Roger Valdivieso1, Christian P Meyer2, Pierre-Alain Hueber1, Malek Meskawi1, Abdullah M Alenizi1, Mounsif Azizi1, Quoc-Dien Trinh2, Vincent Misrai3, Matthew Rutman4, Alexis E Te5, Bilal Chughtai5, Neil J Barber6, Amr M Emara6, Ravi Munver7, Kevin C Zorn8. 1. Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada. 2. Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 3. Department of Urology, Clinique Pasteur Toulouse, Toulouse, France. 4. Department of Urology, Columbia University, New York, NY, USA. 5. Department of Urology, Cornell University, New York, NY, USA. 6. Department of Urology, Frimley Park Hospital, Frimley, Surrey, UK. 7. Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA. 8. Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada. zorn.chumurology@gmail.com.
Abstract
OBJECTIVES: To assess the effect of energy density (kJ/mL) applied on adenoma during photoselective vaporization of the prostate (PVP) treatment for benign prostate hyperplasia (BPH) on functional outcomes, prostate-specific antigen (PSA) reduction and complications. PATIENTS AND METHODS: After exclusions, a total of 440 patients who underwent GreenLight (tm) laser XPS-180W lithium triborate PVP for the treatment of BPH were retrospectively reviewed. Data were collected from seven different international centres (Canada, USA, UK and France). Patients were stratified into four energy density groups (kJ/mL) according to intra-operative energy delivered and prostate volume as determined by preoperative transrectal ultrasonography (TRUS): group 1: <3 kJ/mL; group 2: 3-5 kJ/mL; group 3: 5-7 kJ/mL; and group 4: ≥7 kJ/mL. Energy density groups were chosen arbitrarily. PSA reduction and functional outcomes (International Prostate Symptom Score, quality of life, post-void residual urine volume, maximum urinary flow rate) were compared at 6, 12 and 24 months. Peri-operative complications and retreatment rates were also compared among the groups. RESULTS: The PSA reduction rates at 24 months after the procedure were 51, 61, 79 and 83% for the energy density groups <3, 3-5, 5-7 and ≥7 kJ/mL, respectively (P ≤ 0.01). This held true after accounting for baseline confounders. Energy density was not associated with higher complication rates, including haematuria, stricture formation, incontinence, refractory urinary retention, urinary tract infection and conversion to transurethral resection of the prostate. Functional outcomes at 2 years of follow-up were equivalent among the groups (P > 0.05 for all) and similar retreatment rates were observed (P = 0.36). CONCLUSION: Higher energy usage per cc of prostate was associated with a more significant reduction in PSA level (>50%) at 6, 12 and 24 months, suggesting increased vaporization of adenoma tissue; however, this did not translate into differences in functional outcomes at 2-year follow-up.
OBJECTIVES: To assess the effect of energy density (kJ/mL) applied on adenoma during photoselective vaporization of the prostate (PVP) treatment for benign prostate hyperplasia (BPH) on functional outcomes, prostate-specific antigen (PSA) reduction and complications. PATIENTS AND METHODS: After exclusions, a total of 440 patients who underwent GreenLight (tm) laser XPS-180W lithium triborate PVP for the treatment of BPH were retrospectively reviewed. Data were collected from seven different international centres (Canada, USA, UK and France). Patients were stratified into four energy density groups (kJ/mL) according to intra-operative energy delivered and prostate volume as determined by preoperative transrectal ultrasonography (TRUS): group 1: <3 kJ/mL; group 2: 3-5 kJ/mL; group 3: 5-7 kJ/mL; and group 4: ≥7 kJ/mL. Energy density groups were chosen arbitrarily. PSA reduction and functional outcomes (International Prostate Symptom Score, quality of life, post-void residual urine volume, maximum urinary flow rate) were compared at 6, 12 and 24 months. Peri-operative complications and retreatment rates were also compared among the groups. RESULTS: The PSA reduction rates at 24 months after the procedure were 51, 61, 79 and 83% for the energy density groups <3, 3-5, 5-7 and ≥7 kJ/mL, respectively (P ≤ 0.01). This held true after accounting for baseline confounders. Energy density was not associated with higher complication rates, including haematuria, stricture formation, incontinence, refractory urinary retention, urinary tract infection and conversion to transurethral resection of the prostate. Functional outcomes at 2 years of follow-up were equivalent among the groups (P > 0.05 for all) and similar retreatment rates were observed (P = 0.36). CONCLUSION: Higher energy usage per cc of prostate was associated with a more significant reduction in PSA level (>50%) at 6, 12 and 24 months, suggesting increased vaporization of adenoma tissue; however, this did not translate into differences in functional outcomes at 2-year follow-up.
Authors: Malek Meskawi; Pierre-Alain Hueber; Roger Valdivieso; Franck Bruyere; Vincent Misrai; Georges Fournier; Ravi Munver; Ganesh Sivarajan; Matthew Rutman; Alexis E Te; Bilal Chughtai; Dean Elterman; Tristan Martel; Mounsif Azizi; Pierre I Karakiewicz; Kevin C Zorn Journal: World J Urol Date: 2017-02-22 Impact factor: 4.226
Authors: Khaled Ajib; Mila Mansour; Marc Zanaty; Mansour Alnazari; Pierre-Alain Hueber; Malek Meskawi; Roger Valdivieso; Come Tholomier; Benjamin Pradere; Vincent Misrai; Dean Elterman; Kevin C Zorn Journal: Can Urol Assoc J Date: 2018-03-19 Impact factor: 1.862