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Purpose: Intravesical protrusion of the prostate (IPP) can affect voiding. We evaluated the improvement in lower urinary tract symptoms and patient satisfaction after laser prostate photovaporization in benign prostatic hyperplasia (BPH) patients with or without IPP. Materials and Methods: This prospective study included 134 patients who underwent GreenLight HPS laser photoselective vaporization prostatectomy (PVP) between January 2010 and July 2011 patient. Preoperative IPP was evaluated by using the retroflexed view from flexible cystoscopy. evaluation included complete medical history, International Prostate Symptom Scores (IPSS), maximum flow rate (Qmax), postvoid residual (PVR), serum prostate-specific antigen (PSA), and transrectal ultrasonogram. Changes from baseline in Qmax, PVR, total IPSS, and IPSS subscores (voiding and storage) were analyzed at postoperative months 1, 3, and 6. Results: The patients’ mean age was 66.6±7.8 years. Mean serum PSA and prostate volume were 1.7±1.5 ng/mL and 42.9±16.7 g, respectively. No significant differences existed between the IPP and no IPP groups in preoperative prostate volume, total IPSS, PSA, or lasing time and energy. The mean follow-up duration was 6.2±1.9 months. IPP patients showed significant improvements in total IPSS and voiding subscores at months 1 and 3. Improvements in the quality of life score and storage subscore were not significantly different between the groups. Qmax was significantly improved at 6 months postoperatively in the IPP group versus the no IPP group. Conclusions: Among patients who underwent PVP for BPH, the IPP group showed more symptom improvement, especially in voiding symptoms, than did the no IPP group. Preoperative cystoscopy is helpful for evaluating IPP and for anticipating postoperative outcome.

Purpose: To evaluate the outcome of visual internal urethrotomy with a holmium:yttrium-aluminum-garnet laser along with intralesional triamcinolone injection. Materials and Methods: Patients with an anterior urethral stricture less than 3 cm in length were evaluated by clinical history, physical examination, uroflowmetry, and retrograde urethrogram preoperatively. All patients were treated with holmium laser urethrotomy and intralesional triamcinolone (80 mg) injection under general or regional anesthesia. An 18 F urethral catheter was placed for 5 days. All patients were followed up for 12 months postoperatively by history, uroflowmetry, and if required, retrograde urethrogram or urethroscopy every 3 months. Results: The mean age of the patients was 42.9 years (range, 14 to 70 years). The overall recurrence rate was 24%. The success rate in patients with strictures less than 1 cm in length was 95.8%, whereas that in patients with strictures of 1 to 3 cm in length was 57.7% (p=0.002). The outcome did not depend on age, duration of symptoms, etiology, or location of stricture. Conclusions: Holmium laser urethrotomy with intralesional triamcinolone is a safe and effective minimally invasive therapeutic modality for urethral strictures. This procedure has an encouraging success rate, especially in those with stricture segments of less than 1 cm in length.

Purpose: The prostate-specific antigen (PSA) level decreases after transurethral resection of the prostate (TURP). However, changes in the PSA level after potassium-titanyl-phosphate (KTP) laser vaporization of the prostate are not well known. The aim of this study was to investigate the effect of KTP laser vaporization of the prostate on PSA levels in patients with benign prostatic hyperplasia (BPH). Materials and Methods: Serum PSA levels were checked before and 1, 3, 6, and 12 months after the procedure in patients who underwent KTP laser vaporization between October 2004 and August 2008. Patients with prostate cancer, a history of urinary retention, or prostatitis during the follow-up period were excluded. The results for 278 patients were studied. Results: The mean age of the patients was 69.0±6.7 years (range, 50-91 years) and the mean preoperative PSA level was 2.72±2.93 ng/ml. The PSA level tended to be increased at 1 month after the operation (3.18±3.23 ng/ml, p=0.032) but decreased within 3 months and became stabilized after 6 months at 1.79±1.82 ng/ml (p＜0.001). Conclusions: PSA levels may increase after KTP laser vaporization for a certain period of time, but eventually decrease and become stabilized after 6 months. Therefore, it may be appropriate to wait up to 3 months if the PSA level rises after the procedure, and further investigation should be considered if the PSA level still remains high after 6 months.

Purpose To assess the risk factors for developing urinary retention after removal of the urethral catheter on postoperative day 1 in benign prostatic hyperplasia patients who underwent Greenlight HPS laser photoselective vaporization prostatectomy (PVP). Materials and Methods The study included 427 men who underwent Greenlight HPS laser PVP between 2009 and 2012, excluding patients in whom a catheter was maintained for more than 1 day because of urethral procedures. In all patients, a voiding trial was performed on postoperative day 1; if patients were unable to urinate, the urethral catheter was replaced before hospital discharge. The patients were divided into two groups: early catheter removal (postoperative day 1) and late catheter removal (urethral catheter reinsertion). Preoperative and perioperative parameters were compared between the groups. Results Catheters were successfully removed in 378 (88.6%) patients on postoperative day 1. In 49 patients, the catheters were reinserted and removed a mean of 6.45±0.39 days after surgery. In a multivariate analysis, a history of diabetes was the most significant predictor (p=0.028) of failure of early catheter removal, followed by operative time (p=0.039). There were no significant differences in age, prostate volume, International Prostate Symptom Score, or urodynamic parameters between the two groups. Conclusions It is feasible, safe, and cost-effective to remove the urethral catheter on postoperative day 1 after Greenlight HPS laser PVP, but the procedure should be done carefully in patients who have history of diabetes or an extended operative time.

Purpose: To examine the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for the surgical treatment of benign prostatic hyperplasia and to estimate the time to overcome the learning curve. Materials and Methods: From May 2008 to October 2009, 164 consecutive patients treated with HoLEP were enrolled in this study. International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), and postvoid residual urine (PVR) were documented preoperatively and at 6 weeks and 3, 6, 12, and 18 months postoperatively. The 164 study subjects were divided into 3 groups (group 1 the first 50 patients treated, group 2 the second 50, and group 3 the third 64), and perioperative data and complications were analyzed in these groups to determine the learning curve. In addition, the inverse and upward techniques were compared in terms of the effects and the stability of morcellation. Results: The mean patient age was 69 years, and the average operation time was 62 minutes (range, 20-208 minutes). Mean prostate volume was 54.2 ml and mean resected tissue weight was 18.6 g. Postoperatively, IPSS and PVR decreased and Qmax increased significantly. Postoperative complications were transient incontinence (8.5%), urinary retention (4.3%), hematuria (3.0%), urinary tract infection (1.2%), and urethral stricture (0.6%), and intraoperative complications were minor capsular perforation (4%) and bladder injury (8%). Conclusions: HoLEP was found to be effective and safe regardless of prostate size. We recommend that a systematic educational program be established to reduce the learning curve.

Purpose: Although transurethral resection of the prostate (TURP) is considered the standard surgical treatment for benign prostatic hyperplasia (BPH), Holmium laser enucleation of the prostate (HoLEP) is replacing TURP. We compared TURP with HoLEP with matching for prostate size. Materials and Methods: We retrospectively reviewed the medical charts of patients who underwent TURP and HoLEP performed by one surgeon at Soonchunhyang University Cheonan Hospital. All patients were categorized into 3 groups on the basis of prostate size (group 1, ＜40 g; group 2, 40–79 g; and group 3, ＞80 g), and 45 patients were selected for each method. Results: No major intraoperative complications were encountered. The mean resected tissue weight was 6.3, 18.3, and 28.0 g for groups 1, 2, and 3, respectively, for TURP and 8.7, 25.0, and 39.8 g, respectively, for HoLEP. The mean operation time was 51.8, 89.3, and 101.9 minutes for TURP and 83.6, 122.8, and 131.2 minutes for HoLEP in groups 1, 2, and 3, respectively. HoLEP had better resection efficacy than TURP for any size prostate, but there was no statistical difference between the methods. Both methods resulted in an immediate and significant improvement of International Prostate Symptom Score, peak urinary flow rates, and postvoid residual urine volume. Conclusions: HoLEP is effective for BPH treatment, regardless of prostate size, even in a small prostate. The perioperative morbidity of HoLEP is also comparable to that

Purpose: In recent years, laser surgery has been widely used to treat benign prostatic hyperplasia (BPH). A thulium:yttrium-aluminium-garnet (Tm:YAG) laser was recently introduced for BPH surgery. We compared the effectiveness and safety of Tm:YAG laser vaporesection of the prostate (ThuVaRP) with that of bipolar transurethral resection of the prostate (TURP). Materials and Methods: From January 2010 to December 2012, 86 patients underwent surgical treatment for symptomatic BPH by a single surgeon. We retrospectively analyzed and compared the medical records of 43 patients who underwent ThuVaRP and 43 patients who underwent bipolar TURP. All patients were assessed by using the International Prostate Symptom Score, transrectal ultrasonography, the serum prostate-specific antigen (PSA) level, uroflowmetry, and postvoid residual volume before and 1 month after surgery. All complications were compared between the two groups. Results: ThuVaRP was superior to TURP in catheterization time (p＜0.001) and length of hospital stay (p＜0.001). However, operation time was longer with ThuVaRP than with TURP (p＜0.001). In patients with a large prostate (＞50 g), operation time was much longer with ThuVaRP. One month after surgery, the decrease in PSA was greater (p=0.045) with ThuVaRP than with TURP, and the increase in maximal urine flow rate was greater (p＜0.001) with ThuVaRP than with TURP. The postoperative complication transient urinary incontinence was significantly different between the ThuVaRP group (nine cases, 20.9%) and the TURP group (two cases, 4.7%). Other complications were comparable between groups. Conclusions: The effectiveness and safety of ThuVaRP and TURP were comparable. ThuVaRP is a promising alternative surgical technique to TURP for BPH.

Purpose: To evaluate the accuracy and applicability of the modified Clavien classification system (CCS) in evaluating complications following photoselective vaporization of the prostate by use of the 120W GreenLight high-performance system (HPS-PVP). Materials and Methods: The medical records of 342 men who underwent HPS-PVP were retrospectively analyzed. Patients were older than 40 years and had a prostate volume ＞30 mL and an International Prostate Symptom Score (IPSS) ≥8. Patients with prostatic malignancy, neurogenic bladder, urethral stricture, large postvoid residual volume (＞250 mL), previous prostatic surgery, or urinary tract infection were excluded. All operations were done by a single surgeon, and patients were followed up for uroflowmetry and IPSS postoperatively. All complications were recorded and classified according to the modified CCS, and methods of management were also recorded. Results: The patients’ mean age was 71.6±7.3 years; mean prostate volume was 50.0±17.0 mL, and 95 cases (27.7%) had volumes greater than 70 mL. The mean total IPSS was 21.7±7.9 preoperatively and 12.3±8.1 at the first month postoperatively. A total of 59 patients (17.3%) experienced postoperative complications until the first month after the surgery. Among them, 49 patients (14.3%) showed grade I complications, 9 patients (2.6%) showed grade II complications, and 1 patient (0.3%) showed a grade IIIb complication. No patients had complications graded higher than IIIb. Conclusions: Although the modified CCS is a useful tool for communication among clinicians in allowing comparison of surgical outcomes, this classification should be revised to gain higher accuracy and applicability in the evaluation of postoperative complications of HPS-PVP.

Purpose: The purpose of this study was to identify the risk factors for recatheterization after holmium laser enucleation of the prostate (HoLEP). Materials and Methods: A total of 166 consecutive patients treated with HoLEP by a single surgeon from January 2010 to June 2011 were enrolled in this study. We collected data on preoperative and intraoperative parameters, including intraoperative bladder distention volume. The patients were divided into two groups. Group 1 included patients who voided successfully after removal of the catheter, and group 2 included patients who required recatheterization. Analysis and comparison of the perioperative parameters of both groups was performed for identification of risk factors for recatheterization. Results: Recatheterization was required in 9 of 166 (5.4%) patients. No significant differences in age or preoperative parameters, including prostate-specific antigen, prostate volume, International Prostate Symptom Score, peak flow rate, postvoid residual urine, maximal bladder capacity, and Abrahams Griffiths number, were observed between the two groups. Of the intraoperative parameters, intraoperative bladder distention volume was significantly smaller in group 1 than in group 2 (700.65 mL vs. 897.78 mL, p＜0.001). In the multivariate logistic regression analysis, after adjustment for other variables, intraoperative bladder distention volume was found to be a statistically significant risk factor for postoperative recatheterization (hazard ratio, 1.006; confidence interval, 1.002 to 1.010; p=0.002). Conclusions: Nine of 166 (5.4%) patients failed to void after HoLEP and required catheterization. Intraoperative bladder distention volume was found to be a statistically significant risk factor for recatheterization in this patient group.

Purpose To evaluate the efficacy of photoselective vaporization of the prostate (PVP) with the 120 W Greenlight high performance system (HPS) laser for the treatment of benign prostatic hyperplasia (BPH) with intravesical prostatic protrusion (IPP). Materials and Methods This study was conducted on 389 BPH patients who underwent PVP with the 120 W HPS laser from April 2009 to August 2011. The patients were divided into groups according to IPP: group I was defined as IPP of 0 to 5 mm (n=216), group II as IPP of 5 to 10 mm (n=135), and group III as IPP above 10 mm (n=38). Prostate volume, prostate-specific antigen, International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax), and postvoid residual volume (PVR) were assessed and checked at postoperative 1, 3, 6, and 12 months. Results There was a significant difference in the mean prostate size in each group (p

Purpose: To examine the effectiveness and safety of photoselective vaporization of the prostate (PVP) with the 120 W high-performance system (HPS) Greenlight laser procedure in benign prostatic hyperplasia (BPH) patients taking oral anticoagulant medications. Materials and Methods: This study was conducted on BPH patients taking oral anticoagulant medications form March 2009 to December 2010. Group I consisted of patients who stopped oral anticoagulant medications before surgery (n=30), and group II consisted of patients who continued oral anticoagulant medications before surgery (n=30). PVP applying the 120 W HPS Greenlight laser was done, and followed up for 12 weeks. Follow-up variables were International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), and hemoglobin level change. Results: At 12 weeks after surgery, we confirmed the improvement in the IPSS score of Group I compared with preoperative scores. The quality of life (QoL) score, Qmax and PVR were also improved. respectively, both of which were significantly improved. In Group II, similarly, the total IPSS score, the voiding symptom score, and the storage symptom score were improved in comparison with the preoperative scores. The QoL score, Qmax and the PVR were improved in comparison with the preoperative scores. During the 12-week follow-up period, no major postsurgical complications requiring transfusion, rehospitalization, etc. were observed. Conclusions: The 120 W HPS Greenlight laser PVP procedure can be performed effectively and safely in BPH patients, even those who cannot stop oral anticoagulant medications despite requiring surgery.

Purpose: This study was conducted to analyze the efficacy of photoselective vaporization of the prostate (PVP) with the use of a 980 nm diode laser for benign prostatic hyperplasia (BPH) according to postoperative period. Materials and Methods: Data were collected from 96 patients who were diagnosed with BPH and who underwent PVP with the 980 nm K2 diode laser. Postoperative parameters, including International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum urinary flow rate (Qmax), and post-void residual volume (PVR), were assessed and compared with preoperative baseline values. Results: The mean prostate volume was 45.3±15.6 g, the mean operative time (lasing time) was 22.9±18.3 minutes, the total amount of energy was 126±84 kJ, and the Foley catheter maintenance period after PVP was 24.8±5.6 hours. At 1 month, significant improvements were noted in IPSS (11.7±6.6), QoL score (2.3±1.1), Qmax (12.7±6.1 ml/sec), and PVR (41.9±30.5 ml). After 3 months, all follow-up parameters showed significant improvements that were sustained throughout a period of 6 months after PVP. Conclusions: PVP using a K2 diode laser is a minimally invasive and effective surgical method for improvement of BPH and is associated with minimal morbidity.

Purpose: Most men with benign prostatic hyperplasia (BPH) have bothersome lower urinary tract symptoms (LUTS). This study aimed to investigate the safety and efficacy of high-performance system (HPS) laser photoselective vaporization of the prostate (PVP) for the treatment of BPH in men with detrusor underactivity (DU). Materials and Methods: From March 2009, 371 patients with BPH were divided into 2 groups according to the findings of preoperative urodynamic study: 239 (64.4%) patients with bladder outlet obstruction (BOO) and 132 (35.6%) patients with bladder outlet obstruction with detrusor underactivity (BOO+DU). 120 W HPS laser PVP was performed to resolve the BOO. The perioperative data and postoperative results at 1 month and 12 months, including the International Prostate Symptom Score (IPSS), maximum urinary flow (Qmax), and postvoid residual urine (PVR) values, were evaluated. Results: Compared with the preoperative parameters, significant improvements in IPSS, Qmax, and PVR were observed in each group at 1 and 12 months after the operation. In addition, IPSS, Qmax, and PVR were not significantly different between the BOO and BOO+DU groups at 1 and 12 months after the operation. Conclusions: Surgery to relieve BOO in the patients with BPH seems to be an appropriate treatment modality regardless of the existence of DU.

Purpose: With the use of 12 months of follow-up data, this study was conducted to evaluate the efficacy of photoselective vaporization of the prostate (PVP) with the 120 W Greenlight high performance system (HPS) laser for the treatment of symptomatic benign prostatic hyperplasia. Materials and Methods: Data were collected from 104 patients who were diagnosed with benign prostatic hyperplasia and who underwent PVP with the 120 W Greenlight HPS Laser. Postoperative parameters, including International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum urinary flow rate (Qmax), and postvoid residual volume (PVR), were assessed and compared with preoperative baseline values. Results: The mean age of the patients was 71.1±7.7. The baseline mean prostate-specific antigen level was 3.8±2.7 ng/ml, the mean prostate size was 43.9±20.6 g, the mean preoperative IPSS was 18.4±8.5, the mean QoL score was 4.1±1.0, the mean Qmax was 9.9±5.5 ml/sec, and the mean PVR was 89.6±207.1 ml. During surgery, the mean operation time was 21.8±11.3 minutes, the mean lasing time was 16.9±10.5 minutes, and the mean total applied energy was 170,068±63,181 J. At 1 month, significant improvements were observed in total IPSS (11.5±6.7, p＜0.05), voiding symptom score (6.1±5.4, p＜0.05), and QoL score (2.2±1.5, p＜0.05); however, there were no significant improvements in storage symptom score (4.8±3.8, p=0.06), Qmax (12.6±10.2, p=0.06), and PVR (40.1±30.5, p=0.41). However, 3 months after surgery, all postoperative follow-up parameters showed significant improvements, and the 6- and 12-month data showed sustained improvement of postoperative follow-up parameters. Conclusions: Significant improvements were observed in subjective and objective voiding parameters, which were evident at 3 months after PVP and were sustained throughout a period of 12 months after PVP.

Purpose This study was conducted to perform a comparative analysis of the efficacy and safety of photoselective vaporization of the prostate (PVP) for treatment of benign prostatic hyperplasia (BPH) in men with a prostate volume greater than 60 cc. Materials and Methods The clinical data of 249 men with symptomatic BPH who underwent PVP between January 2006 and June 2008 were retrospectively analyzed. All patients were classified into two groups according to their prostate volume (group A

Purpose Holmium laser enucleation of the prostate (HoLEP) is known to have a steep learning curve and, as a result, its clinical usage has limitations. The purpose of this study was to analyze the learning curve and early complications following the HoLEP procedure. Materials and Methods A retrospective analysis was performed on 161 patients who had undergone the HoLEP procedure for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH) from July 2008 to September 2009. The procedure was done by two surgeons. Perioperatively, enucleated tissue weight, enucleation time, morcellation time, enucleation ratio (enucleation weight/transitional zone volume), and enucleation efficiency (enucleated weight/enucleation time) were analyzed, and early complications were assessed. Results Mean enucleation time, morcellation time, and enucleation ratio were 61.3 min (range, 10-180 min), 12.3 min (range, 2-60 min), and 0.66 (range, 0.07-2.51), respectively. In terms of efficiency, enucleation efficiency was 0.32 g/min (range, 0.02-1.25 g/min) and morcellation efficiency was 1.73 g/min (range, 0.1-7.7 g/min). Concerning the learning curve, enucleation efficiency was stationary after 30 cases (p

Purpose We investigated 2-year follow-up outcomes of patients who underwent potassium-titanyl-phosphate (KTP)-photoselective vaporization of the prostate (PVP) laser therapy for symptomatic benign prostatic hyperplasia (BPH). Materials and Methods Of a total of 169 patients who underwent 80 W KTP-PVP by a single surgeon, we retrospectively analyzed the clinical data of 74 patients who completed 2 years of follow-up. The efficacy of the PVP was assessed at 1, 3, 6, 12, and 24 months postoperatively by use of the International Prostate Symptom Score (IPSS) and uroflowmetry with postvoid residual urine volume (PVR). Safety, including complications, was evaluated at each visit. Results Mean preoperative total prostate and transitional zone volumes were 42.3 ml (range, 34.0-59.0 ml) and 18.6 ml (range, 10.1-28.6 ml) respectively. According to both IPSS and uroflowmetry, compared with baseline, the improvement in each parameter was sustained significantly at both 1 and 2 years postoperatively (p