Photoselective Vaporesection of the Prostate with a Front-firing XXXX Laser: Surgical Technique and Experience After 215 Procedures.

@entity1 @entity1067 @entity12468 @entity15171 @entity954 @entity1486
BACKGROUD: Although photoselective vaporization of the prostate ( @entity12468 ) 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. OBJECTIVE: To describe the novel technique of photoselective vaporesection of the prostate (PVRP) with a front-firing @entity15171 (LBO) laser and to report our initial experience. DESIGN, SETTING, AND @entity1 : This is a prospective study of 215 @entity1 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  34.0ml, and 24.9  5.0, respectively. SURGICAL PROCEDURE: The operative technique is detailed in the accompanying video. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Perioperative data were collected. The @entity1 were followed up at 3, 6, 12 mo after PVRP, and functional outcomes and complications were assessed. RESULTS AND LIMITATIONS: The mean operation time was 44.1  22.6min. The mean hemoglobin decrease was 0.37  0.21g/dl. The catheterization time was 23.9  15.2h 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 @entity1486 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 @entity954 . 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. CONCLUSIONS: PVRP is a novel technique that is effective and safe for treatment of @entity1067 . 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 @entity12468 is also overcome in PVRP. @entity1 SUMMARY: 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 ( @entity12468 ). This technique also solves the problem of the lack of postoperative tissue specimens and the difficulty of handling intractable @entity954 . According to our initial results, PVRP is a novel technique superior to @entity12468 in the treatment of @entity1067 .
