Prostatic Diseases and Male Voiding Dysfunction Safety and Efficacy of Quartz Head Contact Laser Ablation for Large Prostates Using 980-nm Laser: A Comparative Prospective Study Against That for Small- and Medium-sized Prostates Hassan S. Shaker, Ahmed Saafan, Mohammed M. Yassin, Mohammed Fawzy, and Mohammed S. Shoeb OBJECTIVE MATERIALS AND METHODS
RESULTS
CONCLUSION
To examine the safety and efficacy of quartz head laser ablation of the prostate (QLAP) in the treatment of large and huge prostates as compared with small- and medium-sized ones. Two hundred forty-two patients with lower urinary tract symptoms secondary to benign prostatic hypertrophy (BPH) were included in the study, of which 210 patients were evaluable. Patients were divided into 2 groups: group A: patients with BPH volume of 7 fold when the resection weight increases from 60 g and reaches 0.71%.8 Holmium laser enucleation of the prostate (HOLEP) is another alternative. It has the advantage of being associated with minimal morbidity and mortality. The results http://dx.doi.org/10.1016/j.urology.2014.04.067 0090-4295/14
1
are good and comparable with OP, minus its drawbacks.9-11 Nevertheless, the learning curve is steep, and it is estimated that a trainee needs 50 cases to perform HOLEP with reasonable efficiency.9 Furthermore, it is associated with persistent stress urinary incontinence in 4.8% of cases.10 Having said that quartz head contact fiber (QH) has been introduced few years ago as an alternative for the standard side firing, both of which are used with the 980nm diode laser.12 This fiber is an end-firing fiber with a 30 angulation at its distal end, overlaid with quartz to concentrate the energy at its tip. The fiber works in contact mode and does not emit a free beam (Fig. 1). The procedure of quartz head laser ablation of the prostate (QLAP) has proven more efficient and faster than the standard side firing fibers, with results showing significantly less complications.13 The fiber is considerably more efficient in ablating prostatic tissue than the side firing fiber and is much more durable.14 These criteria paved the way for using this fiber in large prostates. In this study, we are examining the safety and efficacy of the QLAP in treating large and huge prostates in comparison with small- and medium-sized prostates, largely to determine whether size may affect the outcome of the QLAP. Our hypothesis is that QLAP is equally efficacious and safe in large-size prostate compared with small-sized ones.
MATERIALS AND METHODS Two hundred forty-two patients with lower urinary tract symptoms secondary to benign prostatic hypertrophy (BPH) were treated with QLAP in the period between April 2009 and December 2011. Inclusion criteria consisted of male patients over the age of 50 years presented with lower urinary tract symptoms and International Prostate Symptom Score (IPSS) symptom score higher than 10, who have failed medical therapy, or have an absolute indication for surgical intervention. Uroflow rate was 4 ng/mL were subjected to transrectal ultrasound-guided biopsies. Those with positive result biopsies for prostatic adenocarcinoma were also excluded from the study. All patients were consented and the protocol was approved by the local ethical committee of the hospital. The data were collected in a prospective fashion. The patients were divided into 2 groups, small (group A,
RESULTS
CONCLUSION
To examine the safety and efficacy of quartz head laser ablation of the prostate (QLAP) in the treatment of large and huge prostates as compared with small- and medium-sized ones. Two hundred forty-two patients with lower urinary tract symptoms secondary to benign prostatic hypertrophy (BPH) were included in the study, of which 210 patients were evaluable. Patients were divided into 2 groups: group A: patients with BPH volume of 7 fold when the resection weight increases from 60 g and reaches 0.71%.8 Holmium laser enucleation of the prostate (HOLEP) is another alternative. It has the advantage of being associated with minimal morbidity and mortality. The results http://dx.doi.org/10.1016/j.urology.2014.04.067 0090-4295/14
1
are good and comparable with OP, minus its drawbacks.9-11 Nevertheless, the learning curve is steep, and it is estimated that a trainee needs 50 cases to perform HOLEP with reasonable efficiency.9 Furthermore, it is associated with persistent stress urinary incontinence in 4.8% of cases.10 Having said that quartz head contact fiber (QH) has been introduced few years ago as an alternative for the standard side firing, both of which are used with the 980nm diode laser.12 This fiber is an end-firing fiber with a 30 angulation at its distal end, overlaid with quartz to concentrate the energy at its tip. The fiber works in contact mode and does not emit a free beam (Fig. 1). The procedure of quartz head laser ablation of the prostate (QLAP) has proven more efficient and faster than the standard side firing fibers, with results showing significantly less complications.13 The fiber is considerably more efficient in ablating prostatic tissue than the side firing fiber and is much more durable.14 These criteria paved the way for using this fiber in large prostates. In this study, we are examining the safety and efficacy of the QLAP in treating large and huge prostates in comparison with small- and medium-sized prostates, largely to determine whether size may affect the outcome of the QLAP. Our hypothesis is that QLAP is equally efficacious and safe in large-size prostate compared with small-sized ones.
MATERIALS AND METHODS Two hundred forty-two patients with lower urinary tract symptoms secondary to benign prostatic hypertrophy (BPH) were treated with QLAP in the period between April 2009 and December 2011. Inclusion criteria consisted of male patients over the age of 50 years presented with lower urinary tract symptoms and International Prostate Symptom Score (IPSS) symptom score higher than 10, who have failed medical therapy, or have an absolute indication for surgical intervention. Uroflow rate was 4 ng/mL were subjected to transrectal ultrasound-guided biopsies. Those with positive result biopsies for prostatic adenocarcinoma were also excluded from the study. All patients were consented and the protocol was approved by the local ethical committee of the hospital. The data were collected in a prospective fashion. The patients were divided into 2 groups, small (group A,
