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Osterberg EC, Choi BB. Review of current laser therapies for the treatment of benign prostatic hyperplasia. Korean J Urol 2013; 54:351-8. [PMID: 23789041 PMCID: PMC3685632 DOI: 10.4111/kju.2013.54.6.351] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 05/20/2013] [Indexed: 12/11/2022] Open
Abstract
The gold standard for symptomatic relief of bladder outlet obstruction secondary to benign prostatic hyperplasia has traditionally been a transurethral resection of the prostate (TURP). Over the past decade, however, novel laser technologies that rival the conventional TURP have multiplied. As part of the ongoing quest to minimize complications, shorten hospitalization, improve resection time, and most importantly reduce mortality, laser prostatectomy has continually evolved. Today, there are more variations of laser prostatectomy, each with several differing surgical techniques. Although abundant data are available confirming the safety and feasibility of the various laser systems, future randomized-controlled trials will be necessary to verify which technique is superior. In this review, we describe the most common modalities used to perform a laser prostatectomy, mainly, the holmium laser and the potassium-titanyl-phosphate lasers. We also highlight the physical and clinical characteristics of each technology with a review of the most current and highest-quality literature.
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CHACKO KNINAN, DONOVAN JENNYL, ABRAMS PAUL, PETERS TIMJ, BROOKES SARAT, THORPE ANDYC, GUJRAL SANDEEP, WRIGHT MARK, KENNEDY LGAIL, NEAL DAVIDE. TRANSURETHRAL PROSTATIC RESECTION OR LASER THERAPY FOR MEN WITH ACUTE URINARY RETENTION: THE CLASP RANDOMIZED TRIAL. J Urol 2001. [DOI: 10.1016/s0022-5347(05)66101-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- K. NINAN CHACKO
- From the Department of Social Medicine, University of Bristol, Department of Urology, Bristol Urological Institute, Bristol, Department of Surgical Sciences, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne and Department of Urology, Sunderland City Hospitals, Sunderland City, United Kingdom
| | - JENNY L. DONOVAN
- From the Department of Social Medicine, University of Bristol, Department of Urology, Bristol Urological Institute, Bristol, Department of Surgical Sciences, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne and Department of Urology, Sunderland City Hospitals, Sunderland City, United Kingdom
| | - PAUL ABRAMS
- From the Department of Social Medicine, University of Bristol, Department of Urology, Bristol Urological Institute, Bristol, Department of Surgical Sciences, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne and Department of Urology, Sunderland City Hospitals, Sunderland City, United Kingdom
| | - TIM J. PETERS
- From the Department of Social Medicine, University of Bristol, Department of Urology, Bristol Urological Institute, Bristol, Department of Surgical Sciences, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne and Department of Urology, Sunderland City Hospitals, Sunderland City, United Kingdom
| | - SARA T. BROOKES
- From the Department of Social Medicine, University of Bristol, Department of Urology, Bristol Urological Institute, Bristol, Department of Surgical Sciences, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne and Department of Urology, Sunderland City Hospitals, Sunderland City, United Kingdom
| | - ANDY C. THORPE
- From the Department of Social Medicine, University of Bristol, Department of Urology, Bristol Urological Institute, Bristol, Department of Surgical Sciences, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne and Department of Urology, Sunderland City Hospitals, Sunderland City, United Kingdom
| | - SANDEEP GUJRAL
- From the Department of Social Medicine, University of Bristol, Department of Urology, Bristol Urological Institute, Bristol, Department of Surgical Sciences, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne and Department of Urology, Sunderland City Hospitals, Sunderland City, United Kingdom
| | - MARK WRIGHT
- From the Department of Social Medicine, University of Bristol, Department of Urology, Bristol Urological Institute, Bristol, Department of Surgical Sciences, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne and Department of Urology, Sunderland City Hospitals, Sunderland City, United Kingdom
| | - L. GAIL KENNEDY
- From the Department of Social Medicine, University of Bristol, Department of Urology, Bristol Urological Institute, Bristol, Department of Surgical Sciences, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne and Department of Urology, Sunderland City Hospitals, Sunderland City, United Kingdom
| | - DAVID E. NEAL
- From the Department of Social Medicine, University of Bristol, Department of Urology, Bristol Urological Institute, Bristol, Department of Surgical Sciences, University of Newcastle-upon-Tyne, Newcastle-upon-Tyne and Department of Urology, Sunderland City Hospitals, Sunderland City, United Kingdom
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Wada S, Yoshimura R, Kyo M, Hase T, Masuda C, Watanabe Y, Ikemoto S, Kawashima H, Kishimoto T. Comparative study of transurethral laser prostatectomy versus transurethral electroresection for benign prostatic hyperplasia. Int J Urol 2000; 7:373-7. [PMID: 11144505 DOI: 10.1046/j.1442-2042.2000.00214.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Transurethral resection of the prostate (TURP) is the gold standard treatment for benign prostatic hyperplasia (BPH). Recently, less invasive transurethral laser prostatectomy, such as visual laser ablation (VLAP) or interstitial laser coagulation (ILCP), have been developed. Herein, we investigated the efficacy of VLAP and ILCP compared to TURP. METHODS A total of 80 patients with BPH were treated: 20 patients by VLAP, 30 patients by ILCP and 30 patients by TURP. All patients were followed up for 12 months after their operations. Treatment outcomes were evaluated by four different criteria: (i) the International Prostatic Symptom Score (I-PSS), (ii) the maximum flow rate (Qmax), (iii) postvoided residual urine volume before treatment and one, three, six and 12 months after treatment, and (iv) prostatic volume before operation and three and six months postoperatively. RESULTS The I-PSS, Qmax and residual urine volume were significantly improved compared to baseline levels and the improvement continued for 12 months in the three groups: for I-PSS (P<0.001 in the VLAP group and P<0.0001 in the ILCP and TURP groups), Qmax (P<0.001 in the VLAP and ILCP groups, and P<0.0001 in the TURP group), residual urine volume (P<0.01 in the VLAP group and P<0.0001 in the ILCP and TURP groups). Significant reduction of the prostatic volume was recorded only in the ILCP and TURP groups (P<0.001). CONCLUSION Visual laser ablation and ILCP can be good alternative treatments for BPH. Visual laser ablation provides good outcomes in patients with small-sized BPH and with risk factors such as heart disease or anticoagulation therapy.
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Affiliation(s)
- S Wada
- Department of Urology, Osaka City University Hospital, Osaka, Japan
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Uchida T, Ohori M, Soh S, Sato T, Iwamura M, Ao T, Koshiba K. Factors influencing morbidity in patients undergoing transurethral resection of the prostate. Urology 1999; 53:98-105. [PMID: 9886596 DOI: 10.1016/s0090-4295(98)00524-x] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Transurethral resection of the prostate (TURP) has become the primary method to relieve bladder outlet obstruction for patients with benign prostatic hyperplasia (BPH). Data from 3861 consecutive patients with BPH who underwent TURP from 1971 to 1996 at our hospital were retrospectively analyzed. METHODS The patients were classified into two groups comprising 1930 patients who underwent TURP from 1971 to 1985 (early group) and 1931 patients who underwent TURP from 1985 to 1996 (late group). Risk factors associated with blood transfusions and perioperative complications were analyzed in these patients. RESULTS Mortality, morbidity, and blood transfusions were noted in 5 (0.1 %), 516 (13.4%), and 507 (13.1%) patients, respectively. The blood transfusion and morbidity rates decreased over the 25-year period (P <0.001, chi-square test for trends), which was reflected in a decrease in these rates in the late group (6.1% and 9.5%, respectively) compared with those of the early group (20.2% and 17.2%, respectively). Postoperative bleeding and morbidity were closely related to prostatic gland size and operating time. The most significant differences for the risk of a blood transfusion were related to resection time, the amount of tissue resected, age, and the decade (1970s, 1980s, or 1990s) in which the surgery was performed (P <0.0005), whereas resection time was significantly correlated with morbidity (P <0.0005). As risk factors for each complication, the time of surgical resection, the decade of surgery, and the amount of tissue resected directly correlated with the incidence of extravasation and hemostatic procedures (P < or =0.003), whereas the incidence of postoperative epididymitis positively correlated with a preoperative vasectomy and a closed drainage system (P <0.0005). CONCLUSIONS Since the 1970s, the rates of blood transfusions and morbidity have decreased for patients undergoing TURP. Advances in techniques, instrumentation, and surgical and perioperative management, including anesthesia, have made TURP a relatively safe procedure, and it remains an effective means for treating patients with BPH.
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Affiliation(s)
- T Uchida
- Department of Urology, Kitasato University School of Medicine, Kanagawa, Japan
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