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Paesano N, Castañeda G, Maccagno A, Caldas P, Chechile G. Thulium laser vaporesection of prostates with volume exceeding 100 cm 3 as an alternative to HoLEP and ThuLEP. J Surg Case Rep 2023; 2023:rjac441. [PMID: 37255953 PMCID: PMC10226809 DOI: 10.1093/jscr/rjac441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/04/2022] [Indexed: 06/01/2023] Open
Abstract
The aim of this study is to evaluate the outcomes of thulium laser vaporesection of prostates with volume exceeding 100 cm3. In the present prospective study, patients with infra-vesical urinary obstruction due to a prostate with volume exceeding 100 cm3 underwent endoscopic vaporesection using thulium laser. In this procedure, prostate chips were resected without morcellation. The technical aspects of surgery, admission time, post-operative catheter time and post-operative complications were analyzed. Flowmetry was performed combined with prostatic ultrasound in the follow-up. Between March 2010 and November 2018, 156 cases with benign prostatic hyperplasia (BPH; volume >100 cm3) were treated. The mean patient age was 67.8 years (48.4-86.6 years), and the mean prostatic volume was 137 cm3 (100-436 cm3). The mean length of hospitalization was 1.48 days (1-8 days), and the mean post-operative catheter time was 5.1 (1-17). Three cases (1.9%) required readmission due to hematuria. The mean follow-up time was 31.2 months (standard deviation = 27.7). Urethral stricture was observed in 14 cases (9%), with bulbar urethra being the most frequent finding. Urinary tract infection was observed in 11 cases (7.1%), and urinary incontinence was observed in 5 cases. The mean peak urinary flow at 12 and 24 months was 26.9 ± 12.5 and 23.9 ± 11.7 ml/s, respectively, and the mean urinary flow during the final follow-up at 41 months was 21.6 ml/s. Thulium laser vaporesection is a valid alternative to open prostatectomy, HoLEP and ThuLEP in patients with large BPH. Urinary flow remained elevated throughout the follow-up.
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Affiliation(s)
- Nahuel Paesano
- Correspondence address. Tel: (+34) 93 285 33 99; E-mail:
| | - Gonzalo Castañeda
- Instituto Médico Tecnológico, Barcelona, Spain
- Prostate Institute Barcelona, Barcelona, Spain
- Department of Urology, Cima Sanitas Hospital, Barcelona, Spain
| | - Alicia Maccagno
- Statistics Area, National University of Cordoba, Córdoba, Argentina
| | - Paulo Caldas
- Department of Urology, Hospital Regional do Oeste, Chapecó, Brazil
| | - Gilberto Chechile
- Instituto Médico Tecnológico, Barcelona, Spain
- Prostate Institute Barcelona, Barcelona, Spain
- Department of Urology, Cima Sanitas Hospital, Barcelona, Spain
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Thulium YAG is the Best Laser for the Prostate Because of Versatility. EUR UROL SUPPL 2022; 48:18-21. [PMID: 36583181 PMCID: PMC9793213 DOI: 10.1016/j.euros.2022.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 12/24/2022] Open
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3
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Gupta A, Kant S, Chaudhari R, Shah B, Sharma S. Thulium laser enucleation of prostate: Novel therapy for benign prostatic hyperplasia. FORMOSAN JOURNAL OF SURGERY 2022. [DOI: 10.4103/fjs.fjs_206_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Bertolo R, Vittori M, Cipriani C, Maiorino F, Iacovelli V, Petta F, Toschi N, Ferro M, Panei M, Travaglia S, Bove P. Is thulium laser vapoenucleation of the prostate equally safe and effective in elderly patients? A propensity score matched analysis of early perioperative and functional outcomes. Actas Urol Esp 2021; 45:648-655. [PMID: 34776396 DOI: 10.1016/j.acuroe.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/22/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate if thulium laser vapoenucleation of the prostate (ThuVEP) is equally safe and effective in a selected cohort of elderly patients when compared to "younger" patients. MATERIALS AND METHODS We performed a retrospective analysis of consecutive patients who underwent ThuVEP between September 2018 and February 2020. After application of the inclusion/exclusion criteria, patients were stratified according to the 75 years-old cut-off point suggested by the WHO. Group A included patients ≤75 years-old; Group B included patients >75 years-old. Preoperative assessment included urological consultation, prostate specific antigen (PSA), International Prostate Symptom Score (IPSS) and quality of life index, transrectal ultrasound to estimate prostate volume (PVol), and uroflowmetry to assess preoperative Qmax, Qave and post-void residual volume (PVR). Perioperative and postoperative data were analyzed during 3-month follow-up. RESULTS After propensity-score analysis, 51 versus 51 patients were 1:1 matched according to PVol, PSA, Qmax, IPSS and QoL. Patients were comparable at baseline excluding age (65 (IQR 59-70) versus 79 (IQR 77-82) years, Group A versus B, respectively, P-value <.001). No differences were found in terms of hemoglobin drop, complications rate, catheterization time and length of hospital stay. Group A (younger) patients had more significant improvement in 30-days absolute Qmax, Qave and ΔQmax. At 90-days follow-up, the differences between the groups disappeared. Within the 90-days follow-up, no significant differences were found in the readmission rate, with no need of reinterventions. CONCLUSIONS In our hands, even in elderly patients affected by BPH, ThuVEP appears to be a safe and effective treatment option.
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Affiliation(s)
- Riccardo Bertolo
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy.
| | - Matteo Vittori
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - Chiara Cipriani
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | | | | | - Filomena Petta
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | - Nicola Toschi
- Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Massimo Panei
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy
| | | | - Pierluigi Bove
- Department of Urology, San Carlo di Nancy Hospital, Rome, Italy; Urology Unit, Department of Surgery, Tor Vergata University of Rome, Rome, Italy
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Taratkin M, Azilgareeva C, Taratkina D, Goryacheva E, Rapoport L, Enikeev D. Laser endoscopic procedures on the prostate: it is the small details that count. Curr Opin Urol 2021; 31:468-472. [PMID: 34231543 DOI: 10.1097/mou.0000000000000919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review aims to highlight the pros and cons of each laser device and to consider additional possible milestones for the development of laser technologies in the surgical treatment of benign prostate hyperplasia. RECENT FINDINGS Over the last three decades, lasers' role in endourology has gone from strength to strength. Specifically, the primary techniques where laser surgery for BPO relief is concerned are vaporization and enucleation. The idea behind vaporization is that lasers are able to vaporize substantial amounts of tissue due to deep ablation depth and increased power. The most efficient devices for vaporization are those affecting hemoglobin as primary chromophore and/or using a continuous firing mode (KTP/LBO:YAG, diode lasers, Tm:YAG). As for enucleation, multiple devices have been suggested for the adequate anatomical enucleation of the prostate (EEP). As it is a skill-dependent technique, the EEP is effective irrespective of which device the surgeon uses. However, some devices have shown significant advances where enucleation is concerned. SUMMARY The choice of device should be based primarily on the technique the surgeon prefers. Although the most suitable lasers for vaporization are hemoglobin-targeting and/or continuous wave devices, the EEP may be done with any enough powered laser, yet some provides specific effects which you should be aware before the surgery.
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Bertolo R, Vittori M, Cipriani C, Mariorino F, Iacovelli V, Petta F, Toschi N, Ferro M, Panei M, Travaglia S, Bove P. Is thulium laser vapoenucleation of the prostate equally safe and effective in elderly patients? A propensity score matched analysis of early perioperative and functional outcomes. Actas Urol Esp 2021; 45:S0210-4806(21)00091-7. [PMID: 34334243 DOI: 10.1016/j.acuro.2020.09.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE To evaluate if thulium laser vapoenucleation of the prostate (ThuVEP) is equally safe and effective in a selected cohort of elderly patients when compared to "younger" patients. MATERIALS AND METHODS We performed a retrospective analysis of consecutive patients who underwent ThuVEP between September 2018 and February 2020. After application of the inclusion/exclusion criteria, patients were stratified according to the 75 years-old cut-off point suggested by the WHO. Group A included patients < 75 years-old; Group B included patients > 75 years-old. Preoperative assessment included urological consultation, prostate specific antigen (PSA), International Prostate Symptom Score (IPSS) and quality of life index, transrectal ultrasound to estimate prostate volume (PVol), and uroflowmetry to assess preoperative Qmax, Qave and post-void residual volume (PVR). Perioperative and postoperative data were analyzed during 3-month follow-up. RESULTS After propensity-score analysis, 51 versus 51 patients were 1:1 matched according to PVol, PSA, Qmax, IPSS and QoL. Patients were comparable at baseline excluding age (65 (IQR 59-70) versus 79 (IQR 77-82) years, Group A versus B, respectively, p-value < 0.001). No differences were found in terms of hemoglobin drop, complications rate, catheterization time and length of hospital stay. Group A (younger) patients had more significant improvement in 30-days absolute Qmax, Qave and ΔQmax. At 90-days follow-up, the differences between the groups disappeared. Within the 90-days follow-up, no significant differences were found in the readmission rate, with no need of reinterventions. CONCLUSIONS In our hands, even in elderly patients affected by BPH, ThuVEP appears to be a safe and effective treatment option.
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Affiliation(s)
- R Bertolo
- Department of Urology, San Carlo di Nancy Hospital, Roma, Italia.
| | - M Vittori
- Department of Urology, San Carlo di Nancy Hospital, Roma, Italia
| | - C Cipriani
- Department of Urology, San Carlo di Nancy Hospital, Roma, Italia
| | - F Mariorino
- Department of Urology, San Carlo di Nancy Hospital, Roma, Italia
| | - V Iacovelli
- Department of Urology, San Carlo di Nancy Hospital, Roma, Italia
| | - F Petta
- Department of Urology, San Carlo di Nancy Hospital, Roma, Italia
| | - N Toschi
- Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Roma, Italia
| | - M Ferro
- Division of Urology, European Institute of Oncology, Milán, Italia
| | - M Panei
- Department of Urology, San Carlo di Nancy Hospital, Roma, Italia
| | - S Travaglia
- Department of Urology, San Carlo di Nancy Hospital, Roma, Italia
| | - P Bove
- Department of Urology, San Carlo di Nancy Hospital, Roma, Italia; Urology Unit, Department of Surgery, Tor Vergata University of Rome, Roma, Italia
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Reasons to go for thulium-based anatomical endoscopic enucleation of the prostate. World J Urol 2021; 39:2363-2374. [PMID: 33948694 DOI: 10.1007/s00345-021-03704-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 04/17/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To summarize the current evidence and the reasons to go for thulium-based anatomical endoscopic enucleation of the prostate (AEEP). METHODS This review discusses the available literature on thulium-based AEEP. RESULTS Thulium lasers operate at a wavelength between 1940 and 2013 nm. This wavelength, which has a low penetration depth in water, allows to perform smooth cuts in the prostatic tissue and allows urologists to perform various procedures: resection, vaporization, enucleation, or vapoenucleation of the prostate. Depending on the type of thulium laser, it can be used either in a continuous, or pulsed mode. CONCLUSION In recent years, an increasing amount of evidence has described the thulium laser as a minimally invasive and size-independent treatment option for benign prostatic enlargement with excellent long-term results.
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Maruccia S, Fulgheri I, Montanari E, Casellato S, Boeri L. Nomenclature in thulium laser treatment of benign prostatic hyperplasia: it's time to pull the rabbit out of the hat. Lasers Med Sci 2021; 36:1355-1367. [PMID: 33389305 DOI: 10.1007/s10103-020-03227-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022]
Abstract
We performed a narrative review with the focus on laser settings and surgical procedure with thulium laser. Our primary goal was to define the most valid settings of each surgical procedure to overcome the inconsistency about nomenclature of thulium surgery and to ensure comparability of future publications. A literature search of articles on thulium laser treatment of benign prostatic hyperplasia (BPH) was conducted between 2009 and 2019. We proposed a new classification standard for laser settings and associated surgical procedure. Each article was analyzed and categorized as concordant or discordant referring to the new classification. In total, 74 papers were included in this narrative review. Overall, 43% and 42% of included studies reported discordant laser parameters and surgical description, respectively. Most of the studies on vaporization were categorized as discordant because they reported a medium/low laser setting instead of high power. Conversely, 93.3% of studies on enucleation were deemed as discordant for laser setting because they reported high power parameters instead of medium-low power setting. Most of the studies on laser enucleation and vapo/enucleation were considered discordant for surgical procedure since authors did not mention the use of mechanical vs. laser method for enucleation. The current literature lacks a uniform definition and standardization of the terminology of thulium laser settings and surgical techniques to guarantee comparability between different approaches. We found a huge heterogeneity in 10 years of surgery with thulium laser. We proposed a new classification of laser setting and procedural description for categorization of thulium laser surgery for BPH.
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Affiliation(s)
- Serena Maruccia
- Department of Urology, Istituti Clinici Zucchi, Monza, Italy
| | - Irene Fulgheri
- Department of Pharmacy, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | | | - Luca Boeri
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.
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He Q, Yu Y, Gao F. Meta-analysis of the effect of antithrombotic drugs on perioperative bleeding in BPH surgery. Exp Ther Med 2020; 20:3807-3815. [PMID: 32855730 PMCID: PMC7444423 DOI: 10.3892/etm.2020.9102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/23/2020] [Indexed: 01/11/2023] Open
Abstract
Effects of antithrombotic agents on the bleeding risk after transurethral resection of the prostate (TURP) were assessed in patients with benign prostatic hyperplasia (BPH). Controlled clinical trials on the effects of perioperative anticoagulant therapy on postoperative bleeding in BPH patients published during January 1990 and February 2019 were searched in PubMed, Embase and the Cochrane Library. Two independent reviewers screened the studies according to the inclusion and exclusion criteria, extracted the data, evaluated the quality, and conducted a meta-analysis using the RevMan 5.3 software. A total of 20 studies were included. Analysis of these studies found that compared with interrupted use of antithrombotic agents, continuous use of antithrombotic drugs led to more frequent post-TURP bleeding (OR=4.34, 95% CI=2.29-8.23), and higher transfusion rate (2.96, 1.19-7.36). Compared with patients who never used antithrombotic agents, those who used antithrombotic agents continuously had higher bleeding risk (5.52, 1.64-18.66). Those who continued using antithrombotic agents during laser treatment had higher transfusion rate than those who stopped using them before the operation (5.39, 1.49-19.53), but it had no significant difference in clot retention, blood transfusion rate, intraoperative hemoglobin decrease and postoperative catheter-indwelling time compared with those who never used antithrombotic agents (P>0.05). Those who continued using antithrombotic agents during TURP showed less intraoperative hemoglobin decrease (-0.46, -0.58-0.35) than the patients who underwent low molecular weight heparin substitution. Interruption of antithrombotic agents during TURP can prevent the risk of postoperative bleeding; continuous use of antithrombotic agents is safe and feasible during laser treatment of BPH; whether low molecular weight heparin substitution is necessary during the discontinuation of antithrombotic agents is controversial.
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Affiliation(s)
- Qian He
- Department of Urology, Sir Run-Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Yanlan Yu
- Department of Urology, Sir Run-Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Fengbin Gao
- Department of Urology, Sir Run-Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
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Herrmann TRW, Wolters M. Transurethral anatomical enucleation of the prostate with Tm:YAG support (ThuLEP): Evolution and variations of the technique. The inventors' perspective. Andrologia 2020; 52:e13587. [PMID: 32286719 DOI: 10.1111/and.13587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/20/2020] [Indexed: 12/27/2022] Open
Abstract
After its introduction, transurethral anatomical enucleation of the prostate with Tm:YAG support (ThuLEP) has evolved as one of the standard techniques of transurethral anatomical endoscopic enucleations of the prostate. Growing evidence has proven ThuLEP as an alternative for the treatment of bladder outlet obstruction caused by benign prostatic enlargement and has been acknowledged by the EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms, incl. Benign Prostatic Obstruction. The uniqueness of ThuLEP as a concept made it a blueprint for other laser and nonlaser enucleating techniques based on the emphasis on two principles: widely blunt anatomical dissection and demystification of energy sources as being secondary for transurethral enucleation. The original technique has been technically refined by the inventor and other working groups in the field. The evolutionary modifications followed the academic discourse on anatomical enucleation for measures to prevent early postoperative stress urinary incontinence and preservation of antegrade ejaculation. Variations of the original three-lobe dissection technique were introduced with two-lobe approach or en bloc dissection. The manuscript is accompanied by an instructional video and surgical atlas on the currently most commonly applied two-lobe technique.
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Affiliation(s)
- Thomas R W Herrmann
- Department of Urology, Spital Thurgau AG (STGAG), Frauenfeld, Switzerland.,Department of Urology and Urological Oncology, Hanover Medical School (MHH), Hanover, Germany
| | - Mathias Wolters
- Department of Urology and Urological Oncology, Hanover Medical School (MHH), Hanover, Germany
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Outcome of simultaneous thulium laser enucleation of bladder tumor and prostate in patients with non-muscle invasive bladder tumor and benign prostatic hyperplasia: a matched-pair comparison with a long-term follow-up. World J Urol 2020; 39:105-111. [PMID: 32215675 DOI: 10.1007/s00345-020-03158-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To access the surgical and oncological outcomes of simultaneous thulium laser enucleation of bladder tumor (ThuLEBT) and thulium laser enucleation of prostate (ThuLEP) in patients with non-muscle invasive bladder tumor (NMIBC) and benign prostatic hyperplasia (BPH). PATIENTS AND METHODS Between June 2009 and June 2017, 118 men with NMIBC who underwent simultaneous ThuLEBT and ThuLEP and fulfilled the inclusion criteria were matched with 118 patients who received ThuLEBT alone. Clinicopathological parameters, surgical outcome data and oncological outcomes were retrospectively analyzed and compared. RESULTS The patients who underwent simultaneous ThuLEBT and ThuLEP experienced a longer length of operation time (70.4 vs. 25.5 min; p < 0.001), but there were no statistically significant differences in catheterization period, hospital stay and complication between the two groups. At a mean follow-up of 58.7 and 55.8 months in ThuLEBT/ThuLEP group and ThuLEBT group, no significant differences in overall recurrence rates, progression rates, recurrence in the bladder neck/prostatic fossa and mean elapsed time to recurrence were detected. The 5-year recurrence-free probability was 73.2% for ThuLEBT/ThuLEP and 69.2% for ThuLEBT (p = 0.361). CONCLUSIONS Our results indicate that simultaneous ThuLEBT and ThuLEP can be safely performed without increasing the surgical risk and the risk of tumor recurrence and progression in patients with NMIBC and BPH, and it may be preferred alternative for select patients.
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Castellani D, Pirola GM, Pacchetti A, Saredi G, Dellabella M. State of the Art of Thulium Laser Enucleation and Vapoenucleation of the Prostate: A Systematic Review. Urology 2020; 136:19-34. [DOI: 10.1016/j.urology.2019.10.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023]
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13
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Chung JS, Seo WI, Oh CK, Kim SC, Park MC, Park SH, Yu J, Lee CH, Kim W, Park TY, Min KS, Chung JI. Effect of 5α-reductase inhibitors on the efficiency of thulium:yttrium-aluminium-garnet (RevoLix®) vaporesection for treating benign prostatic hyperplasia. Investig Clin Urol 2019; 61:67-74. [PMID: 31942465 PMCID: PMC6946814 DOI: 10.4111/icu.2020.61.1.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/08/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose Preoperative use of 5α-reductase inhibitors (5ARIs) may cause fibrosis of the prostate tissue and reduce the efficiency of thulium laser surgery for treating benign prostate hyperplasia (BPH). Thus, we investigated the effects of preoperative 5ARI use in this setting. Materials and Methods This retrospective study examined 184 patients who underwent thulium laser surgery for BPH during 2012–2017. Patients were grouped according to their 5ARI use in order to compare their preoperative and intraoperative characteristics and subsequent outcomes. Surgical efficiency was assessed using vaporesection efficiency. The total operation time, vaporesection time and prostate volume change were measured. Results The 5ARI+ group included 83 patients (45.1%) and the 5ARI− group included 101 patients (54.9%). There were no significant differences in the two groups' preoperative characteristics, postoperative prostate size, thulium laser energy use, or prostate volume reduction rate. However, relative to the 5ARI− group, the 5ARI+ group had a significant shorter total operative time (65.0 min vs. 70.0 min, p=0.013) and a significantly shorter vaporesection time (48.0 min vs. 54.0 min, p=0.014), which resulted in significantly higher vaporesection efficiency in the 5ARI+ group (0.66 mL/min vs. 0.51 mL/min, p<0.001). Both groups exhibit significant improvements in their quality of life score and International Prostate Symptom Score during the 12-month follow-up. Conclusions In contrast with our expectations, the preoperative use of 5ARI increased the efficiency of thulium laser surgery for BPH. Thus, it may not be necessary to stop 5ARI treatment before performing thulium laser surgery in this setting.
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Affiliation(s)
- Jae Seung Chung
- Department of Urology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Won Ik Seo
- Department of Urology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Cheol Kyu Oh
- Department of Urology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seong Cheol Kim
- Department of Urology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Myung Chan Park
- Department of Urology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Hyun Park
- Department of Urology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jihyeong Yu
- Department of Urology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Chan Ho Lee
- Department of Urology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Wansuk Kim
- Department of Urology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Tae Yong Park
- Department of Urology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kweon Sik Min
- Department of Urology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae Il Chung
- Department of Urology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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14
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Xiao KW, Zhou L, He Q, Gao XS, Chen G, Ma YC, Li H, Wang KJ. Enucleation of the prostate for benign prostatic hyperplasia thulium laser versus holmium laser: a systematic review and meta-analysis. Lasers Med Sci 2019; 34:815-826. [PMID: 30604345 DOI: 10.1007/s10103-018-02697-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/23/2018] [Indexed: 02/05/2023]
Abstract
To evaluate the clinical efficacy and safety of thulium laser vapoenucleation/enucleation of the prostate (ThuEP) versus holmium laser enucleation of the prostate (HoLEP) in the management of benign prostatic hyperplasia (BPH). A systematic literature search was performed using PubMed, Embase, and Web of Science to identify eligible studies published before July 2018. Meta-analysis of extracted data was performed with RevMan version 5.3. We chose the fixed- or random-effect model to fit the pooled heterogeneity. Five eligible studies including two randomized controlled trials (RCTs) and three non-RCTs involving 1010 patients were enrolled in our meta-analysis. ThuEP provided less enucleation time when compared with HoLEP (WMD = - 7.73, 95% CI - 14.39-1.07, P = 0.02). During the 1st, 6th, and 12th months of postoperative follow-ups, statistically significant differences were found in Qmax (WMD = 2.05, 95% CI 0.52~3.58) and PVR (WMD = - 6.50, 95% CI - 7.35~- 5.66, P < 0.001) in the 1st month after the operation, also in IPSS (IPSS: WMD = - 1.29, 95% CI - 2.39~- 0.19, P = 0.02) in the 12th month after the operation. As regards other perioperative, postoperative parameters, and complication rates, we found no significant difference. Both ThuEP and HoLEP provided satisfactory micturition improvement with low morbidity after the 1st and 6th months of the operation. However, ThuEP showed higher enucleation efficacy and less intraoperative blood loss and may get a better outcome as compared to the HoLEP group in the early postoperative period with regard to Qmax/PVR and IPSS after the 1st and 12th months of the operation respectively.
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Affiliation(s)
- Kai-Wen Xiao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Liang Zhou
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Qing He
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Xiao-Shuai Gao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Guo Chen
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yu-Cheng Ma
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Kun-Jie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China.
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Pirola GM, Saredi G, Codas Duarte R, Bernard L, Pacchetti A, Berti L, Martorana E, Carcano G, Badet L, Fassi-Fehri H. Holmium laser versus thulium laser enucleation of the prostate: a matched-pair analysis from two centers. Ther Adv Urol 2018; 10:223-233. [PMID: 30034541 DOI: 10.1177/1756287218779784] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/25/2018] [Indexed: 11/15/2022] Open
Abstract
Background The aim of our study was to compare perioperative and functional outcomes of two different prostatic laser enucleation techniques performed in two high-volume centers: 100 W holmium laser enucleation of the prostate (HoLEP) (Lyon, France) and 110 W thulium laser enucleation of the prostate (ThuLEP) (Varese, Italy). Materials and Methods A nonrandomized, observational, retrospective and matched-pair analysis was performed on two homogeneous groups of 117 patients that underwent prostate laser enucleation in the HoLEP or ThuLEP centers between January 2015 and April 2017, following the classical 'three lobes' enucleation technique. The American Society of Anesthesiologists (ASA) score and prostate volume were the main parameters considered for matching the patients between the two groups. Patients on anticoagulant therapy, with documented detrusor hypoactivity or hyperactivity or with the finding of concurrent prostate cancer were excluded from the study. Follow up was assessed at 3, 6 and 12 months after surgery. Results Median enucleation and morcellation time was 75.5 and 11.5 min, respectively, in the HoLEP group versus 70.5 and 12 min, respectively, in the ThuLEP group (p = 0.001 and 0.49, respectively). Enucleated adenoma weight was comparable (44 g versus 45.6 g, p = 0.60). Energy index (3884.63 versus 4137.35 J/g, p = 0.30) and enucleation index (0.57 versus 0.6 g/min, p = 0.81) were similar in the two groups. Catheterization time was comparable (1 versus 1 day; p = 0.14). The International Prostate Symptom Score and Quality of Life score significantly decreased, as well as maximal urinary flow rate. Median prostate-specific antigen (PSA) drop 1 year after surgery was 2.1 ng/ml in the HoLEP group (-52.83%) versus 1.75 ng/ml in the ThuLEP group (-47.85%) (p = 0.013). Conclusion Both HoLEP (100 W) and ThuLEP (110 W) relieve lower urinary tract symptoms in a comparable way with high efficacy and safety, with negligible clinical differences.
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Affiliation(s)
- Giacomo Maria Pirola
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena, 41124, Italy
| | - Giovanni Saredi
- Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Ricardo Codas Duarte
- Department of Urology and Transplantation, Edouard Herriot Hospital, Lyon, France
| | | | - Andrea Pacchetti
- Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Lorenzo Berti
- Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Eugenio Martorana
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulio Carcano
- Department of Surgery, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Lionel Badet
- Department of Urology and Transplantation, Edouard Herriot Hospital, Lyon, France
| | - Hakim Fassi-Fehri
- Department of Urology and Transplantation, Edouard Herriot Hospital, Lyon, France
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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. World J Urol 2018; 36:1355-1364. [DOI: 10.1007/s00345-018-2287-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/28/2018] [Indexed: 02/03/2023] Open
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17
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Razzaghi MR, Fallah Karkan M, Ghiasy S, Javanmard B. Laser Application in Iran Urology: A Narrative Review. J Lasers Med Sci 2017; 9:1-6. [PMID: 29399302 DOI: 10.15171/jlms.2018.01] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The usage of laser in medicine is not recent, and its history in urology goes back to 40 years ago. For the last 2 decades, common uses of laser have been treatments of subjects with urolithiasis, bladder tumors, benign prostatic enlargement, lesions of the genitalia and urinary tract strictures. To evaluate laser application in urology in Iran, we reviewed all of the Iranian literature on the topic. This study was designed to retrieve all studies on laser application in urology in Iran, regardless of publication status or language, covering years 1990-2017. Twenty-six articles were identified: 12 about urolithiasis, 8 about benign prostatic hyperplasia (BPH), 2 case reports, 1 paper about prostate cancer, 1 on female urethral stricture, 1 review and 1 basic sciences study. We conclude that the use of this technology has not yet found its position in Iran, especially in the field of urology. The main causes for it are the difficult accessibility and disturb of laser devices and its accessories, as well as the lack of adequate knowledge of the medical community about this modality.
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Affiliation(s)
- Mohammad Reza Razzaghi
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Fallah Karkan
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saleh Ghiasy
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Javanmard
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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18
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Netsch C, Becker B, Tiburtius C, Moritz C, Becci AV, Herrmann TRW, Gross AJ. A prospective, randomized trial comparing thulium vapoenucleation with holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic obstruction: perioperative safety and efficacy. World J Urol 2017; 35:1913-1921. [PMID: 28698991 DOI: 10.1007/s00345-017-2071-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/07/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES To compare the perioperative outcomes of thulium vapoenucleation of the prostate (ThuVEP) with holmium laser enucleation of the prostate (HoLEP) for patients with symptomatic benign prostatic obstruction (BPO). METHODS Forty-eight and 46 patients were prospectively randomized to ThuVEP and HoLEP. All patients were assessed preoperatively and 4-week postoperatively. The complications were noted and classified according to the modified Clavien classification system. Patient data were expressed as median (interquartile range) or numbers (%). RESULTS Median age at surgery was 73 (67-76) years and median prostate volume was 80 (46.75-100) cc and not different between the groups (p = 0.207). The median operative time was 60 (41-79) minutes without significant differences between both groups (p = 0.275). There were no significant differences between the groups regarding catheterization time [2 (2-2) days, p = 0.966] and postoperative stay [2 (2-3) days, p = 0.80]). Clavien 1 (13.8%), Clavien 2 (3.2%), Clavien 3a (2.1%), and Clavien 3b (4.3%) complications occurred without significant differences between the groups. However, the occurrence of acute postoperative urinary retention was higher after HoLEP compared to ThuVEP (15.2 vs. 2.1%, p ≤ 0.022). At 1-month follow-up, peak urinary flow rates (10.7 vs. 22 ml/s), post-void residual volumes (100 vs. 20 ml), International Prostate Symptom Score (20 vs. 10) and Quality of Life (4 vs. 3) had improved significantly (p ≤ 0.005) without significant differences between the groups. CONCLUSIONS ThuVEP and HoLEP are safe and effective procedures for the treatment of symptomatic BPO. Both procedures give equivalent and satisfactory immediate micturition improvement with low perioperative morbidity.
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Affiliation(s)
- Christopher Netsch
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany.
| | - B Becker
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
| | - C Tiburtius
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
| | - C Moritz
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
| | - A Venneri Becci
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
| | - T R W Herrmann
- Department of Urology, MHH Medical School of Hannover, Hannover, Germany
| | - A J Gross
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
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Müllhaupt G, Abt D, Mordasini L, Köhle O, Engeler DS, Lüthi A, Sauter R, Schmid HP, Schwab C. Absorption of Irrigation Fluid During Thulium Laser Vaporization of the Prostate. J Endourol 2017; 31:380-383. [PMID: 28156134 DOI: 10.1089/end.2016.0888] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To assess the prevalence and extent of irrigation fluid absorption during thulium laser vaporization of the prostate. MATERIAL AND METHODS Fifty-four patients undergoing thulium laser vaporization of the prostate were prospectively included into the trial at a tertiary referral center. Isotonic saline containing 1% ethanol was used for intraoperative irrigation. Absorption of irrigation fluid was measured periodically during the operation using the expired breath ethanol technique. Among others, intra- and postoperative changes in biochemical and hematological laboratory findings were assessed. RESULTS Absorption of irrigation fluid was detected in 7 out of 54 (13%) patients with a median absorption volume of 265 mL (227-615). No significant differences of intra- and postoperative blood parameters were observed between absorbers and nonabsorbers. No risk factor (i.e., age, prostate size, surgery duration, applied energy, and amount of irrigation fluid) for the occurrence of fluid absorption could be identified. CONCLUSION Absorption of irrigation fluid also occurs during thulium laser vaporization of the prostate and should be kept in mind, especially in patients at a high cardiovascular risk. However, compared with previously assessed resection and vaporization techniques, thulium vaporization might have a favorable safety profile regarding fluid absorption.
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Affiliation(s)
- Gautier Müllhaupt
- 1 Department of Urology, Cantonal Hospital St. Gallen , St. Gallen, Switzerland
| | - Dominik Abt
- 1 Department of Urology, Cantonal Hospital St. Gallen , St. Gallen, Switzerland
| | - Livio Mordasini
- 1 Department of Urology, Cantonal Hospital St. Gallen , St. Gallen, Switzerland
| | - Olivia Köhle
- 1 Department of Urology, Cantonal Hospital St. Gallen , St. Gallen, Switzerland
| | - Daniel S Engeler
- 1 Department of Urology, Cantonal Hospital St. Gallen , St. Gallen, Switzerland
| | - Andreas Lüthi
- 2 Department of Anesthesiology, Cantonal Hospital St. Gallen , St. Gallen, Switzerland
| | - Rafael Sauter
- 3 Clinical Trials Unit, Cantonal Hospital St. Gallen , St. Gallen, Switzerland
| | - Hans-Peter Schmid
- 1 Department of Urology, Cantonal Hospital St. Gallen , St. Gallen, Switzerland
| | - Christoph Schwab
- 1 Department of Urology, Cantonal Hospital St. Gallen , St. Gallen, Switzerland
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Seo DH, Kam SC. Recent advances in laser treatment for benign prostatic hyperplasia. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.5.401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Deok Ha Seo
- Department of Urology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Sung Chul Kam
- Department of Urology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
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21
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Wolters M, Huusmann S, Oelke M, Kuczyk MA, Herrmann TRW. Anatomical Enucleation of the Prostate with the Novel Combined Mechanical and Bipolar Vaporization Probe in Ejaculation Sparing and Two-Lobe Manner. ACTA ACUST UNITED AC 2016. [DOI: 10.1089/vid.2016.0028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Mathias Wolters
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - Stephan Huusmann
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - Matthias Oelke
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - Markus Antonius Kuczyk
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Hannover, Germany
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22
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Wolters M, Huusmann S, Oelke M, Kuczyk MA, Herrmann TRW. Anatomical Enucleation of the Prostate with Thulium:YAG Support: Redefinition of the Surgical Approach in Two-Lobe Technique. ACTA ACUST UNITED AC 2016. [DOI: 10.1089/vid.2016.0029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Mathias Wolters
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - Stephan Huusmann
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - Matthias Oelke
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - Markus Antonius Kuczyk
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Hannover, Germany
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24
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Nair SM, Pimentel MA, Gilling PJ. A Review of Laser Treatment for Symptomatic BPH (Benign Prostatic Hyperplasia). Curr Urol Rep 2016; 17:45. [DOI: 10.1007/s11934-016-0603-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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25
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Yu H, Zhang Z, Zhu Y, Chen J, Jiang X, Meng H, Shi B. Long-term outcome following thulium vaporesection of the prostate. Lasers Surg Med 2016; 48:505-10. [PMID: 26940981 DOI: 10.1002/lsm.22495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND The continuous wave 2-μm Thulium Laser has been introduced as potential technology with both high efficiency and safe practice; although little data have been shown regarding the long-term outcomes. OBJECTIVE To analyze the long-term outcomes after thulium vaporesection of the prostate (ThuVaRP). METHODS ThuVaRP was performed using the continuous wave, 2-μm Thulium: YAG laser at 70 W. The perioperative and post-operative follow-up data were analyzed. RESULTS The average age at surgery was 71.5 (range 55-94 years). The median prostate size was 60.1 g (range 36.3-109.8 g). A median operation time was noted at 44.8 ± 6.5 minutes, while the median catheterization time was 3.5 ± 0.5 days. In regards to hospital stay, most patients had an average duration of 5.5 ± 1.5 days. Minor complications requiring non-interventional treatment happened in 237 (36.24%) of 654 patients, while major complications requiring re-interventions occurred in one patient (0.15%). During a 60-month follow-up, bladder neck fibrosis occurred in 1.22% of the patients. A BPH recurrence happened in 17 (2.60%) patients, of which 14 patients (2.14%) received a second surgery. In comparison to the pre-operative baseline, the patients Qmax, PVR volume, IPSS, and Qol scores all improved significantly (P < 0.01) at time of discharge. This continued into the post-operative follow-up visits (3-6-12-18-14-26-48-60 months). CONCLUSIONS ThuVaRP is both an effective and safe treatment procedure for symptomatic BPO (with a low occurrence of complications). Lasers Surg. Med. 48:505-510, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Haiyi Yu
- Department of Urology, 89th Hospital of PLA, Weifang, Shandong, 261000, People's Republic of China
| | - Zhaocun Zhang
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Yaofeng Zhu
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Jun Chen
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Xuewen Jiang
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Hui Meng
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Benkang Shi
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, People's Republic of China
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A review of thulium laser vapo-enucleation of the prostate: A novel laser-based strategy for benign prostate enlargement. Arab J Urol 2015; 13:209-11. [PMID: 26413349 PMCID: PMC4563004 DOI: 10.1016/j.aju.2015.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 06/22/2015] [Accepted: 06/24/2015] [Indexed: 12/01/2022] Open
Abstract
Thulium laser vapo-enucleation of the prostate is the latest addition to the arsenal of minimally invasive therapies available for the surgical treatment of lower urinary tract symptoms secondary to benign prostate hyperplasia. The potential advantages include smoother vaporisation, a clearer visual field and the option of both continuous-wave and pulsed modes, which also potentiate the haemostatic properties of this endoscopic method. Short-term results show that it yields significant improvements in both subjective and objective outcomes, with a strong safety profile. Large-scale randomised studies with a longer follow-up are warranted to determine the durability of this laser procedure.
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Dołowy Ł, Krajewski W, Dembowski J, Zdrojowy R, Kołodziej A. The role of lasers in modern urology. Cent European J Urol 2015; 68:175-82. [PMID: 26251737 PMCID: PMC4526611 DOI: 10.5173/ceju.2015.537] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/03/2015] [Accepted: 04/17/2015] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The functioning of modern urological departments and the high level of service they provide is possible through, among other things, the use of modern laser techniques. MATERIAL AND METHODS Open operations have been replaced by minimally invasive procedures, and classical surgical tools by advanced lasers. The search for new applications with lasers began as technology developed. Among many devices available, holmium, diode and thulium lasers are currently the most popular. RESULTS Depending on the wavelength, the absorption by water and hemoglobin and the depth of penetration, lasers can be used for coagulation, vaporization and enucleation. In many centres, after all the possibilities of pharmacological treatment have been exhausted, lasers are used as the primary treatment for patients with benign prostatic hyperplasia, with therapeutic results that are better than those obtained through open or endoscopic operations. The use of lasers in the treatment of urolithiasis, urinary strictures and bladder tumours has made treatment of older patients with multiple comorbidities safe, without further necessity to modify the anticoagulant drug treatment. Laser procedures are additionally less invasive, reduce hospitalization time and enable a shorter bladder catheterization time, sometimes even eliminating the need for bladder catherterization completely. Such procedures are also characterized by more stable outcomes and a lower number of reoperations. CONCLUSIONS There are also indications that with the increased competition among laser manufacturers, decreased purchase and maintenance costs, and increased operational safety, laser equipment will become mandatory and indispensable asset in all urology wards.
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Affiliation(s)
- Łukasz Dołowy
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Wojciech Krajewski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Janusz Dembowski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Romuald Zdrojowy
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Anna Kołodziej
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
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Rieken M, Bachmann A. Comparison of Transurethral Surgical Methods. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
- Thomas R W Herrmann
- Division of Endourology and Laparoscopy, Hanover Medical School (MHH), Dept. of Urology and Urological Oncology, Carl Neuberg Str. 1, Hanover, 30625, Germany,
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Chang CH, Lin TP, Chang YH, Huang WJS, Lin ATL, Chen KK. Vapoenucleation of the prostate using a high-power thulium laser: a one-year follow-up study. BMC Urol 2015; 15:40. [PMID: 25956819 PMCID: PMC4438483 DOI: 10.1186/s12894-015-0032-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 04/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prostate vaporization and enucleation is a novel treatment option for bladder outlet obstruction caused by benign prostate enlargement. This surgical technique, however, has not yet been standardized. We present our findings of using a high-power thulium laser to accomplish vapoenucleation of the prostate (ThuVEP). METHODS We prospectively collected and analyzed data from 29 patients who underwent ThuVEP between August 2010 and May 2012. The control group included 30 patients who underwent traditional transurethral resection of the prostate (TURP). Operative variables, patient profiles, preoperative and postoperative urine flow rates, prostate volume (measured using transrectal ultrasonography), and the international prostate symptom score (IPSS) were recorded and analyzed using a two-tailed Student's t-test and analysis of variance. RESULTS The ages (mean ± SD) of the patients were 76.1 ± 9.4 and 72.6 ± 7.4 years (p = 0.28) in the ThuVEP and TURP groups, respectively. The average urinary flow rates before and 12 months after the operation (volume/maximum flow/average flow) were 243.3/10.5/5.0 and 302.8/17.6/9.4 (in mL, mL/s, mL/s, respectively) in the ThuVEP group and 247.2/10.8/4.6 and 369.9/20.8/12.0, respectively, in the TURP group. Preoperative and postoperative IPSSs were 17.1 ± 5.0 and 6.5 ± 3.8, respectively, in the ThuVEP group and 18.2 ± 4.5 and 6.2 ± 3.3, respectively, in the TURP group. The mean ratio of the estimated postoperative residual prostate volume to the preoperative total volume was 0.47 (p = 0.449) in both groups. The overall complication rate was 20.7% in the ThuVEP group and 30.0% in the TURP group. CONCLUSIONS One year of follow-up showed that ThuVEP and TURP effectively alleviated subjective and objective voiding symptoms with a low rate of complications. Thus, vapoenucleation using a high-power laser is feasible in elderly patients. TRIAL REGISTRATION ISRCTN registry with study ID ISRCTN52339705 . Date assigned: 06/03/2015.
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Affiliation(s)
- Ching-Hsin Chang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan. .,Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Tzu-Ping Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Urology, National Yang-Ming University School of Medicine, Taipei, Taiwan. .,Shu-Tien Urological Science Research Center, Taipei, Taiwan.
| | - Yen-Hwa Chang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Urology, National Yang-Ming University School of Medicine, Taipei, Taiwan. .,Shu-Tien Urological Science Research Center, Taipei, Taiwan.
| | - William J S Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Urology, National Yang-Ming University School of Medicine, Taipei, Taiwan. .,Shu-Tien Urological Science Research Center, Taipei, Taiwan.
| | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Urology, National Yang-Ming University School of Medicine, Taipei, Taiwan. .,Shu-Tien Urological Science Research Center, Taipei, Taiwan.
| | - Kuang-Kuo Chen
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Urology, National Yang-Ming University School of Medicine, Taipei, Taiwan. .,Shu-Tien Urological Science Research Center, Taipei, Taiwan.
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Kyriazis I, Świniarski PP, Jutzi S, Wolters M, Netsch C, Burchardt M, Liatsikos E, Xia S, Bach T, Gross AJ, Herrmann TRW. Transurethral anatomical enucleation of the prostate with Tm:YAG support (ThuLEP): review of the literature on a novel surgical approach in the management of benign prostatic enlargement. World J Urol 2015; 33:525-30. [DOI: 10.1007/s00345-015-1529-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 02/11/2015] [Indexed: 11/28/2022] Open
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Netsch C, Bach T, Herrmann TRW, Gross AJ. Update on the current evidence for Tm:YAG vapoenucleation of the prostate 2014. World J Urol 2014; 33:517-24. [PMID: 25300823 DOI: 10.1007/s00345-014-1417-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 09/30/2014] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION To evaluate the current role of thulium vapoenucleation of the prostate (ThuVEP) for the treatment of benign prostatic obstruction (BPO). METHODS A Medline search for randomized trials, case series, and comparative studies being published since the initial description of the ThuVEP procedure (2009-2014) was performed to assess the safety, the perioperative morbidity, the efficacy, and the durability of the technique. RESULTS A total of 14 peer-reviewed original articles, seven case series [level of evidence (LOE) 4] and seven comparative studies (LOE 3b), have been identified. ThuVEP has been shown to be a size-independent, safe, efficacious, and durable procedure for the treatment of BPO in large, prospective, and retrospective series (LOE 4/3b). The feasibility and safety of the ThuVEP procedure has also been confirmed in patients at high cardiopulmonary risk on oral anticoagulants (LOE 4). It has also been demonstrated that the erectile function is not impaired by the ThuVEP procedure (LOE 4). However, published ThuVEP series are from very few centers of excellence not exceeding a LOE of 3b. Randomized controlled trials comparing ThuVEP with standard procedures for the treatment of BPO, namely transurethral resection of the prostate, open prostatectomy, or holmium laser enucleation of the prostate, have not been published so far. CONCLUSIONS ThuVEP appears to be a size-independent, safe, efficacious, and durable procedure for the treatment of BPO (LOE 4/3b). Multicentric PRT are however needed to define the current role of ThuVEP in the armamentarium of minimally invasive transurethral surgery of the prostate.
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Affiliation(s)
- C Netsch
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany,
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Zhu Y, Zhuo J, Xu D, Xia S, Herrmann TRW. Thulium laser versus standard transurethral resection of the prostate for benign prostatic obstruction: a systematic review and meta-analysis. World J Urol 2014; 33:509-15. [PMID: 25298242 DOI: 10.1007/s00345-014-1410-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 07/31/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To assess the efficacy and safety of thulium laser versus standard transurethral resection of the prostate (TURP) for treating patients with benign prostatic obstruction. METHODS A systematic search of the electronic databases, including Medline, Embase, Web of Science, and The Cochrane Library, was performed up to February 1, 2014. The pooled estimates of demographic and clinical baseline 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 calculated. RESULTS Seven trials assessing thulium laser versus standard TURP were considered suitable for meta-analysis including four randomized controlled trials (RCTs) and three non-RCTs. Compared with TURP, although thulium laser prostatectomy (TmLRP) needed a longer operative time [weighted mean difference (WMD) 8.18 min; 95 % confidence interval (CI) 1.60-14.75; P = 0.01], patients having TmLRP might benefit from significantly less serum sodium decreased (-3.73 mmol/L; 95 % CI -4.41 to -3.05; P < 0.001), shorter time of catheterization (WMD -1.29 days; 95 % CI -1.95 to -0.63; P < 0.001), shorter length of hospital stay (WMD -1.83 days; 95 % CI -3.10 to -0.57; P = 0.005), and less transfusion (odds ratio 0.09; 95 % CI 0.02-0.41; P = 0.002). During the 1, 3, and, 12 months of postoperative follow-up, the procedures did not demonstrate a significant difference in IPSS, QoL, Qmax, and PVR. CONCLUSIONS TmLRP had a similar efficacy to standard TURP in terms of IPSS, QoL, Qmax, and PVR, and offered several advantages over TURP in terms of blood transfusion, serum sodium decreased, catheterization time, and hospital stay, while TURP was superior in terms of operation duration. Well-designed multicentric/international RCTs with long-term follow-up are still needed.
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Affiliation(s)
- Yiping Zhu
- Department of Urology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiao Tong University, No.100, Haining Road, Shanghai, 200080, People's Republic of China
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Kim C, Jeon MJ, Jung JH, Yang JD, Park H, Kang HW, Lee H. Fabrication of novel bundled fiber and performance assessment for clinical applications. Lasers Surg Med 2014; 46:718-25. [DOI: 10.1002/lsm.22284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Changhwan Kim
- School of Mechanical Engineering; Kyungpook National University; Daegu 702-701 Korea
| | - Myung Jin Jeon
- School of Mechanical Engineering; Kyungpook National University; Daegu 702-701 Korea
| | - Jin Hyang Jung
- Department of surgery, School of Medicine; Kyungpook National University; Daegu 702-210 Korea
| | - Jung dug Yang
- Department of Plastic and Reconstructive Surgery; School of Medicine, Kyungpook National University; Daegu 702-210 Korea
| | - Hoyong Park
- Department of surgery, School of Medicine; Kyungpook National University; Daegu 702-210 Korea
| | - Hyun Wook Kang
- Department of Biomedical Engineering and Center for Marine-integrated Biomedical Technology (BK21 Plus); Pukyong National University; Busan 608-737 Korea
| | - Ho Lee
- School of Mechanical Engineering; Kyungpook National University; Daegu 702-701 Korea
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Abstract
Monopolar transurethral resection of the prostate (TURP) with endoscopic electrocautery remains the gold standard surgical technique for benign prostatic hypertrophy (BPH) by which all new procedures are compared. We reviewed the current literature, and international urological guidelines and consensus opinion on various surgical options for BPH and present a brief overview of alternative techniques including bipolar TURP, transurethral incision of the prostate, transurethral vaporization of the prostate, laser prostatectomy (with holmium, thulium and potassium titanyl phosphate greenlight lasers) and open prostatectomy (with mention of new techniques including laparoscopic and robotic prostatectomy). Emerging, experimental and less established techniques are also described including endoscopic heat generation (transurethral microwave thermotherapy, radiofrequency transurethral needle ablation of the prostate, high intensity focused ultrasound, hot water induced thermotherapy, pulsed electromagnetic radiofrequency), injection therapy (transurethral ethanol ablation and botulinum toxin) and mechanical devices (intraprostatic stents and urethral lift devices). Despite a plethora of surgical options, none have realistically improved outcomes in the long-term compared with TURP. Improvements have been made on improving surgical morbidity and time in hospital. Questions remain in this area, including what specific elements of bladder outflow obstruction (BOO) result in damage to the urinary tract, how does BPH contribute to BOO and how much prostate volume reduction is necessary to relieve BOO or lower urinary tract symptoms. Given these unanswered questions and the multitude of procedures available, it is clear that appropriate counselling is necessary in all men who undergo BPH surgery.
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Affiliation(s)
- Nikesh Thiruchelvam
- Department of Urology, Addenbrookes Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
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Cynk M. Holmium laser enucleation of the prostate: a review of the clinical trial evidence. Ther Adv Urol 2014; 6:62-73. [PMID: 24688602 PMCID: PMC3943367 DOI: 10.1177/1756287213511509] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Transurethral resection of the prostate (TURP) has remained the procedure of choice for the surgical treatment of bladder outflow obstruction for almost five decades, but holmium laser enucleation of the prostate (HoLEP) is now emerging as a challenger as the gold standard procedure. This review summarizes the evidence base for HoLEP, with particular reference to randomized, controlled (level 1) evidence.
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Affiliation(s)
- Mark Cynk
- Consultant, Urological Surgeon, Maidstone and Tunbridge Wells NHS Trust, Maidstone Hospital, Hermitage Lane, Maidstone ME16 9QQ, UK
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Gesierich W, Reichenberger F, Fertl A, Haeussinger K, Sroka R. Endobronchial therapy with a thulium fiber laser (1940 nm). J Thorac Cardiovasc Surg 2014; 147:1827-32. [PMID: 24521960 DOI: 10.1016/j.jtcvs.2013.12.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 12/12/2013] [Accepted: 12/31/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Nd:YAG laser (1064 nm) is standard in bronchology. The thulium fiber laser (1940 nm) has a nearly 1000-fold increased absorption in water, enabling precise tissue ablation with a small margin of coagulation, whereas 1064-nm laser light penetrates deeper into tissue with less controllable effects. OBJECTIVES To assess the safety, feasibility, and versatility of endobronchial thulium laser therapy in an observational cohort study. METHODS Endobronchial treatment with the thulium fiber laser was performed in a cohort study of 187 bronchoscopies on 132 consecutive patients with 135 endobronchial lesions amenable to laser resection. RESULTS The thulium fiber laser produced superficial, precise, and rapid tissue ablation. Eighty-one lesions were completely vaporized; 82 lesions were treated by deep tissue destruction by inserting the fiber into tissue followed by mechanical resection. Tumor bleeding was coagulated with rapid and sustained hemostasis (n = 28). Nitinol stents were removed after resection of severe granulation tissue overgrowth (n = 10). Intact stents were maintained after ablation of in-stent tissue (n = 47). In 11 cases, bleeding occurred during laser treatment (n = 11 of 187). Power settings between 5 and 20 W were found to be safe. CONCLUSIONS Endobronchial therapy with the thulium laser at 1940 nm seems to be safe, feasible, and highly versatile for treatment of airway stenosis and stent obstruction caused by tissue ingrowth. Further studies are warranted.
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Affiliation(s)
- Wolfgang Gesierich
- Department of Pneumology, Asklepios-Fachkliniken Munich-Gauting, Comprehensive Pneumology Center Munich, Gauting, Germany.
| | - Frank Reichenberger
- Department of Pneumology, Asklepios-Fachkliniken Munich-Gauting, Comprehensive Pneumology Center Munich, Gauting, Germany
| | | | - Karl Haeussinger
- Department of Pneumology, Asklepios-Fachkliniken Munich-Gauting, Comprehensive Pneumology Center Munich, Gauting, Germany
| | - Ronald Sroka
- Laser-Forschungslabor, Hospital of University of Munich, Muenchen, Germany
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Thulium laser resection versus plasmakinetic resection of prostates larger than 80 ml. World J Urol 2013; 32:1077-85. [PMID: 24264126 DOI: 10.1007/s00345-013-1210-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 11/11/2013] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To compare the safety and efficiency of thulium laser resection of the prostate-tangerine technique (TmLRP-TT) and plasmakinetic resection of the prostate (PKRP) for aged symptomatic benign prostatic hyperplasia (BPH) patients with large volume prostates (>80 ml) in a prospective randomized trial with an 18-month follow-up. MATERIALS AND METHODS From January 2010 to November 2011, 90 BPH patients with large volume prostates were randomized for surgical treatment with TmLRP-TT (n = 45, group 1) or PKRP (n = 45, group 2). The preoperative and postoperative parameters were recorded and compared. All patients were evaluated at 1, 6, 12 and 18 months postoperatively using the International Prostate Symptom Score (IPSS), quality of life score (QoL), maximum flow rate (Q max), postvoid residual urine volume (PVR) and the five-item version of the International Index of Erectile Function score. All perioperative complications were also documented and classified according to the modified Clavien classification system. RESULTS Compared with the PKRP group, the TmLRP-TT group had a statistically lower hemoglobin drop (0.86 ± 0.42 vs. 1.34 ± 1.04 g/dl, P < 0.01), shorter catheterization time (1.91 ± 0.85 vs. 2.36 ± 0.74 days, P < 0.01) and hospital stay (3.80 ± 0.46 vs. 5.02 ± 0.54 days, P < 0.01). Within the observation period of 18 months, both groups had significant postoperative improvement in IPSS, QoL, Q max and PVR, although no difference was observed between the two groups. Only one patient receiving PKRP treatment required a blood transfusion perioperatively. During the 18-month follow-up, one patient in each group experienced urethral stricture and one patient in the PKRP group experienced bladder neck contracture. Minor complications that required no or noninterventional treatment occurred in 6 (13.33 %) of TmLRP-TT group (Clavien grade 1, 13.33 % and grade 2, 0 %) and 10 (22.22 %) of PKRP group (Clavien grade 1, 20.00 % and grade 2, 2.22 %). No severe complications required reinterventions in both groups (Clavien grade 3, 0 %; grade 4, 0 %; grade 5, 0 %). CONCLUSIONS Both TmLRP-TT and PKRP are safe and effective treatment options for large prostates that require resection. Taking into account less blood loss, shorter catheterization time and hospital stay, TmLRP-TT may be a better treatment for patients with large prostates.
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A randomized trial comparing thulium laser resection to standard transurethral resection of the prostate for symptomatic benign prostatic hyperplasia: four-year follow-up results. World J Urol 2013; 32:683-9. [PMID: 23913094 DOI: 10.1007/s00345-013-1103-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 05/20/2013] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE 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). METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Liu H, Wu J, Xue S, Zhang Q, Ruan Y, Sun X, Xia S. Comparison of the safety and efficacy of conventional monopolar and 2-micron laser transurethral resection in the management of multiple nonmuscle-invasive bladder cancer. J Int Med Res 2013; 41:984-92. [PMID: 23760914 DOI: 10.1177/0300060513477001] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives To compare the safety and efficacy of conventional monopolar transurethral resection of bladder tumour (TURBT) and 2-micron continuous-wave laser resection (2-µm laser) techniques in the management of multiple nonmuscle-invasive bladder cancer (NMIBC), and to investigate long-term effects on tumour recurrence. Methods Patients with multiple NMIBC were randomized to receive TURBT or 2-µm laser in a nonblinded manner. All patients received intravesical chemotherapy with epirubicin (40 mg/40 ml) for 8 weeks, beginning 1 week after surgery, followed with monthly maintenance therapy for 12 months. Three-year follow-up data of preoperative, operative and postoperative management were recorded. Results In total, 120 patients were included: 56 in the TURBT group and 64 in the 2-µm laser group. Intra- and postoperative complications (including bladder perforation, bleeding and irritation) were less frequently observed in the 2-µm laser group compared with the TURBT group. There were no significant differences in first time to recurrence, overall recurrence or occurrence of urethral strictures. Conclusions The 2-µm laser resection method was more effective than TURBT in reducing rates of intra- and postoperative complications, but offered no additional benefit regarding tumour recurrence.
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Affiliation(s)
- H Liu
- University Department of Urology, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - J Wu
- University Department of Urology, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - S Xue
- University Department of Urology, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Q Zhang
- University Department of Urology, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Y Ruan
- University Department of Urology, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - X Sun
- University Department of Urology, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - S Xia
- University Department of Urology, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
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Herrmann TRW, Liatsikos EN, Nagele U, Traxer O, Merseburger AS. [European Association of Urology guidelines on laser technologies]. Actas Urol Esp 2013; 37:63-78. [PMID: 22989380 DOI: 10.1016/j.acuro.2012.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 05/22/2012] [Indexed: 12/14/2022]
Abstract
CONTEXT The European Association of Urology (EAU) Guidelines Office has set up a guideline working panel to analyse the scientific evidence published in the world literature on lasers in urologic practice. OBJECTIVE Review the physical background and physiologic and technical aspects of the use of lasers in urology, as well as current clinical results from these new and evolving technologies, together with recommendations for the application of lasers in urology. The primary objective of this structured presentation of the current evidence base in this area is to assist clinicians in making informed choices regarding the use of lasers in their practice. EVIDENCE ACQUISITION Structured literature searches using an expert consultant were designed for each section of this document. Searches were carried out in the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Medline and Embase on the Dialog/DataStar platform. The controlled terminology of the respective databases was used, and both Medical Subject Headings and EMTREE were analysed for relevant entry terms. One Cochrane review was identified. EVIDENCE SYNTHESIS Depending on the date of publication, the evidence for different laser treatments is heterogeneous. The available evidence allows treatments to be classified as safe alternatives for the treatment of bladder outlet obstruction in different clinical scenarios, such as refractory urinary retention, anticoagulation, and antiplatelet medication. Laser treatment for bladder cancer should only be used in a clinical trial setting or for patients who are not suitable for conventional treatment due to comorbidities or other complications. For the treatment of urinary stones and retrograde endoureterotomy, lasers provide a standard tool to augment the endourologic procedure. CONCLUSIONS In benign prostatic obstruction (BPO), laser vaporisation, resection, or enucleation are alternative treatment options. The standard treatment for BPO remains transurethral resection of the prostate for small to moderate size prostates and open prostatectomy for large prostates. Laser energy is an optimal treatment method for disintegrating urinary stones. The use of lasers to treat bladder tumours and in laparoscopy remains investigational.
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Affiliation(s)
- T R W Herrmann
- Departamento de Urología y Uro-oncología, Medical School of Hanover (MHH), Hanover, Alemania.
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Świniarski PP, Stępień S, Dudzic W, Kęsy S, Blewniewski M, Różański W. Thulium laser enucleation of the prostate (TmLEP) vs. transurethral resection of the prostate (TURP): evaluation of early results. Cent European J Urol 2012; 65:130-4. [PMID: 24578948 PMCID: PMC3921791 DOI: 10.5173/ceju.2012.03.art6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 04/04/2012] [Accepted: 04/17/2012] [Indexed: 11/25/2022] Open
Abstract
Introduction The first decade of XXI century it is a time of the thulium laser implementation to a benign prostatic hyperplasia treatment. Objective The objective of this paper is a comparative assessment of early results thulium laser enucleation of the prostate (TmLEP) versus transurethral resection of the prostate (TURP) in 3-months observation. Materials and methods Patients were randomized to BPH surgical treatment: research group (TmLEP – 54 men) or control group (TURP – 52 men). Between 02.2007-09.2009 non-consecutive patients were examined before, one month, and 3-months after surgery. Perioperative data (age, PV, time of surgery, use of laser, morcellation, catheterization, hospitalization, used energy, Hgb loss and removed tissue weight) were assessed. Before and after surgery IPSS, QoL, Qmax and PVR were controlled. Results Hemoglobin loss was twice lower during TmLEP than TURP [0.95 ±0.77 (0-3.2) vs. 1.81 ±0.97 (0.1-4.7) g/dl, p <0.0001]. Surgery time TmLEP was longer than TURP [102.2 ±38.7 (25-210) vs. 74.5 ±22.8 (25-140) min. p <0.0001]. Without morcellation time [28.1 ±17.9 (5-80) min.], surgery time of both procedures was comparable. Weight of resected tissue was lower in TmLEP than TURP [24.8 ±14.8 (2-65) vs. 34.8 ±14.1 (12-68)g]. without consideration of vaporized tissue. In both groups we noticed a distinct improvement in all parameters: IPSS, QoL, Qmax and PVR, but without any statistically significant differences between them. Complications after surgery were similar in TmLEP and TURP group. Conclusions The thulium laser enucleation of the prostate is safe and efficient BPH treatment method, comparable to the transurethral electroresection in 3-months observation. Lack of long-term research does not allow to form wider conclusions.
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Affiliation(s)
- Piotr Paweł Świniarski
- Clinical Department of Urology and Urological Oncology, 10 Military Clinical Hospital, Bydgoszcz, Poland
| | - Stanisław Stępień
- Clinical Department of Urology and Urological Oncology, 10 Military Clinical Hospital, Bydgoszcz, Poland
| | - Waldemar Dudzic
- Clinical Department of Urology and Urological Oncology, 10 Military Clinical Hospital, Bydgoszcz, Poland
| | - Stanisław Kęsy
- Clinical Department of Urology and Urological Oncology, 10 Military Clinical Hospital, Bydgoszcz, Poland
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Barski D, Richter M, Winter C, Arsov C, de Geeter P, Rabenalt R, Albers P. Holmium laser ablation of the prostate (HoLAP): intermediate-term results of 144 patients. World J Urol 2012; 31:1253-9. [PMID: 22782618 DOI: 10.1007/s00345-012-0901-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 06/21/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To retrospectively analyse the intermediate-term outcome of holmium laser ablation of the prostate (HoLAP) of up to 4 years postoperatively in one of the largest series and to define the selection criteria for patients who benefit from potentially lower complications associated with HoLAP. METHODS Between June 2006 and November 2010, 144 patients with benign prostatic obstruction were treated at two centres with standardised HoLAP (2.0 J/50 Hz or 3.2 J/25 Hz with Versapulse(®) 80-100 W laser Lumenis(®)). Median follow-up was 21 months (range, 1-54). International prostate symptom score and quality of life (IPSS-QoL), PSA, prostate volume, maximal flow rate (Qmax), postvoiding residual volume (Vres) were evaluated pre- and postoperatively. All complications were graded according to CTCAE (v4.03). RESULTS Mean patient age was 70.1 ± 7.7 years (range, 46-90). With a preoperative median prostate volume of 40 ml (range, 10-130), the median operation time was 50 min (range, 9-138). We observed a median catheterisation time of 1 day (range, 0-12) and hospitalisation time of 2 days (range, 1-16). IPSS-QoL, Qmax and Vres were significantly improved after 3 months, and all parameters remained unchanged after 12, 24 and 36 months. The rate of re-operation was significantly lower in patients with prostate volume <40 ml, compared to patients with prostates ≥ 40 ml (9.1 vs. 25 %, p = 0.04). CONCLUSIONS HoLAP is a safe and effective procedure for the treatment of prostates <40 ml. Patients benefit from HoLAP because of a low bleeding rate and short hospital stay. Due to high recurrence rates, HoLAP should be avoided in prostates >40 ml.
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Affiliation(s)
- D Barski
- Department of Urology, Duesseldorf University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany,
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Hauser S, Rogenhofer S, Ellinger J, Strunk T, Müller SC, Fechner G. Thulium Laser (Revolix) Vapoenucleation of the Prostate Is a Safe Procedure in Patients with an Increased Risk of Hemorrhage. Urol Int 2012; 88:390-4. [DOI: 10.1159/000336874] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 01/29/2012] [Indexed: 11/19/2022]
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Bach T, Muschter R, Sroka R, Gravas S, Skolarikos A, Herrmann TR, Bayer T, Knoll T, Abbou CC, Janetschek G, Bachmann A, Rassweiler JJ. Laser Treatment of Benign Prostatic Obstruction: Basics and Physical Differences. Eur Urol 2012; 61:317-25. [DOI: 10.1016/j.eururo.2011.10.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 10/13/2011] [Indexed: 10/16/2022]
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Herrmann TRW, Liatsikos EN, Nagele U, Traxer O, Merseburger AS. EAU guidelines on laser technologies. Eur Urol 2012; 61:783-95. [PMID: 22285403 DOI: 10.1016/j.eururo.2012.01.010] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 01/09/2012] [Indexed: 11/29/2022]
Abstract
CONTEXT The European Association of Urology (EAU) Guidelines Office has set up a guideline working panel to analyse the scientific evidence published in the world literature on lasers in urologic practice. OBJECTIVE Review the physical background and physiologic and technical aspects of the use of lasers in urology, as well as current clinical results from these new and evolving technologies, together with recommendations for the application of lasers in urology. The primary objective of this structured presentation of the current evidence base in this area is to assist clinicians in making informed choices regarding the use of lasers in their practice. EVIDENCE ACQUISITION Structured literature searches using an expert consultant were designed for each section of this document. Searches were carried out in the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Medline and Embase on the Dialog/DataStar platform. The controlled terminology of the respective databases was used, and both Medical Subject Headings and EMTREE were analysed for relevant entry terms. One Cochrane review was identified. EVIDENCE SYNTHESIS Depending on the date of publication, the evidence for different laser treatments is heterogeneous. The available evidence allows treatments to be classified as safe alternatives for the treatment of bladder outlet obstruction in different clinical scenarios, such as refractory urinary retention, anticoagulation, and antiplatelet medication. Laser treatment for bladder cancer should only be used in a clinical trial setting or for patients who are not suitable for conventional treatment due to comorbidities or other complications. For the treatment of urinary stones and retrograde endoureterotomy, lasers provide a standard tool to augment the endourologic procedure. CONCLUSIONS In benign prostatic obstruction (BPO), laser vaporisation, resection, or enucleation are alternative treatment options. The standard treatment for BPO remains transurethral resection of the prostate for small to moderate size prostates and open prostatectomy for large prostates. Laser energy is an optimal treatment method for disintegrating urinary stones. The use of lasers to treat bladder tumours and in laparoscopy remains investigational.
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Affiliation(s)
- Thomas R W Herrmann
- Department of Urology and Urooncology, Medical School of Hanover [MHH], Hanover, Germany.
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Yee CLS, Pal RP, Batchelder A, Khan MA. Risk of erectile dysfunction and retrograde ejaculation associated with thulium laser vaporesection of the prostate for bladder outflow obstruction: a retrospective study. Urol Int 2012; 88:165-9. [PMID: 22237486 DOI: 10.1159/000333046] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 09/09/2011] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to determine the incidence of erectile dysfunction and retrograde ejaculation following thulium:yttrium-aluminium-garnet (Tm:YAG) laser prostate vaporesection (ThuVaRP). PATIENTS AND METHODS Between January 2009 and June 2010, 113 consecutive patients underwent ThuVaRP for bladder outflow obstruction. Of these, 54 (48%) were included in the study as they were able to maintain an erection for sexual intercourse prior to undergoing ThuVaRP. All patients had benign pathology and had not undergone previous bladder neck surgery. The incidence of erectile dysfunction and retrograde ejaculation was reported at a mean follow-up period of 12 months post-operatively. RESULTS The mean patient age was 71 years (range 46-90). The mean follow-up period was 12 months (range 4-21). 11 (20%) patients experienced worsening erectile function with 3 (6%) noticing an improvement. A total of 30 patients (56%) experienced some degree of retrograde ejaculation. 4 patients (7%) noticed an improvement in their ejaculation. Retrograde ejaculation was more common in patients with an indwelling catheter in situ for refractory urinary retention (43 vs. 17%, p = 0.04) and in diabetic patients (27 vs. 4%, p = 0.03). There was an increased trend of erectile dysfunction in men aged ≥70 years, with hypertension and with hypercholesterolaemia, but this was not significant. CONCLUSION Our retrospective study has demonstrated that the overall risk of erectile dysfunction and retrograde ejaculation associated with ThuVaRP is 20 and 56%, respectively.
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Affiliation(s)
- Carol Ling Sze Yee
- Department of Urology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
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Pal RP, Khan MA. Intermediate-term efficacy of Tm:YAG laser prostate vaporesection for bladder outlet obstruction: initial experience from a UK teaching hospital. Urol Int 2011; 88:39-42. [PMID: 22133639 DOI: 10.1159/000330901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 06/28/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess the safety and clinical efficacy of Tm:YAG laser vaporesection of the prostate (ThuVaRP) at intermediate-term follow-up. PATIENTS AND METHODS We identified the first 60 consecutive patients who underwent ThuVaRP at our institute. Operative outcomes assessed were resection time, resection weight, drop in haemoglobin, transfusion rate, catheter time and complication rate. The International Prostate Symptom Score (IPSS) was documented at a mean follow-up period of 19 months postoperatively. RESULTS 45/60 patients underwent treatment due to lower urinary tract symptoms secondary to benign prostatic obstruction, 11/60 patients had a long-term catheter in situ for refractory urinary retention secondary to benign prostatic obstruction, and 4/60 patients had bladder outflow obstruction secondary to adenocarcinoma of the prostate. 1/60 patients developed urosepsis, 1/60 patients developed a urinary tract infection and 1/60 patients required 3-way catheterization and irrigation due to haematuria. No patients required a blood transfusion. The mean IPSS at a mean follow-up interval of 19 months (range 15-28 months) was 5.1 (range 1-23). Postoperative maximum flow rate improved from 7.9 to 17.1 ml/s, and post-micturition residual volume decreased from 254 to 86 ml. CONCLUSION ThuVaRP is safe and appears to have durable efficacy at intermediate follow-up.
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Affiliation(s)
- Raj P Pal
- Department of Urology, University Hospitals of Leicester, Clinical Sciences Unit, Leicester General Hospital, Leicester, UK. rppal @ doctors.org.uk
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Abstract
The world's first laser was developed by Theodore Maiman in 1960. Over the course of the past five decades, this technology has evolved into a highly specialized entity, also finding a niche market in the field of urology. Lasers obtained from various lasing mediums producing amplified light of different wavelengths have been tested for urological applications. Today, these lasers are most commonly used in the surgical management of benign prostatic hyperplasia and as intracorporeal lithotripters. Other uses include ablation of various urologic tumors and incising strictures of the upper- and lower urinary tract. A continuous process of evolution of this technology is taking place, resulting in surgical lasers becoming ever safer, more effective, and more affordable.
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Affiliation(s)
- Amir Zarrabi
- Department of Urology, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa
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