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Fei X, Yong W, Zhang D, Cui J. Advances in fibreoptic ductoscopy for the diagnosis and treatment of pathologic papillary overflow. Heliyon 2024; 10:e23211. [PMID: 38163111 PMCID: PMC10754873 DOI: 10.1016/j.heliyon.2023.e23211] [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: 07/19/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Fibreoptic mammography is widely recognised as the first screening method for pathologic papillary overflow due to its significant advantages in the diagnosis of ductal dilatation, intraductal papilloma and intraductal carcinoma. The use of fibreoptic ductoscopic excisional biopsy techniques, such as biopsy needles, vacuum negative pressure aspiration, biopsy forceps and grasping baskets, has not been promoted largely due to their existing deficiencies. The imaging effect of fibreoptic ductoscopy compared with electronic ductoscopy is also one of the important factors limiting the progress of microscopic excisional biopsy techniques. Finding a more suitable operating space for electronic fibreoptic ductoscopy and the use of electrosurgical excision biopsy techniques should be the focus of research in view of achieving accurate diagnoses in electronic fibreoptic ductoscopy and microscopic excision biopsy. In this review, the development history, clinical application and existing problems of fibreoptic ductoscopy are reviewed and assessed to provide references for the clinical diagnosis and treatment of pathologic papillary overflow.
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Affiliation(s)
- Xiang Fei
- Department of Thyroid and Breast Surgery, People's Hospital of China Medical University, China
| | - Wei Yong
- Department of Thyroid and Breast Surgery, Chengdu Seventh People's Hospital (Cancer Hospital Affiliated to Chengdu Medical College), China
| | - Dongxiao Zhang
- Department of Breast, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, China
| | - Jianchun Cui
- Department of Thyroid and Breast Surgery, People's Hospital of China Medical University, China
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2
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Makineli S, Filipe MD, Euwe F, Sakes A, Dankelman J, Breedveld P, Vriens MR, van Diest PJ, Witkamp AJ. Feasibility of Narrow-Band Imaging, Intraductal Biopsy, and Laser Ablation During Mammary Ductoscopy: Protocol for an Interventional Study. Int J Surg Protoc 2022; 26:73-80. [PMID: 36118293 PMCID: PMC9438461 DOI: 10.29337/ijsp.180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/17/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- S. Makineli
- Department of Surgical Oncology, University Medical Center, Utrecht, The Netherlands
| | - M. D. Filipe
- Department of Surgical Oncology, University Medical Center, Utrecht, The Netherlands
| | - F. Euwe
- Department of Medical Technology and Clinical Physics, University Medical Center, Utrecht, The Netherlands
| | - A. Sakes
- Department of BioMechanical Engineering, Technical University, Delft, The Netherlands
| | - J. Dankelman
- Department of BioMechanical Engineering, Technical University, Delft, The Netherlands
| | - P. Breedveld
- Department of BioMechanical Engineering, Technical University, Delft, The Netherlands
| | - M. R. Vriens
- Department of Surgical Oncology, University Medical Center, Utrecht, The Netherlands
| | - P. J. van Diest
- Department of Pathology, University Medical Center, Utrecht, The Netherlands
| | - A. J. Witkamp
- Department of Surgical Oncology, University Medical Center, Utrecht, The Netherlands
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3
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Grüne B, Siegel F, Waldbillig F, Pfalzgraf D, Kamdje Wabo G, Herrmann J, Kriegmair MC, Nuhn P, Michel MS, von Hardenberg J. Long-term Reinterventions after Thulium Laser Enucleation of the Prostate: 12-Year Experience with more than 1000 Patients. Eur Urol Focus 2022; 8:1370-1375. [PMID: 35016861 DOI: 10.1016/j.euf.2021.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/27/2021] [Accepted: 12/15/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Thulium laser enucleation of the prostate (ThuLEP) is an established treatment option for benign prostatic enlargement (BPE), but long-term outcomes have not yet been reported. OBJECTIVE To prove the durability of ThuLEP by investigating its long-term efficacy and morbidity. DESIGN, SETTING, AND PARTICIPANTS All patients who underwent ThuLEP at a German tertiary referral center between 2009 and 2021 were retrospectively followed up for reinterventions for persistence or regrowth of prostate adenoma (ReIP) or long-term complications (ReIC). INTERVENTION ThuLEP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We calculated the cumulative incidence for ReIP and ReIC at 10 yr. Univariate and multivariate Cox regression models were constructed to identify predictors of ReIP and ReIC. RESULTS AND LIMITATIONS Overall, 1097 patients underwent ThuLEP. The median overall follow-up was 6.0 yr (interquartile range [IQR] 2.4-9.2). For one-third of patients (n = 369), median follow-up of 10 yr (IQR 9.1-11.2) was available. A total of 42 patients (3.8%) underwent ReIP after a median of 2 yr (IQR 0.3-4.9). The rate of long-term ReIC was 2.6% (n = 29) and the median time to ReIC was 0.5 yr (IQR 0.3-1.7). The most frequent ReIC was urethrotomy (n = 16, 1.5%). The cumulative incidence of ReIP and ReIC at 10 yr was estimated at 5.6% and 3.4%, respectively. Enucleation weight ≥60 g was a significant predictor of ReIP (hazard ratio 1.2, p = 0.014). The retrospective study design and the lack of functional outcomes are the main limitations. CONCLUSIONS ThuLEP is a durably effective and safe procedure with low reintervention rates within 12 yr. PATIENT SUMMARY This study investigated long-term outcomes of thulium laser enucleation of the prostate for benign enlargement of the prostate (BPE). Low rates of repeat treatment for BPE recurrence or for other complications were observed. Our results show the safety and efficacy of this treatment over a period of 12 years.
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Affiliation(s)
- Britta Grüne
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Fabian Siegel
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany; Department of Biomedical Informatics at the Center for Preventive Medicine and Digital Health, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frank Waldbillig
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Daniel Pfalzgraf
- Department of Urology, Heilig-Geist-Hospital Bensheim, Bensheim, Germany
| | - Gaetan Kamdje Wabo
- Department of Biomedical Informatics at the Center for Preventive Medicine and Digital Health, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jonas Herrmann
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Nuhn
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maurice Stephan Michel
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jost von Hardenberg
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
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Petov V, Babaevskaya D, Taratkin MS, Chuvalov L, Lusuardi L, Misrai V, Sukhanov R, Scoffone C, Enikeev D. Thulium fiber laser enucleation of the prostate (ThuFLEP). Prospective study of mid- and long-term outcomes in 1328 patients. J Endourol 2022; 36:1231-1236. [PMID: 35414204 DOI: 10.1089/end.2022.0029] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective of our study was to estimate the long-term efficacy and safety of thulium fiber laser enucleation of the prostate (ThuFLEP). MATERIALS AND METHODS We analysed patients who underwent ThuFLEP due to LUTS related to BPO. Both the pre- and perioperative data as well as the follow-up data for 3 years were evaluated: prostate volume, post-void residual (PVR), Qmax, IPSS and QoL, PSA level and the complication rate. Intraoperative data relating to the weight of resected tissue, the duration of surgery, catheterization and data on hospital stays were also collected. A sub-group analysis was performed to assess whether older patients (>65 years) or those with larger glands (>80 cc) are prone to increased complication risks. RESULTS A total of 1328 patients were included in the analysis. The mean age was 66.9±7.5 years. Mean prostate volume was 86.9±41.9 (20-330) cc. All the functional parameters (IPSS, QoL, PVR, Qmax) significantly improved after surgery (p<0.05) and showed durable improvement up to 3-years of follow-up. The frequency of late complications was as follows: stress urinary incontinence - 1.2%; urethral stricture -1.1%; bladder neck contracture - 0.9%. Sub-group analyses revealed increased UTI frequency in older patients (3.5% vs 0.8%, p=0.003) as well as higher rate of SUI (0.4% vs 1.8%, p=0.002) and higher rate of clot retention (11.3% vs 4.4%, p<0.001) in those with larger glands. CONCLUSIONS Irrespective of the patient's age and prostate volume, ThuFLEP represents an effective and durable technique of endoscopic enucleation characterized by a low incidence of complications after 3 years of follow-up. In the hands of an experienced surgeon, ThuFLEP can rightly be considered to be a promising alternative to HoLEP for treatment of LUTS associated with BPO.
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Affiliation(s)
- Vladislav Petov
- Sechenov University, Institute for Urology and Reproductive Health, Moscow, Russian Federation;
| | - Diana Babaevskaya
- Sechenov University, 68477, Institute for Clinical Medicine, Trubetskaya, 8, Moscow, Russian Federation, 119048;
| | - Mark Sergeevich Taratkin
- Sechenov University, Institute for Urology and Reproductive Health, 2/1 Bolshaya Pirogovskaya St., Moscow, Russian Federation, 119991;
| | - Leonid Chuvalov
- Sechenov University, Institute for Urology and Reproductive Health, Moscow, Russian Federation;
| | - Lukas Lusuardi
- Paracelsius Medical University, Urology and Andrology, Müllner Hauptstraße 48, Salzburg, Austria, 5020;
| | - Vincent Misrai
- Clinique Pasteur, 54918, Service d'Urologie, Toulouse, Midi-Pyrénées, France;
| | - Roman Sukhanov
- Sechenov University, 68477, Institute for Urology and Reproductive Health, Moskva, Moskva, Russian Federation;
| | - Cesare Scoffone
- Cottolengo Hospital, Division of Urology, via Cottolengo 9, Torino, Torino, Italy, 10152;
| | - Dmitry Enikeev
- I.M. Sechenov First Moscow State Medical University, Research Institute of Uronephrology and Reproductive Health, Bolshaya Pirogovskaya street 2, building 1, Moscow, Russian Federation, 119435;
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Bertolo R, Cipriani C, Vittori M, Carilli M, Maiorino F, Iacovelli V, Ganini C, Antonucci M, Signoretti M, Petta F, Panei M, Bove P. The efficacy of a suppository based on Phenolmicin P3 and Bosexil (Mictalase®) in control of irritative symptoms in patients undergoing thulium laser enucleation of prostate: a single-center, randomized, controlled, open label, phase III study. BMC Urol 2022; 22:19. [PMID: 35151280 PMCID: PMC8840549 DOI: 10.1186/s12894-022-00974-0] [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: 10/22/2021] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background Several studies described post-operative irritative symptoms after laser enucleation of prostate, sometimes associated with urge incontinence, probably linked to laser-induced prostatic capsule irritation, and potential for lower urinary tract infections We aimed to evaluate the efficacy of a suppository based on Phenolmicin P3 and Bosexil (Mictalase®) in control of irritative symptoms in patients undergoing thulium laser enucleation of prostate (ThuLEP). Methods In this single-center, prospective, randomized, open label, phase-III study, patients with indication to ThuLEP were enrolled (Dec2019–Feb2021—Institutional ethics committee STS CE Lazio approval no.1/N-726—ClinicalTrials.gov NCT05130918). The report conformed to CONSORT 2010 guidelines. Eligible patients were 1:1 randomized. Randomization defined Group A: patients who were administered Mictalase® suppositories twice a day for 5 days, then once a day for other 10 days; Group B: patients who did not receive Mictalase® (“controls”). Study endpoints were evaluated at 15 and 30 days postoperation. Primary endpoint included evaluation of effects of the suppository on irritative symptoms by administering IPSS + QoL questionnaire. Secondary endpoint included evaluation of effects on urinary tract infections by performance of urinalysis with urine culture. Results 111 patients were randomized: 56 in Group A received Mictalase®. Baseline and perioperative data were comparable. At 15-days, no significant differences were found in terms of IPSS + QoL scores and urinalysis parameters. A significant difference in the rate of positive urine cultures favored Group A (p = 0.04). At 30-days follow-up, significant differences were found in median IPSS score (6 [IQR 3–11] versus 10 [5–13], Group A vs B, respectively, p = 0.02). Urinalysis parameters and rate of positive urine cultures were not significantly different. Conclusions The present randomized trial investigated the efficacy of Mictalase® in control of irritative symptoms and prevention of lower urinary tract infections in patients undergoing ThuLEP. IPSS improvement 30-days postoperation was more pronounced in patients who received Mictalase®. Lower rate of positive urine culture favored Mictalase® group 15-days postoperatively. Trial registration The clinical trial has been registered on ClinicalTrials.gov on November 23rd, 2021—Registration number NCT05130918.
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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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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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8
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Giulianelli R, Gentile BC, Mirabile G, Tema G, Nacchia A, Albanesi L, Tariciotti P, Mavilla L, Bellangino M, Lopes Mendes L, Rizzo G, Aloisi P, Vincenti G, Lombardo R. Bipolar Plasma Enucleation of the Prostate: 5 Years Outcomes. J Endourol 2020; 33:396-399. [PMID: 30816063 DOI: 10.1089/end.2019.0050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Aim of our study is to assess outcomes and safety of button bipola transurethral enucleation of the prostate (B-TUEP) in patients with lower urinary tract symptoms (LUTS) caused by benign prostatic enlargement (BPE) in a single-center cohort study. Materials and Methods: All patients with LUTS caused by BPE undergoing button B-TUEP between May 2012 and December 2013 were prospectively enrolled in our study. Data on clinical history, physical examination, urinary symptoms, erectile function, uroflowmetry, and prostate volume were collected at 0, 1, 3, 6, 12, 24, 36, 48, and 60 months. Early and long-term complications were recorded. Results: Overall 50 patients were enrolled at baseline. Nine patients were excluded during the 5 years. All patients completed the procedure without severe complications. In terms of outcomes, improvement in International Prostate Symptom Score (IPSS) were sustained for all 5 years and mean difference from baseline at 5 years was 17 points. As well, improvements in Qmax (maximum urinary flow rate) were sustained for all 5 years and mean improvement at 5 years was 16 mL/second. Erectile function was slightly improved after surgery and maintained for the following 5 years. Conclusions: Our single-center study suggests that B-TUEP may have excellent outcomes at 5 years with no recurrence. Further multicentre studies should confirm our results.
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Affiliation(s)
| | | | | | - Giorgia Tema
- 2 Department of Urology, University "La Sapienza," Rome, Italy
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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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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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11
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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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12
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Saredi G, Pirola GM, Ambrosini F, Barbieri S, Berti L, Pacchetti A, Iovino D, Ietto G, Libassi L, Carcano G. Feasibility of en bloc thulium laser enucleation of the prostate in a large case series. Are results enhanced by experience? Asian J Urol 2019; 6:339-345. [PMID: 31768319 PMCID: PMC6872783 DOI: 10.1016/j.ajur.2019.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/28/2018] [Accepted: 09/25/2018] [Indexed: 11/25/2022] Open
Abstract
Objective To provide the first large single-operator case series of patients who undergo “en bloc” thulium laser enucleation of the prostate (ThuLEP) and to demonstrate an improvement in enucleation efficacy with experience. Methods We prospectively evaluated a cohort of patients with symptomatic benign prostatic hyperplasia (BPH) who underwent “en bloc” ThuLEP between May 2015 and November 2017. Association between dependent variables (delivered energy and operating time) and independent variables (adenoma volume and experience) were estimated with regression analysis. The experience was calculated as the time interval between the date of the first operation of the series and the date of the operation being considered. Results A total of 100 patients were registered for the study. Median operative time was 56.5 min (interquartile range [IQR]: 40–85 min). Median enucleation time was 17.4 min (IQR: 15–21.5 min). Median enucleation index (enucleation time per adenoma gram) was 0.3 min/g (0.2–0.3 min/g). The overall operative time is not influenced by experience, but we registered a significant trend towards a reduction in the total amount of energy delivered energy normalized per adenoma gram (p = 0.0148). Conclusion We believe that further attention is needed for these new “en bloc” prostatic enucleation techniques, which can facilitate some surgical steps, leading to a widespread use of laser technology for BPH surgical treatment.
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Affiliation(s)
- Giovanni Saredi
- Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | - Francesca Ambrosini
- Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | - Lorenzo Berti
- Department of Urology, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | - Domenico Iovino
- Department of Surgery, University of Insubria, Varese, Italy
| | - Giuseppe Ietto
- Department of Surgery, University of Insubria, Varese, Italy
| | - Letizia Libassi
- Department of Surgery, University of Insubria, Varese, Italy
| | - Giulio Carcano
- Department of Surgery, University of Insubria, Varese, Italy
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Enikeev D, Glybochko P, Rapoport L, Okhunov Z, O'Leary M, Potoldykova N, Sukhanov R, Enikeev M, Laukhtina E, Taratkin M. Impact of endoscopic enucleation of the prostate with thulium fiber laser on the erectile function. BMC Urol 2018; 18:87. [PMID: 30314492 PMCID: PMC6186032 DOI: 10.1186/s12894-018-0400-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/02/2018] [Indexed: 11/16/2022] Open
Abstract
Background The impact of number of endoscopic enucleation of the prostate techniques (holmium laser enucleation - HoLEP for example) on erectile function have already been investigated. However, the thulium-fiber laser, in this setting remains unstudied. In this study, we compared sexual function outcomes in patients with benign prostatic hyperplasia (BPH) treated with transurethral resection of the prostate (TURP) or thulium-fiber laser enucleation (ThuFLEP). Methods We performed a retrospective analysis of patients who underwent transurethral resection and endoscopic enucleation of the prostate for BPH; inclusion criteria was the presence of infravesical obstruction (IPSS > 20, Qmax < 10 mL/s). Erectile function (EF) was assessed using the International Index of Erectile Function (IIEF-5) both prior to endoscopic examination, and six months after. Results A total of 469 patients with BPH were included in the study; of these, 211 underwent to ThuFLEP, and 258 TURP. Preoperative IIEF-5 in TURP and ThuFLEP groups were 11.7 (±4.5) and 11.1 (±5.0), respectively (p = 0.17). At six month the IIEF-5 score was unchanged (p = 0.26 and p = 0.08) and comparable in both groups (p = 0.49). However, mean IIEF-5 score shown significant increase of 0.72 in ThuFLEP group, comparing to decrease of 0.24 in TURP patients (p < 0.001). Conclusions Both TURP and ThuFLEP are effective modalities in the management of infravesical obstruction due to BPH. At six months follow-up after surgery, both techniques lead to comparable IIEF-5 score. However, our results demonstrated that the ThuFLEP is more likely to preserve the erectile function leading to increase of IIEF-5 at six months in contrast to TURP which lead to slight drop in IIEF-5 score.
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Affiliation(s)
- Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
| | - Petr Glybochko
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Leonid Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine; Orange, CA, USA
| | - Mitchel O'Leary
- Department of Urology, University of California, Irvine; Orange, CA, USA
| | - Natalya Potoldykova
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Roman Sukhanov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mikhail Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Becker B, Herrmann TRW, Gross AJ, Netsch C. Thulium vapoenucleation of the prostate versus holmium laser enucleation of the prostate for the treatment of large volume prostates: preliminary 6-month safety and efficacy results of a prospective randomized trial. World J Urol 2018; 36:1663-1671. [DOI: 10.1007/s00345-018-2321-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/30/2018] [Indexed: 10/17/2022] Open
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15
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Becker B, Buttice S, Magno C, Gross A, Netsch C. Thulium Vaporesection of the Prostate and Thulium Vapoenucleation of the Prostate: A Retrospective Bicentric Matched-Paired Comparison with 24-Month Follow-Up. Urol Int 2017; 100:105-111. [DOI: 10.1159/000484444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/10/2017] [Indexed: 12/31/2022]
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Netsch C, Becker B, Tiburtius C, Moritz C, Becci AV, Herrmann TRW, Gross AJ. 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; 35:1913-1921. [PMID: 28698991 DOI: 10.1007/s00345-017-2071-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/07/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES To compare the perioperative outcomes of thulium vapoenucleation of the prostate (ThuVEP) with holmium laser enucleation of the prostate (HoLEP) for patients with symptomatic benign prostatic obstruction (BPO). METHODS Forty-eight and 46 patients were prospectively randomized to ThuVEP and HoLEP. All patients were assessed preoperatively and 4-week postoperatively. The complications were noted and classified according to the modified Clavien classification system. Patient data were expressed as median (interquartile range) or numbers (%). RESULTS Median age at surgery was 73 (67-76) years and median prostate volume was 80 (46.75-100) cc and not different between the groups (p = 0.207). The median operative time was 60 (41-79) minutes without significant differences between both groups (p = 0.275). There were no significant differences between the groups regarding catheterization time [2 (2-2) days, p = 0.966] and postoperative stay [2 (2-3) days, p = 0.80]). Clavien 1 (13.8%), Clavien 2 (3.2%), Clavien 3a (2.1%), and Clavien 3b (4.3%) complications occurred without significant differences between the groups. However, the occurrence of acute postoperative urinary retention was higher after HoLEP compared to ThuVEP (15.2 vs. 2.1%, p ≤ 0.022). At 1-month follow-up, peak urinary flow rates (10.7 vs. 22 ml/s), post-void residual volumes (100 vs. 20 ml), International Prostate Symptom Score (20 vs. 10) and Quality of Life (4 vs. 3) had improved significantly (p ≤ 0.005) without significant differences between the groups. CONCLUSIONS ThuVEP and HoLEP are safe and effective procedures for the treatment of symptomatic BPO. Both procedures give equivalent and satisfactory immediate micturition improvement with low perioperative morbidity.
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Affiliation(s)
- Christopher Netsch
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany.
| | - B Becker
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
| | - C Tiburtius
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
| | - C Moritz
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
| | - A Venneri Becci
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
| | - T R W Herrmann
- Department of Urology, MHH Medical School of Hannover, Hannover, Germany
| | - A J Gross
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
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Five-year outcomes of thulium vapoenucleation of the prostate for symptomatic benign prostatic obstruction. World J Urol 2017; 35:1585-1593. [DOI: 10.1007/s00345-017-2034-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/06/2017] [Indexed: 10/19/2022] Open
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18
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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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21
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Herrmann TRW. Enucleation is enucleation is enucleation is enucleation. World J Urol 2016; 34:1353-5. [DOI: 10.1007/s00345-016-1922-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/10/2016] [Indexed: 12/01/2022] Open
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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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Bach T, Wölbling F, Gross AJ, Netsch C, Tauber S, Pottek T, Wülfing C, Brunken C. Prospective assessment of perioperative course in 2648 patients after surgical treatment of benign prostatic obstruction. World J Urol 2016; 35:285-292. [PMID: 27263019 DOI: 10.1007/s00345-016-1866-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 05/23/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE TUR-prostate (TUR-P) is considered the reference method for surgical treatment of benign prostatic obstruction (BPO); Greenlight laser photoselective vaporization (PVP) and thulium laser vapoenucleation (ThuVEP) have also been established as treatments of BPO. Objective of this prospective observation was to compare a large numbers of patients treated in everyday routine. METHODS This prospective multicentre data collection assesses morbidity and perioperative course of consecutive men treated with BPO-related transurethral surgery between 2011 and 2014 in a German metropolis area with TUR-P, PVP or ThuVEP. RESULTS Two thousand six hundred and forty-eight patients have been treated in the time period. All treatment options achieved immediate improvement of voiding parameters. Multivariate analyses proved shorter hospital stay after laser treatments as compared to resection (p < 0.001). In terms of hospital stay, the advantage of ThuVEP compared to TUR-P increased with prostate volume (p < 0.001). Patients with ongoing anticoagulation or bridging had prolonged hospital stay (p < 0.001). Overall adverse events were least frequent in PVP (p 0.016), as were Clavien 3b events (p < 0.001). CONCLUSIONS Surgical treatment of BPO is effective and safe independent of the surgical procedure. Volume reduction is most effective in ThuVEP; PVP has the lowest rate of severe complications. Laser treatment is associated with shorter hospital stay. Surgery under ongoing anticoagulation prolonged the post-operative hospital stay.
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Affiliation(s)
- Thorsten Bach
- Department of Urology, Asklepios Hospital Harburg, Eissendorfer Pferdeweg 52, 21075, Hamburg, Germany.
| | - Felix Wölbling
- Department of Urology, Asklepios Hospital Harburg, Eissendorfer Pferdeweg 52, 21075, Hamburg, Germany
| | - Andreas J Gross
- Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - C Netsch
- Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - S Tauber
- Department of Urology, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Tobias Pottek
- Department of Urology, Asklepios Westklinkum Rissen, Hamburg, Germany
| | | | - Claus Brunken
- Department of Urology, Asklepios Hospital St. Georg, Hamburg, Germany
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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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Elhilali MM, Elkoushy MA. Endoscopic Treatment of Bladder Outlet Obstruction Secondary to the Large Volume Prostate-Where are We? J Urol 2015; 195:548-50. [PMID: 26688573 DOI: 10.1016/j.juro.2015.12.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Mostafa M Elhilali
- Department of Surgery/Division of Urology, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada
| | - Mohamed A Elkoushy
- Department of Surgery/Division of Urology, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada
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Comparison between thulium laser resection of prostate and transurethral plasmakinetic resection of prostate or transurethral resection of prostate. Sci Rep 2015; 5:14542. [PMID: 26444930 PMCID: PMC4595764 DOI: 10.1038/srep14542] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 03/30/2015] [Indexed: 02/05/2023] Open
Abstract
Benign prostatic hyperplasia (BPH) is one of the most common diseases in middle-aged and elderly men. In the present study, we aimed to compare the efficacy and safety of thulium laser resection of the prostate (TMLRP) with either transurethral plasmakinetic resection of the prostate (TUPKP) or transurethral resection of the prostate (TURP). A literature search was performed, eventually, 14 studies involving 1587 patients were included. Forest plots were produced by using Revman 5.2.0 software. Our meta-analysis showed that operation time, decrease in hemoglobin level, length of hospital stay, catheterization time, and development of urethral stricture significantly differed, whereas the transitory urge incontinence rate, urinary tract infection rate, and recatheterization rate did not significantly differ between TMLRP and either TURP or TUPKP. The blood transfusion rate was significantly different between TMLRP and TURP, but not between TMLRP and TUPKP. In addition, the retrograde ejaculation rate between TMLRP and TURP did not significantly differ. At 1, 3, 6, and 12 months of postoperative follow-up, the maximum flow rate, post-void residual, quality of life, and International Prostate Symptom Score did not significantly differ among the procedures. Thus, the findings of this study indicate that TMLRP may be a safe and feasible alternative.
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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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Rausch S, Heider T, Bedke J, Kruck S, Schwentner C, Fischer K, Stenzl A, Kälble T. Analysis of early morbidity and functional outcome of thulium: yttrium-aluminum-garnet laser enucleation for benign prostate enlargement: patient age and prostate size determine adverse surgical outcome. Urology 2015; 85:182-8. [PMID: 25530383 DOI: 10.1016/j.urology.2014.10.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/24/2014] [Accepted: 10/01/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate complications and functional outcome and to identify patient-associated risk factors, we analyzed consecutive patients undergoing thulium:yttrium-aluminum-garnet laser enucleation of the prostate (ThuLEP) in our department. METHODS A total of 234 patients were prospectively analyzed. Preoperative data, postoperative complications, and outcome at 6, 12, and 24 months were recorded. Individual risk factors for complications and treatment failure were assessed by univariate and multivariate analyses. RESULTS Mean age at surgery was 72.88 ± 7.83 years. Mean preoperative prostate size was 84.8 ± 34.9 mL. Thirty-day complication rate was 19.7%. Functional treatment failure occurred in 9.0% of all patients. Decline of mean International Prostate Symptom Score was -75%, quality of life index -76%, and postvoid residual -86% at 24 months. Maximum urine flow at 24 months was improved at +231%. In univariate analysis, age >80 years and prostate size <50 mL were significant predictors of complications, which was confirmed by multivariate analysis (P = .0277 and .0409, respectively). Age >80 years, prostate size <80 mL or <50 mL, and American Society of Anesthesiologists classification were significant predictors of functional treatment failure in univariate analysis. Prostate size <80 mL or <50 mL was significantly associated with treatment failure (P < .001) in multivariate analysis. CONCLUSION ThuLEP is a safe and efficient surgical procedure, even in a patient cohort with high prostate volumes, age, and comorbidities. However, high patient age and small prostate size were significant determinants of adverse outcomes after surgery. To address the question of optimal therapy selection for patients with prostates smaller than 80 mL, further prospective randomized evaluation of ThuLEP and alternative surgical interventions is needed.
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Affiliation(s)
- Steffen Rausch
- Department of Urology, Klinikum Fulda, Fulda, Germany; Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Thomas Heider
- Department of Urology, Klinikum Fulda, Fulda, Germany
| | - Jens Bedke
- Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Stephan Kruck
- Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany
| | | | | | - Arnulf Stenzl
- Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Tilman Kälble
- Department of Urology, Klinikum Fulda, Fulda, Germany
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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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