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Published in: Lasers in Medical Science 4/2015

01-05-2015 | Original Article

Efficacy of a vaporization–resection of the prostate median lobe enlargement and vaporization of the prostate lateral lobe for benign prostatic hyperplasia using a 120-W GreenLight high-performance system laser: the effect on storage symptoms

Authors: Kang Sup Kim, Sae Woong Choi, Woong Jin Bae, Su Jin Kim, Hyuk Jin Cho, Sung-Hoo Hong, Ji Youl Lee, Tae-Kon Hwang, Sae Woong Kim

Published in: Lasers in Medical Science | Issue 4/2015

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Abstract

GreenLight laser photoselective vaporization of the prostate (PVP) was established as a minimally invasive procedure to treat patients with benign prostatic hyperplasia (BPH). However, it may be difficult to achieve adequate tissue removal from a large prostate, particularly those with an enlarged median lobe. The purpose of this study was to investigate the feasibility and clinical effect of a 120-W GreenLight high-performance system laser vaporization–resection for an enlarged prostate median lobe compared with those of only vaporization. A total of 126 patients from January 2010 to January 2014 had an enlarged prostate median lobe and were included in this study. Ninety-six patients underwent vaporization only (VP group), and 30 patients underwent vaporization–resection for an enlarged median lobe (VR group). The clinical outcomes were International Prostate Symptoms Score (IPSS), quality of life (QOL), maximum flow rate (Q max), and post-void residual urine volume (PVR) assessed at 1, 3, 6, and 12 months postoperatively between the two groups. The parameters were not significantly different preoperatively between the two groups, except for PVR. Operative time and laser time were shorter in the VR group than those in the VP group. (74.1 vs. 61.9 min and 46.7 vs. 37.8 min; P = 0.020 and 0.013, respectively) and used less energy (218.2 vs. 171.8 kJ, P = 0.025). Improved IPSS values, increased Q max, and a reduced PVR were seen in the two groups. In particular, improved storage IPSS values were higher at 1 and 3 months in the VR group than those in the VP group (P = 0.030 and 0.022, respectively). No significant complications were detected in either group. Median lobe tissue vaporization–resection was complete, and good voiding results were achieved. Although changes in urinary symptoms were similar between patients who received the two techniques, shorter operating time and lower energy were superior with the vaporization–resection technique. In addition, vaporization–resection may have a beneficial effect on storage symptoms.
Literature
1.
go back to reference Rassweiler J, Teber D, Kuntz R, Hofmann R (2006) Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. Eur Urol 50:969–979CrossRefPubMed Rassweiler J, Teber D, Kuntz R, Hofmann R (2006) Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. Eur Urol 50:969–979CrossRefPubMed
2.
go back to reference Horninger W, Unterlechner H, Strasser H, Bartsch G (1996) Transurethral prostatectomy: mortality and morbidity. Prostate 28:195–200CrossRefPubMed Horninger W, Unterlechner H, Strasser H, Bartsch G (1996) Transurethral prostatectomy: mortality and morbidity. Prostate 28:195–200CrossRefPubMed
3.
go back to reference Doll HA, Black NA, McPherson K et al (1992) Mortality, morbidity and complications following transurethral resection of the prostate for benign prostatic hypertrophy. J Urol 147:1566–1573PubMed Doll HA, Black NA, McPherson K et al (1992) Mortality, morbidity and complications following transurethral resection of the prostate for benign prostatic hypertrophy. J Urol 147:1566–1573PubMed
4.
go back to reference Rieken M, Ebinger Mundorff N, Bonkat G et al (2010) Complications of laser prostatectomy: a review of recent data. World J Urol 28:53–62CrossRefPubMed Rieken M, Ebinger Mundorff N, Bonkat G et al (2010) Complications of laser prostatectomy: a review of recent data. World J Urol 28:53–62CrossRefPubMed
5.
go back to reference Tan A, Liao C, Mo Z, Cao Y (2007) Meta-analysis of holmium laser enucleation versus transurethral resection of the prostate for symptomatic prostatic obstruction. Br J Surg 94:1201–1208CrossRefPubMed Tan A, Liao C, Mo Z, Cao Y (2007) Meta-analysis of holmium laser enucleation versus transurethral resection of the prostate for symptomatic prostatic obstruction. Br J Surg 94:1201–1208CrossRefPubMed
6.
go back to reference Krambeck AE, Handa SE, Lingeman JE (2010) Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol 183:1105–1109CrossRefPubMed Krambeck AE, Handa SE, Lingeman JE (2010) Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol 183:1105–1109CrossRefPubMed
7.
go back to reference Bach T, Netsch C, Haecker A et al (2010) Thulium:YAG laser enucleation (VapoEnucleation) of the prostate: safety and durability during intermediate-term follow-up. World J Urol 28:39–43CrossRefPubMed Bach T, Netsch C, Haecker A et al (2010) Thulium:YAG laser enucleation (VapoEnucleation) of the prostate: safety and durability during intermediate-term follow-up. World J Urol 28:39–43CrossRefPubMed
8.
go back to reference Son H, Ro YK, Min SH et al (2011) Modified vaporization-resection for photoselective vaporization of the prostate using a GreenLight high-performance system 120-W laser: the Seoul technique. Urology 77:427–432CrossRefPubMed Son H, Ro YK, Min SH et al (2011) Modified vaporization-resection for photoselective vaporization of the prostate using a GreenLight high-performance system 120-W laser: the Seoul technique. Urology 77:427–432CrossRefPubMed
9.
go back to reference Brunken C, Seitz C, Tauber S, Schmidt R (2011) Transurethral GreenLight laser enucleation of the prostate—a feasibility study. J Endourol 25:1199–1201CrossRefPubMed Brunken C, Seitz C, Tauber S, Schmidt R (2011) Transurethral GreenLight laser enucleation of the prostate—a feasibility study. J Endourol 25:1199–1201CrossRefPubMed
10.
go back to reference McVary KT, Roehrborn CG, Avins AL et al (2011) Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 185:1793–1803CrossRefPubMed McVary KT, Roehrborn CG, Avins AL et al (2011) Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 185:1793–1803CrossRefPubMed
11.
go back to reference Oelke M, Bachmann A, Descazeaud A et al (2013) EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 64:118–140CrossRefPubMed Oelke M, Bachmann A, Descazeaud A et al (2013) EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 64:118–140CrossRefPubMed
12.
go back to reference Roehrborn CG, Bartsch G, Kirby R et al (2001) Guidelines for the diagnosis and treatment of benign prostatic hyperplasia: a comparative, international overview. Urology 58:642–650CrossRefPubMed Roehrborn CG, Bartsch G, Kirby R et al (2001) Guidelines for the diagnosis and treatment of benign prostatic hyperplasia: a comparative, international overview. Urology 58:642–650CrossRefPubMed
13.
go back to reference Hai MA, Malek RS (2003) Photoselective vaporization of the prostate: initial experience with a new 80 W KTP laser for the treatment of benign prostatic hyperplasia. J Endourol 17:93–96CrossRefPubMed Hai MA, Malek RS (2003) Photoselective vaporization of the prostate: initial experience with a new 80 W KTP laser for the treatment of benign prostatic hyperplasia. J Endourol 17:93–96CrossRefPubMed
14.
go back to reference Bachmann A, Schurch L, Ruszat R et al (2005) Photoselective vaporization (PVP) versus transurethral resection of the prostate (TURP): a prospective bi-centre study of perioperative morbidity and early functional outcome. Eur Urol 48:965–971CrossRefPubMed Bachmann A, Schurch L, Ruszat R et al (2005) Photoselective vaporization (PVP) versus transurethral resection of the prostate (TURP): a prospective bi-centre study of perioperative morbidity and early functional outcome. Eur Urol 48:965–971CrossRefPubMed
15.
go back to reference Bouchier-Hayes DM, Anderson P, Van Appledorn S et al (2006) KTP laser versus transurethral resection: early results of a randomized trial. J Endourol 20:580–585CrossRefPubMed Bouchier-Hayes DM, Anderson P, Van Appledorn S et al (2006) KTP laser versus transurethral resection: early results of a randomized trial. J Endourol 20:580–585CrossRefPubMed
16.
go back to reference Lukacs B, Loeffler J, Bruyere F et al (2012) Photoselective vaporization of the prostate with GreenLight 120-W laser compared with monopolar transurethral resection of the prostate: a multicenter randomized controlled trial. Eur Urol 61:1165–1173CrossRefPubMed Lukacs B, Loeffler J, Bruyere F et al (2012) Photoselective vaporization of the prostate with GreenLight 120-W laser compared with monopolar transurethral resection of the prostate: a multicenter randomized controlled trial. Eur Urol 61:1165–1173CrossRefPubMed
17.
go back to reference Choi SW, Choi YS, Bae WJ et al (2011) 120 W GreenLight HPS laser photoselective vaporization of the prostate for treatment of benign prostatic hyperplasia in men with detrusor underactivity. Korean J Urol 52:824–828CrossRefPubMedCentralPubMed Choi SW, Choi YS, Bae WJ et al (2011) 120 W GreenLight HPS laser photoselective vaporization of the prostate for treatment of benign prostatic hyperplasia in men with detrusor underactivity. Korean J Urol 52:824–828CrossRefPubMedCentralPubMed
18.
go back to reference Wee JH, Choi YS, Bae WJ et al (2012) Influence of intravesical prostatic protrusion on preoperative lower urinary tract symptoms and outcomes after 120 w high performance system laser treatment in men with benign prostatic hyperplasia. Korean J Urol 53:472–477CrossRefPubMedCentralPubMed Wee JH, Choi YS, Bae WJ et al (2012) Influence of intravesical prostatic protrusion on preoperative lower urinary tract symptoms and outcomes after 120 w high performance system laser treatment in men with benign prostatic hyperplasia. Korean J Urol 53:472–477CrossRefPubMedCentralPubMed
19.
go back to reference Choi YS, Bae WJ, Kim SJ et al (2013) Efficacy and safety of 120-W GreenLight high-performance system laser photo vaporization of the prostate: 3-year results with specific considerations. Prostate Int 1:169–176CrossRefPubMedCentralPubMed Choi YS, Bae WJ, Kim SJ et al (2013) Efficacy and safety of 120-W GreenLight high-performance system laser photo vaporization of the prostate: 3-year results with specific considerations. Prostate Int 1:169–176CrossRefPubMedCentralPubMed
20.
go back to reference Horasanli K, Silay MS, Altay B et al (2008) Photoselective potassium titanyl phosphate (KTP) laser vaporization versus transurethral resection of the prostate for prostates larger than 70 mL: a short-term prospective randomized trial. Urology 71:247–251CrossRefPubMed Horasanli K, Silay MS, Altay B et al (2008) Photoselective potassium titanyl phosphate (KTP) laser vaporization versus transurethral resection of the prostate for prostates larger than 70 mL: a short-term prospective randomized trial. Urology 71:247–251CrossRefPubMed
21.
go back to reference Keqin Z, Zhishun X, Jing Z et al (2007) Clinical significance of intravesical prostatic protrusion in patients with benign prostatic enlargement. Urology 70:1096–1099CrossRefPubMed Keqin Z, Zhishun X, Jing Z et al (2007) Clinical significance of intravesical prostatic protrusion in patients with benign prostatic enlargement. Urology 70:1096–1099CrossRefPubMed
22.
go back to reference Kuo HC (1999) Clinical prostate score for diagnosis of bladder outlet obstruction by prostate measurements and uroflowmetry. Urology 54:90–96CrossRefPubMed Kuo HC (1999) Clinical prostate score for diagnosis of bladder outlet obstruction by prostate measurements and uroflowmetry. Urology 54:90–96CrossRefPubMed
23.
go back to reference Chia SJ, Heng CT, Chan SP, Foo KT (2003) Correlation of intravesical prostatic protrusion with bladder outlet obstruction. BJU Int 91:371–374CrossRefPubMed Chia SJ, Heng CT, Chan SP, Foo KT (2003) Correlation of intravesical prostatic protrusion with bladder outlet obstruction. BJU Int 91:371–374CrossRefPubMed
24.
25.
go back to reference Dinis P, Silva J, Ribeiro MJ et al (2004) Bladder C-fiber desensitization induces a long-lasting improvement of BPH-associated storage LUTS: a pilot study. Eur Urol 46:88–93CrossRefPubMed Dinis P, Silva J, Ribeiro MJ et al (2004) Bladder C-fiber desensitization induces a long-lasting improvement of BPH-associated storage LUTS: a pilot study. Eur Urol 46:88–93CrossRefPubMed
26.
go back to reference Van Melick HH, Van Venrooij GE, Eckhardt MD, Boon TA (2002) A randomized controlled trial comparing transurethral resection of the prostate, contact laser prostatectomy and electrovaporization in men with benign prostatic hyperplasia: urodynamic effects. J Urol 168:1058–1062CrossRefPubMed Van Melick HH, Van Venrooij GE, Eckhardt MD, Boon TA (2002) A randomized controlled trial comparing transurethral resection of the prostate, contact laser prostatectomy and electrovaporization in men with benign prostatic hyperplasia: urodynamic effects. J Urol 168:1058–1062CrossRefPubMed
27.
go back to reference Donovan JL, Peters TJ, Neal DE et al (2000) A randomized trial comparing transurethral resection of the prostate, laser therapy and conservative treatment of men with symptoms associated with benign prostatic enlargement: the CLasP study. J Urol 164:65–70CrossRefPubMed Donovan JL, Peters TJ, Neal DE et al (2000) A randomized trial comparing transurethral resection of the prostate, laser therapy and conservative treatment of men with symptoms associated with benign prostatic enlargement: the CLasP study. J Urol 164:65–70CrossRefPubMed
28.
go back to reference Woo HH, Symons JL (2012) GreenLight HPS 120-w laser vaporization vs transurethral resection of the prostate (<60 ml): a 2-year randomized double-blind prospective urodynamic investigation. BJU Int 109:E29CrossRefPubMed Woo HH, Symons JL (2012) GreenLight HPS 120-w laser vaporization vs transurethral resection of the prostate (<60 ml): a 2-year randomized double-blind prospective urodynamic investigation. BJU Int 109:E29CrossRefPubMed
29.
go back to reference Xue B, Zang Y, Zhang Y et al (2013) GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: a prospective randomized trial. J Xray Sci Technol 21:125–132PubMed Xue B, Zang Y, Zhang Y et al (2013) GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: a prospective randomized trial. J Xray Sci Technol 21:125–132PubMed
30.
go back to reference Spaliviero M, Araki M, Culkin DJ, Wong C (2009) Incidence, management, and prevention of perioperative complications of GreenLight HPS laser photoselective vaporization prostatectomy: experience in the first 70 patients. J Endourol 23:495–502CrossRefPubMed Spaliviero M, Araki M, Culkin DJ, Wong C (2009) Incidence, management, and prevention of perioperative complications of GreenLight HPS laser photoselective vaporization prostatectomy: experience in the first 70 patients. J Endourol 23:495–502CrossRefPubMed
31.
go back to reference Capitan C, Blazquez C, Martin MD et al (2011) GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: a randomized clinical trial with 2-year follow-up. Eur Urol 60:734–739CrossRefPubMed Capitan C, Blazquez C, Martin MD et al (2011) GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: a randomized clinical trial with 2-year follow-up. Eur Urol 60:734–739CrossRefPubMed
Metadata
Title
Efficacy of a vaporization–resection of the prostate median lobe enlargement and vaporization of the prostate lateral lobe for benign prostatic hyperplasia using a 120-W GreenLight high-performance system laser: the effect on storage symptoms
Authors
Kang Sup Kim
Sae Woong Choi
Woong Jin Bae
Su Jin Kim
Hyuk Jin Cho
Sung-Hoo Hong
Ji Youl Lee
Tae-Kon Hwang
Sae Woong Kim
Publication date
01-05-2015
Publisher
Springer London
Published in
Lasers in Medical Science / Issue 4/2015
Print ISSN: 0268-8921
Electronic ISSN: 1435-604X
DOI
https://doi.org/10.1007/s10103-015-1740-7

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