Clinical Quotes - Urology - Urologie    

Selected Quotes/Abstracts of Physicians and Clinics using LASERSCOPE Greenlight PVP Laser Systems for the Photoselective Vaporization of the Prostate (BPH or Benign Prostatic Hyperplasia)

19. Freedman S. , Desert Springs Hospital, Las Vegas, USA

20. Neubauer S., Westdeutsches Prostatazentrum, Köln, Germany

Safety and Effectiveness of Photoselective Vaporization of the Prostate (PVP) in Patients on Ongoing Oral Anticoagulation

Objectives: Ongoing oral anticoagulation (OA) contraindicates transurethral electroresection of the prostate. We evaluated the safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients on ongoing OA with coumarin derivatives, aspirin, or clopidogrel, complaining of symptomatic benign prostatic hyperplasia (BPH).

Methods: We evaluated perioperative parameters, functional outcome, and adverse events up to 24 mo postoperatively of patients on OA, and compared results with 92 men at normal risk without anticoagulant therapy undergoing PVP for the same indication (control).
[...]
Conclusions: PVP is characterized by excellent haemostatic properties and very low intraoperative complication rate even in patients on OA. On the basis of our perioperative results, we recommend PVP as first-line procedure for patients with symptomatic BPH at high risk of bleeding.

in: European Urology, In Press, Corrected Proof
Available online 18 August 2006

5-Year Experience:

Reza S. Malek, Prof., M.D.
Randall S. Kuntzman, M.D.

Mayo Clinic - Mayo Foundation
Department of Urology
Rochester, Minnesota, USA

"Photoselective Vaporization of the Prostate: 5-Year Experience with High Power KTP Laser

INTRODUCTION AND OBJECTIVE: Photoselective Vaporization of the Prostate (PVP) utilizes potassium titanyl phosphate (KTP) laser energy, whose photons at 532 nm wavelength are selectively absorbed by hemoglobin with shallow penetration of only 800 µm. Thus, thermal energy is confined to a small volume of superficial prostatic tissue, which is rapidly removed by vaporization of its cellular water, leaving only 1-2 mm rim of coagulation.

We present our 5-years experience with this procedure for treatment of bladder outlet obstruction due to benign prostatic hyperplasia (BPH)."
 
in: The Journal of Urology, Vol. 169, No 4, April 2003
>> see also: Urology Times (USA)

Multi-Center Trial (USA)
(study - 139 patients)

James C. Ulchaker, M.D.¹
Terrance R. Malloy, M.D.²
Barry S. Stein, M.D.³
Alexis E. Te, M.D.⁴
Unyime O. Nseyo, M.D.⁵
Mahmood A. Hai, M.D.⁶
Reza S. Malek, M.D.⁷

Cleveland Clinic Foundation¹ Department of Urology
Cleveland, OH, USA

University of Pennsylvania²
Department of Urology
Philadelphia, PA, USA

Brown University³
Department of Urology
Providence, RI, USA

Cornell Weill Medical College⁴
Department of Urology
New York, NY, USA

Virginia Commonwealth University⁵ Department of Urology
Richmond, VA., USA

Oakwood Annapolis Hospital⁶
Department of Urology
Wayne, MI, USA

Mayo Clinic - Mayo Foundation⁷
Department of Urology
Rochester, Minnesota, USA

"Photoselective Vaporization of the Prostate (PVP) or Treatment of Benign Prostatic Hyperplasia (BPH): A prospective Multi-Center Trial (abstract)

OBJECTIVE: PVP is a relatively new addition to the armamentarium in the surgical treatment of bladder outlet obstruction secondary to BPH. The objective of the study is to demonstrate safety and efficacy of PVP in patients suffering from lower urinary tract symptoms (LUTS) secondary to BPH.

METHODS: One hundred thirty-nine men with obstructive BPH underwent PVP utilizing an 80W quasi-continuous potassium-titanyl-phosphate (KTP) laser with a 70^o side-firing fiber. The mean per-operative prostate volume was 54.5 ± 32 cc. The mean operative time was 39 ± 23 minutes. One hundred seventeen men (84%) were treated as outpatients (<23 hrs). Mean catheter removal time was 14 ± 14 hours (0-72).

RESULTS: At one-year follow-up, mean AUA symptom score, peak urinary flow rate, residual volume, and quality of life score were improved significantly by 92 %, 93 %, 94 %, and 90 % respectively. Prostate volumes, as measured by Transrectal Ultrasound (TRUS) decreased significantly at 6 and 12 months post-operatively. Minor complications included hematuria (8%), transient retention (3 %), transient incontinence (3 %), UTI (1 %). Dysuria lasting longer than 10 days was transient in 8 %.

CONCLUSION: PVP is a safe and effective outpatient treatment providing rapid relief from obstructive BPH with excellent outcomes, minimal morbidity, and quick recovery (*P<0.0001)."

in: J. Endourology, Vol. 17, Suppl., September 2003, p. A319
Presented at World Congress of Endourology, Montreal, Sept. 2003

 
 
 
 
 
 
 

Neil J. Barber, M.D.
Gordon Muir, M.D.

King's College Hospital
Department of Urology
London, UK

"High-power KTP laser prostatectomy: the new challenge to transurethral resection of the prostate

CONCLUSION: While there will be calls for no technique to be accepted without randomized controlled trials, it should be borne in mind that TURP was never subjected to this scrutiny. Perhaps a new approach to novel techniques focusing on morbidity and surrogate end points might be more appropriate. What seems certain is that this new technology is surely a contender to replace traditional existing surgical treatments for symptomatic benign prostatic hyperplasia. This is particularly true in the management of very large prostates, for which the attributes of high-power KTP lasers may finally assign the comparative morbidity of the traditional open procedures to the history books."

In: Current Opinion in Urology, 2004, Vol 14, 21-25

Istituto Clinico Sant'Ambrogio
Servizio di Urologia
Milano, Italia (Italy)

"High Power KTP 532 Laser for Photoselective Vaporization of Prostate (PVP)

Key to the success of PVP is the capacity to completely vaporize tissue, causing immediate reduction of prostatic tissue, immediate and consistent TURP-like results, with no tissue sloughing and delayed necrosis (only 1-2 mm coagulation zone). PVP is fast and bloodless. As opposed to HoLEP, no tissue morcellation is necessary for treatment of large glands."

Full text of clinical study at www.laserscope.com

Hans-Joachim Deuster, M.D. (Leitender Arzt)
Regine Martini, M.D.
Michael Penninger, M.D.
Christian Rheinberg, M.D.

Klinik für Prostata-Therapie
Heidelberg, Deutschland (Germany)

>> siehe Fernsehsendung
Dr. Weiss, SWR (Deutschland)

"Jetzt noch schonender mit dem GreenLight Laser

Die jüngste Entwicklung bei der Behandlung gutartiger Prostata-Vergrößerungen (Benigne Prostata-Hyperplasie, BPH) ist die eines Spezial-Lasers, der im Gegensatz zu den bisherigen Lasersystemen eine Wellenlänge von 532 nm hat. Damit liegt seine Wellenlänge im sichtbaren, grünen Bereich. Dieser so genannte GreenLight Laser hat den bislang ungenutzten Vorteil, dass Licht dieser Wellenlänge optimal von Blutgefäßen und blutreichem Gewebe absorbiert wird. Diese Licht-Absorption führt zu einer Aufnahme von Energie, und das bestrahlte Gewebe verdampft, ohne dass Blut austritt. Mediziner sprechen hier von der "Photoselektiven Vaporisation der Prostata (PVP)". Das Verfahren ist einzigartig und wird seit Neuestem an der Heidelberger Klinik für Prostata-Therapie eingesetzt."

in: www.prostata-therapie.de

J.S. Sandhu, M.D.
B.A.VanderBrinki, M.D.
C. Egan, M.D.
S.A. Kaplan, M.D.
A.E. Te, M.D.

New York Presbyterian Hospital
Department of Urology
New York, NY, USA

Weill Cornell Campus,
New York, NY, USA

"High-Power KTP Photoselective Laser Vaporization Prostatectomy for the Treatment of Benign Prostatic Hyperplasia in Men with Large Prostates

CONCLUSION: These early results demonstrate that PVP is safe and efficacious for men with symptomatic BPH and large volume prostates. Longer-term follow-up is in progress."

in: J. Endourology, Vol. 17, Suppl., September 2003, p. A188


 

Mahmood A. Hai, M.D.

Oakwood Annapolis Hospital
Wayne, MI, USA

"Bloodless photo-selective vaporization of the prostate procedure cuts recovery time to days, not weeks

Mahmood Hai, M.D., Oakwood Annapolis Hospital, urology specialist and clinical advisor of the system, said: This is the most effective and significant treatment I have ever used in my 25 years of treating BPH. This will become the 'gold standard' for treatment of BPH."

in: EMAILWIRE.COM, January 29, 2002

>"Laser Treatment Helps Men Battle Enlarged Prostate

Ned R. Novsam: in the News:

Lasers have been tried in the past, but they lacked the power that the new technology offers and the results were not so good. With some of the other laser procedures, it took six to 12 weeks to see improvement.
The new, powerful laser heats rapidly. The tissue is vaporized and
there is no dead tissue to slough off.

In the 4 years the laser has been tested, virtually no side effects have been observed."

in: www.kenoshaurology.com/articles.shtml

Deaconess Medical Center
Spokane, WA, USA

"GreenLight KTP Laser Photo Vaporization

I am very enthusiastic.
The “GreenLight” KTP laser is a quick and safe endoscopic procedure that safely vaporizes benign prostatic hyperplasia. The results are as effective as the transurethral resection of the prostate and better than other “minimally invasive” treatments such as microwave therapy or interstitial laser therapy that do not remove tissue. Recovery is quick, and the patient can return to full activities within a few days! There is no pain, no bleeding, no prolonged resting, and no adverse effects on erectile function.

I have been performing this procedure since December 2002. This is a great treatment for bladder neck obstruction from benign prostate disease!"

in: www.urology-silverstein.com/ktp.htm

"PVP SURGERY

Researchers say Photoselective Vaporization of the Prostate is a proven, safe and effective treatment for BPH. Alexis E. Te, M.D., from New York-Presbyterian Hospital and Weill Cornell Medical College, says:

"The first significant advance in the treatment of BPH in 50 years. This new laser technique greatly decreases the risk of serious complications from the surgery and allows patients to be immediately free of symptoms and quickly return to work."

in: KGO-TV, San Francisco (ABC-owned television station)

Pedro Torrecillas, M.D.
Norberto Macias, M.D.

Clínica Santa Elena
Malaga, España (Spain)

"Fotovaporizar la próstata evita el sangrado"We have made about 200 procedures.

Norberto Macías, urólogo de la clínica malagueña, ha explicado que el hecho de evitar el sangrado tiene una fuerte incidencia, ya que podemos utilizar esta técnia en todo tipo de pacientes, incluyendo aquéllos con problemas cardiorespiratorios severos, aletaraciones hematológicas o sida. El uso de la fotovaporización reduce la morbilidad y la estancia del enfermo en el hospital al tiempo que aumenta la calidad y el confort posthospitalario. Desde un punto de vista quirúrgico, existe menos riesgo de absorción de líquidos por el peritoneo. Mi experiencia es que se obtiene mayor calidad que con otras alternativas."

in: diario Medico - 21 de marzo de 2003

Instituto de Cirugía Urológica Avanzada, Madrid, España (Spain)

"Vaporización prostática con LÁSER KTP

... el avance más impresionante en la cirugía de la próstata. La opción mínimamente invasiva que permite realizar una operación de próstata de forma ambulante (sin ingreso), y sin necesidad de sondaje posterior a la cirugía. Una técnica desarrollada por la clínica Mayo, ahora disponible en el Instituto de Cirugía Urológica Avanzada."

in: http://www.urologia.tv/icua/es/treatments.aspx?cod=33

"Photo-Selective Vaporization of the Prostate, GreenLight PVP:
A new advance in laser prostate surgery and an alternative to traditional prostate surgery (TURP) for enlarged prostates

No other BPH treatment option has been shown to clinically provide such dramatic and immediate symptom relief while concurrently providing significant uroflow results and minimal, if any, side-effects. The PVP technique is a fast, outpatient treatment that will satisfy both the subjective (symptom relief) and objective (uroflowmetry results) outcomes of a successful BPH treatment. Other minimally invasive BPH treatment options (such as TUMT, microwave, TUNA, thermotherapy) require compromises to be made by the patient and/or the physician."

"New ways in prostate surgery: Two Toronto-area hospitals are running tests of a new, laser-based technology for prostate surgery that offers dramatically better medical outcomes while reducing overall surgical costs by 50 percent or more.

Dr. Baldwin maintains that by freeing up hospital beds, which cost on the order of $1,000 a day, the PVP laser would actually save the hospital money. The older surgical method keeps patients in hospital for an average of three days, costing $3,000 plus surgical supplies,” said Dr. Baldwin, who compared this with the $1,200 expense of the laser treatment. Overall, he noted, the case cost is effectively halved when using the laser procedure. Just as importantly, the clinical results of PVP laser surgery are an improvement on traditional prostate gland surgery."

In: Canadian Healthcare Technology, May 2004

Christian Bornhof, Prof., M.D.

Klinikum Nürnberg
D-Nürnberg

"Laser-Einsatz ermöglicht schonende Behandlung von Prostata-Vergrösserungen"

Der Klinikaufenthalt verkürzt sich von einer Woche auf zwei bis drei Tage. Auch die Tage nach der Operation gestalten sich wesentlich angenehmer, da nach einem Laser-Eingriff kaum blutiger Urin abgeht und daher ein Tag - - statt bisher drei Tage - mit Harnröhren-Katheter vollkommen ausreicht. In vielen Fällen kann sogar ganz darauf verzichtet werden."

in: www.klinikum-nuernberg.de/

"Grünes Licht für die Prostata

Als bewährtes Verfahren (sogenannter Gold-Standard) gilt seit Jahrzehnten die sogenannte TURP („transurethrale Resektion der Prostata“). Dabei führt der Operateur ein optisches Instrument durch die Harnröhre bis zur Prostata und „hobelt“ dort mit dem Hochfrequenzstrom einer Schlingenelektrode Gewebe ab, um den zuvor eingeengten Urinablauf wieder zu öffnen. Im Prinzip macht auch der neue Greenlight-Laser nichts anderes, „allerdings viel schonender“, sagt Schmidt. Denn die Strahlung dieses neuen Lasers wirkt nur sehr oberflächlich und verursacht deshalb kaum Schwellungen oder Ödeme. Der Patient hat nach der Behandlung kaum Beschwerden. Schmidt: „Das gewucherte Gewebe verdampft sofort und praktisch unblutig.“ Bei herkömmlicher OP-Technik bekommt etwa jeder zwanzigste Patient Fremdblut übertragen. Dies ist bei dem neuen Verfahren ganz bestimmt viel seltener der Fall, Schmidt meint sogar „nie“.

in: Hamburger Abendblatt, 3. Februar 2005

"Grünes Licht für die Prostata

Die größte Erfahrung in Deutschland mit dem Greenlight-Laser haben die Urologen der Ludwig-Maximilians-Universität München. Seit Juni 2003 sind dort etwa 100 Patienten nach diesem Verfahren operiert worden.

„Unsere Erfahrungen sind gut, ebenso die postoperativen Ergebnisse“, sagt Privatdozent Dr. Oliver Reich. Jeweils nach vier Wochen, nach sechs und zwölf Monaten werden die Operierten nachuntersucht. Reich: „In geübten Händen ist das Verfahren gut und sicher.“ Der Urologe aus München hat das Verfahren von der berühmten Mayo-Klinik in den USA übernommen: „Ich war selbst erstaunt über die Wirkung.“

in: Hamburger Abendblatt, 3. Februar 2005

Sheldon Freedman, M.D.,

Desert Springs Hospital
Medical Center
The Valley Health System
620 Shadow Lane
Las Vegas, NV 89106

"For men Only - New Treatment Relieves Uncomfortable Prostate Symptoms"

Other minimally invasive techniques cause the prostate tissue to shrink over time. But the GreenLight laser vaporizes tissues instantly so we can be more precise and can produce more reliable outcomes, and patients often see more immediate results. GreenLight PVP is an exciting option for men who have failed other treatments or who don't want to take medications or undergo surgery to relieve their symptoms. "

in: http://valleyhealth.uhspublications.com/summer2004/story12.html

"Bei Prostatahyperplasie wird immer öfter ein Grünlicht-Laser verwendet / Blutungen werden vermieden

Hauptvorteil des Grünlicht-Lasers im Vergleich zu bisherigen Lasertechniken sei, daß bei dem endoskopischen Eingriff das zu entfernende Drüsengewebe sehr oberflächlich und stark erhitzt werden kann bei zugleich geringer Eindringtiefe. Damit verdampft das Gewebe rückstandsfrei. Die Eindringtiefe reicht trotzdem aus, um Blutungen sofort zu stillen. Wenn man das zum ersten Mal macht, denkt man immer: Wo bleibt die erste Blutung? Aber es blutet einfach nicht!", so Neubauer im Gespräch mit der "Ärzte Zeitung".

http://www.aerztezeitung.de

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