Feasibility and safety of prostatic vaporization using 180W greenlight system in day surgery mode / 中华泌尿外科杂志

Objective To evaluate the feasibility and safety of 180W greenlight laser in the treatment of benign prostatic hyperplasia (BPH) in the day surgery mode.Methods A retrospective review included 65 patients with benign prostate hyperplasia who were treated with photoselective vaporization of the prostate (PVP) under 180W greenlight system from Jan 2017 to Jan 2018,was performed.The patients' age ranged from 54 to 75 years old and the prostatic volume ranged from 42 to 93 ml.All patients were classified into two groups [day sugery group (n =29) and inpatient surgery group(n =36)] based on the wishes of patients.In day sugery group,the admission,operation and discharge were completed in 24 hours.The preoperative clinic parameters such as prostate volume,IPSS,Qmax QOL and PVR were recorded in the two groups.The prostatic volume in two groups was (67.3 ± 15.9) ml and (70.4 ± 16.1) ml,respectively.The IPSS and QOL scores in two groups were (23.2±4.6 vs.23.9±4.5) and (4.7±0.9 vs.4.4± 0.8),respectively.The Q and PVR in two groups were [(6.7 ± 2.5) ml/s vs.(6.8 ± 2.8) ml/s] and [(133.9 ± 81.3) ml vs.(105.8 ± 76.3) ml],respectively.The time of catheterization and postoperative hospitalization,total cost,postoperative adverse events were recorded,too.All the clinic data of preoperation,intraoperation and postoperation were compared between two groups.Results The operations and follow-up were successfully executed in all patients.There were not statistical significance differences in preoperative parameters between the two groups (P ＞ 0.05).There were not statistical significance differences in operating time [(67.8 ± 9.8) min vs.(70.9 ± 12.8) min],laser time [(49.8 ± 8.3) min vs.(51.6±10.4) min],energy used [(295.7±112.6) kJ vs.(285.0±108.2) kJ],between the two groups,too (P ＞ 0.05).A significantly less mean catheter duration,hospital stay and hospital charges were observed in the day surgery group [(14.6 ±2.0)hours,(0.5 ±0) days and (23 279 ±511) yuan,respectively] than in the inpatient surgery group [(51.7 ± 1 1.8) hours,(3.0 ± 0.8) days and (27 452 ± 440)yuan,respectively,P ＜0.05].3 cases of urinary retention and 1 case of gross hematuria after the catheter removal were recorded in the day surgery group,2 cases of urinary retention were recorded in the inpatient surgery group,and all of these 6 cases were cured through indwelling catheter.After 3 months follow up,there were not statistical significant differences io IPSS(12.4 ± 3.3 vs.10.6 ± 4.2),Q [(17.4±2.1)ml/s vs.(17.1 ±1.8) ml/s],and QOL (2.1 ±0.7 vs.2.3±0.7)between the two groups (P ＞ 0.05).However,significant difference of those items could be noticed when compared with those items before surgery (P ＜ 0.05).Conclusions In the day surgery mode,180W greenlight laser vaporization of the prostate is safe and effective,without the increase of surgical complications.The length of stay and hospitalization expenses were much less.Thus,this strategy is worth promoting in clinical practice.

Safety and efficacy of straight light beam greenlight PVRP and PVP in treatment of benign prostatic hyperplasia / 中国内镜杂志

Objective To discuss the safety and efficacy of straight light beam greenlight photoselective vaporesection of the prostate (PVRP) and photoselective vaporization of the prostate (PVP) in treatment of benign prostatic hyperplasia. Methods 113 cases of BPH were randomly divided into two groups, 62 cases in PVRP group and 51cases in PVP group. Clinical data was collected and compared between the two groups, including pre-operation and six month after operation international prostate symptom score (IPSS), quality of life (QOL), urine flow rate (Qmax), postvoid residual urine (PVR), as well as operational time, operative bleeding volume, bladder irrigation time, indwelling catheter time after operation and complications after operation. Results All the patients were operated successfully without serious complications. There was significant difference in operative time [(49.4 ± 18.9) min vs (75.1 ± 20.7) min (P 0.05). Conclusions Treatment of straight light beam greenlight PVRP and PVP are safe and effective for BPH. Straight light beam greenlight PVRP has the advantages of shorter operation time.

Clinical effect of PVBT combined with intraoperative Submucosal multi-point injection of gemcitabine for treating NMIBC / 国际外科学杂志

Objective The clinical effect and prognosis of greenlight photoselective laser vaporization combined with intraoperative submucosa multi-point injection of gemcitabin for the treatment of non muscle-invasive bladder tumors(NMIBC).Methods Selected 105 cases of NMIBC Confirmed by pathology from Mar.2012 to Nov.2013 in Guangzhou General Hosptial of Guangzhou Military Command of PLA urology.Put the patients into three groups randomly.Greenlight photoselective laser vaporization for bladder tumors (PVBT) combined with intraoperative submucosal injection of gemcitabine (PVBT group) 38 cases,Transurethral resection of bladder tumor(TURBT) combined with intraoperative submucosal injection of gemcitabine 25 cases (TURBT group),TURBT combined with immediate postoperative bladder perfusion chemotherapy (Control group)42 cases.Maintain the bladder perfusion chemotherapy after surgery,follow-up of 2 years.To compare and analysis the effect and the prognosis of three ways of operation method,And evaluate the quality of life of three groups of patients after treatment.Results The operation of 105 cases were successful,a total of 31 cases of recurrence,included PVBT group 7 cases (18.4％),TURBT group 6 cases (24％),contrlol group 18 cases (42.9％).Tumor progression of time were 12、10、6 month for the first time.The body function,psychological function,social function and material life of four dimensions scores have no obvious difference Three groups (P ＞ 0.05).Conclusions PVBT combined with intraoperative submucosal multi-point injection of gemcitabine is a kind of simple operation,and reduce the complications and the recurrence of the operation,especially suitable for the lateral wall of superficial tumor and intolerance to TURBT surgery for high-risk patients.It is a new better method of expansion clinical application.

Clinical observation of radical transurethral photoselective vaporization of bladder tumours combined with chemotherapy in treating muscle invasive bladder cancer / 中华泌尿外科杂志

Objective To explore the safety and clinical efficacy of radical transurethral photoselective vaporization of bladder tumours (RPVBT) combined with chemotherapy in the treatment of muscle invasive bladder cancer.Methods Collected during Sept.2010 to Sept.2012,a total of 34 patients with muscle invasive bladder cancer who refuse or older,merge the heavier medical disease,difficult to tolerate radical cystectomy.Using RPVBT,vaporization resection to the bladder wall fat layer,postoperatively systemic chemotherapy of gemcitabine combined cisplatin and bladder perfusion chemotherapy of pharmorubicin.The operation time、the first recurrent time and recurrent rate,and the survival rate were measured.Results Operation are completed smoothly,operating time is 30.5-69.0 min and average 49.2 min,intraoperative rinses quantity is 5.9-10.7 L and average 8.3 L.Intraoperative no obvious bleeding,intraoperative no serioue complications,postoperative pathological diagnosis is invasive epithelial cell carcinoma of the urinary tract,pathology classification:low level 15cases,the high level 19 cases.Followup of 12 to 36 months,an average of 21 months,9 cases of recurrence,2 cases underwent radical cystectomy,7 cases again RPVBT,the first tumor recurrence time 3-20 months,11 months and the median time to relapse recurrence rate 26.5％ (9/34),3 cases of relapses diedof bladder cancer metastasis,31 cases of survival.Conclusion Treatment of RPVBT combination chemotherapy in patients with locally invasive bladder cancer,small trauma,less bleeding,high safety,have certain curative effect,It could be a effective treatment strategy for patients of high-risk elderly or unwilling to accept Radadical cystectomy.

The clinical efficacy of the therapy scheme of green light photoselective vaporization combined testicular resection plus anti-androgen on advanced prostate cancer and bladder outlet obstruction / 中国综合临床

Objective To evaluate the clinical efficacy of green light photoselective vaporization(PVP)combined testicular resection plus anti-androgen treatment on advanced prostate cancer and bladder outlet obstruction.Methods Twenty cases with PVP of advanced prostate cancer and bladder outlet obstruction were selected as our subjects,who underwent PVP testicular resection plus anti-androgen treatment.The clinical information was recorded.Results All patients were succeed through surgery.Maximum urinary flow rate (MFR) at the pre-operation was (2.0 ± 1.0) ml/s,and increased to (14.0 ± 4.5) ml/s after operation.Serum prostate specific antigen (PSA) was decreased from the preoperative (176.5 ± 160.5) μg/L to (2.0 ± 1.0)μg/L International prostate symptom score (IPSS) was from (25.0 ± 5.0) down to (8.0 ± 1.0) points.The quality of life (QOL) score was (4.0 ± 2.0) at pre-operation,higher than after operation (1.0 ± 1.0)points.There were significant differences between preoperative and postoperative (t =9.502,7.371,5.328,8.350,P ＜0.05).Every patient was followed up from 3 to 18 months.The improvements regarding of clinical symptoms were seen including voiding,and all patients survived with tumor.Conclusion Advanced prostate cancer associate with bladder outlet obstruction.The therapy plan of PVP joint testicular resection plus antiandrogen is proved to improve symptoms of urethral obstruction and patient quality of life.

Short-term clinical evaluation of photoselective vaporization of the prostate for the patients with benign hyperplasia of prostate in anti-coagulanting status / 中华泌尿外科杂志

Objective To evaluate the safety and efficacy of the photoselective prostate vaporization (PVP) for the patients of benign hyperplasia of prostate (BPH) with oral anti-coagulant.Methods From September 2008 to May 2010,7 cases of BPH with oral anti-coagulant were treated by PVP,with an average age of 74 years.The prothrombin time before the surgery was (13.14 ± 0.15) s.An 100 W Green-light laser source was applied in this study.The prostate volume,operating time,blood loss,catheter indwelling time after the surgery,hospital stay,PVR,Q IPSS score were recorded.Results The mean operating time was (65 ± 22) min without active bleeding or transfusion in this cohort.The haemoglobulin concentration was intact and catheter indwelling time was (22 ± 8) h,while the hospital stay was (2.7 ± 1.2) d.The PVR,Q IPSS score were significantly improved after follow-up of 1 month (P ＜0.01).One case complicated acute urinary retention after operation in this cohort,and the catheter was removed 4 weeks after α-blocker administration.Conclusions PVP is a safe and effective surgical strategy for BPH patients with oral anti-coagulant.However,since there were relatively limited cases enrolled in this study,more randomized controlled clinical trials are needed in the near future.

Curative effect of green light photoselective vaporization for the treatment of high-risk elder patients with benign prostatic hyperplasia / 中国综合临床

Objective To explore the efficacy and safety of greenlight photoselective vaporization of prostate (PVP) in high-risk elder patients with benign prostatic hyperplasia (BPH). Methods A total of 120 high-risk elder patients with BPH underwent PVP procedure. The operating time, blood 1oss, indwelling catheterization and operation-related complications were monitored. The variables such as international prostate symptom score (IPSS), Quality of life (QOL) score, maximum urinary flow rate (Qmax) and residual urine volume (RUV) were recorded and compared pre- and post-operatively. Results All the 120 patients had a good peri-operative condition. The mean operating time was (52. 6 ± 5.8 )min, intraoperative blood loss was (20.4 ±9.5) ml. Among the 120 cases,26 did not received postoperative catheterization. In the other 94 cases received postoperative catheterization, the mean catheterization time was (24. 5 ± 15.9) hour. IPSS and QOL scores decreased from (28.5 ± 3.8) and (5.0 ± 0.8) preoperatively to (7.2 ± 1.8) and (1.5 ± 0.6)postoperatively. Qmax increased from ( 5.2 ± 3.1 ) ml/s to ( 15.2 ± 4.3 ) ml/s, and RUV decreased from ( 118.6 ± 15.2) ml to ( 16. 5 ± 4. 6) ml. There was significant difference for these parameters before and after the operation (Ps ＜ 0. 05 ). Conclusion The PVP is considered to be a safe, effective and minimally invasive procedure to treat BPHin high-risk elder patients. It is easy to manipulate, with advantages of shorter operating time,less blood loss, better tolerance and rapid recovery, especially for high-risk elder patients with BPH.

Greenlight Photoselective Vaporization of the Prostate for Benign Prostatic Hyperplasia in Aged Patients: A Report of 90 Cases / 中国微创外科杂志

Objective To evaluate the efficacy of greenlight photoselective vaporization of the prostate(PVP) for benign prostatic hyperplasia(BPH) in aged patients.Methods A total of 90 aged patients with BPH underwent PVP with an 80 W KTP laser(Laserscope Company) under sacral or peridural anesthesia.Results The operative time was(42.5?18.4)min;the postoperative urinary catheter time was(2.5?0.8)d.Qmax increased significantly from(4.8?1.2)ml/s preoperatively to(18.6?1.4)ml/s postoperatively(t=22.566,P=0.000).International prostate symptom score decreased from(25.5?2.4)points preoperatively to(13.2?1.9)points postoperatively(t=12.286,P=0.000).Residual urine decreased from(76.3?9.4)ml preoperatively to(16.5?2.4)ml postoperatively(t=21.901,P=0.000).Transient dysuria occurred in 4 cases and postoperative delayed hemorrhage in 2 cases.No urinary incontinence occurred.Conclusions PVP for BPH is a safe and effective procedure,and suitable for aged and high-risk patients with BPH.

Photoselective Vaporization of the Prostate for Benign Prostate Hyperplasia / 中国微创外科杂志

Objective To evaluate the safety and clinical efficacy of photoselective vaporization of the prostate(PVP)for the treatment of benign prostatic hyperplasia(BPH).Methods Under caudal block,650 patients with BPH received PVP.By using the pointer,vaporization was started at the 6 o'clock point at the bladder neck and then extended to the 5 and 7 o'clock points,afterwards,the bilateral lobes of the prostate was involved deep into the prostate capsule.Results Five of the cases(8%)were converted to open surgeries because of large prostate or massive hemorrhage.In the other 645 cases,the mean operation time was(45.6?17.3)min,mean blood loss was(56.3?15.2)ml;none of them received blood transfusion.Urethral catheter was indwelled for(1.8?0.5)d after the operation in 504 cases.All the patients were followed up for 3 to 36 months.Three months after the operation,the IPSS and QOL decreased from(29.8?5.2)and(5.2?0.8)to(8.4?2.3)and(1.4?0.5)respectively in the patients(t=37.635,P=0.000 and t=39.084,P=0.000),RUV decreased from(168.0?22.5)ml to(24.6?5.8)ml(t=42.281,P=0.000),Qmax increased from(5.6?2.8)ml/s to(24.7?3.2)ml/s(t=-28.430,P=0.000),respectively.No urinary incontinence and TUR syndrome occurred in this series.Conclusions PVP,which can yield short operation time,little blood loss,and rapid relief,is safe,simple,and effective for patients with BPH,especially for elder patients.