The Effects of 5α-Reductase Inhibition on Benign Prostatic Hyperplasia Treated by Photoselective Vaporization Prostatectomy with the 120 Watt GreenLight HPS Laser System

Strom, Kurt H.; Gu, Xihui; Spaliviero, Massimiliano; Wong, Carson

doi:10.1016/j.jamcollsurg.2010.09.029

Cited by 5 publications

(9 citation statements)

References 23 publications

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“…Similar results were reported in a prospective study by Akari et al who demonstrated no significant difference between IPSS scores, PVR and Qmax between patients on or off 5-ARI therapy following 80 W PVP (17). Similar results were reported by Strom et al in patients undergoing 120 W PVP (16). …”

Section: Pre-operative Factorssupporting

confidence: 91%

“…Indeed, Kuntzman et al demonstrated that bloodless cadaver tissue to be less responsive to KTP laser vaporization than living canine tissue (15). Intra-operatively, Strom et al reported that six months of 5-ARI therapy prior to PVP had no effect on operative duration (31±19 vs. 32±25 mins), lasering time (13±9.2 vs. 13.4±10.3 mins) or energy used (87.1±62.4 vs. 91.8±69.7 kJ) (16). Similarly, post-operative functional data appears independent of the presence of 5-ARI therapy.…”

Section: Pre-operative Factorsmentioning

confidence: 99%

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Optimising patient outcomes with photoselective vaporization of the prostate (PVP): a review

Pascoe

Perera

et al. 2017

Transl. Androl. Urol.

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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 setting of PVP for BPH. A comprehensive search of the electronic databases, including MEDLINE, Embase, Web of Science and The Cochrane Library was performed on articles published after the year 2000. After exclusion, a total of 38 papers were included for review. The evolution of higher powered device has enabled men with larger prostates and those on oral anticoagulation to undergo safely and successfully PVP. Despite continued oral anticoagulation in patients undergoing PVP, the risk of bleeding may be minimised with 5-Alpha Reductase Inhibitor (5-ARI) therapy however further studies are required. Pre-treatment with 5-ARI’s does not hinder the procedure however more studies are required to demonstrate a reliable benefit. Current data suggests that success and complication rate is largely influenced by the experience of the operator. Post-operative erectile dysfunction is reported in patients with previously normal function following PVP, however those with a degree of erectile dysfunction pre-operatively may see improvement with alleviation of LUTS.

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Section: Pre-operative Factorssupporting

confidence: 91%

Section: Pre-operative Factorsmentioning

confidence: 99%

Optimising patient outcomes with photoselective vaporization of the prostate (PVP): a review

Pascoe

Perera

et al. 2017

Transl. Androl. Urol.

View full text Add to dashboard Cite

show abstract

“…Prostate volume is an important parameter in diagnosis and treatment of both benign and malign prostate disease (5,6). For BPH, prostate volume is important in predicting response to 5α-reductase therapy and is also used to select which surgical treatment modality is the best for the patient (7,8). In calculating PSA density, prostate volume is used as the denominator (9).…”

Section: Introductionmentioning

confidence: 99%

What is the best radiological method to predict the actual weight of the prostate?

Kılıç¹,

Özdemır²,

Altinova³

et al. 2014

Turk J Med Sci

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The purpose of the present study was to investigate the composition of kidney stones removed from human patients. Seventeen samples were collected after surgery (5 females and 12 males; age range 2 to 60 years). The samples were analyzed for composition by transmission Fourier transform infrared (FT-IR) spectroscopy. The 17 analyzed samples of kidney stones comprised 29.4% calcium oxalate, 29.4% uric acid, 29.4% calcium oxalate (CaOx)-uric acid, 5.9% phosphate, and 5.9% calcium oxalate-phosphate stones. The results of the study indicated that transmission FT-IR spectroscopy could be used as an environmentally friendly technique for rapid screening of kidney stones.

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“…Some reports suggested that 5-ARIs may only affect microvessel density [22,23] and vascular endothelial growth factor expression [24] at the suburethral level, but not at the hyperplastic prostate level. The 5-ARIs may have little effect on significant bleeding vessels because these drugs only decrease microvessel density in the suburethral region, with little if any effect on the deeper hyperplastic prostate tissues [25]. The grossly visible perforating creeping vessels that bleed during dissection of adenomas cannot be significantly reduced with 5-ARI use alone.…”

Section: Discussionmentioning

confidence: 99%

Transurethral Surgical Anatomy of the Arterial Bleeder in the Enucleated Capsular Plane of Enlarged Prostates During Holmium Laser Enucleation of the Prostate

et al. 2014

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PurposeTo identify the endoscopic vascular anatomy of the prostate during Holmium laser enucleation of the prostate (HoLEP), and analyze the clinical risk factors associated with significant arterial bleeding.MethodsWe identified 107 consecutive patients with benign prostatic hyperplasia who underwent HoLEP between September 2009 and August 2010, performed by a single surgeon (S.J.O.). Two independent reviewers reviewed the surgery video database and completed a prespecified form. The location of bleeding arteries was marked at the level of the bladder neck, proximal prostate, distal prostate, and verumontanum. Arterial bleeding was classified into one of three grades according to bleeding severity (grades 2 and 3 indicate significant bleeding).ResultsThe mean prostate volume was 65.1±31.5 mL, and the mean prostate-specific antigen (PSA) level was 3.69±3.58 ng/mL. During the HoLEP procedure, the most common locations of significant bleeders were the 2-5 and 7-10 o'clock positions in the proximal prostate. The average number of bleeding arteries was 12.1±7.9 per procedure, and 1.93±1.20 per 10 mL of prostate volume. Multivariate analysis revealed that prostate volume and serum PSA were significant parameters for estimating the number of bleeding vessels.ConclusionsDuring the HoLEP procedure, the most common locations of significant bleeders were the 2-5 and 7-10 o'clock positions in the proximal prostate. Prostate volume was associated with the number of bleeders. A careful approach to the capsular plane of the proximal prostate facilitates early hemostasis during the HoLEP procedure, especially with larger adenomas.

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The Effects of 5α-Reductase Inhibition on Benign Prostatic Hyperplasia Treated by Photoselective Vaporization Prostatectomy with the 120 Watt GreenLight HPS Laser System

Cited by 5 publications

References 23 publications

Optimising patient outcomes with photoselective vaporization of the prostate (PVP): a review

Optimising patient outcomes with photoselective vaporization of the prostate (PVP): a review

What is the best radiological method to predict the actual weight of the prostate?

Transurethral Surgical Anatomy of the Arterial Bleeder in the Enucleated Capsular Plane of Enlarged Prostates During Holmium Laser Enucleation of the Prostate

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