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No. 090. Photoselective Vaporisation of the Prostate using the 180W Lithium Triborate Laser – an Australian Multicenter Experience.

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No. 090

Photoselective Vaporisation of the Prostate using the 180W Lithium Triborate Laser – an Australian Multicenter Experience.

Amanda S. J. Chung1, Charles Chabert2, Hin-Wai Yap3, Jimmy Lam4, Nader Awad5, Fadi Wayhid6, Frank Redwig6, Prem Rashid5, Henry H. Woo1.

1Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, Australia; 2John Flynn Hospital, Tugun, Australia; 3St Andrew’s Toowoomba Hospital, Toowoomba, Australia; 4Calvary North Adelaide Hospital, North Adelaide, Australia; 5Port Macquarie Base Hospital, Port Macquarie, Australia; 6Royal Hobart Hospital, Hobart, Australia.

  • Results II
  • Peri-operiative outcomes
  • Peri-operative outcomes are displayed in table 1.
  • Sixty percent (51/85) of men were able to be discharged home voiding successfully without requiring a catheter within 24 hours post-operation.
  • Functional outcomes
  • Functional outcomes at baseline and 3 months respectively are shown in table 2.
  • There is statistically significant and clinically meaningful improvement in all functional parameters between baseline and 3 months follow-up (p<0.01).
  • Adverse events
  • Thirty-eight percent (32/85) of men experienced at least 1 adverse event.
  • There were 39 adverse events.
  • Table 3 shows the adverse events graded by the Clavien-Dindoclassification.1

Introduction

Photoselectivevaporisation of the prostate (PVP) is widely used to treat benign prostatic obstruction (BPO), but there is little experience reported on the new more powerful 180W lithium triborate (LBO) laser.

The 180W LBO laser differs from previous versions of the laser. There a 50% increase in maximum power output and the laser fibre is significantly different. The side firing laser fibre is liquid-cooled and has a 50% greater beam area (spot size; footprint). The coagulation mode at lower power no longer has a quasi-continuous wave form as in the vaporisation mode, but is now pulsed, thereby resulting in more efficient coagulation. Software modifications also allow automatic shut-off of energy delivery in the event of over-heating of the fibre, as can occur when there is excessive tissue contact or reflected energy from prostatic calculi or brachytherapy seeds. This new feature helps to protect the fibre and increase its longevity.

Aim

The aim of this study is to evaluate the safety and efficacy of PVP using the 180W LBO laser for the surgical treatment of BPO, by examining a multicenter Australian experience.

Methods

Data were prospectively collected on all men treated with the 180W LBO laser PVP by 8 urologists across 6 Australian hospitals, from July 2011 to August 2011 inclusive.

The inclusion criteria were all men undergoing PVP for reasons consistent with established guidelines and indications for the surgical treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Men with a history of prostate cancer were excluded from analysis.

Perioperative outcomes such as operating time, laser time, energy usage, post- operative duration of catheterisationand post-operative duration of hospital stay, were measured.

Functional outcomes in terms of International Prostate Symptom Score IPSS), IPSS Quality of Life Score (QoL), maximum urinary flow rate (Qmax), and post void residual urine (PVR), were examined at baseline and 3 months post-operation.

  • Results I
  • Patient factors
  • Eighty-five patients were identified;
  • Median age was 70 years (IQR 65-75);
  • Median prostate volume was 51cc (IQR 35-96);
  • Twenty-seven percent (23/85) of men were in urinary retention requiring catheterisation;
  • Forty-four percent (37/85) of men were taking antiplatelet and/or anticoagulant medication.

Conclusions

Our early multicenter Australian experience indicates that the 180W LBO laser PVP is an efficacious and safe treatment for BPO.

Significant improvements in functional outcome measurements were demonstrated at 3 months follow up, and the majority of adverse events were low grade.

Adverse outcomes were, in the main, minor and complications reduce with experience as is common in surgical practice.

These results are promising, despite the complexity of the patient cohort.

This short term follow-up confirms that PVP appears safe in the management of BPO.

Studies evaluating longer-term outcomes are in progress.

References

1. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Annals of surgery. Aug 2009;250(2):187-196.

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Disclosure

Henry H. Woo is a paid consultant to American Medical Systems.