Photovaporization Of The Prostate Research Articles

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.

Application of 180W XPS GreenLight laser vaporization of the prostate for treatment of benign prostatic hyperplasia.

To evaluate safety, efficacy and clinical outcomes after photovaporization of the prostate with the 180W-XPS Greenlight laser in patients with low urinary tracts symptom secondary to benign prostatic hyperplasia (BPH). All 102 patients with lower urinary tract symptoms who underwent 180W XPS laser vaporization of the prostate from April 2017 to April 2018 were enrolled. The preoperative parameters, postoperative functional, uroflowmetry outcomes and complications were collected. All patients were successfully treated with 180W XPS laser vaporization. Mean preoperative prostate volume was 81±28.7 ml and mean laser time was 28.2±12.5 minutes. No major complications intraoperatively or postoperatively were observed and no blood transfusions were required. Comparing to preoperative characteristics, International Prostate Symptom Score (IPSS), maximum flow rate (Qmax) and post-void residual (PVR) parameters were improved significantly and sustained during the follow-up period. At 3, 6 and 12-month follow-ups, mean urinary peak flow increased from 6.2±2.1 ml per second to 19.8±4.6, 19.4±4.7 and 19.6±4.9 ml per second, respectively. Mean International Prostate Symptom Scores decreased over time, from 28.9±4.5 to 8.2±1.6, 6.2±1.22 and 5.88±1.15 at 3, 6, 12 months, respectively. 180W XPS Greenlight laser vaporization is a safe and effective treatment option for patients with lower urinary tract symptoms secondary to BPH.

The Effect of Anticholinergics for Prevention of Storage Symptoms After Prostate Photovaporization.

To evaluate the efficacy of oral anticholinergics as a preventive strategy of storage symptoms and urinary incontinence associated with the early postoperative period after Greenlight laser photovaporization of the prostate (PVP). To analyze potential variables related to the onset of these symptoms. Retrospective study of 105 patients who underwent PVP using a 180-W Greenlight laser (XPS). Patients were divided into two groups, depending on whether they were or weren´t prescribed anticholinergics when discharged (oral solifenacin 5 mg for 1 month after surgery). Differences between both groups were analyzed according to IPSS, ICIQ-SF and OABq-SF scores at 1 and 6 months. The potentially predictive variables of the symptomatology after undergoing PVP that we analyzed included age, prostate volume, PSA, IPSS, ICIQ-SF, OABq-SF, Qmax, previous use of a permanent urinary catheter, energy used, and laser application time. 58 patients in the group with anticholinergics and 47 in the group without anticholinergics were compared. No significant differences were observed between both groups in IPSS (p = .521), ICIQ-SF (p = .720) or OABq-SF (p = .851) at 1 and 6 months after surgery. Regardless of the use of anticholinergics, there was a significant score improvement between the first and second checkup in all the questionnaires: there was a significant decrease in the mean IPSS (p < .001) and the mean score of the eighth IPSS question on patient's quality of life (p = .026), ICIQ- SF (p = .010) and OAB-q related to symptoms (p = .001) as well as a significant increase in the mean OAB-q score regarding quality of life (p = .005). None of the variables analyzed showed a significant relation to the storage-symptom rate, rate of incontinence, or ICIQ-SF and OABq-SF scores. The use of solifenacin 5 mg after Greenlight laser PVP is not an effective preventive treatment for storage and incontinence symptoms associated with this procedure, which seem to self-limit over time.

Functional outcomes and safety of GreenLight photovaporization of the prostate in the high-risk patient with lower urinary tract symptoms due to benign prostatic enlargement.

Photovaporization of the prostate (PVP) with GreenLight Laser is a surgical treatment for lower urinary tract symptoms. It is considered safe in elderly patients with comorbidities, however, the evidence is inconclusive. The objective of this study is to evaluate the efficacy and safety outcomes of PVP according to the American Society of Anesthesiologists Physical Status (ASAPS). A cohort of 675 patients who underwent PVP between 2012 and 2018 was evaluated. Patients were classified according to their ASAPS as low (I and II) and high risk (III and IV). Surgical characteristics and improvement of symptoms and Quality of Life (QoL) were evaluated. The median age of high-risk group was higher than low-risk group. The high-risk group had more history of anticoagulation, antiaggregation, urinary catheterization, urinary retention and urethral stricture. Longer times of hospitalization (23.7 [interquartile range {IQR} = 18.9-41.35] vs 21.8 hours [IQR = 18.7-26.6], P = .008) and catheterization (19.55 [IQR = 15.6-35.57] vs 17.67 hours [IQR = 14.76-22.5], P = .004) were found in the high-risk group. Conversion and bleeding control were not different between groups. In the follow-up, improvement of International Prostate Symptoms Score (IPSS) and QoL was significant in all patients when compared before and after surgery scores (P < .001). There were no difference between groups for QoL, however, IPSS was lower for the low-risk group (8 [IQR = 4-14.5] vs 5 [2-12], P = .001). PVP with GreenLight Laser is a safe and efficient procedure for all patients despite their comorbidities, with comparable middle-term outcomes which makes it a standard treatment for the entire aging population, improving their QoL.

The role of photovaporization of the prostate in small volume benign prostatic hyperplasia and review of the literature

ObjectiveOur objective was to characterize the safety and efficacy of the 180 W XPS-GreenLight laser in men with lower urinary tract symptoms secondary to a small volume benign prostatic hyperplasia (BPH). MethodsA retrospective analysis was performed for all patients who underwent 180 W XPS-laser photoselective vaporization of the prostate (PVP) vaporization of the prostate between 2012 and 2016 at two-tertiary medical centers. Data collection included baseline comorbidities, disease-specific quality of life scores, maximum urinary flow rate (Qmax), postvoid residual (PVR), complications, prostate volume and prostate-specific antigen (PSA). The secondary endpoints were the incidence of intraoperative and postoperative adverse events. Complications were stratified using the Clavien-Dindo grading system up to 90 days after surgery. ResultsMean age of men was 67.8 years old, with a mean body mass index of 29.7 kg/m2. Mean prostate volume as measured by transrectal ultrasound was 29 mL. Anticoagulation use was 47% and urinary retention with catheter at time of surgery was 17%. Mean hospital stay and catheter time were 0.5 days. Median follow-up time was 6 months with the longest duration of follow-up being 22.5 months (interquartile range, 3–22.5 months). The International Prostate Symptom Score improved from 22.8 ± 7.0 at baseline to 10.7 ± 7.4 (p < 0.01) and 6.3 ± 4.4 (p < 0.01) at 1 and 6 months, respectively. The Qmax improved from 7.70 ± 4.46 mL/s at baseline to 17.25 ± 9.30 mL/s (p < 0.01) and 19.14 ± 7.19 mL/s (p < 0.001) at 1 and 6 months, respectively, while the PVR improved from 216.0 ± 271.0 mL preoperatively to 32.8 ± 45.3 mL (p < 0.01) and 26.2 ± 46.0 mL (p < 0.01) at 1 and 6 months, respectively. The PSA dropped from 1.97 ± 1.76 ng/mL preoperatively to 0.71 ± 0.61 ng/mL (p < 0.01) and 0.74 ± 0.63 ng/mL at 1 and 6 months, respectively. No patient had a bladder neck contracture postoperatively and no capsular perforations were noted intraoperatively. ConclusionThe 180 W GreenLight XPS system is safe and effective for men with small volume BPH. PVP produced improvements in symptomatic and clinical parameters without any safety concern. It represents a safe surgical option in this under studied population.

Does urodynamics predict voiding after benign prostatic hyperplasia surgery in patients with detrusor underactivity?

ObjectiveWe sought to determine if urodynamic study (UDS) predicted voiding outcomes in men with detrusor underactivity (DU) and benign prostatic enlargement (BPE) who underwent photovaporization of the prostate (PVP). MethodsBetween September 2010 and July 2015, 106 male patients with BPE and DU were identified. All patients underwent PVP. Urinary retention was noted by the preoperative necessity for an indwelling or intermittent catheter. Data collection included comorbidities, quality of life (QoL) scores, prostate volume, prostate-specific antigen (PSA), UDS and perioperative outcomes. UDS parameters included volume at first desire to void, volume at first urge to void, volume of severe urge, volume at capacity, compliance, detrusor contractions, maximum urinary flow rate (Qmax), and postvoid residual (PVR). ResultsA total of 106 men were included in this analysis, who had urinary retention with a Foley catheter or clean intermittent catheterization (CIC) at the time of surgery. At baseline we found patients who voided had a detrusor pressure at Qmax (Pdet@Qmax) of 10.05 ± 6.45 cmH2O compared to 16.78 ± 12.17 cmH2O in those who did not void (p = 0.071). Postoperatively, 96 (90.6%, mean age 76.9 ± 26.2 years) of patients voided successfully while 10 (9.4%, mean age 80.52 ± 9.61 years) of patients remained in urinary retention. Mean baseline Qmax was 4.895 ± 5.452 mL/s and 2.900 ± 3.356 mL/s (p = 0.087) in those who voided and did not respectively. PVR was 319.23 ± 330.62 mL in those who voided and 276.88 ± 263.27 mL (p = 0.344) in those who did not void. No UDS parameter predicted who would void postoperatively or improvements in QoL. ConclusionsThe patients with DU and BPE might be able to successfully void after undergoing PVP regardless of UDS findings. All men who voided had improved international prostate symptom score and QoL scores compared to baseline and these parameters were durable up to 12 months.

Dolor por rotura uterina durante trabajo de parto bajo analgesia epidural. Reporte de un caso

A number of transurethral ablative techniques based on the use of innovative medical devices have been introduced in the recent past for the surgical treatment of benign prostatic obstruction (BPO).To conduct a systematic review of the literature and a meta-analysis of available randomized controlled trials (RCTs), and to evaluate the efficacy and safety of transurethral ablative procedures for BPO.A systematic literature search was performed for all RCTs comparing any transurethral surgical technique for BPO to another between 1992 and 2013. Efficacy was evaluated after a minimum follow-up of 1 yr based on International Prostate Symptom Score, maximum flow rate, and postvoid residual volume. Efficacy at midterm follow-up, prostate volume, perioperative data, and short-term and long-term complications were also assessed. Data were analyzed using RevMan software.A total of 69 RCTs (8517 enrolled patients) were included. No significant difference was found in terms of short-term efficacy between bipolar transurethral resection of the prostate (B-TURP) and monopolar transurethral resection of the prostate (M-TURP). However, B-TURP was associated with a lower rate of perioperative complications. Better short-term efficacy outcomes, fewer immediate complications, and a shorter hospital stay were found after holmium laser enucleation of the prostate (HoLEP) compared with M-TURP. Compared with M-TURP, GreenLight photoselective vaporization of the prostate (PVP) was associated with a shorter hospital stay and fewer complications but no different short-term efficacy outcomes.This meta-analysis shows that HoLEP is associated with more favorable outcomes than M-TURP in published RCTs. B-TURP and PVP have resulted in better perioperative outcomes without significant differences regarding efficacy parameters after short-term follow-up compared with M-TURP. Further studies are needed to provide long-term comparative data and head-to head comparisons of emerging techniques.Bipolar transurethral resection of the prostate, photovaporization of the prostate, and holmium laser enucleation of the prostate have shown efficacy outcomes comparable with conventional techniques yet reduce the complication rate. The respective role of these new options in the surgical armamentarium needs to be refined to propose tailored surgical treatment for benign prostatic obstruction relief.

Long-term Patient-reported Clinical Outcomes and Reoperation Rate after Photovaporization with the XPS-180W GreenLight Laser

ObjectiveTo evaluate the long-term reported clinical outcomes after photovaporization of the prostate (PVP) with the XPS-GreenLight laser in patients with symptomatic benign prostatic enlargement (BPE). Design, setting, and participantsA prospective longitudinal study was performed for all consecutive patients with BPE who underwent PVP at our institution between 2010 and 2012. Patient-reported clinical outcomes were assessed at 1 mo, 3 mo, 12 mo, and 57 mo using International Prostate Symptoms Score, International Continence Society, and International Index of Erectile Function short-form questionnaires. Maximum flow rate (Qmax), postvoid residual urine measurements were assessed at 3 mo and 12 mo. Long-term satisfaction, complications, and reoperation rates were assessed by questionnaires. Prostate-specific antigen was measured at 3 mo, 12 mo, and 57 mo. InterventionA single surgeon (GF) has practiced photovaporization with a Moxy fiber, under transrectal ultrasonography monitoring. Long-term clinical outcomes were evaluated using questionnaires. Outcome measurements and statistical analysisThe primary measurement was the reoperation. Results and limitationsEighty-four patients of 102 answered the long-term questionnaire. The mean age was 68±7.2 yr. The mean follow-up was 57.4±6.8 mo. The mean prostate volume was 73±38ml. After treatment, the mean International Prostate Symptoms Score decreased significantly from 19.9±6.4 to 6.1±5.6, 3.9±3.4, and 5.9±5.8, respectively, at 3 mo, 12 mo, and 57 mo. The mean prostate-specific antigen level decreased significantly (−56%) from 4.5±4.3ng/ml preoperatively to 2.0±2.0ng/ml and 2.6±2.2ng/ml, respectively, at 12 mo and 57 mo. The mean Qmax increased from 9.6±3.8ml/s preoperatively to 23.9±11.5ml/s and 25.2±9.2ml/s, respectively, at 3 mo and 12 mo. Overall reoperation rate was 4.8%(4/84). Limitations include the single surgeon single center design study and the lack of long-term objectives data such as urodynamic parameters (postvoid residual urine and Qmax). ConclusionsPhotovaporization of the prostate with the XPS-GreenLight laser is an effective technique able to durably improve reported clinical outcomes in patients with BPE. Patient summaryIn this study we looked at the long-term outcomes after laser therapy with XPS-GreenLight laser for benign prostatic enlargement. We found a few reoperation rates and good stable reported clinical outcomes after a mean follow-up of 57 mo. We conclude that this laser technique can offer durably good reported clinical outcomes.

Urology Residents' Experience and Attitude Toward Surgical Simulation: Presenting our 4-Year Experience With a Multi-institutional, Multi-modality Simulation Model

To evaluate the Urological resident's attitude and experience with surgical simulation in residency education using a multi-institutional, multi-modality model. Residents from 6 area urology training programs rotated through simulation stations in 4 consecutive sessions from 2014 to 2017. Workshops included GreenLight photovaporization of the prostate, ureteroscopic stone extraction, laparoscopic peg transfer, 3-dimensional laparoscopy rope pass, transobturator sling placement, intravesical injection, high definition video system trainer, vasectomy, and Urolift. Faculty members provided teaching assistance, objective scoring, and verbal feedback. Participants completed a nonvalidated questionnaire evaluating utility of the workshop and soliciting suggestions for improvement. Sixty-three of 75 participants (84%) (postgraduate years 1-6) completed the exit questionnaire. Median rating of exercise usefulness on a scale of 1-10 ranged from 7.5 to 9. On a scale of 0-10, cumulative median scores of the course remained high over 4 years: time limit per station (9; interquartile range [IQR] 2), faculty instruction (9, IQR 2), ease of use (9, IQR 2), face validity (8, IQR 3), and overall course (9, IQR 2). On multivariate analysis, there was no difference in rating of domains between postgraduate years. Sixty-seven percent (42/63) believe that simulation training should be a requirement of Urology residency. Ninety-seven percent (63/65) viewed the laboratory as beneficial to their education. This workshop model is a valuable training experience for residents. Most participants believe that surgical simulation is beneficial and should be a requirement for Urology residency. High ratings of usefulness for each exercise demonstrated excellent face validity provided by the course.

Evaluation of bleeding risk in patients on anticoagulation for mechanical cardiac valve operated for benign prostatic obstruction

To evaluate bleeding risk in patients on anticoagulation for mechanical cardiac valve operated for benign prostatic obstruction (BPO). Fifty-eight patients operated between 1998 and 2014, in seven French departments of Urology were included. Forty-five patients were operated by conventional surgery (transurethral resection of the prostate 38, open simple prostatectomies 7), and 13 patients were operated by Greenlight™ photovaporization of the prostate (PVP). In order to assess bleeding risk, blood transfusion was considered as the primary outcome. Fifteen (26%) patients received blood transfusion in the postoperative period. Mean duration of hospitalization was 8.5days. Secondary surgery was required in 12cases (21%), including endoscopic clot removal under general anaesthesia in 10 patients, and suprapubic haemostasis in 3 patients. One patient died 72hours after transurethral resection of the prostate because of a massive pulmonary embolism. Two independent predictors of blood transfusion were identified: conventional surgery use versus PVP, and high preoperative PSA. Blood transfusion rate was significantly lower in the group of patients operated by PVP compared to conventional surgery (0% versus 33%, P=0.010). In addition, the laser surgery was associated with shorter duration of hospitalization (3.4days versus 9.9days, P=0.014). However, it was not found any significant difference between patients operated by PVP compared to conventional surgery in terms of secondary bleeding (3/13 vs 8/45, P=0.7), or second surgery (2/13 vs 10/45, P=0.5). Bleeding risk of BPO surgery in patients with mechanical cardiac valve is high. The PVP seems to decrease significantly the early haemorrhagic risk compared to classic surgical procedures for patients with mechanical cardiac valve. 4.

V5-01 HOLMIUM LASER ENUCLEATION OF THE PROSTATE AS RETREATMENT AFTER UROLIFT DEVICE: FEASIBILITY AND TECHNICAL CONSIDERATIONS

You have accessJournal of UrologyBPH and Voiding Dysfunction1 Apr 2017V5-01 HOLMIUM LASER ENUCLEATION OF THE PROSTATE AS RETREATMENT AFTER UROLIFT DEVICE: FEASIBILITY AND TECHNICAL CONSIDERATIONS Sean McAdams and Mitchell Humphreys Sean McAdamsSean McAdams More articles by this author and Mitchell HumphreysMitchell Humphreys More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1406AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In this video we demonstrate the feasibility of Holmium laser enucleation of the prostate (HoLEP) for retreatment of persistent lower urinary tract symptoms (LUTS) after previous treatment with the UroLift device. Technical considerations with regards to both enucleation and morcellation of resected tissue are discussed. Benign prostatic hyperplasia (BPH) affects millions of men worldwide. The UroLift system (NeoTract Inc., Pleasanton, CA) was recently introduced as a means to perform prostatic urethral lift (PUL) procedure for lateral lobe hypertrophy in patients with obstructive voiding symptoms. Urolift has been associated with a retreatment rate of 7% at 2 years and 14% at 4 years. Retreatment with TURP, photovaporization of the prostate and repeat UroLift has been described without notable issue, but retreatment with HoLEP has not yet been described. METHODS We included two patients who had undergone PUL with UroLift system at outside institutions and presented with recurrent LUTS. Patients were evaluated by cystoscopy, uroflowmetry, transrectal ultrasound of the prostate, and urodynamics to define the etiology of their urinary symptoms and determine appropriate therapy. HoLEP was performed under general anesthesia as previously described. Morcellation of the resected adenoma was performed with the VersaCut reciprocating morcellator (Lumenis Inc, Santa Clara, CA). RESULTS Enucleation was successfully completed in both patients. Monofilament sutures of the Urolift device were easily visualized and transected with the holmium laser. At the bladder neck, both patients were unexpectedly found to have the outer nitinol tab portions of UroLift devices located within the capsule of the prostate, rather than in the intended extracapsular location. Auxiliary maneuvers were required for removal of these nitinol tabs. The inner stainless steel portions of the UroLift device were encountered during morcellation of the resected adenoma. In each instance, the metal tabs became lodged in the reciprocating blades of the morcellator, requiring withdrawal of the morcellator instrument and manual removal of the tab from the morcellator blade. This resulted in brief disruptions in the procedure. There were no operative complications. CONCLUSIONS To our knowledge, we present the first description of HoLEP with morcellation of adenoma tissue after previous prostatic urethral lift surgery with the UroLift device. HoLEP can be performed safely and effectively post Urolift, however morcellation of the adenoma tissue is complicated by the metallic implants of the Urolift device. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e599 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Sean McAdams More articles by this author Mitchell Humphreys More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD27-11 COMPARATIVE EFFECTIVENESS OF TRANSURETHRAL RESECTION TECHNIQUES FOR BENIGN PROSTATIC HYPERPLASIA – ANALYSIS OF AN ALL PAYER INPATIENT DISCHARGE DATABASE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology IV1 Apr 2017PD27-11 COMPARATIVE EFFECTIVENESS OF TRANSURETHRAL RESECTION TECHNIQUES FOR BENIGN PROSTATIC HYPERPLASIA – ANALYSIS OF AN ALL PAYER INPATIENT DISCHARGE DATABASE Christian P. Meyer, Philipp Gild, Nicolas von Landenberg, David F. Friedlander, Jairam R. Eswara, Mani Menon, Felix K.H. Chun, Margit Fisch, Maxine Sun, Benjamin L Chung Chung, Steven L Chang, and Quoc-Dien Trinh Christian P. MeyerChristian P. Meyer More articles by this author , Philipp GildPhilipp Gild More articles by this author , Nicolas von LandenbergNicolas von Landenberg More articles by this author , David F. FriedlanderDavid F. Friedlander More articles by this author , Jairam R. EswaraJairam R. Eswara More articles by this author , Mani MenonMani Menon More articles by this author , Felix K.H. ChunFelix K.H. Chun More articles by this author , Margit FischMargit Fisch More articles by this author , Maxine SunMaxine Sun More articles by this author , Benjamin L Chung ChungBenjamin L Chung Chung More articles by this author , Steven L ChangSteven L Chang More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1232AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Monopolar transurethral resection (mTURP) is the conventional surgical standard of care for bladder outlet obstruction (BOO) secondary to benign prostatic enlargement (BPH). Alternatively, holmium laser techniques, bipolar TURP (bTURP) and Greenlight photovaporization of the prostate (GL-PVP) constitute modern options with favorable safety profiles. However, current literature comparing various BOO treatment modalities is limited by sample size, study design, and the absence of cost data. We sought to compare costs and complication patterns of mTURP, bTURP and GL-PVP in a large, US all-payer discharge database. METHODS Using the Premier Research Database, we identified 20,323 men 40-80 years with a diagnosis of BPH who underwent a BOO procedure between 2003-2013. Using propensity weighted logistical regression, we assessed trends and perioperative outcomes of mTURP, bTURP, and GL-PVP. RESULTS mTURP remained the most frequently performed procedure during the study period, but its utilization decreased by 20% during that time (p<0.001) (Figure 1). Whereas there were no significant differences between bTURP and mTURP with regards to OR time (p>0.99), LOS (p=0.82), and 90-day complication rates (p=0.34), GL-PVP was associated with longer OR times (+12 minutes, 95% CI: 10.25 to 13.75, p<0.001) but demonstrated a shorter LOS (OR: 0.51, 95% CI: 0.37 to 0.7, p<0.001) relative to mTURP. Both bTURP ($982, 95% CI: $509-1456, p<0.001) and GL-PVP ($1536, 95% CI: $1296-1775, p<0.001) were associated with higher 90-day direct hospital costs compared to mTURP. CONCLUSIONS We show that the volume of inpatient endoscopic management of BPH has decreased significantly over the past decade. We found only a modest perioperative safety and outcome benefit with bTURP and GL-PVP over mTURP, while both procedures were associated with higher costs. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e516 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Christian P. Meyer More articles by this author Philipp Gild More articles by this author Nicolas von Landenberg More articles by this author David F. Friedlander More articles by this author Jairam R. Eswara More articles by this author Mani Menon More articles by this author Felix K.H. Chun More articles by this author Margit Fisch More articles by this author Maxine Sun More articles by this author Benjamin L Chung Chung More articles by this author Steven L Chang More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Impact of Minimally Invasive Benign Prostatic Hyperplasia Therapies on 30- and 90-Day Postoperative Office Encounters

To compare the frequency of postoperative encounters in the 30-day and 90-day postoperative periods for various bladder outlet obstruction surgical therapies. All patients who underwent transurethral resection of the prostate (TURP), GreenLight laser photovaporization of the prostate (GL-PVP) (American Medical Systems Inc.), and holmium laser enucleation of the prostate (HoLEP) from January 1, 2012 to December 31, 2014 were followed for 6 months postoperatively. All postoperative encounters such as patient calls or questions, catheter exchanges or removals, and hospital-based readmissions or emergency department visits were recorded in the electronic medical record. Two hundred and ninety-one consecutive patients underwent outlet procedures during the study period: TURP (N = 199; mean age, 71 years; mean body mass index [BMI], 28.5), HoLEP (N = 60; mean age, 68 years; mean BMI, 28.1), or GL-PVP (N = 32; mean age, 72 years; mean BMI, 29.3). No statistically significant difference was observed for age, BMI, preoperative American Urological Association symptom score, or preoperative maximum flow velocity between the 3 groups. Thirty-day postoperative encounters differed significantly between the 3 surgery types (P < .001). Specifically, there were fewer encounters within 30 days of surgery for TURP compared to both HoLEP (≥1 encounter: TURP = 48.7%, HoLEP = 66.7%; P = .006) and GL-PVP (≥1 encounter: TURP = 48.7%, GL-PVP = 93.7%; P < .001). The number of encounters within 90 days postoperatively was also significantly lower for TURP patients (P < .001). TURP results in fewer postoperative encounters in both the 30-day and 90-day postoperative periods compared to HoLEP and GL-PVP. Laser prostate therapies may place increased burden on clinic staff during the 30-day and 90-day postoperative periods.

Photovaporisation prostatique au laser Greenlight® : évaluation des pratiques françaises en 2015

Photovaporization of the prostate by the Greenlight(®) laser (GL) has been strongly developed this past few years in France, representing nearly 30% of surgery for BPH, making France the second GL user worldwide after USA. The objective of this study was to assess the French surgeons practices with the Greenlight(®) laser. During the 4th meeting of French Greenlight(®) users group (GUGL), was proposed a questionnaire on the management of patients and the GL technique. The questionnaire covered the operator's characteristics (age, experience with the GL, etc.), the treatment strategy, preoperative management (anticoagulants…) and postoperative management (ambulatory, removal catheter…) as well as the surgical technique (fiber type, energy used, etc.). Among the 117 participants, 64 answered to the questionnaire (55%). Fifty-six percent chose GL, whatever was the prostate volume, simple prostatectomy was the most commonly alternative used for high prostate size (39%). The aspirin was pursued by 89% of practitioners perioperatively. Conversely, clopidogrel was continued by only 19% and anticoagulant by only 14%. Seventy-three percent of participants commonly used classic vaporization and only 3% used new techniques (GreenLEP). During procedure, 72% used energy between 120W and 160W. Sixty percent used transrectal ultrasound during surgery (32% throughout the procedure). Only 16% of surgeons made ambulatory procedure and almost 33% never. Surgeons with over 3years of experience (vs.<3years) used the technique regardless of the volume in 67% vs. 23.5% (P=0.002). In France Greenlight use is still heterogeneous for the patient's management. New techniques which are currently developing (GreenLEP, vapo-enucleation) are still marginal. Ambulatory is still insufficiently used and need to be developed. The experienced surgeon led to wider indication for the technique. 3.

Laser Vaporization of the Prostate With the 180-W XPS-Greenlight Laser in Patients With Ongoing Platelet Aggregation Inhibition and Oral Anticoagulation

To characterize the safety and efficacy of the 180-W XPS-Greenlight laser in patients on systemic anticoagulation. A retrospective analysis of 384 patients who underwent photoselective vaporization of the prostate with the 180-W XPS-laser between 2010 and 2013 at two centers in the United States and Switzerland was performed. The primary outcome was the intraoperative and postoperative complication rates for those on anticoagulation undergoing photoselective vaporization of the prostate. The secondary outcome was International Prostate Symptom Scores, postvoid residual, maximum flow rate, and prostate-specific antigen levels. Of 384 patients, aspirin, clopidogrel, and warfarin were used in 146 (38%), 34 (8.9%), and 57 (14.8%) patients, respectively. Single-drug, two-drug, and three-drug combinations were used in 142 (35.5%), 37 (9.3%), and 7 (1.7%) of the cases. Median lasing time (39 min vs 36 min; P = .99) and number of fibers used (1.0 vs 1.0; P = .63) were comparable between patients on vs off systemic anticoagulation. Postoperatively, urinary symptoms (International Prostate Symptom Score, quality of life) and objective voiding parameters (maximum flow rate, postvoid residual) improved in both groups of patients. During a maximum follow-up of 2 years, patients on vs off systemic anticoagulation did not show any significant differences in the rate of postoperative urinary tract infection (3.8% vs 5.1%; P = .71), retention (5.1% vs 5.9%; P = .71), urethral stricture (1.5% vs none, P = .05), and reoperation (2.2% vs 1.5%; P = .49). The primary limitation is the retrospective nature of the study. Photovaporization of the prostate with the 180-W XPS-laser is a safe and effective minimal-invasive treatment option for patients on systemic anticoagulation.

Office Based Photovaporization of the Prostate for Benign Prostatic Hyperplasia: Outcomes and Patient Satisfaction

IntroductionWe determined the efficacy, safety and tolerability of photovaporization of the prostate in the office setting for benign prostatic hyperplasia. MethodsBetween 2009 and 2011, 139 men with moderate to severe benign prostatic hyperplasia based on I-PSS (International Prostate Symptom Score) underwent photovaporization of the prostate using a 980 nm diode laser under local anesthesia. We compared preoperative and postoperative post-void residual urine volume, maximum urine flow and I-PSS/quality of life questionnaire responses. We also evaluated postoperative complications and patient satisfaction survey responses. ResultsAn average ± SD of 782.5 ± 811.1 seconds of laser exposure at maximum power (180 W) resulted in a significant change in median post-void residual urine volume (–126 ml or –81.3%), maximum urine flow (4 ml per second or 40.0%) and I-PSS (–19 or –79.2%, each p <0.001). In men with a prostate greater than 70 ml the median change in post-void residual volume was considerably more pronounced at –232.5 ml (–97.9%, p <0.001) while changes in maximum urine flow (3.0 ml per second or 25%, p = 0.027) and I-PSS (–16.5 or –71.7%, p = 0.003) were also significant. The most common complications were vesicular neck contracture in 7% of cases and urinary retention in 6.4%. ConclusionsOffice based photovaporization of the prostate can be a safe, effective and well tolerated approach to benign prostatic hyperplasia in office settings using local anesthesia. We believe that it can become an attractive low cost treatment option for the rapidly expanding population at risk for benign prostatic hyperplasia.

MP3-09 COMPARISON OF SURGICAL OUTCOMES IN BENIGN PROSTATIC HYPERTROPHY MANAGEMENT USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I1 Apr 2015MP3-09 COMPARISON OF SURGICAL OUTCOMES IN BENIGN PROSTATIC HYPERTROPHY MANAGEMENT USING THE NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM Devin Haddad, Louis Krane, Gopal Badlani, and Majid Mirzazadeh Devin HaddadDevin Haddad More articles by this author , Louis KraneLouis Krane More articles by this author , Gopal BadlaniGopal Badlani More articles by this author , and Majid MirzazadehMajid Mirzazadeh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.112AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Increasing surgical techniques are available to provide relief of prostatic obstruction from lower urinary tract symptoms in aging gentlemen. Single institutional data concerning complication rates for rare occurrences are unlikely to be drawn out. Therefore, to compare rates of surgical complications and readmission in management of benign prostatic hyperplasia, we queried the National Surgical Quality Improvement Database (NSQIP) for perioperative adverse events following transurethral resection of the prostate (TURP), laser photo-vaporization of the prostate (PVP), and simple prostatectomy. METHODS Using the NSQIP database we identified TURP, PVP, and simple prostatectomy operations performed from 2010 to 2012 based on CPT codes 52601, 52648, and 55821, respectively. We examined multiple covariates to assess various perioperative outcomes, postoperative complications, and readmission rates. RESULTS Data were grouped by procedure: TURP (N=6653), PVP (N=3274), and simple prostatectomy (N=343) in the NSQIP database. Comparing TURP to PVP, there were no significant differences in rates of readmission, surgical site infections, pneumonia, urinary tract infection, or sepsis. However, there was a higher rate of bleeding in TURP than in PVP (2.65% vs 0.73%, p < 0.001). Comparing TURP to simple prostatectomy, there was no significant differences in rates of readmission, pneumonia, urinary tract infection, or sepsis. However, simple prostatectomy came with risk of superficial, deep, and organ surgical site infections (2.62%, 0.87%, and 0.87%, respectively). Simple prostatectomy also had a higher rate of bleeding relative to TURP (22.16% vs 2.65%, p < 0.001). Comparing PVP to simple prostatectomy, there were no significant differences in rates of readmission, pneumonia, urinary tract infection, or sepsis. However, in addition to the risk of surgical site infections, simple prostatectomy also had a higher rate of bleeding (22.16% vs 0.73%, p < 0.001). CONCLUSIONS In a review of three years of NSQIP data, TURP has a higher rate of bleeding than PVP, but there were no differences in readmission or infection rates. Simple prostatectomies had higher rates of various infections as well as bleeding. Reserving simple prostatectomy for larger sized prostates may contribute to higher bleeding rates, but prostate size is not captured in the NSQIP database and thus this possible association could not be assessed. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e22 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Devin Haddad More articles by this author Louis Krane More articles by this author Gopal Badlani More articles by this author Majid Mirzazadeh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP13-16 EVALUATION OF SAFETY, EFFICIENCY AND SURGICAL OUTCOMES BETWEEN GREENLIGHT 180W-XPS TECHNIQUES: COMPARISON OF PURE PHOTO-VAPORIZATION AND VAPOR-INCISION TECHNIQUES

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III1 Apr 2015MP13-16 EVALUATION OF SAFETY, EFFICIENCY AND SURGICAL OUTCOMES BETWEEN GREENLIGHT 180W-XPS TECHNIQUES: COMPARISON OF PURE PHOTO-VAPORIZATION AND VAPOR-INCISION TECHNIQUES Kevin C. Zorn, Ricardo R. Gonzalez, Greg R. Eure, Lewis S. Kriteman, Pierre-Alain Hueber, Abdullah Alenizi, Marc Bienz, Khaled ElHosni, Malek Meskawi, and Mahmood A. Hai Kevin C. ZornKevin C. Zorn More articles by this author , Ricardo R. GonzalezRicardo R. Gonzalez More articles by this author , Greg R. EureGreg R. Eure More articles by this author , Lewis S. KritemanLewis S. Kriteman More articles by this author , Pierre-Alain HueberPierre-Alain Hueber More articles by this author , Abdullah AleniziAbdullah Alenizi More articles by this author , Marc BienzMarc Bienz More articles by this author , Khaled ElHosniKhaled ElHosni More articles by this author , Malek MeskawiMalek Meskawi More articles by this author , and Mahmood A. HaiMahmood A. Hai More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.356AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent improvements in GreenLight 180W-XPS offer enhanced tissue vaporization and fibre durability. Aside from pure photo-vaporization of the prostate(PVP), various vapour-resection techniques have been described to help improve tissue resection, including vapour-incision techniques (VIT). We sought to evaluate the efficiency, safety and outcome parameters between GreenLight PVP and VIT. METHODS Data of 955 XPS cases were retrospectively collected from 5 experienced surgeons at high-volume GreenLight XPS centers. Preoperative, operative and post-operative parameters were collected and compared between groups. PVP was defined as pure vaporization only while VIT included techniques to incise into adenoma and allow tissue resection and removal. RESULTS As summarized in table1, men undergoing VIT(n=283) had larger prostate size, higher IPSS/QOL and retention preoperatively than those undergoing PVP(n=672). While VIT allowed greater delivery of energy (4.9vs3.5 kJ/g), operative time was longer and had greater need for >2fibres. There were no differences in intra- and post-operative adverse events. While no differences were observed in IPSS/QOL at 6 months post-operatively, more favorable QMax and PVR were observed at 6months, along with greater PSA reduction, in the VIT group. CONCLUSIONS Both Greenlight PVP and VIT techniques can be safely used to treat men with BPH. Both offer significant and durable relief of symptom relief with comparable complication rates. Vapor-resection techniques suggest larger adenoma resection, however long-term data is required to assess if it correlates to greater treatment durability. PVP (n=672) VIT (n=283) p-value Preoperative Patient Characteristics Mean Age (yrs) 66.8 68.1 0.243 Previous BPH Surgery (%) 22.3% 18.3% 0.162 Anticoagulation (%) 7.7% 6.4% 0.485 Mean IPSS 18.5 22.2 <0.001 Mean QOL 3.7 4.3 <0.001 Mean Qmax (mL/s) 9.2 7.3 <0.001 Mean PVR (mL) 183 251 0.001 Mean PSA (ng/mL) 4.3 5.8 <0.001 Mean Prostate Volume (g) 73.3 83.4 <0.001 Urinary Retention (%) 18.0% 31.7% <0.001 Operative Outcomes ASA> 2 (%) 26.4% 32.1% 0.026 Mean Operative Time (min) 49.4 74.3 <0.001 Mean Laser Time (min) 30.1 40.4 <0.001 Mean Energy (kJ) 241.5 355.9 <0.001 Mean kJ/Prostate Volume g (kJ/g) 3.5 4.9 <0.001 # Fibres Used (%) 1 95.5% 82.3% <0.001 2+ 4.5% 17.7% Mean Length of Stay (days) 1.2 1.4 <0.001 Mean Foley Duration (days) 1.3 1.2 0.005 Adverse Outcomes Intraoperative Bleeding (%) 0.4% 0% 0.559 Postoperative Bleeding/Clot Retention (%) 0.9% 1.8% 0.320 Urinary Retention (%) 5.4% 4.6% 0.749 Incontinence, de novo (%) Stress 1.6% 0.7% 0.365 Urge 1.9% 1.4% 0.790 Bladder Neck Stricture (%) 1.5% 1.1% 0.765 6 Months Outcomes Mean IPSS 6.1 5.5 0.266 Mean QOL 1.3 1.0 0.513 Mean Qmax (mL/s) 17.6 19.8 <0.001 Mean PVR (mL) 48.9 37.8 0.006 Mean PSA Drop (ng/mL) -1.8 -2.6 0.001 PSA Percent Reduction (%) 33.2% 44.3% 0.112 Surgical Retreatment Total (n, (%)) 24 (3.6%) 8 (2.8%) 0.695 BPH Regrowth / Obstruction 10 (1.5%) 1 (0.4%) 0.130 Stricture (BN/Urethra) 11 (1.6%) 5 (1.8%) 0.890 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e142-e143 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin C. Zorn More articles by this author Ricardo R. Gonzalez More articles by this author Greg R. Eure More articles by this author Lewis S. Kriteman More articles by this author Pierre-Alain Hueber More articles by this author Abdullah Alenizi More articles by this author Marc Bienz More articles by this author Khaled ElHosni More articles by this author Malek Meskawi More articles by this author Mahmood A. Hai More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

127 PROPIL's study, early outcomes at 1 month: Evolution of the penetration depth by enhanced contrast ultrasonography after photovaporization of the prostate by the GREENLIGHT laser XPS®

127 PROPIL's study, early outcomes at 1 month: Evolution of the penetration depth by enhanced contrast ultrasonography after photovaporization of the prostate by the GREENLIGHT laser XPS®

MP71-19 LOSS OF POWER OUTPUT IS FREQUENTLY DETECTABLE DURING LASER VAPORIZATION OF THE PROSTATE USING THE 180-WATT 532 NM LASER IN COMBINATION WITH MOXYTM LASER FIBERS

INTRODUCTION AND OBJECTIVES: The objective was to measure the penetration depth after PhotoVaporization of the Prostate (PVP) by Enhanced Contrat UltraSonography (ECUS). METHODS: It is a forward-looking study about twelve patients operated by a PVP performed by the GREENLIGHT XPS laser. Ethical committee gave its aproval (EUDRACT N : 2012-001451-39). ECUS was performed (B-mode then contrast mode after injection of 2,4mL of suphur hexafluoride micro bubbles) preoperatively and immediately after the PVP and at 1 month. With ultrasound were measured: width, prostatic volume and diameter of the cavity of vaporization (DC) with the B-mode; then in contrast mode MicroFlow Imaging (MFI): the prostatic width and the NonVascularized cavity diameter (DD). The necrotic depth was measured using the formula: NC 1⁄4 (DD-DC)/2) (Figure 1). RESULTS: The characteristics of the patients were : a median age of 70 years old [57-81], median prostatic volume of 65 cc [40-110], median maximal urinary flow of 7,2 mL/s [2, 9-15,2], median post mictional residual volume of 90 cc [0-213], median IPSS score of 19 [8-24] and a median PSA rate of 4 ng/mL [1,6-7,9]. The results found with ultrasound performed pre and post operatively are summarized in table 1. All the patients had their bladder catheter removed and then discharged the hospital at day 1, except one patient who had an acute retention treated at day 8 by an indwelling catheter. CONCLUSIONS: The use of ECUS showed an unexpected necrotic depth up to 16,5 mm in the immediate post-operative ultrasound. This necrotic depth persisted at 1 month and was measured up to 13 mm. At one month we measured a 26% decrease of the prostatic volume and a 23% of the necrotic depth. These results are to be considered to performe securely PVP without any rectal complication. The continuing follow-up at 6 and 12 months will probably precize the necrotic depth evolution and the potential correlation with the occurrence of irritative voiding dysfunction. Table 1 : Ultrasonography results