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Xiao X, Maolin X, Tao X, Xiaohong D, Jinzhong W, Wei T, Gaoliang C, Mengxi T. Comparative analysis of the safety and efficacy of 1470-nm diode laser enucleation of the prostate and plasmakinetic resection of prostate in the treatment of large volume benign prostatic hyperplasia (>80 ml). Aging Male 2024; 27:2257307. [PMID: 38131620 DOI: 10.1080/13685538.2023.2257307] [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: 06/23/2023] [Accepted: 09/06/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE To compare the efficacy and safety of 1470-nm diode laser enucleation of the prostate (DiLEP) with that of plasmakinetic resection of the prostate (PKRP) in treating patients with large benign prostatic hyperplasia (BPH > 80ml). METHODS The clinical data from 211 cases of BPH (>80 ml) were collected for analysis. The patients were divided into two groups: the PKRP group (n = 118) and the DiLEP group (n = 93), based on the surgical method used. RESULT The DiLEP group demonstrated significantly lower surgical time (p < 0.001), intraoperative bleeding (p < 0.001), bladder flushing time (p = 0.003), indwelling catheter time (p < 0.005), and length of hospital stay (p = 0.018) compared to the PKRP group. However, the quality of the prostatectomy was significantly higher in the DiLEP group (p = 0.005). The Qmax for the DiLEP group was significantly higher than that of the PKRP group (p < 0.05). Compared to the PKRP group, the incidence of urinary incontinence in the DiLEP group increased significantly 4 weeks post-surgery (p = 0.026), although the need for blood transfusion during surgery was significantly reduced (p = 0.037). CONCLUSION Both DiLEP and PKRP are safe and effective methods for treating large-volume BPH. However, DiLEP offers advantages such as more thorough glandular resection, shorter surgical time, reduced bleeding, quicker recovery, and fewer complications.
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Affiliation(s)
- Xiao Xiao
- Department of Urology, Chongqing General Hospital, Chongqing, China
| | - Xiao Maolin
- Department of Urology, Chongqing General Hospital, Chongqing, China
| | - Xiong Tao
- Department of Urology, The People's Hospital of Rongchang District, Chongqing, China
| | - Deng Xiaohong
- Department of Urology, Chongqing General Hospital, Chongqing, China
| | - Wang Jinzhong
- Department of Urology, Chongqing General Hospital, Chongqing, China
| | - Tong Wei
- Department of Urology, Chongqing General Hospital, Chongqing, China
| | - Chen Gaoliang
- Department of Urology, Chongqing General Hospital, Chongqing, China
| | - Tang Mengxi
- Department of Urology, The People's Hospital of Rongchang District, Chongqing, China
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Bucca B, Gobbi LM, Dalpiaz O, Asero V, Scornajenghi CM, Alviani F, Licari LC, Bologna E, Gozzi C. Suprapubic Transvesical Adenoma Resection of the Prostate (STAR-P): A Novel Technique for Surgical Treatment of Benign Prostatic Hyperplasia. Eur Urol Focus 2024:S2405-4569(24)00072-5. [PMID: 38839508 DOI: 10.1016/j.euf.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/24/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND AND OBJECTIVE Several minimally invasive treatments have been developed to treat benign prostatic obstruction (BPO) via a transurethral approach, with a non-negligible risk of complications such as urethral stricture and external sphincter damage. Our aim was to present the Gozzi surgical technique for suprapubic transvesical adenoma resection of the prostate (STAR-P) for BPO and to assess its safety, feasibility, and outcomes. METHODS We conducted a retrospective analysis of 44 consecutive patients who underwent STAR-P for BPO. All the procedures were performed in a single private hospital by one surgeon from 2020 to 2022. An innovative resectoscope designed by the surgeon was subsequently produced by Tontarra Medizintechnik (Wurmlingen, Germany) with a 42.06 Fr external sheath that allows the use of loops of three different sizes. The instrument is inserted into the bladder via suprapubic access, which ensures greater freedom of movement without compromising the external sphincter. Clinical data were retrospectively collected. Preoperative and intraoperative variables, postoperative complications, and functional outcomes of the STAR-P procedure were assessed. A descriptive statistical analysis was performed. KEY FINDINGS AND LIMITATIONS No intraoperative complications were observed. Two patients (4.5%) experienced urinary urgency symptoms after catheter removal that resolved within 90 d. Median times were 105 min for surgery overall and 65 min for resection. All patients showed an improvement in voiding quality. CONCLUSIONS AND CLINICAL IMPLICATIONS STAR-P is a safe, feasible, and cost-effective procedure that spares the bulbomembranous and penile urethra and the external urethral sphincter, and should be discussed with patients as a possible option for treatment of BPO. PATIENT SUMMARY We describe a new, safe, and feasible technique for surgical treatment of urinary obstruction caused by a large prostate. Keyhole surgery is performed through the lower abdomen, which means that the urethra below the prostate is not damaged. Only a small scar of 2-3 cm in the lower abdomen is evident at the end of the healing process.
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Affiliation(s)
- Bruno Bucca
- Urology Unit, Department of Maternal-Child and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy.
| | - Luca M Gobbi
- Urology Unit, Department of Maternal-Child and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Orietta Dalpiaz
- Department of Urology, Hochsteiermark Hospital, Leoben, Austria
| | - Vincenzo Asero
- Urology Unit, Department of Maternal-Child and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Carlo M Scornajenghi
- Urology Unit, Department of Maternal-Child and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Federico Alviani
- Urology Unit, Department of Maternal-Child and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Leslie Claire Licari
- Urology Unit, Department of Maternal-Child and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Eugenio Bologna
- Urology Unit, Department of Maternal-Child and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
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Licari LC, Bologna E, Manfredi C, Franco A, Ditonno F, De Nunzio C, Antonelli A, Simone G, De Sio M, Cindolo L, Olweny EO, Cherullo EE, Leonardo C, Autorino R. Incidence and management of BPH surgery-related urethral stricture: results from a large U.S. database. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00841-z. [PMID: 38714780 DOI: 10.1038/s41391-024-00841-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/10/2024]
Abstract
INTRODUCTION AND OBJECTIVES Urethral stricture (US) is a well-known complication after surgical treatment of benign prostatic hyperplasia (BPH). This study aimed to evaluate the contemporary incidence of the US after different types of BPH surgery, to identify associated risk factors and to assess its management. METHODS A retrospective analysis was conducted using the PearlDiver™ Mariner database, containing de-identified patient records compiled between 2011 and 2022. Specific International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes were employed to identify population characteristics and outcomes. All the most employed surgical procedures for BPH treatment were considered. Multivariable logistic regression was employed to evaluate factors associated with diagnosis of post-operative US. RESULTS Among 274,808 patients who underwent BPH surgery, 10,918 developed post-operative US (3.97%) within 12 months. Higher incidence of US was observed following TURP (4.48%), Transurethral Incision of the Prostate (TUIP) (3.67%), Photoselective Vaporization of the Prostate (PVP) (3.92%), HoLEP/ThuLEP (3.85%), and open Simple Prostatectomy (SP) (3.21%). Lower incidence rates were observed after laparoscopic\robot-assisted SP (1.76%), Aquablation (1.59%), Prostatic Urethral Lift (PUL) (1.07%), Rezum (1.05%), and Prostatic Artery Embolization (PAE) (0.65%). Multivariable analysis showed that patients undergoing PUL, Rezum, Aquablation, PAE, and PVP were associated with a reduced likelihood of developing US compared to TURP. US required surgical treatment in 18.95% of patients, with direct visual internal urethrotomy (DVIU) and urethroplasty performed in 14.55% and 4.50% of cases, respectively. Urethral dilatation (UD) in an outpatient setting was the primary management in most cases (76.7%). CONCLUSIONS The present analysis from a contemporary large dataset suggests that the incidence of US after BPH surgery is relatively low (<5%) and varies among procedures. Around 94% of US cases following BPH surgery are managed using minimally invasive treatment approaches such as UD and DVIU.
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Affiliation(s)
- Leslie Claire Licari
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Eugenio Bologna
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL, USA
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, University of Verona, Verona, Italy
| | - Giuseppe Simone
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Marco De Sio
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luca Cindolo
- Department of Urology, Villa Stuart Hospital, Rome, Italy
| | | | | | - Costantino Leonardo
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
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Reekers JA. Getting it right is better than being right, right? CVIR Endovasc 2024; 7:1. [PMID: 38170369 PMCID: PMC10764674 DOI: 10.1186/s42155-023-00420-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Affiliation(s)
- Jim A Reekers
- Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
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Kim DH, Kang CS, Choi JW, Jeh SU, Choi SM, Lee CW, Kam SC, Hwa JS, Hyun JS. The Efficacy and Safety of 'Inverted Omega En-bloc' Holmium Laser Enucleation of the Prostate (HoLEP) for Benign Prostatic Hyperplasia: A Size-Independent Technique for the Surgical Treatment of LUTS. World J Mens Health 2023; 41:951-959. [PMID: 37118958 PMCID: PMC10523129 DOI: 10.5534/wjmh.220225] [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: 10/13/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 04/30/2023] Open
Abstract
PURPOSE To evaluate the safety, efficiency, and size-dependency of the 'Inverted omega En-bloc (Ʊ)' holmium laser enucleation of the prostate (HoLEP) in benign prostate hyperplasia (BPH) with lower urinary tract symptoms. MATERIALS AND METHODS A retrospective analysis of 716 consecutive patients who underwent HoLEP under the care of a single surgeon from 2014-2021. These patients were treated using the 'Inverted omega En-bloc' HoLEP technique for BPH. The patients were divided into 3 groups: Group 1 (<40 mL, n=328), Group 2 (40-60 mL, n=221), and Group 3 (≤60 mL, n=167). Perioperative parameters, safety, and functional outcomes were assessed and analyzed. RESULTS The perioperative parameters, like enucleation time (45.8±26.9 min), morcellation time (13.2±47.5 min), and catheterization duration (1.6±1.2 d) significantly differed to favor smaller prostate sizes (p<0.01). Significant improvements in the IPSS (total, voiding, storage, and quality of life), post-void residual urine, and maximum flow rate were observed 3 months post-HoLEP and continued during the 1-year follow-up period in all groups (p<0.01). The postoperative complications included urethral stricture in 11 patients (1.5%), bladder neck contracture in 12 (1.7%), urinary incontinence in 14 (2.0%), and bladder injuries in 4 (0.6%). Bladder neck contractures occurred only in Group 1. The postoperative surgical management for complications included urethral sounding (n=9, 1.3%), endoscopic internal urethrotomy (n=2, 0.3%), and re-HoLEP for bladder neck contractures in (n=12, 1.7%). The rate of re-HoLEP for regrowing adenomas was 15 (2.1%). Postoperative medications exceeding 6 months were α-blocker (n=22, 3.1%), cholinergics (n=16, 2.2%), anticholinergics (n=58, 8.1%), antidiuretics (n=18, 2.5%), and daily PDE5 inhibitor (n=38, 5.3%). Thirty-four patients (4.7%) had postoperative incidental prostate cancer. CONCLUSIONS The inverted omega En-bloc HoLEP technique is safe and effective for the treatment of BPH. Moreover, 'Inverted omega En-bloc' HoLEP is a size-independent and effective method for all prostate sizes.
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Affiliation(s)
- Dae Hyun Kim
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Medical Science, Jinju, Korea
| | - Chang Suk Kang
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Medical Science, Jinju, Korea
| | - Jae Whi Choi
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Medical Science, Jinju, Korea
| | - Seong Uk Jeh
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Medical Science, Jinju, Korea
| | - See Min Choi
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Medical Science, Jinju, Korea
| | - Chun Woo Lee
- Department of Urology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Sung Chul Kam
- Department of Urology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jeong Seok Hwa
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Medical Science, Jinju, Korea
| | - Jae Seog Hyun
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Medical Science, Jinju, Korea.
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Eure G, Rukstalis D, Roehrborn C. Prostatic Urethral Lift for Obstructive Median Lobes: Consistent Results Across Controlled Trial and Real-World Settings. J Endourol 2023; 37:50-59. [PMID: 35876440 PMCID: PMC9810349 DOI: 10.1089/end.2022.0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Introduction: The evidence for prostatic urethral lift (PUL), in treating lower urinary tract symptoms/benign prostatic hyperplasia (BPH) in men with obstructive median lobes (OMLs), has grown. In this study, we present the first detailed comparison of outcomes between OML patients treated with PUL in controlled and real-world settings to relevant comparators (subjects treated with transurethral resection of the prostate [TURP] and sham in randomized controlled trials [RCTs]) to demonstrate similar symptom, safety, and patient experience outcomes. Materials and Methods: Symptom and safety outcomes and patient satisfaction were compared through 12 months among controlled PUL studies: BPH6 RCT (35 men randomized to TURP); L.I.F.T. pivotal RCT in subjects with lateral lobe obstruction (66 subjects randomized to sham) and MedLift, an U.S. Food and Drug Administration-approved Investigational Device Exemption (IDE) extension of the L.I.F.T. trial (45 men with OML). Symptom improvement, catheterization, and adverse event rates were compared between MedLift subjects and OML patients (n = 187) from the large real-world retrospective (RWR) study of PUL filtered on baseline characteristics to approximate the MedLift population. Results: Posttreatment, International Prostate Symptoms Score (IPSS) improvement for MedLift subjects was 170% greater compared with sham at 3 months with significantly better quality of life (QoL), Qmax, and benign prostatic hyperplasia impact index (BPHII). Compared with TURP, MedLift IPSS and QoL improved significantly better at 1 and 3 months and with superior ejaculatory function scores at all time points after PUL. IPSS, QoL, postvoid residual (PVR), and Qmax outcomes were equivalent between MedLift and RWR OML groups at 3, 6, and 12 months. RWR OML patients did not experience higher rates of overall adverse events compared with MedLift. Conclusion: Controlled and real-world outcomes confirm PUL is a safe and effective treatment for BPH patients with and without OML.
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Affiliation(s)
- Gregg Eure
- Department of Urology, Urology of Virginia, Virginia Beach, Virginia, USA.,Address correspondence to: Gregg Eure, MS, Department of Urology, Urology of Virginia, Virginia Beach, VA, USA
| | - Daniel Rukstalis
- Prisma Health USC Medical Group, Division of Urology, 300 Palmetto Health Pkwy, Columbia
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Kostenkov NY, Nevirovich ES, Gorelik SG, Kuzmin IV, Novitsky AV, Tkachuk IN. Comparative assessment of the intra- and early postoperative period in patients of elderly and old age after various methods of surgical treatment of large benign prostatic hyperplasia. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.7.201876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is one of the most common diseases in older men. Its significance is determined not only by a decrease in the quality of life of men, but also by the development of a number of complications as a result of infravesical obstruction. About 70% of patients with symptomatic BPH require surgical treatment due to the ineffectiveness of conservative therapy. At the moment, there are many methods of surgical treatment of this pathology in the arsenal of urologists, but there is no consensus on the choice of one or another method of surgical treatment of BPH.
Aim. To study the results of modern and most common surgical methods of large BPH in patients of the older age group.
Materials and methods. The study included 243 patients who were hospitalized at Saint Petersburg City Hospital No. 15 for BPH in the period from November 2019 to November 2021. Control examination after surgery was carried out on days 57, 3 and 6 months after surgery.
Results. The first group of patients underwent bipolar transurethral resection of the prostate (n=67), the second group underwent bipolar plasma-kinetic enucleation of prostate adenoma (n=69), the third group of patients underwent thulium laser enucleation (n=75), and the fourth group of patients performed laparoscopic adenomectomy (n=32). An assessment of intraoperative parameters was carried out: the duration of the operation, the duration of postoperative irrigation, bladder catheterization, bed-day spent in the hospital. In the late postoperative period (after 3 and 6 months), patients were invited for a follow-up examination. In comparison with the initial values, a significant increase in indicators was determined, characterizing the improvement in the quality of life of patients.
Conclusion. In the study, thulium laser enucleation proved to be the most effective and sparing method of BPH surgery in age-related comorbid patients, demonstrating a relatively short operation time, radical method, reduced hospital stay, early rehabilitation of patients, and high efficiency in the late postoperative period.
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Mathieu R, Doizi S, Bensalah K, Lebacle C, Legeais D, Madec FX, Phe V, Pignot G, Irani J. Les complications chirurgicales en urologie adulte : chirurgie de la prostate. Prog Urol 2022; 32:953-965. [DOI: 10.1016/j.purol.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/05/2022] [Indexed: 11/21/2022]
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