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Stephen Clarke Mr Stephen Clarke, FRACS( Urol ),Dip ABU, FAMA, FAICD

Alternatives to TURP - Greenlight Laser. Stephen Clarke Mr Stephen Clarke, FRACS( Urol ),Dip ABU, FAMA, FAICD University of Melbourne, Department of Surgery Austin Hospital , Urology Unit MA , FAICD Urological Surgeon. Topics. BPH Overview Indications for Treatment Surgery - TURP

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Stephen Clarke Mr Stephen Clarke, FRACS( Urol ),Dip ABU, FAMA, FAICD

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  1. Alternatives to TURP - Greenlight Laser Stephen Clarke Mr Stephen Clarke, FRACS(Urol),Dip ABU, FAMA, FAICD University of Melbourne, Department of Surgery Austin Hospital , Urology Unit MA, FAICD Urological Surgeon

  2. Topics • BPH Overview • Indications for Treatment • Surgery - TURP - Greenlight Laser

  3. Demography • 50% of 50 year-olds will have symptoms • 15% will want active treatment

  4. Indications for Treatment • Complications • Symptoms - “Bothersomeness” - IPSS

  5. Treatment Option – Surgery (TURP) Advantages Disadvantages More Invasive procedure Longer Hospitalization required Significant side effects possible • Proven Approach • Durable

  6. Alternatives to TURP • Many attempts to supplant TURP • Usually relied on attempts to produce necrosis • Usually by overheating • Left necrotic tissue to resorb • Very variable, not durable

  7. GreenLight™ PVP • Actually vapourises tissue • Very little bleeding • No intra-op fluid shifts • Faster Recovery • No Histology

  8. Goliath Study 180-W XPS GreenLight Laser Vaporization versus Transurethral Resection of the Prostate for the Treatment of Benign Prostatic Enlargement: Perioperative Safety and 6 Month Efficacy Results of a European Multi-Centre Randomized Trial – The GOLIATH Study Bachmann  A, TubaroA, Barber N, d’Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink J, Ameye F, Saussine C, Bruyère F, Loidl W, Larner T, Gogoi NK, Hindley R, Muschter R, Thrope A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitán C, Knispel H, and Thomas JA Journal: European Urology, Date TBD

  9. IPSS XPS PVP TURP Goliath result: no clinical difference (Difference of 3 in IPSS or AUA is considered to be clinically measurable)

  10. Qmax (ml/s) & PVR (ml) XPS PVP TURP Goliath result: no clinical difference

  11. GreenLight™ PVP vs. TURP Randomized Trial

  12. Goliath TrialConclusion: In this large RCT, PVP demonstrated comparable efficacy to TURP with fewer serious side effects, decreased catheterization times and shorter length of hospital stay.

  13. GreenLight™ Economic Data

  14. Wide Range of Clinical Experience • Additional studies support the use of GreenLight in large glands, anti-coagulant and high risk patients • Large glands – Sandhu, et al. Urol. 2004 Dec;64(6):1155-59. • Anti-coagulants – Sandhu, et al. J Endourolog. 2005;19(10):1196-1198. • High risk patients – Reich, et al. J Urol. 2005 Jan;173:158-160. • Over 500 published clinical articles

  15. Preliminary Cystoscopy • Typical large benign prostate of approximately 70cc on TRUS

  16. Initial Working Space Created Between Lateral Lobes

  17. Completed PVP Procedure • Shorter hospital stay • No need to stop anticoagulation • Earlier return to full activity

  18. Completed PVP Procedure • Shorter hospital stay • No need to stop anticoagulation • Earlier return to full activity • But..... • Somewhat slower • No histology

  19. ■Cryotherapy ■Open Prostatectomy ■Ethanol Ablation ■TURP ■Bladder neck incision (TUIP) ■Holmium Laser Enucleation ■Prostatic Stents ■Microwaves ■Greenlight Laser ■TUNA ■Hormone therapy ■Alpha blockers (egFlomax) ■5 ARIs (egProscar) Ideal treatment ■Herbal Remedies ■Placebo ■Balloon Dilatation BPH Therapy – Efficacy vs. Side Effects

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