Electrovaporization of the Prostate versus Laser Ablation of the Prostate in Men with Benign Prostatic Hypertrophy:A Pressure-Flow Analysis

Shingleton, W. Bruce; Kolski, John M.; Renfroe, D.L.; Fowler, Jackson E.

doi:10.1159/000030259

Cited by 10 publications

(1 citation statement)

References 10 publications

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“…A non‐standard procedure (laser ablation) used in Shingleton et al . [30–33] was classified as PVP, which the SR in the present study and other SRs or HTA reports [28,34,35] classified as hybrid laser. Burke et al .…”

Section: Discussionsupporting

confidence: 47%

Systematic review of surgical treatments for benign prostatic hyperplasia and presentation of an approach to investigate therapeutic equivalence (non‐inferiority)

Biester¹,

Skipka²,

Jahn³

et al. 2011

BJU International

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Study Type – Therapy (systematic review) Level of Evidence 1a What's known on the subject? and What does the study add? Numerous newer (non‐standard) procedures for the treatment of benign prostatic hyperplasia (BPH) exist; however, it is unclear whether they actually have an additional patient‐relevant benefit compared to standard treatment. As no trial investigated non‐inferiority, we defined a non‐inferiority threshold on the basis of published literature. The present systematic review found no proof of an additional benefit of non‐standard treatments for BPH; an indictation of an additional benefit was only shown for holium laser resection of the prostate (HoLRP) and thulium laser resection of the prostate (TmLRP). OBJECTIVE To assess the potential additional benefit of non‐standard vs standard surgical treatments for benign prostatic hyperplasia (BPH) and to present a new methodological approach to investigate therapeutic equivalence (non‐inferiority) regarding symptom reduction. PATIENTS AND METHODS We conducted a systematic review and searched MEDLINE, Embase and the Cochrane Library (last search: 10/2009) for randomized controlled trials (RCTs) and non‐randomized controlled clinical trials (CCTs). Eligible studies were those that included patients with symptomatic BPH requiring surgical treatment and which compared non‐standard procedures (e.g. minimally invasive technologies) with standard ones (e.g. transurethral resection of the prostate, TURP). In addition, only studies analysing patient‐relevant outcomes were considered (e.g. irritative and obstructive symptoms, length of hospital stay, quality of life and adverse events). The main outcome of interest for the present analysis was superiority or non‐inferiority for symptom reduction. As no trial investigated non‐inferiority, we defined a non‐inferiority threshold (0.25 standard deviation) on the basis of published literature. If a non‐standard procedure showed non‐inferiority for symptom reduction, additional outcomes were assessed. Meta‐analyses were conducted if feasible and meaningful. RESULTS In all, 43 mainly low‐quality trials (RCTs only) compared nine non‐standard surgical treatments with standard ones. Mean follow‐up ranged from 6 to 84 months. No non‐standard procedure was superior for symptom reduction. Non‐inferiority for symptom reduction was shown in patients who had undergone holmium laser resection of the prostate (HoLRP) or thulium laser resection of the prostate (TmLRP). As procedural advantages (e.g. no occurrence of transurethral resection syndrome) and other advantages (e.g. shortened hospital stay) were found, an indication of an additional benefit of HoLRP and TmLRP was determined. CONCLUSIONS No proof of superiority for symptom reduction has been shown for non‐standard surgical treatments in patients with BPH. There is a lack of high‐quality RCTs and trials designed to investigate non‐inferiority. Future studies should define a non‐inferiority threshold (ideally, uniform) a priori, so that results of individual studies ar...

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Section: Discussionsupporting

confidence: 47%

Systematic review of surgical treatments for benign prostatic hyperplasia and presentation of an approach to investigate therapeutic equivalence (non‐inferiority)

Biester¹,

Skipka²,

Jahn³

et al. 2011

BJU International

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Lasers for median lobe hyperplasia

Muschter

Gilling²

2001

Curr Urol Rep

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Laser treatment encompases a variety of techniques using different laser wavelengths, application systems, and surgical techniques to achieve contrasting tissue effects such as incision, resection, vaporization, or coagulation. Many studies have proven the clinical efficacy of the various laser techniques for the treatment of benign prostatiuc hyperplasia, including randomized studies versus transurethral prostatectomy (TURP). Recently, long-term follow-up of up to 5 years has demonstrated the durability of the results, although in some of the studies, retreatment rates were higher than after TURP. Median lobes were never seen as a contraindication for treatment in the laser based procedures. Technically, laser treatment techniques such as side-firing transurethral coagulation, contact- and free-beam laser vaporization, interstitial laser coagulation, and the holmium laser-based resection and enucleation are fully suitable for treatment of median lobes. Surprisingly, no studies focussing specifically on laser treatment of median lobes have been published.

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Benign Prostatic Obstruction Relief in Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Enlargement Undergoing Endoscopic Surgical Procedures or Therapy with Alpha-Blockers: A Review of Urodynamic Studies

et al. 2017

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Benign prostatic obstruction (BPO) contributes to the genesis of lower urinary tract symptoms as well as to pathologic remodeling of the lower and upper urinary tract in patients with benign prostate enlargement. Urodynamic studies demonstrate that both medical therapy with alpha-blockers (ABs) and endoscopic surgical procedures provide BPO relief. However, the magnitude of improvement is higher after surgery. Among ABs, silodosin is associated with the highest improvement of bladder outlet obstruction index (BOOI). A complex relationship exists between BOOI improvement and variations of both maximum urinary flow (Q ) and detrusor pressure. When the reduction of BOOI is small, the improvement of Q is clinically irrelevant and the BOOI is mainly influenced by a decrease of detrusor pressure. In contrast, when the magnitude of BOOI reduction is robust, a meaningful improvement of both detrusor pressure and urinary flow is evident. When clustering ABs according to their receptor pharmacologic selectivity and urodynamic efficacy, three subgroups can be identified,with silodosin being the only member of a subgroup characterized by the highest levels of BOOI improvement and α-1A/α-1B receptor affinity ratio.

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Electrovaporization of the Prostate versus Laser Ablation of the Prostate in Men with Benign Prostatic Hypertrophy:A Pressure-Flow Analysis

Cited by 10 publications

References 10 publications

Systematic review of surgical treatments for benign prostatic hyperplasia and presentation of an approach to investigate therapeutic equivalence (non‐inferiority)

Systematic review of surgical treatments for benign prostatic hyperplasia and presentation of an approach to investigate therapeutic equivalence (non‐inferiority)

Lasers for median lobe hyperplasia

Benign Prostatic Obstruction Relief in Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Enlargement Undergoing Endoscopic Surgical Procedures or Therapy with Alpha-Blockers: A Review of Urodynamic Studies

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