Global Greenlight Group: largest international Greenlight experience for benign prostatic hyperplasia to assess efficacy and safety.

PD61-07 GLOBAL GREENLIGHT GROUP: LARGEST INTERNATIONAL GREENLIGHT EXPERIENCE FOR BENIGN PROSTATIC HYPERPLASIA

INTEREXAMINER RELIABILITY OF TRANSRECTAL ULTRASOUND FOR ESTIMATING PROSTATE VOLUME

Objective To evaluate the safety and efficacy of domestic 160-Watt high power greenlight photoselective vaporization for large volume prostate in patients with benign prostate hyperplasia (BPH). Methods From May 2013 to March 2015, 37 cases with BPH treated with 160-Watt high power green laser were enrolled. The mean age was 71 years (range from 59 to 92), the volume of prostate in all the patients was over 80 ml. The volume of the prostate, IPSS, Qmax and QOL were recorded before and 3 months after the operation. Hemoglobin changes pre- and postoperation, catheter time and hospitalization time were recorded and compared. Results The average operation time was 96 min (35-170 min), the average consumption of energy was 520 kJ (345-1082 kJ). The catheter was indwelled for 1 to 6 days (average 3 days). Thirty-two patients were followed up 3 months. Mean Qmax increased from 6 ml/s preoperatively to 15 ml/s. IPSS and QOL improved from 27, 4 to 8, 2 respectively. All the differences were statistically significant (P<0.01). Conclusions The domestic 160-Watt greenlight high power laser is an effective and safe method for the treatment of BPH, and especially appropriate to patients with large volume prostate. Key words: Benign prostate hyperplasia; Greenlight; High power

Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland, which results in the development of lower urinary tract symptoms that can interfere with a patient's daily activities and negatively impact their quality of life. The gold standard treatment for moderate to severe BPH has been transurethral resection of the prostate (TURP), however, this procedure is associated with prolonged hospitalizations and increased complications. An alternative to TURP is Greenlight photoselective vaporization of the prostate (PVP), which is associated with better perioperative safety. The objectives of the research were to 1) assess the cost of Greenlight PVP compared to TURP and bipolar TURP; and 2) assess the predictors of total cost. We conducted a descriptive costing study from the hospital perspective. We evaluated perioperative costs of patients who underwent each procedure from 2013-2015 at a tertiary academic medical centre. A multiple linear regression was performed to identify predictors of total cost. The variables included in regression analysis were patient age, type of procedure, Charlson Comorbidity Index, and distance to clinic. A total of 202 patients received one of the three procedures over the study period. The total cost of Greenlight PVP was $3836 per patient compared to $4963 for TURP and $4978 for bipolar TURP. The linear regression showed that the Charlson Comorbidity Index and type of procedure were independent predictors of total cost. The procedure costs and readmission rates are lower for Greenlight PVP compared to TURP and bipolar TURP, making it a preferable option for hospitals.

Résultats de la photovaporisation prostatique par laser GreenLight XPS-180 W dans l’hyperplasie bénigne de prostate (HBP) de gros volume (≥ 80 mL)

The pathogenesis of benign prostatic hyperplasia (BPH) is extremely complicated which involving the multiple signaling pathways. The deficiency of vitamin D is an important risk factor for BPH, and exogenous vitamin D is effective for the treatment of BPH. In this study, we provided in vitro mechanical evidence of vitamin D as a treatment for BPH using BPH-1, WPMY-1, and PBMC cells. We found that 25-hydroxyvitamin D (25-OH D) level is decreased in BPH and closely correlated with age, prostate volume, maximum flow, international prostate symptom score, and prostate-specific antigen of the BPH patients. We further revealed that 25-OH D ameliorated TGF-β1 induces epithelial-mesenchymal transition (EMT) of BPH-1 cells and proliferation of WPMY-1 cells via blocking TGF-β signaling. Moreover, 25-OH D was able to block NF-κB signaling in PBMCs of BPH patients and STAT3 signaling in BPH cells to relieve inflammation. 25-OH D also protects BPH cells from inflammatory cytokines selected by PBMCs. Finally, we uncovered that 25-OH D alleviated prostate cell oxidative stress by triggering Nrf2 signaling. In conclusion, our data verified that 25-OH D regulated multiple singling pathways to restrain prostate cell EMT, proliferation, inflammation, and oxidative stress. Our study provides in vitro mechanical evidence to support clinical use of vitamin D as a treatment for BPH.

Objective To investigate the effect of intraoperative absorption of irrigation fluid on the safety of transurethral vaporization of prostate (Di VAP) and enucleation of prostate (Di VEP) with 1470 nm semiconductor laser. Methods From July 2016 to February 2017, 40 patients with benign prostatic hyperplasia (BPH) admitted to our hospital were randomly divided into the Di VAP and Di VEP groups. The operation time, irrigation fluid volume, irrigation fluid absorption volume, postoperative persistent irrigation time of bladder, postoperative retention time of urinary catheter, postoperative length of hospital stay, hemoglobin, electrolyte, international prostate symptom score (IPSS), quality of life (QOL) score, maximum urinary flow rate (Qmax), post-void residual urine volume (PVR) and postoperative complications were statistically compared between two groups. Results No statistical significance was noted in age, prostate volume, preoperative IPSS score, PVR, Qmax, mean operation time, irrigation fluid volume, postoperative persistent irrigation time of bladder, postoperative retention time of urinary catheter and postoperative length of hospital stay between two groups (all P>0.05). After corresponding surgery, the hemoglobin level in the Di VAP group was (1.9±1.0) g/L, significantly lower than (12.3±11.3) g/L in the Di VEP group (P=0.001). In the Di VAP group, irrigation fluid absorption was monitored in 3 cases with an average absorption volume of 675 (356-1 078) ml. In the Di VEP group, irrigation fluid absorption was observed in 10 cases with a mean absorption volume of 2 089 (187-7 240) ml with statistical significance between two groups (P<0.05). In both groups, the serum levels of K+ and Na+ did not significantly differ before and after surgery, whereas the hemoglobin level was significantly decreased (P<0.05). The IPSS, QOL, Qmax, PVR and the incidence of postoperative complications did not significantly differ between two groups. Conclusion Both Di VAP and Di VEP with 1 470 nm semiconductor laser are efficacious methods for the treatment of BPH, whereas Di VAP yields less irrigation fluid absorption and blood loss intraoperatively. Key words: Prostatic hyperplasia; Prostatectomy; Irrigation fluid; Absorption

：Objective To investigatethe feasibility and efficacy of transurethral prostate enucleation with 2 μmlaser in the treatment of benign prostatic hyperplasia (BPH). Methods One hundred andseven patients with BPH were treated by transurethral prostate enucleation with 2 μmlaser under continuous epidural anesthesia or laryngeal mask anesthesia. The patient′s,average age was 67±9 yrs (52 to 85 yrs). Of whom, 10 patients had a history of urinaryretention. The mean prostate volume was 72.5±17.6 ml (45 to 158 ml). Two deep trencheswere cut at the 5 and 7 o, clock position from the bladder neck to the verumontanum. Theincision continued to the urethral mucosa and submucosa along with the verumontanumbilaterally in an arc-shape and ended at the internal arc of urethral sphincter. Then theurethral mucosa at the level of the verumontanum was cut and the surgical capsule planewas identified. A retrograde blunt dissection was made along the surgical capsule planewith the resectoscope sheath front-end, and the sheath was swung from side to side toextend the capsule plane. The significantly enlarged middle lobe was treated with laservaporization resection. In the same way, a trench was made at the 12 o, clock position,and the lateral lobe were removed by the sheath from the verumontanum level, finally onlytwo cord-like pedicles were kept at the 1 and 11 o, clock position at the bladder neck, sothat the removed gland tissue was fixed and hung in the gland fossa. For prostate volumeless than 60 ml, the laser vaporization resection was carried out directly. If theprostate volume was greater than 60ml, transurethral resection would be performed insteadof laser vaporization resection. With 4% mannitol irrigation, the enucleated prostatetissue was then cut into small pieces and washed out by a Braun plastic bottle through theresectoscope sheath. Intraoperative bleeding, operative time, catheterization time,postoperative voiding status, maximum urinary flow rate (Qmax) and length of hospital staywere recorded and analyzed. Results All patients successfully completed the transurethralprostate enucleation. The average operative time was 74±12 min (45-150 min). Five casesrequired blood transfusion. There was no recorded urethral stricture and no urinaryincontinence except for one patient who recovered 1 mon after the operation. The follow-uptime was 2-6 mon. The average Qmax was 6.3±0.6 ml/s before and increased to 17.5±1.5ml/s after the operation. The international prostate symptom score (IPSS) and quality oflife (QOL) were reduced from 26.4±5.5 and 4.6±0.5 to 9.3±2.1 and 2.8±0.3 after theoperation, respectively, P<0.01. Postoperative secondary bleeding was not observed.Conclusions Transurethral prostate enucleation with 2 μm laser for BPH is a safe and effective minimally invasivetreatment. Its efficacy is superior to open surgery, and even better than TURP. Key words: Benign prostatic hyperplasia; 2 micron laser; Clinicalresearch

Holmium Laser Enucleation of the Prostate: A Modified Enucleation Technique and Initial Results

Objective To investigate the effect of plasmakinetic excision of the prostate (PKEP) and plasmakinetic resection of the prostate (PKRP) in the treatment of benign prostate hyperplasia (BPH) and their influence on residual urine volume (RUV) and international prostate symptom score (IPSS). Methods The clinical data of 200 BPH patients who were admitted from February 2015 to November 2017 was analyzed, 100 patients undergoing PKRP as the control group and another 100 patients undergoing PKEP as the study group. Then the operation related indexes, complications, RUV, and IPSS score were compared between the two groups. Results The operative indexes such as catheter indwelling time, the resection volume of the prostate, the amount of bleeding in the study group were better than those in control group [(1.21±0.49)d vs.(4.08±1.02)d, (51.53±13.87)g vs.(30.81±11.19)g, (149.15±28.45)ml vs.(303.74±39.36)ml; P 0.05). Conclusion Both PKEP and PKRP could effectively treat BPH. Among them, PKEP has fewer postoperative complications and could be used as the first treatment plan. Key words: Plasmakinetic excision of the prostate (PKEP); Benign prostate hyperplasia (BPH); Plasmakinetic resection of the prostate (PKRP); Residual urine volume; International prostate symptom score

• To investigate the Prostatic Urethral Lift (PUL) procedure, a novel, minimally invasive treatment for symptomatic benign prostatic hyperplasia (BPH), which aims to mechanically open the prostatic urethra without ablation or resection. • To demonstrate the safety and feasibility of this procedure and to make an initial assessment of effectiveness. • The PULprocedure was performed on 19 men in Australia. • Small suture-based implants were implanted transurethrally under cystoscopic visualisation to separate encroaching lateral prostatic lobes. • Patients were evaluated at 2 weeks and 3, 6, and 12 months after PUL. • All cases were successfully completed with no serious or unexpected adverse events (AEs). • Between two and five sutures were delivered in each patient and the prostatic urethral lumen was visually increased in all patients. • Reported postoperative AEs were typically mild and transient and included dysuria and haematuria. • Follow-up cystoscopy at 6 months in a subset of patients showed no calcification. Histological findings from two of three patients who progressed to transurethral resection of the prostate for return of symptoms showed no evidence of inflammation related to the implanted materials. • The mean International Prostate Symptom Score was reduced by 37% at 2 weeks and 39% at 1 year after PUL as compared with baseline. • We demonstrated in this initial experience that the PUL procedure is safe and feasible. • The safety profile of the PUL procedure appears favourable; most patients reported sustained symptom relief to 12 months with minimal morbidity • PUL therefore warrants further study as a new option for the many patients who seek an alternative to current therapies.

Annotation. The purpose of the study is to compare and evaluate the immediate (inpatient) and long-term results of open and laparoscopic retropubic prostatectomy in the surgical treatment of large benign prostatic hyperplasia (more than 80 ml). The immediate (inpatient) and long-term (after discharge from the hospital and up to 2 years of follow-up) results of one-time laparoscopic extraperitoneal retropubic prostatectomy in 50 patients with benign prostatic hyperplasia who were operated in the Clinical Center of Oncology, Hematology, Transplantology and Palliative Care of the Cherkasy Regional Council and urological department of the Vinnytsia Regional Hospital named after M. Pirogov in the period from 2021 to 2023, as well as 120 one-time open retropubic prostatectomies in patients with benign prostatic hyperplasia who were operated in the urological department of the Vinnytsia Regional Hospital named after M. Pirogov for the same period of time. The average time of laparoscopic prostatectomy was 120.3±11.7 minutes, open – 81.1±17.4; average intraoperative blood loss – 118.7±33.6 ml and 520.5±67.4 ml, postoperative bed-day 6.1±1.1 and 9.8±2.9, respectively. Transfusion of blood components due to blood loss was performed in 9 (7.5%) patients after open retropubic prostatectomy, never after laparoscopic. Urological complications after laparoscopic prostatectomy were noted in 2% of patients, open - 19.2%, complications according to Clavien-Dindo – 4% and 33.3%, respectively. According to the conducted uroflowmetry, it was noted that laparoscopic and open retropubic prostatectomies allow equally effective restoration of urination in patients after surgery. When analyzing the long-term results of treatment of patients with benign prostatic hyperplasia, fewer (2.5% versus 8%) postoperative complications were noted after laparoscopic pubic prostatectomy.

Studies on antibacterial, anti-inflammatory and antioxidant activity of herbal remedies used in the treatment of benign prostatic hyperplasia and prostatitis

Objectives To compare the clinical effect between transurethral holmium laser enucleation and transurethral plasmakinetic resection for treatment of benign prostatic hyperplasia(BPH). Methods 83 patients with BPH in our hospital from January 2013 to December 2014 were randomly divided into two groups : 42 patients who underwent transurethral holmium laser enucleation and 41 patients who underwent plasmalinetic energy transurethral resection of the prostate (PKRP), and the operative time, blood loss, the length of hospital stay, complications, residual urine, indwelling time of catheter, compare the differences of international prostate symptoms score (IPSS) were analyzed before and after operation. Results The amount of blood loss and operation time of the holmium laser group were less than that of the PKRP group. The indwelling time of catheter and the length of hospital stay were shorter than that in PKRP group(P 0.05). The incidence of complications in the two groups was not statistically significant (P>0.05). Conclusions Holmium laser or PKRP in the treatment of benign prostatic hyperplasia were also obtained with good efficacy and safety. We can choose the way of holmium laser enucleation, because it can significantly reduce the risk of blood loss, shorten the indwelling catheter time and hospitalization time for patients with transurethral resection of the prostate operation contraindication. Key words: Prostatic Hyperplasia; Urethra; Lasers, Solid-State

Objective To observe the effect of transurethral resection of the prostate in the treatment of benign prostatic hyperplasia. Methods From February 2015 to March 2016, 130 patients with benign prostatic hyperplasia in Shanxi Group Company Worker Hospital were divided into two groups according to different operation method, with 65 cases in cach group.The control group was given routine operation.The observation group received transurethral resection of the prostate.The therapeutic effect of the two groups was compared. Results The QOL, PVR, IPSS index of the observation group were (2.15±0.39)points, (29.56±8.67)mL, (7.49±1.39)points, respectively, which were better than those of the control group(t=7.508, 11.039, 11.502, all P<0.05). The hospitalization time, catheter indwelling time, operation time, intraoperative blood loss, incidence rate of complication in the observation group were (6.15±1.25)d, (2.88±0.41)d, (115.12±4.58)min, (42.69±2.39)mL, 3.08%, respectively, which were better than those in the control group(t=8.928, 24.241, 6.844, 32.920, χ2=5.875, all P<0.05). Conclusion Transurethral resection of the prostate in the treatment of benign prostatic hyperplasia has significant clinical effect, not only can improve patients' QOL, PVR, IPSS index, shorten hospitalization time and operation time, also has the advantages of quick recovery, small trauma, less complications, it is worthy of application. Key words: Transurethral resection of prostate; Prostatic hyperplasia; Clinical effect