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ABSTRACT: GreenLight laser vaporisation has been successfully implemented in the treatment of benign prostatic hyperplasia in the last decade. Besides enhancement of the efficacy of the laser through increase of the power output to a maximum of 80 W and eventually 120 W, the encouraging clinical achievements resulted in a growing popularity of the laser system application. Swiss medical centres have been significantly involved in the evaluation of the clinical adoption of this surgical technique. Particularly the low peri- and post-operative morbidity as well as promising short- to medium-term functional results are noteworthy. In the present paper we present major results of the clinical evaluation of the technique. In addition to the important advantages of the technique, especially the virtually bloodless procedure, we also highlight the drawbacks and limitations of laser vaporisation, which possibly might entail adverse clinical effects. The future significance of this technique will thus have to be re-evaluated taking into account the yet unavailable long-term effects.
Der Urologe 07/2008; 47(8):964-8. · 0.50 Impact Factor
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ABSTRACT: Secondary vesicoureteral reflux (SVUR) after renal transplantation may cause recurrent urinary-tract infections (UTI) and loss of renal function. There are only a few reports on the endoscopic treatment of SVUR by transurethral injection therapy. This is the first report of transurethral injection of dextranomer/hyaluronic acid copolymer (Deflux; Q-Med Scandinavia, Uppsala, Sweden) to relieve SVUR after renal transplantation.
Between November 2003 and October 2005, four women were treated for SVUR with transurethral injections of dextranomer/hyaluronic acid copolymer. All patients had deterioration of renal function attributable to SVUR, recurrent UTI, or both. The mean follow-up was 29 months (range 16-38 months).
Initially, SVUR was corrected in all patients. Recurrent SVUR made a second treatment necessary in two patients. Three patients had no signs of SVUR 15, 27, and 36 months after the treatment. Renal function remained stable in these patients, and two were free of UTI. One of the patients who received two Deflux injections developed a filiform stenosis of the distal ureter, which was corrected by ureteropyeloplasty with the native ureter.
Transurethral injection therapy with Deflux is a minimally invasive treatment option for patients with SVUR after renal transplantation. A second treatment seems to be necessary in some cases. Complications such as ureteral obstruction may occur.
Journal of Endourology 12/2007; 21(11):1357-60. · 1.85 Impact Factor
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ABSTRACT: We report about our experiences with photoselective vaporization of the prostate (PVP) in patients with symptomatic benign prostatic hyperplasia (BPH) and total prostate volume larger than 80 cm(3).
The study included 201 patients with BPH: 51 (25.4%) patients had a prostate volume larger than 80 cm(3) and 150 (74.6%) patients had a volume smaller than 80 cm(3) in the preoperative transrectal ultrasound.
The mean operation time for patients with large prostates was 79 min. Neither TUR syndrome nor severe bleeding was observed. In patients with large adenomas peak urinary flow increased by 135, 136, and 132% after 6, 12, and 24 months, respectively. The overall complication rate was comparable in both groups.
PVP is characterized by excellent perioperative safety and significant improvement of voiding parameters. PVP is feasible in patients with large prostates.
Der Urologe 08/2006; 45(7):858-64. · 0.50 Impact Factor
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ABSTRACT: HintergrundWir berichten ber unsere Erfahrungen mit der photoselektiven Vaporisation der Prostata (PVP) bei Patienten mit symptomatischer benigner Prostatahyperplasie (BPH) und Prostataadenomen >80cm3.Patienten und Methode201Patienten mit BPH wurden in die Studie eingeschlossen; 51 (25,4%) Patienten hatten ein Prostatavolumen >80cm3 und 150 (74,6%) Patienten ein Volumen <80cm3 im transrektalen Ultraschall.ErgebnisseDie mittlere Operationszeit bei Patienten mit groen Adenomen war akzeptabel (79min). Es wurden keine transfusionsbedrftigen Blutungen oder TUR-Syndrome beobachtet. Die maximale Harnflussrate verbesserte sich bei Patienten mit groen Adenomen um 135%, 136% und 132% nach 6, 12 und 24Monaten. Die Komplikationsrate war zwischen den beiden Gruppen vergleichbar.SchlussfolgerungDie PVP ist durch eine hohe perioperative Sicherheit und signifikante Verbesserung der Miktionsverhltnisse gekennzeichnet. Fr Patienten mit Prostatavolumina >80cm3 stellt die PVP eine durchfhrbare Therapieoption dar.BackgroundWe report about our experiences with photoselective vaporization of the prostate (PVP) in patients with symptomatic benign prostatic hyperplasia (BPH) and total prostate volume larger than 80cm3.Patients and methodsThe study included 201 patients with BPH: 51 (25.4%) patients had a prostate volume larger than 80cm3 and 150 (74.6%) patients had a volume smaller than 80cm3 in the preoperative transrectal ultrasound.ResultsThe mean operation time for patients with large prostates was 79min. Neither TUR syndrome nor severe bleeding was observed. In patients with large adenomas peak urinary flow increased by 135, 136, and 132% after 6, 12, and 24months, respectively. The overall complication rate was comparable in both groups.ConclusionPVP is characterized by excellent perioperative safety and significant improvement of voiding parameters. PVP is feasible in patients with large prostates.
Der Urologe 06/2006; 45(7):858-864. · 0.50 Impact Factor
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ABSTRACT: Zusammenfassung: Die Greenlight-Laservaporisation hat in den letzten 10 Jahren breiten Einsatz in der Therapie des benignen Prostatasyndroms (BPS) gefunden. Neben der Steigerung der Effektivität des Lasers durch eine Erhöhung der maximalen Leistung auf zunächst 80 W und später 120 W führten auch die guten Ergebnisse der klinischen Evaluationen zu einer zunehmenden Akzeptanz dieses Lasersystems. In der vorliegenden Arbeit werden wesentliche Ergebnisse der klinischen Evaluation der Technik aus den letzten Jahren dargelegt, an denen Schweizer Kliniken maßgeblich beteiligt waren. Hier sind v. a. die geringe peri- und postoperative Morbidität sowie die bisher guten kurz- und mittelfristigen funktionellen Ergebnisse zu nennen. Neben diesen Vorteilen, die v. a. in der nahezu blutungsfreien Durchführung des Eingriffs begründet liegen, werden jedoch ebenso die Nachteile und Limitationen der Laservaporisation beleuchtet, die möglicherweise auch spezifische klinische Nebenwirkungen zur Folge haben. Der zukünftige Stellenwert der Technik wird daher auch vor dem Hintergrund der noch ausstehenden Langzeitdaten weiter evaluiert werden müssen. GreenLight laser vaporisation has been successfully implemented in the treatment of benign prostatic hyperplasia in the last decade. Besides enhancement of the efficacy of the laser through increase of the power output to a maximum of 80 W and eventually 120 W, the encouraging clinical achievements resulted in a growing popularity of the laser system application. Swiss medical centres have been significantly involved in the evaluation of the clinical adoption of this surgical technique. Particularly the low peri- and post-operative morbidity as well as promising short- to medium-term functional results are noteworthy.In the present paper we present major results of the clinical evaluation of the technique. In addition to the important advantages of the technique, especially the virtually bloodless procedure, we also highlight the drawbacks and limitations of laser vaporisation, which possibly might entail adverse clinical effects. The future significance of this technique will thus have to be re-evaluated taking into account the yet unavailable long-term effects.
