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Haga K, Akagashi K, Tobe M, Uchida K, Honma I, Hirobe E, Ishizaki J, Shimizu T, Nakajima H, Urahama S, Sato Y. One hundred cases of Rezum water vapor thermal therapy for benign prostatic hyperplasia: Real-world data at a single institution in Japan. Int J Urol 2024. [PMID: 39187956 DOI: 10.1111/iju.15558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 07/30/2024] [Indexed: 08/28/2024]
Abstract
OBJECTIVE The objective of our study was to assess the efficacy of Rezum, a minimally invasive surgical treatment, for patients with lower urinary tract symptoms related to benign prostatic hyperplasia (BPH) in real-world clinical practice at a single institution in Japan. MATERIALS AND METHODS We conducted a prospective study involving 100 patients who underwent the Rezum procedure between October 2022 and February 2024. We analyzed patient backgrounds that are compliant with Japanese regulations and assessed descriptive outcomes such as symptom scores, peak flow in uroflowmetry, post-void residual (PVR) volume, and prostate volume (PVol). These data were collected at 1 and/or 3 months postoperatively. RESULTS On average, 4.7 water vapor injections were administered during the Rezum procedures, with a mean operative time of 6.3 min. Patients experienced significant relief in symptoms, with reductions of 55% in International Prostate Symptom Score, 53% in quality of life score, and 30% in Overactive Bladder Symptom Score. There was also a significant decrease in mean PVR volume (50% reduction) and PVol (27% reduction). Among the subgroup of 23 pre-interventional catheter-dependent patients, 91% achieved catheter independence. CONCLUSION Our single-center analysis demonstrates that Rezum is an effective and safe minimally invasive therapeutic option for patients with BPH. This promising novel technique can be particularly beneficial for patients at an augmented risk of bleeding or those considered high risk for anesthesia.
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Affiliation(s)
- Kazunori Haga
- Sanjukai Urological Hospital, Sapporo, Hokkaido, Japan
| | | | - Musashi Tobe
- Sanjukai Urological Hospital, Sapporo, Hokkaido, Japan
| | - Kosuke Uchida
- Sanjukai Urological Hospital, Sapporo, Hokkaido, Japan
| | - Ichiya Honma
- Sanjukai Urological Hospital, Sapporo, Hokkaido, Japan
| | - Emi Hirobe
- Sanjukai Urological Hospital, Sapporo, Hokkaido, Japan
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Singh SP, Barman H, Reena, Rath A, Singh R. Perioperative Dyselectrolytemia in Patients Undergoing Transurethral Resection of the Prostate Using 0.9% Normal Saline Irrigation. Cureus 2024; 16:e59976. [PMID: 38860064 PMCID: PMC11164244 DOI: 10.7759/cureus.59976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND The choice of irrigation fluid used in transurethral resection of the prostate (TURP) has a significant impact on serum electrolyte levels. Among the many available options, 0.9% normal saline (NS) is considered to be more physiological. MATERIAL AND METHODS This observational study was conducted on 60 adult males aged 50-70 years, classified as American Society of Anesthesiologists grade 1 and 2, undergoing TURP with 0.9% NS irrigation under spinal anesthesia achieved with a mixture of 0.5% heavy bupivacaine. The patients' hematocrit and serum electrolyte levels were obtained after six hours and compared with preoperative values. RESULTS Hematocrit reduced from 40.32 ± 6.27 to 31.07 ± 5.40 (p < 0.001). Both serum sodium and potassium decreased from 136.77 ± 3.27 to 128.31 ± 5.91 and from 4.02 ± 0.26 to 3.81 ± 0.36, respectively (p < 0.001). However, serum chloride showed only a minimal increase from 101.58 ± 2.88 to 102.25 ± 1.66 (p < 0.12). CONCLUSION Although the changes in serum sodium and potassium were statistically significant, they did not have any physiological consequences in our study. However, this emphasizes the importance of vigilant electrolyte monitoring to identify and mitigate the risk of electrolyte disturbances during TURP surgeries.
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Affiliation(s)
| | - Hiranmay Barman
- Anaesthesiology, Anandaloke Multispeciality Hospital, Siliguri, IND
| | - Reena
- Anesthesia, Critical Care and Pain Management, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Amrita Rath
- Anesthesia, Critical Care and Pain Management, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
| | - Rambadan Singh
- Anesthesia, Critical Care and Pain Management, Institute of Medical Sciences, Banaras Hindu University, Varanasi, IND
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Wang L, Chen X, Li K, Yin S, Zhu P. Perioperative and functional outcomes of salvage versus primary Holmium laser enucleation of the prostate: Evidence-based on controlled studies. Asian J Surg 2023; 46:5411-5420. [PMID: 37268461 DOI: 10.1016/j.asjsur.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/02/2023] [Indexed: 06/04/2023] Open
Abstract
To evaluate the perioperative and functional outcomes of holmium laser enucleation of the prostate (HoLEP) among patients with and without prior transurethral prostate surgery. we performed a systematic search of the Cochrane Library, PubMed, Embase, Web of Science and Scopus databases for articles evaluating the effectiveness of salvage HoLEP (S-HoLEP) versus primary HoLEP (P-HoLEP) until January 2023. Nine studies involving 6044 patients were included for both quantitative and qualitative analysis. Compared with P-HoLEP, S-HoLEP used more energy (weighted mean difference = 14.27 KJ; 95% CI = 4.75-23.79; P = 0.003) and had an increased incidence of postoperative clot retention (odds ratio = 2.12; 95% CI = 1.25-3.59; P = 0.005) and urethral stricture (OR = 1.99; 95% CI = 1.04-3.8; P = 0.04). However, the International Prostate Symptom Score at the sixth month of follow-up was significantly lower for S-HoLEP than for P-HoLEP (WMD = -0.80; 95% CI = -1.38 to -0.22; P = 0.007). There was no significant difference between S-HoLEP and P-HoLEP in terms of operative time, enucleation time, enucleation efficiency, morcellation time, resected weight, catheterisation time, hospital stay duration, quality of life, maximum urinary flow rate, postvoid residual and intraoperative and postoperative overall complications. compared with P-HoLEP, S-HoLEP is still a feasible and effective method for treating residual benign prostatic hyperplasia, with only a slight increase in the probability of energy utilisation, clot retention and urethral stricture. Despite these minor discrepancies, the overall beneficial effects of the two modalities on symptom resolution is noteworthy.
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Affiliation(s)
- Li Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Xiaobin Chen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Kunpeng Li
- Department of Urology, Affiliated Hospital of Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Shan Yin
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Pingyu Zhu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
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Gravas S, Gacci M, Gratzke C, Herrmann TRW, Karavitakis M, Kyriazis I, Malde S, Mamoulakis C, Rieken M, Sakalis VI, Schouten N, Speakman MJ, Tikkinen KAO, Cornu JN. Summary Paper on the 2023 European Association of Urology Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms. Eur Urol 2023; 84:207-222. [PMID: 37202311 DOI: 10.1016/j.eururo.2023.04.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/06/2023] [Indexed: 05/20/2023]
Abstract
CONTEXT Lower urinary tract symptoms (LUTS) are common, often bothersome, and have multifactorial aetiology. OBJECTIVE To present a summary of the 2023 version of the European Association of Urology guidelines on the management of male LUTS. EVIDENCE ACQUISITION A structured literature search from 1966 to 2021 selected the articles with the highest certainty evidence. The Delphi technique consensus approach was used to develop the recommendations. EVIDENCE SYNTHESIS The assessment of men with LUTS should be practical. A careful medical history and physical examination are essential. Validated symptom scores, urine test, uroflowmetry, and postvoid urine residual, as well as frequency-volume charts for patients with nocturia or predominately storage symptoms should be used. Prostate-specific antigen should be ordered if a diagnosis of prostate cancer changes the treatment plan. Urodynamics should be performed for selected patients. Men with mild symptoms are candidates for watchful waiting. Behavioural modification should be offered to men with LUTS prior to, or concurrent with, treatment. The choice of medical treatment depends on the assessment findings, predominant type of symptoms, ability of the treatment to change the findings, and the expectations to be met in terms of the speed of onset, efficacy, side effects, and disease progression. Surgery is reserved for men with absolute indications, and for patients who fail or prefer not to receive medical therapy. Surgical management has been divided into five sections: resection, enucleation, vaporisation, and alternative ablative and nonablative techniques. The choice of surgical technique depends on patient's characteristics, expectations, and preferences; surgeon's expertise; and availability of modalities. CONCLUSIONS The guidelines provide an evidence-based approach for the management of male LUTS. PATIENT SUMMARY A clinical assessment should identify the cause(s) of symptoms and define the clinical profile and patient's expectations. The treatment should aim to ameliorate symptoms and reduce the risk of complications.
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Affiliation(s)
- Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Christian Gratzke
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | | | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Iason Kyriazis
- Department of Urology, General University Hospital of Patras, Patras, Greece
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | | | - Vasileios I Sakalis
- Department of Urology, Hippokrateion General Hospital, Thessaloniki, Greece.
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Mark J Speakman
- Department of Urology, Taunton & Somerset Hospital, Taunton, UK
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | - Jean-Nicolas Cornu
- Department of Urology, CHU Hôpitaux de Rouen - Hôpital Charles Nicolle, Rouen, France
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De la Cuadra-Grande A, Rioja-Zuazu J, Domínguez-Esteban M, Torres E, Blissett R, Woodward E, Oyagüez I, Fernández-Arjona M. Budget impact analysis of transurethral water vapor therapy for treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia in the Spanish national healthcare system. Expert Rev Pharmacoecon Outcomes Res 2023; 23:499-510. [PMID: 36897833 DOI: 10.1080/14737167.2023.2189591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND Several surgical treatments are available for managing lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH). Water vapor thermal therapy (WVTT) is a new minimally invasive therapy. This study estimates the budget impact of introducing WVTT for LUTS/BPH into the Spanish health care system. METHODS A model simulated the evolution of men over 45 years of age with moderate-severe LUTS/BPH after surgical treatment, over a 4-year time horizon, from the Spanish public health care service´s perspective. The technologies in scope included those most used in Spain: WVTT, transurethral resection (TURP), photoselective laser vapourization (PVP) and holmium laser enucleation (HoLEP). Transition probabilities, adverse events and costs were identified from the scientific literature and validated by a panel of experts. Sensitivity analyses were performed by varying the most uncertain parameters. RESULTS Per intervention, WVTT resulted in savings of €3,317, €1,933 and €2,661 compared to TURP, PVP and HoLEP. Over a 4-year time horizon, when performed in 10% of the cohort of 109,603 Spanish males with LUTS/BPH, WVTT saved €28,770,125 against the scenario without WVTT availability. CONCLUSIONS WVTT could reduce the cost of managing LUTS/BPH, increase the quality of health care and reduce the length of procedure and hospital stay.
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Affiliation(s)
| | - Jorge Rioja-Zuazu
- Urology Department, Clínica Universitaria de Navarra, Navarra, Spain
| | | | - Esperanza Torres
- Health Economics & Market Access, Boston Scientific Inc, Madrid, Spain
| | - Rob Blissett
- Health Economics & Economic Evaluation, MedTech Economics Ltd, Winchester, UK
| | - Emily Woodward
- Health Economics & Market Access, Boston Scientific AG, Solothurn, Switzerland
| | - Itziar Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
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B-TURP versus HoLEP: Peri-Operative Outcomes and Complications in Frail Elderly (>75 y.o.) Patients: A Prospective Randomized Study. Biomedicines 2022; 10:biomedicines10123212. [PMID: 36551968 PMCID: PMC9776283 DOI: 10.3390/biomedicines10123212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Background: The aim of this study was to compare the peri-operative and functional results between trans-urethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS) in middle-old patients. Materials and Methods: This prospective single-center study included patients over 75 years old treated with B-TURP or HoLEP for BPH associated with LUTS with prostate volume (PV) <100 mL. Primary endpoints were the intra-operative blood loss, percentage of loss of hemoglobin, blood transfusion, complications, and the comparison of functional outcomes. All patients were evaluated at 1, 3, 6, and 12 months of follow-up. Results: Overall, 96 patients undergoing HoLEP and 104 B-TURP were eligible and enrolled for the study. Post-operative results showed statistically significant differences between the two groups, all in favor of HoLEP group, specifically in terms of removed prostate tissue, PV reduction rate, hemoglobin values at 24 h, hemoglobin loss, operative time, length of hospitalization, days of catheterization, and urinary flow rates. There was no significant difference in terms of postvoid residual urine volume, perioperative complication, blood transfusion, International Prostate Symptom Score (IPSS), and IPSS quality of life scores. Conclusions: In middle-old patients, the HoLEP technique represents a prostate size-independent treatment option with a more favorable safety profile defined by less bleeding, lower blood transfusions, and a significantly lower hemoglobin drop than B-TURP.
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A Review of Aging and the Lower Urinary Tract: The Future of Urology. Int Neurourol J 2022; 25:273-284. [PMID: 34991304 PMCID: PMC8748297 DOI: 10.5213/inj.2142042.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022] Open
Abstract
Lower urinary tract symptoms (LUTS) are common among elderly people, with significant effects on individuals, caregivers, and the wider health care system. As the elderly population with multiple comorbidities is increasing, the burden of LUTS will increase. This review describes the demographic trends in the aging society, changes in lower urinary tract function with aging, and deterioration of physical and cognitive function in aging, as well as what has been done regarding geriatric urology and what urologists should do to meet the health care needs of the aging population. Frailty and dementia are unmissable factors in the evaluation of elderly patients. Numerous reports have described associations between LUTS and frailty and between LUTS and dementia. Urologists must be aware of the multiplex physical, cognitive, and social characteristics of elderly people. Maintaining a geriatric viewpoint in the diagnosis, treatment, and management of elderly individuals with LUTS will fulfill the unmet needs of elderly people. It is also essential to discuss the treatment and management goals of LUTS with patients and caregivers. Active case identification, appropriate evaluations of LUTS and comorbidities, and a multidisciplinary approach with other health-care professionals are recommended for better treatment and management.
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Shah H, Khater U, Smith N, Katz J, Bhat A, Banerjee I, Shah R. Does prior transurethral resection of prostate have a negative impact on the outcome of holmium laser enucleation of prostate? Results from a prospective comparative study. Urol Ann 2022; 14:118-124. [PMID: 35711492 PMCID: PMC9197008 DOI: 10.4103/ua.ua_106_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/24/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives To prospectively evaluate safety and efficacy of holmium laser enucleation of prostate (HoLEP) for surgical treatment of recurrent symptoms due to prostatomegaly after prior transurethral resection of prostate (TURP). Materials and Methods: We prospectively evaluated 43 patients with a history of TURP who underwent HoLEP (study group). Patients in chronological order who underwent HoLEP without prior TURP were included in the control group. We hypothesized that prior TURP would increase technical difficulties, thereby leading to a reduction in procedure efficiency by 25%. Patients’ demographic, intraoperative, and postoperative data were compared, and statistical analysis was performed. Results: Demographic data in both groups were comparable. The average interval between past TURP and HoLEP was 4.22 years. There was no difficulty in identifying the dissection plane in the study group and the difference in the procedure efficiency between the study and the control groups were statistically insignificant (0.75 ± 0.31 g/min-study group vs. 0.69 ± 0.36 g/min-control group; P = 0.665). The intraoperative parameters and postoperative outcomes were comparable in both groups. Conclusions: Prior TURP does not negatively impact the outcome of HoLEP in treating symptomatic recurrence for enlarged prostate after initial TURP.
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D'Agostino D, Colicchia M, Corsi P, Romagnoli D, Del Rosso A, Modonutti D, Busetto GM, Ferro M, Schiavina R, Molinaroli E, Artibani W, Porreca A. The combination of waterjet ablation (Aquabeam ®) and holmium laser power for treatment of symptomatic benign prostatic hyperplasia: early functional results. Cent European J Urol 2021; 74:222-228. [PMID: 34336242 PMCID: PMC8318024 DOI: 10.5173/ceju.2021.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study was to assess the short-term functional outcomes and the efficacy of hemostasis performed with holmium laser performed following prostatic hydroablation with the Aquabeam® system. Material and methods Between June 2019 and July 2020, 53 consecutive patients underwent Aquabeam® with our modified hemostasis approach with holmium laser. The following standard preoperative assessments were retrospectively recorded: prostate volume; International Prostate Symptom Score (IPSS) and Quality of Life (IPSS-QoL); uroflowmetry including Qmax and post void residual volume (PVR). Results Fifty-three patients consecutively underwent aquablation and holmium laser hemostasis. Median age at surgery, median prostate-specific antigen (PSA) and median prostate volume were 62 years (IQR: 57-66), 2.95 ng/ml (IQR: 1.6-4.8) and 55 ml (IQR: 43-65), respectively.Median operative time was 60 minutes (IQR: 40-80). Median catheterization time and length of hospital stay were 2 days (IQR: 1-3) for both parameters. The median hemoglobin decrease between the preoperative values and those assessed on the second day was equal to 1.25 g/dl (IQR: 0.7-1.85).Continence rate was 100% at catheter removal. Thirty-six patients (72%) reported anterograde ejaculation preservation. IPSS (6, 3-21) and Qmax (19, 9-26) changed dramatically between baseline and 3 months follow-up. Conclusions The combination of Aquabeam® and holmium laser energy for hemostasis is a safe, reproducible technique to relieve moderate lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH) while preserving ejaculation in younger and sexually active individuals. The short-term results showed a lower rate of complications; the encouraging functional results confirm that this can be a valid surgical approach for treatment of BPH.
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Affiliation(s)
- Daniele D'Agostino
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Michele Colicchia
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Paolo Corsi
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Daniele Romagnoli
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Alessandro Del Rosso
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Daniele Modonutti
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | | | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO), Milan, Italy
| | - Riccardo Schiavina
- Department of Urology, Alma Mater Studiorum Bologna, Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Enrico Molinaroli
- Department of Urology, Alma Mater Studiorum Bologna, Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Walter Artibani
- Department of Robotic Urological Surgery, Abano Terme Hospital, Abano Terme, Italy
| | - Angelo Porreca
- Oncological Urology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
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[Bipolar versus monopolar resection of the prostate for lower urinary tract symptoms caused by benign prostatic obstruction]. Urologe A 2021; 60:780-783. [PMID: 33890140 DOI: 10.1007/s00120-021-01524-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
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Yin X, Chen J, Sun H, Liu M, Wang Z, Shi B, Zheng X. Endoscopic enucleation vs endoscopic vaporization procedures for benign prostatic hyperplasia: how should we choose: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22882. [PMID: 33181656 PMCID: PMC7668528 DOI: 10.1097/md.0000000000022882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/27/2020] [Accepted: 09/23/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To assess the safety and efficacy of different endoscopic procedures of the prostate techniques, by comparing endoscopic enucleation (EEP) and endoscopic vaporization procedures (EVP) of the prostate; and laser enucleation procedures (L-EEP) vs laser vaporization procedures (L-EVP) surgeries for benign prostatic hyperplasia. METHODS A systematic literature review was performed in December 2019 using PubMed, Embase and the Cochrane Library to identify relevant studies. Two analyses were carried out: (1) EEP vs EVP; and (2) L-EEP vs L-EVP. Efficacy and safety were evaluated using perioperative data, functional outcomes, including maximum urinary flow rate (Qmax), quality of life (QoL), international prostate symptom score (IPSS), postvoiding residual urine volume (PRV), and rate of complications. Meta-analyses were conducted using RevMan5.3. RESULTS Sixteen studies (4907 patients) evaluated EEP vs EVP, and 12 of them (4392 patients) evaluated L-EEP vs L-EVP. EEP showed improved functional outcomes compared with EVP. EEP was always presented a better Qmax at various follow-up times. EEP also associated with a reduced PRV and IPSS at 12 months postsurgery, an increased Qmax, and reduced IPSS and QoL score at both 24 and 36 months postsurgery. In addition, EEP was associated with less total energy utilized and retreatment for residual adenoma, but a longer catheterization time. Among other outcomes, there was no significant difference. L-EEP favors total energy used, retreatment for residual adenoma, and functional outcomes. L-EEP was associated with reduced PRV at 1, 6, and 12 months postsurgery, a greater Qmax at 6 and 12 months postsurgery, a lower IPSS at 12 months postsurgery, and higher Qmax and lower IPSS and QoL scores at 24 and 36 months postsurgery. However, there was no difference at 3 months postsurgery. No significant differences were observed for other perioperative data and complications. CONCLUSIONS Both EEP and EVP displayed sufficient efficacy and safety for treating benign prostatic hyperplasia. EEP and L-EEP were favored in perioperative data, rate of complications, and functional outcomes. However, the clinical significance of those statistical differences was unclear. Hence, higher-quality randomized controlled trials may be needed to provide a clear algorithm.
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Affiliation(s)
- Xinbao Yin
- Department of Urology, Qilu Hospital of Shandong University
| | - Jun Chen
- Department of Urology, Qilu Hospital of Shandong University
| | - Hui Sun
- Department of Urology, Qilu Hospital of Shandong University
| | - Ming Liu
- Department of Urology, Qilu Hospital of Shandong University
| | - Zehua Wang
- Department of Urology, Qilu Hospital of Shandong University
| | - Benkang Shi
- Department of Urology, Qilu Hospital of Shandong University
| | - Xueping Zheng
- Department of Geriatrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Alexander CE, Scullion MMF, Omar MI, Yuan Y, Mamoulakis C, N'Dow JMO, Chen C, Lam TBL. Reprint - Bipolar vs. monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction: A Cochrane review. Can Urol Assoc J 2020; 14:423-430. [PMID: 32569563 DOI: 10.5489/cuaj.6464] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There remains uncertainty regarding the differences in patient outcomes between monopolar transurethral resection of the prostate (MTURP) and bipolar TURP (BTURP) in the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). METHODS A systematic literature search was carried out up to March 19, 2019. Methods in the Cochrane Handbook were followed. Certainty of evidence (CoE) was assessed using the GRADE approach. RESULTS A total of 59 randomized controlled trials (RCTs) with 8924 participants were included. BTURP probably results in little to no difference in International Prostate Symptom Score (IPSS) at 12 months (mean difference -0.24, 95% confidence internal [CI] -0.39--0.09; participants=2531; RCTs=16; moderate CoE) or health-related quality of life (HRQOL) at 12 months (mean difference -0.12, 95% CI -0.25-0.02; participants=2004, RCTs=11; moderate CoE), compared to MTURP. BTURP probably reduces TUR syndrome (relative risk [RR] 0.17, 95% CI 0.09-0.30; participants= 6,745, RCTs=44; moderate CoE) and blood transfusions (RR 0.42, 95% CI 0.30-0.59; participants=5727, RCTs=38; moderate CoE), compared to MTURP. BTURP may carry similar risk of urinary incontinence at 12 months (RR 0.20, 95% CI 0.01-4.06; participants=751; RCTs=4; low CoE), re-TURP (RR 1.02, 95% CI 0.44-2.40; participants=652, RCTs=6, I2=0%; low CoE) and erectile dysfunction (International Index of Erectile Function [IIEF-5]) at 12 months (mean difference 0.88, 95% CI -0.56-2.32; RCTs=3; moderate CoE), compared to MTURP. CONCLUSIONS BTURP and MTURP probably improve urological symptoms to a similar degree. BTURP probably reduces TUR syndrome and blood transfusion slightly postoperatively. The moderate certainty of evidence available for primary outcomes suggests no need for further RCTs comparing BTURP and MTURP.
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Affiliation(s)
| | - Malo M F Scullion
- Academic Urology Unit, University of Aberdeen, Aberdeen, United Kingdom
| | | | - Yuhong Yuan
- Department of Medicine, Division of Gastroenterology, McMaster University, Hamilton, ON, Canada
| | - Charalampos Mamoulakis
- Department of Urology, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Greece
| | - James M O N'Dow
- Urology Department, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - Changhao Chen
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Thomas B L Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, United Kingdom
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Alexander CE, Scullion MMF, Omar MI, Yuan Y, Mamoulakis C, N'Dow JMO, Chen C, Lam TBL. Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction. Cochrane Database Syst Rev 2019; 12:CD009629. [PMID: 31792928 PMCID: PMC6953316 DOI: 10.1002/14651858.cd009629.pub4] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Transurethral resection of the prostate (TURP) is a well-established surgical method for treatment of men with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). This has traditionally been provided as monopolar TURP (MTURP), but morbidity associated with MTURP has led to the introduction of other surgical techniques. In bipolar TURP (BTURP), energy is confined between electrodes at the site of the resectoscope, allowing the use of physiological irrigation medium. There remains uncertainty regarding differences between these surgical methods in terms of patient outcomes. OBJECTIVES To compare the effects of bipolar and monopolar TURP. SEARCH METHODS A comprehensive systematic electronic literature search was carried out up to 19 March 2019 via CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, PubMed, and WHO ICTRP. Handsearching of abstract proceedings of major urological conferences and of reference lists of included trials, systematic reviews, and health technology assessment reports was undertaken to identify other potentially eligible studies. No language restrictions were applied. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared monopolar and bipolar TURP in men (> 18 years) for management of LUTS secondary to BPO. DATA COLLECTION AND ANALYSIS Two independent review authors screened the literature, extracted data, and assessed eligible RCTs for risk of bias. Statistical analyses were undertaken according to the statistical guidelines presented in the Cochrane Handbook for Systematic Reviews of Interventions. The quality of evidence (QoE) was rated according to the GRADE approach. MAIN RESULTS A total of 59 RCTs with 8924 participants were included. The mean age of included participants ranged from 59.0 to 74.1 years. Mean prostate volume ranged from 39 mL to 82.6 mL. Primary outcomes BTURP probably results in little to no difference in urological symptoms, as measured by the International Prostate Symptom Score (IPSS) at 12 months on a scale of 0 to 35, with higher scores reflecting worse symptoms (mean difference (MD) -0.24, 95% confidence interval (CI) -0.39 to -0.09; participants = 2531; RCTs = 16; I² = 0%; moderate certainty of evidence (CoE), downgraded for study limitations), compared to MTURP. BTURP probably results in little to no difference in bother, as measured by health-related quality of life (HRQoL) score at 12 months on a scale of 0 to 6, with higher scores reflecting greater bother (MD -0.12, 95% CI -0.25 to 0.02; participants = 2004; RCTs = 11; I² = 53%; moderate CoE, downgraded for study limitations), compared to MTURP. BTURP probably reduces transurethral resection (TUR) syndrome events slightly (risk ratio (RR) 0.17, 95% CI 0.09 to 0.30; participants = 6745; RCTs = 44; I² = 0%; moderate CoE, downgraded for study limitations), compared to MTURP. This corresponds to 20 fewer TUR syndrome events per 1000 participants (95% CI 22 fewer to 17 fewer). Secondary outcomes BTURP may carry a similar risk of urinary incontinence at 12 months (RR 0.20, 95% CI 0.01 to 4.06; participants = 751; RCTs = 4; I² = 0%; low CoE, downgraded for study limitations and imprecision), compared to MTURP. This corresponds to four fewer events of urinary incontinence per 1000 participants (95% CI five fewer to 16 more). BTURP probably slightly reduces blood transfusions (RR 0.42, 95% CI 0.30 to 0.59; participants = 5727; RCTs = 38; I² = 0%; moderate CoE, downgraded for study limitations), compared to MTURP. This corresponds to 28 fewer events of blood transfusion per 1000 participants (95% CI 34 fewer to 20 fewer). BTURP may result in similar rates of re-TURP (RR 1.02, 95% CI 0.44 to 2.40; participants = 652; RCTs = 6; I² = 0%; low CoE, downgraded for study limitations and imprecision). This corresponds to one more re-TURP per 1000 participants (95% CI 19 fewer to 48 more). Erectile function as measured by the International Index of Erectile Function score (IIEF-5) at 12 months on a scale from 5 to 25, with higher scores reflecting better erectile function, appears to be similar (MD 0.88, 95% CI -0.56 to 2.32; RCTs = 3; I² = 68%; moderate CoE, downgraded for study limitations) for the two approaches. AUTHORS' CONCLUSIONS BTURP and MTURP probably improve urological symptoms, both to a similar degree. BTURP probably reduces both TUR syndrome and postoperative blood transfusion slightly compared to MTURP. The impact of both procedures on erectile function is probably similar. The moderate certainty of evidence available for the primary outcomes of this review suggests that there is no need for further RCTs comparing BTURP and MTURP.
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Affiliation(s)
- Cameron Edwin Alexander
- University of AberdeenAcademic Urology Unit2nd Floor, Health Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Malo MF Scullion
- University of AberdeenAcademic Urology Unit2nd Floor, Health Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Muhammad Imran Omar
- University of AberdeenAcademic Urology Unit2nd Floor, Health Sciences BuildingForesterhillAberdeenUKAB25 2ZD
- European Association of UrologyArnhemNetherlands
| | - Yuhong Yuan
- McMaster UniversityDepartment of Medicine, Division of Gastroenterology1280 Main Street WestRoom HSC 3N51HamiltonONCanadaL8S 4K1
| | - Charalampos Mamoulakis
- University General Hospital of Heraklion, University of Crete Medical SchoolDepartment of UrologyHeraklion, CreteGreece
| | - James MO N'Dow
- NHS Grampian, Aberdeen Royal InfirmaryUrology DepartmentForesterhillAberdeenScotlandUKAB25 2ZN
| | - Changhao Chen
- Sun Yat‐Sen Memorial Hospital, Sun Yat‐Sen UniversityDepartment of Urology107 Yan‐Jiang RoadGuangzhouChina
| | - Thomas BL Lam
- University of AberdeenAcademic Urology Unit2nd Floor, Health Sciences BuildingForesterhillAberdeenUKAB25 2ZD
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Giampaoli M, Bianchi L, D'agostino D, Corsi P, Romagnoli D, Mineo Bianchi F, Del Rosso A, Schiavina R, Brunocilla E, Artibani W, Porreca A. Can preoperative multiparametric MRI avoid unnecessary prostate biopsies before holmium laser enucleation of the prostate? Preliminary results of a multicentric cohort of patients. MINERVA UROL NEFROL 2019; 71:524-530. [PMID: 31166103 DOI: 10.23736/s0393-2249.19.03463-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Holmium laser enucleation of the prostate (HoLEP) is a surgical technique that allows to safely and effectively treat bladder outlet obstruction due to benign prostate enlargement and retrieve an adequate surgical specimen. We investigated the role of multiparametric magnetic resonance imaging of the prostate (mpMRI) as a tool to exclude incidental prostate cancer (iPCa) and to compare mpMRI alone with a contextual transrectal ultrasound guided biopsy (TRUS-GB). METHODS Retrospective multicentric evaluation of 244 patients underwent to HoLEP with a suspicion of prostate cancer (PCa) due to raised PSA and/or abnormal digital rectal examination (DRE) and a negative mpMRI (PI-RADS score <3), was performed. Of these, 118 patients had only a negative mpMRI (MRI group) while 126 had a negative mpMRI and a contextual preoperative negative TRUS-GB (MRI + TRUS-GB group). Comparison between the two groups, univariate and multivariate analysis were conducted in order to identify any predictive factors of iPCa. RESULTS Median age, PSA, prostate volume and PSA density were 64.0 years (IQR: 58.0-69.0), 6.10 ng/mL (IQR: 4.76-9.65), 86.0 cc (IQR: 65.0-115.0), 50.0 cc (IQR: 37.5-80.0) and 0.08 ng/mL/cc (IQR: 0.06-0.10), respectively. In surgical specimen, iPCa was detected in 21 cases (8.8%). No statistically differences between MRI and MRI + TRUS-GB group were found in terms of iPCa (7.6% and 8.5%, respectively), pathological T stage and ISUP Grade Group. A contextual TRUS-GB added to mpMRI did not correlate to iPCa either at uni- and multivariate analysis while a significant correlation of a PSA density >0.15 ng/mL/cc was found only at univariate analysis. CONCLUSIONS Including a mpMRI in clinical evaluation of patients eligible to HoLEP with a preoperative PCa suspicion leads to low the rates of iPCa and might avoid unnecessary TRUS-GB.
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Affiliation(s)
- Marco Giampaoli
- Department of Urology, Abano Terme Hospital, Abano Terme, Padua, Italy -
| | - Lorenzo Bianchi
- Department of Urology, University of Bologna, Bologna, Italy
| | | | - Paolo Corsi
- Department of Urology, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Daniele Romagnoli
- Department of Urology, Abano Terme Hospital, Abano Terme, Padua, Italy
| | | | | | | | | | - Walter Artibani
- Department of Urology, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Angelo Porreca
- Department of Urology, Abano Terme Hospital, Abano Terme, Padua, Italy
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Porreca A, Giampaoli M, Bianchi L, D'Agostino D, Romagnoli D, Bianchi FM, Rosso AD, Corsi P, Schiavina R, Artibani W, Brunocilla E. Preoperative multiparametric prostate magnetic resonance imaging: a safe clinical practice to reduce incidental prostate cancer in Holmium laser enucleation of the prostate. Cent European J Urol 2019; 72:106-112. [PMID: 31482016 PMCID: PMC6715077 DOI: 10.5173/ceju.2019.1943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 04/20/2019] [Accepted: 04/21/2019] [Indexed: 12/29/2022] Open
Abstract
Introduction Purpose of the study was to investigate the correlation of a preoperative multiparametric magnetic resonance imaging of the prostate (mpMRI) in patients with a suspicion of prostate cancer and eligible for Holmium Laser Enucleation of the Prostate (HoLEP). Material and methods Data of 228 patients who had undergone HoLEP was selected and retrospectively analyzed from a multicentric database. All patients presented with a raised serum PSA and/or an abnormal digital rectal examination (DRE). Prostate cancer (PCa) was excluded either with a negative mpMRI (group ‘NEGATIVE MRI’ n = 113) or a standard biopsy (group ‘NO MRI’ n = 115). Preoperative characteristic surgical and histological outcomes were confronted. A univariate and multivariate logistic regression model was performed to investigate independent predictors of incidental Prostate Cancer (iPCa). Results Both groups presented with no statistical differences in preoperative characteristics besides previous acute urinary retention rates and post-voided residual volume, found to be higher (27.8% vs. 14.2% and median 120cc vs. 80cc) in NO MRI and NEGATIVE MRI respectively. No differences were registered in surgical time, removed tissue, catheterization time, hospital stay and complications rate. Statistically lower rate of iPCa (p = 0.03) was detected in the NEGATIVE MRI group (6.2%) in comparison with NO MRI group (14.8%). In multivariate logistic regression only presence of a preoperative negative mpMRI correlated (p = 0.04) as an independent predictive factor (OR 2.63; 95% CI: 1.02–6.75). Conclusions A negative mpMRI might be a useful tool to be included in a novel preoperative assessment to patients eligible for HoLEP with a suspicion of PCa in order to avoid an incidental PCa.
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Affiliation(s)
- Angelo Porreca
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
| | - Marco Giampaoli
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
| | - Lorenzo Bianchi
- University of Bologna, Department of Urology, Bologna, Italy
| | | | | | | | | | - Paolo Corsi
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
| | | | - Walter Artibani
- Abano Terme Hospital, Department of Urology, Abano Terme, Italy
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Hu H, Zhang W, Liu X, Wang H, Fang Z, Liang C, Wang T, Xu K. Nerve Growth Factor Levels are Associated with Overactive Bladder Symptoms and Long-Term Treatment Outcome after Transurethral Resection of the Prostate in Patients with Benign Prostatic Hyperplasia. J Urol 2018; 200:620-625. [PMID: 29630981 DOI: 10.1016/j.juro.2018.03.130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Hao Hu
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Weiyu Zhang
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Xianhui Liu
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Huanrui Wang
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Zhiwei Fang
- Department of Urology, 1st Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chen Liang
- Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Tao Wang
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Kexin Xu
- Department of Urology, Peking University People's Hospital, Beijing, China.
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Nunes RLV, Antunes AA, Constantin DS. Contemporary surgical treatment of benign prostatic hyperplasia. Rev Assoc Med Bras (1992) 2017; 63:711-716. [PMID: 28977110 DOI: 10.1590/1806-9282.63.08.711] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/21/2017] [Indexed: 11/22/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is a common condition in adult men and its incidence increases progressively with aging. It has an important impact on the individual's physical and mental health and its natural progression can lead to serious pathological situations. Although the initial treatment is pharmacological, except in specific situations, the tendency of disease progression causes a considerable portion of the patients to require surgical treatment. In this case, there are several options available today in the therapeutic armamentarium. Among the options, established techniques, such as open surgery and endoscopic resection using monopolar energy, still prevail in the choice of surgeons because they are more accessible, both from a socioeconomic standpoint in the vast majority of medical services and in terms of training of medical teams. On the other hand, new techniques and technologies arise sequentially in order to minimize aggression, surgical time, recovery and complications, optimizing results related to the efficacy/safety dyad. Each of these techniques has its own peculiarities regarding availability due to cost, learning curve and scientific consolidation in order to achieve recognition as a cutting-edge method in the medical field. The use of bipolar energy in endoscopic resection of the prostate, laser vaporization and enucleation techniques, and videolaparoscopy are examples of new options that have successfully traced this path. Robot-assisted surgery has gained a lot of space in the last decade, but it still needs to dodge the trade barrier. Other techniques and technologies will need to pass the test of time to be able to conquer their space in this growing market.
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Affiliation(s)
- Ricardo Luís Vita Nunes
- Head of the Benign Prostatic Hyperplasia Department, Sociedade Brasileira de Urologia (SBU). Assistant Physician, Division of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP). Head of the Urology Clinic, Hospital Militar de Área de São Paulo - Exército Brasileiro, São Paulo, SP, Brazil
| | - Alberto Azoubel Antunes
- Associate Professor, Division of Urology, Head of the Urology Graduate Program, and Coordinator of the Prostate Sector, Division of Urology, FMUSP, São Paulo, SP, Brazil
| | - Davi Souza Constantin
- Preceptor of Urology, Centro de Referência do Homem do Hospital de Transplantes Euryclides de Jesus Zerbini. MD, Urologist, Hospital Militar de Área de São Paulo - Exército Brasileiro, São Paulo, SP, Brazil
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Herlemann A, Wegner K, Roosen A, Buchner A, Weinhold P, Bachmann A, Stief CG, Gratzke C, Magistro G. “Finding the needle in a haystack”: oncologic evaluation of patients treated for LUTS with holmium laser enucleation of the prostate (HoLEP) versus transurethral resection of the prostate (TURP). World J Urol 2017; 35:1777-1782. [DOI: 10.1007/s00345-017-2048-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 05/05/2017] [Indexed: 12/13/2022] Open
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Prospective randomized study comparing monopolar with bipolar transurethral resection of prostate in benign prostatic obstruction: 36-month outcomes. World J Urol 2017; 35:1595-1601. [DOI: 10.1007/s00345-017-2023-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/11/2017] [Indexed: 11/26/2022] Open
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Smith C, Craig P, Taleb S, Young S, Golzarian J. Comparison of Traditional and Emerging Surgical Therapies for Lower Urinary Tract Symptoms in Men: A Review. Cardiovasc Intervent Radiol 2017; 40:1176-1184. [DOI: 10.1007/s00270-017-1575-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
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Nimeh T, Magnan B, Almallah YZ. Benign Prostatic Hyperplasia: Review of Modern Minimally Invasive Surgical Treatments. Semin Intervent Radiol 2016; 33:244-50. [PMID: 27582614 DOI: 10.1055/s-0036-1586148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Tony Nimeh
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois
| | - Brenden Magnan
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois
| | - Y Zaki Almallah
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois
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Madduri VKS, Bera MK, Pal DK. Monopolar versus bipolar transurethral resection of prostate for benign prostatic hyperplasia: Operative outcomes and surgeon preferences, a real-world scenario. Urol Ann 2016; 8:291-6. [PMID: 27453650 PMCID: PMC4944621 DOI: 10.4103/0974-7796.184900] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Context: Monopolar transurethral resection of prostate (M-TURP) is considered the gold standard for the management of bladder outlet obstruction due to benign prostatic hyperplasia. Its newly introduced modification, bipolar TURP (B-TURP), promises to overcome its most prominent shortcomings, namely bleeding and dilutional hyponatremia. Literature is conflicting regarding merits of B-TURP over M-TURP. Aims: To find a difference, if any, in perioperative outcomes between M-TURP and B-TURP in a real-wold setting. Settings and Design: Prospective nonrandomized study. Subjects and Methods: Operative outcomes of patients undergoing M-TURP and B-TURP from February 2014 to October 2015 were compared. Statistical Analysis Used: Categorical data were compared by Fischer exact test and numerical data were compared by independent samples Mann–Whitney U-test. P <0.05 was considered statistically significant. Results: The mean size of prostate operated by bipolar technology was significantly greater than those operated by monopolar technology (38.12 ± 9.59 cc vs. 66.49 ± 22.95 cc; P < 0.001). The mean fall in postoperative serum sodium concentration was 0.99 ± 0.76 mEq/L for the B-TURP group as compared to 3.60 ± 2.89 mEq/L for the M-TURP group (P < 0.001). The mean drop in postoperative hemoglobin concentration (P = 0.28) was statistically insignificant, even though larger glands were operated by B-TURP. There were three instances of the transurethral resection (TUR) syndrome in the M-TURP group whereas no TUR syndrome occurred in the B-TURP group. Conclusions: In spite of various contrary viewpoints in literature, surgeons prefer to operate on larger prostates using bipolar technology. B-TURP definitely reduces the incidence of bleeding and dilutional hyponatremia, making it a contender to replace M-TURP as the new gold standard.
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Affiliation(s)
- Vijay Kumar Sarma Madduri
- Department of Urology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Malay Kumar Bera
- Department of Urology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
| | - Dilip Kumar Pal
- Department of Urology, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India
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Pearce SM, Pariser JJ, Malik RD, Famakinwa OJ, Chung DE. Outcomes following Thulium vapoenucleation of large prostates. Int Braz J Urol 2016; 42:757-65. [PMID: 27564287 PMCID: PMC5006772 DOI: 10.1590/s1677-5538.ibju.2015.0424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 02/01/2016] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Thulium laser VapoEnucleation of the prostate (ThuVEP) is an evolving surgical technique for BPH. Most studies have focused on outcomes in small to médium sized prostates and have originated from Europe and Asia. We sought to describe our experience with ThuVEP for very large prostates in a North American cohort. MATERIALS AND METHODS From December 2010 to October 2014, 25 men underwent Thu-VEP using the CyberTM® (Quantastem, Italy) thulium laser, all with prostate volume >75mL. Data collected included patient demographics, comorbidities, intraoperative parameters, complications, and post-operative outcomes including maximum flow rate (Qmax), post-void residual (PVR), International Prostate Symptom Score (IPSS), and quality of life score (QoL) in one year of follow-up. Statistical analysis was done using Wilcoxon signed-rank test. RESULTS At baseline, mean age was 70±9 years and prostate size was 163±62g. Most patients (84%) were in retention and 10 (40%) patients were on anticoagulation. Seven (28%) patients went home the day of surgery (mean hospital stay: 1.2±1.2d). There were 2 intraoperative complications (8%), both cystotomies related to morcellation. Nine patients (36%) experienced a complication, all within 30 days. There were no Clavien III complications. Significant improvements were seen in Qmax, PVR, IPSS, and QoL score at each time interval to 12-months following surgery (all p<0.05). Of 21 patients initially in retention, all were voiding at last follow-up. CONCLUSIONS Our findings suggest that ThuVEP is an effective treatment for BPH in patients with large prostates with sustained results for one year.
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Affiliation(s)
- Shane M Pearce
- Section of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA
| | - Joseph J Pariser
- Section of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA
| | - Rena D Malik
- Section of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA
| | - Olufenwa J Famakinwa
- Section of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA
| | - Doreen E Chung
- Section of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA
- Department of Urology, Columbia University Medical Center, New York, NY, USA
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Li Z, Chen P, Wang J, Mao Q, Xiang H, Wang X, Wang X, Zhang X. The impact of surgical treatments for lower urinary tract symptoms/benign prostatic hyperplasia on male erectile function: A systematic review and network meta-analysis. Medicine (Baltimore) 2016; 95:e3862. [PMID: 27310968 PMCID: PMC4998454 DOI: 10.1097/md.0000000000003862] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) is common in adult men and can impair erectile function (EF). It was believed surgical treatments for this illness can improve EF due to the relief of LUTS while they were also reported harmed EF as heating or injury effect. Current network meta-analysis aimed to elucidate this discrepancy.Randomized controlled trials (RCTs) were identified. Direct comparisons were conducted by STATA and network meta-analysis was conducted by Generate Mixed Treatment Comparison. Random-effects models were used to calculate pooled standard mean difference and 95% confidence intervals and to incorporate variation between studies.Eighteen RCTs with 2433 participants were analyzed. Nine approaches were studied as transurethral resection of the prostate (TURP), plasmakinetic resection of the prostate (PKRP), plasmakinetic enucleation of the prostate (PKEP), Holmium laser enucleation of the prostate (HoLEP), Holmium laser resection of the prostate (HoLRP), photoselective vaporization of the prostate (PVP), Thulium laser, open prostatectomy (OP), and laparoscopic simple prostatectomy (LSP). In direct comparisons, all surgical treatments did not decrease postoperative International Index of Erectile Function (IIEF)-5 score except PVP. Moreover, patients who underwent HoLEP, PKEP, Thulium laser, and TURP had their postoperative EF significantly increased. Network analysis including direct and indirect comparisons ranked LSP at the highest position on the variation of postoperative IIEF-5 score, followed by PKRP, HoLEP, TURP, Thulium laser, PKEP, PVP, HoLRP, and OP. In subgroup analysis, only PVP was found lower postoperative EF in the short term and decreased baseline group, whereas TURP increased postoperative IIEF-5 score only for patients with normal baseline EF. However, HoLEP and PKEP showed pro-erectile effect even for patients with decreased baseline EF and short-term follow-up. Our novel data demonstrating surgical treatments for LUTS/BPH showed no negative impact on postoperative EF except PVP. Moreover, HoLEP and PKEP were found pro-erectile effect for all subgroups. New technologies, such as LSP, PKRP, and Thulium laser, were ranked at top positions in the network analysis, although they had no pro-erectile effect in direct comparison due to limited original studies or poor baseline EF. Therefore, further studies and longer follow-up are required to substantiate our findings.
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Affiliation(s)
- Zhuo Li
- Department of Urology, Zhongnan Hospital of Wuhan University
| | - Ping Chen
- Department of Urology, Zhongnan Hospital of Wuhan University
| | - Jun Wang
- Department of Urology, Children's Hospital of Wuhan
| | - Qi Mao
- Department of Urology, Zhongnan Hospital of Wuhan University
| | - Han Xiang
- Department of Urology, Zhongnan Hospital of Wuhan University
| | - Xiao Wang
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, P.R. China
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University
| | - Xinhua Zhang
- Department of Urology, Zhongnan Hospital of Wuhan University
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Assessment and management of male lower urinary tract symptoms (LUTS). Int J Surg 2016; 25:164-71. [DOI: 10.1016/j.ijsu.2015.11.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/07/2015] [Accepted: 11/21/2015] [Indexed: 11/19/2022]
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Rausch S, Heider T, Bedke J, Kruck S, Schwentner C, Fischer K, Stenzl A, Kälble T. Analysis of early morbidity and functional outcome of thulium: yttrium-aluminum-garnet laser enucleation for benign prostate enlargement: patient age and prostate size determine adverse surgical outcome. Urology 2015; 85:182-8. [PMID: 25530383 DOI: 10.1016/j.urology.2014.10.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/24/2014] [Accepted: 10/01/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate complications and functional outcome and to identify patient-associated risk factors, we analyzed consecutive patients undergoing thulium:yttrium-aluminum-garnet laser enucleation of the prostate (ThuLEP) in our department. METHODS A total of 234 patients were prospectively analyzed. Preoperative data, postoperative complications, and outcome at 6, 12, and 24 months were recorded. Individual risk factors for complications and treatment failure were assessed by univariate and multivariate analyses. RESULTS Mean age at surgery was 72.88 ± 7.83 years. Mean preoperative prostate size was 84.8 ± 34.9 mL. Thirty-day complication rate was 19.7%. Functional treatment failure occurred in 9.0% of all patients. Decline of mean International Prostate Symptom Score was -75%, quality of life index -76%, and postvoid residual -86% at 24 months. Maximum urine flow at 24 months was improved at +231%. In univariate analysis, age >80 years and prostate size <50 mL were significant predictors of complications, which was confirmed by multivariate analysis (P = .0277 and .0409, respectively). Age >80 years, prostate size <80 mL or <50 mL, and American Society of Anesthesiologists classification were significant predictors of functional treatment failure in univariate analysis. Prostate size <80 mL or <50 mL was significantly associated with treatment failure (P < .001) in multivariate analysis. CONCLUSION ThuLEP is a safe and efficient surgical procedure, even in a patient cohort with high prostate volumes, age, and comorbidities. However, high patient age and small prostate size were significant determinants of adverse outcomes after surgery. To address the question of optimal therapy selection for patients with prostates smaller than 80 mL, further prospective randomized evaluation of ThuLEP and alternative surgical interventions is needed.
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Affiliation(s)
- Steffen Rausch
- Department of Urology, Klinikum Fulda, Fulda, Germany; Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Thomas Heider
- Department of Urology, Klinikum Fulda, Fulda, Germany
| | - Jens Bedke
- Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Stephan Kruck
- Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany
| | | | | | - Arnulf Stenzl
- Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Tilman Kälble
- Department of Urology, Klinikum Fulda, Fulda, Germany
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Rausch S, Sievert KD. [Lower urinary tract symptoms associated with benign prostatic enlargement]. MMW Fortschr Med 2014; 156 Spec no 2:78-83. [PMID: 25552024 DOI: 10.1007/s15006-014-3297-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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McCahy PJ, Cheng K, Paul E, Gleeson J. The cost of photoselective vaporization of the prostate compared to transurethral resection of the prostate: Experience in a large public Australian teaching centre. JOURNAL OF CLINICAL UROLOGY 2014. [DOI: 10.1177/2051415814526391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The purpose of this study was to compare the cost of photoselective vaporization of the prostate (PVP) with transurethral resection of the prostate (TURP) in the treatment of men with bladder outflow obstruction (BOO). Patients and methods: Men underwent PVP or TURP for clinical BOO or urinary retention. We developed a cost framework to calculate the costs of theatre, recovery and ward time in our publically funded institution and calculated a cost for each procedure including the initial stay and any associated admissions over the first 60 days. These costs were statistically analyzed. Results: A total of 99 men underwent PVP and 97 had TURP. Groups were well matched for age and operative indication. The American Society of Anesthesia (ASA) grade was higher for the PVP group with more taking anticoagulants (36% versus 3.1%). PVP was 74% more expensive (median AUD$4243 vs AUD$2439, p<0.001) than TURP, even in a sub-set analysis excluding the anticoagulated patients. This was because of longer operating time and unavoidable disposable costs. Conclusions: Previous cost studies have all had significant flaws. Using our “bottom up” cost framework suggests that the unavoidable costs of purchasing a laser, single use laser fibers and other paraphernalia will almost always exceed the costs associated with in-patient stay. We caution against establishing a PVP service in a public hospital setting.
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Affiliation(s)
- PJ McCahy
- Monash University, Victoria, Australia
- Department of Urology, Monash Health, Australia
| | - K Cheng
- Department of Urology, Monash Health, Australia
| | - E Paul
- School of Public Health and Preventive Medicine, Monash University, Australia
| | - J Gleeson
- Department of Urology, Monash Health, Australia
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Abstract
PURPOSE OF REVIEW Endoscopic enucleation of the prostate is the most advanced form of surgical management of benign prostate hyperplasia. The purpose of this review is to update the reader on various modalities currently in use, and in trial, for endoscopic enucleation. RECENT FINDINGS A recent paradigm shift has occurred for the proponents of electrosurgery technology to utilizes the advantages offered by laser enucleation with interest in bipolar enucleation. Holmium laser enucleation still has the greatest randomized evidence with the longest follow-up among all the various lasers used to perform enucleation. SUMMARY Randomized trials with longer follow-up are required to demonstrate whether nonholmium types of energy really have advantages in enucleation (speed, ease of use and hemostasis) and durability (decade plus) as compared to the holmium laser.
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Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, McVary K, Novara G, Woo H, Madersbacher S. A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update. Eur Urol 2014; 67:1066-1096. [PMID: 24972732 DOI: 10.1016/j.eururo.2014.06.017] [Citation(s) in RCA: 514] [Impact Index Per Article: 51.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 06/12/2014] [Indexed: 10/25/2022]
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.
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Affiliation(s)
- Jean-Nicolas Cornu
- Department of Urology, Tenon Hospital, University Paris 6, Assistance Publique-Hopitaux de Paris, Paris, France.
| | - Sascha Ahyai
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Jean de la Rosette
- Department of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - Peter Gilling
- Department of Urology, Tauranga Hospital, Tauranga, New Zealand
| | - Christian Gratzke
- Department of Urology, Urologische Klinik und Poliklinik, Klinikum der Universität München-Großhadern, Munich, Germany
| | - Kevin McVary
- Department of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology-Urology Clinic, University of Padua, Padua, Italy
| | - Henry Woo
- Department of Urology, Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, Australia
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Gomez Sancha F, Rivera VC, Georgiev G, Botsevski A, Kotsev J, Herrmann T. Common trend: move to enucleation-Is there a case for GreenLight enucleation? Development and description of the technique. World J Urol 2014; 33:539-47. [PMID: 24929643 PMCID: PMC4375296 DOI: 10.1007/s00345-014-1339-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 06/02/2014] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Transurethral laser prostatectomy has evolved as a viable alternative for the management of benign prostate enlargement. Since the renaissance of laser prostatectomy with the advent of the holmium:yttrium-aluminum-garnet laser in the 1990s, various lasers and subsequent procedures have been introduced. These techniques can be categorized as vaporizing, resecting, and enucleating approaches. Photoselective vaporization of the prostate (PVP) is dominated by high-power lithium triborate (LBO) crystal lasers (GreenLight XPS). The mainstay of this technique is for the treatment of small to medium prostate volumes whereas enucleating techniques, such as holmium laser enucleation of the prostate and thulium enucleation of the prostate, focus on large-volume glands. In order to perspectively "delimit" LBO into the field of large-volume prostates, we developed LBO en bloc enucleation to render it as a competing transurethral enucleating approach. MATERIALS AND METHODS We present a detailed stepwise progressive technique developed in Madrid, Spain, for the complete removal of the transitional zone by vapoenucleation. The steps include exposition of the prostatic capsule by PVP toward the peripheral zone, thereby identifying the anatomical limits of enucleation. Subsequently, the transitional zone is excised in a single bloc and morcellated after its placement into the bladder. CONCLUSION This new GreenLight en bloc enucleation technique allows to treat larger prostates than those previously treated with the PVP technique.
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Mamoulakis C, Sofras F, de la Rosette J, Omar MI, Lam TBL, N'Dow JMO, Ubbink DT. Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2014. [DOI: 10.1002/14651858.cd009629.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Charalampos Mamoulakis
- University Hospital of Heraklion, University of Crete Medical School; Department of Urology; Heraklion Crete Greece
| | - Frank Sofras
- University Hospital of Heraklion, University of Crete Medical School; Department of Urology; Heraklion Crete Greece
| | - Jean de la Rosette
- Academic Medical Center, University of Amsterdam; Department of Urology; Amsterdam Netherlands
| | - Muhammad Imran Omar
- University of Aberdeen; Academic Urology Unit; Health Sciences Building (second floor) Foresterhill Aberdeen Scotland UK AB25 2ZD
| | - Thomas BL Lam
- University of Aberdeen; Academic Urology Unit; Health Sciences Building (second floor) Foresterhill Aberdeen Scotland UK AB25 2ZD
| | - James MO N'Dow
- NHS Grampian, Aberdeen Royal Infirmary; Urology Department; Foresterhill Aberdeen Scotland UK AB25 2ZN
| | - Dirk T Ubbink
- Academic Medical Centre, University of Amsterdam; Quality Assurance & Process Innovation, and Department of Surgery; J1b-215 Academic Medical Centre Meibergdreef 9, PO Box 22700 Amsterdam Netherlands 1100 DE
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Lahlaidi K, Ariane MM, Fontaine E. [Up-to-date on the treatment of benign prostatic hyperplasia. Which adenoma to treat and how to do it?]. Rev Med Interne 2013; 35:189-95. [PMID: 24262410 DOI: 10.1016/j.revmed.2013.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 10/03/2013] [Indexed: 11/18/2022]
Abstract
Benign prostatic hyperplasia is a state of the nature rather than a disease. It affects mainly men over 50 years and represents a public health problem. A literature review on the therapeutic management of benign prostatic hyperplasia was carried out from a selection of publications with the highest level of evidence. Medical treatment is based on herbal medicine, alpha-blockers and 5-alpha-reductase inhibitors. Surgical treatment is used in case of complications or failure of medical management. Surgical options are numerous. Transurethral prostate resection and prostate adenomectomy are the most usual procedures. Due to their significant morbidity, other less invasive procedures have recently been developed. The choice of treatment will depend on prostate volume and anatomy and patient's comorbidities.
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Affiliation(s)
- K Lahlaidi
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - M M Ariane
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - E Fontaine
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France.
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Omar MI, Lam TB, Alexander CE, Graham J, Mamoulakis C, Imamura M, Maclennan S, Stewart F, N'dow J. Systematic review and meta-analysis of the clinical effectiveness of bipolar compared with monopolar transurethral resection of the prostate (TURP). BJU Int 2013; 113:24-35. [PMID: 24053602 DOI: 10.1111/bju.12281] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
To compare monopolar and bipolar transurethral resection of the prostate (TURP) for clinical effectiveness and adverse events. We conducted an electronic search of MEDLINE, Embase, CENTRAL, Science Citation Index, and also searched reference lists of articles and abstracts from conference proceedings for randomised controlled trials (RCTs) comparing monopolar and bipolar TURP. Two reviewers independently undertook data extraction and assessed the risk of bias in the included trials using the tool recommended by the Cochrane Collaboration. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. From the 949 abstracts that were identified, 94 full texts were assessed for eligibility and a total of 24 trials were included in the review. No statistically significant differences were found in terms of International Prostate Symptom Score (IPSS) or health-related quality of life (HRQL) score. Results for maximum urinary flow rate were significant at 3, 6 and 12 months (all P < 0.001), but no clinically significant differences were found and the meta-analysis showed evidence of heterogeneity Bipolar TURP was associated with fewer adverse events including transurethral resection syndrome (risk ratio [RR] 0.12, 95% confidence interval [CI] 0.05-0.31, P < 0.001), clot retention (RR 0.48, 95% CI 0.30-0.77, P = 0.002) and blood transfusion (RR 0.53, 95% CI 0.35-0.82, P = 0.004) Several major methodological limitations were identified in the included trials; 22/24 trials had a short follow-up of ≤1 year, there was no evidence of a sample size calculation in 20/24 trials and the application of GRADE showed the evidence for most of the assessed outcomes to be of moderate quality, including all those in which statistical differences were found. Whilst there is no overall difference between monopolar and bipolar TURP for clinical effectiveness, bipolar TURP is associated with fewer adverse events and therefore has a superior safety profile. Various methodological limitations were highlighted in the included trials and as such the results of this review should be interpreted with caution. There is a need for further well-conducted, multicentre RCTs with long-term follow-up data.
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Lukacs B, Cornu JN, Aout M, Tessier N, Hodée C, Haab F, Cussenot O, Merlière Y, Moysan V, Vicaut E. Management of Lower Urinary Tract Symptoms Related to Benign Prostatic Hyperplasia in Real-life Practice in France: A Comprehensive Population Study. Eur Urol 2013; 64:493-501. [DOI: 10.1016/j.eururo.2013.02.026] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 02/16/2013] [Indexed: 11/25/2022]
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Mamoulakis C, Schulze M, Skolarikos A, Alivizatos G, Scarpa RM, Rassweiler JJ, de la Rosette JJ, Scoffone CM. Midterm Results from an International Multicentre Randomised Controlled Trial Comparing Bipolar with Monopolar Transurethral Resection of the Prostate. Eur Urol 2013; 63:667-76. [DOI: 10.1016/j.eururo.2012.10.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 10/05/2012] [Indexed: 11/28/2022]
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Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, N'dow J, Nordling J, de la Rosette JJ. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 2013; 64:118-40. [PMID: 23541338 DOI: 10.1016/j.eururo.2013.03.004] [Citation(s) in RCA: 817] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 03/01/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To present a summary of the 2013 version of the European Association of Urology guidelines on the treatment and follow-up of male lower urinary tract symptoms (LUTS). EVIDENCE ACQUISITION We conducted a literature search in computer databases for relevant articles published between 1966 and 31 October 2012. The Oxford classification system (2001) was used to determine the level of evidence for each article and to assign the grade of recommendation for each treatment modality. EVIDENCE SYNTHESIS Men with mild symptoms are suitable for watchful waiting. All men with bothersome LUTS should be offered lifestyle advice prior to or concurrent with any treatment. Men with bothersome moderate-to-severe LUTS quickly benefit from α1-blockers. Men with enlarged prostates, especially those >40ml, profit from 5α-reductase inhibitors (5-ARIs) that slowly reduce LUTS and the probability of urinary retention or the need for surgery. Antimuscarinics might be considered for patients who have predominant bladder storage symptoms. The phosphodiesterase type 5 inhibitor tadalafil can quickly reduce LUTS to a similar extent as α1-blockers, and it also improves erectile dysfunction. Desmopressin can be used in men with nocturia due to nocturnal polyuria. Treatment with an α1-blocker and 5-ARI (in men with enlarged prostates) or antimuscarinics (with persistent storage symptoms) combines the positive effects of either drug class to achieve greater efficacy. Prostate surgery is indicated in men with absolute indications or drug treatment-resistant LUTS due to benign prostatic obstruction. Transurethral resection of the prostate (TURP) is the current standard operation for men with prostates 30-80ml, whereas open surgery or transurethral holmium laser enucleation is appropriate for men with prostates >80ml. Alternatives for monopolar TURP include bipolar TURP and transurethral incision of the prostate (for glands <30ml) and laser treatments. Transurethral microwave therapy and transurethral needle ablation are effective minimally invasive treatments with higher retreatment rates compared with TURP. Prostate stents are an alternative to catheterisation for men unfit for surgery. Ethanol or botulinum toxin injections into the prostate are still experimental. CONCLUSIONS These symptom-oriented guidelines provide practical guidance for the management of men experiencing LUTS. The full version is available online (www.uroweb.org/gls/pdf/12_Male_LUTS.pdf).
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Affiliation(s)
- Matthias Oelke
- Department of Urology, Hannover Medical School, Hannover, Germany
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Herrmann TRW, Liatsikos EN, Nagele U, Traxer O, Merseburger AS. [European Association of Urology guidelines on laser technologies]. Actas Urol Esp 2013; 37:63-78. [PMID: 22989380 DOI: 10.1016/j.acuro.2012.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 05/22/2012] [Indexed: 12/14/2022]
Abstract
CONTEXT The European Association of Urology (EAU) Guidelines Office has set up a guideline working panel to analyse the scientific evidence published in the world literature on lasers in urologic practice. OBJECTIVE Review the physical background and physiologic and technical aspects of the use of lasers in urology, as well as current clinical results from these new and evolving technologies, together with recommendations for the application of lasers in urology. The primary objective of this structured presentation of the current evidence base in this area is to assist clinicians in making informed choices regarding the use of lasers in their practice. EVIDENCE ACQUISITION Structured literature searches using an expert consultant were designed for each section of this document. Searches were carried out in the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Medline and Embase on the Dialog/DataStar platform. The controlled terminology of the respective databases was used, and both Medical Subject Headings and EMTREE were analysed for relevant entry terms. One Cochrane review was identified. EVIDENCE SYNTHESIS Depending on the date of publication, the evidence for different laser treatments is heterogeneous. The available evidence allows treatments to be classified as safe alternatives for the treatment of bladder outlet obstruction in different clinical scenarios, such as refractory urinary retention, anticoagulation, and antiplatelet medication. Laser treatment for bladder cancer should only be used in a clinical trial setting or for patients who are not suitable for conventional treatment due to comorbidities or other complications. For the treatment of urinary stones and retrograde endoureterotomy, lasers provide a standard tool to augment the endourologic procedure. CONCLUSIONS In benign prostatic obstruction (BPO), laser vaporisation, resection, or enucleation are alternative treatment options. The standard treatment for BPO remains transurethral resection of the prostate for small to moderate size prostates and open prostatectomy for large prostates. Laser energy is an optimal treatment method for disintegrating urinary stones. The use of lasers to treat bladder tumours and in laparoscopy remains investigational.
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Affiliation(s)
- T R W Herrmann
- Departamento de Urología y Uro-oncología, Medical School of Hanover (MHH), Hanover, Alemania.
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40
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Eraser Laser Enucleation of the Prostate: Technique and Results. Eur Urol 2013; 63:341-6. [DOI: 10.1016/j.eururo.2012.08.049] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 08/23/2012] [Indexed: 11/18/2022]
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Bostanci Y, Kazzazi A, Djavan B. Laser prostatectomy: holmium laser enucleation and photoselective laser vaporization of the prostate. Rev Urol 2013; 15:1-10. [PMID: 23671400 PMCID: PMC3651537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Historically, transurethral resection of the prostate has been the gold standard for the treatment of benign prostatic hyperplasia (BPH). Laser technology has been used to treat BPH for > 15 years. Over the past decade, it has gained wide acceptance by experienced urologists. This review provides an evidence-based update on laser surgery for BPH with a focus on photoselective laser vaporization and holmium laser enucleation of the prostate surgeries and assesses the safety, efficacy, and durability of these techniques.
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Affiliation(s)
- Yakup Bostanci
- Department of Urology, New York University School of Medicine, New York, NY
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Sugihara T, Yasunaga H, Horiguchi H, Nakamura M, Nishimatsu H, Kume H, Ohe K, Matsuda S, Homma Y. In-hospital outcomes and cost assessment between bipolar versus monopolar transurethral resection of the prostate. J Endourol 2012; 26:1053-8. [PMID: 22296567 PMCID: PMC3412058 DOI: 10.1089/end.2011.0592] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We compared the in-hospital outcomes between bipolar and monopolar transurethral resection of the prostate (B-TURP and M-TURP, respectively) on a real-world practice using a large database. PATIENTS AND METHODS Patients who underwent TURP were extracted from the Diagnosis Procedure Combination database, which is a case-mix administrative claims database in Japan. TURP procedures were classified into M-TURP and B-TURP groups according to intraoperative use or nonuse of D-sorbitol solution, respectively, which is the only nonelectrolyte bladder irrigation fluid for M-TURP available in Japan. To exclude causality among autologous and homologous transfusion events, we confined eligible hospitals to those in which no autologous blood preparation was undertaken for TURP and whose annual surgical caseloads were 15 cases or more. Multivariate analyses were conducted for homologous transfusion, postoperative complications, operative time, postoperative length of stay, and total costs. RESULTS There were 5155 M-TURP and 1531 B-TURP patients identified. The results for M-TURP vs B-TURP (effect sizes were evaluated with reference to M-TURP) were 2.3% vs 1.3% for transfusion (odds ratio [OR]=0.54; P=0.013), 3.3% vs 1.7% for postoperative complications (OR=0.46; P<0.01), 98 vs 116 minutes for operative time (20.5% increase; P<0.001), 8.65 vs 8.45 days for postoperative stay (3.6% reduction; P=0.003), and $6103 vs $6062 for cost (1.7% reduction; P=0.018). CONCLUSION B-TURP had significantly lower rates of transfusion and postoperative complications, but a longer operative time. The impacts of B-TURP on shortening the hospital stay and lowering the costs were of little clinical significance.
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Affiliation(s)
- Toru Sugihara
- Department of Urology, Shintoshi Hospital, Iwata, Japan.
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Thangasamy IA, Chalasani V, Bachmann A, Woo HH. Photoselective Vaporisation of the Prostate Using 80-W and 120-W Laser Versus Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia: A Systematic Review with Meta-Analysis from 2002 to 2012. Eur Urol 2012; 62:315-23. [DOI: 10.1016/j.eururo.2012.04.051] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 04/24/2012] [Indexed: 10/28/2022]
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Barski D, Richter M, Winter C, Arsov C, de Geeter P, Rabenalt R, Albers P. Holmium laser ablation of the prostate (HoLAP): intermediate-term results of 144 patients. World J Urol 2012; 31:1253-9. [PMID: 22782618 DOI: 10.1007/s00345-012-0901-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 06/21/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To retrospectively analyse the intermediate-term outcome of holmium laser ablation of the prostate (HoLAP) of up to 4 years postoperatively in one of the largest series and to define the selection criteria for patients who benefit from potentially lower complications associated with HoLAP. METHODS Between June 2006 and November 2010, 144 patients with benign prostatic obstruction were treated at two centres with standardised HoLAP (2.0 J/50 Hz or 3.2 J/25 Hz with Versapulse(®) 80-100 W laser Lumenis(®)). Median follow-up was 21 months (range, 1-54). International prostate symptom score and quality of life (IPSS-QoL), PSA, prostate volume, maximal flow rate (Qmax), postvoiding residual volume (Vres) were evaluated pre- and postoperatively. All complications were graded according to CTCAE (v4.03). RESULTS Mean patient age was 70.1 ± 7.7 years (range, 46-90). With a preoperative median prostate volume of 40 ml (range, 10-130), the median operation time was 50 min (range, 9-138). We observed a median catheterisation time of 1 day (range, 0-12) and hospitalisation time of 2 days (range, 1-16). IPSS-QoL, Qmax and Vres were significantly improved after 3 months, and all parameters remained unchanged after 12, 24 and 36 months. The rate of re-operation was significantly lower in patients with prostate volume <40 ml, compared to patients with prostates ≥ 40 ml (9.1 vs. 25 %, p = 0.04). CONCLUSIONS HoLAP is a safe and effective procedure for the treatment of prostates <40 ml. Patients benefit from HoLAP because of a low bleeding rate and short hospital stay. Due to high recurrence rates, HoLAP should be avoided in prostates >40 ml.
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Affiliation(s)
- D Barski
- Department of Urology, Duesseldorf University Hospital, Moorenstrasse 5, 40225, Düsseldorf, Germany,
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Elshal AM, Elmansy HM, Elhilali MM. Feasibility of holmium laser enucleation of the prostate (HoLEP) for recurrent/residual benign prostatic hyperplasia (BPH). BJU Int 2012; 110:E845-50. [DOI: 10.1111/j.1464-410x.2012.11290.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Laser prostatectomy of lower urinary tract symptoms due to benign prostate enlargement: a critical review of evidence. Curr Opin Urol 2012; 22:22-33. [PMID: 22123291 DOI: 10.1097/mou.0b013e32834dd0ed] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Different transurethral prostatic laser systems are available. In 2011, new Oxford evidence levels (LoEs) were published with significant changes compared with the former version. They are easier to use and incorporate more clinical aspects. Randomized trials of laser systems used before 2002, except Holmium laser, were not included in this critical evidence analysis, as these techniques are not in clinical use any more. RECENT FINDINGS Twenty-five [18 Holmium enucleation of the prostate (HoLEP) and seven photoselective vaporization of the prostate (PVP)] randomized trials covering transurethral electroresection of the prostate or HoLEP, PVP or Thulium laser enucleation were identified. According to evidence levels, there is a large gap in terms of long-term follow-up. The majority of randomised controlled trials are of low quality. Typically with HoLEP, many articles were published covering the same patient population (LoE II). Only one randomised controlled trial was published with Tm:YAG prostatectomy (LoE II) and none with diode lasers (980-1340 nm, LoE IV-V). Large cohort studies (LoE III-IV) provide additional evidence for PVP and HoLEP, typically for subgroups. SUMMARY In 2011, higher evidence on HoLEP and PVP has been published. Evidence levels for HoLEP and PVP are comparable with meta-analysis (LoE II). However, evidence that laser prostatectomy is better than transurethral electroresection of the prostate in terms of efficacy is lacking (LoE II). All lasers are safer in terms of perioperative bleeding (LoE II).
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Mamoulakis C, Sofras F, de la Rosette J, Omar MI, Lam TBL, N'Dow JMO, Ubbink DT. Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009629] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Herrmann TRW, Liatsikos EN, Nagele U, Traxer O, Merseburger AS. EAU guidelines on laser technologies. Eur Urol 2012; 61:783-95. [PMID: 22285403 DOI: 10.1016/j.eururo.2012.01.010] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 01/09/2012] [Indexed: 11/29/2022]
Abstract
CONTEXT The European Association of Urology (EAU) Guidelines Office has set up a guideline working panel to analyse the scientific evidence published in the world literature on lasers in urologic practice. OBJECTIVE Review the physical background and physiologic and technical aspects of the use of lasers in urology, as well as current clinical results from these new and evolving technologies, together with recommendations for the application of lasers in urology. The primary objective of this structured presentation of the current evidence base in this area is to assist clinicians in making informed choices regarding the use of lasers in their practice. EVIDENCE ACQUISITION Structured literature searches using an expert consultant were designed for each section of this document. Searches were carried out in the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Medline and Embase on the Dialog/DataStar platform. The controlled terminology of the respective databases was used, and both Medical Subject Headings and EMTREE were analysed for relevant entry terms. One Cochrane review was identified. EVIDENCE SYNTHESIS Depending on the date of publication, the evidence for different laser treatments is heterogeneous. The available evidence allows treatments to be classified as safe alternatives for the treatment of bladder outlet obstruction in different clinical scenarios, such as refractory urinary retention, anticoagulation, and antiplatelet medication. Laser treatment for bladder cancer should only be used in a clinical trial setting or for patients who are not suitable for conventional treatment due to comorbidities or other complications. For the treatment of urinary stones and retrograde endoureterotomy, lasers provide a standard tool to augment the endourologic procedure. CONCLUSIONS In benign prostatic obstruction (BPO), laser vaporisation, resection, or enucleation are alternative treatment options. The standard treatment for BPO remains transurethral resection of the prostate for small to moderate size prostates and open prostatectomy for large prostates. Laser energy is an optimal treatment method for disintegrating urinary stones. The use of lasers to treat bladder tumours and in laparoscopy remains investigational.
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Affiliation(s)
- Thomas R W Herrmann
- Department of Urology and Urooncology, Medical School of Hanover [MHH], Hanover, Germany.
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Yee CLS, Pal RP, Batchelder A, Khan MA. Risk of erectile dysfunction and retrograde ejaculation associated with thulium laser vaporesection of the prostate for bladder outflow obstruction: a retrospective study. Urol Int 2012; 88:165-9. [PMID: 22237486 DOI: 10.1159/000333046] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 09/09/2011] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this study was to determine the incidence of erectile dysfunction and retrograde ejaculation following thulium:yttrium-aluminium-garnet (Tm:YAG) laser prostate vaporesection (ThuVaRP). PATIENTS AND METHODS Between January 2009 and June 2010, 113 consecutive patients underwent ThuVaRP for bladder outflow obstruction. Of these, 54 (48%) were included in the study as they were able to maintain an erection for sexual intercourse prior to undergoing ThuVaRP. All patients had benign pathology and had not undergone previous bladder neck surgery. The incidence of erectile dysfunction and retrograde ejaculation was reported at a mean follow-up period of 12 months post-operatively. RESULTS The mean patient age was 71 years (range 46-90). The mean follow-up period was 12 months (range 4-21). 11 (20%) patients experienced worsening erectile function with 3 (6%) noticing an improvement. A total of 30 patients (56%) experienced some degree of retrograde ejaculation. 4 patients (7%) noticed an improvement in their ejaculation. Retrograde ejaculation was more common in patients with an indwelling catheter in situ for refractory urinary retention (43 vs. 17%, p = 0.04) and in diabetic patients (27 vs. 4%, p = 0.03). There was an increased trend of erectile dysfunction in men aged ≥70 years, with hypertension and with hypercholesterolaemia, but this was not significant. CONCLUSION Our retrospective study has demonstrated that the overall risk of erectile dysfunction and retrograde ejaculation associated with ThuVaRP is 20 and 56%, respectively.
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Affiliation(s)
- Carol Ling Sze Yee
- Department of Urology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
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Biester K, Skipka G, Jahn R, Buchberger B, Rohde V, Lange S. Systematic review of surgical treatments for benign prostatic hyperplasia and presentation of an approach to investigate therapeutic equivalence (non-inferiority). BJU Int 2011; 109:722-30. [DOI: 10.1111/j.1464-410x.2011.10512.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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