In vitro comparison of the vaporesection of human benign prostatic hyperplasia using 70-and 120-W 2μm lasers

The purpose of the current ex vivo study was to compare the speed of vaporesection of human prostatic tissue with benign prostatic hyperplasia （BPH） and the depth of tissue damage using 70- and 120-W 2-tim laser devices. Fresh prostatic tissue specimens were obtained from five patients by open prostatectomy, and were divided into separate groups （70 and 120 W） based on the energy of the laser output （70 and 120 W, respectively）. The vaporesection speed, coagulation zone depth and the necrotic tissue layer in the prostatic tissue were evaluated. The current result showed that the speeds （mean±s.d.） of vaporesection were 5.21±0.66 and 10.39±1.15 g/5 min for the 70 and 120 W groups, respectively （P=0.000）. There was no difference in the depth of necrosis/ coagulation （0.98±0.1310.30±0.09 and 0.99±0.12/0.31±0.08 mm） for the 70 and 120 W groups, respectively. In conclusion, both 70- and 120-W 2μm laser devices had superficial tissue damage during the vaporesection of human prostate tissue; moreover, the 120-W laser offers a higher vaporesection speed than the 70-W laser.

Contemporary review of the 532 nm laser for treatment of benign prostatic hyperplasia

Benign prostatic hyperplasia(BPH)is a condition that occurs increasingly with age.The established gold standard treatment for BPH has been the electrocautery-based transurethral resection of the prostate(TURP).TURP,however,is associated with several complications and side effects.Therefore,there is an increasing interest in a number of emerging minimally invasive therapies as alterative treatment options.Laser therapy using the Greenlight laser is a promising alternative to the traditional TURP.Selective absorption by hemoglobin allows rapid,hemostatic vaporization of prostate tissue.Additional advantages include avoidance or minimization of complications such as intraoperative fluid absorption,and bleeding,retrograde ejaculation,impotence,and incontinence,as well as its use in treating high volume BPH.We review the use of the Greenlight laser in the treatment of BPH,when comparing complications and advantages in relation to TURP.

Transurethral prostate enucleation with 2 μm laser in treatment of benign prostatic hyperplasia

Objective To investigate the feasibility and efficacy of transurethral prostate enucleation with 2 μm laser in treatment of benign prostatic hyperplasia ( BPH) . Methods One hundred and seven patients with BPH were treated by transurethral prostate enucleation with 2 μm la-

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

Aim： To explore the feasibility and safety of greenlight photoselective vaporization of the prostate （PVP） on high-risk patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplasia （BPH） and to evaluate their clinical and voiding outcome. Methods： A total of 85 high-risk patients with obstructive BPH underwent PVP with an 80 W potassium-titanyl-phosphate laser, which was delivered through a side-deflecting fiber with a 23 Fr continuous flow cystoscope. Operative time, blood loss, indwelling catheterzation, international prostate symptom score （IPSS）, quality of life score （QoL）, uroflowmetry, postvoid residual urine volume and short-term complication rates were evaluated for all patients. Results： All patients got through the perioperative period safely. The chief advantages of PVP were： short operative time （25.6 ± 7.6 min）, little bleeding loss （56.8 ± 14.3 mL） and short indwelling catheterization （1.6 ± 0.8 d）. The IPSS and QoL decreased from （29.6 ± 5.4） and （5.4 ± 0.6） to （9.5 ± 2.6） and （1.3 ± 0.6）, respectively. The vast majority of patients were satisfied with voiding outcome. The mean maximal urinary flow rate increased to 17.8 mL/s and postvoid residual urine volume decreased to 55.6 mL. These results are significantly different from preoperative data （P 〈 0.05）. No patient required blood transfusion or fluid absorption. There were few complications and very high patient satisfaction after operation. Conclusion： PVP has a short operative time and high tolerance, and is safe, effective and minimally invasive for high-risk patients, therefore it might be considered as a good alternative treatment for high-risk patients with obstructive urinary symptoms as a result of BPH.

Management of urethral strictures and stenosis caused by the endo-urological treatment of benign prostatic hyperplasiad-a single-center experience

Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retrospective observational case series.Methods:One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated.Among them,76 were eligible for this study and underwent reconstructive surgery.Preoperative and postoperative assessments were done with symptom scores,uroflowmetry,ultrasound for post-void residue,and urethrogram.Any intervention during follow-up was classed as a failure.The recurrence and 95%confidence interval for recurrence percentage were calculated.Results:The following five categories of patients were identified:Bulbo-membranous(33[43.4%]),navicular fossa(21[27.6%]),penile/peno-bulbar(8[10.5%]),bladder neck stenosis(6[7.9%]),and multiple locations(8[10.5%]).The average age was 69 years(range:60-84 years).Overall average symptom score,flow rate,and post-void residue changed from 21 to 7,6 mL/s to 19 mL/s,and 210 mL to 20 mL,respectively.The average follow-up was 34 months(range:12-58 months).Overall recurrence and complication rates were 10.5%and 9.2%,respectively.The recurrence in each category was seen in 3,1,2,1,and 1 patient,respectively.Overall 95% confidence interval for recurrence percentage was 4.66-19.69.Conclusion:Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH.The bulbo-membranous strictures need continence preserving approach.Navicular fossa strictures require minimally invasive and cosmetic consideration.Peno-bulbar strictures require judicious use of grafts and flaps.Bladder neck stenosis in this cohort could be treated with endoscopic measures.Multiple locations need treatment based on their sites in single-stage as far as possible.

Predictive Factors for a Successful Day Case Benign Prostatic Hyperplasia Surgery: A Review

Introduction: Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one among the foremost common diseases affecting the aging man with, almost 80% of the lads greater than 70 affected. BPH is caused by unregulated proliferation within the prostate, which may cause physical obstruction of the prostatic urethra and result in anatomic bladder outlet obstruction (BOO). Transurethral resection of the prostate (TURP) has been the historical gold standard up till now to which all endoscopic procedures for benign prostatic hyperplasia (BPH) are compared with a mean hospital stay of three days. This surgery although efficacious has been related with increased morbidity and increased day case failure rates as compared to newer techniques. These shortcomings have prompted the utilization of newer methods like Transurethral enucleation and resection of the prostate (TUERP), Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP). This review will discuss the enucleation techniques, advantages and therefore the predictive factors for a successful day case prostate surgery. Materials and Methods: During this review, we discuss the newer techniques utilized in day case BPH surgery as well as the predictive factors for a successful BPH surgery, both enucleation, benefits and morcellation are covered also. Results: TUERP, ThuLEP and HoLEP have literature supporting the advantages of these techniques, which demonstrates its ability in day case BPH surgeries in specially selected cases with favorable factors and a 61% overall success rate. Conclusion: TUERP, ThuLEP and HoLEP Have proven to show favorable outcomes in day case BPH surgery with urologist’s experience, prostate size, duration of operation, age, use of anticoagulants, morning theatre list and ASA score being the key factors for a successful day case surgery.

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

Aim:To explore the feasibility and safely of greenlight photoselective vaporization of the prostate(PVP)on high-risk patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplasia(BPH)and to evalu- ate their clinical and voiding outcome.Methods:A total of 85 high-risk patients with obstructive BPH underwent PVP with an 80W potassium-titanyl-phosphate laser,which was delivered through a side-deflecting fiber with a 23 Fr continuous flow cystoscope.Operative time,blood loss,indwelling catheterzation,international prostate symptom score(IPSS),quality of life score(QoL),uroflowmetry,postvoid residual urine volume and short-term complication rates were evaluated for all patients.Results:All patients got through the perioperative period safely.The chief advantages of PVP were:short operative time(25.6±7.6min),little bleeding loss(56.8±14.3mL)and short indwelling catheterization(1.6±0.8d).The IPSS and QoL decreased from(29.6±5.4)and(5.4±0.6)to(9.5±2.6)and(1.3± 0.6),respectively.The vast majority of patients were satisfied with voiding outcome.The mean maximal urinary flow rate increased to 17.8 roLls and postvoid residual urine volume decreased to 55.6mL.These results are signifi- cantly different from preoperative data(P<0.05).No patient required blood transfusion or fluid absorption.There were few complications and very high patient satisfaction after operation.Conclusion:PVP has a short operative time and high tolerance,and is safe,effective and minimally invasive for high-risk patients,therefore it might be considered as a good alternative treatment for high-risk patients with obstructive urinary symptoms as a result of BPH.

In Vitro Study on the Vaporization Ratio of 2-μm Laser in Human Prostatic Tissue

In this study, the vaporization ratio of the 2-μm laser in the prostatic tissue with benign prostatic hyperplasia was examined in vitro, to explore a technique to estimate the clearance rate of prostatic tissue during the transurethral vaporesection of the prostate. A total of 9 fresh prostatic tissue specimens were obtained by open surgery and the wet weight of the prostatic tissue were measured immediately after the sample collection. Under the simulated conditions of transurethral vaporesection of the prostate by 2-μm laser, each prostate gland was completely vaporesected into fragments with a diameter of less than 1.0 cm in vitro tissue were collected and measured. Then After the vaporesection, the whole fragments of prostatic the lost weight of prostatic tissue, the weight of the collected prostatic tissue and the ratio of the lost weight of prostatic tissue to the wet weight of the prostate glandular organ specimen were calculated. The correlation between the weight of collected prostatic tissue and the weight of the whole glandular organ was analyzed. All the experimental procedures were carried out by one operator. Wet weight of the prostatic gland specimen and the weight of the harvested prostatic tissues after the procedure were recorded. With respect to the wet weight of prostate gland specimen, the percentage of the weight of collected prostatic tissue was （34.45±1.51） %, and the percentage of the lost weight of prostatic tissue was （65.55±1.51）%. Satisfactory linear relationship was observed between the weight of collected prostatic tissue and the wet weight of prostate gland specimen [y=3.245x=6.475 （t=15.097, P=0.000）]. It is concluded that under the simulated conditions of transurethral vaporesection of the prostate by 2-μm laser, the vaporization ratio of prostatic tissue can be calculated on the basis of the weight of collected prostatic tissue, and thereby the clearance of prostatic tissue during the formal operation by 2-μm laser could be quantitatively determined.

Search trends in the treatment for benign prostatic hyperplasia:A twenty-year analysis

ObjectiveMinimally invasive treatments for benign prostatic hyperplasia (BPH) have seen an increase in usage in recent years. We aimed to determine what types of events may influence patient search habits related to surgical BPH treatments.MethodsGoogle Trends was used to determine the frequency of searches for different minimally invasive and prostatic ablative treatments for BPH in the United States. The procedures including transurethral resection of the prostate (TURP), Aquablation therapy (Aquablation), Greenlight laser therapy (Greenlight), transurethral needle ablation, transurethral microwave thermotherapy, Urolift (prostatic urethral lift [PUL]), Rezum, iTind, holmium laser enucleation of the prostate, simple prostatectomy, and prostatic artery embolization were compared.ResultsFrom January 1, 2004 to February 28, 2023, the number of internet search queries have increased for TURP, PUL, Rezum, prostatic artery embolization, and holmium laser enucleation of the prostate. There has been a slight decrease in searches for Greenlight, transurethral needle ablation, transurethral microwave thermotherapy, iTind, simple prostatectomy, and Aquablation.ConclusionDespite increased searches of alternatives, TURP remains the most searched BPH procedure. Additionally, search habits may be influenced by several factors including government approval, corporate acquisition, and marketing campaigns. It is important for physicians to understand the types of events that may cause patients to inquire about certain treatments for better quality health information and clinical visits.

Development of a high-power blue diode laser for precision vaporization of prostate tissue for the surgical management of benign prostatic hyperplasia

This paper explores the advancement and application of high-power blue diode lasers in treating benign prostatic hyperplasia(BPH).Addressing the challenges posed by existing techniques,the study focuses on optimizing tissue removal methods.Energy platform for BPH should balance a range of factors,such as operative time,patient conditions,urinary functions,complications,durability,accessibility,and cost,all while prioritizing patient care.Blueray Medical's innovation of high-power blue diode laser systems for BPH surgery is explored,with emphasis on achieving a balance among these considerations.By illustrating the biomedical effects of lasers and their interaction with soft tissues,particularly emphasizing the role of photon absorption by biomolecules and proteins in tissue behavior,this study outlines the advantages of the highpower blue diode laser system.The initial laboratory experiments and clinical results consistently align with our theoretical predictions,especially in terms of tissue vaporization efficiency,tissue coagulation,and bleeding control.In conclusion,blue diode lasers hold potential to enhance surgical outcomes for BPH.Their unique properties offer benefits like improved tissue removal rate and reduced thermal damages.Integrating blue laser technology into BPH protocols could lead to shorter hospital stays,cost savings,and expanded patient eligibility,although rigorous clinical studies are needed to fully understand their benefits and limitations.

Two-micron （thulium） laser resection of the prostate- tangerine technique： a new method for BPH treatment

Two-micron （thulium） laser resection of the prostate-tangerine technique （TmLRP-TT） is a transurethral procedure that uses a thulium laser fiber to dissect whole prostatic lobes off the surgical capsule, similar to peeling a tangerine. We recently reported the primary results. Here we introduce this procedure in detail. A 70-W, 2-um （thulium） laser was used in continuous-wave mode. We joined the incision by making a transverse cut from the level of the verumontanum to the bladder neck, making the resection sufficiently deep to reach the surgical capsule, and resected the prostate into small pieces, just like peeling a tangerine. As we resected the prostate, the pieces were vaporized, sufficiently small to be evacuated through the reseetoscope sheath, and the use of the mechanical tissue morcellator was not required. The excellent hemostasis of the thulium laser ensured the safety of TmLRP-TT. No patient required blood transfusion. Saline irrigation was used intraoperatively, and no case of transurethral resection syndrome was observed. The bladder outlet obstruction had clearly resolved after catheter removal in all cases. We designed the tangerine technique and proved it to be the most suitable procedure for the use of thulium laser in the treatment of benign prostatic hyperplasia （BPH）. This procedure, which takes less operative time than standard techniques, is safe and combines efficient cutting and rapid organic vaporization, thereby showing the great superiority of the thulium fiber laser in the treatment of BPH. It has been proven to be as safe and efficient as transurethral resection of the prostate （TURP） during the 1-year follow-up.

Feasibility of en bloc thulium laser enucleation of the prostate in a large case series. Are results enhanced by experience?

Objective:To provide the first large single-operator case series of patients who undergo“en bloc”thulium laser enucleation of the prostate(ThuLEP)and to demonstrate an improvement in enucleation efficacy with experience.Methods:We prospectively evaluated a cohort of patients with symptomatic benign prostatic hyperplasia(BPH)who underwent“en bloc”ThuLEP between May 2015 and November 2017.Association between dependent variables(delivered energy and operating time)and independent variables(adenoma volume and experience)were estimated with regression analysis.The experience was calculated as the time interval between the date of the first operation of the series and the date of the operation being considered.Results:A total of 100 patients were registered for the study.Median operative time was 56.5 min(interquartile range[IQR]:40-85 min).Median enucleation time was 17.4 min(IQR:15-21.5 min).Median enucleation index(enucleation time per adenoma gram)was 0.3 min/g(0.2-0.3 min/g).The overall operative time is not influenced by experience,but we registered a significant trend towards a reduction in the total amount of energy delivered energy normalized per adenoma gram(p=0.0148).Conclusion:We believe that further attention is needed for these new“en bloc”prostatic enucleation techniques,which can facilitate some surgical steps,leading to a widespread use of laser technology for BPH surgical treatment.

Sexual outcome of patients undergoing thulium laser enucleation of the prostate for benign prostatic hyperplasia

Treatment of patients with lower urinary tract symptoms （LUTS） secondary to benign prostatic hyperplasia （BPH） may affect the quality of sexual function and ejaculation. The effect of new surgical procedures, which are currently available to treat BPH, on erection and ejaculation, has been poorly studied. This study aimed to assess the effect of thulium laser enucleation of the prostate （ThuLEP） on sexual function and retrograde ejaculation in patients with LUTS secondary to BPH. We performed a prospective study in 110 consecutive patients who had undergone ThuLEP to analyze changes in sexual function and urinary symptoms. To evaluate changes in erection and ejaculation, and the effect of urinary symptoms on the quality of life （QoL）, five validated questionnaires were used： the ICIQ-MLUTSsex, MSHQ-EjD, International Index of Erectile Function 5, International Prognostic Scoring System （IPSS） questionnaire, and QoL index of the intraclass correlation coefficients. Patients also underwent IPSS and flowmetry to assess the outcome of flow. Patients were evaluated before surgery and 3-6 months after ThuLEP, whereas those with previous abdominal surgery were excluded. The patients＇ mean age was 67.83 years. Postoperative urinary symptoms improved after surgery. No significant differences in erectile function before and after surgery were observed. As compared with other techniques described in the literature, the percentage of patients with conserved ejaculation increased by 52.7% after ThuLEP. ThuLEP positively affects urinary symptoms and their effect on the QoL of patients as assessed by questionnaire scores. While endoscopic management of BPH （e.g. transurethral resection of the prostate） causes retrograde ejaculation in most patients, those who undergo ThuLEP have conserved ejaculation and erectile function.

Transurethral dividing vaporesection for the treatment of large volume benign prostatic hyperplasia using 2 micron continuous wave laser

Background The safety and efficiency of transurethral laser resection of the prostate to treat benign prostatic hyperplasia have been verified. However, this method does still not manage large volume prostates efficiently. To tackle this problem, we have designed a method of ＂transurethral dividing vaporesection of prostate＂ using a 2 micron continuous wave laser. The aim of this study was to evaluate the safety and efficiency of this method in the management of large prostates （〉80 ml）.Methods In this study, 45 cases of benign prostatic hyperplasia with a median prostatic volume of （123.7±26.7） ml （range, 80.2-159.8 ml） were treated by the same surgeon under epidural anesthesia. During the surgery, superapubic catheters were needed, and saline solution was used for irrigation. First, the prostate was divided longitudinally into several parts from the bladder neck to the prostatic apex, and then gradually incised transversely chip by chip. Intraoperative blood transfusion rate, postoperative complications, maximum urinary flow rate, International Prostate Symptom Score and quality of life scores were recorded for statistical analysis using SPSS 16.0 software.Results Intraoperatively, no transurethral resection syndrome was observed, and no blood transfusions were needed.The resected prostatic chips were easily flushed out of the bladder through the resectoscope sheath without the use of a morcellator. Median vaporesection time was （95.0±13.2） minutes （range, 75-120 minutes）, and the median retrieved and removed prostatic tissue were （25.2±5.1） g （range, 15.5-34.7 g） and （75.4±16.4） g （range, 43.8-106.1 g）, respectively. Median catheter time and hospital stay were （3.3±0.9） days （range, 3-5 days） and （4.8±1.8） days （range, 3-9 days）, respectively. After a follow-up of 6 to 12 months, two patients had stress urinary incontinence and three had anterior urethral strictures. Satisfactory improvement was seen in maximum urinary flow rate, International Prostate Symptom Score and quality of life scores.Conclusions This study showed that 2 micron laser vaporesection is a safe treatment for benign prostatic hyperplasia patients with large prostates, and the method of ＂dividing vaporesection＂ may help improve both surgical efficiency and patient outcomes.

Two-micrometer thulium laser resection of the prostate-tangerine technique in benign prostatic hyperplasia patients with previously negative transrectal prostate biopsy

The 2-1μm thulium laser resection of the prostate-tangerine technique （TmLRP-TT） has been introduced as a minimally invasive treatment for benign prostatic hyperplasia （BPH）. This study was undertaken to assess the clinical efficacy and safety of TmLRP-TT for the treatment of BPH patients with previously negative transrectal prostate biopsy. A prospective analysis of 51 patients with previously negative transrectal prostate biopsy who underwent surgical treatment using TmLRP-TT was performed from December 2011 to December 2013. Preoperative status, surgical details, and perioperative complications were recorded. The follow-up outcome was evaluated with subjective and objective tests at I and 6 months. TmLRP-TT was successfully completed in all patients. Mean prostate volume, operative duration, and catheterization time were 93.3 ± 37.9 ml, 69.5 ± 39.5 min, and 6.5 ± 1.3 days, respectively. The mean International Prostate Symptom Score, quality of life score, maximum urinary flow rate, and post-void residual urine volume changed notably at 6-month follow-up （22.5 ± 6.9 vs 6.1 ± 3.2, 4.8 ± 1.3 vs 1.1 ± 0.9, 7.3 ± 4.5 vs 18.9 ± 7.1 ml s^-1, and 148.7 ± 168.7 vs 28.4 ± 17.9 ml）. Two （3.9%） patients required blood transfusion perioperatively, while 3 （5.9%） patients experienced transient hematuria postoperatively, and 2 （3.9%） patients received 3 days recatheterization due to clot retention. TmLRP-TT is a safe and effective minimally invasive technique for patients with previously negative transrectal prostate biopsy during the 6-month follow-up. This promising technology may be a feasible surgical method for previously negative transrectal prostate biopsy in the future.

Efficacy and Safety of 120-W Thulium：Yttrium-Aluminum-Garnet Vapoenucleation of Prostates Compared with Holmium Laser Enucleation of Prostates for Benign Prostatic Hyperplasia

Background： This study compared the efficacy and safety between 120-W thulium：yttrium-aluminum-garnet （Tm：YAG） vapoenucleation of prostates （ThuVEP） and holmium laser enucleation of prostates （HoLEP） for patients with lower urinary tract symptoms （LUTS） due to benign prostatic hyperplasia （BPH）. Methods： A retrospective analysis of 88 consecutive patients with symptomatic BPH was carried out, who underwent either 120-W ThuVEP or HoLEP nonrandomly. Patient demographics and peri-operative and 12-month follow-up data were analyzed with the International Prostate Symptom Score （IPSS）, quality of life （QoL） score, maximum flow rate （Qmax）, postvoid residual urine volume （PVR）＋ and rates of peri-operative and late complications. Results： The patients in each group showed no significant difference in preoperative parameters. Compared with the HoLEP group, patients in the 120-W ThuVEP group required significantly shorter time for laser enucleation （58.3 ± 12.8 min vs. 70.5 ± 22.3 min, P = 0.003）, and resulted in a significant superiority in laser efficiency （resected prostate weight/laser enucleation time） for 120-W Tm：YAG laser compared to holmium：YAG laser （0.69 ± 0.18 vs. 0.61 ± 0.19, P = 0.048）. During 1, 6, and 12 months of follow-ups, the procedures did not demonstrate a significant difference in IPSS, QoL score, Qmax, or PVR （P 〉 0.05）. Mean peri-operative decrease of hemoglobin in the HoLEP group was similar to the ThuVEP group （ 17.1 ± 12.0 g/L vs. 15.2± 10.1 g/L, P = 0.415）. Early and late incidences of complications were low and did not differ significantly between the two groups of 120-W ThuVEP and HoLEP patients （P 〉 0.05）. Conclusions： 120-W ThuVEP and HoLEP are potent, safe and efficient modalities of minimally invasive surgeries for patients with LUTS due to BPH. Compared with HoLEP, 120-W TbuVEP offers advantages of reduction of laser enucleation time and improvement of laser efficiency.

Photoselective vaporization of the prostate in the treatment of benign prostatic hyperplasia

Background The treatment of symptomatic benign prostatic hyperplasia （BPH） remains a challenge for most urologic surgeons. We studied a cumulative cohort of patients with symptomatic benign prostatic hyperplasia （BPH） who underwent photoselective vaporization of the prostate （PVP） and evaluated the efficacy and safety of this procedure. Methods A total of 196 patients with lower urinary tract obstruction symptoms secondary to BPH were treated using laser vaporization of the prostate under sacral canal anesthesia at our institutions. The therapeutic results were assessed using following variables ： the safety and efficacy of sacral anesthesia, blood loss, operative time, indwelling catheterization. Preoperative and perioperative parameters were evaluated in the international prostate symptom score （ IPSS）, quality of life score （ QoL）, maximal urinary flow rate （ Qmax）, post-void residual urine volume （PVR） and the change of sexual function. Patients were also assessed for 3-month follow up. Results PVP was performed successfully for all patients. There were 195 patients under sacral anesthesia and 1 patient under epidural anesthesia. Mean operative time was （45.2±18.5 ） minutes. The mean IPSS decreased from （26.6±3.2 ） to （5.6±1.4） and the QoL score decreased from （5.7±0.4） to （ 1.6±0. 5 ）, respectively （ P 〈 0. 05 ）, while mean Qmax increased from （6.7±2.5 ） ml/s preoperatively to （ 19.6± 2.4 ） ml/s, PVR decreased from 158.4 to 25.8 ml, respectively （ P 〈 0.05）. Average catheterization time was （ 1.8±0. 9） days. There was no significant blood loss or fluid absorption during the period of PVP. Complications consisted of transient dysuria in 3 patients （1.5%）, delayed gross hematuria in 5 patients （2. 5% ）, respectively. Significant improvement in clinical outcomes were noted as early as 3 months after PVP treatment. Conclusions PVP is considered as a high satisfaction rate by complication. Hence, PVP is a novel, safe, effective and minimal symptomatic BPH. patient and a minimal postoperative invasive treatment for patients with symptomatic BPH.

Cost Analysis of Surgical Approaches Performed by Residents for Bladder Outlet Obstruction: Laser versus Loop

Purpose: Few studies have analyzed cost differences between holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP), and none as regards resident training. We compared these costs at a teaching institution with residents from two Boston programs. Methods: We reviewed all patients who underwent TURP (January 2007-August 2010) or HoLEP (April 2008-August 2010) with residents, excluding those with prostate cancer, simultaneous procedures at the same time, or prior urethral procedures. Operative approach was determined following consultation between the senior resident and the attending surgeon. Operative, postoperative, and urologic follow-up costs were captured and analyzed from day of surgery to 6 months post-operatively. Costs were calculated by the Department of Decision Support Services. Results: 38 HoLEP and 23 TURP patients met inclusion criteria. The two groups were comparable with the exception of higher ASA score and anticoagulation use in the HoLEP group. Despite a decreased hospital stay (0.42 vs. 1.25 days), total costs for HoLEP were higher than TURP ($8380.00 vs. $5861.78 p < 0.05) due to higher operative times (123 min vs. 74 min, p < 0.05), resulting in higher operative costs ($6768.14 vs. $3853.35, p < 0.05). Conclusions: HoLEP costs are higher than TURP from longer operative times and higher intraoperative costs, partly due to resident teaching. However, senior residents more often selected HoLEP for medically complex and/or anticoagulated patients. Despite resident inexperience with HoLEP, the complication rate remained low. Higher costs must be weighed against HoLEP benefits, which include less morbidity, shorter hospital stays and faster recovery times.

低功率HoLEP与TUPKEP在老年原发性良性前列腺增生治疗中的近期疗效比较

目的观察低功率(60W)经尿道前列腺钬激光剜除术(HoLEP)与经尿道等离子前列腺剜除术(TUPKEP)在老年原发性良性前列腺增生治疗中的近期疗效。方法回顾性选取2016年3月至2022年12月在太原钢铁(集团)有限公司总医院106例老年原发性良性前列腺增生患者作为研究对象,按照治疗方法不同分为两组,每组各53例。观察组患者采用低功率HoLEP治疗,对照组患者采用TUPKEP治疗。比较两组手术相关指标(手术时间、出血量、膀胱冲洗时间、留置导尿管时间、住院时间),比较两组手术前后尿动力参数[最大尿流率(Qmax)、平均尿流率(Qave)、残余尿量(RUV)、有效膀胱容积(ECBC)]、生活质量(QOL)评分、国际勃起功能问卷-5(IIEF-5)评分、国际前列腺症状(IPSS)评分差异,并比较两组术后性功能情况和并发症发生情况。结果观察组的手术时间、膀胱冲洗时间、留置导尿管时间、住院时间分别为(77.06±8.56)min、(34.77±8.05)h、(48.05±6.96)h、(4.51±1.74)d,均短于对照组[(85.41±12.23)min、(47.45±9.63)h、(57.44±11.63)h、(6.55±2.41)d],出血量为(46.12±10.03)mL,少于对照组[(65.85±12.98)mL],差异均有统计学意义(P<0.05);两组的术中输液量和前列腺切除量比较,差异均无统计学意义(P>0.05)。观察组术后6个月Qmax、Qave、ECBC分别为(21.74±3.03)mL/s、(10.45±2.36)mL/s、(224.74±15.78)mL,均高于对照组[(17.86±2.86)mL/s、(8.47±2.11)mL/s、(197.85±12.66)mL],RUV为(13.36±5.44)mL,低于对照组[(25.86±8.05)mL],差异均有统计学意义(P<0.05)。观察组术后6个月IIEF-5评分为(21.96±3.01)分,高于对照组[(20.18±2.97)分],IPSS评分、QOL评分分别为(6.01±0.87)、(9.14±1.23)分,均低于对照组[(9.14±1.23)、(1.57±0.23)分],差异均有统计学意义(P<0.05)。观察组IIEF-5评分≤7分、逆行性射精发生率及并发症发生率与对照组比较,差异均无统计学意义(P>0.05)。结论低功率HoLEP治疗老年原发性良性前列腺增生的近期疗效优于TUPKEP,术后恢复较快,可改善尿动力参数,减轻症状,提高生活质量。

直出式绿激光剜除结合汽化术治疗大体积良性前列腺增生的疗效及体会

目的探讨直出式绿激光剜除结合汽化术(FFGreenLEVP)治疗大体积良性前列腺增生的安全性及有效性。方法回顾性分析2019年1月至2022年12月南京医科大学第二附属医院收治的52例大体积良性前列腺增生患者的临床资料(试验组),前列腺体积80~120 mL,平均(88.92±8.37)mL,均采取FFGreenLEVP治疗。记录并分析手术时间、术中损失血红蛋白量、术中及术后并发症、术后住院时间、术后膀胱冲洗时间、术前及术后2个月国际前列腺症状评分(IPSS)、生活质量指数(QoL)及最大尿流率(Qmax)。将上述指标与2015年5月至2017年10月收治的31例采用经尿道前列腺切除术(TURP)治疗的大体积良性前列腺增生患者的临床资料(对照组)进行比较。结果所有接受FFGreenLEVP治疗的患者均顺利完成手术。手术时间(83.10±10.67)min。术中损失血红蛋白量(10.41±1.20)g。术后膀胱冲洗时间(1.55±0.63)d。术后有6例出现暂时性尿失禁,其中4例拔管后3 d内基本恢复尿控,2例拔管后1周恢复尿控。术后2个月IPSS及QoL评分均显著低于术前,Qmax显著高于术前,差异具有统计学意义(P<0.01)。术后1个月,1例出现轻度尿道外口狭窄,采用尿道扩张后治愈。有46例随访至今无明显复发。与对照组比较,试验组手术时间、术后冲洗时间更短(P<0.01);两组术后2个月QoL评分、IPSS、Qmax比较,差异无统计学意义(P>0.05)。结论FFGreenLEVP治疗大体积良性前列腺增生患者安全有效,可以同时发挥绿激光切割和汽化的优势。