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【Objective】 To evaluate the efficacy and safety of 450 nm semiconductor blue laser combined with triamcinolone acetonide injection in the treatment of bladder neck contracture (BNC). 【Methods】 A 61-year-old male patient with BNC and urethral stricture was treated with 450 nm semiconductor blue laser vaporization combined with triamcinolone acetonide injection. The surgery was performed with a small-caliber laser resectoscope of F22. The follow-up results 3 months after surgery were reported. 【Results】 The operation was successful, the operation time was 30 minutes, and the patient was discharged the next day after operation. Follow-up 3 months after operation showed the maximum urinary flow rate (Qmax) was 22.1 mL/s, the International Prostate Symptom Score (IPSS) was 2, the Quality of Life Scale (QoL) was 0, and no recurrence was observed. 【Conclusion】 It is safe and feasible to use 450 nm semiconductor blue laser combined with triamcinolone acetonide injection to treat bladder neck contracture through a small-caliber laser resectoscope of F22, especially for patients with urethral stricture. The short-term efficacy is satisfactory.
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Objective:To explore the efficacy and safety of five-step 180W XPS greenlight photoselective vaporization of prostate (PVP)for large volume (≥80ml) benign prostatic hyperplasia.Methods:A total of 240 BPH patients (PV≥ 80 ml), treated with five-step 180W XPS PVP from June 2017 to May 2019 in our center, were reviewed retrospectively. The average age was (70.18±7.71) years old, and 129 cases were over 70 years old. The average body mass index was (24.91±2.98 )kg/m 2. The median international prostate symptom score (IPSS) was 23 (20, 26) and the quality of life (QOL) score was 5 (4, 5) points. Besides, the preoperative median prostate volume (PV) was 98.29 (86.49, 116.32) ml, the median maximum urinary flow rate (Q max)was 6 (4, 8) ml/s and postvoid residual urine volume (PVR) was 120 (30, 200) ml. All patients underwent 180W XPS five-step method PVP operation according to the following method. The first step is vaporization of 1-2 o′clock (left lobe) and 10-11 o′clock (right lobe) in order to establish operating channel. The second step is vaporization of the lateral lobe layer by layer from the ventral side to the dorsal side. The third step is channel establishment of 5/7 o′clock mid lobe parasulcus. The forth step is ablation of the middle lobe laterally. The fifth step is vaporization of the apex of the prostate and trimming. The IPSS score, QOL score, Q max and PVR were evaluated 12 months later after the PVP operation. Results:All the 240 cases were treated by five-step 180W XPS PVP operation successfully. The median operation time and laser time were 83 (73, 98.75) min and 66 (60, 76) min. Capsular perforation was found in 3 cases, which occurred in the trimming stage. There were 9 cases treated with TURP to stop bleeding, and no cases suffered blood transfusion. Twenty-two patients underwent bladder irrigation for 6 to 24 hours after the operation, and the median catheter indwelling time and post-operative hospital stay were 3 (3, 4) days and 4 (3, 5) days respectively. Twenty-six patients suffered urinary incontinence, including 22 cases of urinary incontinence and 4 cases of stress urinary incontinence. In addition, there was no severe hematuria, severe bladder irritation or urinary retention among the patients. The postoperative IPSS score was 5(4, 7), QOL score 1(1, 2), Q max 18(15, 20)ml/s and PVR 10(0, 30)ml, which were all significantly improved compared with those before surgery ( P<0.01). None second PVP surgery was performed. Conclusions:The five-step 180W XPS PVP operation has the advantages of improving lower urinary tract symptoms, less blood loss and low incidence of perioperative adverse events. It is easy to use, which is a reliable minimally surgery.
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Objective@#To compare thulium laser vaporization of the prostate (TLVP) and transurethral resection of the prostate (TURP) in the treatment of benign prostate hyperplasia (BPH) analyze the risk factors for postoperative urethral stricture.@*METHODS@#From June 2015 to June 2016, 210 BPH patients in our hospital underwent TURP (n = 126) or TLVP (n = 84). We followed up the patients for 6 months, compared the effects of the two surgical strategies and analyzed the risk factors for postoperative urethral stricture by multivariate logistic regression analysis.@*RESULTS@#Compared with TURP, TLVP achieved significantly shorter time of operation (［78.6 ± 27.5］ vs ［53.2 ± 21.6］ min, P <0.01), postoperative bladder irrigation (［31.5 ± 2.9］ vs ［26.1 ± 3.7］ h, P <0.01), urethral catheterization (［5.3 ± 1.7］ vs ［3.7 ± 1.5］ d, P <0.01) and postoperative hospitalization (［7.9 ± 2.1］ vs ［5.5 ± 1.4］ d, P <0.01) as well as lower urinary leukocyte count at 6 months after surgery (［32.1 ± 12.6］ vs ［24.9 ± 11.7］ /μl, P <0.01) and incidence rate of postoperative complications (11.9% ［15/126］ vs 3.6% ［3/84］, P <0.05), particularly that of urethral stricture (7.9% ［10/126］ vs 1.2% ［1/84］, P <0.05). Logistic regression analysis showed that the preoperative urinary leukocyte count, postoperative urethral catheterization time, and surgical method were independent risk factors for postoperative urethral stricture.@*CONCLUSIONS@#TLVP, in comparison with TURP, has the advantages of definite effect, fast recovery, high safety and low incidence of postoperative urethral stricture. The main risk factors for postoperative urethral stricture include preoperative urinary tract infection, postoperative urethral catheterization time and surgical method.
Subject(s)
Humans , Male , Laser Therapy , Methods , Operative Time , Postoperative Complications , Prostatic Hyperplasia , General Surgery , Quality of Life , Regression Analysis , Risk Factors , Thulium , Therapeutic Uses , Transurethral Resection of Prostate , Treatment Outcome , Urethral Stricture , Urinary Catheterization , Urinary Tract InfectionsABSTRACT
Objective To systematically review and evaluate the perioperative indicators and surgical curative effect of 980 nm diode laser vaporization of prostate and transurethral resesction of prostate (TURP) in treating benign prostatic hyperplasia (BPH). Methods Retrieved published comparative studies 980 nm diode laser vaporization of prostate versus transurethral resesction of prostate in treating benign prostatic hyperplasia, and pooled the data from eligible studies. The statistical analysis was performed using Revman 5.3 software. Results Six trials including 839 patients were eligible to the criteria (450 in 980 nm diode laser group and 389 in TURP group). The baseline of patients characteristics were comparable in all the studies. Meta analysis showed that: the operative time was not significantly different between the 980 nm diode laser group and TURP group [SMD = 0.11, 95 ~ CI (-0.52,0.74), P > 0.05]; Compared with TURP group, 980 nm diode laser group has shorter hospital stays [SMD = -1.95, 95%CI (-3.42, -0.48), P 0.05], QOL [SMD = 0.00, 95%CI (-0.57, 0.57), P > 0.05] and Qmax [SMD = 0.06, 95%CI (-0.26, 0.37), P > 0.05]. Conclusion 980 nm diode laser vaporization of prostate is safe and effective in treating benign prostatic hyperplasia, and compared with TURP, it has advantages in shorter hospital stays and shorter catheterization time.
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La enfermedad de Paget extramamaria (EPE) es una patología maligna observada, sobre todo, en áreas donde existe alta densidad de glándulas apocrinas. Presentamos el caso clínico de una paciente de 68 años de edad, atendida en la Clínica de Colposcopia del Servicio de Oncología, del Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, con diagnóstico de enfermedad de Paget a nivel vulvar, vagina, región de periné y región perianal, manejada con sesiones de vaporización con láser, con evolución satisfactoria. Dado que es una enfermedad poco frecuente, más común en el sexo femenino y en la raza blanca, con mayor incidencia en la séptima década de la vida, como es el caso de nuestra paciente, el objetivo de este trabajo es presentar una revisión de la evaluación clínica, haciendo énfasis en el diagnóstico diferencial, uso de colposcopia para diagnóstico y tratamiento conservador fraccionado con vaporización de láser. La baja incidencia de la enfermedad de Paget de la vulva, vagina, periné y región perianal, así como la ausencia de informes sobre la posibilidad de tratamiento no quirúrgico, motivan a informar a la comunidad científica sobre el manejo con vaporización láser, con la intención de evitar la morbilidad que puede traer consigo el manejo quirúrgico convencional.
Extramammary Paget's disease (EPD) is a malignant disease observed, especially in areas with high density of apocrine glands. We report a case of a patient of 68 years old, attended at the Colposcopy Clinic of Oncology, National Institute of Perinatology Isidro Espinosa de los Reyes, diagnosed with Paget's disease of the vulva, vagina, perineum region and perianal region, and managed with laser vaporization sessions with satisfactory outcome. Since it is a rare disease, more common in females and in whites, with the highest incidence in the seventh decade of life, as is the case of our patient, propose in this paper to present a review of the clinical evaluation with emphasis on the differential diagnosis, use of colposcopy for diagnosis and dividing up conservative treatment with laser vaporization of the disease. The low incidence of Paget's disease of the vulva, vagina, perineum and perianal region, and the absence of reports on the possibility of nonsurgical treatment encouraged to inform the scientific community about the management with laser vaporization, with the intention of avoiding morbidity that can lead to the conventional surgical maneuvers.
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Objective To investigate and compare the clinical effects of 2-micron laser vaporization resection of prostate (2-micron laser) and versus transurethral resection of prostate (TURP) for treatment of benign prostatic hyperplasia(BPH) in this prospective random control study.Methods Sixty patients of BPH were randomly divided into two groups including the 2-micron laser group (n =30) and the TURP group (n =30).The perioperative markers and therapeutic results including duration of surgery,blood lose during surgery,improvement of symptoms after treatment,postoperative bladder washing time,the mean bladder irrigating time,hospital stay time,and recent complications were recorded and analyzed.Results The international prostate symptom score((6.6 ± 1.8) vs.(33.2 ±2.2),(5.7 ± 1.3) vs.(33.4 ±2.3) respectively),maximal urinary flow((20.6 ± 1.5) ml/s vs.(7.8 ± 4.3) m/s,(19.5 ± 1.7) ml/s vs.(8.3 ± 4.5) ml/s respectively),residual urine volume((22.3 ±4.7) ml vs.(57.2 ± 10.5) ml,(26.3 ±7.2) ml vs.(60.2 ± 14.5) ml respectively) were significantly improved in both groups after operation (P =0.005,0.008,0.036,0.001,0.005,0.013 respectively),but the differences between these two groups were not significant (P =0.16,0.49,0.97 respectively).The volume of hemorrhage ((20.9 ± 12.1) ml vs.(55.3 ± 27.8) ml),the mean bladder irrigating time ((1.0 ±0.5) d vs.(3.5 ±0.7) d),cathererization time ((3.2 ± 1.3) d vs.(6.0 ± 1.5) d),hospital stay time ((6.8 ±0.7) d vs.(10.6 ±0.6) d) were significantly less or shorter in the 2-micron laser group than in the TURP group (P =0.009,0.005,0.035,0.03 respectively).There was no significant difference in rates of complications between the two groups (P ＞ 0.05).Conclusion The therapy of 2-micron laser is safer and more efficacious than TURP for BPH patients,with advantages of short surgery duration,little blood loss,and quick recovery.
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Disseminated superficial actinic porokeratosis (DSAP) is a skin condition that usually shows a poor response to different modalities of treatment. Herein we describe 2 patients with DSAP on the face, each treated with 3 to 4 sessions of photodynamic therapy combined with laser vaporization.
Subject(s)
Humans , Actins , Laser Therapy , Lasers, Gas , Photochemotherapy , Porokeratosis , Skin , VolatilizationABSTRACT
PURPOSE: Several studies and papers have reported good short-term results for using 120W HPS laser PVP. Here we report the short-term and long-term clinical outcomes analysis with efficacy and safety of 120W HPS laser PVP for the treatment of BPH. MATERIALS AND METHODS: We performed a retrospective clinical analysis of 357 patients, who underwent 120W HPS laser PVP for the treatment of BPH from April, 2009 to Feb. 2011. The IPSS, Qmax and PVR values were evaluated preoperatively and postoperatively. RESULTS: The mean age at the surgery; 70.35+/-8.28, mean prostate size; 46.56+/-21.11 ml, and mean PSA was 4.16+/-4.35 ng/ml. Mean operation time was 41.8+/-34.1 min, and mean lasing time was 19.8+/-11.3 min. Mean applied energy was 134,294.9+/-225,211.5 J. Thirty cases of co-operation were done. Mean catheter indwelling time was 0.84+/-0.36 day, and mean hospital stay was 1.1+/-0.2 day. The blood loss was minimal so transfusions were not needed. The baseline IPSS-sum; 19.61+/-9.13, QoL score; 4.28+/-1.02, Qmax; 7.94+/-5.51 ml/sec, PVR; 101.62+/-102.58 ml, At 1 month, IPSS-sum; 8.64+/-7.34, QoL score; 2.19+/-1.48, Qmax; 13.32+/-8.94 ml/sec, PVR; 32.54+/-46.07 ml was noted. At 12 months, IPSS-sum; 8.33+/-5.04, QoL score; 1.33+/-1.08, Qmax; 15.75+/-2.90 ml/sec, PVR; 21.56+/-31.28 ml was noted. Within 1 month of operation, 18 cases of dysuria and 27 cases of retention were reported but these were resolved with medication and observation. Compared with preoperative values, there were statistical improvements after the operation. CONCLUSIONS: 120W HPS laser showed statistical improvements after 1 month operation and these results were sustained for 12 months. Although limitations, our long term experience suggest that significant improvements in symptomatic and urodynamic outcomes of 120W HPS laser PVP.
Subject(s)
Humans , Catheters , Dysuria , Laser Therapy , Length of Stay , Prostate , Prostatic Hyperplasia , Retention, Psychology , Retrospective Studies , Urodynamics , VolatilizationABSTRACT
PURPOSE: With the use of 12 months of follow-up data, this study was conducted to evaluate the efficacy of photoselective vaporization of the prostate (PVP) with the 120 W Greenlight high performance system (HPS) laser for the treatment of symptomatic benign prostatic hyperplasia. MATERIALS AND METHODS: Data were collected from 104 patients who were diagnosed with benign prostatic hyperplasia and who underwent PVP with the 120 W Greenlight HPS Laser. Postoperative parameters, including International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum urinary flow rate (Qmax), and postvoid residual volume (PVR), were assessed and compared with preoperative baseline values. RESULTS: The mean age of the patients was 71.1+/-7.7. The baseline mean prostate-specific antigen level was 3.8+/-2.7 ng/ml, the mean prostate size was 43.9+/-20.6 g, the mean preoperative IPSS was 18.4+/-8.5, the mean QoL score was 4.1+/-1.0, the mean Qmax was 9.9+/-5.5 ml/sec, and the mean PVR was 89.6+/-207.1 ml. During surgery, the mean operation time was 21.8+/-11.3 minutes, the mean lasing time was 16.9+/-10.5 minutes, and the mean total applied energy was 170,068+/-63,181 J. At 1 month, significant improvements were observed in total IPSS (11.5+/-6.7, p<0.05), voiding symptom score (6.1+/-5.4, p<0.05), and QoL score (2.2+/-1.5, p<0.05); however, there were no significant improvements in storage symptom score (4.8+/-3.8, p=0.06), Qmax (12.6+/-10.2, p=0.06), and PVR (40.1+/-30.5, p=0.41). However, 3 months after surgery, all postoperative follow-up parameters showed significant improvements, and the 6- and 12-month data showed sustained improvement of postoperative follow-up parameters. CONCLUSIONS: Significant improvements were observed in subjective and objective voiding parameters, which were evident at 3 months after PVP and were sustained throughout a period of 12 months after PVP.
Subject(s)
Humans , Follow-Up Studies , Laser Therapy , Prostate , Prostate-Specific Antigen , Prostatic Hyperplasia , Quality of Life , Residual Volume , Transurethral Resection of Prostate , VolatilizationABSTRACT
La Resección Transuretral (RTU) es el patrón de oro de tratamiento endoscópico de la obstrucción urinaria secundaria a hiperplasia prostática benigna (HPB), no obstante se describen cerca de un 20 por ciento de complicaciones más otros efectos no deseados que se asumen normales para la técnica. La vaporización fotoselectiva prostática (VFP) con láser KTP permite una eficiente vaporización del reportándose excelentes resultados funcionales. Con la finalidad de evaluar esta técnica en protocolo con pacientes ambulatorios en el Complejo Hospitalario San José, se confecciona el presente estudio. Material y Métodos: Se evalúan pacientes sometidos a VFP con láser KTP en el Complejo Hospitalario San José entre noviembre de 2006 y Julio de 2007. En todos se descartó por clínica y laboratorio cáncer prostático y se les practicó estimación de volumen prostático con ecografía transrectal y medición de residuo urinario postmiccional antes y un mes post-quirúrgico. Además se realizaron cuestionarios de síntomas urinarios (I-PSS) y calidad de vida (QoL), disfunción eréctil (IIEF-5) y uroflujometríano invasiva antes de la intervención y a uno y tres meses post quirúrgico. Se considera además el tiempo de uso de catéter urinario y se estima el volumen de sangrado intraoperatorio. Resultados: Fueron intervenidos un total de 120 pacientes, de los cuales 101 ingresaron en el protocolo presentando 83 de ellos seguimiento mínimo de 3 meses. La actividad se desarrolló en forma ambulatoria en un 92,1 por ciento de los casos. En promedio, el tiempo quirúrgico fue de 65 min, con uso de catéter urinario por 21,8 horas y sangrado de 86,5 ml. Existió una reducción del volumen prostático en un 56 por ciento y del residuo post-miccional de un 74 por ciento. El 14,9 por ciento de los pacientes experimentó una o más complicaciones, destacando disuria en 15 y hematuria en 6 pacientes, con un caso con necesidad de reintervención de urgencia. Se objetivó al mes post quirúrgico...
Transuretral prostatic resection (TURP) is currently the gold standard in the treatment of urinary obstruction secondary to benign prostatic hyperplasia (HPB). However, about 20 percent of complications and secondary conditions are associated with this surgery. Fotoselective prostatic vaporization of the prostate (VFP) with KTP laser efficiently vaporizes the prostate with excellent functional results. We report our protocol in the San Jose Hospital Complex Material and methods: All patients that underwent KTP prostate vaporization between November 2006 and July 2007 were evaluated. Prostate cancer was ruled out with PSA and prostate volume was estimated with TRUS. Residual urinary volume was determined preoperatively and at one month postoperatively. Urinary symptoms, quality of life and erectile dysfunction questionnaires were completed by all patients. Non invasive urodinamic study was performed before and after surgery. Catheter time and complications were evaluated. Results: A total of 120 patients underwent the procedure of whom 101 were included in the protocol. Out of these 83 presented a minimum of 3 months follow-up. Day surgery was performed in 92,1 percent of cases. Mean operative time was 65 min with 21.8 hours of catheter time and 86.5 ml of operative bleeding. Prostatic and residual urine volume was reduced in 56 percent and 74 percent respectively. One or more complications were seen in 14,9 percent of cases (irritative symptoms in 15 and hematuria in 6). One patient required emergency reoperation. Symptom scores were reduced significantly IPSS from 26,7to 8,1, QoL 4,6 to 0,7 and maximum urinary flow from 7.3 to 19.9 ml/s. There was no variation in IIEF-5 questionnaires. Conclusion: Prostatic vaporization with KTP laser is a safe and efficient technique. Increased urinary flow and reduced symptom score favor this technique. KTP seems as a promising alternative to traditional TURP...
Subject(s)
Humans , Male , Middle Aged , Prostatic Hyperplasia/surgery , Laser Therapy/methods , Quality of Life , Prospective Studies , Prostatic Hyperplasia/physiopathology , Ambulatory Surgical Procedures , Data Collection , Treatment Outcome , Laser Therapy/adverse effects , Laser Therapy/instrumentation , UrodynamicsABSTRACT
PURPOSE: This study was conducted to evaluate the quality of life and efficacy of treatment after 80 watts high power potassium-titanyl-phosphate laser vaporization for patients with a prostate volume greater than 40cc. We adopted the benign prostatic hyperplasia(BPH) quality of life (QoL)-K1 short form that was developed by the Korean Urological Association in 2001 to more accurately assess the quality of life of patients with BPH. MATERIALS AND METHODS: From July 2005 to March 2006, we performed KTP laser vaporization on a total of 38 patients with symptomatic benign prostatic hyperplasia of the prostate and all their prostate volumes were more than 40cc. All the patients were evaluated preoperatively and then again at 3 and 6 months postoperatively based on the International Prostate Symptom Score(IPSS), the maximum urinary flow rate(Qmax) and the postvoid residual urine(PVR). We conducted a survey of all the patients regarding BPH with using the QoL-K1 short form by means of mail and phone at a mean of 8.7 months(range: 5-12) postoperatively. RESULTS: The mean operation timewas 50.5 minutes(range: 20-120), and the mean duration of admission and catheterization were 2.9+/-0.4 days and 22.0+/-10.9 hours, respectively. The mean total score for the BPH QoL-K1 short form improved from 34.5 preoperatively to 22.5 at 6 months postoperatively(p<0.001). There was a significant improvement in the IPSS, Qmax and PVR after the operation, but there were no differences between these parameters at 3 months and 6 months after KTP laser vaporization. There was dysuria in 9(24%) patients postoperatively and urinary tract infection occurred in 10(26%) of all the patients. CONCLUSIONS: This study showed that KTP laser vaporization was effective in patients with a prostate volume more than 40cc, and the procedure produced improvements in the IPSS, Qmax,PVR and the BPH QoL-K1 short form. Despite the high rate of dysuria and urinary tract infection, the patients treated with KTP laser showed satisfaction about the operation because of the shortened duration of both admission and catheterization.
Subject(s)
Humans , Catheterization , Catheters , Dysuria , Laser Therapy , Lasers, Solid-State , Postal Service , Prostate , Prostatic Hyperplasia , Quality of Life , Urinary Tract Infections , VolatilizationABSTRACT
We report a case of Darier's disease with typical cutaneous and nail lesions in a 50-year-old male patient. He has brownish hyperkeratotic papules on the ant.chest, back, both axilla and groins and verrucous surfaced hypertrophic plaques on the scalp, forehead and both postauricular areas, which were accompanied by a severe itching sensation and malodor. Also he has finger nail lesions such as subungual hyperkeratotic papules, distal wedge shaped notching and multiple longitudinal red lines on the nail plates. Histopathologic features taken from the inguinal area revealed hyperkeratosis, suprabasal clefts and lacuna, protruded villi lined with one layer of basal cells into the cavity and dyskeratotic cells such as corps ronds in the epidermis. Hyperkeratotic papules on the ant.chest, back, both axilla and groins disappeared after systemic treatment withe a low dose of oral etretinate but hypertrophic plaques on the scalp and both postauricular areas still remained clinically and histopathologically. We then the treated postauricular hypertrophic plaques with CO2 laser vaporization and severe malodor with oral isotretinoin and it resulted in a marked improvement.
Subject(s)
Humans , Male , Middle Aged , Acitretin , Axilla , Darier Disease , Epidermis , Etretinate , Fingers , Forehead , Groin , Isotretinoin , Lasers, Gas , Pruritus , Scalp , Sensation , VolatilizationABSTRACT
Even though malignant potential of vaginal intraepithelial neoplasia(VaIN) may be low, the prevalence is increasing and the mean age at diagnosis is decreasing. Various treatment options have been used for the eradication of ValN, but most effective standard protocol is not present because it is a rare disease. Laser vaporization was used to treat 7 patients with VaIN diagnosed at Department of Obstetrics and Gynecology, Seoul National University Hospital between 1992 to 1996. The patients were from 40 to 70 years of age with a mean 57 of years. All patients had a history of radical or simple hysterectomy, and final pathologic diagnosis were as follows : cervical cancer(n=5), cervical intraepithelial neoplasia(n=l), leiomyoma(n=l). Vaginal intrae-pithelial neoplasia(VaIN) was identified between 4 months and 8 years after first operation. All lesions were unifocal disease and found at the upper one third of the vagina. Treatment was performed with a CO2 laser unit and colposcope. Four(57%) out of seven patients had general anesthesia for the purpose of treatment. Patients were followed up for an average of 16.8 months with regular cytologic evaluation, colposcopy and biopsy. Failure of therapy was defined as evidence of intraepithelial neoplasia in any one of these three parameters. Only one patients showed persistent disease and the others remain free of disease. The success rate of therapy was 85.7%(6/7). (continue)