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Chen YY, Hua WX, Huang YH, Shen XY, You JN, Ding X. The safety and efficacy of five surgical treatments in prostate enucleation: a network meta-analysis. BMC Urol 2024; 24:128. [PMID: 38886739 PMCID: PMC11181543 DOI: 10.1186/s12894-024-01517-5] [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: 01/10/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
PURPOSE The aim of our study was to investigate the comparative outcomes of five different energy types on surgical efficacy and postoperative recovery in patients with benign prostate hyperplasia. METHODS The literature was systematically reviewed on December 1st, 2023, encompassing studies retrieved from PubMed, Embase, Web of Science, and The Cochrane Library databases that incorporated clinical studies of holmium laser enucleation of the prostate (HoLEP), Thulium:YAG laser enucleation of the prostate (ThuLEP), transurethral plasmakinetic enucleation of prostate (PKEP), diode laser enucleation of the prostate (DiLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP) in the treatment of prostatic hyperplasia. Two independent reviewers extracted study data and conducted quality assessments using the Cochrane Collaboration's Risk of Bias tool and Newcastle-Ottawa Scale (NOS). Network meta-analysis (NMA) was employed to indirectly analyze the outcomes of endoscopic enucleation of the prostate (EEP) techniques. RESULTS The study included a total of 38 studies, comprising 21 non-randomized controlled trials (nRCTs) and 17 randomized controlled trials (RCTs), incorporating five distinct techniques: holmium laser, Thulium:YAG laser, bipolar plasma, diode laser and thulium fiber laser. In comparing treatment durations, ThuLEP and HoLEP had shorter overall hospital stays than PKEP, while the enucleation time of ThuLEP and HoLEP was shorter than that of ThuFLEP. Moreover, the enucleation tissue weight of both thulium fiber laser and holmium laser was heavier than bipolar plasma. However, the analysis did not reveal any statistically significant variation in complications among the various types of enucleation. In postoperative follow-up, the IPSS at 3 months post-operation was superior in the Thulium:YAG laser group compared to the holmium laser group. The thulium fiber laser technique demonstrated significant advantages over other enucleation methods in terms of QoL and PVR at 12 months after surgery. CONCLUSION Theoretical properties may vary among different energy sources; however, there are no discernible clinical differences in operation-related parameters, postoperative complications, and postoperative follow-up. Therefore, the choice of laser does not significantly impact the outcome. However, due to the limited number of included studies, future research should focus on larger sample sizes and multicenter investigations to further validate the findings of this study.
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Affiliation(s)
- Yun-Yi Chen
- Department of Urinary Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
| | - Wen-Xi Hua
- Department of Hematopathology, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, China
| | - Yu-Hua Huang
- Department of Urinary Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
| | - Xin-Yu Shen
- Department of Urinary Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
| | - Jia-Nan You
- Department of Urinary Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
| | - Xiang Ding
- Department of Urinary Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China.
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Aybal HC, Yilmaz M, Barlas IS, Duvarci M, Tuncel A, Tunc L. Comparison of HoLEP, ThuLEP and ThuFLEP in the treatment of benign prostatic obstruction: a propensity score-matched analysis. World J Urol 2024; 42:374. [PMID: 38871959 DOI: 10.1007/s00345-024-05082-2] [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: 03/30/2024] [Accepted: 05/23/2024] [Indexed: 06/15/2024] Open
Abstract
PURPOSE To compare the efficacy and safety of Holmium laser enucleation of the prostate (HoLEP), Thulium laser enucleation of prostate (ThuLEP) and Thulium fibre laser enucleation of prostate (ThuFLEP) by performing propensity score matched analysis (PSM). METHODS We retrospectively analysed the patients who underwent HoLEP (Group 1, n = 696), ThuLEP (Group 2, n = 146) and ThuFLEP (Group 3, n = 193) surgery because of benign prostatic obstruction (BPO). A 1:1:1 HoLEP: ThuLEP: ThuFLEP group matching was performed using PSM analysis. Perioperative, postoperative functional outcomes and complications were analysed and compared. RESULTS We observed significant improvement in functional parameters regarding IPSS, Qmax, PVR and quality of life in all groups compared to baseline values at the 1st, 6th and 12th postoperative months. There was no significant difference between different laser types in terms of urge (UUI) and stress urinary incontinence (SUI) at 1st postoperative month. In all three groups, no patient had postoperative SUI or UUI at 6th and 12th postoperative months. In addition, no significant difference was observed between laser types in terms of postoperative complications. CONCLUSION HoLEP, ThuLEP and ThuFLEP are safe and effective LEP methods with improvement in functional parameters and low complication rates. Similar results in terms of functional outcomes and complications clearly show that these surgeries are alternatives to each other for the patients with BPO. Experts' opinions, practices and enucleation techniques should also be taken into consideration when choosing a laser for BPO surgery.
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Affiliation(s)
| | - Mehmet Yilmaz
- Department of Urology, SLK Kliniken Heilbronn, Heilbronn, Germany.
| | - Irfan Safak Barlas
- Department of Urology, Acıbadem University Ankara Hospital, Ankara, Turkey
| | - Mehmet Duvarci
- Department of Urology, University of Health Sciences, Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Altug Tuncel
- Ankara Bilkent City Hospital, Department of Urology, University of Health Sciences, Ankara, Turkey
| | - Lutfi Tunc
- Department of Urology, Acıbadem University Ankara Hospital, Ankara, Turkey
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Gross AJ, Rosenbaum C, Becker B, Netsch C. [Development of endoscopic enucleation of the prostate]. Aktuelle Urol 2024; 55:207-212. [PMID: 38599594 DOI: 10.1055/a-2286-1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
This article deals with lasers from their initial description to the most advanced applications in the treatment of benign prostate enlargement.
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Affiliation(s)
- Andreas J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
| | | | - Benedikt Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
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Öztürk H. A novel technique for thulium laser enucleation of the prostate: anterior releasing with ThuLEP (ARTh technique). Lasers Med Sci 2024; 39:126. [PMID: 38714553 PMCID: PMC11076363 DOI: 10.1007/s10103-024-04071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/29/2024] [Indexed: 05/10/2024]
Abstract
Thulium laser enucleation of the prostate (ThuLEP) is a highly effective approach to the treatment of benign prostatic hyperplasia. We present here a description of the "ARTh Technique" and the benefits it offers in terms of improved visualization, short operation times, and easy recognition of the dissection plane, describing specifically the anterior release (AR) technique using ThuLEP(Th). Included in this retrospective study were 32 consecutive patients operated on between January 2022-November 2022. Parameters were measured before and after the procedure: the International Prostate Symptom Score(IPSS), maximum flow rate(Qmax), post-void residual urine(PVR) prostate-specific antigen(PSA), prostate volume, operation-time, morcellation-time, catheterization-time and presence of transient urinary incontinence, and compared. The median age of patients undergoing enucleation of the prostate using the ARTh technique was 64 years (range: 44-83). The median prostate volume of the patients was 83.5 ml(50-128 ml), preoperative-IPSS was 24.8(15-33), postoperative-IPSS was 7(5-11), preoperative-Qmax was 8.1 ml/Sects. (5-11.5 ml/sec), postoperative-Qmax was 26.9 ml/Sect. (20.8-34 ml/sec), preoperative-PVR was 145 ml(75-258 ml), postoperative-PVR was 36.2 ml(0-66 ml), total operation time was 51.4 min(28-82 min), enucleation time was 36.9 min(19-51 min) and morcellation time was 15.3 min(8-27 min). The ARTh technique is a safe procedure that allows the surgeon to easily recognize and adhere to the defined dissection plane, thus decreasing operation times, significantly reducing the rate of postoperative transient urinary incontinence (TUI).
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Affiliation(s)
- Hakan Öztürk
- Department of Urology, Izmir University of Economics, Izmir, Turkey.
- Izmir University of Economics Medicalpoint Hospital, Yeni Girne Boulevard 1825 St. No: 12, Karsiyaka-Izmir, 35350, Turkey.
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Perri D, Pacchetti A, Morini E, Besana U, Mazzoleni F, Verzotti E, Maltagliati M, Romero-Otero J, Pastore AL, Broggini P, Rocco B, Gozen AS, Kallidonis P, Bozzini G. Evaluation of the learning curve for Thulium laser enucleation of the prostate in a contemporary cohort. World J Urol 2024; 42:246. [PMID: 38643250 DOI: 10.1007/s00345-024-04958-7] [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: 12/12/2023] [Accepted: 03/25/2024] [Indexed: 04/22/2024] Open
Abstract
PURPOSE To assess the learning curve of Thulium laser enucleation of the prostate (ThuLEP) of a single surgeon. METHODS Hundred patients suffering from benign prostatic hyperplasia were treated by the same surgeon. In all cases, a well-trained urologist was present in the operating room. Patients urinary function was assessed preoperatively using the International Prostate Symptoms Score (IPSS), maximum flow rate and Post-Void Residual volume. Preoperative prostate volume was recorded. Enucleation and morcellation efficiency and complication rate were evaluated. Patients were divided into 5 cohorts of 20 consecutive cases to assess changes in outcomes through time. RESULTS Mean age of patients was 73.1 years (SD 17.5) and mean prostate volume was 89.7 ml (SD 55.1). Overall, mean enucleation and morcellation efficiency were 1.7 (SD 2.9) and 5.1 (SD 2.7) g/min. A statistically significant increase in enucleation efficiency was observed when comparing cohort 1 vs 2 (0.9 vs 1.3 g/min, p = 0.03) and cohort 2 vs 3 (1.3 vs 1.7 g/min, p = 0.02). A statistically significant increase in morcellation efficiency was observed when comparing cohort 1 vs 2 (2.8 vs 3.7 g/min, p = 0.02) and cohort 2 vs 3 (3.7 vs 4.9 g/min, p = 0.03). In both cases, no significant differences were observed when comparing the following cohorts. Complication rate showed no significant differences throughout the caseload. CONCLUSIONS In our single-surgeon experience, we observed a learning curve of nearly 60 cases for the ThuLEP procedure in presence of a well-trained surgeon. Complication rate was low from the beginning of surgical experience.
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Affiliation(s)
- D Perri
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy.
| | - A Pacchetti
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
| | - E Morini
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
| | - U Besana
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
| | - F Mazzoleni
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
| | - E Verzotti
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
| | - M Maltagliati
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
| | - J Romero-Otero
- Department of Urology, Hospital Universitario, 12 De Octubre, Madrid, Spain
| | - A L Pastore
- Department of Urology, Sapienza University, Rome, Italy
| | - P Broggini
- Sant'Anna Clinic, Lugano, Swiss, Switzerland
| | - B Rocco
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
| | - A S Gozen
- Department of Urology, SLK-Kliniken Heilbronn, Heilbronn, Germany
| | - P Kallidonis
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - G Bozzini
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
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Dalton DC, Shelton TM, Rivera M. Laser Technology Advancements in the Treatment of Benign Prostatic Hypertrophy. Curr Urol Rep 2024; 25:71-78. [PMID: 38349464 DOI: 10.1007/s11934-024-01197-6] [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] [Accepted: 01/23/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE OF REVIEW Lasers have had a significant impact on the treatment of benign prostatic hypertrophy. This article attempts to distill the advancements in laser technology for the treatment of benign prostatic hypertrophy (BPH) into key and understandable points to help make this topic more accessible to urologists. RECENT FINDINGS The holmium:yttrium-aluminum-garnet (YAG) laser, one of the most significant lasers in the field of urology, has recently been improved with pulse modulating technology (Moses™ technology). New thulium:YAG technology allows both pulsed and continuous wave modes. The thulium fiber laser is one of the newer lasers to come to market and has been shown to have effective and safe outcomes. GreenLight™ lasers are predominantly used in photovaporization procedures and have also been studied extensively, although less in recent years. The modern urologist is fortunate to have many high-quality lasers and a wide variety of surgical techniques to choose from when treating BPH. Understanding the basic laser principles and applications will help urologists to select the best treatment options for their patients with BPH.
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Affiliation(s)
- David C Dalton
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
| | - T Max Shelton
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Marcelino Rivera
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
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Omar M, Abdullah MM, Moustafa A, Sultan S. Thirty versus 60-Watt thulium laser enucleation of prostate: Toward the development of low-power anatomical enucleation of the prostate. Urol Ann 2024; 16:129-132. [PMID: 38818432 PMCID: PMC11135353 DOI: 10.4103/ua.ua_159_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/20/2023] [Indexed: 06/01/2024] Open
Abstract
Introduction We aimed to study whether using 30 W versus 60 W thulium enucleation of the prostate (ThuLEP) would affect postoperative outcomes in patients with benign prostatic hyperplasia (BPH). Materials and Methods We prospectively identified male patients with moderate or severe lower urinary tract symptoms due to BPH. We randomized patients into 30 W (Group 1) or 60 W (Group 2) thulium yag laser with a 550 μm laser fiber and a 26 Fr continuous flow resectoscope. We collected data related to prostate size, enucleation time, morcellation time, laser time, perioperative complications, and 1-year functional outcomes. Results A total of 120 patients were included, with a mean age of 67 years and a mean prostate size of 105 g. The preoperative characteristics were similar across both groups. The mean operative time was shorter in the 60 W group, 74 ± 27 vs. 91 ± 33 min in the 30 W group (P = 0.001), and the mean laser time was 55 ± 20 in 60 W versus 71 ± 25 in 30 W (P = 0.0001). The mean hospital stay was 1 day in both groups and at 1-year follow-up; there was a similar improvement in mean Qmax and International Prostate Symptom Score symptom scores. Discussion/Conclusion Both 30 and 60 W ThuLEP provided a safe and comparable outcome with a relatively shorter operative time for the 60 W groups. Perhaps using a 30-W setting would be beneficial in the early learning curve or cases with more bleeding capsular perforators; besides, the financial benefit of manufacturing low-cost low-power devices that may help in the widespread of AEEP.
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Affiliation(s)
- Mohamed Omar
- Department of Urology, Menoufia University, Shebeen El Kom, Menoufia, Egypt
| | | | - Ahmed Moustafa
- Department of Urology, Menoufia University, Shebeen El Kom, Menoufia, Egypt
| | - Sultan Sultan
- Department of Urology, Menoufia University, Shebeen El Kom, Menoufia, Egypt
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Spinos T, Tatanis V, Peteinaris A, Somani B, Kartalas Goumas I, Liatsikos E, Kallidonis P. Thulium fiber laser enucleation of the prostate: a systematic review of the current outcomes. Minerva Urol Nephrol 2024; 76:157-165. [PMID: 38742551 DOI: 10.23736/s2724-6051.24.05654-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
INTRODUCTION One recent addition to different lasers used for endoscopic enucleation of the prostate is the thulium fiber laser (TFL). The purpose of this systematic review is to present the feasibility, safety and efficacy of TFL Enucleation of the Prostate (ThuFLEP). EVIDENCE ACQUISITION PubMed®, Scopus® and Cochrane® primary databases were systematically screened. The search strategy used the PICO (Patients, Intervention, Comparison, Outcome) criteria. Patients should be adults with benign prostatic obstruction (BPO) undergoing ThuFLEP. While comparative studies reporting comparison of ThuFLEP to other BPO treatments were included, cohort studies with no comparison group were also accepted. Outcomes including enucleation time and complication rates were reported. EVIDENCE SYNTHESIS Twelve studies met all the predefined criteria and were included in the final qualitative synthesis. Mean operative time and enucleation time ranged from 46.6±10.2 to 104.5±33.6 and from 38.8±17.9 to 66.0±24.9 minutes, respectively. Most of the complications were Grade I or Grade II ones. Although TFL was found to present some advantages over older BPO treatments, its outcomes were comparable with other endoscopic enucleation approaches. CONCLUSIONS ThuFLEP seems to be a feasible, safe and efficient approach for BPO symptoms management. Limited evidence showed that although ThuFLEP was associated with a reduced total operative time, it was also associated with worse IPSS improvement at 1-year follow-up, when compared with MOSESTM Holmium Laser Enucleation of the Prostate (HoLEP). These findings confirm the well-established opinion that the enucleation technique itself is more important than the technology which is used.
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Affiliation(s)
- Theodoros Spinos
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - Vasileios Tatanis
- Department of Urology, University Hospital of Patras, Patras, Greece
| | | | - Bhaskar Somani
- Department of Urology, University Hospital of Southampton, Southampton, UK
| | | | - Evangelos Liatsikos
- Department of Urology, University Hospital of Patras, Patras, Greece
- Department of Urology, Medical University of Vienna, Vienna, Austria
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AlShammari A, Benzouak T, Khogeer A, AlHaidey R, Arezki A, Fahmy N, Andonian S, Carrier S, Aubé-Peterkin M, Hamouche F. Understanding current ergonomics setup for urologists conducting anatomical endoscopic enucleation of the prostate surgeries: Survey analysis from the endourological society. Am J Surg 2024:S0002-9610(24)00157-0. [PMID: 38448320 DOI: 10.1016/j.amjsurg.2024.02.044] [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: 12/15/2023] [Revised: 02/19/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Ensuring ergonomic posture and safety for surgeons is key to preventing work-related injuries and promoting sustained practice. We evaluated ergonomic aspects of Anatomic Endoscopic Enucleation of the Prostate (AEEP) and its relation to musculoskeletal injuries. METHOD A two-month online survey involving 119 Endourological Society members provided an in-depth analysis of AEEP practices and their musculoskeletal impacts. RESULTS The sample experienced general (65.5%), back (32.8%), neck (35.3%) and shoulder (37%) pain. Female AEEP surgeons reported greater back pain. Experience and age were inversely related to MSK injuries, and operative times over 2 h increased back pain. AEEP procedures predominantly involved sitting (86%) on backless stools (58%), with most surgeons wearing protective eyewear (75.6%) and using large resectoscopes (76.5%). Monitors were usually above eye-level (57%) and beyond 1 m (68.9%). CONCLUSION Musculoskeletal complaints are prevalent among AEEP endourologists. More awareness and further studies on risk factors are necessary to limit work-related injuries in urology.
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Affiliation(s)
- Ahmad AlShammari
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada.
| | - Tarek Benzouak
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Abdulghani Khogeer
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada; Department of Surgery, Faculty of Medicine, Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rakan AlHaidey
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Adel Arezki
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Nader Fahmy
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Sero Andonian
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Serge Carrier
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Mélanie Aubé-Peterkin
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
| | - Fadl Hamouche
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal QC, Canada
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Gamal Eldin A, Abdallah M, Fouad A, Omar M. Evaluation of early apical release with bipolar Collins knife versus Thulium-Yag laser enucleation of large-sized prostate. A randomized study. Arab J Urol 2024; 22:179-185. [PMID: 38818261 PMCID: PMC11136459 DOI: 10.1080/20905998.2024.2321737] [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: 12/08/2023] [Accepted: 02/17/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction and objectives Anatomical endoscopic enucleation of the prostate (AEEP) provides durable management for patients with lower urinary tract symptoms (LUTS) secondary to large-sized prostate over other surgical modalities. We aimed to assess the early outcomes of Collins knife-assisted bipolar enucleation (BipolEP) versus Thulium-Yag enucleation (ThuLEP) in a group of patients with LUTS secondary to a prostate larger than 80 grams. Methods We included patients with benign prostatic hyperplasia (BPH) having a prostate volume > 80 grams, international prostate symptom score (IPSS) >7, urine flow (Q-max) <15, and post-void residual (PVR)>150 ml. We excluded those with a history of previous prostatic surgery, stone, or neurogenic bladder. Bipolar enucleation with early apical release was performed using Collins knife at an 80/100-watt setting (Lamidey Noury), while ThuLEP was conducted using 550- micron fiber and 40/15-watt energy (Lisa Laser). Patients were evaluated before then 2 weeks and 3, 6,12 months postoperatively for changes in IPSS, Q- max, PVR, and the incidence of stress incontinence. Result One hundred and twenty patients were equally randomized with a mean prostate size of 104 ± 25 gram. The mean IPSS score was 25 ± 6, Qmax 7.6 ± 1.3 mL/S, and PVR 225 ± 39. There was no significant difference regarding enucleation time, morcellation time, and enucleated tissue volume. Irrigation volume and post-operative hemoglobin drop were significantly lower in the bipolar group (p = 0.008, p = 0.0002), respectively. At the third-month follow-up, IPSS, Q-max, and PVR were comparable across both groups, with stress incontinence at 3.3% in the bipolar group versus 1.6% in the thulium group, showing an insignificant difference (p = 0.5)." Conclusion Both BipolEP and ThuLEP, with early apical release, provide a safe and effective management of large-size prostate resulting in significant decrease in post-operative stress incontinence incidence during early follow-up. Intraoperative irrigation saline volume, and post-operative hemoglobin drop favored the bipolar group.
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Affiliation(s)
- Ahmed Gamal Eldin
- Faculty of Medicine, Urology Department, Menoufia University, Shibin el Kom, Egypt
| | - Mohammed Abdallah
- Faculty of Medicine, Urology Department, Menoufia University, Shibin el Kom, Egypt
| | - Ahmed Fouad
- Faculty of Medicine, Urology Department, Menoufia University, Shibin el Kom, Egypt
| | - Mohammed Omar
- Faculty of Medicine, Urology Department, Menoufia University, Shibin el Kom, Egypt
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Gauhar V, Nedbal C, Castellani D, Fong KY, Sofer M, Socarrás MR, Tursunkulov AN, Ying LK, Elterman D, Mahajan A, Petov V, Ivanovich SN, Bhatia TP, Enikeev D, Gadzhiev N, Chiruvella M, Teoh JYC, Galosi AB, Sancha FG, Somani BK, Herrmann TRW. Comparison Between Thulium Fiber Laser and High-power Holmium Laser for Anatomic Endoscopic Enucleation of the Prostate: A Propensity Score-matched Analysis from the REAP Registry. Eur Urol Focus 2024; 10:182-188. [PMID: 37414615 DOI: 10.1016/j.euf.2023.06.009] [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: 05/04/2023] [Revised: 05/31/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Different lasers have been developed for treatment of benign prostatic hyperplasia, with no definitively superior technique identified to date. OBJECTIVE To compare surgical and functional enucleation outcomes in real-world multicentre practice using high-power holmium laser (HP-HoLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP) for different prostate sizes. DESIGN, SETTING, AND PARTICIPANTS The study included 4216 patients who underwent HP-HoLEP or ThuFLEP at eight centers in seven countries between 2020 and 2022. Exclusion criteria were previous urethral or prostatic surgery, radiotherapy, or concomitant surgery. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS To adjust for the bias arising from different characteristics at baseline, propensity score matching (PSM) was used to identify 563 matched patients in each cohort. Outcomes included the incidence of postoperative incontinence, early complications (30-d), and delayed complications, and results for the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and postvoid residual volume (PVR). RESULTS AND LIMITATIONS After PSM, 563 patients in each arm were included. Total operative time was similar between the arms, but enucleation and morcellation times were significantly longer for ThuFLEP. The rate of postoperative acute urinary retention was higher in the ThuFLEP arm (3.6% vs 0.9%; p = 0.005), but the 30-d readmission rate was higher in the HP-HoLEP arm (22% vs 8%; p = 0.016). There was no difference in postoperative incontinence rates (HP-HoLEP:19.7%, ThuFLEP:16.0%; p = 0.120). Rates of other early and delayed complications were low and comparable between the arms. The ThuFLEP group had higher Qmax (p < 0.001) and lower PVR (p < 0.001) than the HP-HoLEP group at 1-yr follow-up. The study is limited by its retrospective nature. CONCLUSIONS This real-world study shows that early and delayed outcomes of enucleation with ThuFLEP are comparable to those with HP-HoLEP, with similar improvements in micturition parameters and IPSS. PATIENT SUMMARY As lasers become readily available for the treatment of enlarged prostates causing urinary bother, urologists should focus on performing good anatomic removal of prostate tissue, with the choice of laser not as important for good outcomes. Patients should be counseled about long-term complications, even when the procedure is being performed by an experienced surgeon.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Carlotta Nedbal
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy; Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mario Sofer
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Lie Kwok Ying
- Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Dean Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Abhay Mahajan
- Department of Urology, Sai Urology Hospital and MGM Medical College, Aurangabad, India
| | - Vladislav Petov
- Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Tanuj Paul Bhatia
- Department of Urology, Sarvodaya Hospital and Research Centre, Faridabad, India
| | - Dmitry Enikeev
- Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Vienna Medical University, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Nariman Gadzhiev
- Department of Urology, Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | | | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | | | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Thomas R W Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
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Bohlok J, Söderberg R, Patschan O. Transurethral versus open enucleation of the prostate in Sweden - a retrospective comparative cohort study. Scand J Urol 2023; 58:126-132. [PMID: 38078514 DOI: 10.2340/sju.v58.15327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/24/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE To investigate if treatment with transurethral enucleation of the prostate (TUEP) during the learning curve is as efficient and safe in the short term as transvesical open prostate enucleation (OPE), in patients with benign prostatic obstruction (BPO) > 80 ml in a population in Sweden. Methods: 54 patients with ultrasound verified BPO > 80 ml and indication for surgery underwent TUEP or OPE between 2013 and 2019. Peri- and postoperative outcome variables regarding voiding efficiency and morbidity from 20 OPE at Skåne University Hospital (SUS) and from the first 34 TUEP performed at SUS and Ystad Hospital were retrospectively assembled. Follow-up data from the first 6 postoperative months were collected by chart review. RESULTS Intraoperative bleeding during TUEP was less than in OPE (225 ml vs. 1,000 ml). TUEP took longer surgery time than OPE (210 vs. 150 min.). Within 30 days postoperatively, bleeding occurred less often after TUEP (23% vs. 40%), requiring one fourth of the blood transfusions given after OPE. After TUEP, patients had shorter hospitalisation (3 days vs. 7 days) and catheterisation time (3 days vs. 12 days). During the 6-month follow-up period, incontinence and UTI defined as symtomatic significant bacteriuria (urinary culture) were observed as main complications after TUEP and OPE. Functional outcome data availability (International Prostate Symptom Score [IPSS] questionnaire, uroflowmetry, residual urine) were limited. CONCLUSIONS Treatment with TUEP during the learning curve led to less bleeding, shorter hospitalisation- and catheterisation time than treatment with OPE. However, surgery time was shorter with OPE. There were no major differences between the groups concerning mid-term functional outcomes, with the reservation of an inconsistent follow-up.
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Affiliation(s)
| | | | - Oliver Patschan
- Department of Translational Medicine, Faculty of Medicine, Lund University, Lund, Sweden
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Shoma AM, Ghobrial FK, El-Tabey N, El-Hefnawy AS, El-Kappany HA. A randomized trial of holmium laser vs thulium laser vs bipolar enucleation of large prostate glands. BJU Int 2023; 132:686-695. [PMID: 37667842 DOI: 10.1111/bju.16174] [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] [Indexed: 09/06/2023]
Abstract
OBJECTIVE To compare the outcome and morbidity of bipolar transurethral enucleation of the prostate (B-TUEP) and thulium laser enucleation of the prostate (ThuLEP) with those of holmium laser enucleation of the prostate (HoLEP) in the treatment of large symptomatic benign prostatic obstruction (BPO) through a non-inferiority randomized controlled trial (NCT03916536). PATIENTS AND METHODS A total of 155 patients were recruited from a single centre between February 2019 and August 2020. All had BPO, with a prostate volume ≥80 ml. Patients were randomly assigned to HoLEP, ThuLEP or B-TUEP using computer-generated random tables in a 1:1:1 ratio. Participants, investigators and surgeons were blinded to group assignment until the date of the operation. Thereafter, the patients were followed up at 1, 3, 6 and 12 months. The primary outcome was maximum urinary flow rate (Qmax ) at 6 months. Secondary outcomes included assessment of other functional urinary variables, peri-operative records, and adverse events. RESULTS There were 138 and 120 patients available for analysis at 6 and 12 months. There was no significant difference in Qmax between the groups at 6 and 12 months (P = 0.4 and P = 0.7, respectively), and no significant difference regarding International Prostate Symptom Score (IPSS), quality of life (QoL) or postvoid residual urine volume (PVR). The median (interquartile range) prostate-specific antigen (PSA) reductions (ng/ml) were similar in the three groups at last follow-up point (4.7 [2.2-7.1]; 5.6 [2.3-9.5] and 5 [3.4-10] after HoLEP, ThuLEP and B-TUEP, respectively). Differences in enucleation time, enucleation efficiencies and auxiliary manoeuvres were statistically insignificant (P = 0.1, 0.8 and 0.07, respectively). At 1 year, patients with prostate volumes >120 ml showed significant IPSS improvement in favour of HoLEP and ThuLEP (P = 0.01). Low- and high-grade adverse effects were recorded in 31 and five cases, respectively, with no statistically significant difference between the groups. CONCLUSIONS We conclude that ThuLEP and B-TUEP are as safe and effective as HoLEP for the treatment of large-sized BPO. Significant PSA reductions indicate that there was effective adenoma enucleation with all three approaches. The study provides objective evidence that endoscopic enucleation of the prostate is a technique rather than energy dependent procedure.
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Affiliation(s)
- Ahmed M Shoma
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Fady K Ghobrial
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
- Department of Urology, Faculty of Medicine, Damietta University, Damietta, Egypt
| | - Nasr El-Tabey
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Herrmann TRW. En bloc resection of bladder tumors (ERBT) revisited 12 years after reintroduction: too good to be further ignored. World J Urol 2023; 41:2577-2582. [PMID: 37819587 DOI: 10.1007/s00345-023-04629-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
En bloc resection of bladder tumors (ERBT) orginally described in 1980 and adopted by few centers in the late 1990s has regained attention in the 2010s as a renaissance of a technique with high potential. The advent of new lasers indirectly lead to a better understanding of anatomical dissection from the experience in anatomical dissection in endoscopic enucleation of the prostate. 12 years after the reintroduction of ERBT evidence mounts that it is not only equivalent but better in some regards. However, ERBT still falls short with regard to wide adoption despite the striking technique inherent and reproducible features of accurate staging and specimen quality as requested by pathologist, as well and despite the high intraoperative safety and fast adoption of this technique even in early phase of training. The editorial walks the reader through the timeline of the renaissance speculating why there is a blockage between cognitive understanding and dissonance in surgical practice. The special issues presents the meta-analysis of surgical and oncological data on one hand and the level of understanding and power of this surgical technique in fields offsite oncological results in training achieving results almost right from the start after adoptation. Unlike in earlier years reviewing the literature of ERBT in 2023, ERBT seems not only to be a viable alternative, but something one should turn towards no to underperform with regards to the endpoints achievable by ERBT in a critical disease like bladder cancer.
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Affiliation(s)
- Thomas R W Herrmann
- Department of Urology, Spital Thurgau AG, Kantonsspital Frauenfeld, Pfaffenholzstrasse 4, CH 8501, Frauenfeld, Switzerland.
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, South Africa.
- Hannover Medical School, Hannover, Germany.
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Yıldırım Ü, Ezer M, Uslu M, Örs B. En bloc enucleation of the prostate with early apical release using a high-power (200 W) thulium device: studying a learning curve. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230325. [PMID: 37729364 PMCID: PMC10508896 DOI: 10.1590/1806-9282.20230325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE The aim of this study was to reveal the learning curve of early apical release en bloc laser prostatectomy using a high-power thulium (200 W) laser device. METHODS We obtained data on the initial 60 patients who had thulium laser enucleation of the prostate by a single surgeon between October 2021 and August 2022 to treat the signs and symptoms of benign prostatic hyperplasia at our clinic. The cases were split into three groups, each consisting of 20 patients. Prostate volumes, prostate-specific antigen and hemoglobin levels, the International Prostate Symptom Score, Quality of Life scores, the International Index of Erectile Function-5 scores, and uroflowmetry parameters were documented preoperatively. The enucleation weight, the enucleation and morcellation times, as well as the efficiency, hospitalization, and catheterization durations were calculated. The patients were re-evaluated at 6 months postoperatively, examined for functional results, and compared to baseline conditions. RESULTS Enucleation times, morcellation times, enucleation weight, and enucleation efficiency were significantly different among the groups. However, there was no statistically significant difference in total operative time and morcellation efficiency. In terms of postoperative statistics, the reduction in hemoglobin was significantly greater in Group 1 compared to Group 2. Six months after surgery, all groups had comparable validated ratings (International Prostate Symptom Score, Quality of Life, and the International Index of Erectile Function-5) on postoperative examinations. There were no long-term complications in either group throughout the perioperative period. CONCLUSION Completing 40 first cases would be sufficient for managing the learning curve for early apical release en bloc thulium laser enucleation of the prostate.
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Affiliation(s)
- Ümit Yıldırım
- Kafkas University, Medical School, Department of Urology – Kars, Turkey
| | - Mehmet Ezer
- Kafkas University, Medical School, Department of Urology – Kars, Turkey
| | - Mehmet Uslu
- Kafkas University, Medical School, Department of Urology – Kars, Turkey
| | - Bumin Örs
- Özel Sağlık Hospital, Department of Urology – İzmir, Turkey
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Tunc L, Herrmann T, Guven S, Scoffone CM, Bozzini G, Yilmaz S, Romero-Otero J, Misrai V, Porreca A, Ahyai S, Gozen AS. A Delphi consensus to standardize the technique of anatomical endoscopic enucleation of prostate: a study by ESUT endoscopic enucleation of prostate study group. World J Urol 2023; 41:2303-2309. [PMID: 37421419 DOI: 10.1007/s00345-023-04496-8] [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: 04/23/2023] [Accepted: 06/13/2023] [Indexed: 07/10/2023] Open
Abstract
PURPOSE Our objective was to establish a standardized technique for Anatomical Endoscopic Enucleation of Prostate (AEEP) utilizing a consensus statement to provide robust recommendations for urologists who are new to this procedure. METHODS The participants were electronically sent a questionnaire in three consecutive rounds. In the second and third rounds, the anonymous aggregate results of the previous round were presented. Experts' feedback and comments were then incorporated to refine existing questions or to explore more controversial topics in greater depth. RESULTS Forty-one urologists participated in the first round. In the second round, all Round 1 participants received a 22-question survey, resulting in a consensus on 21 items. In the third round, 76% (19/25) of the second-round respondents also participated, reaching a consensus on 22 additional items. The panelists consensually agreed on detaching the urethral sphincter at the beginning of the enucleation and not at the end of the enucleation. To prevent incontinence, it was recommended that the apical mucosa be preserved through various approaches between 11 and 1 o'clock while gently disrupting the lateral lobes in their apical part, avoiding an excess energy delivery approximation to the apical mucosa. CONCLUSION To optimize laser AEEP procedures, urologists must follow expert guidelines on equipment and surgical technique, including early apical release, using the 3-lobe technique for enucleation, preserving apical mucosa with appropriate approaches, gently disrupting lateral lobes at their apical regions, and avoiding excessive energy delivery near the apical mucosa. Following these recommendations can lead to improved outcomes and patient satisfaction.
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Affiliation(s)
- Lutfi Tunc
- Department of Urology, Acibadem University School of Medicine, Ankara, Turkey
| | - Thomas Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Münsterlingen, Switzerland
| | - Selcuk Guven
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | | | - Giorgio Bozzini
- Department of Urology, ASST Valle Olona, Busto Arsizio, Italy
| | - Sercan Yilmaz
- Department of Urology, Kolan Hospital, Istanbul, Turkey
| | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, 31300, Toulouse, France
| | - Angelo Porreca
- Department of Urology, Policlinico Abano Terme, Abano Terme, Italy
| | - Sacha Ahyai
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Ali Serdar Gozen
- Department of Urology, Medius-Kliniken Ruit, University of Tubingen, Ostfildern, Germany.
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Talamini S, Lai A, Palmer C, van de Walle G, Zuberek M, Crivellaro S. Surgical treatment of benign prostatic hyperplasia: Thulium enucleation versus single-port transvesical robotic simple prostatectomy. BJUI COMPASS 2023; 4:549-555. [PMID: 37636211 PMCID: PMC10447210 DOI: 10.1002/bco2.261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/20/2023] [Accepted: 05/23/2023] [Indexed: 08/29/2023] Open
Abstract
Objective The objective of this work is to compare our outcomes using thulium laser enucleation of prostate (ThuLEP) to the single-port robot-assisted simple prostatectomy (SP RASP) in the surgical management of benign prostatic hyperplasia (BPH). Methods A retrospective cohort study was conducted from January 2017 through December 2021 of men who underwent SP RASP and ThuLEP performed by a single surgeon with an enucleation experience of >300 cases and extensive robotic experience. The primary outcome was changed in International Prostate Symptom Score (IPSS) postoperatively. Secondary outcomes were operative time, length of stay (LOS), change in post-void residuals (PVR), de novo stress- or urge-urinary incontinence (SUI, UUI), and rate of complications. Results One hundred two patients underwent surgery during the study period: 33 RASP and 69 ThuLEP. There was no difference in preoperative characteristics, including age and body mass index, between both groups. Changes in IPSS scores postoperatively were not significant between SP RASP versus ThuLEP (-17 vs. -14, p = 0.2956). SP RASP had a longer operative time (180 vs. 90 min, p < 0.0001). There was no difference in LOS (0 vs. 0 days, p = 0.2904). There was no difference in change in PVR (-96 vs. -91 mL, p = 0.8504). SP RASP patients had significantly less postoperative SUI than ThuLEP (0 vs. 13 patients, p = 0.0083), while there was no difference in UUI between both groups (4 vs. 2 patients, p = 0.0843). There was no difference in 30-day complication rate (21.2% vs. 21.7%, p = 0.9517), although there were three ThuLEP patients with Clavien-Dindo Class III or higher complication. Conclusions There was no difference in change in IPSS scores between the two groups. ThuLEP is associated with shorter postoperative catheter days and decreased operative times. Hospital LOS was equivalent. SP RASP demonstrates significantly improved continence rates. Though SP RASP is within the initial learning curve at our institution, early results demonstrate the role for this modality alongside ThuLEP in the treatment of large gland BPH.
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Affiliation(s)
- Susan Talamini
- Washington University School of MedicineSt. LouisMissouriUSA
| | - Andrew Lai
- College of MedicineUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Cassandra Palmer
- College of MedicineUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | | | - Marcin Zuberek
- College of MedicineUniversity of Illinois at ChicagoChicagoIllinoisUSA
| | - Simone Crivellaro
- College of MedicineUniversity of Illinois at ChicagoChicagoIllinoisUSA
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Paesano N, Castañeda G, Maccagno A, Caldas P, Chechile G. Thulium laser vaporesection of prostates with volume exceeding 100 cm 3 as an alternative to HoLEP and ThuLEP. J Surg Case Rep 2023; 2023:rjac441. [PMID: 37255953 PMCID: PMC10226809 DOI: 10.1093/jscr/rjac441] [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: 08/18/2022] [Accepted: 09/04/2022] [Indexed: 06/01/2023] Open
Abstract
The aim of this study is to evaluate the outcomes of thulium laser vaporesection of prostates with volume exceeding 100 cm3. In the present prospective study, patients with infra-vesical urinary obstruction due to a prostate with volume exceeding 100 cm3 underwent endoscopic vaporesection using thulium laser. In this procedure, prostate chips were resected without morcellation. The technical aspects of surgery, admission time, post-operative catheter time and post-operative complications were analyzed. Flowmetry was performed combined with prostatic ultrasound in the follow-up. Between March 2010 and November 2018, 156 cases with benign prostatic hyperplasia (BPH; volume >100 cm3) were treated. The mean patient age was 67.8 years (48.4-86.6 years), and the mean prostatic volume was 137 cm3 (100-436 cm3). The mean length of hospitalization was 1.48 days (1-8 days), and the mean post-operative catheter time was 5.1 (1-17). Three cases (1.9%) required readmission due to hematuria. The mean follow-up time was 31.2 months (standard deviation = 27.7). Urethral stricture was observed in 14 cases (9%), with bulbar urethra being the most frequent finding. Urinary tract infection was observed in 11 cases (7.1%), and urinary incontinence was observed in 5 cases. The mean peak urinary flow at 12 and 24 months was 26.9 ± 12.5 and 23.9 ± 11.7 ml/s, respectively, and the mean urinary flow during the final follow-up at 41 months was 21.6 ml/s. Thulium laser vaporesection is a valid alternative to open prostatectomy, HoLEP and ThuLEP in patients with large BPH. Urinary flow remained elevated throughout the follow-up.
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Affiliation(s)
- Nahuel Paesano
- Correspondence address. Tel: (+34) 93 285 33 99; E-mail:
| | - Gonzalo Castañeda
- Instituto Médico Tecnológico, Barcelona, Spain
- Prostate Institute Barcelona, Barcelona, Spain
- Department of Urology, Cima Sanitas Hospital, Barcelona, Spain
| | - Alicia Maccagno
- Statistics Area, National University of Cordoba, Córdoba, Argentina
| | - Paulo Caldas
- Department of Urology, Hospital Regional do Oeste, Chapecó, Brazil
| | - Gilberto Chechile
- Instituto Médico Tecnológico, Barcelona, Spain
- Prostate Institute Barcelona, Barcelona, Spain
- Department of Urology, Cima Sanitas Hospital, Barcelona, Spain
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Hutfilz A, Theisen-Kunde D, Bonsanto MM, Brinkmann R. Pulsed thulium laser blood vessel haemostasis as an alternative to bipolar forceps during neurosurgical tumour resection. Lasers Med Sci 2023; 38:94. [PMID: 36973553 PMCID: PMC10042905 DOI: 10.1007/s10103-023-03747-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 02/23/2023] [Indexed: 03/29/2023]
Abstract
Due to wavelength-specific water absorption, infrared lasers like the thulium laser emitting at 1940 nm wavelength proved to be suitable for coagulation in neurosurgery. Commonly bipolar forceps used for intraoperative haemostasis can cause mechanical and thermal tissue damage, whilst thulium laser can provide a tissue-gentle haemostasis through non-contact coagulation. The aim of this work is a less-damaging blood vessel coagulation by pulsed thulium laser radiation in comparison to standard bipolar forceps haemostasis. Ex vivo porcine blood vessels in brain tissue (0.34 ± 0.20 mm diameter) were irradiated in non-contact with a thulium laser in pulsed mode (1940 nm wavelength, 15 W power, 100-500 ms pulse duration), with a CO2 gas flow provided simultaneously at the distal fibre tip (5 L/min). In comparison, a bipolar forceps was used at various power levels (20-60 W). Tissue coagulation and ablation were evaluated by white light images and vessel occlusion was visualised by optical coherence tomography (OCT) B-scans at a wavelength of 1060 nm. Coagulation efficiency was calculated by means of the quotient of the difference between the coagulation and ablation radius to the coagulation radius. Pulsed laser application achieved blood vessel occlusion rate of 92% at low pulse duration of 200 ms with no occurrence of ablation (coagulation efficiency 100%). Bipolar forceps showed an occlusion rate of 100%, however resulted in tissue ablation. Tissue ablation depth with laser application is limited to 40 μm and by a factor of 10 less traumatising than with bipolar forceps. Pulsed thulium laser radiation achieved blood vessel haemostasis up to 0.3 mm in diameter without tissue ablation and has proven to be a tissue-gentle method compared to bipolar forceps.
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Affiliation(s)
| | | | - Matteo Mario Bonsanto
- Department of Neurosurgery, University Medical Center Schleswig-Holstein, 23562, Lübeck, Germany
| | - Ralf Brinkmann
- Medical Laser Center Lübeck, 23562, Lübeck, Germany
- Institute of Biomedical Optics, University of Lübeck, 23562, Lübeck, Germany
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Simple and Convenient Method for Assessing the Severity of Bleeding during Endoscopic Prostate Surgery and the Relationships between Its Corresponding Surgical Outcomes. Diagnostics (Basel) 2023; 13:diagnostics13040592. [PMID: 36832080 PMCID: PMC9955362 DOI: 10.3390/diagnostics13040592] [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: 01/18/2023] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
Bleeding during endoscopic prostate surgery is often overlooked, and appropriate measurement techniques are rarely applied. We proposed a simple and convenient method for assessing the severity of bleeding during endoscopic prostate surgery. We determined the factors affecting bleeding severity and whether they affected the surgical results and functional outcomes. Records from March 2019 to April 2022 were obtained for selected patients who underwent endoscopic prostate enucleation through either 120-W Vela XL Thulium:YAG laser or bipolar plasma enucleation of the prostate. The bleeding index was measured using the following equation: irrigant hemoglobin (Hb) concentration (g/dL) × irrigation fluid volume (mL)/preoperative blood Hb concentration (g/dL) × enucleated tissue (g). Our research revealed that patients who underwent surgery employing the thulium laser, those aged over 80 years, and those with a preoperative maximal flow rate (Qmax) of more than 10 cc/s experienced less surgical bleeding. The patients' treatment outcomes differed depending on the severity of the bleeding. Enucleating prostate tissue was easier in the patients with less severe bleeding, who also had a lower risk of developing urinary tract infections and an improved Qmax.
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Bozzini G, Berti L, Maltagliati M, Besana U, Micali S, Roche JB, Romero-Otero J, Pacchetti A, Perri D, Morini E, Saredi G, Mazzoleni F, Sighinolfi MC, Buizza C, Rocco B. Thulium: YAG vs continuous-wave thulium fiber laser enucleation of the prostate: do potential advantages of thulium fiber lasers translate into relevant clinical differences? World J Urol 2023; 41:143-150. [PMID: 36357602 DOI: 10.1007/s00345-022-04201-1] [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: 03/13/2022] [Accepted: 10/25/2022] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To compare endoscopic enucleation of the prostate using a thulium: yttrium-aluminum-garnet (Tm:YAG) laser and a super-pulsed thulium fiber laser set in continuous-wave (CW) mode, and to evaluate whether theoretical advantages of thulium fiber lasers, related to their shorter wavelength, translate into relevant clinical differences. METHODS In total, 110 patients suffering from lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia were randomized to undergo either thulium:YAG laser enucleation of the prostate (ThuLEP) or CW thulium fiber laser enucleation of the prostate (CW-ThuFLEP). Intraoperative and postoperative variables and complications were compared. Micturition improvement was assessed at 3-month follow-up using the International Prostate Symptom Score (IPSS), post-void residual urine (PVR) and maximum flow rate (Qmax). Erectile function was evaluated using the International Index of Erectile Function-5 (IIEF-5). RESULTS No significant differences between the ThuLEP and CW-ThuFLEP groups were found in terms of operative time (70.69 vs 72.41 min), enucleation time (50.23 vs 53.33 min), enucleated tissue weight (40.2 vs 41.9 g), enucleation efficiency (0.80 vs 0.79 g/min), catheterization time (2.45 vs 2.57 days), hospital stay (2.82 vs 2.95 days) and hemoglobin drop (1.05 vs 1.27 g/dl). At 3-month follow-up, no significant differences were found in IPSS (5.09 vs 5.81), Qmax (26.51 vs 27.13 ml/s), PVR (25.22 vs 23.81 ml) and IIEF-5 (14.01 vs 14.54). CONCLUSION ThuLEP and CW-ThuFLEP were equivalent in relieving patients from LUTS and improving micturition. Theoretical advantages of the TFL, such as shallower penetration depth and improved vaporization capacity, did not translate into relevant perioperative outcomes or clinical differences.
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Affiliation(s)
- Giorgio Bozzini
- Department of Urology, ASST-Lariana, Ospedale Sant'Anna, San Fermo della Battaglia, CO, Italy.
| | - Lorenzo Berti
- Department of Urology, ASST-Valle Olona, Ospedale di Busto Arsizio, Busto Arsizio, VA, Italy.,Department of Urology, Università degli Studi di Modena e Reggio Emilia, Modena, MO, Italy
| | - Matteo Maltagliati
- Department of Urology, ASST-Valle Olona, Ospedale di Busto Arsizio, Busto Arsizio, VA, Italy.,Department of Urology, Università degli Studi di Modena e Reggio Emilia, Modena, MO, Italy
| | - Umberto Besana
- Department of Urology, ASST-Valle Olona, Ospedale di Busto Arsizio, Busto Arsizio, VA, Italy
| | - Salvatore Micali
- Department of Urology, Università degli Studi di Modena e Reggio Emilia, Modena, MO, Italy
| | | | | | - Andrea Pacchetti
- Department of Urology, ASST-Lariana, Ospedale Sant'Anna, San Fermo della Battaglia, CO, Italy
| | - Davide Perri
- Department of Urology, ASST-Lariana, Ospedale Sant'Anna, San Fermo della Battaglia, CO, Italy
| | - Elena Morini
- Department of Urology, ASST-Lariana, Ospedale Sant'Anna, San Fermo della Battaglia, CO, Italy
| | - Giovanni Saredi
- Department of Urology, ASST-Valle Olona, Ospedale di Busto Arsizio, Busto Arsizio, VA, Italy
| | - Federica Mazzoleni
- Department of Urology, ASST-Lariana, Ospedale Sant'Anna, San Fermo della Battaglia, CO, Italy
| | | | - Carlo Buizza
- Department of Urology, ASST-Valle Olona, Ospedale di Busto Arsizio, Busto Arsizio, VA, Italy
| | - Bernardo Rocco
- Department of Urology, ASST-Santi Paolo e Carlo, Milan, MI, Italy
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22
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Sciacqua LV, Vanzulli A, Di Meo R, Pellegrino G, Lavorato R, Vitale G, Carrafiello G. Minimally Invasive Treatment in Benign Prostatic Hyperplasia (BPH). Technol Cancer Res Treat 2023; 22:15330338231155000. [PMID: 36794408 PMCID: PMC9936536 DOI: 10.1177/15330338231155000] [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] [Indexed: 02/17/2023] Open
Abstract
Review efficacy and safety of minimally-invasive treatments for Low Urinary Tract Symptoms (LUTS) in patients affected by Benign Prostate Hyperplasia (BPH). We performed a systematic review of the literature from 1993 to 2022 leveraging original research articles, reviews, and case-studies published in peer-reviewed journals and stored in public repositories. Prostate artery embolization (PAE), transurethral needle ablation (TUNA), transurethral microwave thermotherapy (TUMT), high intensity focused ultrasound (HIFU), laser treatments and Cryoablation are valid and safe alternatives to the gold standard (surgery) in the treatment of LUTS in patients affected by BPH, with fewer undesired effects being reported.
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Affiliation(s)
- L V Sciacqua
- Residency Program in Diagnostic and Interventional Radiology, Università degli Studi di Milano, Milan, Italy
| | - A Vanzulli
- Residency Program in Diagnostic and Interventional Radiology, Università degli Studi di Milano, Milan, Italy
| | - R Di Meo
- Residency Program in Diagnostic and Interventional Radiology, Università degli Studi di Milano, Milan, Italy
| | - G Pellegrino
- Residency Program in Diagnostic and Interventional Radiology, Università degli Studi di Milano, Milan, Italy
| | - R Lavorato
- Researcher at Diagnostic and Interventional Radiology Department, IRCCS Ca' Granda Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - G Vitale
- Department of Medical Biotechnology and Translational Medicine, 9304University of Milan, Milan, Italy.,Istituto Auxologico Italiano, IRCCS, Laboratory of Geriatric and Oncologic Neuroendocrinology Research, Milan, Italy
| | - G Carrafiello
- Diagnostic and Interventional Radiology Department, IRCCS Ca' Granda Fondazione Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
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23
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Thulium YAG is the Best Laser for the Prostate Because of Versatility. EUR UROL SUPPL 2022; 48:18-21. [PMID: 36583181 PMCID: PMC9793213 DOI: 10.1016/j.euros.2022.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 12/24/2022] Open
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24
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Yan J, Gao L, Xu G, Zhang J. The effectiveness and safety of three surgical procedures for the treatment for benign prostatic hyperplasia: A network meta-analysis. Heliyon 2022; 8:e10884. [PMID: 36267366 PMCID: PMC9576883 DOI: 10.1016/j.heliyon.2022.e10884] [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: 05/09/2022] [Revised: 08/27/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
Objective To evaluate the effectiveness and safety of transurethral resection of the prostate (TURP), holmium laser enucleation of the prostate (HoLEP) and thulium laser enucleation of the prostate (ThuLEP) in the treatment of benign prostatic hyperplasia using a network Meta-analysis. Methods Randomized controlled trials of TURP, HoLEP and ThuLEP for benign prostatic hyperplasia were collected by computerized searches of databases including CNKI, WANFANG, VIP, PubMed, The Cochrane Library, the Web of Science and Embase, with a search time frame of build to January 2022. The literature was screened and data was extracted by two investigators separately, while the risk of bias of the included studies was evaluated before systematic evaluation and network meta-analysis using ADDIS 1.16.8 software and RevMan 5.3 software. Results A total of 27 RCTs with a total of 3335 patients were involved. The results of the network meta-analysis showed that ThuLEP was better than the remaining two procedures in terms of enhancing patients' subjective perception and improving objective indicators, and the incidence of adverse events such as postoperative urethral stricture and urinary incontinence was lower compared with that of conventional TURP in both short- and long-term postoperative follow-ups. Conclusion As ThuLEP is effective, safe, and featured with few postoperative complications, it can be the preferred surgical procedure for prostate enlargement. Nevertheless, because of the limited number of studies included, more-sample, multicenter, double-blind clinical randomized controlled trials are required in the future to further verify the findings of the present study.
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25
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Grüne B, Siegel F, Waldbillig F, Pfalzgraf D, Kamdje Wabo G, Herrmann J, Kriegmair MC, Nuhn P, Michel MS, von Hardenberg J. Long-term Reinterventions after Thulium Laser Enucleation of the Prostate: 12-Year Experience with more than 1000 Patients. Eur Urol Focus 2022; 8:1370-1375. [PMID: 35016861 DOI: 10.1016/j.euf.2021.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/27/2021] [Accepted: 12/15/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Thulium laser enucleation of the prostate (ThuLEP) is an established treatment option for benign prostatic enlargement (BPE), but long-term outcomes have not yet been reported. OBJECTIVE To prove the durability of ThuLEP by investigating its long-term efficacy and morbidity. DESIGN, SETTING, AND PARTICIPANTS All patients who underwent ThuLEP at a German tertiary referral center between 2009 and 2021 were retrospectively followed up for reinterventions for persistence or regrowth of prostate adenoma (ReIP) or long-term complications (ReIC). INTERVENTION ThuLEP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We calculated the cumulative incidence for ReIP and ReIC at 10 yr. Univariate and multivariate Cox regression models were constructed to identify predictors of ReIP and ReIC. RESULTS AND LIMITATIONS Overall, 1097 patients underwent ThuLEP. The median overall follow-up was 6.0 yr (interquartile range [IQR] 2.4-9.2). For one-third of patients (n = 369), median follow-up of 10 yr (IQR 9.1-11.2) was available. A total of 42 patients (3.8%) underwent ReIP after a median of 2 yr (IQR 0.3-4.9). The rate of long-term ReIC was 2.6% (n = 29) and the median time to ReIC was 0.5 yr (IQR 0.3-1.7). The most frequent ReIC was urethrotomy (n = 16, 1.5%). The cumulative incidence of ReIP and ReIC at 10 yr was estimated at 5.6% and 3.4%, respectively. Enucleation weight ≥60 g was a significant predictor of ReIP (hazard ratio 1.2, p = 0.014). The retrospective study design and the lack of functional outcomes are the main limitations. CONCLUSIONS ThuLEP is a durably effective and safe procedure with low reintervention rates within 12 yr. PATIENT SUMMARY This study investigated long-term outcomes of thulium laser enucleation of the prostate for benign enlargement of the prostate (BPE). Low rates of repeat treatment for BPE recurrence or for other complications were observed. Our results show the safety and efficacy of this treatment over a period of 12 years.
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Affiliation(s)
- Britta Grüne
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Fabian Siegel
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany; Department of Biomedical Informatics at the Center for Preventive Medicine and Digital Health, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frank Waldbillig
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Daniel Pfalzgraf
- Department of Urology, Heilig-Geist-Hospital Bensheim, Bensheim, Germany
| | - Gaetan Kamdje Wabo
- Department of Biomedical Informatics at the Center for Preventive Medicine and Digital Health, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jonas Herrmann
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Nuhn
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maurice Stephan Michel
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jost von Hardenberg
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
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26
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Himmler M, Grüne B, von Hardenberg J, Hartung FO, Kowalewski KF, Rassweiler-Seyfried MC, Michel MS, Herrmann J. Switching lasers: learning curve of HoLEP in surgeons experienced in ThuLEP. J Endourol 2022; 36:1444-1451. [PMID: 35822547 DOI: 10.1089/end.2022.0262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate perioperative parameters, clinical outcomes, and the learning curve of holmium laser enucleation of the prostate (HoLEP) in surgeons with experience in thulium laser enucleation of the prostate (ThuLEP). MATERIALS AND METHODS The learning curves for HoLEP of the first 50 consecutive patients of two surgeons experienced in ThuLEP were analyzed. In addition, demographic parameters, clini¬cal outcomes and adverse events were evaluated. RESULTS Mean operation time was 70.9 + 29.7 min (SD) (Surgeon 1) and 74.4 + 35.4 min (Surgeon 2), the mean enucleation efficiency was 1.5 + 0.6 g/min (Surgeon 1) and 1.5 + 0.7 g/min (Surgeon 2). The hemoglobin loss was 0.9 + 0.8 g/dl and 0.8 + 0.8 g/dl. For both surgeons, there was a significant learning curve in enucleation efficiency within the first 50 cases (Surgeon 1: p = .034, Surgeon 2: p = .006, both: p = .0003, Spearman's ρ = .351). Both surgeons started with an enucleation efficiency of around 1g/min in their first 10 cases. No significant correlation between hemoglobin loss and experience could be found (p = .823, ρ = .025). While there was no significant learning curve for morcellation efficiency (p = .785, ρ = .028), a significant progress was found for one of the two surgeons regarding laser energy efficiency (p = .014). The overall incidence of all grade treatment-related adverse events was very low at 10.0%, and extremely low for significant complications with Clavien-Dindo Grade > II at 1%. CONCLUSIONS In our analysis, switching to HoLEP is uncomplicated and safe for experienced ThuLEP surgeons. The enucleation efficiency was high from the beginning, but a learning curve was present for both surgeons. No learning curve was noticeable in hemoglobin loss and the incidence of complications, both of which were very low throughout the study.
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Affiliation(s)
- Maren Himmler
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Baden-Württemberg, Germany;
| | - Britta Grüne
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Germany;
| | - Jost von Hardenberg
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Germany;
| | - Friedrich Otto Hartung
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Baden-Württemberg, Germany;
| | - Karl-Friedrich Kowalewski
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Baden-Württemberg, Germany;
| | | | - Maurice Stephan Michel
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Baden-Württemberg, Germany;
| | - Jonas Herrmann
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Baden-Württemberg, Germany;
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27
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Randomized prospective trial of the severity of irritative symptoms after HoLEP vs ThuFLEP. World J Urol 2022; 40:2047-2053. [PMID: 35690952 DOI: 10.1007/s00345-022-04046-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/06/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To compare the short-term postoperative functional outcomes and severity of irritative symptoms following holmium and thulium fiber laser enucleation (HoLEP and ThuFLEP). METHODS This prospective randomized single-blinded study was performed in accordance with CONSORT. The inclusion criteria were IPSS > 20 or Qmax < 10 ml/s. Patients were randomized between HoLEP and ThuFLEP. Demographics, objective data (PSA, prostate volume, etc.), data on urinary and sexual function (IPSS, IIEF, QoL, QUID, Qmax, ICIQ-MLUTS) were collected. Detailed perioperative information and postoperative data on functional outcomes at 1, 2, 3, 4, 6, 8, 10, 12 weeks and 6 months were collected. RESULTS Data on 163 participants were included (77-HoLEP, 86-ThuFLEP). No differences were found in surgery duration; number of postoperative complications (Clavien-Dindo I-III), catheterization time and hospital stay. Functional outcomes up to 6 months didn't differ between the groups (IPPS, IIEF, QoL, QUID, ICIQ-MLUTS, Qmax, p > 0.05). Total ICIQ-MLUTS, bother and voiding scores at 1 and 3 months significantly increased compared with the baseline in both groups (p < 0.05). No difference between the groups were observed. In HoLEP the SUI series rate was 1.3% and 1.3% after 3 and 6 months following the procedure; in ThuFLEP: it was 3.5% and 2.3% respectively (p = 0.35 and p = 0.54). CONCLUSION The preliminary results of the study showed no apparent differences in functional outcomes (IPSS, Qmax), rate of SUI or irritative symptoms. Both ThuFLEP and HoLEP are efficient ways of treating benign prostatic obstruction. Both surgeries are comparable in terms of duration and postoperative complication rates.
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28
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Tontini GE, Dioscoridi L, Rimondi A, Cantù P, Cavallaro F, Giannetti A, Elli L, Pastorelli L, Pugliese F, Mutignani M, Vecchi M. [Not Available]. Endosc Int Open 2022; 10:E386-E393. [PMID: 35528218 PMCID: PMC9068277 DOI: 10.1055/a-1781-7066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/21/2021] [Indexed: 01/28/2023] Open
Abstract
Objectives and study aims
Recent pilot studies have assessed the feasibility of a novel 1.9-/1.5-μm dual emission endoscopic laser treatment (
1.9-/1.5-μm
DEELT) for endoscopic hemostasis, ablation and resection. In this study, we investigated the safety and efficacy of
1.9-/1.5-μm
DEELT in patients with chronic anemia due to gastrointestinal vascular lesions in a real-life multicenter cohort setting.
Patients and methods
Consecutive patients with moderate/severe iron-deficiency anemia undergoing
1.9-/1.5-μm
DEELT for upper and lower gastrointestinal bleeding due to vascular lesions were enrolled in three academic referral centers. Safety and successful ablation of vascular lesions were the primary outcomes. Long-term hemoglobin level, blood transfusion requirements, endoscopic severity scores of complex vascular disorders and technical lasing parameters were also assessed. Long-term hemoglobin variations have been further assessed, with repeated measure analysis of variance and univariate analyses.
Results
Fifty patients (median age 74; range 47 to 91 years) with gastric antral vascular ectasia (GAVE) (22), angioectasia (22) and radiation proctopathy (6) underwent 58
1.9-/1.5-μm
DEELT between 2016 and 2020. All procedures were technically feasible leading to successful ablation of the targeted lesion/s, with no incident or adverse event potentially related to the
1.9-/1.5-μm
DEELT technique. Within a 6-month follow-up, hemoglobin values significantly rose (+ 1.77 at 1 month and + 1.70 g/dL at 6 months,
P
< 0.01), the blood supply requirement decreased (at least one transfusion in 32 versus 13 patients,
P
< 0.01), and GAVE lesions showed a clear endoscopic improvement (from 5 points to 1 points,
P
< 0.01).
Conclusions
The 1.9-/1.5-μm laser system is a safe and effective endoscopic tool for haemostatic ablation of bleeding vascular lesions within the gastrointestinal tract in tertiary referral centers.
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Affiliation(s)
- Gian Eugenio Tontini
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy,Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy,Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Dioscoridi
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, ASST Niguarda, Milan, Italy
| | - Alessandro Rimondi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy,Postgraduate Specialization in Gastrointestinal Diseases, University of Milan, Milan, Italy
| | - Paolo Cantù
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Flaminia Cavallaro
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy,Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Aurora Giannetti
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, ASST Niguarda, Milan, Italy,Gastroenterology and Endoscopy Unit, IRCCS Multimedica, Sesto San Giovanni, Milano
| | - Luca Elli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Pastorelli
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Francesco Pugliese
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, ASST Niguarda, Milan, Italy
| | - Massimiliano Mutignani
- Digestive and Interventional Endoscopy Unit, Niguarda Hospital, ASST Niguarda, Milan, Italy
| | - Maurizio Vecchi
- Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy,Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy,Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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29
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Yan P, Cui Y, Huang Y, Che X, Zhou Z, Feng F. Intraoperative and postoperative outcomes of thulium laser enucleation versus bipolar resection in the transurethral treatment of benign prostatic hyperplasia: a meta-analysis. Lasers Med Sci 2022; 37:2517-2525. [PMID: 35147840 DOI: 10.1007/s10103-022-03519-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/27/2022] [Indexed: 11/28/2022]
Abstract
To compare the intraoperative and postoperative outcomes of thulium laser enucleation of the prostate (ThuLEP) vs bipolar transurethral resection of the prostate (B-TURP) in treating patients with benign prostatic hyperplasia (BPH). Clinical trials of ThuLEP and B-TURP in treating BPH were searched systematically by using PubMed, Cochrane Library databases, and EMBASE (until May 2021). The Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist was followed. The datum was calculated by Review Manager version 5.3.0. Four articles including 782 patients were studied in this analysis. The analysis discovered that there was no significant difference in operative time and percentage of tissue removed between ThuLEP and B-TURP. But the intraoperative irrigated volume and postoperative hemoglobin (Hb) decrease in the ThuLEP group was significantly less compared with the B-TURP group. The catheterization time and hospitalization duration in the B-TURP group was significantly longer than that in the ThuLEP group. Compared with those before treatment, the micturition indexes of the two groups improved significantly. But no significant difference was identified between ThuLEP and B-TURP for the variation of international prostate symptom score, quality of life, maximum flow rate, and post-void residual. By analyzing the postoperative complications, there were no significant discrepancies between ThuLEP and B-TURP in the incidence of blood transfusion, recatheterization, transient incontinence, bladder neck contracture, and urethral stricture. The micturition indexes and clinical symptoms were significantly improved after ThuLEP and B-TURP for patients with BPH. However, ThuLEP was more effective than B-TURP in terms of intraoperative irrigated volume, postoperative Hb decrease, catheterization time, and hospitalization duration.
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Affiliation(s)
- Pihong Yan
- Laboratory Medicine, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Yuanshan Cui
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Yongjin Huang
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xuanyan Che
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China
| | - Zhongbao Zhou
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.
| | - Fan Feng
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, No. 20 East Yuhuangding Road, Yantai, 264000, Shandong, China.
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30
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Chen YT, Hou CP, Juang HH, Lin YH, Yang PS, Chang PL, Chen CL, Weng SC, Tsui KH. Comparison of Outcome and Quality of Life Between Thulium Laser (VelaTM XL) Enucleation of Prostate and Bipolar Transurethral Enucleation of the Prostate (B-TUEP). Ther Clin Risk Manag 2022; 18:145-154. [PMID: 35237038 PMCID: PMC8885124 DOI: 10.2147/tcrm.s352583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/15/2022] [Indexed: 01/10/2023] Open
Affiliation(s)
- Yu-Ting Chen
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chen-Pang Hou
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Health and Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Horng-Heng Juang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Anatomy, School of Medicine, Chang Gung University, Tao-Yuan, Taipei, Taiwan
| | - Yu-Hsiang Lin
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Pei-Shan Yang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Anatomy, School of Medicine, Chang Gung University, Tao-Yuan, Taipei, Taiwan
| | - Phei-Lang Chang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chien-lun Chen
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shu-Chuan Weng
- Health and Management, Yuanpei University of Medical Technology, Hsinchu, Taiwan
- Shu-Chuan Weng, Department of Healthcare Management, Yuanpei University of Medical Technology, Hsinchu, Taipei, Taiwan, Email
| | - Ke-Hung Tsui
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Urology, Shuang Ho Hospital, TMU Research Center of Urology and Kidney, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan
- Correspondence: Ke-Hung Tsui, Taiwan Innovative Medical Association, Department of Urology, Shuang Ho Hospital, College of Medical, Taipei Medical University, Taipei, Taiwan, Email
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31
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Aydogan TB, Binbay M. Learning curve of ThuLEP (Thulium laser enucleation of the prostate): Single‐centre experience on initial consecutive 60 patients. Andrologia 2022; 54:e14366. [DOI: 10.1111/and.14366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/17/2021] [Accepted: 12/24/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Murat Binbay
- Department of Urology Memorial Sisli Hospital Istanbul Turkey
- Department of Urology Bahcesehir University Faculty of Medicine Istanbul Turkey
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32
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Gupta A, Kant S, Chaudhari R, Shah B, Sharma S. Thulium laser enucleation of prostate: Novel therapy for benign prostatic hyperplasia. FORMOSAN JOURNAL OF SURGERY 2022. [DOI: 10.4103/fjs.fjs_206_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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33
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Hou CP, Lin YH, Yang PS, Chang PL, Chen CL, Lin KY, Juang HH, Weng SC, Tsui KH. Clinical Outcome of Endoscopic Enucleation of the Prostate Compared With Robotic-Assisted Simple Prostatectomy for Prostates Larger Than 80 cm 3 in Aging Male. Am J Mens Health 2021; 15:15579883211064128. [PMID: 34903071 PMCID: PMC8679036 DOI: 10.1177/15579883211064128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 12/05/2022] Open
Abstract
This study investigated and compared the surgical outcomes of using endoscopic enucleation (thulium: YAG laser and bipolar plasma; ThuLEP) with robotic-assisted simple prostatectomy (RASP) in the treatment of prostates larger than 80 cm3. Records were obtained for the period from January 2014 to December 2020 for selected patients with BPO who underwent RASP, ThuLEP, or bipolar transurethral enucleation of the prostate (B-TUEP). Patients were excluded if they had active malignant disease, neurogenic bladder, lower urinary tract syndrome for reasons other than BPO, and a history of prostate surgery. Data of 396 patients who underwent B-TUEP, ThuLEP, and RASP were examined. A total of 112 patients met the including criteria, 85 of whom (B-TUEP: 29; ThuLEP: 41; RASP: 15) completed the final visit. The mean operation time and duration of postoperative hospital stays in the RASP group were significantly longer than those of the B-TUEP and ThuLEP groups. Only 1 patient in the RASP group required blood transfusion. The RASP group was superior to the other groups in voiding improvement including Qmax and IPSS voiding score. The pain score of the ThuLEP group after surgery was significantly lower than that of the other two groups during hospitalization, whereas the QoL scores were identical between the three groups at 2 weeks, 3 months, and 6 months post operation. The rates of returning to ER within the first postoperative month did not differ significantly between the three groups, and all the reasons for return involved minor complications that required no additional invasive treatment. These three surgical methods (B-TUEP, ThuLEP, and RASP) are all effective and safe for treating prostates larger than 80 cm3, with each having its particular advantages. B-TUEP requires the shortest operation time, ThuLEP causes the lowest postoperative pain, and RASP results in superior voiding function improvement.
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Affiliation(s)
- Chen-Pang Hou
- Department of Urology, Chang Gung
Memorial Hospital at Linkou, Taoyuan
- Graduate Institute of Clinical Medical
Sciences, College of Medicine, Chang Gung University, Taoyuan
- School of Medicine, Chang Gung
University, Kwei-shan, Tao-Yuan
| | - Yu-Hsiang Lin
- Department of Urology, Chang Gung
Memorial Hospital at Linkou, Taoyuan
- Graduate Institute of Clinical Medical
Sciences, College of Medicine, Chang Gung University, Taoyuan
- School of Medicine, Chang Gung
University, Kwei-shan, Tao-Yuan
| | - Pei-Shan Yang
- Department of Urology, Chang Gung
Memorial Hospital at Linkou, Taoyuan
- School of Medicine, Chang Gung
University, Kwei-shan, Tao-Yuan
| | - Phei-Lang Chang
- Department of Urology, Chang Gung
Memorial Hospital at Linkou, Taoyuan
- School of Medicine, Chang Gung
University, Kwei-shan, Tao-Yuan
| | - Chien-lun Chen
- Department of Urology, Chang Gung
Memorial Hospital at Linkou, Taoyuan
- School of Medicine, Chang Gung
University, Kwei-shan, Tao-Yuan
| | - Kuo-Yen Lin
- Department of Urology, Chang Gung
Memorial Hospital at Linkou, Taoyuan
- School of Medicine, Chang Gung
University, Kwei-shan, Tao-Yuan
| | - Horng-Heng Juang
- Department of Urology, Chang Gung
Memorial Hospital at Linkou, Taoyuan
- Department of Anatomy, School of
Medicine, Chang Gung University, Kwei-shan, Tao-Yuan
| | - Shu-Chuan Weng
- Bachelor Degree Program of Senior
Health and Management, Yuanpei University of Medical Technology, Hsinchu
| | - Ke-Hung Tsui
- Department of Urology, School of
Medicine, College of Medicine, Taipei Medical University, Taipei
- Department of Urology, Shuang Ho
Hospital, Taipei Medical University, New Taipei City
- TMU Research Center of Urology and
Kidney (TMU-RCUK), Taipei Medical University, Taipei
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34
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Teng TC, Shao IH, Hsu YC, Chen Y, Tsao SH, Kang YT, Hsieh ML. Risk Factors of Emergency Room Visits for Bleeding Complications Following Transurethral Procedures in the Treatment of Benign Prostatic Hyperplasia: A Retrospective Cohort Study. Clin Interv Aging 2021; 16:1747-1756. [PMID: 34616148 PMCID: PMC8487796 DOI: 10.2147/cia.s329468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/15/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose Transurethral procedures, including transurethral resection of the prostate (TURP) and laser prostatectomy, are often linked to emergency room (ER) visits for postoperative bleeding. Although some studies have been conducted, the risk factors associated with these ER visits are not completely understood. This retrospective cohort study identified potential risk factors associated with ER visits for postoperative bleeding. Patients and Methods Preoperative assessment data and operational and postoperational parameters recorded at Chang Gung Memorial Hospital, Taiwan between December 2015 and January 2017 for patients who underwent elective transurethral procedures were analyzed to identify potential risk factors. The primary endpoint was ER visits for gross hematuria within three months following operation, and the secondary endpoint was ER visits for blood clot-induced urinary retention (clot retention) within three months following operation. Results A total of 665 patients who underwent elective transurethral procedures were enrolled. The transurethral procedures included monopolar transurethral resection of the prostate (M-TURP), bipolar TURP (B-TURP), greenlight photoselective vaporization of the prostate (PVP), thulium laser enucleation of the prostate (ThuLEP) and thulium laser transurethral vaporesection of the prostate (ThuVARP). Regarding ER visits for clot retention within three months, multivariable logistic regression revealed significantly lower rates of clot retention in patients who received B-TURP than in those who underwent ThuVARP (AOR, 0.18; 95% confidence interval [CI], 0.04–0.82, p = 0.027). Moreover, significantly higher clot retention was observed in patients who underwent two or more rounds of manual irrigation (AOR, 9.51; 95% CI, 1.66–54.43, p = 0.011). Conclusion Multiple manual irrigations shortly after operation can be considered a novel predictor of postoperative clot retention-related ER visits. Among the transurethral procedures, ThuVARP was associated with a higher risk of clot retention-related ER visits than was B-TURP.
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Affiliation(s)
- Tzu-Chi Teng
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - I-Hung Shao
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Yu-Chao Hsu
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Yu Chen
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Shu-Han Tsao
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Yen-Te Kang
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Ming-Li Hsieh
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
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35
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Sabnis RB, Mulawkar PM, Joshi RN. The Urological Society of India guidelines on management of benign prostatic hyperplasia/benign prostatic obstruction (Executive summary). Indian J Urol 2021; 37:210-213. [PMID: 34465948 PMCID: PMC8388351 DOI: 10.4103/iju.iju_121_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
| | | | - Rohit N Joshi
- Department of Urology, Aarna Superspeciality Hospital, Ahmedabad, Gujarat, India
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Pallauf M, Herrmann T, Oswald D, Törzsök P, Deininger S, Lusuardi L. Electrosurgery or laser for benign prostatic enlargement: trumpcard or pitfalls. Curr Opin Urol 2021; 31:444-450. [PMID: 34265843 PMCID: PMC8373441 DOI: 10.1097/mou.0000000000000917] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To summarize and comment on publications of the last 2 years in the field of endoscopic surgery for benign prostatic enlargement, focusing on similarities and differences of laser and electrosurgery. RECENT FINDINGS Because of good hemostasis and safety, invasive endoscopic surgery has evolved to a choice of treatment for vulnerable patients with ongoing antithrombotic medication and in same-day surgery. Recent publications show a good perioperative course and no deterioration in the postoperative outcome. Furthermore, alterations to the original surgical techniques of resection, enucleation, and vaporization have increased the preservation rate for antegrade ejaculation, advancing them to an appealing choice of treatment for sexually active men. Favorable outcomes can be achieved in both laser and electrosurgery. Only the choice of the surgical technique determines the outcome. SUMMARY Various invasive endoscopic surgical techniques are available, offering different advantages and disadvantages for the patient. All of them can be performed with laser and electrosurgery. Therefore, focusing on the proper choice of surgical technique instead of the energy source will guarantee the patient to benefit most.
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Affiliation(s)
- Maximilian Pallauf
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Austria
| | - Thomas Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
| | - David Oswald
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Austria
| | - Peter Törzsök
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Austria
| | - Susanne Deininger
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Austria
| | - Lukas Lusuardi
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Austria
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37
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Taratkin M, Azilgareeva C, Taratkina D, Goryacheva E, Rapoport L, Enikeev D. Laser endoscopic procedures on the prostate: it is the small details that count. Curr Opin Urol 2021; 31:468-472. [PMID: 34231543 DOI: 10.1097/mou.0000000000000919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review aims to highlight the pros and cons of each laser device and to consider additional possible milestones for the development of laser technologies in the surgical treatment of benign prostate hyperplasia. RECENT FINDINGS Over the last three decades, lasers' role in endourology has gone from strength to strength. Specifically, the primary techniques where laser surgery for BPO relief is concerned are vaporization and enucleation. The idea behind vaporization is that lasers are able to vaporize substantial amounts of tissue due to deep ablation depth and increased power. The most efficient devices for vaporization are those affecting hemoglobin as primary chromophore and/or using a continuous firing mode (KTP/LBO:YAG, diode lasers, Tm:YAG). As for enucleation, multiple devices have been suggested for the adequate anatomical enucleation of the prostate (EEP). As it is a skill-dependent technique, the EEP is effective irrespective of which device the surgeon uses. However, some devices have shown significant advances where enucleation is concerned. SUMMARY The choice of device should be based primarily on the technique the surgeon prefers. Although the most suitable lasers for vaporization are hemoglobin-targeting and/or continuous wave devices, the EEP may be done with any enough powered laser, yet some provides specific effects which you should be aware before the surgery.
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38
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Yang K, Meng Y, Zhang K. Educational value of YouTube Surgical Videos of Thulium Laser Enucleation of The Prostate (ThuLEP): the quality assessment. Transl Androl Urol 2021; 10:2848-2856. [PMID: 34430387 PMCID: PMC8350234 DOI: 10.21037/tau-21-263] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/20/2021] [Indexed: 01/05/2023] Open
Abstract
Background To assess the educational value of YouTube surgical videos of thulium laser enucleation of the prostate (ThuLEP). Methods A comprehensive search of “ThuLEP” or “thulium laser enucleation of the prostate” was performed on YouTube on October 31, 2020. According to the LAParoscopic surgery Video Educational GuidelineS, we created a checklist to assess the educational value of these videos. The checklist included 20 options. Each option represented one point. The total score was the sum of all the points. The higher score represents the higher educational value. Results A total of 70 videos were included. The average number of views were 1,366 (range, 11–30,884). The mean video length was 16.59 mins (range, 1.20–70.35 mins). Only 22.9% (16/70) videos had audio or/and written commentary in English language. Although 67.4% (47/70) videos were present step by step, only 21.4% (15/70) videos did the detailed explanation of critical steps. The mean score of the videos was 5.5 points (range, 1–15). No videos met all the points of the checklist. The mean percentage conformity of the videos was 28% (range, 5–75%). The educational score of the videos had no significant positive correlation with the number of views. Conclusions The majority of ThuLEP videos on YouTube platform have low educational value. Videos often lack important and detailed explanations about surgical procedures. The ThuLEP learner should watch these videos selectively. These findings remind us that a global effort should be made to improve the educational value of YouTube surgical videos, and more reporting guidelines about urological endoscopic surgery are still needed.
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Affiliation(s)
- Kunlin Yang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Yisen Meng
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Kai Zhang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
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39
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Meng C, Peng L, Li J, Li J, Li Y, Yang J, Wu J. Comparison of enucleation between thulium laser and holmium laser for benign prostatic hyperplasia: A systematic review and meta-analysis. Asian J Surg 2021; 45:689-697. [PMID: 34384678 DOI: 10.1016/j.asjsur.2021.07.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/24/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
To compare the clinical efficacy and safety of Thulium laser enucleation of prostate (ThuLEP) and Holmium laser enucleation of prostate (HoLEP). We systematically searched PubMed, Embase, and Cochrane Library databases within a period from the date of database establishment to October 2020. RevMan 5.4. was used for calculation and statistical analyses. 8 studies of 2125 patients were included. ThuLEP provided less hemoglobin decrease (MD: -0.37, 95%CI -0.61 to -0.14, P = 0.002) and shorter length of hospital stay (MD: -0.41, 95%CI -0.72 to -0.10, P = 0.01). During the postoperative follow-ups, statistically significant differences only were found in IPSS (MD: -0.96; 95%CI -1.27 to -0.65; P < 0.00001) at the 3rd month. In conclusion, our study demonstrates that ThuLEP, compared with HoLEP, has better security, faster improvement of symptoms. However, our conclusions still require a larger sample size, multi-center, and longer follow-up randomized controlled trials to verify.
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Affiliation(s)
- Chunyang Meng
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
| | - Lei Peng
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
| | - Jinze Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
| | - Jinming Li
- Department of Urology, The Affiliated Hospital of Medical College, North Sichuan Medical College(University), Sichuan, 637000, China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China.
| | - Junbao Yang
- Department of medical genetics and cell biology, North Sichuan Medical College, Nanchong, 63700, Sichuan, China.
| | - Ji Wu
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
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40
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Kaya E, Yılmaz S, Açıkgöz O, Aybal HC, Yılmaz M, Gazel E, Yalcın S, Suarez-Ibarrola R, Tunc L. Laser enucleation for prostates larger than 100 mL: Comparison of HoLEP and ThuLEP. Andrologia 2021; 53:e14125. [PMID: 34029399 DOI: 10.1111/and.14125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 11/28/2022] Open
Abstract
Recently, with the advancements in laser technology, Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP) have come to the fore in the surgical treatment of benign prostatic hyperplasia (BPH). We aimed to evaluate and compare the outcomes of HoLEP and ThuLEP in patients with >100 ml prostate volume. Patients who underwent HoLEP and ThuLEP between July 2017 and March 2020 were reviewed retrospectively. The patients were divided into two groups as HoLEP (Group 1, n = 121) and ThuLEP (Group 2, n = 104). Perioperative parameters, functional outcomes, continence status, intra and post-operative complications were compared between groups in the post-operative 1st and 6th month. No significant difference was found in terms of total laser energy (TLE), morcellation efficiency (ME), enucleated tissue weight (ETW), complication rates (CR) and continence status of patients between both groups (p > .05). In favour of ThuLEP group, there were statistically significant differences regarding total operation time (TOT), laser efficiency (LE), enucleation time (ET) and enucleation efficiency (EE) between groups (p ≤ .05). HoLEP and ThuLEP can be used safely and effectively in prostates larger than 100 ml.
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Affiliation(s)
- Engin Kaya
- Department of Urology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Sercan Yılmaz
- Department of Urology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Onur Açıkgöz
- Department of Urology, Pendik State Hospital, Istanbul, Turkey
| | - Halil Cagrı Aybal
- Department of Urology, Kahramankazan Hamdi Eris State Hospital, Ankara, Turkey
| | - Mehmet Yılmaz
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Freiburg, Germany
| | - Eymen Gazel
- Department of Urology, Ankara Hospital, Acıbadem University, Ankara, Turkey
| | - Serdar Yalcın
- Department of Urology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Freiburg, Germany
| | - Lutfi Tunc
- Department of Urology, Faculty of Medicine, Gazi University, Ankara, Turkey
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41
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Jing Y, Sun Q, Guo W, Zhou D, Zhu Y, Zhao Y, Cui D, Wang X, Ruan Y, Zhao F, Xia S, Han B. A Modified Technique of Thulium Laser Enucleation for Benign Prostatic Hyperplasia With Non-morcellator Approach. Front Surg 2021; 8:657869. [PMID: 34026814 PMCID: PMC8138594 DOI: 10.3389/fsurg.2021.657869] [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: 01/24/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Until recently, most enucleation techniques of the prostate were performed with the application of morcellator. We introduce a modified enucleation technique of thulium laser with non-morcellator approach, which is about incising and vaporizing remaining prostate tissue instead of a morcellator. Methods: A retrospective evaluation of 223 patients undergoing ThuLEP from January 2014 to December 2015 was performed in our institution. One hundred five of the patients used morcellator while the other 118 used non-morcellator approach. All patients were assessed with the International Prostate Symptom Score (IPSS), quality of life (Qol), ultrasonography, serum prostate-specific antigen (PSA), maximal urine flow rate (Qmax), and postvoid residual urine volume (PVR). We reassessed these parameters at 1-, 3-, 6-, and 12-months after operation. Operative time, perioperative, and postoperative complications were also recorded. Results: Significant improvement was noted in the IPSS, QoL, Qmax, and PVR in both groups at the 12-month follow-up, and assessment showed no differences in these parameters between the two groups. Comparisons of the total operation time and enucleation time demonstrated no significant differences between the two groups. Our non-morcellator approach needed more time to incise and vaporize the enucleated tissue compared to morcellation when the prostate volume was about 40–80 ml (p < 0.05), while it showed a significant lower rate of superficial bladder injury than using morcellator (p < 0.05). There were no significant differences in other complications between the two groups (p > 0.05). Conclusions: Our modified technique is a safe and effective procedure for the treatment of BPH avoiding the potential complications caused by morcellator.
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Affiliation(s)
- Yifeng Jing
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qian Sun
- Department of Urology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenhuan Guo
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dapeng Zhou
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiping Zhu
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuyang Zhao
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Di Cui
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaohai Wang
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuan Ruan
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fujun Zhao
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shujie Xia
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bangmin Han
- Department of Urology, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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42
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Pallauf M, Kunit T, Ramesmayer C, Deininger S, Herrmann TRW, Lusuardi L. Endoscopic enucleation of the prostate (EEP). The same but different-a systematic review. World J Urol 2021; 39:2383-2396. [PMID: 33956196 PMCID: PMC8332586 DOI: 10.1007/s00345-021-03705-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/17/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose Various techniques for EEP exist. They differ by surgical steps and the source of energy. It is assumed that the latter is of minor importance, whereas adherence to the anatomical enucleation template determines the postoperative result. So far, no systematic review highlights the differences between the energy sources in use for anatomical EEP. This study will address selfsame topic. Methods A systematic review of the literature was completed on September 1st, 2020. Studies comparing HoLEP, ThuLEP, DiLEP, or BipolEP with TUR-P providing 12 months of postoperative follow-up were included. Two frequentist network meta-analyses were created to compare the techniques of EEP indirectly. Results 31 studies, including 4466 patients, were found eligible for our meta-analysis. Indirect pairwise comparison showed differences in surgery time between BipolEP and HolEP (MD − 16.72 min., 95% CI − 27.75 to − 5.69) and DiLEP and HoLEP (MD − 22.41 min., 95% CI − 39.43 to − 5.39). No differences in the amount of resected prostatic tissue, major and minor complications and postoperative catheterization time were found. The odds for blood transfusions were threefold higher for BipolEP than for HoLEP (OR 3.27, 95% CI 1.02–10.5). The difference was not statistically significant when comparing prospective trials and matched-pair analysis only (OR 3.25, 95% CI 0.94–11.18). The Qmax 12 months after surgery was 2 ml/sec. higher for BipolEP than for DiLEP (MD 2.00, 95% CI 0.17–3.84) and 1.94 ml/sec. lower for DiLEP than for HoLEP (MD − 1.94, 95% CI − 3.65 to − 0.22). Conclusion The energy source used for EEP has an impact on the intervention itself. BipolEP promotes surgical efficiency; laser techniques lower the risk of bleeding. Registry This meta-analysis is registered in the PROSPERO international prospective register registry with the registration number CRD42020205836.
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Affiliation(s)
- M Pallauf
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - T Kunit
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - C Ramesmayer
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - S Deininger
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - T R W Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
| | - L Lusuardi
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
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Reasons to go for thulium-based anatomical endoscopic enucleation of the prostate. World J Urol 2021; 39:2363-2374. [PMID: 33948694 DOI: 10.1007/s00345-021-03704-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 04/17/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To summarize the current evidence and the reasons to go for thulium-based anatomical endoscopic enucleation of the prostate (AEEP). METHODS This review discusses the available literature on thulium-based AEEP. RESULTS Thulium lasers operate at a wavelength between 1940 and 2013 nm. This wavelength, which has a low penetration depth in water, allows to perform smooth cuts in the prostatic tissue and allows urologists to perform various procedures: resection, vaporization, enucleation, or vapoenucleation of the prostate. Depending on the type of thulium laser, it can be used either in a continuous, or pulsed mode. CONCLUSION In recent years, an increasing amount of evidence has described the thulium laser as a minimally invasive and size-independent treatment option for benign prostatic enlargement with excellent long-term results.
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Hartung FO, Kowalewski KF, von Hardenberg J, Worst TS, Kriegmair MC, Nuhn P, Herrmann TRW, Michel MS, Herrmann J. Holmium Versus Thulium Laser Enucleation of the Prostate: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Eur Urol Focus 2021; 8:545-554. [PMID: 33840611 DOI: 10.1016/j.euf.2021.03.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/01/2021] [Accepted: 03/28/2021] [Indexed: 11/04/2022]
Abstract
CONTEXT Holmium (HoLEP) and thulium laser enucleation of the prostate (ThuLEP) are the two methods most commonly applied for endoscopic enucleation of the prostate. It remains unclear which of the two is superior in terms of outcome and complications. OBJECTIVE To compare perioperative and functional outcomes between HoLEP and ThuLEP. EVIDENCE ACQUISITION A systematic review and meta-analysis were performed according to the recommendations of the Cochrane Collaboration and in line with the PRISMA criteria. A comprehensive database search including MEDLINE, Web of Science, CINAHL, ClinicalTrials.gov, and CENTRAL was conducted according to the PICO criteria. Only randomized controlled trials (RCTs) were considered. All review steps were conducted by two independent reviewers. Risk of bias was assessed using the revised Cochrane tool for RCTs. EVIDENCE SYNTHESIS The search identified 556 studies, of which four were eligible for qualitative and quantitative analysis, reporting on a total of 579 patients with follow-up of up to 18 months. No significant differences in operating time, enucleation weight, catheterization time, or hospital stay were observed between ThuLEP and HoLEP. The decrease in hemoglobin was significantly lower for ThuLEP (mean difference -0.54 g/dl, 95% confidence interval [CI] -0.93 to -0.15; p < 0.001), but with low certainty of evidence. Transient urinary incontinence was more common for HoLEP (odds ratio 0.56, 95% CI 0.32-0.99; p = 0.045), again with low certainty of evidence. Furthermore, no significant differences were observed for other complications or for functional measures and symptom scores. CONCLUSIONS ThuLEP and HoLEP offer comparable improvement in symptoms and postoperative voiding parameters. Both procedures are safe and major complications are rare. ThuLEP showed minor advantages for blood loss and the incidence of transient incontinence. This should be interpreted with caution owing to the low certainty of evidence. Therefore, treatment choice should be based on surgeon expertise and local conditions. PATIENT SUMMARY We reviewed four clinical trials that compared holmium and thulium lasers for treatment to reduce the size of the prostate gland. Our review assessed outcomes and complications. We found that both laser techniques are safe and suitable for reducing symptoms due to an enlarged prostate. Blood loss and short-lasting urinary incontinence were slightly lower after thulium compared to holmium laser treatment.
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Affiliation(s)
- Friedrich O Hartung
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Karl-Friedrich Kowalewski
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jost von Hardenberg
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Thomas S Worst
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Nuhn
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Thomas R W Herrmann
- Department of Urology, Spital Thurgau AG Frauenfeld, Münsterlingen, Switzerland; Department of Urology, Hanover Medical School, Hannover, Germany
| | - Maurice S Michel
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jonas Herrmann
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
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Recent evidence for anatomic endoscopic enucleation of the prostate (AEEP) in patients with benign prostatic obstruction on antiplatelet or anticoagulant therapy. World J Urol 2021; 39:3187-3196. [PMID: 33721062 DOI: 10.1007/s00345-021-03647-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/19/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Due to demographic changes in today's society, the number of patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) is increasing. Similarly, the proportion of patients with cardiovascular risk factors undergoing antiplatelet (AP) or anticoagulation (AC) therapy is growing as well. METHODS This review discusses the current literature on various techniques used for anatomic endoscopic enucleation of the prostate (AEEP) in patients on AC/AP therapy. RESULTS The large number of energy sources used for AEEP makes it difficult to compare them. Overall, fewer bleeding-associated complications arise in patients under AP compared to AC or bridging therapy with low molecular weight heparin. However, perioperatively both AP and AC therapy lead to a higher risk of bleeding complications compared to patients not taking anticoagulants. CONCLUSIONS The literature shows that AEEP is possible and efficacious in patients under AC/AP therapy, with only slight differences compared to patients not taking AC/AP drugs, on a short and long-term basis. Nevertheless, the sparse data, the retrospective nature of many studies and the inclusion of prostate sizes between 50 and 110 ml only, make it difficult to come to strong conclusions.
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Gómez-Sancha F. The constant search for the greater good: evolving from TURP to anatomic enucleation of the prostate is a safe bet. World J Urol 2021; 39:2401-2406. [PMID: 33625568 DOI: 10.1007/s00345-021-03637-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE In a troubling moment in history with an ongoing world pandemic and the impending economic crises, there is today a plethora of commercially available options for the minimally invasive treatment of BPH. New industry-driven evaluation criteria of these treatments, the logical marketing hype, a short follow-up for many of them, make challenging to interpret the role they will finally adopt in the armamentarium to treat BPH. METHOD The author comments on recently published literature based in own experience and insight. RESULTS AND CONCLUSIONS In this situation, choosing to evolve from TURP to the next step of endoscopic treatment, the size-independent anatomic endoscopic enucleation of the prostate is a safe bet. It is now exceedingly feasible when the paradigm of AEEP has changed, due to better learning opportunities and technological and surgical technique modifications that have refined this procedure significantly since its inception.
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Bozzini G, Maltagliati M, Besana U, Berti L, Calori A, Sighinolfi MC, Micali S, Roche JB, Gozen A, Mueller A, Pushkar D, Liatsikos E, Boldini M, Buizza C, Rocco B. Holmium laser enucleation of the prostate with Virtual Basket mode: faster and better control on bleeding. BMC Urol 2021; 21:28. [PMID: 33622326 PMCID: PMC7903737 DOI: 10.1186/s12894-021-00797-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/09/2021] [Accepted: 02/12/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To compare clinical intra and early postoperative outcomes between conventional Holmium laser enucleation of the prostate (HoLEP) and Holmium laser enucleation of the prostate using the Virtual Basket tool (VB-HoLEP) to treat benign prostatic hyperplasia (BPH). METHODS This prospective randomized study enrolled consecutive patients with BPH, who were assigned to undergo either HoLEP (n = 100), or VB-HoLEP (n = 100). All patients were evaluated preoperatively and postoperatively, with particular attention to catheterization time, operative time, blood loss, irrigation volume and hospital stay. We also evaluated the patients at 3 and 6 months after surgery and assessed maximum flow rate (Qmax), postvoid residual urine volume (PVR), the International Prostate Symptom Score (IPSS) and the Quality of Life score (QOLS). RESULTS No significant differences in preoperative parameters between patients in each study arm were found. Compared to HoLEP, VB-HoLEP resulted in less hemoglobin decrease (2.54 vs. 1.12 g/dl, P = 0.03) and reduced operative time (57.33 ± 29.71 vs. 42.99 ± 18.51 min, P = 0.04). HoLEP and VB-HoLEP detrmined similar catheterization time (2.2 vs. 1.9 days, P = 0.45), irrigation volume (33.3 vs. 31.7 l, P = 0.69), and hospital stay (2.8 vs. 2.7 days, P = 0.21). During the 6-month follow-up no significant differences in IPSS, Qmax, PVR, and QOLS were demonstrated. CONCLUSIONS HoLEP and VB-HoLEP are both efficient and safe procedures for relieving lower urinary tract symptoms. VB-HoLEP was statistically superior to HoLEP in blood loss and operative time. However, procedures did not differ significantly in catheterization time, hospital stay, and irrigation volume. No significant differences were demonstrated in QOLS, IPSS, Qmax and PVR throughout the 6-month follow-up. TRIAL REGISTRATION Current Controlled Trials ISRCTN72879639; date of registration: June 25th, 2015. Retrospectively registred.
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Affiliation(s)
- Giorgio Bozzini
- Department of Urology, ASST Valle Olona, Via Arnaldo da Brescia, 21052, Busto Arsizio, VA, Italy.
- ESUT, European Section for UroTechnology, Arnhem, Italy.
| | - Matteo Maltagliati
- Department of Urology, ASST Valle Olona, Via Arnaldo da Brescia, 21052, Busto Arsizio, VA, Italy
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Umberto Besana
- Department of Urology, ASST Valle Olona, Via Arnaldo da Brescia, 21052, Busto Arsizio, VA, Italy
| | - Lorenzo Berti
- Department of Urology, ASST Valle Olona, Via Arnaldo da Brescia, 21052, Busto Arsizio, VA, Italy
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Albert Calori
- Department of Urology, ASST Valle Olona, Via Arnaldo da Brescia, 21052, Busto Arsizio, VA, Italy
| | - Maria Chiara Sighinolfi
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- ESUT, European Section for UroTechnology, Arnhem, Italy
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Ali Gozen
- Department of Urology, SLK Kliniken, Heilbron, Germany
| | | | - Dimitry Pushkar
- Department of Urology, Moscow State University, Moscow, Russia
| | | | - Marco Boldini
- Department of Urology, Clinica Sant'Anna, Lugano, Switzerland
| | - Carlo Buizza
- Department of Urology, ASST Valle Olona, Via Arnaldo da Brescia, 21052, Busto Arsizio, VA, Italy
| | - Bernardo Rocco
- ESUT, European Section for UroTechnology, Arnhem, Italy
- Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense, University of Modena and Reggio Emilia, Modena, Italy
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Malde S, Lam W, Adwin Z, Hashim H. Pharmacological and interventional treatment of benign prostatic obstruction: An evidence‐based comparative review. BJUI COMPASS 2021; 2:238-259. [PMID: 35475299 PMCID: PMC8988658 DOI: 10.1002/bco2.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction The recommended treatment for bothersome lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) after the failure of behavioral therapy and fluid modification includes pharmacological, minimally invasive interventional, and surgical approaches. Each option has different risk and benefit profiles, and the urologist must be aware of the unique characteristics of each option in order to be able to accurately counsel the patients based on their individual values and preferences. We provide a comparative review of the commonest pharmacological and most widely performed interventional/surgical treatments for BPO, discussing the evidence for the treatment characteristics that are most useful for the practicing urologist. Methods A search of the PubMed database was performed for articles reporting on the following treatments for LUTS due to BPO: α‐blockers, 5α‐reductase inhibitors, phosphpdiesterase‐5 inhibitors, prostatic urethral lift (Urolift), convective radiofrequency water vapor thermal therapy (Rezum), Temporary implantable Nitinol Device (iTIND), prostate artery embolization (PAE), transurethral resection of the prostate (TURP), photoselective vaporization of the prostate (PVP), Aquablation, and anatomical endoscopic enucleation of the prostate (AEEP). We performed a narrative review focussing on the following outcomes: efficacy, safety, durability, duration of catheterization, length of stay, re‐treatment rate, efficacy in special situations (enlarged median lobe, prostate size, urinary retention, and anticoagulant use), and sexual adverse events. Results AEEP offers the greatest long‐term improvement in maximum flow rate, IPSS, and prostate volume reduction, with lowest re‐treatment rate, followed by PVP, TURP, and Aquablation. Urolift, Rezum, and PAE have similar efficacy for prostate volume up to 80cc, and all are more effective than the pharmacological treatment. Urolift offers the lowest rate of sexual dysfunction, followed by Rezum, and both can be performed as a day case under local anesthesia. Conclusion Several treatment options exist to treat voiding LUTS due to BPO. Newer minimally invasive treatments reduce the hospital stay and postoperative complications, whereas AEEP provides the greatest long‐term symptom improvement at the expense of higher morbidity and sexual dysfunction. Men should be counseled regarding all suitable treatment options as some may favor reduced efficacy in association with reduced side effects.
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Affiliation(s)
- Sachin Malde
- Department of Urology Guy’s and St Thomas’ NHS Foundation Trust London UK
| | - Wayne Lam
- Division of Urology Department of Surgery LKS Faculty of Medicine Queen Mary Hospital The University of Hong Kong Hong Kong Hong Kong SAR
| | - Zainal Adwin
- Department of Surgery Faculty of Medicine Universiti Teknologi MARA Selangor Malaysia
| | - Hashim Hashim
- Bristol Urological Institute Southmead Hospital North Bristol NHS Trust Bristol UK
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Maruccia S, Fulgheri I, Montanari E, Casellato S, Boeri L. Nomenclature in thulium laser treatment of benign prostatic hyperplasia: it's time to pull the rabbit out of the hat. Lasers Med Sci 2021; 36:1355-1367. [PMID: 33389305 DOI: 10.1007/s10103-020-03227-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022]
Abstract
We performed a narrative review with the focus on laser settings and surgical procedure with thulium laser. Our primary goal was to define the most valid settings of each surgical procedure to overcome the inconsistency about nomenclature of thulium surgery and to ensure comparability of future publications. A literature search of articles on thulium laser treatment of benign prostatic hyperplasia (BPH) was conducted between 2009 and 2019. We proposed a new classification standard for laser settings and associated surgical procedure. Each article was analyzed and categorized as concordant or discordant referring to the new classification. In total, 74 papers were included in this narrative review. Overall, 43% and 42% of included studies reported discordant laser parameters and surgical description, respectively. Most of the studies on vaporization were categorized as discordant because they reported a medium/low laser setting instead of high power. Conversely, 93.3% of studies on enucleation were deemed as discordant for laser setting because they reported high power parameters instead of medium-low power setting. Most of the studies on laser enucleation and vapo/enucleation were considered discordant for surgical procedure since authors did not mention the use of mechanical vs. laser method for enucleation. The current literature lacks a uniform definition and standardization of the terminology of thulium laser settings and surgical techniques to guarantee comparability between different approaches. We found a huge heterogeneity in 10 years of surgery with thulium laser. We proposed a new classification of laser setting and procedural description for categorization of thulium laser surgery for BPH.
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Affiliation(s)
- Serena Maruccia
- Department of Urology, Istituti Clinici Zucchi, Monza, Italy
| | - Irene Fulgheri
- Department of Pharmacy, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | | | - Luca Boeri
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.
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Abranches-Monteiro L, Hamid R, D'Ancona C, Alhasso A, Dmochowski R, Ecclestone H, Haylen B, Mousa RA, Onur R, Shah S, Vasudeva P, Oelke M. The International Continence Society (ICS) report on the terminology for male lower urinary tract surgery. Neurourol Urodyn 2020; 39:2072-2088. [PMID: 33045121 DOI: 10.1002/nau.24509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/21/2020] [Indexed: 11/06/2022]
Abstract
INTRODUCTION In the development of terminology of the lower urinary tract (LUT), due to its increasing complexity, the terminology for male LUT surgery needs to be updated using a male-specific approach and via a clinically-based consensus report. METHODS This report combines the input of members of the Standardization Committee of the International Continence Society in a Working Group with recognized experts in the field, assisted by many external referees. Appropriate core clinical categories and a subclassification were developed to give a numeric coding to each definition. An extensive process of 14 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). RESULTS A Terminology Report for male LUT and pelvic floor surgery, encompassing 149 separate definitions/descriptors, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in male LUT surgery. Figures have not been included to avoid any preference or bias towards a specific procedure. CONCLUSIONS A consensus-based Terminology Report for male LUT surgery has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
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Affiliation(s)
| | - Rizwan Hamid
- Department of Urology, University College London Hospitals, London, UK
| | - Carlos D'Ancona
- Department of Urology, Universidade Estadual de Campinas, São Paulo, Brazil
| | - Ammar Alhasso
- Department of Urology, Western General University Hospital, Edinburgh, Scotland
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tenessee, USA
| | | | - Bernard Haylen
- Department of Gynaecology, University of New South Wales, Sydney, Australia
| | - Riyad Al Mousa
- Department of Urology & Neurourology, King Fahd Specialist Hospital, Dammam, Saudi Arabia
| | - Rahmi Onur
- Department of Urology, Marmara University, Istanbul, Turkey
| | - Shahzad Shah
- Department of Urology, Watford General Hospital, London, UK
| | - Pawan Vasudeva
- Department of Urology, VMMC & Safdarjung Hospital, New Delhi, India
| | - Matthias Oelke
- Department of Urology, Paediatric Urology and Uro-Oncology, St. Antonius Hospital, Gronau, Germany
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