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The role of photovaporization of the prostate in small volume benign prostatic hyperplasia and review of the literature |
Dominique Thomasa,1,Kevin C. Zornb,1,Malek Meskawib,Ramy Gouelia,Pierre-Alain Hueberb,Lesa Deonarinea,Vincent Misraib,Alexis Tea,Bilal Chughtaia,*()
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a Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA b Section of Urology, Department of Surgery, University of Montreal Hospital Center, Montreal, QC, Canada |
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Abstract Objective: Our objective was to characterize the safety and efficacy of the 180 W XPS-GreenLight laser in men with lower urinary tract symptoms secondary to a small volume benign prostatic hyperplasia (BPH). Methods: A retrospective analysis was performed for all patients who underwent 180 W XPS-laser photoselective vaporization of the prostate (PVP) vaporization of the prostate between 2012 and 2016 at two-tertiary medical centers. Data collection included baseline comorbidities, disease-specific quality of life scores, maximum urinary flow rate (Qmax), postvoid residual (PVR), complications, prostate volume and prostate-specific antigen (PSA). The secondary endpoints were the incidence of intraoperative and postoperative adverse events. Complications were stratified using the Clavien-Dindo grading system up to 90 days after surgery. Results: Mean age of men was 67.8 years old, with a mean body mass index of 29.7 kg/m 2. Mean prostate volume as measured by transrectal ultrasound was 29 mL. Anticoagulation use was 47% and urinary retention with catheter at time of surgery was 17%. Mean hospital stay and catheter time were 0.5 days. Median follow-up time was 6 months with the longest duration of follow-up being 22.5 months (interquartile range, 3-22.5 months). The International Prostate Symptom Score improved from 22.8 ± 7.0 at baseline to 10.7 ± 7.4 (p < 0.01) and 6.3 ± 4.4 (p < 0.01) at 1 and 6 months, respectively. The Qmax improved from 7.70 ± 4.46 mL/s at baseline to 17.25 ± 9.30 mL/s (p < 0.01) and 19.14 ± 7.19 mL/s (p < 0.001) at 1 and 6 months, respectively, while the PVR improved from 216.0 ± 271.0 mL preoperatively to 32.8 ± 45.3 mL (p < 0.01) and 26.2 ± 46.0 mL (p < 0.01) at 1 and 6 months, respectively. The PSA dropped from 1.97 ± 1.76 ng/mL preoperatively to 0.71 ± 0.61 ng/mL (p < 0.01) and 0.74 ± 0.63 ng/mL at 1 and 6 months, respectively. No patient had a bladder neck contracture postoperatively and no capsular perforations were noted intraoperatively. Conclusion: The 180 W GreenLight XPS system is safe and effective for men with small volume BPH. PVP produced improvements in symptomatic and clinical parameters without any safety concern. It represents a safe surgical option in this under studied population.
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Received: 24 April 2018
Available online: 25 January 2019
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Corresponding Authors:
Bilal Chughtai
E-mail: bic9008@med.cornell.edu
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Variable | Value | Age, year | Mean (median) | 68 (68) | IQR | 60-74 | ASA score, n (%) | I | 9 (15%) | II | 33 (57%) | III | 16 (28%) | BMI, kg/m2 | Mean (median) | 26 (26) | IQR | 24-29 | Antithrombotic therapy use, n (%) | No | 31 (53%) | Yes | 27 (47%) | Median lobe, n (%) | No | 52 (90%) | Yes | 6 (10%) | 5-ARI use, n (%) | No | 20 (34%) | Yes | 38 (66%) | Alpha blockers use, n (%) | No | 13 (22%) | Yes | 45 (78%) | Indwelling catheter, n (%) | No | 48 (83%) | Yes | 10 (17%) | TRUS prostate volume, mL | Mean (median) | 31 (33) | IQR | 27-37 |
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Descriptive characteristics of 58 patients treated with XPS GreenLight for small prostate size (prostate volume ≤40 mL).
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Variable | Value | Lasing time, min | Mean (median) | 21 (21) | IQR | 15-24 | Operative time, min | Mean (median) | 46 (45) | IQR | 30-50 | Energy use, kJ | Mean (median) | 150 (127) | IQR | 99-184 | Number of fibers, n (%) | 1 | 53 (91) | 2 | 4 (7) | 3+ | 1 (2) | Energy density, kJ/g | Mean (median) | 5 (4.2) | IQR | 3.2-5.8 | Hospital stay, day | Mean (median) | 0.5 (0) | IQR | 0-1 |
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Operative characteristics of 58 patients treated with XPS GreenLight for small prostate size (prostate volume ≤40 mL).
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Outcome | n (%) | Clavien-Dindo Grade I | Hematuria | 3 (5.2) | Irritative symptoms | 3 (5.2) | Urinary incontinence | 1 (1.7) | Clavien-Dindo Grade II | Hematuria | 0 (0) | urinary tract infection | 3 (5.2) | Irritative symptoms | 0 (0) | Urinary incontinence | 1 (1.7) | Urinary retention | 0 (0) | First voiding trial failure | 5 (9) | Capsular perforation | 0 (0) | Clavien-Dindo Grade III | Bladder neck contraction | 0 (0) | Clavien-Dindo Grade IV | 0 (0) | Clavien-Dindo Grade V | 0 (0) |
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Postoperative adverse events of patients treated with XPS GreenLight for small prostate size (prostate volume ≤40 mL).
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Variable | Baseline (n = 58) | 30 day (n = 54) | p-Valuea | 6 month (n = 38) | p-Valueb | IPSS | 22.8 ± 7.00 | 10.7 ± 7.4 | <0.01 | 6.31 ± 4.44 | <0.01 | QoL | 4.2 ± 1.04 | 2.11 ± 1.7 | <0.01 | 1.05 ± 1.22 | <0.01 | Qmax (mL/s) | 7.7 ± 4.46 | 17.250 ± 9.3 | <0.01 | 19.14 ± 7.19 | <0.01 | PVR (mL) | 216 ± 277 | 32.8 ± 45.3 | <0.01 | 26.23 ± 46.0 | <0.01 | PSA | 1.97 ± 1.76 | 0.71 ± 0.61 | <0.01 | 0.74 ± 0.63 | <0.01 |
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Postoperative outcomes following photovaporization of the prostate.
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