Abstract
Objective:
Despite significant improvement in the Greenlight (532 nm) laser technology, the surgical techniques did not show similar enhancements. In this video we report an approach for anatomical vaporization using enucleation-based approach: photoselective vapo-enucleation of the prostate (PVEP). The proposed advantages of this technique are that over conventional vaporization techniques are available tissue for pathologic assessment and the objective endpoints of vaporization and over transurethral enucleation techniques are shorter learning curve and simpler setup (no need for tissue morcellator).
Patients and Methods:
This video illustrates a stepwise approach for PVEP. Between July 2014 and October 2015, two surgeons performed 73 PVEP procedures. Surgeon A (with experience of more than 400 transurethral enucleation procedures) performed 52 procedures and surgeon B (enucleation naive) performed 21 procedures. Perioperative parameters were depicted and compared between surgeons. Patients were followed by IPSS, uroflowmetry, and residual urine estimation at 1, 4, and 12 months. Complications were reported according to modified Clavien classification.
Results:
Mean patients' age was 71 ± 8 years and prostate size was 88 ± 13 cc. Mean operating time was (55 ± 18 and 59 ± 19 minutes), lasing time (44 ± 16 and 48 ± 10 minutes), and used laser energy was (345 ± 112 and 381 ± 102 KJ) in surgeons A and B, respectively (p > 0.05). Mean catheter time was (1.7 ± 1 and 1.6 ± 1) days and hospital stay was (1 ± 0.6 and 1 ± 0.5) days in surgeons A and B, respectively (p > 0.05). No periprocedure blood transfusion was needed. After median of 9 (range 6–20) months follow-up, there were significant sustained improvements in all functional outcome measures at different follow-up points. One patient was readmitted for scrotal abscess after acute epididymo-orchitis. Persistent postprocedure grade 1 stress urine leak was reported in one patient. Mean postoperative prostate specific antigen reduction was 75 ± 18%.
Conclusion:
Greenlight laser (XPS™) PVEP is a safe, effective, and promising technique with objective end points entailing more prostate tissue removal.
No competing financial interests exist
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Runtime of video: 8 mins 51 secs
