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      Effectiveness and Safety of Photoselective Vaporization of the Prostate with the 120 W HPS Greenlight Laser in Benign Prostatic Hyperplasia Patients Taking Oral Anticoagulants

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          Abstract

          Purpose

          To examine the effectiveness and safety of photoselective vaporization of the prostate (PVP) with the 120 W high-performance system (HPS) Greenlight laser procedure in benign prostatic hyperplasia (BPH) patients taking oral anticoagulant medications.

          Materials and Methods

          This study was conducted on BPH patients taking oral anticoagulant medications form March 2009 to December 2010. Group I consisted of patients who stopped oral anticoagulant medications before surgery (n=30), and group II consisted of patients who continued oral anticoagulant medications before surgery (n=30). PVP applying the 120 W HPS Greenlight laser was done, and followed up for 12 weeks. Follow-up variables were International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), and hemoglobin level change.

          Results

          At 12 weeks after surgery, we confirmed the improvement in the IPSS score of Group I compared with preoperative scores. The quality of life (QoL) score, Qmax and PVR were also improved. respectively, both of which were significantly improved. In Group II, similarly, the total IPSS score, the voiding symptom score, and the storage symptom score were improved in comparison with the preoperative scores. The QoL score, Qmax and the PVR were improved in comparison with the preoperative scores. During the 12-week follow-up period, no major postsurgical complications requiring transfusion, rehospitalization, etc. were observed.

          Conclusions

          The 120 W HPS Greenlight laser PVP procedure can be performed effectively and safely in BPH patients, even those who cannot stop oral anticoagulant medications despite requiring surgery.

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          Most cited references30

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          Management of anticoagulation before and after elective surgery.

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            Photoselective potassium-titanyl-phosphate laser vaporization of the benign obstructive prostate: observations on long-term outcomes.

            We present long-term observations on photoselective vaporization of the prostate in a prospectively studied cohort of men with obstructive benign prostatic hyperplasia. Obstructive benign prostatic hyperplasia in 94 men was treated with transurethral near contact vaporization with potassium-titanyl-phosphate laser with the patient under general or spinal anesthesia. Baseline characteristics, perioperative data, postoperative outcomes and adverse events were recorded. Mean prostate volume was 45 ml (range 13 to 136). Mean lasing time was 47 minutes (range 10 to 99), and there was minimal blood loss and no evidence of fluid absorption. All 94 men were outpatients and all but 1 became catheter-free in less than 24 hours. Baseline mean American Urological Association symptom index score was 22, quality of life score 4.5, peak urinary flow rate 7.8 ml per second and post-void residual urine volume 197 ml. After surgery percentage changes from baseline in mean values of these parameters, reflecting significant (p <0.0001) improvement at 1, 2, 3 and 5 years, ranged from 83% to 88%, 86% to 90%, 170% to 252% and 76% to 89%, respectively. Complications were mild, and included transient dysuria (6%), delayed hematuria (3%), bladder neck contracture (2%) and 2-day retention (1%). No patient had incontinence or newly developed impotence, but up to 26% of the sexually active men experienced retrograde ejaculation. Postoperatively, low stage prostate cancer was detected in 5% of the patients. : Despite limitations our long-term experience and the literature suggest that significant improvements in symptomatic and urodynamic outcomes of photo-selective vaporization of the prostate are achievable and sustainable.
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              Practice patterns in benign prostatic hyperplasia surgical therapy: the dramatic increase in minimally invasive technologies.

              We describe the trends in transurethral prostatectomy and minimally invasive surgical treatments for benign prostate hyperplasia from 1999 through 2005 among elderly male Medicare beneficiaries. Benign prostatic hyperplasia surgeries were identified using the annual 100% Medicare carrier files which contain physician claims for services reimbursed under Medicare Part B. The annual age group specific procedure rates as well as the age adjusted rates by race and percent of each procedure performed in different clinical settings were calculated. The total number of benign prostatic hyperplasia procedures increased 44% from 88,868 in 1999 to 127,786 in 2005. The minimally invasive surgical treatment procedure counts increased 529% from 11,582 to 72,887 and the rates increased 439% from 136 to 678 per 100,000 males during that period. The transurethral prostate resection rate decreased approximately 5% per year. By 2005 minimally invasive surgical treatment procedures accounted for 57% of total benign prostatic hyperplasia surgeries, while transurethral prostate resection accounted for only 39%. Almost all transurethral microwave thermotherapy, 86% of transurethral needle ablation and 54% of laser coagulation procedures were performed in office clinics, and 78% of laser vaporization procedures were performed in hospital outpatient clinics. Black beneficiaries were 17% less likely to receive minimally invasive surgical treatment than whites in 2005. The increase of total benign prostatic hyperplasia procedure rate was driven by a marked increase in minimally invasive surgical treatment and a continuing decrease of transurethral prostate resection. Differences in the use of minimally invasive surgical treatment across age and racial groups persisted. This dramatic change in the pattern of benign prostatic hyperplasia surgical treatment may have a profound impact on health care expenditures and outcomes, and requires further investigation.
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                Author and article information

                Journal
                Korean J Urol
                KJU
                Korean Journal of Urology
                The Korean Urological Association
                2005-6737
                2005-6745
                March 2011
                18 March 2011
                : 52
                : 3
                : 178-183
                Affiliations
                Department of Urology, The Catholic University of Korea, School of Medicine, Seoul, Korea.
                Author notes
                Corresponding Author: Sae Woong Kim. Department of Urology, Seoul St. Mary's Hospital, 505, Banpo-dong, Seocho-gu, Seoul 137-701, Korea. TEL: +82-2-2258-6226, FAX: +82-2-2258-1080, ksw1227@ 123456catholic.ac.kr
                Article
                10.4111/kju.2011.52.3.178
                3065129
                21461281
                fc9cd362-e034-48b0-8cc9-c8a33cb90cdb
                © The Korean Urological Association, 2011

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 February 2011
                : 22 February 2011
                Categories
                Original Article
                Lasers in Urology

                Urology
                prostatic hyperplasia,laser therapy,anticoagulants
                Urology
                prostatic hyperplasia, laser therapy, anticoagulants

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