Laser Photoselective Vaporization 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.

Greenlight laser (XPS-180watt) prostatectomy for treatment of benign prostate obstruction, Pursuit of durability

ABSTRACT Objectives To report 5-year outcomes, need and predictors of retreatment post greenlight laser photoselective vaporization (GL.PVP) and vapo-enucleation (GL.PVEP), as long-term data on safety and efficacy of GL.PVP and GL.PVEP and on the prostate using XPSTM system are still pending. Patients and methods Primary outcome was the need for retreatment (medical treatment and reintervention) for recurrent BOO. Time-to-event (retreatment) analysis, perioperative events, change in the urinary outcome measures at different follow-up visits, early and late complications and PSA kinetics were reported. Results Between September 2014 and April 2017, 248 patients underwent GL/XPS procedures. GL.PVP and GL.PVEP were carried out for 157 (63.3%) and 91 (36.7%) patients with mean prostate sizes of 60 ± 18 and 100 ± 22 cc, respectively. After a mean duration of 62 ± 9-month follow-up, overall retreatment rate (medical and interventional) was 23% (57 patients). It was comparable between both GL.PVP and GL.PVEP cases: 38 (24.2%) and 19 (20.9%) patients, P = 0.5, respectively. Significantly more surgical reintervention rate was reported after GL.PVP compared to GL.PVEP (P = 0.03). In retreatment group, more intraoperative bleeding (P = 0.02), early postoperative hematuria (P = 0.03), higher median preoperative PSA (P = 0.02) and less postoperative one-year percent PSA reduction (P = 0.02) were detected. Lower postoperative one-year percent PSA reduction independently predicts retreatment with a cut-off point of 64.2% (58.2% sensitivity, 73.4% specificity, AUC 0.647, 95% CI 0.52–0.76). Median (range in months) time to event was 20 (1–60) for all cases and 13.5 (1–42) and 30 (18–60), P = 0.7, for GL.PVP and GL.PVEP groups, respectively. Conclusion Greenlight laser XPS is an effective, durable and versatile tool in treating benign prostatic obstruction. Durability of the outcome is predictable with more postoperative PSA reduction.

Short- and long-term risks of photoselective laser vaporization of the prostate: a population-based comparison with transurethral resection of the prostate

Background Transurethral resection of the prostate (TURP) is the standard surgical treatment for benign prostate enlargement (BPE). Photoselective vaporization of the prostate (PVP) is an alternative, but there is limited real-life evidence of PVP risks. Objective To compare short- and long-term risks of PVP to those of TURP in the treatment of BPE. Materials and methods Consecutive patients who underwent elective PVP or TURP between 2006 and 2018 in 20 hospitals in Finland were retrospectively studied using a combination of national registries (n = 27,408; mean age 71 years). Short-term risks were postoperative mortality, major adverse cardiovascular events (MACE), and reoperations for bleeding. Long-term risks were reoperations for BPE or any urethral operations within 12 years. Differences between treatment groups were balanced by inverse probability of treatment weighting. Risks were analyzed using the Kaplan–Meier method and Cox regression. Results There were no differences in postoperative mortality or MACE between the study groups. Reoperations for bleeding were less frequent after PVP (0.9%, HR: 0.72, p = 0.042). Bleeding was more likely in patients with atrial fibrillation (number needed to treat [NNT] for PVP vs TURP: 61). Cumulative incidence for reoperation was higher after PVP (23.5%) than after TURP in long-term follow-up (17.8%; HR: 1.20, p < 0.0001, NNT: −31.7). Conclusions PVP is associated with lower postoperative bleeding risk but higher long-term reoperation risk than TURP. Patients with high bleeding risk and a low likelihood of needing reoperation appear most suitable for laser vaporization. KEY MESSAGE PVP is associated with lower postoperative bleeding risk but higher long-term reoperation risk than TURP. PVP appears an attractive treatment option, especially for patients with high bleeding risk and a low likelihood of needing a reoperation.

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

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

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

180-W GreenLight laser photoselective vaporization with multiple triamcinolone acetonide injections for the treatment of bladder neck contractures.

Bladder neck contracture (BNC), one of the most challenging complications after transurethral resection of the prostate (TURP) and photoselective vaporization of the prostate (PVP), lacks effective treatment. In the present study, our experience in treating BNC using GreenLight laser vaporization with triamcinolone acetonide (TA) injections was shared. This is a retrospective cohort study that included 46 patients with BNC after TURP and PVP in our center. GreenLight laser surgeries (180W) were carried out and TA was administrated simultaneously. TA injections were repeated every week for three times after surgeries. The perioperative and postoperative parameters were reviewed and compared. Bladder neck tissues were examined by immunohistochemical staining to explore the expressions of collagen I, matrix metalloproteinase-3 (MMP-3), and transforming growth factor-β (TGF-β) after treatments. The chief complaint symptoms of all patients were significantly relieved after our treatments. None of them showed BNC recurrence during the follow-up. Complications were rare and mild. Postoperative assessments including maximal urinary flow rate (P < 0.01), International Prostate Symptom Score (P < 0.01), quality of life index (P < 0.01), and post-void residual volume (P < 0.001) were significantly better than baseline values, respectively. Immunohistochemical staining showed significantly lower expressions of collagen I (P < 0.001), MMP-3 (P < 0.001), and TGF-β (P < 0.001) after treatments. In conclusion, 180-W GreenLight laser with repeated TA injections demonstrated the safety and long-term efficacy in treating BNC, by inhibiting the expressions of fibrotic factors. Our procedure was a promising treatment for BNC after PVP and TURP.

MP29-17 RECOVERY ROOM TIME AND LENGTH-OF-STAY ARE SIMILAR AFTER SPINAL AND GENERAL ANAESTHESIA FOR BPH SURGERY

You have accessJournal of UrologyCME1 May 2022MP29-17 RECOVERY ROOM TIME AND LENGTH-OF-STAY ARE SIMILAR AFTER SPINAL AND GENERAL ANAESTHESIA FOR BPH SURGERY Kirby R. Qin, William Wang, Damien Bolton, and Gregory Jack Kirby R. QinKirby R. Qin More articles by this author , William WangWilliam Wang More articles by this author , Damien BoltonDamien Bolton More articles by this author , and Gregory JackGregory Jack More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002572.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Benign prostatic hyperplasia (BPH) surgery is typically performed under general (GA) or spinal anaesthesia (SA). SA is considered the anaesthetic of choice for as it facilitates early identification of transurethral resection of prostate (TURP) syndrome. However, SA may be associated with longer time spent in the recovery room. Previous studies have compared GA and SA in regards to post-operative pain, but not post-operative recovery. We compare post-operative recovery metrics after GA and SA for BPH surgery. METHODS: This was a retrospective review of 500 consecutive patients from March 2019 to July 2021 who underwent surgical management of BPH at Austin Health in Melbourne, Australia. Our institution performs greenlight laser photoselective vaporisation of prostate (PVP), monopolar and bipolar TURP. All continuous variables were normally distributed, presented as mean±SD, and compared using the Student’s T-test and mean difference (MD) [95% CI]. Categorical variables were compared with the Chi-square test. Comparison of recovery time was achieved using multivariate linear regression. RESULTS: In total, 186 (37.2%) underwent SA for monopolar TURP (n=144, 77.4%), bipolar TURP (n=9, 4.8%) and PVP (n=33, 17.7%). In contrast, 314 (62.8%) underwent GA for monopolar TURP (n=213, 67.8%), bipolar TURP (n=6, 1.9%) and PVP (n=95, 30.3%). SA patients were older than GA patients (73.1±8.9 vs 71.2±8.9 years, MD 1.9 [0.3-3.5], p=0.02), but similar in terms of ASA (p=0.17) and prostate volume (67.3±35.0 cc vs 67.7±38.3 cc, p=0.91). As expected, anaesthetic time was longer for SAs (31.5±11.7 vs 26.6±25.3 minutes, MD 4.9 [2.8-7.0], p<0.001), but total operating room time was similar (76.7±26.6 vs 75.7±29.3 minutes, p=0.72). TURP syndrome amongst SAs and GAs were identical (1.6% vs 1.6%, p=0.99). Recovery room time (82.8±57.2 vs 74.7±42.7 minutes, p=0.07) and length-of-stay (2.5±2.0 vs 2.3±3.3 days, p=0.42) were similar after SA and GA. In multivariate analysis, higher ASA score (p<0.001), PVP surgery (p=0.03), longer resection time (p=0.04) and TURP syndrome (p=0.008) were associated with greater time spent in the recovery room, but choice of anaesthetic was non-significant (p=0.37). CONCLUSIONS: Although our study does not prove if SA can facilitate early identification of TURP syndrome, we have shown that the method of anaesthesia does not significantly impact time spent in the operating room and recovery room or inpatient length-of-stay. This may further support the ongoing use of SA for BPH surgery. Source of Funding: Nil © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e476 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kirby R. Qin More articles by this author William Wang More articles by this author Damien Bolton More articles by this author Gregory Jack More articles by this author Expand All Advertisement PDF DownloadLoading ...

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).

Day Case GreenLight Laser Photoselective Vaporisation of the Prostate (GL-PVP)

Background and Objective In recent years, GreenLight laser photoselective vaporisation of the prostate (GL-PVP) has emerged as the primary ablative surgical treatment option for symptomatic bladder outlet obstruction (BOO) secondary to benign prostatic enlargement (BPE). Unlike the reference procedure, monopolar-transurethral resection of the prostate (M-TURP), GL-PVP can be performed as a day case. As waiting list pressures continue to burden health boards across the UK, exacerbated by the COVID-19 pandemic, enhanced access to day case surgery to optimise patient flow is now of paramount importance. We evaluated the safety and feasibility of day case GL-PVP at our high-volume UK centre and identified predictors of a postoperative overnight stay. Material and Methods We performed a retrospective observational cohort study of all patients who underwent primary GL-PVP at a single institution between October 2016 and June 2021. All procedures were performed utilising the 180W GreenLight XPS™ laser therapy system. Various clinical, operative and functional data were collated, and outcomes were compared between patients who underwent day case surgery and those admitted overnight postoperatively. Results In all, 538 patients underwent GL-PVP during the study period. Median patient age was 72 (interquartile range (IQR) 66–77), and median prostate volume was 62.5cc (IQR 45–90). Five hundred nineteen patients (96.5%) were discharged within 23 hours of admission, and 366 patients (68.0%) were managed as a true day case. Operative and functional outcomes were comparable between patients managed as a day case and those admitted overnight. There was higher patient-reported satisfaction and a lower rate of early hospital readmission in the day-case group. On univariate logistic regression analysis, patients aged ≥80 years (Odds Ratio 2.64 [95% Confidence Interval 1.65– 4.24], p = &lt; 0.001), those with American Society of Anaesthesiologists (ASA) physical status classification score ≥3 (OR 1.92 [95% CI 1.33–2.78], p = &lt; 0.001), those with prostate volume ≥80cc (OR 1.62 [95% CI 1.00–2.61], p = 0.05) and those in whom the operation time ≥60 minutes (OR 1.66 [95% CI 1.10–2.52], p = 0.02) were more likely to be admitted overnight following GL-PVP. On multivariate logistic regression analysis, age ≥80 (OR 2.64 [95% CI 1.47–4.73], p = 0.001) and ASA score ≥3 (OR 2.03 [95% CI 1.28–3.22], p = 0.003) remained predictive variables of an overnight stay. Conclusion From our observations of a large cohort of patients over a study period of almost five years, day case GLPVP is a feasible concept and does not appear to compromise perioperative outcomes. With appropriate service redesign and optimisation of postoperative patient pathways, day case GL-PVP can be established in other centres and may have a role in alleviating waiting list pressures.

Safety profile of GreenLight XPS laser photoselective vaporisation of the prostate in patients at high risk of bleeding

Objective: This study aimed to assess the utility and safety profile of the GreenLight Xcelerated Performance System (XPS) photoselective vaporisation of the prostate (PVP) to treat benign prostatic hyperplasia (BPH) in high-risk patients. Patients and methods: A retrospective study of a prospectively managed database was carried out. The study reviewed a single surgeon’s experience of treating high-risk patients with GreenLight XPS PVP between two sites over a four-year period. Patients considered to be high risk were those who were at an increased risk of bleeding, those who had a prostate size &gt;80 mL, those with preoperative urinary retention and/or those aged &gt;80 years. Results: In total, 374 patients were identified as being high risk for GreenLight PVP. Patient age ranged from 44 to 96 years ( Mage=71 years). Of the 374 patients, 103 were aged &gt;80 years. All 374 patients were considered to be at an increased risk of bleeding, as they underwent GreenLight PVP while taking antiplatelet agents (not including aspirin), anticoagulant agents or both. Ninety-one patients had preoperative urinary retention and indwelling urinary catheter. Fifty-four patients had a prostate size &gt;80 mL. Length of stay varied from 1 to 14 days. Most patients ( n=270) were discharged on postoperative day 1. There were no perioperative blood transfusions. One patient developed acute coronary syndrome on postoperative day 4, requiring percutaneous coronary intervention. Twenty-two patients required readmission: 12 due to urinary retention with or without haematuria, and 10 due to haematuria without associated acute retention. Two patients required cystoscopy and bladder washout. There were two blood transfusions in the ‘readmission due to haematuria’ group. Outcomes for patients aged &gt;80 years were favourable. The average length of stay was 2.7 days (range 1–14 days). This group was responsible for 12 of the 22 readmissions. There were no perioperative cardiovascular events. Conclusion: We conclude that GreenLight XPS PVP is a safe procedure in patients with one or more high-risk factors. The ability to proceed without the need to stop antiplatelets or anticoagulant agents also allows for high-risk medical patients to be treated without the additional risks of cardiovascular events. Level of evidence: Not applicable for this multicentre audit.

MP01-13 GREENLIGHT (532 nm) LASER TRANSURETHRAL PROSTATECTOMY FOR TREATMENT OF BENIGN PROSTATE OBSTRUCTION USING XPS-180 WATT SYSTEM, DOES IT PASS THE TEST OF TIME?

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I (MP01)1 Sep 2021MP01-13 GREENLIGHT (532 nm) LASER TRANSURETHRAL PROSTATECTOMY FOR TREATMENT OF BENIGN PROSTATE OBSTRUCTION USING XPS-180 WATT SYSTEM, DOES IT PASS THE TEST OF TIME? Fady Ghobrial, Mahmoud Laymon, Mohamed Soltan, Ahmed Abolazm, Nasr El-Tabey, and Ahmed Elshal Fady GhobrialFady Ghobrial More articles by this author , Mahmoud LaymonMahmoud Laymon More articles by this author , Mohamed SoltanMohamed Soltan More articles by this author , Ahmed AbolazmAhmed Abolazm More articles by this author , Nasr El-TabeyNasr El-Tabey More articles by this author , and Ahmed ElshalAhmed Elshal More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001962.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate efficacy and durability of greenlight laser (XPS-180watt) based prostatectomy for treatment of benign prostatic obstruction (BPO). The need for medical and or surgical retreatment for recurring or residual BPO as well as their predictors will be assessed. METHODS: After IRB approval, a prospectively maintained database was established for patients with BPO for whom greenlight laser photoselective vaporization (PVP) and vapoenucleation (PVEP) of the prostate were carried out between August 2014 to March 2018. Patients’ perioperative data and urinary functional outcome parameters and postoperative complications were depicted. The need for retreatment was assessed and its predictors retreatment were evaluated. RESULTS: This study included 248 patients, 157 (63.3%) and 91(36.7%) patients underwent PVP and PVEP with mean prostate volume (60±18 and 100±22 ml) respectively. Mean ±SD follow up duration was 62±9 months. At last point follow up, mean ±SD percentage of improvement in IPSS was 61±28 and 78±20 p=0.03, median (range) percentage of improvement in Q max was 119(-13-549) and 123(-13-649) % p=0.2 and median (range) percentage of PSA reduction was 63(-172-99) and 65(-75-97) % p=0.7 for PVP and PVEP groups respectively. Overall retreatment rate (medical and surgical) was 23% (57 patients), 38 (24.2%) after PVP and 19 (20.9%) after PVEP, p=0.5. The need surgical retreatment was statistically significant more after PVP (table 1). Median (range) time to event (defined as medical or surgical re-intervention) was 20 (1-60) for all cases, 3.5 (0-42) and 30 (18-60) months p= 0.7 for PVP and PVEP groups respectively. On multivariate analysis, only percent reduction of one-year post-operative PSA was a significant predictor of need for retreatment (surgical/ medical) of recurring or residual BPO (P 0.021, 95% CI 0.018-0.024). The cutoff point was 64.2% (58.2% sensitivity, 73.4% specificity, AUC 0.647, 95% CI 0.52-0.76) above it there is less probability for having BPO retreatment. CONCLUSIONS: Greenlight laser prostatectomy using XPS-180Watt is an effective and versatile tool in treating BPO. Durability of the outcome is predictable with more postoperative PSA reduction. Source of Funding: No funding © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e5-e6 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fady Ghobrial More articles by this author Mahmoud Laymon More articles by this author Mohamed Soltan More articles by this author Ahmed Abolazm More articles by this author Nasr El-Tabey More articles by this author Ahmed Elshal More articles by this author Expand All Advertisement Loading ...

Review of the application of photoselective vaporization in benign hyperplasia of the prostate

Benign prostatic hyperplasia is the most frequent benign tumor in men, reaching a prevalence of 40% in the fourth decade of life and 80% in men 80 years of age and older. The condition leads to bothersome and incapacitating lower urinary tract symptoms that are currently measured by the International Prostate Symptom Score. At present, there are different alternatives for minimally invasive surgical treatment, such as GreenLight laser photoselective vaporization, that can provide the same benefits for the patient as conventional treatment options.&#x0D; Methods: To find out and describe the usefulness and safety of photoselective vaporization in patients with benign prostatic hyperplasia, a search for information published within the last 10 years was conducted on the PubMed, ScienceDirect, BVS, and ClinicalKey databases, resulting in the selection of 11 notable studies. &#x0D; Conclusion: GreenLight laser photoselective vaporization is a safe and efficacious alternative for managing the symptoms of benign prostatic hyperplasia, in the short term and long term, with a lower risk of complications than transurethral resection of the prostate.

Revisión de la aplicación de la vaporización fotoselectiva en hiperplasia benigna de próstata

Benign prostatic hyperplasia is the most frequent benign tumor in men, reaching a prevalence of 40% in the fourth decade of life and 80% in men 80 years of age and older. The condition leads to bothersome and incapacitating lower urinary tract symptoms that are currently measured by the International Prostate Symptom Score. At present, there are different alternatives for minimally invasive surgical treatment, such as GreenLight laser photoselective vaporization, that can provide the same benefits for the patient as conventional treatment options. Methods: To find out and describe the usefulness and safety of photoselective vaporization in patients with benign prostatic hyperplasia, a search for information published within the last 10 years was conducted on the PubMed, ScienceDirect, BVS, and ClinicalKey databases, resulting in the selection of 11 notable studies. Conclusion: GreenLight laser photoselective vaporization is a safe and efficacious alternative for managing the symptoms of benign prostatic hyperplasia, in the short term and long term, with a lower risk of complications than transurethral resection of the prostate.

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

P0085 - Long-term functional outcomes in large prostates (>80cc): A comparative study between Greenlight laser photoselective vaporization and open simple prostatectomy

P0085 - Long-term functional outcomes in large prostates (>80cc): A comparative study between Greenlight laser photoselective vaporization and open simple prostatectomy

Comparison of Efficacy of Different Surgical Techniques for Benign Prostatic Obstruction.

PurposeWe compared success rates of 3 surgical techniques (holmium laser enucleation of the prostate [HoLEP], transurethral resection of the prostate [TURP], and photoselective laser vaporization prostatectomy [PVP]) for treatment of benign prostatic obstruction (BPO). We aimed to identify preoperative clinical variables and urodynamic parameters that predict surgical success.MethodsA total of 483 patients who underwent surgical treatment for BPO at Samsung Medical Center between 2006 and 2017 were retrospectively analyzed; of these 361, 81, and 41 patients underwent HoLEP, TURP, and PVP, respectively. Prostate-specific antigen, prostate volume, urodynamic parameters, and International Prostate Symptom Score (IPSS)/quality of life (QoL) index were evaluated preoperatively; uroflowmetry, postvoid residual urine, and IPSS/QoL index were measured 6 months postoperatively. Surgical success was defined based on IPSS, maximum flow rate, and QoL index and predictive factors were identified using multiple logistic regression analyses.ResultsSuccess rates of HoLEP, TURP, and PVP were 67.6%, 65.4%, and 34.1%, respectively, and the HoLEP and TURP groups were not significantly different. Regression analysis revealed prostate volume ≥50 mL and bladder outlet obstruction index (BOOI) ≥40 to be independent factors predicting HoLEP success. Only high preoperative QoL could predict the success of TURP, whereas other urodynamic parameters remained unrelated.ConclusionsPatients treated with HoLEP and TURP displayed equivalent efficacies, but PVP was relatively less efficient than both. Preoperative variables of prostate volume ≥50 mL and BOOI ≥40 were independent predictive factors for the success of HoLEP but not of TURP.

Photoselective Laser Vaporization of the Prostate in Benign Prostatic Obstruction: Sexual Function in Focus

The objective: to determine the effect of photoselective laser vaporization (FVP) on individual IIEF domains (sexual activity, libido, erection, ejaculation, ograzm, satisfaction with intercourse) in sexually active men with BPO, as well as the factors on which this effect depends.&#x0D; Materials and methods. 95 sexually active patients with benign prostatic obstruction (BPO) (prostate volume &gt;40 cm3, maximum urinary flow rate Qmax &lt;10 ml/s; QoL≥4) at the age of 45 to 60 years underwent FP (GreenLight XPS, MoxyFiber) ... Sexual function (IIEF), urination parameters (PSS/QoL, PVR, Qmax), prostate volume, intravesical prostate protrusion, PSA were assessed before the intervention and 3 months after.&#x0D; Results. PVP had a statistically significant and clinically significant effect on micturition parameters characterizing obstruction, prostate size and QoL. The median IPSSobstructive decreased by 6 (4–7) points (W=7.6; P&lt;0.01), PVR by 48 (38–60) ml (W=6.2; P&lt;0.01), IPP by 0.9 (0.5–1.5) cm (W=9.4; P&lt;0.01) Vprostate at 31 (22–42) cm3 (W=8.5; P&lt;0.01), QoL by 3 (2–4) points (W=11.2; P&lt;0.01). The median Qmax increased by 23 (15–29) ml/s (W=13.3; P&lt;0.01). The median values of the IPSSirritative and IPSSnocturia domains did not change significantly (P&lt;0.8 and P&lt;0.6, respectively). At 3 months after PVP, 84 (94.6 %) patients restored sexual activity. In 33 (39.28 %) of them, an improvement in erection and 15 (17.85 %) deterioration were found. 61 (72.26 %) lost emission.&#x0D; Conclusions. The most significant effect of PVP on ejaculatory function is the loss of emission. The effect of PVP on erection is multidirectional and manifests itself in its improvement and deterioration. Further research is needed to determine the mechanisms by which PVP affects erection and ejaculation in order to prevent negative effects.

Analyse des coûts de la photovaporisation prostatique au laser Greenlight versus résection transurétrale de la prostate : intérêt de la prise en charge ambulatoire

To compare the costs associated with GreenLight XPS 180W photoselective vaporization of the prostate (PVP) for an outpatient versus standard transurethral resection of the prostate (TURP) with a three nights hospitalization in a French private hospital. A retrospective cost minimization analysis was performed between 2017 and 2019 in a French private hospital for the hospital stays associated with TURP and PVP procedures for benign prostatic hyperplasia (BPH). The peri-operative cost-benefit assessment of the two procedures was analyzed from the establishment's point of view according to the micro-costing method. 871 surgical treatment for BPH had been performed during the period of the study, including 743 photoselective laser vaporization (85%). The average length of stay of patients undergoing TURP was 3,7 days versus 0,9 days for PVP including 64,7% ambulatory. The cost-benefit was more of 500€ per patient in favor of ambulatory PVP compared with TURP in conventional three nights hospitalization for level 1 hospital stays. In this private hospital center, ambulatory PVP seemed more cost-effective than TURP with a three nights hospitalization for a severity level 1 patient. The financial profit for the establishment was mostly due to reduction of the main length of stay and ambulatory care. 3.

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.