Current Laser Treatments for Benign Prostatic Hyperplasia
Identifieur interne : 000427 ( Ncbi/Merge ); précédent : 000426; suivant : 000428Current Laser Treatments for Benign Prostatic Hyperplasia
Auteurs : Hwancheol Son [Corée du Sud] ; Sang Hoon Song [Corée du Sud] ; Jae-Seung Paick [Corée du Sud]Source :
- Korean Journal of Urology [ 2005-6737 ] ; 2010.
Abstract
The latest technical improvements in the surgical armamentarium are remarkable. In particular, advancements in the urologic field are so exceptional that we could observe the flare-up of robot-assisted laparoscopic radical prostatectomy for prostate cancer and laser prostatectomy for benign prostatic hyperplasia (BPH). Photoselective vaporization of the prostate (PVP) and holmium laser prostatectomy are the most generalized options for laser surgery of BPH, and both modalities have shown good postoperative results. In comparison to transurethral prostatectomy (TURP), they showed similar efficacy and a much lower complication rate in randomized prospective clinical trials. Even in cases of large prostates, laser prostatectomy showed comparable efficacy and safety profiles compared to open prostatectomy. From a technical point of view, PVP is considered to be an easier technique for the urologist to master. Furthermore, patients can be safely followed up in an outpatient clinic. Holmium laser enucleation of the prostate (HoLEP) mimics open prostatectomy because the adenomatous tissue is peeled off the surgical capsule in both procedures. Therefore, HoLEP shows notable volume reduction of the prostate similar to open prostatectomy with fewer blood transfusions, shorter hospital stay, and cost reduction regardless of prostate size. Outcomes of laser prostatectomy for BPH are encouraging but sometimes are unbalanced because safety and feasibility studies were reported mainly for PVP, whereas long-term data are mostly available for HoLEP. We need longer-term randomized clinical data to identify the reoperation rate of PVP and to determine which procedure is the ideal alternative to TURP and open prostatectomy for each patient.
Url:
DOI: 10.4111/kju.2010.51.11.737
PubMed: 21165192
PubMed Central: 2991569
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PMC:2991569Le document en format XML
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<front><div type="abstract" xml:lang="en"><p>The latest technical improvements in the surgical armamentarium are remarkable. In particular, advancements in the urologic field are so exceptional that we could observe the flare-up of robot-assisted laparoscopic radical prostatectomy for prostate cancer and laser prostatectomy for benign prostatic hyperplasia (BPH). Photoselective vaporization of the prostate (PVP) and holmium laser prostatectomy are the most generalized options for laser surgery of BPH, and both modalities have shown good postoperative results. In comparison to transurethral prostatectomy (TURP), they showed similar efficacy and a much lower complication rate in randomized prospective clinical trials. Even in cases of large prostates, laser prostatectomy showed comparable efficacy and safety profiles compared to open prostatectomy. From a technical point of view, PVP is considered to be an easier technique for the urologist to master. Furthermore, patients can be safely followed up in an outpatient clinic. Holmium laser enucleation of the prostate (HoLEP) mimics open prostatectomy because the adenomatous tissue is peeled off the surgical capsule in both procedures. Therefore, HoLEP shows notable volume reduction of the prostate similar to open prostatectomy with fewer blood transfusions, shorter hospital stay, and cost reduction regardless of prostate size. Outcomes of laser prostatectomy for BPH are encouraging but sometimes are unbalanced because safety and feasibility studies were reported mainly for PVP, whereas long-term data are mostly available for HoLEP. We need longer-term randomized clinical data to identify the reoperation rate of PVP and to determine which procedure is the ideal alternative to TURP and open prostatectomy for each patient.</p>
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<pmc article-type="review-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Korean J Urol</journal-id>
<journal-id journal-id-type="publisher-id">KJU</journal-id>
<journal-title-group><journal-title>Korean Journal of Urology</journal-title>
</journal-title-group>
<issn pub-type="ppub">2005-6737</issn>
<issn pub-type="epub">2005-6745</issn>
<publisher><publisher-name>The Korean Urological Association</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">21165192</article-id>
<article-id pub-id-type="pmc">2991569</article-id>
<article-id pub-id-type="doi">10.4111/kju.2010.51.11.737</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Review Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Current Laser Treatments for Benign Prostatic Hyperplasia</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Son</surname>
<given-names>Hwancheol</given-names>
</name>
<xref ref-type="aff" rid="A1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Song</surname>
<given-names>Sang Hoon</given-names>
</name>
<xref ref-type="aff" rid="A2">1</xref>
</contrib>
<contrib contrib-type="author" corresp="yes"><name><surname>Paick</surname>
<given-names>Jae-Seung</given-names>
</name>
<xref ref-type="aff" rid="A3">2</xref>
</contrib>
</contrib-group>
<aff id="A1">Department of Urology, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea.</aff>
<aff id="A2"><label>1</label>
Department of Urology, Jeungpyung Health Center, Jeungpyung, Korea.</aff>
<aff id="A3"><label>2</label>
Department of Urology, Seoul National University College of Medicine, Seoul, Korea.</aff>
<author-notes><corresp>Corresponding Author: Jae-Seung Paick. Department of Urology, Seoul National University College of Medicine, 28, Yeongeoun-dong, Jongno-gu, Seoul 110-744, Korea. TEL: +82-2-2072-2422, FAX: +82-2-742-4665, <email>jspaick@snu.ac.kr</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>11</month>
<year>2010</year>
</pub-date>
<pub-date pub-type="epub"><day>17</day>
<month>11</month>
<year>2010</year>
</pub-date>
<volume>51</volume>
<issue>11</issue>
<fpage>737</fpage>
<lpage>744</lpage>
<history><date date-type="received"><day>18</day>
<month>10</month>
<year>2010</year>
</date>
<date date-type="accepted"><day>03</day>
<month>11</month>
<year>2010</year>
</date>
</history>
<permissions><copyright-statement>Copyright © The Korean Urological Association, 2010</copyright-statement>
<copyright-year>2010</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0">http://creativecommons.org/licenses/by-nc/3.0</ext-link>
) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><p>The latest technical improvements in the surgical armamentarium are remarkable. In particular, advancements in the urologic field are so exceptional that we could observe the flare-up of robot-assisted laparoscopic radical prostatectomy for prostate cancer and laser prostatectomy for benign prostatic hyperplasia (BPH). Photoselective vaporization of the prostate (PVP) and holmium laser prostatectomy are the most generalized options for laser surgery of BPH, and both modalities have shown good postoperative results. In comparison to transurethral prostatectomy (TURP), they showed similar efficacy and a much lower complication rate in randomized prospective clinical trials. Even in cases of large prostates, laser prostatectomy showed comparable efficacy and safety profiles compared to open prostatectomy. From a technical point of view, PVP is considered to be an easier technique for the urologist to master. Furthermore, patients can be safely followed up in an outpatient clinic. Holmium laser enucleation of the prostate (HoLEP) mimics open prostatectomy because the adenomatous tissue is peeled off the surgical capsule in both procedures. Therefore, HoLEP shows notable volume reduction of the prostate similar to open prostatectomy with fewer blood transfusions, shorter hospital stay, and cost reduction regardless of prostate size. Outcomes of laser prostatectomy for BPH are encouraging but sometimes are unbalanced because safety and feasibility studies were reported mainly for PVP, whereas long-term data are mostly available for HoLEP. We need longer-term randomized clinical data to identify the reoperation rate of PVP and to determine which procedure is the ideal alternative to TURP and open prostatectomy for each patient.</p>
</abstract>
<kwd-group><kwd>Laser therapy</kwd>
<kwd>Prostatic hyperplasia</kwd>
<kwd>Solid-state lasers</kwd>
</kwd-group>
</article-meta>
</front>
<floats-group><table-wrap id="T1" position="float"><label>TABLE 1</label>
<caption><p>Short-term and long-term results of photoselective vaporization of the prostate</p>
</caption>
<graphic xlink:href="kju-51-737-i001"></graphic>
<table-wrap-foot><fn><p>Ref.: reference number, F/U: follow-up period, Mean P vol.: mean prostate volume, QoL: quality of life, Qmax: maximum urinary flow rate, PVR: post void residual, IPSS: International Prostate Symptom Score, Pre-op: preoperation, Post-op: postoperation</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="T2" position="float"><label>TABLE 2</label>
<caption><p>Complication rates after PVP and HoLEP for BPH</p>
</caption>
<graphic xlink:href="kju-51-737-i002"></graphic>
<table-wrap-foot><fn><p>PVP: photoselective vaporization of prostate, HoLEP: holmium laser enucleation of the prostate, BPH: benign prostatic hyperplasia, Ref.: reference number, AUR: acute urinary retention, UTI: urinary tract infection, GHU: gross hematuria, BNC: bladder neck contracture, Ureth. Str.: urethral stricture, Urinary inc.: urinary incontinence, ED: erectile dysfunction</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="T3" position="float"><label>TABLE 3</label>
<caption><p>Short-term and long-term results of holmium laser prostatectomy for BPH</p>
</caption>
<graphic xlink:href="kju-51-737-i003"></graphic>
<table-wrap-foot><fn><p>Ref.: reference number, F/U: follow-up period, Mean P vol.: mean prostate volume, QoL: quality of life, Qmax: maximum urinary flow rate, PVR: post void residual, IPSS: International Prostate Symptom Score, Pre-op: preoperation, Post-op: postoperation</p>
</fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</pmc>
<affiliations><list><country><li>Corée du Sud</li>
</country>
<region><li>Région capitale de Séoul</li>
</region>
<settlement><li>Séoul</li>
</settlement>
</list>
<tree><country name="Corée du Sud"><region name="Région capitale de Séoul"><name sortKey="Son, Hwancheol" sort="Son, Hwancheol" uniqKey="Son H" first="Hwancheol" last="Son">Hwancheol Son</name>
</region>
<name sortKey="Paick, Jae Seung" sort="Paick, Jae Seung" uniqKey="Paick J" first="Jae-Seung" last="Paick">Jae-Seung Paick</name>
<name sortKey="Song, Sang Hoon" sort="Song, Sang Hoon" uniqKey="Song S" first="Sang Hoon" last="Song">Sang Hoon Song</name>
</country>
</tree>
</affiliations>
</record>
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