Greenlight laser (XPS-180watt) prostatectomy for treatment of benign prostate obstruction, Pursuit of durability.

IF 17.7 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY Accounts of Chemical Research Pub Date : 2023-06-09 eCollection Date: 2024-01-01 DOI:10.1080/2090598X.2023.2220631

Fady K Ghobrial, Mahmoud Laymon, Nasr El-Tabey, Ahmed M Elshal

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Abstract

Objectives: To report 5-year outcomes, need and predictors of retreatment post greenlight laser photoselective vaporization (GL.PVP) and vapo-enucleation (GL.PVEP), as long-term data on safety and efficacy of GL.PVP and GL.PVEP and on the prostate using XPS^TM system are still pending.

Patients and methods: Primary outcome was the need for retreatment (medical treatment and reintervention) for recurrent BOO. Time-to-event (retreatment) analysis, perioperative events, change in the urinary outcome measures at different follow-up visits, early and late complications and PSA kinetics were reported.

Results: Between September 2014 and April 2017, 248 patients underwent GL/XPS procedures. GL.PVP and GL.PVEP were carried out for 157 (63.3%) and 91 (36.7%) patients with mean prostate sizes of 60 ± 18 and 100 ± 22 cc, respectively. After a mean duration of 62 ± 9-month follow-up, overall retreatment rate (medical and interventional) was 23% (57 patients). It was comparable between both GL.PVP and GL.PVEP cases: 38 (24.2%) and 19 (20.9%) patients, P = 0.5, respectively. Significantly more surgical reintervention rate was reported after GL.PVP compared to GL.PVEP (P = 0.03). In retreatment group, more intraoperative bleeding (P = 0.02), early postoperative hematuria (P = 0.03), higher median preoperative PSA (P = 0.02) and less postoperative one-year percent PSA reduction (P = 0.02) were detected. Lower postoperative one-year percent PSA reduction independently predicts retreatment with a cut-off point of 64.2% (58.2% sensitivity, 73.4% specificity, AUC 0.647, 95% CI 0.52-0.76).Median (range in months) time to event was 20 (1-60) for all cases and 13.5 (1-42) and 30 (18-60), P = 0.7, for GL.PVP and GL.PVEP groups, respectively.

Conclusion: Greenlight laser XPS is an effective, durable and versatile tool in treating benign prostatic obstruction. Durability of the outcome is predictable with more postoperative PSA reduction.

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绿光激光（XPS-180瓦）前列腺切除术治疗前列腺良性梗阻追求持久性

目的报告绿光激光光选择性汽化术（GL.PVP）和汽化去核术（GL.PVEP）术后5年的疗效、再治疗的需求和预测因素，因为有关GL.PVP和GL.PVEP以及使用XPSTM系统治疗前列腺的安全性和有效性的长期数据仍未公布：主要结果是复发性BOO是否需要再治疗（药物治疗和再干预）。结果：2014年9月至2017年4月期间，共对220名患者进行了前列腺电切术（PPEP），并使用XPSTM系统进行了前列腺电切术：2014年9月至2017年4月期间，248名患者接受了GL/XPS手术。157例（63.3%）和91例（36.7%）患者接受了GL.PVP和GL.PVEP手术，前列腺平均大小分别为60±18cc和100±22cc。经过平均 62 ± 9 个月的随访，总体再治疗率（药物和介入治疗）为 23% （57 名患者）。GL.PVP和GL.PVEP病例的再治疗率相当：分别为 38 (24.2%) 和 19 (20.9%)，P = 0.5。与 GL.PVP 相比，GL.PVP 后的手术再介入率明显更高（P = 0.03）。在再治疗组中，发现了更多的术中出血（P = 0.02）、术后早期血尿（P = 0.03）、更高的术前 PSA 中位数（P = 0.02）和更低的术后一年 PSA 减少百分比（P = 0.02）。所有病例的中位（以月为单位）事件发生时间为 20（1-60）天，GL.PVP 组和 GL.PVEP 组分别为 13.5（1-42）天和 30（18-60）天，P = 0.7：结论：绿光激光 XPS 是治疗良性前列腺梗阻的一种有效、持久和多功能的工具。结论：绿光激光 XPS 是治疗良性前列腺梗阻的一种有效、持久和通用的工具。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.