Dr. Edward J. Mueller Profile

Dr. Edward J. Mueller

at Univ of Texas Health Science Ctr at San Antonio

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Proceedings Article | 5 March 2010 Paper

Photoselective vaporization of the prostate: outcomes and adverse events of 220 consecutive patients

C. Robson, E. Mueller

Proceedings Volume 7548, 754817 (2010) https://doi.org/10.1117/12.841402

KEYWORDS: Prostate, Ferroelectric materials, Tissues, Laser tissue interaction, Laser therapeutics, Surgery, Bladder, Medicine, Fiber lasers, Water

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Purpose: To evaluate the short term outcomes of 220 consecutive patients who underwent the 532 nm KTP photoselective vaporization of the prostate (PVP) procedure and to evaluate and categorize the complications of the procedure. Materials and Methods: A total of 220 patients with symptomatic benign prostatic obstruction were treated with KTP photoselective vaporization of the prostate. Evaluation measures included the AUA Symptom Score (AUASS)/Quality of Life Score (QOL), peak urinary flow rate (Qmax), post void residual urine (PVR) and adverse events. Results: Symptoms were evaluated at 3 months and adverse events at 1 and 3 months. 181 patients returned for their 1 month visit and 152 returned for their 3 month visit. The American Urological Association Symptom Score (AUASS) decreased from 21.8 to 6.7. The Quality of Life Score (QOL) decreased from 3.8 to 0.7. The peak urinary flow rate (Qmax) increased from 10.7 cc/sec to 22.7 cc/sec. And the post void residual urine (PVR) decreased from 262 cc to 105 cc. Most common adverse events lasting more than 10 days were mild hematuria in 45%, dysuria in 32%, and urgency/frequency in31%. Conclusion: These results confirm that photoselective vaporization of the prostate (PVP) is a safe and effective therapy for benign prostatic obstruction. However, there is frequent, but mild, hematuria and irritative voiding symptoms during the early postoperative period.

Proceedings Article | 12 May 1995 Paper

A single surgeon's experience with contact laser vaporization of the prostate

Edward Mueller

Proceedings Volume 2395, (1995) https://doi.org/10.1117/12.209065

KEYWORDS: Surgery, Laser therapeutics, Prostate, Bladder, Fiber lasers, Nd:YAG lasers, Gold, Neck, Laser vision correction, Bridges

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Herein, I report on my first 50 contact laser prostatectomies performed with the SLT Nd:YAG laser. The obstructed prostatic urethra is opened via contact laser vaporization of the obstructing adenoma. The average pre-op AUA symptom score was 22.9 (range 14 - 30). The average 3 month post-op AUA symptom score was 2.1 (range 0 -8). Eighteen of the patients had the foley catheter removed approximately 4 - 6 hours post-op and were discharged the same day. Thirty patients had the foley catheter removed the morning following surgery and were discharged. And two patients had the foley catheter removed the morning following surgery, but remained in the hospital for medical reasons unrelated to the TURP. Thus, 48 (96%) of the patients were discharged within 24 hours of admission. No patient had to be readmitted to the hospital for any reason. All patients were allowed to return to full activity within 24 hours of discharge. The average hospital cost for the 48 patients discharged within 24 hours was $DOL4,694. This compares to the average hospital cost of an electrocautery TURP of $DOL6-8000. In summary, contact laser TURP using the SLT Nd:YAG laser relived the symptoms of an obstructing prostate comparable to electrocautery TURP. However, these results were achieved with a much shorter hospitalization, a quicker return to full activity and at a lower cost.

Proceedings Article | 12 May 1995 Paper

Contact laser prostatectomy in a patient on chronic anticoagulation

Edward Mueller

Proceedings Volume 2395, (1995) https://doi.org/10.1117/12.209069

KEYWORDS: Bladder, Surgery, Prostate, Laser safety, Magnesium, Tissues, Laser development, Gold, Sodium, Cystoscopy

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The `gold standard' therapy for patients with symptomatic bladder outlet obstruction secondary to benign prostatic hyperplasia has always been electrocautery TURP. However, in patients with medical problems requiring chronic anticoagulation, this procedure is contraindicated due to the extreme risk of hemorrhage, both during the procedure and the immediate post operative period. With the recent development of contact laser prostatectomy the patient on chronic anticoagulation can safely undergo the procedure. Herein, I present a case of a 60 year old with significant bladder outlet obstruction yielding an AUA symptom score of 18. The patient had a history of multiple episodes of deep venous thrombosis of the left leg with three prior pulmonary emboli. He was maintained on chronic anticoagulation with alternating days of 3.5 mg. and 5.0 mg. of warfarin sodium (coumadin). Preoperative cystoscopy showed a 4 cm prostatic fossa obstructed by tri-lobar hypertrophy, with large kissing lateral lobes and visual obstruction from the verumontanum. The patient underwent a contact laser prostatectomy with the SLT Nd:YAG laser at 50 watts. There was minimal bleeding both during the procedure and in the immediate postoperative period. At three months post-op the AUA symptom score had decreased to 2. This case demonstrated that contact laser prostatectomy can be safely and effectively performed in patients on chronic anticoagulation.

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