Comparison of 2-microm continuous wave laser vaporesection of the prostate and transurethral resection of the prostate: a prospective nonrandomized trial with 1-year follow-up.
ABSTRACT To compare the safety and efficacy of the 2-microm continuous wave (cw) laser vaporesection of the prostate with transurethral resection of prostate (TURP) in patients with symptomatic benign prostatic hyperplasia (BPH).
In this prospective study, 100 patients with a prostate weight of < 80 g underwent 2-microm cw laser vaporesection (n = 58) or TURP (n = 42). Efficacy follow-up included measurement of International Prostate Symptom Score, quality of life score, maximal urinary flow rate, and postvoid residual volume. Peri- and postoperative complications were also compared.
The mean operative time was slightly longer in the 2-microm laser group, 54.2 +/- 20.8 minutes, than the TURP group 42.0 +/- 10.5 minutes (P <.05). No blood transfusion was needed in the 2-microm laser group. Catheter indwelling time 1.8 +/- 0.3 days vs 3.4 +/- 1.9 days, and hospitalization time 3.2 +/- 1.6 days vs 6.5 +/- 2.4 day were shorter in 2-microm laser group than in TURP group (P <.05). Within the 12-month follow-up, the mean International Prostate Symptom Score improved by 85.4% in the laser group and 81.1% in the TURP group. Mean maximal urinary flow rate increased 229.2% for the laser group and with a similar increase of 218% for the TURP group (P >.05); however, perioperative morbidity was less in the 2-microm laser group.
The 2-microm cw laser vaporesection is a novel technology with favorable perioperative safety as well as the same therapeutic effect as TURP, and has the advantage of significantly less blood loss, shorter hospitalization, and shorter catheter indwelling time.
- Asian Journal of Andrology 04/2008; 10(2):341-2. · 2.14 Impact Factor
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ABSTRACT: To evaluate the intermediate-term clinical efficacy and the rate of complications in 80 W photoselective vaporization of the prostate (PVP) with the potassium-titanyl-phosphate laser (Greenlight, (AMS, Minnetonka, MN, USA) compared with transurethral resection of the prostate (TURP) in a prospective non-randomised two-centre study. From December 2003 to August 2006, 396 patients (PVP 269, TURP 127) with lower urinary tract symptoms secondary to benign prostatic hyperplasia were included in the study. There was a significant difference in mean age (72 years for PVP vs 68 for TURP, P = 0.001). Patients were therefore stratified in age categories (<70, 70-80, >80 years) and compared for perioperative variables, functional outcome and complications, with a follow-up of up to 24 months. The mean prostate size was greater (overall, 62 vs 48 mL, P < 0.001) and mean operative duration longer (overall 72 vs 53 min; P = 0.001) for PVP in all age categories. The rate of intraoperative bleeding (3% vs 11%), blood transfusions (0% vs 5.5%) and capsule perforations (0.4% vs 6.3%), and early postoperative clot retention (0.4% vs 3.9%) was significantly lower for PVP. Hospitalization time was significantly shorter in the PVP group for patients aged <70 years (3.0 vs 4.7 days) and 70-80 years (4.0 vs 5.0 days; P = 0.001). The improvement of peak urinary flow rate was higher after TURP for any age category. The International Prostate Symptom Score and postvoid residual volume during the follow-up showed no significant difference. After 12 months the overall prostate size reduction was 63% (-30 mL) after TURP and 44% (-27 mL) after PVP. The rate of repeat TURP/PVP was higher in the PVP group (6.7% vs 3.9%, not significant) within the follow-up of up to 2 years. The incidence of urethral and bladder neck strictures was comparable. PVP was more favourable in terms of perioperative safety. Although patients assigned for PVP were older and had larger prostates, PVP resulted in a similar functional outcome. Further follow-up is needed to draw final conclusions about the long-term efficacy of PVP.BJU International 07/2008; 102(10):1432-8; discussion 1438-9. · 3.05 Impact Factor
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ABSTRACT: To provide the first update of the EAU guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic obstruction (BPO). A systematic literature review was conducted based on the results of a MEDLINE search concentrating on the years 1999-2003. In combination with expert opinions recommendations were made on the usefulness of diagnostic tests, therapeutic options and follow-up. During initial assessment the following tests are recommended: medical history, physical examination including digital-rectal examination, International Prostate Symptom Score, urinalysis, serum creatinine and prostate specific antigen measurement, uroflowmetry and post-void residual volume. All other tests are optional or not recommended. Aim of treatment is to improve LUTS and quality of life and to prevent severe BPE-related complications. Development of a 5alpha-reductase type I and II inhibitor and the data of the MTOPS trial providing scientific evidence for a combination therapy were the most significant innovations since the first version. Finally a more detailed knowledge on the natural history with identification of several risk factors for progression is the basis for a risk-profile orientated (preventive) therapy. Updated recommendations for assessment, treatment, and follow-up of patients with LUTS due to BPO are presented.European Urology 12/2004; 46(5):547-54. · 10.48 Impact Factor