ABSTRACT
PURPOSE: To report the results of a randomized controlled trial comparing outcomes between medium power (MP) and high power (HP) laser settings for HoLEPs. METHODS: The primary objective was to compare the enucleation efficiency (EE) of HP- HoLEP (80-100 W) with MP-HoLEP (50 - 60 W). The secondary objectives were to compare treatment efficacy and safety between both groups. To show a 25% difference in EE, a sample size of 45 individuals per treatment arm was required (alpha = 0.05; Beta = 0.80). Patients demographic and perioperative factors were analyzed, including EE, hemoglobin drop, duration of catheterization, and length of hospital stay. The surgical outcome was evaluated with AUA symptom score, maximum flow rate, postvoid residual urine, and complications to assess differences between MP and HP HoLEP at baseline, 3 months, 1, and 5 years. Quantitative outcomes were compared with independent sample t tests (2-tailed) and qualitative outcomes were compared with chi-square tests. RESULTS: Preoperative data with the exception of indication for surgery were comparable in both treatment arms. There was no statistically significant difference in enucleation efficiency between the HP-HoLEP and MP-HoLEP laser setting (0.97 ± 0.47 vs. 0.85 ± 0.47 gm/min, p = 0.209). MP laser settings did not increase perioperative or postoperative complications and resulted in durable outcome comparable with HP laser settings at 5-year follow-up. CONCLUSIONS: MP-HoLEP is safe and efficient and does not compromise the outcome for HoLEPs when compared with HP-HoLEP.
Subject(s)
Laser Therapy , Lasers, Solid-State , Postoperative Complications , Prostate , Prostatic Hyperplasia , Aged , Humans , Laser Therapy/adverse effects , Laser Therapy/instrumentation , Laser Therapy/methods , Lasers, Solid-State/classification , Lasers, Solid-State/therapeutic use , Length of Stay/statistics & numerical data , Male , Middle Aged , Organ Size , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Prostate/diagnostic imaging , Prostate/pathology , Prostate-Specific Antigen/analysis , Prostatic Hyperplasia/blood , Prostatic Hyperplasia/diagnosis , Prostatic Hyperplasia/surgery , Symptom Assessment/methods , Treatment OutcomeABSTRACT
PURPOSE: To perform a bibliometric analysis of lased-based BPH treatment publications and to obtain an understanding of the publication trends over time. MATERIALS AND METHODS: The Medline database was searched for articles in English language regarding laser-based BPH therapy up to 2018. Matching articles were assigned to at least one of the following categories: Ho:YAG, Tm:YAG, green light, diode, Nd:YAG laser and review articles. The laser categories were analysed using bibliometric procedures regarding citation rate, authors, country of origin and journal of publication. Moreover, the articles on laser BPH therapy included in the EAU, AUA and JUA guidelines were analysed to evaluate the most influential articles. RESULTS: In total, 982 articles were included: 317 articles were assigned to green light, 283 to Ho:YAG, 101 to Tm:YAG, 74 to Nd:YAG and 39 to diode lasers. The publication rate for Nd:YAG laser has declined, but continues to grow for Ho:YAG and Tm:YAG lasers. We found a positive correlation between number of authors and year of publication (R = 0.3, p < 0.001*). Articles on Ho:YAG lasers are cited the most (mean 23.0 ± 37.1). Asia has contributed the most articles. Mostly, countries with high health and research and development (R&D) expenditures influenced the guidelines regarding laser-based approaches. Yet, after adjustment of all search results to GDP, health and R&D expenditure, India and China were the most prolific countries. CONCLUSION: Laser-based approaches for BPH treatment are increasing but have not been implemented worldwide. Asia's contribution should be acknowledged. An inflationary trend regarding the number of authors per article is confirmed.
Subject(s)
Laser Therapy , Lasers, Solid-State , Prostatic Hyperplasia/therapy , Publishing , Humans , Internationality , Laser Therapy/instrumentation , Laser Therapy/methods , Laser Therapy/trends , Lasers, Solid-State/classification , Lasers, Solid-State/therapeutic use , MEDLINE/statistics & numerical data , Male , Publishing/statistics & numerical data , Publishing/trendsSubject(s)
Lasers, Solid-State/therapeutic use , Low-Level Light Therapy , Melanosis/radiotherapy , Asian People , Dendritic Cells/radiation effects , Female , Humans , Lasers, Solid-State/adverse effects , Lasers, Solid-State/classification , Low-Level Light Therapy/adverse effects , Melanins/radiation effects , Melanocytes/radiation effects , Microscopy, Confocal , Pain/etiology , Patient SatisfactionABSTRACT
Laser technology has been used in the treatment of BPH for more than 15-20 years in order to challenge transurethral resection of the prostate. The aim of this review article is to analyze the evolution of laser in BPH therapy, from early coagulative techniques - progressively abandoned for their elevated postoperative morbidity and unfavorable outcomes - to the newer techniques of vaporization, resection and enucleation of the prostate. A better comprehension of tissue-laser interactions, the improvement of laser technology and a growing clinical experience have lead to the development of different laser systems (Holmium, KTP, Thulium laser) that challenge TURP. Today, HoLEP and, secondarily, PVP are the laser techniques supported by more clinical evidences and represent valid alternatives to TURP.
Subject(s)
Laser Coagulation , Laser Therapy , Lasers, Solid-State/therapeutic use , Prostatic Hyperplasia/surgery , Transurethral Resection of Prostate/methods , Humans , Laser Coagulation/trends , Laser Therapy/trends , Lasers, Solid-State/classification , Male , Postoperative Complications , Transurethral Resection of Prostate/instrumentation , Transurethral Resection of Prostate/trendsABSTRACT
AIM: To find the optimal techniques and parameters that enables Er:YAG laser to be used successfully for small intraoral soft tissue interventions, in respect to its cutting and coagulation abilities. CASE REPORT: In vitro pre-tests: 4 different Er:YAG laser units and one CO2 unit as the control were used for incision and coagulation on porcine lower jaws and optimal parameters were established for each type of intervention and each laser unit: energy, frequency, type, pulse duration and distance. CASE SERIES: 3 different types of intervention using Er:YAG units are presented: crown lengthening, gingivoplasty and maxillary labial frenectomy with parameters found in the in vitro pre-tests. RESULTS: The results showed a great decrease of the EMG activity of masseter and anterior temporalis muscles. Moreover, the height and width of the chewing cycles in the frontal plane increased after therapy. CONCLUSION: Er:YAG is able to provide good cutting and coagulation effects on soft tissues. Specific parameters have to be defined for each laser unit in order to obtain the desired effect. Reduced or absent water spray, defocused light beam, local anaesthesia and the most effective use of long pulses are methods to obtain optimal coagulation and bleeding control.
