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Holmium:YAG transurethral incision versus laser photoselective vaporization for benign prostatic hyperplasia in a small prostate.
J Urol. 2014 Jan; 191(1):148-54.JU

Abstract

PURPOSE

We assess the perioperative, short-term and long-term functional outcomes of treating bladder outlet obstruction secondary to a small prostate by 1 of 2 laser techniques.

MATERIALS AND METHODS

A retrospective review using a prospectively maintained database was performed of patients treated for bladder outlet obstruction secondary to a prostate smaller than 40 ml. Patients who were treated with GreenLight™ photoselective vaporization of the prostate or holmium laser transurethral incision of the prostate were included in the study.

RESULTS

From January 2002 through December 2010, 191 cases of 1,682 laser prostate surgeries were described. GreenLight photoselective vaporization of the prostate was performed in 144 (75.4%) cases and holmium laser transurethral incision of the prostate was performed in 47 (24.6%) cases. A significantly shorter mean operating time, hospital stay and catheter duration were observed in the holmium laser transurethral incision of the prostate group (30.3 ± 16 minutes, 0.8 ± 0.8 days and 1.3 ± 1.9 days, respectively) than in the photoselective vaporization of the prostate group (45.8 ± 22 minutes, 0.3 ± 0.4 days and 0.4 ± 0.6 days, respectively, p <0.05). At 1 and 5 years after photoselective vaporization of the prostate there were reductions in mean International Prostate Symptom Score, quality of life score and residual urine with improvement in mean maximal flow rate of 57.7% and 62.8%, 58.3% and 57.2%, 65.4% and 73%, and 127.6% and 167.1%, respectively. At 1 and 5 years after holmium laser transurethral incision of the prostate there were reductions in mean International Prostate Symptom Score, quality of life score and residual urine with improvement of mean maximal flow rate of 55.3% and 52.8%, 49.2% and 49%, 45% and 78.1%, and 67.4% and 35.4%, respectively. Subjective and objective urine flow parameters were comparable at different followup points. There was no significant difference between the 2 groups in terms of early and late complications (p >0.05). Reoperation rates were 10.4% and 6.4% in the photoselective vaporization of the prostate and holmium laser transurethral incision of the prostate groups, respectively (p >0.05). The mean estimated cost per holmium laser transurethral incision of the prostate procedure was significantly lower than per photoselective vaporization of the prostate procedure (509.34CAD vs 1,765.92CAD, p = 0.002).

CONCLUSIONS

Holmium laser transurethral incision of the prostate and GreenLight photoselective vaporization of the prostate seem to be equally effective, safe and durable surgical treatment options for small prostates even in high risk patients.

Authors+Show Affiliations

Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada; Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada; Urology Department, Suez Canal University, Ismailia, Egypt.Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada.Division of Epidemiology & Biostatistics, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada.Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada. Electronic address: mostafa.elhilali@muhc.mcgill.ca.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23845460

Citation

Elshal, Ahmed M., et al. "Holmium:YAG Transurethral Incision Versus Laser Photoselective Vaporization for Benign Prostatic Hyperplasia in a Small Prostate." The Journal of Urology, vol. 191, no. 1, 2014, pp. 148-54.
Elshal AM, Elkoushy MA, Elmansy HM, et al. Holmium:YAG transurethral incision versus laser photoselective vaporization for benign prostatic hyperplasia in a small prostate. J Urol. 2014;191(1):148-54.
Elshal, A. M., Elkoushy, M. A., Elmansy, H. M., Sampalis, J., & Elhilali, M. M. (2014). Holmium:YAG transurethral incision versus laser photoselective vaporization for benign prostatic hyperplasia in a small prostate. The Journal of Urology, 191(1), 148-54. https://doi.org/10.1016/j.juro.2013.06.113
Elshal AM, et al. Holmium:YAG Transurethral Incision Versus Laser Photoselective Vaporization for Benign Prostatic Hyperplasia in a Small Prostate. J Urol. 2014;191(1):148-54. PubMed PMID: 23845460.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Holmium:YAG transurethral incision versus laser photoselective vaporization for benign prostatic hyperplasia in a small prostate. AU - Elshal,Ahmed M, AU - Elkoushy,Mohamed A, AU - Elmansy,Hazem M, AU - Sampalis,John, AU - Elhilali,Mostafa M, Y1 - 2013/07/08/ PY - 2013/06/28/accepted PY - 2013/7/13/entrez PY - 2013/7/13/pubmed PY - 2014/4/22/medline KW - BNC KW - BOO KW - BPH KW - CAD KW - Canadian dollars KW - HoLEP KW - Hol KW - I-PSS KW - International Prostate Symptom Score KW - KTP KW - LBO KW - PVP KW - PVR KW - QOL KW - Qmax KW - TOV KW - TRUS KW - TUIP KW - TURP KW - YAG KW - benign prostatic hyperplasia KW - bladder neck contracture KW - bladder outlet obstruction KW - holmium KW - holmium laser enucleation of prostate KW - laser therapy KW - lithium triborate KW - maximal flow rate KW - photoselective vaporization of the prostate KW - potassium titanyl phosphate KW - prostatic hyperplasia KW - quality of life score KW - residual urine KW - transrectal ultrasound KW - transurethral incision of prostate KW - transurethral resection of prostate KW - trial of voiding KW - yttrium-aluminum-garnet SP - 148 EP - 54 JF - The Journal of urology JO - J Urol VL - 191 IS - 1 N2 - PURPOSE: We assess the perioperative, short-term and long-term functional outcomes of treating bladder outlet obstruction secondary to a small prostate by 1 of 2 laser techniques. MATERIALS AND METHODS: A retrospective review using a prospectively maintained database was performed of patients treated for bladder outlet obstruction secondary to a prostate smaller than 40 ml. Patients who were treated with GreenLight™ photoselective vaporization of the prostate or holmium laser transurethral incision of the prostate were included in the study. RESULTS: From January 2002 through December 2010, 191 cases of 1,682 laser prostate surgeries were described. GreenLight photoselective vaporization of the prostate was performed in 144 (75.4%) cases and holmium laser transurethral incision of the prostate was performed in 47 (24.6%) cases. A significantly shorter mean operating time, hospital stay and catheter duration were observed in the holmium laser transurethral incision of the prostate group (30.3 ± 16 minutes, 0.8 ± 0.8 days and 1.3 ± 1.9 days, respectively) than in the photoselective vaporization of the prostate group (45.8 ± 22 minutes, 0.3 ± 0.4 days and 0.4 ± 0.6 days, respectively, p <0.05). At 1 and 5 years after photoselective vaporization of the prostate there were reductions in mean International Prostate Symptom Score, quality of life score and residual urine with improvement in mean maximal flow rate of 57.7% and 62.8%, 58.3% and 57.2%, 65.4% and 73%, and 127.6% and 167.1%, respectively. At 1 and 5 years after holmium laser transurethral incision of the prostate there were reductions in mean International Prostate Symptom Score, quality of life score and residual urine with improvement of mean maximal flow rate of 55.3% and 52.8%, 49.2% and 49%, 45% and 78.1%, and 67.4% and 35.4%, respectively. Subjective and objective urine flow parameters were comparable at different followup points. There was no significant difference between the 2 groups in terms of early and late complications (p >0.05). Reoperation rates were 10.4% and 6.4% in the photoselective vaporization of the prostate and holmium laser transurethral incision of the prostate groups, respectively (p >0.05). The mean estimated cost per holmium laser transurethral incision of the prostate procedure was significantly lower than per photoselective vaporization of the prostate procedure (509.34CAD vs 1,765.92CAD, p = 0.002). CONCLUSIONS: Holmium laser transurethral incision of the prostate and GreenLight photoselective vaporization of the prostate seem to be equally effective, safe and durable surgical treatment options for small prostates even in high risk patients. SN - 1527-3792 UR - https://www.unboundmedicine.com/medline/citation/23845460/Holmium:YAG_transurethral_incision_versus_laser_photoselective_vaporization_for_benign_prostatic_hyperplasia_in_a_small_prostate_ L2 - https://www.jurology.com/doi/10.1016/j.juro.2013.06.113?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -