1
|
Morozov A, Taratkin M, Shpikina A, Ehrlich Y, McFarland J, Dymov A, Kozlov V, Fajkovic H, Rivas JG, Lusuardi L, Teoh JYC, Herrmann T, Baniel J, Enikeev D. Comparison of EEP and TURP long-term outcomes: systematic review and meta-analysis. World J Urol 2023; 41:3471-3483. [PMID: 37980297 DOI: 10.1007/s00345-023-04666-8] [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: 03/30/2023] [Accepted: 09/28/2023] [Indexed: 11/20/2023] Open
Abstract
OBJECTIVE To compare long-term reoperation rate and functional outcomes between EEP (endoscopic enucleation of the prostate) and TURP (transurethral resection of the prostate). EVIDENCE ACQUISITION A systematic literature review of Medline, Scopus, and Web of Science was conducted with primary outcome assessed being reoperation rate and secondary outcomes after a long term (> 3 years) being functional outcomes or related values (prostate volume, PSA level, etc.). EVIDENCE SYNTHESIS Five studies were found with long-term follow-up 4-7 years. EEP reoperation rate ranged from 0 to 1.27%, while from 1.7 to 17.6% for TURP. Meta-analysis showed significantly lower OR for EEP, 0.27 (95% CI 0.24-0.31), with notable homogeneity of the results, I2 = 0%. Long-term Qmax and IPSS were significantly better for EEP. Qmax pooled mean difference was 1.79 (95% CI 1.72-1.86) ml/s with a high concordance among the studies, I2 = 0%. IPSS mean difference -1.24 (95% CI - 1.28 to - 1.2) points, I2 = 57% but QoL did not differ, with mean difference being 0.01 (95% CI - 0.02 to 0.04), I2 = 0%. IIEF-5 score was also significantly better for EEP, mean difference 1.08 (95% CI 1.03-1.13), but heterogeneity was high, I2 = 70%. PSA level and prostate volume were only reported in one study and favored EEP slightly yet statistically significant. CONCLUSION EEP had a significantly lower reoperation rate and better functional outcomes (Qmax and IPSS) at long term compared with TURP. It may also be beneficial in terms of IIEF-5, PVR, and PSA level.
Collapse
Affiliation(s)
- Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Anastasia Shpikina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Yaron Ehrlich
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan McFarland
- Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia
- Faculty of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Alim Dymov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Vasiliy Kozlov
- Department of Public Health and Healthcare, Sechenov University, Moscow, Russia
| | - Harun Fajkovic
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Juan Gomez Rivas
- Department of Urology, Clinico San Carlos University Hospital, Madrid, Spain
| | - Lukas Lusuardi
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Thomas Herrmann
- Department of Urology, Spital Thurgau AG, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Jack Baniel
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
2
|
Elterman D, Gilling P, Roehrborn C, Barber N, Misrai V, Zorn KC, Bhojani N, Te A, Humphreys M, Kaplan S, Desai M, Bach T. Meta-analysis with individual data of functional outcomes following Aquablation for lower urinary tract symptoms due to BPH in various prostate anatomies. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2022; 3:e000090. [PMID: 35047807 PMCID: PMC8749268 DOI: 10.1136/bmjsit-2021-000090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/03/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To evaluate functional outcomes following Aquablation in various prostate volume and anatomical subgroups. DESIGN A meta-analysis with individual patient data undergoing Aquablation therapy from four prospective, global, clinical studies that have been conducted with Aquablation; WATER, WATER II, FRANCAIS WATER and OPEN WATER. SETTING Australia, Canada, Lebanon, Germany, New Zealand, UK and the USA. PARTICIPANTS 425 men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) with 1-year follow-up. INTERVENTIONS Aquablation therapy is an ultrasound guided, robotically executed waterjet ablative procedure for the prostate. MAIN OUTCOME MEASURES The analyses focus International Prostate Symptom Score (IPSS), uroflowmetry, postoperative Incontinence Severity Index (ISI) and surgical retreatment. RESULTS 425 men with prostates ranging in size from 20 to 150 mL underwent Aquablation therapy. The outcomes from the seven questions in the IPSS questionnaire were grouped by the following; prostates <100 mL, prostates ≥100 mL, prostate anatomy with an obstructive median lobe identifed by imaging, and prostate anatomy without an obstructive median lobe. Regardless of subgroup, all outcomes are consistent and demonstrate a significant improvement from baseline. Specifically, improvements in frequency, urgency and nocturia demonstrated bladder function improvement. Patients entering treatment with severe incontinence, ISI score >4, and regardless of prostate size, showed a reduction in incontinence during patient follow-up. Surgical retreatment due to BPH symptoms occurred in 0.7% (95% CI 0.1%-2.0%). CONCLUSIONS Across a variety of prostate anatomies, Aquablation therapy showed remarkable functional improvements following the index procedure. Additionally, men with moderate to severe LUTS/BPH and overactive bladder resulting in urge incontinence showed a reduction in incontinence symptoms postprocedure.
Collapse
Affiliation(s)
- Dean Elterman
- Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Claus Roehrborn
- Urology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Neil Barber
- Urology, Frimley Health NHS Foundation Trust, Frimley, Surrey, UK
| | | | - Kevin C Zorn
- University of Montreal Hospital Center, Universite de Montreal, Montreal, Québec, Canada
| | - Naeem Bhojani
- University of Montreal Hospital Center, Universite de Montreal, Montreal, Québec, Canada
| | - Alexis Te
- Urology, Weill Cornell Medical College, New York, New York, USA
| | | | - Steven Kaplan
- Urology, Mount Sinai Medical Center, New York, New York, USA
| | - Mihir Desai
- Urology, University of Southern California, Los Angeles, California, USA
| | - Thorsten Bach
- Urology, Asklepios Westklinikum Hamburg, Hamburg, Hamburg, Germany
| |
Collapse
|
3
|
Mian A, Pachorek M, Sam AP, Ruel NH, Yang D, Kohler TS, Warner JN. Predictors of Storage Symptom Improvement After Plasma Kinetic Enucleation of the Prostate. Urology 2021; 160:182-186. [PMID: 34813839 DOI: 10.1016/j.urology.2021.11.008] [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: 08/05/2021] [Revised: 10/21/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate which preoperative findings portend poor improvement in storage symptoms in patients undergoing plasma kinetic enucleation of prostate (PKEP). METHODS A single surgeon series of patients who had undergone PKEP with minimum 1 year follow up were evaluated. Patients were grouped into those with less than 33% improvement in storage symptoms (LIS) according to the international prostate symptom score (IPSS) and those with greater than 33% improvement in storage symptoms (GIS). Pre and postoperative factors were evaluated, along with IPSS, storage symptoms percentage (the total from frequency, urgency and nocturia divided by the total IPSS), bother index, and post void residual (PVR) at 6 weeks, 4 months, and yearly. RESULTS Two hundred sixty-eight patients had a minimum 1 year of follow up and had completed the IPSS. IPSS and bother index improved significantly from preoperatively to all time points post operatively in both groups, but the difference was greater in the GIS group. Patients in the GIS group had significantly larger prostates, more prostatic ingrowth, higher preoperative PVR, and a higher overall IPSS compared to the LIS group. Those in the LIS group had a higher incidence of prior prostate surgery, and a higher BMI. However, storage symptom percentages were equal between the GIS and LIS groups at all time points. CONCLUSION Greater prostatic ingrowth, larger prostate volume, higher preoperative PVR volume, and a higher overall IPSS was associated with greater improvement in storage symptoms. Prior prostate surgery and higher BMI portend less improvement in storage symptoms.
Collapse
Affiliation(s)
| | | | | | - Nora H Ruel
- Department of Biostatistics, City of Hope National Medical Center, Duarte, CA
| | - David Yang
- Department of Surgery, Division of Urology, Mayo Clinic, Rochester, MN; Departemnt of Urology, Mayo Clinic, Rochester, MN
| | - Tobias S Kohler
- Department of Surgery, Division of Urology, City of Hope National Medical Center, Duarte, CA; Departemnt of Urology, Mayo Clinic, Rochester, MN
| | | |
Collapse
|
4
|
Comparison of Efficacy of Different Surgical Techniques for Benign Prostatic Obstruction. Int Neurourol J 2021; 25:252-262. [PMID: 33957718 PMCID: PMC8497733 DOI: 10.5213/inj.2040314.157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/19/2020] [Indexed: 11/08/2022] Open
Abstract
Purpose We compared success rates of 3 surgical techniques (holmium laser enucleation of the prostate [HoLEP], transurethral resection of the prostate [TURP], and photoselective laser vaporization prostatectomy [PVP]) for treatment of benign prostatic obstruction (BPO). We aimed to identify preoperative clinical variables and urodynamic parameters that predict surgical success. Methods A total of 483 patients who underwent surgical treatment for BPO at Samsung Medical Center between 2006 and 2017 were retrospectively analyzed; of these 361, 81, and 41 patients underwent HoLEP, TURP, and PVP, respectively. Prostate-specific antigen, prostate volume, urodynamic parameters, and International Prostate Symptom Score (IPSS)/quality of life (QoL) index were evaluated preoperatively; uroflowmetry, postvoid residual urine, and IPSS/QoL index were measured 6 months postoperatively. Surgical success was defined based on IPSS, maximum flow rate, and QoL index and predictive factors were identified using multiple logistic regression analyses. Results Success rates of HoLEP, TURP, and PVP were 67.6%, 65.4%, and 34.1%, respectively, and the HoLEP and TURP groups were not significantly different. Regression analysis revealed prostate volume ≥50 mL and bladder outlet obstruction index (BOOI) ≥40 to be independent factors predicting HoLEP success. Only high preoperative QoL could predict the success of TURP, whereas other urodynamic parameters remained unrelated. Conclusions Patients treated with HoLEP and TURP displayed equivalent efficacies, but PVP was relatively less efficient than both. Preoperative variables of prostate volume ≥50 mL and BOOI ≥40 were independent predictive factors for the success of HoLEP but not of TURP.
Collapse
|
5
|
Choo MS, Son H. Current trends in minimally invasive surgery for benign prostatic hyperplasia. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2020. [DOI: 10.5124/jkma.2020.63.2.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Min Soo Choo
- Department of Urology, Hallym University College of Medicine, Chuncheon, Seoul, Korea
| | - Hwancheol Son
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| |
Collapse
|
6
|
Urinary Biomarkers and Benign Prostatic Hyperplasia. CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00504-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
7
|
[Impact of medical and surgical treatments of LUTS on nocturia]. Prog Urol 2018; 28:848-855. [PMID: 30268350 DOI: 10.1016/j.purol.2018.08.004] [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: 07/25/2018] [Accepted: 08/08/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Nocturia is the most frequently reported lower urinary tract symptom, but the impact of medical and surgical treatments on this symptom remains poorly evaluated. The objective of this work was to carry out a systematic review of the literature on the medical and surgical management of nocturia in men with bladder outlet obstruction due to benign prostatic hyperplasia. MATERIAL AND METHOD A systematic review of the literature was conducted including the effects of medical and surgical treatments on nocturia. Articles were selected by 3 independent reviewers before being analyzed and synthesized. RESULTS Among medical treatments, the most effective on nocturia seems to be desmopressin. Nevertheless, prescribing restrictions to men under 65 years of age hinder its use in routine practice. The effect of other medical treatments remains modest, although significant compared to placebo groups. The decrease in the number of nocturia would decrease from 0.25 to 0.7 in placebo group and from 0.29 to 1.1 in active treatment groups (alpha blocker, diuretic, anti-inflammatory, IPDE-5, 5 alpha reductase inhibitor). Surgical treatments seem to be more effective on nocturia. Although persistent in half of the patients undergoing surgery, the number of nocturia episodes decreased in 70% of them. CONCLUSION Nocturia is one of the most common urinary symptoms and the one that responds the least to the proposed medical and surgical treatments. The information given to patients by urologists must emphasize the modest effects to be expected in this area.
Collapse
|
8
|
Affiliation(s)
| | - Ricardo Vita Nunes
- Divisão de Urologia, Universidade de São Paulo, USP, São Paulo, SP, Brasil
| |
Collapse
|
9
|
Ajib K, Zgheib J, Salibi N, Zanaty M, Mansour M, Alenizi A, El-Hakim A. Monopolar Transurethral Enucleo-Resection of the Prostate Versus Holmium Laser Enucleation of the Prostate: A Canadian Novel Experience. J Endourol 2018; 32:509-515. [PMID: 29641356 DOI: 10.1089/end.2017.0853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To study the functional outcome of patients undergoing transurethral enucleation and resection of the prostate (TUERP) vs patients undergoing holmium laser enucleation of the prostate (HoLEP) in men with bladder outlet obstruction. MATERIALS AND METHODS We retrospectively analyzed our prospectively collected database of two groups of patients. Twenty-four patients underwent TUERP (group 1), and 27 underwent HoLEP (group 2). Preoperative characteristics, intervention parameters, postoperative functional outcomes, uroflowmetry, and complications were collected. RESULTS Mean prostate size in groups 1 and 2 were 87.2 and 93.5 cc, respectively. The mean duration of surgery was 110 minutes in group 1 and 136 minutes in group 2. In group 1, prostate-specific antigen (PSA) dropped from 4.4 to 1.2 ng/cc after 12 months. International Prostate Symptom Score (IPSS) was 3.75 at 12 months with a preoperative value of 20.9. With respect to maximum urinary flow rate (Qmax), it increased to 21.8 mL/s from a preoperative value of 6.4 mL/s. In group 2, the PSA dropped from 7.6 to 1.3 ng/cc. IPSS dropped from 22.3 to 3.8, Qmax increased from 7.7 to 22.5 mL/s. Hemoglobin, complications, and all studied parameters were not statistically significant between both groups. CONCLUSION In this study, TUERP was safe and efficacious in benign prostatic hyperplasia patients with large glands. Modifications can be implemented on the standard transurethral resection of the prostate technique to treat patients with prostate sizes >70 cc.
Collapse
Affiliation(s)
- Khaled Ajib
- 1 Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal , Montréal, Canada .,2 Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Cœur de Montréal , Montreal, Canada
| | - Joseph Zgheib
- 3 Division of Urology, Department of Surgery, Saint George Hospital University Medical Center , Beirut, Lebanon
| | - Noura Salibi
- 4 Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut , Beirut, Lebanon
| | - Marc Zanaty
- 1 Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal , Montréal, Canada .,2 Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Cœur de Montréal , Montreal, Canada
| | - Mila Mansour
- 1 Section of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal , Montréal, Canada
| | - Abdullah Alenizi
- 5 Division of Urology, Department of Surgery, Security Forces Hospital , Riyadh, Saudi Arabia
| | - Assaad El-Hakim
- 2 Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Cœur de Montréal , Montreal, Canada
| |
Collapse
|