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MP02-09 EVALUATION OF SURGICAL OUTCOMES WITH PHOTOSELECTIVE GREENLIGHT XPS LASER VAPORIZATION OF THE PROSTATE IN HIGH MEDICAL RISK MEN WITH BENIGN PROSTATIC ENLARGEMENT: A MULTICENTER STUDY
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
underexplored. Herein, we describe outcomes of HoLEP in a select cohort of patients with significant LUTS, and known low risk PCa. METHODS: Data were collected retrospectively on patients undergoing HoLEP by a single surgeon. A select group of well informed patients with large symptomatic glands and low risk cancer were carefully counseled that HoLEP was an option to address the obstructive BPH, would unpredictably remove the cancer (all, part, or none), emphasizing they were not undergoing a cancer operation, and that HoLEP would be followed by continued surveillance. Pre- and postoperative clinical factors, and operative and hospital stay data were collected. RESULTS: In total, 7 men were included. All men had Gleason 3+3 cancer in at most 20% of at most 3 cores on biopsy. Other preop characteristics are described in Table 1. Mean tissue removed was 48.8g. No patients required transfusion or reoperation. Median length of hospital stay was 24.5 hours; median length of catheterization was 19 hours. On final pathology, 3 of 7 of patients had cancer in the specimen, all of which were Gleason 3+3. At f/u, all flow rates improved, PVR improved or remained low, and PSA significantly decreased in all patients (Table 1). No patient have developed stricture, bladder neck contracture, incontinence, or required reoperation. Median f/u time was 4 months (range 4-24 months). Notably, 2 patients had prostate MRI within 2 years of HoLEP, neither of which showed suspicion for PCa. CONCLUSIONS: We have offered HoLEP judiciously to select patients on surveillance for low risk PCa and significant symptomatic BPH, a complex and increasingly common scenario, with acceptable short term outcomes. Further investigations into long-term cancerspecific outcomes, as well as strategies for continued surveillance, will be crucial in order to further evaluate and refine this new approach.
Source of Funding: None
MP02-09 EVALUATION OF SURGICAL OUTCOMES WITH PHOTOSELECTIVE GREENLIGHT XPS LASER VAPORIZATION OF THE PROSTATE IN HIGH MEDICAL RISK MEN WITH BENIGN PROSTATIC ENLARGEMENT: A MULTICENTER STUDY Emad Rajih*, Owings Mills, MD; Abdullah Alenizi, Malek Meskawi, Come Tholomier, Pierre-Alain Hueber, Mounsif Azizi, Montreal, Canada; Ricardo R. Gonzalez, Houston, TX; Gregg Eure, Virginia beach, MD; Lewis Kriteman, Roswell, GA; Mahmood Hai, Westland, MD; Kevin Zorn, Montreal, Canada INTRODUCTION AND OBJECTIVES: To evaluate the safety and short-term outcomes of photoselective vaporization of the prostate using GreenLight XPS in treatment of high medical risk men.
THE JOURNAL OF UROLOGYâ
e13
METHODS: A multicenter retrospective analysis of 941 men who underwent photoselective vaporization of the prostate between August 2010 and August 2014 was performed. Patients were considered high medical risk if they had an American Society of Anesthesiologists physical status score >¼ 3. Postoperative adverse events, unexpected postoperative medical provider visits after intervention, and functional urinary outcomes were examined. RESULTS: High medical risk men (n¼273) were older (mean age 72.3 +/- 8.1 vs. 67.1 +/- 9 years, p < 0.01), had larger prostate volume (82.8 +/- 48.2 vs. 73.7 +/- 49.4 g, p < 0.01), and were more likely to be on anticoagulant and antiplatelet medications (all p < 0.01). Moreover, overall operative time (65 +/- 35.1 vs. 53.9 +/- 24.9 min), energy delivered (313.4 +/- 207 vs. 258 +/- 164 KJ), and energy density used (4.2 +/- 3.8 vs. 3.8 +/- 3 KJ/g) were greater in the high medical risk group (all p < 0.05). Although high medical risk men were more often treated in a hospital setting (p < 0.01), there were no differences in intraoperative adverse events. Both groups had sustained improvements from baseline for all urinary functional outcomes at six months. Regarding safety, the two groups had comparable 90-day ClavienDindo complication rates, number of urgent care visits, and number of outpatient consultations. High medical risk men, however, had more hospital readmissions within 90-day post-surgery (3.7% vs. 1.3% [p ¼ 0.04]). CONCLUSIONS: Despite older age, comorbidities, and higher use of anticoagulants, HMR men (ASA-PS 3/4) who undergo GL-XPS experience postoperative complications similar to healthier men (ASAPS 1/2) in short term follow-up in addition to symptom improvement. GL-XPS produces safe and effective short-term outcomes in patients with multiple comorbidities.
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Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
RESULTS: Mean age (69.4 years +/- 7.5 d.s. vs. 67.7 years +/8 d.s.) and adenoma weight (55 g +/- 39 d.s. vs. 46 +/- 36 d.s.) were similar in both groups. Energy used in Group 2 (53 kJ +/- 23 d.s.) was 1/ 3 less than in Group 1 (83.5 kJ +/- 32 d.s.). Enucleation time (31 min +/13 vs. 27.5 +/- 15), efficiency (1.64 g/min +/- 0.8 vs. 1.7 +/- 1) and morcellation time (9 min +/- 7.6 vs. 7.7 +/- 7.1) were equivalent. Preand postoperative IPSS (pre: 22 +/- 2.4 d.s. vs. 22 +/- 7 d.s.; post: 6.5 +/- 5 d.s. vs. 7.8 +/- 5 d.s.), incidence of postoperative bleeding (no blood transfusions)(4.2% vs. 3%) and recatheterizations (4.2% vs. 3%) were similar. Long-lasting incontinences of variable entity (mainly mild) were similar (1.4% vs. 1.6%), as well as the incidence of postoperative dysuria (10%) at 3-month follow up. CONCLUSIONS: Low-power en-bloc no-touch HoLEP is feasible, safe and effective as the high-power approach, in the hands of experienced operators, being energy consumption reduced by nearly one third. Source of Funding: None
MP02-11 POSTOPERATIVE DYSURIA AFTER HIGH- AND LOW-POWER EN-BLOC NO-TOUCH HOLEP Cecilia Cracco*, Manuela Ingrosso, Nicola Russo, Cesare Marco Scoffone, Torino, Italy
Source of Funding: Boston Scientific Corporation
MP02-10 LOW-POWER VERSUS HIGH-POWER EN-BLOC NOTOUCH HOLEP: COMPARING FEASIBILITY, SAFETY AND EFFICACY Cesare Marco Scoffone*, Manuela Ingrosso, Nicola Russo, Cecilia Cracco, Torino, Italy INTRODUCTION AND OBJECTIVES: HoLEP (Holmium Laser Enucleation of the Prostate) is a safe and effective procedure for BPO treatment. Six years ago we modified the traditional 3-lobe technique into the so-called en-bloc no-touch approach, characterized by the enucleation of the adenoma in one single horshoe-like piece (en-bloc), largely exploiting the vaporizing plasma bubble generated around the tip of the laser fiber at a short distance from the tissue (no-touch). After more than 250 procedures with the 100-120W holmium laser device, in 2015 we chose to apply a low-power approach to deliver less energy to the capsular plane, and possibly minimize postoperative dysuria. The aim of the present work was to assess the feasibility of the low-power approach, and to compare its outcomes in terms of safety and efficacy with those of the traditional high-power HoLEP. METHODS: 316 patients suffering from BPO (any prostate volume, normal PSA, Qmax <15 ml/sec, IPSS>10, PVR <300 cc) underwent en-bloc no-touch HoLEP in our Department. From January 2012 to May 2015 214 consecutive patients underwent high-power HoLEP (group 1) with the 100-120W Versapulse holmium laser (Lumenis), 2J energy setting, 50 Hz, 100W power. From June 2015 to June 2016 102 consecutive patients underwent low-power HoLEP (group 2) with the 120W Versapulse holmium laser (Lumenis) for the first 20 patients, then the 50W Auriga XL holmium laser device (Boston Scientific), both 2.2J energy setting, 18 Hz frequency, long pulse length, almost 40W power. Patients demographics and clinical data were prospectively registered. Data were correlated using the Pearson correlation test.
INTRODUCTION AND OBJECTIVES: HoLEP (Holmium Laser Enucleation of the Prostate) is a safe and effective procedure for BPO treatment. Six years ago we modified the traditional 3-lobe technique into the so-called en-bloc no-touch approach, characterized by the enucleation of the adenoma in one single horshoe-like piece, exploiting the vaporizing effects of the plasma bubble generated around the tip of the laser fiber at a short distance from the tissue. Transient storage symptoms, mostly resolving spontaneously or with medical therapies within 1-3 months, are described among the early complications in 959% of patients who underwent HoLEP, and have been correlated also with energy consumption. The aim of the present study was to determine whether postoperative dysuria is somehow influenced by the use of a low-power approach rather than of a high-power one. METHODS: 316 patients suffering from BPO (any prostate volume, normal PSA, Qmax <15 ml/sec, IPSS>10, PVR <300 cc) underwent en-bloc no-touch HoLEP in our Department. From January 2012 to May 2015 214 consecutive patients underwent high-power HoLEP (group 1) with the 100-120W Versapulse holmium laser (Lumenis), 2J energy setting, 50 Hz, 100W power. From June 2015 to June 2016 102 consecutive patients underwent low-power HoLEP (group 2) for the first 20 cases with the Versapulse holmium laser (Lumenis), then the 50W Auriga XL holmium laser device (Boston Scientific), both 2.2J energy setting, 18 Hz frequency, long pulse length, almost 40W power. Patients demographics and clinical data were prospectively registered. IPSS questionnaires were self-administered before surgery and at 3-month follow up, VAS evaluation 1 month after surgery. RESULTS: Age (range 51-87 years) and adenoma weight (range 10-200 grams) were similar in the two groups. Mean energy employed for enucleation was 83.5 kJ +/- 32 d.s. for group 1, 53.4 kJ +/23 d.s. for group 2 (p<0.01), with a kJ/g ratio 2 +/- 1 vs. 1.5 +/- 0.8. Mean enucleation time was equivalent (31 min +/- 13 d.s. vs. 27.5 min +/- 11 d.s.), mean enucleation efficiency too (1.64 g/min +/- 0.8 d.s. vs. 1.7 g/min +/- 1 d.s.). Pre- and postoperative IPSS were similar (pre: 22 +/- 2.4 d.s. vs. 22 +/- 7 d.s.; post: 6.5 +/- 5 d.s. vs. 7.8 +/- 5 d.s.). Postoperative dysuria had the same incidence (10%), but in group 2 mean VAS evaluation at 1-month follow up was significantly better (6.2 +/- 1.5 d.s. in group 1, 2.4 +/- 3 d.s. in group 2). CONCLUSIONS: Low-power en-bloc no-touch HoLEP uses less energy than the high-power approach, with reduced kJ/g ratio and similar postoperative dysuria (10%), being intensity and duration of the storage symptoms reduced. Source of Funding: None
underexplored. Herein, we describe outcomes of HoLEP in a select cohort of patients with significant LUTS, and known low risk PCa. METHODS: Data were collected retrospectively on patients undergoing HoLEP by a single surgeon. A select group of well informed patients with large symptomatic glands and low risk cancer were carefully counseled that HoLEP was an option to address the obstructive BPH, would unpredictably remove the cancer (all, part, or none), emphasizing they were not undergoing a cancer operation, and that HoLEP would be followed by continued surveillance. Pre- and postoperative clinical factors, and operative and hospital stay data were collected. RESULTS: In total, 7 men were included. All men had Gleason 3+3 cancer in at most 20% of at most 3 cores on biopsy. Other preop characteristics are described in Table 1. Mean tissue removed was 48.8g. No patients required transfusion or reoperation. Median length of hospital stay was 24.5 hours; median length of catheterization was 19 hours. On final pathology, 3 of 7 of patients had cancer in the specimen, all of which were Gleason 3+3. At f/u, all flow rates improved, PVR improved or remained low, and PSA significantly decreased in all patients (Table 1). No patient have developed stricture, bladder neck contracture, incontinence, or required reoperation. Median f/u time was 4 months (range 4-24 months). Notably, 2 patients had prostate MRI within 2 years of HoLEP, neither of which showed suspicion for PCa. CONCLUSIONS: We have offered HoLEP judiciously to select patients on surveillance for low risk PCa and significant symptomatic BPH, a complex and increasingly common scenario, with acceptable short term outcomes. Further investigations into long-term cancerspecific outcomes, as well as strategies for continued surveillance, will be crucial in order to further evaluate and refine this new approach.
Source of Funding: None
MP02-09 EVALUATION OF SURGICAL OUTCOMES WITH PHOTOSELECTIVE GREENLIGHT XPS LASER VAPORIZATION OF THE PROSTATE IN HIGH MEDICAL RISK MEN WITH BENIGN PROSTATIC ENLARGEMENT: A MULTICENTER STUDY Emad Rajih*, Owings Mills, MD; Abdullah Alenizi, Malek Meskawi, Come Tholomier, Pierre-Alain Hueber, Mounsif Azizi, Montreal, Canada; Ricardo R. Gonzalez, Houston, TX; Gregg Eure, Virginia beach, MD; Lewis Kriteman, Roswell, GA; Mahmood Hai, Westland, MD; Kevin Zorn, Montreal, Canada INTRODUCTION AND OBJECTIVES: To evaluate the safety and short-term outcomes of photoselective vaporization of the prostate using GreenLight XPS in treatment of high medical risk men.
THE JOURNAL OF UROLOGYâ
e13
METHODS: A multicenter retrospective analysis of 941 men who underwent photoselective vaporization of the prostate between August 2010 and August 2014 was performed. Patients were considered high medical risk if they had an American Society of Anesthesiologists physical status score >¼ 3. Postoperative adverse events, unexpected postoperative medical provider visits after intervention, and functional urinary outcomes were examined. RESULTS: High medical risk men (n¼273) were older (mean age 72.3 +/- 8.1 vs. 67.1 +/- 9 years, p < 0.01), had larger prostate volume (82.8 +/- 48.2 vs. 73.7 +/- 49.4 g, p < 0.01), and were more likely to be on anticoagulant and antiplatelet medications (all p < 0.01). Moreover, overall operative time (65 +/- 35.1 vs. 53.9 +/- 24.9 min), energy delivered (313.4 +/- 207 vs. 258 +/- 164 KJ), and energy density used (4.2 +/- 3.8 vs. 3.8 +/- 3 KJ/g) were greater in the high medical risk group (all p < 0.05). Although high medical risk men were more often treated in a hospital setting (p < 0.01), there were no differences in intraoperative adverse events. Both groups had sustained improvements from baseline for all urinary functional outcomes at six months. Regarding safety, the two groups had comparable 90-day ClavienDindo complication rates, number of urgent care visits, and number of outpatient consultations. High medical risk men, however, had more hospital readmissions within 90-day post-surgery (3.7% vs. 1.3% [p ¼ 0.04]). CONCLUSIONS: Despite older age, comorbidities, and higher use of anticoagulants, HMR men (ASA-PS 3/4) who undergo GL-XPS experience postoperative complications similar to healthier men (ASAPS 1/2) in short term follow-up in addition to symptom improvement. GL-XPS produces safe and effective short-term outcomes in patients with multiple comorbidities.
e14
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Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
RESULTS: Mean age (69.4 years +/- 7.5 d.s. vs. 67.7 years +/8 d.s.) and adenoma weight (55 g +/- 39 d.s. vs. 46 +/- 36 d.s.) were similar in both groups. Energy used in Group 2 (53 kJ +/- 23 d.s.) was 1/ 3 less than in Group 1 (83.5 kJ +/- 32 d.s.). Enucleation time (31 min +/13 vs. 27.5 +/- 15), efficiency (1.64 g/min +/- 0.8 vs. 1.7 +/- 1) and morcellation time (9 min +/- 7.6 vs. 7.7 +/- 7.1) were equivalent. Preand postoperative IPSS (pre: 22 +/- 2.4 d.s. vs. 22 +/- 7 d.s.; post: 6.5 +/- 5 d.s. vs. 7.8 +/- 5 d.s.), incidence of postoperative bleeding (no blood transfusions)(4.2% vs. 3%) and recatheterizations (4.2% vs. 3%) were similar. Long-lasting incontinences of variable entity (mainly mild) were similar (1.4% vs. 1.6%), as well as the incidence of postoperative dysuria (10%) at 3-month follow up. CONCLUSIONS: Low-power en-bloc no-touch HoLEP is feasible, safe and effective as the high-power approach, in the hands of experienced operators, being energy consumption reduced by nearly one third. Source of Funding: None
MP02-11 POSTOPERATIVE DYSURIA AFTER HIGH- AND LOW-POWER EN-BLOC NO-TOUCH HOLEP Cecilia Cracco*, Manuela Ingrosso, Nicola Russo, Cesare Marco Scoffone, Torino, Italy
Source of Funding: Boston Scientific Corporation
MP02-10 LOW-POWER VERSUS HIGH-POWER EN-BLOC NOTOUCH HOLEP: COMPARING FEASIBILITY, SAFETY AND EFFICACY Cesare Marco Scoffone*, Manuela Ingrosso, Nicola Russo, Cecilia Cracco, Torino, Italy INTRODUCTION AND OBJECTIVES: HoLEP (Holmium Laser Enucleation of the Prostate) is a safe and effective procedure for BPO treatment. Six years ago we modified the traditional 3-lobe technique into the so-called en-bloc no-touch approach, characterized by the enucleation of the adenoma in one single horshoe-like piece (en-bloc), largely exploiting the vaporizing plasma bubble generated around the tip of the laser fiber at a short distance from the tissue (no-touch). After more than 250 procedures with the 100-120W holmium laser device, in 2015 we chose to apply a low-power approach to deliver less energy to the capsular plane, and possibly minimize postoperative dysuria. The aim of the present work was to assess the feasibility of the low-power approach, and to compare its outcomes in terms of safety and efficacy with those of the traditional high-power HoLEP. METHODS: 316 patients suffering from BPO (any prostate volume, normal PSA, Qmax <15 ml/sec, IPSS>10, PVR <300 cc) underwent en-bloc no-touch HoLEP in our Department. From January 2012 to May 2015 214 consecutive patients underwent high-power HoLEP (group 1) with the 100-120W Versapulse holmium laser (Lumenis), 2J energy setting, 50 Hz, 100W power. From June 2015 to June 2016 102 consecutive patients underwent low-power HoLEP (group 2) with the 120W Versapulse holmium laser (Lumenis) for the first 20 patients, then the 50W Auriga XL holmium laser device (Boston Scientific), both 2.2J energy setting, 18 Hz frequency, long pulse length, almost 40W power. Patients demographics and clinical data were prospectively registered. Data were correlated using the Pearson correlation test.
INTRODUCTION AND OBJECTIVES: HoLEP (Holmium Laser Enucleation of the Prostate) is a safe and effective procedure for BPO treatment. Six years ago we modified the traditional 3-lobe technique into the so-called en-bloc no-touch approach, characterized by the enucleation of the adenoma in one single horshoe-like piece, exploiting the vaporizing effects of the plasma bubble generated around the tip of the laser fiber at a short distance from the tissue. Transient storage symptoms, mostly resolving spontaneously or with medical therapies within 1-3 months, are described among the early complications in 959% of patients who underwent HoLEP, and have been correlated also with energy consumption. The aim of the present study was to determine whether postoperative dysuria is somehow influenced by the use of a low-power approach rather than of a high-power one. METHODS: 316 patients suffering from BPO (any prostate volume, normal PSA, Qmax <15 ml/sec, IPSS>10, PVR <300 cc) underwent en-bloc no-touch HoLEP in our Department. From January 2012 to May 2015 214 consecutive patients underwent high-power HoLEP (group 1) with the 100-120W Versapulse holmium laser (Lumenis), 2J energy setting, 50 Hz, 100W power. From June 2015 to June 2016 102 consecutive patients underwent low-power HoLEP (group 2) for the first 20 cases with the Versapulse holmium laser (Lumenis), then the 50W Auriga XL holmium laser device (Boston Scientific), both 2.2J energy setting, 18 Hz frequency, long pulse length, almost 40W power. Patients demographics and clinical data were prospectively registered. IPSS questionnaires were self-administered before surgery and at 3-month follow up, VAS evaluation 1 month after surgery. RESULTS: Age (range 51-87 years) and adenoma weight (range 10-200 grams) were similar in the two groups. Mean energy employed for enucleation was 83.5 kJ +/- 32 d.s. for group 1, 53.4 kJ +/23 d.s. for group 2 (p<0.01), with a kJ/g ratio 2 +/- 1 vs. 1.5 +/- 0.8. Mean enucleation time was equivalent (31 min +/- 13 d.s. vs. 27.5 min +/- 11 d.s.), mean enucleation efficiency too (1.64 g/min +/- 0.8 d.s. vs. 1.7 g/min +/- 1 d.s.). Pre- and postoperative IPSS were similar (pre: 22 +/- 2.4 d.s. vs. 22 +/- 7 d.s.; post: 6.5 +/- 5 d.s. vs. 7.8 +/- 5 d.s.). Postoperative dysuria had the same incidence (10%), but in group 2 mean VAS evaluation at 1-month follow up was significantly better (6.2 +/- 1.5 d.s. in group 1, 2.4 +/- 3 d.s. in group 2). CONCLUSIONS: Low-power en-bloc no-touch HoLEP uses less energy than the high-power approach, with reduced kJ/g ratio and similar postoperative dysuria (10%), being intensity and duration of the storage symptoms reduced. Source of Funding: None