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Bulut EC, Elmas B, Koparal MY, Coşkun Ç, Aydın U, Erten KŞ, Çetin S, Alishov S, Atan A, Yeşil S, Küpeli B. A Comparison of the First 60 Enucleation Cases Using a Thulium Fiber Laser without a Mentor to a Transurethral Resection of the Prostate (TURP) and Open Prostatectomy, and the Learning Curve. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1356. [PMID: 39202637 PMCID: PMC11356040 DOI: 10.3390/medicina60081356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/13/2024] [Accepted: 08/19/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: In the surgical treatment of benign prostatic hyperplasia (BPH), laser enucleation of the prostate is recommended as an alternative to transurethral resection (TURP) and open prostatectomy (OP). The thulium fiber laser, with its superficial penetration depth, can offer a rapid learning process by causing less heat injury and capsule damage. This study compares the first 60 cases of an endourologist performing thulium fiber enucleation of the prostate (ThuFLEP) without a mentor to the results of OP and TURP performed by experienced surgeons. It also identifies the case number at which the operation time for ThuFLEP starts to plateau. Materials and Methods: Between 1 November 2021 and 1 November 2023, the initial 60 ThuFLEP cases of an endourologist with no prior enucleation experience were compared with TURP and OP operations performed by experienced surgeons. Since the first 60 ThuFLEP cases involved 80-120 cc prostates, TURP and OP operations within this size range performed during the same period were included in the study. The groups were assessed for age, preoperative and postoperative prostate volume, PSA levels, the IPSS, the IPSS Quality of Life (QoL), and maximum urinary flow (Qmax). The 60 consecutive ThuFLEP cases were divided into three groups of 20 (Groups 1, 2, and 3) and compared for operation time, IPSS, and Qmax. Results: The operation time for TURP was shorter than for ThuFLEP and OP (p < 0.001). There was no significant difference between ThuFLEP and OP in postoperative Qmax and IPSS, while TURP had lower values than the other two methods. For ThuFLEP, the operation time was longer in the first 20 cases but plateaued in groups 2 and 3 (p < 0.001). Postoperative Qmax and IPSS values showed no significant differences among the three ThuFLEP groups (p > 0.05). Conclusions: For large prostates, ThuFLEP provides better postoperative results than TURP and offers shorter catheterization and hospital stay times than OP. Its short learning curve makes it a preferable method for treating BPH compared to other laser techniques.
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Affiliation(s)
- Ender Cem Bulut
- Urology Department, School of Medicine, Gazi University, Ankara 06560, Türkiye; (B.E.); (M.Y.K.); (K.Ş.E.); (S.Ç.); (A.A.); (S.Y.); (B.K.)
| | - Burak Elmas
- Urology Department, School of Medicine, Gazi University, Ankara 06560, Türkiye; (B.E.); (M.Y.K.); (K.Ş.E.); (S.Ç.); (A.A.); (S.Y.); (B.K.)
| | - Murat Yavuz Koparal
- Urology Department, School of Medicine, Gazi University, Ankara 06560, Türkiye; (B.E.); (M.Y.K.); (K.Ş.E.); (S.Ç.); (A.A.); (S.Y.); (B.K.)
| | - Çağrı Coşkun
- Urology Department, Ağrı Training and Research Hospital, Ağrı 04200, Türkiye; (Ç.C.); (U.A.)
| | - Uğur Aydın
- Urology Department, Ağrı Training and Research Hospital, Ağrı 04200, Türkiye; (Ç.C.); (U.A.)
| | - Kadir Şerefhan Erten
- Urology Department, School of Medicine, Gazi University, Ankara 06560, Türkiye; (B.E.); (M.Y.K.); (K.Ş.E.); (S.Ç.); (A.A.); (S.Y.); (B.K.)
| | - Serhat Çetin
- Urology Department, School of Medicine, Gazi University, Ankara 06560, Türkiye; (B.E.); (M.Y.K.); (K.Ş.E.); (S.Ç.); (A.A.); (S.Y.); (B.K.)
| | - Sabuhi Alishov
- Urology Department, Parkhayat Kütahya Hospital, Kütahya 43020, Türkiye;
| | - Ali Atan
- Urology Department, School of Medicine, Gazi University, Ankara 06560, Türkiye; (B.E.); (M.Y.K.); (K.Ş.E.); (S.Ç.); (A.A.); (S.Y.); (B.K.)
| | - Süleyman Yeşil
- Urology Department, School of Medicine, Gazi University, Ankara 06560, Türkiye; (B.E.); (M.Y.K.); (K.Ş.E.); (S.Ç.); (A.A.); (S.Y.); (B.K.)
| | - Bora Küpeli
- Urology Department, School of Medicine, Gazi University, Ankara 06560, Türkiye; (B.E.); (M.Y.K.); (K.Ş.E.); (S.Ç.); (A.A.); (S.Y.); (B.K.)
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Al Barajraji M, Moussa I, Soscia GL, Naudin M, Lempereur L, Coscarella M. Evaluation of the learning curve for Thulium fiber laser enucleation of prostate (ThuFLEP): retrospective study of a single-surgeon experience in real-world settings. World J Urol 2024; 42:444. [PMID: 39060790 DOI: 10.1007/s00345-024-05167-y] [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: 04/10/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
PURPOSE To assess the learning curve of Thulium Fiber Laser Enucleation of prostate (ThuFLEP) of a single surgeon inexperienced in laser endoscopic enucleation of prostate (EEP). METHODS We retrospectively analyzed all patients with benign prostate hyperplasia undergoing ThuFLEP at our center between January 2022 and August 2023 by one surgeon. Inclusion criteria were International Prostate Symptom Score > 7, prostate volume < 200 g, and maximal urinary flow rate < 15 mL/s. The surgeon was inexperienced in laser EEP and trained by watching educational videos of ThuFLEP before starting to perform the procedure under mentoring during the first 4 cases. Procedural data (enucleation and morcellation efficiency, complications) and functional results up to 3 months were evaluated. Patients were divided into 4 cohorts of 20 consecutive cases to evaluate outcomes evolution throughout time. RESULTS The mean age of the patients was 69.9 years (SD 7.8) and mean prostate volume was 89.9 g (SD 25.8). Preoperative functional parameters were comparable between the groups. Mean enucleation efficiency (EE) ratio and morcellation efficiency (ME) ratio reached respectively 0.78 g/min (SD 0.55) and 2.49 g/min (SD 1.03) and both variables significantly increased from group 1 to group 3 (p < 0,001). Perioperative complications remained low throughout the caseload with similar significant 3-month functional improvements between all groups. CONCLUSION This is the first study to evaluate ThuFLEP learning curve for a single surgeon inexperienced in laser EEP with limited mentoring. Under these real-world conditions, nearly 60 cases were needed to complete the learning curve with a complications rate remaining low throughout the training process.
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Affiliation(s)
- Moncef Al Barajraji
- Department of Urology, CHU Ambroise Paré Hospital, Université Libre de Bruxelles, 808, Route de Lennik Bruxelles, Mons, 1070, Belgium.
| | - Ilan Moussa
- Department of Urology, CHU Ambroise Paré Hospital, Université Libre de Bruxelles, 808, Route de Lennik Bruxelles, Mons, 1070, Belgium
| | - Gian-Luca Soscia
- Department of Urology, CHU Ambroise Paré Hospital, Université Libre de Bruxelles, 808, Route de Lennik Bruxelles, Mons, 1070, Belgium
| | - Michel Naudin
- Department of Urology, CHU Ambroise Paré Hospital, Université Libre de Bruxelles, 808, Route de Lennik Bruxelles, Mons, 1070, Belgium
| | - Louise Lempereur
- Department of Urology, CHU Ambroise Paré Hospital, Université Libre de Bruxelles, 808, Route de Lennik Bruxelles, Mons, 1070, Belgium
| | - Mathieu Coscarella
- Department of Urology, CHU Ambroise Paré Hospital, Université Libre de Bruxelles, 808, Route de Lennik Bruxelles, Mons, 1070, Belgium
- Department of Urology, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre Bruxelles, Brussels, Belgium
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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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Wang Q, Alshayyah R, He Y, Wen L, Yu Y, Yang B. Is the Peripheral Zone Thickness an Indicator of a Learning Curve in Bipolar Transurethral Plasma Enucleation of the Prostate?—A Single Center Cohort Study. Front Surg 2022; 8:795705. [PMID: 35187047 PMCID: PMC8847292 DOI: 10.3389/fsurg.2021.795705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background We conducted this cohort study to assess the differences in the learning curve of bipolar transurethral plasma enucleation of the prostate (B-TUEP) associated with prostatic peripheral zone thickness (PZT) under MRI quantitative measurements. Methods For the study, 60 patients with benign prostatic hyperplasia (BPH) were involved. PZT are defined as “Thin” (<7 mm), “Thick” (>10 mm), and “Medium” (in between), with 20 patients in each group. Learning stages were defined as Group 1 (No. 1–20), Group 2 (No. 21–40), and Group 3 (No. 41–60). We measured parameters of the prostate, such as PZT and transitional zone thickness (TZT), with MRI. A learner with no experience in enucleation performed the operations. Statistical analyses were performed to compare the differences. Pearson correlation analysis and multiple linear regression analysis evaluated the relationship between characteristics of patients. P < 0.05 was deemed statistically significant. Results One-Way ANOVA revealed different enucleation efficiency (0.811 ± 0.18 vs. 0.748 ± 0.14 vs. 0.634 ± 0.16), prostate volume (58.9 ± 15.33 vs. 57.3 ± 15.58 vs. 46.6 ± 14.10), and thickness of transition zone (44.45 ± 7.60 vs. 42.45 ± 6.08 vs. 34.78 ± 6.04) among Thin, Medium, and Thick groups. The enucleation efficiency is different between groups divided by learning stages (Group 1 vs. Group 3, 0.658 vs. 0.783; Group 2 vs. Group 3, 0.751 vs. 0.783). Pearson correlation analysis reveals that PZT was negatively correlated with prostate volume (r = −0.427), resection weight (r = −0.35), enucleation efficiency (r = −0.445), and TZT (r = −0.533), and was positively correlated with Q-max (r = 0.301) and bladder outlet obstruction index (BOOI) (r = 0.388). The regression coefficients of PZT, TZT, prostate volume, and Q-max were −0.012, 0.008, 0.007, and 0.013, respectively (all P < 0.05). Conclusion Lower PZT is independent of higher enucleation efficiency, larger adenoma, and higher TZT. PZT may be an important factor on the learning curve of B-TUEP. Higher TZT, prostate volume. and Q-max may also relate to higher enucleation efficiency. For B-TUEP learners, it seems easier to perform the operation when the PZT is low, though more care should be taken with the capsule perforation. Further, the capsule plane should be maintained more attentively if the PZT is high.
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Li B, Hao L, Pang K, Zang G, Wang J, Yang C, Zhang J, Cai L, Wang X, Han C. Assessment of Sexual Outcomes in Patients Undergoing Thulium Laser Prostate Surgery for Management of Benign Prostate Hyperplasia: A Systematic Review and Meta-analysis. Sex Med 2022; 10:100483. [PMID: 35045372 PMCID: PMC9023247 DOI: 10.1016/j.esxm.2021.100483] [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: 10/26/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
Background Thulium laser (Tm:YAG) prostate surgery is a safe and effective procedure with low morbidity and comparable clinical outcomes to those of transurethral resection of the prostate (TURP). However, the sexual function outcomes (erectile and ejaculatory function) have been scarcely studied. Aim We aimed to assess the impact of Tm:YAG prostate surgery on sexual outcomes (erectile and ejaculatory function) and compare them with those patients undergoing TURP. Material and Methods We searched digital databases like PUBMED, SCOPUS, CENTRAL and EMBASE using relevant keywords to identify comparative studies on TURP and non-comparative studies on Tm:YAG prostate surgery that assessed sexual outcomes. We performed qualitative and quantitative analyses with the extracted data. We carried out a meta-analysis to compare postoperative International Index of Erectile Function (IIEF-5) scores and incidences of retrograde ejaculation (RE) in patients undergoing either Tm:YAG or TURP. The pre-operative and post-operative IIEF-5 scores were pooled to estimate overall scores. Results We included 5 comparative and 8 non-comparative studies in this review. We found the postoperative IIEF-5 score improvements to be significantly higher in the Tm:YAG prostate surgery group than in the TURP group with a significant mean difference (MD) of 0.45 (95% CI, 0.18 to 0.72; P = .001). We found no significant associations between the procedures. The pooled OR for the association of RE was estimated at 0.90 (95% CI, 0.50 to 1.60; P = .71; I2 = 0%). Conclusion Tm:YAG prostate surgery improves erectile function more than TURP, according to our findings. Tm:YAG prostate aided surgery also outperforms TURP in terms of preserving sexual function following surgery.However, We found similar or no difference in incidence of RE between Tm:YAG prostate surgery and TURP. Bibo L, Hao L, Pang K, et al. Assessment of Sexual Outcomes in Patients Undergoing Thulium Laser Prostate Surgery for Management of Benign Prostate Hyperplasia: A Systematic Review and Meta-analysis. Sex Med 2022;10:100483.
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Affiliation(s)
- Bibo Li
- Department of Chest Disease Center, Zhejiang Rongjun hospital, Zhejiang Province, China
| | - Lin Hao
- Xuzhou Central Hospital, Xuzhou, China
| | - Kun Pang
- Xuzhou Central Hospital, Xuzhou, China
| | | | - Jian Wang
- Xuzhou Central Hospital, Xuzhou, China
| | - Chendi Yang
- Suzhou Hospital of Chinese Medicine, Suzhou, China
| | - Jianjun Zhang
- Suqian People's Hospital of Nanjing Drum-Tower Hospital Group, the Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - Longjun Cai
- Suqian People's Hospital of Nanjing Drum-Tower Hospital Group, the Affiliated Suqian Hospital of Xuzhou Medical University, Suqian, China
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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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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: 6] [Impact Index Per Article: 2.0] [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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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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Current Bladder Dysfunction Reports Thulium Laser Prostatectomy. CURRENT BLADDER DYSFUNCTION REPORTS 2021. [DOI: 10.1007/s11884-021-00627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Franz J, Suarez-Ibarrola R, Pütz P, Sigle A, Lusuardi L, Netsch C, Lehrich K, Herrmann TRW, Gratzke C, Miernik A. Morcellation After Endoscopic Enucleation of the Prostate: Efficiency and Safety of Currently Available Devices. Eur Urol Focus 2021; 8:532-544. [PMID: 33858810 DOI: 10.1016/j.euf.2021.03.021] [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: 01/29/2021] [Revised: 03/12/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022]
Abstract
CONTEXT Although several studies have compared different morcellators and enucleation techniques for the management of benign prostatic hyperplasia (BPH), there is sparse literature on morcellation, so further experimental and clinical research is required for its optimization. OBJECTIVE To critically appraise the contemporary literature on prostate morcellation and to evaluate the safety and efficiency of currently available morcellators for endoscopic enucleation of the prostate (EEP) in the context of BPH. EVIDENCE ACQUISITION A comprehensive review of the English and French literature relevant to prostate morcellation was performed using the PubMed-MEDLINE, Cochrane Library, Web of Science, and Wiley Online Library database from 1998 to 2020 using PICOS (patient population, intervention, comparison, outcome, and study design) criteria. EVIDENCE SYNTHESIS We retrieved 26 studies involving 5652 patients treated with a morcellator that were eligible for data extraction and analysis. The mean patient age was 67.4 (range 61.4-72.8) yr. The weighted mean efficiency of Piranha, VersaCut, and DrillCut morcellators was 5.29, 3.95, and 5.3 g/min, respectively. Several approaches, such as en bloc, two-lobe, inverse, and improved techniques, may increase morcellation efficiency and safety. The lowest weighted mean rate of bladder wall injury was 1.24% for Piranha, followed by 1.98% for DrillCut, and 5.23% for VersaCut, while the VersaCut morcellator had the lowest weighted mean rate of device malfunction at 0.74%, compared to 2.07% for Piranha and 7.86% for DrillCut. CONCLUSIONS All three morcellators are efficient and safe for prostatic morcellation after EEP. Further development of devices and techniques may improve the efficiency and safety profile of morcellation. To increase safety, surgeon expertise, technical equipment, and patient characteristics should be considered. Therefore, interdisciplinary exchange of knowledge and further technological innovations are strongly encouraged. PATIENT SUMMARY We reviewed the safety and efficacy of devices called morcellators. These devices cut tissue into small pieces that are easier to remove from the body, and are used during laser surgery for benign enlargement of the prostate. Three morcellators are currently available on the market and are comparable in safety and efficacy.
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Affiliation(s)
- Julia Franz
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Philipp Pütz
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - August Sigle
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Lukas Lusuardi
- Department of Urology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Karin Lehrich
- Department of Urology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | | | - Christian Gratzke
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany.
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Amato M, Eissa A, Puliatti S, Secchi C, Ferraguti F, Minelli M, Meneghini A, Landi I, Guarino G, Sighinolfi MC, Rocco B, Bianchi G, Micali S. Feasibility of a telementoring approach as a practical training for transurethral enucleation of the benign prostatic hyperplasia using bipolar energy: a pilot study. World J Urol 2021; 39:3465-3471. [PMID: 33538866 PMCID: PMC7859466 DOI: 10.1007/s00345-021-03594-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 01/08/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction Telementoring is one of the applications of telemedicine capable of bringing highly experienced surgeons to areas lacking expertise. In the current study, we aimed to assess a novel telementoring application during the learning curve of transurethral enucleation of the prostate using bipolar energy (TUEB). Material and methods A telementoring system was developed by our engineering department. This application was used to mentor ten prospective cases of TUEB performed by an expert endourologist (novice to the TUEB). A questionnaire was filled by the operating surgeon and the mentor to provide subjective evaluation of the telementoring system. Finally, the outcomes of these patients were compared to a control group consisting of ten consecutive patients performed by the mentor. Results Ten consecutive TUEB were performed using this telementoring application. Delayed and interrupted connection were experienced in two and one patients, respectively; however, their effect was minor, and they did not compromise the safety of the procedure. None of the patients required conversion to conventional transurethral resection of the prostate. Only one patient in our series experienced grade IIIb complication. Conclusion The telementoring application for TUEB is promising. It is a simple and low-cost tool that could be a feasible option to ensure patients’ safety during the initial phase of the learning curve without time and locations constraints for both the mentor and the trainee; However, it should be mentioned that telementoring cannot yet replace the traditional surgical training with the mentor and trainee being in the operative room. Further studies are required to confirm the current results Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03594-9.
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Affiliation(s)
- Marco Amato
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.,ORSI Academy, Melle, Belgium
| | - Ahmed Eissa
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.,Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.,ORSI Academy, Melle, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Cristian Secchi
- Department of Sciences and Methods for Engineering (DISMI), University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Federica Ferraguti
- Department of Sciences and Methods for Engineering (DISMI), University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Marco Minelli
- Department of Sciences and Methods for Engineering (DISMI), University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | | | - Isotta Landi
- Department of Psychology and Cognitive Sciences, University of Trento, Royereto, Italy
| | - Giulio Guarino
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Maria Chiara Sighinolfi
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124, Modena, Italy.
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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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13
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Taratkin M, Kovalenko A, Laukhtina E, Paramonova N, Spivak L, Wachtendorf LJ, Eminovic S, Afyouni AS, Okhunov Z, Karagezyan M, Mikhailov V, Strakhov Y, Herrmann TR, Enikeev D. Ex vivo study of Ho:YAG and thulium fiber lasers for soft tissue surgery: which laser for which case? Lasers Med Sci 2020; 37:149-154. [PMID: 33175250 DOI: 10.1007/s10103-020-03189-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/04/2020] [Indexed: 12/11/2022]
Abstract
The goal of this study was to assess the ablation, coagulation, and carbonization characteristics of the holmium:YAG (Ho:YAG) laser and thulium fiber lasers (TFL). The Ho:YAG laser (100 W av.power), the quasi-continuous (QCW) TFL (120 W av.power), and the SuperPulsed (SP) TFL (50 W av.power) were compared on a non-frozen porcine kidney. To control the cutting speed (2 or 5 mm/s), an XY translation stage was used. The Ho:YAG was tested using E = 1.5 J and Pav = 40 W or Pav = 70 W settings. The TFL was tested using E = 1.5 J and Pav = 30 W or Pav = 60 W settings. After ex vivo incision, histological analysis was performed in order to estimate thermal damage. At 40 W, the Ho:YAG displayed a shallower cutting at 2 and 5 mm/s (1.1 ± 0.2 mm and 0.5 ± 0.2 mm, respectively) with virtually zero coagulation. While at 70 W, the minimal coagulation depth measured 0.1 ± 0.1 mm. The incisions demonstrated zero carbonization. Both the QCW and SP TFL did show effective cutting at all speeds (2.1 ± 0.2 mm and 1.3 ± 0.2 mm, respectively, at 30 W) with prominent coagulation (0.6 ± 0.1 mm and 0.4 ± 0.1 mm, respectively, at 70 W) and carbonization. Our study introduced the TFL as a novel efficient alternative for soft tissue surgery to the Ho:YAG laser. The SP TFL offers a Ho:YAG-like incision, while QCW TFL allows for fast, deep, and precise cutting with increased carbonization.
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Affiliation(s)
- Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
| | - Anastasia Kovalenko
- NTO "IRE-Polus", One Vvedenskogo Sq, Fryazino, Moscow Region, Russia, 141120
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Nina Paramonova
- Centralized Pathology Department, Sechenov University, Moscow, Russia
| | - Leonid Spivak
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Semil Eminovic
- Faculty of Medicine, Philipps University Marburg, Marburg, Germany
| | | | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, CA, USA
| | - Marina Karagezyan
- Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia
| | - Vasily Mikhailov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Yuriy Strakhov
- Centralized Pathology Department, Sechenov University, Moscow, Russia
| | - Thomas Rw Herrmann
- Department of Urology, Spital Thurgau AG, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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14
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Enikeev D, Taratkin M, Glybochko P. Re: Thulium Laser Transurethral Vaporesection of the Prostate Versus Transurethral Resection of the Prostate for Men with Lower Urinary Tract Symptoms or Urinary Retention (UNBLOCS): A Randomized Controlled Trial. Eur Urol 2020; 79:317-318. [PMID: 32958299 DOI: 10.1016/j.eururo.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/03/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Petr Glybochko
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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15
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Systematic review of the endoscopic enucleation of the prostate learning curve. World J Urol 2020; 39:2427-2438. [PMID: 32940737 DOI: 10.1007/s00345-020-03451-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/07/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION It has been shown that endoscopic enucleation of the prostate (EEP) allows for similar efficacy and safety, no matter what energy and type of instruments we use, but the length of learning may differ greatly. The aim of this systematic review is to verify if there is any significant difference between EEP methods in learning. EVIDENCE ACQUISITION We performed a systematic literature search in three databases and included only the articles containing their own data on the EEP learning curve assessment during the last 10 years. The primary endpoint was to determine the necessary experience needed to achieve a plateau. The secondary endpoints were to review methods used to evaluate a learning curve. EVIDENCE SYNTHESIS The final sample included 17 articles, containing a total of 4615 EEPs performed by 76 surgeons, the most common method was HoLEP (9/17). The majority of articles studying HoLEP report a learning curve of experience level achievement in roughly 30-40 (min 20; max 60) cases. The studies of GreenLight laser showed high heterogeneity in the results with minimum of 20 cases and maximum of 150-200 cases. TUEB required roughly 40-50 cases to reach the plateau. CONCLUSION Although EEP is considered challenging, it shows a steep learning curve with a plateau after 30-50 cases. Proper criteria are critical for accurate assessment of the learning curve. The Trifecta and Pentafecta criteria are currently the most appropriate method to evaluate EEP learning.
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16
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Cheng BKC, Li TCF, Yu CHT. Sexual outcomes of endoscopic enucleation of prostate. Andrologia 2020; 52:e13724. [PMID: 32557813 DOI: 10.1111/and.13724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/24/2020] [Accepted: 05/30/2020] [Indexed: 12/28/2022] Open
Abstract
The emergence of various endoscopic enucleation techniques in the past decade has provided surgeons with more options and opportunities in performing enucleation. With the same surgical principle as holmium laser enucleation of prostate, the early results of different techniques were comparable. However, sexual outcomes of endoscopic enucleation of the prostate (EEP) were less commonly reported than the voiding and urodynamic outcomes. In this review, the sexual outcomes including erectile function, ejaculatory and orgasmic function of various endoscopic enucleation technique would be studied. The overall sexual outcomes were heterogeneous and inconclusive. Outcomes measurement, sample size calculation, hypothesis generation and selection criteria were not specifically designed for sexual outcomes or even available. There were also limitations in the individual sexual assessment tools. Nonetheless, most studies showed no significant deterioration of erectile function after EEP, and ejaculation dysfunction was common. Looking forward in the field of benign prostatic enlargement surgery, the 'one size fits all' notion should be abandoned. Treatment should be tailor-made according to the prostate size, co-morbidities and sexual needs. The sexual outcomes of enucleation have to be better studied and defined. More prospective controlled studies focusing primarily on sexual functions are needed. For enucleation surgeons, exploring different ejaculatory-sparing technique could be the golden opportunities in further consolidating the role and expanding the indication of enucleation surgery.
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Affiliation(s)
| | | | - Chloe Hui-Tung Yu
- Department of Surgery, United Christian Hospital, Hong Kong, Hong Kong
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Teoh JY, Cho C, Wei Y, Isotani S, Tiong H, Ong T, Kijvikai K, Chu PS, Chan ES, Ng C. Surgical training for anatomical endoscopic enucleation of the prostate. Andrologia 2020; 52:e13708. [PMID: 32557751 DOI: 10.1111/and.13708] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/05/2020] [Accepted: 05/20/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- 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
| | - Chak‐Lam Cho
- Division of Urology Department of Surgery Union Hospital Hong Kong China
| | - Yong Wei
- Department of Urology The First Affiliated Hospital of Fujian Medical University Fuzhou China
| | - Shuji Isotani
- Department of Urology Juntendo University Graduate School of Medicine Tokyo Japan
| | - Ho‐Yee Tiong
- Department of Surgery Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Teng‐Aik Ong
- Department of Surgery University of Malaya Kuala Lumpur Malaysia
| | - Kittinut Kijvikai
- Department of Urology Ramathibodi Hospital Mahidol University Salaya Thailand
| | - Peggy Sau‐Kwan Chu
- Division of Urology Department of Surgery Tuen Mun Hospital Hong Kong China
| | - Eddie Shu‐Yin Chan
- S.H. Ho Urology Centre Department of Surgery Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong China
| | - Chi‐Fai Ng
- S.H. Ho Urology Centre Department of Surgery Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong China
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18
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Herrmann TR, Gravas S, de la Rosette JJMCH, Wolters M, Anastasiadis AG, Giannakis I. Lasers in Transurethral Enucleation of the Prostate-Do We Really Need Them. J Clin Med 2020; 9:E1412. [PMID: 32397634 PMCID: PMC7290840 DOI: 10.3390/jcm9051412] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 12/21/2022] Open
Abstract
The acronym EEP, coding for transurethral Endoscopic Enucleation of the Prostate, was introduced in 2016 by the European Association of Urology (EAU) guidelines panel on management of non-neurogenic male lower urinary tract symptoms (LUTS) and benign prostatic obstruction (BPO). Since then, a laser-based treatment, Holmium Laser Enucleation of the Prostate (HoLEP), and the current-based treatment of bipolar enucleation of the prostate (BipoLEP) are equally appreciated as valuable options for the management of benign prostatic obstruction (BPO). This was mainly inspired by the results of two meta-analyses on randomized controlled trials, comparing open prostatectomy with either Holmium Laser Enucleation of the Prostate (HoLEP) or bipolar enucleation of the prostate (BipoLEP). Prior to that, HoLEP was embraced as the only valid option for transurethral enucleation, although evidence for equivalence existed as early as 2006, but was not recognized due to a plethora of acronyms for bipolar energy-based treatments and practiced HoLEP-centrism. On the other hand, the academic discourse focused on different (other) laser approaches that came up, led by Thulium:Yttrium-Aluminum-Garnet (Tm:YAG) Vapoenucleation (ThuVEP) in 2009 and, finally, transurethral anatomical enucleation with Tm:YAG support (thulium laser enucleation of the prostate, ThuLEP) in 2010. Initially, the discourse on lasers focused on the different properties of lasers rather than technique or surgical anatomy, respectively. In and after 2016, the discussion ultimately moved towards surgical technique and accepting anatomical preparation as the common of all EEP techniques (AEEP). Since then, the unspoken question has been raised, whether lasers are still necessary to perform EEP in light of existing evidence, given the total cost of ownership (TCO) for these generators. This article weighs the current evidence and comes to the conclusion that no evidence of superiority of one modality over another exists with regard to any endpoint. Therefore, in the sense of critical importance, AEEP can be safely and effectively performed without laser technologies and without compromise.
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Affiliation(s)
- Thomas R.W. Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, 8569 Münsterlingen, Switzerland; (A.G.A.); (I.G.)
- Department of Urology, Hannover Medical School, 30625 Hannover, Germany;
| | - Stavros Gravas
- Department of Urology, University Hospital of Larisa, 41500 Larisa, Greece;
| | | | - Mathias Wolters
- Department of Urology, Hannover Medical School, 30625 Hannover, Germany;
| | | | - Ioannis Giannakis
- Department of Urology, Spital Thurgau AG, Frauenfeld, 8569 Münsterlingen, Switzerland; (A.G.A.); (I.G.)
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19
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Castellani D, Pirola GM, Pacchetti A, Saredi G, Dellabella M. State of the Art of Thulium Laser Enucleation and Vapoenucleation of the Prostate: A Systematic Review. Urology 2020; 136:19-34. [DOI: 10.1016/j.urology.2019.10.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023]
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20
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Enikeev D, Netsch C, Rapoport L, Gazimiev M, Laukhtina E, Snurnitsyna O, Alekseeva T, Becker B, Taratkin M, Glybochko P. Novel thulium fiber laser for endoscopic enucleation of the prostate: A prospective comparison with conventional transurethral resection of the prostate. Int J Urol 2019; 26:1138-1143. [DOI: 10.1111/iju.14115] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/01/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Dmitry Enikeev
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | | | - Leonid Rapoport
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Magomed Gazimiev
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Olesya Snurnitsyna
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Tatyana Alekseeva
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Benedikt Becker
- Department of Urology Asklepios Hospital Barmbek Hamburg Germany
| | - Mark Taratkin
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Petr Glybochko
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
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21
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Netsch C, Gross AJ. Thulium laser enucleation of the prostate. Curr Opin Urol 2019; 29:302-303. [PMID: 30950888 DOI: 10.1097/mou.0000000000000610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Thulium vapoenucleation of the prostate (ThuVEP) for prostates larger than 85 ml: long-term durability of the procedure. Lasers Med Sci 2019; 34:1637-1643. [DOI: 10.1007/s10103-019-02760-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 02/26/2019] [Indexed: 11/26/2022]
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23
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Xiao KW, Zhou L, He Q, Gao XS, Chen G, Ma YC, Li H, Wang KJ. Enucleation of the prostate for benign prostatic hyperplasia thulium laser versus holmium laser: a systematic review and meta-analysis. Lasers Med Sci 2019; 34:815-826. [PMID: 30604345 DOI: 10.1007/s10103-018-02697-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/23/2018] [Indexed: 02/05/2023]
Abstract
To evaluate the clinical efficacy and safety of thulium laser vapoenucleation/enucleation of the prostate (ThuEP) versus holmium laser enucleation of the prostate (HoLEP) in the management of benign prostatic hyperplasia (BPH). A systematic literature search was performed using PubMed, Embase, and Web of Science to identify eligible studies published before July 2018. Meta-analysis of extracted data was performed with RevMan version 5.3. We chose the fixed- or random-effect model to fit the pooled heterogeneity. Five eligible studies including two randomized controlled trials (RCTs) and three non-RCTs involving 1010 patients were enrolled in our meta-analysis. ThuEP provided less enucleation time when compared with HoLEP (WMD = - 7.73, 95% CI - 14.39-1.07, P = 0.02). During the 1st, 6th, and 12th months of postoperative follow-ups, statistically significant differences were found in Qmax (WMD = 2.05, 95% CI 0.52~3.58) and PVR (WMD = - 6.50, 95% CI - 7.35~- 5.66, P < 0.001) in the 1st month after the operation, also in IPSS (IPSS: WMD = - 1.29, 95% CI - 2.39~- 0.19, P = 0.02) in the 12th month after the operation. As regards other perioperative, postoperative parameters, and complication rates, we found no significant difference. Both ThuEP and HoLEP provided satisfactory micturition improvement with low morbidity after the 1st and 6th months of the operation. However, ThuEP showed higher enucleation efficacy and less intraoperative blood loss and may get a better outcome as compared to the HoLEP group in the early postoperative period with regard to Qmax/PVR and IPSS after the 1st and 12th months of the operation respectively.
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Affiliation(s)
- Kai-Wen Xiao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Liang Zhou
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Qing He
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Xiao-Shuai Gao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Guo Chen
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yu-Cheng Ma
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Kun-Jie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China.
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24
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Enikeev D, Okhunov Z, Rapoport L, Taratkin M, Enikeev M, Snurnitsyna O, Capretz T, Inoyatov J, Glybochko P. Novel Thulium Fiber Laser for Enucleation of Prostate: A Retrospective Comparison with Open Simple Prostatectomy. J Endourol 2019; 33:16-21. [DOI: 10.1089/end.2018.0791] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dmitry Enikeev
- Institute of Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, California
| | - Leonid Rapoport
- Institute of Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mark Taratkin
- Institute of Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mikhail Enikeev
- Institute of Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Olesya Snurnitsyna
- Institute of Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Taylor Capretz
- Department of Urology, University of California, Irvine, California
| | - Jasur Inoyatov
- Institute of Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Petr Glybochko
- Institute of Urology and Reproductive Health, Sechenov University, Moscow, Russia
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25
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Nestler S, Bach T, Herrmann T, Jutzi S, Roos FC, Hampel C, Thüroff JW, Thomas C, Neisius A. Surgical treatment of large volume prostates: a matched pair analysis comparing the open, endoscopic (ThuVEP) and robotic approach. World J Urol 2018; 37:1927-1931. [PMID: 30515596 DOI: 10.1007/s00345-018-2585-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 11/27/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To compare open simple prostatectomy, endoscopic enucleation and laparoscopic, robot-assisted enucleation of high-volume prostate in terms of operation time, blood loss, transfusion and complication rates and early continence rates. MATERIAL AND METHODS Patients with BPH treated endoscopically (ThuVEP, Hamburg and Hannover) or robotically (Mainz) were evaluated prospectively for prostate size, free flow and validated questionnaires (IPSS, QoL). 35 patients were matched to patients after open prostatectomy (Mainz) for age, prostate size, IPSS and QoL scores. Operation time was noted from the first cut to the last suture; blood loss was estimated by the drop of haemoglobin preoperatively and one day after surgery. Transfusion rates were documented. Early continence was estimated by pad use over the first 24 h after catheter removal. Statistical analysis was performed with SPSS 22.0. RESULTS No significant differences in prostate size, age and preoperative questionnaires were found (p > 0.3). Postoperative flow and the results of the questionnaires were significantly improved (all p < 0.05), without difference between the approaches (p > 0.8). Endoscopic surgery showed superiority in operation time (both p < 0.05); blood loss and transfusion rates were significantly lower compared to open surgery (both p < 0.01) and lower than in robotic surgery without reaching significance (p = 0.18, p = 0.36). Similar results were seen in early continence rates. CONCLUSION Due to our results, endoscopic surgery should be considered as first-line therapy unless there are comorbidities like diverticula and/or bladder calculi that can be easily treated simultaneously by robotic surgery. Against the background of these findings, indications favouring open surgery are getting sparse.
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Affiliation(s)
| | - T Bach
- Department of Urology, Hospital Harburg, Hamburg, Germany
| | - T Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland.,Hannover Medical School (MHH), Hannover, Germany
| | - S Jutzi
- Hannover Medical School (MHH), Hannover, Germany
| | - F C Roos
- Department of Urology, University of Mainz, Mainz, Germany.,Department of Urology, University of Frankfurt, Frankfurt, Germany
| | - C Hampel
- Department of Urology, University of Mainz, Mainz, Germany.,Department of Urology, Marien Hospital, Erwitte, Germany
| | - J W Thüroff
- Department of Urology, University of Mainz, Mainz, Germany
| | - C Thomas
- Department of Urology, University of Mainz, Mainz, Germany
| | - A Neisius
- Department of Urology, University of Mainz, Mainz, Germany.,Department of Urology, Brüderkrankenhaus Trier, University of Mainz, Trier, Germany
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26
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Castellani D, Claudini R, Gasparri L, Branchi A, Pavia MP, Dellabella M. Is complete anatomical endoscopic laser enucleation of the prostate always necessary? Yes, it is! Urologia 2018; 86:93-95. [PMID: 30458688 DOI: 10.1177/0391560318812302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Thulium laser enucleation of the prostate is gaining popularity due to its short learning curve and low postoperative morbidity. The aim of Thulium laser enucleation of the prostate is the complete endoscopic enucleation of the adenoma. We report an unusual case of bladder outlet obstruction developed 6 weeks after Thulium laser enucleation of the prostate. CASE DESCRIPTION A 74-year-old man complained of severe voiding phase symptoms lasting 2 weeks, starting 6 weeks after Thulium laser enucleation of the prostate. He underwent a transrectal ultrasound, which showed a wide prostatic fossa. A cystoscopy revealed that the prostatic fossa was filled with whitish tissue arising from two tiny residual adenomas. The obstructing tissue was resected with the aid of Thulium laser and the histopathology report showed necrotic prostatic glands. CONCLUSION Partially enucleated and left inside adenoma may become necrotic and cause bladder outlet obstruction several weeks after Thulium laser enucleation of the prostate. Transrectal ultrasound control at the end of enucleation may help reduce this complication.
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Johnson B, Sorokin I, Singla N, Roehrborn C, Gahan JC. Determining the Learning Curve for Robot-Assisted Simple Prostatectomy in Surgeons Familiar with Robotic Surgery. J Endourol 2018; 32:865-870. [DOI: 10.1089/end.2018.0377] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Brett Johnson
- Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Igor Sorokin
- Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Claus Roehrborn
- Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Jeffrey C. Gahan
- Department of Urology, University of Texas Southwestern, Dallas, Texas
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Comparison Between Two Different En Bloc Thulium Laser Enucleation of the Prostate: Does Technique Influence Complications and Outcomes? Urology 2018; 119:121-126. [DOI: 10.1016/j.urology.2018.05.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 12/18/2022]
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Enikeev D, Glybochko P, Rapoport L, Gahan J, Gazimiev M, Spivak L, Enikeev M, Taratkin M. A Randomized Trial Comparing The Learning Curve of 3 Endoscopic Enucleation Techniques (HoLEP, ThuFLEP, and MEP) for BPH Using Mentoring Approach-Initial Results. Urology 2018; 121:51-57. [PMID: 30053397 DOI: 10.1016/j.urology.2018.06.045] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 05/30/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess the differences in the learning curve associated with different techniques of endoscopic enucleation of the prostate. MATERIALS AND METHODS Ninety patients were randomly assigned into 3 groups (30 patients in each): HoLEP, ThuFLEP or MEP. Inclusion criteria for the study included prostate volume <80 cc, IPSS > 20, or Qmax < 10. The EEPs were performed by 3 surgeons experienced in transurethral resection of the prostate. Assignment of surgeons to surgical technique was also randomized. None of the surgeons had prior experience in EEP. RESULTS ThuFLEP was slightly superior (with no significant difference [P > .05]) to HoLEP and MEP in terms of overall enucleation rate-1.0 g/min vs 0.8 g/min and 0.7 g/min, respectively. We observed similar enucleation rates at the initial stages of training (first 20 surgeries) with insignificant increase in ThuFLEP efficiency. At next 10 surgeries ThuFLEP and HoLEP efficiency were higher than of MEP (P < .001) without significant difference between techniques of laser EEP (P = .07). CONCLUSION Endoscopic enucleation of the prostate can be adopted safely and effectively within 30 surgeries if the technique is learned with a mentoring approach. EEP is shown to be safe and effective even in the initial stages of learning. Laser EEP (HoLEP, ThuFLEP) appears to lend itself to quicker adaptation compared MEP.
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Affiliation(s)
- Dmitry Enikeev
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation.
| | - Petr Glybochko
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
| | - Leonid Rapoport
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
| | - Jeffrey Gahan
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
| | - Magomed Gazimiev
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
| | - Leonid Spivak
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
| | - Mikhail Enikeev
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
| | - Mark Taratkin
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
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Enikeev D, Glybochko P, Okhunov Z, Alyaev Y, Rapoport L, Tsarichenko D, Enikeev M, Sorokin N, Dymov A, Taratkin M. Retrospective Analysis of Short-Term Outcomes After Monopolar Versus Laser Endoscopic Enucleation of the Prostate: A Single Center Experience. J Endourol 2018; 32:417-423. [DOI: 10.1089/end.2017.0898] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dmitry Enikeev
- Research Institute for Uronephrology and Reproductive Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Petr Glybochko
- Research Institute for Uronephrology and Reproductive Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, California, USA
| | - Yuriy Alyaev
- Research Institute for Uronephrology and Reproductive Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Leonid Rapoport
- Research Institute for Uronephrology and Reproductive Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Dmitry Tsarichenko
- Research Institute for Uronephrology and Reproductive Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Mikhail Enikeev
- Research Institute for Uronephrology and Reproductive Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Nikolay Sorokin
- Research Institute for Uronephrology and Reproductive Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Alim Dymov
- Research Institute for Uronephrology and Reproductive Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Mark Taratkin
- Research Institute for Uronephrology and Reproductive Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Netsch C, Gross AJ. Letter to the Editor: A prospective, randomized trial comparing thulium vapoenucleation with holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic obstruction: perioperative safety and efficacy. World J Urol 2017; 36:501-502. [PMID: 29256018 DOI: 10.1007/s00345-017-2158-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/11/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Christopher Netsch
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany.
| | - A J Gross
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
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Weng CH, Yang S, Chen HY, Chang HK, Chen M, Lin WC, Chow YC, Tsai WK, Lin WR, Hsu JM. Complications of laser enucleation of the prostate: Results at two institutions. UROLOGICAL SCIENCE 2017. [DOI: 10.1016/j.urols.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Treatment outcomes of benign prostate hyperplasia by thulium vapoenucleation of the prostate in aging men. UROLOGICAL SCIENCE 2016. [DOI: 10.1016/j.urols.2016.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Wolters M, Huusmann S, Oelke M, Kuczyk MA, Herrmann TRW. Anatomical Enucleation of the Prostate with the Novel Combined Mechanical and Bipolar Vaporization Probe in Ejaculation Sparing and Two-Lobe Manner. ACTA ACUST UNITED AC 2016. [DOI: 10.1089/vid.2016.0028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Mathias Wolters
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - Stephan Huusmann
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - Matthias Oelke
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - Markus Antonius Kuczyk
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Hannover, Germany
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Wolters M, Huusmann S, Oelke M, Kuczyk MA, Herrmann TRW. Anatomical Enucleation of the Prostate with Thulium:YAG Support: Redefinition of the Surgical Approach in Two-Lobe Technique. ACTA ACUST UNITED AC 2016. [DOI: 10.1089/vid.2016.0029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Mathias Wolters
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - Stephan Huusmann
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - Matthias Oelke
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - Markus Antonius Kuczyk
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Hannover, Germany
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Pearce SM, Pariser JJ, Malik RD, Famakinwa OJ, Chung DE. Outcomes following Thulium vapoenucleation of large prostates. Int Braz J Urol 2016; 42:757-65. [PMID: 27564287 PMCID: PMC5006772 DOI: 10.1590/s1677-5538.ibju.2015.0424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 02/01/2016] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Thulium laser VapoEnucleation of the prostate (ThuVEP) is an evolving surgical technique for BPH. Most studies have focused on outcomes in small to médium sized prostates and have originated from Europe and Asia. We sought to describe our experience with ThuVEP for very large prostates in a North American cohort. MATERIALS AND METHODS From December 2010 to October 2014, 25 men underwent Thu-VEP using the CyberTM® (Quantastem, Italy) thulium laser, all with prostate volume >75mL. Data collected included patient demographics, comorbidities, intraoperative parameters, complications, and post-operative outcomes including maximum flow rate (Qmax), post-void residual (PVR), International Prostate Symptom Score (IPSS), and quality of life score (QoL) in one year of follow-up. Statistical analysis was done using Wilcoxon signed-rank test. RESULTS At baseline, mean age was 70±9 years and prostate size was 163±62g. Most patients (84%) were in retention and 10 (40%) patients were on anticoagulation. Seven (28%) patients went home the day of surgery (mean hospital stay: 1.2±1.2d). There were 2 intraoperative complications (8%), both cystotomies related to morcellation. Nine patients (36%) experienced a complication, all within 30 days. There were no Clavien III complications. Significant improvements were seen in Qmax, PVR, IPSS, and QoL score at each time interval to 12-months following surgery (all p<0.05). Of 21 patients initially in retention, all were voiding at last follow-up. CONCLUSIONS Our findings suggest that ThuVEP is an effective treatment for BPH in patients with large prostates with sustained results for one year.
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Affiliation(s)
- Shane M Pearce
- Section of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA
| | - Joseph J Pariser
- Section of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA
| | - Rena D Malik
- Section of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA
| | - Olufenwa J Famakinwa
- Section of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA
| | - Doreen E Chung
- Section of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA
- Department of Urology, Columbia University Medical Center, New York, NY, USA
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Yu H, Zhang Z, Zhu Y, Chen J, Jiang X, Meng H, Shi B. Long-term outcome following thulium vaporesection of the prostate. Lasers Surg Med 2016; 48:505-10. [PMID: 26940981 DOI: 10.1002/lsm.22495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND The continuous wave 2-μm Thulium Laser has been introduced as potential technology with both high efficiency and safe practice; although little data have been shown regarding the long-term outcomes. OBJECTIVE To analyze the long-term outcomes after thulium vaporesection of the prostate (ThuVaRP). METHODS ThuVaRP was performed using the continuous wave, 2-μm Thulium: YAG laser at 70 W. The perioperative and post-operative follow-up data were analyzed. RESULTS The average age at surgery was 71.5 (range 55-94 years). The median prostate size was 60.1 g (range 36.3-109.8 g). A median operation time was noted at 44.8 ± 6.5 minutes, while the median catheterization time was 3.5 ± 0.5 days. In regards to hospital stay, most patients had an average duration of 5.5 ± 1.5 days. Minor complications requiring non-interventional treatment happened in 237 (36.24%) of 654 patients, while major complications requiring re-interventions occurred in one patient (0.15%). During a 60-month follow-up, bladder neck fibrosis occurred in 1.22% of the patients. A BPH recurrence happened in 17 (2.60%) patients, of which 14 patients (2.14%) received a second surgery. In comparison to the pre-operative baseline, the patients Qmax, PVR volume, IPSS, and Qol scores all improved significantly (P < 0.01) at time of discharge. This continued into the post-operative follow-up visits (3-6-12-18-14-26-48-60 months). CONCLUSIONS ThuVaRP is both an effective and safe treatment procedure for symptomatic BPO (with a low occurrence of complications). Lasers Surg. Med. 48:505-510, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Haiyi Yu
- Department of Urology, 89th Hospital of PLA, Weifang, Shandong, 261000, People's Republic of China
| | - Zhaocun Zhang
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Yaofeng Zhu
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Jun Chen
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Xuewen Jiang
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Hui Meng
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Benkang Shi
- Department of Urology, Qilu Hospital, Shandong University, Jinan, Shandong, 250012, People's Republic of China
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Huusmann S, Wolters M, Kramer MW, Bach T, Teichmann HO, Eing A, Bardosi S, Herrmann TRW. Tissue damage by laser radiation: an in vitro comparison between Tm:YAG and Ho:YAG laser on a porcine kidney model. SPRINGERPLUS 2016; 5:266. [PMID: 27006875 PMCID: PMC4777968 DOI: 10.1186/s40064-016-1750-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 02/12/2016] [Indexed: 12/04/2022]
Abstract
The understanding of tissue damage by laser radiation is very important for the safety in the application of surgical lasers. The objective of this study is to evaluate cutting, vaporization and coagulation properties of the 2 µm Tm:YAG laser (LISA Laser Products OHG, GER) in comparison to the 2.1 µm Ho:YAG laser (Coherent Medical Group, USA) at different laser power settings in an in vitro model of freshly harvested porcine kidneys. Laser radiation of both laser generators was delivered by using a laser fiber with an optical core diameter of 550 µm (RigiFib, LISA Laser GER). Freshly harvested porcine kidneys were used as tissue model. Experiments were either performed in ambient air or in aqueous saline. The Tm:YAG laser was adjusted to 5 W for low and 120 W for the high power setting. The Ho:YAG laser was adjusted to 0.5 J and 10 Hz (5 W average power) for low power setting and to 2.0 J and 40 Hz (80 W average power) for high power setting, accordingly. The specimens of the cutting experiments were fixed in 4 % formalin, embedded in paraffin and stained with Toluidin blue. The laser damage zone was measured under microscope as the main evaluation criteria. Laser damage zone consists of an outer coagulation zone plus a further necrotic zone. In the ambient air experiments the laser damage zone for the low power setting was 745 ± 119 µm for the Tm:YAG and 614 ± 187 µm for the Ho:YAG laser. On the high power setting, the damage zone was 760 ± 167 µm for Tm:YAG and 715 ± 142 µm for Ho:YAG. The incision depth in ambient air on the low power setting was 346 ± 199 µm for Tm:YAG, 118 ± 119 µm for Ho:YAG. On the high power setting incision depth was 5083 ± 144 µm (Tm:YAG) and 1126 ± 383 µm (Ho:YAG) respectively. In the saline solution experiments, the laser damage zone was 550 ± 137 µm (Tm:YAG) versus 447 ± 65 µm (Ho:YAG), on the low power setting and 653 ± 137 µm (Tm:YAG) versus 677 ± 134 µm (Ho:YAG) on the high power setting. Incision depth was 1214 ± 888 µm for Ho:YAG whereas Tm:YAG did not cut tissue at 5 W in saline solution. On the high power setting, the incision depth was 4050 ± 1058 µm for Tm:YAG and 4083 ± 520 µm for Ho:YAG. Both lasers create similar laser damage zones of <1 mm in ambient air and in saline solution. These in vitro experiments correspond well with in vivo experiments. Thereby, Tm:YAG offers a cutting performance, coagulation and safety profile similar to the standard Ho:YAG lasers in urological surgery.
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Affiliation(s)
- Stephan Huusmann
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Carl Neuberg Str. 1, 30625 Hannover, Germany
| | - Mathias Wolters
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Carl Neuberg Str. 1, 30625 Hannover, Germany
| | - Mario W Kramer
- Department of Urology, Clinic of the University of Schleswig Holstein / Campus Luebeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Thorsten Bach
- Department of Urology, Asklepios Hospital Harburg, Eissendorfer Pferdeweg 52, 21075 Hamburg, Germany
| | | | - Andreas Eing
- LISA Laser Products OHG, Max-Planck-Strasse 1, 37191 Katlenburg-Lindau, Germany
| | - Sebastian Bardosi
- MVZ wagnerstibbe Pathologie, Neuropathologie und Laboratoriumsmedizin, An der Lutter 24, 37075 Göttingen, Germany
| | - Thomas R W Herrmann
- Department of Urology and Urological Oncology, Hannover Medical School (MHH), Carl Neuberg Str. 1, 30625 Hannover, Germany
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Barbalat Y, Velez MC, Sayegh CI, Chung DE. Evidence of the efficacy and safety of the thulium laser in the treatment of men with benign prostatic obstruction. Ther Adv Urol 2016; 8:181-91. [PMID: 27247628 DOI: 10.1177/1756287216632429] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In 2005, the high power thulium laser was introduced for the surgical treatment of benign prostatic obstruction. It has several properties that confer theoretical advantages over other lasers used for the same indication, such as technical versatility and a relatively small zone of thermal damage. Studies using the 70-150 W thulium laser systems demonstrate good efficacy of these procedures with low morbidity and few complications even in higher risk patients. Different techniques have been employed to treat the prostate with this technology, including enucleation, vapoenucleation, vaporization and resection. Comparative studies have been published comparing thulium laser prostatectomy to monopolar transurethral resection of prostate (TURP), bipolar TURP and holmium laser enucleation of prostate (HoLEP). In this review we discuss the current literature on the safety and efficacy of various thulium techniques for the treatment of benign prostatic hyperplasia and examine comparative studies.
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Affiliation(s)
- Yana Barbalat
- Columbia University Medical Center, New York, NY, USA
| | | | | | - Doreen E Chung
- Columbia University Medical Center, 161 Fort Washington Avenue, HIP 11th Floor, New York, NY 10032, USA
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Hong K, Liu YQ, Lu J, Xiao CL, Huang Y, Ma LL. Efficacy and safety of 120-W thulium:yttrium-aluminum-garnet vapoenucleation of prostates compared with holmium laser enucleation of prostates for benign prostatic hyperplasia. Chin Med J (Engl) 2015; 128:884-9. [PMID: 25836607 PMCID: PMC4834003 DOI: 10.4103/0366-6999.154282] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND This study compared the efficacy and safety between 120-W thulium:yttrium-aluminum-garnet (Tm:YAG) vapoenucleation of prostates (ThuVEP) and holmium laser enucleation of prostates (HoLEP) for patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). METHODS A retrospective analysis of 88 consecutive patients with symptomatic BPH was carried out, who underwent either 120-W ThuVEP or HoLEP nonrandomly. Patient demographics and peri-operative and 12-month follow-up data were analyzed with the International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum flow rate (Qmax), postvoid residual urine volume (PVR), and rates of peri-operative and late complications. RESULTS The patients in each group showed no significant difference in preoperative parameters. Compared with the HoLEP group, patients in the 120-W ThuVEP group required significantly shorter time for laser enucleation (58.3 ± 12.8 min vs. 70.5 ± 22.3 min, P = 0.003), and resulted in a significant superiority in laser efficiency (resected prostate weight/laser enucleation time) for 120-W Tm:YAG laser compared to holmium:YAG laser (0.69 ± 0.18 vs. 0.61 ± 0.19, P = 0.048). During 1, 6, and 12 months of follow-ups, the procedures did not demonstrate a significant difference in IPSS, QoL score, Qmax, or PVR (P > 0.05). Mean peri-operative decrease of hemoglobin in the HoLEP group was similar to the ThuVEP group (17.1 ± 12.0 g/L vs. 15.2 ± 10.1 g/L, P = 0.415). Early and late incidences of complications were low and did not differ significantly between the two groups of 120-W ThuVEP and HoLEP patients (P > 0.05). CONCLUSIONS 120-W ThuVEP and HoLEP are potent, safe and efficient modalities of minimally invasive surgeries for patients with LUTS due to BPH. Compared with HoLEP, 120-W ThuVEP offers advantages of reduction of laser enucleation time and improvement of laser efficiency.
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Affiliation(s)
| | - Yu-Qing Liu
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
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A review of thulium laser vapo-enucleation of the prostate: A novel laser-based strategy for benign prostate enlargement. Arab J Urol 2015; 13:209-11. [PMID: 26413349 PMCID: PMC4563004 DOI: 10.1016/j.aju.2015.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 06/22/2015] [Accepted: 06/24/2015] [Indexed: 12/01/2022] Open
Abstract
Thulium laser vapo-enucleation of the prostate is the latest addition to the arsenal of minimally invasive therapies available for the surgical treatment of lower urinary tract symptoms secondary to benign prostate hyperplasia. The potential advantages include smoother vaporisation, a clearer visual field and the option of both continuous-wave and pulsed modes, which also potentiate the haemostatic properties of this endoscopic method. Short-term results show that it yields significant improvements in both subjective and objective outcomes, with a strong safety profile. Large-scale randomised studies with a longer follow-up are warranted to determine the durability of this laser procedure.
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Saredi G, Pirola GM, Pacchetti A, Lovisolo JA, Borroni G, Sembenini F, Marconi AM. Evaluation of the learning curve for thulium laser enucleation of the prostate with the aid of a simulator tool but without tutoring: comparison of two surgeons with different levels of endoscopic experience. BMC Urol 2015; 15:49. [PMID: 26055885 PMCID: PMC4459696 DOI: 10.1186/s12894-015-0045-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 06/02/2015] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to determine the learning curve for thulium laser enucleation of the prostate (ThuLEP) for two surgeons with different levels of urological endoscopic experience. Methods From June 2012 to August 2013, ThuLEP was performed on 100 patients in our institution. We present the results of a prospective evaluation during which we analyzed data related to the learning curves for two surgeons of different levels of experience. Results The prostatic adenoma volumes ranged from 30 to 130 mL (average 61.2 mL). Surgeons A and B performed 48 and 52 operations, respectively. Six months after surgery, all patients were evaluated with the International Prostate Symptom Score questionnaire, uroflowmetry, and prostate-specific antigen test. Introduced in 2010, ThuLEP consists of blunt enucleation of the prostatic apex and lobes using the sheath of the resectoscope. This maneuver allows clearer visualization of the enucleation plane and precise identification of the prostatic capsule. These conditions permit total resection of the prostatic adenoma and coagulation of small penetrating vessels, thereby reducing the laser emission time. Most of the complications in this series were encountered during morcellation, which in some cases was performed under poor vision because of venous bleeding due to surgical perforation of the capsule during enucleation. Conclusions Based on this analysis, we concluded that it is feasible for laser-naive urologists with endoscopic experience to learn to perform ThuLEP without tutoring. Those statements still require further validation in larger multicentric study cohort by several surgeon. The main novelty during the learning process was the use of a simulator that faithfully reproduced all of the surgical steps in prostates of various shapes and volumes.
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Affiliation(s)
- Giovanni Saredi
- Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | - Giacomo Maria Pirola
- Department of Urology, University of Modena e Reggio Emilia, viale Borri, 57, 21100, Varese, Modena, Italy.
| | - Andrea Pacchetti
- Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | | | - Giacomo Borroni
- Department of Surgery, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
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Affiliation(s)
- Thomas R W Herrmann
- Division of Endourology and Laparoscopy, Hanover Medical School (MHH), Dept. of Urology and Urological Oncology, Carl Neuberg Str. 1, Hanover, 30625, Germany,
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Hay D, Khan MS, Van Poppel H, Van Cleynenbreugel B, Peabody J, Guru K, Challacombe B, Dasgupta P, Ahmed K. Current status and effectiveness of mentorship programmes in urology: a systematic review. BJU Int 2015; 116:487-94. [PMID: 24571359 DOI: 10.1111/bju.12713] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The objectives of this review were to identify and evaluate the efficacy of mentorship programmes for minimally invasive procedures in urology and give recommendations on how to improve mentorship. A systematic literature search of the PubMed/Medline databases was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. In all, 21 articles were included in the review and divided into four categories: fellowships, mini-fellowships, mentored skills courses and novel mentorship programmes. Various structures of mentorship programme were identified and in general, mentorship programmes were found to be feasible, having content validity and educational impact. Perioperative data showed equally good outcomes when comparing trainees and specialists. Mentorship programmes are effective and represent one of the best current methods of training in urology. However, participation in such programmes is not widespread. The structure of mentorship programmes is highly variable, with no clearly defined 'best approach' for postgraduate training. This review offers recommendations as to how this 'best approach' can be established.
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Affiliation(s)
- Daniel Hay
- MRC Centre for Transplantation, King's College London, London, UK.,King's Health Partners, Department of Urology, Guy's Hospital, London, UK
| | - Mohammed Shamim Khan
- MRC Centre for Transplantation, King's College London, London, UK.,King's Health Partners, Department of Urology, Guy's Hospital, London, UK
| | - Hendrik Van Poppel
- Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ben Van Cleynenbreugel
- Department of Urology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - James Peabody
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Khurshid Guru
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Ben Challacombe
- MRC Centre for Transplantation, King's College London, London, UK.,King's Health Partners, Department of Urology, Guy's Hospital, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King's College London, London, UK.,King's Health Partners, Department of Urology, Guy's Hospital, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, King's College London, London, UK.,King's Health Partners, Department of Urology, Guy's Hospital, London, UK
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Netsch C, Knoll T, Gross AJ, Wendt-Nordahl G. [Thulium vapoenucleation of prostates larger than 80 ml using a 1.9-µm and a 2-µm thulium laser. Early perioperative results from two centres]. Urologe A 2014; 54:1414-20. [PMID: 25312754 DOI: 10.1007/s00120-014-3652-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Numerous studies have shown that thulium vapoenucleation of the prostate (ThuVEP) is a size-independent minimally invasive procedure for the treatment of benign prostatic enlargement. All ThuVEP series have been performed with a 2-µm thulium laser device so far. The aim of this study was to evaluate the complications and early postoperative results of two thulium-devices with different wavelengths for ThuVEP in prostates larger than 80 ml. MATERIALS AND METHODS A retrospective bi-centric matched-paired analysis with 296 patients was performed. Based on prostate size, 148 were matched at each centre and laser device, respectively. A 2-µm (RevoLix, LISA Laser products, Katlenburg, Germany n=148) and a 1.9-µm (vela XL, starmedtec, Starnberg, Germany, n=148) thulium laser with a power output of 90 and 80 W was used. Patients' data were assessed and compared. RESULTS The median prostate volume (interquartile) was 100 ml (range 86.25-120 ml). At discharge, Qmax (preoperative 7.9 and 9 ml/s vs. postoperative 19.35 and 16.2 ml/s) and postvoiding-residual urine (preoperative 130 and 45 ml vs. postoperative 20 and 25 ml) were significantly improved after 2-µm and 1.9-µm ThuVEP (p<0.001). The median catheterization time and hospitalization times were 2 and 4 days in both groups. Perioperative complications occurred in 89 patients (30.1%): Clavien 1 (12.2%), Clavien 2 (9.1%), Clavien 3a (0.7%), Clavien 3b (7.1%), and Clavien 4a (1%). Regarding the occurrence of complications, there were no differences between the two thulium devices. CONCLUSION ThuVEP represents a safe and effective treatment for prostates larger than 80 ml. Both thulium laser devices give satisfactory immediate micturition improvement with low perioperative morbidity.
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Affiliation(s)
- C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland.
| | - T Knoll
- Abteilung für Urologie, Urologische Klinik Sindelfingen, Sindelfingen, Deutschland
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland
| | - G Wendt-Nordahl
- Abteilung für Urologie, Urologische Klinik Sindelfingen, Sindelfingen, Deutschland
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Netsch C, Bach T, Herrmann TRW, Gross AJ. Update on the current evidence for Tm:YAG vapoenucleation of the prostate 2014. World J Urol 2014; 33:517-24. [PMID: 25300823 DOI: 10.1007/s00345-014-1417-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 09/30/2014] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION To evaluate the current role of thulium vapoenucleation of the prostate (ThuVEP) for the treatment of benign prostatic obstruction (BPO). METHODS A Medline search for randomized trials, case series, and comparative studies being published since the initial description of the ThuVEP procedure (2009-2014) was performed to assess the safety, the perioperative morbidity, the efficacy, and the durability of the technique. RESULTS A total of 14 peer-reviewed original articles, seven case series [level of evidence (LOE) 4] and seven comparative studies (LOE 3b), have been identified. ThuVEP has been shown to be a size-independent, safe, efficacious, and durable procedure for the treatment of BPO in large, prospective, and retrospective series (LOE 4/3b). The feasibility and safety of the ThuVEP procedure has also been confirmed in patients at high cardiopulmonary risk on oral anticoagulants (LOE 4). It has also been demonstrated that the erectile function is not impaired by the ThuVEP procedure (LOE 4). However, published ThuVEP series are from very few centers of excellence not exceeding a LOE of 3b. Randomized controlled trials comparing ThuVEP with standard procedures for the treatment of BPO, namely transurethral resection of the prostate, open prostatectomy, or holmium laser enucleation of the prostate, have not been published so far. CONCLUSIONS ThuVEP appears to be a size-independent, safe, efficacious, and durable procedure for the treatment of BPO (LOE 4/3b). Multicentric PRT are however needed to define the current role of ThuVEP in the armamentarium of minimally invasive transurethral surgery of the prostate.
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Affiliation(s)
- C Netsch
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany,
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Transurethral surgical anatomy of the arterial bleeder in the enucleated capsular plane of enlarged prostates during holmium laser enucleation of the prostate. Int Neurourol J 2014; 18:138-44. [PMID: 25279241 PMCID: PMC4180164 DOI: 10.5213/inj.2014.18.3.138] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 08/28/2014] [Indexed: 11/14/2022] Open
Abstract
Purpose To identify the endoscopic vascular anatomy of the prostate during Holmium laser enucleation of the prostate (HoLEP), and analyze the clinical risk factors associated with significant arterial bleeding. Methods We identified 107 consecutive patients with benign prostatic hyperplasia who underwent HoLEP between September 2009 and August 2010, performed by a single surgeon (S.J.O.). Two independent reviewers reviewed the surgery video database and completed a prespecified form. The location of bleeding arteries was marked at the level of the bladder neck, proximal prostate, distal prostate, and verumontanum. Arterial bleeding was classified into one of three grades according to bleeding severity (grades 2 and 3 indicate significant bleeding). Results The mean prostate volume was 65.1±31.5 mL, and the mean prostate-specific antigen (PSA) level was 3.69±3.58 ng/mL. During the HoLEP procedure, the most common locations of significant bleeders were the 2-5 and 7-10 o'clock positions in the proximal prostate. The average number of bleeding arteries was 12.1±7.9 per procedure, and 1.93±1.20 per 10 mL of prostate volume. Multivariate analysis revealed that prostate volume and serum PSA were significant parameters for estimating the number of bleeding vessels. Conclusions During the HoLEP procedure, the most common locations of significant bleeders were the 2-5 and 7-10 o'clock positions in the proximal prostate. Prostate volume was associated with the number of bleeders. A careful approach to the capsular plane of the proximal prostate facilitates early hemostasis during the HoLEP procedure, especially with larger adenomas.
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Jiang Q, Xia S. Two-micron (Thulium) Laser Prostatectomy: An Effective Method for BPH Treatment. CURRENT BLADDER DYSFUNCTION REPORTS 2014; 9:142-144. [PMID: 24817920 PMCID: PMC4000410 DOI: 10.1007/s11884-014-0233-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The two-micron (thulium) laser is the newest laser technique for treatment of bladder outlet obstruction resulting from benign prostatic hyperplasia (BPH). It takes less operative time than standard techniques, provides clear vision and lower blood loss as well as shorter catheterization times and hospitalization times. It has been identified to be a safe and efficient method for BPH treatment regardless of the prostate size.
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Affiliation(s)
- Qi Jiang
- Department of Urology, Shanghai First People’s Hospital, School of Medicine, Shanghai Jiao Tong University, No.100, Haining Road, Shanghai, 200080 China
| | - Shujie Xia
- Department of Urology, Shanghai First People’s Hospital, School of Medicine, Shanghai Jiao Tong University, No.100, Haining Road, Shanghai, 200080 China
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Long-term outcome following Thulium VapoEnucleation of the prostate. World J Urol 2014; 32:1551-8. [DOI: 10.1007/s00345-014-1260-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 02/04/2014] [Indexed: 10/25/2022] Open
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