Enhancing continence post holmium laser enucleation of the prostate: assessment of novel technique through randomized clinical trial.

BACKGROUND: Transient urinary incontinence (UI) is distressing event following holmium laser enucleation of the prostate (HoLEP). Novel technique namely, veil sparing HoLEP (VS-HoLEP), was proposed to improve early continence outcome. In this trial (NCT03494049), VS-HoLEP was compared to standard HoLEP (St-HoLEP). METHODS: VS-HoLEP entails early apical separation with sparing of ventral apical mucosal veil proximal to the verumontanum. Eligible symptomatic BPH patients were randomly allocated to St-HoLEP (91) and VS-HoLEP (89). The primary outcome was UI as depicted by one-hour pad test at one month postoperatively. Other outcome measures include all perioperative parameters, complications, and urinary outcome measures at different follow-up points. RESULTS: Median preoperative prostate size was 138 (50:282) and 128 (50:228) mL in St-HoLEP and VS-HoLEP groups respectively. At one month the number of patients with positive one-hour pad test was 21 (23.1%) and 10 (11.4%) in St-HoLEP and VS-HoLEP groups respectively (P 0.047). The difference was significantly in favor of VS-HoLEP considering the number of patients reporting UI, the number of patients with positive one-hour pad test as well as the grade of UI reported at one and 4 months. The difference was not statistically significant at 12 months. The median time to patients' reported continence was 8 (1-52) and 1.5 (1-52) weeks in St-HoLEP and VS-HoLEP groups respectively (P≤0.005). The technique independently predicted positive one-hour pad test at one and four months respectively. At twelve months presence of DM (diabetes mellitus) and more percent PSA reduction independently predicted positive one-hour pad test. CONCLUSIONS: Veil sparing HoLEP enhances significantly early postoperative urine continence both subjectively and objectively. Optimization of the surgical technique could cut short the number of leaking patients and reduce the degree as well as the duration of transient postoperative urine leak.

Comparison of Long-term Effect and Complications Between Holmium Laser Enucleation and Transurethral Resection of Prostate: Nations-Wide Health Insurance Study.

OBJECTIVE: To investigate and compare the postoperative efficacy and complications of the transurethral resection of prostate (TURP) and holmium laser enucleation (HoLEP) using the nationwide insurance database of Korea. METHODS: We created a cohort of benign prostatic hyperplasia (BPH) patients treated with TURP and HoLEP between 2011 and 2017 from the nationwide database of reimbursement. We compared the postoperative effects between the two surgical groups. RESULTS: We retrieved a total of 58,346 patients (TURP 38,308 and HoLEP 20,038 patients). The mean follow-up duration was 51.6 and 47.6 months, respectively. The rate of reoperation was significantly higher in the TURP group (4.50%) than in the HoLEP group (1.27%) (P < .01). The postoperative use of alpha-blockers and dutasteride/finasteride was significantly higher in the TURP group until 24 months postoperatively. The rate of the postoperative use of medications for symptoms of overactive bladder was lower in the TURP group than in the HoLEP group until 12 months postoperatively, but it did not differ after 12 months postoperatively. Overall, urethral surgeries were less frequently performed in the TURP group than in the HoLEP group (P < .05); however, more severe cases required surgeries under general anesthesia in the TURP group (P < .05). Postoperative surgery for stress incontinence was performed in 0.10% and 0.31% of patients after TURP and HoLEP, respectively (P < .01). CONCLUSION: This study showed the superiority of HoLEP compared to TURP in terms of postoperative efficacy and its inferiority in terms of complications of stress incontinence in real life practice.

Stimulation of collagen and elastin production in-vivo using 1,540 nm Er:Glass laser: assessment of safety and efficacy.

Introduction: Induction of collagen and elastin remodeling in the human skin can be achieved by non-ablative fractional laser (NAFXL) and ablative fractional laser (AFXL). Our objective was to compare the safety, efficacy, tolerability, and ability to induce collagen and elastin remodeling of NAFXL versus AFXL in a series of treatments over time.Materials and Methods: In this prospective, proof of principle, single-case study, the safety, tolerability and efficacy of the laser systems were assessed via histopathology and clinical evaluations including photographs. Optical biopsies by means of multiphoton tomography (MPT) were used to evaluate the induction of collagen and elastin remodeling.Results: Treatments by both NAFXL and AFXL were well tolerated. The NAFXL system was found to be less painful and resulted in a shorter down- and healing times. MPT findings showed the superior capability of the AFXL procedure to induce collagen; on the other hand, elastin induction was more pronounced after NAFXL treatments.Conclusions: While NAFXL is as effective and safe as the traditional AFXL, it is better tolerated and has a shorter downtime. Serial optical biopsies over time over time can be a useful tool to assess the induction of collagen and elastin remodeling in the human skin.

Retrospective Assessment of Endoscopic Enucleation of Prostate Complications: A Single-Center Experience of More Than 1400 Patients.

Introduction: Endoscopic enucleation of the prostate (EEP) is a safe method of treating benign prostatic hyperplasia, regardless of prostate volume and type of applied energy. To date, however, there has been no study that examines complication rates with respect to the type of applied energy. This study aims to address this problem by providing a retrospective analysis of >1400 patients who have undergone prostate enucleation. Materials and Methods: We performed a retrospective analysis of all patients undergoing EEP between 2013 and 2018 at a single tertiary institution. This analysis included patients who had undergone one of three forms of EEP: holmium laser enucleation of the prostate (HoLEP), thulium fiber laser enucleation of the prostate (ThuFLEP), or monopolar enucleation of the prostate (MEP). We compared intraoperative and early postoperative complications, as well as complications at 3 and 6 months follow-up. Results: A total of 1413 patients were included in this study; 36% patients underwent HoLEP, 57.5% had ThuFLEP, and 6.5% MEP. The most frequent complication in the early postoperative period was a mild fever (2.76% of the cases). The morcellation was delayed to a separate stage because of intensive hemorrhaging in 1.4% of the cases. Bladder tamponade was found in 1.1% of the cases. We found no correlation between complication rate and either prostate volume or energy source. Stress urinary incontinence was found in 3.9% of patients at 3 months and in only 1.4% of patients at 6 months after the operation. Urethral stricture at 6 months after the surgery was found in 1.4% of patients, whereas bladder neck sclerosis was found in only 0.9% of these cases. No significant difference was observed between these complication frequencies and any preoperative factors or energy source. Conclusions: All EEP types are safe with equal rates of complications intraoperatively, postoperatively, and at 6 months follow-up.

Ejaculatory Hood Sparing versus Standard Laser Photoselective Vaporization of the Prostate: Sexual and Urodynamic Assessment through a Double Blinded, Randomized Trial.

PURPOSE: In a preliminary clinical trial we assessed the efficacy of ejaculatory hood sparing GreenLight™ Laser prostate photoselective vaporization to preserve antegrade ejaculation and urodynamic relief of obstruction compared to standard GreenLight prostate photoselective vaporization. MATERIALS AND METHODS: Standard prostate photoselective vaporization was classically performed in 24 patients. Ejaculatory hood sparing vaporization was performed with preservation of the paracollicular and supracollicular tissue proximal to the verumontanum in 25 patients. Patients were assessed at baseline, and 1, 3, 6 and 12 months postoperatively using the Ej-MSHQ (Ejaculatory Domain of Male Sexual Health Questionnaire) and the IIEF-15 (International Index of Erectile Function-15). The I-PSS (International Prostate Symptom Score), uroflowmetry and post-void residual urine volume were reported at each followup visit. A standard urodynamic study was performed at 6 months. RESULTS: Antegrade ejaculation was reported in 85% and 31.6% of patients after hood sparing and standard prostate vaporization, respectively (p=0.001). A significant reduction in the EJ-MSHQ score was reported after standard vaporization at 6 and 12 months (each p <0.001) with no significant difference after hood sparing vaporization (p=0.18 and 0.078, respectively). The median EJ-MSHQ score was 28.5 (range 1 to 33) and 27 (range 1 to 33) for hood sparing vaporization, and 9.5 (range 1 to 35) and 9 (range 0 to 33) for standard vaporization at 6 (p=0.005) and 12 months (p <0.001), respectively. Each group showed a decline in the mean total IIEF-15 score at 1 year but it was statistically significant only after standard vaporization (p=0.001). All urinary outcome measures revealed comparable significant improvement at all followups. Postoperative urodynamic assessment demonstrated a significant comparable decrease in the Bladder Outlet Obstruction Index from a median of 64 (range 21 to 207) to 23.5 (range 10 to 53) after hood sparing vaporization (p=0.005) and from 87 (range 38 to 186) to 19.5 (range 7 to 51) after standard vaporization (p=0.001). At 1 year the overall re-treatment rate was comparable in the 2 groups (p=0.26). CONCLUSIONS: In well informed, sexually interested patients ejaculatory hood sparing GreenLight prostate photoselective vaporization is feasible and effective treatment of small to moderate sized benign prostatic hyperplasia with a superior sexual function related outcome. Short-term relief of obstruction is objectively comparable to that of standard prostate photoselective vaporization.

Inverted internal limiting membrane flap technique and an autologous platelet concentrate to treat an Nd: YAG laser-induced macular hole: A case report.

RATIONALE: Nd:YAG laser-induced macular holes (MHs) feature more extensive anatomical defects and worse functional outcomes than idiopathic MHs. Although new treatment options for large refractory MHs have been suggested, the current literature on Nd:YAG laser-induced MHs suggests only conventional pars plana vitrectomy combined with internal limiting membrane (ILM) peeling, which is the same treatment as for idiopathic MHs. PATIENT CONCERNS: A 40-year-old dermatologist was referred to us because of a sudden decrease in visual acuity following exposure to a floor-tile-reflected single-shot Nd:YAG laser beam while not wearing protective goggles. DIAGNOSES: An Nd:YAG laser-induced MH was diagnosed based on fundoscopy and optical coherence tomography (OCT). INTERVENTIONS: Pars plana vitrectomy using an inverted ILM flap technique and autologous platelet concentrate (APC) was performed. OUTCOMES: Postoperative spectral domain OCT and en-face OCT showed "U-shaped" closure of the MH and a decreased ellipsoid zone defect, while the best-corrected visual acuity improved from 20/500 to 20/25. LESSONS: The inverted ILM flap technique combined with APC is an effective option to achieve successful MH closure and visual improvement in patients with an Nd:YAG laser-induced MH.

Assessment of skin lesions produced by focused, tunable, mid-infrared chalcogenide laser radiation.

BACKGROUND: Traditionally, fractional laser treatments are performed with focused laser sources operating at a fixed wavelength. Using a tunable laser in the mid-infrared wavelength range, wavelength-dependent absorption properties on the ablation process and thermal damage formation were assessed with the goal to obtain customizable tissue ablations to provide guidance in finding optimized laser exposure parameters for clinical applications. METHODS: Laser tissue experiments were carried out on full thickness ex vivo human abdominal skin using a mid-infrared tunable chromium-doped zinc selenide/sulfide chalcogenide laser. The laser has two independent channels: a continuous wave (CW) output channel which covers a spectrum ranging from 2.4 µm to 3.0 µm with up to 9.2 W output power, and a pulsed output channel which ranges from 2.35 µm to 2.95 µm. The maximum pulse energy of the pulsed channel goes up to 2.8 mJ at 100 Hz to 1,000 Hz repetition rate with wavelength-dependent pulse durations of 4-7 ns. RESULTS: Total ablation depth, ablation efficiency, and coagulation zone thickness were highly correlated to wavelength, pulse width, and pulse energy. Using the same total radiant exposure at 2.85 µm wavelength resulted in 10-times smaller coagulation zones and 5-times deeper ablation craters for one hundred 6 ns pulses compared to one 100 ms pulse. For a fixed pulse duration of 6 ns and a total radiant exposure of 2.25 kJ/cm2 the ablation depth increased with longer wavelengths. CONCLUSION: The tunable laser system provides a useful research tool to investigate specific laser parameters such as wavelength on lesion shape, ablation depth and thermal tissue damage. It also allows for customization of the characteristics of laser lesions and therefore facilitates the selection of suitable laser parameters for optimized fractional laser treatments. Lasers Surg. Med. 50:961-972, 2018.© 2018 Wiley Periodicals, Inc.

The clinical effectiveness and cost-effectiveness of fractional CO2 laser in acne scars and skin rejuvenation: A meta-analysis and economic evaluation.

INTRODUCTION: Fractional CO2 has many indications in medicine including in treatment of acne scars and rejuvenation. The aim of this study was to evaluate the safety, efficacy, and cost-effectiveness of Fractional CO2 Laser in comparison with other methods of rejuvenation and acne scar treatment. MATERIALS AND METHODS: Several databases including Medline, OVID, EMBASE, CINHAL, SCOPUS, Web of science, CRD, and Cochrane were searched. After conducting the search and evaluation of selected publications, critical appraisal was done and eligible studies were accepted for inclusion in the systematic review. RESULTS AND DISCUSSION: From 2667 identified publications two of the trials were eligible. The effectiveness and complications of Fractional CO2 laser were comparable with Er:YAG but Fractional CO2 laser was 14.7% (p = 0.01) more effective than Q-Switched ND:YAG laser. Cost affectivity of this method was the same as other alternative lasers. In conclusion Fractional CO2 laser is an effective and safe method for curing of several kinds of skin diseases. Nevertheless there was not sufficient evidence to support its advantage. This device has equal or lower price in comparison to competent technologies except for the non- fractional ablative CO2 laser that has the same or lower price and comparable effects.

Histological Gingival Assessment after Conventional and Laser Gingivectomy.

BACKGROUND: Gingivectomy is a procedure often performed in everyday clinical practice using numerous instruments. AIM: To evaluate and compare the gingival cut surface after gingivectomy with 6 different surgical instruments - a surgical scalpel, an Er:YAG laser, a CO2 laser, a ceramic bur, an electrocautery device, and a diode laser. MATERIALS AND METHODS: Gingivectomy using the above listed instruments was performed in 18 patients. The histological samples excised with a surgical scalpel were assigned as a control group and the other five types - as test groups. The following histological parameters were measured: coagulation layer thickness (in µm); presence or absence of a microscopic rupture and presence or absence of hemostasis in-depth. RESULTS: The best instrument of the above listed ones which demonstrated excellent results is the CO2 laser. The Er:YAG laser has a thin coagulation layer and lack of hemostasis in-depth. The diode laser has the widest coagulation layer which is an advantage from a clinical point of view. Electrocautery proved to be as effective as the diode laser, but it should not be used around metal restorations. The ceramic bur has less pronounced hemostasis in-depth. CONCLUSIONS: Modern dentistry uses a wide variety of methods that are designed to be applied in everyday practice. Good knowledge of the ways to use them, their advantages and disadvantages is essential to obtaining the optimal result depending on the clinical case.

Focal choroidal excavation and a traumatic macular hole secondary to accidental Q-switched Nd:YAG laser.

Today, the widespread use of laser instruments in various fields has resulted in many accidental retinal injuries. Here we describe a rare clinical case of full-thickness macular hole (MH) and focal choroidal excavation (FCE) caused by a 1064-nm Q-switched Nd:YAG laser. After pars plana vitrectomy and the following 14 months, consecutive optical coherence tomography imagings showed closure of the MH. Visual acuity improved even in the absence of the outer retina and in the presence of FCE. We speculate that different focusing effects of the unexpected Nd:YAG lasers which target different levels of retinal tissue generate diverse prognosis.

A new imaging technique for assessment of the effectiveness of long pulse Nd:YAG 532 nm laser in treatment of facial port wine stain.

BACKGROUND: PWS is a vascular malformation presented at birth and associated with a psychological problem to the patients. Many types of laser systems were used to solve this problem. AIM OF THE STUDY: To assess the efficacy of long-pulsed Nd:YAG 532-nm laser in the treatment of port wine stain both clinically and by imaging technique. PATIENTS AND METHODS: This is an interventional therapeutic clinical study for the treatment of facial port-twine stain with long-pulsed, 532-nm, Nd:YAG laser. The treatment sessions were done every 4 weeks for 12 sessions and follow-up after 3 months of the last session. The assessment of the response was done before and at the end of follow-up period, both objectively (percent of improvement, photo comparison by using PSNR) and subjectively (patient satisfaction). RESULTS: Sixteen patients completed all sessions of the treatment. The improvement score for the PWS were failure = 0%, mild = 6.25%, moderate = 12.5%, good = 31.25%, and excellent = 50%. The values of PSNR for all the patients have been recorded and were fewer than 25 which means that the response for the treated lesions was very good. CONCLUSION: The long-pulsed Nd:YAG laser 532 nm is an effective and safe method of treatment of facial PWSs without significant residue. The PSNR was a new, simple, cheap and noninvasive method for assessment of the response of PWSs to laser therapy.

Surgical treatment and optical coherence tomographic evaluation for accidental laser-induced full-thickness macular holes.

PurposeTo report OCT appearance and surgical outcomes of full-thickness macular holes (MHs) accidentally caused by laser devices.Patients and methodsThis retrospective case series included 11 eyes of 11 patients with laser-induced MHs treated by pars plana vitrectomy, internal limiting membrane (ILM) peeling, and gas or silicone oil tamponade. Evaluations included a full ophthalmic examination, macular spectral-domain optical coherence tomography (SD-OCT), and fundus photography. Main outcome measures is MH closure and final visual acuity; the secondary outcome was the changes of retinal pigment epithelium and photoreceptor layer evaluated by sequential post-operative SD-OCT images.ResultsFive patients were accidentally injured by a yttrium aluminum garnet (YAG) laser and six patients by handheld laser. MH diameters ranged from 272 to 815 µm (mean, 505.5±163.0 µm) preoperatively. Best-corrected visual acuity (BCVA) improved from a mean of 0.90 logMAR (range, counting finger-8/20) preoperatively to a mean of 0.34 logMAR (range, a counting finger-20/20) postoperatively (P=0.001, t=4.521). Seven of 11 patients (63.6%) achieved a BCVA better than 10/20. Ten patients had a subfoveal hyperreflectivity and four patients had a focal choroidal depression subfoveal preoperatively. At the last follow-up, all 11 eyes demonstrated the following: closure of the macular hole, variable degrees of disruption of external limiting membrane (ELM) and outer photoreceptor ellipsoid and interdigitation bands. In 10 eyes, the disruption was in the form of focal defects in the outer retina. After surgery, the subfoveal hyperreflectivity and focal choroidal depression remained.ConclusionAccidental laser-induced full-thickness macular holes can be successfully closed with surgery. Inadvertent retinal injury from laser devices, especially handheld laser injury has occurred with increasing frequency in recent years. However, there is a paucity of data regarding these types of injuries, mostly in the form of case reports. We hereby reported 11 eyes of 11 patients with laser-induced macular holes treated by vitrectomy. All the macular holes closed after surgery and the corresponding visual acuities significantly improved postoperatively.

A Split-Face Assessment of the Synergistic Potential of Sequential Q-Switched Nd:YAG Laser and 1565 nm Fractional Nonablative Laser Treatment for Facial Rejuvenation in Fitzpatrick Skin Type II-V Patients.

Recent appreciation of the multifactorial pathophysiology of skin aging has led to increased use of parallel treatment regimens. This prospective, split-face, randomized study assessed the safety and efficacy of same-day sequential Q-switched Nd:YAG laser and 1565 nm non-ablative fractional laser (SST) facial rejuvenation treatment in comparison to fractional non-ablative laser (NAFL) treatment only. Seventeen patients underwent three treatment sessions, conducted at 4-6-week intervals, in which SST treatment was delivered on a randomly selected side of the face followed by NAFL treatment on the contralateral side immediately thereafter. Immediate skin responses were assessed within 30 minutes of treatment, while wrinkle/elastosis scores, and skin tone and texture were evaluated 1, 3, and 6 months following the final treatment session. While SST and NAFL proved equally safe, SST was associated with signi cantly lower pain scores in all three treatment sessions. Both treatment regimens yielded signi cant improvements in wrinkle/elastosis scores, which were maintained throughout the 6 months of follow up. Physician-evaluated skin tone and patient ratings of skin texture and overall improvement of the SST-treated side were consistently higher than the contralateral NAFL-treated side. Histological analysis suggested a broader effect, alongside sparing of the outermost epidermal layer with the SST versus NAFL treatment. Although the SST regimen failed to demonstrate statistically signi cant clinical superiority over the NAFL regimen, the significantly lower pain levels, consistently higher physician and patient ratings following SST may justify its regular use as a skin rejuvenation technique. J Drugs Dermatol. 2016;15(11):1335-1342..

Retrospective analysis of melasma treatment using a dual mode of low-fluence Q-switched and long-pulse Nd:YAG laser vs. low-fluence Q-switched Nd:YAG laser monotherapy.

BACKGROUND: Despite the effectiveness of low-fluence Q-switched Nd:YAG laser (QSNY) treatment in melasma, adverse events, including mottled hypopigmentation (MH) and rebound hyperpigmentation (RH) have been reported. OBJECTIVE: To compare the effectiveness and safety of combination therapy using low-fluence QSNY and long-pulse Nd:YAG laser (LPNY) (Dual toning), with low-fluence QSNY monotherapy (QS toning), in Asian melasma patients. MATERIALS AND METHODS: Patients were treated for 10 sessions at 1-week intervals with QSNY (6 mm spot); 2.5-3.0 J/cm(2) for QS toning (n = 177) or 2.1-2.5 J/cm(2) for dual toning (n = 183). The dual toning group was immediately treated with LPNY (7 mm spot, 15-17 J/cm(2)). The results were evaluated using the modified Melasma Area and Severity Index (mMASI) score and the physician's global assessment. RESULTS: MH or RH were significantly lower (1.1% vs. 14.1%) and the treatment efficacy was improved (median decrease of mMASI, 3.6 vs. 3.0) in the dual toning group compared with the QS toning group. Periorbital melasma showed distinctively high rates of adverse events in the QS toning group (23.9% vs. 5.7%), which were significantly reduced in the dual toning group (2.9%). CONCLUSION: Dual toning could represent a safe and effective treatment for Asian melasma patients, as it is associated with minimal adverse events and improved treatment efficacy compared with QS toning monotherapy.

New application of the long-pulsed Nd-YAG laser as an ablative resurfacing tool for skin rejuvenation: a 7-year study.

BACKGROUND: Carbon dioxide (CO2 ) and erbium-yttrium aluminum garnet (Er-YAG) lasers are the gold standards in ablative skin resurfacing. Neodymium-doped yttrium aluminum garnet (Nd-YAG) laser is considered a nonablative skin resurfacing laser whose usage is limited due to its high cost. AIM: To assess the efficacy and safety of Nd-YAG as an ablative resurfacing laser and to compare the results with those previously published for CO2 and Erbium-YAG lasers. PATIENTS/METHODS: A total of 296 patients (251 female and 45 male) with Fitzpatrick skin types III-IV and dermatological conditions amenable to ablative skin resurfacing participated in this study. Nd-YAG laser parameters assessed were wavelength (1064 nm), pulse duration (5 ms), fluence (10 J/cm(2) ), and spot size (8-10 mm). Efficacy of Nd-YAG laser was assessed by comparing pre- and posttreatment photographs. RESULTS: An improvement of 30-80% was observed in treated patients. The degree of improvement correlated positively with the number of laser sessions. The most common side effect was hyperpigmentation. Other side effects were less common and mild in intensity compared with published results for gold standard ablative lasers. CONCLUSION: Not only was the Nd-YAG laser found to be as effective as Er-YAG and CO2 lasers, but treated patients also had shorter recovery and treatment times, and at lower cost.

Two laser ablation techniques for a prostate less than 60 mL: lessons learned 70 months after a randomized controlled trial.

OBJECTIVE: To report lessons learned and predictors of long-term outcome after a randomized trial comparing 2 widely available lasers (2123 nm and 532 nm) in prostate ablation as treatment of symptomatic benign prostatic hyperplasia. METHODS: Between March 2005 and April 2007, 109 patients with a prostate volume of less than 60 mL were recruited and randomized to treatment: 57 underwent holmium laser ablation of the prostate (HOLAP) and 52 underwent photoselective vaporization of the prostate (PVP) using an 80-W potassium titanyl phosphate laser. The changes in subjective (International Prostate Symptom Score quality of life and International Index of Erectile Function-15) and objective (postvoid residual urine maximal flow rate) outcome parameters were compared. The long-term outcome, timing, and predictors of negative outcome were assessed. Cost analysis was included. RESULTS: After a median of 71.3 months, significant comparable improvement was documented in all subjective and objective urinary parameters from baseline measures at different points of follow-up. Retreatment for infravesical obstruction was 19.2% in HOLAP and 25% in PVP (P >.05). Smaller prostate volume was significantly associated with bladder neck contracture (BNC) after laser ablation, regardless the type of laser used. BNC and de novo urethral stricture seem to be the main causes for an early (first-year) reintervention. Redo treatment for recurring prostate adenoma was associated with less postoperative prostate-specific antigen reduction (<20%). Procedure costs were CaD $200.45 higher in the PVP group (P >.05). CONCLUSION: PVP and HOLAP seem to be equally effective and safe, with similar long-term outcome data, including cost. Regardless the laser wavelength, at least 1 of 5 patients will need retreatment. BNC is a more prevalent cause of early retreatment in smaller glands with both lasers. Postoperative prostate-specific antigen reduction of less than 20% warrants careful follow-up for recurrent symptoms secondary to residual prostate tissue.

[Assessment of retinal thickness obtain by optical coherence tomography after Nd: YAG capsulotomy]. / Ocena grubosci siatkówki na podstawie badania optycznej koherentnej tomografii po wykonaniu Nd: YAG kapsulotomii.

PURPOSE: To measure central macular thickness change after Nd: YAG capsulotomy using optical coherence tomography (OCT). MATERIAL AND METHODS: 55 patients (43 females and 12 males), mean age 65.1 +/- 13.9 years (range 21-87) who underwent Nd: YAG capsulotomy for posterior capsule opacification. Patients were examined preoperatively and one day, one week, one month, three months and six months after Nd: YAG capsulotomy. Central retinal thickness was measured by Stratus IV OCT Optical Coherence Tomography from Carl Zeiss Meditec, Inc. using "fast macular thickness" map protocol. All patients underwent ophthalmic examination including best-corrected visual acuity, fundus examination and intraocular pressure measurement. RESULTS: The initial median and range of the central retinal thickness was 212 microm (168-228), after one day 207 microm (168-232), after one week 207 microm (166-241), after one month 207 microm (163-252), after 3 months 207 microm (171-242), and 210 microm (170-235) 6 months after treatment. Proportional changes of the central retinal thickness was after one day -0.5 (-13.3 to 5.6), after one week 0.5 (-11.6 to 8.1), after one month -0.4 (-8.3 to 14.5), after 3 months 0.5 (-8.7 to 10.0) and 6 months after capsulotomy 0.5 (-5.8 to 7.7). There was no statistically significant change of the central macular thickness in any time point. Cystoid macular edema was observed in three patients 9.0 and 14 weeks after treatment. No other complications were noticed. CONCLUSIONS: Laser capsulotomy should be considered as a safe procedure for the macula. Optical coherence tomography is a useful diagnostic method that can be used in qualification and monitoring of patients undergoing Nd: YAG capsulotomy.

Q-switched YAG laser vs. punch biopsy excision for iatrogenic radiation tattoo markers--a randomized controlled trial.

BACKGROUND: Ink markers are tattooed as landmarks before radiotherapy of breast cancer with the purpose of obtaining a precise radiation field. The black tattoo spots may cause potential psychological distress for the affected women. OBJECTIVE: The objective of this study was to evaluate the efficacy and adverse effects in a side-by-side comparison of Q-switched (Q-sw) YAG laser vs. punch biopsy excision of iatrogenic radiation tattoo markers. METHODS: Ten female volunteers with black tattoo markers after previous radiotherapy for breast cancer were included. Subjects received one punch biopsy excision and a series of three treatments at 6-week intervals with Q-sw YAG laser (Q-YAG 5 system, 1064 nm, Palomar Inc., Burlington, VT, USA); the interventions was randomly assigned to two closely located tattoos (n = 20). Treatment measures were evaluated 12 weeks after final treatment and included clinical efficacy, patient satisfaction, preferred treatment and adverse effects. A blinded observer evaluated the efficacy and adverse effects from photographs. RESULTS: Ten patients completed the study. Blinded photographic evaluations showed an overall excellent clearance (75-100% reduction in tattoo appearance) from both excision and laser treatments (P = 0.317). Patients were equally satisfied with Q-sw YAG laser treatment [median 9 (5.75-10, 25-75 percentiles)] and excision therapy [median 10 (5.75-10)] (P = 0.672). However, the majority of the patients preferred YAG laser (n = 8) to excision (n = 2) (P = 0.022) because adverse effects in terms of hypopigmentation (0/10 vs. 8/10 patients) and scarring (1/10 vs. 8/10 patients) occurred more frequently and appeared more pronounced in excision biopsy (hypopigmentation P = 0.014, scarring P = 0.021). CONCLUSION: Q-sw YAG laser and punch biopsy excision are effective to clear iatrogenic radiation tattoo markers, but patients preferred the laser treatment because of less pronounced adverse effects.

Holmium laser enucleation of the prostate and holmium laser ablation of the prostate: indications and outcome.

PURPOSE OF REVIEW: Holmium laser enucleation of the prostate (HoLEP) has been proposed as an alternative to transurethral resection of the prostate and to open prostatectomy for patients with lower urinary tract symptoms because of large benign prostatic enlargement. The aim of this review is to critically analyze currently available evidence-based reports regarding HoLEP, with particular interest in long-term follow-up results. RECENT FINDINGS: The use of holmium laser for the treatment of benign prostatic hyperplasia was first reported in 1996. HoLEP seems to represent a valid alternative to both transurethral resection of the prostate and open prostatectomy, with valid long-term functional results, a low rate of short-term and long-term complications, and very low rates of reintervention. SUMMARY: HoLEP represents a valid alternative to both transurethral resection of the prostate and open prostatectomy for treatment of patients suffering from lower urinary tract symptoms due to benign prostatic enlargement. The recently published long-term follow-up data demonstrate the durability of functional results. HoLEP can be offered as the size-independent gold standard treatment of patients with lower urinary tract symptoms because of benign prostatic enlargement.