Effects of the School-Based Integrated Health Promotion Program With Hydroponic Planting on Green Space Use and Satisfaction, Dietary Habits, and Mental Health in Early Adolescent Students: A Feasibility Quasi-Experiment.

Background: School-based green space activities have been found to be beneficial to the physical activity level and lifestyle habits of adolescent students. However, their effects on green space use and satisfaction, mental health, and dietary behaviors required further investigation. This study aimed to investigate the effects of school-based hydroponic planting integrated with health promotion activities in improving green space use, competence and satisfaction, healthy lifestyle, mental health, and health-related quality of life (QoL) among early adolescent students in secondary schools. Methods: This study adopted a three-group comparison design (one control and two intervention groups). Secondary school students (N = 553) of grades 7-9 participated in either (1) hydroponic planting (two times per week for 8 months) integrated with health promotion activities; (2) only health promotion activities (one time per week for 6 weeks); or (3) control group. Outcomes assessed by questionnaire included green space use and satisfaction, life happiness, lifestyle, depressive symptoms, and health-related QoL. Results: After adjusting for sex and school grade, the scores in "green space distance and use" and "green space activity and competence" were significantly better in the intervention groups than in the control group. Hydroponic planting integrated with health promotion activities was also associated with better scores in dietary habits and resistance to substance use. Intervention groups had a higher score in "Green space sense and satisfaction" and life happiness when compared with the control group. Conclusions: Our study shows that the school-based hydroponic planting integrated with health promotion activities were feasible and, to a certain extent, useful to improve green space use and competence, dietary habits, and resistance to substance use among early adolescent students in secondary schools in urban areas. Future studies should address the limitations identified, for example, designing a randomized controlled trial that could fit school schedules to generate new evidence for physical and mental health in adolescent communities.

Risks and Benefits of Postoperative Double-J Stent Placement After Ureteroscopy: Results from the Clinical Research Office of Endourological Society Ureteroscopy Global Study.

PURPOSE: Double-J stent placement after stone removal by ureteroscopy (URS) is common and recommended in many cases but debatable in others. In this study, the risks and benefits of postoperative Double-J stent placement in URS stone treatment procedures undertaken in current clinical practice are examined. MATERIALS AND METHODS: The Clinical Research Office of Endourological Society (CROES) URS is a prospective, observational, international multicenter study, in which patients are candidates for URS as primary treatment or after failure of prior treatment for ureteral and renal stones. Baseline, intraoperative, and postoperative data were collected. Predictors and outcomes of postoperative stent placement were analyzed by inverse probability-weighted regression adjustment of the relationship between a Double-J stent placement and outcomes (complications, readmission [including retreatment], and length of hospital stay). RESULTS: Significant predictors of postoperative Double-J stent placement in URS treatment of ureteral stones were intraoperative complications, impacted stones, operation time, stone burden, age, presence of a solitary kidney, and stone-free rate. In renal stone treatment, the predictors identified included operation time, age, preoperative stent placement, anticoagulant use, presence of a solitary kidney, and intraoperative complications. In both ureteral and renal stone treatment groups, postoperative placement of a Double-J stent resulted in significantly fewer postoperative complications (p < 0.001) compared with patients who did not receive a stent. CONCLUSIONS: Patient- and procedure-related variables were identified, which may enable an individualized approach to postoperative stenting, resulting in improved clinical outcomes in urologic stone treatment by URS.

Clinical Research Office of the Endourological Society Global GreenLight Laser Study: Outcomes from a contemporary series of 713 patients.

OBJECTIVE: To evaluate the outcome in patients undergoing photoselective vaporization of the prostate for benign prostatic obstruction as part of the Clinical Research Office of the Endourological Society Global GreenLight Laser Study. METHODS: Data were collected on 713 patients with lower urinary tract symptoms suggestive of benign prostatic obstruction undergoing photoselective vaporization of the prostate at 25 centers worldwide, between April 2010 and April 2012. Three types of GreenLight laser powers were used: 80 W, 120 W or 180 W. Intraoperative and postoperative complications were recorded. Outcome parameters measured at baseline, 6-12 weeks, 6 months and 12 months were: uroflow measurements, International Prostate Symptom Score; prostate-specific antigen and International Index of Erectile Function. RESULTS: Operating time was shortest with the 180-W laser at 53.8 min. Intraoperatively, bleeding occurred in 3.1% of patients. Statistically significant changes were reported in maximum flow rate, postvoid residual urine, International Prostate Symptom Score, quality of life score and prostate-specific antigen (P < 0.01) at each time-point assessed for the 80- and 120-W lasers as well as for the 180-W laser, with the exception of prostate-specific antigen at 6 months and 12 months. There were 14 Clavien-Dindo grade III-A complications and two grade III-B. The incontinence rate at 12 months was 6.3%, 4.5%, and 2.6% for the 80, 120 and 180 W lasers, respectively. The overall blood transfusion rate was 0.4%. CONCLUSIONS: Objective and subjective improvement after GreenLight laser treatment worldwide was significant at 1-year follow up. Morbidity and complications were low. Although not a randomized control study, the data can provide an indication of the outcome of the different GreenLight laser powers.

Continence outcomes after bladder neck preservation during robot-assisted laparoscopic prostatectomy (RALP).

PURPOSE: Urinary incontinence is one of the major prostate cancer treatment-related morbidities. We review our initial robot-assisted laparoscopic prostatectomy (RALP) experience, focusing on post-surgery continence rates. MATERIAL AND METHODS: Two-hundred and thirty-three consecutive patients were identified from a prospectively maintained RALP database. A bladder neck sparing dissection was preferentially performed during transperitoneal RALP. On postoperative day 5 or 6 (clinic logistics), the urethral catheter was removed following a normal cystogram. RESULTS: Median operative time was 190 minutes and estimated blood loss was 75 mL. Three (1.3%) patients required bladder neck reconstruction, while 198 (85.0%) had bilateral, 20 (8.6%) had unilateral and 15 (6.4%) did not undergo nerve sparing prostatectomy. One-hundred and ninety-nine (85.4%) patients had negative surgical margins. Median hospitalization and urethral catheter duration were 1.0 and 5.0 days, respectively. At six weeks, a median 1.0 pad per day usage was reported and mean AUASS and QoL were significantly improved from baseline (p < 0.05). Of the 220 patients having a minimum three-month follow-up, 152 (69.1%) achieved urinary continence without pads. Age, AUASS, QoL, prostate volume and prior TUR surgery independently had significant impact on early continence rate (p < 0.05). CONCLUSION: A bladder neck sparing dissection allows for early return of urinary continence following RALP without compromising cancer control.

Does elevated body mass index (BMI) affect the clinical outcomes of robot-assisted laparoscopic prostatectomy (RALP): a prospective cohort study.

OBJECTIVES: With the prevalence of obesity in the United States, a significant proportion of robot-assisted laparoscopic prostatectomy (RALP) candidates have an elevated body mass index (BMI). We determine if this impacts on the clinical outcomes of RALP. METHODS: 218 consecutive patients underwent RALP were identified from a prospectively maintained RALP database recorded and compared for their demographics, clinical outcomes and adverse events in normal weight (BMI <25 kg/m(2)), overweight (BMI ≥25 and <30 kg/m(2)) and obese (BMI ≥30 kg/m(2)) groups. RESULTS: 36 normal weight, 115 overweight and 67 obese patients were identified. There were no significant differences in demographic data among the three groups except for mean BMI (23.1 vs. 27.5 vs. 32.8 kg/m(2), p < 0.001). The median operative time was longer in obese patients compared to both overweight (210 vs. 189 min, p = 0.031) and normal weight (210 vs. 177 min, p = 0.008) patients. There were no significant differences in median estimated blood loss, mean prostate volume, positive surgical margin rate and time to continence without pads. The median urethral catheter duration and hospitalization were similar in all groups. Patients with elevated BMI had a significantly higher median Gleason score (p = 0.046) and incidence of pathologic T3 disease (p = 0.038). The incidence of adverse events was low and there were no significant differences among the three groups (p > 0.05). CONCLUSIONS: Elevated BMI appears to increase the RALP operative time, but has little impact on other intraoperative parameters, clinical outcomes or patient morbidity. RALP is a safe and effective procedure in patients with elevated BMI.

Does prostate configuration affect the efficacy and safety of GreenLight HPS™ laser photoselective vaporization prostatectomy (PVP)?

We evaluate the efficacy and safety of GreenLight HPS™ laser photoselective vaporization prostatectomy (PVP) for the treatment of benign prostatic hyperplasia (BPH) with different prostate configuration. Patients were stratified into two groups: bilobe (group I) and trilobe (group II) BPH. Transurethral PVP was performed using a 120 W GreenLight HPS™ side-firing laser system. American Urological Association Symptom Score (AUASS), Quality of Life (QoL) score, maximum flow rate (Q max), and postvoid residual (PVR) were measured preoperatively and at 1 and 4 weeks and 3, 6, 12, 18, 24 and 36 months postoperatively. A number of 160 consecutive patients were identified (I: 86, II: 74). Among the preoperative parameters, there were significant differences (p < 0.05) in prostate volume (I: 46.0 ± 19.8; II: 87.5 ± 39.6 ml), Q max (I: 9.9 ± 3.9; II: 8.7 ± 3.5 ml/sec), PVR (I: 59.2 ± 124.6; II: 97.7 ± 119.1 ml) and PSA (I: 1.4 ± 1.4; II: 3.6 ± 2.6 ng/ml), while AUASS and QoL were similar (p > 0.05). Significant differences (p < 0.05) in laser utilization (I: 9.5 ± 6.6; II: 19.5 ± 11.6 min) and energy usage (I: 63.1 ± 43.9; II: 132.5 ± 81.1 kJ) were noted. Clinical outcomes (AUASS, QoL, Q max, and PVR) showed immediate and stable improvement from baseline (p < 0.05) within each group, but no significant differences between the two groups were observed during the follow-up period (p > 0.05). The incidences of adverse events were low and similar in both groups. Our experience suggests that BPH configuration has little effect on the efficacy and safety of GreenLight HPS™ laser PVP.

Factors that impact the outcome of minimally invasive pyeloplasty: results of the Multi-institutional Laparoscopic and Robotic Pyeloplasty Collaborative Group.

PURPOSE: We compared laparoscopic and robotic pyeloplasty to identify factors associated with procedural efficacy. MATERIALS AND METHODS: We conducted a retrospective multicenter trial incorporating 865 cases from 15 centers. We collected perioperative data including anatomical and procedural factors. Failure was defined subjectively as pain that was unchanged or worse per medical records after surgery. Radiographic failure was defined as unchanged or worsening drainage on renal scans or worsening hydronephrosis on computerized tomography. Bivariate analyses were performed on all outcomes and multivariate analysis was used to assess factors associated with decreased freedom from secondary procedures. RESULTS: Of the cases 759 (274 laparoscopic pyeloplasties with a mean followup of 15 months and 465 robotic pyeloplasties with a mean followup of 11 months, p <0.001) had sufficient data. Laparoscopic pyeloplasty, previous endopyelotomy and intraoperative crossing vessels were associated with decreased freedom from secondary procedures on bivariate analysis, with a 2-year freedom from secondary procedures of 87% for laparoscopic pyeloplasty vs 95% for robotic pyeloplasty, 81% vs 93% for patients with vs without previous endopyelotomy and 88% vs 95% for patients with vs without intraoperative crossing vessels, respectively. However, on multivariate analysis only previous endopyelotomy (HR 4.35) and intraoperative crossing vessels (HR 2.73) significantly impacted freedom from secondary procedures. CONCLUSIONS: Laparoscopic and robotic pyeloplasty are highly effective in treating ureteropelvic junction obstruction. There was no difference in their abilities to render the patient free from secondary procedures on multivariate analysis. Previous endopyelotomy and intraoperative crossing vessels reduced freedom from secondary procedures.

Does age affect the efficacy and safety of GreenLight HPS™ laser photoselective vaporization prostatectomy?

BACKGROUND: To evaluate the efficacy and safety of GreenLight HPS(™) (High Performance System) laser photoselective vaporization prostatectomy (PVP) for the treatment of benign prostatic hyperplasia (BPH) in patients of different age groups. METHODS: 164 consecutive patients were stratified into two groups: age <70 (group I, n = 93) and age ≥70 (group II, n = 71) years. Transurethral PVP was performed using a GreenLight HPS™ side-firing laser system. Voiding parameters were measured preoperatively and at 1 and 4 weeks and 3, 6, 12, 18, 24 and 36 months postoperatively. RESULTS: Among the preoperative parameters evaluated, there were significant differences (p < 0.05) in prostate volume (I: 58.7; II: 73.6 mL) and serum prostate-specific antigen (I: 1.9; II: 2.9 ng/mL), while American Urological Association Symptom Score (AUASS), Quality of Life (QoL), maximum flow rate (Qmax), Sexual Health Inventory for Men (SHIM) and post void residual (PVR) were similar (p > 0.05) between groups. No significant differences in laser utilization, energy usage and operating time were noted. Clinical outcomes (AUASS, QoL, Qmax, PVR) showed immediate and stable improvement from baseline (p < 0.05) within each group, but no significant differences between the two groups were observed during the follow-up period. The incidence of adverse events was low and similar in both groups. CONCLUSIONS: The results suggest that age has little effect on the efficacy and safety of GreenLight HPS™ laser PVP.

Does size really matter? The impact of prostate volume on the efficacy and safety of GreenLight HPS™ laser photoselective vaporization of the prostate.

PURPOSE: To evaluate the efficacy and safety of GreenLight HPS™ laser photoselective vaporization of the prostate (PVP) for the treatment of benign prostatic hyperplasia (BPH) in patients with different prostate volumes. PATIENTS AND METHODS: Between July 2006 and February 2011, 207 consecutive patients were identified from a prospectively maintained urologic database. Based on preoperative prostate volume measured by transrectal ultrasonography, patients were stratified into two groups: ≥ 80 cc (group 1, n=57) and < 80 cc (group 2, n=150). Transurethral PVP was performed using a 120W GreenLight HPS side-firing laser system. American Urological Association Symptom Score (AUASS), quality-of-life (QoL) score, maximum flow rate (Qmax), and postvoid residual (PVR) volume were measured preoperatively and at 1 and 4 weeks and 3, 6, 12, 18, 24, and 36 months postoperatively. RESULTS: Among the preoperative parameters evaluated, there were significant differences (P<0.05) in the incidence of preoperative urinary retention (1: 24.6%; 2: 7.3%), serum prostate-specific antigen level (1: 4.5 ± 2.7; 2: 1.8 ± 1.9 ng/mL), QoL (1: 4.2 ± 1.1; 2: 4.7 ± 0.9), and mean prostate volume (1: 118.1 ± 37.9; 2: 48.5 ± 15.5 cc), while AUASS, Qmax, and PVR were similar (P>0.05) between groups. Significant differences (P<0.05) in laser use (1: 22.8 ± 13.3; 2: 10.4 ± 6.4 minutes) and energy usage (1: 152.7 ± 90.6; 2: 70.9 ± 44.8 kJ) were also noted. Clinical outcomes (AUASS, QoL, Qmax, and PVR) showed immediate and stable improvement from baseline (P<0.05) within each group, but no significant differences between the two groups were observed during the follow-up period (P>0.05). The incidence of adverse events was low and similar in both cohorts. CONCLUSIONS: These results suggest that prostate volume has little effect on the efficacy and safety of GreenLight HPS laser PVP, and that this technique remains a viable surgical option for BPH, irrespective of preoperative prostate volume.

Hand-assisted laparoscopic nephroureterectomy with cystoscopic en-bloc excision of the distal ureter and bladder cuff and isthmusectomy in a horseshoe kidney for invasive urothelial carcinoma of the renal pelvis.

Upper tract invasive urothelial carcinoma and horseshoe kidneys are familiar to the practicing urologist but relatively rare individual entities. The complication of managing them when they coexist in the same patient can be challenging. Herein, we present the first reported case in which an upper tract invasive urothelial carcinoma in a horseshoe kidney was successfully managed with a combined hand-assisted laparoscopic nephroureterectomy and isthmusectomy with cystoscopic en-bloc excision of the distal ureter and bladder cuff. This highlights the fact that complex anatomy can be managed in a completely minimally invasive fashion, and sound oncologic principles can still be maintained.

Selective renal parenchymal clamping in robot-assisted laparoscopic partial nephrectomy: a multi-institutional experience.

PURPOSE: We describe our multi-institutional experience using a laparoscopic clamp to induce selective regional ischemia during robot-assisted laparoscopic partial nephrectomy (RALPN) without hilar occlusion. PATIENTS AND METHODS: A retrospective review of Institutional Revew Board-approved databases of patients who underwent selective regional clamping during RALPN at four institutions was performed. RESULTS: In 20 patients who were treated for elective indications, RALPN with parenchymal clamping was successful in 17 (85%). Mean age was 63 years (24-78 y). Median tumor diameter was 2.2 cm (1.1-7.2 cm). Mass location was polar in 13 (76%) and interpolar in 4 (24%). Median R.E.N.A.L. nephrometry score was 6 (4-10). Median overall operative time was 190 minutes (129-309 min), while selective clamp time was 26 minutes (19-52 min). Collecting system repair occurred in 8 (47%) patients. No patients needed a blood transfusion. There was no significant difference in preoperative (median 86 mL/min/1.73 m(2)) and immediate postoperative glomerular filtration rate (GFR) (median 78 mL/min/1.73 m(2), P=0.33) or with the most recent GFR (median 78 mL/min/1.73 m(2), P=0.54) at a mean follow-up of 6.1 months (1.2-11.9 mos). Final pathology determination revealed renal-cell carcinoma in 71% with no positive margins on frozen or final evaluation. In three additional patients who were undergoing RALPN, bleeding because of incomplete distal clamp compression necessitated subsequent central hilar clamping for the completion of the procedure. CONCLUSIONS: In our preliminary multi-institutional experience, regional ischemia using a laparoscopic parenchymal clamp is feasible during RALPN for hemostasis. Careful preoperative selection of patients is needed to determine ideal patient and tumor characteristics. Further comparison studies are necessary to determine the true utility of this technique.

The clinical research office of the endourological society percutaneous nephrolithotomy global study: staghorn versus nonstaghorn stones.

PURPOSE: The study compared characteristics and outcomes in patients with staghorn or nonstaghorn stones who were treated with percutaneous nephrolithotomy (PCNL) within the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study. PATIENTS AND METHODS: Data over a 1-year period from consecutively treated patients from 96 centers worldwide were collated. The following variables in patients with staghorn or nonstaghorn stones were compared: National prevalence, patient characteristics, access method, puncture frequency and outcomes, including bleeding rates, operative time, and duration of hospital stay. RESULTS: Data from 5335 eligible patients were collated; 1466 (27.5%) with staghorn and 3869 (72.5%) with nonstaghorn stones. Staghorn stone presentation varied between centers from 67% in Thailand to 13% in Argentina. The frequencies of previous procedures were similar between groups, but shockwave lithotripsy was less frequent in patients with staghorn stones compared with nonstaghorn (16.8% vs 22.6%) and positive preoperative urine cultures were more frequent in patients with staghorn than nonstaghorn stones (23.4% vs 13.1%). Patients with staghorn stones underwent multiple punctures more frequently than those with nonstaghorn stones (16.9% vs 5.0%). Postoperative fever, bleeding, and the need for blood transfusion were more frequent, the median operative time and duration of hospital stay were longer, while the proportion of patients remaining stone free was lower (56.9% vs 82.5%) in patients with staghorn than nonstaghorn stones. CONCLUSIONS: The proportion of patients with staghorn stones varies widely between centers. Stone-free rates were lower, complications more frequent, and operative time and hospital stay were longer in patients with staghorn stones.

Intermediate outcomes of GreenLight HPS™ laser photoselective vaporization prostatectomy for symptomatic benign prostatic hyperplasia.

PURPOSE: GreenLight HPS™ laser photoselective vaporization prostatectomy (PVP) is a treatment option for lower urinary tract symptoms secondary to benign prostatic hyperplasia. We review our experience using the 120 W GreenLight HPS laser system. MATERIALS AND METHODS: We prospectively evaluated our experience with GreenLight HPS laser PVP. All patients who failed medical therapy underwent GreenLight HPS laser PVP (C.W.). All had American Urological Association Symptom Score, Quality of Life score, Sexual Health Inventory for Men, American Society of Anesthesiologists risk score, serum prostate-specific antigen, maximum flow rate, and postvoid residual determinations and volumetric measurements with transrectal ultrasonography. Transurethral PVP was performed using a GreenLight HPS side-firing laser system. RESULTS: 170 consecutive patients were identified, having a mean age of 67.4±9.5 years. The mean prostate volume was 65.3±36.7 mL and mean American Society of Anesthesiologists score was 2.3±0.7. Mean laser time, operating time, and energy usage were 14.1±10.5 minutes, 33.5±24.7 minutes, and 95.0±72.3 kJ, respectively. All were outpatient procedures with 100 (58.8%) patients catheter-free at discharge. 35 (20.5%) and 26 (15.3%) patients had follow-up of 24 and 36 months, respectively. Eight (4.7%) patients developed a urinary tract infection. No bladder neck contracture or urethral stricture were reported. American Urological Association Symptom Score, Quality of Life, maximum flow rate, and postvoid residual showed immediate and stable improvement from baseline (p<0.05) that has been durable to 36 months. The Sexual Health Inventory for Men score did not change postoperatively. CONCLUSIONS: Our intermediate results suggest that GreenLight HPS laser PVP is safe, effective, and durable for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia.

Second prize: Recurrence rates after percutaneous and laparoscopic renal cryoablation of small renal masses: does the approach make a difference?

BACKGROUND AND PURPOSE: As radiologic detection of small renal masses increases, patients are increasingly offered percutaneous renal cryoablation (PRC) or transperitoneal laparoscopic renal cryoablation (TLRC). This multicenter experience compares these approaches. PATIENTS AND METHODS: Between September 1998 and May 2010, review of our PRC and TLRC experience was performed. Patients with ≥ 12-month follow-up were included for analysis. Post-treatment surveillance consisted of laboratory studies and imaging at regular intervals. Treatment failure was considered if persistent mass enhancement or interval tumor growth was radiographically evident. Repeated biopsy and re-treatment were recommended in the event of recurrence. RESULTS: Sixty-one patients underwent PRC and 84 patients underwent TLRC. No significant differences were noted with respect to demographic factors. Mean tumor size was 2.7 ± 1.1 cm (PRC) and 2.5 ± 0.8 (TLRC) cm (P = 0.090). Mean follow-up was 31.0 ± 15.9 months (PRC) and 42.3 ± 21.2 (TLRC) months (P = 0.008), with local tumor recurrence noted in 10/61 (16.4%) PRC and 5/84 (5.9%) TLRC (P = 0.042). For PRC, disease-free survival (DFS) and overall survival (OS) were 93.7% and 88.9%, respectively, with four patients having evidence of disease at last follow-up. DFS and OS were 91.7% and 89.3% for TLRC, with seven patients having evidence of disease at last follow-up. DFS (P = 0.654) and OS (P = 0.939) were similar. CONCLUSIONS: In this multicenter study of well-matched cohorts, PRC had higher primary treatment failure rates than TLRC. While no differences were noted between DFS and OS, analysis is limited by intermediate follow-up. Further study is necessary to discern reasons for the higher recurrence rates in PRC and to determine what long-term consequences exist.

Laser surgery simulation platform: toward full-procedure training and rehearsal for benign prostatic hyperplasia (BPH) therapy.

Recently, photo-selective vaporization of the prostate (PVP) has been a popular alternative to the standard electrocautery - transurethral resection of prostate (TURP). Here we introduce a new training system for practicing the laser therapy by using a virtual reality (VR) simulator. To interactively and realistically simulate PVP on a virtual organ with an order of a quarter million elements, a few novel and practical solutions have been applied to handle the challenges in modeling tissue ablation, contact/collision and deformation; endoscopic instruments tracking, haptic rendering and a web/database curriculum management module are integrated into the system. Over 40 urologists and surgical experts have been invited nationally and participated in the system verification.

The effects of 5α-reductase inhibition on benign prostatic hyperplasia treated by photoselective vaporization prostatectomy with the 120 Watt GreenLight HPS laser system.

BACKGROUND: We sought to determine whether the efficacy and efficiency of 120W GreenLight HPS (American Medical Systems, Inc) laser photoselective vaporization prostatectomy (PVP) is compromised in patients on chronic 5α-reductase inhibitor (RI) therapy. STUDY DESIGN: Our GreenLight HPS laser PVP experience in patients with and without long-term 5αRI was evaluated. American Urological Association Symptom Score (AUASS), quality of life (QoL) score, maximum urinary flow rate (Qmax), and postvoid residual (PVR) were measured preoperatively and at 1 and 4 weeks and at 3, 6, 12, 18, and 24 months postsurgery. PSA values and transrectal ultrasonography (TRUS) prostate volumes were determined preoperatively and at 3 months postsurgery. RESULTS: Fifty-seven patients were on either dutasteride or finasteride (5αRI+) and 124 were not (5αRI-). Mean prostate volumes were 67.1 ± 35.3 mL and 69.2 ± 41.9 mL (p = 0.646) and mean PSA values were 2.2 ± 2.4 ng/mL and 2.7 ± 2.6 ng/ml (p = 0.289), respectively. There were no significant differences in the parameters of laser use (13.6 ± 9.2 minutes and 13.4 ± 10.4 minutes, p = 0.965) and energy usage (87.1 ± 62.4 kJ and 91.8 ± 69.6 kJ, p = 0.623). The majority of patients were catheter-free at discharge for this wholly outpatient procedure. AUASS, QoL, and Qmax values showed significant improvement within each group (p < 0.05). Compared with baseline, PVR values improved in both groups but did not decrease significantly in 5αRI+ (p > 0.05). There was no significant difference in the degree of improvement between the 2 groups in all parameters (AUASS, QoL, Qmax, PVR, PSA, and TRUS volume). CONCLUSIONS: The efficacy and efficiency of PVP with the GreenLight HPS laser are not negatively affected in patients on chronic 5αRI therapy.

Does Greenlight HPS(™) laser photoselective vaporization prostatectomy affect sexual function?

PURPOSE: We evaluate the impact of GreenLight High-Performance System (HPS™) laser photoselective vaporization prostatectomy (PVP) on sexual function after treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: We prospectively evaluated our initial single surgeon experience with GreenLight HPS™ laser PVP. All patients had American Urological Association Symptom Score (AUASS), Sexual Health Inventory for Men (SHIM), maximum flow rate (Qmax), and postvoid residual (PVR) determinations. Transurethral PVP was performed using a 120W GreenLight HPS™ side-firing laser system. AUASS, SHIM, Qmax, and PVR were evaluated 1, 4, 12, 24, and 52 weeks postsurgery. Wilcoxon signed rank test and the Student t-test were used to assess the changes from baseline. RESULTS: Seventy-two patients completed 52 weeks of follow-up, having a median age of 69 (45-89) years. The median prostate volume was 62 (21-263) mL. Median AUASS improved significantly from 23 to 8, 6, 5, 5, and 4 (P < 0.05) at 1, 4, 12, 24, and 52 weeks, respectively. Median SHIM changed from 15 to 12, 16, 19, 16, and 17 during the follow-up period (P = 0.032, 0.427, 0.074, 0.081, and 0.259). Minimum change (0 ± 5) in SHIM occurred in 85.5%, 90.5%, 78.8%, 77.5%, and 73.7% of patients; 11.3%, 6.3%, 6.0%, 4.8%, and 7.0% of patients had deterioration of erectile function (SHIM reduction >5); and 3.2%, 3.2%, 15.2%, 17.7%, and 19.3% of patients had improvement of erectile function (SHIM increase >5). Incidence of new-onset retrograde ejaculation was 30%. CONCLUSION: GreenLight HPS™ laser PVP appears to not have a detrimental effect on erectile function.

Training, credentialing, proctoring and medicolegal risks of robotic urological surgery: recommendations of the society of urologic robotic surgeons.

PURPOSE: With the exponential growth of robotic urological surgery, particularly with robot assisted radical prostatectomy, guidelines for safe initiation of this technology are a necessity. Currently no standardized credentialing system exists to our knowledge to evaluate surgeon competency and safety with robotic urological surgery performance. Although proctoring is a modality by which such competency can be evaluated, other training tools and guidelines are needed to ensure that the requisite knowledge and technical skills to perform this procedure have been acquired. We evaluated the current status of proctoring and credentialing in other surgical specialties to discuss and recommend its application and implementation specifically for robot assisted radical prostatectomy. MATERIALS AND METHODS: We reviewed the literature on safety and medicolegal implications of proctoring and the safe introduction of surgical procedures to develop recommendations for robot assisted radical prostatectomy proctoring and credentialing. RESULTS: Proctoring is an essential mechanism for robot assisted radical prostatectomy institutional credentialing and should be a prerequisite for granting unrestricted privileges on the robot. This should be differentiated from preceptoring, wherein the expert is directly involved in hands-on training. Advanced technology has opened new avenues for long-distance observation through teleproctoring. Although the medicolegal implications of an active surgical intervention by a proctor are not clearly defined, the role as an observer should grant immunity from malpractice liability. CONCLUSIONS: The implementation of guidelines and proctoring recommendations is necessary to protect surgeons, proctors, institutions and, above all, the patients who are associated with the institutional introduction of a robot assisted radical prostatectomy program. With no current guidelines we anticipate this article will serve as a catalyst of interorganizational discussion to initiate regulatory oversight of surgeon certification and proctorship.

Incidence, management, and prevention of perioperative complications of GreenLight HPS laser photoselective vaporization prostatectomy: experience in the first 70 patients.

PURPOSE: We report the incidence, prevention, and management of perioperative adverse events in patients treated with GreenLight HPS laser photoselective vaporization prostatectomy (PVP). MATERIALS AND METHODS: A side-firing GreenLight HPS laser system was used to perform transurethral PVP. American Urological Association Symptom Score, Quality of Life score, Sexual Health Inventory for Men score, serum prostate-specific antigen (PSA), maximum flow rate (Qmax), and postvoid residual were assessed preoperatively and at 1, 4, 12, 24, and 52 weeks postsurgery. Preoperative and 3-month postsurgery volumetric prostate measurements with transrectal ultrasonography, operative times (laser and total), and energy usage were recorded. Serum PSA was obtained at the 12- and 52-week visit. Adverse events were recorded perioperatively and at each follow-up interval. RESULTS: Seventy consecutive patients with a median age of 67 (45-87) years, median prostate volume of 61.6 (20.9-263.0) mL, and median PSA of 1.4 (0.1-10.1) ng/mL underwent GreenLight HPS laser PVP from July 2006 through March 2008. All procedures were performed in an outpatient setting, with a mean laser time of 13 (3-34) minutes, mean total operative time of 30 (6-100) minutes, and mean energy usage of 85 (11-235) kJ. Perioperative complications included intraoperative bleeding (1.4%), postoperative clinically nonsignificant hematuria (78.5%), hematuria requiring clot evacuation (1.4%), urinary retention requiring recatheterization (2.8%), urinary tract infection (4.3%), and prostatitis (1.4%). No urethral strictures, bladder neck contracture, or urinary incontinence were noted. CONCLUSIONS: GreenLight HPS laser PVP appears to have a low incidence of perioperative adverse events.