Edward Collins

180-W XPS GreenLight Laser Therapy for Benign Prostate Hyperplasia: Early Safety, Efficacy, and Perioperative Outcome After 201 Procedures

BACKGROUND Photoselective vaporisation of the prostate has evolved from the GreenLight 80-W KTP powered laser to the latest 180-W XPS laser involving a MoXy fibre. OBJECTIVE Evaluate the prevalence of perioperative complications and short-term outcome for the first time with the XPS laser in men with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE). DESIGN, SETTING, AND PARTICIPANTS Prospective data were collected from consecutive patients at seven centres worldwide during June 2010 and March 2011. Indication for surgery was based on the European Association of Urology and the American Urological Association guidelines. Patients receiving anticoagulants or those with retention were included and analysed separately. INTERVENTION 180-W XPS GreenLight laser prostatectomy using the MoXy fibre. MEASUREMENTS Standard parameters associated with transurethral prostate surgery and perioperative prevalence of surgery-associated problems or complications were documented. RESULTS AND LIMITATIONS A total of 201 patients were included in the study. Mean follow-up was 5.8 mo (standard deviation [SD]: 2.8; range: 1-12 mo). A quarter of the patients had a prostate volume≥80 ml. For prostates between 51 and 60 ml, a mean of 300 kJ (SD: 112) of energy was applied (lasing time: 35.0 min; SD: 15). Statistically significant improvements were noted in all key parameters postoperatively. The prevalence of perioperative complications was low. Limitations of the study are short duration of follow-up and limited number of available patients for the functional follow-up. CONCLUSIONS The 180-W GreenLight XPS laser is a new effective treatment option with a low prevalence of perioperative complications for patients suffering from LUTS due to BPE.

Treatment of Hemorrhage from Renal Trauma by Angiographic Injection of Clot

Experimental results in rats and modest clinical experience now indicate that persistent or massive hemorrhage from renal trauma can be treated by injection of clot(under angiographic control) into the bleeding vessels. There is minimal loss of renal tissue and an operation is avoided.

Initial EDAP LT-01 Lithotripsy Group Experience in the United States

The initial United States cooperative experience with the EDAP LT-01 second generation piezoelectric extracorporeal shock wave lithotriptor using ultrasonic guidance is presented. Particular to the machine are lack of radiation exposure, no need for anesthesia, a purely outpatient procedure, no electrocardiographic problems, a high degree of safety and a paucity of complications. The equipment is described briefly. The same machine currently is being used to destroy renal and biliary stones. The results are encouraging and highly comparable to the initial experience with the earlier machines. Fragmentation rates are approximately 86%, with destruction rates of 63.4% over-all. Ultrasound localization and monitoring proved surprisingly easy to learn and were increasingly less of a problem as experience was gained. No serious complications were observed, and there were no renal losses and no deaths. Only 3 cases of steinstrasse were noted among 461 with 633 stones targeted during 595 treatments.

Granular cell myoblastoma: Perineal neoplasm of probable neural origin

A seventy-year-old man with a painless, perineal neoplasm was found to have a granular cell myoblastoma densely adherent to the bulbar urethra. This case represents the fourth known perineal neoplasm of neural origin.