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Kim HW, Lee JZ, Kim TN, Shin DG. Holmium Laser Enucleation of the Prostate for Advanced Prostate Cancer-Related Bladder Outlet Obstruction: Assessing Effectiveness and Unraveling Factors Impacting Postoperative Urinary Incontinence. World J Mens Health 2024; 42:650-657. [PMID: 38772535 PMCID: PMC11216967 DOI: 10.5534/wjmh.240060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/06/2024] [Accepted: 03/13/2024] [Indexed: 05/23/2024] Open
Abstract
PURPOSE This study investigated the factors associated with transient urinary incontinence (TUI) after holmium laser enucleation of the prostate (HoLEP) as a palliative treatment in patients with severe bladder outlet obstruction (BOO) and advanced prostate cancer (PCA). MATERIALS AND METHODS Data of 28 patients with advanced PCA (≥cT3) who underwent palliative HoLEP between October 2018 and March 2021 were included in this retrospective study. After collection of the pre-, intra-, and postoperative (1, 3, and 12 months) data of patients from their medical records, variables of patients with and without TUI at 1 and 3-12 months postoperatively were statistically compared. Multivariate analysis was performed to investigate the factors associated with postoperative TUI. RESULTS Compared to baseline, the mean total international prostate symptom score, quality of life score, maximum flow rate (Qmax), and postvoid residual (PVR) were significantly improved 1 month postoperatively, and this was maintained until 12 months postoperatively (p<0.001). Of the 28 patients, 14 (50.00%) and 6 (21.43%) presented with TUI at 1 and 3-12 months postoperatively, respectively. Patients with TUI at 1 month follow-up showed a significantly lower preoperative Qmax (p=0.027), larger preoperative PVR (p=0.004), and higher likelihood of bladder neck tumor invasion (p=0.046). Conversely, patients with TUI at 3-12 months postoperatively were significantly older (p=0.033) and had a longer enucleation time (p=0.033). Multivariate analysis demonstrated that the factors affecting TUI were preoperative Qmax (odds ratio [OR]=0.61; 95% confidence interval [CI]=0.39-0.93; p=0.016) and bladder invasion of the tumor (OR=26.72; 95% CI=1.83-390.42; p=0.022) after 1 month; however, none of the variables correlated significantly with TUI at 3-12 months. CONCLUSIONS Palliative HoLEP is an effective management option in patients with advanced PCA-related BOO. Lower preoperative Qmax and bladder neck tumor invasion are the factors affecting TUI at 1 month postoperatively.
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Affiliation(s)
- Hyeon Woo Kim
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
| | - Jeong Zoo Lee
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
| | - Tae Nam Kim
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
| | - Dong Gil Shin
- Department of Urology, Pusan National University School of Medicine, Busan, Korea.
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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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Roper C, Slade A, Caras R, Shelton T, Rivera M. Ejaculatory and erectile function outcomes following holmium laser enucleation of the prostate. Prostate 2024; 84:791-796. [PMID: 38558096 DOI: 10.1002/pros.24697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 02/17/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Holmium laser enucleation of the prostate (HoLEP) is a surgical treatment option for benign prostatic hyperplasia (BPH). Many men develop retrograde ejaculation postprocedure, but there is conflicting evidence regarding sexual function outcomes post-HoLEP. We sought to examine significant variations in patient-reported erectile and ejaculatory function within 12 months post-HoLEP. MATERIALS AND METHODS We conducted a retrospective study for patients who underwent HoLEP between Nov 2018 and Feb 2022. Of the reviewed patients, 277 patients met inclusion criteria and completed pre and postoperative questionnaires, which included the Male Sexual Health Questionnaire- Ejaculatory Dysfunction (MSHQ-EJD) and the International Index of Erectile Function/Sexual Health Inventory for Men (IIEF-5/SHIM). Surveys were provided to patients up to 12 months postprocedure. Demographics and comorbidities associated with sexual dysfunction were collected. Responses to each question were analyzed to detect sub-categorical variations in sexual function as the secondary objective. Data was analyzed by using a linear mixed model. RESULTS There was a significant decline in total scores for the MSHQ-EJD (8.70 pre-HoLEP vs. 6.58 post HoLEP, p ≤ 0.001) including a significant decline (p < 0.005) in questions 1-3 which assess ejaculatory ability, strength, and volume. There was not a significant decline in question 4 which assesses bother (2.552 pre-HoLEP vs. 3.119 post-HoLEP, p = 0.526). There was not a significant decline in the IIEF-5/SHIM postoperatively (11.51 pre-HoLEP vs. 13.327 post-HoLEP, p = 0.498). CONCLUSIONS Patients undergoing HoLEP do not experience a decline in erectile function. Patients do experience a decline in ejaculatory function but did not find this bothersome.
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Affiliation(s)
- Chinade Roper
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Austen Slade
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Ronald Caras
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Thomas Shelton
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Marcelino Rivera
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
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Schumacher S, Marghawal D, Brunken C, Herzberg J. Patient reported outcome and quality of life measured by a simple questionnaire in patients with symptomatic benign prostate hyperplasia treated by holmium laser enucleation of the prostate (HoLEP). Front Surg 2024; 11:1358701. [PMID: 38389860 PMCID: PMC10881724 DOI: 10.3389/fsurg.2024.1358701] [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: 12/20/2023] [Accepted: 01/15/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction Holmium Laser Enucleation of the Prostate (HoLEP) is established as an effective transurethral treatment option for LUTS due to BPH with improved postoperative outcome. The aim of this study was to evaluate the medium-term results by patient reported outcome measurement and to detect potential risk factors for postoperative complications or impaired outcome. Methods We performed a retrospective single-center cohort study including all patients undergoing HoLEP in the study center between April 2019 and December 2021. Therefore, perioperative parameters and postoperative outcome was documented and all patients were asked for their outcome (PROM), complications, IPSS, QoL and changes in sexual and continence function by a questionnaire at a single time point. Results In the study period, a total of 541 patients with a mean age of 72.5 ± 8.4 years were treated by HoLEP in the study center. 71.7% of the questionnaires were returned after a mean observation period of 14.9 ± 6.3 month. 91% of the patients reported to the single-timepoint questionnaire reporting a good satisfaction with the procedure and a low postoperative complication rate. The international prostate symptom score could be reduced significantly to 6.2 ± 5.7 (preoperative 19.0 ± 7.2; p < 0.001). Patients with an ASA score ≥ 3, prostate volume > 80 ml, medication with platelet inhibitors or DOAK or preoperative need of an indwelling catheter didn't show an increased complication rate. Conclusion The overall satisfaction with the procedure and its results are high. We could not identify any independent risk factors for postoperative complications after HoLEP. The used questionnaire is a simple tool for postoperative patient reported outcome measurement with a good correlation to clinical parameters.
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Affiliation(s)
| | - David Marghawal
- Department of Urology, Krankenhaus Reinbek St. Adolf-Stift, Reinbek, Germany
| | - Claus Brunken
- Department of Urology, Krankenhaus Reinbek St. Adolf-Stift, Reinbek, Germany
| | - Jonas Herzberg
- Department of Surgery, Krankenhaus Reinbek St. Adolf-Stift, Reinbek, Germany
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Liu K, Zhao X, Xiao R, Zhao L, Xiao C, Zhang S, Ma L. Factors predicting indistinct plane of surgical capsule in patients underwent HoLEP procedures. World J Urol 2024; 42:26. [PMID: 38206399 DOI: 10.1007/s00345-023-04736-x] [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: 07/31/2023] [Accepted: 11/01/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To evaluate factors that effectively predict indistinct plane (IP) in patients who underwent holmium laser enucleation of the prostate (HoLEP). METHODS Data of 208 consecutive patients from our HoLEP database were reviewed and analyzed. IP was defined in 107 cases, as the plane could be identified only depending on endoscopic beak dissection rather than laser dissection in the initial stage of HoLEP, whereas the control group consisted of 101 cases. Variables including age, body mass index, prostatic volume (PV), intravesical prostatic protrusion, prostate-specific antigen, prostate-specific antigen density, bladder stones, urinary tract infection, microscopic hematuria, prior biopsy (PB), diabetes, hypertension, history of acute urinary retention, 5-alpha reductase inhibitor treatment, catheter dependency, residual urine, region, smoking, and alcohol consumption were compared between the two groups. The risk factors for predicting the presence of IP were determined using a multivariable binary logistic regression model using a forward selection approach with a focus on improvement in the area under the receiver operating characteristic curve (AUC). RESULTS The incidence of IP was 51.4% (107/208). PV (OR = 0.977, p < 0.001) and PB (OR = 0.297, p = 0.028) were identified as the independent predictors of capsule plane status. PV with a cutoff of 54 ml had the best predictive effectiveness for IP based on AUC (0.727; 95% CI 0.659-0.795). The specificity and sensitivity of this cutoff were 82.2% and 53.3%, respectively. CONCLUSION PV is the most reliable factor to predict IP during HoLEP procedures. There is a high possibility of IP in patients with a PV less than 54 ml.
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Affiliation(s)
- Ke Liu
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China
| | - Xun Zhao
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China
| | - Ruotao Xiao
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China
| | - Lei Zhao
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China
| | - Chunlei Xiao
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China.
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China
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Şirin ME, Karaaslan M, Ordu M, Yilmaz M. Effect of Ho:YAG laser on kidney tissue with Virtual Basket ™ and Bubble Blast ™ pulse modulation: an experimental ex vivo study. World J Urol 2023; 41:3091-3095. [PMID: 37550550 DOI: 10.1007/s00345-023-04555-0] [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: 03/31/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023] Open
Abstract
PURPOSE There is a lack of studies in the literature on effects of Virtual Basket™ (VB) and Bubble Blast™ (BB) laser pulse modulations of the Ho:YAG laser on tissue. We aimed to compare the effects of standard modulation (SM), VB, and BB pulse modulations of Ho:YAG laser on kidney tissue. METHODS An ex vivo experiment was conducted using veal kidneys. The Quanta System Cyber Ho 100W laser generator with a broad setting spectrum at 15-80 W, 10-40 Hz, 1.5-2 J, and medium pulse duration were tested. Incision depth (ID), vaporization area (VA), coagulation area (CA), and total laser area (TLA = VA + CA) were evaluated. Histopathological measurement outcomes were grouped as a low-power group (15, 20, and 30 W) and a high-power group (40, 60, and 80 W) according to the power outputs used. RESULTS A total of 108 experiments were performed. In saline and high-power output (40, 60, 80 W), mean VA, TLA, and ID, histopathological measurements were higher in BB pulse modulation than VB and SM pulse modulations (p: 0.03, p: 0.001, and p: 0.003, respectively). In contrast, mean CA and LE measurements were higher in SM than in VB and BB pulse modulations (p < 0.001 and p < 0.001, respectively). There was no statistically significant difference in mean histopathological measurements of VA, CA, TLA, and ID, among SM, VB, and BB pulse modulations in the low-power output group in saline (p > 0.05). CONCLUSION VB can allow controlled dissection, as it does not create a large VA during surgical procedures. BB should be used in a controlled manner in soft tissue surgery due to its strong effect on tissues.
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Affiliation(s)
- Mehmet Emin Şirin
- Department of Urology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | | | - Melike Ordu
- Faculty of Medicine, Department of Medical Pathology, Aksaray University, Aksaray, Turkey
| | - Mehmet Yilmaz
- Urology, Asklepios Klinik Triberg, Triberg, Germany.
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Yilmaz M, Karaaslan M, Polat ME, Tonyali S, Aybal HÇ, Şirin ME, Toprak T, Tunç L, Gratzke C, Miernik A. Is day-case surgery feasible for laser endoscopic enucleation of the prostate? A systematic review. World J Urol 2023; 41:2949-2958. [PMID: 37689604 PMCID: PMC10632304 DOI: 10.1007/s00345-023-04594-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 08/23/2023] [Indexed: 09/11/2023] Open
Abstract
PURPOSE Laser endoscopic enucleation of the prostate (EEP) for benign prostatic obstruction has become increasingly prevalent worldwide. Considering the medical cost-savings and concomitantly fewer nosocomial infections, the feasibility of same-day postoperative discharge of patients who have undergone laser EEP in terms of its safety and effectiveness has become a subject matter of growing interest. We aimed to review those studies focussing on day-case surgery (DCS) in patients undergoing laser EEP. METHODS A systematic search was conducted using PubMed-MEDLINE and Web of Science databases until October 2022 with the following search terms: "same day discharge AND laser enucleation of the prostate", "day-case AND laser enucleation of the prostate", "same day surgery AND laser enucleation of the prostate" and "one day surgery AND laser enucleation of the prostate" by combining PICO (population, intervention, comparison, outcome) terms. We identified 15 eligible studies. RESULTS While 14 of the studies focussed on holmium laser EEP, one focused on thulium laser vapoenucleation of the prostate. We observed an improvement in functional parameters in all studies we reviewed, and DCS success and readmission rates ranged between 35.3-100% and 0-17.8%, respectively. The complication rates varied between 0 and 36.7%, most of the complicatons were Clavien-Dindo (CD) I and II. CD ≥ III complications did not significantly differ between same day discharge (SDD) and non-SDD groups in the studies. CONCLUSION Laser EEP is feasible and promising DCS treatment option delivering improved functional parameters compared to baseline values, and lower perioperative complication and readmission rates in certain patients.
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Affiliation(s)
- Mehmet Yilmaz
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany
| | | | - Muhammed Emin Polat
- Department of Urology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Senol Tonyali
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany
- Department of Urology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | | | - Mehmet Emin Şirin
- Department of Urology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Tuncay Toprak
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Lütfi Tunç
- Faculty of Medicine, Department of Urology, Gazi University, Ankara, Turkey
| | - Christian Gratzke
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany.
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Canat HL, Gurbuz C, Bozkurt M. Transurethral resection of the prostate (TURP) versus transperineal laser ablation (TPLA) due to benign prostatic hyperplasia (BPH): prospective and comparative study. Int Urol Nephrol 2023; 55:2747-2752. [PMID: 37498422 DOI: 10.1007/s11255-023-03717-8] [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: 04/16/2023] [Accepted: 07/08/2023] [Indexed: 07/28/2023]
Abstract
AIM We aimed to compare the first-year results of Transurethral resection of the prostate (TURP), the gold standard method, and Transperineal laser ablation (TPLA) techniques. MATERIAL AND METHODS This study was designed as a prospective, randomized, controlled, and single-center and was conducted between November 2021 and February 2023. TURP candidates were included in the study. Demographic data and perioperative data were recorded. Preoperative and first-year International Prostate Symptom Score (IPSS), International Erectile Function Index (IIEF-5), Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD), QoL, peak urinary flow rate (Qmax), prostate volume (PV) and postvoid residual (PVR) data were recorded. RESULTS Fifty patients were included in the study and were assigned to equal numbers of groups. TPLA group had a higher ASA score (p = 0.03). There was improvement in IPSS, Qmax, and PVR parameters compared to baseline values in both groups at 1 year (p < 0.01). The improvement in Qmax was better in the TURP group (p < 0.01). IIEF-5 score was similar between groups (p = 0.83 and p = 0.12, respectively). The MSHQ scores in the first year did not change according to their baseline values in the TPLA group (p = 0.54 and p = 0.34, respectively). CONCLUSION According to the first-year results of TPLA, the symptomatic improvement effect without sacrificing ejaculatory functions is comparable to TURP. We think that this method will can be an alternative, especially for patients who want to avoid ejaculatory dysfunction, who have a high risk of anesthesia, and whose anticoagulant/antiplatelet therapy cannot be discontinued.
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Affiliation(s)
- Halil Lutfi Canat
- Department of Urology, Basaksehir Cam and Sakura City Hospital, Basaksehir Olimpiyat Bulvarı yolu, Basaksehir, 34480, Istanbul, Turkey
| | - Cenk Gurbuz
- Department of Urology, Osmanoglu Hospital, Istanbul, Turkey
| | - Muammer Bozkurt
- Department of Urology, Basaksehir Cam and Sakura City Hospital, Basaksehir Olimpiyat Bulvarı yolu, Basaksehir, 34480, Istanbul, Turkey.
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Murad L, Bouhadana D, Nguyen DD, Chughtai B, Zorn KC, Bhojani N, Elterman DS. Treating LUTS in Men with Benign Prostatic Obstruction: A Review Article. Drugs Aging 2023; 40:815-836. [PMID: 37556075 DOI: 10.1007/s40266-023-01054-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/10/2023]
Abstract
Benign prostatic obstruction (BPO) is a prevalent condition that affects men, primarily toward their old age. The condition is often accompanied by lower urinary tract symptoms (LUTS), which can significantly impair a patient's quality of life and lead to other medical complications. Accurate diagnosis of BPO is essential for effective management of complications secondary to BPO, and treatment plans should be tailored patients, and occasionally according to surgeon experience. As such, this literature review aims to analyze the current available data on male LUTS secondary to BPO by providing a comprehensive overview of relevant studies, as well as the surgical and medical management guidelines from the Canadian Urological Association (CUA), American Urological Association (AUA), and European Association of Urology (EAU). By synthesizing the existing literature, this review purports to summarize the current body of knowledge surrounding BPO and male LUTS, and support healthcare providers in making informed decisions about the management of male LUTS secondary to BPO, ultimately improving patient outcomes and quality of life.
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Affiliation(s)
- Liam Murad
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - David Bouhadana
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - David-Dan Nguyen
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College-New York Presbyterian, New York, NY, USA
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Dean S Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada.
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Yanaral F, Gültekin MH, Halis A, Akbulut F, Sarilar O, Ozgor F. Adjustable Male Sling for The Treatment of Postprostatectomy Stress Urinary Incontinence: Intermediate-Term Follow-Up Results. Cureus 2023; 15:e43280. [PMID: 37692721 PMCID: PMC10492627 DOI: 10.7759/cureus.43280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Objective To evaluate the outcomes of adjustable male sling (Argus®) implantation in the management of post-prostatectomy incontinence (PPI) with intermediate-term follow-up results. Materials and methods The data on adjustable male sling surgery between September 2015 and September 2020 were retrospectively analyzed. Patients were preoperatively evaluated with a voiding diary, 24-hour pad test, and validated questionnaire. Functional outcomes were also evaluated using 24-hour pad requirement and pad weight, and the International Consultation on Incontinence (ICIQ-SF) score. Results A total of 16 patients (eight having undergone the transurethral resection of the prostate [TUR-P] and eight radical prostatectomy [RP]) were enrolled in the study. Thirteen patients had moderate (81.25%) PPI, and three patients (18.75%) had severe PPI. With the mean follow-up of 36.9±14.3 months, nine patients (56.2%) were noted as cured and four (25%) as improved, with an overall success rate of 81.2%. At the last follow-up visit, the median number of pads used per day decreased from 3.5 to 1, and the 24-hour pad test result decreased from 300 to 50 gr (p < 0.001 and p < 0.001, respectively). The ICIQ-SF score decreased from the initial mean of 15.8 ± 2.3 to 7.1 ± 6.6 (p < 0.001). When the outcomes were compared according to the etiology, there was no statistically significant difference (p = 0.522). Conclusions Male sling surgery can be performed safely in patients with moderate and severe stress urinary incontinence with low complication and high success rates. The results of TUR-P-related PPI are similar to those of surgery performed due to the etiology of RP.
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Affiliation(s)
- Fatih Yanaral
- Urology, Haseki Education and Research Hospital, Istanbul, TUR
| | | | - Ahmet Halis
- Urology, Haseki Education and Research Hospital, Istanbul, TUR
| | - Fatih Akbulut
- Urology, Haseki Education and Research Hospital, Istanbul, TUR
| | - Omer Sarilar
- Urology, Haseki Education and Research Hospital, Istanbul, TUR
| | - Faruk Ozgor
- Urology, Haseki Education and Research Hospital, Istanbul, TUR
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Cai H, Zhu C, Fang J. Ultrasound-guided perineal laser ablation versus prostatic arterial embolization for benign prostatic hyperplasia: two similar short-term efficacies. Acta Radiol 2023; 64:2033-2039. [PMID: 36437581 DOI: 10.1177/02841851221140214] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are many ways to treat prostatic hyperplasia; these are currently more inclined to minimally invasive treatment. We mainly compared the differences between two treatment methods, ultrasound-guided transperineal laser ablation (US-TPLA) and prostatic artery embolization (PAE). PURPOSE To evaluate the efficacy and safety of US-TPLA and PAE in the treatment of benign prostatic hyperplasia (BPH). MATERIAL AND METHODS The clinical information for 40 patients with BPH admitted to our hospital between June 2018 and January 2021 were retrospectively analyzed. The changes in International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual (PVR), prostate volume (PV), and the incidence of complications were compared between groups. RESULTS The IPSS (P < 0.001; P < 0.001), QoL (P < 0.001; P < 0.001), Qmax (P < 0.001; P < 0.001), PVR (P < 0.001; P < 0.001), and PV (P < 0.001; P < 0.001) at three and six months after US-TPLA and PAE improved with respect to those before surgery. There was no significant difference in IPSS (P = 0.235; P = 0.151), QoL (P = 0.527; P = 0.294), Qmax (P = 0.776; P = 0.420), PVR (P = 0.745; P = 0.607), and PV (P = 0.527; P = 0.573) between the groups at three and six months after surgery. No serious complications occurred in either group. CONCLUSION US-TPLA and PAE seem to have a similar short-term efficacy. The efficacy of the two procedures is comparable, and neither is associated with serious complications. US-TPLA and PAE are both effective complementary measures for the treatment of BPH.
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Affiliation(s)
- Huaijie Cai
- Department of Ultrasound, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, PR China
| | - Conghui Zhu
- Department of Interventional Radiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, PR China
| | - Jianhua Fang
- Department of Ultrasound, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, PR China
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12
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V.I.P. Score: A Comprehensive Grading System to Predict Difficulty of HoLEP Procedure for Small-to-Moderate Sized Prostate (<120 ml). Urology 2023:S0090-4295(23)00208-X. [PMID: 36907469 DOI: 10.1016/j.urology.2023.02.037] [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: 12/14/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVES To develop a comprehensive scoring system in addition to the conventionally used prostatic volume (PV), for predicting the difficulty of holmium laser enucleation of the prostate (HoLEP) that may arise with small-to-moderate sized prostate. METHODS We retrospectively reviewed 151 consecutive patients who underwent HoLEP and had a PV less than 120 ml. Based on previous literature, a difficult procedure was defined as a prolonged operative time (OT>90 min) in 88 cases, while the control group (OT≤90 min) consisted of 63 patients. The clinical data, including age, body mass index, PV, intravesical prostatic protrusion (IPP), prostate specific antigen (PSA), prostate specific antigen density, urinary tract infection, microscopic hematuria, prior biopsy, diabetes mellitus, hypertension, history of acute urinary retention, catheter dependency and use of antiplatelet / anticoagulation drugs or 5-alpha reductase inhibitor were compared between the two groups. RESULTS Univariate analysis revealed significant differences between the two groups. Multivariate analysis identified three main independent predictors for difficulty, including volume (V) (60-90 ml OR=9.812, P<0.001) (≥90 ml OR=18.173, P=0.01), IPP (I) (OR=3.157, P=0.018), and PSA (P) (≥4 ng/ml OR=16.738, P<0.001). Therefore, a V.I.P. score was developed based on the regression model and ranged from 0 to 7 points. The area under the curve showed preferable predictive ability of the V.I.P. score compared to PV (0.906 versus 0.869). CONCLUSIONS We developed a V.I.P. score that can accurately predict the difficulty of the HoLEP procedure for PV less than 120 ml in order to optimize clinical outcomes.
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13
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Elterman D, Aubé-Peterkin M, Evans H, Elmansy H, Meskawi M, Zorn KC, Bhojani N. UPDATE - Canadian Urological Association guideline: Male lower urinary tract symptoms/benign prostatic hyperplasia. Can Urol Assoc J 2022; 16:245-256. [PMID: 35905485 PMCID: PMC9343161 DOI: 10.5489/cuaj.7906] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Affiliation(s)
- Dean Elterman
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | | | - Howard Evans
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Hazem Elmansy
- Division of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Malek Meskawi
- Division of Urology, Université de Montréal, Montreal, QC, Canada
| | - Kevin C. Zorn
- Division of Urology, Université de Montréal, Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Université de Montréal, Montreal, QC, Canada
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14
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Sun F, Yao H, Bao X, Wang X, Wang D, Zhang D, Zhou Z, Wu J. The Efficacy and Safety of HoLEP for Benign Prostatic Hyperplasia With Large Volume: A Systematic Review and Meta-Analysis. Am J Mens Health 2022; 16:15579883221113203. [PMID: 35864746 PMCID: PMC9310232 DOI: 10.1177/15579883221113203] [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] [Indexed: 11/26/2022] Open
Abstract
This meta-analysis was to evaluate the efficacy and safety of holmium laser enucleation of prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) with large volume. PubMed, Embase, and Cochrane Library databases (until March 2022) were used to search related randomized controlled trials. A total of 11 studies including 1,258 patients were involved. HoLEP could significantly decrease the length of hospital stay and accelerate recovery. In subanalysis, HoLEP had better perioperative outcomes than bipolar transurethral resection of the prostate (B-TURP) and bipolar transurethral enucleation of the prostate (BPEP). The improvement in operative time and enucleation time was better in thulium laser enucleation of the prostate (ThuLEP) than HoLEP. In the follow-up period, the HoLEP decreased post-void residual urine (PVR) in short-term intervals and improved patients’ maximum flow rate (Qmax) and prostate-specific antigen (PSA) in mid- and long-term intervals. In subanalysis, HoLEP presented significant improvements in Qmax, PSA, and quality of life (QoL) than B-TURP, and HoLEP could also improve Qmax than ThuLEP after 6 months of surgery. The HoLEP reduced the risk of postoperative bleeding compared with other surgeries in safety. In our study, we confirmed the advantages of HoLEP in treating BPH when the prostate size was larger than 80 mL, which indicated that HoLEP could be the best choice for treatment of large volume of prostate.
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Affiliation(s)
- Fengze Sun
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Huibao Yao
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Xingjun Bao
- The second clinical medical college, Binzhou Medical University, Yantai, Shandong, China
| | - Xiaofeng Wang
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Di Wang
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Dongxu Zhang
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Zhongbao Zhou
- Department of Urology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jitao Wu
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
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15
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Meng C, Peng L, Li J, Li J, Li Y, Yang J, Wu J. Comparison of enucleation between thulium laser and holmium laser for benign prostatic hyperplasia: A systematic review and meta-analysis. Asian J Surg 2021; 45:689-697. [PMID: 34384678 DOI: 10.1016/j.asjsur.2021.07.045] [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: 04/21/2021] [Revised: 06/24/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
To compare the clinical efficacy and safety of Thulium laser enucleation of prostate (ThuLEP) and Holmium laser enucleation of prostate (HoLEP). We systematically searched PubMed, Embase, and Cochrane Library databases within a period from the date of database establishment to October 2020. RevMan 5.4. was used for calculation and statistical analyses. 8 studies of 2125 patients were included. ThuLEP provided less hemoglobin decrease (MD: -0.37, 95%CI -0.61 to -0.14, P = 0.002) and shorter length of hospital stay (MD: -0.41, 95%CI -0.72 to -0.10, P = 0.01). During the postoperative follow-ups, statistically significant differences only were found in IPSS (MD: -0.96; 95%CI -1.27 to -0.65; P < 0.00001) at the 3rd month. In conclusion, our study demonstrates that ThuLEP, compared with HoLEP, has better security, faster improvement of symptoms. However, our conclusions still require a larger sample size, multi-center, and longer follow-up randomized controlled trials to verify.
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Affiliation(s)
- Chunyang Meng
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
| | - Lei Peng
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
| | - Jinze Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
| | - Jinming Li
- Department of Urology, The Affiliated Hospital of Medical College, North Sichuan Medical College(University), Sichuan, 637000, China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China.
| | - Junbao Yang
- Department of medical genetics and cell biology, North Sichuan Medical College, Nanchong, 63700, Sichuan, China.
| | - Ji Wu
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
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16
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MRI Evaluation of Patients Before and After Interventions for Benign Prostatic Hyperplasia: An Update. AJR Am J Roentgenol 2021; 218:88-99. [PMID: 34259037 DOI: 10.2214/ajr.21.26278] [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] [Indexed: 12/18/2022]
Abstract
Transurethral resection of the prostate is the most commonly performed procedure for the management of patients with lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH). However, in recent years, various minimally invasive surgical therapies have been introduced to treat BPH. These include laser-based procedures such as holmium laser enucleation of the prostate and photoselective vaporization of the prostate as well as thermal ablation procedures such as water vapor thermal therapy (Rezūm), all of which result in volume reduction of periurethral prostatic tissue. In comparison, a permanent metallic device (UroLift) can be implanted to pull open the prostatic urethra without an associated decrease in prostate size, and selective catheter-directed prostate artery embolization results in a global decrease in prostate size. The goal of this article is to familiarize radiologists with the underlying anatomic changes that occur in BPH as visualized on MRI and to describe the appearance of the prostate on MRI performed after these procedures. Complications encountered on imaging after these procedures are also discussed. Although MRI is not currently used in the routine preprocedural evaluation of BPH, emerging data support a role for MRI in predicting postprocedure outcomes.
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17
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Yıldız A, Akdemir S, Anıl H, Arslan M. Safety and Efficacy of High-Powered Holmium Laser Enucleation of the Prostate within 1-3 Weeks Following Prostate Biopsy. Urol Int 2021; 105:852-857. [PMID: 33780959 DOI: 10.1159/000514422] [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: 12/03/2020] [Accepted: 01/09/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE We aim to document the feasibility, perioperative safety, and the 12-month efficacy of holmium laser enucleation of the prostate (HoLEP) within 1-3 weeks following transrectal ultrasound (TRUS)-guided prostate biopsy. METHODS Data of the patients who underwent HoLEP following TRUS-guided prostate biopsy between March 2017 and July 2020 were analyzed retrospectively. Patients were divided into 2 groups: group 1 had undergone HoLEP in the early period after TRUS-guided prostate biopsy, while group 2 patients were biopsy-naive ("control group"). All patients were assessed preoperatively by a physical examination with the digital rectal examination; time from biopsy to HoLEP; measurement of Qmax, postvoiding residual volume, and prostate volume by transabdominal ultrasonography; serum prostate-specific antigen level, the International Prostate Symptom Score (IPSS); the International Index of Erectile Function-5 questionnaire; and urine analysis. The patients were reevaluated at 3- and 12-month follow-up. Perioperative and postoperative complications were documented according to the modified Clavien-Dindo System. RESULTS Group 1 comprised 66 patients with a mean age of 67.3 ± 6.7 (range, 53-86) years, and group 2 comprised 114 patients with a mean age of 69.4 ± 9.4 (range, 36-95) years. The operation, enucleation, and morcellation efficiencies were not statistically significant between the groups. Preoperative Qmax and IPSS values were significantly improved after HoLEP surgery in the 3rd and 12th months in all patients. Our complication rates were similar in both groups. CONCLUSION High-powered HoLEP using 140 W energy within 1-3 weeks following TRUS-guided prostate biopsy is a feasible procedure with high enucleation efficiency, low perioperative morbidity, and excellent functional outcomes. A recent TRUS-guided prostate biopsy is not a contraindication to HoLEP.
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Affiliation(s)
- Ali Yıldız
- Department of Urology, Faculty of Medicine, Okan University Hospital, Istanbul, Turkey
| | - Serkan Akdemir
- Department of Urology, Private Tinaztepe Hospital, Izmir, Turkey
| | - Hakan Anıl
- Department of Urology, Adana City Training and Research Hospital, Adana, Turkey
| | - Murat Arslan
- Department of Urology, Faculty of Medicine, Okan University Hospital, Istanbul, Turkey
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18
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Yıldız A, Akdemir S, Anıl H, Arslan M. Watt matters: Safety and efficacy of using a 140-W high-powered holmium laser for enucleation of the prostate (HoLEP). Turk J Urol 2021; 47:131-136. [PMID: 33819443 DOI: 10.5152/tud.2021.20558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/01/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to assess the perioperative and the 12-month efficacy and safety of 140 W high-powered holmium laser for enucleation of the prostate (HP-HoLEP) for the treatment of benign prostatic obstruction. MATERIAL AND METHODS The data of 540 patients who underwent HoLEP by a single surgeon were analyzed retrospectively. Preoperative evaluation included a physical examination with a digital rectal examination, measurement of maximum urinary flow rate (Qmax), postvoid residual volume (PVR) and prostate volume by transabdominal ultrasonography, serum prostate-specific antigen (PSA), international prostate symptom score (I-PSS) and international index of erectile function-5 (IIEF-5) questionnaires, and urine analysis. Morcellation, enucleation, and operation efficiencies were calculated with the resected weight divided by morcellation, enucleation, and operative times, respectively. The patients were reassessed at 1, 3, 6, and 12 months after surgery by I-PSS, IIEF-5, Qmax, PSA, and the occurrence of complications. RESULTS The mean operative time was 65.2±20.9 minutes. The mean enucleation time and efficiency were 53±15.1 minutes and 1.72±0.4 g/min, respectively. The mean morcellation time and efficiency were 12.3±15.1 minutes and 7.4±3.2 g/min respectively. Clavien grade 1 complications were observed in 102 (18.9%) patients, Clavien grade 2 complications in 20 (3.7%) patients, and Clavien grade 3b complications in 23 (5.4%) patients. I-PSS, Qmax, and IIEF-5 at postoperative 1, 3, 6, and 12 months were significantly better than baseline results. CONCLUSION Our study demonstrated that 140 W HP-HoLEP can be performed with high enucleation efficiency, low perioperative and postoperative complication rates, and excellent functional results.
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Affiliation(s)
- Ali Yıldız
- Department of Urology, Okan University Hospital, Faculty of Medicine, İstanbul, Turkey
| | - Serkan Akdemir
- Department of Urology, Private Tınaztepe Hospital, İzmir, Turkey
| | - Hakan Anıl
- Department of Urology, Adana City Training and Research Hospital, Adana, Turkey
| | - Murat Arslan
- Department of Urology, Okan University Hospital, Faculty of Medicine, İstanbul, Turkey
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19
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Li P, Wang C, Tang M, Han P, Meng X. Holmium laser enucleation of prostate by using en-bloc and bladder neck preservation technique: technical consideration and influence on functional outcomes. Transl Androl Urol 2021; 10:134-142. [PMID: 33532303 DOI: 10.21037/tau-20-852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background This study aimed to evaluate the efficacy and safety of holmium laser enucleation of prostate (HoLEP) by using en-bloc and bladder neck preservation technique on benign prostatic hyperplasia (BPH) and assess the influence of this procedure on urinary and sexual functional outcomes. Methods A total of 704 patients with BPH undergoing HoLEP were retrospectively analysed. Amongst them, 213 who met the sexual function assessment criteria were further assessed the influence of the technique on sexual functional outcomes. Results The mean operative time, resected prostate weight and mean estimated blood loss were 69.3±14.8 min, 53.4±17.6 g and 62.1±23.7 mL, respectively. The mean duration of catheterization after surgery and mean hospital stay were 2.1±1 and 5.4±3.6 days, respectively. The post-void residual volume, maximum urinary flow rate, international prostate symptom score and quality of life score were all significantly improved postoperation (P<0.05). Amongst the 213 patients with normal antegrade ejaculation before surgery, postoperative international index of erectile function scores slightly improved, although the difference was insignificant (P>0.05). The difference in the Erection Hardness Grading Scale before and after surgery was statistically insignificant (P>0.05). A total of 25 (11.7%) patients had retrograde ejaculation after surgery. Conclusions HoLEP by an en-bloc and bladder neck preservation technique can obtain good functional outcome with small injury and high efficiency, especially for patients who need to preserve normal sexual function and anterograde ejaculation.
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Affiliation(s)
- Pu Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chengming Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Tang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Peng Han
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoxin Meng
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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20
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Proietti S, Rodríguez-Socarrás ME, Eisner BH, Lucianò R, Basulto Martinez MJ, Yeow Y, Rapallo I, Saitta G, Scarfò F, Gaboardi F, Giusti G. Thulium:YAG Versus Holmium:YAG Laser Effect on Upper Urinary Tract Soft Tissue: Evidence from an Ex Vivo Experimental Study. J Endourol 2020; 35:544-551. [PMID: 32808543 DOI: 10.1089/end.2020.0222] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: There are limited data regarding the effect of thulium laser (Tm:YAG) and holmium laser (Ho:YAG) on upper urinary tract. The aim of this study was to compare soft tissue effects of these two lasers at various settings, with a focus on incision depth (ID) and coagulation area (CA). Materials and Methods: An ex vivo experimental study was performed in a porcine model. The kidneys were dissected to expose the upper urinary tract and the block samples containing urothelium and renal parenchyma were prepared. The laser fiber, fixed on a robotic arm, perpendicular to the target tissue was used with a 100 W Ho:YAG and a 200 W Tm:YAG. Incisions were made with the laser tip in contact with the urothelium and in continuous movement at a constant speed of 2 mm/s over a length of 1.5 cm. Total energy varied from 5 to 30 W. Incision shape was classified as follows: saccular, triangular, tubular, and irregular. ID, vaporization area (VA), CA, and total laser area (TLA = VA + CA) were evaluated. Statistical analysis was performed using the SPSS V23 package, p-values <0.05 were considered statistically significant. Results: A total of 216 experiments were performed. Incision shapes were saccular (46%), triangular (38%), and irregular (16%) with the Ho:YAG, while they were tubular (89%) and irregular (11%) with the Tm:YAG. ID was significantly deeper with the Ho:YAG (p = 0.024), while CA and TLA were larger with the Tm:YAG (p < 0.001 and p < 0.005). Conclusion: ID was deeper with Ho:YAG, whereas CA and TLA were larger with the Tm:YAG. Considering surgical principles for endoscopic ablation of upper tract urothelial carcinoma, these results suggest that Tm:YAG may have a lower risk profile (less depth of incision) while also being more efficient at tissue destruction. Future in vivo studies are necessary to corroborate these findings.
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Affiliation(s)
- Silvia Proietti
- Ville Turro Division, Department of Urology, European Training Center of Endourology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Moises Elias Rodríguez-Socarrás
- Ville Turro Division, Department of Urology, European Training Center of Endourology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Brian Howard Eisner
- Department of Urology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Mario José Basulto Martinez
- Ville Turro Division, Department of Urology, European Training Center of Endourology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Yuyi Yeow
- Ville Turro Division, Department of Urology, European Training Center of Endourology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Ilenia Rapallo
- Ville Turro Division, Department of Urology, European Training Center of Endourology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giuseppe Saitta
- Ville Turro Division, Department of Urology, European Training Center of Endourology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Franco Gaboardi
- Ville Turro Division, Department of Urology, European Training Center of Endourology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Guido Giusti
- Ville Turro Division, Department of Urology, European Training Center of Endourology, IRCCS San Raffaele Hospital, Milan, Italy
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Robles J, Pais V, Miller N. Mind the Gaps: Adoption and Underutilization of Holmium Laser Enucleation of the Prostate in the United States from 2008 to 2014. J Endourol 2020; 34:770-776. [PMID: 31880957 DOI: 10.1089/end.2019.0603] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose: There is increasing recognition of the advantages of holmium laser enucleation of the prostate (HoLEP) for benign prostatic hypertrophy (BPH) treatment in the United States but relatively little is known about the extent of HoLEP adoption over time. This study aims to assess national HoLEP adoption rates and regional trends from 2008 to 2014. Methods: We retrospectively analyzed a data set of 100% Medicare claims to determine the rate of U.S. HoLEP adoption in 2008, 2011, and 2014. Rates were adjusted by age and race and stratified by hospital referral region (HRR). Linear and logistic regression models were used to assess for trends in HoLEP adoption over time. Results: Total U.S. BPH cases decreased 24% from 2008 to 2014 and HoLEP cases increased significantly from 1086 (2008) to 3368 (2014). Despite this, HoLEP accounted for just 4% of total BPH cases in 2014. In 2008, 28/306 (9%) of HRRs recorded >10 HoLEP cases per year. This increased to 89 HRRs (29%) in 2011 but stabilized at 94 HRRs (31%) in 2014. In 2014, over 50% of states still had only 0 to 1 sites doing 10+ HoLEP cases per year. Conclusions: Based on this 100% sample of Medicare claims from 2008 to 2014, surgical BPH treatment volume has decreased, while HoLEP volume and regional adoption have tripled. However, rates of HoLEP remain extremely low at just 4% of all BPH procedures in 2014, and large regional gaps in care exist. These data indicate that HoLEP remains substantially underutilized and the majority of regions still lack access to centers performing >10 HoLEP cases per year.
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Affiliation(s)
- Jennifer Robles
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Vernon Pais
- Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Nicole Miller
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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22
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Wei Y, Ke ZB, Xu N, Xue XY. Complications of anatomical endoscopic enucleation of the prostate. Andrologia 2020; 52:e13557. [PMID: 32147865 DOI: 10.1111/and.13557] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 01/31/2020] [Accepted: 02/08/2020] [Indexed: 12/31/2022] Open
Abstract
Transurethral resection of the prostate (TURP) remains the 'gold standard' for surgical treatment of benign prostatic obstruction (BPO). Recently, anatomical endoscopic enucleation of the prostate (AEEP) using holmium laser, thulium laser and plasma, etc., is extensively applied in clinical practice. However, perioperative complications of AEEP are inevitable in spite of lower incidence compared with TURP. This study reviewed the literature related to the aetiology, prevention and treatment of common complications of AEEP, which would contribute to the diagnosis and treatment of BPO.
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Affiliation(s)
- Yong Wei
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhi-Bin Ke
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ning Xu
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xue-Yi Xue
- Department of Urology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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23
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Bell C, Moore SL, Gill A, Obi-Njoku O, Hughes SF, Saleemi A, Ellis G, Khan F, Shergill IS. Safety and efficacy of Holmium laser enucleation of the prostate (HoLEP) in patients with previous transperineal biopsy (TPB): outcomes from a dual-centre case-control study. BMC Urol 2019; 19:97. [PMID: 31640663 PMCID: PMC6805368 DOI: 10.1186/s12894-019-0523-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023] Open
Abstract
Background We investigated the surgical feasibility, safety and effectiveness of 50 W (low power) Holmium Laser enucleation of the prostate (HoLEP) in patients who have undergone previous template biopsy of the prostate (TPB). Methods Data encompassing pre-operative baseline characteristics, intra-operative measures and post-operative outcomes was collected for 109 patients undergoing HoLEP across two UK centres. Patients were stratified into two groups; group 1 (n = 24) had undergone previous TPB were compared with ‘controls’ (no previous TPB) in group 2 (n = 85). The primary outcome was successful HoLEP. Results There were no statistically significant differences in either key baseline characteristics or mass of prostate enucleated between groups 1 and 2. There was no statistically significant difference in enucleation or morcellation times parameters between the two groups other than enucleation efficiency in favour of group 1 (p = 0.024). Functional outcomes improved, without any statistically significant difference, in both groups. Conclusions In patients with a previous TPB, HoLEP is surgically feasible, safe and effective. TPB should not be considered a contraindication to HoLEP. Our work provides a strong foundation for further research in this area.
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Affiliation(s)
- Chris Bell
- Department of Urology, Wrexham Maelor Hospital, Wrexham, Wales, UK. .,North Wales Clinical Research Centre, Gwenfro, Wrexham Technology Park, Wrexham, LL13 7YP, UK.
| | - Sacha L Moore
- Department of Urology, Wrexham Maelor Hospital, Wrexham, Wales, UK
| | - Amarit Gill
- Department of Urology, Wrexham Maelor Hospital, Wrexham, Wales, UK.,North Wales Clinical Research Centre, Gwenfro, Wrexham Technology Park, Wrexham, LL13 7YP, UK
| | - Obinna Obi-Njoku
- North Wales Clinical Research Centre, Gwenfro, Wrexham Technology Park, Wrexham, LL13 7YP, UK
| | - Stephen F Hughes
- North Wales Clinical Research Centre, Gwenfro, Wrexham Technology Park, Wrexham, LL13 7YP, UK
| | - Asad Saleemi
- Department of Urology, Luton and Dunstable University Hospital, Lewsey Road, Luton, LU4 0DZ, UK
| | - Gidon Ellis
- Department of Urology, Luton and Dunstable University Hospital, Lewsey Road, Luton, LU4 0DZ, UK
| | - Farooq Khan
- Department of Urology, Luton and Dunstable University Hospital, Lewsey Road, Luton, LU4 0DZ, UK
| | - Iqbal S Shergill
- Department of Urology, Wrexham Maelor Hospital, Wrexham, Wales, UK.,North Wales Clinical Research Centre, Gwenfro, Wrexham Technology Park, Wrexham, LL13 7YP, UK
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Miernik A, Gross AJ, Schoeb DS, Sievert KD, Rassweiler JJ, Netsch C, Häcker A, Leyh H, Olbert PJ, Klein JT, Homberg R, Westphal PJ, Herrmann TRW. [Endoscopic enucleation of the prostate]. Urologe A 2019; 58:437-450. [PMID: 30923856 DOI: 10.1007/s00120-019-0910-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The spectrum of surgical procedures for the minimally invasive treatment of benign prostatic hyperplasia (BPH) has significantly increased over the last two decades. The simple suprapubic prostatectomy (subtotal prostatectomy, SP) has largely lost relevance in current practice. On the other hand, transurethral resection of the prostate (TURP) has been further standardized and potentially made safer by the introduction of the bipolar technique and low-pressure systems.Transurethral (endoscopic) enucleation techniques (endoscopic enucleation of the prostate, EEP) are increasingly competing with the current gold standard TURP and are replacing SP for treatment of larger adenomas. This approach is especially related to the rapid development of laser technology, which has sustainably changed the face of modern BPH treatment in a similar way to stone therapy. This has been incorporated in the clinical patient management, clinical studies and standardization of numerous surgical techniques that are systematically described in this article. Additionally, efforts have also been made to use other energy sources, such as bipolar current in EEP. With respect to scientific objectivity, high-quality clinical trials are regularly published which further strengthen the position of EEP.
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Affiliation(s)
- A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstraße 55, 79106, Freiburg, Deutschland.
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland
| | - D S Schoeb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstraße 55, 79106, Freiburg, Deutschland
| | - K D Sievert
- Klinik für Urologie, Klinikum Lippe, Röntgenstraße 18, 32756, Detmold, Deutschland
| | - J J Rassweiler
- Klinik für Urologie, SLK-Kliniken Heilbronn GmbH, Am Gesundbrunnen 20-26, 74078, Heilbronn, Deutschland
| | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland
| | - A Häcker
- Klinik für Urologie, Kinderurologie und urologische Onkologie, Marienhaus Klinikum Hetzelstift, Stiftstraße 10, 67434, Neustadt an der Weinstraße, Deutschland
| | - H Leyh
- Klinik für Urologie, Klinikum Garmisch-Partenkirchen, Auenstraße 6, 82467, Garmisch-Partenkirchen, Deutschland
| | - P J Olbert
- BRIXSANA private clinic, Julius-Durst-Straße 28, 39042, Brixen, Italien
| | - J-T Klein
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Prittwitzstraße 43, 89075, Ulm, Deutschland
| | - R Homberg
- Klinik für Urologie, Kinderurologie und Uro-Gynäkologie, St. Barbara-Klinik Hamm-Heessen, Am Heessener Wald 1, 59073, Hamm, Deutschland
| | - P J Westphal
- Klinik für Urologie und Kinderurologie, Krankenhaus Maria Hilf der Alexianer GmbH, Dießemer Bruch 81, 47805, Krefeld, Deutschland
| | - T R W Herrmann
- Kantonsspital Frauenfeld, Klinik für Urologie, Spital Thurgau AG, Pfaffenholzstrasse 4/Postfach, 8501, Frauenfeld, Schweiz
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Lokeshwar SD, Harper BT, Webb E, Jordan A, Dykes TA, Neal DE, Terris MK, Klaassen Z. Epidemiology and treatment modalities for the management of benign prostatic hyperplasia. Transl Androl Urol 2019; 8:529-539. [PMID: 31807429 DOI: 10.21037/tau.2019.10.01] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is one of the most common conditions affecting men. BPH can lead to a number of symptoms for patients commonly referred to as lower urinary tract symptoms (LUTS). Over the last decade, increased modifiable risk factors, such as metabolic disease and obesity, have resulted in an increased incidence of BPH. This increasing incidence has brought about a multitude of treatment modalities in the last two decades. With so many treatment modalities available, physicians are tasked with selecting the optimal therapy for their patients. Current therapies can first be divided into medical or surgical intervention. Medical therapy for BPH includes 5-alpha-reductase inhibitors and alpha-blockers, or a combination of both. Surgical interventions include a conventional transurethral resection of the prostate (TURP), as well as newer modalities such as bipolar TURP, holmium laser enucleation of the prostate (HoLEP), Greenlight and thulium laser, and prostatic urethral lift (PUL). Emerging therapies in this field must also be further investigated for safety and efficacy. This narrative review attempts to consolidate current and emerging treatment options for BPH and highlights the need for additional investigation on optimizing treatment selection.
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Affiliation(s)
- Soum D Lokeshwar
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Benjamin T Harper
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Eric Webb
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Andre Jordan
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Thomas A Dykes
- Division of Urology, Charlie Norwood Veteran Affairs Medical Center, Augusta, GA, USA
| | - Durwood E Neal
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Martha K Terris
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA.,Division of Urology, Charlie Norwood Veteran Affairs Medical Center, Augusta, GA, USA
| | - Zachary Klaassen
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Li C, Guo L, Wang P, Shi L, Sun X, Hu C, Zhang G, Zhang L, Zhang Y, Wang X. ALA-PDT combined with holmium laser therapy of postoperative recurrent extramammary Paget’s disease. Photodiagnosis Photodyn Ther 2019; 27:92-94. [DOI: 10.1016/j.pdpdt.2019.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 04/30/2019] [Accepted: 05/13/2019] [Indexed: 12/30/2022]
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27
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He G, Shu Y, Wang B, Du C, Chen J, Wen J. Comparison of Diode Laser (980 nm) Enucleation vs Holmium Laser Enucleation of the Prostate for the Treatment of Benign Prostatic Hyperplasia: A Randomized Controlled Trial with 12-Month Follow-Up. J Endourol 2019; 33:843-849. [PMID: 31298571 DOI: 10.1089/end.2019.0341] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To compare the clinical efficacy and safety between diode laser (980 nm) enucleation of the prostate (DiLEP) and holmium laser enucleation of the prostate (HoLEP) for treating benign prostatic hyperplasia (BPH). Patients and Methods: One hundred twenty-six BPH patients in our hospital from December 2016 to December 2017 were enrolled in this study. They were randomized to the DiLEP group or HoLEP group, which were administrated with DiLEP and HoLEP treatment, respectively. The patient's characteristics, such as age, body mass index, comorbidities, prostate volume, and prostate-specific antigen, were recorded before surgery. The perioperative outcomes and complications were also compared. The maximum flow rate (Qmax), postvoid residual (PVR), international prostate symptom score (IPSS), and quality-of-life (QoL) score were assessed at baseline and 3, 6, and 12 months postoperatively. Results: No significant differences were observed for the patient's baseline characteristics between both groups. For the perioperative outcomes, including operative time, resected tissue weight, catheter duration, and hospital stay, no significant difference was found between the two groups. However, the DiLEP group showed less blood loss and decrease in hemoglobin compared with the HoLEP group. The incidence of early or late complications was similar for both groups. The Qmax, PVR, IPSS, and QoL for both groups of patients were dramatically improved after surgery. By comparing the Qmax, PVR, IPSS, and QoL between the two groups, no significant differences were detected in the 3-, 6-, or 12-month follow-up. Conclusions: This study demonstrated that both DiLEP and HoLEP are efficient and safe treatments for BPH patients. DiLEP showed less blood loss and decrease in hemoglobin than HoLEP, which indicated that the diode laser (980 nm) generates a better hemostasis effect.
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Affiliation(s)
- Gaofei He
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuanyuan Shu
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bohan Wang
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chuanjun Du
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jimin Chen
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiaming Wen
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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The effect of prostatic tissue density on the perioperative outcomes of Holmium laser enucleation of prostate (HoLEP): a pilot study. World J Urol 2019; 38:455-461. [PMID: 31076849 DOI: 10.1007/s00345-019-02802-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 05/04/2019] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate the effect of prostate tissue density (PTD) on perioperative Holmium laser enucleation of prostate (HoLEP) outcomes. METHODS Two hundred fourteen patients underwent HoLEP between December 2016 and August 2018 (group 1: PTD < 1 g/mL and group 2: PTD ≥ 1 g/mL). Enucleation time (ET), morcellation time (MT), total operation time (TOT), total laser energy (TLE), efficiency of laser (EL), efficiency of enucleation (EE), efficiency of morcellation (EM), enucleation rate (ER), and enucleated tissue weight (ETW) were recorded. RESULTS The mean ages of the groups 1, 2 were 61.36±5.92 and 63.1±7.52 years, respectively. TOT (76.4 vs 86.21 min), ET (69.18 vs 79.94 min), EE (0.80 vs 0.91 g/min), and ETW (55.8 vs 70.23 g) were not significantly different between the two groups. However, the MT was longer in group 2 (11.27 ± 8.57 min and 7.22 ± 5.46 min, p = 0.0001). Furthermore, EM was higher in group 1 (9.81 ± 5.61 g/min and 7.45 ± 4.14 g/min, p = 0.0003). The EL and TLE were similar in both groups. PTD positively correlated with MT (ρ = 0.272, p = 0.0005) and negatively correlated with EM (ρ = - 0.315, p = 0.0001). No correlations were identified between the PTD and EL or EE. CONCLUSIONS PTD is a factor that influences the HoLEP on perioperative outcomes. The PTD particularly affects the morcellation phase of the surgery. Patients with higher PTD will have a longer duration of MT and lesser EM. Future studies with the use of different imaging methods will give insight into the duration and difficulty of the HoLEP.
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Affiliation(s)
| | - Ricardo Vita Nunes
- Divisão de Urologia, Universidade de São Paulo, USP, São Paulo, SP, Brasil
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30
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Robertson CN. Prostate Cancer Treatment Options for Men with Significant Urinary Symptoms and Enlarged Prostates. Prostate Cancer 2018. [DOI: 10.1007/978-3-319-78646-9_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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