Lithium Triborate Laser Research Articles

En bloc GreenLight laser enucleation of the prostate (GreenLEP): An in-depth look at the anatomical endoscopic enucleation of the prostate using a 532-nm lithium triborate laser.

GreenLight laser enucleation of the prostate (GreenLEP) is an alternative endoscopic enucleation of the prostate (EEP) technique for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). GreenLEP is an 'en bloc' EEP technique to remove the transitional zone tissue in one piece. The procedure is a combination of laser enucleation and blunt gentle mechanical dissection using the tip of the resectoscope. The advantage of mechanical dissection is that it allows for better visualisation of the capsule and in some cases makes the dissection a little faster. This procedure is performed with a 532-nm lithium triborate laser (GreenLight™ XPS 180W generator, AMS), a 2090 side-firing fibre and a Piranha™ morcellator (Richard Wolf GmbH). We offer a review of the evolution of the technique including the most important technical aspects, complications, advantages/disadvantages, tips and tricks and a visual step by step guide to perform the GreenLEP technique. GreenLEP is one of the latest energy sources reported in the armamentarium of EEP techniques for the treatment of BPO. GreenLEP has previously demonstrated its feasibility, safety and similar short- to mid-term functional outcomes compared to surgical gold standards in the literature.

Dependence of laser-induced tissue ablation on optical fiber movements for laser prostatectomy.

The aim of the current study was to identify the efficient fiber movements for 532-nm laser prostatectomy. 532-nm Lithium triborate (LBO) laser light was tested on 120 kidney tissues at three different translational speeds (TS 1, 2, and 4mm/s) and four different rotational speeds (RS 0.5, 1.0, 1.6, and 2.1rad/s). The applied power was 120W at a 2-mm working distance and 60° sweeping angle. Ablation rate and dimensions of resulting ablation craters were measured. Slower TSs and RSs created deeper and wider ablation craters with thinner coagulation, leading to more efficient ablation performance. Maximal ablation rate was achieved at a TS of 2mm/s and RSs of 0.5 and 1.0rad/s. An RS of 0.5rad/s accompanied surface carbonization for all the TSs. Irrespective of TS, ablation rate became saturated at faster RSs than 1.0rad/s. Faster TSs or RSs reduced tissue ablation, but increased thermal coagulation due to a shorter interaction time. Optimal ablation efficiency occurred at a TS of 2mm/s and a RS of 1.0rad/s with a thin coagulation of around 1.0mm and no or minimal carbonization. Further studies will validate the current findings with prostate tissue and high-power levels for laser prostatectomy.

A Study of the Role of 180W XPS Lithium Triborate Laser in the Treatment of Patients With Lower Urinary Tracts Symptoms Due to Benign Prostatic Hyperplasia.

Introduction: Benign prostatic hyperplasia (BPH) is a disease of the prostate commonly seen in elderly males known to cause lower urinary tract symptoms (LUTS) that may require surgery as a part of treatment. Transurethral resection of the prostate (TURP) is considered the gold standard of surgical treatment, but it is not without complications. Laser photoselective vaporisation of the prostate (PVP), introduced in 1998 as an 80 W Nd:YAG laser which passed through a KTP (potassium-titanylphosphate) crystal, emerged as a safe alternative to TURP in selected cases. A recent upgrade to the Greenlight XPS 180 W powered with an LBO (lithium triborate) crystal has been available for use since 2012. Data on the use of this new upgrade is still being collected and analysed, especially in patients with large prostates or high risk cases. We analysed cases done at Jaslok Hospital over a 2-year period. Methods: A total of 34 patients who underwent Laser PVP using XPS 180W for LUTS due to BPH at Jaslok Hospital were part of this study. We analysed the pre- and postoperative variables and the intraoperative parameters of all patients. Results: The XPS 180W was found to be safe and efficacious. Eighteen patients were high-risk cases, classified as ASA (American Society of Anesthesiologists) Classes 3 and 4. Average postoperative catheter duration was 40.18 hours. In prostates of size <80 mL, an average of 229 kJ of energy was used. In large prostates (>80 mL), an average of 390 kJ of energy was used. No major complications were seen in any of the high-risk patients, classified as Clavien Dindo Class 3 and 4. The postoperative drop in IPSS (International Prostate Symptom Score) was 8.7. Conclusion: We found that Green Light Laser XPS 180W may be used for large (>80 g) prostates, hitherto an indication for open surgery, and that it may be used in high-risk patients, who were otherwise unfit for TURP. It is safe and efficacious. Further, multicenter trials are required to confirm the findings.

Green Laser Enucleation of the Prostate “En bloc Technique”: Surgical Technique and Initial Experience

Introduction and Objectives: Green laser “en bloc” enucleation of the prostate (GreenLEP) is an alternative enucleation technique for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. All endoscopic enucleation of the prostate procedures require significant endoscopic surgical skills and have a steep learning curve. The aim of this study is to demonstrate the GreenLEP surgical technique step-by-step and report our initial experience. Material and Methods: We report our single surgeon's (E.R.) initial experience with this novel technique. Thirty patients underwent GreenLEP between July 2015 and March 2016 in our institution with prostate volumes between 60 and 140 cc. All patients were evaluated preoperatively and after surgery (at 1, 3, and 6 months) by prostate-specific antigen, prostate volume, International Prostate Symptom Score, quality-of-life score, maximum flow rate, and postvoid residual urine volume, and all the complications were recorded. The surgery was performed with a 532-nm lithium triborate laser (GreenLight™ XPS 180W device; American Medical Systems, Minnetonka, MN), 2090 side-fire laser fiber at the following power settings: 80W for cutting, 25W for coagulation, and a Piranha™ morcellation system (Richard Wolf GmbH, Germany) using single-use blade. Results: The mean operative time was 64 minutes (range: 55–95 minutes) and the mean amount of retrieved prostate tissue was 70 g (range 40–120 g). There was no need for blood transfusion. Capsular perforation occurred in four cases. We did not have any case of bladder injuries related to the morcellation procedure. The postoperative catheterization time (same as hospital stay) was 48 hours, except in two cases: one of incomplete morcellation because of bleeding and required an endoscopic second look (morcellation for residual adenoma), and the other required open surgery conversion for removal of the enucleated adenoma (poor vision because of venous bleeding caused by surgical perforation of the capsule during enucleation). Transient urinary incontinence was present in three cases and was completely resolved in 2 months. Three months later, all the parameters evaluated preoperatively showed significant improvement. Conclusions: GreenLEP appears to be a safe alternative enucleation technique for the complete removal of en bloc adenomatous prostate tissue. Regardless of gland size, it is particularly advantageous for the treatment of large prostates (not recommended for small glands). Endoscopic laser enucleation of the prostate is feasible with a side-firing fiber. This technique is probably easier to learn in a progressive pathway, that is, vaporization, vapoenucleation, and finally enucleation. These promising results warrant further studies to assess long-term outcomes. No competing financial interests exist. Runtime of video: 10 mins

Photoselective Vaporization of the Prostate: Long-Term Outcomes and Safety During 10 Years of Follow-Up.

To evaluate the long-term outcomes and safety photoselective vaporization of the prostate (PVP). From April 2005 to December 2015, a total of 1154 patients with benign prostatic hyperplasia underwent PVP. The type of Green Light laser was an 80 W potassium-titanyl-phosphate laser and later a 120 W lithium triborate laser. Before and after surgery, the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post-voiding volume of residual urine (PVR), prostate-specific antigen (PSA) level, and prostate volume were assessed regularly. After surgery, events such as second PVP, transurethral incision, and permanent urethral catheterization were defined as retreatment. The mean and median periods of follow-up after PVP were 35.4 and 24.0 months, respectively. The maximum duration of follow-up was 125 months. Compared with before surgery, the IPSS, quality of life score, and PSA concentration improved significantly, even at 10 years after PVP; however, Qmax and PVR were not improved at 10 years. The retreatment-free survival rate was 93.9% at 5 years and 79.0% at 10 years. Prostate cancer was found in 27 cases after PVP, and all patients who were found to have prostate cancer remained alive. Prostate cancer-free survival after PVP was 96.7% at 5 years and 89.4% at 10 years. Our data suggest that the efficacy of PVP was maintained for 10 years; however, it may decrease after more than 10 years. PVP also did not promote the progression of or worsen the prognosis of prostate cancer.

Transurethral 160-W straight beam green laser vaporesection of the prostate: initial experience after 180 procedures.

Although the photoselective vaporization of the prostate has been considered one of the most promising alternatives for treatment of benign prostatic hyperplasia (BPH), published clinical data with the surgical technology of straight beam lithium triborate laser (LBO) is still lacking. To evaluate the technical improvement and initial experience of the 160-W straight beam LBO laser photoselective vaporesection of the prostate (PVRP) for the surgical treatment of BPH. From September 2012 to September 2014, including a 12-month follow-up, a prospective randomized study was performed. 180 patients undergoing PVRP were included in the study. All patients were preoperatively assessed by International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), post-void residual urine (PVR), prostate-specific antigen level, and prostate volume measurement. Perioperative parameters and complications were recorded. Patients were reassessed at 1, 3, 6 and 12 months postoperatively. PVRP resulted in a significant improvement of IPSS, Qmax, and PVR. Mean operative time was 48.3 ± 14.4 min. A significant improvement for PVRP was achieved regarding the catheter indwelling and hospital stay time. No severe perioperative complications were recorded. No requiring blood transfusion in all patients. Capsule perforation was observed in four patients in the group. There were four patients experienced bladder neck contracture and another four patients were diagnosed urethral stricture, all of whom were treated well by dilatation finally without reoperation. 160-W straight beam LBO laser PVRP appears to be a feasible and safe alternative for symptomatic BPH with decreased length of catheter indwelling and hospital stay time postoperatively.

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.

MP42-16 ASSESSMENT OF ENERGY DENSITY USAGE DURING 180W LITHIUM TRIBORATE LASER PHOTO-SELECTIVE VAPORIZATION OF THE PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA. IS THERE AN OPTIMAL AMOUNT OF KILO-JOULES PER GRAM OF PROSTATE?

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III1 Apr 2016MP42-16 ASSESSMENT OF ENERGY DENSITY USAGE DURING 180W LITHIUM TRIBORATE LASER PHOTO-SELECTIVE VAPORIZATION OF THE PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA. IS THERE AN OPTIMAL AMOUNT OF KILO-JOULES PER GRAM OF PROSTATE? Roger Valdivieso, Christian Meyer, Pierre-Alain Hueber, Malek Meskawi, Abdullah Alenizi, Quoc-Dien Trinh, Vincent Misrai, Matthew Rutman, Alexis Te, Bilal Chughtai, Neil Barber, Amr Emara, Ravi Munver, and Kevin Zorn Roger ValdiviesoRoger Valdivieso More articles by this author , Christian MeyerChristian Meyer More articles by this author , Pierre-Alain HueberPierre-Alain Hueber More articles by this author , Malek MeskawiMalek Meskawi More articles by this author , Abdullah AleniziAbdullah Alenizi More articles by this author , Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author , Vincent MisraiVincent Misrai More articles by this author , Matthew RutmanMatthew Rutman More articles by this author , Alexis TeAlexis Te More articles by this author , Bilal ChughtaiBilal Chughtai More articles by this author , Neil BarberNeil Barber More articles by this author , Amr EmaraAmr Emara More articles by this author , Ravi MunverRavi Munver More articles by this author , and Kevin ZornKevin Zorn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.204AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The ideal amount of energy delivery during photo-selective vaporization of the prostate (PVP) for optimal treatment of benign prostate hyperplasia (BPH) has not been established. The aim of this study is to assess the effect of energy density (kJ/cc) applied on adenoma during treatment on functional outcomes, PSA reduction and complications. METHODS After exclusions, a total of 440 patients that underwent Greenlight laser XPS 180W LBO PVP for the treatment of BPH were retrospectively reviewed. Data was collected from seven different international centers (Canada, the United States, the United Kingdom and France). Patients were stratified into four energy density groups (kJ/cc) according to intraoperative energy delivered and prostate volume as determined by pre-operative trans-rectal ultrasound (TRUS): group 1: <3 kJ/cc, group 2: 3 to 5 kJ/cc, group 3: 5 to 7 kJ/cc and group 4: =7kJ/cc. Energy density groups were chosen arbitrarily. PSA reduction and functional outcomes (IPSS, QoL, PVR, Qmax) were compared at 6, 12 and 24 months. Moreover, perioperative complications and retreatment rates were also compared between groups. RESULTS PSA reduction at 24 months post procedure was 51%, 61%, 79% and 83% for an energy density groups of <3, 3-5, 5-7 and =7 kJ/g respectively (p=0.01). This held true after accounting for baseline confounders. Energy density was not associated with increased complication rates, including hematuria, stricture formation, incontinence, refractory urinary retention, urinary tract infection and conversion to TURP. Functional outcomes at 2 years of follow-up were equivalent between groups (p>0.05 for all) and comparable re-treatment rates were observed (p=0.36). CONCLUSIONS Increased energy usage per cc of prostate is associated with a more significant PSA reduction (>50%) at 6,12 and 24 months suggesting increased vaporization of adenoma tissue. However this did not translate into differences in functional outcomes at two years of follow-up. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e576 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Roger Valdivieso More articles by this author Christian Meyer More articles by this author Pierre-Alain Hueber More articles by this author Malek Meskawi More articles by this author Abdullah Alenizi More articles by this author Quoc-Dien Trinh More articles by this author Vincent Misrai More articles by this author Matthew Rutman More articles by this author Alexis Te More articles by this author Bilal Chughtai More articles by this author Neil Barber More articles by this author Amr Emara More articles by this author Ravi Munver More articles by this author Kevin Zorn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

V3-08 GREEN LASER ENUCLEATION OF THE PROSTATE (GREENLEP) “EN-BLOC TECHNIQUE”

You have accessJournal of UrologyMale Voiding/Sexual Dysfunction/BPH/ Incontinence/Infection/Infertility1 Apr 2016V3-08 GREEN LASER ENUCLEATION OF THE PROSTATE (GREENLEP) “EN-BLOC TECHNIQUE” Enrique Rijo, Jose Antonio Lorente, Oscar Bielsa, and Fernando Gomez-Sancha Enrique RijoEnrique Rijo More articles by this author , Jose Antonio LorenteJose Antonio Lorente More articles by this author , Oscar BielsaOscar Bielsa More articles by this author , and Fernando Gomez-SanchaFernando Gomez-Sancha More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1528AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laser vaporization is an alternative to transurethral resection of the prostate (TURP) for the treatment of small to medium glands. For large prostates (>80ml.) open prostatectomy or Holmium laser enucleation of the prostate (HoLEP) remains the prefered choice of treatment. Green laser ‘en bloc’ enucleation of the prostate (GreenLEP) followed by mechanical morcellation is an alternative enucleation technique developed by Fernando Gomez-Sancha in Madrid, Spain. The aim of this video is to demonstrate the GreenLEP technique step-by-step. METHODS The surgery was performed with a 532-nm lithium triborate laser (GreenLightTM XPS 180W, American Medical Systems, Minnetonka, Minnesota, USA), 2090 side-fire laser fiber at power settings: 80W for cutting, 20W for coagulation and a PiranhaTM morcellation system (Richard Wolf GmbH, Germany) using the Vmax blade. Case Report: A 64-year-old patient presented with lower urinary tract symptoms secondary to benign prostatic obstruction with no response to alpha-blockers. The prostate volume was 92 mL, PSA of 2.4 ng/mL, peak urinary flow rate (Qmax) was 8 mL/sec, postvoid residual volumen (PVR) of 150 mL and international prostate symptom score (IPSS) of 22. It was decided to proceed with GreenLEP technique in this case. RESULTS The total operative time was 64 minutes, laser time 22 minutes, morcellation time 8 minutes, total energy employed was 52kJ and 73g. of tissue were enucleated (pathology report showed no evidence of prostate cancer). The bladder catheter was removed at 24 hours postsurgery and the patient was discharged 48 hours postoperative without complication. Three months later all the parameters showed significant improvement (PSA: 0.4 ng/mL, IPSS: 4, Qmax: 26 mL/seg and PVR: 20 mL). There was no incontinence or erectile dysfunction as a result of the procedure. CONCLUSIONS GreenLEP represents a safe alternative enucleation technique for the complete removal of en bloc adenomatous prostate tissue, regardless of gland size, it is particularly advantageous for the treatment of large prostates. Endoscopic laser enucleation of the prostate is feasible with a side-firing fiber. Gentle mechanical dissection allows for an optimal visualization and understanding of the anatomical planes. Low energy coagulation (20W) is used against the capsule providing excellent hemostasis. These promising results warrant further studies to assess longterm outcomes. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e469 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Enrique Rijo More articles by this author Jose Antonio Lorente More articles by this author Oscar Bielsa More articles by this author Fernando Gomez-Sancha More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A systematic review of experience of 180-W XPS GreenLight laser vaporisation of the prostate in 1640 men.

To systematically review the literature regarding clinical outcomes of 180-W XPS GreenLight laser (GL) vaporisation for the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). Recent publications were identified in the field of 180-W GL vaporisation for the treatment of LUTS due to BPH. We searched for peer-reviewed original articles in the English language. Search items were: '180W lithium triborate laser' or '180W greenlight laser' or '180 watt lithium triborate laser' or '180 watt greenlight laser' or 'XPS greenlight laser'. In all, 30 papers published between 2012 and 2014 matched this search. Of these, 10 papers were identified dealing with consecutive cohorts of patients treated with the 180-W XPS GL RESULTS: The 10 papers included a total experience of 1640 patients. The only randomised controlled trial in this field compares 180-W with transurethral resection of the prostate (TURP). Functional outcomes and prostate volume reduction after GL vaporisation were similar to TURP. Catheterisation time and hospital stay were shorter in patients undergoing 180W XPS GL vaporisation (41 and 66 h vs 60 and 97 h, respectively). Four papers compared the 180-W XPS system to former GL devices showing increased operation time efficiency and comparable postoperative voiding results and adverse events. One paper defined the learning curve to achieve an expert level according to the speed of the procedure and the effectiveness of volume reduction was met after 120 procedures. The 180-W XPS GL offers shorter operation times than former devices. In the one randomised controlled trial comparison with TURP, volume reduction and functional results were comparable to those of TURP. Longer term studies are required.

Does prostate size impact upon perioperative outcomes associated with photoselective vaporization of the prostate using the 180W lithium triborate laser?

Introduction:Photoselective vaporization of the prostate (PVP) has been widely adopted as a surgical treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). Recently, a high-powered 180 W lithium triborate (LBO) laser has become commercially available and there is relatively little information on the impact of this very high-powered laser on perioperative outcomes. Even more so is the impact of the laser on outcomes according to prostate size.Objectives:The objective of this study was to evaluate perioperative outcomes after PVP with the 180W laser, relative to prostate size.Patients and Methods:A prospectively maintained institutional ethics approved database was retrospectively reviewed. Subjects were analyzed according to transrectal ultrasound and categorized into groups namely 0-39 mL, 40-79 mL, 80-120 mL and >120 mL. Perioperative measures included energy utilized, length of operation, duration catheterization, post operative length of stay (POLOS), Clavien-Dindo adverse events and number discharged home within 24 hours catheter free.Results:With increasing prostate size, there was a statistically significant increase in energy utilization and operation time (P < 0.01 between groups). Duration of catheterization, POLOS, incidence of Grade 3 and above Clavien-Dindo adverse events and discharge home catheter free within 24 hours was not statistically significant across groups.Conclusions:Prostate volume impacts upon energy utilized with PVP surgery. Prostate volume does not influence duration of catheterization or POLOS. Clavien-Dindo Grade 3 or greater adverse events were low and do not appear to be influenced by prostate size. The ability to be discharged home catheter free within 24 hours likewise does not appear to be influenced by prostate size.

Photoselective Vaporesection of the Prostate with a Front-firing Lithium Triborate Laser: Surgical Technique and Experience After 215 Procedures

BackgroudAlthough photoselective vaporization of the prostate (PVP) is considered one of the most promising alternatives to transurethral radical prostatectomy, a longer operative time, an unsatisfactory tissue removal rate, and the absence of postoperative pathology samples remain the main criticisms for this procedure. ObjectiveTo describe the novel technique of photoselective vaporesection of the prostate (PVRP) with a front-firing lithium triborate (LBO) laser and to report our initial experience. Design, setting, and participantsThis is a prospective study of 215 patients undergoing PVRP between November 2011 and March 2013. Their average age, prostate size, and International Prostate Symptom Score (IPSS) were 70.3±7.3 yr, 70.4±34.0ml, and 24.9±5.0, respectively. Surgical procedureThe operative technique is detailed in the accompanying video. Outcome measurements and statistical analysisPerioperative data were collected. The patients were followed up at 3, 6, 12 mo after PVRP, and functional outcomes and complications were assessed. Results and limitationsThe mean operation time was 44.1±22.6min. The mean hemoglobin decrease was 0.37±0.21g/dl. The catheterization time was 23.9±15.2h and the postoperative hospital stay was 1.8±0.8 d. Significant improvements were observed in maximum flow, IPSS, and postvoid residual urine at each follow-up time point. Compared to preoperative values, prostate volume and serum prostate-specific antigen fell by 67% and 63%, respectively, at 3 mo after PVRP. No major complications were noted. Application of a hemostat for a front-firing LBO laser makes it easy to handle intractable intraoperative bleeding. The main limitation of this study is the short follow-up period. The influence of PVRP on sexual function and the learning curve remain to be evaluated. ConclusionsPVRP is a novel technique that is effective and safe for treatment of benign prostatic hyperplasia. This technique retains the excellent hemostatic property of LBO lasers and has a short operation time and a high tissue removal rate. The problem of the lack of postoperative tissue samples for PVP is also overcome in PVRP. Patient summaryWe have developed a novel technique named photoselective vaporesection of the prostate (PVRP) with a front-firing green laser. Our results show that PVRP retains the excellent hemostatic property of a green laser, but has a much shorter operation time and a higher rate of tissue removal than photoselective vaporization of the prostate (PVP). This technique also solves the problem of the lack of postoperative tissue specimens and the difficulty of handling intractable intraoperative bleeding. According to our initial results, PVRP is a novel technique superior to PVP in the treatment of benign prostatic hyperplasia.

The massively enlarged prostate: experience with photoselective vaporization of the ≥100 cc prostate using the 180 W lithium triborate laser.

To determine if there is a role for high-powered photoselective vaporization of the prostate (PVP) in large prostates for the management of bladder outlet obstruction. This study aims to evaluate the safety and efficacy of PVP in prostates ≥100 cc. A retrospective analysis of a prospectively maintained database (ethics approved), single-surgeon, single-center series, between November 2010 and February 2013 of males with ≥100 cc prostates who underwent PVP. Perioperative and functional outcomes at baseline, 3, and 6 months were evaluated. Thirty-five males were identified, median age 70 (interquartile range [IQR] 66-79) with prostates ≥100 cc (median 132, IQR 118-157). Preoperatively, 11/35 (31%) were in urinary retention and 11/35 (31%) were anticoagulated. Perioperative outcomes showed median laser time 75 minutes, operating time 103 minutes, and energy use 750 kJ. Median postoperative length of stay was 20 hours, catheterization 12 hours, and 33/35 (94%) were discharged catheter free. Twelve adverse events in 11 men were recorded, all Clavien-Dindo Grade I-II with 1 Grade IIIa complication. Paired functional outcomes showed statistically significant (p<0.05) improvements in the median International Prostate Symptom Score (IPSS) (20, 6, 6), quality of life (QoL) Index (4, 1, 1), maximum urinary flow rate (Qmax) (9.5, 20.5, 19.5 mL/s), and postvoid residual (149, 40, 41 mL) (baseline, 3, and 6 months). PVP using the 180 W LBO laser in large prostates appears feasible and efficacious, with short duration of catheterization and postoperative length of stay. Acceptable morbidity was recorded. Enormous energy utilization was delivered within acceptable operating times. Early results indicate excellent functional outcomes at 3 and 6 months following PVP.

Detrusor Overactivity Does Not Predict Bothersome Storage Symptoms After Photoselective Vaporization of the Prostate With Lithium Triborate Laser

To find out if detrusor overactivity (DO) is a predictor of moderate or severe storage lower urinary tract symptoms (LUTS) persisting 6 months after photoselective vaporization of the prostate (PVP). Patients with bladder outlet obstruction proved by urodynamics who underwent PVP with the lithium triborate laser were followed for 6 months with the International Prostate Symptom Score (IPSS) questionnaire. Moderate-to-severe storage LUTS were defined as IPSS storage domain score >8 and/or a score for an IPSS question on urgency >3. Predictive values of DO, IPSS domains, urgency, prostate volume, bladder outlet obstruction grade, and energy used were tested by logistic regression analysis. Seventy-six men at the age of 66.4 ± 6.8 years underwent PVP, including 36 (47.4%) with DO. Incidence of moderate or severe storage LUTS was decreasing from 60.5% to 48.7% at week 6 and 11.8% at month 6 postoperatively. At a univariate analysis, urgency score and storage domain score were significantly associated with bothersome storage LUTS at month 6. Multivariate analysis confirmed predictive value of preoperative urgency having an odds ratio of 5.7 (95% confidence interval, 1.41-23.16; P = .014). DO was not associated with the defined outcome. In our group, DO was not useful in predicting persistent storage symptoms after PVP. Patients with severe preoperative urgency should be informed about a risk of such outcome.

Photoselective vaporization of the prostate using GreenLight 120-W lithium triborate laser to treat symptomatic benign prostatic hyperplasia: A single-centre prospective study

Objective: We evaluated the safety and efficacy of photoselective vaporization of the prostate (PVP) using GreenLight 120-W lithium triborate (LBO) laser to treat symptomatic small-to-medium sized benign prostatic hyperplasia (BPH).Methods: This prospective non-controlled observational study included symptomatic BPH men ≥50 years with international prostate symptom score (IPSS) ≥14, prostate volume (PV) ≤80 cc and maximum flow rate (Q-max) ≤15 mL/s. PVP was performed using the GreenLight 120-W LBO laser machine. Patients were assessed at baseline and postoperatively at discharge, 2 weeks, and 3, 6 and 12 months. We measured changes in IPSS, PV, PSA, Q-max, post-void residual (PVR), hemoglobin (Hb), serum sodium (Na+) and reported complications. Statistical significance was p &lt; 0.05.Results: The study included 103 men with mean age of 67 (±standarddeviation) ±9.7 years. Thirty patients were on indwelling urethral catheters for refractory urinary retention and 12 on ongoing anticoagulants. The mean baseline IPSS, PV, PSA, Q-max and PVR parameters significantly improved at follow-up (p &lt; 0.001; each). Mean measurements at baseline versus at six months were: IPSS 25.6 ± 4.2 vs. 7.4±2.3; PV 44.6 ± 9.2 vs. 21.6 ± 6.3 cc (51.6% reduction); Q-max 5.8 ± 3.4 vs. 20.4 ± 4.8 mL/s; PVR 110 ± 40 vs. 35 ± 9 cc. Mean baseline Hb and serum Na+ declined nonsignificantly (p &gt; 0.05) at discharge and at 2 weeks. No patient needed a blood transfusion. Secondary procedures were needed in 2 patients for urethral and bladder neck strictures. The re-treatment rate for residual adenoma was 0.97%.Conclusion: PVP using the GreenLight 120-W LBO laser to treat small-to-medium sized symptomatic BPH demonstrated significant improvements in efficacy parameters and high safety profile within 12 months of follow-up. The procedure entails good hemostasis with minimal blood loss even in patients receiving ongoing anticoagulants.

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 ...

634 Photoselective vaporisation of the prostate using the 180W lithium triborate laser in the treatment of benign prostatic obstruction: An international multicenter experience

with respect to demographic and baseline characteristics (Table 1). General and spinal anesthesia were evenly distributed between the two treatment arms: general (77 PVP, 70 TURP) and spinal (57 PVP, 51 TURP). The median procedure times for PVP and TURP were 46.0 minutes and 36.0 minutes respectively. For both modalities, the median time spent in post-surgical recovery was 1.3 hours. Subjects treated with PVP had a median catheterization time of 21.7 hours and 46.0 hours in TURP subjects. The median time spent in the hospital was 29.3 hours (PVP) compared to 69.9 hours (TURP). Preliminary 3-month data is presented in Table 1, 6-month end-point data is expected to be available March of 2013. CONCLUSIONS: Published TURP data is limited with few large historical studies. This international, multi-center prospective, randomized study comparing PVP and TURP will provide high-level evidence on procedural and post-procedural outcomes.

Early experience photoselective vaporisation of the prostate using the 180W lithium triborate and comparison with the 120W lithium triborate laser

Purpose:There is a paucity of information on the clinical efficacy and safety of the photoselective vaporization (PVP) of the prostate using the 180W lithium triborate (LBO) laser. We report on initial outcomes of PVP with the 180W laser, comparing the first 50 cases with the last 50 cases performed with the 120W LBO laser.Methods:All cases performed by a single surgeon (HHW) have been prospectively maintained. The last 50 cases treated with the 120W LBO laser (December 2009 to August 2010) were compared with the first 50 cases treated with the 180W LBO (July 2010 to June 2011). Patient variables were recorded preoperatively and at 3 months postoperatively. Perioperative data was also recorded.Results:The 180W cases had a larger median transrectal ultrasound prostate volume (68 mL vs. 51 mL, P<0.05). For the 180W and 120W LBO lasers, total operating time was 64.2 and 72.5 minutes (not significant [NS] at P=0.22), lasering time 49.6 and 54.6 minutes (NS, P=0.30) and energy utilisation 477.6 kJ and 377.9 kJ (P<0.05) respectively. When compared per gram of prostate tissue lasered, the 180W is quicker at 0.67 min/g vs. 1.0 min/g for the 120W laser. Complications using the Clavien-Dindo classification included 5 grade 1 complications and 3 grade 3b (bladder neck contractures) with the 180W LBO laser. The 120 W LBO laser had 4 grade 1 complications and 1 grade 2.Conclusions:There is little change in clinical outcomes with the transition from 120W to 180W LBO PVP with an already experienced PVP surgeon. The 180W LBO laser appears to have impacted upon patient selection with significantly increased prostate size and associated with increased energy utilisation. There appears to be a trend toward shorter laser times.

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 GreenLight 120-W lithium triborate laser to treat symptomatic benign prostatic hyperplasia: A single-centre prospective study

We evaluated the safety and efficacy of photoselective vaporization of the prostate (PVP) using GreenLight 120-W lithium triborate (LBO) laser to treat symptomatic small-to-medium sized benign prostatic hyperplasia (BPH). This prospective non-controlled observational study included symptomatic BPH men ≥50 years with international prostate symptom score (IPSS) ≥14, prostate volume (PV) ≤80 cc and maximum flow rate (Q-max) ≤15 mL/s. PVP was performed using the GreenLight 120-W LBO laser machine. Patients were assessed at baseline and postoperatively at discharge, 2 weeks, and 3, 6 and 12 months. We measured changes in IPSS, PV, PSA, Q-max, post-void residual (PVR), hemoglobin (Hb), serum sodium (Na+) and reported complications. Statistical significance was p < 0.05. The study included 103 men with mean age of 67 (±standard deviation)±9.7 years. Thirty patients were on indwelling urethral catheters for refractory urinary retention and 12 on ongoing anticoagulants. The mean baseline IPSS, PV, PSA, Q-max and PVR parameters significantly improved at follow-up (p < 0.001; each). Mean measurements at baseline versus at six months were: IPSS 25.6 ± 4.2 vs. 7.4±2.3; PV 44.6 ± 9.2 vs. 21.6 ± 6.3 cc (51.6% reduction); Q-max 5.8 ± 3.4 vs. 20.4 ± 4.8 mL/s; PVR 110 ± 40 vs. 35 ± 9 cc. Mean baseline Hb and serum Na+ declined non-significantly (p > 0.05) at discharge and at 2 weeks. No patient needed a blood transfusion. Secondary procedures were needed in 2 patients for urethral and bladder neck strictures. The re-treatment rate for residual adenoma was 0.97%. PVP using the GreenLight 120-W LBO laser to treat small-to-medium sized symptomatic BPH demonstrated significant improvements in efficacy parameters and high safety profile within 12 months of follow-up. The procedure entails good hemostasis with minimal blood loss even in patients receiving ongoing anticoagulants.