ABSTRACT
OBJECTIVE: To prospective compared the preoperative parameters and postoperative functional outcomes between anatomic vapor-incision technique (AVIT) and the photoselective vaporization of prostate (PVP) with Greenlight 180W-XPS. METHODS: Total 174 BPH patients were enrolled in the study and 86 cases, 88 cases were underwent with traditional PVP and AVIT, respectively. The relevant pre-, intra-, and postoperative data were recorded and compared between the both groups. RESULTS: No significant differences were observed between both groups in baseline characteristics and no major complications (capsule perforation and TUR syndrome) occurred intraoperatively. In AVIT group, the energy consumption and energy density were greater than those in PVP group. The operative time and laser time were longer in AVIT group than it in PVP group. Compared to the AVIT group, the incidence of irritative symptoms after operation was higher in the PVP group. During the follow-up period, the functional outcomes (IPSS, QoL, prostate volume and PSA level) in both groups were significant improved compared to the baseline. The reduction of prostate volume and PSA level were significant greater in AVIT group than it in PVP group. CONCLUSION: Compared to PVP, AVIT is safe and efficacious treatment for BPH patients with more adenoma removal and more improvements of clinical outcomes. But the long-term follow-up data is needed to evaluate the functional outcomes and retreatment rates.
Subject(s)
Laser Therapy , Prostatic Hyperplasia , Surgical Wound , Transurethral Resection of Prostate , Humans , Laser Therapy/methods , Lasers , Male , Prospective Studies , Prostate/surgery , Prostate-Specific Antigen , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/surgery , Quality of Life , Surgical Wound/complications , Transurethral Resection of Prostate/methods , Treatment Outcome , VolatilizationABSTRACT
Two-micrometer laser resection of prostate-tangerine technique dissects whole prostatic lobes off the surgical capsular, similar to peeling a tangerine. The present study aimed to evaluate the safety and efficacy of 2-µm continuous laser vaporization in the treatment of high-risk patients with benign prostatic hyperplasia (BPH) during the 24-month follow-up. The study included 248 patients with moderate to severe lower urinary tract symptoms who underwent 2-µm continuous laser vaporization of the prostate. All patients were accompanied with different degree comorbidities and 94 patients were taking oral anticoagulants. BPH was successfully treated with 2-µm continuous laser vaporization in all patients. Mean pre-operative prostate volume was 76 ± 25.3 ml and mean operative time was 49.8 ± 16.5 min. There were no major complications intra-operatively or postoperatively, and no blood transfusions were needed. About 20 patients (8.1%) needed bladder irrigation postoperatively. Average catheterization time was 2.0 ± 1.8 days (range 1-5 days). Four patients required reoperation due to enlarged prostates from residual adenoma. At 3-, 6-, 12-, and 24-month follow-ups, maximum urinary flow rates (Qmax) increased from 6.9 ± 1.7 to 19.1 ± 4.2, 19.5 ± 4.6, 19.4 ± 4.6, and 19.5 ± 4.1 ml/s, respectively. Mean International Prostate Symptom Scores (IPSS) decreased from 27.6 ± 5.1 (pre-operation) to 9.2 ± 2.6, 7.12 ± 1.42, 6.18 ± 1.32, and 6.25 ± 1.30 at 3-, 6-, 12-, and 24-month post-operation, respectively. Two-micrometer continuous laser vaporization is a safe and effective surgical endoscopic technique associated with low complication rate in BPH patients at high risk and those on anticoagulation therapy who have severe LUTS caused by BPH.
Subject(s)
Lasers/adverse effects , Prostatic Hyperplasia/surgery , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Postoperative Complications/etiology , Postoperative Period , Preoperative Care , Risk Factors , Treatment OutcomeABSTRACT
The most recent advance in laser treatment of benign prostatic hyperplasia (BPH) is the introduction of a high-performance system (HPS) 120-W laser. The HPS laser beam at a wavelength of 532~nm is highly absorbed by oxyhemoglobin in the tissue and maintains focus with negligible divergence up to 3 mm from the fiber and with limited divergence at 5 mm. This study is designed to evaluate the three-year clinical efficacy and safety of photoselective vaporization of the prostate (PVP, n=100 cases) with GreenLight HPS laser compared with transurethral resection of the prostate (TURP, n=100 cases) for treatment of BPH. The results showed that the mean operating time, catheterization time and admission time were significantly shorter in the PVP group, respectively. There were dramatic improvements in International Prostate Symptom Score (IPSS), quality of life (Qol), maximum flow rate (Qmax) and postvoid residual (PVR) compared with preoperative values and the degree of improvements was comparable in both groups. The intraoperative complications were lower in PVP group. In summary, PVP is an effective technique in patients with BPH, when compared to TURP, producing equivalent improvements in IPSS, Qmax, Qol and PVR with the advantages of markedly reduced catheterization time, admission time and adverse events.
Subject(s)
Laser Therapy/methods , Prostatic Hyperplasia/therapy , Transurethral Resection of Prostate/methods , Aged , Aged, 80 and over , Analysis of Variance , Humans , Laser Therapy/adverse effects , Lasers , Male , Middle Aged , Perioperative Period , Postoperative Complications/etiology , Prospective Studies , Prostatic Hyperplasia/surgery , Transurethral Resection of Prostate/adverse effects , Treatment OutcomeABSTRACT
The purpose of this study is to evaluate the safety and efficacy of 120-W potassium titanyl phosphate (KTP) laser vaporization in patients with benign prostatic hyperplasia (BPH) who also had cardiopulmonary diseases who were taking long-term anticoagulants and were at high risk of bleeding complications. The prospective study included 188 patients with severe lower urinary tract symptoms who underwent 120-W KTP laser vaporization of the prostate. All patients were at high cardiopulmonary risk, having presented with an American Society of Anesthesiology score of 3 or greater. Of those, 45 patients were taking oral anticoagulants, and 1 had a severe bleeding disorder. BPH was successfully treated with 120-W KTP laser vaporization in all patients. Mean preoperative prostate volume ± SD was 66 ± 23.1 ml, and mean operative time was 50.8 ± 15.5 min. There were no major complications intraoperatively or postoperatively, and no blood transfusions were required. Postoperatively, only 14 patients (7.4 %) required bladder irrigation. Average catheterization time was 1.9 ± 1.5 days (range, 1-5 days). Three patients required reoperation due to enlarged prostates from residual adenoma. At 3-, 6,- 12-, and 24-month follow-ups, mean urinary peak flow increased from 8.0 ± 3.6 ml/s to 19.1 ± 5.6, 19.2 ± 4.7, 19.1 ± 4.65, and 19.2 ± 4.34 ml/s, respectively. Mean International Prostate Symptom Scores decreased over time, from 25.6 ± 5.1 (3 months) to 9.4 ± 2.8, 7.05 ± 1.46, 6.24 ± 1.36, and 6.20 ± 1.32 (24 months), respectively. 120-W HPS KTP laser vaporization is a safe and effective treatment option in BPH patients at high risk and those on anticoagulation therapy who have severe LUTS secondary to BPH.