A Systematic Review and Meta-Analysis of Functional Outcomes and Complications Following the Photoselective Vaporization of the Prostate and Monopolar Transurethral Resection of the Prostate

Kang, Dong Hyuk; Ham, Won Sik; Choi, Young Deuk; Lee, Joo Yong

doi:10.5534/wjmh.2016.34.2.110

Cited by 16 publications

(11 citation statements)

References 39 publications

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“…This was more pronounced in patients with BPH with DU than in those without DU. (3) In general, the improvements in micturition symptoms, QoL and PVR in the patients with DU were maintained up to 5 years after PV or HoLEP. (4) In patients with BPH with DU, improvements in micturition symptoms and QoL during the long-term period after HoLEP were greater than improvements after PV.…”

Section: Discussionmentioning

confidence: 87%

Effect of preoperative detrusor underactivity on long‐term surgical outcomes of photovaporization and holmium laser enucleation in men with benign prostatic hyperplasia: a lesson from 5‐year serial follow‐up data

et al. 2019

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Objectives To investigate the impact of preoperative detrusor underactivity (DU) on serial treatment outcomes over the course of 5 years after photovaporization (PV) or holmium laser enucleation (HoLEP) in patients with benign prostatic hyperplasia (BPH), to compare its impact after PV vs HoLEP, and to identify predictors of long‐term lower urinary tract symptoms (LUTS) improvement. Materials and Methods This study involved 245 patients with BPH who had complete 5‐year follow‐up data (PV using 120W‐HPS, n = 143, HoLEP, n = 102), grouped as follows: PV‐HPS‐DU(+), n = 114; PV‐HPS‐DU(−), n = 29; HoLEP‐DU(+), n = 56; and HoLEP‐DU(−), n = 46. Bladder contractility index (BCI) < 100 was regarded as DU. Serial treatment outcomes for the International Prostate Symptom Score (IPSS) questionnaire, uroflowmetry and serum PSA level at 6 months, and at 1, 2, 3, 4 and 5 years after surgery, were compared among the groups. LUTS improvement was defined as a reduction in total IPSS of ≥50% relative to baseline. Results Improvement in total IPSS, quality of life (QoL) index and post‐void residual urine volume (PVR) in the PV‐HPS‐DU(+) and PV‐HPS‐DU(−) groups were maintained up to 5 years after PV, except for maximum urinary flow rate (Qmax) and bladder voiding efficiency. In the HoLEP‐DU(+) and HoLEP‐DU(−) groups, improvements in all outcome variables were maintained up to 5 years after HoLEP. Deteriorations in subtotal voiding symptom score, total IPSS and Qmax with time during the long‐term period after surgery were more pronounced in the PV‐HPS‐DU(+) and HoLEP‐DU(+) groups than in the PV‐HPS‐DU(−) and HoLEP‐DU(−) groups. Reductions in subtotal voiding symptom score, total IPSS, QoL index, and serum PSA were greater in the HoLEP‐DU(+) group than in the PV‐HPS‐DU(+) group throughout follow‐up. The type of surgery (HoLEP vs PV) and higher baseline BCI were independent predictors of LUTS improvement at 5 years after surgery. Conclusion Generally, improvement of micturition symptoms, QoL and PVR in patients with DU appears to be maintained up to 5 years after PV or HoLEP. Deterioration of voiding symptoms and urinary flow rate at long‐term follow‐up visits after PV or HoLEP was more pronounced in patients with LUTS/BPH with DU than in those without DU. Patients with BPH with DU may benefit from more complete removal of prostatic adenoma by HoLEP and greater baseline bladder contractility in terms of micturition symptoms and QoL.

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Section: Discussionmentioning

confidence: 87%

Effect of preoperative detrusor underactivity on long‐term surgical outcomes of photovaporization and holmium laser enucleation in men with benign prostatic hyperplasia: a lesson from 5‐year serial follow‐up data

et al. 2019

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“…This evidence underscores the usefulness of evaluating goal achievement in helping patients to develop realistic treatment expectations and increasing treatment satisfaction. Nevertheless, to date, most studies that have evaluated treatment outcomes of medical or surgical therapies for LUTS/BPH have used traditional outcome measures rather than the tools to assess patient goal attainment [ 18 – 20 ]. The traditional outcome measures cannot recognize that individual patients perceive their bothersome symptoms and their specific goals or treatment responses differ.…”

Section: Discussionmentioning

confidence: 99%

Self-assessed goal achievement (SAGA) after Holmium laser enucleation of the prostate (HoLEP): Association with patients' postoperative satisfaction

Cho

Kim

et al. 2018

PLoS ONE

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This study aimed to determine serial changes in self-assessed goal achievement (SAGA) and treatment satisfaction after HoLEP, to identify correlations between the two, and to compare them with results assessed by traditional outcome measures. For a total of 170 patients, outcomes were evaluated serially at postoperative 1-, 3-, 6-, and 12-months using IPSS, OABSS, SAGA questionnaires and uroflowmetry. The SAGA questionnaire consisted of five questions including one open-ended question (self-assessed goals and degree of SAGA) and another question regarding treatment satisfaction. The number of self-assessed treatment goals was two or more in 74.1% of the patients. Most common treatment goal was relief from straining/hesitancy, followed by increased daytime frequency, nocturia and feeling of incomplete emptying. Degree of achievement for the first or second goal and treatment satisfaction tended to increase with time throughout the follow-up period. Patients with the greatest treatment satisfaction scores showed greater improvement by traditional outcome parameters including quality of life (QOL) index, total OABSS, maximum flow rate (Qmax), post-void residual urine volume (PVR) and bladder voiding efficiency (BVE) compared to those without treatment satisfaction. After adjusting for other influential variables, the improvements in subjective outcome parameters including total IPSS, QOL index and total OABSS were significantly associated with treatment satisfaction, but improvements in objective outcome parameters including Qmax, PVR and BVE were not. In addition, the degree of SAGA for the first goal or second goal was more predictive in determining treatment satisfaction than the traditional outcome measures. In conclusion, treatment goals of patients with lower urinary tract symptoms (LUTS)/BPH vary from individual to individual. The degree of SAGA and treatment satisfaction for HoLEP tends to increase with time throughout the follow-up period. Compared to the traditional outcome measures, the degree of goal achievement can be more predictive when assessing patient-centered outcomes such as treatment satisfaction.

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“…Many researchers have studied changes in erectile function after PVP, but they have not reached a conclusion about the effect of PVP on erectile function [ 7 8 9 10 11 12 13 14 ]. As mentioned earlier, Paick et al [ 7 ] reported that sexual functioning improved after 6 months following treatment with 80-W potassium-titanyl-phosphate (KTP) PVP.…”

Section: Discussionmentioning

confidence: 99%

“…Several recent studies have reported that medical therapy for ED or BPH could each influence the other [ 5 6 ]. From the surgeon's point of view, the idea that surgical treatment for BPH might affect ED is a focus of current research [ 7 8 9 10 11 12 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although most of the studies used the same questionnaire ( i.e. , the 5-item International Index of Erectile Function [IIEF-5]), they used different definitions of what constituted a significant change in erectile function [ 7 8 9 10 11 12 13 14 ]. Thus, based on the current literature, it is not possible to draw any conclusions about the impact of PVP on erectile function.…”

Section: Introductionmentioning

confidence: 99%

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Changes in Erectile Function after Photoselective Vaporization of the Prostate with a 120-W GreenLight High-Performance System Laser: 2-Year Follow-Up

Park

Cho

et al. 2017

World J Mens Health

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PurposeTo evaluate the impact of photoselective vaporization of the prostate (PVP) with a 120-W GreenLight high-performance system on erectile function in a 2-year follow-up study.Materials and MethodsOne hundred seventy-seven patients who underwent PVP during 2008 to 2012 were analyzed retrospectively. The patients were divided into 5 groups according to their preoperative 5-item International Index of Erectile Function (IIEF-5) scores: Group I (IIEF-5: 5~7, n=28), II (IIEF-5: 8~11, n=47), III (IIEF-5: 12~16, n=43), IV (IIEF-5: 17~21, n=34), and V (IIEF-5: 22~25, n=25). The patients were assessed before surgery and 6, 12, and 24 months after the PVP. Their International Prostate Symptom Score/quality of life, maximum urinary flow rate/post-void residual urine volume, and IIEF-5 scores were measured at each visit.ResultsThe mean age and presence of hypertension were significantly different among the 5 groups. Perioperative parameters and postoperative complication rates showed no statistical differences. After PVP, voiding parameters were significantly improved in all the groups and sustained during the 2-year follow-up. The postoperative IIEF-5 scores fell slightly overall, while group V showed the largest significant deterioration. In multivariate analysis, body mass index (BMI) was the only independent predictor of decreased erectile function after PVP.ConclusionsErectile function declined in all the groups after PVP, with the most extensive deterioration observed in patients with normal erectile function preoperatively. Preoperative BMI was the only independent risk factor for a meaningful decrease in erectile function after PVP.

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A Systematic Review and Meta-Analysis of Functional Outcomes and Complications Following the Photoselective Vaporization of the Prostate and Monopolar Transurethral Resection of the Prostate

Cited by 16 publications

References 39 publications

Effect of preoperative detrusor underactivity on long‐term surgical outcomes of photovaporization and holmium laser enucleation in men with benign prostatic hyperplasia: a lesson from 5‐year serial follow‐up data

Effect of preoperative detrusor underactivity on long‐term surgical outcomes of photovaporization and holmium laser enucleation in men with benign prostatic hyperplasia: a lesson from 5‐year serial follow‐up data

Self-assessed goal achievement (SAGA) after Holmium laser enucleation of the prostate (HoLEP): Association with patients' postoperative satisfaction

Changes in Erectile Function after Photoselective Vaporization of the Prostate with a 120-W GreenLight High-Performance System Laser: 2-Year Follow-Up

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