Laser Photoselective Vaporization Prostatectomy Research Articles

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

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

Effect of Photoselective Vaporization Prostatectomy on Lower Urinary Tract Symptoms in Benign Prostatic Hyperplasia With or Without Intravesical Prostatic Protrusion

PurposeIntravesical protrusion of the prostate (IPP) can affect voiding. We evaluated the improvement in lower urinary tract symptoms and patient satisfaction after laser prostate photovaporization in benign prostatic hyperplasia (BPH) patients with or without IPP.Materials and MethodsThis prospective study included 134 patients who underwent GreenLight HPS laser photoselective vaporization prostatectomy (PVP) between January 2010 and July 2011 patient. Preoperative IPP was evaluated by using the retroflexed view from flexible cystoscopy. evaluation included complete medical history, International Prostate Symptom Scores (IPSS), maximum flow rate (Qmax), postvoid residual (PVR), serum prostate-specific antigen (PSA), and transrectal ultrasonogram. Changes from baseline in Qmax, PVR, total IPSS, and IPSS subscores (voiding and storage) were analyzed at postoperative months 1, 3, and 6.ResultsThe patients' mean age was 66.6±7.8 years. Mean serum PSA and prostate volume were 1.7±1.5 ng/mL and 42.9±16.7 g, respectively. No significant differences existed between the IPP and no IPP groups in preoperative prostate volume, total IPSS, PSA, or lasing time and energy. The mean follow-up duration was 6.2±1.9 months. IPP patients showed significant improvements in total IPSS and voiding subscores at months 1 and 3. Improvements in the quality of life score and storage subscore were not significantly different between the groups. Qmax was significantly improved at 6 months postoperatively in the IPP group versus the no IPP group.ConclusionsAmong patients who underwent PVP for BPH, the IPP group showed more symptom improvement, especially in voiding symptoms, than did the no IPP group. Preoperative cystoscopy is helpful for evaluating IPP and for anticipating postoperative outcome.

Risk Factors for Failure of Early Catheter Removal After Greenlight HPS Laser Photoselective Vaporization Prostatectomy in Men With Benign Prostatic Hyperplasia

PurposeTo assess the risk factors for developing urinary retention after removal of the urethral catheter on postoperative day 1 in benign prostatic hyperplasia patients who underwent Greenlight HPS laser photoselective vaporization prostatectomy (PVP).Materials and MethodsThe study included 427 men who underwent Greenlight HPS laser PVP between 2009 and 2012, excluding patients in whom a catheter was maintained for more than 1 day because of urethral procedures. In all patients, a voiding trial was performed on postoperative day 1; if patients were unable to urinate, the urethral catheter was replaced before hospital discharge. The patients were divided into two groups: early catheter removal (postoperative day 1) and late catheter removal (urethral catheter reinsertion). Preoperative and perioperative parameters were compared between the groups.ResultsCatheters were successfully removed in 378 (88.6%) patients on postoperative day 1. In 49 patients, the catheters were reinserted and removed a mean of 6.45±0.39 days after surgery. In a multivariate analysis, a history of diabetes was the most significant predictor (p=0.028) of failure of early catheter removal, followed by operative time (p=0.039). There were no significant differences in age, prostate volume, International Prostate Symptom Score, or urodynamic parameters between the two groups.ConclusionsIt is feasible, safe, and cost-effective to remove the urethral catheter on postoperative day 1 after Greenlight HPS laser PVP, but the procedure should be done carefully in patients who have history of diabetes or an extended operative time.

2168 EFFECT OF PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE ON THE LOWER URINARY TRACT SYMPTOMS AND PATIENT'S SATISFACTION IN BENIGN PROSTATIC HYPERPLASIA PATIENTS WITH/WITHOUT INTRAVESICAL PROTRUSION OF PROSTATE USING FLEXIBLE CYSTOSCOPY: PROSPECTIVE, CASE-CONTROLLED STUDY

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology III1 Apr 20122168 EFFECT OF PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE ON THE LOWER URINARY TRACT SYMPTOMS AND PATIENT'S SATISFACTION IN BENIGN PROSTATIC HYPERPLASIA PATIENTS WITH/WITHOUT INTRAVESICAL PROTRUSION OF PROSTATE USING FLEXIBLE CYSTOSCOPY: PROSPECTIVE, CASE-CONTROLLED STUDY Seung Hwan Lee, Dong Hoon Lee, Kyung Kgi Park, Mun Su Chung, Byung Ha Chung, and Joong Shik Lee Seung Hwan LeeSeung Hwan Lee Seoul, Korea, Republic of More articles by this author , Dong Hoon LeeDong Hoon Lee Seoul, Korea, Republic of More articles by this author , Kyung Kgi ParkKyung Kgi Park Seoul, Korea, Republic of More articles by this author , Mun Su ChungMun Su Chung Seoul, Korea, Republic of More articles by this author , Byung Ha ChungByung Ha Chung Seoul, Korea, Republic of More articles by this author , and Joong Shik LeeJoong Shik Lee Seoul, Korea, Republic of More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2341AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The anatomical configuration of the prostate, in particular the extent of intravesical protrusion of the prostate (IPP) could affect voiding symptoms. We aimed to evaluate the symptom improvement of lower urinary tract symptoms (LUTS) and patent¡s satisfaction in benign prostatic hyperplasia (BPH) patents with or without IPP. METHODS This prospective study included 134 patients who underwent GreenLight HPSTM laser photoselective vaporization prostatectomy (PVP) between January 2010 and July 2011. Preoperative measurement for IPP was evaluated using retroflexed view by flexible cystoscopy. Each patient evaluation also included complete medical history, International Prostatic Symptom Scores (IPSS), maximum flow rate (Qmax), postvoid residual (PVR), prostatic specific antigen (PSA) and transrectal ultrasonogram. The changes from baseline in Qmax, PVR, total IPSS and IPSS sub-score (voiding & storage) were analyzed during postoperative 1, 3 and 6 months. RESULTS The overall mean age was 68.3 ±8.4 years. The mean total IPSS and prostate volume was 2.02±0.93ng/ml and 36.2±14.5gm, respectively. There were no significant differences not only in preoperative data such as prostate volume, total IPSS and PSA but also in lasing time and lasing energy between IPP and no IPP group. Mean follow up duration was 6.2„b±1.9 months. IPP group showed significant improvements in total IPSS and voiding sub-scores at 1 and 3 months. However, improvement of the QOL score and storage sub-scores was not different between 2 groups. Qmax and PVR significantly improved in IPP group at postoperative 6 months (+7.7 ml/sec) compared with no IPP group (+6.1 ml/sec). No major complication occurred. CONCLUSIONS PVP showed more symptom improvement especially in voiding symptom of IPP patients rather than no IPP patients. Preoperative cystoscopy would be helpful for evaluating IPP and anticipating the postoperative outcome. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e874-e875 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seung Hwan Lee Seoul, Korea, Republic of More articles by this author Dong Hoon Lee Seoul, Korea, Republic of More articles by this author Kyung Kgi Park Seoul, Korea, Republic of More articles by this author Mun Su Chung Seoul, Korea, Republic of More articles by this author Byung Ha Chung Seoul, Korea, Republic of More articles by this author Joong Shik Lee Seoul, Korea, Republic of More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Does prostate configuration affect the efficacy and safety of GreenLight HPS™ laser photoselective vaporization prostatectomy (PVP)?

We evaluate the efficacy and safety of GreenLight HPS™ laser photoselective vaporization prostatectomy (PVP) for the treatment of benign prostatic hyperplasia (BPH) with different prostate configuration. Patients were stratified into two groups: bilobe (group I) and trilobe (group II) BPH. Transurethral PVP was performed using a 120W GreenLight HPS™ side-firing laser system. American Urological Association Symptom Score (AUASS), Quality of Life (QoL) score, maximum flow rate (Q max), and postvoid residual (PVR) were measured preoperatively and at 1 and 4weeks and 3, 6, 12, 18, 24 and 36months postoperatively. A number of 160 consecutive patients were identified (I: 86, II: 74). Among the preoperative parameters, there were significant differences (p < 0.05) in prostate volume (I: 46.0 ± 19.8; II: 87.5 ± 39.6ml), Q max (I: 9.9 ± 3.9; II: 8.7 ± 3.5ml/sec), PVR (I: 59.2 ± 124.6; II: 97.7 ± 119.1ml) and PSA (I: 1.4 ± 1.4; II: 3.6 ± 2.6ng/ml), while AUASS and QoL were similar (p > 0.05). Significant differences (p < 0.05) in laser utilization (I: 9.5 ± 6.6; II: 19.5 ± 11.6min) and energy usage (I: 63.1 ± 43.9; II: 132.5 ± 81.1kJ) were noted. Clinical outcomes (AUASS, QoL, Q max, and PVR) showed immediate and stable improvement from baseline (p < 0.05) within each group, but no significant differences between the two groups were observed during the follow-up period (p > 0.05). The incidences of adverse events were low and similar in both groups. Our experience suggests that BPH configuration has little effect on the efficacy and safety of GreenLight HPS™ laser PVP.

Can 80 W KTP Laser Vaporization Effectively Relieve the Obstruction in Benign Prostatic Hyperplasia?: A Nonrandomized Trial

PurposeThere is little data evaluating the changes of severity of bladder outlet obstruction after 80 W-potassium-titanyl-phosphate (KTP) photoselective laser vaporization prostatectomy (PVP) by pressure-flow study. We evaluated the efficacy of PVP to relieve the obstruction in benign prostate hyperplasia (BPH) compared with transurethral resection of the prostate (TURP).Materials and MethodsThis is a prospective, non-randomized single center study. The inclusion criteria were as follows: Men suffering from lower urinary tract symptoms (LUTS) secondary to BPH, age ≥50 years, International Prostatic Symptom Score (IPSS) ≥13, maximum flow rate (Qmax) ≤15 ml/s, and ability to give fully informed consent. Patients with neurogenic cause or detrusor underactivity were excluded. The IPSS, bother score, Qmax, postvoid residual volume (PVR), detrusor pressure at maximum flow rate (PdetQmax), bladder outlet obstruction index (BOOI), and prostate volume were measured before and 6 months after surgery and compared between PVP and TURP.ResultsSixty-seven patients (53 in PVP, 14 in TURP) were evaluable. In both groups, the IPSS, bother score, Qmax, and PVR had significantly improved (p<0.05), and there were no differences between the changes in those parameters. PVP could effectively reduce the PdetQmax, prostate volume, and BOOI from baseline (from 68.7±23.3 to 40.6±11.2 cmH2O, 49.5±16.3 to 31.3±12.1 ml, 49.8±25.6 to 9.8±20.7), similar to TURP. There were no differences in postoperative PdetQmax, prostate volume, or BOOI between the two groups. The percentage of patients with BOOI ≥40 was decreased from 64% to 4% in the PVP group and from 86% to 14% in the TURP group.ConclusionsPVP could reduce the prostate volume effectively and relieve bladder outlet obstruction similar to TURP by the 6-month follow up in men with BPH.

Does age affect the efficacy and safety of GreenLight HPS™ laser photoselective vaporization prostatectomy?

Background: To evaluate the efficacy and safety of GreenLight HPS™ (High Performance System) laser photoselective vaporization prostatectomy (PVP) for the treatment of benign prostatic hyperplasia (BPH) in patients of different age groups. Methods: 164 consecutive patients were stratified into two groups: age <70 (group I, n = 93) and age ≥70 (group II, n = 71) years. Transurethral PVP was performed using a GreenLight HPS™ side-firing laser system. Voiding parameters were measured preoperatively and at 1 and 4 weeks and 3, 6, 12, 18, 24 and 36 months postoperatively. Results: Among the preoperative parameters evaluated, there were significant differences (p < 0.05) in prostate volume (I: 58.7; II: 73.6 mL) and serum prostate-specific antigen (I: 1.9; II: 2.9 ng/mL), while American Urological Association Symptom Score (AUASS), Quality of Life (QoL), maximum flow rate (Qmax), Sexual Health Inventory for Men (SHIM) and post void residual (PVR) were similar (p > 0.05) between groups. No significant differences in laser utilization, energy usage and operating time were noted. Clinical outcomes (AUASS, QoL, Qmax, PVR) showed immediate and stable improvement from baseline (p < 0.05) within each group, but no significant differences between the two groups were observed during the follow-up period. The incidence of adverse events was low and similar in both groups. Conclusions: The results suggest that age has little effect on the efficacy and safety of GreenLight HPS™ laser PVP.

Intermediate Outcomes of GreenLight HPS™ Laser Photoselective Vaporization Prostatectomy for Symptomatic Benign Prostatic Hyperplasia

GreenLight HPS™ laser photoselective vaporization prostatectomy (PVP) is a treatment option for lower urinary tract symptoms secondary to benign prostatic hyperplasia. We review our experience using the 120 W GreenLight HPS laser system. We prospectively evaluated our experience with GreenLight HPS laser PVP. All patients who failed medical therapy underwent GreenLight HPS laser PVP (C.W.). All had American Urological Association Symptom Score, Quality of Life score, Sexual Health Inventory for Men, American Society of Anesthesiologists risk score, serum prostate-specific antigen, maximum flow rate, and postvoid residual determinations and volumetric measurements with transrectal ultrasonography. Transurethral PVP was performed using a GreenLight HPS side-firing laser system. 170 consecutive patients were identified, having a mean age of 67.4±9.5 years. The mean prostate volume was 65.3±36.7 mL and mean American Society of Anesthesiologists score was 2.3±0.7. Mean laser time, operating time, and energy usage were 14.1±10.5 minutes, 33.5±24.7 minutes, and 95.0±72.3 kJ, respectively. All were outpatient procedures with 100 (58.8%) patients catheter-free at discharge. 35 (20.5%) and 26 (15.3%) patients had follow-up of 24 and 36 months, respectively. Eight (4.7%) patients developed a urinary tract infection. No bladder neck contracture or urethral stricture were reported. American Urological Association Symptom Score, Quality of Life, maximum flow rate, and postvoid residual showed immediate and stable improvement from baseline (p<0.05) that has been durable to 36 months. The Sexual Health Inventory for Men score did not change postoperatively. Our intermediate results suggest that GreenLight HPS laser PVP is safe, effective, and durable for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia.

The Effects of 5α-Reductase Inhibition on Benign Prostatic Hyperplasia Treated by Photoselective Vaporization Prostatectomy with the 120 Watt GreenLight HPS Laser System

We sought to determine whether the efficacy and efficiency of 120W GreenLight HPS (American Medical Systems, Inc) laser photoselective vaporization prostatectomy (PVP) is compromised in patients on chronic 5α-reductase inhibitor (RI) therapy. Our GreenLight HPS laser PVP experience in patients with and without long-term 5αRI was evaluated. American Urological Association Symptom Score (AUASS), quality of life (QoL) score, maximum urinary flow rate (Qmax), and postvoid residual (PVR) were measured preoperatively and at 1 and 4 weeks and at 3, 6, 12, 18, and 24 months postsurgery. PSA values and transrectal ultrasonography (TRUS) prostate volumes were determined preoperatively and at 3 months postsurgery. Fifty-seven patients were on either dutasteride or finasteride (5αRI+) and 124 were not (5αRI-). Mean prostate volumes were 67.1 ± 35.3 mL and 69.2 ± 41.9 mL (p = 0.646) and mean PSA values were 2.2 ± 2.4 ng/mL and 2.7 ± 2.6 ng/ml (p = 0.289), respectively. There were no significant differences in the parameters of laser use (13.6 ± 9.2 minutes and 13.4 ± 10.4 minutes, p = 0.965) and energy usage (87.1 ± 62.4 kJ and 91.8 ± 69.6 kJ, p = 0.623). The majority of patients were catheter-free at discharge for this wholly outpatient procedure. AUASS, QoL, and Qmax values showed significant improvement within each group (p < 0.05). Compared with baseline, PVR values improved in both groups but did not decrease significantly in 5αRI+ (p > 0.05). There was no significant difference in the degree of improvement between the 2 groups in all parameters (AUASS, QoL, Qmax, PVR, PSA, and TRUS volume). The efficacy and efficiency of PVP with the GreenLight HPS laser are not negatively affected in patients on chronic 5αRI therapy.

Photoselective Vaporization Prostatectomy: Experience With a Novel 180 W 532 nm Lithium Triborate Laser and Fiber Delivery System in Living Dogs

We studied vaporization parameters, and anatomical and histopathological outcomes of photoselective vaporization of the prostate with the novel GreenLight™ XPS™ 180 W, 532 nm lithium triborate laser and MoXy™ fiber in a survival model of living dogs. We compared these findings with those of the existing GreenLight HPS™ 120 W 532 nm lithium triborate laser photoselective vaporization of the prostate in living dogs. Eight dogs underwent antegrade photoselective vaporization of the prostate with the 180 W laser delivered through a new 750 μm (vs the existing 600 μm core diameter), 50% larger, spot sized, side firing fiber. Four dogs were sacrificed 3 hours and 8 weeks postoperatively, respectively. We recorded laser energy and time. Prostates were sectioned, measured and histologically analyzed after hematoxylin and eosin, triphenyltetrazolium chloride or Gomori trichrome staining and compared with a normal control. Photoselective vaporization of the prostate with the 180 W laser bloodlessly created a 76% larger cavity (mean 11.8 vs 6.7 cm(3), p = 0.014), vaporized tissue at a 77% higher rate (mean 2.3 vs 1.3 cm(3) per minute, p = 0.03) and did so in 37% less time per volume vaporized (0.5 vs 0.8 minutes per cm(3), p = 0.003). Hematoxylin and eosin, and triphenyltetrazolium chloride staining histologically revealed a 33% thicker mean coagulation zone vs that of 120 W laser photoselective vaporization of the prostate (2.0 ± 0.4 vs 1.5 ± 0.3 mm, p <0.005). In prostates healed for 8 weeks postoperatively hematoxylin and eosin, and Gomori trichrome staining showed re-epithelialized cavities with negligible submucosal fibrosis compared with a normal prostate. GreenLight XPS 180 W 532 nm lithium triborate laser photoselective vaporization of the prostate with the MoXy fiber has a significantly higher vaporization rate and speed with a deeper hemostatic coagulation zone but favorable tissue interaction and healing equal to those of HPS 120 W laser photoselective vaporization of the prostate in dogs.

Does Greenlight HPS™ Laser Photoselective Vaporization Prostatectomy Affect Sexual Function?

We evaluate the impact of GreenLight High-Performance System (HPS™) laser photoselective vaporization prostatectomy (PVP) on sexual function after treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). We prospectively evaluated our initial single surgeon experience with GreenLight HPS™ laser PVP. All patients had American Urological Association Symptom Score (AUASS), Sexual Health Inventory for Men (SHIM), maximum flow rate (Qmax), and postvoid residual (PVR) determinations. Transurethral PVP was performed using a 120W GreenLight HPS™ side-firing laser system. AUASS, SHIM, Qmax, and PVR were evaluated 1, 4, 12, 24, and 52 weeks postsurgery. Wilcoxon signed rank test and the Student t-test were used to assess the changes from baseline. Seventy-two patients completed 52 weeks of follow-up, having a median age of 69 (45-89) years. The median prostate volume was 62 (21-263) mL. Median AUASS improved significantly from 23 to 8, 6, 5, 5, and 4 (P < 0.05) at 1, 4, 12, 24, and 52 weeks, respectively. Median SHIM changed from 15 to 12, 16, 19, 16, and 17 during the follow-up period (P = 0.032, 0.427, 0.074, 0.081, and 0.259). Minimum change (0 ± 5) in SHIM occurred in 85.5%, 90.5%, 78.8%, 77.5%, and 73.7% of patients; 11.3%, 6.3%, 6.0%, 4.8%, and 7.0% of patients had deterioration of erectile function (SHIM reduction >5); and 3.2%, 3.2%, 15.2%, 17.7%, and 19.3% of patients had improvement of erectile function (SHIM increase >5). Incidence of new-onset retrograde ejaculation was 30%. GreenLight HPS™ laser PVP appears to not have a detrimental effect on erectile function.

Does prostate configuration affect the efficacy and safety of GreenLight HPS (tm) Laser photoselective vaporization prostatectomy (PVP)?

Does prostate configuration affect the efficacy and safety of GreenLight HPS (tm) Laser photoselective vaporization prostatectomy (PVP)?

Clinical outcomes of secondary or tertiary treatment of benign prostatic hyperplasia (BPH) with GreenLight HPS(tm) laser photoselective vaporization prostatectomy

Clinical outcomes of secondary or tertiary treatment of benign prostatic hyperplasia (BPH) with GreenLight HPS(tm) laser photoselective vaporization prostatectomy

Photoselective vaporization of the prostate in men with a history of chronic oral anti-coagulation

A considerable percentage of patients with benign prostatic hyperplasia (BPH) also have additional cardiac pathologies, which often require anticoagulant therapy. The aim of this study was to evaluate the efficacy and safety of photoselective vaporization of the prostate (PVP) for BPH in cardiac patients receiving anticoagulant therapy. A total of 67 patients suffering from BPH and high risk cardiac pathologies were operated on using laser prostatectomy. All patients had cardiac pathologies with bleeding disorders requiring anticoagulant use, and underwent standard urologic evaluation for BPH. Patients were treated with laser prostatectomy for relief of the obstruction using the KTP/532 laser energy at 80 W. The mean patient age was 71.4 years (range 55-80). Mean prostate volume on transrectal ultrasonography was 73.2 mL (range 44-120). Operation time ranged from 40 to 90 min, with an average value of 55 min. The average hospital stay was 48 hours (range 12-72) and the Foley catheters were removed within 48 hours, with a mean catheterization time of 34.2 +/- 5.9 hours (0-48). No patient required an additional procedure due to severe bleeding necessitating intervention during the early postoperative phase. Mean International symptoms scoring system (IPSS) values and post voiding residual volume decreased and peak urinary flow rate increased (p < 0.001). Our results showed that the mean prostate volume had decreased by 53% at 6 months. High-power photo selective laser vaporization prostatectomy is a feasible, safe, and effective alternative for the minimal invasive management of BPH, particularly in cardiac patients receiving anticoagulant therapy.

High-Power Potassium-Titanyl-Phosphate or GreenLight HPSTM Laser Photoselective Vaporization Prostatectomy: A Systematic Approach

Background and Purpose: Care must be taken to avoid adverse events when using a high-power laser system for the treatment of benign prostatic hyperplasia. We describe a systematic, safe, effective, and reproducible technique for potassium-titanyl-phosphate (KTP) and GreenLight HPSTM laser photoselective vaporization prostatectomy (PVP). Technique: With the patient under anesthesia in the dorsal lithotomy position, cystoscopy is performed. Using a high-power KTP/GreenLight HPSTM laser system, a groove is created along the lateral–median lobe junction from the bladder neck to the verumontanum to delineate the margins of vaporization. The remainder of the ipsilateral lobe is vaporized using a series of overlapping passes along the length of the groove. The contralateral lobe is vaporized in a similar manner. Finally, the median lobe is vaporized from lateral to medial. A 20F urethral catheter is placed at the conclusion of the procedure. Results: This technique has been successful in over 500 consecutive patients. Conclusion: This systematic approach has been safe, effective, and reproducible for KTP/LBO laser PVP. It has become our standard technique for this procedure. The author is a consultant for American Medical Systems, Inc. Runtime of video: 6 min 59 sec

Photoselective Laser Vaporization Prostatectomy Versus Transurethral Prostate Resection: A Cost Analysis

Laser procedures to treat symptomatic benign prostatic hyperplasia are becoming more common despite concern for potentially increasing cost burdens often associated with new technologies. Actual costs associated with photoselective laser vaporization prostatectomy and transurethral prostate resection were measured using the EPSi and TSI (Eclipsys) hospital cost accounting systems at 2 large tertiary referral centers for the first 12 months that GreenLight HPS was performed. Only patients who presented for photoselective laser vaporization prostatectomy or transurethral prostate resection as the principal treatment during the hospital visit were included in study. A total of 250 men underwent transurethral prostate resection and 220 underwent photoselective laser vaporization prostatectomy, including 194 (78%) and 209 (95%), respectively, treated on an outpatient basis with less than 23 hours of hospitalization. Overall costs of laser vaporization were lower than those of transurethral prostate resection ($4,266 +/- $1,182 vs $5,097 +/- $5,003, p = 0.01). Average inpatient length of stay was also longer in the resection group. The actual costs of photoselective laser vaporization prostatectomy at our affiliated hospitals are lower than those of transurethral prostate resection. The primary reason is likely that most patients who undergo laser vaporization are treated on an outpatient basis compared to those who undergo resection. While significant complications are uncommon, those that prolong inpatient hospitalization such as hyponatremia (transurethral resection syndrome), which is associated with transurethral prostate resection but not with photoselective laser vaporization prostatectomy, can add substantial expense. Further studies are warranted to investigate these findings on a broader scale.

Photoselective Vaporization Prostatectomy with 120 W Greenlight HPS on Bleeding Tendency Patients—Vaporization Incision Technique

Abstract Objectives: Photoselective laser vaporization prostatectomy (PVP) is a hemostatic procedure for men with benign prostatic hyperplasia. The study demonstrates that the modified vaporization...

POD-10.10: Decreased Efficiency of GreenLight HPS™ Laser Photoselective Vaporization Prostatectomy (PVP) with Long-Term 5α-Reductase Inhibition Therapy: Is It True?

POD-10.10: Decreased Efficiency of GreenLight HPS™ Laser Photoselective Vaporization Prostatectomy (PVP) with Long-Term 5α-Reductase Inhibition Therapy: Is It True?

MP-06.12: Clinical Outcomes of GreenLight HPS™ Laser Photoselective Vaporization Prostatectomy (PVP) for Benign Prostatic Hyperplasia (BPH)

MP-06.12: Clinical Outcomes of GreenLight HPS™ Laser Photoselective Vaporization Prostatectomy (PVP) for Benign Prostatic Hyperplasia (BPH)

UP-3.063: Greenlight HPS™ Laser Photoselective Vaporization Prostatectomy (PVP) for Failed Prior Surgical Treatment of Benign Prostatic Hyperplasia (BPH)

UP-3.063: Greenlight HPS™ Laser Photoselective Vaporization Prostatectomy (PVP) for Failed Prior Surgical Treatment of Benign Prostatic Hyperplasia (BPH)