Objective: To compare the clinical effect of diode laser enucleation of the prostate (DIOD) with that of transurethral resection of the prostate (TURP) on benign prostate hyperplasia (BPH) with different prostate volumes. METHODS: This retrospective study included 256 BPH patients treated by DIOD (n = 141) or TURP (n = 115) from March 2012 to August 2015. According to the prostate volume, we divided the patients into three groups: <60 ml (42 for DIOD and 31 for TURP), 60－80 ml (51 for DIOD and 45 for TURP), and >80 ml (48 for DIOD and 39 for TURP). We obtained the relevant data from the patients before, during and at 6 months after surgery, and compared the two surgical strategies in operation time, perioperative levels of hemoglobin and sodium ion, post-operative urethral catheterization time and bladder irrigation time, pre- and post-operative serum PSA levels, International Prostate Symptoms Score (IPSS), post-void residual urine (PVR) volume and maximum urinary flow rate (Qmax), and incidence of post-operative complications among different groups. RESULTS: In the <60 ml group, there were no remarkable differences in the peri- and post-operative parameters between the two surgical strategies. In the 60－80 ml group, DIOD exhibited a significant superiority over TURP in the perioperative levels of hemoglobin (［3.25 ± 1.53］ g/L vs ［4.77 ± 1.67］ g/L, P <0.05) and Na+ (［3.58 ± 1.27］mmol/L vs ［9.67 ± 2.67］ mmol/L, P <0.01), bladder irrigation time (［30.06 ± 6.22］h vs ［58.32 ± 10.25］ h, P <0.01), and urethral catheterization time (［47.61 ± 13.55］ h vs ［68.01 ± 9.69］ h, P <0.01), but a more significant decline than the latter in the postoperative PSA level (［2.34 ± 1.29］ ng/ml vs ［1.09 ± 0.72］ ng/ml, P <0.05), and similar decline was also seen in the >80 ml group (［3.35 ± 1.39］ ng/ml vs ［1.76 ± 0.91］ ng/ml, P <0.05). No blood transfusion was necessitated and nor postoperative transurethral resection syndrome or urethral stricture observed in DIOD. However, the incidence rate of postoperative pseudo-urinary incontinence was significantly higher in the DIOD (22.7%, 32/141) than in the TURP group (7.83%, 9/115) (P <0.05). CONCLUSIONS DIOD, with its obvious advantages of less blood loss, higher safety, faster recovery, and more definite short-term effectiveness, is better than TURP in the treatment of BPH with medium or large prostate volume and similar to the latter with small prostate volume.
Humans ; Lasers, Semiconductor ; adverse effects ; therapeutic use ; Male ; Operative Time ; Organ Size ; Postoperative Complications ; etiology ; Prostate ; pathology ; Prostatic Hyperplasia ; pathology ; surgery ; Quality of Life ; Retrospective Studies ; Therapeutic Irrigation ; Transurethral Resection of Prostate ; adverse effects ; methods ; statistics & numerical data ; Treatment Outcome ; Urethral Stricture ; etiology ; Urinary Catheterization ; Urinary Incontinence ; etiology

ObjectiveTo evaluate the influence of the resected prostate tissue volume (RPV) on the improvement of International Prostate Symptom Score (IPSS), quality of life (QOL), and voiding function after transurethral resection of the prostate (TURP).

METHODSThis study included 82 men with benign prostatic hyperplasia treated by TURP. Before and three months after TURP, we obtained the IPSS, QOL score, post-voiding residual urine volume (PVR), and maximum urinary flow rate (Qmax) from the patients. We measured the total prostate volume (TPV) and transition zone volume (TZV) by transrectal ultrasound preoperatively and investigate the influence of the RPV, RPV/TZV ratio, and RPV/TPV ratio on the efficiency of TURP.

RESULTSAt three months after TURP, the mean Qmax increased by 9.27 ml/s, IPSS decreased by 15.86, QOL score increased by 3.47, PVR decreased by 87.1 ml, and 72.0% of the patients felt satisfied with the surgical results. There was no statistically significant difference in RPV between the patients satisfied and those dissatisfied with the results. Both the RPV/TPV and RPV/TZV ratios significantly increased in the satisfaction group as compared with the dissatisfaction group (P=0.002 and P=0.004). The areas under the ROC curve for the RPV/TPV and RPV/TZV ratios were 0.793 (P=0.001) and 0.687 (P=0.009), respectively.

CONCLUSIONSRPV is closely related to the short-term outcomes of TURP, and the ratios of RPV/TPV and RPV/TZV may be used as new markers to predict the outcomes of TURP.

Aged ; Humans ; Male ; Middle Aged ; Organ Size ; Patient Satisfaction ; Postoperative Period ; Prostate ; diagnostic imaging ; pathology ; surgery ; Prostatic Hyperplasia ; diagnostic imaging ; pathology ; surgery ; Quality of Life ; Transurethral Resection of Prostate ; Treatment Outcome ; Ultrasonography ; Urination ; physiology

INTRODUCTIONRecurrent prostate adenoma is a long-term complication following transurethral resection of the prostate (TURP). Transurethral enucleation and resection of the prostate (TUERP) is more appealing, since the nodular adenoma can be completely removed through endoscopy. TUERP is also hypothesised to result in a lower frequency of recurrent adenoma. This study aimed to compare the early outcomes of TUERP and TURP, and assess the feasibility and safety of TUERP.

METHODSWe compared the outcome of 81 patients who underwent TUERP with that of 85 patients who underwent TURP. International prostate symptom score, quality of life score, prostate volume, degree of intravesical prostatic protrusion, maximum flow rate, post-void residual volume and prostate-specific antigen (PSA) level were obtained pre- and postoperatively. Complications (e.g. transfusion rate, incontinence, infection and urethral stricture) were analysed.

RESULTSOperative time was significantly longer in the TUERP group compared to the TURP group (85.3 minutes vs. 51.6 minutes). After TUERP, the maximum flow rate was significantly higher (21.1 mL/s vs. 17.1 mL/s) and PSA level was significantly lower (1.2 ng/mL vs. 1.9 ng/mL) than after TURP. The rates of infection, transfusion and urethral stricture were similar for both groups, but the TUERP group had a higher rate of temporary incontinence (13.6% vs. 4.7%).

CONCLUSIONThe lower PSA level and better maximum flow rate achieved following TUERP suggest that prostate adenoma removal was more complete with TUERP. Long-term follow-up is required to establish whether TUERP results in fewer resections for recurrent adenoma.

Aged ; Aged, 80 and over ; Hospitals ; Humans ; Length of Stay ; Male ; Medical Records ; Middle Aged ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; methods ; Prostatic Hyperplasia ; pathology ; surgery ; Retrospective Studies ; Singapore ; Transurethral Resection of Prostate ; Treatment Outcome

OBJECTIVETo sum up the clinical experience in the management of benign prostatic hyperplasia (BPH) with the prostate weighing over 80 ml by transurethral resection of the prostate (TURP) combined with 2 μm continuous-wave laser vaporesection (LVR).

METHODSWe retrospectively analyzed the clinical effects of TURP combined with 2 μm LVR in the treatment of 46 cases of BPH with the prostate volume > 80 ml.

RESULTSAll the operations were successfully accomplished. The operation time and intraoperative blood loss were (112.0 ± 20.0) min (range 86-176 min) and (77.9 ± 25.9) ml (range 50-200 ml), respectively. The catheters were withdrawn at 7 days after surgery. Transient urinary incontinence occurred in 6 cases and secondary hemorrhage was found in 2 postoperatively. Six-month follow-up revealed no urethral stricture or other complications. Compared with the baseline, the international prostate symptom score (IPSS) was significantly decreased at 6 months after operation (26.3 ± 1.8 vs 11.6 ± 1.7, P <0.05), and so were the quality of life (QOL) score (5.3 ± 0.7 vs 1.3 ± 1.1, P <0.05) and post-void residual urine (PVR) ([115.5 ± 55.6] ml vs [19.9 ± 11.6] ml, P <0.05). However, the maximum urinary flow rate (Qmax) was remarkably increased from (4.1 ± 2.6) ml/s to (16.2 ± 1.7) ml/s (P <0.05).

CONCLUSIONTURP combined with 2 μm LVR is safe and effective for the treatment of BPH with the prostate volume >80 ml.

Aged ; Blood Loss, Surgical ; Humans ; Laser Therapy ; methods ; Male ; Middle Aged ; Organ Size ; Prostate ; pathology ; Prostatic Hyperplasia ; pathology ; surgery ; Quality of Life ; Retrospective Studies ; Transurethral Resection of Prostate ; methods ; Treatment Outcome ; Urethral Stricture ; Urinary Incontinence ; etiology ; Urinary Retention

OBJECTIVETo evaluated the safety and effect of the 120-W GreenLight HPS laser photoselective vaporization of the prostate (PVP) in different BPH populations.

METHODSThis study included 174 BPH patients treated by PVP using 120-W Green-Light HPS laser. According to the prostate volume (PV) ( < 80 or ≥ 80 ml), history of 5-alpha reductase inhibitor (5-ARI) medication, and history of acute urinary retention (AUR), we divided the patients into a PV < 80 ml, a PV ≥ 80 ml, a 5-ARI, a no 5-ARI; an AUR, and a no AUR group. We collected the baseline, perioperative, and follow-up data about the patients, and compared them among different groups.

RESULTSThe patients were aged 69.4 ± 7.7 years, of whom PVP was successfully performed for 136 and PVP was intraoperatively converted to transurethral resection of the prostate (TURP) in the other 38, with a mean operation time of (49.4 ± 16.3) min. The preoperative PV averaged (67.9 ± 29.8) ml. There was no intraoperative blood transfusion, transurethral resection syndrome, or capsule perforation. Bladder neck contracture occurred in 2 cases and urethral stricture developed in another 2 postoperatively. All the patients showed a significant improvement in the prostatic function parameters and no significant differences were observed between the PV < 80 ml and PV ≥ 80 ml, 5-ARI and no 5-ARI, or AUR and no AUR groups.

CONCLUSIONPVP with 120-W GreenLight HPS laser is safe and efficient for the treatment of BPH and the its effect is not influenced by the prostate volume, history of 5-ARI medication, or history of AUR. However, preoperative urinary catheterization may increase the difficulty of surgery and the risk of conversion to TURP.

5-alpha Reductase Inhibitors ; therapeutic use ; Aged ; Humans ; Laser Therapy ; adverse effects ; methods ; Male ; Operative Time ; Organ Size ; Prostate ; pathology ; surgery ; Prostatic Hyperplasia ; pathology ; surgery ; Transurethral Resection of Prostate ; Treatment Outcome ; Urethral Stricture ; etiology ; Urinary Bladder ; Urinary Retention

PURPOSE: To evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for extremely large prostates. MATERIALS AND METHODS: Patients undergoing HoLEP between July 2008 and December 2013 from the Seoul National University Hospital Benign Prostatic Hyperplasia Database Registry were retrospectively analyzed. The patients were divided into three groups according to their total prostate volume (TPV): group A (TPV<100 mL), group B (100 mL< or =TPV<200 mL), and group C (TPV> or =200 mL); the clinical data of the three groups were compared. All patients were followed up 2 weeks, 3 months, and 6 months after surgery. RESULTS: A total of 502 patients (group A, 426; group B, 70; group C, 6) with a mean age of 69.0 (standard deviation, +/-7.3) years were included in our analysis. The mean prostate volume and prostate-specific antigen level were 68.7+/-36.9 mL and 4.15+/-4.24 ng/mL, respectively. The enucleation and morcellation times were longer in group C (p<0.001), and the enucleation efficacy was higher in this group (p<0.001, R2=0.399). Moreover, the mean postoperative catheterization and hospitalization periods were significantly longer in group C (p=0.004 and p=0.011, respectively). However, there were no significant differences between the groups in any other postoperative events, including recatheterization, reoperation, urinary tract infection, clot retention, and bladder neck contracture (p range, 0.516-0.913). One patient in group C experienced recurrence of the urethral stricture. CONCLUSIONS: HoLEP in patients with an extremely large prostate can be performed efficiently and safely.
Aged ; Aged, 80 and over ; Holmium ; Humans ; Laser Therapy/*adverse effects ; Lasers, Solid-State/*therapeutic use ; Male ; Middle Aged ; Organ Size ; *Postoperative Complications ; Prostate/pathology/*surgery ; Prostate-Specific Antigen/blood ; Prostatic Hyperplasia/*surgery ; Quality of Life ; Retrospective Studies ; Seoul ; Transurethral Resection of Prostate/*methods ; Treatment Outcome

PURPOSE: Heat shock protein (HSP) 27 protects the cell by controlling apoptosis and immune reactions, and c-FLIP (cellular-FLICE inhibitory protein) inhibits apoptosis by inhibiting caspase-8 activity. We investigated the relationship of HSP27 and c-FLIP expression to prostate-specific antigen, Gleason score sum (GSS), and pathologic stage. MATERIALS AND METHODS: Samples from 163 patients between May 2004 and April 2010 were analyzed: 83 from patients that had underwent a radical prostatectomy, and 80 from those that underwent transurethral resection of the prostate to alleviate urinary symptoms from benign prostate hyperplasia. c-FLIP and HSP27 expression were observed by immunohistochemistry staining. Samples with less than 5% expression-positive cells were scored as 1, with 5%-50% were scored as 2, and with more than 50% were scored as 3. Local reactions were identified as 0.5 and evaluated. RESULTS: Both the presence of HSP27 within the tumor and the number of cancer cells positive for HSP27 were significantly correlated to GSS and pathologic stage (p<0.001, p=0.001, p<0.001, p<0.001). The same was true for c-FLIP expression (p<0.001). GSS was more highly correlated to HSP27 expression than to c-FLIP expression (r=0.814 for HSP27, r=0.776 for c-FLIP), as was pathologic stage (r=0.592 for HSP27, r=0.554 for c-FLIP). CONCLUSIONS: In prostate cancer, higher GSS and a more advanced pathologic stage were associated with a higher likelihood of having a HSP27-positive tumor and more HSP27-positive tumor cells. HSP27 expression was correlated with GSS and prostate cancer stage. A more advanced pathologic stage corresponded to a higher likelihood of having a c-FLIP-positive tumor and more c-FLIP-positive tumor cells. HSP27 expression had a higher correlation with prostate cancer stage and GSS than c-FLIP expression did.
Aged ; Biomarkers, Tumor/*metabolism ; CASP8 and FADD-Like Apoptosis Regulating Protein/*metabolism ; HSP27 Heat-Shock Proteins/*metabolism ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Grading ; Neoplasm Proteins/metabolism ; Neoplasm Staging ; Prostatectomy/methods ; Prostatic Hyperplasia/metabolism/surgery ; Prostatic Neoplasms/*metabolism/pathology/surgery ; Transurethral Resection of Prostate

Mps one binder (MOB) proteins are integral components of signaling pathways that control important cellular processes, such as mitotic exit, centrosome duplication, apoptosis, and cell proliferation. However, the biochemical and cellular functions of the human MOB (hMOB) protein family remain largely unknown. The present study investigated the association between hMOB3B expression and clinicopathological characteristics of prostate cancer (PCa).Study subjects included 137 PCa patients and 137 age-matched benign prostatic hyperplasia (BPH) patients. hMOB3B expression was estimated using real-time PCR and compared with clinicopathological parameters of PCa. hMOB3B mRNA expression was significantly lower in PCa tissues than in BPH control tissues (P<0.001). According to receiver operating characteristics curve analysis, the sensitivity of hMOB3B expression for PCa diagnosis was 84.7%, with a specificity of 86% (AUC=0.910; 95% CI=0.869-0.941; P<0.001). hMOB3B expression was significantly lower in patients with elevated prostate specific antigen (PSA) levels (> or =10 ng/mL), a Gleason score> or =8, and metastatic disease (any T, N+/M+) than in those with low PSA levels, a low Gleason score, and non-metastatic disease (each P<0.05). In conclusion, low levels of hMOB3B are closely associated with aggressive clinicopathologic features in patients with PCa. Our results suggest that hMOB3B may act as a tumor suppressor in human PCa.
Aged ; Aged, 80 and over ; Biomarkers, Tumor/*metabolism ; Case-Control Studies ; Disease Susceptibility ; Gene Expression ; Humans ; Kallikreins/blood ; Male ; Microtubule-Associated Proteins/*metabolism ; Middle Aged ; Neoplasm Grading ; Polymerase Chain Reaction ; Prostate/*pathology/surgery ; Prostate-Specific Antigen/blood ; Prostatic Hyperplasia/blood/pathology ; Prostatic Neoplasms/blood/*pathology/surgery

PURPOSE: The thulium laser is the most recently introduced technology for the surgical treatment of benign prostatic hyperplasia (BPH). Until recently, most thulium laser enucleation of the prostate (ThuLEP) was performed by use of the three-lobe technique. We introduce a novel one-lobe enucleation technique for ThuLEP called the "All-in-One" technique. We report our initial experiences here. MATERIALS AND METHODS: From June 2013 to May 2014, a total of 47 patients underwent the All-in-One technique of ThuLEP for symptomatic BPH performed by a single surgeon. All patients were assessed with the International Prostate Symptom Score (IPSS), transrectal ultrasonography, serum prostate-specific antigen (PSA), maximal urine flow rate (Qmax), and postvoid residual urine volume (PVR) before and 1 month after surgery. We reassessed IPSS, Qmax, and PVR 3 months after surgery. To assess the efficacy of the All-in-One technique, we checked the PSA reduction ratio, transitional zone volume reduction ratio, and enucleation failure rate. RESULTS: The mean operative time was 82.1+/-33.3 minutes. The mean enucleation time and morcellation time were 52.7+/-21.7 minutes and 8.2+/-7.0 minutes, respectively. The mean resected tissue weight and decrease in hemoglobin were 36.9+/-24.6 g and 0.4+/-0.8 g/dL, respectively. All perioperative parameters showed significant improvement (p<0.05). No major complications were observed. The PSA reduction ratio, transitional zone volume reduction ratio, and enucleation failure rate were 0.81, 0.92, and 4.3%, respectively. CONCLUSIONS: The All-in-One technique of ThuLEP showed efficacy and effectiveness comparable to that of other techniques. We expect that this new technique could reduce the operation time and the bleeding and improve the effectiveness of enucleation.
Aged ; Humans ; Lasers, Solid-State/adverse effects/*therapeutic use ; Male ; Middle Aged ; Operative Time ; Prostate-Specific Antigen/blood ; Prostatic Hyperplasia/pathology/*surgery ; Retrospective Studies ; Thulium ; Transurethral Resection of Prostate/adverse effects/*methods ; Treatment Outcome

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 our institute. 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 of TURP.
Aged ; Follow-Up Studies ; Humans ; Laser Therapy/*methods ; Lasers, Solid-State/*therapeutic use ; Male ; Operative Time ; Organ Size ; Prostate/*pathology ; Prostatic Hyperplasia/*surgery ; Retrospective Studies ; Transurethral Resection of Prostate/*methods ; Treatment Outcome