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Romero Otero J, Justo Quintas J, García Gómez B, Manfredi C, Sopeña Sutil R, Peña Vallejo E, Lista Mateos F, Bozzini G, Rodríguez Antolín A, García Rojo E. Prospective randomized multicenter study to evaluate holmium vs. new thulium fiber laser for prostate enucleation. Minerva Urol Nephrol 2024; 76:491-498. [PMID: 39051894 DOI: 10.23736/s2724-6051.24.05706-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) commonly causes lower urinary tract symptoms (LUTS) in men. Holmium (HoLEP) and thulium (ThuLEP) laser enucleation are established techniques for BPH treatment. Thulium fiber laser (TFL) for prostate enucleation (ThuFLEP) shows promising outcomes. METHODS A prospective randomized multicenter study was conducted. Patients with BPH and LUTS unresponsive to medical therapy were enrolled. Preoperative, surgical, perioperative and postoperative data were recorded with follow-up at 3 and 6 months. The primary outcome was functional improvement, and the secondary outcome was safety in terms of complications. RESULTS Two hundred patients were included (HoLEP 100, ThuFLEP 100). No significant baseline difference was found between groups. At 3 and 6 months we found statistically significant improvements from baseline for both HoLEP and ThuFLEP in efficacy: International Prostatic Symptoms Score (IPSS), IPSS-Quality of Life (QoL), maximum urinary flow rate (Qmax), and post-void residual volume (PVR; P<0.05). At 6 months, mean±SD IPSS, IPSS-QoL, Qmax, and PVR for HoLEP vs. ThuFLEP were 5.8±4.9 vs. 4.8±5.0 points (P=0.57), 1.6±1.4 vs. 0.7±1.1 points (P=0.09), 29.9±12.5 vs. 29.6±8.0 mL/s (P=0.8), and 16.3±17.7 vs. 15.5±13.4 mL (P=0.92), respectively. No intraoperative complication was recorded. No Clavien-Dindo ≥III complications occurred during hospitalization. After 6 months, 8 (8%) and 6 (6%) patients reported mild stress urinary incontinence in HoLEP and ThuFLEP groups, respectively (P=0.24). Urethral stenosis was observed in 3 men (3%) in the HoLEP group and 1 subject (1%) in the ThuFLEP group (P=0.72). CONCLUSIONS HoLEP and ThuFLEP are effective and safe for BPH treatment, with comparable functional outcomes and complication rates at 6 months. Further research is needed to confirm these findings.
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Affiliation(s)
- Javier Romero Otero
- Department of Urology, HM Sanchinarro University Hospital, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain -
| | - Juan Justo Quintas
- Department of Urology, HM Sanchinarro University Hospital, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain
| | - Borja García Gómez
- Department of Urology, University Hospital HM Montepríncipe, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Madrid, Spain
| | - Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Raquel Sopeña Sutil
- Department of Urology, University Hospital HM Montepríncipe, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Madrid, Spain
| | - Elena Peña Vallejo
- Department of Urology, HM Sanchinarro University Hospital, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain
| | - Fernando Lista Mateos
- Department of Urology, University Hospital HM Montepríncipe, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Madrid, Spain
| | - Giorgio Bozzini
- Department of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy
| | - Alfredo Rodríguez Antolín
- Department of Urology, HM Sanchinarro University Hospital, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain
| | - Esther García Rojo
- Department of Urology, HM Sanchinarro University Hospital, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain
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Wenk MJ, Hartung FO, Egen L, Netsch C, Kosiba M, Grüne B, Herrmann J. The long-term learning curve of holmium laser enucleation of the prostate (HoLEP) in the en-bloc technique: a single surgeon series of 500 consecutive cases. World J Urol 2024; 42:436. [PMID: 39046537 PMCID: PMC11269500 DOI: 10.1007/s00345-024-05097-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/29/2024] [Indexed: 07/25/2024] Open
Abstract
PURPOSE To evaluate perioperative parameters, clinical outcomes, and the learning curve of holmium laser enucleation of the prostate (HoLEP) of a single surgeon in 500 consecutive cases. METHODS Demographic parameters, outcomes, and adverse events were evaluated. The learning curve for HoLEP in en-bloc technique of the first 500 consecutive patients was analyzed in clusters of 100 (clusters 1-5) using the Wilcoxen rank test, Chi² test and Kruskal Wallis test. RESULTS Enucleation weight was similar in the clusters 1,2,3, and 5 (62 g, 63 g, 61 g, 61 g), in cluster 4 it was slightly higher at 73 g. There was a significant reduction in operating time from 67 min (cluster 1) to 57 min (cluster 2), 46 min (cluster 3), 53 min (cluster 4), and 43 min (cluster 5), p < 0.001. Enucleation efficiency (g/min) showed a steady increase (1.72, 2.24, 2.79, 2.92 vs. 2.99, p < 0.001). Laser energy efficiency also improved (2.17 vs. 2.12 vs. 1.71 vs. 1.65 vs. 1.55; p < 0.001). There was no measurable learning curve regarding the length of hospital stay (mean 2.5 days), catheterization time (1.9 days), hemoglobin drop (approx. 1 g/dl) or complications (p > 0.1). CONCLUSIONS HoLEP using the en-bloc technique is a safe and highly effective method. Over time, a slight but steady learning curve and improvement in operation time, enucleation efficiency and laser energy efficiency were shown even for an experienced surgeon - after 500 cases, still no plateau was reached. There was no measurable learning curve regarding blood loss, complications, length of hospital stay, and catheterization time.
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Affiliation(s)
- M J Wenk
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - F O Hartung
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - L Egen
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - C Netsch
- Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - M Kosiba
- Department of Urology, University Hospital Frankfurt, Frankfurt Main, Germany
| | - B Grüne
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jonas Herrmann
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Cantiello F, Crocerossa F, Alba S, Carbonara U, Pandolfo SD, Falagario U, Veccia A, Ucciero G, Ferro M, Mondaini N, Damiano R. Refining surgical strategies in ThuLEP for BPH: a propensity score matched comparison of En-bloc, three lobes, and two lobes techniques. World J Urol 2024; 42:431. [PMID: 39037668 PMCID: PMC11263241 DOI: 10.1007/s00345-024-05136-5] [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: 05/03/2024] [Accepted: 06/21/2024] [Indexed: 07/23/2024] Open
Abstract
PURPOSE This study compares the peri-operative and functional outcomes of three distinct surgical techniques in Thulium Laser Enucleation of the Prostate (ThuLEP) for benign prostatic hyperplasia (BPH). The main aim is to assess whether the En-bloc, Three-lobe, and Two-lobe techniques have differential effects on surgical efficacy and patient outcomes. METHODS A retrospective analysis was conducted on patients undergoing ThuLEP for BPH between January 2019 and January 2024 at two tertiary centers. Propensity score matching was utilized to balance baseline characteristics among patients undergoing the different techniques. Surgical parameters, including operative time, enucleation time, morcellation time, energy consumption, and postoperative outcomes, were compared among the groups. RESULTS Following propensity score matching, 213 patients were included in the analysis. Intraoperative analysis revealed significantly shorter enucleation, laser enucleation, morcellation and operative times and total energy delivered in the En-bloc and Two-lobe groups compared to the Three-lobe group. No significant differences were observed among the groups in terms of intraoperative and postoperative complications. There were no significant differences in functional outcomes at the 3-month follow-up among the groups. CONCLUSION The findings of this study suggest that while the En-bloc and Two-lobe techniques may offer efficiency benefits and could be considered safe alternatives in ThuLEP procedures, the reduction in laser enucleation time and energy delivered did not necessarily translate into improvements in post operative storage symptoms or other functional outcomes for the patients. Surgeon preference and proficiency may play a crucial role in selecting the most suitable technique for individual patients. Future research should focus on larger-scale prospective studies to further validate these findings and explore potential factors influencing surgical outcomes.
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Affiliation(s)
- Francesco Cantiello
- Department of Urology, Magna Graecia University of Catanzaro, Viale Europa, 100 Catanzaro (CZ), Catanzaro, 88100, Italy
| | - Fabio Crocerossa
- Department of Urology, Magna Graecia University of Catanzaro, Viale Europa, 100 Catanzaro (CZ), Catanzaro, 88100, Italy.
| | - Stefano Alba
- Department of Urology, Romolo Hospital, Rocca di Neto (Kr), Crotone, Italy
| | - Umberto Carbonara
- Unit of Urology, GVM - Santa Maria Hospital, Bari, Italy
- Department of Emergency and Organ Transplantation-Urology, University of Bari, Bari, Italy
| | | | - Ugo Falagario
- Department of Urology and Kidney Transplantation, University of Foggia, Foggia, Italy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Matteo Ferro
- Division of Urology, European Institute of Oncology (IEO)-IRCCS, Milan, Italy
| | - Nicola Mondaini
- Department of Urology, Magna Graecia University of Catanzaro, Viale Europa, 100 Catanzaro (CZ), Catanzaro, 88100, Italy
| | - Rocco Damiano
- Department of Urology, Magna Graecia University of Catanzaro, Viale Europa, 100 Catanzaro (CZ), Catanzaro, 88100, Italy
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Gross AJ, Rosenbaum C, Becker B, Netsch C. [Development of endoscopic enucleation of the prostate]. Aktuelle Urol 2024; 55:207-212. [PMID: 38599594 DOI: 10.1055/a-2286-1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
This article deals with lasers from their initial description to the most advanced applications in the treatment of benign prostate enlargement.
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Affiliation(s)
- Andreas J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
| | | | - Benedikt Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
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Juliebø-Jones P, Gauhar V, Castellani D, Fong KY, Sofer M, Zawadzki M, Gadzhiev N, Pirola GM, Mahajan AD, Maheshwari PN, Malkhasyan V, Biligere S, Gökce Mİ, Cormio L, Enikeev D, Gómez Sancha F, Herrmann TRW, Somani BK. Real world propensity score matched analysis evaluating the influence of en-bloc vs. non en-bloc techniques, energy and instrumentation on enucleation outcomes for large and very large prostates. World J Urol 2024; 42:299. [PMID: 38710824 PMCID: PMC11074046 DOI: 10.1007/s00345-024-04959-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/25/2024] [Indexed: 05/08/2024] Open
Abstract
PURPOSE The primary aim of the study was to evaluate if en-bloc vs. non en-bloc made a difference to intra-, peri- and post-operative surgical outcomes of anatomical endoscopic enucleation (AEEP) in large (> 80 cc) and very large prostates (> 200 cc). The secondary aim was to determine the influence of energy and instruments used. METHODS Data of patients with > 80 cc prostate who underwent surgery between 2019 and 2022 were obtained from 16 surgeons across 13 centres in 9 countries. Propensity score matching (PSM) was used to reduce confounding. Logistic regression was performed to evaluate factors associated with postoperative urinary incontinence (UI). RESULTS 2512 patients were included with 991 patients undergoing en-bloc and 1521 patients undergoing non-en-bloc. PSM resulted in 481 patients in both groups. Total operation time was longer in the en-bloc group (p < 0.001), enucleation time was longer in the non en-bloc group (p < 0.001) but morcellation times were similar (p = 0.054). Overall, 30 day complication rate was higher in the non en-bloc group (16.4% vs. 11.4%; p = 0.032). Rate of late complications (> 30 days) was similar (2.3% vs. 2.5%; p > 0.99). There were no differences in rates of UI between the two groups. Multivariate analysis revealed that age, Qmax, pre-operative, post-void residual urine (PVRU) and total operative time were predictors of UI. CONCLUSIONS In experienced hands, AEEP in large prostates by the en-bloc technique yields a lower rate of complication and a slightly shorter operative time compared to the non en-bloc approach. However, it does not have an effect on rates of post-operative UI.
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
- Department of Urology, Haukeland University Hospital, Bergen, Norway.
- Department of Urology, University Hospital Southampton, Southampton, UK.
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong Hospital, Singapore, Singapore
| | - Daniele Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mario Sofer
- Department of Urology, Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | - Giacomo Maria Pirola
- Urology Unit, IRCCS Multimedica, Multimedica Group, San Giuseppe Hospital, Milan, Italy
| | - Abhay D Mahajan
- Sai Urology Hospital and Mahatma Gandhi Mission's Medical College and Hospital, Aurangabad, India
| | | | - Vigen Malkhasyan
- Urology Unit, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | - Mehmet İlker Gökce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Luigo Cormio
- Andrology and Urology Unit, Bonomo Teaching Hospital, Andria, Italy
- Department of Urology, Ospedali Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Dmitry Enikeev
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Urology Department, Rabin Medical Center, Petah Tikva, Israel
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Thomas R W Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
- Department of Clinical Medicine, Hannover Medical School, Hannover, Germany
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
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Omar M, Abdullah MM, Moustafa A, Sultan S. Thirty versus 60-Watt thulium laser enucleation of prostate: Toward the development of low-power anatomical enucleation of the prostate. Urol Ann 2024; 16:129-132. [PMID: 38818432 PMCID: PMC11135353 DOI: 10.4103/ua.ua_159_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/20/2023] [Indexed: 06/01/2024] Open
Abstract
Introduction We aimed to study whether using 30 W versus 60 W thulium enucleation of the prostate (ThuLEP) would affect postoperative outcomes in patients with benign prostatic hyperplasia (BPH). Materials and Methods We prospectively identified male patients with moderate or severe lower urinary tract symptoms due to BPH. We randomized patients into 30 W (Group 1) or 60 W (Group 2) thulium yag laser with a 550 μm laser fiber and a 26 Fr continuous flow resectoscope. We collected data related to prostate size, enucleation time, morcellation time, laser time, perioperative complications, and 1-year functional outcomes. Results A total of 120 patients were included, with a mean age of 67 years and a mean prostate size of 105 g. The preoperative characteristics were similar across both groups. The mean operative time was shorter in the 60 W group, 74 ± 27 vs. 91 ± 33 min in the 30 W group (P = 0.001), and the mean laser time was 55 ± 20 in 60 W versus 71 ± 25 in 30 W (P = 0.0001). The mean hospital stay was 1 day in both groups and at 1-year follow-up; there was a similar improvement in mean Qmax and International Prostate Symptom Score symptom scores. Discussion/Conclusion Both 30 and 60 W ThuLEP provided a safe and comparable outcome with a relatively shorter operative time for the 60 W groups. Perhaps using a 30-W setting would be beneficial in the early learning curve or cases with more bleeding capsular perforators; besides, the financial benefit of manufacturing low-cost low-power devices that may help in the widespread of AEEP.
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Affiliation(s)
- Mohamed Omar
- Department of Urology, Menoufia University, Shebeen El Kom, Menoufia, Egypt
| | | | - Ahmed Moustafa
- Department of Urology, Menoufia University, Shebeen El Kom, Menoufia, Egypt
| | - Sultan Sultan
- Department of Urology, Menoufia University, Shebeen El Kom, Menoufia, Egypt
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Spinos T, Tatanis V, Peteinaris A, Somani B, Kartalas Goumas I, Liatsikos E, Kallidonis P. Thulium fiber laser enucleation of the prostate: a systematic review of the current outcomes. Minerva Urol Nephrol 2024; 76:157-165. [PMID: 38742551 DOI: 10.23736/s2724-6051.24.05654-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
INTRODUCTION One recent addition to different lasers used for endoscopic enucleation of the prostate is the thulium fiber laser (TFL). The purpose of this systematic review is to present the feasibility, safety and efficacy of TFL Enucleation of the Prostate (ThuFLEP). EVIDENCE ACQUISITION PubMed®, Scopus® and Cochrane® primary databases were systematically screened. The search strategy used the PICO (Patients, Intervention, Comparison, Outcome) criteria. Patients should be adults with benign prostatic obstruction (BPO) undergoing ThuFLEP. While comparative studies reporting comparison of ThuFLEP to other BPO treatments were included, cohort studies with no comparison group were also accepted. Outcomes including enucleation time and complication rates were reported. EVIDENCE SYNTHESIS Twelve studies met all the predefined criteria and were included in the final qualitative synthesis. Mean operative time and enucleation time ranged from 46.6±10.2 to 104.5±33.6 and from 38.8±17.9 to 66.0±24.9 minutes, respectively. Most of the complications were Grade I or Grade II ones. Although TFL was found to present some advantages over older BPO treatments, its outcomes were comparable with other endoscopic enucleation approaches. CONCLUSIONS ThuFLEP seems to be a feasible, safe and efficient approach for BPO symptoms management. Limited evidence showed that although ThuFLEP was associated with a reduced total operative time, it was also associated with worse IPSS improvement at 1-year follow-up, when compared with MOSESTM Holmium Laser Enucleation of the Prostate (HoLEP). These findings confirm the well-established opinion that the enucleation technique itself is more important than the technology which is used.
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Affiliation(s)
- Theodoros Spinos
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - Vasileios Tatanis
- Department of Urology, University Hospital of Patras, Patras, Greece
| | | | - Bhaskar Somani
- Department of Urology, University Hospital of Southampton, Southampton, UK
| | | | - Evangelos Liatsikos
- Department of Urology, University Hospital of Patras, Patras, Greece
- Department of Urology, Medical University of Vienna, Vienna, Austria
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Hartung FO, Egen L, Gruene B, Wenk MJ, Kowalewski KF, Patroi P, Rassweiler-Seyfried MC, Michel MS, Herrmann J. Pulse modulation in En-Bloc HoLEP: does it really matter? A propensity score matched analysis. World J Urol 2024; 42:154. [PMID: 38483598 PMCID: PMC10940490 DOI: 10.1007/s00345-024-04830-8] [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: 09/18/2023] [Accepted: 01/16/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Holmium laser enucleation of the prostate (HoLEP) is an established option in the surgical treatment of benign prostatic hyperplasia. Pulse modulation, such as MOSES® technology, has recently been introduced and may offer potential advantages in HoLEP. METHODS Perioperative data from 117 patients who underwent MOSES® laser enucleation of the prostate (MoLEP) were collected. Propensity score matching using prostate volume, age, body mass index (BMI), and anticoagulant intake was performed using a database of 237 patients treated with HoLEP. In total, 234 patients were included in the analysis. RESULTS Prostate volume (104 vs. 102 ml), age (70 vs. 71 years), BMI (27 vs. 27), and anticoagulant intake (34 vs. 35%) did not differ significantly between the groups. There were no significant differences in operation time (61.5 vs. 58.1 min, p = 0.42), enucleation efficiency (2.5 vs. 2.6 g/min, p = 0.74), hemostasis time (7.8 vs. 8 min, p = 0.75) and hemoglobin drop (0.9 vs. 0.7 mg/dl, p = 0.48). The complication rates were low in both groups (16.2% for HoLEP and 17.1% for MoLEP). No differences were noted in the Clavien-Dindo Classification (p = 0.63) and the Comprehensive Complication Index (p = 0.24). The rate of complications > CDC IIIa was 0.9% for HoLEP (endoscopic coagulation) and 1.7% for MoLEP (2 cases of endoscopic coagulation). No transfusions were administered. CONCLUSION Overall, the enucleation efficiency was high in both groups and the procedure time was short. HoLEP is an efficient and safe treatment option in experienced hands, regardless of the use of pulse modulation technology.
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Affiliation(s)
- Friedrich Otto Hartung
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Luisa Egen
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Britta Gruene
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Maren Juliane Wenk
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Karl-Friedrich Kowalewski
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Paul Patroi
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Marie-Claire Rassweiler-Seyfried
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Maurice Stephan Michel
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jonas Herrmann
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Tokat E, Acar C, Gurocak S, Sinik Z. The prospective evaluation of learning curve of bipolar anatomic endoscopic prostate enucleation (AEEP) with Herrmann's vapoenucleation probe. World J Urol 2024; 42:121. [PMID: 38446229 DOI: 10.1007/s00345-024-04804-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: 09/09/2023] [Accepted: 01/16/2024] [Indexed: 03/07/2024] Open
Abstract
PURPOSE We aimed to evaluate the learning curve of Bipolar Endoscopic Prostate Enucleation (BIPOLEP) in benign prostate enlargement without a mentorship. METHODS The prospective data of 55 patients underwent BIPOLEP surgery by a single surgeon during 3 years were evaluated. The demographic, peri-operative and follow-up data were recorded. Trifecta was defined as a combination of complete enucleation and morcellation within < 90 min and without any conversion to standard TURP. Pentafecta was defined as a combination of Trifecta without postoperative complications or stress urinary incontinence at 3 months. The learning curve was considered to have been overcome when the surgeon obtained Trifecta/Pentafecta in four consecutive patients. RESULTS The mean age of the study group was 67.9 ± 6.8 years with mean prostate volume of 102.3 ± 56.4 ml. The mean operation time and enucleation time were 103.5 ± 41.1 and 65.78 ± 22.6 min, respectively. Trifecta and Pentafecta were achieved in 23rd (from 19th to 23rd) and 34th (from 30 to 34th) patients, respectively. Among the seven consecutive patients between Trifecta and Pentafecta, prostate capsule perforation was occurred during the surgery in four patients (26th, 27th and 29th patients). The mean follow-up duration was 16.7 ± 6.4 (3-24 months, range) months. Urethral stricture was observed in four (7. 2%) patients while bladder neck contracture was observed 1 (1.8%) patient. After the 3rd month, no patient reported stress incontinence. CONCLUSION Bipolar endoscopic enucleation of prostate is a safe surgical method and has similar and/or short learning curve compared to HOLEP even without a mentorship program.
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Affiliation(s)
- Eda Tokat
- University of Health Sciences, Ankara Training and Research Hospital, Department of Urology, Ankara, Turkey.
| | - Cenk Acar
- Hisar Intercontinental Hospital, Department of Urology, Istanbul, Turkey
| | - Serhat Gurocak
- Gazi University School of Medicine, Department of Urology, Section of Pediatric Urology, Ankara, Turkey
| | - Zafer Sinik
- Odak Hospital, Department of Urology, Denizli, Turkey
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Gauhar V, Nedbal C, Castellani D, Fong KY, Sofer M, Socarrás MR, Tursunkulov AN, Ying LK, Elterman D, Mahajan A, Petov V, Ivanovich SN, Bhatia TP, Enikeev D, Gadzhiev N, Chiruvella M, Teoh JYC, Galosi AB, Sancha FG, Somani BK, Herrmann TRW. Comparison Between Thulium Fiber Laser and High-power Holmium Laser for Anatomic Endoscopic Enucleation of the Prostate: A Propensity Score-matched Analysis from the REAP Registry. Eur Urol Focus 2024; 10:182-188. [PMID: 37414615 DOI: 10.1016/j.euf.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/31/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Different lasers have been developed for treatment of benign prostatic hyperplasia, with no definitively superior technique identified to date. OBJECTIVE To compare surgical and functional enucleation outcomes in real-world multicentre practice using high-power holmium laser (HP-HoLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP) for different prostate sizes. DESIGN, SETTING, AND PARTICIPANTS The study included 4216 patients who underwent HP-HoLEP or ThuFLEP at eight centers in seven countries between 2020 and 2022. Exclusion criteria were previous urethral or prostatic surgery, radiotherapy, or concomitant surgery. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS To adjust for the bias arising from different characteristics at baseline, propensity score matching (PSM) was used to identify 563 matched patients in each cohort. Outcomes included the incidence of postoperative incontinence, early complications (30-d), and delayed complications, and results for the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and postvoid residual volume (PVR). RESULTS AND LIMITATIONS After PSM, 563 patients in each arm were included. Total operative time was similar between the arms, but enucleation and morcellation times were significantly longer for ThuFLEP. The rate of postoperative acute urinary retention was higher in the ThuFLEP arm (3.6% vs 0.9%; p = 0.005), but the 30-d readmission rate was higher in the HP-HoLEP arm (22% vs 8%; p = 0.016). There was no difference in postoperative incontinence rates (HP-HoLEP:19.7%, ThuFLEP:16.0%; p = 0.120). Rates of other early and delayed complications were low and comparable between the arms. The ThuFLEP group had higher Qmax (p < 0.001) and lower PVR (p < 0.001) than the HP-HoLEP group at 1-yr follow-up. The study is limited by its retrospective nature. CONCLUSIONS This real-world study shows that early and delayed outcomes of enucleation with ThuFLEP are comparable to those with HP-HoLEP, with similar improvements in micturition parameters and IPSS. PATIENT SUMMARY As lasers become readily available for the treatment of enlarged prostates causing urinary bother, urologists should focus on performing good anatomic removal of prostate tissue, with the choice of laser not as important for good outcomes. Patients should be counseled about long-term complications, even when the procedure is being performed by an experienced surgeon.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Carlotta Nedbal
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy; Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mario Sofer
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Lie Kwok Ying
- Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Dean Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Abhay Mahajan
- Department of Urology, Sai Urology Hospital and MGM Medical College, Aurangabad, India
| | - Vladislav Petov
- Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Tanuj Paul Bhatia
- Department of Urology, Sarvodaya Hospital and Research Centre, Faridabad, India
| | - Dmitry Enikeev
- Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Vienna Medical University, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Nariman Gadzhiev
- Department of Urology, Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | | | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Andrea Benedetto Galosi
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | | | - Bhaskar Kumar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Thomas R W Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
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Capogrosso P, Ventimiglia E, Fallara G, Schifano N, Costa A, Candela L, Pellegrino F, Colandrea G, Cignoli D, De Angelis M, Belladelli F, Longoni M, Avesani G, Lanzaro F, Scattoni V, Dehò F, Salonia A, Briganti A, Montorsi F. Holmium Laser Enucleation of the Prostate Is Associated with Complications and Sequelae Even in the Hands of an Experienced Surgeon Following Completion of the Learning Curve. Eur Urol Focus 2023; 9:813-821. [PMID: 37069007 DOI: 10.1016/j.euf.2023.03.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Holmium laser enucleation of the prostate (HoLEP) is considered a challenging procedure even for surgeons who have completed the learning curve. OBJECTIVES To assess outcomes and complications following HoLEP performed by a highly experienced surgeon. DESIGN, SETTING, AND PARTICIPANTS This was a single-institution prospective study (NCT03583034) performed at a tertiary referral centre that included 243 consecutive patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) treated with HoLEP by a single experienced surgeon (>1600 cases). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients were assessed using validated questionnaires and uroflowmetry at baseline and several follow-up dates. Intraoperative and postoperative complications were recorded. Kaplan-Meier analysis was used to estimate recovery rates for urinary continence and erectile function. Logistic regression models were constructed to assess predictors of postoperative complications. RESULTS AND LIMITATIONS Of the 243 patients, 78 (32.1%) had an indwelling urethral catheter. The median prostate volume (PV) was 87 cm3 (interquartile range 60-115) and 146 patients (59.8%) had PV >80 cm3. At 3-mo follow-up, 219 patients (90.1%) had a peak flow rate >20 ml/s and 182 (74.9%) had no postvoid residual urine. The improvement in subjective symptoms was significant at 1-mo follow-up and was maintained until 12 mo after surgery. Urinary continence recovery was slow, with an estimated rate of 68% (95% confidence interval [CI] 62-74%) at 1 mo and 94% (95% CI 91-97%) at 12 mo after HoLEP. The recovery rate for erectile function was 53% (95% CI 46-61%) at 1 mo and 85% (95% CI 77-90%) at 12 mo. Postoperative complications occurred in 36 patients (14.8%) during their hospital stay, in 34 (14%) within 1 mo following discharge from hospital, and in ten (4.1%) at later follow-up dates. Clinically significant complications (Clavien-Dindo ≥2) were observed in 44 cases (18%) and were more common for patients with an indwelling catheter at baseline (odds ratio 5.05; p = 0.006). CONCLUSIONS HoLEP is an effective procedure for treating LUTS due to BPE, although it is not devoid of complications and sequelae, even in the hands of a highly experienced surgeon. PATIENT SUMMARY Holmium laser treatment of the prostate to reduce its size has positive results for urinary function when performed by an experienced surgeon, even in complex cases, although there can be complications.
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Affiliation(s)
- Paolo Capogrosso
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Nicolò Schifano
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Antonio Costa
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Luigi Candela
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Pellegrino
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Gianmarco Colandrea
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Daniele Cignoli
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Mario De Angelis
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Mattia Longoni
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Giulio Avesani
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Lanzaro
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Vincenzo Scattoni
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Federico Dehò
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
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Enikeev D, Taratkin M. Thulium Fiber Laser: Bringing Lasers to a Whole New Level. EUR UROL SUPPL 2022; 48:31-33. [PMID: 36588770 PMCID: PMC9795521 DOI: 10.1016/j.euros.2022.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Dmitry Enikeev
- Department of Urology, Medical University of Vienna, Vienna, Austria,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia,Corresponding author. Department of Urology, Medical University of Vienna, Vienna, Austria. Tel. +7 925 5177926.
| | - Mark Taratkin
- Department of Urology, Medical University of Vienna, Vienna, Austria
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Bhandarkar A, Patel D. Comparison of Holmium Laser Enucleation of the Prostate with Bipolar Plasmakinetic Enucleation of the Prostate: A Randomized, Prospective Controlled Trial at Midterm Follow-Up. J Endourol 2022; 36:1567-1574. [PMID: 35943885 DOI: 10.1089/end.2022.0449] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: To compare the clinical efficacy and safety of holmium laser enucleation of the prostate (HoLEP) with bipolar plasmakinetic enucleation of the prostate (BPEP) in the surgical management of obstructive benign prostatic hyperplasia (BPH) at midterm (minimum 3 years) follow-up. Patients and Methods: Between June 2016 and January 2018, 181 patients who had bothersome lower urinary tract symptoms or refractory retention of urine due to obstructive BPH (prostate 32-128 g) were randomized to undergo either HoLEP or BPEP using the en bloc technique. Patient's age, associated comorbidities, baseline International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), postvoid residual (PVR) urine, and quality of life (QoL) scores were comparable in both groups. From each group, 86 patients who completed regular follow-up for 36 months were analyzed. Results: The mean preoperative prostate volume was comparable in both groups (HoLEP group 61.09 ± 28.25 and BPEP group 62.66 ± 27.37 g). The HoLEP group showed a significantly better enucleation time (27.87 ± 13.18 minutes vs 38.37 ± 14.55 minutes), operative time (30.91 ± 14.82 minutes vs 41.63 ± 16.19 minutes), and enucleation efficiency (1.69 ± 0.28 vs 1.28 ± 0.06 g/min), with a lesser drop in hemoglobin (0.46 ± 0.23 vs 0.87 ± 0.26 g/dL). Bladder irrigation time, catheterization time, hospital stay, and sodium drop were comparable in both groups. One patient in the BPEP group needed clot evacuation. Both groups showed a significant reduction in IPSS, improvement in Qmax, reduction in PVR, and improved QoL scores at 3 months, which was maintained till 36 months. At the 3-year follow-up, two patients in each group needed reintervention for bladder neck contracture. Conclusions: HoLEP and BPEP provide comparable safety and efficacy in the treatment of bladder outlet obstruction due to BPH at the immediate and midterm (3-5 years) follow-up. HoLEP has an advantage of being faster with lesser perioperative morbidity.
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Costa Silva A, Abreu-Mendes P, Morgado A, Dinis P, Martins Silva C. Analysis of benign prostatic obstruction surgery: A long-term evaluation in a real-life context. Arch Ital Urol Androl 2022; 94:295-299. [DOI: 10.4081/aiua.2022.3.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/20/2022] [Indexed: 11/23/2022] Open
Abstract
Objective: Surgery is the treatment for male lower urinary tract symptoms (LUTS) relat-ed to benign prostatic obstruction (BPO) refractory to pharma-cological treatment or with complications. This study aimed to assess factors associated with the need for surgical reinterven-tion and/or continuation of pharmacological treatment. Materials and methods: A retrospective analysis of patients who underwent prostatic surgery for male LUTS associated with BPO between 1 May 2015 and 1 May 2016, with a minimum follow-up of five years, in an academic tertiary hospital. The type of surgery, preoperative, postoperative and follow-up analysis were collected in a database. Results: A total of 212 patients were included with a mean age of 70 ± 8.66 years at five years follow-up. At 5 years, a total of 86.9% of patients do not need pharmacological treatment and 12% required surgical reintervention. Of the preoperative parameters, it was found a relationship between prior prostatitis and the need for second surgery with an odds ratio of 4.6.
Conclusions: Patients should be informed of the potential need for pharmacological treatment following surgery, or even of the need for reintervention. History of prostatitis seems to be a risk factor for reintervention.
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Himmler M, Grüne B, von Hardenberg J, Hartung FO, Kowalewski KF, Rassweiler-Seyfried MC, Michel MS, Herrmann J. Switching lasers: learning curve of HoLEP in surgeons experienced in ThuLEP. J Endourol 2022; 36:1444-1451. [PMID: 35822547 DOI: 10.1089/end.2022.0262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate perioperative parameters, clinical outcomes, and the learning curve of holmium laser enucleation of the prostate (HoLEP) in surgeons with experience in thulium laser enucleation of the prostate (ThuLEP). MATERIALS AND METHODS The learning curves for HoLEP of the first 50 consecutive patients of two surgeons experienced in ThuLEP were analyzed. In addition, demographic parameters, clini¬cal outcomes and adverse events were evaluated. RESULTS Mean operation time was 70.9 + 29.7 min (SD) (Surgeon 1) and 74.4 + 35.4 min (Surgeon 2), the mean enucleation efficiency was 1.5 + 0.6 g/min (Surgeon 1) and 1.5 + 0.7 g/min (Surgeon 2). The hemoglobin loss was 0.9 + 0.8 g/dl and 0.8 + 0.8 g/dl. For both surgeons, there was a significant learning curve in enucleation efficiency within the first 50 cases (Surgeon 1: p = .034, Surgeon 2: p = .006, both: p = .0003, Spearman's ρ = .351). Both surgeons started with an enucleation efficiency of around 1g/min in their first 10 cases. No significant correlation between hemoglobin loss and experience could be found (p = .823, ρ = .025). While there was no significant learning curve for morcellation efficiency (p = .785, ρ = .028), a significant progress was found for one of the two surgeons regarding laser energy efficiency (p = .014). The overall incidence of all grade treatment-related adverse events was very low at 10.0%, and extremely low for significant complications with Clavien-Dindo Grade > II at 1%. CONCLUSIONS In our analysis, switching to HoLEP is uncomplicated and safe for experienced ThuLEP surgeons. The enucleation efficiency was high from the beginning, but a learning curve was present for both surgeons. No learning curve was noticeable in hemoglobin loss and the incidence of complications, both of which were very low throughout the study.
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Affiliation(s)
- Maren Himmler
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Baden-Württemberg, Germany;
| | - Britta Grüne
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Germany;
| | - Jost von Hardenberg
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Germany;
| | - Friedrich Otto Hartung
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Baden-Württemberg, Germany;
| | - Karl-Friedrich Kowalewski
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Baden-Württemberg, Germany;
| | | | - Maurice Stephan Michel
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Baden-Württemberg, Germany;
| | - Jonas Herrmann
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Baden-Württemberg, Germany;
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Randomized prospective trial of the severity of irritative symptoms after HoLEP vs ThuFLEP. World J Urol 2022; 40:2047-2053. [PMID: 35690952 DOI: 10.1007/s00345-022-04046-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/06/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To compare the short-term postoperative functional outcomes and severity of irritative symptoms following holmium and thulium fiber laser enucleation (HoLEP and ThuFLEP). METHODS This prospective randomized single-blinded study was performed in accordance with CONSORT. The inclusion criteria were IPSS > 20 or Qmax < 10 ml/s. Patients were randomized between HoLEP and ThuFLEP. Demographics, objective data (PSA, prostate volume, etc.), data on urinary and sexual function (IPSS, IIEF, QoL, QUID, Qmax, ICIQ-MLUTS) were collected. Detailed perioperative information and postoperative data on functional outcomes at 1, 2, 3, 4, 6, 8, 10, 12 weeks and 6 months were collected. RESULTS Data on 163 participants were included (77-HoLEP, 86-ThuFLEP). No differences were found in surgery duration; number of postoperative complications (Clavien-Dindo I-III), catheterization time and hospital stay. Functional outcomes up to 6 months didn't differ between the groups (IPPS, IIEF, QoL, QUID, ICIQ-MLUTS, Qmax, p > 0.05). Total ICIQ-MLUTS, bother and voiding scores at 1 and 3 months significantly increased compared with the baseline in both groups (p < 0.05). No difference between the groups were observed. In HoLEP the SUI series rate was 1.3% and 1.3% after 3 and 6 months following the procedure; in ThuFLEP: it was 3.5% and 2.3% respectively (p = 0.35 and p = 0.54). CONCLUSION The preliminary results of the study showed no apparent differences in functional outcomes (IPSS, Qmax), rate of SUI or irritative symptoms. Both ThuFLEP and HoLEP are efficient ways of treating benign prostatic obstruction. Both surgeries are comparable in terms of duration and postoperative complication rates.
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Taratkin M, Enikeev D. Does Endoscopic Enucleation of the Prostate Need New Lasers? Current Perspective on New Laser Devices. Eur Urol Focus 2022; 8:394-395. [DOI: 10.1016/j.euf.2022.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/04/2022] [Indexed: 12/11/2022]
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Tuncel A, Aykanat C, Akdemir S, Oksay T, Arslan M, Başboga S, Aslan Y, Balci M, Guzel O. Comparison of holmium laser enucleation with bipolar transurethral enucleation of the prostate in patients with benign prostatic hyperplasia: Results of a multicentre study. Andrologia 2022; 54:e14420. [PMID: 35285532 DOI: 10.1111/and.14420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 01/04/2023] Open
Abstract
To assess the efficacy and morbidity of the holmium laser enucleation of the prostate and bipolar transurethral enucleation of the prostate in patients with benign prostatic hyperplasia. The study included 60 (55%) and 49 (45%) patients who underwent laser and bipolar enucleation of the prostate respectively. According to the perioperative data, except for length of hospital stay and enucleated prostate weight, all the remaining parameters were similar between the groups. There were significant differences between the preoperative and the postoperative third and 12th month voiding parameters in both groups. In the laser group, the maximum urine flow rate value was better than the bipolar group at the postoperative third and 12th months. However, we did not find any statistically significant difference between the groups in terms of the serum prostate-specific antigen level, International Prostate Symptom Score and postvoid residual urine volume at the postoperative third and 12th months. Our results show that both laser and bipolar techniques are effective minimally invasive surgical treatment options for men with benign prostatic hyperplasia. When compared to bipolar technique, laser technique provides shorter hospital stay, more prostatic tissue enucleation and better maximum urine flow rate values.
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Affiliation(s)
- Altug Tuncel
- Department of Urology, Ankara State Hospital, University of Health Sciences School of Medicine, Ankara, Turkey
| | - Can Aykanat
- Department of Urology, Ministry of Health, Yozgat State Hospital, Yozgat, Turkey
| | - Serkan Akdemir
- Department of Urology, Tinaztepe Health Group Hospital, Izmir, Turkey
| | - Taylan Oksay
- Department of Urology, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Murat Arslan
- Department of Urology, Okan University School of Medicine, Istanbul, Turkey
| | - Serdar Başboga
- Department of Urology, Ankara State Hospital, University of Health Sciences School of Medicine, Ankara, Turkey
| | - Yilmaz Aslan
- Department of Urology, Ankara State Hospital, University of Health Sciences School of Medicine, Ankara, Turkey
| | - Melih Balci
- Department of Urology, Ankara State Hospital, University of Health Sciences School of Medicine, Ankara, Turkey
| | - Ozer Guzel
- Department of Urology, Ankara State Hospital, University of Health Sciences School of Medicine, Ankara, Turkey
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Wang Q, Alshayyah R, He Y, Wen L, Yu Y, Yang B. Is the Peripheral Zone Thickness an Indicator of a Learning Curve in Bipolar Transurethral Plasma Enucleation of the Prostate?—A Single Center Cohort Study. Front Surg 2022; 8:795705. [PMID: 35187047 PMCID: PMC8847292 DOI: 10.3389/fsurg.2021.795705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background We conducted this cohort study to assess the differences in the learning curve of bipolar transurethral plasma enucleation of the prostate (B-TUEP) associated with prostatic peripheral zone thickness (PZT) under MRI quantitative measurements. Methods For the study, 60 patients with benign prostatic hyperplasia (BPH) were involved. PZT are defined as “Thin” (<7 mm), “Thick” (>10 mm), and “Medium” (in between), with 20 patients in each group. Learning stages were defined as Group 1 (No. 1–20), Group 2 (No. 21–40), and Group 3 (No. 41–60). We measured parameters of the prostate, such as PZT and transitional zone thickness (TZT), with MRI. A learner with no experience in enucleation performed the operations. Statistical analyses were performed to compare the differences. Pearson correlation analysis and multiple linear regression analysis evaluated the relationship between characteristics of patients. P < 0.05 was deemed statistically significant. Results One-Way ANOVA revealed different enucleation efficiency (0.811 ± 0.18 vs. 0.748 ± 0.14 vs. 0.634 ± 0.16), prostate volume (58.9 ± 15.33 vs. 57.3 ± 15.58 vs. 46.6 ± 14.10), and thickness of transition zone (44.45 ± 7.60 vs. 42.45 ± 6.08 vs. 34.78 ± 6.04) among Thin, Medium, and Thick groups. The enucleation efficiency is different between groups divided by learning stages (Group 1 vs. Group 3, 0.658 vs. 0.783; Group 2 vs. Group 3, 0.751 vs. 0.783). Pearson correlation analysis reveals that PZT was negatively correlated with prostate volume (r = −0.427), resection weight (r = −0.35), enucleation efficiency (r = −0.445), and TZT (r = −0.533), and was positively correlated with Q-max (r = 0.301) and bladder outlet obstruction index (BOOI) (r = 0.388). The regression coefficients of PZT, TZT, prostate volume, and Q-max were −0.012, 0.008, 0.007, and 0.013, respectively (all P < 0.05). Conclusion Lower PZT is independent of higher enucleation efficiency, larger adenoma, and higher TZT. PZT may be an important factor on the learning curve of B-TUEP. Higher TZT, prostate volume. and Q-max may also relate to higher enucleation efficiency. For B-TUEP learners, it seems easier to perform the operation when the PZT is low, though more care should be taken with the capsule perforation. Further, the capsule plane should be maintained more attentively if the PZT is high.
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Pang KH, Ortner G, Yuan Y, Biyani CS, Tokas T. Complications and functional outcomes of endoscopic enucleation of the prostate: a systematic review and meta-analysis of randomised-controlled studies. Cent European J Urol 2022; 75:357-386. [PMID: 36794026 PMCID: PMC9903163 DOI: 10.5173/ceju.2022.174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction There are several endoscopic enucleation procedures (EEP) using different energy sources: holmium laser enucleation of the prostate (HoLEP), thulium laser enucleation of the prostate (ThuLEP), Greenlight® (GreenVEP) and diode (DiLEP) lasers, and plasma kinetic enucleation of the prostate (PKEP). The comparative outcomes among these EEPs are unclear. We aimed to compare the peri-operative and post-operative outcomes, complications and functional outcomes among different EEPs. Material and methods A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. Only randomised-controlled trials (RCT) comparing EEPs were included. The risk of bias was assessed using the Cochrane tool for RCTs. Results The search identified 1153 articles and 12 RCTs were included. The number of RCTs for each comparison was, HoLEP vs ThuLEP; n = 3, HoLEP vs PKEP; n = 3, PKEP vs DiLEP; n = 3, HoLEP vs GreenVEP; n = 1, HoLEP vs DiLEP; n = 1, ThuLEP vs PKEP; n = 1. Operative time was shorter and blood loss was lower with ThuLEP compared with HoLEP, whereas operative time was shorter for HoLEP compared with PKEP. Blood loss was lower with HoLEP and DiLEP compared with PKEP. There were no Clavien-Dindo IV-V complications, and the incidence of Clavien-Dindo I complications was lower with ThuLEP compared with HoLEP. No significant differences were detected among EEPs regarding urinary retention, stress urinary incontinence, bladder neck contracture or urethral stricture. Lower International Prostate Symptom Score (IPSS) and higher quality of life (QoL) scores were in favour of ThuLEP compared with HoLEP at 1 month. Conclusions EEP improves symptoms and uroflowmetry parameters with a low incidence of high-grade complications. ThuLEP was associated with shorter operative time, lower blood loss, and lower incidence of low-grade complications compared with HoLEP.
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Affiliation(s)
- Karl H. Pang
- Institute of Andrology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Gernot Ortner
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria
| | - Yuhong Yuan
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Chandra Shekhar Biyani
- Pyrah Department of Urology, The Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom
| | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria,Training and Research in Urological Surgery and Technology (T.R.U.S.T.) – Group, Hall in Tirol, Austria
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Li J, Cao D, Huang Y, Meng C, Peng L, Xia Z, Li Y, Wei Q. Holmium laser enucleation versus bipolar transurethral enucleation for treating benign prostatic hyperplasia, which one is better? Aging Male 2021; 24:160-170. [PMID: 34895034 DOI: 10.1080/13685538.2021.2014807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE This study aims to evaluate the overall efficacy and safety between holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral enucleation of the prostate (B-TUEP) for the treatment of benign prostatic hyperplasia (BPH). METHOD We systematically searched electronic databases (PubMed, Scopus, Web of Science, and Cochrane Library) to identify eligible comparative studies as of July 2021. The parameters including perioperative results, complications, and functional outcomes were evaluated. RevMan version 5.4 was used for the analysis. RESULTS A total of 10 studies involving 1725 patients were included. HoLEP had lower operative time (p = .03), shorter catheterization time (p = .007), lower bladder irrigation time (p = .01), and higher enucleation weight (p = .01) compared with B-TUEP. However, there were no significant differences between the techniques regarding the length of stay (LOS), hemoglobin drop, transfusion rates, and complications. Furthermore, no significant differences were also observed in postoperative functional outcomes at 1, 3, 6, 12, or 24 months. CONCLUSIONS HoLEP has more advantages in perioperative parameters compared with B-TUEP, but no significant differences are found regarding functional outcomes and complications. Large-scale studies with long-term follow-up are required to compare the outcomes of these two techniques.
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Affiliation(s)
- Jinze Li
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, PR China
- West China School of Clinical Medicine, Sichuan University, Chengdu, PR China
| | - Dehong Cao
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yin Huang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, PR China
- West China School of Clinical Medicine, Sichuan University, Chengdu, PR China
| | - Chunyang Meng
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, PR China
| | - Lei Peng
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, PR China
| | - Zhongyou Xia
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, PR China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, PR China
| | - Qiang Wei
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, PR China
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22
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Herrmann TRW, Misrai V, Sancha FG, Bach T. TURPxit or not: contemporary management options for benign prostatic obstruction. World J Urol 2021; 39:2251-2254. [PMID: 34283282 PMCID: PMC8332635 DOI: 10.1007/s00345-021-03780-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Thomas R. W. Herrmann
- Urology Spital Thurgau AG, Pfaffenholzstrasse 4, 8501 Frauenfeld, Switzerland
- Hannover Medical Scholl MHH, Carl Neuberg Str. 1, 30625 Hannover, Germany
- Stellenbosch University Western Cape, Stellenbosch, South Africa
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, 45 avenue de Lombez, Toulouse, France
| | - Fernando Gómez Sancha
- Department of Urology and Robotic Surgery, ICUA-Clínica CEMTRO, Ventisquero de la Condesa 42, 28035 Madrid, Spain
- Urology Department, Hill Clinic, Sofia, Bulgaria
| | - Thorsten Bach
- Department of Urology, AsklepiosWestklinikumHamburg, Suurheid 20, 22559 Hamburg, Germany
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