Intravesical bacillus Calmette–Guérin has been the standard of care for high‐risk non‐muscle‐invasive bladder cancer for 40 years. It remains one of the most successful immunotherapies ever used. ...Bacillus Calmette–Guérin shows superior efficacy to alternative intravesical treatments, and has an established role in reducing both recurrence and progression in non‐muscle‐invasive bladder cancer. It remains relatively safe, and has acceptable tolerability of both local and systemic side‐effects. The present review provides insights into the role of bacillus Calmette–Guérin compared with alternative treatments both in primary and refractory settings.
Abstract Context A number of transurethral ablative techniques based on the use of innovative medical devices have been introduced in the recent past for the surgical treatment of benign prostatic ...obstruction (BPO). Objective To conduct a systematic review of the literature and a meta-analysis of available randomized controlled trials (RCTs), and to evaluate the efficacy and safety of transurethral ablative procedures for BPO. Evidence acquisition A systematic literature search was performed for all RCTs comparing any transurethral surgical technique for BPO to another between 1992 and 2013. Efficacy was evaluated after a minimum follow-up of 1 yr based on International Prostate Symptom Score, maximum flow rate, and postvoid residual volume. Efficacy at midterm follow-up, prostate volume, perioperative data, and short-term and long-term complications were also assessed. Data were analyzed using RevMan software. Evidence synthesis A total of 69 RCTs (8517 enrolled patients) were included. No significant difference was found in terms of short-term efficacy between bipolar transurethral resection of the prostate (B-TURP) and monopolar transurethral resection of the prostate (M-TURP). However, B-TURP was associated with a lower rate of perioperative complications. Better short-term efficacy outcomes, fewer immediate complications, and a shorter hospital stay were found after holmium laser enucleation of the prostate (HoLEP) compared with M-TURP. Compared with M-TURP, GreenLight photoselective vaporization of the prostate (PVP) was associated with a shorter hospital stay and fewer complications but no different short-term efficacy outcomes. Conclusions This meta-analysis shows that HoLEP is associated with more favorable outcomes than M-TURP in published RCTs. B-TURP and PVP have resulted in better perioperative outcomes without significant differences regarding efficacy parameters after short-term follow-up compared with M-TURP. Further studies are needed to provide long-term comparative data and head-to head comparisons of emerging techniques. Patient summary Bipolar transurethral resection of the prostate, photovaporization of the prostate, and holmium laser enucleation of the prostate have shown efficacy outcomes comparable with conventional techniques yet reduce the complication rate. The respective role of these new options in the surgical armamentarium needs to be refined to propose tailored surgical treatment for benign prostatic obstruction relief.
HoLEP has come of age Vincent, Michael W.; Gilling, Peter J.
World journal of urology,
04/2015, Letnik:
33, Številka:
4
Journal Article
Recenzirano
Introduction
Lower urinary tract symptoms (LUTS) are a common complaint and although can be adequately managed with medication, surgery remains the mainstay of treatment. Transurethral resection has ...been the reference ‘gold standard’, but due to its complications and issues with larger volume prostates, many alternatives have been developed and assessed. Holmium laser enucleation of the prostate (HoLEP) has shown excellent efficacy, durability and safety and has become an important alternative that has gained guideline approval.
Results
HoLEP has been shown to have outcomes that are equivalent or better than TURP in both urodynamic measurements and symptom scores. Its outcomes have been proven to be durable and cost-effective. HoLEP has fewer and less serious complications when compared to the current reference standard, its use also allows earlier removal of catheter and hospital discharge. Appropriate mentoring reduces many of the issues associated with the steep learning curve, thus removing the main hurdle to its widespread adoption as the surgical treatment of choice for LUTS due to benign prostatic hyperplasia (BPH).
Conclusions
HoLEP fulfils all of the requirements as an alternative/replacement for TURP and open prostatectomy, with equivalent outcomes and reduced complications. With improvements in the learning curve, it could now be considered the true gold standard surgical treatment for BPH. HoLEP has come of age.
Study Type – Therapy (RCT)
Level of Evidence 1b
What's known on the subject? and What does the study add?
HoLEP has been widely adopted worldwide as an alternative to TURP but long term results have ...been lacking despite the strong scientific basis for the technique.
This study provides long‐term results from the original RCT comparing the two techniques.
OBJECTIVE
•
To assess the durability of holmium laser enucleation of prostate in comparison to transurethral resection of the prostate (TURP).
PATIENTS AND METHODS
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Patients were enrolled in the present study between June 1997 and December 2000 and followed per protocol.
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All patients were urodynamically obstructed with a prostate volume of between 40 and 200 mL.
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At long‐term follow‐up, variables assessed included Benign Prostatic Hyperplasia Impact Index (BPHII), International Continence Society Short Form Male questionnaire (ICSmale‐SF) and the International Index of Erectile Function (IIEF).
•
Adverse events, including the need for retreatment, were specifically assessed.
RESULTS
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Thirty‐one (14 holmium laser enucleation of the prostate HoLEP and 17 TURP) of the initial 61 patients were available, with 12 deceased and 18 lost to follow‐up.
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The mean (range) follow‐up was 7.6 (5.9–10.0) years and the mean (±sd) age at follow‐up was 79.8 (±6.2) years.
•
The mean (±sd) values (HoLEP vs TURP) were as follows: maximum urinary flow rate (Qmax), 22.09 ± 15.47 vs 17.83 ± 8.61 mL/s; American Urological Association (AUA) symptom score, 8.0 ± 5.2 vs 10.3 ± 7.42; quality of life (QOL) score 1.47 ± 1.31 vs 1.31 ± 0.85; BPHII, 1.53 ± 2.9 vs 0.58 ± 0.79; IIEF‐EF (erectile function), 11.6 ± 7.46 vs 9.21 ± 7.17; ICSmale Voiding Score (VS), 4.2 ± 3.76 vs 3.0 ± 2.41; ICSmale Incontinence Score (IS), 3.07 ± 3.3 vs 1.17 ± 1.4.
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There were no significant differences in any variable between the two groups beyond the first year.
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Of the assessable patients, none required re‐operation for recurrent BPH in the HoLEP arm and three (of 17) required re‐operation in the TURP arm .
CONCLUSION
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The results of this randomized trial confirm that HoLEP is at least equivalent to TURP in the long term with fewer re‐operations being necessary.
To report 1-year safety and efficacy outcomes after either Aquablation or transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms related to benign prostatic ...hyperplasia (BPH)
This double-blinded, multicenter prospective randomized controlled trial assigned 181 patients with BPH-related moderate-to-severe lower urinary tract symptoms to either electrocautery-based prostate resection (TURP) or Aquablation. Efficacy endpoints included reduction in International Prostate Symptom Score and improvement in uroflow parameters. The primary safety endpoint was the occurrence of Clavien-Dindo persistent grade 1 or grade 2 or higher complications.
BPH symptom score improvements were similar across groups with 12-month reduction of 15.1 points after TURP or Aquablation. In both groups, mean maximum urinary flow rates increased markedly postoperatively, with mean improvements of 10.3 cc/s for Aquablation versus 10.6 cc/s for TURP (P = .8632). At 1 year, Prostate-specific antigen (PSA) was reduced significantly (P < .01) in both groups by 1 point; the reduction was similar across groups (P = .9125). Surgical retreatment for BPH rates for TURP were 1.5% and Aquablation 2.6% within 1 year from the study procedure (P = not significant (NS)). The rate of late complications was low, with no procedure-related adverse events after month 6.
The 1-year outcomes after TURP and Aquablation were similar and the rate of late procedure-related complications was low. (ClinicalTrials.gov number, NCT02505919).
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