2005 PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE IN PATIENTS WITH INCREASED RISK OF BLEEDING – 10 YEARS' EXPERIENCE

Vol. 189, No. 4S, Supplement, Wednesday, May 8, 2013

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strictures). 2 patients developed severe incontinence during the first 3 months but improved at 6 months follow-up (one pad per day and no pad, respectively). CONCLUSIONS: PVP with the Greenlight XPS 180W laser is a safe procedure with low complication rate, shorter duration of catheterization, irrigations and hospital stay. Mid-term functional evaluation is good but long-term follow-up is needed to assess the durability of these results. Table 1: results Baseline 1 month 19.7 ⫾ 6.7 8.7 ⫾ 6.0ⴱ

I-PSS

3 months 6.2 ⫾ 5.2ⴱ

12 months 3.5 ⫾ 3.2ⴱ

Qmax (mL/sec)

9.7 ⫾ 4.7

PVR (mL)

101 ⫾ 81

27 ⫾ 32ⴱ

20 ⫾ 26ⴱ

Retention (pts)

31 (24%)

0

0

0

PSA (ng/mL)

4.9 ⫾ 5.6

–

2.0 ⫾ 2.1ⴱ

2.3 ⫾ 2.0ⴱ

73 ⫾ 40

–

30 ⫾ 18ⴱ

34 ⫾ 20ⴱ

Prostate volume (mL) ⴱ(p⬍ 0.00001)

21.4 ⫾ 11.0ⴱ 23.6 ⫾ 11.9ⴱ 24.3 ⫾ 10.8ⴱ 34 ⫾ 43ⴱ

Source of Funding: None

Source of Funding: None

2004 GREENLIGHT HPS-120W VS GREENLIGHT XPS-180W LASER VAPORIZATION OF THE PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA: A GLOBAL, MULTI-CENTER, AND PROSPECTIVE COMPARATIVE ANALYSIS ACCORDING TO PROSTATE SIZE Pierre-Alain Hueber*, Daniel Liberman, Tal Ben-Zvi, Montreal, Canada; Henry H. Woo, Sydney, Australia; Mahmood A. Hai, Westland, MI; Alexis E. Te, Bilal Chughtai, Richard Lee, Matthew Rutman, New York, NY; Ricardo R. Gonzalez, Houston, TX; Neil Barber, Frimley, United Kingdom; Kevin C. Zorn, Montreal, Canada INTRODUCTION AND OBJECTIVES: The aim was to evaluate the surgical performance and impact of prostate volume (PV) of the new Greenlight XPS-180W laser system (AMS, Minnetonka, MI, USA) in comparison with the former generation HPS-120W system for the treatment of BPH by photo-selective vaporization of the prostate (PVP). METHODS: From July 2007 to March 2012, a total of 1809 patients underwent Greenlight PVP for the treatment of BPH performed at 7 international centers. 1187 cases were performed using HPS120W and 622 cases using XPS-180W laser system. Data were all collected prospectively. Comparative analysis was performed between XPS and HPS and according to PV ⬍80 and ⬎80 cc. RESULTS: The XPS compared to HPS, allowed significantly reduced laser and operative time with a mean lasing time of 29.6 min vs. 65.8 min and total operative time of 53 min vs. 80 min respectively (p⬍0.01 for both). The number of fiber used during procedures was significantly reduced with the XPS system 1.11 vs. 2.28 fiber (p⬍0.01) while total energy delivered was 250.2 vs. 267.7 kJ (p⫽0.043) respectively. Overall using XPS and HPS systems, the mean operative time (104.3 vs 55.6 min), mean laser time (86.5 vs 37.3 min) and mean energy usages (400 vs 197 kJ) were all significantly increased according to PV ⬎80 cc vs ⬍80cc. However, when stratified according to PV, XPS demonstrates significant advantages compared to HPS regardless of prostate size in all operative parameters (p⬍0.01) but energy; total energy delivery was equivalent between the two systems (p⬎0.05). CONCLUSIONS: The XPS-180W system exhibits reduced operative time and laser time with similar total energy delivery per given PV suggesting a significant increased efficiency compared to the HPS-120W system. Overall, both with XPS-180W and HPS-120W mean operative time, laser time and energy usage increased according to prostate size. This suggests evaluation of PV should be a mandatory assessment as part of pre-operative evaluation of Greenlight PVP because it has direct implications for the operating parameters.

2005 PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE IN PATIENTS WITH INCREASED RISK OF BLEEDING – 10 YEARS’ EXPERIENCE Malte Rieken*, Georg Mu¨ller, Gernot Bonkat, Stephen Wyler, Thomas Gasser, Alexander Bachmann, Basel, Switzerland INTRODUCTION AND OBJECTIVES: Photoselective Vaporization of the Prostate (PVP) is regarded to be especially suitable for patients with increased risk of bleeding. However, large cohorts analyzing the safety and efficacy of PVP in this group of patients are scarce. We present our 10 years’ experience with PVP in patients under platelet aggregation inhibition and oral anticoagulation. METHODS: Data of 908 patients who underwent PVP at our center between 09/2002 and 10/2012 with the 80-W (09/2002 to 04/2007), 120-W (05/2007 to 09/2010) and 180-W laser (10/2010 to 10/2012) were analyzed. Intraoperative data, perioperative complications, functional outcome, and hospitalization or surgical revision due to bleeding within the first 3 postoperative months were compared between patients with (OAC-Group) and without oral anticoagulation or platelet aggregation inhibition (No OAC-Group). RESULTS: Patients matched in preoperative prostate volume, voiding parameters (maximum urine flow, postvoid residual volume) and micturition symptoms (IPSS, QoL). Of the 908 patients, 450 (49.6%) were under treatment with ongoing acetylsalicylic acid (n⫽264, 29.1%), oral anticoagulation (n⫽121, 13.3%), Clopidogrel (n⫽17, 1.9%), two drugs (n⫽50, 5.5%) or all three drugs (n⫽6, 0.7%). Duration of Surgery and hospitalization were comparable between the two groups. Energy application per case was significantly higher (240 vs. 221 kJ, p⬍0.001) and duration of catheterization significantly longer (49 vs. 47 h, p⬍0.01) in the OAC-Group. Conversion to TURP was necessary in 6.4% (OAC-Group) and 8.3% (No OAC-Group; p⫽ns). Impaired visibility due to bleeding occurred in 3.3% (OAC-Group) and 9.8% (No OAC-Group; p⬍0.001). Voiding parameters and micturition symptoms significantly improved (p⬍0.001), and the PSA-value was significantly reduced (p⬍0.001) in both groups at three months compared to the preoperative values. Bleeding with the necessity for hospitalization within 3 months after surgery was recorded in 2.7% (OAC-Group) and 0.9% (No OAC-Group; p⫽0.03). Surgical revision due to bleeding was necessary in 4 (OAC-Group) and 1 patients (No OAC-Group; p⫽ns). CONCLUSIONS: Our case series confirms the intra- and early postoperative safety of PVP in patients with ongoing oral anticoagula-

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tion or platelet aggregation inhibition. Thus, PVP can be recommended as safe and effective treatment modality for patients with increased risk of bleeding. Source of Funding: None

2006 IRRIGATION FLUID ABSORPTION DURING 120W HIGH-POWER GREENLIGHT LASER VAPORIZATION OF THE PROSTATE: RESULTS FROM A PROSPECTIVE INVESTIGATION USING EXPIRED BREATH ETHANOL MEASUREMENTS Nico Grossmann*, Marian Severin Wettstein, Christian D. Fankhauser, Lukas John Hefermehl, Janine C. Capol, Matthias Zimmermann, Tullio Sulser, Alexander Mu¨ller, Thomas Hermanns, Zu¨rich, Switzerland INTRODUCTION AND OBJECTIVES: Greenlight laser vaporisation (LV) of the prostate has been shown to be a safe procedure even for high-risk patients with lower urinary tract symptoms caused by prostate enlargement. Intra-operative fluid absorption was not detectable during LV using the first generation 80W greenlight laser. For the more powerful 120W greenlight laser, a different spectrum of adverse events, including a higher rate of capsular perforations and more bleeding complications, has been reported. The aim of the present investigation was to assess if fluid absorption occurs during LV using the more powerful 120W laser. METHODS: A total of 50 consecutive patients was investigated during 120W greenlight LV of the prostate. Intra-operative irrigation was performed using isotonic saline containing 1% ethanol. The breath ethanol concentration was measured every 10 min throughout the procedure with a conventional alcometer. The volume of fluid absorption was calculated from the results of these measurements. Intraoperative changes of haemoglobin, haematocrit, venous pH and serum electrolytes were also recorded. RESULTS: The median patients’ age was 69 y (range: 49-84) and the median prostate volume 41 mL (23-118). 25 patients (50%) were operated under thrombocyte aggregation inhibition and 8 (16 %) under anti-coagulation therapy. The median operation time was 70 min (30-170), the median irrigation volume 18 L (8-45) and the median applied laser energy 230 kJ (65-400). 22 patients (44 %) had a positive ethanol breath test. The median amount of fluid absorption in these patients was 1249 mL (138-3452). The surgeons reported intra-operative events in form of opened venous sinuses (n⫽ 2), capsular perforation (n⫽3) or a deep bladder neck incision (n⫽5) In 10 of these patients (45%). In the group of patients with a positive ethanol test, a significant decrease of the haemoglobin, haematocrit and venous pH and a significant increase of the serum chloride were detectable. CONCLUSIONS: Intra-operative fluid absorption was detectable in 44% of the patients undergoing 120W greenlight LV of the prostate. Absorption of isotonic saline does not result in a classical TUR-syndrome. However, care must be taken in cardiovascular highrisk patients because absorption of up to 3.5 liters of saline can result in serious complications in these patients. Intra-operative monitoring with venous pH or serum chloride might help to detect potentially dangerous fluid absorption if ethanol breath ethanol measurements are not performed. Source of Funding: None

2007 BIPOLAR PLASMA VAPORIZATION VERSUS STANDARD TUR IN CASES OF SECONDARY BLADDER NECK SCLEROSIS – A PROSPECTIVE, MEDIUM TERM, RANDOMIZED COMPARISON Bogdan Geavlete*, Cristian Moldoveanu, Catalin Iacoboaie, Florin Stanescu, Petrisor Geavlete, Bucharest, Romania INTRODUCTION AND OBJECTIVES: This prospective, randomized, medium term trial aimed to assess the efficiency, safety and

Vol. 189, No. 4S, Supplement, Wednesday, May 8, 2013

postoperative results of the bipolar plasma vaporization (BPV) by comparison to monopolar transurethral resection (TUR) in cases of secondary bladder neck sclerosis (BNS). METHODS: A total of 70 patients with BNS secondary to TURP (46 cases), open prostatectomy for benign prostatic hyperplasia (BPH - 18 cases) and radical prostatectomy for prostate cancer (6 cases) were enrolled in the trial. The inclusion criteria consisted of maximum flow rate (Qmax) below10 mL/s and International Prostate Symptom Score (IPSS) over 19. All patients were evaluated preoperatively as well as at 1, 3, 6, 12 and 18 months after surgery by IPSS, quality of life score (QoL), Qmax and post-voiding residual urinary volume (PVR). RESULTS: The mean operation time (10.3 versus 14.9 minutes), catheterization period (0.75 versus 2.1 days) and hospital stay (1.1 versus 3.2 days) were significantly reduced in the BPV series. During the immediate postoperative follow-up, the re-catheterization for acute urinary retention only occurred in the TUR group (5.7%). The medium term re-treatment requirements due to BNS recurrence were lower in the BPV study arm (2.8% versus 8.5%). At the 1, 3, 6, 12 and 18 month’s assessment, statistically similar parameters were found concerning the IPSS and QoL symptom scores, Qmax and PVR values specific for the two therapeutic alternatives. CONCLUSIONS: BPV constitutes a valuable endoscopic treatment approach for secondary BNS patients. The method emphasized superior efficacy, a satisfactory safety profile and similar medium term follow-up features when compared to standard TUR. Results IPSS

BPV

TUR

p value

1 month

3.8

4.0

0.766

3 months

3.6

3.9

0.629

6 months

3.5

3.6

0.892

12 months

3.3

3.5

0.714

18 months

3.4

3.3

0.881

1 month

1.4

1.5

0.939

3 months

1.2

1.4

0.525

6 months

1.1

1.2

0.962

12 months

1.1

1.1

0.696

18 months

1.2

1.1

0.179

1 month

23.0

23.3

0.880

3 months

23.2

23.6

0.817

6 months

23.5

23.8

0.868

12 months

23.9

24.2

0.852

18 months

23.8

24.0

0.922

1 month

31

28

0.460

3 months

24

23

0.733

6 months

22

21

0.694

12 months

19

18

0.699

18 months

21

17

0.133

Qol

Qmax (mL/s)

PVR (mL)

Source of Funding: None