Three-year outcome following holmium laser enucleation of the prostate combined with mechanical morcellation in 330 consecutive patients

OBJECTIVES: A prospective study to assess safety, efficacy, and medium-term durability of holmium laser enucleation of the prostate (HoLEP) combined with mechanical morcellation for the treatment of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE). METHODS: Between January 2000 and July 2003, 330 consecutive patients underwent HoLEP at our institution. All patients were pre-operatively assessed with transrectal ultrasound gland volume evaluation, maximum urinary flow rate (Q(max)), international prostate symptoms score (IPSS), and the single-question quality of life (QoL). Intra-, peri-, and postoperative parameters were evaluated and the patients were reassessed at 1-, 3-, 6-, 12-, 18-, 24-, and 36-mo follow-up with the same examinations. RESULTS: Patients' mean age was 66+/-8.1 yr; prostate volume was 62+/-34 cc. Enucleation time was 45.4+/-22.9 min and morcellation time 17.3+/-14 min, whilst resected weight was 40+/-27.5 g. Catheter time was 23+/-14.7h and hospital stay was 48+/-26 h. Mean serum hemoglobin and sodium did not drop significantly from baseline after the procedure (p=013). A significant improvement occurred in Q(max) (25.1+/-10.7 ml/s), IPSS (0.7+/-1.3), and QoL (0.2+/-0.5) at the 3-yr follow-up compared with baseline (p<0.05). Twenty-eight percent of patients complained of irritative urinary symptoms, typically self-limiting after 3 mo; transient stress incontinence was reported in 7.3% of patients. Nine patients (2.7%) had persistent BOO, requiring reoperation. CONCLUSIONS: HoLEP represents an effective and safe surgical intervention. The relief from BOO also proved to be durable after 3-yr follow-up. The present report adds to the evidence that HoLEP could be the standard "size-independent" surgical treatment for symptomatic BPE-related BOO.     

Transurethral photoselective vaporization versus transvesical open enucleation for prostatic adenomas >80ml: 12-mo results of a randomized prospective study

OBJECTIVES: To compare the effectiveness and the safety of photoselective vaporization of the prostate (PVP) to open prostatectomy (OP) for the surgical treatment of large prostatic adenomas. METHODS: A total of 125 patients with prostate glands >80ml were randomly allocated to PVP (n=65) or OP (n=60) and prospectively evaluated at 1, 3, 6, and 12 mo postoperatively. International Prostate Symptom Score (IPSS) and peak urinary flow rate (Q(max)) were chosen as primary treatment-related end points. RESULTS: The patients who underwent PVP experienced a longer length of operation time, shorter time of catheterization, and shorter hospital stay. Adverse events were minor and of similar profiles in both groups, although patients who underwent OP showed a higher transfusion rate. All functional parameters improved significantly compared to baseline values in both groups. The IPSS did not differ between the two groups at 3, 6, and 12 mo postoperatively. Patients who underwent OP scored better in the IPSS quality of life score at 6 and 12 mo postoperatively. No significant differences between the two groups in the Q(max), postvoid residual urine volume, and International Index for Erectile Function-5 questionnaire were detected. At 3 mo prostate volume was significantly lower in the OP group compared to the PVP group (median value 10ml vs. 50ml; p<0.001) and remained as such throughout follow-up, whereas prostate-specific antigen values reached statistical difference at 6 mo (median value 2ng/ml vs. 2.4ng/ml; p=0.028). CONCLUSIONS: Our results indicate that for a 12-mo period PVP is a highly acceptable treatment alternative to OP.     

Holmium laser enucleation versus transurethral resection of the prostate: 3-year follow-up results of a randomized clinical trial

OBJECTIVES: To report 3-yr follow-up results of a randomised clinical trial comparing holmium laser enucleation of the prostate (HoLEP) with transurethral resection of the prostate (TURP). METHODS: A total of 200 patients with urodynamic obstruction and a prostate volume of less than 100 cc were prospectively randomised and assigned to HoLEP or TURP. All patients were assessed preoperatively and followed at 1, 6, 12, 18, 24, and 36 mo postoperatively. American Urological Association Symptom Score (AUA SS), maximum flow rate (Q(max)), and postvoid residual (PVR) [urine] volume were obtained at each follow-up. Perioperative data and postoperative outcome were compared. All complications were recorded. RESULTS: AUA SS were significantly better 2 yr postoperatively in the HoLEP group (1.7 vs. 3.9, p<0.0001) and similar at 3 yr (2.7 vs. 3.3, p=0.17). PVR volume was significantly better 2 yr (5.6 vs. 19.9 ml, p<0.001) and 3 yr (8.4 vs. 20.2 ml, p=0.012) postoperatively in HoLEP patients. Q(max) was similar in the HoLEP and TURP groups at 2 yr (28.0 vs. 29.1 ml/s, p=0.83) and at 3 yr (29.0 vs. 27.5 ml/s, p=0.41) postoperatively. Late complications consisted of urethral strictures, bladder-neck contractures, and BPH recurrence; reoperation rates were 7.2% in the HoLEP and 6.6% in the TURP group (p=1.0). CONCLUSIONS: After 2 and 3 yr of follow-up, HoLEP micturition outcomes compare favourably with TURP. Late complications are equally low. HoLEP may be a real alternative to TURP.     

Functional outcome following photoselective vaporisation of the prostate (PVP): urodynamic findings within 12 months follow-up

OBJECTIVES: We determined the impact of potassium-titanyl-phosphate (KTP) laser therapy of the prostate on urodynamic results, voiding function, quality of life, and sexual function. DESIGN, SETTING, AND PARTICIPANTS: Forty-five patients complaining of symptomatic benign prostatic hyperplasia (BPH) and urodynamically proven obstructive voiding were included in the prospective study. Follow-up exams were repeated 3 mo and 12 mo after the treatment. INTERVENTION: All patients underwent photoselective 80-Watt KTP laser vaporisation of the prostate performed by two experienced surgeons. MEASUREMENTS: Disease-specific quality of life and sexual function were assessed using the International Prostate Symptom Score (IPSS) and International Inventory of Erectile Function (IIEF). Video-urodynamics were carried out to determine changes in pressure flow and bladder function. RESULTS AND LIMITATIONS: The average preoperative prostate volume was 47.63ml (range 30-75m). The mean preoperative PSA-value, which had been 3.5ng/ml (range 0.13-7ng/ml) initially, dropped by 34.2% after 3 mo and 37.1% after 12 mo. Despite transient micturition complaints (40%), all patients showed significant improvement in the IPSS in urinary peak flow and detrusor pressure at peak flow. The mean post-void residual urine volume decreased, while erectile function and libido scores remained unaffected by the procedure according to the IIEF. Detrusor contractility was also not affected in any of the patients. The single-centre study design and small number of patients may have limited the study results. CONCLUSIONS: KTP laser therapy of the prostate achieves significant improvements both symptomatically as well as with respect to objective micturition parameters. The procedure leads to a functional deobstruction of the lower urinary tract with steady improvement results throughout the follow up period.     

GreenLight laser vaporization of the prostate: single-center experience and long-term results after 500 procedures

BACKGROUND: Long-term data of photoselective vaporization of the prostate (PVP) for treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is scanty. OBJECTIVE: Evaluate the long-term efficacy and the complication rate in 80-watt (W) PVP. DESIGN, SETTING, AND PARTICIPANTS: 500 consecutive patients with LUTS secondary to BPH underwent PVP between September 2002 and April 2007. The mean follow-up was 30.6+/-16.6 (5.2-60.6) mo. INTERVENTION: All patients underwent 80-W PVP performed by seven surgeons. MEASUREMENTS: We evaluated perioperative parameters, including operation time, delivered energy, changes of hemoglobin and serum sodium, catheterization, and hospitalization time as well as intraoperative and postoperative complications. Patients presenting for follow-up had data assessed on the International Prostate Symptom Score and quality-of-life questionnaire (IPPS-QoL), maximal flow rate (Q(max)), and post-voiding residual volume (Vres). RESULTS AND LIMITATIONS: Mean patient age was 71.4+/-9.6 (46-96) yr, with a mean preoperative prostate volume of 56.1+/-25.3 (10-180) ml. Mean operation time was 66.4+/-26.8 (10-160) min, and mean energy delivery was 206+/-94 (2.4-619.0) kJ. Despite ongoing oral anticoagulation in 45% of the patients (n=225), no severe intraoperative complications were observed. Mean catheterization and postoperative hospitalization time was 1.8+/-1.2 (0-10) and 3.7+/-2.9 (0-35) d, respectively. The mean IPSS after 3 yr was 8.0+/-6.2, the QoL score was 1.3+/-1.3, the Q(max) was 18.4+/-8.0ml/s, and the Vres was 28+/-42ml. The retreatment rate was 6.8%. Urethral and bladder neck strictures were observed in 4.4% and 3.6% of the patients, respectively. Localized prostate cancer was diagnosed during follow-up in six patients. CONCLUSION: PVP is a safe and effective procedure for treatment of LUTS secondary to BPH. Patients on ongoing oral anticoagulation can be safely operated on. PVP leads to an immediate and sustained improvement of subjective and objective voiding parameters. The late complication rate is comparable to that of transurethral electroresection of the prostate.     

Technique and short-term outcome of green light laser (KTP, 80W) vaporisation of the prostate

OBJECTIVE: Photoselective laser vaporisation prostatectomy with an 80-W potassium-titanyl-phosphate (KTP) laser is an effective procedure for men with symptomatic benign prostatic hyperplasia. The main advantages of the laser treatment are less blood loss and the short hospital stay. METHODS: The DVD and photos show the main steps and difficulties of the procedure. All patients were evaluated preoperatively and postoperatively by using the International Prostate Symptom Score, volume of prostate, maximum flow rate, haemoglobin values, and postmicturition volume of residual urine. Days of bladder catheterisation, duration of the procedure, and prostate-specific antigen values were determined as well. RESULTS: The results in 140 patients, who underwent KTP laser treatment, were evaluated. The mean age of the patients was 69+/-7.8 yr. Mean volume of prostates, mean operative time, and mean energy delivery were 43+/-22 ml, 53+/-16 min, and 181+/-58 kJ, respectively. The bladder catheter was removed usually on the first postoperative day. Preoperative haemoglobin values were just slightly higher at 14.4+/-1.3g/dl compared to the postoperative values of 13.9+/-1.4 g/dl. The most common complication, dysuria, was seen in 35 patients (25%), followed by mild haematuria in 21 patients (15%). CONCLUSIONS: Photoselective laser vaporisation of the prostate is a treatment option in men who are at high risk for clinically significant bleeding. The procedure provides a high level of intraoperative and postoperative safety and seems to be comparable to transurethral resection of the prostate in the relief of obstructive symptoms.     

980-nm Diode laser: a novel laser technology for vaporization of the prostate

OBJECTIVE: The wavelength 980 nm of a recently introduced diode laser system for treatment of benign prostatic enlargement offers a high simultaneous absorption in water and haemoglobin, and is postulated to combine high tissue ablative properties with a good haemostasis. METHODS: The Ceralas HPD150 diode laser system was evaluated in the well-established ex vivo model of the isolated blood-perfused porcine kidney to evaluate tissue ablation capacity and haemostatic properties at different generator settings. A histological examination of the ablated renal tissue followed. The results were compared with the reference standards transurethral resection of the prostate (TURP) and potassium-titanyl-phosphate (KTP) laser. RESULTS: The diode laser displays a higher tissue ablation capacity, reaching 7.24+/-1.48 g after 10 min, compared with the KTP laser (3.99+/-0.48 g; p<0.05), whereas only 30s are needed to resect the tissue in the same surface area using TURP, resulting in 8.28+/-0.38 g of tissue removal. With a bleeding rate of 0.14+/-0.07 g/min, the diode laser offers haemostatic properties equivalent to the KTP laser (0.21+/-0.07 g/min) and a significantly reduced bleeding compared with TURP (20.14+/-2.03 g/min; p<0.05). The corresponding depths of the coagulation zones are 290.1+/-46.9 microm for the diode laser, 666.9+/-64.0 microm for the KTP laser (p<0.05), and 287.1+/-27.5 microm for TURP. CONCLUSIONS: In the standardised ex vivo investigation, the 980-nm diode laser offers a higher tissue ablation capacity and similar haemostasis compared with the KTP laser. In comparison with TURP, both tissue ablation and bleeding are significantly reduced. The promising ex vivo results warrant further clinical investigation.     

Intraprostatic botulinum toxin type a injection in patients unfit for surgery presenting with refractory urinary retention and benign prostatic enlargement. Effect on prostate volume and micturition resumption

OBJECTIVES: To evaluate the effect of intraprostatic injection of botulinum toxin A (BoNTA) on prostate volume and refractory urinary retention in patients with benign prostatic enlargement. METHODS: Twenty-one men with benign prostatic enlargement on chronic indwelling catheter for at least 3 mo who were not candidates for surgery because of poor general condition received 200 U BoNTA in the transition zone by transrectal approach under ultrasound guidance. Patients were reevaluated at 1 and 3 mo posttreatment. RESULTS: Patients had a mean age of 80+/-2 yr. Injections were done without anaesthetic support as an outpatient procedure. No significant local effects occurred. Baseline prostate volume of 70+/-10 ml decreased to 57+/-10 ml (p<0.0006) at 1 mo and to 47+/-7 ml (p=0.03 against 1 mo) at 3 mo. At 1 mo, 16 patients (76%) could resume voiding with a mean Qmax of 9.0+/-1.2 ml/s. At 3 mo, 17 patients (81%) voided with a mean Qmax of 10.3+/-1.4 ml/s. Residual urine was 80+/-19 ml and 92+/-24 ml at the two time points, respectively. Mean serum total PSA decreased from 6.0+/-1.1 ng/ml at baseline to 5.0+/-0.9 ng/ml at 3 mo (p=0.04). CONCLUSIONS: BoNTA injection into the prostate swiftly reduces prostate volume and may be a promising treatment for refractory urinary retention in patients with benign prostatic enlargement who are unfit for surgery. Future studies will determine the duration of BoNTA effect.     

Plasma Vaporisation of the Prostate: Initial Clinical Results

Background

Laser vaporisation of the prostate has had a considerable impact in recent years. In an attempt to achieve tissue vaporisation with bipolar high-frequency generators, plasma vaporisation was recently introduced.

Objective

To provide the first clinical information on bipolar plasma vaporisation of the prostate for patients with lower urinary tract symptoms (LUTS) due to bladder outlet obstruction (BOO).

Design, setting, and participants

Thirty patients were included in this prospective bicentre study.

Intervention

All patients underwent bipolar plasma vaporisation with a novel electrode (Olympus Winter & Ibe GmbH, Hamburg, Germany).

Measurements

International Prostate Symptom Score (IPSS), bother score, maximum flow rate (Q_max), and postvoid residual were evaluated at baseline and at the time of discharge as well as at 1, 3, and 6 mo after the intervention.

Results and limitations

Mean preoperative prostate volume was 59 ± 32 ml (range: 30–170), and mean operating time was 61 ± 26 min (range: 20–140). Besides one reoperation (conventional transurethral prostatectomy) due to persistent obstruction, no major complication occurred intra- or postoperatively and no blood transfusion was required. Catheterisation time averaged 41 ± 35 h (range: 18–192). Transient mild to moderate dysuria was noted in four patients (13%). At 1, 3, and 6 mo, Q_max increased from 6.6 ± 2.7 ml/s preoperative to 17.3 ± 4.7 ml/s (p < 0.01), 18.5 ± 4.6 ml/s (p < 0.01), and 18.1 ± 5.0 ml/s (p < 0.01), respectively. The IPSS decreased from 20.8 ± 3.6 to 10.4 ± 3.5 (p < 0.01), 8.2 ± 2.9 (p < 0.01), and 8.1 ± 3.1 (p < 0.01), respectively. These data represent a small nonrandomised study cohort with limited follow-up.

Conclusions

Our initial experience indicates that bipolar plasma vaporisation might be a safe and effective treatment option for patients with LUTS due to BOO. To define the potential role of this novel technique, randomised trials with longer follow-up are mandatory.     

良性前列腺增生患者膀胱内前列腺突人程度的超声测定

目的 探讨良性前列腺增生(BPH)患者膀胱内前列腺突入程度(IPP)测定对膀胱出口梗阻及膀胱功能的预测与评价. 方法 BPH患者206例,年龄55～84岁,均为首次就诊,有不同程度的尿频、尿急等下尿路症状.行经腹B超测定IPP并根据程度分2组:研究组78例(IPP>10mm)和对照组128例(IPP≤10 mm),分析2组患者临床资料及尿动力学检查结果 间的关系. 结果 研究组和对照组前列腺体积[(73.7±35.9)、(62.8±36.5)ml]、前列腺特异性抗原[(1.81±0.67)、(1.64±0.36)ng/ml]、残余尿量[(290.2±217.2)、(228.2±167.9)ml]、急性尿潴留发生率(33.3%、18.0%)及膀胱小梁化发生率(23.1%、11.7%)比较差异均有统计学意义(P<0.05).IPP与前列腺体积、残余尿量呈正相关(r分别为0.401,0.342).2组患者排尿期最大尿流率[(7.6±4.1)、(9.1±3.6)ml/s]、膀胱过度活动症发生率(82.1%,17.2%)、膀胱顺应性降低率(35.9%,12.5%)、最大逼尿肌压力[(109.8±84.9)、(84.9±44.1)cm H2O,1 cm H2O=0.098 kPa]及膀胱出口梗阻指数(75.2±27.1、65.9±34.6)比较差异均有统计学意义(P<0.05); IPP与最大尿流率呈负相关(r=-0.284),与最大逼尿肌压力及膀胱出口梗阻指数呈正相关(r分别为0.252,0.456).经保守治疗后,2组患者急性尿潴留复发率分别为64.3%(9/14)和23.5%(4/17)(P<0.05). 结论 IPP可以作为初步预测及评价膀胱出口梗阻程度和膀胱功能的指标之一;前列腺突入膀胱的BPH患者膀胱出口梗阻及膀胱功能受损程度明显高于无突入患者,对于前列腺突入膀胱的BPH患者.尤其是合并急性尿潴留患者应及早采取外科手术治疗.     

Eraser Laser Enucleation of the Prostate: Technique and Results

Background

Eraser, a 1318-nm diode laser, has been used for 15 yr for resection of lung metastases. It was recently introduced in urology for small kidney tumors and for the treatment of benign prostatic obstruction.

Objective

To demonstrate on video our technique of Eraser laser enucleation of the prostate (ELEP) and report our experience.

Design, setting, and participants

From June 2010 to October 2011, 43 consecutive patients were prospectively evaluated. All of them had lower urinary tract symptoms suggestive of benign prostatic obstruction and a mean prostate size of 59.9 ml (range: 34–89 ml) on transrectal ultrasound. Their mean prostate-specific antigen value was 3.4 ng/ml (range: 0.8–5.0 ng/ml); mean maximum flow rate (Q_max), 6.9 ml/s (range: 2–11 ml/s); mean International Prostate Symptom Score (IPSS), 25.9 (range: 18–32); and mean postvoid residual (PVR), 170.5 ml (range: 60–330 ml).

Surgical procedure

The details of the technique are shown on video.

Outcome measurements and statistical analysis

Success was defined as patients being able to void with improved IPSS, Q_max, PVR volume, and ameliorated quality of life.

Results and limitations

The mean operating time was 67.0 ± 11.43 min. Mean serum hemoglobin was 15.1 ± 0.87 g/l before, and 14.39 ± 0.94 g/l after surgery. Mean blood loss was 115.90 ± 98.12 ml. No blood transfusions were required. All patients had their catheters removed within 2 d and were able to void spontaneously after this time. Significant improvements were noted in Q_max, quality of life, IPSS, and PVR volume from baseline to each follow-up time point.Based on the validated Clavien-Dindo system, we observed one grade 1d complication, one grade 2 complication, and one grade 3b complication.

Conclusions

ELEP is a safe and reproducible method for relieving bladder outflow obstruction and lower urinary tract symptoms. Its advantages include minimal blood loss, short catheterization time, and a brief hospital stay.     

1470nm激光治疗75岁以上良性前列腺增生患者的短期随访

目的 报告75岁以上患者经尿道1470 nm激光前列腺剜除术后的随访结果。方法 本课题采用前瞻性研究方法,选择2017年5月至2019年4月期间在我院接受经尿道1470 nm激光前列腺剜除术的62例患者作为研究对象,记录国际前列腺症状评分（IPSS）、尿流量（Qmax）、残余尿（PVR）、生活质量指数评分（QOL）在术后1年内的变化,包括PVR>150 mL以及前列腺体积>50 mL的特殊患者的术后情况。结果 在所有62例患者中,58（93.5%）6个月内症状明显缓解,平均IPSS和QOL评分显著下降,并在整个随访期内保持不变;平均PVR从术前的近150 mL下降到32 mL（6个月）和30 mL（12个月）,平均Qmax从11.2 mL/s增加到1个月时的峰值14.1 mL/sL,12个月时达到14.2 mL/s,其中,PVR>150 mL以及前列腺体积>50 mL的患者的上述各项参数与总体间差异没有统计学意义（P>0.05）。结论 1470 nm激光前列腺剜除术明显改善了前列腺增生患者的下尿路症状和生活质量,前列腺体积和术前残余尿量不影响手术效果。     

980nm半导体红激光汽化术在良性前列腺增生治疗中的应用

目的:探讨980 nm半导体红激光汽化术治疗良性前列腺增生(BPH)的安全性和疗效。方法:应用980 nm半导体红激光对92例BPH患者行激光汽化切除术。患者年龄65～89岁,平均前列腺体积为(50.1±13.0)ml,观察记录手术时间、出血量、手术并发症,记录并统计分析手术前后国际前列腺症状评分(IPSS)、生活质量评分(QOL)、最大尿流率(Qmax)及残余尿量(PVR)等指标的差异有无统计学意义。结果:手术全部成功,手术时间平均(70.2±16.9)min,术中无明显出血,无输血病例。患者术后留置尿管2～5 d,平均留置尿管时间(2.4±0.3)d,IPSS术后1个月为(8.7±2.0)分,3个月为(7.7±1.1)分,明显低于术前[(17.9±3.7)分,P<0.01],Qmax及PVR明显好于术前(P<0.01),无患者出现尿失禁及明显的膀胱刺激征。结论:980 nm半导体红激光汽化切除术治疗BPH是安全有效的。     

1470nm半导体激光经尿道前列腺汽化术治疗BPH的疗效观察

目的:探讨1 470nm半导体激光经尿道前列腺汽化术治疗BPH的疗效和安全性。方法:应用1470nm半导体激光对46例BPH患者进行激光汽化切除术。患者年龄62~86岁,平均前列腺体积为(56.2±12.1)ml。同时观察记录手术时间、术中出血量、手术并发症及手术前后IPSS、生活质量评分(QOL)、最大尿流率(Qmax)及剩余尿量(PVR)等指标,评估其差异有无统计学意义。结果:本组手术全部成功,手术时间平均(75.6±14.8)min,术中无明显出血,无输血病例。术后导尿管留置时间2~4d,平均留置尿管时间(2.5±0.4)d;IPSS术后1个月为(8.8±2.2)分,3个月为(7.6±1.2)分,明显低于术前[(18.5±3.6)分,P0.01],Qmax及PVR明显好于术前(P0.01)。所有患者均未出现尿失禁及明显的膀胱刺激症状。结论:1 470nm半导体激光汽化术治疗BPH效果肯定,值得临床推广。     

TUVP与TURP联合应用治疗良性前列腺增生

目的 :探讨治疗良性前列腺增生 (BPH)的有效方法。　方法 :联合应用经尿道前列腺电汽化术 (TUVP)与经尿道前列腺电切术 (TURP)治疗BPH 179例病人。　结果 :179例病人住院时间 6～ 12d ,平均 5 .5d。术后随访 6～ 36个月。国际前列腺症状评分 (IPSS)由术前的 2 9.0分下降到 7.6分 (P <0 .0 5 ) ;最大尿流率 (Qmax)从术前的 5 .81ml/s上升到 14 .8ml/s(P <0 .0 5 )。　结论 :联合应用TUVP与TURP治疗BPH是安全、有效的方法。     

Complications of laser enucleation of the prostate: Results at two institutions

ObjectiveBenign prostate hyperplasia (BPH) is a common disease with bothersome symptoms. Conventional transurethral resection of prostate is the gold standard surgical treatment. Recently, various laser enucleation techniques of the prostate for BPH have been adopted worldwide. We report perioperative and postoperative complications with the modified Clavien classification system at two institutions.Materials and methodsWe performed a retrospective analysis through chart review among patients who had undergone laser enucleation of the prostate for BPH in two tertiary referral centers between January, 2009 and December, 2012. The primary outcome was peri- and postoperative complications, whereas secondary outcome was duration of hospital stay and catheterization. The mean age of 271 patients was 72.1 years (range, 51–93 years). Their mean prostate volume was 62.8 mL (range, 22–270 mL). Fifty-seven (21%) patients had prostate volume > 80 mL. There were 101 patients and 169 patients in the diode and thulium groups, respectively.ResultsNo patients had Grade 5 complications. There were Grade 4a complications in three (1.1%) patients, Grade 3a in 22 (8.1%) patients, Grade 2 in nine (3.3%) patients, and Grade 1 in 62 (22.9%) patients. The prostate volume > 80 mL was not significantly related to higher complication rate (p = 0.456). The average duration of hospital stay and catheterization were 3.05 ± 0.75 days and 2.25 ± 1.29 days. Four patients (1.5%) needed secondary resection for residual prostate tissue. The complication rate of acute urine retention (AUR; p = 0.285), urethral stricture (p = 0.996), minor (p = 0.430), major (p = 0.371), or all complications (p = 0.105) was not statistically different between diode and thulium groups.ConclusionLaser enucleation of the prostate was a safe treatment with low significant complication rate, even for large-volume prostates. The complication rates between diode and thulium lasers were not significantly different. The reoperation rate of laser enucleation was very low but patients with extremely large prostate volume may have higher risk.     

接触与非接触式激光经尿道前列腺切除术(附51例报告)

为探讨并发症少、死亡率低的治疗前列腺增生症（BPH）的更有效方法，采用接触与非接触式激光联合治疗BPH51例。术中先以接触式激光将5、7点间腺体切除，再以非接触式侧射探头高功率（60W）照射树叶腺体致组织塌陷，扩大排尿通道。11例腺体较大、组织炭化重者加用经尿道前列腺切除术（TURP）。结果51例中，48例成功，3例因腺体≥80ml改行开放手术。术后随访1～12个月，平均6.6个月，平均最大尿流率17．2±4．4ml／s，IPSS平均递减8.5分。认为接触与非接触式激光联合经尿道前列腺切除术安全有效，适用于具有前列腺增生梗阻、刺激症状重的高危患者，腺体较大及中叶凸向膀胱2cm者，单独使用激光效果不佳，可在激光气化、凝固腺体基础上酌加TURP。腺体≥80ml或中叶凸向膀胱＞3cm者，不适宜腔内治疗。     

Ex vivo and in vivo investigations of the novel 1,470 nm diode laser for potential treatment of benign prostatic enlargement

Perioperative haemorrhage is still the major complication of transurethral resection of the prostate (TURP) for benign enlargement of the prostate. Photoselective vaporisation of the prostate (PVP) with the potassium–titanyl–phosphate (KTP) laser has been shown to achieve instant tissue ablation with excellent haemostatic properties. Our aim was to determine the tissue removal capacity, coagulation and haemostatic property of the novel 1,470 nm diode laser, ex vivo and in vivo. We evaluated two prototype diode laser systems at 1,470 nm in an ex vivo, isolated, blood-perfused, porcine kidney model (n = 5; 10 W–50 W) and in an in vivo investigation of beagle prostate (n = 4; 100 W) to assess vaporisation capacities and coagulation properties at different generator settings. The diode laser evaluation was compared with an 80 W KTP laser in the porcine model. After the laser treatment we performed a histological examination to compare the depth of coagulation and vaporisation. The diode laser system (50 W) showed significantly lower (P < 0.0001) capacities for tissue removal than the 80 W KTP laser (0.96 mm ± 0.17 mm and 5.93 mm ± 0.25 mm, respectively, P < 0.0001), while coagulation zones were significantly (P < 0.001) larger in diode laser-treated kidneys (3,39 mm ± 0.93 mm and 1.27 mm ± 0.13 mm, respectively). In vivo, the diode laser displayed rapid ablation of prostatic tissue with no intraoperative haemorrhage. Histological examination revealed coagulation zones of 2.30 mm (±0.26) at 100 W in the diode laser-treated prostates.     

经尿道接触式激光切除前列腺增生106例报告

采用美国ＳＬＴ接触式Ｎｄ：ＹＡＧ激光治疗仪经尿道治疗前列腺增生症１０６例。结果；有效手术时间为５０－１５０ｍｉｎ，平均８５ｍｉｎ，术中均未输血。均于术后６－２４ｈ停止冲洗膀胱，３－７ｄ拔除尿道内气囊导尿管，７－１４ｄ拔除膀胱造瘘管，出院。１０６例中９６例治愈，有效率为９０．５７％。     

Functional outcome after laser vaporisation of the prostate with the KTP laser

BACKGROUND: Treatment for bladder outlet obstruction (BOO) caused by benign prostatic hyperplasia (BPH) impairs the quality of life. The potassium tintanyl phosphate (KTP) vaporisation of the prostate offers promising modalities in treatment of BOO. We prospectively determined the impact of KTP-lasertherapy on voiding function, quality of life and sexual function. PATIENTS AND METHODS: So far a total of n=123 patients complaining of symptomatic BPH were treated with an 80 watt Laser. N= 40 of them agreed to participate in the study and were evaluated prospectively. Preoperative pressure-flow-studies verified significant bladder outlet obstruction in all cases. Disease specific quality of life and sexual function were assessed using the International Prostate Symptom Score (IPSS) and International Inventory of Erectile Function (IIEF). Three months after treatment follow-up video-urodynamics were carried out to determine changements in pressure flow and bladder function. RESULTS: All patients showed significant improvement after a hospital stay of 4,9 days. The maximum flow rate increased from 9,1 ml/sec preoperatively to 20,2 ml/sec and the amount of residual urine decreased from 98 ml preoperatively to 17 ml immediately after removal of the catheter. Urodynamics after the follow up period showed that the maximum urinary flow improved from 9.7 ml/s preoperatively to 17,6 ml/s and the volume of residual urine decreased from a median of 127.5 ml preoperatively to 45 ml postoperatively. The IPSS and IIEF decreased from a median of 20,4 preoperatively to 8,16 and from a median of 14 preoperatively to 12,7 respectively. The pressure-flow study verified the desobstruction and showed a decline in detrusor pressure at maximum flow from 76,66 cm H2O to 33,79 cm H2O. The urethral opening pressure sank from 75.86 cm H2O preoperatively to 37,51 cm H2O postoperatively. CONCLUSION: The potassium tintanyl phosphate (KTP) vaporisation of the prostate is a promising new method in the treatment of benign prostatic hyperplasia as shown by the data. Beside its low perioperative and postoperative morbidity due to a high hemostatic property it offers a good tissue debulking effect.