Tal Ben-Zvi

180 W vs 120 W lithium triborate photoselective vaporization of the prostate for benign prostatic hyperplasia: a global, multicenter comparative analysis of perioperative treatment parameters.

OBJECTIVE To evaluate the surgical performance of the new Greenlight XPS-180 W laser system (American Medical Systems, Minnetonka, MI) and the effect of prostate volume (PV), in comparison with the former HPS-120 W system, for the treatment of benign prostatic hyperplasia by photo-selective vaporization of the prostate. METHODS Between July 2007 and March 2012, 1809 patients underwent laser photo-selective vaporization of the prostate (1187 patients with the use of HPS-120 W and 622 patients with the use of XPS-180 W) at 7 international centers. All data were collected prospectively. Comparative analysis was performed between XPS and HPS according to PV measured by transrectal ultrasound. RESULTS The XPS compared with HPS, allowed significantly reduced laser and operative time (29.6 minutes vs 65.8 minutes and 53 minutes vs 80 minutes, respectively; P <.01 for both). The number of fiber used during the procedures was significantly reduced with the XPS system (1.11 vs 2.28; P <.01), whereas total energy delivered was lower (250.2 kJ vs 267.7 kJ; P = .043). Overall, the mean operative time, mean laser time, and mean energy were all significantly increased according to PV >80 mL vs <80 mL. However, when stratified according to PV, XPS demonstrates significant advantages compared with HPS, regardless of prostate size in all operative parameters (P <.01). CONCLUSION The new XPS-180 W system exhibits significant advantages in all surgical parameters compared with the HPS-120 W system. Overall, with XPS-180 W and HPS-120 W, mean operative time, laser time, and energy usage increased according to PV. This suggests that preoperative evaluation of PV by transrectal ultrasound should be mandatory.

Prognostic value of urinary prostate cancer antigen 3 (PCA3) during active surveillance of patients with low-risk prostate cancer receiving 5α-reductase inhibitors

To determine the clinical performance of the urinary prostate cancer antigen 3 (PCA3) test to predict the risk of Gleason grade re‐classification amongst men receiving a 5α‐reductase inhibitor (5ARI) during active surveillance (AS) for prostate cancer.

Preoperative nutritional factors and outcomes after radical cystectomy: A narrative review

Only a few nutritional factors have been identified to predict the risk of developing complications after radical cystectomy (RC). This narrative review delineates the current known effects of preoperative nutritional status factors in this context. The report highlights the heterogeneity between study methods and results. We determined that low albuminemia values increase mortality risk and overall complications. In addition, obesity tends to increase the risk of developing venous thromboembolism and adverse events. Additional prospective studies, using standardized methods to both define and report complications, should be conducted to strengthen the connections between preoperative nutritional status factors and post-RC complications. Furthermore, intervention studies testing the impact of strategies to improve nutritional status on the risk of complications after RC are also needed.

An in-house Composix™-based pubovaginal sling trial for female stress urinary incontinence: Five-year comparative followup to tension-free and transobturator vaginal tapes

INTRODUCTION We compared the efficacy of three slings in the long-term treatment of stress urinary incontinence (SUI): tension-free vaginal tape (TVT), vaginal tape-obturator (TVT-O), and an in-house two-layered polypropylene mesh with a submicronic polytetrafluoroethylene (Composix™). Our primary endpoint was the objective measurement of continence (24-hour pad test). Secondarily, we measured the satisfaction and complication rates. METHODS This prospective, non-randomized study included 128 patients with SUI. Preoperative evaluation included medical history, physical exam, 24-hour pad test, Urinary Incontinence Quality of Life Scale (IQOL), FPSUND, and global satisfaction questionnaires. Patients were followed at one month postoperative, biannually for two years, and then annually for a total of five years. Followup visits included a focused questionnaire, physical exam, satisfaction questionnaire, 24-hour pad test, IQOL, and FPSUND questionnaires. RESULTS Composix, TVT, and TVT-O groups included 60, 34, and 34 patients, respectively. No significant differences were found in baseline characteristics except for the pad test. Length of catheterization was the only immediate operative significant parameter (Composix 4.7 days vs. TVT 1.1 days vs. TVT-O 2.6 days; p=0.03). The entire cohort had significant improvements in their IQOL, FPSUND, and pad test at one and four years (p<0.01). The cohort-wide 24-hour pad test average weight was 30.4 g preoperatively vs. 5 g at 12 months (p<0.00001) (Composix 37 to 5 g, TVT 83 to 4 g, and TVT-O 55 to 5 g). The Composix group had a higher number of minor complications (Clavien I, II) and secondary procedures. CONCLUSIONS This single-surgeon cohort with five-year followup demonstrated a large improvement and maintenance of continence in all three surgical groups. The Composix-based sling provided comparable continence outcomes at a fraction of the cost; however, its increased morbidity and higher complication rate raise concerns over future use.

2004 GREENLIGHT HPS-120W VS GREENLIGHT XPS-180W LASER VAPORIZATION OF THE PROSTATE FOR BENIGN PROSTATIC HYPERPLASIA: A GLOBAL, MULTI-CENTER, AND PROSPECTIVE COMPARATIVE ANALYSIS ACCORDING TO PROSTATE SIZE

INTRODUCTION AND OBJECTIVES: The aim was to evaluate the surgical performance and impact of prostate volume (PV) of the new Greenlight XPS-180W laser system (AMS, Minnetonka, MI, USA) in comparison with the former generation HPS-120W system for the treatment of BPH by photo-selective vaporization of the prostate (PVP). METHODS: From July 2007 to March 2012, a total of 1809 patients underwent Greenlight PVP for the treatment of BPH performed at 7 international centers. 1187 cases were performed using HPS120W and 622 cases using XPS-180W laser system. Data were all collected prospectively. Comparative analysis was performed between XPS and HPS and according to PV 80 and 80 cc. RESULTS: The XPS compared to HPS, allowed significantly reduced laser and operative time with a mean lasing time of 29.6 min vs. 65.8 min and total operative time of 53 min vs. 80 min respectively (p 0.01 for both). The number of fiber used during procedures was significantly reduced with the XPS system 1.11 vs. 2.28 fiber (p 0.01) while total energy delivered was 250.2 vs. 267.7 kJ (p 0.043) respectively. Overall using XPS and HPS systems, the mean operative time (104.3 vs 55.6 min), mean laser time (86.5 vs 37.3 min) and mean energy usages (400 vs 197 kJ) were all significantly increased according to PV 80 cc vs 80cc. However, when stratified according to PV, XPS demonstrates significant advantages compared to HPS regardless of prostate size in all operative parameters (p 0.01) but energy; total energy delivery was equivalent between the two systems (p 0.05). CONCLUSIONS: The XPS-180W system exhibits reduced operative time and laser time with similar total energy delivery per given PV suggesting a significant increased efficiency compared to the HPS-120W system. Overall, both with XPS-180W and HPS-120W mean operative time, laser time and energy usage increased according to prostate size. This suggests evaluation of PV should be a mandatory assessment as part of pre-operative evaluation of Greenlight PVP because it has direct implications for the operating parameters. Source of Funding: None