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Khanmammadova N, Jiang JF, Gomez RKM, Gao A, Chu TY, Shahait M, Myklak K, Lee DI, Das AK. Propensity Score Matching Analysis of Differential Outcomes in Holmium Laser Enucleation of the Prostate vs. Robotic-Assisted Simple Prostatectomy. J Clin Med 2024; 13:5135. [PMID: 39274350 PMCID: PMC11396548 DOI: 10.3390/jcm13175135] [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: 06/25/2024] [Revised: 08/20/2024] [Accepted: 08/27/2024] [Indexed: 09/16/2024] Open
Abstract
Background & Objectives: Patients with bladder outlet obstruction (BOO) due to massive prostate enlargement have several surgical treatment options, such as robot-assisted simple prostatectomy (RASP) and holmium laser enucleation of the prostate (HoLEP). Postoperative outcomes may differ between those undergoing RASP and HoLEP. RASP has been associated with a lower incidence of transient stress urinary incontinence (SUI), while HoLEP allows for shorter catheterization times. Here, we report on our experience with both surgical modalities. Methods: Data were collected from prospectively maintained databases for 37 RASP patients and 181 HoLEP patients treated from July 2021 to November 2023. To control for selection bias, propensity score matching (PSM) was utilized based on age and prostate size. We compared patients' preoperative, perioperative, and postoperative outcomes both before and after applying PSM. Results: Before the PSM, the median prostate size was significantly lower in the HoLEP group (p < 0.001). The HoLEP group also had significantly shorter operative times (p ≤ 0.001) and lower weights of resected adenoma (p ≤ 0.001). After the PSM of 31 RASP and 31 HoLEP patients, all baseline patient characteristics were comparable. No significant differences were observed in operation time (p = 0.140) or in the weight of resected adenoma (p = 0.394) between the modalities. The median (IQR) length of catheterization was significantly shorter in the HoLEP group (1 [1-4] days) compared to the RASP group (7 [7-8] days), in both pre- and post-matching analyses (p ≤ 0.001 for both), reflecting the standard of practice. In contrast, in both pre- and post-PSM analyses, the average hospital stay was significantly shorter in the RASP cohort, as same-day discharge is standard in our center, whereas the HoLEP cohort required overnight stays due to routine continuous bladder irrigation before discharge (p < 0.001 for all). Notably, the SUI rates and American Urological Association (AUA) symptom scores were comparable at 3 months within both matched and unmatched cohorts (pre-PSM: p = 0.668, p = 0.083; post-PSM: p = 1, p = 0.152, respectively). Conclusions: Our comparative analysis indicates that both RASP and HoLEP yield similar outcomes, including SUI rates, at 3 months. While HoLEP provided shorter durations of postoperative catheterization, RASP offered shorter hospital stays.
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Affiliation(s)
- Narmina Khanmammadova
- Department of Urology, University of California Irvine, 3800 W Chapman Ave., Suite 7200, Orange, CA 92868, USA
| | - James F Jiang
- Department of Urology, University of California Irvine, 3800 W Chapman Ave., Suite 7200, Orange, CA 92868, USA
| | - Ralph Kevin Medina Gomez
- Department of Urology, University of California Irvine, 3800 W Chapman Ave., Suite 7200, Orange, CA 92868, USA
| | - Ashley Gao
- Department of Urology, University of California Irvine, 3800 W Chapman Ave., Suite 7200, Orange, CA 92868, USA
| | - Timothy Young Chu
- Department of Urology, University of California Irvine, 3800 W Chapman Ave., Suite 7200, Orange, CA 92868, USA
| | - Mohammed Shahait
- School of Medicine, University of Sharjah, Sharjah 26666, United Arab Emirates
| | - Kristene Myklak
- Department of Urology, University of California Irvine, 3800 W Chapman Ave., Suite 7200, Orange, CA 92868, USA
| | - David I Lee
- Department of Urology, University of California Irvine, 3800 W Chapman Ave., Suite 7200, Orange, CA 92868, USA
| | - Akhil K Das
- Department of Urology, University of California Irvine, 3800 W Chapman Ave., Suite 7200, Orange, CA 92868, USA
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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.
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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
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Krishnamoorthi R, Ganapathy A A, Hari Priya VM, Kumaran A. Future aspects of plant derived bioactive metabolites as therapeutics to combat benign prostatic hyperplasia. JOURNAL OF ETHNOPHARMACOLOGY 2024; 330:118207. [PMID: 38636573 DOI: 10.1016/j.jep.2024.118207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 04/20/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Benign prostatic hyperplasia (BPH), characterized by prostate enlargement due to cell proliferation, is a common urinary disorder in men over 50, manifesting as lower urinary tract symptoms (LUTS). Currently, several therapeutic options are accessible for treating BPH, including medication therapy, surgery and watchful waiting. Conventional drugs such as finasteride and dutasteride are used as 5α-reductase inhibitors for the treatment of BPH. However long-term use of these drugs is restricted due to their unpleasant side effects. Despite the range of available medical therapies, the effective treatment against BPH is still inadequate. Certain therapeutic plants and their phytochemicals have the aforementioned goals and work by regulating this enzyme. AIM OF THE STUDY This review aims to provide a comprehensive insight to advancements in diagnosis of BPH, modern treatment methods and the significance of ethnobotanically relevant medicinal plants as alternative therapeutics for managing BPH. MATERIAL AND METHODS A thorough and systematic literature search was performed using electronic databases and search engines such as PubMed, Web of Science, NCBI and SciFinder till October 2023. Specific keywords such as "benign prostatic hyperplasia", "medicinal plants", "phytochemicals", "pharmacology", "synergy", "ethnobotany", "5-alpha reductase", "alpha blocker" and "toxicology". By include these keywords, a thorough investigation of pertinent papers was assured, and important data about the many facets of BPH could be retrieved. RESULTS After conducting the above investigation, 104 herbal remedies were found to inhibit Phosphodiesterase-5 (PDE-5) inhibition, alpha-blockers, or 5α -reductase inhibition effects which are supported by in vitro, in vivo and clinical trial studies evidence. Of these, 89 plants have ethnobotanical significance as alpha-blockers, alpha-reductase inhibition, or PDE-5 inhibition, and the other fifteen plants were chosen based on their ability to reduce BPH risk factors. Several phytocompounds, including, rutaecarpine, vaccarin, rutin, kaempferol, β-sitosterol, quercetin, dicaffeoylquinic acid, rutaevin, and phytosterol-F have been reported to be useful for the management of BPH. The use of combination therapy offers a strong approach to treating long-term conditions compare to single plant extract drugs. Furthermore, several botanical combinations such as lycopene and curcumin, pumpkin seed oil and saw palmetto oil, combinations of extracts from Funtumia africana (Benth.) Stapf and Abutilon mauritianum (Jacq.) Medik., and Hypselodelphys poggeana (K.Schum.) Milne-Redh. and Spermacoce radiata (DC.) Sieber ex Hiern are also supported through in vitro and in vivo studies for managing BPH through recuperation in patients with chronic long-term illnesses, as measured by the International Prostate Symptom Score. CONCLUSION The review proposes and endorses careful utilization of conventional medications that may be investigated further to discover possible PDE-5, 5 alpha-reductase, an alpha-blocker inhibitor for managing BPH. Even though most conventional formulations, such as 5 alpha-reductase, are readily available, systemic assessment of the effectiveness and mechanism of action of the herbal constituents is still necessary to identify novel chemical moieties that can be further developed for maximum efficacy. However, there exist abundant botanicals and medicinal plants across several regions of Africa, Asia, and the Americas, which can be further studied and developed for utilization as a potential phytotherapeutic for the management of BPH.
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Affiliation(s)
- Raman Krishnamoorthi
- Chemical Sciences and Technology Division, CSIR-National Institute for Interdisciplinary Science and Technology (NIIST), Thiruvananthapuram, 695 019, Kerala, India
| | - Anand Ganapathy A
- Chemical Sciences and Technology Division, CSIR-National Institute for Interdisciplinary Science and Technology (NIIST), Thiruvananthapuram, 695 019, Kerala, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - V M Hari Priya
- Chemical Sciences and Technology Division, CSIR-National Institute for Interdisciplinary Science and Technology (NIIST), Thiruvananthapuram, 695 019, Kerala, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Alaganandam Kumaran
- Chemical Sciences and Technology Division, CSIR-National Institute for Interdisciplinary Science and Technology (NIIST), Thiruvananthapuram, 695 019, Kerala, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
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Tarcan T, Acar Ö, Malde S, Sinha S, Sahai A, Perrouin-Verbe MA, Hashim H, Agro EF, Wein A, Abrams P. Can we predict whether a man with acute or chronic urinary retention will void after bladder outflow resistance reduction surgery? ICI-RS 2023. Neurourol Urodyn 2024; 43:1439-1446. [PMID: 38291822 DOI: 10.1002/nau.25404] [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: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 02/01/2024]
Abstract
AIMS To address the predictive factors of a successful voiding after bladder outflow resistance reduction surgery (BORRS) in men presenting with acute or chronic urinary retention (UR). METHODS A think tank (TT) of ICI-RS was gathered in 2023, Bristol, UK, to discuss several aspects of the problem, such as the pathophysiology of UR, the clinical and urodynamic evaluation of men with UR and whether it is possible to predict which men will be able to successfully void after treatment with contemporary surgical options. RESULTS The TT agreed that successful voiding after BORRS depends on several factors but that a strong recommendation cannot be made regarding preoperative evaluation and whether there are predictive factors of success because of the heterogeneity of patients and methodology in published trials. The diagnosis of obstruction in men with UR may be challenging when there is apparent reduced detrusor contraction during urodynamic studies. Even in the absence of bladder contractility there is documentation of such cases that have voided adequately after BORRS. Still, detrusor underactivity and inadequate relief of prostatic obstruction are the main causes of an unsuccessful voiding after BORRS. Conventional resection and enucleation methods remain the most successful surgeries in relieving UR in men, whereas the efficacy of minimally invasive surgical treatments needs to be assessed further. CONCLUSION Research is needed to understand the pathophysiology of UR and the predictors of successful voiding after different types of BORRS in men with UR.
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Affiliation(s)
- Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
| | - Ömer Acar
- Department of Urology, Koc University School of Medicine, Istanbul, Turkey
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust and King's College, London, UK
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | - Arun Sahai
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust and King's College, London, UK
| | | | - Hashim Hashim
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Enrico Finazzi Agro
- Department of Surgical Sciences, University of Rome Tor Vergata and Urology Unit, Policlinico Tor Vergata University Hospital, Rome, Italy
| | - Alan Wein
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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Watanabe K, Otsuka A, Kitagawa Y, Sano A, Sato R, Matsushita Y, Watanabe H, Tamura K, Motoyama D, Ito T, Takada S, Miyake H. Preoperative factors predicting poor therapeutic efficacy of holmium laser enucleation of the prostate in patients with benign prostatic hyperplasia. Low Urin Tract Symptoms 2024; 16:e12530. [PMID: 39011581 DOI: 10.1111/luts.12530] [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: 01/20/2024] [Revised: 06/27/2024] [Accepted: 06/25/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES We assessed preoperative factors predicting the poor therapeutic efficacy of holmium laser enucleation of the prostate (HoLEP) in benign prostatic hyperplasia (BPH) patients. METHODS The present study included 159 patients who underwent HoLEP between August 2015 and June 2021 at our institution. Overall therapeutic efficacy was divided into good and poor therapeutic efficacies according to changes in the international prostate symptom score (IPSS), IPSS quality of life (IPSS-QOL), and the maximum urinary flow rate. Patients were divided into good and poor therapeutic efficacy groups based on findings obtained 3 months after HoLEP, and comparative assessments were performed between the two groups. RESULTS The therapeutic efficacy of HoLEP was poor in 53 (33.3%) out of 159 patients. Intravesical prostatic protrusion (IPP), IPSS, IPSS-QOL, post-void residual volume (PVR), and the presence of overactive bladder (OAB) were significantly higher in the poor therapeutic efficacy group than in the good therapeutic efficacy group. A multivariable analysis of several factors identified the preoperative presence of OAB and short IPP as independent risk factors for the poor therapeutic efficacy of HoLEP. When treatment efficacy was divided according to risk factors, poor therapeutic efficacy was observed in only 14% of patients with prolonged IPP and the absence of OAB. CONCLUSIONS The therapeutic efficacy of HoLEP may be poor in patients with OAB and short IPP, resulting in the significant deterioration of lower urinary tract symptoms. Accordingly, it is important to consider the presence or absence of OAB and IPP measurements when selecting indications for HoLEP.
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Affiliation(s)
- Kyohei Watanabe
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsushi Otsuka
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuichi Kitagawa
- Department of Urology, JA Shizuoka Kohseiren Enshu Hospital, Hamamatsu, Japan
| | - Asuka Sano
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Ryo Sato
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuto Matsushita
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiromitsu Watanabe
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Keita Tamura
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Daisuke Motoyama
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
- Department of Developed Studies for Advanced Robotic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Toshiki Ito
- Department of Urology, Fujieda Municipal General Hospital, Fujieda, Japan
| | - Sanki Takada
- Department of Urology, JA Shinshiro Municipal Hospital, Hamamatsu, Japan
| | - Hideaki Miyake
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Hines L, Mali K, Campbell T, Jain R, Quarrier SO. Advancing Holmium Laser Enucleation of the Prostate Outcomes Reporting: An Assessment of Patient-Reported Outcomes in the Literature. Urology 2024; 187:147-153. [PMID: 38442790 DOI: 10.1016/j.urology.2024.02.045] [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: 12/12/2023] [Revised: 01/22/2024] [Accepted: 02/28/2024] [Indexed: 03/07/2024]
Abstract
Holmium laser enucleation of the prostate (HoLEP) is a size-independent option for benign prostatic hyperplasia surgical management. Since lower urinary tract symptoms (LUTS) are a quality-of-life issue, studies should prioritize patient-reported outcomes (PROs). This HoLEP review assesses PROs inclusion in the top 20 cited HoLEP studies and defines their limitations. PROs were categorized by domain: LUTS, incontinence, sexual function, pain, hematuria, and patient satisfaction. On review, no top-cited study included all PRO domains. The nuanced patient experience after HoLEP could be better defined via standardized utilization of validated PROs, while also improving comparability between HoLEP studies.
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Affiliation(s)
- Laena Hines
- Department of Urology, University of Rochester Medical Center, Rochester, NY.
| | - Kaela Mali
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Timothy Campbell
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - Rajat Jain
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - Scott O Quarrier
- Department of Urology, University of Rochester Medical Center, Rochester, NY
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Schumacher S, Marghawal D, Brunken C, Herzberg J. Patient reported outcome and quality of life measured by a simple questionnaire in patients with symptomatic benign prostate hyperplasia treated by holmium laser enucleation of the prostate (HoLEP). Front Surg 2024; 11:1358701. [PMID: 38389860 PMCID: PMC10881724 DOI: 10.3389/fsurg.2024.1358701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/15/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction Holmium Laser Enucleation of the Prostate (HoLEP) is established as an effective transurethral treatment option for LUTS due to BPH with improved postoperative outcome. The aim of this study was to evaluate the medium-term results by patient reported outcome measurement and to detect potential risk factors for postoperative complications or impaired outcome. Methods We performed a retrospective single-center cohort study including all patients undergoing HoLEP in the study center between April 2019 and December 2021. Therefore, perioperative parameters and postoperative outcome was documented and all patients were asked for their outcome (PROM), complications, IPSS, QoL and changes in sexual and continence function by a questionnaire at a single time point. Results In the study period, a total of 541 patients with a mean age of 72.5 ± 8.4 years were treated by HoLEP in the study center. 71.7% of the questionnaires were returned after a mean observation period of 14.9 ± 6.3 month. 91% of the patients reported to the single-timepoint questionnaire reporting a good satisfaction with the procedure and a low postoperative complication rate. The international prostate symptom score could be reduced significantly to 6.2 ± 5.7 (preoperative 19.0 ± 7.2; p < 0.001). Patients with an ASA score ≥ 3, prostate volume > 80 ml, medication with platelet inhibitors or DOAK or preoperative need of an indwelling catheter didn't show an increased complication rate. Conclusion The overall satisfaction with the procedure and its results are high. We could not identify any independent risk factors for postoperative complications after HoLEP. The used questionnaire is a simple tool for postoperative patient reported outcome measurement with a good correlation to clinical parameters.
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Affiliation(s)
| | - David Marghawal
- Department of Urology, Krankenhaus Reinbek St. Adolf-Stift, Reinbek, Germany
| | - Claus Brunken
- Department of Urology, Krankenhaus Reinbek St. Adolf-Stift, Reinbek, Germany
| | - Jonas Herzberg
- Department of Surgery, Krankenhaus Reinbek St. Adolf-Stift, Reinbek, Germany
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Wymer KM, Thao V, Narang G, Sharma V, Borah BJ, Cheney S, Humphreys MR. Evaluation of Private Payer and Patient Out-of-Pocket Costs Associated With the Surgical Management of Benign Prostatic Hyperplasia. Urology 2024; 184:87-93. [PMID: 38065310 DOI: 10.1016/j.urology.2023.10.038] [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: 05/18/2023] [Revised: 09/28/2023] [Accepted: 10/14/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE To evaluate and compare the financial burden of various surgical interventions for the management of benign prostatic hyperplasia (BPH). METHODS We identified commercially insured men with a diagnosis of BPH who underwent a procedure of interest (simple prostatectomy (SP), transurethral resection of the prostate (TURP), holmium laser enucleation of the prostate (HoLEP), photovaporization of the prostate (PVP), prostatic urethral lift (PUL), or water vapor thermal therapy (WVTT)) between 2015 and 2021 with the OptumLabs Data Warehouse. Primary outcome was total health care costs (THC) which included both patient out-of-pocket (OOP) and health plan paid costs for the index procedure and combined follow-up years 1-5. A generalized linear model was used to estimate adjusted costs controlling for demographic and clinical characteristics. Patients undergoing WVTT were excluded from extended follow-up analyses due to limited data. RESULTS Among 25,407 patients with BPH, 10,117 (40%) underwent TURP, 6353 (25%) underwent PUL, 5411 (21%) underwent PVP, 1319 (5%) underwent SP, 1243 (5%) underwent WVTT, and 964 (4%) underwent HoLEP. Index procedure costs varied significantly with WVTT being the least costly [THC: $2637 (95% confidence interval (CI): $2513-$2761)], and SP being the costliest [THC: $14,423 (95% CI: $12,772-$16,075)]. For aggregate index and 5-year follow-up costs, HoLEP ($31,926 [95% CI: $29,704-$34,148]) was the least costly and PUL ($36,596 [95% CI: $35,369-37,823]) was the costliest. CONCLUSION BPH surgical treatment is associated with significant system-level health care costs. The level of impact varies between procedures. Minimally invasive options, such as WVTT, may offer initial cost reductions; however, HoLEP and SP are associated with lower follow-up costs.
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Affiliation(s)
- Kevin M Wymer
- Department of Urology, Mayo Clinic, Rochester, MN; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN.
| | - Viengneesee Thao
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN
| | - Gopal Narang
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Bijan J Borah
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN
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Liu K, Zhao X, Xiao R, Zhao L, Xiao C, Zhang S, Ma L. Factors predicting indistinct plane of surgical capsule in patients underwent HoLEP procedures. World J Urol 2024; 42:26. [PMID: 38206399 DOI: 10.1007/s00345-023-04736-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/01/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To evaluate factors that effectively predict indistinct plane (IP) in patients who underwent holmium laser enucleation of the prostate (HoLEP). METHODS Data of 208 consecutive patients from our HoLEP database were reviewed and analyzed. IP was defined in 107 cases, as the plane could be identified only depending on endoscopic beak dissection rather than laser dissection in the initial stage of HoLEP, whereas the control group consisted of 101 cases. Variables including age, body mass index, prostatic volume (PV), intravesical prostatic protrusion, prostate-specific antigen, prostate-specific antigen density, bladder stones, urinary tract infection, microscopic hematuria, prior biopsy (PB), diabetes, hypertension, history of acute urinary retention, 5-alpha reductase inhibitor treatment, catheter dependency, residual urine, region, smoking, and alcohol consumption were compared between the two groups. The risk factors for predicting the presence of IP were determined using a multivariable binary logistic regression model using a forward selection approach with a focus on improvement in the area under the receiver operating characteristic curve (AUC). RESULTS The incidence of IP was 51.4% (107/208). PV (OR = 0.977, p < 0.001) and PB (OR = 0.297, p = 0.028) were identified as the independent predictors of capsule plane status. PV with a cutoff of 54 ml had the best predictive effectiveness for IP based on AUC (0.727; 95% CI 0.659-0.795). The specificity and sensitivity of this cutoff were 82.2% and 53.3%, respectively. CONCLUSION PV is the most reliable factor to predict IP during HoLEP procedures. There is a high possibility of IP in patients with a PV less than 54 ml.
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Affiliation(s)
- Ke Liu
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China
| | - Xun Zhao
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China
| | - Ruotao Xiao
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China
| | - Lei Zhao
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China
| | - Chunlei Xiao
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China.
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China
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10
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Dean NS, Lee MS, Assmus MA, Guo J, Xu P, McDonald A, Fadl-Alla A, Helin J, Krambeck AE. Does Resectoscope Sheath Size Influence Holmium Laser Enucleation of the Prostate Outcomes? A Prospective Randomized Controlled Trial. J Endourol 2023; 37:1261-1269. [PMID: 37786336 DOI: 10.1089/end.2023.0383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Introduction: Holmium laser enucleation of the prostate (HoLEP) is routinely performed with a 24F, 26F, or a 28F scope. Proponents of the larger scopes propose that a bigger sheath size allows for superior flow and visibility leading to a more efficient operation and better hemostasis. Those utilizing the smaller scopes suggest that the smaller sheath is less traumatic, resulting in lower stricture rates and temporary incontinence. We sought to compare outcomes of ambulatory HoLEP using the 24F and 28F laser scope. Materials and Methods: From May 2022 to March 2023, we randomized patients undergoing HoLEP (<200 cm3 in size) 1:1 to either a 24F or 28F scope. The primary outcome was differences in surgical duration between groups (minutes). Secondary outcomes included surgeon scope evaluation and postoperative patient results. Results: There was no difference in patient characteristics in those randomized to 28F (n = 76) vs 24F (n = 76) (p > 0.05) scopes. Procedural duration and efficiencies were not different between groups (all p > 0.05). The 28F scope was associated with improved surgeon-graded irrigation flow and visibility (p < 0.001). Patients treated with the 28F scope were more likely to achieve effective same-day trial of void (SDTOV) (28F 94.3% vs 24F 82.1%, p = 0.048) and have a shorter length of stay (LOS) (28F 7.0 vs 24F 11.9 hours, p = 0.014), however, rates of same-day discharge (SDD) were not statistically different (28F 87.8% vs 24F 78.4%, p = 0.126). There was no difference between the cohorts in rates of 90-day emergency room presentations, re-admissions, complications, or functional ouctomes (p > 0.05). Conclusions: We identified no clear advantage of scope size with regard to intraoperative or postoperative outcomes at 3-month follow-up due to scope size. However, if SDD is part of your postoperative pathway, the 28F scope may shorten LOS and increase rates of effective SDTOV. Clinicaltrials.gov: NCT05308017.
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Affiliation(s)
- Nicholas S Dean
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew S Lee
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Urology, Ohio State University, Columbus, Ohio, USA
| | - Mark A Assmus
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Urology, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Jenny Guo
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Perry Xu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alyssa McDonald
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alla Fadl-Alla
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jessica Helin
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amy E Krambeck
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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11
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Spinos T, Tatanis V, Liatsikos E, Kallidonis P. Same-day catheter removal after holmium laser enucleation of the prostate (HoLEP): a systematic review. World J Urol 2023; 41:3503-3510. [PMID: 37878061 DOI: 10.1007/s00345-023-04655-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/22/2023] [Indexed: 10/26/2023] Open
Abstract
PURPOSE To summarize all existing evidence regarding the feasibility, safety, and efficacy of same-day trial of void and catheter removal after Holmium Laser Enucleation of the Prostate (HoLEP). Although there have been many reports of the safety and efficacy of same-day discharge from the hospital for selected patients undergoing HoLEP, in most of these reports, patients return to the hospital, usually on postoperative day one, to undergo a trial of void and catheter removal. METHODS PubMed®, Scopus®, and Cochrane® primary databases were systematically screened, from inception to 17 January 2023. The search strategy used the PICO (Patient, Intervention, Comparison, Outcomes) Framework. We followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS Six studies met all the predefined criteria and were included in the final qualitative synthesis. Four studies were retrospective and two were prospective. Four studies were non-comparative, while two were comparative ones. The same-day catheter removal success rate ranged from 85.5 to 90% among studies, while only one grade-IIIb Clavien-Dindo complication was reported, which was unrelated to surgery. CONCLUSION Same-day catheter removal is a feasible, safe, and efficient approach for selected patients undergoing HoLEP. Certain factors, such as intraoperative furosemide administration, were found to improve same-day catheter-free rates, while preoperative PVR and urinary retention were independent predictive factors of same-day trial of void failure.
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Affiliation(s)
- Theodoros Spinos
- Department of Urology, University of Patras Hospital, 26504, Patras, Greece
| | - Vasileios Tatanis
- Department of Urology, University of Patras Hospital, 26504, Patras, Greece
| | - Evangelos Liatsikos
- Department of Urology, University of Patras Hospital, 26504, Patras, Greece
- Department of Urology, Medical University of Vienna, 1090, Vienna, Austria
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12
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Banno T, Nakamura K, Ozaki A, Kouchi Y, Ohira T, Shimmura H. A Propensity Score-Matched Analysis of Perioperative Outcomes of Holmium Laser Enucleation of the Prostate Between Lumenis Pulse 120H and VersaPulse Select 80W. J Endourol 2023; 37:1043-1048. [PMID: 37427433 DOI: 10.1089/end.2022.0804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Objectives: Holmium laser enucleation of the prostate (HoLEP) is a valid and safe procedure for the treatment of benign prostatic hyperplasia. This study aimed to examine the perioperative outcomes of HoLEP using a new laser platform, Lumenis Pulse™ 120H, and a previous laser platform, VersaPulse Select 80W. Methods: A total of 612 patients who underwent holmium laser enucleation were enrolled, including 188 and 424 patients who underwent enucleation using Lumenis Pulse 120H and VersaPulse Select 80W, respectively. They were matched using propensity scores with preoperative patient characteristics, and the differences between the two groups, including operative time, enucleated specimen, transfusion rate, and complication rate, were examined. Results: Propensity score-matched cohort comprised 364 patients with 182 in the Lumenis Pulse 120H group (50.0%) and 182 in the VersaPulse Select 80W group (50.0%). Operative time was significantly shorter with Lumenis Pulse 120H (55.2 ± 34.4 vs 101.4 ± 54.3 minutes, p < 0.001). In contrast, no significant differences were seen in resected specimen weight (43.8 ± 29.8 vs 39.6 ± 22.6 g, p = 0.36), rate of incidental prostate cancer (7.7% vs 10.4%, p = 0.36), transfusion rate (0.6% vs 1.1%, p = 0.56), and perioperative complication rates, including urinary tract infection, hematuria, urinary retention, and capsular perforation (5.0% vs 5.0%, 4.4% vs 2.7%, 0.5% vs 4.4%, 0.5% vs 0%, respectively, p = 0.13). Conclusions: Lumenis Pulse 120H improved the operative time significantly, which is regarded as one of the disadvantages of HoLEP.
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Affiliation(s)
- Taro Banno
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | - Kazutaka Nakamura
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | - Akihiko Ozaki
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | - Yukiko Kouchi
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
| | | | - Hiroaki Shimmura
- Department of Urology, Jyoban Hospital of Tokiwa Foundation, Iwaki, Japan
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13
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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.
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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.
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14
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Yoon HS, Chung DH, Cho SY, Cho MC, Paick JS, Oh SJ. Risk Factors of Salvage Procedure for Refractory Morcellation During Holmium Laser Enucleation of the Prostate. Int Neurourol J 2023; 27:200-206. [PMID: 37798887 PMCID: PMC10556432 DOI: 10.5213/inj.2346076.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/22/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE We aimed to identify the risk factors for salvage procedure (SP) required for refractory adenomatous tissue resistant to morcellation during holmium laser enucleation of the prostate (HoLEP). METHODS Patients who underwent HoLEP between January 2010 and April 2020 at Seoul National University Hospital were analyzed. SPs were defined as cases of conversion to resection of the prostatic tissue using an electrosurgical loop after morcellation or secondary morcellation a few days after surgery or conversion to open cystotomy. RESULTS Among a total of 2,427 patients, 260 were identified as having SP (SP group) (transurethral resection-nodule [n = 250, 96.1%], secondary morcellation a few days after surgery [n = 9, 3.5%], and conversion to open cystotomy [n = 1, 0.4%]). Patients in the SP group were older and had higher 5-α reductase inhibitors use, higher prostate-specific antigen, larger total prostate volume, and larger transition zone volume (TZV) than those in the non-SP group. In the multivariable logistic regression analysis, only age and TZV were associated with SP. Compared to 40s and 50s, the odds ratios (ORs) were 3.84 in 60s (95% confidence interval [CI] 1.37-10.78, P = 0.011), 4.53 in 70s (95% CI, 1.62-12.62, P = 0.004), and 6.59 in 80s or older (95% CI, 2.23-19.46, P = 0.001). The ORs of the SP were analyzed per TZV quartile. Compared to TZV ≤ 20.3 mL, the OR was 3.75 in 32.0 mL < TZV ≤ 50.4 mL (95% CI, 2.00-7.04, P < 0.001) and 8.25 in 50.4 mL < TZV (95% CI, 4.06-16.77, P < 0.001). CONCLUSION The risk of refractory morcellation increased in patients aged > 60 years or those with TZV > 32 mL. In order to more efficiently remove these resistant adenomas, it is necessary to develop more efficient morcellators in the future.
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Affiliation(s)
- Hyun Sik Yoon
- Department of Urology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Dae Hyuk Chung
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Yong Cho
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Min Chul Cho
- Department of Urology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Seung Paick
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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15
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Wong HPN, So WZ, Tiong HY. Ho:YAG versus cold knife visual internal urethrotomy for the management of short segment urethral stricture: surgical experience and cost are potential factors. World J Urol 2023; 41:2299-2300. [PMID: 37392218 DOI: 10.1007/s00345-023-04493-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 07/03/2023] Open
Affiliation(s)
- Hoi Pong Nicholas Wong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| | - Wei Zheng So
- Department of Urology, National University Hospital, Singapore, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, Singapore, Singapore
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16
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Shelton TM, Drake C, Vasquez R, Rivera M. Comparison of Contemporary Surgical Outcomes Between Holmium Laser Enucleation of the Prostate and Robotic-Assisted Simple Prostatectomy. Curr Urol Rep 2023; 24:221-229. [PMID: 36800115 PMCID: PMC9936114 DOI: 10.1007/s11934-023-01146-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE OF REVIEW This study reviews contemporary literature on RASP and HoLEP to evaluate perioperative outcomes, common complications, cost analytics, and future directions of both procedures. RECENT FINDINGS RASP is indicated for prostates > 80 mL, while HoLEP is size-independent. No notable differences were found in operative time, PSA nadir (surrogate for enucleation volume), re-catheterization rates, or long-term durability. Prolonged incontinence and bladder neck contracture rates are low for both surgeries. Patients experience similar satisfaction outcomes and improvements in uroflowmetry and post-void residual volumes. HoLEP demonstrates shorter hospitalizations, lower transfusion rates, lower costs, and higher rates of same-day discharge. RASP offers a shorter learning curve and lower rates of early postoperative urinary incontinence. HoLEP is a size-independent surgery that offers advantages for patients seeking a minimally invasive procedure with the potential for catheter-free same-day discharge. Future directions with single-port simple prostatectomy may offer parity in same-day discharge, but further research is needed to determine broader feasibility.
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Affiliation(s)
- T Max Shelton
- Department of Urology, Indiana University School of Medicine, 1801 North Senate Blvd., Indianapolis, IN, 46202, USA
| | - Connor Drake
- Department of Urology, Indiana University School of Medicine, 1801 North Senate Blvd., Indianapolis, IN, 46202, USA
- Indiana University School of Medicine, Indianapolis, USA
| | - Ruben Vasquez
- Department of Urology, Indiana University School of Medicine, 1801 North Senate Blvd., Indianapolis, IN, 46202, USA
| | - Marcelino Rivera
- Department of Urology, Indiana University School of Medicine, 1801 North Senate Blvd., Indianapolis, IN, 46202, USA.
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17
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Assmus MA, Lee MS, Helon JW, Krambeck AE. Tranexamic Acid Does Not Improve Outcomes of Holmium Laser Enucleation of the Prostate: A Prospective Randomized Controlled Trial. J Endourol 2023; 37:171-178. [PMID: 36222618 DOI: 10.1089/end.2022.0407] [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: 02/07/2023] Open
Abstract
Introduction: Tranexamic acid (TXA) is a clot promoting agent utilized during orthopedic procedures to decrease bleeding. Urologists have demonstrated the benefits of TXA in percutaneous surgery. Our objective was to assess the safety and efficacy of single-dose TXA on same-day holmium laser enucleation of the prostate (HoLEP) outcomes. Methods: From September 2021 to January 2022, we prospectively randomized 110 patients undergoing HoLEP to either 1 g of TXA after induction or no treatment. Institutional Review Board (IRB) approval (STU00215134) and registry with ClinicalTrials.gov (NCT05082142) were obtained before enrollment. Primary outcome was the rate of effective same-day discharge (SDD). Secondary outcomes included transfusion rate, same-day catheter removal, length of stay (LOS), and 90-day complications. Power analysis determined that 110 patients should be enrolled to detect a 25% difference in SDD rate. Results: There was no difference in patient demographic and prostate features between the control (n = 55) and TXA groups (n = 55; all p > 0.05). The overall rate of effective SDD was not different between the control and TXA groups (49/55 [89%] vs 51/55 [93%], p = 0.74). Median LOS (hh:mm) was not different between groups (03:07 vs 02:50, p = 0.23) with only 3/110 (2.7%) having an LOS >24 hours. Effective same-day catheter removal occurred in 99/110 (90%) patients with no difference between groups (49/55 vs 50/55, p = 0.99). There was no difference in operative parameters (time, energy, specimen weight) and postoperative complications between groups (all p > 0.05). No patients required transfusions and there were no major 90-day complications related to surgery (Clavien-Dindo ≥IIIb). Conclusion: TXA administration is safe but did not impact SDD after HoLEP.
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Affiliation(s)
- Mark A Assmus
- Department of Urology, Northwestern University, Chicago, Illinois, USA
| | - Matthew S Lee
- Department of Urology, Northwestern University, Chicago, Illinois, USA
| | - Jessica W Helon
- Department of Urology, Northwestern University, Chicago, Illinois, USA
| | - Amy E Krambeck
- Department of Urology, Northwestern University, Chicago, Illinois, USA
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18
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Wymer KM, Narang G, Slade A, Sharma V, Thao V, Borah BJ, Rivera M, Cheney S, Humphreys MR. Evaluation of the Cost-Effectiveness of Surgical Treatment Options for Benign Prostatic Hyperplasia. Urology 2023; 171:96-102. [PMID: 36270339 DOI: 10.1016/j.urology.2022.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare the cost-effectiveness of surgical interventions for BPH. METHODS Using a Markov model, a cost-utility analysis was performed comparing HoLEP, B-TURP, WVTT, and PUL for prostate size <80cc (index patient 1) and HoLEP and SP for prostate size >80cc (index patient 2). Model probabilities and utility values were drawn from the literature. Analysis was performed at a 5-year time horizon with extrapolation to a lifetime horizon. Primary outcomes included quality-adjusted life years (QALYs), 2021 Medicare costs, and incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay threshold of $100,000/QALY. Univariate and probabilistic sensitivity analyses were performed. RESULTS At 5 years, costs per patient for index patient 1 were $3292 (WVTT), $6532 (HoLEP), $6670 (B-TURP), and $10,257 (PUL). HoLEP resulted in the highest QALYs (4.66), followed by B-TURP (4.60), PUL (4.38), and WVTT (4.38). This translated to HoLEP being most cost-effective (ICER $11,847). For index patient 2, HoLEP was less costly ($6,585 vs $15,404) and more effective (4.654 vs 4.650) relative to SP. On sensitivity analysis for index patient 1, B-TURP became most cost-effective if cost of HoLEP increased two-fold or chronic stress incontinence following HoLEP increased ten-fold. When follow-up time was varied, WVTT was preferred at very short follow up (<1 year), and HoLEP became more strongly preferred with longer follow up. CONCLUSION At 5 years follow up, HoLEP is a cost-effective surgical treatment for BPH- independent of gland size.
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Affiliation(s)
- Kevin M Wymer
- Department of Urology, Mayo Clinic, Phoenix, AZ; Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | | | - Austen Slade
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN
| | - Viengneesee Thao
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN; Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Bijan J Borah
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN; Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Marcelino Rivera
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
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B-TURP versus HoLEP: Peri-Operative Outcomes and Complications in Frail Elderly (>75 y.o.) Patients: A Prospective Randomized Study. Biomedicines 2022; 10:biomedicines10123212. [PMID: 36551968 PMCID: PMC9776283 DOI: 10.3390/biomedicines10123212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Background: The aim of this study was to compare the peri-operative and functional results between trans-urethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS) in middle-old patients. Materials and Methods: This prospective single-center study included patients over 75 years old treated with B-TURP or HoLEP for BPH associated with LUTS with prostate volume (PV) <100 mL. Primary endpoints were the intra-operative blood loss, percentage of loss of hemoglobin, blood transfusion, complications, and the comparison of functional outcomes. All patients were evaluated at 1, 3, 6, and 12 months of follow-up. Results: Overall, 96 patients undergoing HoLEP and 104 B-TURP were eligible and enrolled for the study. Post-operative results showed statistically significant differences between the two groups, all in favor of HoLEP group, specifically in terms of removed prostate tissue, PV reduction rate, hemoglobin values at 24 h, hemoglobin loss, operative time, length of hospitalization, days of catheterization, and urinary flow rates. There was no significant difference in terms of postvoid residual urine volume, perioperative complication, blood transfusion, International Prostate Symptom Score (IPSS), and IPSS quality of life scores. Conclusions: In middle-old patients, the HoLEP technique represents a prostate size-independent treatment option with a more favorable safety profile defined by less bleeding, lower blood transfusions, and a significantly lower hemoglobin drop than B-TURP.
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Analysis of Holmium Laser Enucleation of Prostate Fixed Operating Room Times. Urology 2022; 168:86-89. [PMID: 35772482 DOI: 10.1016/j.urology.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate factors influencing fixed operating room time during holmium laser enucleation of the prostate. MATERIALS AND METHODS A prospective observational study was performed for all holmium laser enucleation of the prostate (HoLEP) cases performed by a single surgeon over a 24-month period. Operating room (OR) time was divided into fixed and variable time. The variable time was defined as cut-to-close time. Fixed time included in room time to anesthesia release time (IRAT), anesthesia release time to cut time (ARCT), and close time to wheels out (CTWO). The effects of time of day and anesthesia personnel (AP) changes on fixed operating room time were evaluated. RESULTS A total of 406 HoLEPs were analyzed. There was no statistically significant difference in nonprocedural OR times between morning and afternoon surgeries (IRAT, P=0.38, ARCT P=0.10, CTWO P=0.77). Median nonprocedural OR times accounted for 27% (IQR: 22%-31%) of the total procedure time in the AM group and 29% (IQR: 24%-33%) in the PM group (P=0.005). Of the HoLEPs,78.1% (178/228) experienced one or more AP changes during the procedure. The median fixed OR time was not significantly different between procedures with 1 AP and procedures with ≥2 APs (IRAT, P=0.53; ARCT, P=0.71; CTWO, P=0.98). CONCLUSIONS Fixed operating room time makes up a significant portion of HoLEP procedures and should be considered when evaluating OR efficiency. The time of day and number of anesthesia personnel involved did not affect the fixed OR times.
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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.
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Lavoie C, Levine M, Wollin T, Schuler T, De S. Repeat Imaging to Avoid Surgery: An Initiative to Reduce-Negative Ureteroscopy in Patients with Ureteral Stones. JOURNAL OF UROLOGICAL SURGERY 2022. [DOI: 10.4274/jus.galenos.2021.2021.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Koraş Ö, Gökalp F, Yıldırak E, Sigva H, Tamkaç N, Porgali S, Kulak B, Uçurmak F, Görür S. Are HoLEP Surgical Videos on YouTube Biased and Misleading or Are They Leading the Industry? JOURNAL OF UROLOGICAL SURGERY 2022. [DOI: 10.4274/jus.galenos.2021.2021.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Risk Factors for Transurethral Coagulation for Hemostasis During Holmium Laser Enucleation of the Prostate. Int Neurourol J 2022; 26:153-160. [PMID: 35793994 PMCID: PMC9260329 DOI: 10.5213/inj.2142414.207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/01/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE We aimed to identify risk factors for transurethral coagulation (TUC) using bipolar electrocautery for hemostasis during holmium laser enucleation of the prostate (HoLEP) surgery for benign prostatic hyperplasia (BPH). METHODS We analyzed the clinical outcomes of HoLEP surgery performed by a single surgeon between January 2010 and April 2020 at the Seoul National University Hospital. Patient characteristics and perioperative parameters were used to identify the risk factors for TUC. The TUC group was defined as a case of conversion to hemostasis using electrocautery during the hemostasis step after enucleation. RESULTS Of 1,563 patients, 357 underwent TUC (TUC group; 22.8%) as an adjuvant (n=299, 19.1%) or salvage (n=58, 3.7%) therapy. Patients in the TUC group were older (mean±standard deviation, 70.6±7.3 years vs. 69.3±7.0 years; P=0.002), had more 5-alpha reductase inhibitor (5-ARI) use (35.6% vs. 25.9%, P<0.001), higher serum prostate-specific antigen (PSA) (5.4 ±4.8 ng/mL vs. 3.8 ±4.5 ng/mL, P <0.001), larger total prostate volume (TPV) (89.5 ±44.7 mL vs. 66.0 ±32.6 mL, P<0.001), and larger transitional zone volume (TZV) (57.3±34.9 mL vs. 37.7±24.2 mL, P<0.001) than those who did not undergo TUC (non-TUC group). In univariate logistic regression analysis, age, 5-ARI use, PSA, TPV, and TZV correlated with TUC, whereas in multivariate logistic regression analysis, only TZV was associated with TUC. The odds ratios (ORs) of TUC were analyzed per TZV quartile. Compared to TZV<22.3 mL, the OR was 2.42 in 34.1 mL≤TZV<53.5 mL (95% confidence interval [CI], 1.58-3.72; P<0.001), 5.17 in ≥53.5 mL (95% CI, 3.44-7.77; P<0.001). CONCLUSION The risk of TUC during HoLEP surgery increases in patients with TZV >35 mL. Therefore, TUC may be potentially necessary in patients with a large transition zone volume in patients with BPH.
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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.
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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;
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The comparison study of anatomic vapor-incision technique (AVIT) using the 180W-XPS Greenlight laser and photoselective vaporization of the prostate(PVP) for the treatment of benign prostatic hyperplasia. Urology 2022; 167:191-197. [DOI: 10.1016/j.urology.2022.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/17/2022] [Accepted: 03/31/2022] [Indexed: 11/18/2022]
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Bhatia S, Acharya V, Jalaeian H, Kumar J, Bryant E, Richardson A, Malkova K, Harward S, Sinha V, Kably I, Kava BR. Effect of Prostate Artery Embolization on Erectile Function - A Single Center Experience of 167 Patients. J Sex Med 2022; 19:594-602. [PMID: 35184995 DOI: 10.1016/j.jsxm.2022.01.006] [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: 08/12/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prostate artery embolization (PAE) is an emerging therapy for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). AIM This retrospective study was conducted to assess the effect of prostate artery embolization (PAE) on erectile function in a cohort of patients with LUTS attributable to BPH at 3-months after the procedure. METHODS A retrospective review was performed on 167 patients who underwent PAE. Data collected included Sexual Health Inventory in Men (SHIM) scores at 3, 6, and 12 months post-PAE, in conjunction with the International Prostate Symptom Scores (IPSS), Quality of Life (QoL) scores, and prostate volumes. Primary outcome was erectile function as assessed by SHIM scores at 3 months after PAE. An analysis was performed to identify patients with a ±5-point SHIM change to group them according to this minimum clinically significant difference in erectile function. Adverse events were recorded using the Clavien-Dindo (CD) classification. OUTCOMES At 3 months following PAE, median IPSS decreased by 16.0 [IQR, 9.0-22.0] points, median QOL decreased by 4.0 [IQR, 2.0-5.0] points, and median prostate volume decreased by 33 g [IQR, 14-55]. RESULTS Median SHIM score was 17.0 [IQR, 12.0-22.0] at baseline, 18.0 [IQR, 14.0-23.0] at 3 months [P = .031], 19.0 [IQR, 14.5-21.5] at 6 months [P = .106] and 20 [IQR, 16.0-24.0] at 12 months [P = .010] following PAE. In patients with no erectile dysfunction (ED) at baseline, 21% (n = 9) reported some degree of decline in erectile function post-PAE. However, 38% (n = 40) of patients who presented with mild-to-moderate ED reported improvement in their erectile function 3 months following PAE. Overall, the changes in baseline SHIM score were relatively small; 82% (n = 137) of patients did not have more than 5 points of change in their SHIM scores at 3 months following PAE. CLINICAL IMPLICATIONS Our findings suggest PAE has no adverse impact on erectile function for most patients. STRENGTHS & LIMITATIONS The study was performed at a single center with 1 operator's experience, and is retrospective with no control group. CONCLUSION Findings suggest that prostate artery embolization has no adverse effect on erectile function in the majority of patients with LUTS attributable to BPH at 3 months after the procedure. Bhatia S, Acharya V, Jalaeian H, et al., Effect of Prostate Artery Embolization on Erectile Function - A Single Center Experience of 167 Patients. J Sex Med 2022;19:594-602.
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Affiliation(s)
- Shivank Bhatia
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Vedant Acharya
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Hamed Jalaeian
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Jessica Kumar
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA.
| | - Evan Bryant
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Andrew Richardson
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Kseniia Malkova
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Sardis Harward
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Vishal Sinha
- Weill Cornell Department of Radiology, New York, NY, USA
| | - Issam Kably
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Bruce R Kava
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
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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.
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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
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Assmus MA, Ganesh MB, Lee MS, Large T, Krambeck AE. Contemporary Outcomes for Patients Undergoing Concurrent Surgeries at the Time of Holmium Laser Enucleation of the Prostate Before and After Moses 2.0 BPH Mode. J Endourol 2021; 35:S8-S13. [PMID: 34910607 DOI: 10.1089/end.2021.0531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Outcomes of holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia has been well studied. As comfort with the procedure has improved, the number of concurrent surgeries performed with HoLEP has increased. Technology and technique optimization have safely transitioned HoLEP toward same-day catheter removal and discharge. We aim to assess the success and safety of transitioning toward a same-day care pathway for patients undergoing concurrent surgeries with HoLEP. Materials and Methods: With institutional review board approvals, we queried the electronic medical record and retrospective clinical registry to examine perioperative characteristics and outcomes of patients who underwent HoLEP performed by two endourologists at two centers between July 1, 2016, and June 1, 2021, in which ≥1 concurrent surgical procedure was performed. Results: There were 188 patients with an average age of 72.3 years, who underwent HoLEP with ≥1 concurrent surgical procedure within the study period. In total, 221 non-HoLEP procedures were performed with 30/188 (16.0%) undergoing ≥3 total procedures in a single operation. The four-most common concurrent procedures were cystolitholapaxy 86/221 (38.9%), ureteroscopy 57/221 (25.8%), transurethral resection of bladder tumor 14/221 (6.3%), and percutaneous nephrolithotomy 14/221 (6.3%). Postoperatively, 3 (1.6%) patients required transfusion. After transitioning to a same-day care path, the proportion of patients who had successful same-day catheter removal and same-day discharge increased (all p < 0.05). Median length of stay decreased (from 23 hours 11 minutes to 3 hours 49 minutes, p = 0.008). Our 90-day readmission rate for urology complication was 7.9%, and only 3.6% of patients undergoing concurrent stone surgery required an additional stone surgery within 90 days. The overall Clavien-Dindo ≥3b rate was 4.8% (9-3b, 0-4, 0-5). Conclusions: Advances in HoLEP technique and technology allow for safe same-day discharge for concurrent surgery performed at the time of HoLEP. Few patients were readmitted within 90 days and no patients experienced Clavien-Dindo ≥4 complications.
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Affiliation(s)
- Mark A Assmus
- Department of Urology, Northwestern University, Chicago, Illinois, USA
| | - Meera B Ganesh
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Matthew S Lee
- Department of Urology, Northwestern University, Chicago, Illinois, USA
| | - Tim Large
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amy E Krambeck
- Department of Urology, Northwestern University, Chicago, Illinois, USA
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Kim TH, Song PH. Anatomical endoscopic enucleation of bladder outlet obstruction. Yeungnam Univ J Med 2021; 39:12-17. [PMID: 34749443 PMCID: PMC8895962 DOI: 10.12701/yujm.2021.01522] [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: 09/29/2021] [Accepted: 10/18/2021] [Indexed: 12/04/2022] Open
Abstract
Anatomical endoscopic enucleation of the prostate (AEEP) differs from other endoscopic modalities for bladder outlet obstruction (BOO) because it extracts the whole benign prostatic hyperplasia component. AEEP has been launched for almost 40 years as a first-line treatment method for BOO regardless of prostate size according to several guidelines. However, it remains underperformed worldwide. In this review article, we elaborate on the advantages and disadvantages of AEEP compared to other surgical modalities for BOO to investigate its efficacy and safety as a gold standard surgical management option for males with BOO.
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Affiliation(s)
- Tae Hyo Kim
- Department of Urology, College of Medicine, Dong-A University, Busan, Korea
| | - Phil Hyun Song
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
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Sabnis RB, Mulawkar PM, Joshi RN. The Urological Society of India guidelines on management of benign prostatic hyperplasia/benign prostatic obstruction (Executive summary). Indian J Urol 2021; 37:210-213. [PMID: 34465948 PMCID: PMC8388351 DOI: 10.4103/iju.iju_121_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
| | | | - Rohit N Joshi
- Department of Urology, Aarna Superspeciality Hospital, Ahmedabad, Gujarat, India
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Whiting D, Penev B, Guest K, Cynk M. Holmium laser enucleation of the prostate: A single-centre case series of 1000 patients. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211033741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To describe the short and long-term complications of over 1000 cases of Holmium laser enucleation of the prostate (HoLEP) in a single centre. Methods: A prospective database of all HoLEP procedures performed between December 2003 and March 2017 was analysed. Results: A total of 1016 HoLEP procedures were performed. Median patient age was 72 years (range 41–95). There was a significant improvement in urinary flow, post-void residual volume, IPSS and QoL score ( p < 0.0001). Pre-operative acute urinary retention was present in 403 patients (39.7%). Post-operatively five patients (1.2%) continued with a long-term catheter. Early and late complications consisted of failed initial voiding trial (10.6%), stress incontinence (transient 6.5%; persistent 0.3%), frequency/dysuria (5.6%), urinary tract infection (5.3%), urethral stricture (4.8%), submeatal stenosis (1.9%), return to theatre (1.5%), bladder neck stenosis (1.3%), bleeding (1.2%), epididymitis (0.7%), confusion (0.3%), transurethral resection of the prostate conversion (0.2%), ureteric obstruction (0.2%), vomiting (0.2%), anuric renal failure (0.1%), chest infection (0.1%), chest pain (0.1%), myocardial infarction (0.1%), rectoprostatic fistula (0.1%), supraventricular tachycardia (0.1%) and urinary sepsis (0.1%). Five-year reoperation rate was 3.7%. Conclusion: HoLEP is a safe treatment for bladder outflow obstruction secondary to an enlarged prostate. It is associated with few early and late complications and has a low reoperation rate. Level of evidence: 4
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Affiliation(s)
- Danielle Whiting
- Department of Urology, Basingstoke and North Hampshire Hospital, UK
| | - Branimir Penev
- Department of Urology, Maidstone and Tunbridge Wells NHS Trust, UK
| | | | - Mark Cynk
- Department of Urology, Maidstone and Tunbridge Wells NHS Trust, UK
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Das A, Han TM, Rudnick B, Hardacker T, Shenot PJ, Shvero A. Holmium Laser Enucleation of the Prostate Following Previous Prostatic Urethral Lift. J Endourol 2021; 36:111-116. [PMID: 34235977 DOI: 10.1089/end.2021.0351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To determine the feasibility and operative challenges of holmium laser enucleation of the prostate (HoLEP) in patients with a previous prostatic urethral lift (PUL) procedure. MATERIALS AND METHODS A retrospective review was performed on files of all patients that underwent HoLEP at our institution between 2013 and 2021. 793 consecutive HoLEP cases were identified. Data collected included demographics, the time elapsed since previous PUL, number of PUL implants, pre-operative prostate size, intra-operative complications/challenges, and post-operative follow-up. RESULTS 22 men with a mean pre-operative prostate size of 90 grams (range 32-180 g) underwent HoLEP at a median of 14.4 months (range 2.8-48) after PUL. 63.6% (14/22) of cases involved prostates with pre-operative sizes ≥ 80 grams. Three cases involved PUL implant jamming of morcellator blades which required replacing the blades. 15 cases (68.2%) required using a grasper or a basket device to remove free PUL implants or adenoma parts with PUL implants embedded in them. One patient needed a second procedure to remove a relatively large piece of calcified adenoma. non-post-PUL HoLEP was more time efficient than post-PUL HoLEP (0.77 ml/min versus 0.55 ml/min respectively). There was no difference in functional outcome between post-PUL and non-post-PUL HoLEP cases. CONCLUSIONS While HoLEP can be performed safely and effectively in the PUL failure population, unique challenges arise. PUL implants may distort prostate anatomy, jam morcellator blades, and may be encountered in aberrant locations. Patients with borderline indications for PUL, should be aware of the possibility of performing HoLEP in case of PUL failure.
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Affiliation(s)
- Akhil Das
- Thomas Jefferson University Sidney Kimmel Medical College, 12313, Urology, Philadelphia, Pennsylvania, United States;
| | - Timothy M Han
- Thomas Jefferson University Sidney Kimmel Medical College, 12313, Urology, Philadelphia, Pennsylvania, United States;
| | - Benjamin Rudnick
- Thomas Jefferson University Sidney Kimmel Medical College, 12313, Urology, Philadelphia, Pennsylvania, United States;
| | - Thomas Hardacker
- Thomas Jefferson University Sidney Kimmel Medical College, 12313, Urology, Philadelphia, Pennsylvania, United States;
| | - Patrick J Shenot
- Thomas Jefferson University Sidney Kimmel Medical College, 12313, Urology, Philadelphia, Pennsylvania, United States;
| | - Asaf Shvero
- Thomas Jefferson University Sidney Kimmel Medical College, 12313, Urology, Philadelphia, Pennsylvania, United States.,Sheba Medical Center at Tel Hashomer, 26744, Urology, Ramat Gan, Israel.,Tel Aviv University Sackler Faculty of Medicine, 58408, Tel Aviv, Israel;
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Gury L, Mallet R, Robert G. Holmium laser en-bloc enucleation of the prostate: Bi-centric prospective evaluation of 109 consecutive cases. Prog Urol 2021; 32:121-129. [PMID: 34154962 DOI: 10.1016/j.purol.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/27/2020] [Accepted: 01/29/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Holmium laser enucleation of the prostate (HoLEP) is a validated alternative to transurethral resection of the prostate (TURP) and open prostatectomy (OP) for surgical treatment of bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH). The surgical technique may vary considerably from one surgeon to another. The three-lobe technique remains the reference procedure, but some surgeons claim "en bloc" enucleation could help to shorten enucleation time. Our objective was to prospectively assess the clinical results of "en bloc" HoLEP. METHODS Consecutive 109 patients presenting with lower urinary tract symptoms (LUTS) related to BPH and selected for surgical treatment were prospectively included in an observational clinical study. There were no exclusion criteria as long as the patient was operated on by one of the two participating surgeons. The surgeons involved had previous experience of more than 200 HoLEP cases, including more than 50 "en bloc" procedures, before starting the clinical study. Clinical data were prospectively collected in a common computerized database and analysed once the 3-month follow-up data were collected including complications, maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), the International Prostate Symptom Score (IPSS) and the Quality of life score (QoL). RESULTS Overall, 109 consecutive patients were included with median IPSS and QoL score of 20/35 and 5/6 respectively. At inclusion median prostatic size was 70mL, Qmax was 8mL/s, and PVR was160mL. The median length of the complete procedure, the enucleation and the morcellation were, respectively, 41min, 30min and 10min. The mean enucleation efficiency was 1.5g/min, and the mean morcellation efficiency was 4.5g/min. The median bladder catheterization and hospitalization length were of 18hours and 1 day respectively and 41% of patients had day-case procedure. Early post-operative complications were reported in 17 cases (16%) including 3 Clavien IIIb (bladder clot removal in the operating room). At 3-month, the IPSS and QoL decreased to 3/35 and 1/6 while Qmax and PVR improved to 26mL/s and 40mL. CONCLUSION In this bi-centric study evaluating short-term outcomes of the "en bloc" technique, the operating time was very short (41min) with excellent functional outcomes. A prospective clinical trial is necessary to confirm these results are due to the surgical technique itself and not only to the skills of the surgeons.
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Affiliation(s)
- L Gury
- Department of urology, Pellegrin hospital, Bordeaux, France.
| | - R Mallet
- Department of urology, Périgueux, France
| | - G Robert
- Department of urology, Pellegrin hospital, Bordeaux, France
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Piazza P, Bianchi L, Giampaoli M, Droghetti M, Casablanca C, Ercolino A, Beretta C, Recenti D, Balestrazzi E, Puliatti S, Rosiello G, Amato M, Romagnoli D, D'Agostino D, Gaudiano C, Golfieri R, Porreca A, Mottrie A, Schiavina R. Short Time Delay Between Previous Prostate Biopsy for Prostate Cancer Assessment and Holmium Laser Enucleation of the Prostate Correlates with Worse Perioperative Outcomes. Eur Urol Focus 2021; 8:563-571. [PMID: 33858812 DOI: 10.1016/j.euf.2021.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/08/2021] [Accepted: 04/04/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND No data are available regarding the impact of time between a previous transrectal prostate biopsy (PB) and holmium laser enucleation of the prostate (HoLEP) on perioperative outcomes. OBJECTIVE To evaluate the impact of time from PB to HoLEP on perioperative outcomes. DESIGN, SETTING, AND PARTICIPANTS A total of 172 consecutive patients treated with HoLEP within 12 mo of a single previous transrectal PB at two tertiary centers were included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients were stratified into two groups according to the median time from PB to HoLEP (namely, ≤6 and >6 mo). The primary outcome was intraoperative complications. Multivariate logistic regressions were used to identify the predictors of intraoperative complications. Linear regressions were used to test the association between the time from PB to HoLEP and intraoperative complications, enucleation efficiency, and enucleation time. RESULTS AND LIMITATIONS In total, 93 (54%) and 79 (46%) patients had PB ≤ 6 and >6 mo before HoLEP, respectively. Patients in PB ≤ 6 mo group experienced higher rates of intraoperative complications than those in PB > 6 mo group (14% vs 2.6%, p = 0.04). At multivariable analysis, time between PB and HoLEP was an independent predictor of intraoperative complications (odds ratio: 0.74; 95% confidence interval: 0.6-0.9; p = 0.006). Finally, the risk of intraoperative complications reduced by 1.5%, efficiency of enucleation increased by 4.1%, and enucleation time reduced by 1.7 min for each month passed from PB to HoLEP (all p ≤ 0.006). Selection of patients with only one previous PB represents the main limitation. CONCLUSIONS The time from PB to HoLEP of ≤6 mo is associated with a higher risk of intraoperative complications, lower enucleation efficacy, and longer enucleation time. PATIENT SUMMARY Patients with a prostate biopsy (PB) ≤6 mo before holmium laser enucleation of the prostate (HoLEP) had significantly worse outcomes than those with a PB > 6 mo before HoLEP.
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Affiliation(s)
- Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy; ORSI Academy, Melle, Belgium
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy.
| | - Marco Giampaoli
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Matteo Droghetti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Carlo Casablanca
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Amelio Ercolino
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Carlo Beretta
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Dario Recenti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Eleonora Balestrazzi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Stefano Puliatti
- ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Rosiello
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Amato
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Caterina Gaudiano
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rita Golfieri
- Università degli Studi di Bologna, Bologna, Italy; Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Angelo Porreca
- Department of Urology, Veneto Institute of Oncology IOV - IRCCS, 35128 Padua, Italy
| | | | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
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Whiting D, Penev B, Ijaaz A, Guest K, Cynk M. En bloc enucleation technique during holmium laser enucleation of the prostate: An analysis of its efficiency. Low Urin Tract Symptoms 2021; 13:372-376. [PMID: 33821575 DOI: 10.1111/luts.12379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/06/2021] [Accepted: 03/18/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Despite the acknowledgment that holmium laser enucleation of the prostate (HoLEP) is a safe, efficacious procedure with benefits over traditional treatments, it is not widely adopted. Its steep learning curve is considered responsible, and the new en bloc technique (EBT) aims to improve this. METHODS A retrospective analysis of 268 consecutive patients (215 lobe technique [LT] and 53 EBT) who underwent HoLEP between May 2016 and April 2020 was performed. Data were collected on patient demographics, prostate volume, enucleation time, prostatic weight, and length of stay. RESULTS There was no difference in mean prostate volume and enucleated prostatic weight between the LT and EBT (99.2 mL vs 98.5 mL, P = .95216, and 71.7 g vs 69.3 g, P = .92034, respectively). There was a reduction in mean enucleation time with the EBT to 37.7 minutes compared with 53.3 minutes (LT) (P < .00001). This translated to an improved operative efficiency of 1.84 g/min (EBT) compared to 1.33 g/min (LT) (P < .00001). The EBT demonstrated a continuous improvement in operative efficiency with increasing prostate size unlike the LT where efficiency plateaus. CONCLUSIONS The EBT for HoLEP demonstrates a significant improvement in operative efficiency which has the potential to reduce the surgeons' learning curve and lead to more widespread adoption.
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Affiliation(s)
| | | | - Anam Ijaaz
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | | | - Mark Cynk
- Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
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Assmus MA, Large T, Lee MS, Agarwal DK, Rivera ME, Krambeck AE. Same-Day Discharge Following Holmium Laser Enucleation in Patients Assessed to Have Large Gland Prostates (≥175 cc). J Endourol 2021; 35:1386-1392. [PMID: 33567989 DOI: 10.1089/end.2020.1218] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Holmium laser enucleation of the prostate (HoLEP) is a highly effective and durable minimally invasive surgery for benign prostatic hyperplasia. Historically, alternative treatments for large glands (≥175 cc) are associated with prolonged length of stay (LOS) and postoperative catheterization. However, advances in laser technology combined with surgical technique optimization have early evidence supporting same-day discharge. We look to examine contemporary same-day discharge outcomes for large glands. Materials and Methods: With Institutional Review Board (IRB) approval we queried our electronic medical record and retrospective clinical registry to examine perioperative outcomes of large gland (≥175 cc) prostates that underwent HoLEP with consideration for same-day discharge. Results: From December 10, 2019 to September 29, 2020 we identified 55 patients with a preoperative prostate size ≥175 cc (39 CT, 12 MRI, 4 transrectal ultrasound), of which 45 were scheduled for same-day discharge and 10 for admission. Mean preoperative prostate size was 229.9 cc (range 175-535 cc) and 36 (65.5%) were in urinary retention. Mean preoperative prostate-specific antigen (PSA) was 8.58 ng/mL, American Urological Association Symptom Score (AUASS) 22.3, and Qmax 8.8 mL/second. At 3 months postoperative follow-up mean AUASS was 6.7, PSA 0.87 ng/mL and Qmax 20.4 mL/second. All comer same-day discharge rate was 70% (38/55). Of patients planned for same-day discharge 38/45 (84%) were effective. Average LOS for all patients was 11.8 hours with catheterization of 21.2 hours. When compared with 2010 published large gland outcomes, our current LOS represents a 220% reduction. Looking specifically at patients planned for same-day discharge, average LOS and catheter duration was 8.8 and 17.0 hours, whereas LOS and catheter duration for patients planned for admission was 25.7 and 39.4 hours, respectively. Conclusions: We report the first outcomes of preoperatively planned same-day discharge for HoLEP in large glands (≥175 cc). A combination of technologic advances and optimization of technique have allowed for a safe adoption of same-day discharge, providing additional advantages over alternative large gland treatments.
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Affiliation(s)
- Mark A Assmus
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tim Large
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Matthew S Lee
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Deepak K Agarwal
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Marcelino E Rivera
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amy E Krambeck
- Department of Urology, Northwestern University, Chicago, Illinois, USA
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Malde S, Lam W, Adwin Z, Hashim H. Pharmacological and interventional treatment of benign prostatic obstruction: An evidence‐based comparative review. BJUI COMPASS 2021; 2:238-259. [PMID: 35475299 PMCID: PMC8988658 DOI: 10.1002/bco2.74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction The recommended treatment for bothersome lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) after the failure of behavioral therapy and fluid modification includes pharmacological, minimally invasive interventional, and surgical approaches. Each option has different risk and benefit profiles, and the urologist must be aware of the unique characteristics of each option in order to be able to accurately counsel the patients based on their individual values and preferences. We provide a comparative review of the commonest pharmacological and most widely performed interventional/surgical treatments for BPO, discussing the evidence for the treatment characteristics that are most useful for the practicing urologist. Methods A search of the PubMed database was performed for articles reporting on the following treatments for LUTS due to BPO: α‐blockers, 5α‐reductase inhibitors, phosphpdiesterase‐5 inhibitors, prostatic urethral lift (Urolift), convective radiofrequency water vapor thermal therapy (Rezum), Temporary implantable Nitinol Device (iTIND), prostate artery embolization (PAE), transurethral resection of the prostate (TURP), photoselective vaporization of the prostate (PVP), Aquablation, and anatomical endoscopic enucleation of the prostate (AEEP). We performed a narrative review focussing on the following outcomes: efficacy, safety, durability, duration of catheterization, length of stay, re‐treatment rate, efficacy in special situations (enlarged median lobe, prostate size, urinary retention, and anticoagulant use), and sexual adverse events. Results AEEP offers the greatest long‐term improvement in maximum flow rate, IPSS, and prostate volume reduction, with lowest re‐treatment rate, followed by PVP, TURP, and Aquablation. Urolift, Rezum, and PAE have similar efficacy for prostate volume up to 80cc, and all are more effective than the pharmacological treatment. Urolift offers the lowest rate of sexual dysfunction, followed by Rezum, and both can be performed as a day case under local anesthesia. Conclusion Several treatment options exist to treat voiding LUTS due to BPO. Newer minimally invasive treatments reduce the hospital stay and postoperative complications, whereas AEEP provides the greatest long‐term symptom improvement at the expense of higher morbidity and sexual dysfunction. Men should be counseled regarding all suitable treatment options as some may favor reduced efficacy in association with reduced side effects.
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Affiliation(s)
- Sachin Malde
- Department of Urology Guy’s and St Thomas’ NHS Foundation Trust London UK
| | - Wayne Lam
- Division of Urology Department of Surgery LKS Faculty of Medicine Queen Mary Hospital The University of Hong Kong Hong Kong Hong Kong SAR
| | - Zainal Adwin
- Department of Surgery Faculty of Medicine Universiti Teknologi MARA Selangor Malaysia
| | - Hashim Hashim
- Bristol Urological Institute Southmead Hospital North Bristol NHS Trust Bristol UK
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Westhofen T, Weinhold P, Kolb M, Stief CG, Magistro G. Evaluation of Holmium Laser Enucleation of the Prostate Learning Curves with and without a Structured Training Programme. Curr Urol 2021; 14:191-199. [PMID: 33488337 DOI: 10.1159/000499239] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022] Open
Abstract
Background/Aims To evaluate perioperative parameters, early functional outcomes, and the safety profile of holmium laser enucleation of the prostate learning curves with and without mentoring. Methods The learning curves of 2 surgeons of their first 100 consecutive patients treated with holmium laser enucleation of the prostate were retrospectively analyzed. We analyzed demographic parameters, clinical outcomes, adverse events, and the progress during each learning experience. Results The only statistically significant differences between the two learning curves were found for operation time (138.2 ± 60.7 vs. 98.2 ± 37.7 min; p < 0.001) in favor of the supervised approach, the total weight of resected prostatic tissue (81.5 ± 50.5 vs. 65.0 ± 6.7 g; p < 0.001) with more tissue removal by the surgeon without guidance, and the perioperative hemoglobin drop (1.9 ± 1.4 vs. 1.1 ± 1.0 g/dl; p < 0.001) in favor of the learning curve with a training programme. In multivariate logistic regression, the time factor was independently associated with a higher drop in hemoglobin levels (OR 1.015; 95% CI 1.000-1.023; p = 0.001). The improvements of clinical outcomes as determined by International Prostate Symptom Score, quality of life, peak urinary flow rate and postvoid residual volume were comparable. After the first 50 procedures the mean operation time significantly improved from 147 to 107.5 minutes for the learning curve without supervision (p < 0.001), whereas the surgical time was consistent throughout the 100 cases with a mentoring programme. The overall incidence of treatment-related adverse events was significantly higher without the training programme (16 vs. 5%; p = 0.008). Conclusions Our study clearly showed the benefits of a structured training programme to overcome the steep learning curve.
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Affiliation(s)
- Thilo Westhofen
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Philipp Weinhold
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Maurice Kolb
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Giuseppe Magistro
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
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Wright HC, Fedrigon D, De S. Learning From Those who Learned: A Survey of Fellowship Trained HoLEP Surgeons and Their Current Practice Patterns. Urology 2021; 149:193-198. [PMID: 33412221 DOI: 10.1016/j.urology.2020.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To gain insight from the experience of learning Holmium laser enucleation of the prostate (HoLEP), teaching HoLEP, and the current HoLEP practice patterns of fellowship-trained endourologists. METHODS Surveys were electronically distributed to United States (U.S.) practicing urologists who completed American Endourology fellowships (that included HoLEP) within the past 6 years. Questions focused on HoLEP training and current practice patterns. RESULTS As of September 2019, 12% (6/49) of U.S. endourology fellowships reported including HoLEP as a component of training. With a 73% response rate (16 of 22), 81% participated in over 20 cases during training, while 50% participated in over 50. A total of 25% independently completed over 50 cases from start to finish. At training completion, most (80%) felt comfortable/somewhat comfortable completing an entire HoLEP independently and managing post-op complications. Seventy-five percent practice HoLEP currently, and 25% teach to trainees. When asked "What is most challenging about HoLEP in current practice?" common responses were: efficiency/profitability concerns, poor reimbursement, educating OR/hospital staff, establishing case volume, minimizing sphincter trauma, and large glands (>200gm). CONCLUSION With diverse exposure in fellowship, most incorporate HoLEP into their practice after training. Aspects of the procedure remain challenging after several years of experience. Profitability/reimbursement concerns should be further explored to increase HoLEP adoption.
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Affiliation(s)
- Henry C Wright
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
| | - Donald Fedrigon
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Smita De
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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Tsuboi I, Maruyama Y, Sadahira T, Ando N, Nishiyama Y, Araki M, Kurashige T, Ichikawa T, Arata R, Ono N, Watanabe T, Hayata S, Shiina H, Nasu Y. Efficacy of holmium laser enucleation in patients with a small (less than 30 mL) prostate volume. Investig Clin Urol 2021; 62:298-304. [PMID: 33943050 PMCID: PMC8100012 DOI: 10.4111/icu.20200450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/09/2020] [Accepted: 01/04/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the efficacy of holmium laser enucleation of the prostate (HoLEP) in patients with a small prostate volume (≤30 mL). Materials and Methods We retrospectively evaluated 1,135 patients who underwent HoLEP at two institutions between July 2007 and March 2020. Patients who were not evaluated for the International Prostate Symptom Score (IPSS) before or after HoLEP were excluded. We divided patients into two groups according to estimated prostate volume (ePV): ≤30 (n=198) and >30 mL (n=539). The patient characteristics, IPSS, peak urinary flow rate (Qmax), postvoid residual urine volume (PVR), and other data were compared before and after surgery in each group and between the two groups. Multivariate analysis was performed to identify the factors associated with the efficacy of HoLEP in the group with ePV ≤30 mL. Results A total of 737 patients were included in this retrospective study. ePV (23.4 mL vs. 50 mL; p<0.001) and PVR differed significantly between the two groups. The IPSS, IPSS-quality of life, PVR, and Qmax significantly improved after HoLEP in both groups. Improvements in the IPSS, IPSS-quality of life, Qmax, and PVR were greater in the >30 mL group (p<0.001), whereas operation time and morcellation time were significantly shorter in the ≤30 mL group. In the multivariate analysis, age <70 years was independently associated with improvement by HoLEP. Conclusions HoLEP is an effective treatment for patients with a small prostate, even though the extent of improvement after HoLEP was greater in those with a larger prostate.
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Affiliation(s)
- Ichiro Tsuboi
- Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Yuki Maruyama
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Okayama Urological Research Group, Okayama, Japan.
| | - Takuya Sadahira
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Nobuyoshi Ando
- Department of Urology, Kagawa Rosai Hospital, Kagawa, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Yasuhiro Nishiyama
- Department of Urology, Kochi Health Sciences Center, Kochi, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Motoo Araki
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Takushi Kurashige
- Department of Urology, Tottori Municipal Hospital, Tottori, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Takaharu Ichikawa
- Department of Urology, National Hospital Organization Okayama Medical Center, Okayama, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Ryoji Arata
- Department of Urology, Kochi Health Sciences Center, Kochi, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Noriaki Ono
- Department of Urology, Kochi Health Sciences Center, Kochi, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Toyohiko Watanabe
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Syunji Hayata
- Department of Urology, Tottori Municipal Hospital, Tottori, Japan.,Okayama Urological Research Group, Okayama, Japan
| | - Hiroaki Shiina
- Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Yasutomo Nasu
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Okayama Urological Research Group, Okayama, Japan
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Vale L, Fossion L. Endoscopic transvesical adenomectomy of the prostate, a new minimally invasive approach for large benign prostatic hyperplasia. What has our experience taught us? Cent European J Urol 2020; 73:482-489. [PMID: 33552574 PMCID: PMC7848824 DOI: 10.5173/ceju.2020.0053.r3] [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: 03/18/2020] [Revised: 09/07/2020] [Accepted: 09/24/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction Recent technical advances have made new minimally invasive techniques possible to treat large volume (>80 ml) benign prostatic hyperplasia (BPH). The endoscopic transperitoneal adenomectomy of the prostate (ETAP) is a new minimally invasive technique developed in our centre. The aim of this study was to describe the safety, efficacy and to evaluate our learning curve in ETAP. Material and methods This was a single-centre study that enrolled eighty-eight consecutive patients with large BPH who underwent ETAP. Pre-, per- and postoperative data were prospectively collected. Statistical analysis compared the first 40 patients submitted to ETAP (Group A) with the subsequent 48 patients (Group B). Results There were no significant differences in the surgical procedure between groups. The median operating time was 94 (80-110) minutes and the estimated blood loss 150 (100-300) ml. There were no perioperative blood transfusions nor any conversions to open approach needed. Median hospital stay was 3 (3-5) days and catheter was removed mainly at day 9 (5-11). The median Qmax improved from 8.0 (6.2-9.9) ml/s to 15.0 (11.5-23.0) ml/s postoperatively and the median International Prostate Symptom Score (IPSS) score decreased from 20 (15-24) to 6 (4-11) after the procedure. Conclusions ETAP is a secure and feasible minimally invasive technique for treatment of large BPH. The functional outcomes of this technique are consistent and promising.
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Affiliation(s)
- Luís Vale
- Maxima Medical Centre, Department of Urology, Veldhoven, The Netherlands.,Centro Hospitalar Universitário São João, Department of Urology, Porto, Portugal.,Faculty of Medicine, University of Porto, Department of Biomedicine, Porto, Portugal
| | - Laurent Fossion
- Maxima Medical Centre, Department of Urology, Veldhoven, The Netherlands
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Liu K, Xiao C, Hao Y, Ma L. 'Seven-step two-lobe' HoLEP: a modification to gain efficiency of the enucleation applying relatively low-power holmium laser devices. World J Urol 2020; 39:2627-2633. [PMID: 33025143 DOI: 10.1007/s00345-020-03470-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/21/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE In order to increase the efficiency of the low-power holmium laser enucleation of the prostate (LP-HoLEP), and introduce it as a standard surgery for BPH, we described a modified 'seven-step two-lobe' HoLEP (ST HoLEP) technique applying 60-W device in a stepwise manner. METHODS From July 2016 to August 2019, 120 patients who received LP-HoLEP at our hospital because of urinary tract symptoms caused by BPH were included in the study. The patients were assigned into two groups, 60 consecutive patients received modified ST HoLEP compared with another preexisting 60 consecutive patients who received the conventional three-lobe HoLEP (T HoLEP) before the technical modification. The clinical parameters, including patient characteristics, perioperative data, as well as voiding outcomes, and complications were evaluated after at least 3-month follow-up. RESULTS The median enucleation efficiency of the ST HoLEP was 0.72 gm/min, which was significantly higher than 0.62 gm/min of the T HoLEP. Despite the preoperative IPSS was slightly higher in T HoLEP group, the other preoperative and perioperative data showed no statistical difference between the two groups. After ST HoLEP procedure, the urinary incontinence rate was continually improved at 1-week, 1-month, and 3-month follow-up which were 13.3%, 6.7%, and 1.7%, respectively. There was no significant difference in postoperative voiding outcomes and urinary continence results in 3-month follow-up. CONCLUSION The ST HoLEP technique was proved to increase the efficiency which was benefit from minimizing the surgical incision, facilitating the single surgical plane identification and maintenance during the whole enucleation procedure.
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Affiliation(s)
- Ke Liu
- Department of Urology, Peking University Third Hospital, No.49, North Garden Rd. Haidian District, Beijing, 100191, China
| | - Chunlei Xiao
- Department of Urology, Peking University Third Hospital, No.49, North Garden Rd. Haidian District, Beijing, 100191, China.
| | - Yichang Hao
- Department of Urology, Peking University Third Hospital, No.49, North Garden Rd. Haidian District, Beijing, 100191, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, No.49, North Garden Rd. Haidian District, Beijing, 100191, China
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Hodhod A, Oquendo F, Tablowski T, Abdul-Hadi R, Shahrour W, Kotb A, Prowse O, Elmansy H. 'Top-Down' holmium laser enucleation of the prostate. Report of initial cases performed by a single surgeon. Arab J Urol 2020; 19:130-136. [PMID: 34104486 PMCID: PMC8158276 DOI: 10.1080/2090598x.2020.1805964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives To present the 12-month outcomes of ‘Top-Down’ holmium laser enucleation of the prostate (HoLEP). Patients and methods We retrospectively reviewed the charts of prospectively collected patients who underwent Top-Down HoLEP between 2017 and 2018. All cases were operated upon by a single urologist (H.E), using a 100-W holmium:YAG laser with a 550-μm laser fibre. We recorded the enucleation time, morcellation time, intraoperative, and postoperative complications. All patients had postoperative follow-up visits at 1, 3, 6 and 12 months. The evaluation included the International Prostate Symptom Score (IPSS), quality-of-life (QoL) assessment, measurement of maximum urinary flow rate (Qmax) and the post-void residual urine volume (PVR). Results A total of 60 consecutive patients were recruited. The median (range) prostatic volume, resected prostatic weight, and percentage of resected prostatic tissue were 124 (70–266) mL, 90 (44–242) g and 76 (46–97)%, respectively. The median (range) enucleation and morcellation times were 80 (25–200) and 14.5 (4–58) min, respectively. One patient had a simple bladder mucosal injury and another developed clot retention. At 3 months, three patients (5%) had stress urinary incontinence (SUI) and eight patients (13.3%) presented with urge UI (UUI). At the last follow-up visit, one patient (1.7%) presented with persistent SUI, while three patients (5%) presented with UUI. The IPSS and QoL significantly improved during the follow-up period (P = 0.045 and P = 0.04, respectively). Conclusion The results of the Top-Down technique are comparable to those of traditional HoLEP. However, the Top-Down technique may reduce the complexity, operating time, and SUI rates. Abbreviations BN: bladder neck; HoLEP: holmium laser enucleation of the prostate; PVR: post-void residual urine volume; Qmax: maximum urinary flow rate; QoL: quality of life; TOV: trial of voiding; (S)(U)UI: (stress) (urge) urinary incontinence
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Affiliation(s)
- Amr Hodhod
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Fabiola Oquendo
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Thomas Tablowski
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Ruba Abdul-Hadi
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Walid Shahrour
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Ahmed Kotb
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Owen Prowse
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Hazem Elmansy
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
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Giulianelli R, Gentile BC, Mirabile G, Tema G, Nacchia A, Albanesi L, Tariciotti P, Mavilla L, Bellangino M, Lopes Mendes L, Rizzo G, Aloisi P, Vincenti G, Lombardo R. Bipolar Plasma Enucleation of the Prostate: 5 Years Outcomes. J Endourol 2020; 33:396-399. [PMID: 30816063 DOI: 10.1089/end.2019.0050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Aim of our study is to assess outcomes and safety of button bipola transurethral enucleation of the prostate (B-TUEP) in patients with lower urinary tract symptoms (LUTS) caused by benign prostatic enlargement (BPE) in a single-center cohort study. Materials and Methods: All patients with LUTS caused by BPE undergoing button B-TUEP between May 2012 and December 2013 were prospectively enrolled in our study. Data on clinical history, physical examination, urinary symptoms, erectile function, uroflowmetry, and prostate volume were collected at 0, 1, 3, 6, 12, 24, 36, 48, and 60 months. Early and long-term complications were recorded. Results: Overall 50 patients were enrolled at baseline. Nine patients were excluded during the 5 years. All patients completed the procedure without severe complications. In terms of outcomes, improvement in International Prostate Symptom Score (IPSS) were sustained for all 5 years and mean difference from baseline at 5 years was 17 points. As well, improvements in Qmax (maximum urinary flow rate) were sustained for all 5 years and mean improvement at 5 years was 16 mL/second. Erectile function was slightly improved after surgery and maintained for the following 5 years. Conclusions: Our single-center study suggests that B-TUEP may have excellent outcomes at 5 years with no recurrence. Further multicentre studies should confirm our results.
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Affiliation(s)
| | | | | | - Giorgia Tema
- 2 Department of Urology, University "La Sapienza," Rome, Italy
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Kleinguetl C, Virani S, Bird ET, El Tayeb MM. Safety and efficacy of male urethral slings for management of persistent stress urinary incontinence after holmium laser enucleation of the prostate. Proc (Bayl Univ Med Cent) 2020; 33:554-556. [PMID: 33100527 DOI: 10.1080/08998280.2020.1778976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Holmium laser enucleation of the prostate gland (HoLEP) is an alternative to the traditional transurethral resection of the prostate, especially for large-volume prostates. One complication is urinary incontinence, which is usually stress urinary incontinence (SUI). Little data exist on surgical interventions for SUI after HoLEP. This retrospective case series examined the safety and possible efficacy of a midurethral sling (MUS) following HoLEP. Between January 2016 and February 2019, 610 HoLEPs were performed at our institution. Three (0.5%) had persistent, overly bothersome symptoms of SUI. All three underwent MUS placement with a transobturator AdVance® male sling after failed pelvic floor rehabilitation. The degree of SUI was evaluated by pad use pre-HoLEP, post-HoLEP, and post-MUS placement. Surgical times for HoLEP and MUS were evaluated. No patients were using pads for incontinence before HoLEP. The average pad use was 7 post-HoLEP and 0.3 post-MUS. The average morcellated prostate was 48 g, and surgical time was 68 min (52 for enucleation and 15 for morcellation). No complications were reported with MUS placement intraoperatively or postoperatively. MUS for persistent and bothersome SUI after HoLEP shows promise as a safe and effective surgical option.
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Affiliation(s)
- Colin Kleinguetl
- Division of Urology, Baylor Scott and White Medical Center - Temple, Temple, Texas
| | - Shohaib Virani
- College of Medicine, Texas A&M Health Science Center, Temple, Texas
| | - Erin T Bird
- Division of Urology, Baylor Scott and White Medical Center - Temple, Temple, Texas
| | - Marawan M El Tayeb
- Division of Urology, Baylor Scott and White Medical Center - Temple, Temple, Texas
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Fallara G, Capogrosso P, Schifano N, Costa A, Candela L, Cazzaniga W, Boeri L, Belladelli F, Scattoni V, Salonia A, Montorsi F. Ten-year Follow-up Results After Holmium Laser Enucleation of the Prostate. Eur Urol Focus 2020; 7:612-617. [PMID: 32576532 DOI: 10.1016/j.euf.2020.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/16/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Scarce data are available about long-term follow-up (FU) in men undergoing holmium laser enucleation of the prostate (HoLEP). OBJECTIVE To investigate the risk of being symptomatic at 10-yr FU after HoLEP. DESIGN, SETTING, AND PARTICIPANTS Perioperative data from 125 patients submitted to HoLEP in 2007-2010 by a single, highly experienced surgeon were analyzed. Patients were assessed by International Prostate Symptoms Score (IPSS), prostate-specific antigen (PSA), and uroflowmetry at 6-mo and 10-yr FU. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Logistic regression models tested the association between clinically significant predictors and the risk of being symptomatic at long-term FU (defined as IPSS≥8 and/or peak flow rate [PFR]<15ml/s and/or postvoid residual volume [PVR]>20ml, need for symptomatic medical treatment, or redo surgery). RESULTS AND LIMITATIONS At surgery, median (interquartile range) age was 66 years (61, 69), prostate volume was 78ml (56, 105), and PFR was 9ml/s (7, 12). All patients showed favorable outcomes (ie, IPSS and uroflowmetry parameters) 6 months after surgery. At median 126-month FU, PFR was 16ml/s (13, 23), PVR was 10ml (5, 15), total IPSS was 5 (1-7), and PSA was 0.7 ng/ml (0.4, 1.3). Of all, 32 patients (26%) were symptomatic at long-term FU, seven (5.7%) reported urinary incontinence, and six (4.7%) underwent redo surgery throughout the FU period due to either bladder neck contracture or urethral stricture. Older patients at surgery (odds ratio [OR]: 1.12; 95% confidence interval [CI]: 1.03-1.22; p=0.006) and patients who never recovered full continence postoperatively (OR: 0.49; 95% CI: 0.01-0.27; p=0.001) were at a higher risk of being symptomatic at very long-term FU, after adjusting for baseline clinical characteristics. CONCLUSIONS HoLEP ensures a durable relief of urinary symptoms in almost 75% of patients up to 10 years after surgery. Older patients and those who do not recover from incontinence after surgery should be counseled carefully regarding a higher risk of symptom recurrence at long-term assessment. PATIENT SUMMARY Consistent symptom relief is preserved even 10 years after holmium laser enucleation of the prostate in almost 75% of patients. Older age and incomplete continence recovery after surgery were the two most relevant risk factors for being symptomatic at long-term follow-up. Postoperative functional outcomes are kept in three out of four patients at 10-yr follow-up after holmium laser enucleation of the prostate. Conversely, the older the patient at surgery and the presence of incomplete continence recovery throughout the postoperative period, the greater the probability of being symptomatic at long-term follow-up.
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Affiliation(s)
- Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicolò Schifano
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Antonio Costa
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Luigi Candela
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Walter Cazzaniga
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Luca Boeri
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Vincenzo Scattoni
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
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Aho T, Armitage J, Kastner C. Anatomical endoscopic enucleation of the prostate: The next gold standard? Yes! Andrologia 2020; 52:e13643. [PMID: 32406130 DOI: 10.1111/and.13643] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 03/29/2020] [Accepted: 04/12/2020] [Indexed: 11/30/2022] Open
Abstract
Anatomical endoscopic enucleation of the prostate (AEEP) differs from other surgical techniques for benign prostatic obstruction (BPO) in that it removes the entire benign prostatic hyperplasia (BPH) component of the prostate. We summarise the main advantages of AEEP compared to other surgical techniques for BPO. These include better urodynamic relief of bladder outlet obstruction, superior outcomes for urinary retention even in the presence of impaired detrusor contractility, safe and effective for any size prostate, and superior durability compared to vaporisation and resection techniques. We summarise evidence that suggests AEEP offers outcomes that are independent of patient age and prostate volume. We conclude that AEEP is the gold standard surgical treatment for men with either lower urinary tract symptoms (LUTS) or urinary retention, regardless of prostate volume, detrusor contractility and age. It offers the ability to safely and effectively treat a wider range of patients than any other BPO procedure. More widespread use of mentorship programmes, that take advantage of the growing number of experienced mentors, is recommended to train more urologists in AEEP.
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Affiliation(s)
- Tevita Aho
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - James Armitage
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Christof Kastner
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Herrmann TR, Gravas S, de la Rosette JJMCH, Wolters M, Anastasiadis AG, Giannakis I. Lasers in Transurethral Enucleation of the Prostate-Do We Really Need Them. J Clin Med 2020; 9:E1412. [PMID: 32397634 PMCID: PMC7290840 DOI: 10.3390/jcm9051412] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 12/21/2022] Open
Abstract
The acronym EEP, coding for transurethral Endoscopic Enucleation of the Prostate, was introduced in 2016 by the European Association of Urology (EAU) guidelines panel on management of non-neurogenic male lower urinary tract symptoms (LUTS) and benign prostatic obstruction (BPO). Since then, a laser-based treatment, Holmium Laser Enucleation of the Prostate (HoLEP), and the current-based treatment of bipolar enucleation of the prostate (BipoLEP) are equally appreciated as valuable options for the management of benign prostatic obstruction (BPO). This was mainly inspired by the results of two meta-analyses on randomized controlled trials, comparing open prostatectomy with either Holmium Laser Enucleation of the Prostate (HoLEP) or bipolar enucleation of the prostate (BipoLEP). Prior to that, HoLEP was embraced as the only valid option for transurethral enucleation, although evidence for equivalence existed as early as 2006, but was not recognized due to a plethora of acronyms for bipolar energy-based treatments and practiced HoLEP-centrism. On the other hand, the academic discourse focused on different (other) laser approaches that came up, led by Thulium:Yttrium-Aluminum-Garnet (Tm:YAG) Vapoenucleation (ThuVEP) in 2009 and, finally, transurethral anatomical enucleation with Tm:YAG support (thulium laser enucleation of the prostate, ThuLEP) in 2010. Initially, the discourse on lasers focused on the different properties of lasers rather than technique or surgical anatomy, respectively. In and after 2016, the discussion ultimately moved towards surgical technique and accepting anatomical preparation as the common of all EEP techniques (AEEP). Since then, the unspoken question has been raised, whether lasers are still necessary to perform EEP in light of existing evidence, given the total cost of ownership (TCO) for these generators. This article weighs the current evidence and comes to the conclusion that no evidence of superiority of one modality over another exists with regard to any endpoint. Therefore, in the sense of critical importance, AEEP can be safely and effectively performed without laser technologies and without compromise.
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Affiliation(s)
- Thomas R.W. Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, 8569 Münsterlingen, Switzerland; (A.G.A.); (I.G.)
- Department of Urology, Hannover Medical School, 30625 Hannover, Germany;
| | - Stavros Gravas
- Department of Urology, University Hospital of Larisa, 41500 Larisa, Greece;
| | | | - Mathias Wolters
- Department of Urology, Hannover Medical School, 30625 Hannover, Germany;
| | | | - Ioannis Giannakis
- Department of Urology, Spital Thurgau AG, Frauenfeld, 8569 Münsterlingen, Switzerland; (A.G.A.); (I.G.)
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Abedi A, Razzaghi MR, Rahavian A, Hazrati E, Aliakbari F, Vahedisoraki V, Allameh F. Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article. J Lasers Med Sci 2020; 11:197-203. [PMID: 32273963 DOI: 10.34172/jlms.2020.33] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Several therapeutic approaches such as holmium laser enucleation of the prostate (HoLEP) have been introduced to relieve bladder outlet obstruction caused by benign prostatic hyperplasia (BPH). Compared with other techniques including the transurethral resection of the prostate (TURP) and simple open prostatectomy, HoLEP results in a shorter hospital stay and catheterization time and fewer blood loss and transfusions. HoLEP is a size-independent treatment option for BPH with average gland size from 36 g to 170 g. HoLEP is a safe procedure in patients receiving an anticoagulant and has no significant influence on the hemoglobin level. Also, HoLEP is an easy and safe technique in patients with a prior history of prostate surgery and a need for retreatment because of adenoma regrowth. The postoperative erectile dysfunction rate of patients treated with HoLEP is similar to TURP or open prostatectomy and about 77% of these patients experience loss of ejaculation. Patients with transitional zone volume less than 30 mL may suffer from persistent stress urinary incontinence following HoLEP so other surgical techniques like bipolar TURP are a good choice for these patients. In young patients, considering HoLEP with high prostate-specific antigen density and a negative standard template prostate biopsy, multiparametric MRI needs to be considered to exclude prostate cancer.
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Affiliation(s)
- Amirreza Abedi
- Urology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Razzaghi
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhossein Rahavian
- Urology Department, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ebrahim Hazrati
- School of Medicine, 501 Hospital (Imam Reza), AJA University of Medical Sciences, Tehran, Iran
| | - Fereshte Aliakbari
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahid Vahedisoraki
- Department of Urology, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farzad Allameh
- Laser Application in Medical Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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