ABSTRACT
BACKGROUND: Prostate-specific antigen (PSA) variations after photoselective vaporization of the prostate are an unsolved question. PATIENTS AND METHODS: We included prospectively 323 patients who underwent GreenLight® prostate vaporization for prostatic hyperplasia between 2005 and 2013. We excluded patients with prostate cancer and those with concomitant prostate biopsies. Serum PSA levels were measured before and after the procedure at 1, 6, 12, 24, 36, and 48 months. RESULTS: The median preoperative PSA level was 4.50 ng/mL; it decreased to 2.41 ng/mL at 1 month (47% reduction), 2.17 ng/mL at 6 months (52% reduction), 2.30 ng/mL at 1 year (49% reduction), 2.40 ng/mL at 2 years (47% reduction), 2.31 ng/mL at 3 years (49% reduction), and 2.54 ng/mL at 4 years (44% reduction) (P values were all <0.0001). The median PSA nadir at 6 months was significantly different from the median PSA level at 1, 2, 3, and 4 years (respectively P=0.0046, P=0.0017, P=0.0006, and P=0.01). Patients who received ≤3000 J/cc had a significant trend to a PSA reascension after 6 months. Patients who received ≥4000 J/cc did not show any significant PSA reascension during the 4 years after procedure. Energy was correlated with the PSA reascension in univariate and multivariate analysis. CONCLUSIONS: The PSA level significantly decreased by half 1 month after the procedure, reached its nadir at 6 months, and showed a slight progressive reascension during the 4 following years. Applying an energy rate ≥4000 J/cc of prostate induced PSA stability over time whereas energy ≤3000 J/cc induced a reascension of the PSA level after 6 months.
Subject(s)
Laser Therapy/methods , Prostate-Specific Antigen/blood , Prostate/pathology , Prostatic Hyperplasia/surgery , Aged , Aged, 80 and over , Biomarkers/blood , Biopsy , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Prospective Studies , Prostate/surgery , Prostatic Hyperplasia/blood , Prostatic Hyperplasia/pathology , VolatilizationABSTRACT
Lumbar ureteral benign stenosis can be managed by laparoscopy. Prevention of repeat strictures after ureteral anastomosis includes the placement of a ureteral catheter. When laparoscopy is used to perform the anastomosis, a second position is needed to insert the Double J stent. We provide a way to place the double pigtail ureteral catheter only using laparoscopy.
