- Email: [email protected]
2270 PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE (PVP) USING GREEN LIGHT HPS: IS OUTCOME SIZE DEPENDENT?
e910
THE JOURNAL OF UROLOGY姞
Vol. 185, No. 4S, Supplement, Wednesday, May 18, 2011
2270
2271
PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE (PVP) USING GREEN LIGHT HPS: IS OUTCOME SIZE DEPENDENT?
RADICAL PROSTATECTOMY AFTER PREVIOUS PROSTATE SURGERY: CLINICAL AND FUNCTIONAL OUTCOMES
Hazem Elmansyⴱ, Ahmed Kotb, Mostafa Elhilali, Montreal, Canada
Umberto Capitanioⴱ, Andrea Gallina, Nazareno Suardi, Alberto Briganti, Vincenzo Scattoni, Giorgio Gandaglia, Luca Villa, Manuela Tutolo, Marco Bianchi, Massimo Freschi, Patrizio Rigatti, Francesco Montorsi, Renzo Colombo, Milan, Italy
INTRODUCTION AND OBJECTIVES: The aim of our work was to compare the efficacy of HPS in the treatment of symptomatic BPH, for prostate glands below and above 60 grams. METHODS: A retrospective analysis of 134 patients treated by HPS was done. Nine patients were converted to other procedure due to bleeding and were excluded from the analysis. The remaining 125 cases included 89 and 36 patients with prostate size less and more than 60 grams respectively. International Prostate Symptom score (IPSS), International Index of Erectile Function (IIEF-5), Maximum Flow Rate (Qmax), Post void Residual Urine (PVR) and serum PSA were recorded. Operative data and number of fibers used and complication rates were also recorded. Patients were evaluated at 1, 3,6 months, and 1 year follow up. RESULTS: The mean age of the patients was 73 years,the mean preoperative TRUS volume was 53.6 (15.5-129) grams. The mean energy, operative time and the number of laser fibers were significantly higher in patients with prostate ⬎60 grams. Functional outcomes; including IPSS, QOL, PVR and Qmax were comparable in both groups.One(1.1%)and 8(18%) patients were converted intraoperatively to other procedure (p ⬍0.0001),in patients with prostate gland below and above 60 grams respectively. Postoperative complications including stricture,bladder neck obstruction, urge and stress incontinence were 1.6%, 2.4%, 18.4% and 3.2% for the whole cohort.Table(1) CONCLUSIONS: Due to our intent to reach the prostatic capsule during vaporization, the functional results following HPS management for BPH seems to be comparable for patients with prostate volume less and more than 60 grams. However; patients with prostate volume more than 60 grams significantly required longer operative time and nearly 1/3 of the cases required more than 1 fiber. Also the rate of conversion and redo surgery was significantly higher with prostate volume more than 60 grams,making HPS, although effective, probably not the first choice with larger prostate glands.
INTRODUCTION AND OBJECTIVES: We evaluated the impact of previous prostate surgery performed for lower urinary tract symptoms (SxLUTS), in terms of overall perioperative and postoperative morbidity, and early functional outcome in patients who underwent radical prostatectomy (RP). METHODS: From January 2001 to January 2010, 3741 consecutive patients underwent open RP, of whom 283 (7.6%) had previously undergone SxLUTS. Perioperative and postoperative data were compared between group 1 (with previous SxLUTS) and group 2 (without previous SxLUTS). The functional results were assessed by validated questionnaires (IIEF and ICIQ). RESULTS: Patients in group 1 were younger (65.6 vs 69.0 years, p⬍0.001) relative to group 2. Pre-operative risk groups according to D’Amico categories were 35.7% vs 44.0% (low risk), 42.3% vs. 39.4% (intermediate risk) and 22.1% vs. 16.7% (high risk) in group 1 and 2, respectively (p⫽0.01). The preoperative rate of fully potent patients was significantly higher in patients not treated with SxLUTS (38.4% vs. 26.4%, p⫽0.01). Operative time (147 vs 151 minutes), hospital stay (9.4 vs 9.5 days), bladder catheterization (9.5 vs 10.4 days) and blood loss (1108 vs 1169 cc) were similar in the two groups (all p⬎0.1). Surgical complications according to the Clavien classification resulted grade 2 and 3 in 15.5% and 1.0% vs. 16.6% and 0.4% in group 1 and 2, respectively (p⫽0.4). The 1 and 2-year urinary continence recovery rates were not significantly different for patients treated with SxLUTS as compared to non-SxLUTS patients (72% vs. 69% and 79% vs. 74% respectively; p⫽NS). The 1 and 2-year erectile function recovery rates were not significantly different between the two groups (38% vs. 48% and 39% vs. 46% respectively; p⫽NS). These data were confirmed at multivariable Cox regression analyses where the variable depicting previous SxLUTS was not associated with urinary continence and erectile function recovery after accounting for patient age at surgery, surgical volume, nerve sparing technique and pre-operative functional and oncologic characteristics (p⬎0.2). CONCLUSIONS: Radical retropubic prostatectomy can be performed safely after previous prostate surgery for bladder outlet obstruction. Candidates for second line prostate surgery should be informed that functional results may be achieved as satisfactory as those achieved after the same surgical approach in naı¨ve patients. Source of Funding: None
2272 EJACULATION-PRESERVING PHOTOSELECTIVE VAPORIZATION OF PROSTATE(EP-PVP): SIX YEARS EXPERIENCE FROM A MULTI-CENTRE STUDY Shahin Tabatabaeiⴱ, Boston, MA; Benjamin Choi, New York, NY; Gordon Muir, London, United Kingdom
Source of Funding: none
INTRODUCTION AND OBJECTIVES: Orgasmic dysfunction and dry orgasm are some of the most common complications of benign prostate surgery. Besides infertility, dry and diminished orgasm may decrease sexual satisfaction. There is no agreement of the mode of causation, with both retrograde ejaculation and ejaculatory duct obstruction having been proposed. We present the technique and results of a modification of GreenLight® laser prostatectomy, devised to reduce orgasmic dysfunction. METHODS: Ejaculation preserving, photo selective vaporization of prostate (EP-PVP) was used in patients who had undergone GreenLight® PVP and who wished to preserve ejaculation. The technique involves three steps: 1) Preservation of bladder neck muscle fibers; 2) Preservation of precollicular tissue; 3) preservation of paracollicular prostate tissue (Ejaculatory hood).
THE JOURNAL OF UROLOGY姞
Vol. 185, No. 4S, Supplement, Wednesday, May 18, 2011
2270
2271
PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE (PVP) USING GREEN LIGHT HPS: IS OUTCOME SIZE DEPENDENT?
RADICAL PROSTATECTOMY AFTER PREVIOUS PROSTATE SURGERY: CLINICAL AND FUNCTIONAL OUTCOMES
Hazem Elmansyⴱ, Ahmed Kotb, Mostafa Elhilali, Montreal, Canada
Umberto Capitanioⴱ, Andrea Gallina, Nazareno Suardi, Alberto Briganti, Vincenzo Scattoni, Giorgio Gandaglia, Luca Villa, Manuela Tutolo, Marco Bianchi, Massimo Freschi, Patrizio Rigatti, Francesco Montorsi, Renzo Colombo, Milan, Italy
INTRODUCTION AND OBJECTIVES: The aim of our work was to compare the efficacy of HPS in the treatment of symptomatic BPH, for prostate glands below and above 60 grams. METHODS: A retrospective analysis of 134 patients treated by HPS was done. Nine patients were converted to other procedure due to bleeding and were excluded from the analysis. The remaining 125 cases included 89 and 36 patients with prostate size less and more than 60 grams respectively. International Prostate Symptom score (IPSS), International Index of Erectile Function (IIEF-5), Maximum Flow Rate (Qmax), Post void Residual Urine (PVR) and serum PSA were recorded. Operative data and number of fibers used and complication rates were also recorded. Patients were evaluated at 1, 3,6 months, and 1 year follow up. RESULTS: The mean age of the patients was 73 years,the mean preoperative TRUS volume was 53.6 (15.5-129) grams. The mean energy, operative time and the number of laser fibers were significantly higher in patients with prostate ⬎60 grams. Functional outcomes; including IPSS, QOL, PVR and Qmax were comparable in both groups.One(1.1%)and 8(18%) patients were converted intraoperatively to other procedure (p ⬍0.0001),in patients with prostate gland below and above 60 grams respectively. Postoperative complications including stricture,bladder neck obstruction, urge and stress incontinence were 1.6%, 2.4%, 18.4% and 3.2% for the whole cohort.Table(1) CONCLUSIONS: Due to our intent to reach the prostatic capsule during vaporization, the functional results following HPS management for BPH seems to be comparable for patients with prostate volume less and more than 60 grams. However; patients with prostate volume more than 60 grams significantly required longer operative time and nearly 1/3 of the cases required more than 1 fiber. Also the rate of conversion and redo surgery was significantly higher with prostate volume more than 60 grams,making HPS, although effective, probably not the first choice with larger prostate glands.
INTRODUCTION AND OBJECTIVES: We evaluated the impact of previous prostate surgery performed for lower urinary tract symptoms (SxLUTS), in terms of overall perioperative and postoperative morbidity, and early functional outcome in patients who underwent radical prostatectomy (RP). METHODS: From January 2001 to January 2010, 3741 consecutive patients underwent open RP, of whom 283 (7.6%) had previously undergone SxLUTS. Perioperative and postoperative data were compared between group 1 (with previous SxLUTS) and group 2 (without previous SxLUTS). The functional results were assessed by validated questionnaires (IIEF and ICIQ). RESULTS: Patients in group 1 were younger (65.6 vs 69.0 years, p⬍0.001) relative to group 2. Pre-operative risk groups according to D’Amico categories were 35.7% vs 44.0% (low risk), 42.3% vs. 39.4% (intermediate risk) and 22.1% vs. 16.7% (high risk) in group 1 and 2, respectively (p⫽0.01). The preoperative rate of fully potent patients was significantly higher in patients not treated with SxLUTS (38.4% vs. 26.4%, p⫽0.01). Operative time (147 vs 151 minutes), hospital stay (9.4 vs 9.5 days), bladder catheterization (9.5 vs 10.4 days) and blood loss (1108 vs 1169 cc) were similar in the two groups (all p⬎0.1). Surgical complications according to the Clavien classification resulted grade 2 and 3 in 15.5% and 1.0% vs. 16.6% and 0.4% in group 1 and 2, respectively (p⫽0.4). The 1 and 2-year urinary continence recovery rates were not significantly different for patients treated with SxLUTS as compared to non-SxLUTS patients (72% vs. 69% and 79% vs. 74% respectively; p⫽NS). The 1 and 2-year erectile function recovery rates were not significantly different between the two groups (38% vs. 48% and 39% vs. 46% respectively; p⫽NS). These data were confirmed at multivariable Cox regression analyses where the variable depicting previous SxLUTS was not associated with urinary continence and erectile function recovery after accounting for patient age at surgery, surgical volume, nerve sparing technique and pre-operative functional and oncologic characteristics (p⬎0.2). CONCLUSIONS: Radical retropubic prostatectomy can be performed safely after previous prostate surgery for bladder outlet obstruction. Candidates for second line prostate surgery should be informed that functional results may be achieved as satisfactory as those achieved after the same surgical approach in naı¨ve patients. Source of Funding: None
2272 EJACULATION-PRESERVING PHOTOSELECTIVE VAPORIZATION OF PROSTATE(EP-PVP): SIX YEARS EXPERIENCE FROM A MULTI-CENTRE STUDY Shahin Tabatabaeiⴱ, Boston, MA; Benjamin Choi, New York, NY; Gordon Muir, London, United Kingdom
Source of Funding: none
INTRODUCTION AND OBJECTIVES: Orgasmic dysfunction and dry orgasm are some of the most common complications of benign prostate surgery. Besides infertility, dry and diminished orgasm may decrease sexual satisfaction. There is no agreement of the mode of causation, with both retrograde ejaculation and ejaculatory duct obstruction having been proposed. We present the technique and results of a modification of GreenLight® laser prostatectomy, devised to reduce orgasmic dysfunction. METHODS: Ejaculation preserving, photo selective vaporization of prostate (EP-PVP) was used in patients who had undergone GreenLight® PVP and who wished to preserve ejaculation. The technique involves three steps: 1) Preservation of bladder neck muscle fibers; 2) Preservation of precollicular tissue; 3) preservation of paracollicular prostate tissue (Ejaculatory hood).