Standard Transurethral Resection Research Articles

964 A prospective, randomised trial comparing holmium laser enucleation of the prostate (HoLEP) to standard transurethral resection of the prostate for symptomatic benign prostatic hyperplasia: Two-year follow-up results

964 A prospective, randomised trial comparing holmium laser enucleation of the prostate (HoLEP) to standard transurethral resection of the prostate for symptomatic benign prostatic hyperplasia: Two-year follow-up results

Significance of muscularis mucosae on the risk of recurrence and progression in patients with superficial bladder cancer

Background. Due to the currently accepted operative technique of the transurethral resection (TUR) of bladder, during the surgery we obtain a histological material that is multiple pieces of the tissueof exophytic area of tumor, the bladder base and the bladder wall, in which a specialist histologist can be guided only with careful labeling, and the correct pathologic diagnosis is possible only in case of the presence of all layers of the bladder wall in the preparation. The performanceof TUR of bladderen blochas allowed visualizing an additional morphological feature in the preparation – its own muscularis mucosa. Objective. The evaluation of effectiveness of the transurethral surgical treatment of thepatients with superficial bladder cancer by comparing the immediate and long-term results of the standard TUR and the TUR of bladder wall tumor en bloc. The assessment of the role of the tumor invasion of propermuscularis mucosa in the prediction of recurrence and progression of superficial bladder cancer. Materials and methods. We analyzed the results of the examination and treatment of 270 patients with newly diagnosed «bladder cancer» who were treated between 2003 and 2012. All patients were divided into 2 groups: the main group (n = 94) who underwent the transurethral resection of the wall bladder tumor en bloc, and the compared group (n = 176) who underwent the standard transurethral resection. As a result wehave evaluated the role of the tumor invasion of propermuscularis mucosa in the prediction of recurrence and progression of superficial bladder cancer. Results and conclusions. The technique of the operation affects the recurrence rate by reducing it from 47.7 % in cases of the standard TUR to 34 % in cases of the TUR en bloc (p 0.05). The application of the TUR en bloc reduces the frequency of progressionby 4 times (p < 0.001) and increases the termsbeforethe progression by almost 2 times (p < 0.05). It allows to reduce the recurrences in the area of the resection to a minimum and to increase the periods before the occurrence of relapse. The presence of the damage ofproper muscularis mucosa (the in-growth or invasion, the categories T1b and T1c) increases the frequency of relapses for more than 2 times, and the way out of the tumor outside the layer of proper muscularis mucosareduces the term of relapse by 2.5 times, the progression rate increases from 2 % to 22.7 % and 18.5 %, and the average time before progression reduces from 41.5 to 26.0 and 17.1 with increase of the depth of tumor invasion with categories T1a, T1b and T1c respectively.

Two Micrometer Continuous-Wave Thulium Laser Treating Primary Non-Muscle-Invasive Bladder Cancer: Is It Feasible? A Randomized Prospective Study.

Until now, various laser types have been used in the treatment of bladder cancer. The purpose of this study is to evaluate the feasibility and effectiveness of 2 μm continuous-wave (CW) thulium laser in treating primary non-muscle-invasive bladder cancer (NMIBC). A comparative (randomized prospective) interventional study was conducted in our center. A total of 400 patients with Ta or T1 bladder cancer were enrolled and randomized to transurethral resection of bladder tumor (TURBT) or laser vaporesection (LVRBT). Patients in the TURBT group received standard transurethral resection with a bipolar electrocautery system, while those in the LVRBT group received transurethral vaporesction with a 2 μm CW thulium laser. All patients received intravesical irrigation with sterile water for at least 12 h immediately after the procedure. The end-points of this study were tumor recurrence and/or progression, or the completion of 36 months of follow-up (10 cystoscopies) with no recurrence. A total of 292 patients were included in our analysis, of whom 143 received TURBT and 149 received LVRBT. During 36 months of follow-up, 129 cases (44.2%) had recurrence: 61 (42.7%) in the TURBT group and 68 (45.6%) in the LVRBT group (p = 0.608). Tumor progression was found in 19 patients (6.5%): 11 in the TURBT (7.7%) and 8 (5.4%) in the LVRBT group (p = 0.421). Median tumor-free survival was 25.2 months (25.46 in the TURBT group vs. 24.9 in the LVRBT group, p = 0.729). Overall recurrence rate was 14.7%, 42.1%, and 62.5% in the low, intermediate low, and intermediate high risk subgroups, respectively. Operation time was significantly lower in the TURBT than in the LVRBT group (28.43 vs. 31.5 min, p = 0.044). Use of a 2 μm CW thulium laser is feasible and effective in treating primary NMIBC. With a cystoscopic biopsy of the bladder muscle, 2 μm CW thulium laser could retrieve sufficient diagnostic and prognostic specimens.

Multicentre prospective evaluation of the learning curve of holmium laser enucleation of the prostate (HoLEP).

To describe the step-by-step learning curve of the holmium laser enucleation of the prostate (HoLEP) surgical technique. A prospective, multicentre observational study was conducted, involving surgeons experienced in transurethral resection of the prostate and open prostatectomy but never having performed HoLEP. The main judgment criterion was the ability of the surgeon to perform four consecutive successful procedures, defined by the following: complete enucleation and morcellation within <90 min, without any conversion to standard transurethral resection of the prostate (TURP), with acceptable stress, and with acceptable difficulty (evaluated by Likert scales). Each surgeon included 20 consecutive cases. Of nine centres, three abandoned HoLEP before the end of the study due to complications, and one was excluded for treating patients off protocol. Only one centre achieved the main judgment criterion of four consecutive successful HoLEP procedures. Overall, the procedures were successfully performed in 43.6% of cases. Reasons for unsuccessful procedures were mainly operative time >90 min (n = 51), followed by conversion to TURP (n = 14), incomplete morcellation (n = 8), significant stress (n = 9), or difficulty (n = 14) during HoLEP. Ignoring operating time, 64% of procedures were successful and four out of five centres did four consecutive successful cases. Of the five centres that completed the study, four chose to continue HoLEP. Even in a prospective training structure, HoLEP has a steep learning curve exceeding 20 cases, with almost half of our centres choosing to abandon or not to continue with the technique. Operating time and difficulty of the enucleation seem the most important problems for a beginner. A more intensely mentored and structured mentorship programme might allow safer adoption of the procedure.

MP26-06 NEUTROPHIL TO LYMPHOCYTE RATIO PREDICTS RECURRENCE OF NON-MUSCLE INVASIVE BLADDER CANCER

INTRODUCTION AND OBJECTIVES: To report our experience of a prospective cohort study with a selected group of patients with low-risk non muscle-invasive bladder cancer (NMIBC) included in an observation and monitoring program after the diagnosis of recurrence. METHODS: Inclusion criteria: small (<10 mm) papillary, asymptomatic tumor with negative urinary cytology found on follow-up cystoscopy in patients with previous resections of NMIBC (Stage pTa, pT1a), grade 1-2, and number of lesions between 1 and 5. No symptomatic patients or those with carcinoma in situ or grade 3 tumors were included. All patients included in the observation group were closely monitored with cytology and flexible cystoscopy every 3-4 months. All pathologic studies were performed by a single experienced uropathologist and fully dedicated cytologists RESULTS: The data from 55 patients (70 active surveillance events) were analyzed. The mean patient age was 69.8 years. The median follow-up was 36 months. Pathologic characteristics before observation were pTa in 80%, Stage pT1a in 20%, grade 1 in 82% and grade 2 in 18%. The median time patients remained in observation was 18.9 months. Eighty-nine percent of the patients did not experience stage progression and 82% showed no grade progression. No patient experienced progression to muscle-invasive disease. The patients who discontinued the observational setting and underwent transurethral resection are those who showed an increase in the number and/or size of the lesions, a worsening of the symptoms (mainly haematuria), or positive urine cytology findings at follow up. CONCLUSIONS: The observation of these tumors, without active treatment, is a common clinical practice; however, although routinely performed by some urologists, clinical guidelines do not take this option into account yet. An active surveillance protocol is reasonable in patients presenting with small, recurrent papillary bladder cancer after resection of low grade Ta T1 tumors. The observational option allows to spare several surgeries, also considering the minimal risk for tumor progression in these patients. Whenever a significant change in tumor morphology or size is noted, patients are referred to a standard transurethral resection of bladder tumor (TURBT).

Transurethral en bloc resection of bladder tumors

Background. The high incidence of recurrent non-muscle-invasive bladder carcinoma (BC) necessitates searches for new surgical methods. Objective: to comparatively evaluate the efficiency and safety of en block resection of bladder tumors versus transurethral resection (TUR). Subjects and methods. In January 2010 to June 2013, a total of 292 patients with primary and recurrent bladder tumor stages, cTa-T2, underwent transurethral endoscopic treatment (as TUR) at the Unit of Minimally Invasive Urology, Moscow City Clinical Hospital Fifty-Seven. A major portion of these patients were included in the study of the efficiency and safety of en bloc TUR of bladder tumors. The criteria for study inclusion were primary or recurrent non-muscle-invasive bladder tumor measuring 1 to 3 cm, stage pTa-T1, signed informed consent to participate in the study and patients» readiness to undergo control examinations in inpatient setting for one year. The exclusion criteria were a confirmed or detected muscleinvasive tumor, multiple bladder involvement (&gt; 3 tumors), as well as detected tumors spreading to the ureter, bladder neck, and prostatic urethra. The primary study endpoint was considered to be a recurrence of a tumor after TUR of the bladder (TURB). The secondary endpoint was the frequency of concealed bladder perforation, blood transfusions, recystoscopies for bladder tamponade, early recystoscopies to specify a BC stage, and the frequency of immediate intravesical injection of a chemical. For final analysis, the investigators selected 106 patients in a group where tumors were removed en bloc (a study group) and 133 patients in a group where tumors were retrieved using traditional TURB (a control group). In the study group, the tumor was removed en bloc by a monopolar J-shaped electrode (sand wedge electrode) in 45 patients, by a hook-like electrode in 14, by a hybrid procedure (hydropreparation and monopolar electrosurgery by a water-jet hybrid knife) in 10, and by holmium laser in the remaining 37 patients. Results. The recurrence rates in the study and control groups were 10.4 and 21.8 %, respectively (p ≤ 0.05). There were no significant differences in the time of surgery, the periods of bladder drainage, and the frequency of complications. In the study group, the immediate instillation of a chemical was possible in 54.7 % of the patients versus 24 % in the control group (р ≤ 0.05), indirectly suggesting that en bloc TUR of the bladder was less safe (the bladder resection area, concealed perforations, hemorrhagic complications, etc. were less.). Early recystoscopy and biopsy were required in 9.4 % of the patients in the study group versus 24 % of those in the control group (p ≤ 0.05), which is mainly attributable to more qualitative histological material obtained during en bloc TUR. According to the visual analogue scale, the quality of the histological materials obtained by retrieving the tumor en block was 93 versus 61 scores during standard TUR. Conclusion. En bloc TUR of the bladder is more effective and safer than standard TUR in the group of patients with non-muscle-invasive BC and 1–3-cm tumors. Histological material obtained by removing the tumor en bloc can provide a more qualitative morphological opinion.

Bladder injury secondary to obturator reflex is more common with plasmakinetic transurethral resection than monopolar transurethral resection of bladder cancer.

IntroductionTransurethral resection (TUR) is the most common surgical technique for the diagnosis and initial treatment of bladder cancer. In this study, we evaluated two surgical techniques in terms of bladder injury due to obturator reflex in patients that underwent TUR for non-muscle invasive bladder cancer (NMIBC).Material and methods93 patients who underwent TUR for bladder cancer were analyzed. Fifty patients underwent monopolar resection and 43 patients underwent plasmakinetic resection. Standard TUR were performed with conventional Storz monopolar resection using a U-shaped cutting loop, 120V cutting/80 V coagulation settings, 5% mannitol fluid was used for irrigation. For bipolar resection, an Olympus ESG-400 plasmakinetic loop bipolar device using a U-shaped cutting loop, 160V cutting/80V coagulation settings and normal saline for irrigation was used.ResultsIn the monopolar resection group; obturator reflex was seen in 4 (8%) patients. Bladder perforation caused by the obturator reflex was seen in 4 (8%) patients, but hemorrhage and other major complications were not seen in this group. In the bipolar resection group; obturator reflex was seen in 15 (34%) patients. Bladder perforation caused by the obturator reflex was seen in 10 (23%) patients.ConclusionsBipolar transurethral resection of bladder tumor was not superior to monopolar resection with respect to obturator reflex and bladder perforation. We conclude that we do not yet have enough experience concerning the long-term complications and major complications associated with bipolar resection of bladder cancer.

Efficacy of bipolar "button" plasma vaporization of the prostate for benign prostatic obstruction, compared to the standard technique.

Objective:The objective of the following study is to evaluate the efficiency of transurethral plasma vaporization of the prostate in saline bipolar plasma vaporization of the prostate (BPVP) using the button electrode and comparing it to the standard transurethral resection of the prostate (TURP).Patients and Methods:During the period of the year between 2007 and 2013, 152 patients with benign prostatic hyperplasia were rolled in our study. Fifty-two patients were underwent BPVP and 100 TURP. All patients were evaluated preoperatively, 24 h and at 3 months postoperatively. International Prostate Symptom Score (I-PSS), quality-of-life (QOL) score, Qmax and Qave and post void residual (PVR) urine. Operative time, hospital stay, catheterization time, and complications were reported. Mean serum Hb, hematocrit and serum sodium changes were reported preoperatively and within 24 h postoperatively in both groups. Statistical analysis is performed using SPSS program version 20 for windows.Results:Mean age at surgery was 60.8 ± 8 (range 63- 92) and 66 ± 8.6 (range 50-83) for BPVP and TURP groups, respectively. Mean prostatic volume was 46 ± 11 (range 30-92) and 43 ± 8 (range 30-80) in both groups, respectively. Patients from both series had similar preoperative characteristics. The mean operative duration 53 ± 21 1 ± 2.1 (range 1-7) versus 3 ± 3.3 (range 3-8) days (P value 0.0001) were significantly (range 20-80) versus 62 ± 16 min (range 30-126) (P value 0.004), catheterization period 2 ± 0.28 ( range 2-4) versus 3 ± 3.2 (range 2-7) days (P value 0.03).Conclusions:BPVP has superior efficacy in short-term results and less complication rates compared with classic TURP.

Abstract 3729: An individualized approach to bladder cancer treatment using patient-derived cell lines to predict response to chemotherapeutic agents

Abstract Introduction: Chemotherapy (both intravesical and systemic) can reduce the risk of recurrence and progression in various stages of bladder cancer. However, recurrence after treatment failure is associated with an increased risk of progression. There are currently no established methods for predicting patient-specific responses to treatment prior to drug selection. In our studies, we have developed a novel protocol for efficient establishment of cell lines from primary human bladder tumors, which enables in vitro drug sensitivity assays using chemotherapeutic agents. Methods: Using an Institutional Review Board-approved tissue acquisition protocol, informed consent was obtained prior to specimen acquisition for all samples. Specimens were obtained during standard transurethral resection of papillary bladder tumors. Following generation of a single-cell suspension, epithelial cells were isolated using immunomagnetic cell separation and used for establishment of adherent cell cultures using a novel protocol. We performed immunohistochemistry on parental tissue as well as cultured cells to confirm that the urothelial cancer phenotype was maintained during serial passaging. For sensitivity assays, cultured cells were passaged and treated with chemotherapeutic agents, followed by assessment of cell viability using MTT assays. Results: To date, seven specimens from patients with papillary urothelial carcinoma have been obtained, resulting in the establishment of six independent adherent cell lines. All established lines have been serially passaged (as high as P10) without significant decline in growth rate, and maintained expression of CK7, uroplakin III, p53, and Ki67 in patterns similar to parental tissue. Cells from line #7 were treated with mitomycin C, docetaxel, gemcitabine, and rapamycin at three different equivalent concentrations, resulting in a unique sensitivity profile that was reproduced in a replicate experiment performed at a subsequent passage. Conclusions: We have established a novel protocol for culture and rapid expansion of primary cells from human bladder tumors for assays of drug response. Ultimately, we envision that this approach will provide a basis for the design of patient-specific therapeutic regimens for bladder cancer. Citation Format: LaMont Barlow, Chee Wai Chua, Ming Lei, G. Joel DeCastro, Ketan Badani, Mitchell Benson, James McKiernan, Michael Shen. An individualized approach to bladder cancer treatment using patient-derived cell lines to predict response to chemotherapeutic agents. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3729. doi:10.1158/1538-7445.AM2014-3729

Plasmakinetic vaporization versus transurethral resection of the prostate: Six-year results.

Benign prostate hyperplasia (BPH) is becoming more prevalent in parallel to the changing demographic structures of the community. Transurethral resection is still considered the most effective treatment. Due to advances in technology, different treatment modalities are being attempted. In our study, we compared the long-term results of standard transurethral resection of prostate (TURP) with plasmakinetic vaporization of prostate (PKVP, Gyrus Medical Ltd., Bucks, UK). Of the 75 patients who were admitted to our outpatient clinic between 2001 and 2003 with lower urinary tract complaints and who were randomized into two groups (transurethral resection (TUR) and PKVP), 36 were enrolled to study and completed a follow-up period of 72 months. Both groups were equal in terms of age and preoperative parameters. The preoperative maximum uroflow rate (Qmax) in the PKVP group was 6 (2.3) mL/s and the rates were 21.8 (3.4) and 20.1 (3.1) during the control visits at 36 and 72 months, respectively. For the PKVP group, these rates were 6 (3.1), 14.4 (2.6), and 15.6 (2.8), respectively. In terms of the international prostate symptom score (IPSS), for the TUR group, these values were 22 (3.8), 5.7 (1.2), and 7.9 (2.6). For the PKVP group, the respective values were 21 (3.4), 7.6 (1.4), and 11 (2.4). The IPSS and Qmax values measured at the 36(th) and 72(nd) months for both groups were significantly different from each other (p<0.05). Compared to standard TURP, PKVP was found to be unsuccessful in the treatment of BPH when long-term outcomes were considered.

MP71-12 IS THERE A ROLE FOR HOLMIUM LASER CHANNEL OF THE PROSTATE IN PATIENTS WITH PROSTATE CANCER?

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II1 Apr 2014MP71-12 IS THERE A ROLE FOR HOLMIUM LASER CHANNEL OF THE PROSTATE IN PATIENTS WITH PROSTATE CANCER? Mohamed Elkoushy, Ahmed Elshal, and Mostafa Elhilali Mohamed ElkoushyMohamed Elkoushy More articles by this author , Ahmed ElshalAhmed Elshal More articles by this author , and Mostafa ElhilaliMostafa Elhilali More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2171AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Compared to the standard transurethral resection of the prostate (TURP), “Channel TURP” is frequently used despite its significant morbidity in patients with prostate cancer. The aim of the present study was to assess the role of prostatic holmium laser channel (Ho:PCh) in men with bladder outlet obstruction (BOO) associated with prostate cancer. METHODS A retrospective review for patients with BOO associated with prostate cancer who underwent Ho:PCh was performed. The standard holmium laser enucleation of the prostate (HoLEP) was performed. However, sharp laser enucleation of obstructing prostate tissue was needed most of the time. Patient’s hospital records and charts were comprehensively reviewed for perioperative and follow-up data. Energy to prostate ratio (E/P) was calculated as energy/ resected tissue (KJ/ml) as an indicator of the need to use sharp dissection. Morcellation ratio (MR) was calculated as resected weight/ morcellation time (g/min) as an indicator of the prostate consistency for morcellation. RESULTS Forty-one patients with prostate cancer undergoing Ho:PCh by a single surgeon (MME) were identified between March 2000 and June 2011. The mean ±SD (range) age was 73.8 ± 8.7 (56- 93) years and the mean PSA at presentation was 20.6±25.7 (0.69- 162.19) ng/ml. Mean operating time was 103 ± 37 (50- 202) min with a mean E/P ratio of 4.3±2.4 (1.6- 12.5) KJ/ml and a mean MR of 3.1±2.0 (0.7- 7.3) g/min. Mean post-operative hospital stay and catheter time were 1.2 ± 0.46 and 1.3 ± 1.0, respectively (Table 1). After a mean follow up of 32.8 (1-132) months, the mean IPSS and QoL significantly improved by 74% (16 vs. 4.2, p=0.001) and 56% (3.3 vs. 0.6, p=0.001), respectively. Mean peak flow rate had increased by 228% (6.4 vs. 21 ml/sec, p=0.005) and the mean residual urine volume decreased by 92% (180 vs. 14 ml, p=0.009). Eight patients (19.5%) experienced early adverse events that were managed conservatively including 4 (9.8%) with clot retention, 3 (7.3%) failed initial trial of voiding and one patient had transient stress incontinence. Local failure rate was 17.1% including 4 patients (9.8%) undergoing a second Ho:PCh procedure and 3 (7.3%) who did not want further surgery. CONCLUSIONS Holmium laser channel of the prostate seems to be an effective and safe option for patients presenting with BOO secondary to prostate cancer. Table 1: Demographic and perioperative data Variables Mean ± SD / No (%) Variables Mean ± SD / No (%) Age at time of surgery (years) 73.8 ± 8.7 (56-93) Weight of enucleated tissue 56.4 ± 29.8 (17-151) Patients with Diabetes Mellitus 14 (34.14%) Energy utilized (KJ) 195.25 ± 101.81 Patients on ongoing anticoagulants 13 (31.7%) Energy/ prostate ratio (KJ/ml) 4.3 ± 2.4 Patients with indwelling urethral catheters 18 (43.9%) Enucleation time (min) 87.9 ± 35.3 Preoperative ASA score 1.26 ± 0.55 (1-3) Morcellation time (min) 16.4 ± 10.1 Preoperative PSA (ng/dl) 20.6 ± 25.7 (0.69- 162.19) Morcellation ratio (g/min) 103 ± 37 Preoperative IPSS 20.4 ± 9.4 Operating time (min) 103 ± 37 Preoperative QoL 3.8 ± 1.5 Catheterization time (days) 1.3 ± 1.0 Preoperative Qmax (mL/sec) 6.4 ± 5.0 Hospital stay (days) 1.2 ± 0.46 Preoperative PVR (mL) 371 ± 278 Failed trial of voiding 3 (7.3 %) Preoperative IIEF-score 0.52 ± 2.4 Postoperative hematuria (conservative) 4 (9.8%) Preoperative prostate size by TRUS (cc) 83.4 ± 50.0 (25-258) Transient urinary incontinence 1 (2.4%) Concomitant cystolithotripsy 4 (9.8%) ASA: American Society of Anesthesiologists, PSA: Prostatic specific antigen, IPSS: International prostate symptoms score, QoL: Quality of life, Qmax: Maximum flow rate, PVR: Post-void residual urine, IIEF: International index of erectile function, TRUS: Transrectal ultrasound. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e794-e795 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Mohamed Elkoushy More articles by this author Ahmed Elshal More articles by this author Mostafa Elhilali More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Multicenter study on costs associated with two surgical procedures: GreenLight XPS 180 W versus the gold standard transurethral resection of the prostate

ObjectiveTo analyze the costs associated with two surgical procedures for lower urinary tract symptoms secondary to benign prostatic hyperplasia: GreenLight XPS 180W versus the gold standard transurethral resection of the prostate. MethodsA multicenter, retrospective cost study was carried out from the National Health Service perspective, over a 3-month time period. Costs were broken down into pre-surgical, surgical and post-surgical phases. Data were extracted from records of patients operated sequentially, with IPSS=15, Qmax=15mL/seg and a prostate volume of 40–80mL, adding only direct healthcare costs (€, 2013) associated with the procedure and management of complications. ResultsA total of 79 patients sequentially underwent GL XPS (n: 39) or TURP (n: 40) between July and October 2013. Clinical outcomes were similar (94.9% and 92.5%, GL XPS and TURP, respectively) without significant differences (p=0.67). The average direct cost per patient was reduced by 114€ in GL XPS versus TURP patients; the cost was higher in the surgical phase with GL XPS (difference: 1209€; p<0.001) but was lower in the post-surgical phase (difference: €−1351; p<0.001). ConclusionsThe GreenLight XPS 180-W laser system is associated with a reduction in costs with respect to transurethral resection of prostate in the surgical treatment of LUTS secondary to PBH. This reduction is due to a shorter inpatient length of stay that offsets the cost of the new technology.

Efficacy and safety of potassium-titanyl- phosphate laser vaporization for clinically non-muscle invasive bladder cancer.

Although transurethral resection of the bladder tumor (TURBT) is still regarded as thegold standard for the treatment of clinical non-muscle invasive bladder cancer, alternative surgical options remain investigating. Our aim was to evaluate the efficacy and safety of potassium- titanyl-phosphate (KTP) laser for the treatment of primary, clinically non-muscle invasive bladder cancer compared with standard transurethral resection of bladder tumor. The data of primary non-muscle invasive bladder cancer patients treated by either KTP laser vaporization (PVB group) or TURBT were analyzed retrospectively. The preoperative conditions and intraoperative complications such as obturator nerve reflex and bladder perforation and postoperative characteristics such as catheterization time and tumor recurrence were compared. The patients' demographics and tumor characteristics in the two groups were comparable. PVB was superior to TURBT in terms of intraoperative complications such as obturator nerve reflex (P = .0289), postoperative bladder irrigation (P = .038) and postoperative catheterization time (P < .0001). Recurrence rate after PVB was also lower than that after TURBT. Our results indicated that PVB is a feasible, safe and effective alternative surgical approach for the management of primary, clinically non-muscle invasive bladder cancer, especially for those with lifetime oral taken anticoagulation medicine, with fewer perioperative complications and lower recurrence.

Estudio multicéntrico de costes de 2 técnicas quirúrgicas: láser GreenLight XPS 180 W vs resección transuretral de la próstata

ObjectiveTo analyze the costs associated with two surgical procedures for lower urinary tract symptoms secondary to benign prostatic hyperplasia: GreenLight XPS 180¦W versus the gold standard transurethral resection of the prostate. MethodsA multicenter, retrospective cost study was carried out from the National Health Service perspective, over a 3-month time period. Costs were broken down into pre-surgical, surgical and post-surgical phases. Data were extracted from records of patients operated sequentially, with IPSS=15, Qmax=15mL/seg and a prostate volume of 40-80mL, adding only direct healthcare costs (€, 2013) associated with the procedure and management of complications. ResultsA total of 79 patients sequentially underwent GL XPS (n: 39) or TURP (n: 40) between July and October, 2013. Clinical outcomes were similar (94.9% and 92.5%, GL XPS and TURP, respectively) without significant differences (P=.67). The average direct cost per patient was reduced by €114 in GL XPS versus TURP patients; the cost was higher in the surgical phase with GL XPS (difference: €1,209; P<.001) but was lower in the post-surgical phase (difference: €–1,351; P<.001). ConclusionsThe GreenLight XPS 180-W laser system is associated with a reduction in costs with respect to transurethral resection of prostate in the surgical treatment of LUTS secondary to PBH. This reduction is due to a shorter inpatient length of stay that offsets the cost of the new technology.

Influence of body mass index on Benign Prostatic Hyperplasia-related complications in patients undergoing prostatectomy.

ObjectivesTo examine the link between increased body mass index and benign prostatic hyperplasia (BPH) related complications, namely: acute urinary retention (AUR), Bladder stones and Bladder diverticula.Material and methodsPatients: We reviewed the medical records of BPH patients who underwent prostatectomy over three years period from 2010–2012. Prostatectomy was either done in the gold standard transurethral resection of the prostate (TURP) or using green light laser selective photo-vaporization (PVP). Age, PSA, Prostate Volume (PV) as measured by ultrasonography, patients’ weight & height, BPH related complications mainly AUR, bladder stones, and bladder diverticula were all taken in account. The BMI was calculated as weight in kg divided by square height in meters. The BMI was divided in 4 categories according to WHO classification: underweight if BMI ≤18.50 kg/m2; normal weight if BMI = 18.50-24.9 kg/m2; overweight: BMI ≥25 kg/m2; and obese BMI if ≥30 kg/m2. Statistical analysis: done using the SPSS package version 16. Chi-square test was used for comparison between groups where p-value was considered significant if <0.05 and ANOVA test was used for comparison between multiple variables.Results197 patients were included in this study, of those 95(48%) underwent TURP and 102(52%) underwent PVP. The two groups were found to be similar in mean age and PSA, and significantly different in prostate volume and operating room (O.R.) time.ConclusionsAlthough the mean weight for patients undergoing prostatectomy in this study was in the overweight range, yet only 59/197(30%) patients with increased BMI presented with AUR. In this particular cohort of patients undergoing prostatectomy there was no significant differences in the development of AUR, bladder stone and diverticulum formation between patients with increased BMI (overweight and obese) and those with normal BMI. Further studies are recommended to explore the influence of increased BMI on BPH-related complications.

A randomized trial comparing thulium laser resection to standard transurethral resection of the prostate for symptomatic benign prostatic hyperplasia: four-year follow-up results

To report the results of a randomized prospective trial with a 4-year follow-up, comparing the thulium laser resection of the prostate-tangerine technique (TmLRP-TT) with transurethral resection of prostate (TURP) for treatment of symptomatic benign prostatic hyperplasia (BPH). BPH patients (96) were randomized for surgical treatment with TmLRP-TT (47) or TURP (49). All patients were assessed pre-operatively and followed at 12, 24, 36, and 48 months post-operatively. Several parameters related to BPH were collected at each follow-up, including International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rates (Qmax), and post-void residual volume (PVR). All late complications were also recorded. Dramatic improvement in micturition parameters was observed after TmLRP-TT compared with pre-operative values. Median IPSS decreased 75.6 % in the subsequent 12 months and 61.2 % in 48 months, while median QoL decreased by 80.4 and 59.1 %, respectively. Compared with baseline, numerical values of Qmax increased 1.07-fold and those of PVR decreased 73.1 % in the fourth year. Moreover, all micturition parameters in the TmLRP-TT group were similar to those of TURP patients at every annual assessment. Some late complications after the operations were also observed: one patient suffered from urethral strictures and one from bladder-neck contractures after TmLRP-TT. Re-operation rates were equal in the two groups. Micturition remained stable after TmLRP-TT during the 4-year follow-up. Outcomes compared favourably with TURP, with lower peri-operative morbidity and equally low occurrence of late adverse effects. Thus, TmLRP-TT can be an available option for BPH patients, especially older, high-risk patients.

2007 BIPOLAR PLASMA VAPORIZATION VERSUS STANDARD TUR IN CASES OF SECONDARY BLADDER NECK SCLEROSIS – A PROSPECTIVE, MEDIUM TERM, RANDOMIZED COMPARISON

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology (II)1 Apr 20132007 BIPOLAR PLASMA VAPORIZATION VERSUS STANDARD TUR IN CASES OF SECONDARY BLADDER NECK SCLEROSIS – A PROSPECTIVE, MEDIUM TERM, RANDOMIZED COMPARISON Bogdan Geavlete, Cristian Moldoveanu, Catalin Iacoboaie, Florin Stanescu, and Petrisor Geavlete Bogdan GeavleteBogdan Geavlete Bucharest, Romania More articles by this author , Cristian MoldoveanuCristian Moldoveanu Bucharest, Romania More articles by this author , Catalin IacoboaieCatalin Iacoboaie Bucharest, Romania More articles by this author , Florin StanescuFlorin Stanescu Bucharest, Romania More articles by this author , and Petrisor GeavletePetrisor Geavlete Bucharest, Romania More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2426AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES This prospective, randomized, medium term trial aimed to assess the efficiency, safety and postoperative results of the bipolar plasma vaporization (BPV) by comparison to monopolar transurethral resection (TUR) in cases of secondary bladder neck sclerosis (BNS). METHODS A total of 70 patients with BNS secondary to TURP (46 cases), open prostatectomy for benign prostatic hyperplasia (BPH - 18 cases) and radical prostatectomy for prostate cancer (6 cases) were enrolled in the trial. The inclusion criteria consisted of maximum flow rate (Qmax) below10 mL/s and International Prostate Symptom Score (IPSS) over 19. All patients were evaluated preoperatively as well as at 1, 3, 6, 12 and 18 months after surgery by IPSS, quality of life score (QoL), Qmax and post-voiding residual urinary volume (PVR). RESULTS The mean operation time (10.3 versus 14.9 minutes), catheterization period (0.75 versus 2.1 days) and hospital stay (1.1 versus 3.2 days) were significantly reduced in the BPV series. During the immediate postoperative follow-up, the re-catheterization for acute urinary retention only occurred in the TUR group (5.7%). The medium term re-treatment requirements due to BNS recurrence were lower in the BPV study arm (2.8% versus 8.5%). At the 1, 3, 6, 12 and 18 month's assessment, statistically similar parameters were found concerning the IPSS and QoL symptom scores, Qmax and PVR values specific for the two therapeutic alternatives. CONCLUSIONS BPV constitutes a valuable endoscopic treatment approach for secondary BNS patients. The method emphasized superior efficacy, a satisfactory safety profile and similar medium term follow-up features when compared to standard TUR. Results BPV TUR p value IPSS 1 month 3.8 4.0 0.766 3 months 3.6 3.9 0.629 6 months 3.5 3.6 0.892 12 months 3.3 3.5 0.714 18 months 3.4 3.3 0.881 Qol 1 month 1.4 1.5 0.939 3 months 1.2 1.4 0.525 6 months 1.1 1.2 0.962 12 months 1.1 1.1 0.696 18 months 1.2 1.1 0.179 Qmax (mL/s) 1 month 23.0 23.3 0.880 3 months 23.2 23.6 0.817 6 months 23.5 23.8 0.868 12 months 23.9 24.2 0.852 18 months 23.8 24.0 0.922 PVR (mL) 1 month 31 28 0.460 3 months 24 23 0.733 6 months 22 21 0.694 12 months 19 18 0.699 18 months 21 17 0.133 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e824 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bogdan Geavlete Bucharest, Romania More articles by this author Cristian Moldoveanu Bucharest, Romania More articles by this author Catalin Iacoboaie Bucharest, Romania More articles by this author Florin Stanescu Bucharest, Romania More articles by this author Petrisor Geavlete Bucharest, Romania More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

520 Bipolar resection versus standard transurethral resection of the prostate: A prospective randomized study with 2-year follow-up

520 Bipolar resection versus standard transurethral resection of the prostate: A prospective randomized study with 2-year follow-up

Endoscopic Resection. Aspects of Technique and Optimization of Outcomes. Current Indications to PDD-Guided Resection

Trans-Urethral Resection (TUR) of bladder tumors is the gold standard to make the correct diagnosis and remove all visible lesions. The strategy of resection depends on the size of the lesion. Small tumors can be resected en bloc, while larger tumors should be resected separately in fractions to obtain a correct pathological diagnosis. Random biopsies from normal-looking mucosa should be performed in patients with positive urinary cytology and absence of visible tumor in the bladder. As a standard procedure, cystoscopy and TUR are performed using white light. Photodynamic diagnosis (PDD) is most useful for detecting CIS, and therefore should be restricted to those patients with a suspected high-grade tumor.

Safety and efficacy of 120w high performance system greenlight laser vaporization for non-muscle-invasive bladder cancer

We evaluated the safety and efficacy of 120W potassium-titanyl-phosphate (KTP) laser vaporization on patients with non-muscle invasive bladder cancer compared with standard transurethral resection of bladder tumor (TUR-BT). One hundred and fifty-eight patients of non-muscle invasive bladder cancer who underwent either 120W potassium-titanyl-phosphate (KTP) laser vaporization (HPS group, n=74) or transurethral resection of the bladder tumor (TUR-BT group, n=84) were analyzed respectively. The preoperative, intraoperative and postoperative clinical data were recorded and compared in two groups. All patients were successfully treated with 120W-KTP laser vaporization or TUR-BT. No significant differences were observed in operative time, perioperative and postoperative serum sodium and hemoglobin levels between two groups. Importantly, HPS had less specific side effects of TURBT, such as obturator nerve reflex, postoperative bladder irrigation and catheterization time, which shows statistic difference significantly (p< 0.05). Recurrence rate was lower in HPS group than those in TUR-BT group. The 120W-HPS KTP laser as a safe and feasible procedure provids an alternative for the patients with non-muscle invasive bladder cancer, especially for those on anticoagulation therapy.