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Grosso AA, Amparore D, Di Maida F, de Cillis S, Cocci A, Di Dio M, Russo GI, Cimino S, Quarà A, Salvi M, Fiori C, Mari A, Porpiglia F, Minervini A, Tuccio A. Comparison of perioperative and short-terms outcomes of en-bloc Holmium laser enucleation of the prostate (HoLEP) and robot-assisted simple prostatectomy: a propensity-score matching analysis. Prostate Cancer Prostatic Dis 2024; 27:478-484. [PMID: 37857831 DOI: 10.1038/s41391-023-00743-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/04/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Surgical treatment of symptomatic benign prostatic hyperplasia (BPH) has seen an evolution during the last decades. On one hand, en-bloc HoLEP emerged as a valid endoscopic treatment regardless prostate size. On the other hand, robot-assisted simple prostatectomy (RASP) has gained attention in larger prostates showing encouraging results. Herein, for the first time in the scientific scenario, we sought to compare the outcomes of RASP and en-bloc HoLEP cases after propensity-score matching (PSM) analysis. METHODS We retrospectively queried our prospectively database of patients treated with HoLEP or RASP between 2017 and 2022 among two high-volume centers. PSM was applied based on the International Prostate Symptom Score (IPSS) questionnaire, prostate volume and max-flow rate. All procedures were performed by a single surgeon per center. Outcomes were assessed at 1, 3, and 6-month postoperatively and therefore annually. Trifecta definition was used to assess "success" in surgical procedures and was defined as the contemporary presence of: a) no postoperative complications within the first postoperative month; b) 1-month postoperative Qmax >15 ml/s and c) no urinary incontinence at 3-month evaluation. RESULTS Overall, 48 HoLEP and 47 RASPs were matched. Operative time, hospitalization time (median 4 vs 5 days) and catheterization time (median 3 vs 2 day) were found to be shorter in the HoLEP group as compared to the counterpart (p < 0.05). Early postoperative complication rate was also lower in the HoLEP cohort (6.2% vs 12.6%; p = 0.03) as well as postoperative haemoglobine blood level drop (1.4 vs 2.4 g/dL; p = 0.03). On the other hand, postoperative antegrade ejaculation (55.3% vs 6.8%) 1-month max flow (median 28 vs 24 ml/sec) and continence rates (0% vs 20.8%) favored RASP (p < 0.05). Overall, Trifecta rate was similar in the two groups (76.1% vs 82.6%). CONCLUSION Both HoLEP and RASP are safe and effective treatments for symptomatic BPH. HoLEP demonstrated to have lower perioperative risks while is affecting by a higher probability of transient early UI. On the other hand, RASP is more effective in reducing postoperative ejaculatory dysfunction.
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Affiliation(s)
- Antonio Andrea Grosso
- Department of experimental and clinical Medicine-University of Florence; Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy.
| | - Daniele Amparore
- Division of Urology, Department of Oncology, University of Turin, Turin, Italy
| | - Fabrizio Di Maida
- Department of experimental and clinical Medicine-University of Florence; Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Sabrina de Cillis
- Division of Urology, Department of Oncology, University of Turin, Turin, Italy
| | - Andrea Cocci
- Department of experimental and clinical Medicine-University of Florence; Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Michele Di Dio
- Division of Urology, Department of Surgery, SS Annunziata Hospital, Cosenza, Italy
| | | | | | - Alberto Quarà
- Division of Urology, Department of Oncology, University of Turin, Turin, Italy
| | - Matteo Salvi
- Department of experimental and clinical Medicine-University of Florence; Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, University of Turin, Turin, Italy
| | - Andrea Mari
- Department of experimental and clinical Medicine-University of Florence; Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, University of Turin, Turin, Italy
| | - Andrea Minervini
- Department of experimental and clinical Medicine-University of Florence; Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Agostino Tuccio
- Department of experimental and clinical Medicine-University of Florence; Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
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Elmansy H, Abbas L, Fathy M, Hodhod A, Shabana W, Alkandari A, Habib E, Meshref A, Roshdy MA, Shahrour W. Top-down holmium laser enucleation of the prostate (HoLEP) versus traditional HoLEP for the treatment of benign prostatic hyperplasia (BPH): 1-year outcomes of a randomized controlled trial. Prostate Cancer Prostatic Dis 2024; 27:462-468. [PMID: 37783838 DOI: 10.1038/s41391-023-00730-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND The top-down holmium laser enucleation of the prostate (HoLEP) technique recently emerged as a safe and effective modification of traditional HoLEP. In our randomized controlled trial, we compared intraoperative and postoperative outcomes of traditional and top-down HoLEP for the treatment of benign prostatic hyperplasia (BPH) in patients with a prostate size ≥80 g. METHODS One-hundred patients with BPH and a prostate volume ≥80 cc participated in this prospective randomized controlled trial. Outcome measures were collected and compared, including IPSS, QoL, flow rate, PVR, IIEF-15, PSA, and TRUS prostate volume changes. Perioperative complications were also recorded. All patients were followed up at 1, 3, 6, and 12 months. RESULTS There were no significant differences in preoperative baseline characteristics between the two surgical groups. The median prostate volume for the traditional and top-down HoLEP groups was 107 and 102 cc, respectively. The operative parameters and postoperative outcomes were comparable for both cohorts. The median enucleation time for traditional HoLEP was 60 min, which was not significantly longer than that of top-down HoLEP (52 min) (p = 0.07). At 3 months follow-up, there was no statistically significant difference in transient stress urinary incontinence (SUI) in the traditional HoLEP (4.1%) versus the top-down HoLEP group (2.2%), (p = 0.61). There were no significant differences in functional and sexual outcomes between the two groups at 12 months. CONCLUSIONS The HoLEP procedure significantly improves patients' urinary functional outcomes and has comparable postoperative outcomes regardless of the technique utilized.
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Affiliation(s)
- Hazem Elmansy
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada.
| | - Loay Abbas
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
- Urology Department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Moustafa Fathy
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Amr Hodhod
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Waleed Shabana
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Abdulrahman Alkandari
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Enmar Habib
- Urology Department, Cairo University, Cairo, Egypt
| | - Alaa Meshref
- Urology Department, Cairo University, Cairo, Egypt
| | - Mamdouh A Roshdy
- Urology Department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Walid Shahrour
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
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Barlas IS, Aybal HC, Duvarci M, Akdagcik Z, Aksoy ME, Saglican Y, Peker T, Guven S, Tunc L. Revisiting the external urethral sphincter: new anatomical insights from a human cadaver study. World J Urol 2024; 42:496. [PMID: 39183200 DOI: 10.1007/s00345-024-05204-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 08/06/2024] [Indexed: 08/27/2024] Open
Abstract
PURPOSE The external urethral sphincter (EUS) is critical for urinary continence, but its complex anatomy is not fully understood, complicating its preservation during prostate surgeries. This study aims to elucidate the anatomy and development of the EUS to enhance surgical techniques for continence preservation. METHODS The study consisted of a postmortem examination of three male cadavers, aged 52, 64, and 60, with intact urogenital systems. Specimens including the prostate and EUS were dissected, fixed in formalin, and stained with Hematoxylin-Eosin for microscopic analysis. Histological assessments focused on the muscle composition and structure of the EUS and prostate. RESULTS Macroscopic examination revealed symmetrical prostates without pathologies. Histologically, the anterior prostate lacked tubuloalveolar glands, showing striated muscle fibers from the external urethral sphincter extending into the prostate and prostatic urethra. Reduced glandular structure and prevalent smooth muscle were noted. This intricate integration of striated muscle fibers at the EUS-prostate interface underscores the anatomical complexity vital for surgical preservation of urinary continence. CONCLUSION Our study reveals a complex EUS-prostate relationship, challenging the view of the EUS as merely a circular muscle. The findings demonstrate the importance of the EUS's extension into the prostate for urethral stabilization and continence. Recognizing this anatomy is crucial for maintaining urinary continence in prostate surgeries and enhancing postoperative outcomes.
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Affiliation(s)
| | - Halil Cagri Aybal
- Department of Urology, Polatli Duatepe State Hospital, Ankara, Turkey
| | - Mehmet Duvarci
- Department of Urology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | | | - Mehmet Emin Aksoy
- Center of Advanced Simulation and Education, Acibadem University, Istanbul, Turkey
| | - Yesim Saglican
- Acibadem Medical School, Department of Pathology, Acibadem University, Istanbul, Turkey
| | - Tuncay Peker
- Medical School, Department of Anatomy, Gazi University, Ankara, Turkey
| | - Selcuk Guven
- Meram School of Medicine, Department of Urology, Necmettin Erbakan University, Konya, Turkey
| | - Lutfi Tunc
- Department of Urology, Ankara Acibadem Hospital, Ankara, Turkey
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Wu SW, Tseng CS, Yuan LH, Huang YW, Chen YJ, Kuo MC, Chueh JSC, Huang SW. Prospective study of urinary incontinence recovery following endoscopic enucleation of the prostate. BJU Int 2024. [PMID: 39030920 DOI: 10.1111/bju.16475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2024]
Abstract
OBJECTIVE To investigate the clinical trajectories and identify risk factors linked to post-enucleation urinary incontinence (UI). PATIENTS AND METHODS In this prospective study (April 2020 to March 2022) at a single institution, 316 consecutive patients receiving endoscopic enucleation due to benign prostatic enlargement were included. Patient information and perioperative details were collected. Follow-ups, from 1 to 6 months, assessed postoperative UI using International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and a four-item pad questionnaire, classified per International Continence Society definitions. Logistic regression analysed predictors at 1 week, while generalised estimating equation assessed risk factors from 1 to 3 months postoperatively. RESULTS Patients with a median prostate volume of 57 mL underwent enucleation, with 22.5% experiencing postoperative UI at 1 week, 5.6% at 3 months, decreasing to 1.9% at 6 months. Multivariable analysis identified age (>80 years), specimen weight (>70 g), en bloc with anteroposterior dissection, and anal tone (Digital Rectal Examination Scoring System score <3) as potential factors influencing UI. Subgroup analysis revealed that specimen weight was associated with both continuous and stress UI. Anal tone was related to both other types and stress UI, while overactive bladder symptoms were associated with urge UI. CONCLUSION In summary, our study elucidates transient risk factors contributing to temporary post-enucleation UI after prostatectomy. Informed decisions and personalised interventions can effectively alleviate concerns regarding postoperative UI.
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Affiliation(s)
- Shao-Wei Wu
- Department of Urology, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
| | - Chi-Shin Tseng
- Department of Urology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Lun-Hsiang Yuan
- Department of Urology, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
| | - Yu-Wen Huang
- Department of Urology, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
| | - Yi-Jhou Chen
- Department of Urology, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
| | - Ming-Chieh Kuo
- Department of Urology, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
| | - Jeff Shih-Chieh Chueh
- Department of Urology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Shi-Wei Huang
- Department of Urology, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
- Department of Urology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
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Heidenberg DJ, Choudry MM, Cheney SM. Reply to Editorial Comment on "The Impact of Standard vs Early Apical Release HoLEP Technique on Postoperative Incontinence and Quality of Life". Urology 2024; 189:110-111. [PMID: 38729269 DOI: 10.1016/j.urology.2024.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024]
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Bogdanović J, Trivunić-Dajko S. Editorial Comment on "The Impact of Standard vs Early Apical Release HoLEP Technique on Postoperative Incontinence and Quality of Life". Urology 2024; 189:108-109. [PMID: 38648943 DOI: 10.1016/j.urology.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Jovo Bogdanović
- Faculty of Medicine Novi Sad, University of Novi Sad & Clinic of Urology, University Clinical Centre of Vojvodina, Novi Sad, Serbia.
| | - Sandra Trivunić-Dajko
- Faculty of Medicine Novi Sad, University of Novi Sad & Centre for Pathology, University Clinical Centre of Vojvodina, Novi Sad, Serbia
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Aybal HC, Yilmaz M, Barlas IS, Duvarci M, Tuncel A, Tunc L. Comparison of HoLEP, ThuLEP and ThuFLEP in the treatment of benign prostatic obstruction: a propensity score-matched analysis. World J Urol 2024; 42:374. [PMID: 38871959 DOI: 10.1007/s00345-024-05082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 05/23/2024] [Indexed: 06/15/2024] Open
Abstract
PURPOSE To compare the efficacy and safety of Holmium laser enucleation of the prostate (HoLEP), Thulium laser enucleation of prostate (ThuLEP) and Thulium fibre laser enucleation of prostate (ThuFLEP) by performing propensity score matched analysis (PSM). METHODS We retrospectively analysed the patients who underwent HoLEP (Group 1, n = 696), ThuLEP (Group 2, n = 146) and ThuFLEP (Group 3, n = 193) surgery because of benign prostatic obstruction (BPO). A 1:1:1 HoLEP: ThuLEP: ThuFLEP group matching was performed using PSM analysis. Perioperative, postoperative functional outcomes and complications were analysed and compared. RESULTS We observed significant improvement in functional parameters regarding IPSS, Qmax, PVR and quality of life in all groups compared to baseline values at the 1st, 6th and 12th postoperative months. There was no significant difference between different laser types in terms of urge (UUI) and stress urinary incontinence (SUI) at 1st postoperative month. In all three groups, no patient had postoperative SUI or UUI at 6th and 12th postoperative months. In addition, no significant difference was observed between laser types in terms of postoperative complications. CONCLUSION HoLEP, ThuLEP and ThuFLEP are safe and effective LEP methods with improvement in functional parameters and low complication rates. Similar results in terms of functional outcomes and complications clearly show that these surgeries are alternatives to each other for the patients with BPO. Experts' opinions, practices and enucleation techniques should also be taken into consideration when choosing a laser for BPO surgery.
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Affiliation(s)
| | - Mehmet Yilmaz
- Department of Urology, SLK Kliniken Heilbronn, Heilbronn, Germany.
| | - Irfan Safak Barlas
- Department of Urology, Acıbadem University Ankara Hospital, Ankara, Turkey
| | - Mehmet Duvarci
- Department of Urology, University of Health Sciences, Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Altug Tuncel
- Ankara Bilkent City Hospital, Department of Urology, University of Health Sciences, Ankara, Turkey
| | - Lutfi Tunc
- Department of Urology, Acıbadem University Ankara Hospital, Ankara, Turkey
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Bucca B, Gobbi LM, Dalpiaz O, Asero V, Scornajenghi CM, Alviani F, Licari LC, Bologna E, Gozzi C. Suprapubic Transvesical Adenoma Resection of the Prostate (STAR-P): A Novel Technique for Surgical Treatment of Benign Prostatic Hyperplasia. Eur Urol Focus 2024:S2405-4569(24)00072-5. [PMID: 38839508 DOI: 10.1016/j.euf.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/24/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND AND OBJECTIVE Several minimally invasive treatments have been developed to treat benign prostatic obstruction (BPO) via a transurethral approach, with a non-negligible risk of complications such as urethral stricture and external sphincter damage. Our aim was to present the Gozzi surgical technique for suprapubic transvesical adenoma resection of the prostate (STAR-P) for BPO and to assess its safety, feasibility, and outcomes. METHODS We conducted a retrospective analysis of 44 consecutive patients who underwent STAR-P for BPO. All the procedures were performed in a single private hospital by one surgeon from 2020 to 2022. An innovative resectoscope designed by the surgeon was subsequently produced by Tontarra Medizintechnik (Wurmlingen, Germany) with a 42.06 Fr external sheath that allows the use of loops of three different sizes. The instrument is inserted into the bladder via suprapubic access, which ensures greater freedom of movement without compromising the external sphincter. Clinical data were retrospectively collected. Preoperative and intraoperative variables, postoperative complications, and functional outcomes of the STAR-P procedure were assessed. A descriptive statistical analysis was performed. KEY FINDINGS AND LIMITATIONS No intraoperative complications were observed. Two patients (4.5%) experienced urinary urgency symptoms after catheter removal that resolved within 90 d. Median times were 105 min for surgery overall and 65 min for resection. All patients showed an improvement in voiding quality. CONCLUSIONS AND CLINICAL IMPLICATIONS STAR-P is a safe, feasible, and cost-effective procedure that spares the bulbomembranous and penile urethra and the external urethral sphincter, and should be discussed with patients as a possible option for treatment of BPO. PATIENT SUMMARY We describe a new, safe, and feasible technique for surgical treatment of urinary obstruction caused by a large prostate. Keyhole surgery is performed through the lower abdomen, which means that the urethra below the prostate is not damaged. Only a small scar of 2-3 cm in the lower abdomen is evident at the end of the healing process.
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Affiliation(s)
- Bruno Bucca
- Urology Unit, Department of Maternal-Child and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy.
| | - Luca M Gobbi
- Urology Unit, Department of Maternal-Child and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Orietta Dalpiaz
- Department of Urology, Hochsteiermark Hospital, Leoben, Austria
| | - Vincenzo Asero
- Urology Unit, Department of Maternal-Child and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Carlo M Scornajenghi
- Urology Unit, Department of Maternal-Child and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Federico Alviani
- Urology Unit, Department of Maternal-Child and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Leslie Claire Licari
- Urology Unit, Department of Maternal-Child and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Eugenio Bologna
- Urology Unit, Department of Maternal-Child and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
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Lin KJ, Hou CP, Tsai HY, Tsao SH, Juang HH, Lin YH. Impact of age and anterior fibromuscular stroma preservation on post-enucleation voided volume. World J Urol 2024; 42:278. [PMID: 38691246 DOI: 10.1007/s00345-024-04996-1] [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: 12/14/2023] [Accepted: 04/11/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE This study is centered on the critical role of anterior fibromuscular stroma (AFS) preservation in prostate enucleation, an emerging strategy aimed at minimizing postoperative urinary incontinence-a common concern in benign prostatic hyperplasia (BPH) surgeries. By focusing on postoperative voiding volumes (VV), our research investigates the efficacy of AFS preservation. This approach, distinct in its methodology, is hypothesized to improve urinary function post-surgery, thereby offering a potentially significant advancement in BPH surgical treatments. MATERIALS AND METHODS A retrospective analysis was conducted, comparing patients who underwent prostate enucleation in 2017 without intentional AFS preservation to those in 2019 with this technique. We examined variables including age, BMI, diabetes, hypertension, and preoperative VV to assess their effect on post-catheter removal VV. The study's methodology includes a thorough review of the primary statistical analysis methods employed. RESULTS Our analysis indicates that while the 2017 and 2019 cohorts were similar in most preoperative parameters, the 2019 group that underwent AFS-preserved surgery showed a significant improvement in postoperative VVs. This was less pronounced in the patient group aged over 70, underscoring the importance of this demographic in our study. CONCLUSIONS The study concludes that intentional preservation of AFS during prostate enucleation positively impacts early postoperative VVs, with limited improvement in older patients. These findings highlight the potential of AFS preservation not only in enhancing urinary outcomes post-surgery but also in shaping future BPH surgical procedures and research directions.
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Affiliation(s)
- Kuo-Jen Lin
- Department of Urology, Chang Gung Memorial Hospital-Linkou, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Chen-Pang Hou
- Department of Urology, Chang Gung Memorial Hospital-Linkou, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Han-Yu Tsai
- Department of Urology, Chang Gung Memorial Hospital-Linkou, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Shu-Han Tsao
- Department of Urology, Chang Gung Memorial Hospital-Linkou, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Horng-Heng Juang
- Department of Urology, Chang Gung Memorial Hospital-Linkou, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
- Department of Anatomy, School of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan
| | - Yu-Hsiang Lin
- Department of Urology, Chang Gung Memorial Hospital-Linkou, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan.
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.
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Kamalov AA, Sorokin NI, Strigunov AA, Nesterova OY, Bondar IV. Incidence and predictors of urinary incontinence rates after thulium fiber laser enucleation of prostate performed by single surgeon. Arab J Urol 2024; 22:261-267. [PMID: 39355795 PMCID: PMC11441080 DOI: 10.1080/20905998.2024.2330737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 03/10/2024] [Indexed: 10/03/2024] Open
Abstract
Purpose We aimed to evaluate the predictive clinical and operative risk factors for urinary incontinence (UI) rates following thulium fiber enucleation of benign prostate hyperplasia (ThuFLEP). Materials and methods We conducted a retrospective cohort review of a prospectively maintained database for patients who underwent ThuFLEP between 2021 and 2023 in our university clinic performed by a single surgeon with high experience (more than 3000 endoscopic enucleation). To perform the operation, we used a thulium fiber laser Fiberlase U3 (IRE Polus ltd, Fryazino, Russia) with operating modes of 1.5 J and 40 Hz 60 W. Postoperative UI rates and risk factors following ThuFLEP were assessed for three follow-up intervals (up to 1 months, from 1 to 3 months and after 3 months post-ThuFLEP). Statistical analysis was conducted using univariate and multivariate logistic regression. Results Out of total 578 patients who underwent ThuFLEP, the study included 381 patients with full information about continence status. Long-term UI (more than 3 months) were found only in 1.6% cases with 0.8% for stress UI, 0.3% for urge UI and 0.5% for mixed UI. Univariate logistic regression analysis has shown that higher total laser energy (OR = 1.009; 95% CI = 1.001-1.018; p = 0.036) and enucleation technique (OR = 0.272; 95% CI = 0.113-0.656; p = 0.004 in favor of En-bloc ThuFLEP) were associated with UI overall, while at multivariable analysis only En-bloc ThuFLEP was protective factor for UI (OR = 0.302; 95%CI = 0.123-0.739; p = 0.009). For short-term UI (less than 1 months) early sphincter release was found as protective factor at both uni- and multivariate analysis compare to longer UI. Conclusion Short-term UI up to 3 months following ThuFLEP is associated with early sphincter release, while overall UI rates are related with enucleation technique (preferable En-bloc) and total laser energy (preferable lower energy). The surgeon should take all these risk factors into account before choosing the technique of BPH surgical treatment.
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Affiliation(s)
- Armais Albertovich Kamalov
- Academy of the RAS, Medical Research and Educational Centre, Lomonosov Moscow State University, Moscow, Russia
- Department of Urology and Andrology, Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russia
| | - Nikolay Ivanovich Sorokin
- Department of Urology and Andrology, Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russia
- Urology and Andrology Unit, Medical Research and Education Centre, Lomonosov University, Moscow, Russia
| | - Andrey Alekseevich Strigunov
- Department of Urology and Andrology, Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russia
- Urology and Andrology Unit, Medical Research and Education Centre, Lomonosov University, Moscow, Russia
- Urologist, Medical Research and Education center, Lomonosov Moscow State University, Moscow, Russia
| | - Olga Yurevna Nesterova
- Department of Urology and Andrology, Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russia
- Urologist, Researcher, Urology and AndrologyUnit, Medical Research and Education center, Lomonosov Moscow State University, Moscow, Russia
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Kronenberg P, Cerrato C, Juliebø-Jones P, Herrmann T, Tokas T, Somani BK. Advances in lasers for the minimally invasive treatment of upper and lower urinary tract conditions: a systematic review. World J Urol 2023; 41:3817-3827. [PMID: 37906263 DOI: 10.1007/s00345-023-04669-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/26/2023] [Indexed: 11/02/2023] Open
Abstract
PURPOSE Technological advancements in laser lithotripsy are expanding into numerous fields of urology, like ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), and benign and malignant soft-tissue treatments. Since the amount of research regarding lasers in urology has grown exponentially, we present a systematic review of the most recent and relevant advances encompassing all lasers used in urological endoscopic treatment. METHODS We performed a literature search using PubMed (May 2023) to obtain information about lasers for urological purposes. We included only recent data from published articles between 2021 and 2023 or articles ahead of print. RESULTS Lasers are widely used in lithotripsy for ureteric, renal, and bladder stones, benign prostate surgery, and bladder and upper tract tumor ablation. While the holmium (Ho:YAG) laser is still predominant, there seems to be more emphasis on pulse modulation and newer lasers such as thulium fiber laser (TFL) and pulsed Tm:YAG laser. CONCLUSION The use of lasers and related technological innovations have shown increasing versatility, and over time have proven to be invaluable in the management of stone lithotripsy, treatment of benign and malignant prostate diseases, and urothelial tumors. Laser endoscopic treatment is heavily based on technological nuances, and it is essential to know at least the basics of these technologies. Ultimately the choice of laser used depends on its availability, cost, surgeon experience and expertise.
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Affiliation(s)
| | - Clara Cerrato
- University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Thomas Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | - Theodoros Tokas
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, Medical School, University General Hospital of Heraklion, University of Crete, Heraklion, Greece
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12
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Tunc L, Herrmann T, Guven S, Scoffone CM, Bozzini G, Yilmaz S, Romero-Otero J, Misrai V, Porreca A, Ahyai S, Gozen AS. A Delphi consensus to standardize the technique of anatomical endoscopic enucleation of prostate: a study by ESUT endoscopic enucleation of prostate study group. World J Urol 2023; 41:2303-2309. [PMID: 37421419 DOI: 10.1007/s00345-023-04496-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/13/2023] [Indexed: 07/10/2023] Open
Abstract
PURPOSE Our objective was to establish a standardized technique for Anatomical Endoscopic Enucleation of Prostate (AEEP) utilizing a consensus statement to provide robust recommendations for urologists who are new to this procedure. METHODS The participants were electronically sent a questionnaire in three consecutive rounds. In the second and third rounds, the anonymous aggregate results of the previous round were presented. Experts' feedback and comments were then incorporated to refine existing questions or to explore more controversial topics in greater depth. RESULTS Forty-one urologists participated in the first round. In the second round, all Round 1 participants received a 22-question survey, resulting in a consensus on 21 items. In the third round, 76% (19/25) of the second-round respondents also participated, reaching a consensus on 22 additional items. The panelists consensually agreed on detaching the urethral sphincter at the beginning of the enucleation and not at the end of the enucleation. To prevent incontinence, it was recommended that the apical mucosa be preserved through various approaches between 11 and 1 o'clock while gently disrupting the lateral lobes in their apical part, avoiding an excess energy delivery approximation to the apical mucosa. CONCLUSION To optimize laser AEEP procedures, urologists must follow expert guidelines on equipment and surgical technique, including early apical release, using the 3-lobe technique for enucleation, preserving apical mucosa with appropriate approaches, gently disrupting lateral lobes at their apical regions, and avoiding excessive energy delivery near the apical mucosa. Following these recommendations can lead to improved outcomes and patient satisfaction.
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Affiliation(s)
- Lutfi Tunc
- Department of Urology, Acibadem University School of Medicine, Ankara, Turkey
| | - Thomas Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Münsterlingen, Switzerland
| | - Selcuk Guven
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | | | - Giorgio Bozzini
- Department of Urology, ASST Valle Olona, Busto Arsizio, Italy
| | - Sercan Yilmaz
- Department of Urology, Kolan Hospital, Istanbul, Turkey
| | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, 31300, Toulouse, France
| | - Angelo Porreca
- Department of Urology, Policlinico Abano Terme, Abano Terme, Italy
| | - Sacha Ahyai
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Ali Serdar Gozen
- Department of Urology, Medius-Kliniken Ruit, University of Tubingen, Ostfildern, Germany.
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13
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Lin YH, Chang SY, Tsao SH, Hou CP, Chen CL, Lin WC, Tsui KH, Juang HH. Anterior fibromuscular stroma-preserved endoscopic enucleation of the prostate: a precision anatomical approach. World J Urol 2023; 41:2127-2132. [PMID: 36585497 DOI: 10.1007/s00345-022-04270-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Benign prostate obstruction (BOO) is becoming increasingly important in this aging society. Some urge/stress urinary incontinence (UUI/SUI) still occurs after endoscopic enucleation of the prostate (EEP). It remains unclear how post-EEP incontinence can be avoided. Currently, early apical release to ameliorate the traction of the external sphincter is the best technique for incontinence prevention. OBJECTIVE To describe our surgical technique of anterior fibromuscular stroma (AFS)-preserved EEP for BOO. DESIGN, SETTING, AND PARTICIPANTS The medical records of 60 consecutive patients who underwent AFS-preserved EEP for BOO in our center from September 2019 to December 2019 were retrospectively reviewed. SURGICAL PROCEDURE AFS-preserved EEP starts at the 12 o'clock position of the urethra, and the junction between the AFS and transitional zone (T-zone) was identified. The AFS and T-zone were separated first to protect the AFS in the initial operative procedure. Then, following the usual enucleation procedure, AFS-preserved EEP could be achieved. MEASUREMENTS Postoperative prostate-specific antigen (PSA), testosterone, urethral stricture, and voiding status, such as incontinence, uroflow, and postvoiding residual urine were assessed. RESULTS AND LIMITATIONS The data show that AFS-preserved EEP could achieve similar surgical outcomes as other early apical release approaches. CONCLUSIONS The preserved AFS provides a nice landmark at the 12 o'clock position during EEP.
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Affiliation(s)
- Yu-Hsiang Lin
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan.
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
| | - Shin-Yuan Chang
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
| | - Shu-Han Tsao
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chen-Pang Hou
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chien-Lun Chen
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wen-Chou Lin
- Department of Urology, MacKay Memorial Hospital, Taipei 112, Taiwan
| | - Ke-Hung Tsui
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, Taipei 112, Taiwan.
- TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei 112, Taiwan.
| | - Horng-Heng Juang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan.
- Department of Anatomy, School of Medicine, Chang Gung University, Kwei-Shan, Taoyuan 333, Taiwan.
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14
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Tamalunas A, Schott M, Keller P, Atzler M, Ebner B, Hennenberg M, Stief CG, Magistro G. Efficacy, Efficiency, and Safety of En-bloc vs Three-lobe Enucleation of the Prostate: A Propensity Score-matched Analysis. Urology 2023:S0090-4295(23)00172-3. [PMID: 36828266 DOI: 10.1016/j.urology.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/25/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To assess efficacy, efficiency, and safety in holmium laser enucleation of the prostate (HoLEP), we directly compared intraoperative performance, postoperative outcomes, and safety in the original 3-lobe enucleation technique with the more recent en-bloc method. As HoLEP is widely accepted as a size-independent method for surgical treatment of patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO), detailed understanding of its benefits is mandatory. METHODS We conducted a retrospective, propensity score-matched analysis of 1,396 men who underwent HoLEP for LUTS/BPO between 2017 and 2020. We included 606 patients in the final analysis (en-bloc n = 303; 3-lobe n = 303), who were matched for prostate size (50 cc), age, body mass index, and preoperative international prostate symptom score. Patients were then stratified by technique, and groups were compared for perioperative parameters, safety, and short-term functional outcomes. RESULTS While postoperative symptoms and urodynamic parameters improved irrespective of technique, we report significantly less adverse events (Clavien-Dindo classification ≥II vs <II) for patients receiving en-bloc enucleation. Additionally, en-bloc enucleation was more efficient, that is, less than half of total laser energy (kJ), twice shorter enucleation time, and surgical performance (g/kJ/min) significantly increased 4-fold with prostate volume, compared to 3-lobe enucleation. CONCLUSION While HoLEP in general is a safe and effective procedure, en-bloc enucleation techniques offer better surgical performance.
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Affiliation(s)
| | - Melanie Schott
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Patrick Keller
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Atzler
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Benedikt Ebner
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Martin Hennenberg
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Giuseppe Magistro
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
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15
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Ericson CA, Baird BA, Mauler DJ, Lyon TD, Ball CT, Dora CD. Early apical release versus En-bloc no touch technique for holmium laser enucleation of the prostate: a high-volume single-surgeon cohort study. World J Urol 2023; 41:167-172. [PMID: 36357603 DOI: 10.1007/s00345-022-04206-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/06/2022] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To determine whether the early apical release (EAR) technique for holmium laser enucleation of the prostate (HOLEP) is associated with improved perioperative outcomes compared to the En-bloc no touch (EBNT) technique. METHODS Consecutive men treated with HOLEP by a single surgeon from August 2018 to March 2021 were identified. Beginning in June 2021 all procedures were performed using the EAR technique, and these were compared to the preceding cases done with the EBNT technique. Intraoperative outcomes included operative time, need for open conversion, enucleation efficiency (tissue removed per minute of OR time), and enucleation ratio (tissue removed relative to preoperative gland size on imaging). Postoperative outcomes included catheter reinsertion, blood transfusion, and complications classified by the Clavien-Dindo scale. RESULTS We identified 801 men, including 571 (71%) treated with EBNT and 230 (29%) with EAR. Median preoperative characteristics were similar between groups. The EAR approach was associated with significantly longer mean operating room time, 100.5 min versus 91.9 min, p = 0.003. However, EAR patients had a much lower rate of conversion to open cystotomy (0.43% versus 3.0%). There were no significant differences in rate of catheter reinsertion or perioperative complications between groups (p > 0.05). CONCLUSION EAR technique by an experienced HoLEP surgeon resulted in longer operative times, potentially reflecting an initial learning curve, but essentially eliminated the need for open cystotomy. Perioperative results including catheter reinsertion rate and bleeding complications were similar between the two cohorts. These data support continued use of the EAR technique for HOLEP to minimize risk of open conversion.
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Affiliation(s)
- Christian A Ericson
- Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Bryce A Baird
- Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | | | - Timothy D Lyon
- Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Colleen T Ball
- Department of Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | - Chandler D Dora
- Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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16
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Grosso AA, Di Maida F, Nardoni S, Salvi M, Giudici S, Lambertini L, Cadenar A, Tellini R, Cocci A, Mari A, Minervini A, Tuccio A. Patterns and Predictors of Optimal Surgical and Functional Outcomes after Holmium Laser Enucleation of the Prostate (HoLEP): Introducing the Concept of "Trifecta". World J Mens Health 2023:41.e6. [PMID: 36593708 DOI: 10.5534/wjmh.220042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/23/2022] [Accepted: 06/07/2022] [Indexed: 01/03/2023] Open
Abstract
PURPOSE The present study sought to provide reproducible and patient-oriented metrics to assess the rate of "successful" outcomes (Trifecta) following holmium laser enucleation of the prostate (HoLEP). Clinical and surgical predictors of failure to achieve Trifecta were investigated. MATERIALS AND METHODS We queried our prospectively collected database of all patients treated with HoLEP between March 2017 and January 2021. Trifecta was defined as the contemporary presence of: (1) no postoperative complication within 3 months; (2) no urinary incontinence at 3-months follow-up; and (3) 3-month postoperative max flow-rate >15 mL/s. Cases were grouped according to Trifecta achievement. All surgical procedures were carried out by a single surgeon. Surgical experience was divided into two different eras according to the number of procedures conducted (surgical era). Multivariate logistic regression analysis was performed to assess predictors of Trifecta failure. RESULTS Overall 305 patients were included. Of these, 192 patients (63.0%) achieved Trifecta. Preoperative patient-related features were comparable between the two groups, except for a higher post-void residual (PVR) in non-Trifecta patients (median 180 vs. 130 mL, p=0.003). A significant proportion of Trifecta patients (88.5%) were treated in the second surgical era and in 126 (65.6%) cases an en-bloc enucleation was performed. Multivariate analysis confirmed PVR ≥250 mL, first surgical era and standard three-lobes enucleation technique as independent predictors of Trifecta failure. CONCLUSIONS In our experience the rate of "successful" HoLEP, defined according to our newly introduced Trifecta metric, was 63.0%. We demonstrated that surgical strategy together with rising experience and baseline PVR are key elements to forecast the outcomes.
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Affiliation(s)
- Antonio Andrea Grosso
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Fabrizio Di Maida
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Samuele Nardoni
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Matteo Salvi
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Sofia Giudici
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Luca Lambertini
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Anna Cadenar
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Riccardo Tellini
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Cocci
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Agostino Tuccio
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy.
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17
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Hout M, Gurayah A, Arbelaez MCS, Blachman-Braun R, Shah K, Herrmann TRW, Shah HN. Incidence and risk factors for postoperative urinary incontinence after various prostate enucleation procedures: systemic review and meta-analysis of PubMed literature from 2000 to 2021. World J Urol 2022; 40:2731-2745. [PMID: 36194286 DOI: 10.1007/s00345-022-04174-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the risk of urinary incontinence (UI) after various prostate enucleation procedures (PEP). METHODS PubMed was searched from January 2000 to July 2021 for studies investigating UI after PEP. The articles were divided into 5 subgroups: holmium, thulium, greenlight laser, electrocautery, and simple prostatectomy. Meta-analysis was performed to examine rate of stress (SUI), urge (UUI) or unspecified UI at short (< 3 months), intermediate (3-6 months), and long-term (> 6 months). The impact of age, prostate size, surgery time, laser time, postoperative nadir PSA level and technical modifications on UI was analyzed. RESULTS Most (69.4%) of 49 articles included employed holmium laser. There was no significant difference in incidence of short-, intermediate-, and long-term UI, SUI and UUI between five sub-groups and within different technical modifications. Although not statistically significant, the incidence of UI was higher (15%) at short-term with green-light and simple prostatectomy (95% CI 9-23 and 1-84), and higher (4%) at intermediate-term with holmium laser (95% CI 2-8). SUI was more prevalent at short-term with holmium laser (4%; 95% CI 2-5%), and at intermediate term with simple prostatectomy (3%; 95% CI 1-14). UUI was higher in the thulium group (10%, 95% CI 7-16). Increased age, surgery time, laser time and prostate size up to 80 cc were associated with higher UI. There was no correlation between postoperative PSA and UI. CONCLUSIONS There is no significant difference in incidence of UI, SUI and UUI after various PEP. Patients age, prostate size, surgery and laser time are linearly associated with UI.
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Affiliation(s)
- Mohammad Hout
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | - Aaron Gurayah
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | - Maria Camila Suarez Arbelaez
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | - Ruben Blachman-Braun
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | - Khushi Shah
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | | | - Hemendra N Shah
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA.
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18
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Letter to the Editor regarding the article "The "Omega Sign": a novel HoLEP technique that improves continence outcomes after enucleation". World J Urol 2022; 40:1067-1068. [PMID: 33744989 DOI: 10.1007/s00345-021-03667-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 12/13/2022] Open
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19
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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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20
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Grosso AA, Di Maida F, Mari A, Nardoni S, Tuccio A, Minervini A. Holmium laser ablation of the prostate (HoLAP) with moses technology for the surgical treatment of benign prostatic hyperplasia. Int Braz J Urol 2021; 48:200-201. [PMID: 34735095 PMCID: PMC8691238 DOI: 10.1590/s1677-5538.ibju.2021.0455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/15/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Antonio Andrea Grosso
- Department of Experimental and Clinical Medicine, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Fabrizio Di Maida
- Department of Experimental and Clinical Medicine, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Samuele Nardoni
- Department of Experimental and Clinical Medicine, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Agostino Tuccio
- Department of Experimental and Clinical Medicine, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
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21
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Porreca A, Schiavina R, Romagnoli D, Corsi P, Salvaggio A, D'Agostino D, Ferro M, Busetto GM, Falabella R, Crestani A. T-L technique for HoLEP: perioperative outcomes of a large single-centre series. Cent European J Urol 2021; 74:366-371. [PMID: 34729227 PMCID: PMC8552945 DOI: 10.5173/ceju.2021.3.105] [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: 04/12/2021] [Revised: 05/17/2021] [Accepted: 05/27/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction The aim of this article was to describe, step-by-step, an original technique (T-L technique) in a single centre series of patients who underwent holmium laser enucleation of the prostate (HoLEP) for symptomatic benign prostatic hyperplasia and analyze perioperative outcomes. Material and methods We retrospectively analyzed data of 567 patients who underwent HoLEP. The T-L technique consists of a series of incisions used as landmarks, performed at the beginning of the procedure before enucleation. Two T-shape incisions are performed at the level of bladder neck (at the 5-7 and 12 o’clock positions); two L-shape incisions are performed at the level of verumontanum, bilaterally, to mark the apex and to limit the sphincter. Another T-shape incision is performed on the bladder neck at the 12 o’clock position posterior to the level of verumontanum. Results The median operative time (OT) was 80 minutes (IQR 64–105); 50 minutes (IQR 35–70) and 15 minutes (IQR 10–20) for enucleation and the morcellation phase, respectively. Conversion to transurethral resection of the prostate (TURP) was necessary in 3/567 (0.6%) patients. Intraoperative complications occurred in 3.4% of cases, capsule perforation occurred in 12/567 (2%) of cases, while bladder perforation during morcellation occurred in 8/567 (1.4%) of cases. Postoperative complications were observed in 20/567 (3.5%) of patients. Specifically, grade 1–2 occurred in 19/567 (3.3%) and grade 3 was recorded in 1/567 (0.2%). Conclusions The T-L technique for HoLEP is safe and reproducible with a low rate of perioperative complications. The positioning of some landmarks before enucleation allows for the better orientation during enucleation and could be very useful in case of large prostates.
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Affiliation(s)
- Angelo Porreca
- Oncological Urology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Riccardo Schiavina
- Department of Urology, Alma Mater Studiorum Bologna, Policlinico S. Orsola Malpighi, Bologna, Italy
| | - Daniele Romagnoli
- Department of Urology, Policlinico Abano Terme, Abano Terme (PD), Italy
| | - Paolo Corsi
- Department of Urology, Policlinico Abano Terme, Abano Terme (PD), Italy
| | - Antonio Salvaggio
- Department of Urology, Policlinico Abano Terme, Abano Terme (PD), Italy
| | | | - Matteo Ferro
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Gian Maria Busetto
- Urology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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Jeje EA, Alabi TO, Ojewola RW, Ogunjimi MA, Tijani KH, Asiyanbi GK. Monopolar transurethral resection of the prostate using water as the irrigation fluid: Our initial experience. Niger Postgrad Med J 2021; 28:175-180. [PMID: 34708703 DOI: 10.4103/npmj.npmj_502_21] [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] [Indexed: 11/04/2022]
Abstract
Background Monopolar transurethral resection of the prostate (M-TURP) has been the gold standard of surgical intervention in patients with benign prostatic hyperplasia with the indication for surgery. This can be achieved using varieties of irrigation fluids. Objectives To document our experience with M-TURP using water as irrigation fluid in 123 consecutive patients. Materials and Methods A retrospective study of all patients who had M-TURP with water as irrigation fluid was performed between January 2017 and July 2019. Information retrieved from theatre records and case notes includes patient's socio-demographic data, indications for surgery, intra-operative findings, the volume of resected chips and irrigation fluid used, post-operative complications and patient's satisfaction with the outcome of the procedure. These data were analysed using SPSS version 23. Results Data from 123 patients were analysed and presented. The age range was 44-96 years with a mean of 69 years. Prostate volume ranges from 13.9 to 276.00 mls with a mean of 95.69 mls while resected prostate volume ranges from 2.0 to 158.0 mls with a mean of 56.68 mls. Volume of the sterile water used as irrigation fluid ranged from 5.0 L to 174.0 L with a mean of 68.7 L. Mean reduction in International Prostate Symptoms Score, improvement in Q-max and reduction in post-void residual urine were 22.1, 16.9 and 141.6 mls, respectively. Transfusion rate was 6.5% while the duration of admission ranges from 1 to 6 days, with a mean of 2.5 days. The overall complication rate was 26.0%. Ninety-six percent were satisfied with the outcome. Conclusion M-TURP using water as irrigation fluid is safe and is as good as using the more rather expensive glycine or normal saline in bipolar TURP.
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Affiliation(s)
- Emmanuel A Jeje
- Department of Surgery, College of Medicine of University of Lagos, Idi-Araba, Lagos, Nigeria / Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Taiwo O Alabi
- Department of Surgery, Urology Unit, Federal Medical Centre, Lagos, Nigeria
| | - Rufus W Ojewola
- Department of Surgery, College of Medicine of University of Lagos, Idi-Araba, Lagos, Nigeria / Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Moses A Ogunjimi
- Department of Surgery, College of Medicine of University of Lagos, Idi-Araba, Lagos, Nigeria / Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Kehinde H Tijani
- Department of Surgery, College of Medicine of University of Lagos, Idi-Araba, Lagos, Nigeria / Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Gabriel K Asiyanbi
- Anaesthesia, College of Medicine of University of Lagos, Idi-Araba, Lagos, Nigeria / Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
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23
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Tunc L, Bozzini G, Scoffone CM, Guven S, Hermann T, Porreca A, Misrai V, Ahyai S, Zor M, Aksoy E, Gozen AS. Determination of Face and Content Validity of Cadaveric Model for Holmium Anatomic Endoscopic Enucleation of the Prostate Training: An ESUT AEEP Group Study. EUR UROL SUPPL 2021; 32:28-34. [PMID: 34667956 PMCID: PMC8505198 DOI: 10.1016/j.euros.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 01/15/2023] Open
Abstract
Background Bench and virtual reality nonbiological simulator models for anatomic endoscopic enucleation of the prostate (AEEP) surgery have been reported in the literature. These models are acceptable but have limited practical applications. Objective To validate a fresh-frozen human cadaver model for holmium AEEP training and assess its content validity. Design, setting, and participants Holmium AEEP operations on fresh-frozen cadavers performed by an experienced surgeon were recorded, and a video, including the main steps of the operation, was produced. Outcome measurements and statistical analysis The video and an accompanying questionnaire were subsequently distributed electronically to ESUT AEEP study group experts and associates (N = 32) for assessment of the AEEP training model. A ten-point Likert global rating scale was used to measure the content validity. Results and limitations A total of 26 answers were returned (81%). The experts agreed on the model’s suitability for AEEP training (mean Likert score: 8). According to the responses, “identifying anatomic structures and landmarks” was the most valuable aspect of the model in terms of AEEP training (median Likert score: 9). Conversely, the experts found the model’s ability, in terms of demonstrating laser and tissue reactions, to be weak (median Likert score: 6) Conclusions Based on the content validity assessment, the fresh-frozen cadaver-training model for laser AEEP seems to be a promising model for demonstrating and learning the correct prostate enucleation technique. Patient summary An increasing number of researchers have proposed that anatomic endoscopic enucleation of the prostate (AEEP) should replace transurethral resection of the prostate surgery and become the gold standard for treatment of bladder outlet obstruction due to benign prostatic hyperplasia. AEEP requires anatomic familiarity for enucleation, technical knowledge, and a solid training program before starting with the first cases. This is the first cadaver study to assess the content validity of a fresh-frozen human cadaver model for AEEP training.
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Affiliation(s)
- Lutfi Tunc
- Department of Urology, Gazi University School of Medicine, Ankara, Turkey
| | - Giorgio Bozzini
- Department of Urology, ASST Valle Olona, Busto Arsizio, Italy
| | | | - Selcuk Guven
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Thomas Hermann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Münsterlingen, Switzerland
| | - Angelo Porreca
- Department of Urology, Policlinico Abano Terme, Abano Terme, Italy
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Sascha Ahyai
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - Murat Zor
- Department of Urology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Emin Aksoy
- Center of Advanced Simulation and Education (CASE), Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Ali S Gozen
- SLK-Kliniken Heilbronn GmbH, Heilbronn, Germany
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You C, Li X, Du Y, Wang H, Wei T, Zhang X, Wang A. Comparison of different laser-based enucleation techniques for benign prostate hyperplasia: A systematic review and meta-analysis. Int J Surg 2021; 94:106135. [PMID: 34600125 DOI: 10.1016/j.ijsu.2021.106135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/17/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND To summarize the current evidence on different laser-based enucleation techniques for benign prostate hyperplasia and compare the efficacy and safety of en-bloc, two-lobe and three-lobe techniques. MATERIALS AND METHODS Through a systematical search of multiple scientific databases in March 2021, we performed a systematic review and cumulative meta-analysis of the primary outcomes of interest according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines, whose protocol was registered with PROSPERO(CRD42021240684). RESULTS A total of 9 studies were included. All three laser enucleation techniques had no statistically significant difference in terms of enucleated prostate weight, maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), international prostate symptom score (IPSS), transient UI (TUI), persistent UI (PUI) and early postoperative complications. A shorter enucleation time was associated with the en-bloc technique compared to three technique (MD: -8.26, 95%CI: -12.73--3.79, p = 0.0003), whereas no significant difference was found in en-bloc versus two-lobe technique (MD:0.97,95%CI: -0.30-2.24,p = 0.13) and two-lobe versus three-lobe technique (MD: -3.19, 95%CI: -7.45-1.06, p = 0.14). A higher enucleation rate was associated with the en-bloc and two-lobe technique (MD: 0.05, 95%CI: 0.00-0.10, p = 0.03; MD: 0.09, 95%CI: 0.01-0.17, p = 0.03, respectively). A superior QoL was related to the two-lobe enucleation technique compared to three-lobe technique (MD: 0.22, 95%CI: 0.06-0.39, p = 0.009), whereas no meaningful difference was found in the group of en-bloc versus two-lobe (MD: -0.12, 95%CI: -0.62-0.37, p = 0.62) and group of en-bloc versus three-lobe (MD: -0.14, 95%CI: -0.56-0.29, p = 0.52). CONCLUSIONS En-bloc and two-lobe laser-based enucleation techniques are feasible and safe alternative to three-lobe technique with comparable surgical outcomes and similar functional outcomes. A superior enucleation efficiency was associated with En-bloc and the two-lobe techniques compared to the three-lobe technique.
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Affiliation(s)
- Chengyu You
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College, Nanchong, 63700, Sichuan, China
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Yılmaz S, Kaya E, Yalcin S, Gazel E, Aybal HÇ, Açıkgöz O, Yılmaz M, Guven S, Gozen AS, Tunc L. Is 'Omega Sign' anatomical endoscopic enucleation of the prostate technique reproducible? Andrologia 2021; 53:e14137. [PMID: 34057215 DOI: 10.1111/and.14137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/10/2021] [Accepted: 05/18/2021] [Indexed: 11/27/2022] Open
Abstract
We aimed to evaluate the learning curve of the surgically standardised 'Omega Sign' anatomical endoscopic enucleation (AEEP) of the prostate surgery technique for junior surgeons. This study is a retrospective comparison of cases that underwent AEEP by a mentor surgeon and three junior surgeons who have completed their learning curve. A video-based laser enucleation of the prostate assessment tool (LEAT) composed of 8 steps of the technique was used to assess a senior surgeon and junior surgeons' surgical compatibility and consistency. The surgeon who defined Omega Sign technique was determined as group 1, and cases by three junior surgeons were identified as group 2. The end points were to assess the reproducibility and repeatability and operative post-operative outcomes of the technique. 55 patients' videos were rated by five experienced endourologists. There was no significant difference in LEAT scores between the groups among all steps. The most symmetry was found in the 1st and 3rd steps. Inter-rater consistency was also high for each step, with no statistically significant difference between the evaluators. The standardised anatomical 'Omega Sign' technique is reproducible for the junior surgeons. The operative steps can be performed with high consistency, and the functional and perioperative outcomes are comparable with the senior surgeon.
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Affiliation(s)
- Sercan Yılmaz
- Department of Urology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Engin Kaya
- Department of Urology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Serdar Yalcin
- Department of Urology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Eymen Gazel
- Department of Urology, Acıbadem University Ankara Hospital, Ankara, Turkey
| | - Halil Çagri Aybal
- Department of Urology, Kahramankazan Hamdi Eris State Hospital, Ankara, Turkey
| | - Onur Açıkgöz
- Department of Urology, Pendik State Hospital, Istanbul, Turkey
| | - Mehmet Yılmaz
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Freiburg, Germany
| | - Selcuk Guven
- Department of Urology, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
| | - Ali Serdar Gozen
- SLK-Kliniken Heilbronn, Department of Urology, University of Heidelberg, Heilbronn, Germany
| | - Lutfi Tunc
- Department of Urology, Gazi University Faculty of Medicine, Ankara, Turkey
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26
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Kaya E, Yılmaz S, Açıkgöz O, Aybal HC, Yılmaz M, Gazel E, Yalcın S, Suarez-Ibarrola R, Tunc L. Laser enucleation for prostates larger than 100 mL: Comparison of HoLEP and ThuLEP. Andrologia 2021; 53:e14125. [PMID: 34029399 DOI: 10.1111/and.14125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 11/28/2022] Open
Abstract
Recently, with the advancements in laser technology, Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP) have come to the fore in the surgical treatment of benign prostatic hyperplasia (BPH). We aimed to evaluate and compare the outcomes of HoLEP and ThuLEP in patients with >100 ml prostate volume. Patients who underwent HoLEP and ThuLEP between July 2017 and March 2020 were reviewed retrospectively. The patients were divided into two groups as HoLEP (Group 1, n = 121) and ThuLEP (Group 2, n = 104). Perioperative parameters, functional outcomes, continence status, intra and post-operative complications were compared between groups in the post-operative 1st and 6th month. No significant difference was found in terms of total laser energy (TLE), morcellation efficiency (ME), enucleated tissue weight (ETW), complication rates (CR) and continence status of patients between both groups (p > .05). In favour of ThuLEP group, there were statistically significant differences regarding total operation time (TOT), laser efficiency (LE), enucleation time (ET) and enucleation efficiency (EE) between groups (p ≤ .05). HoLEP and ThuLEP can be used safely and effectively in prostates larger than 100 ml.
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Affiliation(s)
- Engin Kaya
- Department of Urology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Sercan Yılmaz
- Department of Urology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Onur Açıkgöz
- Department of Urology, Pendik State Hospital, Istanbul, Turkey
| | - Halil Cagrı Aybal
- Department of Urology, Kahramankazan Hamdi Eris State Hospital, Ankara, Turkey
| | - Mehmet Yılmaz
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Freiburg, Germany
| | - Eymen Gazel
- Department of Urology, Ankara Hospital, Acıbadem University, Ankara, Turkey
| | - Serdar Yalcın
- Department of Urology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Freiburg, Germany
| | - Lutfi Tunc
- Department of Urology, Faculty of Medicine, Gazi University, Ankara, Turkey
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27
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Whiting D, Penev B, Ijaaz A, Guest K, Cynk M. En bloc enucleation technique during holmium laser enucleation of the prostate: An analysis of its efficiency. Low Urin Tract Symptoms 2021; 13:372-376. [PMID: 33821575 DOI: 10.1111/luts.12379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/06/2021] [Accepted: 03/18/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Despite the acknowledgment that holmium laser enucleation of the prostate (HoLEP) is a safe, efficacious procedure with benefits over traditional treatments, it is not widely adopted. Its steep learning curve is considered responsible, and the new en bloc technique (EBT) aims to improve this. METHODS A retrospective analysis of 268 consecutive patients (215 lobe technique [LT] and 53 EBT) who underwent HoLEP between May 2016 and April 2020 was performed. Data were collected on patient demographics, prostate volume, enucleation time, prostatic weight, and length of stay. RESULTS There was no difference in mean prostate volume and enucleated prostatic weight between the LT and EBT (99.2 mL vs 98.5 mL, P = .95216, and 71.7 g vs 69.3 g, P = .92034, respectively). There was a reduction in mean enucleation time with the EBT to 37.7 minutes compared with 53.3 minutes (LT) (P < .00001). This translated to an improved operative efficiency of 1.84 g/min (EBT) compared to 1.33 g/min (LT) (P < .00001). The EBT demonstrated a continuous improvement in operative efficiency with increasing prostate size unlike the LT where efficiency plateaus. CONCLUSIONS The EBT for HoLEP demonstrates a significant improvement in operative efficiency which has the potential to reduce the surgeons' learning curve and lead to more widespread adoption.
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Affiliation(s)
| | | | - Anam Ijaaz
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | | | - Mark Cynk
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
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28
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Yılmaz S, Yalçın S, Yılmaz M, Açıkgöz O, Aybal HÇ, Gazel E, Kaya E, Tunç L. Comparison of outcomes of Holmium enucleation of the prostate for small- and moderate-sized prostates. Andrologia 2021; 53:e13970. [PMID: 33432683 DOI: 10.1111/and.13970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/25/2020] [Accepted: 12/28/2020] [Indexed: 12/16/2022] Open
Abstract
There is an ongoing discussion in the literature on the surgical treatment option for small prostate size benign prostate hyperplasia (BPH) patients. This study aimed to evaluate the efficacy of Holmium laser enucleation of the prostate (HoLEP) surgery in small (<30 ml) and moderate (30-80 ml) prostate size as accepted in European Association of Urology guideline. We retrospectively analysed our database between May 2016 and May 2019 and patients who underwent HoLEP surgery. Patients who have prostate size <80 ml were included the study. These patients were divided into two group: group 1 with prostate size <30 ml (n: 64) and group 2 with prostate size 30-80 ml (n: 101). Enucleation time (ET), morcellation time (MT), total operation time (OT), enucleation efficiency (EE), morcellation efficiency (ME), intra- and post-operative complications were analysed. While EE and Hb drop were better in favour of group 2; PSA drop, ET, MT, OT and ME were superior in favour of group 1. In group 1, intra-operative complications were higher (6 vs. 2; p < .05) and post-operative complications did not differ statistically between groups (p = .14). No statistically significant finding was found between groups regarding incontinence. In conclusion, HoLEP is a reliable method in terms of its results in patients with small prostates.
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Affiliation(s)
- Sercan Yılmaz
- Department of Urology, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Serdar Yalçın
- Department of Urology, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Mehmet Yılmaz
- Department of Urology, Zile State Hospital, Tokat, Turkey
| | - Onur Açıkgöz
- Department of Urology, Pendik State Hospital, Istanbul, Turkey
| | - Halil Çağrı Aybal
- Department of Urology, Kahramankazan Hamdi Eris State Hospital, Ankara, Turkey
| | - Eymen Gazel
- Department of Urology, Acıbadem University Ankara Hospital, Ankara, Turkey
| | - Engin Kaya
- Department of Urology, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Lütfi Tunç
- Department of Urology, Gazi University Faculty of Medicine, Ankara, Turkey
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Yılmaz S, Kaya E, Gazel E, Yalcın S, Aybal HC, Yılmaz M, Açıkgöz O, Özdemir H, Tunc L. HoLEP after prostate biopsy: does it have any impact? World J Urol 2020; 39:2605-2611. [PMID: 33185708 DOI: 10.1007/s00345-020-03518-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/30/2020] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Holmium laser enucleation of the prostate (HoLEP) has recently become the recommended treatment for prostate in all sizes in benign prostate hyperplasia surgery. A recent prostate biopsy performed prior to the HoLEP procedure can make surgeons concerned about the surgery. We aimed to investigate the per- and postoperative outcomes of the HoLEP procedure in patients who underwent prostate biopsy and to evaluate the most appropriate surgery time after biopsy. METHODS The data of 160 patients who underwent HoLEP by a single surgeon between March 2017 and December 2019 were retrospectively reviewed. The patients were divided into two groups, Group 1 consisted of 80 patients without prostate biopsy and Group 2 consisted of 80 patients with prior prostate biopsy. All HOLEP procedures in group 2 were performed at least 2 weeks following biopsy. Per- and postoperative outcomes, complications were evaluated. RESULTS No significant differences were found between groups in terms of by enucleation time, efficiency of laser, efficiency of enucleation, hospitalization time, and catheterization removal time. Only morcellation time was shorter in biopsy naïve patients. There were no statistical differences in postoperative outcomes. Previous prostate biopsy did not affect the continence status in our study group. There were not any Clavien grade 4 or higher complications. Urinary tract infection was higher in early post-biopsy period, there was no difference among the groups. CONCLUSıON: Our study confirms that HoLEP is a safe and efficient surgical procedure for the patients with prior prostate biopsy. We believe that it can be safely performed 2nd week following prostate biopsy.
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Affiliation(s)
- Sercan Yılmaz
- Department of Urology, Gulhane Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Engin Kaya
- Department of Urology, Gulhane Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Eymen Gazel
- Department of Urology, Acıbadem University Ankara Hospital, Ankara, Turkey
| | - Serdar Yalcın
- Department of Urology, Gulhane Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Halil Cagrı Aybal
- Department of Urology, Kahramankazan Hamdi Eris State Hospital, Ankara, Turkey
| | - Mehmet Yılmaz
- Department of Urology, Zile State Hospital, Kahya Mahallesi Ata Caddesi No: 1 Zile, 60400, Tokat, Turkey.
| | - Onur Açıkgöz
- Department of Urology, Pendik State Hospital, Istanbul, Turkey
| | - Hakan Özdemir
- Department of Radiology, Diason Ultrasonography Center, Ankara, Turkey
| | - Lutfi Tunc
- Department of Urology, Gazi University School of Medicine, Ankara, Turkey
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30
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Oh S, Shitara T. Enucleation of the prostate: An anatomical perspective. Andrologia 2020; 52:e13744. [DOI: 10.1111/and.13744] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- Seung‐June Oh
- Department of Urology Seoul National University College of Medicine Seoul National University Hospital Seoul Korea
| | - Toshiya Shitara
- Department of Urology Fuchinobe General Hospital Sagamihara Kanagawa Japan
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31
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Gilling PJ. HoLEP is the complete technique for treating BPH. BJU Int 2020; 126:3. [DOI: 10.1111/bju.15099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Peter J. Gilling
- Bay of Plenty District Health Board Clinical School Tauranga New Zealand
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