[Outcome of Photoselective Vaporizaion of the Prostate with 180 W Greenlight XPS™ System for Treatment of Large Prostatic Hyperplasia of at Least 100 Ml].

We report the outcome of photoselective vaporizaion of the prostate (PVP) with the 180W GreenLight XPS™ system (180 W-XPS) for large benign prostatic hyperplasia (BPH) with a prostate volume of ≥100 ml, in comparison with that with the 120 W GreenLight HPS™ system (120 W-HPS). We studied the outcomes of 86 patients who underwent PVP with 180 W-XPS for BPH with a prostate volume of ≥100 ml between February 2019 and October 2021, in comparison with those of 86 patients who underwent PVP with 120 W-HPS. 180 W-XPS significantly improved postoperative international prostate specific score, quality of life score, overactive bladder symptom score, Qmax, and residual urine volume. The operative time was significantly shorter in 180 W-XPS {100.5 min (150-175)}, than in 120 W-HPS {117.5 min (18-189)}, p＜ 0.05), the laser irradiation time was significantly shorter in 180 W-XPS {63.0 min (35-83)}, than in 120 WHPS : {79. 0 min (24-102)} (p ＜0. 05), and the laser fluence was significantly higher in 180 W-XPS {633647J (291991-805011)}, than in 120 W-HPS {396832J (40000-481842)} (p＜0. 05). At 3 and 12 months postoperatively, the prostate volume reduction rates were 59.8 and 66.7%, respectively, for the 180 W-XPS patients which were rates significantly higher than those for the 120 W-HPS patients, 49.5 and 45.0%, respectively. The PSA reduction rates were 58.1 and 53.2％, respectively, which were significantly higher rates than those for the 120 W-HPS patients, 41.3 and 25.7％, respectively. The 180 W-XPS system was considered to be a more effective and efficient treatment than the 120 W-HPS.

[Initial Experience with 180W-XPS Photoselective Vaporization of the Prostate (PVP) for Benign Prostatic Hyperplasia].

We analyzed the perioperative parameters, postoperative urinary status, and complications of 200 patients who underwent photoselective vaporization of the prostate (PVP) with the 180W-X-ray photoelectron spectroscopy (XPS) for benign prostatic hyperplasia at our hospital. In addition, we compared perioperative parameters and complications, as well as the rate of decrease in prostate-specific antigen (PSA) and prostate volume at 3 and 12 months after surgery, with those of the last 200 patients who underwent PVP with the 120W-high-performance system (HPS). The results showed significant differences between methods in operative time (XPS: 67.9±29.0 minutes, HPS: 95.2±32.1 minutes, p＜0.05), laser exposure time (XPS: 41.4±17.8 minutes, HPS: 60.1±19.7 minutes, p＜0.05), and laser dose (XPS: 385,937±180,872, HPS: 300,316±105,528, p＜0.05). In addition, there were significant differences in the rates of decrease in PSA and prostate volume in the 180W-XPS group compared with the 120W-HPS group. The transpiration efficiency of the 180W-XPS was higher than that of the 120W-HPS.

Sedentary behavior is associated with arteriosclerosis in frail older adults.

This prospective, cross-sectional, cohort observational study was conducted to evaluate the associations between sedentary behavior and arteriosclerosis-related vascular issues in community-dwelling frail older adults. We included 116 Japanese community-dwelling older adults (92 females and 24 males) who availed daycare at two long-term care insurance facilities in the cities of Yokkaichi and Handa between 2017 and 2019. An unpaired t-test and the chi-square test were used for intergroup comparisons. Logistic regression analysis was conducted with cardio-ankle vascular index as the dependent variable, sedentary behavior as the explanatory variable, and the other evaluated factors as covariates. Long-time sedentary behavior (based on the median value for all participants) was associated with high cardio-ankle vascular index after adjusting for age, sex, body mass index, ankle-brachial index, and walking MET-minutes in 1 week (odds ratio 3.086, 95% confidence interval 1.275-7.467, p=0.012). After adjusting for other variables (care needs certificate, skeletal muscle mass index, body fat percentage, grip strength, 4-m walking duration, etc), there was a significant association between long-time sedentary behavior and high cardio-ankle vascular index values (odds ratio 4.977, 95% confidence interval 1.497-16.554, p=0.009). The results study confirmed an association between long-time sedentary behavior in frail older adults and the degree of arterial stiffness assessed by the cardio-ankle vascular index. Interventions in older adults that focus on daily sedentary time to prevent the onset and exacerbation of geriatric syndromes secondary to the progression of arteriosclerosis warrant further investigation.

Optimal Monitoring of Prostate-Specific Antigen Detects Prostate Cancer at the Localized Stage after Photoselective Vaporization for Benign Prostatic Hyperplasia.

INTRODUCTION: Photoselective vaporization of the prostate (PVP) does not provide prostate tissue for pathologic analysis. Here, we carried out early monitoring for prostate cancer by measuring prostate-specific antigen (PSA) levels and assessing clinicopathological features after PVP. MATERIALS AND METHODS: Patients (n = 800) who underwent PVP and were followed-up for more than 12 months were analyzed retrospectively. After PVP, PSA levels were measured at 3 and 12 months and each year thereafter. Prostate biopsies were performed when PSA levels increased continuously. We assessed the characteristics of patients diagnosed with prostate cancer. RESULTS: The mean follow-up period was 49 months. After PVP, 54 patients underwent biopsies, and 23 patients were diagnosed with prostate cancer. Overall, 10, 10, and 3 patients had clinical stage T1c, T2a, and T2b disease, respectively, and there were no cases of stage T2c disease or greater. CONCLUSIONS: We found that it was possible to diagnose prostate cancer at a localized stage under our optimal PSA monitoring schedule before and after PVP.

Photoselective Vaporization of the Prostate: Long-Term Outcomes and Safety During 10 Years of Follow-Up.

PURPOSE: To evaluate the long-term outcomes and safety photoselective vaporization of the prostate (PVP). PATIENTS AND METHODS: From April 2005 to December 2015, a total of 1154 patients with benign prostatic hyperplasia underwent PVP. The type of Green Light laser was an 80 W potassium-titanyl-phosphate laser and later a 120 W lithium triborate laser. Before and after surgery, the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post-voiding volume of residual urine (PVR), prostate-specific antigen (PSA) level, and prostate volume were assessed regularly. After surgery, events such as second PVP, transurethral incision, and permanent urethral catheterization were defined as retreatment. RESULTS: The mean and median periods of follow-up after PVP were 35.4 and 24.0 months, respectively. The maximum duration of follow-up was 125 months. Compared with before surgery, the IPSS, quality of life score, and PSA concentration improved significantly, even at 10 years after PVP; however, Qmax and PVR were not improved at 10 years. The retreatment-free survival rate was 93.9% at 5 years and 79.0% at 10 years. Prostate cancer was found in 27 cases after PVP, and all patients who were found to have prostate cancer remained alive. Prostate cancer-free survival after PVP was 96.7% at 5 years and 89.4% at 10 years. CONCLUSION: Our data suggest that the efficacy of PVP was maintained for 10 years; however, it may decrease after more than 10 years. PVP also did not promote the progression of or worsen the prognosis of prostate cancer.

[A case of large vesicourethral stone resulting from long-term retention of a Foley catheter].

We report a case of a large vesicourethral stone resulting from a long-term indwelling urethral catheter. A 66-year-old man visited our hospital emergency room on October 24, 2006 with a chief complaint of difficult urination. Although a urethral catheter was inserted temporarily based on the diagnosis of the doctor on duty, the patient did not return to our hospital for follow-up examination. On July 10, 2008, he was wheeled into our hospital with symptoms of general fatigue, urinary retention and post-renal failure due to urethral catheter obstruction. The catheter was undisturbed, and computed tomography revealed a large bladder stone that extended along the lines of the catheter. A cystostomy was established, and after renal function had recovered, the bladder stone was completely removed via laparotomy following the transurethral approach. The stone consisted of magnesium ammonium phosphate and calcium phosphate. It was concluded that the stone was closely related to a urinary tract infection caused by a Proteus strain. We discuss this unusual case, which is characterized by the stone size and the clinical course.

[Safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients with oral anticoagulant therapy].

We investigated the safety and efficacy of photoselective vaporization of the prostate (PVP) in 318 men who had lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia with or without oral anticoagulant therapy (OAT). PVP was done using an 80 W potassium titanyl phosphate (KTP) laser under general or spinal anesthesia. We evaluated perioperative parameters, functional outcome (international prostate symptom score, quality of life score, maximum flow rate, postvoid residual urine volume), and adverse events up to 3 months postoperatively. The results in 51 patients under OAT (the group includes 6 men ongoing oral anticoagulants during the procedure) were compared with those obtained in 267 men who underwent PVP for the same indication but who were not under OAT (control). KTP laser vaporization was successfully performed on all patients. There was minimal blood loss, thus none of the patients needed a blood transfusion. No major complications occurred intraoperatively or postoperatively. In patients under OAT, the international prostate symptom score, quality of life score, maximum flow rate and postvoid residual urine volume were significantly improved from preoperative data (p < 0.05), and were comparable with the control. Although postoperative gross hematuria increased with resumption of OAT, PVP using 80 W KTP laser proved to be safe and effective for men who were taking oral anticoagulant medication.

Photoselective vaporization of the prostate using high power (80 W) KTP laser: one year follow up of the first 101 patients in Japan.

OBJECTIVES: We present one year observations on Photoselective Vaporization of the Prostate (PVP) of 101 men with benign prostatic hyperplasia (BPH) to investigate its safety and efficacy. METHODS: 101 patients underwent Photoselective Vaporization of the Prostate (PVP) using 80 W Potassium-titanyl-phosphate (KTP) laser 17 patients were being treated with oral anticoagulant therapy, and anticoagulants were stopped before operation. Baseline characteristics, perioperative data, adverse events and postoperative outcome were evaluated immediate postoperatively, and at 2 weeks and 1, 3, 6 and 12 months postoperatively were recorded. RESULTS: With all 101 patients KTP laser vaporization was performed successfully. There was minimal blood loss and none of patients need blood transfusion. No major complication occurred intraoperatively or postoperatively. At 1, 3, 6, and 12 months mean International Prostate Symptom Score index (IPSS) decreased from 20.3 preoperatively to 8.9, 6.9, 6.2 and 7.2. Mean QQL score decreased from 5.1 to 2.3, 1.7, 1.5 and 1.6. Mean urinary peak flow increased from 7.5 ml per second to 15.6, 16.7 16.7 and 16.7 respectively. Complication was mild, included transient dysuria (8.9%). CONCLUSIONS: Photoselective vaporization of the prostate (PVP) using 80W Potassium-titanyl-phosphate (KTP) laser for benign prostatic hyperplasia (BPH) proved to be an effective and safe procedure for our patients including those treated with oral anticoagulants.

[Photoselective vaporization of the prostate (PVP) using 80 watt high power potassium-titanyl-phosphate (KTP) laser for benign prostatic hyperplasia: the first fifty-seven patients in Japan].

OBJECTIVE: To assess the safety and efficacy of photoselective vaporization of the prostate (PVP) using 80 watt high power potassium-titanyl-phosphate (KTP) laser for benign prostatic hyperplasia (BPH). METHODS: Fifty-seven patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia underwent 80 W KTP laser vaporization of the prostate. According to their International Prostate Symptom Score Index (IPSS) and Quality of life (QOL) score as well as measurements of their peak flow rate and postvoiding residual urine volume (RUV), they fulfilled the diagnostic criteria of BPH. Vaporization was performed with the GreenLight PV ADDStat fiber, which was inserted through a 22.5Fr. continuous flow laser cystoscope, and a saline solution was used for irrigation. KTP laser energy was generated by a GreenLight PV (Minnetonka, Minnesota) generator. The end point of the procedure was to create a cavity like in TURP. Once vaporization was completed, an18Fr Foley catheter was inserted and was removed the next morning, as a rule. Patients were evaluated preoperatively, and at 2 weeks and 1, 3 and 6 months postoperatively. RESULTS: The procedure could be performed without any intraoperative complication. None of the patients required continuous bladder irrigation or blood transfusion postoperatively. The mean age was 71.0 +/- 8.3 years (range 52 to 86). The preoperative prostate volume was 41.0 +/- 24.9 (mean +/- SD, range 6.7 to 107.2) and the preoperative serum PSA was 4.5 +/- 4.1 ng/ml. Preoperative and immediate postoperative serum sodium concentration was 141.9 +/- 1.8 mEq/L and 142.2 +/- 1.8 mEq/L, respectively (p = 0.23). The hemoglobin value changed from 14.0 +/- 1.4 mg/dl preoperatively to 13.4 +/- 1.4 mg/dl postoperatively. The operating time was 68.3 +/- 35.0 minutes (range 21 to 170) and total laser energy was 171.1 +/- 80.3 kJ (range 18.1 to 484.8). The catheter indwelling time was 18.6 +/- 3.3 hrs (range 15 to 48). At 2 weeks and 1, 3 and 6 months the International Prostate Symptom Score decreased from 20.2 +/- 8.9 to 11.4 +/- 7.8, 9.3 +/- 6.0, 6.6 +/- 5.0 and 6.1 +/- 5.0, respectively. The maximum urinary flow increased from 7.2 +/- 2.9 mL/s to 13.6 +/- 7.6, 12.2 +/- 6.1, 15.3 +/- 7.4, and 15.3 +/- 7.5 mL/s, respectively. CONCLUSIONS: Photoselective vaporization of the prostate (PVP) using the high power (80 W) potassium-titanyl-phosphate laser for benign prostatic hyperplasia (BPH) proved to be an effective and safe procedure for our patients.

Immunization with recombinant Calmette-Guerin bacillus (BCG)-hepatitis C virus (HCV) elicits HCV-specific cytotoxic T lymphocytes in mice.

Since virus-specific cytotoxic T lymphocytes (CTLs) play a critical role in preventing the spread of hepatitis C virus (HCV), an effective HCV vaccine should be capable of eliciting HCV-specific CTLs. In the present study, we assessed the capability of a novel recombinant vaccine using an attenuated tuberculosis bacillus, Calmette-Guerin bacillus (BCG), as a vaccine vehicle to elicit HCV-specific CTLs. BCG was engineered to express the CTL epitope of HCV-non-structure protein 5a (NS5a) as a chimeric protein with alpha antigen of mycobacteria. Immunization with this recombinant BCG elicited major histocompatibility complex class I-restricted CD8(+) HCV-NS5a-specific CTLs in mice. Immunized mice showed a substantial reduction in the vaccinia virus titer compared with control mice when the immunized mice were challenged with a recombinant vaccinia virus expressing HCV-NS5a genes. These findings provide evidences for the possibility of BCG as a vaccine vector and its continued exploration as a vehicle for eliciting HCV-specific immunity.