lithium-borate and Urinary-Retention

To determine if there is a role for high-powered photoselective vaporization of the prostate (PVP) in large prostates for the management of bladder outlet obstruction. This study aims to evaluate the safety and efficacy of PVP in prostates ≥100 cc.. A retrospective analysis of a prospectively maintained database (ethics approved), single-surgeon, single-center series, between November 2010 and February 2013 of males with ≥100 cc prostates who underwent PVP. Perioperative and functional outcomes at baseline, 3, and 6 months were evaluated.. Thirty-five males were identified, median age 70 (interquartile range [IQR] 66-79) with prostates ≥100 cc (median 132, IQR 118-157). Preoperatively, 11/35 (31%) were in urinary retention and 11/35 (31%) were anticoagulated. Perioperative outcomes showed median laser time 75 minutes, operating time 103 minutes, and energy use 750 kJ. Median postoperative length of stay was 20 hours, catheterization 12 hours, and 33/35 (94%) were discharged catheter free. Twelve adverse events in 11 men were recorded, all Clavien-Dindo Grade I-II with 1 Grade IIIa complication. Paired functional outcomes showed statistically significant (p<0.05) improvements in the median International Prostate Symptom Score (IPSS) (20, 6, 6), quality of life (QoL) Index (4, 1, 1), maximum urinary flow rate (Qmax) (9.5, 20.5, 19.5 mL/s), and postvoid residual (149, 40, 41 mL) (baseline, 3, and 6 months).. PVP using the 180 W LBO laser in large prostates appears feasible and efficacious, with short duration of catheterization and postoperative length of stay. Acceptable morbidity was recorded. Enormous energy utilization was delivered within acceptable operating times. Early results indicate excellent functional outcomes at 3 and 6 months following PVP.

Topics: Aged; Aged, 80 and over; Borates; Databases, Factual; Humans; Laser Therapy; Light; Lithium Compounds; Male; Middle Aged; Operative Time; Organ Size; Prospective Studies; Prostate; Prostatic Hyperplasia; Quality of Life; Retrospective Studies; Transurethral Resection of Prostate; Treatment Outcome; Urinary Bladder Neck Obstruction; Urinary Retention

Although photoselective vaporization of the prostate (PVP) is considered one of the most promising alternatives to transurethral radical prostatectomy, a longer operative time, an unsatisfactory tissue removal rate, and the absence of postoperative pathology samples remain the main criticisms for this procedure.. To describe the novel technique of photoselective vaporesection of the prostate (PVRP) with a front-firing lithium triborate (LBO) laser and to report our initial experience.. This is a prospective study of 215 patients undergoing PVRP between November 2011 and March 2013. Their average age, prostate size, and International Prostate Symptom Score (IPSS) were 70.3 ± 7.3 yr, 70.4 ± 34.0 ml, and 24.9 ± 5.0, respectively.. The operative technique is detailed in the accompanying video.. Perioperative data were collected. The patients were followed up at 3, 6, 12 mo after PVRP, and functional outcomes and complications were assessed.. The mean operation time was 44.1 ± 22.6 min. The mean hemoglobin decrease was 0.37 ± 0.21 g/dl. The catheterization time was 23.9 ± 15.2 h and the postoperative hospital stay was 1.8 ± 0.8 d. Significant improvements were observed in maximum flow, IPSS, and postvoid residual urine at each follow-up time point. Compared to preoperative values, prostate volume and serum prostate-specific antigen fell by 67% and 63%, respectively, at 3 mo after PVRP. No major complications were noted. Application of a hemostat for a front-firing LBO laser makes it easy to handle intractable intraoperative bleeding. The main limitation of this study is the short follow-up period. The influence of PVRP on sexual function and the learning curve remain to be evaluated.. PVRP is a novel technique that is effective and safe for treatment of benign prostatic hyperplasia. This technique retains the excellent hemostatic property of LBO lasers and has a short operation time and a high tissue removal rate. The problem of the lack of postoperative tissue samples for PVP is also overcome in PVRP.. We have developed a novel technique named photoselective vaporesection of the prostate (PVRP) with a front-firing green laser. Our results show that PVRP retains the excellent hemostatic property of a green laser, but has a much shorter operation time and a higher rate of tissue removal than photoselective vaporization of the prostate (PVP). This technique also solves the problem of the lack of postoperative tissue specimens and the difficulty of handling intractable intraoperative bleeding. According to our initial results, PVRP is a novel technique superior to PVP in the treatment of benign prostatic hyperplasia.

Topics: Aged; Aged, 80 and over; Borates; Humans; Laser Therapy; Lasers, Solid-State; Length of Stay; Lithium Compounds; Male; Middle Aged; Operative Time; Postoperative Complications; Prospective Studies; Prostate; Prostate-Specific Antigen; Quality of Life; Time Factors; Transurethral Resection of Prostate; Treatment Outcome; Urinary Retention; Volatilization