Laser Treatment of Benign Prostatic Obstruction: Basics and Physical Differences

Bach, Thorsten; Muschter, R.; Sroka, R.; Gravas, Stavros; Skolarikos, Andreas; Herrmann, Thomas; Bayer, Thomas A.; Knoll, Thomas; Abbou, Claude-Clément; Janetschek, Guenter; Bachmann, Alexander; Rassweiler, Jens

doi:10.1016/j.eururo.2011.10.009

Cited by 127 publications

(61 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These re-intervention rates (total 3.9%) are in line with the HoLEP literature: Elzayat et al [17] and Tyson and Lerner [18] reported an immediate re-intervention rate of 3.6 and 7.9% after HoLEP. One patient (3.9%) after ThuVEP required re-hospitalization for manual/continuous bladder irrigation comparable to HoLEP (3.6%) [17] and PVP (0-3.7%) [6,9,19,20,22,23,24], while none of the patients in the ThuVARP group needed re-hospitalisation due to bleeding complications as reported in the literature [20]. …”

Section: Discussionmentioning

confidence: 76%

“…The most prominent lasers, the KTP laser, the holmium, and the thulium laser, have shown its safety and efficacy in numerous studies during the past decade even in high-risk patients on OA [1,2,9,10,11,12,13,14,15,16,17,18,19,20,21]. Although these lasers are versatile tools that principally enable vaporization, (vapo)resection, or (vapo)enucleation of the prostate [22], the KTP laser is predominantly used for photoselective vaporization of the prostate (PVP) [1,2,10,11,12,13,14,15,16], the holmium laser for holmium laser enucleation of the prostate (HoLEP) [1,9,10,17,18], and the thulium laser for ThuVEP or ThuVARP [1,9,10,19,20,21]. For the latter, no study has been published so far that compared the outcomes and the safety profiles of these thulium laser prostatectomy procedures in high-risk patients on OA.…”

Section: Discussionmentioning

confidence: 99%

“…Various, more minimally invasive laser devices have been introduced as alternatives to TURP for the surgical treatment of BPO during the past 20 years [9,10]: the potassium-titanyl-phosphate (KTP) [2,11,12,13,14,15,16], the holmium:YAG [17,18], and the thulium:YAG [19,20,21] laser. These different types enable the performance of laser prostatectomy as a vaporisation, (vapo)resection, or (vapo)enucleation procedure [22]. No studies have analysed the risk profiles of these lasers using the different approaches to prostatectomy in patients on OA.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Thulium Vaporesection of the Prostate and Thulium Vapoenucleation of the Prostate in Patients on Oral Anticoagulants: A Retrospective Three-Centre Matched-Paired Comparison

et al. 2015

Self Cite

View full text Add to dashboard Cite

Introduction: To evaluate the short-term results of thulium vaporesection of the prostate (ThuVEP) and thulium vapoenucleation of the prostate (ThuVARP) in patients with benign prostatic obstruction on oral anticoagulants (OA). Methods: A 3-centre retrospective matched-paired comparison of patients treated by ThuVEP (n = 26) or ThuVARP (n = 26) was performed. Thirty-four patients were on aspirin/ticlopidin, 7 on clopidogrel or clopidogrel and aspirin, and 11 on phenprocoumon at the time of surgery. Results: Haemoglobin decrease was higher after ThuVEP compared to ThuVARP (1.5 vs. 0.3 g/dl, p < 0.001). The rate of postoperative blood transfusions (3.9 vs. 0%), clot retention (3.9 vs. 0%), and re-operation (7.7 vs. 0%) was not different between ThuVEP and ThuVARP (p = 0.274). Catheterization time was shorter for ThuVARP (1 vs. 2 days, p < 0.01). Q_max was significantly higher after ThuVEP at 6-month follow-up (31 vs. 21.5 ml/s, p < 0.001), while improvements in International Prostate Symptom Score, quality of life, and post-voiding residual urine showed no differences between the groups. Urethral or bladder neck strictures did not occur during the 6-month follow-up in both groups. Conclusions: ThuVEP and ThuVARP are safe and efficacious procedures in patients on OA. Although patients assigned to ThuVEP had higher Q_max at 6-month follow-up, ThuVARP resulted in similar functional outcomes.

show abstract

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Thulium Vaporesection of the Prostate and Thulium Vapoenucleation of the Prostate in Patients on Oral Anticoagulants: A Retrospective Three-Centre Matched-Paired Comparison

et al. 2015

Self Cite

View full text Add to dashboard Cite

show abstract

“…Before conclusion, some considerations should be noted, including (1) during the operation procedure, steam bubbles will be generated continuously in front of the laser fiber with every pulse [31]. These bubbles mechanically separate tissue bridges, resulting into energy reflection and scattering.…”

Section: Discussionmentioning

confidence: 99%

A comparison of incidences of bladder neck contracture of 80- versus 180-W GreenLight laser photoselective vaporization of benign prostatic hyperplasia

Song

Liu

et al. 2016

Lasers Med Sci

View full text Add to dashboard Cite

Bladder neck contracture (BNC) after GreenLight laser photoselective vaporization (PVP) of benign prostatic hyperplasia is a common complication. In the present study, data of patients received 80 or 180 W PVP were collected. Perioperative parameters, including applied energy, irradiation time, catheter removal time, and hospital stay, were recorded. Postoperative parameters, including maximum urinary flow rate, International Prostate Symptom Score, post-void residual volume, and incidences of BNC, were recorded at 3 and 12 months after operations. Bladder neck tissues were taken at 3 months after operations for immunohistochemical staining and western blot analysis to examine the expressions of collagen I, matrix metalloproteinase-3 (MMP-3), and transforming growth factor-β (TGF-β). Sample size of patients was calculated with a power of 80 %. Chi-square test and one-way analysis of variance were performed as statistical methods. Three hundred twenty-six patients who received potassium titanyl phosphate (KTP) laser and 256 who received X-ray photoelectron spectroscopy (XPS) laser entered into the study. Perioperative parameters were comparable, except for shorter irradiation time in 180 W group (P = 0.032). Postoperative parameters were also similar, except for higher incidence of BNC in 80 W group at 3 months after operations (P = 0.022). Immunohistochemical staining and western blot analysis showed higher expressions of collagen I, MMP-3, and TGF-β in 80 W group than in 180 W group. In conclusion, 80 W GreenLight laser showed a comparable efficacy with 180-W laser in PVP but showed a higher incidence of BNC in short term, which might be the result of up-regulated fibrotic factors in bladder neck triggered by lasers.

show abstract

“…Moreover, it has a minimal tissue penetration depth of 0.4 mm, with less probability of scarring. 5 Therefore, the previously mentioned adhesions between the prostatic lobes and excessive healing of the incisions, 3,6 responsible for impairment of the results after TUIP, could be avoided.…”

Section: Introductionmentioning

confidence: 99%

Holmium laser transurethral incision of the prostate: Can prostate size predict the long-term outcome?

Elkoushy

Elshal

Elhilali

2015

CUAJ

View full text Add to dashboard Cite

Introduction:We determine the impact of prostate size on the long-term outcome of holmium laser transurethral incision of the prostate (Ho-TUIP) for bladder outlet obstruction (BOO) secondary to benign prostate enlargement (BPE). Methods: A retrospective review of prospectively collected data was performed for patients undergoing Ho-TUIP by a single surgeon for patients presenting with lower urinary tract symptoms (LUTS) secondary to BOO. Patients were stratified into 2 groups: Group 1 included patients with prostate ≤30 cc and Group 2 included patients with prostate >30 cc. Demographic, operative and followup data were recorded and analyzed. In addition, intraoperative and long-term adverse events were included. Results: In total, 82 patients underwent surgery between March 1998 and March 2013, including 9 (11%) reoperated patients. Only prostate size independently predicted reoperation after Ho-TUIP (adjusted odds ratio [aOR], 95% confidence interval [CI] 7.12 [2.92-9.14], p = 0.01). The receiver operating characteristic (ROC) analysis showed an optimal cutoff value of prostate volume of 29 cc to characterize long-term reoperation after TUIP, with area under the curve (AUC) of 0.96, sensitivity of 89.7 and specificity of 88.9. Group 1 included 51 patients and Group 2 included 31 patients. The international prostate symptoms score (IPSS) and peak flow rate (Qmax) significantly improved in both groups at different follow-up points. At the 12-month follow-up, the percent change in IPSS and Qmax were comparable between both groups. However, after 12 months, the degree of improvement in all voiding parameters was significantly higher in Group 1 (p < 0.001 at all points of follow-up). After a median follow-up of 5.3 years (range: 1-13), both groups had comparable early and late adverse events with significantly higher reoperation rate in Group 2 (3.9% vs. 22.6%, p = 0.02). Overall retrograde ejaculation was detected in 25.6% of sexually active men and it was comparable between both groups (23.5% vs. 29%, p = 0.61). On multivariable analysis, patients with prostate volume >30 cc were associated with significantly higher reoperation for BOO (aOR 95% CI 5.72 [2.83-8.14], p = 0.02), significantly higher IPSS (aOR 1.72), higher quality of life index (aOR 1.72) and lower Qmax (aOR 0.28). Conclusion: Ho-TUIP is a durable, safe and efficient treatment of BOO secondary to a small-sized prostate. The long-term outcome could be improved and the re-operation rate could be minimized with appropriate selection of cases, with prostate glands no bigger than 30 cc.

show abstract

Laser Treatment of Benign Prostatic Obstruction: Basics and Physical Differences

Cited by 127 publications

References 37 publications

Thulium Vaporesection of the Prostate and Thulium Vapoenucleation of the Prostate in Patients on Oral Anticoagulants: A Retrospective Three-Centre Matched-Paired Comparison

Thulium Vaporesection of the Prostate and Thulium Vapoenucleation of the Prostate in Patients on Oral Anticoagulants: A Retrospective Three-Centre Matched-Paired Comparison

A comparison of incidences of bladder neck contracture of 80- versus 180-W GreenLight laser photoselective vaporization of benign prostatic hyperplasia

Holmium laser transurethral incision of the prostate: Can prostate size predict the long-term outcome?

Contact Info

Product

Resources

About