Diode Laser Vaporization for Benign Prostate Hyperplasia: Outcome After 126 Procedures.

Purpose: Photoselective vaporization of the prostate (PVP) with a 940-nm diode laser is an option for treating symptoms caused by benign prostatic hyperplasia (BPH). Here, we present our experience using this technology. Methods: We prospectively evaluated 126 patients with lower urinary tract symptoms (LUTS) secondary to BPH who underwent PVP with a 940-nm diode laser from January 2011 to January 2014. The patients were assessed using the International Prostate Symptom Score (IPSS), quality of life (QoL) score, prostate-specific antigen (PSA) level, maximum urinary flow (Qmax) by uroflowmetry, postvoid residual volume, and prostate volume by ultrasound at baseline and 3, 6, 12, and 24 months after the procedure. Results: The average patient age was 68.8 ± 8.7 years (range 48-90 years), whereas the average preoperative parameters were as follows: IPSS, 26.1 ± 5.2; IPSS-QoL, 4.9 ± 0.8; Qmax, 4.5 ± 3.1 mL/s; prostate volume, 76.5 ± 35.5 mL; and PSA level, 3.9 ± 2.6 ng/mL. The average catheterization time was 24.7 ± 25.5 hours (range 3-120 hours), and the length of hospital stay was 22.4 ± 17.0 hours (range 8-144 hours). The mean follow-up duration was 17.9 months (range 1-36 months). All parameters showed significant improvement after 12 months. After 24 months, the IPSS (8.8 ± 5.4, p < 0.07), IPSS-QoL (1.6 ± 0.9, p < 0.13), Qmax (15.9 ± 7.3 mL/s, p < 0.11), and PSA level (1.2 ± 0.8 ng/mL, p < 0.11) were improved compared with the baseline, but the difference was not significant, probably due to the small number of patients evaluated in this period. No patients required a transfusion. Conclusions: The results suggest that PVP with a 940-nm diode laser is safe, effective, and durable for the treatment of LUTS secondary to BPH. The patients continue to be monitored for evaluation of the long-term results. A prospective randomized study would allow more solid conclusions regarding the technology to be reached.

Reduction in Renal Specimen After Laparoscopic Radical Nephrectomy: A Histopathologic Analysis.

Abstract Background and Purpose: There is no consensus on the most appropriate way to extract the kidney after laparoscopy. A previous study evaluated the reduction in total kidney volume and incision size (40%) after perfusion with a 5% hypertonic solution in a porcine model. The purpose of the current study was to compare the histopathologic renal tumor diagnosis before and after this perfusion. Furthermore, fluid drained from the renal vein was analyzed for the presence of neoplastic cells. Materials and Methods: After radical nephrectomy, specimens of 21 cases of renal tumors were studied. A small piece of the tumor was removed and fixed in formaldehyde. After that, 500 mL of a 5% NaCL solution was infused through the renal artery. The first 10 mL drained from the vein was collected and sent for cytologic study. The specimens and the fragment were analyzed. The parameters studied were histologic subtypes, Fuhrman grade, necrosis, and microvascular invasion. Results: Clear-cell renal carcinoma was found in 81% of the cases. Two cases of chromophobic renal carcinoma, one case of papillary tumor, and one case of oncocytoma were found. There were no differences in histologic subtypes, Fuhrman grade, necrosis, and microvascular invasion before and after perfusion in most of the cases. All cytologic analysis of drained liquid from the renal vein was negative for neoplastic cells. Conclusions: Renal perfusion with 5% NaCL solution after laparoscopic radical nephrectomy did not interfere with the histopathologic and cytologic characteristics of the kidney. In addition, all samples from the liquid drained from the renal vein were negative for neoplastic cells. These findings suggest that renal shrinkage with hypertonic saline after laparoscopic radical nephrectomy is feasible and might be useful for patients with kidney cancer. Validation of our results as well as their impact on clinical outcomes is warranted.