Vaporize, anatomically vaporize or enucleate the prostate? The flexible use of the GreenLight laser
Purposes GreenLight laser has gained increasing acceptance as a less invasive treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH/LUTS). Three surgical options were developed: standard photovaporization (PVP), anatomical PVP and GreenLight enucleation of prostate (Gre...
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| Veröffentlicht in: | International urology and nephrology 2017-03, Vol.49 (3), p.405-411 |
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| creator | Cindolo, Luca Ruggera, Lorenzo Destefanis, Paolo Dadone, Claudio Ferrari, Giovanni |
| description | Purposes
GreenLight laser has gained increasing acceptance as a less invasive treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH/LUTS). Three surgical options were developed: standard photovaporization (PVP), anatomical PVP and GreenLight enucleation of prostate (GreenLEP); however, literature lacks a direct comparison among the procedures. Aim of the present study is to compare the three techniques in a multicentre series of patients.
Methods
Data were collected from consecutive patients with indication to surgical management of BPH/LUTS in five institutions. Patients underwent standard PVP, anatomical PVP or GreenLEP according to surgeon preferences. Standard parameters associated with transurethral prostate surgery were documented prior surgery and during the follow-up. Patients’ perception of improvement was measured using a single-item scale. Early (within first 30 post-operative days) and delayed post-operative complications were recorded. Descriptive statistics, univariate and multivariate analysis were used.
Results
We evaluate 367 consecutive patients (mean age 69.1 years). Median prostate size and PSA were 68 ml (IQR 50–90) and 2.8 ng/ml (IQR 1.7–4.3), respectively. The median operative time and applied energy were 60 min (IQR 45–75) and 250 kJ (IQR 160–364). Catheterization time and median post-operative stay were 1 and 2 days. No patient was transfused. The overall median
Q
max
values increased for 8–19 ml/s (
p
|
| doi_str_mv | 10.1007/s11255-016-1494-6 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1877846199</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1877846199</sourcerecordid><originalsourceid>FETCH-LOGICAL-c405t-7f43f5c072c26a3708c3d32cd3b7e31fef4220088e565bfbb9fd7d77750fd4d73</originalsourceid><addsrcrecordid>eNqNkc9LHDEUx4NU6mr7B3gpgV56cOzLr0nmVIpUW1jwYnsNmcyLjmRntsmMVP_6Zt1VpCD0FF7yed8k70PIMYNTBqA_Z8a4UhWwumKykVW9RxZMaVFxZeQbsgABrGI1FwfkMOdbAGgMwFtywA1IyYVZEP_LrcfUP-AJdYObxlXvXYz39G63TcdEcZh9RDchnW6QrtOYp1J8oVelChH_9G1EOufChkfiIiEOy_76ZqLRZUzvyH5wMeP73XpEfp5_uzr7Xi0vL36cfV1WXoKaKh2kCMqD5p7XTmgwXnSC-060GgULGCTnAMagqlUb2rYJne601gpCJzstjsinbW554u8Z82RXffYYoxtwnLNlRmsja9Y0_4EqBbUqUy7ox3_Q23FOQ_nIJhCM4oKbQrEt5ct4csJg16lfuXRvGdiNLLuVZYssu5Fl69LzYZc8tyvsnjue7BSAb4FcjoZrTC-ufjX1Lzr7nnk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1870852328</pqid></control><display><type>article</type><title>Vaporize, anatomically vaporize or enucleate the prostate? The flexible use of the GreenLight laser</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Cindolo, Luca ; Ruggera, Lorenzo ; Destefanis, Paolo ; Dadone, Claudio ; Ferrari, Giovanni</creator><creatorcontrib>Cindolo, Luca ; Ruggera, Lorenzo ; Destefanis, Paolo ; Dadone, Claudio ; Ferrari, Giovanni</creatorcontrib><description>Purposes
GreenLight laser has gained increasing acceptance as a less invasive treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH/LUTS). Three surgical options were developed: standard photovaporization (PVP), anatomical PVP and GreenLight enucleation of prostate (GreenLEP); however, literature lacks a direct comparison among the procedures. Aim of the present study is to compare the three techniques in a multicentre series of patients.
Methods
Data were collected from consecutive patients with indication to surgical management of BPH/LUTS in five institutions. Patients underwent standard PVP, anatomical PVP or GreenLEP according to surgeon preferences. Standard parameters associated with transurethral prostate surgery were documented prior surgery and during the follow-up. Patients’ perception of improvement was measured using a single-item scale. Early (within first 30 post-operative days) and delayed post-operative complications were recorded. Descriptive statistics, univariate and multivariate analysis were used.
Results
We evaluate 367 consecutive patients (mean age 69.1 years). Median prostate size and PSA were 68 ml (IQR 50–90) and 2.8 ng/ml (IQR 1.7–4.3), respectively. The median operative time and applied energy were 60 min (IQR 45–75) and 250 kJ (IQR 160–364). Catheterization time and median post-operative stay were 1 and 2 days. No patient was transfused. The overall median
Q
max
values increased for 8–19 ml/s (
p
< 0.05), median International Prostate Symptoms Score decreased from 24 to 7 (
p
< 0.05). A total of 7.4% urinary retention, 33.4% bothersome storage symptoms, 2.5% short-term stress incontinence were recorded. Three heart attacks, one pulmonary embolism and one death occurred. Prostate volume was a predictive factor for post-operative storage symptoms (
p
= 0.049). Nine percentage of patients experienced long-term complications (4, 0.9 and 0.9% of urethral stricture, bladder neck contracture and prostatic fossa sclerosis, respectively) with 2.5% of long-term stress urinary incontinence (conservatively managed). The reintervention rate was 6%. Late complications were associated at univariate analysis with pharmacological therapy (combination therapy vs. alpha blockers alone vs. none:
p
value = 0.042) and with the surgical approach (standard PVP vs. anatomical PVP vs. GreenLEP
p
value = 0.011). The patients’ perception of satisfaction was 68% “greatly improved”, 27% “improved”, 4% “not changed” and 1% “worsened” with no differences between techniques.
Conclusion
The availability of three different GreenLight laser techniques allows surgeons with different skills to safety use this technology that remains effective with high patient satisfaction. Anatomical vaporization seems to guarantee the best balance between functional outcomes, surgical procedures and complications.</description><identifier>ISSN: 0301-1623</identifier><identifier>EISSN: 1573-2584</identifier><identifier>DOI: 10.1007/s11255-016-1494-6</identifier><identifier>PMID: 28044238</identifier><identifier>CODEN: IURNAE</identifier><language>eng</language><publisher>Dordrecht: Springer Netherlands</publisher><subject>Aged ; Humans ; Laser Therapy - adverse effects ; Laser Therapy - methods ; Lasers, Solid-State - adverse effects ; Lasers, Solid-State - therapeutic use ; Length of Stay ; Lower Urinary Tract Symptoms - etiology ; Lower Urinary Tract Symptoms - surgery ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Nephrology ; Operative Time ; Organ Size ; Patient Satisfaction ; Postoperative Complications - etiology ; Prostate - pathology ; Prostatic Hyperplasia - complications ; Prostatic Hyperplasia - pathology ; Prostatic Hyperplasia - surgery ; Reoperation ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome ; Urology ; Urology - Original Paper</subject><ispartof>International urology and nephrology, 2017-03, Vol.49 (3), p.405-411</ispartof><rights>Springer Science+Business Media Dordrecht 2017</rights><rights>International Urology and Nephrology is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c405t-7f43f5c072c26a3708c3d32cd3b7e31fef4220088e565bfbb9fd7d77750fd4d73</citedby><cites>FETCH-LOGICAL-c405t-7f43f5c072c26a3708c3d32cd3b7e31fef4220088e565bfbb9fd7d77750fd4d73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11255-016-1494-6$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11255-016-1494-6$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28044238$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cindolo, Luca</creatorcontrib><creatorcontrib>Ruggera, Lorenzo</creatorcontrib><creatorcontrib>Destefanis, Paolo</creatorcontrib><creatorcontrib>Dadone, Claudio</creatorcontrib><creatorcontrib>Ferrari, Giovanni</creatorcontrib><title>Vaporize, anatomically vaporize or enucleate the prostate? The flexible use of the GreenLight laser</title><title>International urology and nephrology</title><addtitle>Int Urol Nephrol</addtitle><addtitle>Int Urol Nephrol</addtitle><description>Purposes
GreenLight laser has gained increasing acceptance as a less invasive treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH/LUTS). Three surgical options were developed: standard photovaporization (PVP), anatomical PVP and GreenLight enucleation of prostate (GreenLEP); however, literature lacks a direct comparison among the procedures. Aim of the present study is to compare the three techniques in a multicentre series of patients.
Methods
Data were collected from consecutive patients with indication to surgical management of BPH/LUTS in five institutions. Patients underwent standard PVP, anatomical PVP or GreenLEP according to surgeon preferences. Standard parameters associated with transurethral prostate surgery were documented prior surgery and during the follow-up. Patients’ perception of improvement was measured using a single-item scale. Early (within first 30 post-operative days) and delayed post-operative complications were recorded. Descriptive statistics, univariate and multivariate analysis were used.
Results
We evaluate 367 consecutive patients (mean age 69.1 years). Median prostate size and PSA were 68 ml (IQR 50–90) and 2.8 ng/ml (IQR 1.7–4.3), respectively. The median operative time and applied energy were 60 min (IQR 45–75) and 250 kJ (IQR 160–364). Catheterization time and median post-operative stay were 1 and 2 days. No patient was transfused. The overall median
Q
max
values increased for 8–19 ml/s (
p
< 0.05), median International Prostate Symptoms Score decreased from 24 to 7 (
p
< 0.05). A total of 7.4% urinary retention, 33.4% bothersome storage symptoms, 2.5% short-term stress incontinence were recorded. Three heart attacks, one pulmonary embolism and one death occurred. Prostate volume was a predictive factor for post-operative storage symptoms (
p
= 0.049). Nine percentage of patients experienced long-term complications (4, 0.9 and 0.9% of urethral stricture, bladder neck contracture and prostatic fossa sclerosis, respectively) with 2.5% of long-term stress urinary incontinence (conservatively managed). The reintervention rate was 6%. Late complications were associated at univariate analysis with pharmacological therapy (combination therapy vs. alpha blockers alone vs. none:
p
value = 0.042) and with the surgical approach (standard PVP vs. anatomical PVP vs. GreenLEP
p
value = 0.011). The patients’ perception of satisfaction was 68% “greatly improved”, 27% “improved”, 4% “not changed” and 1% “worsened” with no differences between techniques.
Conclusion
The availability of three different GreenLight laser techniques allows surgeons with different skills to safety use this technology that remains effective with high patient satisfaction. Anatomical vaporization seems to guarantee the best balance between functional outcomes, surgical procedures and complications.</description><subject>Aged</subject><subject>Humans</subject><subject>Laser Therapy - adverse effects</subject><subject>Laser Therapy - methods</subject><subject>Lasers, Solid-State - adverse effects</subject><subject>Lasers, Solid-State - therapeutic use</subject><subject>Length of Stay</subject><subject>Lower Urinary Tract Symptoms - etiology</subject><subject>Lower Urinary Tract Symptoms - surgery</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Nephrology</subject><subject>Operative Time</subject><subject>Organ Size</subject><subject>Patient Satisfaction</subject><subject>Postoperative Complications - etiology</subject><subject>Prostate - pathology</subject><subject>Prostatic Hyperplasia - complications</subject><subject>Prostatic Hyperplasia - pathology</subject><subject>Prostatic Hyperplasia - surgery</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Severity of Illness Index</subject><subject>Treatment Outcome</subject><subject>Urology</subject><subject>Urology - Original Paper</subject><issn>0301-1623</issn><issn>1573-2584</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkc9LHDEUx4NU6mr7B3gpgV56cOzLr0nmVIpUW1jwYnsNmcyLjmRntsmMVP_6Zt1VpCD0FF7yed8k70PIMYNTBqA_Z8a4UhWwumKykVW9RxZMaVFxZeQbsgABrGI1FwfkMOdbAGgMwFtywA1IyYVZEP_LrcfUP-AJdYObxlXvXYz39G63TcdEcZh9RDchnW6QrtOYp1J8oVelChH_9G1EOufChkfiIiEOy_76ZqLRZUzvyH5wMeP73XpEfp5_uzr7Xi0vL36cfV1WXoKaKh2kCMqD5p7XTmgwXnSC-060GgULGCTnAMagqlUb2rYJne601gpCJzstjsinbW554u8Z82RXffYYoxtwnLNlRmsja9Y0_4EqBbUqUy7ox3_Q23FOQ_nIJhCM4oKbQrEt5ct4csJg16lfuXRvGdiNLLuVZYssu5Fl69LzYZc8tyvsnjue7BSAb4FcjoZrTC-ufjX1Lzr7nnk</recordid><startdate>20170301</startdate><enddate>20170301</enddate><creator>Cindolo, Luca</creator><creator>Ruggera, Lorenzo</creator><creator>Destefanis, Paolo</creator><creator>Dadone, Claudio</creator><creator>Ferrari, Giovanni</creator><general>Springer Netherlands</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20170301</creationdate><title>Vaporize, anatomically vaporize or enucleate the prostate? The flexible use of the GreenLight laser</title><author>Cindolo, Luca ; Ruggera, Lorenzo ; Destefanis, Paolo ; Dadone, Claudio ; Ferrari, Giovanni</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c405t-7f43f5c072c26a3708c3d32cd3b7e31fef4220088e565bfbb9fd7d77750fd4d73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Humans</topic><topic>Laser Therapy - adverse effects</topic><topic>Laser Therapy - methods</topic><topic>Lasers, Solid-State - adverse effects</topic><topic>Lasers, Solid-State - therapeutic use</topic><topic>Length of Stay</topic><topic>Lower Urinary Tract Symptoms - etiology</topic><topic>Lower Urinary Tract Symptoms - surgery</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Nephrology</topic><topic>Operative Time</topic><topic>Organ Size</topic><topic>Patient Satisfaction</topic><topic>Postoperative Complications - etiology</topic><topic>Prostate - pathology</topic><topic>Prostatic Hyperplasia - complications</topic><topic>Prostatic Hyperplasia - pathology</topic><topic>Prostatic Hyperplasia - surgery</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Severity of Illness Index</topic><topic>Treatment Outcome</topic><topic>Urology</topic><topic>Urology - Original Paper</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cindolo, Luca</creatorcontrib><creatorcontrib>Ruggera, Lorenzo</creatorcontrib><creatorcontrib>Destefanis, Paolo</creatorcontrib><creatorcontrib>Dadone, Claudio</creatorcontrib><creatorcontrib>Ferrari, Giovanni</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>International urology and nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cindolo, Luca</au><au>Ruggera, Lorenzo</au><au>Destefanis, Paolo</au><au>Dadone, Claudio</au><au>Ferrari, Giovanni</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Vaporize, anatomically vaporize or enucleate the prostate? The flexible use of the GreenLight laser</atitle><jtitle>International urology and nephrology</jtitle><stitle>Int Urol Nephrol</stitle><addtitle>Int Urol Nephrol</addtitle><date>2017-03-01</date><risdate>2017</risdate><volume>49</volume><issue>3</issue><spage>405</spage><epage>411</epage><pages>405-411</pages><issn>0301-1623</issn><eissn>1573-2584</eissn><coden>IURNAE</coden><abstract>Purposes
GreenLight laser has gained increasing acceptance as a less invasive treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (BPH/LUTS). Three surgical options were developed: standard photovaporization (PVP), anatomical PVP and GreenLight enucleation of prostate (GreenLEP); however, literature lacks a direct comparison among the procedures. Aim of the present study is to compare the three techniques in a multicentre series of patients.
Methods
Data were collected from consecutive patients with indication to surgical management of BPH/LUTS in five institutions. Patients underwent standard PVP, anatomical PVP or GreenLEP according to surgeon preferences. Standard parameters associated with transurethral prostate surgery were documented prior surgery and during the follow-up. Patients’ perception of improvement was measured using a single-item scale. Early (within first 30 post-operative days) and delayed post-operative complications were recorded. Descriptive statistics, univariate and multivariate analysis were used.
Results
We evaluate 367 consecutive patients (mean age 69.1 years). Median prostate size and PSA were 68 ml (IQR 50–90) and 2.8 ng/ml (IQR 1.7–4.3), respectively. The median operative time and applied energy were 60 min (IQR 45–75) and 250 kJ (IQR 160–364). Catheterization time and median post-operative stay were 1 and 2 days. No patient was transfused. The overall median
Q
max
values increased for 8–19 ml/s (
p
< 0.05), median International Prostate Symptoms Score decreased from 24 to 7 (
p
< 0.05). A total of 7.4% urinary retention, 33.4% bothersome storage symptoms, 2.5% short-term stress incontinence were recorded. Three heart attacks, one pulmonary embolism and one death occurred. Prostate volume was a predictive factor for post-operative storage symptoms (
p
= 0.049). Nine percentage of patients experienced long-term complications (4, 0.9 and 0.9% of urethral stricture, bladder neck contracture and prostatic fossa sclerosis, respectively) with 2.5% of long-term stress urinary incontinence (conservatively managed). The reintervention rate was 6%. Late complications were associated at univariate analysis with pharmacological therapy (combination therapy vs. alpha blockers alone vs. none:
p
value = 0.042) and with the surgical approach (standard PVP vs. anatomical PVP vs. GreenLEP
p
value = 0.011). The patients’ perception of satisfaction was 68% “greatly improved”, 27% “improved”, 4% “not changed” and 1% “worsened” with no differences between techniques.
Conclusion
The availability of three different GreenLight laser techniques allows surgeons with different skills to safety use this technology that remains effective with high patient satisfaction. Anatomical vaporization seems to guarantee the best balance between functional outcomes, surgical procedures and complications.</abstract><cop>Dordrecht</cop><pub>Springer Netherlands</pub><pmid>28044238</pmid><doi>10.1007/s11255-016-1494-6</doi><tpages>7</tpages></addata></record> |
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| ispartof | International urology and nephrology, 2017-03, Vol.49 (3), p.405-411 |
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| language | eng |
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| subjects | Aged Humans Laser Therapy - adverse effects Laser Therapy - methods Lasers, Solid-State - adverse effects Lasers, Solid-State - therapeutic use Length of Stay Lower Urinary Tract Symptoms - etiology Lower Urinary Tract Symptoms - surgery Male Medicine Medicine & Public Health Middle Aged Nephrology Operative Time Organ Size Patient Satisfaction Postoperative Complications - etiology Prostate - pathology Prostatic Hyperplasia - complications Prostatic Hyperplasia - pathology Prostatic Hyperplasia - surgery Reoperation Retrospective Studies Severity of Illness Index Treatment Outcome Urology Urology - Original Paper |
| title | Vaporize, anatomically vaporize or enucleate the prostate? The flexible use of the GreenLight laser |
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