1
|
Ditonno F, Bianchi A, Fumanelli F, Brancelli C, Malandra S, Rizzetto R, Balzarro M, Rubilotta E, Autorino R, Bertolo R, Veccia A, Antonelli A. The Learning Curve for Holmium Laser Enucleation of the Prostate: A Single-Center Analysis of Surgical And Functional Outcomes. J Endourol 2024. [PMID: 39135470 DOI: 10.1089/end.2024.0422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024] Open
Abstract
Background: To report the surgical and functional outcomes of the holmium laser enucleation of the prostate (HoLEP) surgical program implemented at a high-volume tertiary referral center and to estimate the learning curve (LC) duration for this surgical procedure. Methods: Data of all consecutive patients undergoing HoLEP at the University of Verona between June 2022 and April 2024 were retrieved from a prospectively maintained institutional database of patients undergoing benign prostatic hyperplasia (BPH) surgical treatment. The primary endpoint was functional outcomes evaluation during the surgeons' LC. The secondary endpoint was to define the surgical LC for HoLEP. A multivariable test of means was performed to compare functional outcomes at different time points. After adjusting for potential confounders (age, preoperative pharmacotherapy, and prostate volume), multivariable linear regression models were fitted to evaluate the effect of experience on operative time (OT) and enucleation efficiency. To assess LCs for HoLEP surgery, the non-risk-adjusted cumulative sum (CUSUM) method was used. Results: A statistically significant improvement in International Prostate Symptoms Score (IPSS) score, delta% IPSS score, IPSS quality of life (IPSS-QoL) score, and delta% IPSS-QoL score was observed over the study period. Furthermore, the incidence of irritative symptoms (p < 0.001) and stress incontinence (p = 0.01) significantly decreased over time, with a 12-month incidence of 8.4% and 9.5%, respectively. A statistically significant association between experience and both OT and enucleation efficiency was observed in multivariable linear regression analysis. The CUSUM chart for OT and enucleation efficiency showed a steep initial upward/downward trend of ∼50 cases each, and a plateau until ∼100 procedures are reached, where the breakpoint is recognized for both variables and where the CUSUM curve goes below the locally weighted scatterplot smoothing curve in the corresponding observed-expected CUSUM plot. Conclusions: HoLEP represents an effective treatment for BPH, demonstrating significant improvement in BPH-related symptoms over the study period, despite the considerable LC of ∼50 cases associated with the procedure.
Collapse
Affiliation(s)
- Francesco Ditonno
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Alberto Bianchi
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Francesca Fumanelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Claudio Brancelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Sarah Malandra
- Residency Program in Health Statistics and Biometrics, University of Verona, Verona, Italy
| | - Riccardo Rizzetto
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Matteo Balzarro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Emanuele Rubilotta
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | | | - Riccardo Bertolo
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Alessandro Veccia
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy
| |
Collapse
|
2
|
Yang B, Lavigne A, Carugo D, Turney B, Somani B, Stride E. Mitigating infections in implantable urological continence devices: risks, challenges, solutions, and future innovations. A comprehensive literature review. Curr Opin Urol 2024:00042307-990000000-00175. [PMID: 39105299 DOI: 10.1097/mou.0000000000001208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
PURPOSE OF REVIEW Stress urinary incontinence is a growing issue in ageing men, often following treatment for prostate cancer or bladder outflow obstruction. While implantable urological devices offer relief, infections are a significant concern. These infections can lead to device removal, negating the benefits and impacting patient outcomes. This review explores the risks and factors contributing to these infections and existing strategies to minimize them. These strategies encompass a multifaceted approach that considers patient-specific issues, environmental issues, device design and surgical techniques. However, despite these interventions, there is still a pressing need for further advancements in device infection prevention. RECENT FINDINGS Faster diagnostics, such as Raman spectroscopy, could enable early detection of infections. Additionally, biocompatible adjuncts like ultrasound-responsive microbubbles hold promise for enhanced drug delivery and biofilm disruption, particularly important as antibiotic resistance rises worldwide. SUMMARY By combining advancements in diagnostics, device design, and patient-specific surgical techniques, we can create a future where implantable urological devices offer men a significant improvement in quality of life with minimal infection risk.
Collapse
Affiliation(s)
- Bob Yang
- Royal Berkshire NHS Foundation Trust
- Oxford University, Oxford
| | | | | | | | - Bhaskar Somani
- University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | | |
Collapse
|
3
|
Chuang SH, Kor CT, Tseng PH, Chang CP, Shih HJ, Pan Y, Huang SH. Risk Factors for Bladder Neck Contracture following Transurethral Resection of the Prostate in Patients with Benign Prostatic Enlargement. Urol Int 2024; 108:442-448. [PMID: 38740009 DOI: 10.1159/000539296] [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: 11/29/2023] [Accepted: 04/22/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Benign prostatic enlargement (BPE) and lower urinary tract symptoms present challenges in aging men, often addressed through transurethral resection of the prostate (TURP). Despite technological advancements, bladder neck contracture (BNC) remains a concern. This study explores predictors, including comorbidities, influencing BNC after TURP. METHODS A retrospective cohort study at Changhua Christian Hospital analyzed 2041 BPE patients undergoing bipolar TURP. Preoperative urinary catheterization and resection speed were categorized. Patient data included demographics, comorbidities, operative details, and outcomes. Statistical analyses utilized χ2, Kruskal-Wallis tests, and Cox regression models. RESULTS Within 3 years, 306 (15%) patients developed BNC. Univariate Cox regression identified chronic heart failure (p = 0.033), chronic obstructive pulmonary disease (COPD; p = 0.002), preoperative urinary catheterization (p < 0.001), and low resection speed (p = 0.045) as significant BNC risk factors. Notably, COPD (p = 0.011) and preoperative urinary catheterization (p < 0.001) emerged as independent risk factors for BNC development in multivariate Cox regression analysis. CONCLUSIONS Preoperative urinary catheterization and COPD were significant predictors of BNC post-TURP, while resection speed showed no significant influence. These findings offer clinicians insights for risk assessment, enhancing patient outcomes, and optimizing resources post-TURP.
Collapse
Affiliation(s)
- Shu-Han Chuang
- Division of General Practice, Department of Medical Education, Changhua Christian Hospital, Changhua, Taiwan
| | - Chew-Teng Kor
- Big Data Center, Changhua Christian Hospital, Changhua, Taiwan
- Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua, Taiwan
| | - Po-Hung Tseng
- Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Chin-Pao Chang
- Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Hung-Jen Shih
- Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yueh Pan
- Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Sheng-Hsien Huang
- Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| |
Collapse
|
4
|
Montorsi F, Capogrosso P, Zaffuto E, Dehò F. Re: Friedrich O Hartung, Karl-Friedrich Kowalewski, Jost von Hardenberg, et al. Holmium Versus Thulium Laser Enucleation of the Prostate: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Eur Urol Focus 2022;8:545-54. Eur Urol Focus 2024; 10:489. [PMID: 36774272 DOI: 10.1016/j.euf.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 01/12/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Unit of Urology, ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, Varese, Italy; University of Insubria, Varese, Italy.
| | - Emanuele Zaffuto
- Unit of Urology, ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, Varese, Italy; University of Insubria, Varese, Italy
| | - Federico Dehò
- Unit of Urology, ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, Varese, Italy; University of Insubria, Varese, Italy
| |
Collapse
|
5
|
Kronenberg P, Cerrato C, Juliebø-Jones P, Herrmann T, Tokas T, Somani BK. Advances in lasers for the minimally invasive treatment of upper and lower urinary tract conditions: a systematic review. World J Urol 2023; 41:3817-3827. [PMID: 37906263 DOI: 10.1007/s00345-023-04669-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/26/2023] [Indexed: 11/02/2023] Open
Abstract
PURPOSE Technological advancements in laser lithotripsy are expanding into numerous fields of urology, like ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), and benign and malignant soft-tissue treatments. Since the amount of research regarding lasers in urology has grown exponentially, we present a systematic review of the most recent and relevant advances encompassing all lasers used in urological endoscopic treatment. METHODS We performed a literature search using PubMed (May 2023) to obtain information about lasers for urological purposes. We included only recent data from published articles between 2021 and 2023 or articles ahead of print. RESULTS Lasers are widely used in lithotripsy for ureteric, renal, and bladder stones, benign prostate surgery, and bladder and upper tract tumor ablation. While the holmium (Ho:YAG) laser is still predominant, there seems to be more emphasis on pulse modulation and newer lasers such as thulium fiber laser (TFL) and pulsed Tm:YAG laser. CONCLUSION The use of lasers and related technological innovations have shown increasing versatility, and over time have proven to be invaluable in the management of stone lithotripsy, treatment of benign and malignant prostate diseases, and urothelial tumors. Laser endoscopic treatment is heavily based on technological nuances, and it is essential to know at least the basics of these technologies. Ultimately the choice of laser used depends on its availability, cost, surgeon experience and expertise.
Collapse
Affiliation(s)
| | - Clara Cerrato
- University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Thomas Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
| | - Theodoros Tokas
- Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria
- Department of Urology, Medical School, University General Hospital of Heraklion, University of Crete, Heraklion, Greece
| | | |
Collapse
|
6
|
Westhofen T, Buchner A, Eismann L, Rodler S, Keller P, Atzler M, Jokisch F, Waidelich R, Becker A, Stief CG, Weinhold P. The Impact of Laser Energy on Functional Outcome Following Holmium Laser Enucleation of the Prostate. Urology 2023; 182:190-195. [PMID: 37696310 DOI: 10.1016/j.urology.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To assess the impact of total laser energy applied, as well as enucleation efficiency on short-term functional outcomes for patients treated for lower urinary tract symptoms (LUTS) with Holmium laser enucleation of the prostate (HoLEP). METHODS A retrospective analysis of 1593 consecutive patients who underwent HoLEP for LUTS due to benign prostate obstruction in a tertiary care center between January 2018 and January 2021 was performed. Perioperative parameters and short-term functional outcome were evaluated. Spearman's rank correlation and linear regression analysis was applied to identify the relationship between total laser energy applied or enucleation efficiency and functional outcome (P < .05). RESULTS Median weight of enucleated tissue was 65g, median tissue retrieval percentage was 72.2% and median surgery speed was 0.8g/min. Median laser energy applied was 48.8 kJ, median enucleation efficiency was 1.4g/kJ. No significant correlation between the total laser energy and postoperative International Prostate Symptom Score (IPSS), peak urinary flow (Qmax) or postvoid residual urine volume (PVR) was found (P-range: .473-.969). Likewise, no correlation was found between enucleation efficiency and postoperative IPSS, Qmax, and PVR (P-range: .080-.932). Perioperative improvement of functional outcome (delta IPSS, delta Qmax, and delta PVR) did not correlate with total laser energy applied (P-range: .211-.785) or with enucleation efficiency (P-range: .118-.543). Those results were confirmed in linear regression analysis. CONCLUSION The results of this study reveal that functional outcome following HoLEP are not dependant on the amount of laser energy applied or enucleation efficiency. Our results should support the increased use of HoLEP as surgical treatment option for LUTS due to BPH.
Collapse
Affiliation(s)
- Thilo Westhofen
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany.
| | - Alexander Buchner
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lennert Eismann
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Severin Rodler
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Patrick Keller
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Atzler
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Friedrich Jokisch
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Raphaela Waidelich
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Armin Becker
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Philipp Weinhold
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| |
Collapse
|
7
|
Palacios DA, Kaouk J, Abou Zeinab M, Ferguson EL, Abramczyk E, Wright HC, Pramod N, De S. Holmium Laser Enucleation of the Prostate vs Transvesical Single-port Robotic Simple Prostatectomy for Large Prostatic Glands. Urology 2023; 181:98-104. [PMID: 37517682 DOI: 10.1016/j.urology.2023.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To compare the perioperative outcomes of transvesical single-port robotic simple prostatectomy (SP-RASP) and holmium laser enucleation of the prostate (HoLEP). MATERIALS AND METHODS A retrospective review was performed of patients undergoing SP-RASP and HoLEP from 2019 to 2022 with preoperative prostatic volume (PPV) >80 cm3. Percent of prostate adenoma removed (%PAR) was estimated by specimen weight normalized by PPV. Univariate analysis was performed using chi-square, Fisher exact, and Wilcoxon rank-sum tests. A subgroup analysis with 1:1 matching for PPV was also performed. RESULTS A total of 50 SP-RASP and 90 HoLEP cases were analyzed. The median (interquartile range) PPV was 169 (128-244)cm3 for SP-RASP and 129 (100-150)cm3 for HoLEP, (P < .01). The median (interquartile range) %PAR was 57(44-68) for SP-RASP vs 51(42-62) for HoLEP (P = .10). Overall, 11(12%) HoLEP and 5(10%) SP-RASP patients experienced complications (P = .51). Same-day discharge occurred in 24(48%) SP-RASP vs 7(8%) HoLEP patients (P < .01). Median foley catheter duration was longer in SP-RASP (6 vs 1 day, P < .01) and trial of void was successful at first attempt in >94% (P = .68). Transient de novo incontinence was reported in 24(28%) HoLEP vs 2(5%) SP-RASP (P < .01). No differences in voiding parameters were observed at latest follow up. Subgroup postmatched analysis revealed analogous findings. CONCLUSION SP-RASP and HoLEP have similar favorable perioperative outcomes for management of large prostatic adenomas. SP-RASP may be considered in patients unwilling to accept the risk of transient incontinence and in those with unfavorable urethral access, large bladder stone burden, or diverticula.
Collapse
Affiliation(s)
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH.
| | - Mahmoud Abou Zeinab
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Ethan L Ferguson
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Emily Abramczyk
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Henry C Wright
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH; Northwestern Medicine, Algonquin, IL
| | - Nikhil Pramod
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Smita De
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH
| |
Collapse
|
8
|
Hughes T, Harper P, Somani BK. Treatment Algorithm for Management of Benign Prostatic Obstruction: An Overview of Current Techniques. Life (Basel) 2023; 13:2077. [PMID: 37895457 PMCID: PMC10608556 DOI: 10.3390/life13102077] [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: 09/24/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
The management of benign prostatic obstruction (BPO) should involve a treatment algorithm that takes into account prostate size, and patient's symptoms and preference with the aim of helping with urinary symptoms and enhance quality of life. The diagnostic assessment for men with lower urinary tract symptoms (LUTS) should be comprehensive to help choose the best management strategy. Strategies from lifestyle modifications to medical treatment with alpha blockers and/or 5-alpha-reductase inhibitors to surgical procedures can all be used in the management algorithm. Surgical management ranges from transurethral resection of prostate (TURP) to minimally invasive surgical therapies (MIST) including laser therapies such as Holmium laser enucleation (HoLEP) and photoselective vaporisation (PVP), aquablation, Rezūm system, prostate artery embolisation (PAE), prostatic urethral lift (PUL), temporary implantable nitinol device (iTind) and Optilume BPH catheter system. BPO is a common urological condition that has a significant impact on quality of life and economic burden globally and is likely to become increasingly prevalent with an ageing population. Selecting the most appropriate treatment modality will depend on the individual patient preferences, availability of resources, cost, anatomical factors and the goals of treatment.
Collapse
Affiliation(s)
- Thomas Hughes
- Department of Urology, South Warwickshire University Hospital NHS Foundation Trust, Warwick CV34 5BW, UK;
| | - Philip Harper
- Department of Surgery, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| |
Collapse
|
9
|
Pandolfo SD, Del Giudice F, Chung BI, Manfredi C, De Sio M, Damiano R, Cherullo EE, De Nunzio C, Cacciamani GE, Cindolo L, Porpiglia F, Mirone V, Imbimbo C, Autorino R, Crocerossa F. Robotic assisted simple prostatectomy versus other treatment modalities for large benign prostatic hyperplasia: a systematic review and meta-analysis of over 6500 cases. Prostate Cancer Prostatic Dis 2023; 26:495-510. [PMID: 36402815 DOI: 10.1038/s41391-022-00616-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/20/2022] [Accepted: 11/07/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Current guidelines recommend simple prostatectomy or endoscopic enucleation of the prostate (EEP) as treatment of choice for bladder prostatic obstruction (BPO) caused by large prostate glands. We aimed to provide a wide-ranging analysis of the currently available evidence, comparing safety and effectiveness of robot-assisted simple prostatectomy (RASP) versus open simple prostatectomy (OSP), laparoscopic simple prostatectomy (LSP), and laser EEP. METHODS A systematic search was performed across MEDLINE, EMBASE, and Web of Science databases for retrospective and prospective studies comparing RASP to OSP or LSP or laser EEP (HoLEP/ThuLEP). Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) recommendations were followed to design the search strategies, selection criteria, and evidence report. A meta-analysis evaluated perioperative safety and effectiveness outcomes. The weighted mean difference and risk ratio were used to compare continuous and dichotomous variables, respectively. Quality was assessed using the Newcastle-Ottawa scale and the Cochrane Collaboration's tool for RCT article assessing risk of bias. RESULTS 15 studies, including 6659 patients, were selected for meta-analysis: 13 observational studies, 1 non-randomized prospective study, and 1 randomized controlled trial. RASP was associated with statistically significant longer operative time (OT) and lower postoperative complication rate, length of stay (LOS), estimated blood loss (EBL), and transfusion rate (TR) compared to OSP. LSP showed longer LOS and lower postoperative SHIM score, with no difference in OT, EBL, and complications. Compared to laser EEP, RASP presented longer LOS and catheterization time and higher TR. ThuLEP presented shorter OT than RASP. No difference were found in functional outcomes between groups both subjectively (IPSS, QoL) and objectively (Qmax, PVR). CONCLUSION RASP has become a size-independent treatment for the management of BPO caused by a large prostate gland. It can duplicate the functional outcomes of OSP while offering a better safety profile. When compared to LSP, the latter still stands as a valid lower-cost option, but it requires solid laparoscopic skill sets and therefore it is unlikely to spread on larger scale. When compared to laser EEP, RASP offers a shorter learning curve, but it still suffers from longer catheterization time and LOS.
Collapse
Affiliation(s)
- Savio Domenico Pandolfo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
- Department of Urology, Stanford Medical Center, Stanford, CA, USA
| | - Benjamin I Chung
- Department of Urology, Stanford Medical Center, Stanford, CA, USA
| | - Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco De Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rocco Damiano
- Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Edward E Cherullo
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Cosimo De Nunzio
- Urology Unit, Ospedale Sant'Andrea, La Sapienza University of Rome, Rome, Italy
| | - Giovanni E Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Luca Cindolo
- Department of Urology, Villa Stuart, Private Hospital, Rome, Italy
| | - Francesco Porpiglia
- Division of Urology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA.
| | - Fabio Crocerossa
- Urology Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
| |
Collapse
|
10
|
Capogrosso P, Ventimiglia E, Fallara G, Schifano N, Costa A, Candela L, Pellegrino F, Colandrea G, Cignoli D, De Angelis M, Belladelli F, Longoni M, Avesani G, Lanzaro F, Scattoni V, Dehò F, Salonia A, Briganti A, Montorsi F. Holmium Laser Enucleation of the Prostate Is Associated with Complications and Sequelae Even in the Hands of an Experienced Surgeon Following Completion of the Learning Curve. Eur Urol Focus 2023; 9:813-821. [PMID: 37069007 DOI: 10.1016/j.euf.2023.03.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Holmium laser enucleation of the prostate (HoLEP) is considered a challenging procedure even for surgeons who have completed the learning curve. OBJECTIVES To assess outcomes and complications following HoLEP performed by a highly experienced surgeon. DESIGN, SETTING, AND PARTICIPANTS This was a single-institution prospective study (NCT03583034) performed at a tertiary referral centre that included 243 consecutive patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) treated with HoLEP by a single experienced surgeon (>1600 cases). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients were assessed using validated questionnaires and uroflowmetry at baseline and several follow-up dates. Intraoperative and postoperative complications were recorded. Kaplan-Meier analysis was used to estimate recovery rates for urinary continence and erectile function. Logistic regression models were constructed to assess predictors of postoperative complications. RESULTS AND LIMITATIONS Of the 243 patients, 78 (32.1%) had an indwelling urethral catheter. The median prostate volume (PV) was 87 cm3 (interquartile range 60-115) and 146 patients (59.8%) had PV >80 cm3. At 3-mo follow-up, 219 patients (90.1%) had a peak flow rate >20 ml/s and 182 (74.9%) had no postvoid residual urine. The improvement in subjective symptoms was significant at 1-mo follow-up and was maintained until 12 mo after surgery. Urinary continence recovery was slow, with an estimated rate of 68% (95% confidence interval [CI] 62-74%) at 1 mo and 94% (95% CI 91-97%) at 12 mo after HoLEP. The recovery rate for erectile function was 53% (95% CI 46-61%) at 1 mo and 85% (95% CI 77-90%) at 12 mo. Postoperative complications occurred in 36 patients (14.8%) during their hospital stay, in 34 (14%) within 1 mo following discharge from hospital, and in ten (4.1%) at later follow-up dates. Clinically significant complications (Clavien-Dindo ≥2) were observed in 44 cases (18%) and were more common for patients with an indwelling catheter at baseline (odds ratio 5.05; p = 0.006). CONCLUSIONS HoLEP is an effective procedure for treating LUTS due to BPE, although it is not devoid of complications and sequelae, even in the hands of a highly experienced surgeon. PATIENT SUMMARY Holmium laser treatment of the prostate to reduce its size has positive results for urinary function when performed by an experienced surgeon, even in complex cases, although there can be complications.
Collapse
Affiliation(s)
- Paolo Capogrosso
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Nicolò Schifano
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Antonio Costa
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Luigi Candela
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Pellegrino
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Gianmarco Colandrea
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Daniele Cignoli
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Mario De Angelis
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Mattia Longoni
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Giulio Avesani
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Lanzaro
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Vincenzo Scattoni
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Federico Dehò
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
| |
Collapse
|
11
|
Lin YH, Chang SY, Tsao SH, Hou CP, Chen CL, Lin WC, Tsui KH, Juang HH. Anterior fibromuscular stroma-preserved endoscopic enucleation of the prostate: a precision anatomical approach. World J Urol 2023; 41:2127-2132. [PMID: 36585497 DOI: 10.1007/s00345-022-04270-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Benign prostate obstruction (BOO) is becoming increasingly important in this aging society. Some urge/stress urinary incontinence (UUI/SUI) still occurs after endoscopic enucleation of the prostate (EEP). It remains unclear how post-EEP incontinence can be avoided. Currently, early apical release to ameliorate the traction of the external sphincter is the best technique for incontinence prevention. OBJECTIVE To describe our surgical technique of anterior fibromuscular stroma (AFS)-preserved EEP for BOO. DESIGN, SETTING, AND PARTICIPANTS The medical records of 60 consecutive patients who underwent AFS-preserved EEP for BOO in our center from September 2019 to December 2019 were retrospectively reviewed. SURGICAL PROCEDURE AFS-preserved EEP starts at the 12 o'clock position of the urethra, and the junction between the AFS and transitional zone (T-zone) was identified. The AFS and T-zone were separated first to protect the AFS in the initial operative procedure. Then, following the usual enucleation procedure, AFS-preserved EEP could be achieved. MEASUREMENTS Postoperative prostate-specific antigen (PSA), testosterone, urethral stricture, and voiding status, such as incontinence, uroflow, and postvoiding residual urine were assessed. RESULTS AND LIMITATIONS The data show that AFS-preserved EEP could achieve similar surgical outcomes as other early apical release approaches. CONCLUSIONS The preserved AFS provides a nice landmark at the 12 o'clock position during EEP.
Collapse
Affiliation(s)
- Yu-Hsiang Lin
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan.
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
| | - Shin-Yuan Chang
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
| | - Shu-Han Tsao
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chen-Pang Hou
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chien-Lun Chen
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wen-Chou Lin
- Department of Urology, MacKay Memorial Hospital, Taipei 112, Taiwan
| | - Ke-Hung Tsui
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, Taipei 112, Taiwan.
- TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei 112, Taiwan.
| | - Horng-Heng Juang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan.
- Department of Anatomy, School of Medicine, Chang Gung University, Kwei-Shan, Taoyuan 333, Taiwan.
| |
Collapse
|
12
|
Martinez-Salas ADJ, Garcia-Rivera OU, Reyna-Blanco I, Jimenez-Garcia AD, Rosas-Hernandez H. Adequate Mentorship Program for Holmium Laser Enucleation of the Prostate (HoLEP) Leads to Satisfactory Short-Term Outcomes in the Early Learning Curve of Young Urologists: First-Year Outcomes of a Newly Established Mentorship Training in Mexico. Cureus 2023; 15:e41756. [PMID: 37575804 PMCID: PMC10416137 DOI: 10.7759/cureus.41756] [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] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Benign prostatic hyperplasia (BPH) is one of the most common causes of lower urinary tract symptoms in men. Holmium Laser Enucleation of the Prostate (HoLEP) has been recommended by international guidelines as an alternative to transurethral resection of the prostate (TURP). HoLEP's learning curve and the lack of adequate mentorship remains an obstacle for the worldwide adoption of this technique. Objective To report the first-year learning curve of a newly established mentorship program in young urologists without any previous HoLEP experience. Methods We report a cohort of patients with BPH, with prostate size ≥70 grams, treated with HoLEP, analyzed for perioperative data and complications, and short-term postoperative complications and functional outcomes, at three and six months after surgery. Results A total of 47 patients were managed with HoLEP. Mean total operative time was 149.8 ± 42.9 minutes. We experienced five (10.6%) intraoperative complications, including one intravesical resection of the prostate with bipolar energy, three conversions to TURP and one conversion to open prostatectomy. We experienced four postoperative complications, all of them Clavien-Dindo ≤2. Median International Prostate Symptom Score (IPSS) decrease at six months was -17 points from baseline. Mean post-void residual volume and prostate-specific antigen significantly decreased by the third postoperative month. Multiple linear regression showed that prostate size is directly related to increased surgical time during the early learning curve. Discussion Our experience adequately reflects the importance of HoLEP mentorship in young urologists seeking training in this technique. Both surgeons had perioperative and postoperative outcomes deemed satisfactory based on previously published learning curves. Conclusions HoLEP is a technically difficult procedure, however, adequate mentorship leads to satisfying short-term outcomes since the early stages of the learning curve in young urologists with no previous training on this technique.
Collapse
Affiliation(s)
| | - Oscar Uriel Garcia-Rivera
- Urology, Centro Medico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, MEX
| | - Irving Reyna-Blanco
- Urology, Hospital General Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) Tlahuac "Dra. Matilde Petra Montoya Lafragua", Mexico City, MEX
| | - Aldo Daniel Jimenez-Garcia
- Urology, Hospital General Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) Tlahuac "Dra. Matilde Petra Montoya Lafragua", Mexico City, MEX
| | | |
Collapse
|
13
|
Assmus MA, Krambeck AE. Moses Laser Enucleation of the Prostate (MoLEP): Use of Pulse Modulated Holmium Laser Technology for Prostate Enucleation. CURRENT BLADDER DYSFUNCTION REPORTS 2023. [DOI: 10.1007/s11884-023-00698-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
|
14
|
Campobasso D, Barbieri A, Bocchialini T, Pozzoli GL, Dinale F, Facchini F, Grande MS, Kwe JE, Larosa M, Guarino G, Mezzogori D, Simonetti E, Ziglioli F, Frattini A, Maestroni UV. Safety profile of treatment with greenlight versus Thulium Laser for benign prostatic hyperplasia. Arch Ital Urol Androl 2023; 95:11101. [PMID: 36924373 DOI: 10.4081/aiua.2023.11101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/31/2022] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE The major strengths of surgical treatment of benign prostatic hyperplasia with laser are reduced morbidity compared to endoscopic resection. No studies analysed the different risk of intra/peri-operative events between patients undergoing Thulium and GreenLight procedures. MATERIALS AND METHODS We retrospectively reviewed 100 consecutive cases undergoing GreenLight vaporization and Thulium procedures performed during the learning curve of two expert endoscopic surgeons. Pre-operative data, intra and post-operative events at 90 days were analysed. RESULTS Patients on antiplatelet/anticoagulant therapy were pre-dominant in the Green group (p < 0.0001). Rates of blood transfusion (p < 0.0038), use of resectoscope (p < 0.0086), and transient stress urinary incontinence were statistically higher in the Thulium group. On the contrary conversions to TURP (p < 0.023) were more frequent in GreenLight patients. Readmissions were more frequently necessary in GreenLight group (24%) vs. Thulium group (26.6%). The overall complication rate in GreenLight and Thulium groups were 31% and 53% respectively; Clavien 3b complications were 13% in Thulium patients versus 1% in GreenLight patients. CONCLUSIONS GreenLight and Thulium treatments show similar safety profiles. Randomized controlled trial are needed to better clarify the rate of major complications in Thulium group, and the incidence of post-operative storage symptoms in these patients' populations.
Collapse
Affiliation(s)
- Davide Campobasso
- Department of Urology, Ospedale Civile di Guastalla and Ospedale Ercole Franchini di Montecchio Emilia, Guastalla; Department of Urology, University Hospital of Parma.
| | | | | | - Gian Luigi Pozzoli
- Department of Urology, Ospedale Civile di Guastalla and Ospedale Ercole Franchini di Montecchio Emilia, Guastalla.
| | | | - Francesco Facchini
- Department of Urology, Ospedale Civile di Guastalla and Ospedale Ercole Franchini di Montecchio Emilia, Guastalla.
| | - Marco Serafino Grande
- Department of Urology, Ospedale Civile di Guastalla and Ospedale Ercole Franchini di Montecchio Emilia, Guastalla.
| | - Jean Emmanuel Kwe
- Department of Urology, Ospedale Civile di Guastalla and Ospedale Ercole Franchini di Montecchio Emilia, Guastalla; Urological Residency School Network, Department of Urology, University Hospital of Modena and Reggio Emilia, Modena.
| | - Michelangelo Larosa
- Department of Urology, Ospedale Civile di Guastalla and Ospedale Ercole Franchini di Montecchio Emilia, Guastalla.
| | - Giulio Guarino
- Department of Urology, Ospedale Civile di Guastalla and Ospedale Ercole Franchini di Montecchio Emilia, Guastalla; Urological Residency School Network, Department of Urology, University Hospital of Modena and Reggio Emilia, Modena.
| | - Davide Mezzogori
- Department of Engineering and Architecture, University of Parma.
| | - Elisa Simonetti
- Department of Urology, Ospedale Civile di Guastalla and Ospedale Ercole Franchini di Montecchio Emilia, Guastalla.
| | | | - Antonio Frattini
- Department of Urology, Ospedale Civile di Guastalla and Ospedale Ercole Franchini di Montecchio Emilia, Guastalla.
| | | |
Collapse
|
15
|
Kanne M, Beutel H, Krediet J, Kössler R, Kittner B, Schmuck N, Spreu T, Friedersdorff F, Maxeiner A. [Quality of life and outcome after holmium laser enucleation of the prostate (HoLEP)]. Aktuelle Urol 2023; 54:24-29. [PMID: 36096141 DOI: 10.1055/a-1921-9485] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Holmium Laser Enucleation of the Prostate (HoLEP) was established 20 years ago as an alternative to Transurethral Resection of the Prostate (TUR-P) based on improved morbidity in patients with benign prostate syndrome (BPS). HoLEP can be applied independently to almost all sizes of prostate glands and is recommended in national and international guidelines. Although the HoLEP procedure has a good reputation, many patients still prefer conservative treatment due to fears of side-effects such as pain and urinary incontinence. The aim of this study was to identify patients' feelings, fears and perception of their HoLEP treatment based on Patient-reported Outcome Measures (PROMs) via questionnaires. MATERIAL UND METHODS During the time period from June to December 2020, 152 consecutive patients were treated by HoLEP due to BPS and were interviewed based on questionnaires right after their surgical treatment and 3 months later concerning their satisfaction as well as micturition and continence. Based on a written informed consent, 112 patients were included in the study, and a complete 3-month follow-up was available for 88 patients. RESULTS The mean volume of enucleated prostate tissue was 62.1 [g] and the mean prostate volume estimated pre-operatively (trans-rectal ultrasound) was 83.1 [cm3]. Overall patient-reported satisfaction with the hospital stay including surgical treatment was 94.6%; after 3 months it was 91.8%. Concerning micturition, 76.5% of the patients reported satisfaction after surgery and 80.4% were satisfied after 3 months. Urinary incontinence was reported in 8.3% initially and in 9.1% after 3 months. Positive answers to questions concerning the quality of life index [L] were obtained in 62.1% initially and their number increased to 85.7% after 3 months. The share of negative answers decreased from 11.7% after surgery to 3.4% within the 3-month follow-up. DISCUSSION HoLEP is a well-established treatment of BPS with lower side-effects compared with TUR-P according to the literature. To address doubts and misgivings, it is important to perform surveys on subjective patient satisfaction after the surgical procedure and over time. The high patient satisfaction could help future patients and the urologists treating them to establish the indication for HoLEP treatment earlier in order to avoid severe LUTS or catheterization.
Collapse
Affiliation(s)
- Martin Kanne
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Holger Beutel
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Jorien Krediet
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Robert Kössler
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Beatrice Kittner
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Nils Schmuck
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Thomas Spreu
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany.,Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Maxeiner
- Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
16
|
Cooley LF, Assmus M, Ganesh M, Lee M, Helon J, Krambeck AE. Predictors of Failed Same-Day Catheter Removal After Holmium Laser Enucleation of the Prostate. Urology 2022; 170:168-173. [PMID: 35963396 DOI: 10.1016/j.urology.2022.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/01/2022] [Accepted: 07/28/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To determine factors associated with failure of same-day trial of void (SDTOV) following holmium laser enucleation of the prostate (HoLEP). BACKGROUND HoLEP is increasingly utilized for patients with benign prostatic hyperplasia. Advancements in technology have improved operative efficiency and hemostasis making same-day, catheter-free discharge possible. METHODS We conducted a retrospective review on 190 patients undergoing HoLEP from July, 2021 to January, 2022 by a single center. We assessed pre- and intra-operative variables associated with our primary outcome: failure of same-day catheter removal. Post-operative complications and outcomes at a ≤7 days and 3-month follow up were examined. Continuous and categorical variables were analyzed using unpaired t-tests (Mann Whitney) and chi-square, respectively. Univariate and multivariable logistic regression models were fitted to examine the associations of failed SDTOV. RESULTS Of 190 candidates for a SDTOV, 90% (171/190) were successful. We found no difference between SDTOV success and failures with regards to age, comorbidities, presence of pre-operative urinary retention, anesthesia factors, operative time, volume resected, enucleation time, and morcellation time (all P>0.05). Pre-operatively, 26.3% (50/190) were on antiplatelet and 6.3% (12/190) were on anticoagulation. While pre-operative antiplatelet therapy was not associated with SDTOV failure (P=0.78), pre-operative anticoagulation use was (4.7% vs. 21.1%, P=0.021). Patients who continued anticoagulation through surgery had the highest rate of SDTOV failure (2.3% (4/171) vs. 15.8% (3/19), P=0.023). For those with successful SDTOV, 4.1% (7/171) required catheterization following discharge. At 3 months, no patient required catheterization. CONCLUSION On the day of surgery, patients eligible for SDTOV successfully voided 90% of the time. History of preop anticoagulation, whether continued or held, increased SDTOV failure.
Collapse
Affiliation(s)
- Lauren Folgosa Cooley
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mark Assmus
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Meera Ganesh
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Matthew Lee
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jessica Helon
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Amy E Krambeck
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| |
Collapse
|
17
|
Hout M, Gurayah A, Arbelaez MCS, Blachman-Braun R, Shah K, Herrmann TRW, Shah HN. Incidence and risk factors for postoperative urinary incontinence after various prostate enucleation procedures: systemic review and meta-analysis of PubMed literature from 2000 to 2021. World J Urol 2022; 40:2731-2745. [PMID: 36194286 DOI: 10.1007/s00345-022-04174-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the risk of urinary incontinence (UI) after various prostate enucleation procedures (PEP). METHODS PubMed was searched from January 2000 to July 2021 for studies investigating UI after PEP. The articles were divided into 5 subgroups: holmium, thulium, greenlight laser, electrocautery, and simple prostatectomy. Meta-analysis was performed to examine rate of stress (SUI), urge (UUI) or unspecified UI at short (< 3 months), intermediate (3-6 months), and long-term (> 6 months). The impact of age, prostate size, surgery time, laser time, postoperative nadir PSA level and technical modifications on UI was analyzed. RESULTS Most (69.4%) of 49 articles included employed holmium laser. There was no significant difference in incidence of short-, intermediate-, and long-term UI, SUI and UUI between five sub-groups and within different technical modifications. Although not statistically significant, the incidence of UI was higher (15%) at short-term with green-light and simple prostatectomy (95% CI 9-23 and 1-84), and higher (4%) at intermediate-term with holmium laser (95% CI 2-8). SUI was more prevalent at short-term with holmium laser (4%; 95% CI 2-5%), and at intermediate term with simple prostatectomy (3%; 95% CI 1-14). UUI was higher in the thulium group (10%, 95% CI 7-16). Increased age, surgery time, laser time and prostate size up to 80 cc were associated with higher UI. There was no correlation between postoperative PSA and UI. CONCLUSIONS There is no significant difference in incidence of UI, SUI and UUI after various PEP. Patients age, prostate size, surgery and laser time are linearly associated with UI.
Collapse
Affiliation(s)
- Mohammad Hout
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | - Aaron Gurayah
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | - Maria Camila Suarez Arbelaez
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | - Ruben Blachman-Braun
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | - Khushi Shah
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | | | - Hemendra N Shah
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA.
| |
Collapse
|
18
|
Randomized prospective trial of the severity of irritative symptoms after HoLEP vs ThuFLEP. World J Urol 2022; 40:2047-2053. [PMID: 35690952 DOI: 10.1007/s00345-022-04046-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/06/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To compare the short-term postoperative functional outcomes and severity of irritative symptoms following holmium and thulium fiber laser enucleation (HoLEP and ThuFLEP). METHODS This prospective randomized single-blinded study was performed in accordance with CONSORT. The inclusion criteria were IPSS > 20 or Qmax < 10 ml/s. Patients were randomized between HoLEP and ThuFLEP. Demographics, objective data (PSA, prostate volume, etc.), data on urinary and sexual function (IPSS, IIEF, QoL, QUID, Qmax, ICIQ-MLUTS) were collected. Detailed perioperative information and postoperative data on functional outcomes at 1, 2, 3, 4, 6, 8, 10, 12 weeks and 6 months were collected. RESULTS Data on 163 participants were included (77-HoLEP, 86-ThuFLEP). No differences were found in surgery duration; number of postoperative complications (Clavien-Dindo I-III), catheterization time and hospital stay. Functional outcomes up to 6 months didn't differ between the groups (IPPS, IIEF, QoL, QUID, ICIQ-MLUTS, Qmax, p > 0.05). Total ICIQ-MLUTS, bother and voiding scores at 1 and 3 months significantly increased compared with the baseline in both groups (p < 0.05). No difference between the groups were observed. In HoLEP the SUI series rate was 1.3% and 1.3% after 3 and 6 months following the procedure; in ThuFLEP: it was 3.5% and 2.3% respectively (p = 0.35 and p = 0.54). CONCLUSION The preliminary results of the study showed no apparent differences in functional outcomes (IPSS, Qmax), rate of SUI or irritative symptoms. Both ThuFLEP and HoLEP are efficient ways of treating benign prostatic obstruction. Both surgeries are comparable in terms of duration and postoperative complication rates.
Collapse
|
19
|
Ventimiglia E, Dehò F, Gallina A, Capogrosso P, Montorsi F. Development and validation of a nomogram for predicting early stress urinary incontinence following endoscopic enucleation of the prostate. World J Urol 2022; 40:1253-1254. [PMID: 33715075 DOI: 10.1007/s00345-021-03654-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/28/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
- Eugenio Ventimiglia
- University Vita-Salute San Raffaele, Milano, Italy.,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, 20132, via Olgettina 60, Milan, Italy
| | - Federico Dehò
- Unit of Urology, ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, Varese, Italy
| | - Andrea Gallina
- Urology Department, Ospedale Regionale Di Lugano, Università Della Svizzera Italiana, Lugano, Svizzera
| | - Paolo Capogrosso
- Unit of Urology, ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, Varese, Italy
| | - Francesco Montorsi
- University Vita-Salute San Raffaele, Milano, Italy. .,Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, 20132, via Olgettina 60, Milan, Italy.
| |
Collapse
|
20
|
Petov V, Babaevskaya D, Taratkin MS, Chuvalov L, Lusuardi L, Misrai V, Sukhanov R, Scoffone C, Enikeev D. Thulium fiber laser enucleation of the prostate (ThuFLEP). Prospective study of mid- and long-term outcomes in 1328 patients. J Endourol 2022; 36:1231-1236. [PMID: 35414204 DOI: 10.1089/end.2022.0029] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective of our study was to estimate the long-term efficacy and safety of thulium fiber laser enucleation of the prostate (ThuFLEP). MATERIALS AND METHODS We analysed patients who underwent ThuFLEP due to LUTS related to BPO. Both the pre- and perioperative data as well as the follow-up data for 3 years were evaluated: prostate volume, post-void residual (PVR), Qmax, IPSS and QoL, PSA level and the complication rate. Intraoperative data relating to the weight of resected tissue, the duration of surgery, catheterization and data on hospital stays were also collected. A sub-group analysis was performed to assess whether older patients (>65 years) or those with larger glands (>80 cc) are prone to increased complication risks. RESULTS A total of 1328 patients were included in the analysis. The mean age was 66.9±7.5 years. Mean prostate volume was 86.9±41.9 (20-330) cc. All the functional parameters (IPSS, QoL, PVR, Qmax) significantly improved after surgery (p<0.05) and showed durable improvement up to 3-years of follow-up. The frequency of late complications was as follows: stress urinary incontinence - 1.2%; urethral stricture -1.1%; bladder neck contracture - 0.9%. Sub-group analyses revealed increased UTI frequency in older patients (3.5% vs 0.8%, p=0.003) as well as higher rate of SUI (0.4% vs 1.8%, p=0.002) and higher rate of clot retention (11.3% vs 4.4%, p<0.001) in those with larger glands. CONCLUSIONS Irrespective of the patient's age and prostate volume, ThuFLEP represents an effective and durable technique of endoscopic enucleation characterized by a low incidence of complications after 3 years of follow-up. In the hands of an experienced surgeon, ThuFLEP can rightly be considered to be a promising alternative to HoLEP for treatment of LUTS associated with BPO.
Collapse
Affiliation(s)
- Vladislav Petov
- Sechenov University, Institute for Urology and Reproductive Health, Moscow, Russian Federation;
| | - Diana Babaevskaya
- Sechenov University, 68477, Institute for Clinical Medicine, Trubetskaya, 8, Moscow, Russian Federation, 119048;
| | - Mark Sergeevich Taratkin
- Sechenov University, Institute for Urology and Reproductive Health, 2/1 Bolshaya Pirogovskaya St., Moscow, Russian Federation, 119991;
| | - Leonid Chuvalov
- Sechenov University, Institute for Urology and Reproductive Health, Moscow, Russian Federation;
| | - Lukas Lusuardi
- Paracelsius Medical University, Urology and Andrology, Müllner Hauptstraße 48, Salzburg, Austria, 5020;
| | - Vincent Misrai
- Clinique Pasteur, 54918, Service d'Urologie, Toulouse, Midi-Pyrénées, France;
| | - Roman Sukhanov
- Sechenov University, 68477, Institute for Urology and Reproductive Health, Moskva, Moskva, Russian Federation;
| | - Cesare Scoffone
- Cottolengo Hospital, Division of Urology, via Cottolengo 9, Torino, Torino, Italy, 10152;
| | - Dmitry Enikeev
- I.M. Sechenov First Moscow State Medical University, Research Institute of Uronephrology and Reproductive Health, Bolshaya Pirogovskaya street 2, building 1, Moscow, Russian Federation, 119435;
| |
Collapse
|
21
|
Autorino R, Amparore D, Loizzo D, Pandolfo SD, Checcucci E, Porpiglia F. Robot-assisted Simple Prostatectomy Is Better than Endoscopic Enucleation of the Prostate. Eur Urol Focus 2022; 8:368-370. [DOI: 10.1016/j.euf.2022.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/16/2022] [Indexed: 02/08/2023]
|
22
|
Droghetti M, Porreca A, Bianchi L, Piazza P, Giampaoli M, Casablanca C, D'Agostino D, Cochetti G, Romagnoli D, Schiavina R, Brunocilla E. Long-term outcomes of Holmium laser enucleation of prostate and predictive model for symptom recurrence. Prostate 2022; 82:203-209. [PMID: 34694647 DOI: 10.1002/pros.24259] [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: 05/19/2021] [Revised: 09/20/2021] [Accepted: 10/04/2021] [Indexed: 11/10/2022]
Abstract
INTRODUCTION AND OBJECTIVES Holmium laser enucleation of prostate (HoLEP) represents one of the most studied surgical techniques for benign prostatic hyperplasia (BPH). Its efficacy in symptom relief has been widely depicted. However, few evidence is available regarding the possible predictors of symptom recurrence. We aimed to evaluate long-term outcomes, symptom recurrence rate, and predictors in patients that underwent HoLEP. MATERIALS AND METHODS We retrospectively analyzed data from patients that consecutively underwent HoLEP for BPH from 2012 to 2015 at two tertiary referral centers. Functional outcomes were evaluated by uroflowmetry parameters and International Prostate Symptom Score (IPSS) questionnaire administration at follow-up visits at 12, 24, and 60 months. The primary outcome was the symptomatic patients' rate presenting lower urinary tract symptoms (LUTS) after 60 months from surgery, defined as in case of one or more of the following: IPSS more than 7, post voidal residue (PVR) more than 20 ml, need for medical therapy for LUTS or redo surgery for bladder outlet obstruction. Multivariable logistic regression analyses evaluated predictors for being symptomatic at follow-up. Covariates consisted of: preoperative peak flow rate (PFR), PVR, and IPSS, prostate volume, age (all as continuous), and surgical technique. RESULTS A total of 567 patients were available for our analyses. Median prostate volume was 80cc, with a median PFR of 8 ml/s and median PVR of 100cc. One hundred and twenty-five (22%) patients were found to be symptomatic at follow-up. Redo surgery was needed for 25 (4.4%) patients. After adjusting for possible confounders, an increase in preoperative PVR (odds ratio [OR] 1.005) and IPSS (OR 1.12) resulted as independent predictors for symptom recurrence (all p < 0.001). CONCLUSIONS HoLEP can provide durable symptom relief regardless of the chosen technique. Patients with an important preoperative symptom burden or a high PVR should be carefully counseled on the risk of symptom recurrence.
Collapse
Affiliation(s)
- Matteo Droghetti
- Division of Urology, IRCCS Azienda ospedaliero universitaria di Bologna, Bologna, Italy
| | - Angelo Porreca
- Department of Urology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda ospedaliero universitaria di Bologna, Bologna, Italy
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda ospedaliero universitaria di Bologna, Bologna, Italy
| | - Marco Giampaoli
- Division of Urology, IRCCS Azienda ospedaliero universitaria di Bologna, Bologna, Italy
| | - Carlo Casablanca
- Division of Urology, IRCCS Azienda ospedaliero universitaria di Bologna, Bologna, Italy
| | | | | | | | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda ospedaliero universitaria di Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Division of Urology, IRCCS Azienda ospedaliero universitaria di Bologna, Bologna, Italy
| |
Collapse
|
23
|
Abbosov S, Sorokin N, Shomarufov A, Kadrev A, Nuriddinov KU, Mukhtarov S, Akilov F, Kamalov A. Bladder neck contracture as a complication of prostate surgery: Alternative treatment methods and prospects (literature review). UROLOGICAL SCIENCE 2022. [DOI: 10.4103/uros.uros_127_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
24
|
Press B, Ghiraldi E, Kim DD, Nair H, Johnson K, Kellner D. “En-Bloc” Enucleation with Early Apical Release Compared to Standard Holmium Laser Enucleation of the Prostate: A Retrospective Pilot Study During the Initial Learning Curve of a Single Surgeon. Urology 2022; 165:275-279. [DOI: 10.1016/j.urology.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/21/2021] [Accepted: 01/09/2022] [Indexed: 11/25/2022]
|
25
|
Sessa F, Campi R, Granieri S, Tuccio A, Polverino P, Spatafora P, Sebastianelli A, Cocci A, Rivetti A, Gacci M, Carini M, Serni S, Oriti R, Minervini A. Proctored Step by Step Training Program for GreenLight Laser Anatomic Photovaporization of the Prostate: A Single Surgeon's Experience. Front Surg 2021; 8:705105. [PMID: 34395511 PMCID: PMC8358301 DOI: 10.3389/fsurg.2021.705105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To evaluate the feasibility and safety of a proctored step-by-step training program for GreenLight laser anatomic photovaporization (aPVP) of the prostate. Methods: Data from patients undergoing aPVP between January 2019 and December 2020 operated by a single surgeon following a dedicated step-by-step proctored program were prospectively collected. The procedure was divided into five modular steps of increasing complexity. Preoperative patients' data as well as total operative time, energy delivered on the prostate and postoperative data, were recorded. Then, we assessed how the overall amount of energy delivered and the operative times varied during the training program. Surgical steps were analyzed by cumulative summation. Univariable and multivariable regression models were built to assess the predictors of the amount of energy delivered on the prostate. Results: Sixty consecutive patients were included in the analysis. Median prostate volume was 56.5 mL. The training program was succesfully completed with no intraoperative or meaningful post-operative complications. The energy delivered reached the plateau after the 40th case. At multivariable analysis, increasing surgeon experience was associated with lower amounts of energy delivered as well as lower operative times. Conclusions: A step-by-step aPVP training program can be safely performed by surgeons with prior endoscopic experience if mentored by a skilled proctor. Considering the energy delivered as an efficacy surrogate metrics (given its potential impact on persistent postoperative LUTS), 40 cases are needed to reach a plateau for aPVP proficiency. Further studies are needed to assess the safety of our step-by-step training modular program in other clinical contexts.
Collapse
Affiliation(s)
- Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stefano Granieri
- Azienda Socio-Sanitaria Territoriale (ASST)-Brianza, General Surgery Unit, Vimercate, Italy
| | - Agostino Tuccio
- Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Paolo Polverino
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Pietro Spatafora
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Arcangelo Sebastianelli
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Cocci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Anna Rivetti
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rino Oriti
- Unit of Urology, S.Stefano Hospital, University of Florence, Prato, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| |
Collapse
|
26
|
Bole R, Hebert KJ, Gottlich HC, Bearrick E, Kohler TS, Viers BR. Narrative review of male urethral sling for post-prostatectomy stress incontinence: sling type, patient selection, and clinical applications. Transl Androl Urol 2021; 10:2682-2694. [PMID: 34295753 PMCID: PMC8261433 DOI: 10.21037/tau-20-1459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
Male stress urinary incontinence (SUI) following prostate treatment is a devastating complaint for many patients. While the artificial urinary sphincter is the gold standard treatment for male SUI, the urethral sling is also popular due to ease of placement, lack of mechanical complexity, and absence of manual dexterity requirement. A literature review was performed of male urethral sling articles spanning the last zz20 years using the PubMed search engine. Clinical practice guidelines were also reviewed for comparison. Four categories of male urethral sling were evaluated: the transobturator AdVance and AdVance XP, the bone-anchored InVance, the quadratic Virtue, and the adjustable sling series. Well selected patients with mild to moderate urinary incontinence and no prior history of radiation experienced the highest success rates at long-term follow up. Patients with post-prostatectomy climacturia also reported improvement in leakage after sling. Concurrent penile prosthesis and sling techniques were reviewed, with favorable short-term outcomes demonstrated. Male urethral sling is a user-friendly surgical procedure with durable long-term outcomes in carefully selected men with mild stress urinary incontinence. Multiple sling types are available with varying degrees of efficacy and complication rates. Longer follow-up and larger cohort sizes are needed for treatment of newer indications such as climacturia as well as techniques involving dual placement of sling and penile prosthesis.
Collapse
Affiliation(s)
- Raevti Bole
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Boyd R. Viers
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
27
|
Transurethral Incision with Transverse Mucosal Realignment for the Management of Bladder Neck Contracture and Vesicourethral Anastomotic Stenosis. Urology 2021; 152:102-108. [PMID: 33766717 DOI: 10.1016/j.urology.2021.02.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess efficacy and safety of a novel cystoscopic technique for definitive repair of bladder neck contracture (BNC) and vesicourethral anastomotic stenosis (VUAS). METHODS A retrospective review of patients who underwent a transurethral incision with transverse mucosal realignment between July 2019 and December 2020 by a single surgeon was completed. This is novel procedure of incising a scar cystoscopically and using a laparoscopic suturing device transurethrally to bring healthy bladder mucosa across the defect, like a YV plasty. Patients were only included if they had ≥4 months follow-up. Surgical success was defined as ability to pass a 17 French flexible cystoscope through the previously stenotic segment at 4 month follow up. RESULTS Nineteen patients with a median follow-up of 6 months were included in this analysis. Etiology of posterior urethral stenosis was 53% from VUAS and 47% from BNC, with 32% of patients having prior pelvic radiation. Success was achieved in 89% of patients after 1 procedure and 100% of patients achieved success after a second procedure. There was no de novo incontinence or major complications. CONCLUSION Transurethral incision with transverse mucosal realignment for VUAS and BNC has a high success rate after only 1 procedure. This is the first reported series of an endoscopic Y-V plasty type repair for BNC and VUAS. Longer term follow up to ensure durability and reporting from other institutions will be needed to establish reproducibility.
Collapse
|
28
|
Misrai V, Herrmann TRW. Surgeon's heuristics and decision making: a BPH storytelling. World J Urol 2021; 39:2407-2408. [PMID: 33404699 DOI: 10.1007/s00345-020-03579-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/19/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Vincent Misrai
- Department of Urology, Clinique Pasteur, 31300, Toulouse, France.
| | - Thomas R W Herrmann
- Department of Urology, Spital Thurgau AG, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
| |
Collapse
|
29
|
Same Day Discharge is a Successful Approach for the Majority of Patients Undergoing Holmium Laser Enucleation of the Prostate. Eur Urol Focus 2021; 8:228-234. [PMID: 33414073 DOI: 10.1016/j.euf.2020.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/03/2020] [Accepted: 12/18/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Limited research has focused on success with hospital discharge on the same day of surgery after holmium laser enucleation of the prostate (HoLEP). OBJECTIVE To determine the success of same-day discharge in our HoLEP cohort and factors associated with this approach. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of our prospectively maintained HoLEP database demonstrated that 473 adult males underwent HoLEP from July 2018 to December 2019 at a tertiary referral center and high-volume HoLEP hospital. Patients were divided into groups according to planned inpatient admission (PIA), successful same-day discharge (SDD), or unplanned admission (UA). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The PIA, SDD, and UA groups were assessed for differences in preoperative demographic data, perioperative surgical data, and postoperative follow-up data. SDD and UA were then compared to determine if any specific factors predicted UA, including univariate and multivariate logistic regression analyses. RESULTS AND LIMITATIONS Age (p = 0.0049), use of anticoagulation (p = 0.037), American Society of Anesthesiologists score of 3-4 (p = 0.0017), and enucleation time (p=0.0178) were significantly higher in the PIA group. Morcellation time (p = 0.0059) and the rate of bedside catheter irrigation (p = 0.04) were higher in the UA group. The SDD group had the highest rate of successful voiding trial (p = 0.0001). Among the three groups, there was no difference in the rate of postoperative complications (p = 0.141). In a comparison of the SDD and UA groups, morcellation time (p = 0.041), the rate of bedside clot evacuation (p = 0.004), and successful voiding trial (p = 0.003) all favored SDD. There was no difference in 90-d complications (p = 0.536). A limitation is the retrospective nature of this study. CONCLUSIONS HoLEP can be successfully performed as day surgery without an increase in postoperative complications. HoLEP as day surgery is possible for any patient who does not require admission for medical comorbidities. PATIENT SUMMARY Same-day discharge (SDD) after holmium laser enucleation of the prostate (HoLEP) is possible and is successful in 87.4% of patients. Patients with longer morcellation times and with post-procedure hematuria with clots are more likely to have an unplanned admission. Use of a 120-W modulated-pulse laser resulted in a higher rate of SDD success. The culture change to day surgery is time-intensive owing to education of the postsurgical care units and clinic staff, and in our experience took approximately 9 mo to seamlessly integrate SDD as our HoLEP standard of care.
Collapse
|
30
|
Montorsi F, Ventimiglia E, Capogrosso P, Briganti A, Salonia A. Re: Thulium Laser Transurethral Vaporesection of the Prostate Versus Transurethral Resection of the Prostate for Men with Lower Urinary Tract Symptoms or Urinary Retention (UNBLOCS): A Randomised Controlled Trial. Eur Urol 2020; 79:316-317. [PMID: 33309032 DOI: 10.1016/j.eururo.2020.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Department of Urology, ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, Varese, Italy
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| |
Collapse
|
31
|
Kretschmer A, Mazzone E, Barletta F, Leni R, Heidegger I, Tsaur I, van den Bergh RCN, Valerio M, Marra G, Kasivisvanathan V, Buchner A, Stief CG, Briganti A, Montorsi F, Tilki D, Gandaglia G. Initial Experience with Radical Prostatectomy Following Holmium Laser Enucleation of the Prostate. Eur Urol Focus 2020; 7:1247-1253. [PMID: 32962962 DOI: 10.1016/j.euf.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/12/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although an increasing number of prostate cancer (PCa) patients received holmium laser enucleation of the prostate (HoLEP) previously for benign prostatic obstruction (BPO), there is still no evidence regarding the outcomes of radical prostatectomy (RP) in this setting. OBJECTIVE To assess functional and oncological results of RP in PCa patients who received HoLEP for BPO previously in a contemporary multi-institutional cohort. DESIGN, SETTING, AND PARTICIPANTS A total of 95 patients who underwent RP between 2011 and 2019 and had a history of HoLEP were identified in two institutions. Functional as well as oncological follow-up was prospectively assessed and retrospectively analyzed. INTERVENTION RP following HoLEP compared with RP without previous transurethral surgery. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients with complete follow-up data were matched with individuals with no history of BPO surgery using propensity score matching. Complications were assessed using the Clavien-Dindo scale. RESULTS AND LIMITATIONS The median follow-up was 50.5 mo. We found no significant impact of previous HoLEP on positive surgical margin rate (14.0% [HoLEP] vs 18.8% [no HoLEP], p = 0.06) and biochemical recurrence-free survival (hazard ratio 0.74, 95% confidence interval [CI] 0.32-1.70, p = 0.4). Patients with a history of HoLEP had increased 1-yr urinary incontinence rates after RP. After adjusting for confounders, no significant impact of previous HoLEP was found (odds ratio [OR] 0.87, 95% CI 0.74-1.01; p = 0.07). Previous HoLEP did not hamper 1-yr erectile function recovery (OR 1.22, 95% CI 1.05-1.43; p = 0.01). Limitations include retrospective design and small sample size. CONCLUSIONS RP after previous HoLEP is surgically feasible, with low complication rates and no negative impact on biochemical recurrence-free survival. However, in a multivariable analysis, we observed significantly worse 1-yr continence rates in patients after previous HoLEP. PATIENT SUMMARY In the current study, we assessed the oncological and functional outcomes of radical prostatectomy in patients who underwent holmium laser enucleation of the prostate (HoLEP) previously due to prostatic bladder outlet obstruction. A history of HoLEP did not hamper oncological results, 1-yr continence, and erectile function recovery.
Collapse
Affiliation(s)
- Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians University of Munich, Munich, Germany.
| | - Elio Mazzone
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Barletta
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Riccardo Leni
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, Mainz University Medicine, Mainz, Germany
| | | | | | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital-Hamburg Eppendorf, Hamburg, Germany
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | |
Collapse
|