Laser Photoselective Vaporization Of The Prostate Research Articles

Therapeutic efficacy of 180-W GreenLight laser photoselective vaporization of the prostate for storage symptoms concomitant with benign prostatic obstruction and a search for outcome predictors.

Benign prostatic obstruction (BPO) is the most common cause of lower urinary tract symptoms among men. GreenLight photoselective vaporization of the prostate (GL-PVP) using a 180-W Xcelerated performance system (XPS) laser is a well-established method for treating BPO-induced voiding symptoms. However, its therapeutic effects on storage symptoms remain unclear. This study aimed to analyze the storage outcomes in patients who underwent 180-W XPS GL-PVP for BPO and to identify outcome predictors. Patients who underwent 180-W XPS GL-PVP for BPO between May 2018 and May 2021 were retrospectively reviewed. Data on clinical characteristics, prostate volume, preoperative and postoperative International Prostate Symptom Scores (IPSS), and preoperative urodynamic parameters were collected. A favorable storage outcome was defined as ≥50% reduction in the IPSS storage subscore. Ninety-nine male patients were included, with a mean age of 69.4 ± 9.6 years and a baseline prostatic volume of 75.9 ± 33.1 mL. The IPSS total, storage, and voiding subscores significantly decreased after GL-PVP (all p < 0.001). Seventy-two patients achieved favorable storage outcome at 6 months. Multivariate analysis revealed that detrusor underactivity was predictive of unfavorable storage outcomes (p = 0.022), while IPSS voiding-to-storage subscore ratio >1.25 and the presence of detrusor overactivity were predictive of favorable storage outcomes (p = 0.008 and 0.033, respectively). 180-W XPS GL-PVP provided excellent outcomes in both voiding and storage lower urinary tract symptoms concomitant with BPO. Preoperative IPSS and multichannel urodynamic parameters including detrusor overactivity and underactivity are valuable predictors of postoperative storage outcomes.

SC71 - Efficacy and safety profile of greenlight laser photoselective vaporization of the prostate in fragile and elderly patients: results from the italian greenlight laser study group

SC71 - Efficacy and safety profile of greenlight laser photoselective vaporization of the prostate in fragile and elderly patients: results from the italian greenlight laser study group

Management of prostatosymphyseal fistula following photoselective vaporization of the prostate: Case series and systematic review of the literature.

Background:This study is aimed to describe our institutional experience and review the literature to date on prostatosymphyseal fistula (PSF), or puboprostatic fistula, following bladder outlet procedures such as transurethral resection of the prostate (TURP) or laser photoselective vaporization of the prostate (PVP).Materials and methods:We retrospectively queried our institutional experience for management of PSF following PVP performed for symptomatic benign prostatic hyperplasia. We also performed a systematic literature review for PSF following PVP or TURP. Finally, we describe our surgical approach to the management of this challenging condition.Results:We identified 7 cases of PSF following PVP from our institution, as well as an additional 7 cases following PVP and 9 cases following TURP from literature review. The diagnosis of PSF was made between 0.5 and 24 months following PVP, and the most specific symptoms were pubic pain and difficulty ambulating. Most patients requiring several evaluations before the diagnosis was made using appropriate imaging studies. Seventy percent of patients required surgical intervention including fistula repair or prostatectomy. Our surgical approach has evolved, and we now routinely perform robotic fistula repair with Y-V plasty and interposition flap with excellent results.Conclusions:Puboprostatic fistula is a rare and poorly described complication of PVP or TURP. To the best of our knowledge, this case series of PSF following PVP represents the largest series to date and doubles the number of reported cases in the literature. Robotic fistula repair with interposition of either peritoneal or perivesical fat flaps appears to be a viable management strategy.

Outpatient 180 W XPS GreenLight Laser Photoselective Vaporization of the Prostate: 7-Year Experience.

Purpose: GreenLight XPS Laser System (GL-XPS) photoselective vaporization of the prostate (PVP) is not only noninferior to transurethral resection of the prostate, but also with shorter rates of hospital stay and length of catheterization. Scarce literature has been published about the feasibility and safety of performing GL-XPS PVP in an outpatient setting. Our aim is to report our 7-year experience with outpatient GL-XPS PVP. Methods: Medical charts of all patients who underwent GL-XPS PVP between 2013 and 2020 were reviewed. Patients were discharged after careful monitoring in the recovery room and the catheter was removed either at home or at a scheduled hospital visit. We used the Shapiro-Wilk test to assess for normal distribution, and the evaluation of homoscedasticity was performed with the SD test. For qualitative variables, the comparison between groups was carried using the chi-square test and for the quantitative variables we used the nonparametric Mann-Whitney U test. Results: A total of 537 patients were treated, 517 in an outpatient basis. Median age was 68 years (interquartile range [IQR] 62-76), median prostate volume 50 cc (IQR 40-70). 22.8% were on anticoagulants or antiplatelet therapy. Median operative time was 100 minutes (IQR 75-125), length of hospital stay 5 hours (IQR 4-6.45), mean length of catheterization 48 hours (SD 14.92). Readmission rate within 90 days of surgery was 11.7%, 58 (10.8%) for surgical-related complications. Median time for readmission was 4 days (IQR 2-24). Immediate readmission (within 10 days) was recorded in 7.6% of patients, urinary retention was the main cause. No significant differences were found trying to find perioperative predictors for readmission. Conclusions: Our experience suggests that outpatient GL-XPS PVP could be performed safely with a predefined outpatient pathway, with a low readmission and complication rate. (IRB number CEI-521).

P0083 - Outpatient 180 W XPS GreenLight™ Laser photoselective vaporization of the prostate: Seven year experience

P0083 - Outpatient 180 W XPS GreenLight™ Laser photoselective vaporization of the prostate: Seven year experience

Risk of urinary morbidity associated with photoselective vaporization of the prostate (PVP) in prostate cancer patients undergoing a combined radiotherapy regimen consisting of dynamic adaptive radiotherapy (DART) and brachytherapy boost.

231 Background: Recent studies have shown PVPs to be associated with diminished perioperative and postoperative complications compared to transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH). This is the first study to evaluate the timing of PVP intervention and post-treatment morbidity related to a combined regimen of DART and Pd-103 brachytherapy for treatment of prostate cancer. Methods: Between 12/05 and 04/20, 51 consecutive patients underwent Greenlight Laser (GLL) or Olympus Plasma Button (OPB) PVP after DART (median dose: 45 Gy) and before Pd-103 brachytherapy (median dose: 90 Gy). 27 patients received GLL PVP and 24 patients received OPB PVP. Peripheral seed loading designs were utilized to achieve optimal urethral sparing. The time from DART to PVP ranged from 1 to 81 days (median: 18 days). For 12 patients, the interval between DART and PVP was ≤7 days. The time from PVP to seed implant ranged from 0 to 55 days (median: 18 days). For 13 patients, the interval between PVP and implant was ≤7 days. American Urological Association (AUA) symptom scores were compiled prior to PVP and on the last post-brachytherapy follow-up. Post-implant follow-up ranged from 6 months to 15 years (median: 6.4 years). Results: No patient experienced post-implant urinary retention or incontinence. Morbidity was limited to RTOG grade 1-2 symptoms, with the exception of one patient who experienced protracted dysuria, which was identified to be secondary to a pre-existing prostate anomaly (steep urethral curvature). Only that patient required dilation for urethral stricture. AUA scores improved or remained the same in 43 of 51 patients. Only 1 patient of the remaining 8 experienced an increase in AUA &gt; 8 points. Conclusions: In our experience, there have been remarkably few adverse urinary sequelae following Pd-103 implantation in patients with prior PVP and DART. In contrast to TURPs, PVPs are safe even with short intervals between DART and brachytherapy. Based upon these results, pre-implant PVP is preferred, rather than PVPs or TURPs in the post-implant setting.

Predictors of re-intervention after greenlight laser photoselective vaporization of the prostate: multicenter long/mid-term follow-up experience

Aim: Greenlight photoselective vaporization of the prostate (PVP) is considered a safe alternative to transurethral resection of the prostate (TURP) in men with lower urinary tract symptoms (LUTS) and a prostate volume of 30-80 mL for the comparable short- and mid-term results. Long-term re-treatment rate is still being debated.

Editorial Comment on: "Impact of Body Mass Index on Outcomes Following Anatomic GreenLight Laser Photoselective Vaporization of the Prostate" by Pierce et al.

Editorial Comment on: "Impact of Body Mass Index on Outcomes Following Anatomic GreenLight Laser Photoselective Vaporization of the Prostate" by Pierce et al.

Editorial Comment on: “Impact of Body Mass Index on Outcomes Following Anatomic GreenLight Laser Photoselective Vaporization of the Prostate” by Pierce et al.

<i>Editorial Comment on:</i> “Impact of Body Mass Index on Outcomes Following Anatomic GreenLight Laser Photoselective Vaporization of the Prostate” by Pierce et al.

SC118 - Haemorrhagic complications after Greenlight laser photo-selective vaporization of the prostate: results from a monocentric cohort of high-risk patients

SC118 - Haemorrhagic complications after Greenlight laser photo-selective vaporization of the prostate: results from a monocentric cohort of high-risk patients

SC124 - Predicting factors of post-operative acute urinary retention after Greenlight laser photoselective vaporization of the prostate

SC124 - Predicting factors of post-operative acute urinary retention after Greenlight laser photoselective vaporization of the prostate

Impact of Body Mass Index on Outcomes Following Anatomic GreenLight Laser Photoselective Vaporization of the Prostate.

Introduction: Obesity can lead to increased risk of perioperative complications in surgical patients, but evidence is lacking regarding the impact of obesity on bladder outlet surgery outcomes. We sought to assess the safety and efficacy of GreenLight photoselective vaporization of the prostate (PVP) in obese patients by comparing functional outcomes and complications in men, stratified according to the body mass index (BMI). Materials and Methods: A retrospective analysis was undertaken of 424 men who underwent 180W GreenLight PVP between 2012 and 2016 at two tertiary medical centers. Patients were stratified based on the World Health Organization (WHO) classification of obesity as determined by BMI. Normal weight men had BMI <25 kg/m2, overweight men had BMI between 25 and 30 kg/m2, and obese men had BMI greater than 30 kg/m2. Primary endpoints examined were differences in intraoperative outcomes and incidence of intraoperative and postoperative complications between BMI groups. Secondary endpoints were improvements in the International Prostate Symptom Score, quality of life score, and the uroflowmetry variables, maximum urinary flow rate and postvoid residual. Results: The BMI groups did not differ regarding operative time or lasing time after matching for prostate volume, but overweight patients in the matched cohort still required higher mean energy use than normal weight men (258.6 kJ vs 233.9 kJ; p = 0.017). No significant differences between BMI groups were observed for intraoperative complications, postoperative complications, or readmission rates. All functional parameters were significantly improved at 24 months for each group, with no differences in improvement between groups. On multivariable analysis, BMI was not a significant predictor for outcomes following PVP. Conclusions: Increased BMI has a negligible effect on intraoperative parameters and does not affect postoperative complication rates or functional outcomes. GreenLight XPS 180W PVP is a safe and effective procedure in overweight and obese men.

GreenLight XPS 180-W Laser Vaporization of Prostate in High-Risk Elderly Patients: A Single-Center Experience.

Purpose: To evaluate the safety and efficacy of GreenLight XPS 180-W laser photoselective vaporization of the prostate (PVP) in high-risk elderly patients with benign prostatic hyperplasia. Materials and methods: This retrospective study included 150 elderly patients with enlarged prostate glands (>40 mL) receiving 180-W photoselective vaporization at our department between January 2016 and October 2018. All patients were of advanced age (>80 years) and included those at higher risk of bleeding and cardiopulmonary disease. Perioperative data were collected and analyzed. Results: All operations were completed uneventfully without conversion to open surgery, and nobody died due to postoperative complications. The mean preoperative prostate volume was 65 ± 12.5 mL, mean operative time was 63 ± 12.5 min, mean laser working time was 51 ± 9.2 min, and mean catheterization time was 2.7 ± 1.8 days. There were significant improvements in International Prostate Symptom Scores, quality of life, maximum flow rate, and postvoid residual volume compared with preoperative values. Intraoperative as well as short- and long-term postoperative complication rates were 0.7%, 29.8%, and 13.3%, respectively. Three patients required rehospitalization for postoperative complications, one needed reoperation, and the others recovered after conservative treatment. Conclusions: PVP with a GreenLight XPS 180-W laser in high-risk elderly patients is safe and feasible. It provides a dramatic improvement in both short- and long-term functional outcomes and deserves promotion.

PD09-07 RETURNING THE ER: AN ANALYSIS OF EMERGENCY VISITS FOLLOWING UROLOGIC OUTPATIENT PROCEDURES

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety II (PD09)1 Apr 2020PD09-07 RETURNING THE ER: AN ANALYSIS OF EMERGENCY VISITS FOLLOWING UROLOGIC OUTPATIENT PROCEDURES Luke Witherspoon*, Rodney Breau, Christopher Knee, Ranjeeta Mallick, J. Stuart Oake, and Luke Lavallee Luke Witherspoon*Luke Witherspoon* More articles by this author , Rodney BreauRodney Breau More articles by this author , Christopher KneeChristopher Knee More articles by this author , Ranjeeta MallickRanjeeta Mallick More articles by this author , J. Stuart OakeJ. Stuart Oake More articles by this author , and Luke LavalleeLuke Lavallee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000836.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urologic surgeries have been previously identified as having high rates of readmission compared to other surgeries. This study aims to identify risk factors leading to presentation to the emergency department (ED) following urologic outpatient surgery. METHODS: We examined all outpatient surgeries performed by urology, general surgery, thoracic surgery, and gynecology occurring at three hospitals within The Ottawa Hospital system between April 1, 2008, and February 28, 2018. We captured all ED visits within 90 days of the outpatient procedure. Surgical characteristics included hospital campus, procedure end time, and day/month/year of procedure. Patient characteristics assessed included age, sex, marital status, presence of primary care provider, socioeconomic status (SES), American Society of Anesthesiologists (ASA) score, and Elixhauser comorbidity index. RESULTS: 38,377 outpatient procedures were performed by the four services assessed over our time period. 5641 ED visits within 90 days were identified. Urological procedures accounted for 47.5% (n=2681) of the patients returning to the ED, representing a 16.2% rate of return to the emergency room following urologic day surgery. Furthermore, urologic patients were more likely to have several visits to the emergency room within 90 days compared to other surgical services (p<0.05). Univariable analyses of individual variables found that increased age, low SES, unmarried status were all associated with higher rates of ED visits (p<0.05). The median ER visit day post-procedure ranged from 5-17 depending on procedure type. Of the noted reasons for emergency presentation, the top 5 causes were directly related to urology with retention (11% of visits), and hematuria (10% of visits) being the most common. Of urological day surgery procedures ureteroscopy (Relative Risk (RR) 3.69, 95% CI 2.17,6.29), Greenlight Laser Photoselective Vaporization of the prostate (RR 3.6, 95% CI 2.05, 6.34), and ureteric stent insertion (RR 3.83, 95% CI 2.17, 6.76) had the highest rates of return to emergency in 90 days on multivariate analysis. CONCLUSIONS: ED visits following urologic outpatient procedures are common. This study identifies risk factors to identify patients that may benefit from additional education or support after outpatient urologic surgery to reduce ED care needs. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e177-e177 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luke Witherspoon* More articles by this author Rodney Breau More articles by this author Christopher Knee More articles by this author Ranjeeta Mallick More articles by this author J. Stuart Oake More articles by this author Luke Lavallee More articles by this author Expand All Advertisement PDF downloadLoading ...

SC21 - Is Greenlight laser photoselective vaporization of the prostate a safe technique? Results from a wide monocentric series complications analysis, with a focus on postoperative fever and sepsis

SC21 - Is Greenlight laser photoselective vaporization of the prostate a safe technique? Results from a wide monocentric series complications analysis, with a focus on postoperative fever and sepsis

Vaporization of Prostate by 160W GreenLight Laser on Postoperative Erectile Function

ObjectiveTo evaluate the impact of photoselective vaporization of the prostate (PVP) on erectile function (EF) utilizing a 160W GreenLight laser system with up to 36 months of follow-up in men with lower urinary tract symptoms caused by benign prostatic hyperplasia. MethodsA prospectively maintained database of patients who underwent GreenLight PVP was retrospectively reviewed. International Index of Erectile Function-5 (IIEF-5) questionnaire was used to assess EF. In total, 265 sexually active patients who underwent 160W GreenLight laser PVP were identified and divided into Group A with baseline IIEF-5 <19 and group B with baseline IIEF-5 ≥19. IIEF-5, International Prostate Symptom Score, quality of life, postvoid residual, and Qmax were recorded preoperatively, perioperatively, and at follow-up after 1, 3, 6, 12, 24, and 36 months. Recorded data were analyzed statistically using t- and χ2 tests. ResultsThe preoperative and perioperative data of the 2 groups were comparable. Significant improvements in International Prostate Symptom Score, Qmax, quality of life, and postvoid residual were observed in both groups at every follow-up visit throughout the 36 months with no significant difference between the groups. EF was sustained postoperatively compared with the baseline in the whole study population. In Group A (preoperative IIEF-5 <19), EF was significantly improved at 1 month and 12 month (P= .02 and P= .002). ConclusionIn patients undergoing PVP by 160W GreenLight laser for lower urinary tract symptoms secondary to benign prostatic hyperplasia, no significant detrimental effect was observed in the EF at up to 3 years of follow-up. However, in patients with preoperative erectile dysfunction (ED), we showed a significant improvement.

1111 - Ejaculatory hood sparing vs. standard GreenLight™ laser photoselective vaporization of the prostate: Sexual and urodynamic assessment through randomized controlled trial

1111 - Ejaculatory hood sparing vs. standard GreenLight™ laser photoselective vaporization of the prostate: Sexual and urodynamic assessment through randomized controlled trial

Comparison Between Thulium Laser VapoEnucleation and GreenLight Laser Photoselective Vaporization of the Prostate in Real-Life Setting: Propensity Score Analysis

To compare in daily practice efficacy and safety of standard 180-Watt GreenLight laser photoselective vaporization (PVP) and Thulium laser Vaporesection of the prostate (ThuVEP). All men were evaluated with prostate volume, prostate-specific antigen, International Prostate Symptom Score, and maximum urinary flow. Patient global impression of improvement was evaluated with patient global impression of improvement scale for 6 months. Antiplatelet/anticoagulant therapy, operation time, 24-hour hemoglobin drop , length of catheterization, discharge day, early complications, and reoperation after 30 days were gathered. Differences between interventions were estimated using propensity scores to adjust for different patients characteristics. The propensity scores were estimated by fitting a stepwise logistic regression model with intervention type as the dependent variable and all the covariates. Five hundred five men underwent the surgical procedures (291 PVP and 214 ThuVEP). Mean age was 69.6 years. Mean prostate volume was 54 mL. Median operation time was 55 minutes. Median catheterization time was 2 days in both series. After matching, the postoperative stay was similar in both groups (2 days). Hemoglobin drop for 24 hours was statistically significantly lower in PVP (-0.5 vs -0.8 g/dL, P .002). Most of the complications were mild-to-moderate and comparable among groups. Δ Maximum urinary flow was similar 6-month after surgery before and after matching, whereas PVP group had a better improvement 12-month after surgery. 96.4% of all patients had an improvement of their symptoms, with no difference between groups, before and after matching. Our study demonstrated that PVP and ThuVEP are similar in term of complications and outcomes, with high patients' satisfaction.

Perioperative major acute cardiovascular events after 180-W GreenLight laser photoselective vaporization of the prostate.

Major acute cardiovascular events (MACE) prevalence after 180-W GreenLight (180-W GL) laser photoselective vaporization (PVP) have never been explored. Aim of our study is to evaluate perioperative MACE that occurred concomitantly with 180-W GL PVP. We relied on a multi-institutional database that included 14 centers. Data from 923 patients who underwent 180-W GL PVP were reviewed. We abstracted pre- and perioperative data of patients who experienced perioperative MACE, such as angina pectoris, acute myocardial infarction, other chronic ischemic heart disease, transient ischemic attack, or cerebrovascular accident as well as deep venous thrombosis with or without pulmonary embolism. We relied on a case-series format to report the main findings of our analyses. 18 (1.9%) patients reported MACE in 7 centers. Median age was 69.5 (IQR 66.0-79.2) years. Of all, 7 patients underwent standard PVP and 11 anatomical PVP. Eleven patients (61.1%) were not under anticoagulant/antiplatelet treatment, 6(33.3%) were under low dose aspirin, and 1 (5.6%)was under clopidogrel. Four patients(22.2%) had an instrumental and laboratory diagnosis of myocardial infarction, 7(38.9%) had an episode of angina pectoris with or without rhythm alteration, 3(16.7%) reported symptomatic deep venous thrombosis, and 4(22.2%) had other MACE-like events. Physician should take in consideration the possibility of MACE or MACE-like events. The real MACE rate may be different as only half of included centers reported MACE. Since the main target of laser surgery are high-risk bleeding patients, prospective observational trials focused on detection of these possible complications are warranted.

Evaluation of the effectiveness of laser photoselective vaporization of the prostate in the treatment of patients with benign prostatic hyperplasia.

The prolongation of the life of men results in the growing number of people suffering from benign prostatic hyperplasia (BPH). In 2010, BPH concerned more than 200 million men in the whole world, which at that time made up 6% of the population of men at large. Currently, the population of men in the world amounts about three billion six hundred million. The modern surgical treatment of BPH consists of minimally invasive techniques, including laser systems. Evaluation of the effectiveness of photoselective vaporization of the prostate (PVP) on the basis of subjective parameters assessed by patients using IPSS and QoL questionnaires as well as objective parameters obtained from results of urodynamic tests. Between 2012 and 2015, 120 patients with benign prostatic hyperplasia were included in the study and underwent PVP. Finally, 77 patients were included in the study. In all patients, IPSS and QoL sheets were carried out 1, 6 and 12 months, and urodynamic tests 12 months a er the surgical treatment. The statistically significant change in the value of each parameter assessed: decrease in the IPSS, QoL, PVR, Pmax, Pop, the degree of obstruction according to Schäfer and ICS nomogram, and an increase in the values of Qmax and Qave. Photoselective vaporization of the prostate is an effective method of therapy in patients with benign prostatic hyperplasia.