Photoselective vaporization of the prostate: the basel experience after 108 procedures

OBJECTIVES: This study aims to investigate safety and efficacy of 80 watt high-power potassium titanyl phosphate (KTP) laser vaporization of the prostate in men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). METHODS: 108 patients underwent 80W KTP laser vaporization. Functional follow-up included measurement of maximum urinary flow rate (Qmax), postvoid residual volume (Vres) and International Prostate Symptom Score (IPSS) within a 12 months period. RESULTS: The average prostate volume was 52.2+/-24.3 ml and the preoperative PSA value was 3.6+/-3.6 ng/dl. Mean operation time was 54.5+/-25.0 min. Qmax increased highly significantly (p<0.001) by 111% (+7.9 ml/s) at discharge, 212% (+15.1 ml/s) after three months, 201% (+14.3 ml/s) after six months and 252% (+17.9 ml/s) after 12 months. Correspondingly, Vres, IPSS and Bother Score improved to an extent that was statistically highly significant (p<0.001) immediately after surgery. The observed complication rate within one year was low. CONCLUSIONS: 80 W KTP laser vaporization is a virtually bloodless, safe and effective procedure for surgical treatment of LUTS secondary to BPH. A significant improvement of objective and subjective voiding parameters was observed just after surgery. KTP laser vaporization is associated with a low rate of complications.     

Photoselective laser vaporization prostatectomy for acute urinary retention in China

PURPOSE: To assess the clinical efficacy and safety of photoselective laser vaporization of the prostate (PVP) in the treatment of patients with acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Forty-two patients (mean age 72 +/- 5 years, range 65-89) with AUR because of BPH were treated with a prospective trial of PVP with the potassium-titanyl-phosphate (KTP) laser. The treatment outcome was evaluated with subjective and objective tests at 1, 3, 6, and 12 months after PVP using the International Prostate Symptom Score (IPSS), disease-specific quality of life (QoL) score, postvoid residual (PVR) urine volume, and maximum urinary flow rate (Qmax). The International Index of Erectile Function questionnaire and a self-designed ejaculatory questionnaire were completed at different follow-up times to determine patient satisfaction and changes in sexual function. RESULTS: After preliminary urine drainage and adequate preoperative preparation, PVP was performed and bladder outlet obstruction was effectively relieved. The mean prostate volume was 62.5 +/- 11.7 cc, and the mean residual volume with retention was 650 mL (range 240-1200 mL). Mean operative time was 28.6 +/- 5.7 minutes. Mean catheterization duration was 5.6 days (range 3-14 d). There was significant subjective improvement of symptoms and objective improvement in urinary flow rates at 12 months. The mean IPSS and QoL score decreased significantly (P < 0.05). Mean PVR volume also decreased. The mean Qmax was 16.2 +/- 4.6 mL/sec after treatment. Only two patients had recurrent urinary retention during follow-up. There were no intraoperative or postoperative adverse events. CONCLUSIONS: The early clinical results suggest that the PVP is a promising safe, effective, and less-invasive treatment with minimal morbidity for patients with urine retention secondary to BPH.     

Safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients on ongoing oral anticoagulation

OBJECTIVES: Ongoing oral anticoagulation (OA) contraindicates transurethral electroresection of the prostate. We evaluated the safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients on ongoing OA with coumarin derivatives, aspirin, or clopidogrel, complaining of symptomatic benign prostatic hyperplasia (BPH). METHODS: We evaluated perioperative parameters, functional outcome, and adverse events up to 24 mo postoperatively of patients on OA, and compared results with 92 men at normal risk without anticoagulant therapy undergoing PVP for the same indication (control). RESULTS: Within 40 mo, 116 men on OA were included, with 31% (n=36) receiving coumarin derivatives; 61% (n=71), aspirin; and 8% (n=9), clopidogrel. Mean prostate volume (62+/-34ml vs. 57+/-25ml; p=0.289) and mean operation time (67+/-28min vs 63+/-29min; p=0.313) were comparable with control. We observed no bleeding complications necessitating blood transfusions. Average postoperative decrease of haemoglobin was 8.6% for patients on OA versus 8.8% for control. At 3, 6, 12, and 24 mo postoperatively, improvement of the International Prostate Symptom Score ranged from 60-70%; postvoid residual volume, 80-88%; and average maximum urinary flow rate, 116-140%, respectively. Postoperative complications were low and comparable with control. CONCLUSIONS: PVP is characterized by excellent haemostatic properties and very low intraoperative complication rate even in patients on OA. On the basis of our perioperative results, we recommend PVP as first-line procedure for patients with symptomatic BPH at high risk of bleeding.     

Rapid communication: holmium laser ablation of large prostate glands: an endourologic alternative to open prostatectomy

PURPOSE: To assess the efficacy and safety of holmium laser ablation of the prostate (HoLAP) to treat patients with large glands who would otherwise be recommended for open prostatectomy. PATIENTS AND METHODS: A series of 17 patients aged 54 to 79 years (mean 68.2 years) with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) (n = 14) or prostate carcinoma (n = 3) and a transurethral ultrasonography-assessed prostate volume of >80 cc were treated with a 100 W holmium laser. The endpoint of treatment was complete vaporization of obstructing prostate tissue down to the capsular fibers with an adequate prostate cavity. RESULTS: The mean laser time was 77 minutes (range 43-203 minutes), the catheter time 2.12 days (range 1-5 days), and the length of stay 1.34 days (range 1-3 days). None of the patients required continuous bladder irrigation. Prostate volume decreased from 121.82 +/- 42.10 cc to 54.58 +/- 20.65 cc (55%; P < 0.01). The American Urological Association Symptom Score decreased from 20.41 +/- 5.35 to 5.70 +/- 2.20 (70%; P < 0.01). The peak urinary flow rate (Q(max)) increased from 6.92 +/- 5.71 to 15.06 +/- 7.57 (217%; P < 0.01). Serum sodium changed from 138.53 +/- 2.50 mEq/L to 138.00 +/- 3.29 mEq/L (P = 0.4). Hemoglobin changed from 14.4 +/- 1.15 g/dL to 13.58 +/- 1.29 g/dL (-5%). No patient had postoperative stress incontinence. CONCLUSION: The HoLAP technique is effective in the treatment of patients with LUTS secondary to BPH and for some patients with prostate carcinoma. Because of the excellent hemostatic properties of the holmium laser wavelength, large glands can be vaporized safely with minimal morbidity and a short hospital stay. The clinical advantages over open prostatectomy include clinically insignificant perioperative blood loss, no stress incontinence, short duration of catheterization, and no skin incision.     

Rapid communication: photoselective vaporization of the prostate versus transurethral resection of the prostate for the large prostate: a prospective nonrandomized bicenter trial with 2-year follow-up

PURPOSE: To present our 2-year data comparing photoselective vaporization of the prostate (PVP) and transurethral resection of the prostate (TURP) for patients suffering from lower urinary tract symptoms (LUTS) secondary to large-volume benign prostatic hyperplasia. MATERIALS AND METHODS: In this prospective, nonrandomized study, 81 patients with a prostate volume of between 70 and 150 mL underwent either PVP (40) or TURP (41). All patients were preoperatively assessed by International Prostate Symptom Score (IPSS), transrectal ultrasonography (TRUS), uroflowmetry, and postvoid residual urine (PVR) measurement. We compared parameters, complications, and functional follow-up between the groups. RESULTS: The baseline characteristics of the two groups were similar. Mean operative time was 126.2 +/- 17.4 minutes for PVP and 77.9 +/- 8.3 minutes for TURP (P < 0.001). Bleeding requiring blood transfusion in one patient and transurethral resection (TUR) syndrome in one patient were observed in the TURP group. Catheter indwelling times and hospitalization times of patients in the PVP group were all shorter than those of patients in the TURP group (P < 0.001). In both the groups, an immediate and highly significant improvement of maximum urinary flow rate (Q(max)), PVR, and IPSS was evident. Capsule perforation was observed in one patient undergoing TURP. Reoperation was required in three patients in the group of PVP and one patient in the TURP group. We observed urethral stricture in two patients after TURP. CONCLUSION: The postoperative micturition improvement was significant and lasting, and was equivalent in both groups. The rate of late complications is equally low with both procedures. Catheterization time and hospital stay were significantly shorter with PVP.     

经尿道选择性绿激光汽化术与前列腺汽化电切除术治疗良性前列腺增生的疗效比较

目的 比较经尿道选择性绿激光前列腺汽化术（PVP）与前列腺汽化电切除术（TUVP）治疗良性前列腺增生（BPH）的安全性及疗效。方法 随机采用PVP与TUVP两种手术方式治疗BPH患者163例,其中PVP组105例,TUVP组58例。对两组患者的国际前列腺症状评分（IPSS）、生活质量评分（QOL）、术中出血量、手术时间、冲洗液清亮时间、留置尿管时间、最大尿流率、术后并发症等进行比较。结果 两组手术前后IPSS、QOL、Qmax、剩余尿量（RUV）比较均显著改善（P〈0．05）,但两组之间症状改善差异无统计学意义（P〉0．05）。TUVP组手术时间平均（37±15）min,PVP组则为平均（45±28）min,TUVP手术操作时间少于PVP,但差异无统计学意义（P〉0．05）。PVP组术中出血量少、拔除尿管早,优于TUVP组（P〈0,05）。术后随访6个月两组前列腺症状评分及最大尿流率疗效相同。TUVP组术后血尿明显（41．4％）,需膀胱冲洗,而PVP术后尿路刺激症状明显（55．2％,P〈0．05）。结论 PVP手术是一种手术过程非常安全、并发症少,能达到与TUVP完全相同治疗效果的手术方式。     

The efficacy and safety of 2-μm continuous laser in the treatment of high-risk patients with benign prostatic hyperplasia

Two-micrometer laser resection of prostate-tangerine technique dissects whole prostatic lobes off the surgical capsular, similar to peeling a tangerine. The present study aimed to evaluate the safety and efficacy of 2-μm continuous laser vaporization in the treatment of high-risk patients with benign prostatic hyperplasia (BPH) during the 24-month follow-up. The study included 248 patients with moderate to severe lower urinary tract symptoms who underwent 2-μm continuous laser vaporization of the prostate. All patients were accompanied with different degree comorbidities and 94 patients were taking oral anticoagulants. BPH was successfully treated with 2-μm continuous laser vaporization in all patients. Mean pre-operative prostate volume was 76?±?25.3 ml and mean operative time was 49.8?±?16.5 min. There were no major complications intra-operatively or postoperatively, and no blood transfusions were needed. About 20 patients (8.1%) needed bladder irrigation postoperatively. Average catheterization time was 2.0?±?1.8 days (range 1–5 days). Four patients required reoperation due to enlarged prostates from residual adenoma. At 3-, 6-, 12-, and 24-month follow-ups, maximum urinary flow rates (Qmax) increased from 6.9?±?1.7 to 19.1?±?4.2, 19.5?±?4.6, 19.4?±?4.6, and 19.5?±?4.1 ml/s, respectively. Mean International Prostate Symptom Scores (IPSS) decreased from 27.6?±?5.1 (pre-operation) to 9.2?±?2.6, 7.12?±?1.42, 6.18?±?1.32, and 6.25?±?1.30 at 3-, 6-, 12-, and 24-month post-operation, respectively. Two-micrometer continuous laser vaporization is a safe and effective surgical endoscopic technique associated with low complication rate in BPH patients at high risk and those on anticoagulation therapy who have severe LUTS caused by BPH.     

The application of 120-W high-performance system GreenLight laser vaporization of the prostate in high-risk patients

The purpose of this study is to evaluate the safety and efficacy of 120-W potassium titanyl phosphate (KTP) laser vaporization in patients with benign prostatic hyperplasia (BPH) who also had cardiopulmonary diseases who were taking long-term anticoagulants and were at high risk of bleeding complications. The prospective study included 188 patients with severe lower urinary tract symptoms who underwent 120-W KTP laser vaporization of the prostate. All patients were at high cardiopulmonary risk, having presented with an American Society of Anesthesiology score of 3 or greater. Of those, 45 patients were taking oral anticoagulants, and 1 had a severe bleeding disorder. BPH was successfully treated with 120-W KTP laser vaporization in all patients. Mean preoperative prostate volume ± SD was 66?±?23.1 ml, and mean operative time was 50.8?±?15.5 min. There were no major complications intraoperatively or postoperatively, and no blood transfusions were required. Postoperatively, only 14 patients (7.4 %) required bladder irrigation. Average catheterization time was 1.9?±?1.5 days (range, 1–5 days). Three patients required reoperation due to enlarged prostates from residual adenoma. At 3-, 6,- 12-, and 24-month follow-ups, mean urinary peak flow increased from 8.0?±?3.6 ml/s to 19.1?±?5.6, 19.2?±?4.7, 19.1?±?4.65, and 19.2?±?4.34 ml/s, respectively. Mean International Prostate Symptom Scores decreased over time, from 25.6?±?5.1 (3 months) to 9.4?±?2.8, 7.05?±?1.46, 6.24?±?1.36, and 6.20?±?1.32 (24 months), respectively. 120-W HPS KTP laser vaporization is a safe and effective treatment option in BPH patients at high risk and those on anticoagulation therapy who have severe LUTS secondary to BPH.     

Interstitial laser coagulation of the prostate for management of acute urinary retention

PURPOSE: We evaluated the clinical efficacy and benefit of interstitial laser coagulation of the prostate (ILCP) in patients with benign prostatic hyperplasia (BPH) presenting with acute urinary retention. MATERIALS AND METHODS: Patients presenting with acute urinary retention were prospectively evaluated. Patients underwent ILCP and outcomes were evaluated by post-void residual urine, maximum flow rate, International Prostate Symptom Score, and disease specific quality of life score at baseline, 1, 3, 6 and 12 months. RESULTS: A total of 85 patients were enrolled in the study and 53 were diagnosed with acute urinary retention secondary to BPH. A total of 33 were not catheter-free after a week and 28 of them agreed to undergo ILCP. Mean preoperative prostate volume was 54.6 ml (range 23.0 to 130.0) and mean residual volume presenting with retention was 602 ml (range 200 to 1,150). There were no intraoperative or postoperative adverse events except urinary infection in 2 patients. Mean catheterization duration was 6.3 days (range 3 to 18) and all patients became catheter-free postoperatively. Mean followup was 16.9 months (range 7 to 31). Mean maximum flow rate (+/-SD) was 11.2 ml per second (+/-5.7) 3 months after treatment. Mean International Prostate Symptom Score and quality of life scores decreased from 23.1 (+/-6.4) at baseline to 8.0 (+/-5.3) at 3 months (p <0.001), and 5.0 (+/-1.2) to 1.9 (+/-1.6, p <0.001), respectively. Mean estimated prostate volume decreased by 19.4% (54.6 to 44.0 ml) 6 months postoperatively (p <0.001). Only 2 patients had recurrent urinary retention during followup. CONCLUSIONS: Our study suggested that ILCP is a safe and effective therapy for patients with BPH presenting with acute urinary retention.     

Photoselective vaporization of the prostate: initial experience with a new 80 W KTP laser for the treatment of benign prostatic hyperplasia

PURPOSE: To study the safety and efficacy of a new high-power potassium-titanyl-phosphate laser (KTP/532; Niagara PV trade mark laser system; Laserscope, San Jose, CA) for transurethral photoselective vaporization of benign obstructive prostate tissue. PATIENTS AND METHODS: The KTP/532 laser energy at 80 W was delivered by a 6F side-firing fiber through a 23F continuous-flow cystoscope. Photoselective vaporization of the prostate (PVP) using sterile water irrigation was performed under spinal anesthesia on an outpatient basis in 10 patients with a preoperative mean prostate volume of 41.37 +/- 18.5 cc (range 24-76.3 cc). The mean lasing time was 19.8 +/- 4.9 minutes. RESULTS: Two patients experienced 1 to 7 days of mild dysuria, and one who was taking warfarin had mild transient hematuria, but none had urinary retention or other complications. The mean catheterization time was 17.2 +/- 9.6 hours (range 0-28 hours). At 1 year, the outcomes, which had showed significant improvement sustained throughout the follow-up, were as follows: mean American Urological Association Symptom Score decreased from 23.2 +/- 4.7 to 2.6 +/- 0.5 (88.8%), the mean quality of life score improved from 4.3 +/- 0.7 to 0.4 +/- 0.5 (90.7%), the mean peak urinary flow rate increased from 10.3 +/- 1.4 mL/sec to 30.7 +/- 5.8 mL/sec (198.1%), and the mean postvoiding residual volume decreased from 137.6 +/- 112.2 mL to 3.0 +/- 4.8 mL (97.8%). The mean prostate volume decreased by 27%. CONCLUSIONS: This pilot study indicates that PVP with the new 80 W KTP/532 laser is a simple, safe, and efficacious outpatient procedure for the treatment of obstructive BPH.     

GreenLight laser photoselective vaporization of the prostate for treatment of benign prostate hyperplasia/lower urinary tract symptoms in patients with different post-void residual urine

The purpose of this study is to assess the safety and efficacy of GreenLight laser photoselective vaporization of the prostate (PVP) for the treatment of benign prostate hyperplasia/lower urinary tract symptoms (BPH/LUTS) in patients with different post-void residual urine (PVR). BPH/LUTS patients treated with PVP from January 2014 to January 2016 were enrolled in the present study. All patients were divided into PVR?>?50, 50?≤?PVR?<?400, and PVR?≥?400 ml groups, and standard general and urological methods for BPH/LUTS were carried out. PVP surgery was performed, and the follow-up outcome was investigated 6 months after surgery. A total of 429 patients were included, and there were no significant differences in comorbid diseases or habits among the three groups. The maximum urinary flow rate (Qmax) differed significantly among the groups (P?<?0.001), while patients in the PVR?<?50 ml group had higher maximum detrusor pressure (Pdet.max) level than the other two groups (P?<?0.001). Patients in 50?≤?PVR?<?400 (P?<?0.001) and PVR?≥?400 (P?<?0.001) ml groups were more likely to develop detrusor underactivity than those in the PVR?<?50 ml group. All patients were treated with PVP, and there were no severe complications requiring rehospitalization or reoperation except nine designed re-treatments. Follow-up data of 387 patients were available. Significant improvement in outcome parameters (International Prostate Symptom Score [IPSS], Qmax, and PVR) was observed in comparison with baseline measurements for the three groups. PVP significantly improved the IPSS, Qmax, and PVR in patients with different PVR; PVP is a safe and effective procedure for BPH/LUTS patients.     

KTP激光汽化治疗伴下尿路梗阻的晚期前列腺癌

目的 总结经尿道KTP激光前列腺汽化术(PVP)治疗伴有下尿路梗阻晚期前列腺癌的临床疗效.方法 伴有下尿路梗阻的晚期前列腺癌患者33例.年龄(76±6)岁.其中T3 18例,T4 15例.前列腺体积36～140 ml.患者术前IPSS为28.2±3.6,QOL为5.0±0.7,Q_(max) 4.7～10.1 ml/s,残余尿量(RU)为(126.0±25.2)ml.33例均行KTP激光经尿道汽化前列腺治疗.19例初发前列腺癌患者同时行PVP和睾丸切除,14例为睾丸切除和抗雄激素等治疗后仍有明显的排尿梗阻症状,有尿潴留史15例.分别对术前及PVP术后1、6个月患者IPSS、QOL Qmax、血PSA、RU等指标进行统计分析.采用SPSS 13.0软件处理数据,均数间比较采用配对t检验.结果 33例手术经过顺利.28例术后3～4 d拔除导尿管,排尿情况改善明显;5例初次拔管后仍有排尿困难而再次留置导尿,延时拔管后均能自行排尿.术后并发症包括血尿14例、短暂尿失禁3例.术后1个月时IPSS、QOL、Q_(max)、血PSA、RU分别为14.6±2.8、3.1±0.4、(13.2±5.6)ml/s、(16.3±13.4)ng/ml、(24.6±5.9)ml;术后6个月时分别为14.2±3.3、3.4±0.5、(12.2±3.4)ml/s、(8.0±6.5)ng/ml、(31.1±8.7)ml.术后1、6个月的IPSS评分、QOL、Qmax、血PSA与术前比较差异均有统计学意义(P＜0.01),术后1、6个月间IPSS评分、QOL、Q_(max)比较差异无统计学意义(P＞0.05).结论 PVP可以有效解除前列腺癌患者的下尿路梗阻症状,明显改善患者生活质量.安全、有效.     

Evaluation of greenlight photoselective vaporization of the prostate for the treatment of high-risk patients with benign prostatic hyperplasia

目的:评估选择性绿激光前列腺汽化术(PVP)治疗具有严重下尿路症状的前列腺增生(BPH)高危患者的可行性和安全性,探讨其临床和排尿效果。方法:采用 PVP 治疗85名前列腺增生(BPH)高危患者,激光功率80W,激光是通过汽化双鞘镜(23F)侧孔光纤传输。分别评估手术时间、术中出血量、术后留置尿管时间、国际前列腺症状评分(IPSS)、生活质量评分(QoL)、尿流率、残余尿量及近期并发症等指标。结果:所有患者手术顺利,PVP 的主要优点是手术时间短,平均手术时间为25.6±7.6分钟,出血少56.8±147.3 mL,留置尿管时间短1.6±0.8 d。IPSS 及 QoL 分别从29.6±5.4和5.4±0.6降低到9.5±2.6和1.3±0.6。患者对术后效果满意。患者的平均最大尿流率增加到17.8mL/s,残留尿量降到55.6 mL。上述结果与术前各项指标比皆有显著差异(P<0.05)。无患者要求输血及液体吸收,并发症少,且满意率高。结论:PVP 手术时间短,患者耐受性好,对于 BPH 高危患者来说是一种安全有效的微创式手术法,所以它可能是有梗阻性尿道症 BPH 高危患者的一种良好治疗选择。     

北京多中心社区良性前列腺增生患病率调查:BPC-BPH研究结果

目的 调查北京地区BPH患病现状. 方法 采用分层多阶段整群不等比例随机抽样方法选择年龄≥50岁男性作为研究对象,分别记录IPSS、腹部B超测垦前列腺体积和剩余尿量、测定Q_(max).结果 进行方差分析. 结果 符合标准的研究对象共1644名男性,平均年龄64.5(50～93)岁.IPSS(9.9±8.2)分,前列腺体积平均(30.8±19.4)ml,Q_(max),平均(14.7±7.5)ml/s,三者与年龄有相关性.中-重度下尿路症状患病率50.8%(835/1644),69.7%(1146/1644)的被调查者前列腺总体积>20 ml,Q_(max)<15ml/s占53.8%(883/1642).以IPSS>7分、前列腺体积>20 ml、Q_(max)<15ml/s为界,本组BPH患病率为26.8%(441/1644). 结论 北京地区≥50岁男性下尿路症状、前列腺体积与年龄正相关,Q_(max)与年龄负相关,本组BPH患病率为26.8%,较以往增加.     

Long-term outcome of transrectal high- intensity focused ultrasound therapy for benign prostatic hyperplasia

OBJECTIVE: The aim of this study was to determine the long-term outcome after transrectal high-intensity focused ultrasound (HIFU) therapy for patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). METHODS: Between June 1992 and March 1995, 98 men (mean age: 66 years) with LUTS due to BPH underwent transrectal HIFU therapy at our institution, and the data of 80 patients were included in this long-term analysis. Principal inclusion criteria were a peak flow rate (Qmax) < or =15 ml/s, AUA/IPSS score > or =18 and a prostate volume < or =75 ml. Postoperatively, patients were seen at 6-month intervals with assessment of symptom score, uroflowmetry and post-void residual volume. In the present analysis, follow-up was terminated at 4 years. The mean follow-up of the study population (excluding the patients who underwent transurethral resection of the prostate, TURP, due to insufficient therapeutic response) was 41.3 months (range: 13-48 months). RESULTS: In treatment responders (HIFU only; n = 45), the symptom score decreased from preoperatively 19.6 to 8.5 (-53%) after 12 months and subsequently showed only marginal fluctuations within the 4-year study period. The Qmax increased from preoperatively 9.1 to 11.8 ml/s (+30%) after 12 months and gradually declined to 10.2 ml/s (+12%) after 4 years. 35 men (43.8%) underwent TURP due to insufficient therapeutic response during the 4-year study period. The mean time interval between HIFU therapy and TURP was 26.5+/-2.7 months (range: 1-48 months). The retreatment-free period was significantly longer for patients with a pretreatment average flow rate >5 ml/s (p = 0.05) and lower grades of urodynamically documented bladder outflow obstruction (p = 0.03). A similar trend, which did not reach statistical significance, was noted for individuals with higher Qmax and lower post-void residuals. CONCLUSIONS: These long-time data indicate that transrectal HIFU therapy for BPH, at least in its present form, did not stand the test of time, as 43.8% of patients had to undergo TURP within 4 years after initial therapy. These data underline the need for long-term studies with follow-ups over several years to reliably assess the role of less invasive treatment options for BPH.     

Atorvastatin treatment for men with lower urinary tract symptoms and benign prostatic enlargement

OBJECTIVE: To evaluate the effects of atorvastatin in men with lower urinary tract symptoms (LUTS) and prostatic enlargement due to presumed BPH. METHODS: This was a phase 2, double-blind, randomised, placebo-controlled clinical study. Eligible patients were aged > or =50 yr, with International Prostate Symptom Score (IPSS) > or = 13, total prostate volume (TPV) > or = 30 ml, and maximum urinary flow rate 5-15 ml/s. All patients had serum low-density lipoprotein (LDL) 100-190 mg/dl at baseline. Patients received either atorvastatin 80 mg daily (n=176) or placebo (n=174) for 26 wk. End points included IPSS, TPV, transition zone volume (TZV), maximum urinary flow rate (Q(max)), serum PSA, and lipids. RESULTS: There was no difference between the effects of atorvastatin and placebo on the primary end point of mean change from baseline in IPSS after 26 wk of double-blind treatment (-4.5 vs. -4.3; p=0.263). Similarly, no effect was seen on the lower urinary tract secondary end points including TPV (-1.6 vs. -1.9 ml; p=0.654), TZV (-0.0 vs. -0.8 ml; p=0.421), Q(max) (+1.1 vs. +0.7 ml/s; p=0.612), and PSA (-0.24 vs. -0.14 ng/ml; p=0.235). Atorvastatin had a significant effect on serum lipid levels compared with placebo (eg, LDL: -75.6 vs. -6.1 mg/dl; p<0.001). CONCLUSIONS: Atorvastatin is not effective over 6 mo in the treatment of men with LUTS and prostatic enlargement due to presumed BPH who have serum LDL in the range 100-190 mg/dl.     

Low incidence of acute urinary retention in the general male population: the triumph project

OBJECTIVE: To describe the incidence of acute urinary retention (AUR) in the general male population and in a population of men newly diagnosed with lower urinary tract symptoms suggestive of BPH (LUTS/BPH). METHODS: We performed a retrospective cohort study in the Integrated Primary Care Information (IPCI) database, a GP research database in The Netherlands, during the period 1995-2000. All males, > or =45 years, without a history of AUR or radical cystectomy were included in the study. In addition, we followed a sub-cohort of men, newly diagnosed with LUTS/BPH. AUR was defined as the sudden inability to urinate, requiring catheterization. RESULTS: Amongst 56,958 males with a mean follow-up of 2.8 years, 344 AUR cases occurred (incidence rate 2.2/1000 man-years) of whom more than 40% were precipitated. AUR was the first symptom of LUTS/BPH in 73 (49%) of the 149 AUR cases that occurred in men newly diagnosed with LUTS/BPH. The risk of AUR was 11-fold higher in patients newly diagnosed with LUTS/BPH (RR 11.5; 95%CI: 8.4-15.6) with an overall incidence rate of 18.3/1000 man-years (95%CI: 14.5-22.8). CONCLUSIONS: The incidence rate of AUR is low in the general population but substantial in a population of men newly diagnosed with LUTS/BPH. The incidence rate increases with age and AUR is precipitated in approximately 40% of all cases. Within the LUTS/BPH cohort, AUR is the first presenting symptom of BPH in 50% of all AUR cases.     

Transurethral electrovaporization of the prostate (TUVP) is effective,safe and durable

Transurethral electrovaporization of the prostate (TUVP) is one of the alternative, minimally invasive procedures to treat BPH with promising initial results. We reviewed the available English literature to evaluate the long-term safety, efficacy and durability of TUVP using various vaporizing electrodes. We performed a MEDLINE keyword search and assessed all prospective randomized studies, which compared TUVP to standard transurethral resection of the prostate (TURP) that reached 1 y follow-up. Data were analysed for improvement of IPSS and Q(max), operation time, hospital stay, perioperative bleeding, postoperative irritative symptoms, long-term side effects and reoperation rate. We reviewed a total of 244 TUVP compared to 259 TURP patients in six prospective randomized studies that reached 1 y follow-up. Less perioperative bleeding, shorter catheterization time (mean of TUVP: 30 h vs TURP: 61 h) and shorter hospital stay (mean of 1.4 days vs TURP: 3.4 days) were reported in the TUVP patients. The improvement in IPSS (71%) and mean Q(max) (20 ml/s) was similar in both groups. The reoperation rate was 2% per year in both vaporization and resection patients. In conclusion, analysis of the prospective randomized trials that reached 1 year follow-up revealed that TUVP is as effective as standard TURP in the treatment of BPH. Long-term side effects and reoperation rates are comparable and the initial improvement was maintained over 1 year for the majority of patients.     

Photoselective vaporization of the prostate with GreenLight 120-W laser versus transurethral resection of the prostate for benign prostatic hyperplasia: a systematic review with meta-analysis of randomized controlled trials

The aim of this study is to assess the overall efficacy and safety of photoselective vaporization of the prostate (PVP) with GreenLight 120-W laser versus transurethral resection of the prostate (TURP) for treating patients of benign prostate hyperplasia (BPH) with lower urinary tract symptoms (LUTS). We performed a literature search of The Cochrane Library and the electronic databases, including Embase, Medline, and Web of Science. Manual searches were conducted of the conference proceedings, including European Association of Urology and American Urological Association (2007 to 2012). Outcomes reviewed included clinical baseline characteristics, perioperative data, complications, and postoperative functional results, such as postvoid residual (PVR), international prostate symptom score (IPSS), quality of life (QoL), and maximum flow rate (Q_max). Six randomized controlled trials (RCTs) were enrolled. Three hundred and forty-seven patients undergone 120-W PVP, and 350 patients were treated with TURP in the RCTs. There were no significant differences for clinical characteristics in these trials. In perioperative data, catheterization time and length of hospital stay were shorter in the PVP group. However, the operation time was shorter in the TURP group. Capsular perforation, blood transfusion, clot retention, and macroscopic hematuria were markedly less likely in PVP-treated subjects. The other complications between PVP and TURP did not demonstrate a statistic difference. There were no significant differences in QoL, PVR, IPSS, and Q_max in the 1, 3, 6, 12, and 24 months of postoperative follow-up. There was no significant difference at postoperation follow-up of functional outcomes including IPSS, PVR, Q_max, and QoL between the TURP-treated subjects and PVP-treated subjects. Owing to a shorter catheterization time, reduced hospital duration and less complication, PVP could be used as an alternative and a promising minimal invasive surgical procedure for the treatment of BPH.     

Photoselective laser vaporization of the prostate in the treatment of bladder outlet obstruction in advanced-stage prostate cancer: a single-center experience

Abstract Background and Purpose: The study in China is the first on photoselective vaporization of the prostate (PVP) applied to bladder outlet obstruction (BOO) or urinary retention from advanced-stage prostate cancer (PCa). The aim is to evaluate the efficacy and safety of PVP in the treatment of patients with BOO secondary to advanced-stage PCa. Patients and Methods: Forty-five patients (mean age 76.13±5.88 years, range 62-89 years) with BOO or urinary retention secondary to advanced-stage PCa received PVP with a potassium-titanyl-phosphate laser. The treatment outcome was evaluated with subjective and objective tests at 1, 3, 6, and 12 months after PVP using the International Prostate Symptom Score (IPSS), quality of life (QoL) score, postvoid residual (PVR) urine volume, and maximum urinary flow rate (Qmax). The operative time, indwelling catheterization time, and operative complications were also observed. Results: All 45 patients recovered without incident. The mean operative time was 50±7.6 minutes. The catheterization duration was 3.2 days (range 2-7 days). There was significant improvement in Qmax from 7.29±0.93 to 12.16±2.75?mL/sec after treatment at 12 months. Mean PVR volume decreased from 210.94±179.49 to 54.45±33.16?mL. Mean IPSS score decreased from preoperative 28.19±3.64 to postoperative 14.61±2.81 (P<0.05), QoL score decreased from 5.03±0.69 to 3.66±0.65 (P<0.05). There were no intraoperative adverse events. Postoperative complications included mild transient hematuria in 12 (26.7%) patients and mild dysuria in 11 (24.4%) patients within 4 weeks. Conclusions: The clinical results suggest that PVP is a safe, efficient, and less-invasive treatment for patients with BOO or urinary retention secondary to advanced-stage PCa.