Practice Patterns in Benign Prostatic Hyperplasia Surgical Therapy: The Dramatic Increase in Minimally Invasive Technologies

Yu, Xinhua; Elliott, Sean P.; Wilt, Timothy J; McBean, A. Marshall

doi:10.1016/j.juro.2008.03.039

Cited by 167 publications

(119 citation statements)

References 16 publications

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“…Although conventional monopolar transurethral resection (TUR) of the prostate (TURP) has been applied as a gold standard surgical modality in the recent decades (6)(7)(8)(9)(10)(11)(12), but its outcomes including patient discomfort, prolonged catheterization and hospitalization durations, need to transfusion and re-admission due to hemorrhage or clot retention, high volume of irrigation fluid, electrolyte imbalance and TUR syndrome, urinary retention, urethral stricture, incontinence, retrograde ejaculation or erectile dysfunction (6)(7)(8)(13)(14)(15)(16)(17)(18)(19)(20) elicited the tendency to the use of the newer technologies such as bipolar energy or laser energy for resection, vaporization, ablation or enucleation and changing the irrigation fluid from glycine to normal saline in the endoscopic management of BPH (6,8,(13)(14)(15)(20)(21)(22)(23)(24)(25)(26).…”

Section: Introductionmentioning

confidence: 99%

Bipolar transurethral vaporization: a superior procedure in benign prostatic hyperplasia: a prospective randomized comparison with bipolar TURP

et al. 2014

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ARTICLE INFO ______________________________________________________________ ______________________Objective: To compare the outcomes of bipolar transurethral vaporization of the prostate (TUVP) with bipolar transurethral resection of the prostate (TURP). Materials and Methods: In a prospective randomized trial, 88 patients with moderate to severe lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) underwent bipolar TUVP (N = 39) or bipolar TURP (N = 49) from October 2010 to November 2011. The inclusion criteria were age > 50 years, prostate volume of 30-80mL, serum PSA < 4ng/mL, IPSS ≥ 20, Q max ≤ 10mL/s and failed medical therapy. The perioperative and postoperative outcomes were evaluated and the IPSS and Q max were assessed preoperatively and 3 months after procedure in all cases. Results: Both groups were similar in patient age, prostate volume, preoperative IPSS and Q max . The TUVP group had significantly lower mean values of operative time, hospital stay, catheterization period, irrigation fluid volume and serum hemoglobin, creatinine, sodium and potassium changes compared with TURP group. No significant differences were seen between two groups regarding complications (TUVP = 10.3%; TURP = 12.2%) and modified Clavien classification of complications. No TUR syndrome, obturator reflex or epididymitis occurred in both groups. Re-hospitalization and transfusion due to clot retention (N = 2) and urethral stricture (N = 1) were reported only in the TURP group. Three patients experienced urinary retention after catheter removal in the TUVP group. Two patients were re-catheterized temporarily and one patient required repeat bipolar TUVP. Three months after surgery, two groups had significant improvement in IPSS and Q max . But the TUVP group had significantly lower IPSS and higher Q max than TURP group. Conclusions: Bipolar TUVP is a safe, effective and low cost procedure among minimally invasive surgeries of BPH. Compared with bipolar TURP, the bipolar TUVP had similar complications, better perioperative and postoperative outcomes, superior hemostasis and higher efficacy.

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Section: Introductionmentioning

confidence: 99%

Bipolar transurethral vaporization: a superior procedure in benign prostatic hyperplasia: a prospective randomized comparison with bipolar TURP

et al. 2014

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“…We could not examine trends in the use of transurethral microwave thermotherapy (TUMT) and transurethral needle ablation (TUNA) of the prostate, because the SASD and SID databases do not reliably capture these office based procedures. 6 However, TUMT and TUNA offer less durable results, 21,22 so a clinical decision for a patient with symptomatic LUTS first involves the decision for an operative versus office based procedure and then secondarily a decision for or against laser prostatectomy. Therefore, a comparison of laser prostatectomy and TURP more accurately reflects the real clinical decision-making process.…”

Section: Discussionmentioning

confidence: 99%

“…However, as technology has evolved, the surgical management of BPH has changed over the last decade, with laser prostatectomy increasing in popularity after the introduction of green light laser vaporization in 2000. 5,6 Based on the available limited comparative effectiveness data, laser prostatectomy may have several advantages, including shorter hospital stay, shorter catheterization time, lower risk of clot retention, and no risk for transurethral resection (TUR) syndrome. [7][8][9] In fact, a recent study did report favorable outcomes after laser prostatectomy even in men who underwent surgery while on anticoagulation.…”

Section: Introductionmentioning

confidence: 99%

“…However, despite the potential advantages of laser prostatectomy, TURP has remained the most common procedure performed among the elderly. 6 In an effort to understand decisions surrounding use of laser prostatectomy versus TURP, we evaluated recent trends in transurethral surgery for BPH in an all payer dataset, focusing on patient and provider factors that are associated with receipt of laser prostatectomy.…”

Section: Introductionmentioning

confidence: 99%

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1974 Population Based Trends in the Surgical Treatment of Benign Prostatic Hyperplasia

Schroeck

Hollingsworth²,

Kaufman

et al. 2012

Journal of Urology

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Purpose-Laser prostatectomy has increased in popularity over the last decade. However, traditional transurethral resection of the prostate (TURP) remains common. In an effort to understand decisions surrounding use of laser prostatectomy versus TURP, we evaluated trends in transurethral surgery for benign prostatic hyperplasia (BPH) in an all payer dataset, focusing on patient and provider factors that are associated with receipt of laser prostatectomy. Methods-Using the State Inpatient and Ambulatory Surgery Databases for Florida, we identified subjects undergoing laser prostatectomy or TURP (2001 to 2009). We calculated rates of surgery over time, stratified by procedure type. We used multilevel regression to examine patient (age, race, level of comorbidity) and provider (surgeon volume) factors associated with receipt of laser prostatectomy versus TURP.Results-While the overall rates of transurethral surgery remained stable (p=0.227) over the study period, use of laser prostatectomy rose 400% (from 25 to 114 procedures per 100,000 men, p<0.001), replacing about half of all TURPs. Patients were less likely to undergo laser prostatectomy if they were older (OR 0.65, 95% CI 0.61-0.70) and less healthy (OR 0.48, 95% CI 0.45-0.51). While these factors were predictive of surgery type, the majority of the variation in laser prostatectomy use (69%) was explained by the urologist a patient saw.Conclusions-Laser prostatectomy utilization has increased over the last decade at the expense of TURP, driven largely by provider effects. However, the elderly and more infirm patients are the least likely to receive it, raising concerns about underuse in this population.

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“…1,2 Transurethral resection of the prostate (TURP) and open prostatectomy are usually considered gold standard treatment options in these patients. [3][4][5] The remarkable risk of mortality and morbidity of both procedures, especially TURP syndrome and bleeding, has prompted the search for minimally invasive laser-based techniques. 6 Photoselective vaporization of the prostate (PVP) is widely used and has been extensively studied with different systems, such as the 80W KTP laser, the GreenLight HPS 120W (GL-HPS) system (American Medical Systems, Minnetonka, MN), and most recently the GreenLight XPS 180W (GL-XPS) system.…”

Section: Introductionmentioning

confidence: 99%

Safety, efficacy and outcomes of the new GreenLight XPS 180W laser system compared to the GreenLight HPS 120W system for the treatment of benign prostatic hyperplasia in a prospective nonrandomized single-centre study

Eken

Soyupak²,

Acil

et al. 2015

CUAJ

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E56Cite as: Can Urol Assoc J 2015;9(1-2):e56-60. http://dx.doi.org/10.5489/cuaj.2263 Published online February 9, 2015. AbstractIntroduction: We compare and evaluate the safety, efficacy, and short-term outcomes of the new GreenLight XPS 180W (GL-XPS) laser system with the former generation GreenLight HPS 120W (GL-HPS) system for the treatment of benign prostatic hyperplasia (BPH) in a prospective nonrandomized single-centre study. Methods: From May 2012 to June 2013, 161 consecutive patients with lower urinary tract symptoms secondary to BPH were included: 88 patients were treated with the GL-HPS system and 73 were treated with the GL-XPS system. The perioperative variables International Prostate Symptom Score (IPSS), quality of life (QOL), and maximum flow rate (Qmax) were recorded at baseline, at one month and 6 months. Serum prostate-specific antigen (PSA) was assessed at baseline. Results: The mean age was 70.2 years in the GL-HPS group and 68.6 years in the GL-XPS group. Prostate volumes were 62.3 mL and 61.3 mL, respectively. Both groups showed significant postoperative improvement in the IPSS, QOL, Qmax variables compared to baseline levels. There were no significant differences in improvement in IPSS and QOL between groups. However, both operating and catheterization times were shorter in patients in the GL-XPS group. The overall postoperative complication rate was similar in both groups. Conclusion: Both GreenLight systems provide safe, effective tissue vaporization with significant clinical relief of BPH obstruction. The GL-XPS system appears more favourable with regard to reduced operating and hospitalization time, suggesting more cost-effective and efficient tissue removal.

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Practice Patterns in Benign Prostatic Hyperplasia Surgical Therapy: The Dramatic Increase in Minimally Invasive Technologies

Cited by 167 publications

References 16 publications

Bipolar transurethral vaporization: a superior procedure in benign prostatic hyperplasia: a prospective randomized comparison with bipolar TURP

Bipolar transurethral vaporization: a superior procedure in benign prostatic hyperplasia: a prospective randomized comparison with bipolar TURP

1974 Population Based Trends in the Surgical Treatment of Benign Prostatic Hyperplasia

Safety, efficacy and outcomes of the new GreenLight XPS 180W laser system compared to the GreenLight HPS 120W system for the treatment of benign prostatic hyperplasia in a prospective nonrandomized single-centre study

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