar (P>0.05) between groups. Significant differences (P<0.05) in laser use (1: 22.8 ± 13.3; 2: 10.4 ± 6.4 minutes) and energy usage (1: 152.7 ± 90.6; 2: 70.9 ± 44.8 kJ) were also noted. Clinical outcomes (AUASS, QoL, Qmax, and PVR) showed immediate and stable improvement from baseline (P<0.05) within each group, but no significant differences between the two groups were observed during the follow-up period (P>0.05). The incidence of adverse events was low and similar in both cohorts. These results suggest that prostate volume has little effect on the efficacy and safety of GreenLight HPS laser PVP, and that this technique remains a viable surgical option for BPH, irrespective of preoperative prostate volume.

MP-05.14 GreenLight HPS Laser 120 W Versus Diode Laser 150W Vaporization of the Prostate: Results of a Prospective, Randomized Study

Lasers have gained a strong position between the various treatment alternatives for BPH, but, as the technology is still evolving, clinical evidence is needed to prove their safety and efectiveness. A prospective randomised study was conducted to evaluate the surgical efficacy, safety and follow-up results of two laser systems: GreenLight HPS laser (120 W, 532 nm) and BioLitec Diode laser (150 W, 980 nm).

MP-05.13 GreenLight HPS Laser Prostatectomy for Chronic Retention of Urine: A Safe and Efficacious Option

MP-05.13 GreenLight HPS Laser Prostatectomy for Chronic Retention of Urine: A Safe and Efficacious Option