Traditional Transurethral Resection Of The Prostate Research Articles

Comparative Analysis of Rapid Transurethral and Reverse Sequential Resection with Plasma Excision Equipment for BPH Treatment

Objective: To compare the rapid transurethral sequential excision and reverse sequential excision combined with plasma excision equipment for BPH treatment of benign prostatic hyperplasia (BPH) and traditional transurethral resection of prostate (TURP) in patients with BPH. Methods: The study conducted at the Department of Urology, the First Affiliated Hospital of Jinzhou Medical University, aimed to compare the efficacy of two surgical approaches for treating benign prostatic hyperplasia (BPH) with traditional transurethral resection of the prostate (TURP). From October 2021 to October 2023,128 BPH patients were divided into two groups: 64 underwent rapid transurethral sequential excision and reverse sequential excision combined with plasma excision equipment, while the other 64 underwent TURP. Results: The excision weight was higher, and intraoperative blood loss was lower in the group using plasma excision equipment compared to TURP. Additionally, this group experienced shorter procedure times, less bladder irrigation, catheterization duration, and shorter hospital stays (P < 0.05). Postoperative follow-up at three months revealed significant improvements in the International Prostate Symptom Score (IPSS) and Overactive Bladder Score (OABSS) in both groups, with greater improvement in the plasma excision equipment group (P < 0.05). At one- and three-months post-surgery, bladder function, urodynamics, and bladder compliance were compared between the groups. The plasma excision equipment group showed better bladder compliance and urinary flow rates than the TURP group, while residual urine volume was higher in the plasma excision equipment group (P < 0.05). Conclusion: rapid transurethral sequential excision and reverse sequential excision combined with plasma excision equipment demonstrated superior perioperative indicators, treatment efficacy, preservation of erectile function, and improvement in urodynamics compared to traditional TURP for BPH treatment.

PD41-01 TRENDS IN THE DIAGNOSTIC AND SURGICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA (BPH) IN THE UNITED STATES: ANNUAL CHANGES IN THE SELECTION OF TREATMENT OPTIONS AND AVERAGE COSTS DIFFERENTIAL FOR DIAGNOSTIC/SURGICAL TECHNIQUE

You have accessJournal of UrologyCME1 Apr 2023PD41-01 TRENDS IN THE DIAGNOSTIC AND SURGICAL MANAGEMENT OF BENIGN PROSTATIC HYPERPLASIA (BPH) IN THE UNITED STATES: ANNUAL CHANGES IN THE SELECTION OF TREATMENT OPTIONS AND AVERAGE COSTS DIFFERENTIAL FOR DIAGNOSTIC/SURGICAL TECHNIQUE Jin-Kyu Oh, Francesco Del Giudice, Eugenio Bologna, Vincenzo Asero, Carlo Maria Scornajenghi, Ettore De Berardinis, Alessandro Sciarra, Satvir Basran, Shufeng Li, Federico Belladelli, and Benjamin I. Chung Jin-Kyu OhJin-Kyu Oh More articles by this author , Francesco Del GiudiceFrancesco Del Giudice More articles by this author , Eugenio BolognaEugenio Bologna More articles by this author , Vincenzo AseroVincenzo Asero More articles by this author , Carlo Maria ScornajenghiCarlo Maria Scornajenghi More articles by this author , Ettore De BerardinisEttore De Berardinis More articles by this author , Alessandro SciarraAlessandro Sciarra More articles by this author , Satvir BasranSatvir Basran More articles by this author , Shufeng LiShufeng Li More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , and Benjamin I. ChungBenjamin I. Chung More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003346.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Transurethral resection of the prostate (TURP) is the gold standard treatment for benign prostatic hyperplasia (BPH). However, laser surgery techniques (e.g., photoselective vaporization of the prostate [PVP], holmium laser, thulium laser enucleation of the prostate [HoLEP or ThuLEP]), and minimally invasive treatment options (e.g., UroLift®) are increasingly replacing TURP. The aim of the study is to present the annual rates of BPH surgery and to analyze recent trends in the utilization of newer surgical modalities and any changes in medical costs related to these treatments over a 15-year period in the US. METHODS: Patient data was collected from the Optum Clinformatics® Data Mart Claims Database. Trends and distribution of surgical BPH techniques over the years of enrollment were analyzed across US regions. We then reviewed trends in adoption of diagnostic BPH methods including urodynamic studies, cystourethroscopy, transrectal ultrasound, prostatic biopsy, uroflowmetry, and the measurement of post-void residual urine volume (PVR). Finally, incidental diagnoses of prostate cancer (PCa) detected during BPH procedures were recorded over the years to depict the trends in PCa detection as well as median prostate specific antigen (PSA) values associated with BPH patients ultimately treated with a procedure. RESULTS: N=51,448 patients underwent BPH procedures from 2004 to 2017. There was a significant increase in the annual rate from 770 in 2004 to 6,571 in 2017. The mean patient age (±SD) increased from 67.6 years old (± 8.4) in 2004 to 73.4 years old (±8.4) in 2017. More than 60% of patients underwent cystourethroscopy and post-void residual urine check for workup prior to surgical management. TURP was the most common and PVP was the second most common BPH procedure. The total number of BPH diagnoses were 44,820 and the median cost for each procedure was $1459, $1875, $1419, and $3284 for TURP, PVP, HOLEP/ThULEP, Urolift, respectively. The median overall cost was $2471. With regard to the costs of treating BPH surgically, the diagnostic and treatment costs demonstrated annual increases while the detection rate of prostate cancer after BPH surgery gradually decreased from 19.87% in 2004 to 5.78% in 2017. CONCLUSIONS: We found recent trends in BPH management that demonstrates that alternative methods are starting to replace the traditional TURP technique, although TURP still remains the most common procedure. Future studies should assess whether these newer methods are both efficacious and cost effective over the long term. Of note, the cumulative incidence of PCa diagnosis was reduced over time, likely multifactorial in nature. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1058 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jin-Kyu Oh More articles by this author Francesco Del Giudice More articles by this author Eugenio Bologna More articles by this author Vincenzo Asero More articles by this author Carlo Maria Scornajenghi More articles by this author Ettore De Berardinis More articles by this author Alessandro Sciarra More articles by this author Satvir Basran More articles by this author Shufeng Li More articles by this author Federico Belladelli More articles by this author Benjamin I. Chung More articles by this author Expand All Advertisement PDF downloadLoading ...

Functional outcomes of GreenLight 180-W photoselective vaporization in patients with large (≥ 80cc) prostates: an analysis of over 3000 men in the Global Greenlight Group (GGG) database.

GreenLight photoselective vaporization of the prostate (PVP) has gained widespread adoption as an option to traditional transurethral resection of the prostate. Prior reports expressed concern with the use of PVP in large prostates.The aim of this study was to investigate the adjusted outcomes of GreenLight PVP in men with large (≥ 80cc) vs. small prostates (< 80cc). Data were obtained from the Global Greenlight Group which pools data from 7 high volume centers. Men with established benign prostatic hyperplasia who underwent GreenLight PVP using the XPS-180W system between 2011 and 2019 were eligible and assigned into two groups based on their prostate size (≥ 80 and < 80cc). 11 functional and perioperative covariates were collected.Analyses were adjusted for patient age and presence of median lobe. 3426 men met the inclusion criteria. 34.6% (n = 1187) of patients had a large prostate size. Baseline age and prostate volume were significantly different between the groups.The magnitude of absolute improvement in unadjusted international prostate symptom score was significantly greater in the large (≥ 80cc) prostate group at 12months, with an absolute change of 19.17 points (95% CI 18.46-19.88; p < 0.01). There was also a significant drop in PVR at both 6- (p = 0.007) and 12months (p = 0.005).Therewere no significant differences in transfusion (p = 0.42), hematuria (p = 0.80), or 30-day readmission rates (p = 0.28). Greenlight PVP is a safe and effective alternative for patients with prostate sizes ≥ 80cc, with durable outcomes relatively independent from prostate size.

Recent Trends in the Diagnostic and Surgical Management of Benign Prostatic Hyperplasia in the U.S. from 2004 to 2017: Annual Changes in the Selection of Treatment Options and Medical Costs

Background: Transurethral resection of the prostate (TURP) is the gold-standard treatment for benign prostatic hyperplasia (BPH). However, laser surgery techniques (e.g., photoselective vaporization of the prostate (PVP), holmium laser, thulium laser enucleation of the prostate (HoLEP or ThuLEP)), and minimally invasive treatment options (e.g., UroLift) are increasingly replacing TURP. This study seeks to report the annual incidence, management trends, and costs of BPH procedures in the U.S. Methods: Data analyses of U.S. health insurance claims from 2004 to 2017, collected from the de-identified Optum Clinformatics Claims Database, were performed to determine the number of BPH patients and the treatment selected. Results: A total of 51,448 patients underwent BPH procedures from 2004 to 2017. There was a significant increase in the annual rate from 770 in 2004 to 6571 in 2017. The mean patient age (±SD) increased from 67.6 years old (±8.4) in 2004 to 73.4 years old (±8.4) in 2017. More than 60% of patients underwent cystourethroscopy and a post-void residual urine check for workup prior to surgical management. TURP was the most-common, and PVP was the second-most-common BPH procedure. Medical and total treatment costs increased, while the detection rate of prostate cancer after BPH surgery gradually decreased from 19.87% in 2004 to 5.78% in 2017. Conclusions: Our study demonstrates a recent trend in BPH management that replaces the traditional TURP technique with alternative methods. Due to rising costs, future studies should assess whether these newer methods are cost effective over the long term.

Comparison of effectiveness and postoperative complications of different surgical methods in the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis based on randomized controlled trials.

BackgroundMore and more new surgical procedures for the treatment of benign prostate hyperplasia (BPH) are proposed creatively. However, the existing clinical evidence shows that the effectiveness and safety of various procedures exist inconsistent.MethodsThe randomized controlled trials comparing the international prostate score, length of hospital stay, maximum urinary flow rate, operation time, and complication rates of prostatic artery embolization (PAE), Greenlight-XPS Laser prostate vaporization procedure (GLL PVP), diode laser enucleation of prostate (DILEP) and plasmakinetic resection of the prostate (PKRP), transurethral resection of the prostate (TURP) in patients with BPH were screened out in databases. The primary outcome was pooled using a restricted maximum likelihood-based random-effect model and inverse variance-based fixed-effect model. Cochrane Q statistics and I2 statistics were computed to quantify between-study heterogeneity. The risk of bias of each included study was assessed using the revised Cochrane risk of bias tool.ResultsThis meta-analysis ultimately included 14 original research papers, with 1,940 participants enrolled. Eight studies were considered to be at moderate risk of bias, while the others were at mild risk of bias. Although the improvement in functional outcome of the DILEP procedure was equivalent to that of the PKRP procedure, the DILEP procedure group had fewer hospital stays than the PKRP group (P=0.01). In addition, even though the performance of the GLL PVP procedure in the improvement of functional outcome was inferior to the counterpart of TURP (P=0.64), it had a much fewer hospital stays (P=0.01). Moreover, there is still insufficient evidence for the improvement of subjective functional indicators of postoperative patients with PAE compared with TURP [international prostate symptom score (IPSS): P=0.73; IPSS QoL: P=0.91], but achieved less satisfactory objective functional outcomes (Qmax: P=0.06; PVR: P=0.00).DiscussionNew surgical procedures such as GLL PVP, PAE, and DILEP were safer than traditional TURP procedures. However, it is not superior to traditional surgery in the improvement of clinical symptoms. In clinical practice, the pros and cons of the new operation and the traditional operation should be carefully weighed, and the operation that is most suitable for the patient's condition should be selected.

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

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

Safety and efficacy of male urethral slings for management of persistent stress urinary incontinence after holmium laser enucleation of the prostate

Holmium laser enucleation of the prostate gland (HoLEP) is an alternative to the traditional transurethral resection of the prostate, especially for large-volume prostates. One complication is urinary incontinence, which is usually stress urinary incontinence (SUI). Little data exist on surgical interventions for SUI after HoLEP. This retrospective case series examined the safety and possible efficacy of a midurethral sling (MUS) following HoLEP. Between January 2016 and February 2019, 610 HoLEPs were performed at our institution. Three (0.5%) had persistent, overly bothersome symptoms of SUI. All three underwent MUS placement with a transobturator AdVance® male sling after failed pelvic floor rehabilitation. The degree of SUI was evaluated by pad use pre-HoLEP, post-HoLEP, and post-MUS placement. Surgical times for HoLEP and MUS were evaluated. No patients were using pads for incontinence before HoLEP. The average pad use was 7 post-HoLEP and 0.3 post-MUS. The average morcellated prostate was 48 g, and surgical time was 68 min (52 for enucleation and 15 for morcellation). No complications were reported with MUS placement intraoperatively or postoperatively. MUS for persistent and bothersome SUI after HoLEP shows promise as a safe and effective surgical option.

How to optimise urinary continence in anatomical endoscopic enucleation of the prostate?

The traditional transurethral resection of the prostate (TURP) is considered as gold-standard surgical treatment to relievesymptoms resultingfrom bladder outlet obstruction by prostate enlargement. However, with the advances of novel laser technologies and more experienced surgeon conquering the steep learning curve, anatomical endoscopic enucleation of prostate (AEEP) has become amore popular alternative surgical technique. Although AEEP has compatible functional outcome, less blood loss, shorter catheterisation duration and hospital stay, the risk of post-operative urinary incontinence (UI) is often an issue of concern. In this review, we focus on discussion about risk factors related to increased incidence of UI, some surgical tips to avoid damaging external urinary sphincter and treatment strategiesto facilitate recovery of urinary continence after surgery.

Clinical Case Review - First HoLEP using Lumenis. LTD patented MOSES technology at the First center in Iraq using the Lumenis. LTD high-power holmium laser system Pulse 120H with Moses technology

Introduction: In Iraq Dr. Duraid Alhadithi Urologist at Al_Andulus urology clinic, has introduced a Holmium Laser Enucleation of the Prostate (HoLEP) service as the gold standard for the treatment of Benign Prostatic Hyperplasia (BPH). Materials and Methods: The Al_Andulus urology clinic, Iraq, purchased the first Lumenis.LTD high power Holmium Laser Pulse 120H with Moses technology system and Dr. Duraid Alhadithi said ‘although we start using lasers in treating BPH lately, we decided to start from the top and nothing is better now than the Lumenis. LTD Pulse 120H with Moses technology for HoLEP’. The patient for this clinical case review is the 6th patient in the series of 10 treated using the HOLEP with MOSES technology technique at the Al_Andulus urology clinic, Iraq, he is a 68-year-old smoker, echocardiography study was good EJ F 58 with pre-clinical studies of; • IPSS 26 • QoL 6 • Q max 8ml/sec • PSA 2, 85 PSA is 2.85 ng/ml • Prostate size 75ml by abdominal ultrasound with a middle lobe. And the digital rectal examination was of a uniformly enlarged firm prostate, median sulcus intact with no hard nodules. Results: The patient had an operation time 75 minutes including 10 minutes of Morcellation with no significant blood loss and no drop-in hematocrit a hospital stay of 18 hours total with catheter removal early in morning and the patient passed urine twice before discharge. Conclusion: In conclusion Dr. Duraid Alhadithi Urologist at Al_Andulus urology clinic, Iraq ‘After this surgery I believe that HOLEP with MOSES technology using the Lumenis.LTD Pulse 120H Holmium Laser System will be the gold standard method in treating prostates in Iraq due to many factors including minimal bleeding, minimal need for bladder irrigation post operatively, rapid recovery, early removal of catheter, and complete resection of the prostate gland comparing to traditional Trans Urethral Resection of the Prostate (TURP)’.

Thulium laser VapoResection of the prostate versus traditional transurethral resection of the prostate or transurethral plasmakinetic resection of prostate for benign prostatic obstruction: a systematic review and meta-analysis.

To compare the efficacy and safety of thulium laser VapoResection of the prostate (ThuVaRP) versus standard traditional transurethral resection of the prostate (TURP) or plasmakinetic resection of prostate (PKRP) for benign prostatic obstruction. Systematic searches were performed in the Medline, EMBASE, the Cochrane Library, Web of Science, and CNKI in December 2017. The outcomes of demographic and clinical characteristics, perioperative variables, complications, and postoperative efficacy including International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and postvoid residual (PVR) were assessed. 16 studies were selected in the meta-analysis including nine randomized controlled trials (RCTs) and seven non-RCTs. Among of them, nine studies compared ThuVaRP with PKRP, while seven studies compared ThuVaRP with TURP. It seemed that ThuVaRP needed longer operation time than TURP (WMD = 6.41, 95% CI 1.38-11.44, p = 0.01) and PKRP (WMD = 10.15, 95% CI 5.20-15.10, p < 0.0001). ThuVaRP was associated with less serum hemoglobin decreased, catheterization time, and the length of hospital stay compared with TURP (WMD = - 0.58, 95% CI - 0.77 to 0.38, p < 0.00001; WMD = - 1.89, 95% CI - 2.67 to 1.11, p < 0.00001; WMD = - 2.25, 95% CI - 2.91 to 1.60, p < 0.00001) and PKRP (WMD = - 0.28, 95% CI - 0.46 to 0.10, p = 0.002; WMD = - 1.88, 95% CI - 2.87 to 0.89, p = 0.0002; WMD = - 2.08, 95% CI - 2.63 to 1.54, p<0.00001). According to our assessment, there was no significantly difference in postoperative efficacy. The pooled data indicated that ThuVaRP had a nearly efficacy to TURP and PKRP based on IPSS, QoL, Qmax, and PVR. Although ThuVaRP was associated with longer operation time, it got distinct superiority on serum hemoglobin decreased, catheterization time, and hospital stay.

MP62-17 EIGHTEEN YEARS OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE: A SINGLE CENTER EXPERIENCE

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I1 Apr 2018MP62-17 EIGHTEEN YEARS OF HOLMIUM LASER ENUCLEATION OF THE PROSTATE: A SINGLE CENTER EXPERIENCE Ahmed Ibrahim, Mohannad Alharbi, Mostafa Elhilali, and Serge Carrier Ahmed IbrahimAhmed Ibrahim More articles by this author , Mohannad AlharbiMohannad Alharbi More articles by this author , Mostafa ElhilaliMostafa Elhilali More articles by this author , and Serge CarrierSerge Carrier More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2018AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Meta-analyses and randomized trials have confirmed how well established holmium laser enucleation of the prostate (HoLEP) for treatment of benign prostatic hyperplasia (BPH). HoLEP showed superior efficacy compared to the traditional transurethral resection of the prostate. The aim of the present study was to report our experience with long-term outcomes of HoLEP over a period of 18 years. METHODS between March 1998 and March 2016, a prospectively collected database for patients undergoing HoLEP for symptomatic BPH performed by a single surgeon was reviewed. Demographic and perioperative data were collected together with the International Prostate Symptoms Score (IPSS), Quality of Life (QoL), peak flow rate (Qmax), residual urine (PVR), and prostate specific antigen (PSA) changes. In addition, perioperative and late adverse events were recorded. RESULTS Demographic and perioperative data are presented in table 1. After a mean follow-up of 11.2 years (2-18 years), 1455 patients were included with a mean age of 68.9 ( 53- 86) years. The mean catheter time and hospital stay were 1.2 and 1.3 days, respectively. Intraoperatively, no patient needed blood transfusion. Urethral stricture and bladder neck contracure were encountered in 21 (1.4%) and 30(2.1%) patients, respectively while 21 (1.4%) patinets needed redo HoLEP for regrowth of obstructing adenoma (Table 1). Regarding the long-term functional outcomes, there were significant differences between baseline and post-operative values of PSA, IPSS, QoL, Qmax, and PVR (p<0.001) (Table 2). CONCLUSIONS Holmium laser enucleation of the prostate is safe, effective and durable for benign prostatic hyperplasia over long-term follow-up. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e838-e839 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Ahmed Ibrahim More articles by this author Mohannad Alharbi More articles by this author Mostafa Elhilali More articles by this author Serge Carrier More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Photoselective Vaporesection of the Prostate with an End-firing Lithium Triborate Crystal Laser.

Background:Photoselective vaporization of the prostate is a technique that is widely used for the treatment of benign prostatic hyperplasia (BPH) and has pronounced advantages compared to the traditional transurethral resection of the prostate. Following the recent introduction of end-firing lithium triborate lasers, we have created a new technique called photoselective vaporesection of the prostate (PVRP). This study described our initial experience using the PVRP technique for the treatment of BPH.Methods:This prospective study included a total of 35 patients with BPH who underwent PVRP from August 2013 to July 2014. The chief clinical parameters were obtained and evaluated during the perioperative period and follow-up, including the International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum urinary flow rate, and prostate volume. All variables were evaluated for statistically significant differences compared to baseline values using the analysis of variance.Results:The mean subgroup IPSS and QoL scores significantly improved during follow-up; the respective decreases in IPSS storage score, IPSS voiding score, IPSS nocturia score, and QoL score were 75.3%, 83.6%, 51.4%, and 71.7%, respectively (all P < 0.001 compared with baseline). Three patients were diagnosed with prostate cancer based on postoperative pathological examinations. There were no serious perioperative complications.Conclusion:The PVRP technique demonstrates satisfactory short-term clinical outcomes and perioperative safety in the treatment of BPH.

Trends in the surgical treatment of benign prostatic hyperplasia in a tertiary hospital

To assess current treatment trends and perioperative outcomes of transurethral resection of the prostate (TURP) and photoselective vaporization of the prostate (PVP) in a tertiary institution. We prospectively collected a database of all patients undergoing TURP and PVP for benign prostatic hyperplasia (BPH) at a tertiary hospital between January 2011 and December 2013. Patient characteristics such as length of stay, readmission, anticoagulation status, American Society of Anesthesiologists (ASA) score and need for blood transfusion were recorded and analysed. In total, 560 cases were included: 204 (36.4%) underwent TURP and 356 (63.6%) PVP. Patients undergoing PVP had higher ASA scores (P < 0.001) and were more frequently on continuing anticoagulant therapy (P < 0.001). With regards to non-aspirin/asasantin coagulation therapy, 61 (17.1%) patients underwent PVP with their anticoagulants continued while no patients who received TURP continued anticoagulation. Blood transfusion percentages were similar at 1.0% for TURP and 1.7% for PVP but readmission proportions were higher after PVP (32 patients, 9.0%) compared to TURP (10 patients, 4.9%). These differences were attenuated when excluding patients continuing anticoagulation during the procedure. At our institution, the use of PVP has been increasing on a year-by-year basis. The results of the current study demonstrated that PVP is safe in patients with increased anaesthetic risk or on active anticoagulation when compared to traditional TURP. While this makes PVP an attractive alternative to TURP in high-risk anticoagulated patients, these patients may have complex post-discharge issues that should be addressed during the informed consent process.

Analysis of Transurethral Resection of the Prostate Costs across New York State Hospitals Using Severity of Illness Score

IntroductionUsing data on surgical treatment for benign prostatic hyperplasia we evaluated the effect of beneficiary health status on hospital reported costs. MethodsWe examined the records of 9,895 patients in the New York State Hospital Inpatient Cost Transparency database who underwent surgical treatment for benign prostatic hyperplasia, including laser prostatectomy and traditional transurethral resection of the prostate, in New York State from 2009 to 2011. ResultsUsing the 3M™ APR-DRG (All Patient Refined Diagnosis Related Group) severity of illness index as a measure of patient preoperative health we found a significant increase in the cost of transurethral resection of the prostate for patients with higher severity of illness scores. We confirmed an increase in the cost and the cost variability of transurethral resection of the prostate for patients with higher severity of illness scores. ConclusionsOur findings illustrate the inherent unpredictability of cost forecasting and budgeting for these patients.

Evaluation of continence following 532 nm laser prostatectomy for patients previously treated with radiation therapy or brachytherapy

Urinary complications such as bladder outlet obstruction or urinary retention following radiation therapy or brachytherapy have been reported in up to 15% of men. When conservative therapy has failed, surgical intervention with transurethral resection of the prostate (TURP) may be performed, but carries a significant risk of incontinence, ranging from 18% to 70% in reported literature. We reviewed a cohort of men previously treated with radiation or brachytherapy, who underwent laser prostatectomy. From February 2004 to October 2011, 12 patients (Six = brachytherapy and Six = external beam radiation) underwent 532 nm GreenLight™ laser prostatectomy by a single surgeon (BBC) for chronic retention or debilitating obstructive symptoms. Preoperative, intraoperative, and postoperative parameters were collected prospectively and reviewed retrospectively. Statistical analysis was performed with a Wilcox Rank sum test with significance defined as P < 0.05. The median patient age was 77.4 (Interquartile range (IQR) 73.9, 79.1). Prior to surgery, five patients were catheter dependent. Intraopertively, the median operative time was 48 minutes (IQR 35, 67); median lasing time was 28 minutes (IQR 23, 44); median Joules used was 126,873 (IQR 95,030, 222,336) J. Postoperative median follow up was 22.9 (IQR 13.4, 41.7) months. Significant improvements were noted in IPSS, QoL scores, PVR, and Qmax after PVP treatment. At 12 months, the median decrease in IPSS, QoL scores, and PVR was 15 (IQR 14.5, 22) to 10 (IQR 5.5, 13.5), 5 (IQR 3.5, 5) to 2 (IQR 1, 3.5), 200 (IQR 171, 327.5) to 5 (IQR 1.25, 8), respectively (P < 0.05 for all). Similarly, at 12 months, the median increase in Qmax (ml/second) was 4 (IQR 3, 10) to 15.9 (IQR 11, 16) (P = 0.04). There were no reportable complications at 12 months. None of the 12 patients that underwent 532 nm GreenLight™ laser prostatectomy developed stress urinary incontinence. One patient developed metastatic prostate cancer and the remaining patients had no evidence of biochemical recurrence. In this pilot study, 532 nm GreenLight™ laser prostatectomy is feasible and safe in patients who have undergone prior radiotherapy for prostate cancer. Laser prostatectomy provides a durable response while maintaining continence in this cohort suffering from severe lower urinary tract symptoms (LUTS) or retention. Larger, randomized trials comparing GreenLight™ laser prostatectomy to traditional TURP are necessary to confirm non-inferiority.

Thulium laser vaporesection versus standard transurethral resection of the prostate: A randomized trial with transpulmonary thermodilution hemodynamic monitoring

To characterize the hemodynamics comparing thulium laser vaporesection of the prostate with traditional transurethral resection of the prostate. A total of 80 consecutive patients with benign prostatic hyperplasia were randomly assigned into the thulium laser vaporesection of the prostate group or transurethral resection of the prostate group. Transpulmonary thermodilution hemodynamic monitoring was used before and 1 h after surgery to assess patient hemodynamics. Acute complications and treatment efficiency were evaluated after surgery. There were no statistical differences in age, prostate volume, anticoagulants and International Prostate Symptom Score between the two groups. The postoperative Stroke Volume Index was significantly higher in the thulium laser vaporesection of the prostate group (P = 0.007). The extravascular lung water and intrathoracic blood volume indices differed significantly pre- and postoperatively, and were similar in both groups. Decreases in serum sodium and hemoglobin concentrations after surgery were lower in the thulium laser vaporesection of the prostate group (P < 0.01). Acute complications, and improvements in International Prostate Symptom Score and maximum urinary flow rates, were similar in both groups. Transpulmonary thermodilution hemodynamic monitoring provides additional safety measures during surgical procedures. Thulium laser vaporesection of the prostate is associated with fewer hemodynamic changes and provides similar efficacy to transurethral resection of the prostate. Thus, it can be considered a safe and effective procedure.

Population Based Trends in the Surgical Treatment of Benign Prostatic Hyperplasia

Laser prostatectomy has increased in popularity in the last decade. However, traditional transurethral resection of the prostate remains common. To understand decisions about the use of laser prostatectomy vs transurethral prostate resection, we evaluated trends in transurethral surgery for benign prostatic hyperplasia in an all payer data set, focusing on patient and provider factors associated with the receipt of laser prostatectomy. Using Florida State Inpatient Database and Ambulatory Surgery Database, we identified patients who underwent laser prostatectomy or transurethral prostate resection from 2001 to 2009. We calculated surgery rates with time, stratified by procedure type. We used multilevel regression to examine patient (age, race and comorbidity level) and provider (surgeon volume) factors associated with the receipt of laser prostatectomy vs transurethral prostate resection. While the overall rates of transurethral surgery remained stable during the study period (p = 0.227), laser prostatectomy use increased 400% from 25 to 114 procedures per 100,000 men (p <0.001), replacing about half of all transurethral prostate resections. Patients were less likely to undergo laser prostatectomy if they were older (OR 0.65, 95% CI 0.61-0.70) and less healthy (OR 0.48, 95% CI 0.45-0.51). While these factors were predictive of surgery type, most of the variation in laser prostatectomy use (69%) was determined by the urologist seen by the patient. Laser prostatectomy use has increased in the last decade at the expense of transurethral prostate resection, driven largely by provider effects. However, elderly and more infirm patients are least likely to undergo it, raising concern about underuse in this population.

1974 POPULATION BASED TRENDS IN THE SURGICAL TREATMENT OF BENIGN PROSTATIC HYPERPLASIA

Purpose: Laser prostatectomy has increased in popularity in the last decade. However, traditional transurethral resection of the prostate remains common. To understand decisions about the use of laser prostatectomy vs transurethral prostate resection, we evaluated trends in transurethral surgery for benign prostatic hyperplasia in an all payer data set, focusing on patient and provider factors associated with the receipt of laser prostatectomy.Materials and Methods: Using Florida State Inpatient Database and Ambulatory Surgery Database, we identified patients who underwent laser prostatectomy or transurethral prostate resection from 2001 to 2009. We calculated surgery rates with time, stratified by procedure type. We used multilevel regression to examine patient (age, race and comorbidity level) and provider (surgeon volume) factors associated with the receipt of laser prostatectomy vs transurethral prostate resection.Results: While the overall rates of transurethral surgery remained stable during the stu...

The impact of minimally invasive surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function: a systematic review

A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for the effects of minimally invasive procedures for treatment of symptomatic benign prostatic hyperplasia (BPH) on male sexual function. The studies searched were trials that enrolled men with symptomatic BPH who were treated with laser surgeries, transurethral microwave therapy (TUMT), transurethral needle ablation of the prostate (TUNA), transurethral ethanol ablation of the prostate (TEAP) and high-intensity frequency ultrasound (HIFU), in comparison with traditional transurethral resection of the prostate (TURP) or sham operations. A total of 72 studies were identified, of which 33 met the inclusion criteria. Of the 33 studies, 21 were concerned with laser surgeries, six with TUMT, four with TUNA and two with TEAP containing information regarding male sexual function. No study is available regarding the effect of HIFU for BPH on male sexual function. Our analysis shows that minimally invasive surgeries for BPH have comparable effects to those of TURP on male erectile function. Collectively, less than 15.4% or 15.2% of patients will have either decrease or increase, respectively, of erectile function after laser procedures, TUMT and TUNA. As observed with TURP, a high incidence of ejaculatory dysfunction (EjD) is common after treatment of BPH with holmium, potassium-titanyl-phosphate and thulium laser therapies (> 33.6%). TUMT, TUNA and neodymium:yttrium aluminum garnet visual laser ablation or interstitial laser coagulation for BPH has less incidence of EjD, but these procedures are considered less effective for BPH treatment when compared with TURP.

Bipolar transurethral resection in saline vs traditional monopolar resection of the prostate: results of a randomized trial with a 2‐year follow‐up

To present 2-year follow-up data of a randomized clinical trial comparing bipolar transurethral resection in saline (TURIS) with monopolar transurethral resection of the prostate (TURP). In all, 100 consecutive patients with benign prostatic hyperplasia (BPH) were randomized to TURIS or TURP. The breath ethanol test was used before and every 10 min during surgery to assess fluid absorption. Complications and treatment efficacy were evaluated after surgery. The operative duration and resected tissue weight were similar between the groups. The mean decreases in serum sodium and haemoglobin after surgery were significantly less in the TURIS group. The mean (standard deviation) irrigant absorbed was significantly less in TURIS than in the TURP group, at 208 (344) mL vs 512 (706) mL respectively (P < 0.001). In both the TURIS and TURP groups there were significant improvements in International Prostate Symptoms Scores and maximum urinary flow rates. The acute and late complications in the groups were statistically similar. Bipolar TURIS seems to be a safe and effective procedure, which is associated with significantly less fluid absorption and similar efficacy as traditional monopolar TURP.