Photovaporization Of The Prostate Research Articles

MP51-09 ASSOCIATION BETWEEN LOW TESTOSTERONE AND PERIOPERATIVE OUTCOMES IN PATIENTS UNDERGOING TRANSURETHRAL PROSTATE SURGERY

You have accessJournal of UrologyCME1 Apr 2023MP51-09 ASSOCIATION BETWEEN LOW TESTOSTERONE AND PERIOPERATIVE OUTCOMES IN PATIENTS UNDERGOING TRANSURETHRAL PROSTATE SURGERY Jasmine Lin, Daniel Greenberg, Sai Kaushik S. R. Kumar, Xinlei Mi, Edward Schaeffer, Robert Brannigan, and Joshua Halpern Jasmine LinJasmine Lin More articles by this author , Daniel GreenbergDaniel Greenberg More articles by this author , Sai Kaushik S. R. KumarSai Kaushik S. R. Kumar More articles by this author , Xinlei MiXinlei Mi More articles by this author , Edward SchaefferEdward Schaeffer More articles by this author , Robert BranniganRobert Brannigan More articles by this author , and Joshua HalpernJoshua Halpern More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Low testosterone (T) has been associated with decreased muscle mass, increased frailty, and a higher risk of cardiovascular disease. Therefore, low T and its consequences may adversely impact perioperative outcomes for patients undergoing surgical procedures. We sought to characterize the association between low T, frailty and perioperative outcomes in patients undergoing transurethral resection of the prostate (TURP) and laser photovaporization of the prostate (PVP). METHODS: We identified men who underwent TURP or PVP with a recorded T level within 1 year prior to their procedure date. We compared the clinical characteristics, lab values, and Hospital Frailty Risk Scores (HFRS) of patients with low (<300 ng/dL) versus normal (≥300 ng/dL) T. Descriptive statistics were performed using t-test and chi-squared test, where applicable. Univariate and multivariate regression were performed to determine the association between low T and specific perioperative outcomes. RESULTS: Among 181 patients who underwent either TURP or PVP, 89 (49%) had low T. Mean preoperative T was 176.0 (±100.9) versus 471.7 (±162.4) ng/dL in the low versus normal T group (p<0.001). Patients with low T were older (68.7±9.2 vs. 64.8±11.7 years old, p=0.014) and had longer post-op stays (4.1±10.3 vs. 1.4±0.9 days, p=0.03), lower post-op hemoglobin (12.5±2.0 vs. 13.8±1.7, p<0.001) and hematocrit (37.3±6.0 vs. 41.0±4.7, p<0.001) values. Patients with low T also had higher rates of readmission within 180 days (28% vs. 13%, p=0.020). T was not independently associated with frailty (p=0.6). On multivariable analysis, both HFRS and low preoperative T were independently associated with 180-day readmission on multivariable analysis (OR 1.04, 95% CI 1.00-1.07, p=0.05 and OR 1.00, 95% CI 0.99-1.0, p=0.002, respectively). CONCLUSIONS: Almost half of men undergoing transurethral surgery had low T. While low T was not independently associated with frailty, both low T and frailty were independently associated with higher risk of 180-day readmission. While future prospective studies are needed, low T may be an independent risk factor for adverse perioperative outcomes after transurethral surgery, indicating a potential for T assessment and possibly treatment pre-operatively. Source of Funding: Urology Care Foundation Research Scholar Award SP0071384 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e696 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jasmine Lin More articles by this author Daniel Greenberg More articles by this author Sai Kaushik S. R. Kumar More articles by this author Xinlei Mi More articles by this author Edward Schaeffer More articles by this author Robert Brannigan More articles by this author Joshua Halpern More articles by this author Expand All Advertisement PDF downloadLoading ...

The impact of 5-alpha reductase inhibitors on perioperative and functional outcomes of Greenlight photovaporization of the prostate: An analysis of the Global Greenlight Group database

The impact of 5-alpha reductase inhibitors on perioperative and functional outcomes of Greenlight photovaporization of the prostate: An analysis of the Global Greenlight Group database

Does Preoperative Bladder Compliance Affect Long-Term Functional Outcomes after Laser Prostatectomy?

We assessed the effects of preoperative bladder compliance on the long-term functional outcomes, especially focused on postoperative storage symptom changes, after laser prostatectomy. From January 2008 to March 2014, 1,608 men who underwent laser prostatectomy, including holmium laser enucleation or photo-vaporization of the prostate, were included in the analysis. We divided patients into 3 groups according to bladder compliance on a baseline urodynamic study: <12.5, 12.5-25, ≥25 mL/cmH2O. A multivariable analysis was performed to determine the impact of bladder compliance on changes in long-term functional outcomes after laser prostatectomy. Bladder compliance was less than 12.5 mL/cmH2O in 50 (3.1%), 12.5-25 mL/cmH2O in 232 (14.4%) patients. As bladder compliance decreased, the baseline International Prostate Symptom (IPSS) total score and storage sub-score were increased; the voiding sub-score remain unchanged. At postoperative 12 and 36 months, absolute improvements in the IPSS total score and storage sub-score were higher in <12.5 mL/cmH2O group compared to other groups, although those were equivalent at postoperative 1 months. On the multivariable analysis, decreased bladder compliance <12.5 mL/cmH2O was significantly associated with superior improvement in storage sub-score at postoperative 36 months, although it was not associated with voiding sub-score. In patients with preoperative bladder compliance <12.5 mL/cmH2O, storage symptoms could be further improved at 36 months after laser prostatectomy compared to others. Thus, laser prostatectomy could be a considerable treatment option for patients with severely decreased bladder compliance.

Comparison of Emergency Room Visits and Rehospitalization for Bleeding Complications following Transurethral Procedures for the Treatment of Benign Prostatic Hyperplasia: A Population-Based Retrospective Cohort Study.

Background: The postoperative bleeding complications associated with laser surgery of the prostate and transurethral resection of the prostate (TURP) were compared. Methods: We used the Taiwan National Health Insurance Research Database to conduct an observational population-based cohort study. All eligible patients who received transurethral procedures between January 2015 and September 2018 were enrolled. Patients who received laser surgery or TURP were matched at a ratio of 1:1 by using propensity score matching, and the association of these procedures with bleeding events was evaluated. Results: A total of 3302 patients who underwent elective transurethral procedures were included. The multivariable Cox regression analysis revealed that diode laser enucleation of the prostate (DiLEP) resulted in significantly higher emergency room risks within 90 days after surgery due to clot retention than the Monopolar transurethral resection of the prostate (M-TURP) (Hazard Ratio: 1.52; 95% Confidence Interval [CI], 1.06–2.16, p = 0.022). Moreover, GreenLight photovaporization of the prostate (PVP) (0.61; 95% CI, 0.38–1.00 p = 0.050) and thulium laser vaporesection of the prostate (ThuVARP) (0.67; 95% CI, 0.47–0.95, p = 0.024) resulted in significantly fewer rehospitalization due to clot retention than did M-TURP. No significant increase in blood clots were observed in patients using comedications and those with different demographic characteristics and comorbidities. Conclusions: Among the investigated six transurethral procedures for Benign prostatic hyperplasia, PVP and ThuVARP were safer than M-TURP because bleeding events and clot retention were less likely to occur, even in patients receiving anticoagulant or antiplatelet therapy. However, DiLEP and holmium laser enucleation of the prostate (HoLEP) did not result in fewer bleeding events than M-TURP.

Comparison of postoperative functional results in holmium laser enucleation of the prostate, green laser photovaporization of the prostate and transurethral resection of the prostate in the treatment of obstructive prostatic hyperplasia

Objective: To compare the functional results in patients undergoing transurethral resection of the prostate (TURP), photovaporization of the prostate with GreenLight ® laser (FTV) and prostate enucleation with Holmium laser (HOLEP), for the treatment of benign prostatic obstruction at the Central Military Hospital. Material and methods: The international index of prostate symptomatology questionnaire (IPSS), Uroflowmetry (Qmax), pre and post void ultrasonography (PVR) were applied to patients undergoing TURP, VTF and HOLEP pre and postoperatory from January 2018 to March 2019. Shapiro-Wilks tests were analyzed for quantitative variables; parametric behavioral data were analyzed with ANOVA tests, and non-parametric data were analyzed with Mann-Whitney and Kruskal-Wallis U tests. GraphPad PRISM v7.0 statistical package was used. Results: 46 patients underwent to TURP, 62 to HOLEP and 17 to VFT were evaluated, removing those who did not achieve complete postoperative follow-up; describing the demographic characteristics, the most frequent comorbidities and the parameters evaluated preoperatively. At follow-up, HOLEP was slightly better than FTV or TURP; without finding statistical significance between the groups, observing an important improvement in the reference values of IPSS, Qmax and PVR after surgery in all populations. Conclusions: No superiority of any technique was proven in short-term postoperative functional results, so we propose to perform long-term studies, considering adding trans and postoperative parameters in order to demonstrate superiority of these techniques.

MP04-01 IMPACT OF 5-ALPHA REDUCTASE INHIBITORS ON FUNCTIONAL OUTCOMES OF GREENLIGHT PHOTOVAPORIZATION OF THE PROSTATE (PVP): AN ANALYSIS OF 3500 MEN IN THE GLOBAL GREENLIGHT GROUP (GGG) DATABASE

MP04-01 IMPACT OF 5-ALPHA REDUCTASE INHIBITORS ON FUNCTIONAL OUTCOMES OF GREENLIGHT PHOTOVAPORIZATION OF THE PROSTATE (PVP): AN ANALYSIS OF 3500 MEN IN THE GLOBAL GREENLIGHT GROUP (GGG) DATABASE

PD45-03 THE MORBIDITY OF PROSTATIC URETHRAL LIFTS IN THE MANAGEMENT OF BLADDER OUTLET OBSTRUCTION FOLLOWING RADIOTHERAPY

You have accessJournal of UrologyCME1 May 2022PD45-03 THE MORBIDITY OF PROSTATIC URETHRAL LIFTS IN THE MANAGEMENT OF BLADDER OUTLET OBSTRUCTION FOLLOWING RADIOTHERAPY Monika Tedeschi, Lauren Keenan, Gregg Eure, and Kurt McCammon Monika TedeschiMonika Tedeschi More articles by this author , Lauren KeenanLauren Keenan More articles by this author , Gregg EureGregg Eure More articles by this author , and Kurt McCammonKurt McCammon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002613.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior data suggests prostatic urethral lifts (PULs) may be efficacious in the management of bladder outlet obstruction (BOO) in patients who have undergone radiation for prostate cancer; however, there is limited data on the morbidity of PULs in the treatment of BOO after radiation. METHODS: In this retrospective review, patients with a history of radiotherapy who underwent bladder outlet procedures between October 2011 and September 2020 were investigated. Forms of radiotherapy included external beam radiation (EBRT), brachytherapy (BT), EBRT + BT, and proton therapy (PT). We previously demonstrated PULs significantly improve obstructive voiding symptoms and quality of life at 6 and 12 months following the procedure. In this review, we assessed the morbidity of PULs by investigating the need for additional procedures and adverse events following PULs. RESULTS: Ninety patients with a history of radiation underwent a bladder outlet procedure between October 2011 and September 2020. Twenty-five patients underwent PULs. Other outlet procedures following radiation included transurethral resection of the prostate (n=32), photovaporization of the prostate (n=28), transurethral incision of the prostate (n=4), and prostate laser enucleation (n=1). Of the 25 patients who underwent PULs, more than half (56%) experienced at least one adverse side effect. Incontinence was the most common adverse event (36%) and stone formation (16%) was the second most common. Eight patients (32%) required additional procedures and the average time to re-treatment after PULs was 10.8 months. All 8 patients received at least one in-office cystoscopy. Two patients chose to undergo placement of an artificial urinary sphincter due to severity of incontinence/negative impact of quality of life, 4 patients required explanation of an implant and/or laser lithotripsy due to stone formation, and 1 patient required a urethroplasty. Of the patients that required additional procedures, 2 underwent ERBT, 3 underwent BT, 1 underwent EBRT and BT, and 2 underwent PT. CONCLUSIONS: PULs significantly improved patients’ obstructive voiding symptoms and quality of life at 6 and 12 months following the procedure; however, PULs are not without morbidity. Patients need to be counseled on adverse side effects and the likelihood of multiple additional procedures. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e783 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Monika Tedeschi More articles by this author Lauren Keenan More articles by this author Gregg Eure More articles by this author Kurt McCammon More articles by this author Expand All Advertisement PDF DownloadLoading ...

GreenLight photovaporization of the prostate in high-medical-risk patients: an analysis of the Global GreenLight Group (GGG) database.

We sought to characterize the adjusted outcomes of GreenLight photoselective vaporization of the prostate (PVP) in high-medical-risk (HMR) patients using data from the largest international database. Data were obtained from the Global GreenLight Group (GGG) database which pools data of eight high-volume, experienced surgeons, from a total of seven international centers. Eligible study participants underwent GreenLight PVP using the XPS-180W system between 2011 and 2019. HMR patients were defined as patients with ASA III or greater and were compared to non-HMR patients. Analyses were adjusted for patient age and prostate volume. In the HMR group, patients on average were older and had smaller prostates than the non-HMR control group. Compared to non-HMR patients, transfusions occurred more frequently (2.6% vs. 0.14%, p < 0.01) and the odds of readmission were elevated [OR 2.0, (95% CI 1.4-2.8, p < 0.01)] among HMR patients. Twelve months postoperatively, HMR patients experience greater improvement in QoL than the control group [+ 0.54 (95% CI 0.07-1.0, p = 0.02)]. PVR also decreased 93.1ml more in HMR than in non-HMR patients after 12months (95% CI 33.6-152.6, p < 0.01). We found that GreenLight PVP is safe and effective in improving functional outcomes in higher-risk patients with severe systemic disease compared to their lower-risk counterparts. Though absolute risks remain low, GreenLight PVP is associated with higher odds of transfusion and readmission in the high-risk cohort. The findings of our study reaffirm current guidelines that propose PVP as a viable treatment option for HMR patients.

MP09-18 COMPARING DIFFERENT TREATMENT OPTIONS FOR BLADDER OUTLET OBSTRUCTION IN PATIENTS FOLLOWING RADIOTHERAPY FOR PROSTATE CANCER

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II (MP09)1 Sep 2021MP09-18 COMPARING DIFFERENT TREATMENT OPTIONS FOR BLADDER OUTLET OBSTRUCTION IN PATIENTS FOLLOWING RADIOTHERAPY FOR PROSTATE CANCER Monika Tedeschi, Lauren Keenan, Gregg Eure, and Kurt McCammon Monika TedeschiMonika Tedeschi More articles by this author , Lauren KeenanLauren Keenan More articles by this author , Gregg EureGregg Eure More articles by this author , and Kurt McCammonKurt McCammon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001982.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is no consensus on the best treatment option for bladder outlet obstruction (BOO) in patients who have received radiation therapy for prostate cancer. In this review, we look at the efficacy of prostatic urethral lifts (PULs), laser photovaporization of the prostate (PVP), and transurethral resection of the prostate (TURP) in the treatment of BOO in patients who have undergone radiotherapy. METHODS: In this retrospective review, patients with a history of radiotherapy who required a BOO procedure between October 2011 and September 2020 were investigated. Different forms of radiation included external beam radiation (EBRT), brachytherapy (BT), EBRT + BT, and proton therapy. International Prostate Symptom Scores (IPSS) and Quality of Life (QOL) scores were assessed prior to the intervention and at 6-month and 12-month post-procedure intervals. Need for additional procedures as well as adverse side effects following initial BOO procedure were assessed. RESULTS: Eighty-five patients with a history of radiation underwent treatment for BOO between October 2011 and September 2020. Twenty-five, 28, and 32 patients underwent PULs, PVP, and TURP, respectively. The average time from radiotherapy to a BOO procedure was 6.9 years. Prior to undergoing PULs, the mean IPSS and QOL scores were 21.3 and 4.7, respectively. Six-month post-procedure IPSS and QOL scores were significantly improved from pre-procedure scores (14.4 (p=0.0009) and 3.2 (p=0.003), respectively). Twelve-month post-procedure IPSS and QOL scores were also significantly improved compared to pre-procedure scores (13.4 (p=0.002) and 3.1 (p=0.008), respectively). Thirty-two percent of patients who underwent PULs required additional procedures compared to 68% of patients who underwent PVP (p=0.009). The was no significant difference between TURP and PULs in the need for additional procedures. Regardless of surgical approach, incontinence was the most common adverse event (40%, 54%, and 28% of patients undergoing PULs, PVP, and TURP, respectively). PVP had the highest rate of urethral strictures (28%). PULs had the highest rate of prostatic calcifications (16%). Of the radiation treatments, EBRT + BT had the highest rate of incontinence at 81%. CONCLUSIONS: PULs significantly improved patients’ obstructive voiding symptoms and quality of life at 6 and 12 months following the procedure. Regardless of the surgical approach, patients with BOO and a history of radiation need to be counseled on adverse side effects and the high likelihood of multiple additional procedures. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e167-e167 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Monika Tedeschi More articles by this author Lauren Keenan More articles by this author Gregg Eure More articles by this author Kurt McCammon More articles by this author Expand All Advertisement Loading ...

MP09-11 GREENLIGHT LASER PROSTATECTOMY: ARE OUTCOMES SUSTAINABLE AFTER A DECADE OF SURGERY? A SINGLE CENTER EXPERIENCE WITH UP TO 15 YEARS' FOLLOW-UP

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II (MP09)1 Sep 2021MP09-11 GREENLIGHT LASER PROSTATECTOMY: ARE OUTCOMES SUSTAINABLE AFTER A DECADE OF SURGERY? A SINGLE CENTER EXPERIENCE WITH UP TO 15 YEARS' FOLLOW-UP Ahmed Ibrahim, Nawar Touma, Ahmad M. AlShammari, Serge Carrier, and Mélanie Aubé-Peterkin Ahmed IbrahimAhmed Ibrahim More articles by this author , Nawar ToumaNawar Touma More articles by this author , Ahmad M. AlShammariAhmad M. AlShammari More articles by this author , Serge CarrierSerge Carrier More articles by this author , and Mélanie Aubé-PeterkinMélanie Aubé-Peterkin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001982.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since its introduction in 2005, GreenLight laser has been widely adopted as a convenient source of energy for surgical treatment of benign prostatic hyperplasia (BPH). However, there is paucity in the literature quantifying long-term outcomes (>10 years) of GreenLight laser prostatectomy. Herein, we report our single-center experience with long-term outcomes over a period of 15 years. METHODS: Between 2005 and 2020, a prospectively maintained database for patients undergoing GreenLight photovaporization of the prostate (PVP) for symptomatic BPH was reviewed. Three Generations of Green Light Laser were used over this time period. Patients with ≥10-years follow-up were included. Demographic and perioperative data were collected together with the International Prostate Symptoms Score (IPSS), Quality of Life (QoL), peak flow rate (Qmax), post-void residual urine (PVR), and PSA changes. In addition, perioperative and late adverse events were recorded. RESULTS: After a mean follow-up of 12.1 years (10-15 years), 124 patients were included with a mean age of 73.9 (range: 54- 85) years and a mean preoperative prostate size of 72.4±15.3mL. Demographic and perioperative data are presented in Table 1. Blood transfusion rate was 2.4%. Development of bladder neck contracture and urethral stricture were encountered in 7 (5.6%) and 9 (4.3%) of patients. 6 (4.8%) patients required repeat surgery for adenoma regrowth. Additionally, there were significant reductions in mean IPSS, QoL and PVR (60.4% and 65%, and 72.6%, respectively) (p <0.001). Likewise, there was a significant increase in Qmax (8.2 to 17.7 ml/s, p <0.001) with PSA reduction by 64.2 % compared to its baseline value. CONCLUSIONS: Our long-term functional outcomes support the durability of the GreenLight laser prostatectomy with acceptable long-term adverse events after a decade of surgery. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e163-e164 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed Ibrahim More articles by this author Nawar Touma More articles by this author Ahmad M. AlShammari More articles by this author Serge Carrier More articles by this author Mélanie Aubé-Peterkin More articles by this author Expand All Advertisement Loading ...

Proctored Step by Step Training Program for GreenLight Laser Anatomic Photovaporization of the Prostate: A Single Surgeon's Experience.

Objectives: To evaluate the feasibility and safety of a proctored step-by-step training program for GreenLight laser anatomic photovaporization (aPVP) of the prostate.Methods: Data from patients undergoing aPVP between January 2019 and December 2020 operated by a single surgeon following a dedicated step-by-step proctored program were prospectively collected. The procedure was divided into five modular steps of increasing complexity. Preoperative patients' data as well as total operative time, energy delivered on the prostate and postoperative data, were recorded. Then, we assessed how the overall amount of energy delivered and the operative times varied during the training program. Surgical steps were analyzed by cumulative summation. Univariable and multivariable regression models were built to assess the predictors of the amount of energy delivered on the prostate.Results: Sixty consecutive patients were included in the analysis. Median prostate volume was 56.5 mL. The training program was succesfully completed with no intraoperative or meaningful post-operative complications. The energy delivered reached the plateau after the 40th case. At multivariable analysis, increasing surgeon experience was associated with lower amounts of energy delivered as well as lower operative times.Conclusions: A step-by-step aPVP training program can be safely performed by surgeons with prior endoscopic experience if mentored by a skilled proctor. Considering the energy delivered as an efficacy surrogate metrics (given its potential impact on persistent postoperative LUTS), 40 cases are needed to reach a plateau for aPVP proficiency. Further studies are needed to assess the safety of our step-by-step training modular program in other clinical contexts.

Changing Paradigms: Green Laser Vaporization for Prostates over 80 mL: A Comparative Study.

Introduction and Objectives: Benign prostatic enlargement (BPE) and big prostates are common. Photovaporization of the prostate (PVP) with Greenlight™ laser 180 W XPS is considered a reliable therapy for prostates <80 mL and an alternative for the treatment of bigger ones in selected cases. The aim of this study is to evaluate efficacy, safety, and functional outcomes of PVP among patients with prostates over and under 80 mL. Materials and Methods: After protocol approbation by our Institutional Ethics Committee, a cohort of 840 patients with BPE who underwent PVP with Greenlight laser between 2012 and 2019 in a single center was evaluated. Groups were stratified according to prostate volume, to less and greater than 80 mL (Groups 1 and 2, respectively). The primary outcomes were efficacy [prostate-specific antigen (PSA) drop, improvement of International Prostatic Symptom Score (IPSS), and quality of life] and variables regarding safety of the procedure. Peri- and postoperative outcomes were analyzed. Complications were assessed according to Clavien-Dindo classification. Overall patient satisfaction was evaluated with visual analog scale. Results: Preoperative variables showed no statistical difference among groups. Mean follow-up was 47 [interquartile range; IQR = 26-70] months. Longer operative time and a higher energy use was seen in bigger prostates (p < 0.001). Efficacy was similar between groups, with a reduction of ≥4 points in IPSS score in 83.1% and 89.5% in Groups 1 and 2 (p = 0.053), PSA drop was 1 ± 2.6 and 1.7 ± 4.7 (p = 0.32). Group 2 had a higher conversion rate (0.3% vs 4.9%, p < 0.001) and higher blood transfusion rate (0% vs 2.4%, p < 0.001). There were no differences in hospital stay, catheterization time, urethral stricture, or re-treatment rates. Conclusions: GreenLight PVP is a safe and effective procedure in prostates ≥80 mL. It shows the same advantages demonstrated for those under that volume, particularly short hospital stay and catheterization time. Surgeon's experience is important to avoid complications, such as conversion and transfusion. PVP should be considered a first-line alternative for the treatment of bigger prostates.

GreenLight Laser™ Photovaporization versus Transurethral Resection of the Prostate: A Systematic Review and Meta-Analysis.

GreenLight laser™ photovaporization of the prostate (GLL-PVP) has become a valid alternative to traditional transurethral resection of the prostate (TURP) in men requiring surgery for benign prostatic hyperplasia. We aimed to review systematically the safety and efficacy of studies comparing GLL PVP and TURP in the medium-term. A comprehensive literature search was performed. Twelve studies were identified for meta-analysis. Meta-analyses showed a longer postoperative catheterization time (risk ratio (RR): 1.12, 95% CI:1.09–1.14, p<0.00001) and length of stay (RR: 1.16, 95% CI:1.12–1.19, p<0.00001) in the TURP group; higher risk of transfusion in the TURP group (RR: 6.51, 95% CI: 2,90–14,64 p<0.00001); no difference in the risk of urinary tract infections (RR: 0.83, 95% CI: 0.58–1.18, p=0.30) and transient re-catheterization (RR: 1.11, 95% CI: 0.76–1.60, p=0.60). Regarding reoperation rate, no difference was found in term of postoperative urethral stricture (RR: 1.13, 95% CI: 0.73–1.75, p=0.59) and bladder neck contracture (RR: 0.66, 95% CI: 0.31–1.40, p=0.28). A significantly higher incidence in reoperation for persistent/regrowth adenoma was present in the GLLL-PVP (RR: 0.64, 95% CI: 0.41–0.99, p=0.05). Data at 2-year follow-up showed significant better post-voiding residual (PVR) (MD: -1.42, 95% CI: -2.01, -0.82, p<0.00001) and International Prostate Symptom Score (IPSS) (MD: -0.35, 95% CI: -0.50, -0.20, p<0.00001) after TURP. No difference was found in the mean PVR at 2 years after TURP, in the mean maximum flow rate (Qmax) (MD: 0.30, 95% CI: -0.02–0.61, p=0.06) and quality of life QoL score (MD: 0.05, 95% CI: -0.02–0.42, p=0.13). At 5-year follow-up, data showed better IPSS (MD: -1.70, 95% CI: -2.45,-0.95, p<0.00001), QoL scores (MD: -0.35, 95% CI: -0.69, -0.02, p=0.04) and Qmax (MD: 3.29, 95% CI: 0.19–6.38, p=0.04) after TURP. Data of PVR showed no significant difference (MD: -11.54, 95% CI: -29.55–6.46, p=0.21). In conclusion, our analysis shows that GLL-PVP is a safer and more efficacious procedure than standard TURP in the early and medium-term. However, in the long term period GLL-PVP showed a higher incidence of reoperation rate due to incomplete vaporization/regrowth of prostatic adenoma.

Returning to the emergency room: An analysis of emergency encounters following urological outpatient surgery.

Previous reports indicate urological surgeries are associated with high rates of hospital re-admission. This study aims to identify factors associated with emergency room (ER) encounters following urological outpatient surgery. All outpatient surgeries performed at The Ottawa Hospital between April 1, 2008, and March 31, 2018 by urology, general surgery, gynecology, and thoracic surgery were identified. All ER encounters within 90 days of surgery were captured. Rates of ER encounters by surgical service and procedure type were determined. Patient and surgical factors associated with ER encounters were identified. Factors included age, sex, marital status, presence of primary care provider, procedure, and American Society of Anesthesiologists (ASA) score. A total of 38 377 outpatient surgeries by the included surgical services were performed during the study period, of which urology performed 16 552 (43.1%). Overall, 5641 (14.7%) ER encounters were identified within 90 days of surgery, including 2681 (47.5%) after urological surgery. On multivariable analysis, higher ASA score IV vs. I was associated with higher risk of ER encounter (relative risk [RR] 1.95, 95% confidence interval (CI) 1.46-2.5) and being married was associated with a lower risk of ER encounter (RR 0.85, 95% CI 0.77-0.93). Urological surgeries with the highest risk of ER encounters, compared to the lowest risk procedure (circumcision), were greenlight laser photo vaporization of the prostate (PVP) (RR 3.2, 95% CI 1.8-5.61), ureteroscopy (RR 3.2, 95% CI 1.9-5.4), and ureteric stent insertion (RR 3.1, 95% CI 1.8-5.5). ER encounters following outpatient surgery are common. This study identifies risk factors to recognize patients that may benefit from additional support to reduce ER care needs.

Impact of detrusor underactivity on the postoperative outcomes after benign prostatic enlargement surgery.

Previous studies suggest that men with detrusor underactivity (DUA) have less symptomatic improvement after prostate surgery than those with normal contractility, but the available data is controversial. We aim to determine the differences in functional outcomes of patients with or without DUA who underwent photovaporization of the prostate (PVP) with GreenLight™180 W XPS. A cohort of patients with lower urinary tract symptoms (LUTS) who underwent PVP between 2012 and 2019 was evaluated. Patients were stratified according to bladder contractility index (BCI). DUA was defined as BCI < 100. Those with normal contractility (BCI = 100-150) were included in Group 1, and those with DUA (BCI < 100) in Group 2. Primary outcomes were symptomatic improvement defined as a reduction ≥ 4 points in the international prostate symptom score (IPSS) and a reduction of at least 1 point in the quality of life (IPSS-QoL). Complications according to the Clavien-Dindo classification were also recorded. A total of 271 patients who underwent PVP with GreenLight™ and met the inclusion criteria were assessed. Group 1 included 158 patients, while Group 2 included 113 patients. Mean follow-up was 24 months. Patients with normal contractility had a median reduction of 11 points (18.9 ± 8.0 to 7.1 ± 7.0) while patients with DUA had a median reduction of 10 points (19.3 ± 6.9 to 8.6 ± 8.4) in IPSS score; these differences were not statistically significant (p = .20). Patients in Group 1 had a 1.92 higher chance of QoL improvement (OR, 1.92; 90% CI, 1.10-3.37), compared to those in Group 2. Failure to void after PVP was most frequently reported in DUA patients (OR, 2.36; 90% CI, 1.26-4.43). Sociodemographic characteristics, intraoperative complications, conversion rates, hospital stay, and urinary catheterization time were similar between groups. Patients with LUTS, regardless of their BCI, improved their symptoms after PVP according to the IPSS. However, patients with DUA were more likely not to improve their QoL after the procedure and had a higher chance of failure to void in the immediate postoperative period. An appropriate counseling process with the patient discussing possible outcomes based on these findings should be encouraged.

Misaligned Incentives in Benign Prostatic Enlargement Surgery: More Complex and Efficacious Procedures Are Earning Fewer Relative Value Units

Background: Relative value units (RVUs) are the measure of value used in US Medicare reimbursement. Medicare determines physician work RVUs (wRVUs) from the Relative Value Update Committee (RUC) for a procedure based on operative time, technical skill and effort, mental effort and judgment, and stress. In theory, work RVUs should account for the complexity and operative time involved in a procedure. The aim of this study was to assess whether major procedures for treatment of benign prostatic enlargement (BPE) are fairly compensated based on complexity and operative time in the RVU system and compare them with the intended reimbursement. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database and the Centers for Medicare and Medicaid Services (CMS) Medicare Physician Fee Schedule were queried from 2015 to 2017. Single, current, procedural terminology codes associated with BPE treatments were included: transurethral resection of the prostate (TURP), photovaporization of the prostate (PVP), holmium laser enucleation of the prostate (HoLEP), retropubic simple prostatectomy (RSP), and suprapubic simple prostatectomy (SSP). The CMS operative times and the NSQIP real data were used in turn to calculate separate values for wRVUs per hour (wRVUs/hr) of operative time. The wRVUs/hr derived from CMS operative times represent RUC-estimated wRVUs/hr and wRVUs/hr derived from NSQIP represent actual wRVUs/hr. Results: A total of 27,664 cases were included from the NSQIP dataset. Median wRVU was 15.3 (interquartile range [IQR] 12.2-15.3), median operative time 50 minutes (IQR 33-74), and median wRVUs/hr 17.0 (IQR 11.6-26.2). RUC-estimated wRVUs/hr were TURP 12.2, PVP 12.2, RSP 9, SSP 9.3, and HoLEP 7.3. The actual wRVUs/hr were TURP 19.1, PVP 15.5, RSP 10.2, HoLEP 9.4, and SSP 7.6. Conclusions: Laser enucleation and simple prostatectomy are highly complex and efficacious procedures for treating BPE, yet the current payment schedule assigns these procedures the least amount of wRVUs/hr. Financial incentives for performing BPE surgeries are clearly misaligned.

Impact of the presence of a median lobe on functional outcomes of greenlight photovaporization of the prostate (PVP): an analysis of the Global Greenlight Group (GGG) Database.

Previous analyses ofthe impact of median lobe presence on Greenlight photoselective vaporization of the prostate (PVP) outcomes were limited by their small sample size and the ability to adjust for important confounders. As such, we sought to investigate the impact of prostate median lobe presence on the operative outcomes of 180W XPS GreenLight PVP using a large international database. Data were obtained from the Global GreenLight Group (GGG) database whichpools data of eight high-volume, experienced surgeons, from a total of seven international centers. All men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180W system between 2011 and 2019 were eligible for the study. Patients were assigned to two groups based on presence or absence of median lobes. Analyses were adjusted for patient age, prostate volume, body mass index, and American Society of Anesthesia (ASA) score. A total of 1650 men met the inclusion criteria. A median lobe was identified in 621 (37.6%) patients. Baseline prostate volume, patient age, and ASA score varied considerably between the two groups. In adjusted analyses, the operative and lasing time of patients with median lobes was 6.72 (95% CI 3.22-10.23; p < 0.01) minutes and 2.90 (95% CI 1.02-4.78; p < 0.01) minutes longer than the control group. Men with median lobes had similar postoperative functional outcomes to those without a median lobe except for a 1.59-point greater drop in the 12-month IPSS score compared to baseline (95% CI 0.11-3.08; p = 0.04) in the median lobe group, and a decrease in PVR after 6months which was 46.51ml (95% CI 4.65-88.36; p = 0.03) greater in patients with median lobes compared to men without median lobes. Our findings suggest that the presence of a median lobe has no clinically significant impact on procedural or postoperative outcomes for patients undergoing Greenlight PVP using the XPS-180W system.

Postoperative treatment with phytotheraphy Graminex G63 (CERNILEN-Flogo®) after greenlight laser XPS (180W) photovaporization of the prostate (PVP), can affect patient's quality of life?

Phytotherapic treatment as Cernilen-flogo® is commonly used to treat chronic pelvic pain, chronic prostatitis, and BPE (benign prostatic enlargement). In our study, for the first time, we aim to evaluate postoperatively Cernilen-flogo® therapy in patients with BPE/LUTS (lower urinary tract symptoms) previously treated with Greenlight laser XPS (180W) photovaporization of prostate (PVP) to improve surgical outcomes. We collected data from patients treated with PVP for BPE/LUTS international prostate symptom score (IPSS) >20 unresponding to conventional treatment. Two groups of patients were analyzed: Group A including 15 patients (50%) treated postoperatively with Cernilen-flogo® vs. no treatment Group B. One expert surgeon performed all the procedures. 30 patients included with BPE/LUTs previously treated with PVP. There was no difference between patients' demographic, median age, prostate volume and PSA (prostate specific antigen) level. All patients had a postoperative evaluation after 30-45 days. Patients with postoperative complications (acute urinary retention, postoperative hematuria) were excluded from our study. All patients had a preoperative and postoperative evaluation of IPSS, bother score (BS) and pelvic discomfort (visual analogic scale VAS). Preoperatively there was no significative difference in IPSS, BS and VAS. IPSS Group A was postoperatively 7.13 (SD 1.64) and Group B was 7.33 (SD 1.58) (p=0.67); BS Group A was postoperatively 1.33 (SD 0.81), Group B was 1.73 (SD 1.09) (p=0.30), and VAS Group A was 2.73 (SD 1.9) and Group B was 4.33 (SD 1.58) (p=0.004) showing a statistically significative difference between the two groups in pelvic discomfort with a better outcome in patients treated with Cernilen-flogo®. Our study showed that Cernilen-flogo® treatment after PVP is effective and minimize patient's pelvic discomfort showed by lower VAS level resulting in better postoperatively patient's quality of life (QOL).

PD61-05 EARLY POSTOPERATIVE EJACULATORY AND ERECTILE FUNCTION FOLLOWING PHOTOVAPORIZATION OF THE PROSTATE (PVP) AND BIPOLAR PLASMA VAPORIZATION OF THE PROSTATE (BPVP)

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology IV (PD61)1 Apr 2020PD61-05 EARLY POSTOPERATIVE EJACULATORY AND ERECTILE FUNCTION FOLLOWING PHOTOVAPORIZATION OF THE PROSTATE (PVP) AND BIPOLAR PLASMA VAPORIZATION OF THE PROSTATE (BPVP) Lina Posada Calderon*, Mitali Kini, Hudson Pierce, Alexis Te, James A. Kashanian, and Bilal Chightai Lina Posada Calderon*Lina Posada Calderon* More articles by this author , Mitali KiniMitali Kini More articles by this author , Hudson PierceHudson Pierce More articles by this author , Alexis TeAlexis Te More articles by this author , James A. KashanianJames A. Kashanian More articles by this author , and Bilal ChightaiBilal Chightai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000978.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: GreenLight Photovaporization of the Prostate (PVP) and PlasmaButton bipolar plasma vaporization of the prostate (BPVP) use different energy delivery systems to ablate prostatic tissue in patients with benign prostatic hyperplasia (BPH). Although erectile and ejaculatory dysfunction are an ongoing concern following surgical therapies for BPH, immediate changes and early erectile function following these techniques have not been described. We aimed to describe the erectile changes occurring post-operatively and how they evolve for the first 6 months after surgery. METHODS: Patients with lower urinary tract symptoms (LUTS) secondary to BPH, an International Prostate Symptom Score (IPSS) >12, a prostate volume <80 ml and maximum flow rate (Qmax) <15 ml/s were screened to undergo PVP or BPVP. Male Sexual Health Questionnaire (MSHQ) as well as IPSS and Qmax were assessed preoperatively and at 1, 3 and 6 months postoperatively. Mean values for total MSHQ score as well as for the erection and ejaculation subscales were assessed at each of the time points for each of the procedures. A student’s t-test was performed to compare MSHQ scores at baseline and 6 months post-operatively. RESULTS: A total of 27 patients received PVP (n=13) or BPVP (n=14). Median age was 62.5 (Interquartile range (IQR) 70.3-71.8), median preoperative IPSS 18 (IQR 15.5 – 22), median prostate volume 51.3 (IQR 41-57) and median Qmax 9.4 (IQR 6.1-11.3). Mean baseline MSHQ was 64.6 (standard deviation (SD) 29.5) and mean postoperative measures were 55.7 (SD 32.4), 73.8 (SD 34.4) and 52.7 (SD 44.8) at 1 month, 3 months and 6 months, respectively. The mean change between MSHQ preoperatively and at 6 months was 11.9 points, which was not statistically significant (p=0.166). The change in score for each of the items of the questionnaire is shown in Table 1. Within the PVP group, the mean MSHQ change between baseline and at 6 months was -3.5 (p=0.786) and within the BPVP the mean change was -19.6 (p=0.095). CONCLUSIONS: Early erectile function following prostate ablation with PVP and BPVP drops slightly after the first month but recovers, achieving non-significantly different values compared to baseline. Patients should be counseled on early erectile changes and expectation for the first 6 months after surgery. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1281-e1282 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lina Posada Calderon* More articles by this author Mitali Kini More articles by this author Hudson Pierce More articles by this author Alexis Te More articles by this author James A. Kashanian More articles by this author Bilal Chightai More articles by this author Expand All Advertisement PDF downloadLoading ...

Operative time comparison of aquablation, greenlight PVP, ThuLEP, GreenLEP, and HoLEP

The BPH surgical armamentarium is composed of a rapidly expanding number of technologies and techniques. These include greenlight photovaporization of the prostate (PVP), greenlight enucleation of the prostate (GreenLEP), holmium laser enucleation of the prostate (HoLEP), thulium laser enucleation of the prostate (ThuLEP) and, more recently, the aquablation procedure. To the best of our knowledge, no direct comparison in operative time has been performed. Data for this study were pooled from five sources. For aquablation, patient-level data from four studies of the aquablation procedure were provided by the device manufacturer as well as from a high-volume commercial user. PVP, GreenLEP, HoLEP, and ThuLEP were performed by high-volume, experienced experts. Endpoints included total operative time, resection time, and proportion of total operative time for resection. General linear models were used to evaluate the relationship between prostate volume (or other continuous predictors) and procedure time. Total procedure time was related to prostate size. Except for the small prostate size range (size < 40cc), at any given prostate volume, procedure time was highest for PVP, intermediate for LEPs, and lowest for Aquablation. The relationship between procedure time and prostate size (i.e., slope of the fitted lines) was 0.16min/g for aquablation, 0.32min/g, 0.28min/g and 0.32min/g for GreenLEP, HoLEP and ThuLEP, respectively, and 0.63min/g for PVP. In our analysis of pooled data of multi-surgical techniques and technologies, aquablation provided the lowest operative time across all prostate volumes. PVP had the longest procedure time for prostates > 40cc.