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Thulium laser enucleation of the prostate
摘要： Various, more minimally invasive laser-based procedures have been introduced into clinical practice for the treatment of symptomatic benign prostatic obstruction (BPO) during the past 20 years as alternatives to open prostatectomy and transurethral resection of the prostate to decrease perioperative morbidity and to achieve comparable outcomes. The most prominent role played the frequency-doubled neodymium:yttrium–aluminium–garnet (YAG) laser or GreenLight laser and the holmium:YAG laser. Since the introduction of holmium laser enucleation of the prostate (HoLEP) in 1998, this procedure has gained worldwide acceptance because of complete dissection of the prostate adenoma from the prostatic pseudocapsule. HoLEP has been proven to be a size-independent, well tolerated and efficient procedure with excellent long-term outcomes. The shallow learning curve of the HoLEP technique has, however, limited its widespread use. A learning curve of at least 25–50 cases was found acceptable using a structured mentorship programme. On the basis of HoLEP, a wide array of so-called ‘me too’ laser-based transurethral enucleation techniques have been described during the past 12 years using diode, GreenLight and thulium lasers, of whom the latter played the most prominent role. Thulium:YAG vapoenucleation of the prostate (ThuVEP) has been found to be a size-independent, well tolerated and effective procedure with low-perioperative morbidity and excellent long-term results. The durability of ThuVEP was demonstrated by a prostate-specific antigen (PSA)-reduction rate of 77.1% at 5-year follow-up. The completeness of adenoma removal by ThuVEP was currently confirmed by a retrospective matched-paired comparison between ThuVEP and thulium vaporesection of the prostate (ThuVARP): the PSA-reduction was significantly higher after ThuVEP compared with ThuVARP (78.9 vs. 23.4%) at 24-month follow-up, which may lead to a higher reoperation rate after ThuVARP during long-term follow-up.
关键词： Thulium laser enucleation,BPO,ThuVEP,prostate,HoLEP
更新于2025-09-12 10:27:22
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Novel thulium fiber laser for endoscopic enucleation of the prostate: A prospective comparison with conventional transurethral resection of the prostate
摘要： Objective: To compare the efficacy and safety of a novel thulium fiber laser for endoscopic enucleation of the prostate with monopolar transurethral resection of the prostate in patients with smaller glands (<80 cc). Methods: A total of 51 patients underwent thulium fiber laser enucleation of the prostate, and 52 patients underwent monopolar transurethral resection of the prostate. All patients were assessed preoperatively, and at 3, 6, and 12 months postoperatively (International Prostate Symptom Score, maximum urine flow rate, International Prostate Symptom Score-quality of life). Preoperative prostate volumes and prostate-specific antigen levels were complications were graded according to the Clavien classification. Results: Mean surgery time was longer in the thulium fiber laser enucleation of the prostate group (46.6 ± 10.2 vs 39.9 ± 8.6 min, P < 0.001), while catheterization and hospital stay were greater (P < 0.001). At 12 months, there were no differences in functional outcomes (International Prostate Symptom Score, maximum urine flow rate). Despite comparable prostate volumes at 12 months (P = 0.864), the prostate-specific antigen level in the thulium fiber laser enucleation of the prostate group (0.5 ± 0.5 ng/mL) was lower than in the transurethral resection of the prostate group (1.1 ± 1.0 ng/mL; P < 0.001). Hemoglobin and serum sodium decrease was lower in the thulium fiber laser enucleation of the prostate group (1.01 ± 0.4 g/dL and 1.1 ± 1.1 mmol/L) than in the transurethral resection of the prostate group (1.8 ± 0.8 g/dL and 4.1 ± 1.1 mmol/L; P < 0.001). Urinary incontinence rates at 12 months were comparable (P = 0.316). Conclusions: Thulium fiber laser enucleation of the prostate with novel thulium fiber laser in patients with smaller prostate glands (<80 cc) is comparable to transurethral resection of the prostate in voiding parameters improvement and complication rates. At the same time, the technique allows for a more substantial prostate-specific antigen decrease, indicating more complete removal of adenoma.
关键词： transurethral resection of the prostate,benign prostatic hyperplasia,endoscopic enucleation of the prostate,thulium fiber laser
更新于2025-09-11 14:15:04
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Safety and efficacy of Holmium laser enucleation of the prostate (HoLEP) in patients with previous transperineal biopsy (TPB): outcomes from a dual-centre case-control study
摘要： Background: We investigated the surgical feasibility, safety and effectiveness of 50 W (low power) Holmium Laser enucleation of the prostate (HoLEP) in patients who have undergone previous template biopsy of the prostate (TPB). Methods: Data encompassing pre-operative baseline characteristics, intra-operative measures and post-operative outcomes was collected for 109 patients undergoing HoLEP across two UK centres. Patients were stratified into two groups; group 1 (n = 24) had undergone previous TPB were compared with ‘controls’ (no previous TPB) in group 2 (n = 85). The primary outcome was successful HoLEP. Results: There were no statistically significant differences in either key baseline characteristics or mass of prostate enucleated between groups 1 and 2. There was no statistically significant difference in enucleation or morcellation times parameters between the two groups other than enucleation efficiency in favour of group 1 (p = 0.024). Functional outcomes improved, without any statistically significant difference, in both groups. Conclusions: In patients with a previous TPB, HoLEP is surgically feasible, safe and effective. TPB should not be considered a contraindication to HoLEP. Our work provides a strong foundation for further research in this area.
关键词： Prostate,Benign prostatic enlargement (BPE),Lower urinary tract symptoms (LUTS),Urinary retention,Transperineal template biopsy,Holmium laser Enucleation of the prostate (HoLEP)
更新于2025-09-11 14:15:04
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Magnetic resonance image‐guided focal laser ablation in clinically localized prostate cancer: safety and efficacy
摘要： Background: To evaluate the safety and efficacy of focal laser ablation (FLA) in low-intermediate risk prostate cancer. Methods: Inclusion criteria were men aged 50–75 years, prostate-specific antigen (PSA) ≤15 ng/mL, clinical stage T1c–T2a, one or two lesions (PI-RADS ≥3) on magnetic resonance imaging (MRI), and Gleason score 6 (>3 mm) or Gleason 7 on targeted biopsy. Treatment success was defined as no clinically significant cancer in ablated areas. The study is prospective. Under MRI guidance, laser ablation was applied to the visible lesion(s). International Prostate Symptoms Score, Sexual Health Inventory in Men score and PSA levels were assessed at baseline and repeated at 1, 3, 6, 12 and 18 months. MRI was repeated at 3 and 12 months. Cancer control was assessed at 6 months using targeted and systematic biopsies. Results: FLA was performed in 49 patients. Gleason scores were 3 + 3 in 13 patients (26.5%), 3 + 4 in 29 (59.2%) and 4 + 3 in 7 (14.3%). No significant complications were noticed. International Prostate Symptoms Score measurements up to 18 months were not different from baseline (all P > 0.05). Sexual Health Inventory in Men scores dropped in the first year (all P < 0.05), but were not different from baseline levels at 18 months (P = 0.097). PSA levels dropped significantly at 3–18 months (all P < 0.05). Treatment was successful in 39 patients (79.6%). Persistent cancer in treated areas was found in 10 patients (20.4%). Conclusions: FLA is safe with no impact on urinary and sexual functions at 18 months follow-up. Oncologic control is encouraging. Larger scale studies and longer follow-up are required.
关键词： Prostate cancer,Prostate cancer treatment outcome,Focal laser ablation,Focal therapy
更新于2025-09-11 14:15:04
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Pyuria and Post-Operation Urinary Tract Infection after Diode Laser Vaporesection of the Prostate
摘要： Background: Monopolar transurethral resection of prostate (m-TURP) remains the gold standard for benign prostate obstruction (BPO). Recently developed laser surgical technique provides fewer peri-operative complications with equivalent outcomes. Diode laser vaporesection (DiLRP) offers better hemostasis, shorter catheterization duration, and shorter hospital stay, however, deep thermal penetration might cause prolonged prostatic urethra inflammation and subsequent complications. We conducted a retrospective study to compare the pyuria duration and post-operative urinary tract infection sequelae (POUTIs) between DiLRP and m-TURP. Methods: From July 2011 to September 2015, we retrieved medical records for patients with lower urinary tract symptoms resulting from prostate obstruction who underwent m-TURP and DiLRP. Demographic characteristics were recorded from a computerized database. The duration of pyuria after operation was compared by Kaplan-Meier analysis and risk factors were evaluated by Cox regression analysis. Results: One hundred twelve patients underwent DiLRP and 81 underwent m-TURP performed by the same surgeon during the same period. The mean age of the patients was 72 – 7.3 years in the DiLRP group and 70 – 7.6 years in the m-TURP group (p = 0.069). There was a higher percentage of anticoagulant used in the DiLRP group than in the m-TURP group (18.5% vs. 7.4%, p = 0.028). Operation time was longer but post-operative normal saline irrigation interval was shorter in DiLRP compared with m-TURP, respectively (62.8 – 20.6 vs. 47.4 – 22.1 minutes, p < 0.001; 2.1 – 0.3 vs. 2.5 – 0.9 days, p < 0.001). The post-operative infections were statistically significantly higher in the DiLRP group, including epididymitis (10.2% vs. 1.2%, p = 0.013) and POUTIs-related hospitalization (8.3% vs. 1.2%, p = 0.031).The DiLRP resulted in longer pyuria period (16 vs. 12 weeks, p = 0.0014), with factors including operative method by DiLRP (hazard ratio [HR]: 1.828, p = 0.003) and age (HR: 0.665, p = 0.040). Conclusions: According to our study, DiLRP associated with more POUTIs is possibly caused by a longer pyuria period. Further larger prospective studies are necessary for the evaluation of the association between post-operative pyuria and POUTIs.
关键词： inflammation,infection,pyuria,prostate,laser
更新于2025-09-11 14:15:04
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Sensitive Detection of Prostate Specific Antigen Based on Copper Ions Doped Ag-Au Nanospheres Labeled Immunosensor
摘要： A sandwich-type electrochemical immunosensor was designed for quantitative detection of prostate speci?c antigen (PSA). Gold-platinum bimetallic functionalized tin oxide graphene (GS-SnO2-Au@Pt) has a large speci?c surface area, good conductivity and biocompatibility, which was used as the sensing interface to capture PSA coating antibody (Ab1). The copper ions doped Ag-Au nanospheres (Cu2+@Ag-Au) was prepared and used as a label of PSA labeling antibody (Ab2), which generated high intensive electrochemical redox signal based on the reduction reaction of Cu2+. The L-cysteine was applied as a bridge to connect Au nanoparticles (NPs) and Ag NPs, and to keep the nanosized gap between Au nuclear and Ag shell. This structure not only makes full advantage of space effect to load more Ag NPs but also increases the speci?c surface area for loaded more Cu2+. The proposed immunosensor with a wide range (10 pg mL?1 to 100 ng mL?1) and a low detection limit (3.84 pg mL?1) shows excellent performance in the detection of PSA. The results indicate that proposed immunosensor provides a promising application for the quantitative detection of biomolecules in serum samples.
关键词： Cu2+@Ag-Au,prostate speci?c antigen,GS-SnO2-Au@Pt,electrochemical immunosensor,signal amplification
更新于2025-09-11 14:15:04
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Greenlight laser enucleation of the prostate
摘要： Symptomatic benign prostatic hyperplasia increases greatly in men beginning in the sixth decade of life. The American Urological Association (AUA) and European Association of Urology (EAU) recommend surgical intervention in patients who fail medical therapy [1,2]. The surgical approach is dependent on patient anatomy, patient and surgeon preference, medical comorbidities, as well as surgeon experience and prostate size. Transurethral prostatectomy is historically prostate size-dependent because of irrigant absorption (dilutional hyponatremia) and procedure time [photovaporization of the prostate (PVP)]. Incomplete resection of large adenoma can fail to improve patient symptoms.
关键词： Greenlight laser enucleation of the prostate,surgical intervention,benign prostatic hyperplasia,transurethral prostatectomy
更新于2025-09-11 14:15:04
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Comparing the Staging/Restaging Performance of 68Ga-Labeled Prostate-Specific Membrane Antigen and 18F-Choline PET/CT in Prostate Cancer
摘要： PET/CT using prostate-specific membrane antigen (PSMA) and choline radiotracers is widely used for diagnosis of prostate cancer. However, the roles of and differences in diagnostic performance between these 2 radiotracers for prostate cancer are unclear. The aim of this study was to compare the staging and restaging performance of 68Ga-labeled PSMA and 18F-choline PET/CT imaging in prostate cancer. Methods: A comprehensive search was performed in PubMed for studies reporting the staging performance of 68Ga-PSMA and 18F-choline PET/CT in prostate cancer from the inception of the database to October 1, 2018, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Thirty-five studies were included in this systematic review and meta-analysis. Pooled estimates of patient- and lesion-based sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) for 68Ga-PSMA and 18F-choline PET/CT were calculated alongside 95% confidence intervals. Summary receiver operating characteristic curves were plotted, and the area under the summary receiver operating characteristic curve (AUC) was determined alongside the Q* index. Results: The patient-based overall pooled sensitivity, specificity, PLR, NLR, DOR, and AUC of 68Ga-PSMA PET/CT for staging in prostate cancer (13 studies) were 0.92, 0.94, 7.91, 0.14, 79.04, and 0.96, respectively, whereas those of 18F-choline PET/CT (16 studies) were 0.93, 0.83, 4.98, 0.10, 68.27, and 0.95. The lesion-based overall pooled sensitivity, specificity, PLR, NLR, DOR, and AUC of 68Ga-PSMA PET/CT for staging in prostate cancer (9 studies) were 0.83, 0.95, 23.30, 0.17, 153.58, and 0.94, respectively, and those of 18F-choline PET/CT (4 studies) were 0.81, 0.92, 8.59, 0.20, 44.82, and 0.98. In both patient- and lesion-based imaging, there was no statistically significant difference in the abilities of detecting or excluding prostate cancer between 68Ga-PSMA PET/CT and 18F-choline PET/CT. Conclusions: For staging and restaging performance in patients with prostate cancer, there was no significant difference between 68Ga-PSMA PET/CT and 18F-choline PET/CT. 68Ga-PSMA PET/CT and 18F-choline PET/CT have demonstrated high diagnostic performance for accurate staging and restaging in patients with prostate cancer, and thus both should be considered for staging in this disease.
关键词： 18F-fluorocholine (18F-choline),PET,staging,prostate cancer,68Ga-PSMA CT
更新于2025-09-11 14:15:04
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Holmium Laser Enucleation of the Prostate: Modified Two-Lobe Technique versus Traditional Three-Lobe Technique—A Randomized Study
摘要： Background. Holmium laser enucleation of the prostate (HoLEP) is considered the standard endoscopic treatment of benign prostatic hyperplasia (BPH), but traditional HoLEP surgery will cause some postoperative complications. This study was attempted to evaluate the safety and efficacy of modified two-lobe technique versus traditional three-lobe technique of HoLEP focusing mainly on incidences of retrograde ejaculation (RE) and urinary incontinence (UI). Methods. From March 2014 to February 2017, 191 men with BPH were randomly assigned to two groups: 97 underwent modified two-lobe technique; 94 underwent traditional three-lobe technique. All patients were followed up for 12 months. Primary outcomes were incidences of RE and UI, and secondary outcomes were international prostate symptom score (IPSS), quality of life (QOL), maximal urine flowing rate (MFR), and residual urine among the studied patients. Results. Compared with the traditional technique, patients in the modified group had a statistically significant decrease in frequency of UI (1.03% vs 8.51%, p = 0.036) and RE in the 6th month (33.33% vs 63.64%, p = 0.030) and 12th month (13.33% vs 50%, p = 0.034) and a significant increase in ejaculatory volume in the 6th month (p = 0.050) and 12th month (p = 0.003). Besides, the modified HoLEP was more beneficial to patients according to the change of QoL score at 1 month (p = 0.002), 3 months (p = 0.004), 6 months (p = 0.026), and 12 months (p = 0.015). Conclusions. The modified two-lobe technology of HoLEP reduced the incidence of RE and UI, which improved the quality of life of the patients after surgery compared to the traditional three-lobe technology. This trial is registered with ChiCTR1800018553.
关键词： urinary incontinence,benign prostatic hyperplasia,Holmium laser enucleation of the prostate,retrograde ejaculation,quality of life
更新于2025-09-11 14:15:04
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Simultaneous 18F-fluciclovine Positron Emission Tomography and Magnetic Resonance Spectroscopic Imaging of Prostate Cancer
摘要： Purpose: To investigate the associations of metabolite levels derived from magnetic resonance spectroscopic imaging (MRSI) and 18F-?uciclovine positron emission tomography (PET) with prostate tissue characteristics. In a cohort of 19 high-risk prostate cancer patients that underwent simultaneous PET/MRI, we evaluated the diagnostic performance of MRSI and PET for discrimination of aggressive cancer lesions from healthy tissue and benign lesions. Data analysis comprised calculations of correlations of mean standardized uptake values (SUVmean), maximum SUV (SUVmax), and the MRSI-derived ratio of (total choline + spermine + creatine) to citrate (CSC/C). Whole-mount histopathology was used as gold standard. Results: The results showed a moderate signi?cant correlation between both SUVmean and SUVmax with CSC/C ratio. Conclusions: We demonstrated that the simultaneous acquisition of 18F-?uciclovine PET and MRSI with an integrated PET/MRI system is feasible and a combination of these imaging modalities has potential to improve the diagnostic sensitivity and speci?city of prostate cancer lesions.
关键词： citrate,benign prostatic hyperplasia,chemical shift imaging,prostate cancer,positron emission tomography,magnetic resonance spectroscopy
更新于2025-09-11 14:15:04