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2177 PHOTOSELECTIVEVAPORIZATION OF THE PROSTATE WITH GREENLIGHT 120W LASER COMPARED TO MONOPOLAR TRANSURETHRAL RESECTION OF THE PROSTATE: A MULTICENTER, RANDOMIZED CONTROLLED TRIAL
e878
THE JOURNAL OF UROLOGY姞
dard HPS-PVP in men with prostate volumes ⬎80cc. G-LEP also appears to be more time-efficient, consumes less energy and obtains tissue for pathological evaluation. Further follow-up is required to assess the durability of VIT to PVP vaporization only for large prostate glands. Source of Funding: None
2177 PHOTOSELECTIVEVAPORIZATION OF THE PROSTATE WITH GREENLIGHT 120W LASER COMPARED TO MONOPOLAR TRANSURETHRAL RESECTION OF THE PROSTATE: A MULTICENTER, RANDOMIZED CONTROLLED TRIAL. Bertrand Lukacs*, Paris, France; Joyce Loeffler, Nice, France; Franck Bruye`re, Tours, France; Pascal Blanchet, West French Indies, France; Albert Gelet, Lyon, France; Patrick Coloby, Pontoise, France; Alexandre De la Taille, Creteil, France; Philippe Lemaire, Reims, France; Jean-Christophe Baron, Saint Cyr Sur Loire, France; Jean-Nicolas Cornu, Mounir Aout, He´le`ne Rousseau, Eric Vicaut, Paris, France INTRODUCTION AND OBJECTIVES: Evidence supporting the use of Greenlight HPS-120W photovaporization of the prostate (PVP) as an alternative to transurethral resection of the prostate (TURP) in current clinical practice is lacking.Our objective was to assess the non-inferiority of PVP compared to TURP in surgical management of low urinary tract symptoms related to benign prostatic hyperplasia (LUTS/BPH) and the superiority of PVP over TURP on hospital stay duration. METHODS: A multicenter prospective randomized controlled trial was conducted in nine tertiary reference centres. Patients over 50 presenting LUTS/BPH needing surgical relief of prostatic obstruction underwent monopolar TURP or PVP with Greenlight™ HPS-120W laser. Protocol was reviewed by ethics commitee and all patient gave written informed consent to be included in the study. Pre-operative evaluation included International Prostatic Symptom Score (I-PSS), bother (I-PSS question 8), Euro-QOL (quality of life) questionnaire, uroflowmetry, Danish Prostate Symptom Score Sexual (DAN-PSSsex) and overall sexual satisfaction. These items added to peri-operative parameters and adverse events were prospectively collected at 1, 3, 6 and 12 months. The main outcome measure was the I-PSS score at 12 months visit associated with hospital stay duration, compared using the student t test.All analysis was driven according to the intent to treat (ITT) principle. RESULTS: 136 patients (68 men in each group) were included in the intent to treat analysis. Median [interquartile range] I-PSS scores at 12 months follow-up were not significantly different between the two groups (5[3-9] for TURP vs 6[3-9] for PVP). Mean length of stay was significantly shorter in the PVP group than in the TURP group (mean⫾SD (95% confidence interval) 1.78⫾1.29 [1.52-2.04] vs 3.01⫾1.63 [2,68-3,34], respectively, p⬍0.0001). Uroflowmetry parameters, early and late complications, were comparable in both groups at last follow-up. Sexual outcomes, notably ejaculation, were slightly better in the PVP group without reaching statistical significance. CONCLUSIONS: PVP is an acceptable alternative to TURP with similar results on LUTS improvement in the short-term. PVP is associated to a reduced hospital stay. A trend towards improvement of sexual parameters, notably ejaculation, has been observed in the PVP group at last follow-up. Longer follow-up studies are required to confirm the clinical benefits of this technique for surgical management of LUTS/BPH. Source of Funding: Funded by the French Ministry of Health
Vol. 187, No. 4S, Supplement, Wednesday, May 23, 2012
2178 EARLY EXPERIENCE PHOTOSELECTIVE VAPORISATION OF THE PROSTATE USING THE 180W LITHIUM TRIBORATE AND COMPARISON WITH THE 120W LITHIUM TRIBORATE LASER. Nicholas Campbell*, Amanda Chung, Peter Yoon, Isaac Thangasamy, Henry Woo, Sydney, Australia INTRODUCTION AND OBJECTIVES: There is little information on the clinical efficacy and safety of the photoselective vaporization (PVP) of the prostate using the new highly powerful 180W lithium triborate (LBO) laser. The objective of this study was to report on initial outcomes of PVP with the 180W laser with the first 50 cases and to compare it the last 50 cases performed with the 120W LBO laser. METHODS: A registry of all PVP cases performed by a single surgeon (HHW) has been prospectively maintained. The last 50 cases treated with the 120W LBO laser (December 2009 to August 2010) were compared with the first 50 cases treated with the 180W LBO (July 2010 and June 2011). The inclusion criteria were all men undergoing PVP for indications consistent with established guidelines for surgery for benign prostatic hyperplasia. Baseline patient variables for men treated with the 120W and 180W LBO laser were recorded preoperatively and compared to postoperative parameters at 3 months and perioperative data was also recorded. RESULTS: The 180W cases had a larger mean TRUS prostate volume (80.5cc versus 59.4cc, p⬍0.05). For the 180W and 120W LBO lasers, total operating time was 64.2 and 72.5 minutes (NS, p⫽0.22), lasering time 49.6 and 69.3 minutes (NS, p⫽0.30) and energy utilisation 477.6kJ and 377.9kJ (p⬍0.05) respectively. Complications did not significantly differ between the two lasers. Using the Clavien-Dindo classification there were 5 grade 1 complications and 3 grade 3b (bladder neck contractures) with the 180W LBO laser and with the 120 W LBO laser there were 4 grade 1 complications and 1 grade 2. CONCLUSIONS: This study demonstrates that there is little change in clinical outcomes with the transition from 120W to 180W LBO PVP with an already experienced PVP surgeon. The introduction of the more powerful 180W LBO laser appears to have impacted upon patient selection with significantly increased prostate size and associated with increased energy utilisation. There appears to be a trend toward shorter laser times. Comparison of 180W versus 120W LBO Laser Perioperative Parameters 180W baseline 180W 3 month 120W baseline 120W 3 month IPSS 21 10 27 9 QL
4
2
4
2
Qmax (ml/s)
9
29
9
26
227
55
168
51
PVR (ml)
Source of Funding: None
2179 AIM OF STUDY WAS TO COMPARE PLASMA KINETIC (PK) TRANSURETHRAL RESECTION OF PROSTATE Suresh Patankar*, Pune, India INTRODUCTION AND OBJECTIVES: Aim of study was to compare bipolar Plasma Kinetic with standard monopolar TURP in terms of catheter time, hospital stay, operating time, blood loss, complications, urinary flow rates and symptom relief, quality of life and International Index of Erectile Function.(IIEF-5) , in large number of patients with 5 years follow up. METHODS: A total of 512 patients were randomized to either TURP or PK resection of prostate between January 2004 to December 2005 . All of them were evaluated by detail medical history, physical examination , blood analysis, PSA, urinanalysis and culture, AUA Symptom Score, 3D-TRUS measurement of prostate volume , Omax, IIEF-5 and Quality of Life score. TURP was carried out using a 26 F resectoscope and a single wire loop for resection . Glycine was used as irrigation fluid. For the PK Superpulse system, the dedicated resectoscope was used, and normal saline was used as the irrigation fluid.
THE JOURNAL OF UROLOGY姞
dard HPS-PVP in men with prostate volumes ⬎80cc. G-LEP also appears to be more time-efficient, consumes less energy and obtains tissue for pathological evaluation. Further follow-up is required to assess the durability of VIT to PVP vaporization only for large prostate glands. Source of Funding: None
2177 PHOTOSELECTIVEVAPORIZATION OF THE PROSTATE WITH GREENLIGHT 120W LASER COMPARED TO MONOPOLAR TRANSURETHRAL RESECTION OF THE PROSTATE: A MULTICENTER, RANDOMIZED CONTROLLED TRIAL. Bertrand Lukacs*, Paris, France; Joyce Loeffler, Nice, France; Franck Bruye`re, Tours, France; Pascal Blanchet, West French Indies, France; Albert Gelet, Lyon, France; Patrick Coloby, Pontoise, France; Alexandre De la Taille, Creteil, France; Philippe Lemaire, Reims, France; Jean-Christophe Baron, Saint Cyr Sur Loire, France; Jean-Nicolas Cornu, Mounir Aout, He´le`ne Rousseau, Eric Vicaut, Paris, France INTRODUCTION AND OBJECTIVES: Evidence supporting the use of Greenlight HPS-120W photovaporization of the prostate (PVP) as an alternative to transurethral resection of the prostate (TURP) in current clinical practice is lacking.Our objective was to assess the non-inferiority of PVP compared to TURP in surgical management of low urinary tract symptoms related to benign prostatic hyperplasia (LUTS/BPH) and the superiority of PVP over TURP on hospital stay duration. METHODS: A multicenter prospective randomized controlled trial was conducted in nine tertiary reference centres. Patients over 50 presenting LUTS/BPH needing surgical relief of prostatic obstruction underwent monopolar TURP or PVP with Greenlight™ HPS-120W laser. Protocol was reviewed by ethics commitee and all patient gave written informed consent to be included in the study. Pre-operative evaluation included International Prostatic Symptom Score (I-PSS), bother (I-PSS question 8), Euro-QOL (quality of life) questionnaire, uroflowmetry, Danish Prostate Symptom Score Sexual (DAN-PSSsex) and overall sexual satisfaction. These items added to peri-operative parameters and adverse events were prospectively collected at 1, 3, 6 and 12 months. The main outcome measure was the I-PSS score at 12 months visit associated with hospital stay duration, compared using the student t test.All analysis was driven according to the intent to treat (ITT) principle. RESULTS: 136 patients (68 men in each group) were included in the intent to treat analysis. Median [interquartile range] I-PSS scores at 12 months follow-up were not significantly different between the two groups (5[3-9] for TURP vs 6[3-9] for PVP). Mean length of stay was significantly shorter in the PVP group than in the TURP group (mean⫾SD (95% confidence interval) 1.78⫾1.29 [1.52-2.04] vs 3.01⫾1.63 [2,68-3,34], respectively, p⬍0.0001). Uroflowmetry parameters, early and late complications, were comparable in both groups at last follow-up. Sexual outcomes, notably ejaculation, were slightly better in the PVP group without reaching statistical significance. CONCLUSIONS: PVP is an acceptable alternative to TURP with similar results on LUTS improvement in the short-term. PVP is associated to a reduced hospital stay. A trend towards improvement of sexual parameters, notably ejaculation, has been observed in the PVP group at last follow-up. Longer follow-up studies are required to confirm the clinical benefits of this technique for surgical management of LUTS/BPH. Source of Funding: Funded by the French Ministry of Health
Vol. 187, No. 4S, Supplement, Wednesday, May 23, 2012
2178 EARLY EXPERIENCE PHOTOSELECTIVE VAPORISATION OF THE PROSTATE USING THE 180W LITHIUM TRIBORATE AND COMPARISON WITH THE 120W LITHIUM TRIBORATE LASER. Nicholas Campbell*, Amanda Chung, Peter Yoon, Isaac Thangasamy, Henry Woo, Sydney, Australia INTRODUCTION AND OBJECTIVES: There is little information on the clinical efficacy and safety of the photoselective vaporization (PVP) of the prostate using the new highly powerful 180W lithium triborate (LBO) laser. The objective of this study was to report on initial outcomes of PVP with the 180W laser with the first 50 cases and to compare it the last 50 cases performed with the 120W LBO laser. METHODS: A registry of all PVP cases performed by a single surgeon (HHW) has been prospectively maintained. The last 50 cases treated with the 120W LBO laser (December 2009 to August 2010) were compared with the first 50 cases treated with the 180W LBO (July 2010 and June 2011). The inclusion criteria were all men undergoing PVP for indications consistent with established guidelines for surgery for benign prostatic hyperplasia. Baseline patient variables for men treated with the 120W and 180W LBO laser were recorded preoperatively and compared to postoperative parameters at 3 months and perioperative data was also recorded. RESULTS: The 180W cases had a larger mean TRUS prostate volume (80.5cc versus 59.4cc, p⬍0.05). For the 180W and 120W LBO lasers, total operating time was 64.2 and 72.5 minutes (NS, p⫽0.22), lasering time 49.6 and 69.3 minutes (NS, p⫽0.30) and energy utilisation 477.6kJ and 377.9kJ (p⬍0.05) respectively. Complications did not significantly differ between the two lasers. Using the Clavien-Dindo classification there were 5 grade 1 complications and 3 grade 3b (bladder neck contractures) with the 180W LBO laser and with the 120 W LBO laser there were 4 grade 1 complications and 1 grade 2. CONCLUSIONS: This study demonstrates that there is little change in clinical outcomes with the transition from 120W to 180W LBO PVP with an already experienced PVP surgeon. The introduction of the more powerful 180W LBO laser appears to have impacted upon patient selection with significantly increased prostate size and associated with increased energy utilisation. There appears to be a trend toward shorter laser times. Comparison of 180W versus 120W LBO Laser Perioperative Parameters 180W baseline 180W 3 month 120W baseline 120W 3 month IPSS 21 10 27 9 QL
4
2
4
2
Qmax (ml/s)
9
29
9
26
227
55
168
51
PVR (ml)
Source of Funding: None
2179 AIM OF STUDY WAS TO COMPARE PLASMA KINETIC (PK) TRANSURETHRAL RESECTION OF PROSTATE Suresh Patankar*, Pune, India INTRODUCTION AND OBJECTIVES: Aim of study was to compare bipolar Plasma Kinetic with standard monopolar TURP in terms of catheter time, hospital stay, operating time, blood loss, complications, urinary flow rates and symptom relief, quality of life and International Index of Erectile Function.(IIEF-5) , in large number of patients with 5 years follow up. METHODS: A total of 512 patients were randomized to either TURP or PK resection of prostate between January 2004 to December 2005 . All of them were evaluated by detail medical history, physical examination , blood analysis, PSA, urinanalysis and culture, AUA Symptom Score, 3D-TRUS measurement of prostate volume , Omax, IIEF-5 and Quality of Life score. TURP was carried out using a 26 F resectoscope and a single wire loop for resection . Glycine was used as irrigation fluid. For the PK Superpulse system, the dedicated resectoscope was used, and normal saline was used as the irrigation fluid.