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Tonyali S, Bargen MFV, Glienke M, Ortac M, Sigle A. Simulation and quantitative evaluation of three surgical techniques of endoscopic enucleation of prostate on a realistic phantom model. World J Urol 2024; 43:39. [PMID: 39699638 DOI: 10.1007/s00345-024-05404-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 11/27/2024] [Indexed: 12/20/2024] Open
Abstract
OBJECTIVE To evaluate the impact of three different AEEP techniques on the training performance of novices using a realistic hydrogel prostate phantom model. MATERIAL AND METHODS The experimental setup utilized realistic prostate phantom model provided by the Max Planck Institute for Intelligent Systems, Germany. For the enucleation, we utilized a new solid-state pulsed thulium laser (Thulio®, Dornier MedTech, Weßling, Germany). We explored three different AEEP techniques-bilobar, trilobar, and en-bloc-repeated ten times each, totaling 30 procedures. RESULTS Median enucleation time was 9.5 min (range: 6-16), median laser time was 4.29 min (3.21-6.34), median total energy used was 25.8 kJ (19.4-38.1), and median number of laser pulses was 12.8 thousand (9.7-17). There were no significant differences in operation time, laser time, pulses, or joules among the en-bloc, two-lobe, and three-lobe techniques (p = 0.113, 0.143, 0.148, 0.141 respectively). Ultrasound evaluations showed the one-lobe technique to be superior in accuracy, smoothness, and circularity (p = 0.0002, 0.012, 0.00005 respectively) (Figs. 9, 10, 11), despite having the highest perforation rate, which was not statistically significant compared to other techniques (p = 1.4). The one-lobe technique's higher accuracy may increase the risk of perforation. In contrast, the three-lobe technique had the lowest perforation rate and removal efficiency due to its lower accuracy. CONCLUSION The en-bloc, bilobar, and trilobar enucleation techniques exhibited comparable operation times. The one-lobe method emerged as superior in terms of accuracy, smoothness, and circularity. However, it also presented the highest rate of perforation.
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Affiliation(s)
- Senol Tonyali
- Department of Urology, Istanbul University Istanbul Faculty Medicine, Istanbul, Türkiye.
- Department of Urology, University of Freiburg Medical Center, Freiburg, Germany.
- Faculty of Medicine, Department of Urology, University Medical Center Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany.
| | | | - Maximilian Glienke
- Department of Urology, University of Freiburg Medical Center, Freiburg, Germany
| | - Mazhar Ortac
- Department of Urology, Istanbul University Istanbul Faculty Medicine, Istanbul, Türkiye
| | - August Sigle
- Department of Urology, University of Freiburg Medical Center, Freiburg, Germany
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Lim EJ, Castellani D, Somani BK, Gökce MI, Fong KY, Sancha FG, Herrmann TR, Biligere S, Tursunkulov AN, Dellabella M, Sofer M, Enikeev D, Petov V, Gadzhiev N, Elterman D, Mahajan A, Socarras MR, Yunusov DS, Nasirov F, Teoh JY, Gauhar V. High-power holmium laser versus thulium fiber laser for endoscopic enucleation of the prostate in patients with glands larger than 80 ml: Results from the Prostate Endoscopic EnucLeation study group. Prostate Int 2024; 12:40-45. [PMID: 38523902 PMCID: PMC10960086 DOI: 10.1016/j.prnil.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 03/26/2024] Open
Abstract
Background Endoscopic enucleation of the prostate (EEP) has gained acceptance as an equitable alternative to transurethral resection of the prostate for benign prostate hyperplasia (BPH). Our primary aim is to compare peri-operative outcomes of EEP using thulium fiber laser (TFL) against high-power holmium laser (HPHL) in hands of experienced surgeons for large prostates (≥80 ml in volume). Secondary outcomes were assess complications within 1 year of follow up. Materials and Methods We retrospectively reviewed patients with benign prostatic hyperplasia who underwent EEP with TFL or HPHL in 13 centers (January 2019-January 2023). Patients with prostate volume ≥80 ml were included, while those with concomitant prostate cancer, previous prostate/urethral surgery, and pelvic radiotherapy were excluded. Results Of 1,929 included patients, HPHL was utilized in 1,459 and TFL in 470. After propensity score matching (PSM) for baseline characteristics, 247 patients from each group were analyzed. Overall operative time (90 [70, 120] vs. 52.5 [39, 93] min, P < 0.001) and enucleation time (90 [70, 105] vs. 38 [25, 70] min, P < 0.001) were longer in the TFL group, with comparable morcellation time (13 [10, 19.5] vs. 13 [10, 16.5] min, P = 0.914). In terms of postoperative outcomes, there were no differences in 30-day complications such as acute urinary retention, urinary tract infection or sepsis. In the PSM cohort, univariable analyses showed that higher age, lower preoperative Qmax, higher preoperative PVRU, and longer operation time were associated with higher odds of postoperative incontinence, while 2-lobe enucleation had lower odds of incontinence compared to 3-lobe enucleation. Conclusions This real-world study reaffirms that HPHL and TFL in large prostates are equally efficacious in terms of 30-day complications. TFL with the en-bloc technique has a shorter operative time which significantly improves short- and medium-term functional outcomes.
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Affiliation(s)
- Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Mehmet I. Gökce
- Department of Urology, Ankara University, School of Medicine, Ankara, Turkey
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Fernando G. Sancha
- Department of Urology and Robotic Surgery, ICUA-Clínica CEMTRO, Madrid, Spain
| | - Thomas R.W. Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Sarvajit Biligere
- Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore
| | | | | | - Mario Sofer
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dmitry Enikeev
- Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Vladislav Petov
- Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Nariman Gadzhiev
- Department of Urology, Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | - Dean Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Abhay Mahajan
- Department of Urology, Sai Urology Hospital and MGM Medical College, Aurangabad, India
| | - Moises R. Socarras
- Department of Urology and Robotic Surgery, ICUA-Clínica CEMTRO, Madrid, Spain
| | | | - Furkat Nasirov
- Urology Department, Tashkent Medical Academy, Uzbekistan
| | - Jeremy Y.C. Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore
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