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Aizezi X, Feng L, Wang Z, Ma Y, Li J, Keremu A, Rouzi M, Dilixiati A, Wang B, Shi H, Huang J. Comparison of the efficacy of HoLEP and TURP in the treatment of elderly benign prostatic hyperplasia patients: a retrospective study. Aktuelle Urol 2024. [PMID: 38262432 DOI: 10.1055/a-2210-5913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To prove that holmium laser prostatectomy (HoLEP) is safe and effective in the treatment of benign prostatic hyperplasia (BPH), and is superior to transurethral prostatectomy (TURP) for elderly patients. METHODS We retrospectively studied 565 HoLEP patients and 76 TURP elderly patients. HoLEP patients were first divided into three groups according to their age(Under 65 years old group, 65-79 years old group and over 80 years old group), and their preoperative, intraoperative, and postoperative characteristics were then compared. Secondly, the same characteristics of HoLEP and TURP patients over 80 years were compared. Chi-square test, one-way ANOVA and Fisher's exact test were used in this study. RESULTS Firstly, we compared HoLEP patients in different age groups and found that there was statistically significant difference in diabetes, CCVD and bladder stones, among the three groups (P<0.05).Secondlye, we compared HoLEP and TURP treatments in elderly patients (≥80 years old). The patients with HoLEP had a higher share of diabetes, CCVD and anticoagulation (P<0.05). Moreover, compared with TURP patients, HoLEP patients had shorter enucleation duration, more enucleate prostate weight, fewer hemoglobin diminutions, shorter bladder irrigation time, shorter catheter-indwelling period, and shorter hospital period (P<0.05). Although there was no difference in IPSS, Qmax and QOL between the two groups before operation (P>0.05), the difference was statistically significant, 6 months after the operation (P<0.05). CONCLUSION HoLEP is safe and effective for BPH patients, and is superior to transurethral TURP for elderly patients.
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Affiliation(s)
- Xierzhati Aizezi
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
| | - Liancheng Feng
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
| | - Zheng Wang
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
| | - Yuan Ma
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
| | - Jifu Li
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
| | - Abuduweili Keremu
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
| | - Maihemujiang Rouzi
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
| | - Ailiyaer Dilixiati
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
| | - Beiping Wang
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
| | - Hanzhen Shi
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
| | - Jinxing Huang
- Urology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, China
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Yilmaz M, Karaaslan M, Polat ME, Tonyali S, Aybal HÇ, Şirin ME, Toprak T, Tunç L, Gratzke C, Miernik A. Is day-case surgery feasible for laser endoscopic enucleation of the prostate? A systematic review. World J Urol 2023; 41:2949-2958. [PMID: 37689604 PMCID: PMC10632304 DOI: 10.1007/s00345-023-04594-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 08/23/2023] [Indexed: 09/11/2023] Open
Abstract
PURPOSE Laser endoscopic enucleation of the prostate (EEP) for benign prostatic obstruction has become increasingly prevalent worldwide. Considering the medical cost-savings and concomitantly fewer nosocomial infections, the feasibility of same-day postoperative discharge of patients who have undergone laser EEP in terms of its safety and effectiveness has become a subject matter of growing interest. We aimed to review those studies focussing on day-case surgery (DCS) in patients undergoing laser EEP. METHODS A systematic search was conducted using PubMed-MEDLINE and Web of Science databases until October 2022 with the following search terms: "same day discharge AND laser enucleation of the prostate", "day-case AND laser enucleation of the prostate", "same day surgery AND laser enucleation of the prostate" and "one day surgery AND laser enucleation of the prostate" by combining PICO (population, intervention, comparison, outcome) terms. We identified 15 eligible studies. RESULTS While 14 of the studies focussed on holmium laser EEP, one focused on thulium laser vapoenucleation of the prostate. We observed an improvement in functional parameters in all studies we reviewed, and DCS success and readmission rates ranged between 35.3-100% and 0-17.8%, respectively. The complication rates varied between 0 and 36.7%, most of the complicatons were Clavien-Dindo (CD) I and II. CD ≥ III complications did not significantly differ between same day discharge (SDD) and non-SDD groups in the studies. CONCLUSION Laser EEP is feasible and promising DCS treatment option delivering improved functional parameters compared to baseline values, and lower perioperative complication and readmission rates in certain patients.
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Affiliation(s)
- Mehmet Yilmaz
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany
| | | | - Muhammed Emin Polat
- Department of Urology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Senol Tonyali
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany
- Department of Urology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | | | - Mehmet Emin Şirin
- Department of Urology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Tuncay Toprak
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Lütfi Tunç
- Faculty of Medicine, Department of Urology, Gazi University, Ankara, Turkey
| | - Christian Gratzke
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany.
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Yilmaz M, Heuring CEM, Dressler FF, Suarez-Ibarrola R, Gratzke C, Miernik A, Hein S. Temperature assessment study of ex vivo holmium laser enucleation of the prostate model. World J Urol 2022; 40:1867-1872. [PMID: 35614278 PMCID: PMC9236967 DOI: 10.1007/s00345-022-04041-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 05/02/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose There isscarce evidence to date on how temperature develops during holmium laser enucleation of the prostate (HoLEP). We aimed to determine the potential heat generation during HoLEP under ex vivo conditions. Methods We developed two experimental setups. Firstly, we simulated HoLEP ex vivo using narrow-neck laboratory bottles mimicking enucleation cavities and a prostate resection trainer. Seven temperature probes were placed at different locations in the experimental setup, and the heat generation was measured separately during laser application. Secondly, we simulated high-frequency current-based coagulation of the vessels using a roller probe. Results We observed that the larger the enucleated cavity, the higher the temperature rises, regardless of the irrigation flow rate. The highest temperature difference with an irrigation flow was approximately + 4.5 K for a cavity measuring 100ccm and a 300 ml/min irrigation flow rate. The higher flow rate generates faster removal of the generated heat, thus cooling down the artificial cavity. Furthermore, the temperature differences at different irrigation flow rates (except at 0 ml/min) were consistently below 5 K. Within the resection trainer, the temperature increase with and without irrigation flow was approximately 0.5 K and 3.0 K, respectively. The mean depth of necrosis (1084 ± 176 µm) achieved by the roller probe was significantly greater when using 144 W energy. Conclusion Carefully adjusted irrigation and monitoring during HoLEP are crucial when evacuating the thermal energy generated during the procedure. We believe this study of ours provides evidence with the potential to facilitate clinical studies on patient safety. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-022-04041-z.
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Affiliation(s)
- Mehmet Yilmaz
- Faculty of Medicine, Department of Urology, University of Freiburg-Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Cäcilia Elisabeth Maria Heuring
- Faculty of Medicine, Department of Urology, University of Freiburg-Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Franz Friedrich Dressler
- Faculty of Medicine, Institute of Pathology, University Medical Center Schleswig Holstein Lübeck Campus, Ratzeburger Allee, 23538, Lübeck, Germany
| | - Rodrigo Suarez-Ibarrola
- Faculty of Medicine, Department of Urology, University of Freiburg-Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Christian Gratzke
- Faculty of Medicine, Department of Urology, University of Freiburg-Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Arkadiusz Miernik
- Faculty of Medicine, Department of Urology, University of Freiburg-Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Simon Hein
- Faculty of Medicine, Department of Urology, University of Freiburg-Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany
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Acikgoz O, Yilmaz M, Aybal HC, Yilmaz S, Gazel E, Yalcin S, Duvarci M, Kaya E, Miernik A, Tunc L. Impact of diabetes mellitus on urinary continence after holmium laser enucleation of the prostate due to lower urinary tract symptoms: a retrospective study. Cent European J Urol 2022; 74:535-540. [PMID: 35083073 PMCID: PMC8771128 DOI: 10.5173/ceju.2021.0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Diabetes mellitus (DM) is known as a risk factor of stress urinary incontinence after Holmium laser enucleation of the prostate (HoLEP). We aimed to compare the postoperative continence status of patients with and without DM, after HoLEP surgery. Material and methods A total of 214 patients who underwent HoLEP between January 2017 and January 2020 were retrospectively assessed. Functional outcomes, perioperative total operation time (TOT)(min), enucleation time (ET)(min), enucleation efficiency (EE)(g/min), enucleated tissue weight (ETW)(g), morcellation efficiency (ME)(g/min), morcellation time (MT)(min), continence status, intraoperative and postoperative complications according to Clavien–Dindo classification were recorded. Results A total of 96 patients had DM additional to benign prostate hyperplasia (BPH) (Group 1), while 118 patients had only benign prostate hyperplasia without DM (Group 2). When comparing preoperative and postoperative functional outcomes, a statistically significant improvement was observed in both groups from baseline to the 1st and 6th month follow-up (p ≤0.001). There were no statistically significant differences between groups in postoperative stress urinary incontinence at postoperative months 1 and 6 (1.7% vs 2.1%, p = 1 and 0.8% vs 1%, p = 1; respectively). There was no significant difference between groups in intraoperative and postoperative complications (p >0.05). Conclusions HoLEP is safe to perform in patients with DM at low complication and urinary incontinence rates.
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Affiliation(s)
- Onur Acikgoz
- Department of Urology, Pendik State Hospital, Istanbul, Turkey
| | - Mehmet Yilmaz
- Department of Urology, University of Freiburg-Medical Centre, Faculty of Medicine, Freiburg, Germany
| | - Halil Cagri Aybal
- Department of Urology, Kahramankazan Hamdi Eris State Hospital, Ankara, Turkey
| | - Sercan Yilmaz
- Department of Urology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Eymen Gazel
- Department of Urology, Acibadem University Ankara Hospital, Ankara, Turkey
| | - Serdar Yalcin
- Department of Urology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Mehmet Duvarci
- Department of Urology, University of Health Sciences, Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Engin Kaya
- Department of Urology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Arkadiusz Miernik
- Department of Urology, University of Freiburg-Medical Centre, Faculty of Medicine, Freiburg, Germany
| | - Lutfi Tunc
- Department of Urology, Gazi University Faculty of Medicine, Ankara, Turkey
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Assmus MA, Ganesh MB, Lee MS, Large T, Krambeck AE. Contemporary Outcomes for Patients Undergoing Concurrent Surgeries at the Time of Holmium Laser Enucleation of the Prostate Before and After Moses 2.0 BPH Mode. J Endourol 2021; 35:S8-S13. [PMID: 34910607 DOI: 10.1089/end.2021.0531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Outcomes of holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia has been well studied. As comfort with the procedure has improved, the number of concurrent surgeries performed with HoLEP has increased. Technology and technique optimization have safely transitioned HoLEP toward same-day catheter removal and discharge. We aim to assess the success and safety of transitioning toward a same-day care pathway for patients undergoing concurrent surgeries with HoLEP. Materials and Methods: With institutional review board approvals, we queried the electronic medical record and retrospective clinical registry to examine perioperative characteristics and outcomes of patients who underwent HoLEP performed by two endourologists at two centers between July 1, 2016, and June 1, 2021, in which ≥1 concurrent surgical procedure was performed. Results: There were 188 patients with an average age of 72.3 years, who underwent HoLEP with ≥1 concurrent surgical procedure within the study period. In total, 221 non-HoLEP procedures were performed with 30/188 (16.0%) undergoing ≥3 total procedures in a single operation. The four-most common concurrent procedures were cystolitholapaxy 86/221 (38.9%), ureteroscopy 57/221 (25.8%), transurethral resection of bladder tumor 14/221 (6.3%), and percutaneous nephrolithotomy 14/221 (6.3%). Postoperatively, 3 (1.6%) patients required transfusion. After transitioning to a same-day care path, the proportion of patients who had successful same-day catheter removal and same-day discharge increased (all p < 0.05). Median length of stay decreased (from 23 hours 11 minutes to 3 hours 49 minutes, p = 0.008). Our 90-day readmission rate for urology complication was 7.9%, and only 3.6% of patients undergoing concurrent stone surgery required an additional stone surgery within 90 days. The overall Clavien-Dindo ≥3b rate was 4.8% (9-3b, 0-4, 0-5). Conclusions: Advances in HoLEP technique and technology allow for safe same-day discharge for concurrent surgery performed at the time of HoLEP. Few patients were readmitted within 90 days and no patients experienced Clavien-Dindo ≥4 complications.
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Affiliation(s)
- Mark A Assmus
- Department of Urology, Northwestern University, Chicago, Illinois, USA
| | - Meera B Ganesh
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Matthew S Lee
- Department of Urology, Northwestern University, Chicago, Illinois, USA
| | - Tim Large
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amy E Krambeck
- Department of Urology, Northwestern University, Chicago, Illinois, USA
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Yilmaz M, Toprak T, Suarez-Ibarrola R, Sigle A, Gratzke C, Miernik A. Incidental prostate cancer after holmium laser enucleation of the prostate-A narrative review. Andrologia 2021; 54:e14332. [PMID: 34837229 DOI: 10.1111/and.14332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/05/2021] [Accepted: 11/19/2021] [Indexed: 12/24/2022] Open
Abstract
Prostate cancer can be detected incidentally after surgical therapy for benign prostatic obstruction such as holmium laser enucleation of the prostate (HoLEP), thus called incidental prostate cancer (iPCa). We aimed to review the studies on iPCa detected after HoLEP and investigate its prevalence. A detailed search of original articles was conducted via the PubMed-MEDLINE, Web of Science, Wiley Online Library and Cochrane Library databases in the last 10 years up to 1 May 2021 with the following search string solely or in combination: "prostate cancer", "prostate carcinoma", "holmium laser enucleation of the prostate" and "HoLEP". We identified 19 articles to include in our analysis and divided them into six main categories: HoLEP versus open prostatectomy and/or transurethral resection of the prostate in terms of iPCa, oncological and functional outcomes, the role of imaging modalities in detecting iPCa, predictive factors of iPCa, the role of prostate-specific antigen kinetics in detecting iPCa and the management of iPCa after HoLEP. We found that the iPCa after HoLEP rate ranges from 5.64% to 23.3%. Functional and oncological outcomes were reported to be encouraging. Oncological treatment options are available in a wide range.
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Affiliation(s)
- Mehmet Yilmaz
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Freiburg, Germany
| | - Tuncay Toprak
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Rodrigo Suarez-Ibarrola
- 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
| | - 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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Castellucci R, Marchioni M, Fasolis G, Varvello F, Ditonno P, Di Rienzo G, Greco F, Altieri VM, Frattini A, Ferrari G, Schips L, Cindolo L. The safety and feasibility of the simultaneous use of 180-W GreenLight laser for prostate vaporization during concomitant surgery. ACTA ACUST UNITED AC 2020; 92. [PMID: 33348957 DOI: 10.4081/aiua.2020.4.297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 08/21/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To explore the safety and feasibility of photo-selective vaporization of the prostate (PVP) with GreenLight XPS 180 Watt laser (GL-180- W XPS) combined with other surgical procedures. MATERIAL AND METHODS Data on patients in whom GL-180-W XPS was performed to relieve lower urinary tract symptoms/ benign prostatic hyperplasia (LUTS/BPH) symptoms were extracted from a multi-institutional database (2011-2016). Patients were stratified into two groups. In the first all patients who had GL-180-W XPS with a concomitant procedure during the same surgical session were included as cases while those who underwent GL-180-W XPS PVP only were included as control. RESULTS A total of 487 patients were included. Fifty-eight (11.9%) patients underwent concomitant procedures. Multivariable linear regression models failed to find an association between concomitant procedures and longer laser time (p = 0.4). Similarly, multivariable linear regression models failed to find an association between concomitant procedures and laser time even when the analyses were repeated and stratified into endoscopic (p = 0.6) and open/laparoscopic (p = 0.4) procedures. Multivariable logistic regression models failed to demonstrate any association between concomitant procedures and early complications (OR:1.39, CI: 0.379-2.44, p = 0.2), late complications (OR:1.84, CI:0.78-3.98; p = 0.1) and acute urinary retention (OR:1.84, CI:0.78-3.98; p = 0.1). When the analyses were repeated and the concomitant procedures stratified into endoscopic and open/laparoscopic ones, they yielded virtually the same results. CONCLUSIONS GL-180-W XPS PVP could be safely performed in concomitant endoscopic or open/laparoscopic surgery. These results should be taken into consideration in the counseling of the patient who might choose to undergo simultaneous procedures.
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Affiliation(s)
| | - Michele Marchioni
- Department of Urology, SS Annunziata Hospital, "G. D'Annunzio" University, Chieti.
| | | | | | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari.
| | - Gaetano Di Rienzo
- Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari.
| | | | | | - Antonio Frattini
- Department of Urology, "Ercole Franchini" Hospital, Montecchio Emilia.
| | | | - Luigi Schips
- Department of Urology, SS Annunziata Hospital, "G. D'Annunzio" University, Chieti.
| | - Luca Cindolo
- Department of Urology, Private Hospital Villa Stuart, Rome.
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Mouton M, Michel C, Bourgi A, Baumert H. [Holmium laser enucleation of the prostate: Analysis of early complications. Patient selection for day-case surgery]. Prog Urol 2020; 30:89-96. [PMID: 31959571 DOI: 10.1016/j.purol.2019.11.009] [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: 02/20/2019] [Revised: 10/30/2019] [Accepted: 11/28/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the complications and the risk factors of Holmium LASER Enucleation of the prostate (HoLEP) and to propose selection criteria for day-case surgery. MATERIAL AND METHODS We included retrospectively all consecutive single-center HoLEP procedures performed between January 1, 2012 and December 31, 2016. We reported the pre-operative characteristics of the patients (age, BMI, ASA score, estimated prostate volume, presence of a preoperative catheter, operative indication, antiplatelet or anticoagulant intake) and the peri operative data (duration of intervention, catheterization, hospitalization, transfusion, histopathological findings, 30-day postoperative complications given to Clavien-Dindo classification, presence of a catheter at discharge, urologist experience). Uni- and multi-variate analyzes were performed to investigate risk factors for complications. RESULTS One thousand two hundred and one patients were included. The overall complication rate was 19.15 %. The transfusion rate was 3.7%. We demonstrated that the age at procedure (P=0.019), an ASA score>2 (P=0.0019), a high prostatic volume (P=0.011), an anticoagulant intake (P=<0.0001), a poor-urologist experience (P=0.048) and a long operative time (P=0.0144) were at risks of complications. CONCLUSION The identification of postoperative complication risk factors after HoLEP could help to better select patients who are offered day-case surgery and minimize the risk of failure or early readmission. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- M Mouton
- Service d'urologie, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France.
| | - C Michel
- Service d'urologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - A Bourgi
- Service d'urologie, hôpital français du Levant, rue Fouad Chehab, Sin El-Fil, Beyrouth, Liban
| | - H Baumert
- Service d'urologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
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Marien T, Kadihasanoglu M, Miller NL. Holmium laser enucleation of the prostate: patient selection and perspectives. Res Rep Urol 2016; 8:181-192. [PMID: 27800470 PMCID: PMC5085273 DOI: 10.2147/rru.s100245] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Multiple endoscopic surgical options exist to treat benign prostatic hyperplasia (BPH), including holmium laser enucleation of the prostate (HoLEP). HoLEP alleviates obstructive prostatic tissue via enucleation, both bluntly with a resectoscope and by cutting tissue with the holmium laser, and removal of adenoma via morcellation. This article reviews patient selection for HoLEP in order to optimize outcomes, costs, and patient satisfaction. Methods A literature review of all studies on HoLEP was conducted. Studies that focused on outcomes in regard to patient and procedural factors were closely reviewed and discussed. Results Various studies found that men with large or small prostates, on antithrombotic therapy, in urinary retention, with bladder hypocontractility, with prostate cancer, undergoing retreatment for BPH, or in need of concomitant surgery for bladder stones and other pathologies do well with HoLEP, as demonstrated by excellent functional and symptomatic outcomes as well as low complication rates. There is a 74–78% rate of retrograde ejaculation following HoLEP. Techniques to preserve ejaculatory function following enucleative techniques have not been able to demonstrate a significant improvement. Conclusion Patient selection for HoLEP can include most men with bothersome BPH who have evidence of bladder outlet obstruction and are healthy enough to undergo surgery. The ability to safely perform concomitant surgery with HoLEP benefits the patient by sparing them an additional anesthetic and also decreases costs. Patients should be made aware of the risk of retrograde ejaculation following HoLEP and counseled on treatment alternatives if maintaining ejaculatory function is desired.
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Affiliation(s)
- Tracy Marien
- Department of Urology, Vanderbilt Medical Center, Nashville, TN, USA
| | | | - Nicole L Miller
- Department of Urology, Vanderbilt Medical Center, Nashville, TN, USA
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Elshal AM, Eldemerdash Y, Mekkawy R, Taha DE, Laymon M, El-Nahas AR, El-Assmy A. Prostate tissue retrieval after holmium laser enucleation of the prostate; assessment of non-morcellation approaches. Arab J Urol 2016; 14:147-55. [PMID: 27489742 PMCID: PMC4963166 DOI: 10.1016/j.aju.2016.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 01/23/2016] [Accepted: 02/13/2016] [Indexed: 12/17/2022] Open
Abstract
Objectives To review non-morcellation approaches for tissue retrieval after holmium laser enucleation of the prostate (HoLEP) and whether these approaches demolish the advantages of the HoLEP procedure. Patients and methods We reviewed our prospectively maintained laser prostate database for HoLEP procedures where non-morcellation approaches were used for retrieval of the enucleated adenoma. Non-morcellation approaches were adopted in cases of morcellator malfunction or whenever concomitant pathology indicated laparotomy. Patients were stratified into the laparotomy group (Group I) or the transurethral resection (TUR) group (Group II). Safety and efficacy of each approach were assessed and compared. Results Between August 2012 and July 2015, of 392 HoLEP procedures non-morcellation approaches were used for tissue retrieval in 37 (9.4%). In 19 procedures a laparotomy approach was adopted (17 mini-laparotomies and two conventional laparotomies for concomitant diverticulectomy). TUR of the enucleated adenoma was adopted in 18 patients. Baseline demographic data and indications for surgery were comparable between the groups. However, significantly larger prostates were treated in Group I. There were no significant differences between the groups for tissue retrieval time, histopathological findings of retrieved tissue, and peri-procedure biochemical changes. However, significantly more tissue was retrieved (median tissue weight 115 vs 38 g) and at a faster rate (4.6 vs 1.09 g/min) in Group I. The median hospital stay was similar in both groups, but the median time to catheter removal was longer in Group I (5 vs 2 days). Minimal and similar peri-procedure complications were reported in both groups and in both groups there was a significant and comparable improvement in all urinary outcome measures. Conclusion In the absence or malfunction of a tissue morcellator, or whenever concomitant pathology indicates laparotomy, non-morcellation tissue retrieval approaches are feasible options for endourologists practicing transurethral enucleation of prostate adenoma. These approaches are valid alternatives retaining most of the advantages of the transurethral prostate enucleation procedure.
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Affiliation(s)
- Ahmed M Elshal
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Yasser Eldemerdash
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ramy Mekkawy
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Diaa-Eldin Taha
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mahmoud Laymon
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed R El-Nahas
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed El-Assmy
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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