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Thulium Laser Vapoenucleation of the Prostate (ThuVEP) in Men at High Cardiovascular Risk and on Antithrombotic Therapy: A Single-Center Experience
摘要： Bleeding is the most common complication of transurethral resection of the prostate and simple open prostatectomy, especially in men on antiplatelet/anticoagulant therapy. The present study aimed to evaluate the safety and effectiveness of thulium laser vapoenucleation of the prostate (ThuVEP) for benign prostatic hyperplasia in patients on chronic antithrombotic medications. Between January 2015 and December 2019, 88 men underwent the procedure under antithrombotic agents in our center. The mean age was 74.7 ± 6.1 years. Median prostate volume was 66.5 mL. Patients on oral anticoagulants were bridged to low-molecular-weight heparin (n = 35). Aspirin (n = 39), clopidogrel (n = 10), and ticlopidine (n = 4) were maintained. Of the patients, 69.3% had an American Society of Anesthesiologists score ≥ 3. Blood loss at 24 h was comparable in all groups. Median catheterization length and postoperative stays were 2 and 3 days respectively. Acute cardiovascular events occurred in 2 patients (2.3%). Of the patients, 4 required prolonged bladder irrigation, 2 required blood transfusions, 1 required a cystoscopy for bleeding control, and 1 required a suprapubic cystostomy for blood clot evacuation. No patients died within 30 days of being discharged. Late complications occurred in 3 (3.8%) patients (1 optical urethrotomy and 1 bladder neck incision for stenosis; 1 acute myocardial infarction). All follow-up visits (1, 6, and 12-month) showed a significant improvement in all urinary parameters compared to baseline. ThuVEP appears to be a feasible surgical option in high-risk patients on antithrombotic regimens, with acceptable postoperative morbidity, good functional outcome, and low incidence of medium-term reoperation rate.
关键词： aging,postoperative complications,intraoperative complications,prostatectomy,laser therapy,platelet aggregation inhibitors,ThuVEP,benign prostatic hyperplasia,anticoagulants
更新于2025-09-23 15:19:57
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GREEN LIGHT PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE: ONE LASER FOR DIFFERENT PROSTATE SIZES
摘要： INTRODUCTION GreenLight laser vaporization of the prostate (PVP) is a safe and effective procedure for Benign Prostatic Hyperplasia. Long term results and advantages of PVP in patients with large and symptomatic prostate are still under evaluation. MATERIALS AND METHODS In a multicenter experience, patients who underwent standard or anatomical PVP were retrospectively reviewed. Patients with follow-up >12 months were divided into two groups based on prostate volume (<100cc vs ≥100cc). Pre- and peri-operative data as well as post-operative results and complications were recorded after 3, 6, 12 months and then annually. RESULTS 1031 patients were eligible, 916 of these had a prostate volume of <100 cc and 115 ≥100 cc. Median follow-up period was 25.0 months (IQR 16.5-35.0) and 16.0 months (IQR 12.0-24.0) in ≥100 and <100 groups, respectively. No difference was found in terms of catheterization time, post-operative stay and post-operative acute urine retention. Patients with prostate ≥100 required longer operative time (75 versus 55 minutes), lasing time (41.7 versus 24.9 minutes), and higher energy used but lower energy density. Patients with prostate ≥100 had a higher incidence of early (50.4 versus 35.7%) and late complications (21.7 versus 12.8%) and early urge/incontinence symptoms (40.9 versus 29.3%). No statistically significant differences were found for the Qmax and IPSS results between the two groups. The re-intervention rate in ≥100 group was 3.5% versus 2.3% in <100. CONCLUSIONS In the midterm follow-up, Greenlight PVP guarantees the same results in different prostate volumes groups. Early and late complications are more frequent in large prostates.
关键词： complications,photoselective vaporization of the prostate,prostate volume,benign prostatic hyperplasia,GreenLight laser
更新于2025-09-23 15:19:57
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Use of lasers seems to result in a small decrease in postoperative complications after labial frenectomy compared with scalpels
摘要： The authors conducted a systematic review (SR) to compare the postoperative complications after labial frenectomy (LF) with lasers and scalpels. The authors searched 5 electronic databases and the gray literature for randomized clinical trials addressing this question. The authors included 7 studies in which researchers enrolled a total of 397 participants who were followed up through 90 days. Meta-analysis showed that participants who received LF with a laser had pain scores, on average, 3.18 and 1.04 points lower than those who received LF with a scalpel at 1 and 7 days, respectively. Participants who received LF with a laser had discomfort during speech, on average, 2.15 and 1.60 points lower than those who received LF with a scalpel at 1 and 7 days, respectively. Participants who received LF with a laser had discomfort during chewing, on average, 2.90 and 1.56 points lower than those who received LF with a scalpel at 1 and 7 days, respectively. There were no statistical differences between the groups on the odds of consuming analgesics.
关键词： frenectomy,labial,Surgery,laser,postoperative complications,scalpel,frenulum,systematic review
更新于2025-09-23 15:19:57
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Nd:YAG Laser Posterior Capsulotomy in Adult Patients with Uveitis
摘要： Purpose: To study the complication rate of Nd:YAG laser posterior capsulotomy in patients with uveitis. Method: Retrospective case note analysis of pseudophakic uveitis patients having undergone Nd:YAG laser posterior capsulotomy between January 2016 and December 2018. Complications documented included uveitis flare, raised intraocular pressure, intraocular lens damage/displacement, cystoid macular edema, and retinal detachment. Results: There were 39 eyes of 38 patients (20M, 18F; age 27–89 years). Mean interval between cataract surgery and laser was 55 months (range 8–286 months). Mean laser energy was 79 mJ (range 33–207 mJ). At 3 months 62% of eyes achieved a 2–5 Snellen line improvement that was maintained at 12 months. Vision was unchanged in 21% of eyes due to preexisting pathology, with no eyes having worse vision. No post-laser complications were documented. Conclusions: Nd:YAG laser posterior capsulotomy is a safe procedure in uveitis patients, resulting in a good improvement in vision.
关键词： pseudophakia,Nd:YAG laser,posterior capsulotomy,complications,Uveitis
更新于2025-09-23 15:19:57
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CT-guided transthoracic core needle biopsy for small pulmonary lesions: diagnostic performance and adequacy for molecular testing
摘要： Background: Computed tomography (CT)-guided transthoracic needle biopsy is a well-established, minimally invasive diagnostic tool for pulmonary lesions. Few large studies have been conducted on the diagnostic performance and adequacy for molecular testing of transthoracic core needle biopsy (TCNB) for small pulmonary lesions. Methods: This study included CT-guided TCNB with 18-gauge cutting needles in 560 consecutive patients with small (≤3 cm) pulmonary lesions from January 2012 to January 2015. There were 323 males and 237 females, aged 51.8±12.7 years. The size of the pulmonary lesions was 1.8±0.6 cm. The sensitivity, specificity, accuracy and complications of the biopsies were investigated. The risk factors of diagnostic failure were assessed using univariate and multivariate analyses. The sample’s adequacy for molecular testing of non-small cell lung cancer (NSCLC) was analyzed. Results: The overall sensitivity, specificity, and accuracy for diagnosis of malignancy were 92.0% (311/338), 98.6% (219/222), and 94.6% (530/560), respectively. The incidence of bleeding complications was 22.9% (128/560), and the incidence of pneumothorax was 10.4% (58/560). Logistic multivariate regression analysis showed that the independent risk factors for diagnostic failure were a lesion size ≤1 cm [odds ratio (OR), 3.95; P=0.007], lower lobe lesions (OR, 2.83; P=0.001), and pneumothorax (OR, 1.98; P=0.004). Genetic analysis was successfully performed on 95.45% (168/176) of specimens diagnosed as NSCLC. At least 96.8% of samples with two or more passes from a lesion were sufficient for molecular testing. Conclusions: The diagnostic yield of small pulmonary lesions by CT-guided TCNB is high, and the procedure is relatively safe. A lesion size ≤1 cm, lower lobe lesions, and pneumothorax are independent risk factors for biopsy diagnostic failure. TCNB specimens could provide adequate tissues for molecular testing.
关键词： Core needle biopsy,complications,small pulmonary lesions,diagnostic performance,molecular testing
更新于2025-09-19 17:15:36
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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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The qualification and training of laser/intense pulse light hair removal operators within South Africa
摘要： Background: Lasers and intense pulse light (IPL) sources are powerful devices that can cause skin burns, pigmentary changes, and scarring if used incorrectly. Adequate training is essential, and regulations are required to limit complications. Aims: The purpose was to investigate the qualifications and training obtained by laser hair removal operators in South Africa. Methods: Questionnaires were distributed and information gathered from owners/managers of laser clinics, suppliers of laser devices in South Africa, individuals in the workplace performing laser hair removal procedures, and accredited tertiary institutions. Results: A majority of clinic owners/managers (94.45%) felt that more emphasis should be placed on laser hair removal training at a tertiary level, and 66.67% outsource additional training provided by the manufacturer of laser devices. Based on the survey to manufacturers, 50% did not require any formal qualification as a minimum requirement, while 33.33% indicated laser hair removal training is incorporated at a NQF level 4 (National/Senior Certificate). The majority of individuals (68.89%) received training from tertiary institutions; however, they did not receive any practical training, and 60.87% felt the amount of training was insufficient. According to the survey sent to tertiary institutions in South Africa, only 27.78% offer laser hair removal training, and of these, 20% offer no practical training and 50% indicated that no practical examination is provided. Conclusions: There is a clear lack of training in laser hair removal in South Africa. The industry should have standard requirements in terms of minimum practical and theoretical hours with regards to the therapy.
关键词： training,intense pulse light,laser hair removal,laser complications
更新于2025-09-16 10:30:52
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Full-Field Erbium:YAG Laser Resurfacing: Complications and Suggested Safety Parameters
摘要： Background: Laser skin resurfacing with erbium-doped yttrium aluminum garnet (Er:YAG) lasers is a newer alternative to CO2 laser treatment, and was developed to reduce common complications. Although Er:YAG lasers have been available for years, safety parameters for efficacious resurfacing with these devices have not previously been available. Objectives: The aim of this study was to utilize one practice’s laser treatment settings and outcomes data to identify complication rates for various energies and areas of the face and to offer safe energy/depth parameters for treating each area. Methods: A retrospective chart review was performed for full-field confluent laser resurfacing patients treated with a Sciton Contour Tunable Resurfacing Er:YAG laser by the senior author. The data were retroactively analyzed with a time range of 8?years (January 2007-December 2015). Results: The overall complication rate for MicroLaserPeels (ablation of 50?μm or less) was 10.1% (20 of 198 treatments) and the rate for deep resurfacing treatments was 26.5% (71 of 268 cases). In MicroLaserPeel treatments the cheek area had the highest complication rate, followed by the forehead, nose, perioral, and eyelid areas, in that order (complication rate range, 0%-9.1%). In deep resurfacing treatments the perioral area had the highest complication rate, 38.6% of 145 cases. This was followed by the lids, cheek, nose, and forehead, in that order (complication rate range, 15.2%-20.9%). There is a correlation between increased depth of ablation and increased rate of complication. Conclusions: The study confirmed the efficacy of Er:YAG resurfacing and provides guidance for a safer approach to excellent outcomes.
关键词： complications,laser skin resurfacing,safety parameters,Er:YAG laser
更新于2025-09-16 10:30:52
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Lasers in Spine Surgery
摘要： Laser spine surgery has been a focus of intense interest in the lay press and among patients. On the Internet, a host of purported benefits to laser surgery exists. Lasers have long been used in pain management procedures such as percutaneous diskectomy. However, a few published articles are available on lasers in conventional spine surgery. From our review of the literature, the purported advantages of lasers, such as reduced inflammation and degeneration, are not been supported by preclinical research. The available clinical studies do not show a notable advantage for laser surgery. Moreover, the low enrollment, nonblinded, retrospective studies that are available are heavily subject to bias. The documented advantages of laser spine surgery described in the research studies are not consistent with the public’s impression of its purported benefits. Furthermore, laser-specific complications are present about which patients should be informed. On the basis of the current research, we conclude that lasers add distinct potential complications without any corresponding clinical benefit. Because of the public interest, we feel that this is an important topic for the general orthopaedic community.
关键词： Complications,Percutaneous diskectomy,Clinical studies,Preclinical research,Laser spine surgery
更新于2025-09-12 10:27:22
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Transscleral Diode Laser Cyclophotocoagulation
摘要： To compare the outcomes of standard pop-titrated transscleral cyclophotocoagulation (TSCPC) and slow-coagulation TSCPC in the treatment of glaucoma. Design: Retrospective case series. Participants: Seventy-eight eyes with glaucoma of any type or stage that underwent TSCPC as part of their treatment course. Methods: This study compared 52 eyes treated with slow-coagulation TSCPC with 26 eyes treated with standard pop-titrated TSCPC. Patient demographics, treatment course, surgical techniques, settings, and outcomes were assessed. Main Outcome Measures: Visual acuity (VA), intraocular pressure (IOP), and postsurgical complications. Results: The initial mean VA was 1.94 logarithm of the minimum angle of resolution (logMAR; standard deviation [SD], 0.73 logMAR) in the slow-coagulation TSCPC group and 1.71 logMAR (SD, 0.90 logMAR) in the standard TSCPC group (P ? 0.507). Initial IOP was 37 mmHg (SD, 13 mmHg) in the slow-coagulation group and 39 mmHg (SD, 13 mmHg) in the standard group (P ? 0.297). The follow-up periods were 16.36 and 24.68 months for the slow-coagulation and standard groups, respectively (P ? 0.124). Visual acuity remained better than light perception in 71.1% of slow-coagulation TSCPC patients and 65.0% of standard TSCPC patients (P ? 0.599). Intraocular pressure remained less than 20 mmHg in 46% of slow-coagulation TSCPC patients and 44% of standard TSCPC patients (P ? 0.870). The mean number of complications was higher in the standard group (1.46; SD, 1.24) versus the slow-coagulation group (0.62; SD, 0.75; P ? 0.002). The incidence of the need for a second procedure (slow-coagulation group, 28.8%; standard group, 23.1%; P ? 0.588) and maximum number of medications needed to control IOP after surgery (P ? 0.771) were similar between the 2 groups. Conclusions: In this case series, slow-coagulation TSCPC and standard pop-titrated TSCPC resulted in similar VA and IOP outcomes in the treatment of glaucomatous eyes. The complication profiles of the techniques also were comparable, although standard TSCPC showed a higher incidence of prolonged inflammation after surgery. This study suggests that slow-coagulation TSCPC may achieve equivalent control of IOP while reducing the incidence of prolonged postoperative inflammation—a feared complication of TSCPC—when compared with standard pop-titrated TSCPC.
关键词： intraocular pressure,visual acuity,glaucoma,complications,slow-coagulation,transscleral cyclophotocoagulation,standard pop-titrated
更新于2025-09-12 10:27:22