Skip to main content

Advertisement

SpringerLink
Log in

Photoselective sharp enucleation of the prostate with a front-firing 532-nm laser: an innovative surgical technique for benign prostatic hyperplasia—a single-center study of 475 cases

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To describe the novel technique of photoselective sharp enucleation of the prostate (PSEP) with a front-firing 532-nm laser and evaluate its efficacy and safety.

Methods

A seven-step standardized surgical procedure was established, and PSEP was performed in an en bloc or lobulate manner according to the size of the middle lobe of the prostate. The following clinical data of 583 patients who underwent PSEP in our center from November 2016 to May 2018 were retrospectively reviewed: maximum flow rate (Qmax), International Prostate Symptom Score (IPSS), quality of life score (Qols), post-void residual volume (PVR), prostate volume, operation time, serum prostate-specific antigen (PSA) concentration, and complications at 1, 6, and 12 months postoperatively.

Results

Of the 583 patients, 475 had complete clinical information and were included in the study. The median operation time was 39 min. There were significant improvements in the Qmax, IPSS, Qols, PVR and PSA concentration at each follow-up time point postoperatively. Postoperative hemorrhage occurred in 22 patients (4.6%), urinary retention in 29 (6.1%), urinary tract infection in 55 (11.6%), bladder neck contracture in 8 (1.7%), urethral strictures in 11 (2.3%), and stress urinary incontinence in 9 (1.9%).

Conclusions

PSEP is effective and safe for the treatment of benign prostatic hyperplasia. The innovative technique integrates the excellent hemostatic property of the 532-nm laser and the high efficiency of enucleation. It decreases the occurrence of postoperative incontinence associated with “blunt” enucleation of 532-nm laser and eliminates the lack of tissue samples problem associated with photoselective vaporization of the prostate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Gavras S, Drake MJ, Gratzke C, Madersbacher C, Tikkinen KAO, Mamoulakis C, Bach T, Gacci M, Herrmann TRW, Karavitakis M, Malde S, Sakalis V, Umbach R (2015) European Association of Urology. Guidelines on the management of non-neurogenic male lower urinary tract symptoms (LUTS) including benign prostate obstruction (BPO). https://uroweb.org/wp-content/uploads/EAU-Guidelines-Non-Neurogenic-Male-LUTS-Guidelines-2015-v2.pdf

  2. Lai S, Peng P, Diao T, Hou H, Wang X, Zhang W, Liu M, Zhang Y, Seery S, Wang J (2019) Comparison of photoselective green light laser vaporisation versus traditional transurethral resection for benign prostate hyperplasia: an updated systematic review and meta-analysis of randomised controlled trials and prospective studies. BMJ Open. https://doi.org/10.1136/bmjopen-2018-028855

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hueber PA, Ben-Zvi T, Liberman D, Bhojani N, Gautam G, Deklaj T, Katz M, Zorn KC (2012) Mid term outcomes of initial 250 case experience with GreenLight 120W-HPS photoselective vaporization prostatectomy for benign prostatic hyperplasia: comparison of prostate volumes <60 cc, 60 cc-100 cc and >100 cc. Can J Urol 19(5):6450–6458

    PubMed  Google Scholar 

  4. Valdivieso R, Hueber PA, Meskawi M, Belleville E, Ajib K, Bruyere F, Te AE, Chughtai B, Elterman D, Misrai V, Zorn KC (2018) Multicentre international experience of 532-nm laser photoselective vaporization with GreenLight XPS in men with very large prostates. BJU Int 122(5):873–878. https://doi.org/10.1111/bju.14208

    Article  CAS  PubMed  Google Scholar 

  5. Elshal AM, Elmansy HM, Elhilali MM (2013) Two laser ablation techniques for a prostate less than 60 mL: lessons learned 70 months after a randomized controlled trial. Urology 82(2):416–422. https://doi.org/10.1016/j.urology.2013.02.074

    Article  PubMed  Google Scholar 

  6. Guo S, Muller G, Lehmann K, Talimi S, Bonkat G, Puschel H, Gasser T, Bachmann A, Rieken M (2015) The 80-W KTP GreenLight laser vaporization of the prostate versus transurethral resection of the prostate (TURP): adjusted analysis of 5-year results of a prospective non-randomized bi-center study. Lasers Med Sci 30(3):1147–1151. https://doi.org/10.1007/s10103-015-1721-x

    Article  PubMed  Google Scholar 

  7. Gomez Sancha F, Rivera VC, Georgiev G, Botsevski A, Kotsev J, Herrmann T (2015) Common trend: move to enucleation-Is there a case for GreenLight enucleation? Development and description of the technique. World J Urol 33(4):539–547. https://doi.org/10.1007/s00345-014-1339-9

    Article  PubMed  Google Scholar 

  8. Misrai V, Kerever S, Phe V, Zorn KC, Peyronnet B, Roupret M (2016) Direct comparison of GreenLight Laser XPS photoselective prostate vaporization and GreenLight Laser En Bloc Enucleation of the prostate in enlarged glands greater than 80 ml: a study of 120 patients. J Urol 195(4 Pt 1):1027–1032. https://doi.org/10.1016/j.juro.2015.10.080

    Article  PubMed  Google Scholar 

  9. Stone BV, Chughtai B, Forde JC, Tam AW, Lewicki P, Te AE (2016) Safety and efficacy of GreenLight XPS laser vapoenucleation in prostates measuring Over 150 mL. J Endourol 30(8):906–912. https://doi.org/10.1089/end.2016.0288

    Article  PubMed  Google Scholar 

  10. Elshal AM, Elkoushy MA, El-Nahas AR, Shoma AM, Nabeeh A, Carrier S, Elhilali MM (2015) GreenLight laser (XPS) photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic hyperplasia: a randomized controlled study. J Urol 193(3):927–934. https://doi.org/10.1016/j.juro.2014.09.097

    Article  PubMed  Google Scholar 

  11. Panthier F, Pasquier J, Bruel S, Azancot V, De La Taille A, Gasman D (2019) En bloc greenlight laser enucleation of prostate (GreenLEP): about the first hundred cases. World J Urol. https://doi.org/10.1007/s00345-019-02941-1

    Article  PubMed  Google Scholar 

  12. Gong Y-G, Liu R-M, Gao R (2015) Photoselective Vaporesection of the prostate with a front-firing lithium triborate laser: surgical technique and experience after 215 procedures. Eur Urol 67(6):1152–1159. https://doi.org/10.1016/j.eururo.2014.12.021

    Article  PubMed  Google Scholar 

  13. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kyriazis I, Swiniarski PP, Jutzi S, Wolters M, Netsch C, Burchardt M, Liatsikos E, Xia S, Bach T, Gross AJ, Herrmann TR (2015) Transurethral anatomical enucleation of the prostate with Tm:YAG support (ThuLEP): review of the literature on a novel surgical approach in the management of benign prostatic enlargement. World J Urol 33(4):525–530. https://doi.org/10.1007/s00345-015-1529-0

    Article  PubMed  Google Scholar 

  15. Herrmann TR (2016) Enucleation is enucleation is enucleation is enucleation. World J Urol 34(10):1353–1355. https://doi.org/10.1007/s00345-016-1922-3

    Article  PubMed  Google Scholar 

  16. Tuccio A, Sessa F, Campi R, Grosso AA, Viola L, Muto G, Scoffone C, Cracco CM, Gomez-Sancha F, Misrai V, Muto G, Mari A, Di Maida F, Tellini R, Figueiredo F, Carini M, Oriti R, Amparore D, Fiori C, Porpiglia F, Minervini A (2020) En-bloc endoscopic enucleation of the prostate: a systematic review of the literature. Minerva Urol Nefrol 72(3):292–312. https://doi.org/10.23736/S0393-2249.20.03706-6

    Article  PubMed  Google Scholar 

  17. Becker B, Herrmann TRW, Gross AJ, Netsch C (2018) Thulium vapoenucleation of the prostate versus holmium laser enucleation of the prostate for the treatment of large volume prostates: preliminary 6-month safety and efficacy results of a prospective randomized trial. World J Urol 36(10):1663–1671. https://doi.org/10.1007/s00345-018-2321-8

    Article  CAS  PubMed  Google Scholar 

  18. Endo F, Shiga Y, Minagawa S, Iwabuchi T, Fujisaki A, Yashi M, Hattori K, Muraishi O (2010) Anteroposterior dissection HoLEP: a modification to prevent transient stress urinary incontinence. Urology 76(6):1451–1455. https://doi.org/10.1016/j.urology.2010.03.071

    Article  PubMed  Google Scholar 

  19. Misraï V, Pasquie M, Bordier B, Elman B, Lhez JM, Guillotreau J, Zorn K (2018) Comparison between open simple prostatectomy and green laser enucleation of the prostate for treating large benign prostatic hyperplasia: a single-centre experience. World J Urol 36(5):793–799. https://doi.org/10.1007/s00345-018-2192-z

    Article  PubMed  Google Scholar 

  20. Biers SM, Oliver HC, King AJ, Adamson AS (2009) Does laser ablation prostatectomy lead to oncological compromise? BJU Int 103(4):454–457. https://doi.org/10.1111/j.1464-410X.2008.08039.x

    Article  PubMed  Google Scholar 

  21. Yang Z, Liu T, Wang X (2016) Comparison of thulium laser enucleation and plasmakinetic resection of the prostate in a randomized prospective trial with 5-year follow-up. Lasers Med Sci 31(9):1797–1802. https://doi.org/10.1007/s10103-016-2052-2

    Article  PubMed  Google Scholar 

  22. Thomas JA, Tubaro A, Barber N, d’Ancona F, Muir G, Witzsch U, Grimm M-O, Benejam J, Stolzenburg J-U, Riddick A, Pahernik S, Roelink H, Ameye F, Saussine C, Bruyère F, Loidl W, Larner T, Gogoi N-K, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitán C, Knispel H, Bachmann A (2016) A multicenter randomized noninferiority trial comparing GreenLight-XPS laser vaporization of the prostate and transurethral resection of the prostate for the treatment of benign prostatic obstruction: two-yr outcomes of the GOLIATH Study. Eur Urol 69(1):94–102. https://doi.org/10.1016/j.eururo.2015.07.054

    Article  PubMed  Google Scholar 

  23. Leonardo C, Lombardo R, Cindolo L, Antonelli A, Greco F, Porreca A, Veneziano D, Pastore A, Dalpiaz O, Ceruti C, Verze P, Borghesi M, Schiavina R, Falabella R, Minervini A, Group A (2020) What is the standard surgical approach to large volume BPE? Systematic review of existing randomized clinical trials. Minerva Urol Nefrol 72(1):22–29. https://doi.org/10.23736/S0393-2249.19.03589-6

    Article  Google Scholar 

Download references

Funding

Supported by the Foundation of the Innovative Scientific Research of Army Medical University (SWH2016ZDCX2008)and the Natural Science Foundation of Chongqing (cstc2018jscx-msyb0682).

Author information

Author notes

  1. Yongquan Wang and Zhengchao Liu contributed equally to this work

Authors and Affiliations

  1. Urological Institution of the People’s Liberation Army, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China

    Yongquan Wang, Zhengchao Liu, Tao Jiang, Xiaozhou Zhou, Zhipeng Chen, Jun Zheng, Dishi Yan, Yuanxiu Zhou, Zhansong Zhou & Wenhao Shen

Authors
  1. Yongquan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zhengchao Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tao Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiaozhou Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhipeng Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jun Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dishi Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yuanxiu Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Zhansong Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Wenhao Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YW: Project development, manuscript writing, data analysis; ZL: Project development, manuscript writing; TJ: Data collection and management, manuscript writing; XZ: Data collection and management, statistical analysis; ZC: Data collection and management; JZ: Data collection and management; DY: Data acquisition and management; YZ: Data acquisition and management; ZZ: Project development, supervision, WS: Project development, supervision, manuscript editing.

Corresponding authors

Correspondence to Zhansong Zhou or Wenhao Shen.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethics approval

This retrospective study was performed in compliance with the ethical principles of the World Medical Association Declaration of Helsinki and was approved by the Ethics Committee of the First Affiliated Hospital of Army Medical University, PLA (No. KY2019117).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publish

Patients signed informed consent regarding publishing their data and photographs.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 95946 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, Y., Liu, Z., Jiang, T. et al. Photoselective sharp enucleation of the prostate with a front-firing 532-nm laser: an innovative surgical technique for benign prostatic hyperplasia—a single-center study of 475 cases. World J Urol 39, 3025–3033 (2021). https://doi.org/10.1007/s00345-020-03547-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-020-03547-8

Keywords

Search

Navigation