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von Bargen MF, Glienke M, Tonyali S, Sigle A, Wilhelm K, Schoenthaler M, Gratzke C, Miernik A. Real-world experience with the new pulsed solid-state Thulium: YAG laser (Thulio) for endoscopic enucleation of the prostate. World J Urol 2024; 42:467. [PMID: 39093491 PMCID: PMC11296962 DOI: 10.1007/s00345-024-05141-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/21/2024] [Indexed: 08/04/2024] Open
Abstract
PURPOSE The solid-state Thulium laser (Tm: YAG) is a novel alternative to the widely used Holmium laser for endoscopic enucleation of the prostate (EEP) due to its relatively high peak power. The aim of this study was to examine the efficacy and safety of a new pulsed Tm: YAG laser in its first application in humans. METHODS Data were retrospectively collected for the first 103 patients who underwent EEP with a new pulsed solid-state Tm: YAG laser (Thulio®, Dornier MedTech Systems GmbH, Weßling, Germany). Peri- and postoperative data were assessed. Procedure-specific complications were graded using Clavien-Dindo Classifications (CDC). Patients were interviewed 15 months after the surgery to evaluate functional and long-term outcomes. Statistical analysis was performed with Statistical Package for the Social Sciences (SPSS®). RESULTS The mean preoperative prostate volume was 105.6 ± 55.0 ml. Median enucleation speed was 4.1 g per minute (range 1.1-9.7). Short-term postoperative complications occurred in 21 patients (20.4%), but no high-grade complications (CDC ≥ IV) were observed. Five patients suffered gross haematuria and required reintervention (CDC IIIb; 4.9%). After 15 months, 76 patients (73.8%) participated in the follow-up interview, where seven patients (9.2%) reported complications, including two reinterventions for urethral strictures (CDC IIIb; 2.6%). Most patients reported an improvement in continence (54.0%) and urine stream (93.4%), but no difference in erectile function (81.6%). No persistent dysuria was reported. Patient satisfaction with the surgery results was very high (96.1%). CONCLUSION Endoscopic enucleation of the prostate with the new pulsed solid-state Tm: YAG laser is a safe and effective option for surgical BPH treatment. TRIAL REGISTRATION German Clinical Trials Register number: DRKS00031676. Registration date: 10 May 2023, retrospectively registered.
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Affiliation(s)
- Maximilian Ferry von Bargen
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - M Glienke
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - S Tonyali
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany
- Department of Urology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - A Sigle
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - K Wilhelm
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - M Schoenthaler
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - C Gratzke
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - A Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg - Medical Centre, Hugstetter Str. 55, 79106, Freiburg, Germany
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Romero Otero J, Justo Quintas J, García Gómez B, Manfredi C, Sopeña Sutil R, Peña Vallejo E, Lista Mateos F, Bozzini G, Rodríguez Antolín A, García Rojo E. Prospective randomized multicenter study to evaluate holmium vs. new thulium fiber laser for prostate enucleation. Minerva Urol Nephrol 2024; 76:491-498. [PMID: 39051894 DOI: 10.23736/s2724-6051.24.05706-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND Benign prostatic hyperplasia (BPH) commonly causes lower urinary tract symptoms (LUTS) in men. Holmium (HoLEP) and thulium (ThuLEP) laser enucleation are established techniques for BPH treatment. Thulium fiber laser (TFL) for prostate enucleation (ThuFLEP) shows promising outcomes. METHODS A prospective randomized multicenter study was conducted. Patients with BPH and LUTS unresponsive to medical therapy were enrolled. Preoperative, surgical, perioperative and postoperative data were recorded with follow-up at 3 and 6 months. The primary outcome was functional improvement, and the secondary outcome was safety in terms of complications. RESULTS Two hundred patients were included (HoLEP 100, ThuFLEP 100). No significant baseline difference was found between groups. At 3 and 6 months we found statistically significant improvements from baseline for both HoLEP and ThuFLEP in efficacy: International Prostatic Symptoms Score (IPSS), IPSS-Quality of Life (QoL), maximum urinary flow rate (Qmax), and post-void residual volume (PVR; P<0.05). At 6 months, mean±SD IPSS, IPSS-QoL, Qmax, and PVR for HoLEP vs. ThuFLEP were 5.8±4.9 vs. 4.8±5.0 points (P=0.57), 1.6±1.4 vs. 0.7±1.1 points (P=0.09), 29.9±12.5 vs. 29.6±8.0 mL/s (P=0.8), and 16.3±17.7 vs. 15.5±13.4 mL (P=0.92), respectively. No intraoperative complication was recorded. No Clavien-Dindo ≥III complications occurred during hospitalization. After 6 months, 8 (8%) and 6 (6%) patients reported mild stress urinary incontinence in HoLEP and ThuFLEP groups, respectively (P=0.24). Urethral stenosis was observed in 3 men (3%) in the HoLEP group and 1 subject (1%) in the ThuFLEP group (P=0.72). CONCLUSIONS HoLEP and ThuFLEP are effective and safe for BPH treatment, with comparable functional outcomes and complication rates at 6 months. Further research is needed to confirm these findings.
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Affiliation(s)
- Javier Romero Otero
- Department of Urology, HM Sanchinarro University Hospital, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain -
| | - Juan Justo Quintas
- Department of Urology, HM Sanchinarro University Hospital, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain
| | - Borja García Gómez
- Department of Urology, University Hospital HM Montepríncipe, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Madrid, Spain
| | - Celeste Manfredi
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Raquel Sopeña Sutil
- Department of Urology, University Hospital HM Montepríncipe, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Madrid, Spain
| | - Elena Peña Vallejo
- Department of Urology, HM Sanchinarro University Hospital, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain
| | - Fernando Lista Mateos
- Department of Urology, University Hospital HM Montepríncipe, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Madrid, Spain
| | - Giorgio Bozzini
- Department of Urology, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy
| | - Alfredo Rodríguez Antolín
- Department of Urology, HM Sanchinarro University Hospital, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain
| | - Esther García Rojo
- Department of Urology, HM Sanchinarro University Hospital, HM Hospitales, Instituto de Investigación Sanitaria HM Hospitales and ROC Clinic, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain
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Huang HN, Sun YH, Liu X, Tao WQ. Analysis of Postoperative Urinary Incontinence and Influencing Factors of Transurethral Holmium Laser Enucleation of the Prostate. Urol Int 2024:1-7. [PMID: 38744260 DOI: 10.1159/000539201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Aims of the study were to investigate the related factors of urinary incontinence after transurethral holmium laser enucleation of the prostate (HoLEP) and to provide guidance for clinical urinary control of HoLEP. METHODS The clinical data of 548 patients who underwent HoLEP were retrospectively analyzed. The patients were followed up for the occurrence of urinary incontinence in the short term (2 weeks), medium term (3 months), and long term (6 months) after HoLEP. RESULTS Among the 548 benign prostatic hyperplasia patients, 79 cases (14.42%) had urinary incontinence at 2 weeks, 19 cases (3.47%) at 3 months, and 2 cases (0.36%) at 6 months after surgery. Logistic regression analysis showed that age, prostate volume, diabetes mellitus, operation time, prostate tissue weight, and histological prostatitis were risk factors for recent urinary incontinence (p < 0.05). Age, diabetes, and operation time were risk factors for mid-term urinary incontinence (p < 0.05). The incidence of long-term urinary incontinence was low and no risk factor analysis was performed. CONCLUSIONS For good urinary control after HoLEP, in addition to surgery-related factors such as surgical skills, proficiency, and precise anatomy, patients' risk factors should also be paid attention to in order to improve postoperative urinary control more effectively and reduce the incidence of urinary incontinence.
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Affiliation(s)
- Hui-Ning Huang
- Department of Urology, The Third Affiliated Hospital of Guangxi Medical University, Nanning, China,
| | - Yi-Hai Sun
- Department of Urology, The Third Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xin Liu
- Department of Urology, The Third Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wei-Qi Tao
- Department of Urology, The Third Affiliated Hospital of Guangxi Medical University, Nanning, China
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Forlini V, Pellegrino C, Lena F, Capitanucci ML, Van Uitert A, Mosiello G. Thulium Laser for the Treatment of Posterior Urethral Valves in Infants. J Endourol 2023; 37:1276-1281. [PMID: 37742112 DOI: 10.1089/end.2023.0025] [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] [Indexed: 09/25/2023] Open
Abstract
Objective: Thulium laser (ThL) has become popular in urology, because of its powerful action on tissue, achieving optimal ablation and hemostasis. Aim of our article was to evaluate efficacy of ThL in infants affected by posterior urethral valve (PUV) ablation. Patients and Methods: Clinical charts of 25 infants (age ≤12 months) who underwent PUV ablation were retrospectively reviewed. According to our protocol, all patients performed voiding cystourethrography and cystoscopy 6 to 8 months after initial treatment. Several factors, including age and weight at surgery, operative time, postoperative bleeding, catheterization period, postoperative urinary retention, retreatment for valve remnants, and stricture at follow-up, were evaluated. Preoperative, intraoperative, and postoperative data were analyzed. Results: Mean age at primary surgery was 4.5 months (5 days-10.5 months) and mean weight at primary surgery was 5.7 kg (2.5-10.3 kg). Mean operative time was 29.5 minutes (range 15-50 minutes). None of the patients experienced intraoperative and postoperative bleeding. In all cases, postoperative catheterization period was 1 day. Residual valves were found in 6 of 25 (24%) patients. No cases of urethral stricture were registered during follow-up (48.4 months, range: 11-95). Analyzing literature data using other techniques, complication rate of ThL PUV ablation seems lower than standard treatments (electrofulguration, cold knife) and comparable with those reported with other laser techniques. Conclusion: PUV ablation with ThL has proven to be feasible and safe in infants. Further studies are needed to define the real effectiveness of this laser technology in PUV ablation. Miniaturized instruments and ThL technology make early PUV treatment feasible also in low body weight newborns.
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Affiliation(s)
- Valentina Forlini
- Division of Neuro-Urology and Surgery for Continence, Bambino Gesù Childrens' Hospital, IRCCS Rome, ERN EUROGEN Affiliated Center, Rome, Italy
- Pediatric Surgery Division, University of Genoa, Genoa, Italy
| | - Chiara Pellegrino
- Division of Neuro-Urology and Surgery for Continence, Bambino Gesù Childrens' Hospital, IRCCS Rome, ERN EUROGEN Affiliated Center, Rome, Italy
| | - Federica Lena
- Division of Neuro-Urology and Surgery for Continence, Bambino Gesù Childrens' Hospital, IRCCS Rome, ERN EUROGEN Affiliated Center, Rome, Italy
- Pediatric Surgery Division, University of Genoa, Genoa, Italy
| | - Maria Luisa Capitanucci
- Division of Neuro-Urology and Surgery for Continence, Bambino Gesù Childrens' Hospital, IRCCS Rome, ERN EUROGEN Affiliated Center, Rome, Italy
| | - Allon Van Uitert
- Division of Neuro-Urology and Surgery for Continence, Bambino Gesù Childrens' Hospital, IRCCS Rome, ERN EUROGEN Affiliated Center, Rome, Italy
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Giovanni Mosiello
- Division of Neuro-Urology and Surgery for Continence, Bambino Gesù Childrens' Hospital, IRCCS Rome, ERN EUROGEN Affiliated Center, Rome, Italy
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Savin Z, Dekalo S, Herzberg H, Ben-David R, Bar-Yosef Y, Beri A, Yossepowitch O, Sofer M. Improving Prostatic Preoperative Volume Estimation and Planning before Laser Enucleation. J Pers Med 2022; 12:jpm12111761. [PMID: 36573723 PMCID: PMC9696623 DOI: 10.3390/jpm12111761] [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] [Received: 08/15/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 12/30/2022] Open
Abstract
We aimed to validate a formula for improving the estimation of prostatic volume by abdominal ultrasound (AUS) prior to transurethral laser enucleation. A total of 293 patients treated for benign prostate hyperplasia (BPH) by laser enucleation from 2019−2022 were included. The preoperative AUS volume was adjusted by the formula 1.082 × Age + 0.523 × AUS − 53.845, which was based on specimens retrieved by suprapubic prostatectomy. The results were compared to the weight of the tissue removed by laser enucleation as determined by the intraclass correlation coefficient test (ICC). The potential impact of preoperative planning on operating time was calculated. The ICC between the adjusted volumes and the enucleated tissue weights was 0.86 (p < 0.001). The adjusted volume was more accurate than the AUS volume (weight-to-volume ratio of 0.84 vs. 0.7, p < 0.001) and even more precise for prostates weighing >80 g. The median operating time was 90 min. The adjusted volume estimation resulted in an overall shorter expected preoperative operating time by a median of 21 min (24%) and by a median of 40 min in prostates weighing >80 g. The adjustment formula accurately predicts prostate volume before laser enucleation procedures and may significantly improve preoperative planning, the matching of a surgeon’s level of expertise, and the management of patients’ expectations.
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Affiliation(s)
- Ziv Savin
- The Department of Urology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
- Correspondence: ; Tel.: +972-528-361-123
| | - Snir Dekalo
- The Department of Urology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Haim Herzberg
- The Department of Urology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Reuben Ben-David
- The Department of Urology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Yuval Bar-Yosef
- The Department of Urology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Avi Beri
- The Department of Urology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Ofer Yossepowitch
- The Department of Urology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Mario Sofer
- The Department of Urology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 6423906, Israel
- The Endourology Unit, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
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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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