Abstract:Benign prostatic hyperplasia (BPH) is a common pathology causing lower urinary tract symptoms (LUTS) and may significantly impact quality of life. While transurethral resection of the prostate (TURP) remains the gold standard treatment, there are many evolving technologies that are gaining popularity. Photoselective vaporization of the prostate (PVP) is one such therapy which has been shown to be non-inferior to TURP. We aimed to review the literature and discuss factors to optimise patient outcomes in the set… Show more
“…Liang et al 9 found that the risk of bleeding complications was 2.58 times greater in men treated with TURP who were taking anticoagulants or antiplatelets than not, but that those treated with HoLEP or photoselective vapourisation of the prostate (PVP), such as GreenLight, had a bleeding risk that was not significantly different from the control group. Albisinni et al 16 concluded that laser prostate vapourisation or enucleation with GreenLight PVP or HoLEP was safe in frail, elderly men, while Pascoe et al 17 found no increase in complications after PVP in men with prostates larger than 100 mL compared with in those with smaller glands, although operative time and retreatment rates were higher. In general, systematic reviews of high-risk men with benign prostatic hyperplasia concur that all available interventions have comparable efficacy, particularly with IPSS, Qmax, and PVR outcomes, but that laser enucleation and vapourisation therapies have a more favourable perioperative profile, in terms of length of stay, blood loss, and catheterisation time.…”
Objective
To compare efficacy and safety outcomes of GreenLight, Holmium and Thulium laser techniques with standard monopolar and bipolar transurethral resection of the prostate (TURP) in high-risk patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO).
Methods
We conducted a systematic literature review of studies in patients undergoing BPO surgeries who may be considered high-risk for standard TURP, with higher risk defined as follows: large prostates (≥80 mL) and/or taking antithrombotic agents and/or urinary retention and/or age >80 years and/or significant comorbidity. Outcomes summarised included bleeding complications, re-intervention rates, hospital length of stay, and standard measures of disease and symptom severity for all available timepoints.
Results
A total of 276 studies of 32,722 patients reported relevant data. Studies were heterogeneous in methodology, population and outcomes reported. IPSS reduction, Qmax improvement and PVR were similar across all interventions. Mean values at baseline and after 12 months across interventions were 13.2−29 falling to 2.3−10.8 for IPSS, 0−19 mL/s increasing to 7.5−34.1 mL/s for Qmax and 41.4−954 mL falling to 5.1−138.3 mL for PVR. Laser treatments show some advantages compared with monopolar and bipolar TURP for some adverse events and safety parameters such as bleeding complications. Duration of hospital stay, reinterventions and recatheterisations were lower with GreenLight, HoLEP, Thulium lasers, and bipolar enucleation than TURP.
Conclusions
Laser therapies are effective and well-tolerated treatment options in high-risk patients with BPO compared with monopolar or bipolar TURP. The advantageous safety profile of laser treatments means that patients with a higher bleeding risk should be offered laser surgery preferentially to mTURP or bTURP.
“…Liang et al 9 found that the risk of bleeding complications was 2.58 times greater in men treated with TURP who were taking anticoagulants or antiplatelets than not, but that those treated with HoLEP or photoselective vapourisation of the prostate (PVP), such as GreenLight, had a bleeding risk that was not significantly different from the control group. Albisinni et al 16 concluded that laser prostate vapourisation or enucleation with GreenLight PVP or HoLEP was safe in frail, elderly men, while Pascoe et al 17 found no increase in complications after PVP in men with prostates larger than 100 mL compared with in those with smaller glands, although operative time and retreatment rates were higher. In general, systematic reviews of high-risk men with benign prostatic hyperplasia concur that all available interventions have comparable efficacy, particularly with IPSS, Qmax, and PVR outcomes, but that laser enucleation and vapourisation therapies have a more favourable perioperative profile, in terms of length of stay, blood loss, and catheterisation time.…”
Objective
To compare efficacy and safety outcomes of GreenLight, Holmium and Thulium laser techniques with standard monopolar and bipolar transurethral resection of the prostate (TURP) in high-risk patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO).
Methods
We conducted a systematic literature review of studies in patients undergoing BPO surgeries who may be considered high-risk for standard TURP, with higher risk defined as follows: large prostates (≥80 mL) and/or taking antithrombotic agents and/or urinary retention and/or age >80 years and/or significant comorbidity. Outcomes summarised included bleeding complications, re-intervention rates, hospital length of stay, and standard measures of disease and symptom severity for all available timepoints.
Results
A total of 276 studies of 32,722 patients reported relevant data. Studies were heterogeneous in methodology, population and outcomes reported. IPSS reduction, Qmax improvement and PVR were similar across all interventions. Mean values at baseline and after 12 months across interventions were 13.2−29 falling to 2.3−10.8 for IPSS, 0−19 mL/s increasing to 7.5−34.1 mL/s for Qmax and 41.4−954 mL falling to 5.1−138.3 mL for PVR. Laser treatments show some advantages compared with monopolar and bipolar TURP for some adverse events and safety parameters such as bleeding complications. Duration of hospital stay, reinterventions and recatheterisations were lower with GreenLight, HoLEP, Thulium lasers, and bipolar enucleation than TURP.
Conclusions
Laser therapies are effective and well-tolerated treatment options in high-risk patients with BPO compared with monopolar or bipolar TURP. The advantageous safety profile of laser treatments means that patients with a higher bleeding risk should be offered laser surgery preferentially to mTURP or bTURP.
“…It is well-established that TURP is effective in improving LUTSs and maintains its efficacy in the long-term [ 8 ]. Other surgical alternatives to TURP have been introduced, including holmium enucleation of the prostate (HoLEP), photoselective vaporization of the prostate (PVP), and bipolar transurethral resection in saline [ 9 , 10 , 11 ]. However, most conventional transurethral procedures have several disadvantages.…”
A prostatic urethral lift (PUL) can be performed under local anesthesia in patients normally at high risk for general anesthesia due to multiple comorbidities. However, the clinical efficacy of PULs in patients with multiple comorbidities remains unknown. Therefore, in this this study, we aimed to evaluate the clinical efficacy of the PUL in patients with a high number of comorbidities by comparing its clinical efficacy in these patients with that in healthy individuals. We performed a retrospective observational cohort study, in which patients who underwent a PUL between December 2016 and January 2019 at a single tertiary care center were categorized into two groups: healthy individuals who wanted to preserve sexual function (Group 1) and patients with a high number of comorbidities who were at high risk for general anesthesia, based on an American Society of Anesthesiologists (ASA) score of ≥3 (Group 2). The International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), and post-void residual urine (PVR) were obtained preoperatively and compared throughout the 2-year follow-up. A total of 66 patients were enrolled, of whom 36 patients were included in Group 1 and 30 in Group 2. In Group 1, IPSS, IPSS quality of life (QoL), and Qmax significantly improved and were then maintained during follow-up, whereas, in Group 2, improvements in these parameters were not maintained during follow-up, except for IPSS QoL. Eleven patients (36%) in Group 2 required additional treatment for the recurrence of lower urinary tract symptoms. In conclusion, patients with a high number of comorbidities had a low therapeutic effect after PUL, suggesting a high rate of treatment failure. Therefore, comorbidity status should be considered when evaluating the potential benefits of the PUL procedure during preoperative counseling.
“…Gastroenterologists have used LTV to treat esophageal and rectal cancer [8,9]. In order to achieve desired clinical outcomes, various lasers have been evaluated through ex vivo, in vivo, and clinical studies to compare tissue removal capability, hemostasis, perioperative complications, and postoperative complications [3,[10][11][12].…”
Section: Introductionmentioning
confidence: 99%
“…Ideally, LTV is expected to remove tissue efficiently with excellent hemostasis and minimal collateral tissue damage, which can reduce hospitalization time and complications [12][13][14]. For the best clinical outcomes, the surgeons are often trained and required to control the power density over the tissue during surgery by adjusting the distance between the catheter tip and the tissue surface, keeping a constant sweeping speed of the catheter, and closely monitoring the tissue responses to laser vaporization.…”
Laser-tissue vaporization through a fiber catheter is evolving into a major category of surgical operations to remove diseased tissue. Currently, during a surgery, the surgeon still relies on personal experience to optimize surgical techniques. Monitoring tissue temperature during laser-tissue vaporization would provide important feedback to the surgeon; however, simple and low-cost temperature sensing technology, which can be seamlessly integrated with a fiber catheter, is not available. We propose to monitor tissue temperature during laser-tissue vaporization by detecting blackbody radiation (BBR) between 1.6 µm-1.8 µm, a relatively transparent window for both water and silica fiber. We could detect BBR after passing through a 2-meter silica fiber down to ∼70°C using lock-in detection. We further proved the feasibility of the technology through ex vivo tissue studies. We found that the BBR can be correlated to different tissue vaporization levels. The results suggest that this simple and low-cost technology could be used to provide objective feedback for surgeons to maximize laser-tissue vaporization efficiency and ensure the best clinical outcomes.
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