Photoselective Vaporization of the Prostate and Simultaneous Suprapubic Cystostomy for the Treatment of Benign Prostatic Hyperplasia in Patients with Mild to Severe Detrusor Underactivity

2015 ◽  
Vol 95 (3) ◽  
pp. 269-275 ◽  
Author(s):  
Zhenggang Yu ◽  
Jian Li ◽  
Zhaoyi Li ◽  
Ruipeng Hou
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Maximum Flow ◽  
Prostatic Hyperplasia ◽  
Urinary Flow ◽  
Detrusor Underactivity ◽  
Suprapubic Cystostomy ◽  
Bladder Compliance ◽  
Significant Difference ◽  
Photoselective Vaporization ◽  
Postvoid Residual Urine

Introduction: This study investigated the clinical efficacy and safety of photoselective vaporization of the prostate (PVP) and simultaneous suprapubic cystostomy for benign prostatic hyperplasia (BPH) in patients with mild to severe detrusor underactivity (DU). Subjects and Methods: Seventy-eight patients with BPH were divided into 3 groups according to the severity of DU: mild DU group, moderate DU group and severe DU group. The preoperative and postoperative data, including the detrusor pressure at maximum flow (Pdetmax), bladder compliance, maximum urinary flow (Qmax), postvoid residual urine (PVR) values, International Prostate Symptom Score (IPSS) and quality of life (QoL) were evaluated. Results: The therapeutic effectiveness including cure and improvement in mild and moderate DU group was significantly higher than that of the severe group. Compared to the preoperative values, Pdetmax, bladder compliance, Qmax, PVR, IPSS and QoL scores at 12 months postoperatively had significantly improved. In addition, the above parameters at 12 months postoperatively in the mild or moderate DU group had significant difference compared to the severe DU group. Conclusion: PVP and simultaneous suprapubic cystostomy seem to be an appropriate treatment modality in BPH patients with mild and/or moderate DU as well as in patients with severe DU and slightly reduced bladder compliance.

scholarly journals Safety and efficacy of photoselective vaporization of the prostate using the 180-W GreenLight XPS laser system in patients taking oral anticoagulants

2018 ◽  
Vol 46 (3) ◽  
pp. 1230-1237 ◽  
Author(s):  
Alper Eken ◽  
Bülent Soyupak
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
International Prostate Symptom Score ◽  
Oral Anticoagulants ◽  
Laser System ◽  
Urine Volume ◽  
Prostatic Hyperplasia ◽  
Urinary Flow ◽  
Residual Urine Volume ◽  
Photoselective Vaporization ◽  
Maximum Urinary Flow

Objective To evaluate the safety and efficacy of the 180-W GreenLight XPS laser system for the treatment of benign prostatic hyperplasia in patients taking oral anticoagulants. Methods All consecutive patients admitted for lower urinary tract symptoms associated with benign prostatic hyperplasia from November 2012 to October 2016 and who underwent photoselective vaporization of the prostate with the 180-W GreenLight XPS laser were included in the study. The perioperative outcomes examined were the operating time, laser time, energy usage, and duration of postoperative catheterization. Functional parameters (International Prostate Symptom Score, maximum urinary flow rate, and post-void residual urine volume), prostate volume, and serum prostate-specific antigen concentration were examined at baseline and 3 months. Perioperative complications, if any, were noted. Results All functional parameters (International Prostate Symptom Score, maximum urinary flow rate, and post-void residual urine volume) significantly improved from baseline to 3 months. A small number of patients experienced at least one minor adverse event. There was no difference in the rate of adverse events between patients who were and were not taking anticoagulants. Conclusions Photoselective vaporization with a 180-W laser is an efficacious and safe treatment for benign prostatic hyperplasia, even in patients taking anticoagulant medications.

scholarly journals Comparison of Safety, Efficacy and Cost Effectiveness of Photoselective Vaporization with Bipolar Vaporization of Prostate in Benign Prostatic Hyperplasia

2017 ◽  
Vol 11 (2) ◽  
pp. 103-109 ◽  
Author(s):  
Priyanka Rai ◽  
Alok Srivastava ◽  
Ishwar R. Dhayal ◽  
Sanjeet Singh
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Benign Prostatic Hyperplasia ◽  
Blood Transfusion ◽  
Maximum Flow ◽  
Prostatic Hyperplasia ◽  
International Prostatic Symptom Score ◽  
Photoselective Vaporization

Objectives: To compare bipolar vaporization of prostate (BPVP) with photoselective vaporization (PVP) of prostate in the surgical management of benign prostatic hyperplasia in terms of safety, efficacy and cost effectiveness. Methods: Data was analyzed retrospectively for patients who underwent either PVP or BPVP between August 2012 to July 2014 for prostate size ≤ 80 ml. Preoperative and postoperative period values along with details like operative time, blood loss, hospitalization days, catheter removal time, blood transfusion and etc., were noted down. International prostatic symptom score, quality of life scores, post void residue, and maximum flow rate were recorded preoperatively and postoperatively at each follow-up visit. Follow-up was performed at 1, 3, 6 ,12 and 18 months. Results: Similar preoperative characteristics were observed in all the study arms. Hemoglobin drop, transfusion rate, catheter time and hospital days were similar in both the groups. The follow-up data indicates sustainable significant improvement in international prostatic symptom score, quality of life, post void residue and maximum flow rate in both the groups. As expected the cost of the procedure was significantly more in PVP group as compared to BPVP group (p < 0.01). Neither group had severe perioperative complications and no blood transfusion was required in both the groups. Conclusion: Both PVP and BPVP were safe and effective alternatives in men requiring surgery for benign prostatic hyperplasia including patients who were on anticoagulants. Additionally, BPVP has the advantage of being significantly cheaper and therefore it can be more useful in developing countries.

scholarly journals Photoselective vaporization of the prostate using GreenLight 120-W lithium triborate laser to treat symptomatic benign prostatic hyperplasia: A single-centre prospective study

2013 ◽  
Vol 7 (3-4) ◽  
pp. e193-6 ◽  
Author(s):  
Hisham A. Mosli ◽  
Taha A. Abdel-Meguid ◽  
Mohammad H. Abdulwahhab ◽  
Ahmad Al-Sayyad ◽  
Hasan M. Farsi ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Statistical Significance ◽  
Maximum Flow ◽  
Prostatic Hyperplasia ◽  
Treatment Rate ◽  
Symptomatic Benign Prostatic Hyperplasia ◽  
Lithium Triborate ◽  
Photoselective Vaporization ◽  
Efficacy Parameters

Objective: We evaluated the safety and efficacy of photoselective vaporization of the prostate (PVP) using GreenLight 120-W lithium triborate (LBO) laser to treat symptomatic small-to-medium sized benign prostatic hyperplasia (BPH).Methods: This prospective non-controlled observational study included symptomatic BPH men ≥50 years with international prostate symptom score (IPSS) ≥14, prostate volume (PV) ≤80 cc and maximum flow rate (Q-max) ≤15 mL/s. PVP was performed using the GreenLight 120-W LBO laser machine. Patients were assessed at baseline and postoperatively at discharge, 2 weeks, and 3, 6 and 12 months. We measured changes in IPSS, PV, PSA, Q-max, post-void residual (PVR), hemoglobin (Hb), serum sodium (Na+) and reported complications. Statistical significance was p < 0.05.Results: The study included 103 men with mean age of 67 (±standarddeviation) ±9.7 years. Thirty patients were on indwelling urethral catheters for refractory urinary retention and 12 on ongoing anticoagulants. The mean baseline IPSS, PV, PSA, Q-max and PVR parameters significantly improved at follow-up (p < 0.001; each). Mean measurements at baseline versus at six months were: IPSS 25.6 ± 4.2 vs. 7.4±2.3; PV 44.6 ± 9.2 vs. 21.6 ± 6.3 cc (51.6% reduction); Q-max 5.8 ± 3.4 vs. 20.4 ± 4.8 mL/s; PVR 110 ± 40 vs. 35 ± 9 cc. Mean baseline Hb and serum Na+ declined nonsignificantly (p > 0.05) at discharge and at 2 weeks. No patient needed a blood transfusion. Secondary procedures were needed in 2 patients for urethral and bladder neck strictures. The re-treatment rate for residual adenoma was 0.97%.Conclusion: PVP using the GreenLight 120-W LBO laser to treat small-to-medium sized symptomatic BPH demonstrated significant improvements in efficacy parameters and high safety profile within 12 months of follow-up. The procedure entails good hemostasis with minimal blood loss even in patients receiving ongoing anticoagulants.

A Comparative Study on the Safety and Efficacy of Tamsulosin and Alfuzosin in the Management of Symptomatic Benign Prostatic Hyperplasia: A Randomized Controlled Clinical Trial

2005 ◽  
Vol 33 (5) ◽  
pp. 562-573 ◽  
Author(s):  
MCM Lapitan ◽  
V Acepcion ◽  
J Mangubat
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Sexual Function ◽  
Prostatic Hyperplasia ◽  
Controlled Clinical Trial ◽  
Urinary Flow ◽  
Double Blind ◽  
Symptomatic Benign Prostatic Hyperplasia ◽  
Once Daily ◽  
Treatment Regimens ◽  
Significant Difference

This randomized, double-blind, parallel-design trial compared the efficacy and safety of tamsulosin and alfuzosin in 76 men with symptomatic benign prostatic hyperplasia. Patients were randomized to receive 0.2 mg tamsulosin once daily orally ( n = 40) or 10 mg alfuzosin once daily orally ( n = 36), and changes in the International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax) and the Danish prostatic symptom sexual function score and morbidity rates were compared after 8 weeks of treatment. There was a mean overall decrease in the IPSS, with no significant difference between the treatment groups. There was an overall increase in the Qmax, which again was similar in the two groups. There was no significant change in the sexual function scores in either group. The incidence of adverse events was similar for tamsulosin (25%) and alfuzosin (19.4%) therapy. In conclusion, both treatment regimens similarly improved the IPSS and Qmax, did not alter sexual function and were well tolerated.

scholarly journals Comparison of Nonspherical Polyvinyl Alcohol Particles and Microspheres for Prostatic Arterial Embolization in Patients with Benign Prostatic Hyperplasia

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Jin Ho Hwang ◽  
Sang Woo Park ◽  
Il Soo Chang ◽  
Sung Il Jung ◽  
Hae Jeong Jeon ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Polyvinyl Alcohol ◽  
Clinical Success ◽  
Arterial Embolization ◽  
Prostatic Hyperplasia ◽  
Urinary Flow ◽  
Prostatic Volume ◽  
Early Results ◽  
Significant Difference ◽  
Pva Particles

Purpose. To report early results following prostatic artery embolization (PAE) and compare outcomes between nonspherical polyvinyl alcohol (PVA) particles and microspheres to treat lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Methods. PAE was performed in nine patients (mean age: 78.1 years) with symptomatic BPH. Embolization was performed using nonspherical PVA particles (250–355 μm) in four patients and microspheres (300–500 μm) in five patients. Results. PAE was technically successful in all nine patients (100%). During a mean follow-up of 10.1 months, improvements in mean International Prostate Symptom Score (IPSS), Quality of Life (QoL), prostatic volume (total volume and transition zone), and peak urinary flow (Qmax) were 9.8 points, 2.3 points, 28.1 mL, 17.8 mL, and 4.5 mL/s, respectively. Clinical success was obtained in seven of nine patients (78%). Patients in the microsphere group showed greater improvement in IPSS, QoL, prostatic volume, and Qmax compared to patients in the nonspherical PVA particle group. However, significant difference was noted only in the prostatic volume. Conclusion. PAE is a feasible, effective, and safe treatment option for BPH with LUTS. Use of microspheres showed greater prostatic volume reduction compared to nonspherical PVA particles.

scholarly journals Efficacy and Safety of Silodosin and Dutasteride Combination Therapy in Acute Urinary Retention due to Benign Prostatic Hyperplasia: A Single-Arm Prospective Study

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Kazuhisa Hagiwara ◽  
Takuya Koie ◽  
Hiromichi Iwamura ◽  
Atsushi Imai ◽  
Shingo Hatakeyama ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Combination Therapy ◽  
Urinary Retention ◽  
Acute Urinary Retention ◽  
Prostatic Hyperplasia ◽  
First Episode ◽  
Urinary Flow ◽  
Daily Trial ◽  
Postvoid Residual Urine

This study aimed to assess the efficacy of combination therapy with dutasteride and silodosin in patients with acute urinary retention (AUR) caused by benign prostatic hyperplasia (BPH). Eighty consecutive patients with a first episode of AUR were enrolled in this study. All patients received silodosin 8 mg and dutasteride 0.5 mg daily. Trial without catheter (TWOC) was attempted every 2 weeks until 12 weeks after the initiation of medication. The primary endpoint was the rate of catheter-free status at 12 weeks. Voided volume (VV), postvoid residual urine (PVR), uroflowmetry, International Prostatic Symptoms Score (IPSS), and quality of life due to urinary symptoms (IPSS-QOL) were also measured. All patients were followed up for more than 12 weeks and were included in this analysis. The success rate of TWOC at 12 weeks was 88.8%. VV and maximum urinary flow rate were significantly higher at 2, 4, 8, and 12 weeks compared with the time of AUR (P<0.001). IPSS and IPSS-QOL were significantly lower at 2, 4, 8, and 12 weeks compared with the time of AUR (P<0.001). In conclusion, a combination of dutasteride and silodosin therapy may be effective and safe for patients with AUR due to BPH.

scholarly journals Clinical Significance of Intravesical Prostatic Protrusion Index in Patients with Clinical Diagnosis of Benign Prostatic Hyperplasia. 

2021 ◽  
Author(s):  
Seyed Reza Yahyazadeh ◽  
Seyed Shahaboddin Izadi
Keyword(s):  
Quality Of Life ◽  
Benign Prostatic Hyperplasia ◽  
International Prostate Symptom Score ◽  
Prostate Volume ◽  
Prostatic Hyperplasia ◽  
Urinary Flow ◽  
Postvoid Residual Urine ◽  
Intravesical Prostatic Protrusion ◽  
Maximum Urinary Flow

Abstract Purpose: To investigate the clinical significance of the intravesical prostatic protrusion (IPP) index in benign prostatic hyperplasia (BPH) patients to clarify its diagnostic value in predicting the clinical and structural abnormalities of the prostate. Materials and Methods: In this descriptive and analytical cross-sectional study, we include every man older than 50 years old with lower urinary tract symptoms (LUTS), predominantly voiding or obstructive, suggestive of BPH. The patients were evaluated to determine the following indices: IPSS (International Prostate Symptom Score) Index, QoL (quality of life), prostate volume (PV) and postvoid residual urine (PVR), serum PSA level, and the maximum urinary flow rate (Qmax) obtained by uroflowmetry. Subsequently, the assessment of the IPP index was undertaken by transabdominal ultrasonography. The categorization of the IPP index was done into 3 grades: grade one (below 5 mm), grade two (between 5 and 10 mm), and grade three (greater than 10 mm). Results: The significant direct correlation between the intravesical prostatic protrusion and international prostate symptom score, quality of life, prostate volume, postvoid residual urine, and serum PSA as well as inversely with the maximum urinary flow rate was confirmed both before and after the medical treatment. Also, the need for surgical intervention increased significantly with increasing IPP levels. Conclusion: The intravesical prostatic protrusion can be used to evaluate and predict the severity of symptoms and outcomes in patients with clinical BPH.

scholarly journals Comparison of α-Blocker Monotherapy and α-Blocker plus 5α-Reductase Inhibitor Combination Therapy Based on Prostate Volume for Treatment of Benign Prostatic Hyperplasia

2012 ◽  
Vol 40 (3) ◽  
pp. 899-908 ◽  
Author(s):  
K-J Joo ◽  
W-S Sung ◽  
S-H Park ◽  
W-J Yang ◽  
T-H Kim
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Combination Therapy ◽  
Reductase Inhibitor ◽  
Prostate Volume ◽  
Specific Antigen ◽  
Urine Volume ◽  
Prostatic Hyperplasia ◽  
Urinary Flow ◽  
Volume Transition ◽  
Postvoid Residual Urine

OBJECTIVE: This study compared α-blocker monotherapy with combination therapy involving an α-blocker and a 5-α reductase inhibitor for benign prostatic hyperplasia (BPH), according to baseline prostate volume. METHODS: Korean men diagnosed with BPH were randomized to 12 months' treatment with 0.2 mg tamsulosin or 0.2 mg tamsulosin plus 0.5 mg dutasteride. Prostate specific antigen (PSA), prostate volume, transition zone volume (TZV), International Prostate Symptom Score (IPSS), maximal urinary flow rate ( Qmax), postvoid residual urine volume and sexual function were assessed at baseline and after 12 months' treatment. Variables were analysed based on baseline prostate volumes of ≤ 35 ml or > 35 ml. RESULTS: In total, 216 men with BPH were included. Combination therapy resulted in significant improvements in prostate volume, TZV, PSA, IPSS and Qmax, which were most pronounced in men with a prostate volume > 35 ml. CONCLUSIONS: Tamsulosin monotherapy was sufficient treatment for BPH in Korean men with a prostate volume ≤ 35 ml. Combination tamsulosin and dutasteride therapy provided greater benefits than tamsulosin monotherapy in men with BPH whose prostate volume was > 35 ml.

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