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Optimising patient outcomes with photoselective vaporization of the prostate (PVP): a review
摘要： Benign prostatic hyperplasia (BPH) is a common pathology causing lower urinary tract symptoms (LUTS) and may significantly impact quality of life. While transurethral resection of the prostate (TURP) remains the gold standard treatment, there are many evolving technologies that are gaining popularity. Photoselective vaporization of the prostate (PVP) is one such therapy which has been shown to be non-inferior to TURP. We aimed to review the literature and discuss factors to optimise patient outcomes in the setting of PVP for BPH. A comprehensive search of the electronic databases, including MEDLINE, Embase, Web of Science and The Cochrane Library was performed on articles published after the year 2000. After exclusion, a total of 38 papers were included for review. The evolution of higher powered device has enabled men with larger prostates and those on oral anticoagulation to undergo safely and successfully PVP. Despite continued oral anticoagulation in patients undergoing PVP, the risk of bleeding may be minimised with 5-Alpha Reductase Inhibitor (5-ARI) therapy however further studies are required. Pre-treatment with 5-ARI’s does not hinder the procedure however more studies are required to demonstrate a reliable benefit. Current data suggests that success and complication rate is largely influenced by the experience of the operator. Post-operative erectile dysfunction is reported in patients with previously normal function following PVP, however those with a degree of erectile dysfunction pre-operatively may see improvement with alleviation of LUTS.
关键词： sexual function,outcomes,urinary function,Benign prostatic hyperplasia (BPH),prostate,photoselective vaporization of the prostate (PVP)
更新于2025-09-19 17:15:36
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Comparison of photoselective green light laser vaporisation versus traditional transurethral resection for benign prostate hyperplasia: an updated systematic review and meta-analysis of randomised controlled trials and prospective studies
摘要： Objective To assess the efficacy and safety of green-light laser photoselective vaporisation of the prostate (PVP) compared with transurethral resection of the prostate (TURP) for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Design Systematic review and meta-analysis, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Data sources PubMed, EMBASE, the Cochrane Library until October 2018. Eligibility criteria Randomised controlled trials and prospective studies comparing the safety and efficacy of PVP versus TURP for LUTS manifesting through BPH. Data extraction and synthesis Perioperative parameters, complications rates and functional outcomes including treatment-related adverse events such as International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), postvoid residual (PVR), quality of life (QoL) and International Index of Erectile Function (IIEF). results 22 publications consisting of 2665 patients were analysed. Pooled analysis revealed PVP is associated with reduced blood loss, transfusion, clot retention, TUR syndrome, capsular perforation, catheterisation time and hospitalisation, but also with a higher reintervention rate and longer intervention duration (all p<0.05). No significant difference in IPSS, Qmax, QoL, PVR or IIEF at 3, 24, 36 or 60 months was identified. There was a significant difference in QoL at 6 months (MD=?0.08; 95% CI ?0.13 to ?0.02; p=0.007), and IPSS (MD = ?0.10; 95% CI ?0.15 to ?0.05; p<0.0001) and Qmax (MD=0.62; 95% CI 0.06 to 1.19; p=0.03) at 12 months, although these differences were not clinically relevant. Conclusion PVP is an effective alternative, holding additional safety benefits. PVP has equivalent long-term IPSS, Qmax, QoL, PVR, IIEF efficacy and fewer complications. The main drawbacks are dysuria and reintervention, although both can be managed with non-invasive techniques. The additional shortcoming is that PVP does not acquire histological tissue examination which removes an opportunity to identify prostate cancer.
关键词： PVP,transurethral resection of the prostate,benign prostatic hyperplasia,photoselective vaporization of the prostate,BPH,green-light laser,vaporization,TURP
更新于2025-09-19 17:13:59
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Holmium laser enucleation of the prostate: Problem-based evolution of the technique
摘要： Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive and size-independent treatment for benign prostatic hyperplasia with excellent long-term surgical outcome. Considered difficult to learn, different modifications of the technique have been proposed in the last 21 years to overcome the most common problems encountered during this procedure. We present a step-by-step technique including the reasons and advantages of each modification we have progressively adopted until we evolved into our totally en-bloc no-touch low-power HoLEP.
关键词： holmium laser,EEP,Enucleation,HoLEP,benign prostatic hyperplasia
更新于2025-09-19 17:13:59
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Is Greenlight laser photoselective vaporization of the prostate a safe technique? Results from a wide monocentric series complications analysis, with a focus on postoperative fever and sepsis
摘要： GreenLight laser Photoselective Vaporization of the Prostate (PVP) is an effective surgical treatment for Benign Prostatic Hyperplasia (BPH). Moreover, its high coagulative power makes GreenLight reliable in high-risk patients (pts). Despite this, post-operative complications still represent a source of concern when surgery is performed in the most fragile pts. The aim of our study was to retrospectively review a large cohort of pts underwent GreenLight PVP and perform a complications analysis, with a focus on post-operative fever and sepsis.
关键词： sepsis,Benign Prostatic Hyperplasia,postoperative complications,Photoselective Vaporization of the Prostate,GreenLight laser,fever
更新于2025-09-19 17:13:59
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Endoscopic Diagnosis and Treatment in Prostate Pathology || Laser Treatment for Benign Prostatic Hyperplasia
摘要： The word “LASER” is an acronym for “light amplification by stimulated emission of radiation.” Laser is one of the most important scientific discoveries of the last half of the twentieth century, often compared in importance with the discovery of electricity. Shortly after it was discovered, its applications in industry and especially in medicine increased continuously, contributing to many modern methods of diagnosis and treatment. The progress recorded over the last few years (the emergence of new types of lasers and optical fibers) has transformed laser into one of the ideal sources of energy used in medicine. The development of endoscopic instruments and the possibility of using laser fibers with very small diameters have significantly and positively influenced its use in urology, more than in any other medical specialty.
关键词： Er:YAG,Laser,Diode,Nd:YAG,Urology,Benign Prostatic Hyperplasia,Thulium,Ho:YAG,KTP
更新于2025-09-16 10:30:52
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Efficacy and safety of 1470-nm Diode Laser Enucleation of the Prostate in Individuals with Benign Prostatic Hyperplasia Continuously Administered Oral Anticoagulants or Antiplatelet Drugs
摘要： Objective: To evaluate the efficacy and safety of 1470-nm Diode Laser Enucleation of the Prostate (DiLEP) in patients with benign prostatic hyperplasia (BPH) continuously receiving oral anticoagulants or antiplatelet drugs. Methods: From January 2016 to June 2017, 144 patients were submitted to 1470-nm DiLEP, including forty-nine (34.0%) continuously administered anticoagulants or antiplatelet drugs per os due to cardiac and/or cerebrovascular diseases (Group A), while ninety-five (66.0%) were not (Group B). Evaluation was performed preoperatively, and at postoperative 3, 6, and 12 months, respectively. Patient baseline features, operative data, perioperative complications and postsurgical outcomes were assessed. Results: Both groups had comparable preoperative parameters, except age (77.3±7.5 vs 73.2±8.8 years, P=0.007). Meanwhile, surgical time, sodium decrease, catheterization duration and hospital stay markedly differed between the two groups. In comparison with group B, group A patients had statistically higher blood loss (14.9±7.3 g/L vs 10.2±7.0 g/L, P<0.001) and increased bladder irrigation time (21.1±10.9h vs 16.1±9.0h, P=0.004). One case required blood transfusion in group A, because of moderate anemia preoperatively. Both groups showed similar blood transfusion and complication rates. IPSS, QoL score, Qmax and PVR were markedly improved in both groups at 3, 6, and 12-months follow-up postoperatively compared with baseline values. However, no statistically significant differences were observed between the two groups in various assessment parameters at follow-up (P>0.05). Conclusions: These findings demonstrated that 1470-nm DiLEP is efficient and safe in BPH cases receiving continuous oral anticoagulant or antiplatelet drugs. Anticoagulation therapy did not significantly influence the results and complication rates.
关键词： anticoagulation,1470-nm diode laser,laser surgery,benign prostatic hyperplasia
更新于2025-09-16 10:30:52
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Mind the Gaps: Adoption and Underutilization of Holmium Laser Enucleation of the Prostate (HoLEP) in the United States from 2008-2014
摘要： There is increasing recognition of the advantages of Holmium Laser Enucleation of the Prostate (HoLEP) for Benign Prostatic Hypertrophy (BPH) treatment In the United States (U.S.) but relatively little is known about the extent of HoLEP adoption over time. This study aims to assess national HoLEP adoption rates and regional trends from 2008‐2014. Methods: We retrospectively analyzed a dataset of 100% Medicare claims to determine the rate of U.S. HoLEP adoption in 2008, 2011 and 2014. Rates were adjusted by age and race and stratified by Hospital Referral Region (HRR). Linear and logistic regression models were used to assess for trends in HoLEP adoption over time. Results: Total U.S. BPH cases decreased 24% from 2008‐2014 and HoLEP cases increased significantly from 1086 (2008) to 3368 (2014). Despite this, HoLEP accounted for just 4% of total BPH cases in 2014. In 2008 28/306 (9%) of HRRs recorded >10 HoLEPs/year. This increased to 89 HRRs (29%) in 2011 but stabilized at 94 HRRs (31%) in 2014. In 2014, over 50% of states still had only 0‐1 sites doing 10+ HoLEPs/year. Conclusions: Based on this 100% sample of Medicare claims from 2008‐2014, surgical BPH treatment volume has decreased while HoLEP volume and regional adoption have tripled. However, rates of HoLEP remain extremely low at just 4% of all BPH procedures in 2014 and large regional gaps in care exist. This data indicates that HoLEP remains substantially under‐ utilized and the majority of regions still lack access to centers performing >10 HoLEPs/year.
关键词： lasers/supply & distribution,transurethral resection of prostate/trends,benign prostatic hyperplasia,prostatic hyperplasia/surgery
更新于2025-09-12 10:27:22
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Current surgical techniques of enucleation in holmium laser enucleation of the prostate
摘要： Holmium laser enucleation of the prostate (HoLEP) has been accepted as the most efficient method of transurethral surgery for benign prostatic hyperplasia. The originally developed three-lobe technique has popularized this surgery; this method is based on three longitudinal incisions, by which the median lobe is removed, and subsequently, both lateral lobes are enucleated. To maintain a consistent surgical plane and to minimize sphincteric damage, the traditional three-lobe technique is continuously being refined and evolving. A few modifications of the original technique have been developed, and several en bloc enucleation methods have been introduced. However, more clinical evidence is required to show the superiority of newer techniques over the original three-lobe technique in terms of efficacy and long-term side effects. To date, none of the newer techniques have been accepted as a standard technique for HoLEP.
关键词： Enucleation,Laser therapy,Prostatic hyperplasia,Transurethral resection of prostate,Holmium
更新于2025-09-12 10:27:22
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Transperineal laser ablation for percutaneous treatment of benign prostatic hyperplasia: a feasibility study. Results at 6 and 12 months from a retrospective multi-centric study
摘要： Purpose To investigate the effectiveness and safety of SoracteLite?—transperineal percutaneous laser ablation (TPLA) in the treatment of patients with symptomatic benign prostatic hyperplasia (BPH) at 6 and 12 months follow-up. Methods Patients with urinary symptoms secondary to BPH underwent TPLA under local anesthesia in four centers. Under US guidance, up to four 21G applicators were inserted in the prostatic tissue. Each treatment was performed with diode laser operating at 1064 nm changing the illumination time according to prostate size. The primary end-points of this study were change in IPSS, PVR, Qmax, QoL, and prostatic volume at 6 an 12 months from SoracteLiteTM TPLA treatment. Secondary end-point was the assessment of complications. Results Analysis was performed on data 160 patients (mean age 69.8 ± 9.6 years) with at least 6 months follow and of 83 patients (mean age 67.9 ± 8.7 years) with at least 12 months follow-up. At 6 months, IPSS improved from 22.5 ± 5.1 to 7.7 ± 3.3 (P < 0.001), PVR from 89.5 ± 84.6 to 27.2 ± 44.5 ml (P < 0.001), Qmax from 8.0 ± 3.8 to 14.3 ± 3.9 ml/s (P < 0.001), QoL from 4.5 ± 1.1 to 1.8 ± 1.0 (P < 0.001), volume from 75.0 ± 32.4 to 60.3 ± 24.5 ml (P < 0.001). At 12 months, IPSS improved from 22.5 ± 4.5 to 7.0 ± 2.9 (P < 0.001), PVR from 71.7 ± 93.9 to 17.8 ± 51.0 ml (P < 0.001), Qmax from 8.6 ± 5.2 to 15.0 ± 4.0 ml/s (P < 0.001), QoL from 4.2 ± 0.6 to 1.6 ± 0.9 (P < 0.001), volume from 87.9 ± 31.6 to 58.8 ± 22.9 ml (P < 0.001). 7/160 (4.3%) grade I and 1/160 (0.6%) grade III complication occurred. Conclusions SoracteLite? TPLA allows signi?cant improvement of IPSS, Qol, Qmax, PVR, and reduction of prostatic volume at 6 and 12 months.
关键词： Minimally invasive therapy,Benign prostatic hyperplasia,Laser ablation,Transperineal laser ablation,Prostate treatment
更新于2025-09-12 10:27:22
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Comparison Between 1-Day and Inpatient Procedure of Holmium Laser Enucleation in Patients With Benign Prostate Hyperplasia
摘要： Holmium laser enucleation of the prostate (HoLEP) is one of the minimally invasive procedures that is used for patients with benign prostate hyperplasia. The procedure usually requires patients to stay in the hospital 2 nights or longer. The present study evaluated the safety and feasibility of HoLEP with discharge of the patients on Day 1 after surgery (1-day surgery). A total of 1,164 patients were included in the study, with 510 of them planned for 1-day surgery and others planned for inpatient surgery. The primary outcomes included complication rate and clinical outcomes. A total 489 out of 510 patients received 1-day HoLEP and were discharged on Day 1 after surgery. In a 30-day follow-up period, no significant differences were found between the 1-day and inpatient surgery groups in terms of the rate of complications and clinical outcomes. Patients in the 1-day surgery group had a significantly shorter waiting time for admission (9.5 ± 4.8 vs. 17.6 ± 7.4 days, p < .05), and the mean hospitalization cost was lower (CNY$ 9140.6 ± 1452.2 vs. 10533.4 ± 1594, p < .05).The 1-day HoLEP surgery was safe and had satisfactory clinical outcomes. This treatment strategy could reduce the waiting time for admission and cost of hospitalization. Majority of the patients found this 1-day surgery beneficial, especially elderly patients who prefer to have an early return home and rapid resumption of activities.
关键词： holmium laser enucleation of the prostate,benign prostate hyperplasia,lower urinary tract symptoms,1-day surgery
更新于2025-09-12 10:27:22