Laser Photoselective Vaporization Of The Prostate Research Articles

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.

GreenLight laser photoselective vaporization of the prostate for treatment of benign prostate hyperplasia/lower urinary tract symptoms in patients with different post-void residual urine.

The purpose of this study is to assess the safety and efficacy of GreenLight laser photoselective vaporization of the prostate (PVP) for the treatment of benign prostate hyperplasia/lower urinary tract symptoms (BPH/LUTS) in patients with different post-void residual urine (PVR). BPH/LUTS patients treated with PVP from January 2014 to January 2016 were enrolled in the present study. All patients were divided into PVR > 50, 50 ≤ PVR < 400, and PVR ≥ 400ml groups, and standard general and urological methods for BPH/LUTS were carried out. PVP surgery was performed, and the follow-up outcome was investigated 6months after surgery. A total of 429 patients were included, and there were no significant differences in comorbid diseases or habits among the three groups. The maximum urinary flow rate (Qmax) differed significantly among the groups (P < 0.001), while patients in the PVR < 50ml group had higher maximum detrusor pressure (Pdet.max) level than the other two groups (P < 0.001). Patients in 50 ≤ PVR < 400 (P < 0.001) and PVR ≥ 400 (P < 0.001) ml groups were more likely to develop detrusor underactivity than those in the PVR < 50ml group. All patients were treated with PVP, and there were no severe complications requiring rehospitalization or reoperation except nine designed re-treatments. Follow-up data of 387 patients were available. Significant improvement in outcome parameters (International Prostate Symptom Score [IPSS], Qmax, and PVR) was observed in comparison with baseline measurements for the three groups. PVP significantly improved the IPSS, Qmax, and PVR in patients with different PVR; PVP is a safe and effective procedure for BPH/LUTS patients.

Assessment of energy density usage during 180W lithium triborate laser photoselective vaporization of the prostate for benign prostatic hyperplasia. Is there an optimum amount of kilo-Joules per gram of prostate?

To assess the effect of energy density (kJ/mL) applied on adenoma during photoselective vaporization of the prostate (PVP) treatment for benign prostate hyperplasia (BPH) on functional outcomes, prostate-specific antigen (PSA) reduction and complications. After exclusions, a total of 440 patients who underwent GreenLight (tm) laser XPS-180W lithium triborate PVP for the treatment of BPH were retrospectively reviewed. Data were collected from seven different international centres (Canada, USA, UK and France). Patients were stratified into four energy density groups (kJ/mL) according to intra-operative energy delivered and prostate volume as determined by preoperative transrectal ultrasonography (TRUS): group 1: <3 kJ/mL; group 2: 3-5 kJ/mL; group 3: 5-7 kJ/mL; and group 4: ≥7 kJ/mL. Energy density groups were chosen arbitrarily. PSA reduction and functional outcomes (International Prostate Symptom Score, quality of life, post-void residual urine volume, maximum urinary flow rate) were compared at 6, 12 and 24 months. Peri-operative complications and retreatment rates were also compared among the groups. The PSA reduction rates at 24 months after the procedure were 51, 61, 79 and 83% for the energy density groups <3, 3-5, 5-7 and ≥7 kJ/mL, respectively (P ≤ 0.01). This held true after accounting for baseline confounders. Energy density was not associated with higher complication rates, including haematuria, stricture formation, incontinence, refractory urinary retention, urinary tract infection and conversion to transurethral resection of the prostate. Functional outcomes at 2 years of follow-up were equivalent among the groups (P > 0.05 for all) and similar retreatment rates were observed (P = 0.36). Higher energy usage per cc of prostate was associated with a more significant reduction in PSA level (>50%) at 6, 12 and 24 months, suggesting increased vaporization of adenoma tissue; however, this did not translate into differences in functional outcomes at 2-year follow-up.

Greenlight high-performance system (HPS) 120-W laser vaporization versus transurethral resection of the prostate for the treatment of benign prostatic hyperplasia: a meta-analysis of the published results of randomized controlled trials.

To assess the efficacy and the safety of Greenlight(TM) high-performance system (HPS) 120-W laser photoselective vaporization of the prostate (PVP) compared with transurethral resection of the prostate (TURP) for treatment of benign prostatic hyperplasia (BPH). The related original studies only including randomized controlled trials were searched by databases MEDLINE, EMBASE, Google Scholar, and the Cochrane Controlled Trial Register. The databases were updated till July 2014. The risk ratio, mean difference, and their corresponding 95% confidence intervals were calculated. Risk of bias of the enrolled trials were assessed according to Cochrane Handbook. A total of four trials involving 559 patients were enrolled. Statistical analysis was performed by software Review Manager (V5.3.3). There was no significant difference in International Prostate Symptom Score (IPSS) and maximum flow rate (Qmax) between PVP and TURP at 6-, 12-, and 24-month follow-up. Patients in the PVP group were associated with significantly lower risk of capsule perforation (risk ratio (RR) = 0.06, 95% confidence interval (95%CI) = 0.01 to 0.46; p = 0.007), significantly lower transfusion requirements (RR = 0.12, 95%CI = 0.03 to 0.43; p = 0.001), a shorter catheterization time (mean difference (MD) = -41.93, 95%CI = -54.87 to -28.99; p < 0.00001), and a shorter duration of hospital stay (MD = -2.09, 95%CI = -2.58 to -1.59; p < 0.00001) than that in the TURP group. In the TURP group, the patients were associated with a lower risk of re-operation (RR = 3.68, 95%CI = 1.04 to 13.00; p = 0.04) and a shorter operative time (MD = 9.28, 95%CI = 2.80 to 15.75; p = 0.005) than those in the PVP group. In addition, no statistically significant differences were detected between groups in terms of the rates of transurethral resection syndrome, urethral stricture, bladder neck contracture, incontinence, and infection. Greenlight(TM) 120-W laser PVP is as effective as TURP for symptom reduction and improvement of the quality of life. Laser PVP shows advantages over TURP in terms of intraoperative safety, whereas TURP is found to have a shorter operative time and lower re-operative risk.

Postoperative Lower Urinary Tract Storage Symptoms: Does Prostate Enucleation Differ from Prostate Vaporization for Treatment of Symptomatic Benign Prostatic Hyperplasia?

To assess the degree of postoperative storage symptoms after GreenLight™ laser photoselective vaporization of the prostate (PVP) and Holmium laser enucleation of the prostate (HoLEP) for management of benign prostatic hyperplasia (BPH) and its predictors. A retrospective review was performed for patients who underwent HoLEP or PVP for non catheter-dependent patients with BPH. Patients were followed up at 1, 3, 6, and 12 months and then annually by International Prostate Symptoms Score (IPSS), quality of life index, peak flow rate, residual urine volume, and prostate-specific antigen (PSA) level. Moderate or severe storage symptoms were defined as IPSS storage subscore ≥ 9. Of 1673 laser procedures, a total of 1100 procedures met the inclusion criteria including 809 HoLEPs and 291 PVPs. The HoLEP group had significantly larger preoperative prostates and longer operative time. In the HoLEP group, postoperative IPSS was significantly better than in the PVP group at all follow-up points (P<0.05). Storage subscore was significantly higher after PVP and did not improve until 6 months postoperatively when it became comparable with that of the HoLEP group. The number of patients with IPSS-storage score ≥ 9 were significantly higher in the PVP group at 1 and 3 months follow-up (37.3% vs 15.1%, P<0.001) and (26.4% vs 17.5%, P=0.004), respectively. XPS-180W was associated with the lowest storage symptoms among the three GreenLight generations at all follow-up visits. In multivariate analysis, baseline IPSS-storage subscore ≥ 9, prolonged operative time >100 minutes, and lower percent of postoperative PSA level reduction significantly predicted less improvement of postoperative storage symptoms regardless of the laser procedure. Storage urinary symptoms significantly improved more after HoLEP compared with PVP, irrespective of the generation of GreenLight laser used. Recovery from bothersome storage urinary symptoms after prostate vaporization is time dependent, and baseline degree of storage symptoms, prolonged operative time, and lower percent of postoperative PSA level reduction negatively predicts postoperative improvement of storage symptoms regardless of the laser procedure.

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.

The Cutoff Value of Bladder Voiding Efficiency for Predicting Surgical Outcomes After GreenLight HPS™ Laser Photoselective Vaporization of the Prostate

A large postvoid residual (PVR) has been considered to be an indicator for the need to further management. However, the threshold level of PVR has been not defined. We determined the PVR volume by using bladder voiding efficiency (BVE) that would predict surgical outcomes after GreenLight HPS™ laser photoselective vaporization of the prostate (HPS-PVP). A total of 193 patients who underwent HPS-PVP were divided into two groups based on BVE: >75% (group A) and ≤75% (group B). BVE was calculated by dividing voided volume by voided volume plus PVR. Surgical outcomes were assessed from the ratio of the IPSS, the difference in Qmax, and the difference in the quality of life IPSS subscore (QoL) before surgery and at 3, 12, and 36 months postoperatively. There were significant improvements in all outcome measures after 3, 12, and 36 months; the improvement in Qmax was greater in group A than group B at each time point. The IPSS ratio was significantly greater in group A than group B at 3 months. There was no difference in QoL between the groups. The multivariate logistic regression analysis showed that BVE correlated significantly with short-term surgical success, but not with prostate volume or age. In the area under curve of ROC analysis, the BVE cutoff value of 75% showed the highest sensitivity and specificity for predicting the short-term success of surgical outcomes. Our results suggest that a large PVR may predict relatively slight improvements in short-term surgical outcomes after HPS-PVP. The cutoff value of PVR in predicting surgical success is 25% or more of residual fraction.

PD26-06 GREENLIGHT XPS-180W LASER VAPORIZATION OF THE PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA: A GLOBAL, MULTI-CENTER STUDY INCLUDING 1053 PATIENTS, ANALYSIS OF COMPLICATION RATES AND OUTCOMES AT 2 YEARS ACCORDING TO PROSTATE SIZE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I1 Apr 2014PD26-06 GREENLIGHT XPS-180W LASER VAPORIZATION OF THE PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA: A GLOBAL, MULTI-CENTER STUDY INCLUDING 1053 PATIENTS, ANALYSIS OF COMPLICATION RATES AND OUTCOMES AT 2 YEARS ACCORDING TO PROSTATE SIZE Pierre-Alain Hueber, Marc Bienz, Daniel Liberman, Vincent Misrai, Matthew Rutman, Alexis E. Te, Bilal Chughtai, Richard Lee, Neil Barber, Amr M. Emara, Ricardo Gonzalez, and Kevin C. Zorn Pierre-Alain HueberPierre-Alain Hueber More articles by this author , Marc BienzMarc Bienz More articles by this author , Daniel LibermanDaniel Liberman More articles by this author , Vincent MisraiVincent Misrai More articles by this author , Matthew RutmanMatthew Rutman More articles by this author , Alexis E. TeAlexis E. Te More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , Richard LeeRichard Lee More articles by this author , Neil BarberNeil Barber More articles by this author , Amr M. EmaraAmr M. Emara More articles by this author , Ricardo GonzalezRicardo Gonzalez More articles by this author , and Kevin C. ZornKevin C. Zorn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2093AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The aim of this study was to evaluate the safety and outcomes at 2 years of the new Greenlight XPS-180W laser system (AMS, Minnetonka, MI, USA) for the treatment of BPH in a large multicenter cohort. METHODS A total of 1053 patients underwent Greenlight laser photo-selective vaporization of the prostate for the treatment of BPH performed at 6 international centers between 2010 and 2012. Perioperative variables (International Prostate Symptom Score (IPSS), QoL, maximum flow rate (Qmax), post-void residual (PVR) and PSA levels were recorded at baseline, 3 and 6, 12 and 24 months post-operatively. The analysis of patients characteristics, operative parameters, complications and uroflowmetry outcomes was also stratified according to prostate volume >80 and <80cc. RESULTS Overall Mean (SD) patient age was 70.17 (9.23) years, with a mean PV of 74.54 cc (45.1) and PSA of 4.38 ng/ml (5). When stratified according to prostate size, all parameters (but BMI and QoL) including age (70.45 vs 67.36 years), PSA (5.8 vs 3.9 ng/ml), IPSS (22.5 vs 20.8), Qmax (6.1 vs 7.1ml/s) and PVR (267 vs 202 ml) were significantly different between prostate group size >80 cc compared to <80cc (p<0.001). In terms of complication, conversion to TURP was more prevalent in patients with larger glands (11.2% vs 1.1%; p<0.001). All other rates of complications including perforation (0.6% vs 0.6%), bleeding obscuring vision (3.8% vs 6.7%), bleeding hematuria (0.5 vs 0%) and blood transfusion (0.3% vs 0.5%) were relatively low and without significant difference between the two groups. Statistically, significant improvements compared to baseline were noted in all key clinical outcome parameters postoperatively at 3, 6, 12 and 24 months (p<0.05) without significant difference between the two groups (see figure). CONCLUSIONS XPS systems provide safe and effective tissue vaporization with significant clinical relief of BPH obstruction associated with objective outcomes and PSA reduction at 24 months confirming the mid-term durability of this procedure regardless of prostate size. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e761 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Pierre-Alain Hueber More articles by this author Marc Bienz More articles by this author Daniel Liberman More articles by this author Vincent Misrai More articles by this author Matthew Rutman More articles by this author Alexis E. Te More articles by this author Bilal Chughtai More articles by this author Richard Lee More articles by this author Neil Barber More articles by this author Amr M. Emara More articles by this author Ricardo Gonzalez More articles by this author Kevin C. Zorn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Usage of GreenLight HPS 180-W laser vaporisation for treatment of benign prostatic hyperplasia

Laser therapy has gained increasing acceptance as a relatively less invasive treatment for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). From the early procedure of interstitial laser coagulation through to the use of holmium laser enucleation of the prostate, there has been an expanding body of evidence on the efficacy of such procedures. One of the newer lasers is the Green Light HPS 180 W laser. Studies with this GreenLight laser (GLL) (American Medical Systems, Inc, Minnetonka, MN, USA) showing results as good as those of transurethral resection of the prostate (TURP). In this paper, the efficacy of the new GLL 180-W versus the gold standard TURP in patients with LUTS due to BPH was tested in a prospective clinical trial. To compare results of Green light laser (GLL) evaporisation of the prostatae and transurethral resection of the prostate (TURP) for treatment of BPH. MATERIJALS AND METHODS: A total of 62 patients with BPH were randomly assigned to two equal groups: TURP or GLL. Both groups were compared regarding all relevant preoperative, operative, and postoperative parameters. Functional results in terms of improvement of International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and postvoid residual (PVR) urine were assessed at 1, 3, 6 and 12 mo. A total of 62 patients completed 12 mo of follow-up in the TURP and GLL groups, respectively. Baseline characteristics were comparable. Mean operative time was significantly shorter for TURP. Compared to preoperative values, there was significant reduction in hemoglobin levels at the end of TURP only. A significant difference in favor of GLL was achieved regarding the duration of catheterization and hospital stay. In the GLL, no major intraoperative complications were recorded and none of the patients required blood transfusion. Among TURP patients, 6 required transfusion, 1 developed TUR syndrome, and capsule perforation was observed in 5 patients. There was dramatic improvement in Qmax, IPSS, and GLL compared with preoperative values and the degree of improvement was comparable in both groups at all time points of follow-up. Four TURP patients and one GLL patients developed bladder neck contracture treated by bladder neck incision; none in either group experienced urethral stricture or urinary incontinence. Compared to transurethral resection of the prostate, GreenLight HPS 180-W laser photoselective vaporization of the prostate is safe and effective in the treatment of patients suffering from lower urinary tract symptoms due to benign prostatic hyperplasia.

180 W vs 120 W Lithium Triborate Photoselective Vaporization of the Prostate for Benign Prostatic Hyperplasia: A Global, Multicenter Comparative Analysis of Perioperative Treatment Parameters

To evaluate the surgical performance of the new Greenlight XPS-180 W laser system (American Medical Systems, Minnetonka, MI) and the effect of prostate volume (PV), in comparison with the former HPS-120 W system, for the treatment of benign prostatic hyperplasia by photo-selective vaporization of the prostate. Between July 2007 and March 2012, 1809 patients underwent laser photo-selective vaporization of the prostate (1187 patients with the use of HPS-120 W and 622 patients with the use of XPS-180 W) at 7 international centers. All data were collected prospectively. Comparative analysis was performed between XPS and HPS according to PV measured by transrectal ultrasound. The XPS compared with HPS, allowed significantly reduced laser and operative time (29.6 minutes vs 65.8 minutes and 53 minutes vs 80 minutes, respectively; P <.01 for both). The number of fiber used during the procedures was significantly reduced with the XPS system (1.11 vs 2.28; P <.01), whereas total energy delivered was lower (250.2 kJ vs 267.7 kJ; P = .043). Overall, the mean operative time, mean laser time, and mean energy were all significantly increased according to PV >80 mL vs <80 mL. However, when stratified according to PV, XPS demonstrates significant advantages compared with HPS, regardless of prostate size in all operative parameters (P <.01). The new XPS-180 W system exhibits significant advantages in all surgical parameters compared with the HPS-120 W system. Overall, with XPS-180 W and HPS-120 W, mean operative time, laser time, and energy usage increased according to PV. This suggests that preoperative evaluation of PV by transrectal ultrasound should be mandatory.

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

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

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

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

1971 PHOTOSELECTIVE VAPORISATION OF THE PROSTATE USING THE 180W LITHIUM TRIBORATE LASER IN THE TREATMENT OF BENIGN PROSTATIC OBSTRUCTION: AN INTERNATIONAL MULTICENTER EXPERIENCE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology (I)1 Apr 20131971 PHOTOSELECTIVE VAPORISATION OF THE PROSTATE USING THE 180W LITHIUM TRIBORATE LASER IN THE TREATMENT OF BENIGN PROSTATIC OBSTRUCTION: AN INTERNATIONAL MULTICENTER EXPERIENCE Amanda Chung, Alexander Bachmann, Fernando Gomez Sancha, Edward Collins, Shahin Tabatabaei, Gordon Muir, and Henry Woo Amanda ChungAmanda Chung Sydney, Australia More articles by this author , Alexander BachmannAlexander Bachmann Basel, Switzerland More articles by this author , Fernando Gomez SanchaFernando Gomez Sancha Madrid, Spain More articles by this author , Edward CollinsEdward Collins San Francisco, CA More articles by this author , Shahin TabatabaeiShahin Tabatabaei Boston, MA More articles by this author , Gordon MuirGordon Muir London, United Kingdom More articles by this author , and Henry WooHenry Woo Sydney, Australia More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2390AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laser prostatectomy has gained popularity in the treatment of benign prostatic obstruction. This study evaluates our international multicenter experience regarding the safety and efficacy of using photoselective vaporization of the prostate (PVP) with the 180W lithium triborate (LBO) laser in the treatment of men with lower urinary tract symptoms due to benign prostatic obstruction (BPO). METHODS Databases of 540 men treated with the 180W LBO laser PVP for BPO in 5 countries by 6 urologists, from 2010 to 2012 inclusive, were collated and analysed. Perioperative and functional outcomes [International Prostate Symptom Score (IPSS), Quality of Life Score (QoL), maximum urinary flow rate (Qmax), post-void residual urine (PVR)] were assessed at baseline and 3 months post-operation. Statistical analyses were conducted in Microsoft Excel 2011, and comparisons made using Student's t test. RESULTS Of the 540 patients (median patient age 70 years, median prostate volume 60 cc), 24% (130/540) men were in urinary retention, and 34% (182/540) men were taking antiplatelet and/or anticoagulant medications. The median operation time was 57 minutes, median laser time 35 minutes, median energy usage 286 kJ, median duration of catheterization 18 hours, and median duration of hospital stay 24 hours. 93% (501/540) of men went home voiding successfully without requiring any catheterization. There was significant improvement (p<0.01) in all functional outcomes from baseline to 3 months follow up (mean IPSS 30 to 8, QoL 4 to 2, Qmax 8 to 23 mL/s, PVR 170 to 39 mL). 11% (62/540) men experienced at least one complication. There were 76 complications in total. The majority of complications were low grade and of minimal consequence to the patient (44 were Clavien-Dindo grade I, 17 were grade II, 10 were grade III). There were 5 grade IV complications, and no grade V complications. CONCLUSIONS Our international multicenter experience shows that PVP using the 180W LBO laser is an efficacious and safe treatment for men with lower urinary tract symptoms due to BPO. 93% of treated men went home voiding successfully without a catheter. There was significant improvement in all functional outcomes from baseline to 3 months follow-up, and the majority of complications were low grade. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e809 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amanda Chung Sydney, Australia More articles by this author Alexander Bachmann Basel, Switzerland More articles by this author Fernando Gomez Sancha Madrid, Spain More articles by this author Edward Collins San Francisco, CA More articles by this author Shahin Tabatabaei Boston, MA More articles by this author Gordon Muir London, United Kingdom More articles by this author Henry Woo Sydney, Australia More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

GreenLight HPS 120-W laser photoselective vaporization of the prostate as early therapy for acute urinary retention in advanced prostate cancer patients

We evaluate the safety, efficacy, and oncological outcomes of early palliative photoselective vaporization of the prostate (PVP) by GreenLight high-performance system (HPS) 120-W laser in patients with acute urinary retention (AUR) induced by advanced prostate cancer (PCa). A total of 39 advanced PCa patients with AUR who underwent PVP were enrolled in this retrospective study. Baseline parameters, perioperative, and postoperative complications were reviewed. The functional outcomes were evaluated at 1, 3, 6, and 12months after surgery using the International Prostate Symptom Score (IPSS), quality of life (QoL) score, peak urinary flow rate (Q max), and postvoid residual urine volume (PVR). At baseline, mean age was 72.8 ± 6.8years and mean prostate-specific antigen (PSA) level was 45.2 ± 26.9ng/mL. The average energy consumed was 171.2 ± 72.3kJ during a mean operative time of 46.3 ± 13.7min. Mean catheterization duration was 3.3 ± 0.8days. Mean hospitalization time was 5.2 ± 0.5days. Compared with the preoperative values, there were significant continuous improvement in IPSS, QoL score, Q max, and PVR at all time points of follow-up. The mean PSA nadir was 0.33 ± 0.15ng/mL and the mean time to PSA nadir was 10.3 ± 2.5months. Nine patients (23%) eventually developed hormone refractory prostate cancer. No patient experienced severe intraoperative and postoperative complications. Our preliminary investigation shows that GreenLight HPS 120-W laser PVP is a safe and effective treatment for advanced PCa patients with AUR. Patients may obtain some oncological benefits from tumor cytoreduction by early palliative PVP.

Male Sexual Function Outcome After Three Laser Prostate Surgical Techniques: A Single Center Perspective

To assess the change and predictors of sexual-related outcomes after laser prostate surgery. This is a longitudinal study of 216 sexually active men who underwent laser prostatectomy between 2005 and 2010. The International Index of Erectile Function-15 questionnaire was used both preoperatively and during the first year of follow-up. Cases with unreliable answers or patients without interested partners were excluded. All relevant data of both groups were depicted and statistically analyzed. We identified 191 patients that met the inclusion criteria, 99 holmium laser enucleation of the prostate, 34 holmium laser ablation, and 58 photoselective vaporization of the prostate (GreenLight-532-mm laser photoselective vaporization of the prostate). There were significant differences among the 3 groups regarding the International Index of Erectile Function-15 direction of change at 1 year, being unchanged in (22.2%, 24.4%, and 29.3%), improved in (60.6%, 29.4%, and 41.4), and declined in (17.2%, 41.2%, and 29.3%) in the 3 groups, respectively (P < .05). After adjusting for clinical and perioperative variables, the independent risk factors for decline in the International Index of Erectile Function score were basal International Index of Erectile Function ≥ 55 and energy to prostate ratio. In holmium laser enucleation of the prostate group, there was significant improvement of the mean overall score, erectile function, desire, and intercourse satisfaction domains (P < .05). In holmium laser ablation and photoselective vaporization of the prostate groups, there were no significant changes between mean preopeative and postoperative scores (P > .05). The incidence of new onset retrograde ejaculation in the holmium laser enucleation of the prostate group was (77.3%) significantly different compared to (31.1%) in the holmium laser ablation group and (33.2%) in photoselective vaporization of the prostate group (P < .05). Laser prostate surgery using more size-related laser energy might have possible negative influence on sexual function. Patients with normal preoperative sexuality are more at risk.

Can We Predict the Outcome of 532 nm Laser Photoselective Vaporization of the Prostate? Time to Event Analysis

We evaluated the safety, efficacy and predictability of the long-term outcome of GreenLight™ (532 nm laser) photoselective vaporization of the prostate to treat patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. We performed a longitudinal study of patients who underwent GreenLight (532 nm laser) photoselective vaporization of the prostate at our center between June 2002 and November 2011. All patient data were prospectively maintained in the prostate unit database. Two types of laser equipment were used, including the KTP in 91 cases (31.6%) and the GreenLight HPS™ in 197 (68.4%). Larger glands were treated with HPS and KTP photoselective vaporization (mean ± SD volume 45.6 ± 22.5 and 39.6 ± 15.2 ml, respectively, p <0.05). After photoselective vaporization with the KTP laser, we noted a 59.1% and 61.8% decrease in the International Prostate Symptom Score, and a 140.7% and 118.4% improvement in the maximal urine flow rate at 1 and 5 years, respectively. Similarly, after prostate vaporization with the HPS we observed a 65.1% and 62.1% decrease in the International Prostate Symptom Score, and a 123.1% and 107.3% improvement in the maximal urine flow rate at 1 and 4 years, respectively. At a mean of 40.5 months (range 3 to 114) of followup reoperation was indicated in 7.6% of cases. The overall rates of bladder neck contracture, de novo urethral stricture and residual/recurrent adenoma were 3.4% (10 cases), 2.1% (6) and 2.1% (6) with no statistically significant difference between vaporization with the KTP and HPS lasers. Most adverse events occurred during year 1 postoperatively. More bladder neck contractures developed after vaporization was done in smaller glands (p <0.05). More cases with residual prostatic adenoma had a prostate volume of 50 ml or greater vs less than 50 ml (4 of 71 or 5.6% vs 2 of 207 or 0.96%). GreenLight (532 nm laser) photoselective vaporization of the prostate seems to be safe and effective for lower urinary tract symptoms secondary to benign prostatic hyperplasia. A long lasting, successful outcome is predictable. With careful surveillance during year 1 postoperatively and early intervention for adverse events, a sustainable functional outcome could be achieved without re-treatment.

Photoselective vaporization of the prostate with the 120W lithium triborate laser for the treatment of acute urinary retention

PurposeWhilst photoselective vaporization of the prostate (PVP) is used to treat benign prostatic hyperplasia, there is little reported about its performance in urinary retention. The objective of this study is to evaluate the efficacy and safety of GreenLight™ high performance system 120W lithium triborate laser (American Medical Systems, Inc, Minnetonka, MN) PVP in men with urinary retention.Patients and methodsRetrospective analysis of data of all men in urinary retention who underwent treatment with the 120W lithium triborate laser PVP by a single surgeon from November 2006 to July 2010 was performed (n = 78), median age 71 years (interquartile range, 64–80), median prostate volume 91 mL (interquartile range, 58–121). Perioperative outcomes and functional outcomes at baseline, and at 3 and 12 months post-operation were examined.ResultsPatients managed preoperatively by urethral catheterization (n = 61) and suprapubic catheterization (n = 5) were of greater age (by 8.2 years, P < 0.05) and higher American Society of Anesthesiologists scores (P = 0.000, Fisher’s exact test mid P) than patients managed by intermittent self-catheterization (n = 12), but there was no difference in outcomes. There were three Clavien grade III, two Clavien grade IV, and no Clavien grade V complications. There were also no blood transfusions. Fifty-three men (68%) voided successfully post-PVP and went home catheter-free within 24 hours. At 3 months, 62 out of 64 evaluable men (97%) were voiding well without needing any form of catheterization. At 3 months and 12 months, median International Prostate Symptom Score was 7 and 6; International Prostate Symptom Score Quality of Life Index 1 and 1; peak urinary flow 19 and 22 mL/sec; and post-void ultrasound measured residual urine volume 52 and 60 mL, respectively.ConclusionPVP for urinary retention is an efficacious and safe treatment modality.

Photoselective vaporization of the prostate using the 180W lithium triborate laser

Photoselective vaporization of the prostate (PVP) is widely used to treat benign prostatic obstruction (BPO), but there is little experience reported on the new more powerful 180W lithium triborate (LBO) laser. This study evaluates the safety and efficacy of using the 180W LBO laser to treat BPO by examining a multicentre Australian experience. Retrospective review of prospectively collected data on all men treated by 180W LBO laser PVP by eight urologists across six Australian hospitals, from July 2011 to August 2011, was performed. Perioperative and functional outcomes were examined at baseline and 3 months. Of the 85 men (median age 70 years, prostate volume 51 cm(3)) identified, 27% (23/85) were in urinary retention and 44% (37/85) were taking antiplatelet/anticoagulant medication. Median operating time was 46 min, laser time 27 min, energy use 211 kJ, post-operative duration of catheterization 15 h and hospitalization 22 h. Functional outcomes from baseline to 3 months, respectively, were for IPSS 25-7; QoL 5-2; Qmax 7.7-18.4; and PVR 147-38. All improvements were statistically significant (P < 0.01). Thirty-eight percent (32/85) of patients experienced at least one adverse event. Most adverse events were low Clavien-Dindo grade I-II. There were five grade III, two grade IV and no grade V adverse events. Sixty per cent (51/85) of men were able to be discharged home voiding successfully without a catheter within 24-h post-PVP. Our early multicentre Australian experience indicates the 180W LBO laser PVP is an efficacious and safe treatment for BPO.

160-Watt Lithium Triboride Laser Vaporization Versus Transurethral Resection of Prostate: A Prospective Nonrandomized Two-center Trial

To evaluate the safety and efficacy of 160-W lithium triboride laser photoselective vaporization of the prostate (PVP) for the surgical treatment of benign prostatic hyperplasia compared with transurethral resection of the prostate (TURP). From July 2010 to January 2011, a prospective nonrandomized study was performed. A total of 108 patients (57 underwent PVP and 51 TURP) were included in the present study. All patients were preoperatively assessed by International Prostate Symptom Score, transrectal ultrasonography, uroflowmetry, and postvoid residual urine volume measurement. The perioperative parameters and complications were recorded. The patients were reassessed at 1, 3, and 6 months postoperatively. The mean operative time was 57.4 ± 17.3 minutes for TURP and 64.3 ± 20.5 minutes for PVP (P = .044). A significant difference in favor of PVP was achieved for the catheter indwelling time and hospital stay time. Bleeding requiring blood transfusion in 8 patients, and transurethral resection syndrome was observed in 3 patients in the TURP group. Capsule perforation was observed in 5 patients in the TURP group. No severe perioperative complications were recorded in the PVP group. Finally, 4 patients in the TURP group and 1 patient in the PVP group experienced urethral stricture (P = .047). The results of the present study have shown that 160-W lithium triboride laser vaporization is more favorable in terms of perioperative safety and results in a shorter postoperative catheter time and shorter length of hospital stay than with TURP.

Potassium-Titanyl-Phosphate Laser Photoselective Vaporization for Benign Prostatic Hyperplasia: 5-Year Follow-Up from a District General Hospital

The 80-W potassium-titanyl-phosphate (KTP) laser photoselective vaporization of the prostate (PVP) is a minimally invasive surgical option for patients with symptomatic benign prostatic hyperplasia, although evidence of long-term efficacy is limited. We present the long-term outcomes from a heterogeneous patient population. We prospectively collected data for all patients who underwent 80-W KTP laser PVP treatment between 2004 and 2005. Evaluation occurred pr-operatively, and then at 3, 6, 12, and 60 months postoperatively. This included International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), postvoid residual (PVR) volume, serum prostate-specific antigen measurement, and transrectal ultrasonography-estimated prostate volume. A total of 115 patients were eligible for analysis, with a mean age of 77 years and mean prostate volume of 55.8 cc. Of these, 74% were operated on for lower urinary tract symptoms, 23% for acute urinary retention, and 3% for chronic retention; 30% of patients were American Society of Anesthesiologists score ≥ 3, and 93% were treated as 23-hour stays. No patients needed blood transfusion, and there were no cases of transurethral resection syndrome. An initial trial-without catheter failed in 11 (9.6%), although 8 of these successfully voided after a further week. At 5-year follow-up, mean Qmax improved from 8.0 ± 5.0 mL to 13.9 ± 7.7 mL and mean IPSS improved from 22 ± 5 to 9 ± 7. There were no cases of urethral strictures, but there was a 3.3% rate of bladder neck stenosis and an overall re-treatment rate of 21% over 5 years. We confirm the long-term durability of the 80-W KTP laser PVP with minimal perioperative morbidity. It is therefore a safe option for high-risk patients with medical comorbidities, although its high reoperation rate may limit its use to this specific patient population.