Photoselective Vaporization Of The Prostate Research Articles

Simulation training in transurethral resection/laser vaporization of the prostate; evidence from a systematic review by the European Section of Uro-Technology.

Transurethral resection (TURP) and photoselective vaporization of the prostate (PVP) constitute established surgical options to treat benign prostate hyperplasia. We investigated the current literature for simulators that could be used as a tool for teaching urologists alone or within the boundaries of a course or a curriculum. A literature search was performed using PubMed, Scopus, EMBASE, and Cochrane Central Register of Controlled Trials-CENTRAL. Search terms included: Simulat*, train*, curricull*, transurethral, TUR*, vaporesect*, laser. The efficacy of different simulators and the impact of different devices, curricula and courses in training and trainee learning curves were the primary endpoints. Thirty-onestudies are selected and presented. Validated virtual reality TURP simulators are the UW VR, PelvicVision, Uro-Trainer, and TURPsim™. Validated synthetic TURP models are Dr. K. Forke's TURP trainer, Bristol TURP trainer, different tissue prostate models, and 3D-printed phantoms. The Myo Sim PVP and the GreenLightTM are sufficiently validated PVP simulators. Several TURP and PVP training curricula have been developed and judged as applicable. Finally, the TURP modules of the European Urology Residents Education Programme (EUREP) Hands-on Training course and the Urology Simulation Bootcamp Course (USBC) are the most basic annual TURP courses identified in the international literature. Simulators and courses or curricula are valuable learning and training TURP/PVP tools. The existent models seem efficient, are not always adequately evaluated and accepted. As part of training curricula and training courses, the use of training simulators can significantly improve quality for young urologists' education and clinical practice.

MRI Evaluation of Patients Before and After Interventions for Benign Prostatic Hyperplasia: An Update.

Transurethral resection of the prostate is the most commonly performed procedure for the management of patients with lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH). However, in recent years, various minimally invasive surgical therapies have been introduced to treat BPH. These include laser-based procedures such as holmium laser enucleation of the prostate and photoselective vaporization of the prostate as well as thermal ablation procedures such as water vapor thermal therapy (Rezūm), all of which result in volume reduction of periurethral prostatic tissue. In comparison, a permanent metallic device (UroLift) can be implanted to pull open the prostatic urethra without an associated decrease in prostate size, and selective catheter-directed prostate artery embolization results in a global decrease in prostate size. The goal of this article is to familiarize radiologists with the underlying anatomic changes that occur in BPH as visualized on MRI and to describe the appearance of the prostate on MRI performed after these procedures. Complications encountered on imaging after these procedures are also discussed. Although MRI is not currently used in the routine preprocedural evaluation of BPH, emerging data support a role for MRI in predicting postprocedure outcomes.

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

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

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

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

PD18-02 LONG-TERM RATES OF TREATMENT FAILURE FOR AMBULATORY TURP AND PVP: AN ASSESSMENT USING STATE-LEVEL CLAIMS DATA

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III (PD18)1 Sep 2021PD18-02 LONG-TERM RATES OF TREATMENT FAILURE FOR AMBULATORY TURP AND PVP: AN ASSESSMENT USING STATE-LEVEL CLAIMS DATA Wesley Chou, Daniel Frendl, Ya-Wen Chen, David Chang, and Michelle Kim Wesley ChouWesley Chou More articles by this author , Daniel FrendlDaniel Frendl More articles by this author , Ya-Wen ChenYa-Wen Chen More articles by this author , David ChangDavid Chang More articles by this author , and Michelle KimMichelle Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002007.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While photoselective vaporization of the prostate (PVP) has become one of the most common ambulatory procedures for BPH, its long-term durability compared to transurethral resection of the prostate (TURP) is not well established. Existing studies often group together heterogenous procedural codes in inpatient and outpatient settings or occur in regions with low PVP uptake. We evaluate state-level outcomes up to 10 years after PVP or TURP, specifically in the ambulatory setting. METHODS: Using the New York Statewide Planning and Research Cooperative System database, we identified men ≥40 years old who underwent index ambulatory BPH procedure, specifically PVP (Common Procedural Terminology [CPT] 52648) or single-stage TURP (CPT 52601) from 2002-2016. The primary endpoint of interest was a composite outcome defined as reoperation or postoperative catheterization for urinary retention ≥60 days from index operation. Kaplan-Meier estimates and multivariate Fine-Gray competing risk models were performed to 10 years, with death as the competing risk. RESULTS: We identified 19,624 men in our cohort with a median age of 69 years (interquartile range [IQR]: 62-76) and a median follow-up of 3.9 years (IQR: 1.9-6.7). PVP was more common than TURP (69% vs. 31%, respectively). At 10 years, unadjusted cumulative rates of composite failure were respectively 21% and 20% for PVP and TURP (p=0.86). Kaplan-Meier estimates found no differences in composite failure (log-rank: p=0.62, Fig. 1). Competing risk models did not show increased hazards of treatment failure for PVP vs. TURP after adjustment for demographic and clinical factors (Table 1). CONCLUSIONS: In a state-wide study, we found no difference in 10-year rates of composite failure after ambulatory PVP or TURP. These results support equivalence of long-term durability in a population where both techniques are commonly performed in the outpatient setting. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e355-e355 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wesley Chou More articles by this author Daniel Frendl More articles by this author Ya-Wen Chen More articles by this author David Chang More articles by this author Michelle Kim More articles by this author Expand All Advertisement Loading ...

MP01-15 OUTPATIENT 180 W XPS GREENLIGHT™ LASER PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE: SEVEN YEAR EXPERIENCE

INTRODUCTION AND OBJECTIVE:GreenLight XPS Laser System (GL-XPS) photoselective vaporization of the prostate (PVP) is not only non-inferior to Transurethral resection of the prostate (TURP), but wit...

PD18-05 DOES PRIOR PROSTATE SURGERY AFFECT OUTCOMES OF PATIENTS UNDERGOING ROBOTIC SIMPLE PROSTATECTOMY?

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III (PD18)1 Sep 2021PD18-05 DOES PRIOR PROSTATE SURGERY AFFECT OUTCOMES OF PATIENTS UNDERGOING ROBOTIC SIMPLE PROSTATECTOMY? Matthew Lee, Chinonyerem Okoro, Jennifer Lee, Aeen Asghar, David Strauss, Griffin Reyes, Shawn Shekar, Ziho Lee, Andrew Harbin, and Daniel Eun Matthew LeeMatthew Lee More articles by this author , Chinonyerem OkoroChinonyerem Okoro More articles by this author , Jennifer LeeJennifer Lee More articles by this author , Aeen AsgharAeen Asghar More articles by this author , David StraussDavid Strauss More articles by this author , Griffin ReyesGriffin Reyes More articles by this author , Shawn ShekarShawn Shekar More articles by this author , Ziho LeeZiho Lee More articles by this author , Andrew HarbinAndrew Harbin More articles by this author , and Daniel EunDaniel Eun More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002007.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical management of patients with enlarged prostates and lower urinary tract symptoms (LUTS) who failed prior prostate surgery may be challenging due to increased prostatic scarring and fibrosis. We compared outcomes of robotic simple prostatectomy (RASP) in patients with a history of prior prostate surgery versus patients without a history of prior prostate surgery. METHODS: We retrospectively reviewed our multi-institutional outcomes for all consecutive patients who underwent RASP between 05/2013 and 01/2021. The indication for RASP included LUTS refractory to medical and/or surgical management, and a prostate volume ≥80 milliliters. Patients were grouped based on whether or not they underwent prior prostate surgery. Postoperatively, urinary function was assessed using the American Urological Association Symptom Score (AUASS) and Quality of Life (QOL) score. Continuous and categorical variables were compared between both groups using independent t-tests and chi-square tests, respectively; p<0.05 was considered significant. RESULTS: Overall, 520 patients met inclusion criteria (Table 1). Among the 87 (16.7%) patients who underwent prior prostate surgery, 49 (56.3%), 8 (9.2%), 1 (1.1%), 26 (29.9%) and 3 (3.4%) patients underwent transurethral resection of the prostate, transurethral microwave therapy, water vapor thermal therapy, photoselective vaporization of the prostate or prostatic urethral lift, respectively. There was no difference in mean prostate volume (p=0.40), estimated blood loss (p=0.32), robotic console time (p=0.86) or major 30-day postoperative (Clavien>2) complications (p=0.80) between both groups. With regards to urinary function, the mean improvement in preoperative and postoperative AUASS (p=0.31) and QOL scores (p=0.11) were similar between both groups. CONCLUSIONS: For management of patients with enlarged prostates and LUTS, RASP is associated with an improvement in urinary function outcomes and a low risk of postoperative complications. Perioperative outcomes of RASP are similar in patients who underwent prior prostate surgery versus those that did not undergo prior prostate surgery. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e356-e357 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Lee More articles by this author Chinonyerem Okoro More articles by this author Jennifer Lee More articles by this author Aeen Asghar More articles by this author David Strauss More articles by this author Griffin Reyes More articles by this author Shawn Shekar More articles by this author Ziho Lee More articles by this author Andrew Harbin More articles by this author Daniel Eun More articles by this author Expand All Advertisement Loading ...

Risk Factors of Emergency Room Visits for Bleeding Complications Following Transurethral Procedures in the Treatment of Benign Prostatic Hyperplasia: A Retrospective Cohort Study.

PurposeTransurethral procedures, including transurethral resection of the prostate (TURP) and laser prostatectomy, are often linked to emergency room (ER) visits for postoperative bleeding. Although some studies have been conducted, the risk factors associated with these ER visits are not completely understood. This retrospective cohort study identified potential risk factors associated with ER visits for postoperative bleeding.Patients and MethodsPreoperative assessment data and operational and postoperational parameters recorded at Chang Gung Memorial Hospital, Taiwan between December 2015 and January 2017 for patients who underwent elective transurethral procedures were analyzed to identify potential risk factors. The primary endpoint was ER visits for gross hematuria within three months following operation, and the secondary endpoint was ER visits for blood clot-induced urinary retention (clot retention) within three months following operation.ResultsA total of 665 patients who underwent elective transurethral procedures were enrolled. The transurethral procedures included monopolar transurethral resection of the prostate (M-TURP), bipolar TURP (B-TURP), greenlight photoselective vaporization of the prostate (PVP), thulium laser enucleation of the prostate (ThuLEP) and thulium laser transurethral vaporesection of the prostate (ThuVARP). Regarding ER visits for clot retention within three months, multivariable logistic regression revealed significantly lower rates of clot retention in patients who received B-TURP than in those who underwent ThuVARP (AOR, 0.18; 95% confidence interval [CI], 0.04–0.82, p = 0.027). Moreover, significantly higher clot retention was observed in patients who underwent two or more rounds of manual irrigation (AOR, 9.51; 95% CI, 1.66–54.43, p = 0.011).ConclusionMultiple manual irrigations shortly after operation can be considered a novel predictor of postoperative clot retention-related ER visits. Among the transurethral procedures, ThuVARP was associated with a higher risk of clot retention-related ER visits than was B-TURP.

Сравнительная характеристика современных методов хирургического лечения доброкачественной гиперплазии предстательной железы (литературный обзор)

The article presents an overview of modern domestic and foreign literature, dedicated to the problem of surgical treatment of benign prostatic hyperplasia. There exists a wide range of approaches to surgical treatment of benign prostatic hyperplasia. A decision in favor of a certain method is individual and takes into account somatic status of the patient, peculiarities of growth of adenoma and the volume of prostate. In the article, a general tendency of using different endourologic interventions is emphasized. In case of moderate dimensions of the prostate the preferable methods are endoscopic enucleation, transurethral resection and photoselective vaporization of the prostate that are comparable in terms of functional, morphological parameters and duration of recovery period. However, application of non-invasive transurethral interventions in case of the gland volume more than 80 cm3 is limited and requires further improvement of surgical technique. Aquablation, transurethral microwave thermotherapy are promising methods requiring further independent randomized studies.

Influence of the median lobe on the results at 4 years of the prostate vaporization by GreenLight laser.

The aim of this study was to examine the influence of a median lobe (ML) on complications and functional results after 4 years of GreenLight photoselective vaporization of the prostate (PVP). All men undergoing GreenLight PVP for benign prostatic hyperplasia were included in the baseline analysis and followed prospectively. Two groups were formed according to the presence or absence of the prostatic ML. Complications classified according Clavien and Dindo and functional results (International Prostate Symptom Score [IPSS], quality of life, maximum urinary flow rate [Qmax], and postvoid residual [PVR]) were evaluated with 4 years of follow-up. The pre- and postoperative data were compared by a chi-square test (χ2 ) for the qualitative variables and by a Student t test for the quantitative variables. A total of 432 patients (172 with ML and 260 without ML) were included prospectively from September 2005 to October 2013. The initial populations were comparable. At 4 years of follow-up, the improvement in mean IPSS was significantly greater for patients with ML at 6, 12, 24, and 48 months. The improvement in Qmax was significantly greater for patients with ML at 1, 6, 24, and 48 months. There was no significant difference between the two groups concerning the PVR reduction, the occurrence of complications, the level of average prostate-specific antigen, and the average ultrasound volume at 4 years. There is a clearer and longer-lasting improvement in urinary symptoms in patients with prostatic ML. The indication of PVP in those patients seems to be excellent, with good results persisting at 4 years.

P0083 - Outpatient 180 W XPS GreenLight™ Laser photoselective vaporization of the prostate: Seven year experience

P0083 - Outpatient 180 W XPS GreenLight™ Laser photoselective vaporization of the prostate: Seven year experience

Comparison of bipolar plasmakinetic resection of prostate versus photoselective vaporization of prostate by a three year retrospective observational study

Comprehensive evaluation of photoselective vaporization of the prostate (PVP) versus plasmakinetic resection of the prostate (PKRP) in treating benign prostatic hyperplasia (BPH) is inadequate. This single-centre, retrospective observational study was designed to compare their efficacy, complications and sexual function. A total of 215 patients under PVP or PKRP were included in the study, propensity score matching (PSM) was performed to match the baseline characteristics of the two groups, and perioperative and three-year follow-up data were compared between them. Finally, 120 patients (60 for PVP and 60 for PKRP) were matched after PSM. Compared with the PKRP group, the intraoperative haemoglobin loss was lower (9.08 vs 13.75 g/L, P < 0.001) and the duration of catheterization and postoperative hospital stay were shorter (2.97 vs 4.10 day, P < 0.001; 3.95 vs 5.13 day, P < 0.001, respectively), but the operation time was longer (56.72 vs 49, 90 min, P < 0.001) in the PVP group. Urination measurements were improved for both groups after surgery, although no significant differences were found between them during follow-up. Sexual function after surgery was partly increased; however, frequent retrograde and discomfortable ejaculation occurred in both groups. In addition, dysuria incidence and retreatment were higher in the PVP group at 12 months. In conclusion, PVP is safe and effective in relieving BPH-related lower urinary tract symptoms with less perioperative blood loss and earlier recovery without inferior sexual function effects. However, the study is potentially affected by residual unmeasured confounding.

Évaluation de l’effet de la densité d’énergie délivrée lors d’une photovaporisation prostatique laser : étude rétrospective monocentrique

Greenlight XPS-180W® (AMS, San José, USA) photoselective vaporisation of the prostate (PVP) is considered as an alternative to transurethral resection of the prostate. The objective of this study was to assess the effect of energy density applied on adenoma during PVP treatment for benign prostate hyperplasia (BPH) on postoperative outcomes. A single-centre retrospective study has been conducted in the department of Urology of Colmar Hospital, in patients with symptomatic BPH, treated by PVP, between January 2016 and January 2019. Patients were stratified into two groups according to energy delivered and prostate volume as determined preoperatively: Low density (<4kJ/mL) and high density (>4kJ/mL). Perioperative complications, PSA evolution and functional outcomes (International Prostate Symptom Score, quality of life, maximum urinary flow rate, post-void residual urine volume) were compared with a minimal delay of 6 months. The retreatment rate was similar in the two groups. A total of 215 patients were included with median follow-up of 25 months. High energy density was associated with less glandular volume. There were no statistically significant differences between the two groups concerning the perioperative complications and the functional outcomes. The postoperative reduction of the PSA level was more significant in the high-energy group (41% vs. 28%, P=0.03). The perioperative complications and functional outcomes of PVP with Greenlight XPS-180W® laser are equivalent depending on the energy density delivered. The greater decrease in postoperative PSA for high-energy density could nevertheless suggest better quality tissue destruction. 3.

Global Greenlight Group: largest international Greenlight experience for benign prostatic hyperplasia to assess efficacy and safety.

Greenlight photo-selective vaporization of the prostate (GL-PVP) has gained international acceptance as a safe and effective alternative procedure for the treatment of benign prostatic hyperplasia (BPH), especially in anticoagulated men. This descriptive analysis aims to characterize the current state of GL-PVP, pooling data from international centers. Data from 3627 patients who underwent GL-PVP with the XPS-180W system in seven international centers performed by eight expert surgeons between 2011 and 2019 were retrospectively analyzed. Demographic, perioperative, and postoperative data were collected, including IPSS, QoL, Qmax, PVR, and PSA, and complications. At baseline, median age, prostate volume, PSA, and IPSS were 70years (interquartile range 64-77), 64 (47-90), 3.1ng/mL (1.8-6), and 22 (19-27), respectively. Median lasing and operative time were 34 (23-48) and 62min (46-85), respectively. Median energy use was 250.0kJ (168.4-367.9), with 92.6% of procedures being completed with one laser fiber. In 60.1% of cases, catheter was removed on postoperative day 1 with median length of 2days. All-cause mortality within 30days was 0.3%. Median PSA reduction at 3months and 60months compared to baseline was 43.9 and 46.4%, respectively (p < 0.001). All functional outcomes (IPSS, QoL, Qmax, and PVR) were significantly improved across study period when compared to baseline (p < 0.001). For those men with longer follow-up available, the observed surgical BPH retreatment rate was 1.5% CONCLUSION: Using the largest multi-user, international database of GL-PVP, Greenlight XPS laser treatment in experienced hands is a safe, effective, and durable BPH treatment option.

Environmental Safety of the 180-W GreenLight Laser: A Pilot Study On Plume And Irrigating Fluids

To analyze the chemical composition of the surgical smoke and the outflow irrigation fluid produced during a common endourological surgical procedure to treat benign prostatic obstruction (BPO). A prospective study was performed to analyze the surgical smoke generated during photoselective vaporization of the prostate (PVP) using the 180-W GL-XPS GreenLight Laser system. Surgical smoke samples were collected from 5 patients, and irrigation fluid samples were collected from 5 different patients. Qualitative organic compound determination was performed on both types of collected specimens using headspace-gas chromatography/mass spectrometry (HS-GC/MS) analysis. Four organic compounds were identified in the analyses of the smoke samples: tetradecane, hexadecane, 7-methylpentadecane and 2,6-dimethyleptadecane. In the analysis of fluid samples, 16 organic elements were identified. Interestingly, two compounds present in the first group (7-methylpentadecane and 2,6-dimethyleptadecane) were not detected in the fluid samples from the second group. None of the sixteen compounds detected in the fluids were present in all of the samples. Overall, seven of these compounds can be classified as toxic for acute exposure, while 4 others may represent a health hazard. We found that the different types of surgical smoke and irrigation fluids produced during PVP with a GreenLight Laser contain a limited number of organic compounds with a potential inhalation hazard. More studies are needed to understand the potential hazard for the exposed employees.

Risk of urinary morbidity associated with photoselective vaporization of the prostate (PVP) in prostate cancer patients undergoing a combined radiotherapy regimen consisting of dynamic adaptive radiotherapy (DART) and brachytherapy boost.

231 Background: Recent studies have shown PVPs to be associated with diminished perioperative and postoperative complications compared to transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH). This is the first study to evaluate the timing of PVP intervention and post-treatment morbidity related to a combined regimen of DART and Pd-103 brachytherapy for treatment of prostate cancer. Methods: Between 12/05 and 04/20, 51 consecutive patients underwent Greenlight Laser (GLL) or Olympus Plasma Button (OPB) PVP after DART (median dose: 45 Gy) and before Pd-103 brachytherapy (median dose: 90 Gy). 27 patients received GLL PVP and 24 patients received OPB PVP. Peripheral seed loading designs were utilized to achieve optimal urethral sparing. The time from DART to PVP ranged from 1 to 81 days (median: 18 days). For 12 patients, the interval between DART and PVP was ≤7 days. The time from PVP to seed implant ranged from 0 to 55 days (median: 18 days). For 13 patients, the interval between PVP and implant was ≤7 days. American Urological Association (AUA) symptom scores were compiled prior to PVP and on the last post-brachytherapy follow-up. Post-implant follow-up ranged from 6 months to 15 years (median: 6.4 years). Results: No patient experienced post-implant urinary retention or incontinence. Morbidity was limited to RTOG grade 1-2 symptoms, with the exception of one patient who experienced protracted dysuria, which was identified to be secondary to a pre-existing prostate anomaly (steep urethral curvature). Only that patient required dilation for urethral stricture. AUA scores improved or remained the same in 43 of 51 patients. Only 1 patient of the remaining 8 experienced an increase in AUA &gt; 8 points. Conclusions: In our experience, there have been remarkably few adverse urinary sequelae following Pd-103 implantation in patients with prior PVP and DART. In contrast to TURPs, PVPs are safe even with short intervals between DART and brachytherapy. Based upon these results, pre-implant PVP is preferred, rather than PVPs or TURPs in the post-implant setting.

High rates of re-intervention after photoselective vaporization of the prostate.

High rates of re-intervention after photoselective vaporization of the prostate.

Pharmacological and interventional treatment of benign prostatic obstruction: An evidence-based comparative review.

IntroductionThe recommended treatment for bothersome lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) after the failure of behavioral therapy and fluid modification includes pharmacological, minimally invasive interventional, and surgical approaches. Each option has different risk and benefit profiles, and the urologist must be aware of the unique characteristics of each option in order to be able to accurately counsel the patients based on their individual values and preferences. We provide a comparative review of the commonest pharmacological and most widely performed interventional/surgical treatments for BPO, discussing the evidence for the treatment characteristics that are most useful for the practicing urologist.MethodsA search of the PubMed database was performed for articles reporting on the following treatments for LUTS due to BPO: α‐blockers, 5α‐reductase inhibitors, phosphpdiesterase‐5 inhibitors, prostatic urethral lift (Urolift), convective radiofrequency water vapor thermal therapy (Rezum), Temporary implantable Nitinol Device (iTIND), prostate artery embolization (PAE), transurethral resection of the prostate (TURP), photoselective vaporization of the prostate (PVP), Aquablation, and anatomical endoscopic enucleation of the prostate (AEEP). We performed a narrative review focussing on the following outcomes: efficacy, safety, durability, duration of catheterization, length of stay, re‐treatment rate, efficacy in special situations (enlarged median lobe, prostate size, urinary retention, and anticoagulant use), and sexual adverse events.ResultsAEEP offers the greatest long‐term improvement in maximum flow rate, IPSS, and prostate volume reduction, with lowest re‐treatment rate, followed by PVP, TURP, and Aquablation. Urolift, Rezum, and PAE have similar efficacy for prostate volume up to 80cc, and all are more effective than the pharmacological treatment. Urolift offers the lowest rate of sexual dysfunction, followed by Rezum, and both can be performed as a day case under local anesthesia.ConclusionSeveral treatment options exist to treat voiding LUTS due to BPO. Newer minimally invasive treatments reduce the hospital stay and postoperative complications, whereas AEEP provides the greatest long‐term symptom improvement at the expense of higher morbidity and sexual dysfunction. Men should be counseled regarding all suitable treatment options as some may favor reduced efficacy in association with reduced side effects.

Photoselective Vaporization of the Prostate in the Management of Lower Urinary Tract Symptoms in Prostate Cancer Patients on Active Surveillance

To demonstrate the safety and efficacy of photoselective vaporization of the prostate in alleviating refractory lower urinary tract symptoms in prostate cancer patients who are managed with active surveillance and to explore the association of this procedure with prostate specific antigen (PSA) levels and cancer progression rates. Between 2008-2018, active surveillance patients who had refractory symptoms and needed surgery were studied. Perioperative functional variables were collected and analyzed. Disease progression was defined as an upgrade or upstage on surveillance biopsies or multiparametric prostate magnetic resonance imaging. Mean postop scores were estimated using locally-weighted methods. The risk of progression was reported using Kaplan-Meier's method. Seventy-one patients were included in the study. The median age was 68 years and the median surveillance time before surgery was 4 years. At 12 months, there were substantial improvements in the mean International Prostate Symptom Score (18-5.9), maximum flow rate (6.8-14 mL/s), postvoid residual (240-73mL), PSA (8.1-5.2 ng/mL), and prostate volume (85-57mL). At 30-days, only 2 patients with grade-III complications. Late consequences included tissue regrowth in 4 and urethral stricture (requiring a single dilation) in 3 patients. PSA levels decreased by 36% at 12 months postoperatively. With a median follow-up of 3.7 years, 7 men progressed and received radical treatment. At 3 years, the probability of remaining on surveillance was 93% (95% CI 87%- 100%). Photoselective vaporization of the prostate offers substantial relief of symptoms in active surveillance patients with refractory symptoms, without adverse effects on disease progression rates.

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

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