1
|
Lim EJ, Castellani D, Somani BK, Gökce MI, Fong KY, Sancha FG, Herrmann TR, Biligere S, Tursunkulov AN, Dellabella M, Sofer M, Enikeev D, Petov V, Gadzhiev N, Elterman D, Mahajan A, Socarras MR, Yunusov DS, Nasirov F, Teoh JY, Gauhar V. High-power holmium laser versus thulium fiber laser for endoscopic enucleation of the prostate in patients with glands larger than 80 ml: Results from the Prostate Endoscopic EnucLeation study group. Prostate Int 2024; 12:40-45. [PMID: 38523902 PMCID: PMC10960086 DOI: 10.1016/j.prnil.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 03/26/2024] Open
Abstract
Background Endoscopic enucleation of the prostate (EEP) has gained acceptance as an equitable alternative to transurethral resection of the prostate for benign prostate hyperplasia (BPH). Our primary aim is to compare peri-operative outcomes of EEP using thulium fiber laser (TFL) against high-power holmium laser (HPHL) in hands of experienced surgeons for large prostates (≥80 ml in volume). Secondary outcomes were assess complications within 1 year of follow up. Materials and Methods We retrospectively reviewed patients with benign prostatic hyperplasia who underwent EEP with TFL or HPHL in 13 centers (January 2019-January 2023). Patients with prostate volume ≥80 ml were included, while those with concomitant prostate cancer, previous prostate/urethral surgery, and pelvic radiotherapy were excluded. Results Of 1,929 included patients, HPHL was utilized in 1,459 and TFL in 470. After propensity score matching (PSM) for baseline characteristics, 247 patients from each group were analyzed. Overall operative time (90 [70, 120] vs. 52.5 [39, 93] min, P < 0.001) and enucleation time (90 [70, 105] vs. 38 [25, 70] min, P < 0.001) were longer in the TFL group, with comparable morcellation time (13 [10, 19.5] vs. 13 [10, 16.5] min, P = 0.914). In terms of postoperative outcomes, there were no differences in 30-day complications such as acute urinary retention, urinary tract infection or sepsis. In the PSM cohort, univariable analyses showed that higher age, lower preoperative Qmax, higher preoperative PVRU, and longer operation time were associated with higher odds of postoperative incontinence, while 2-lobe enucleation had lower odds of incontinence compared to 3-lobe enucleation. Conclusions This real-world study reaffirms that HPHL and TFL in large prostates are equally efficacious in terms of 30-day complications. TFL with the en-bloc technique has a shorter operative time which significantly improves short- and medium-term functional outcomes.
Collapse
Affiliation(s)
- Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Bhaskar K. Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Mehmet I. Gökce
- Department of Urology, Ankara University, School of Medicine, Ankara, Turkey
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Fernando G. Sancha
- Department of Urology and Robotic Surgery, ICUA-Clínica CEMTRO, Madrid, Spain
| | - Thomas R.W. Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Sarvajit Biligere
- Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore
| | | | | | - Mario Sofer
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dmitry Enikeev
- Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Vladislav Petov
- Department of Urology, Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Nariman Gadzhiev
- Department of Urology, Saint Petersburg State University Hospital, Saint Petersburg, Russia
| | - Dean Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Canada
| | - Abhay Mahajan
- Department of Urology, Sai Urology Hospital and MGM Medical College, Aurangabad, India
| | - Moises R. Socarras
- Department of Urology and Robotic Surgery, ICUA-Clínica CEMTRO, Madrid, Spain
| | | | - Furkat Nasirov
- Urology Department, Tashkent Medical Academy, Uzbekistan
| | - Jeremy Y.C. Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, National University Health System, Singapore
| |
Collapse
|
2
|
Wen Z, Deng XZ, Wang L, Chen LL, Liu Y, Chen CX, Wang CJ, Yang XS. Efficacy and safety of transurethral thulium laser enucleation versus robot-assisted prostatectomy for large-volume benign prostatic hyperplasia: a systematic review and meta-analysis. J Robot Surg 2023; 17:2633-2646. [PMID: 37731152 DOI: 10.1007/s11701-023-01715-7] [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: 08/05/2023] [Accepted: 09/02/2023] [Indexed: 09/22/2023]
Abstract
To compare perioperative outcomes between Holmium laser enucleation of the prostate (HoLEP) and robotic-assisted simple pasta-ectomy (RASP)for large-volume benign prostatic hyperplasia(> 80 ml). In August 2023, we undertook a comprehensive search of major global databases including PubMed, Embase, and Google Scholar, focusing solely on articles written in English. Studies that were merely reviews or protocols without any specific published data were omitted. Furthermore, articles that comprised conference abstracts or content not pertinent to our subject of study were also disregarded. To calculate the inverse variances and 95% confidence intervals (CIs) for categorical variables' mean differences, we employed the Cochran-Mantel-Haenszel approach along with random-effects models. The findings were denoted in the form of odds ratios (ORs) and 95% CIs. A p-value less than 0.05 was deemed to indicate statistical significance. Our finalized meta-analysis incorporated six articles, including one randomized controlled trial (RCT) and five cohort studies. These studies accounted for a total of 1218 patients, 944 of whom underwent Holmium Laser Enucleation of the Prostate (HoLEP) and 274 who underwent Robotic-Assisted Simple Prostatectomy (RASP). The pooled analysis from these six papers demonstrated that compared to RASP, HoLEP had a shorter hospital stay, shorter catheterization duration, and a lower blood transfusion rate. Moreover, HoLEP patients exhibited a smaller reduction in postoperative hemoglobin levels. Statistically, there were no significant differences between the two procedures regarding operative time, postoperative PSA, the weight of prostate specimens, IPSS, Qmax, PVR, QoL, and postoperative complications. (HoLEP) and (RASP) are both effective and safe procedures for treating large-volume benign prostatic hyperplasia. HoLEP, with its benefits of shorter catheterization and hospitalization duration, lesser decline in postoperative hemoglobin, and reduced blood transfusion needs, stands as a preferred choice for treating extensive prostate enlargement. However, further validation through more high-quality clinical randomized trials is required.
Collapse
Affiliation(s)
- Zhi Wen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xian-Zhong Deng
- Department of Urology, Chengdu Xinhua Hospital Affiliated to North Sichuan Medical College, Chengdu, China
| | - Li Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Lin-Lin Chen
- Department of Hemodialysis, Sixth People's Hospital of Nanchong, Sichuan, China
| | - Yang Liu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Cai-Xia Chen
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Chong-Jian Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Xue-Song Yang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
| |
Collapse
|
3
|
Shuai H, Xu P, Xu Q, Luo J, Zhou L, Zhou J, Wu T. Comparison of the efficacy and safety of robotic-assisted simple prostatectomy and laser enucleation of prostate for large benign prostatic hyperplasia. J Robot Surg 2023; 17:2687-2695. [PMID: 37796379 DOI: 10.1007/s11701-023-01734-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/24/2023] [Indexed: 10/06/2023]
Abstract
Laser enucleation of the prostate (LEP) and robotic-assisted simple prostatectomy (RASP) are two main treatment methods for large benign prostatic hyperplasia (BPH), but the superiority between these two methods in treating large BPH is currently unclear. This study aims to conduct a meta-analysis to compare the efficacy and the safety of LEP and RASP in treating large BPH. We systematically searched the PubMed, Embase, and Cochrane Library databases for studies that compared safety and efficacy outcomes of both LEP and RASP. Review Manager 5.3 was used for the meta-analysis. Six studies with a total of 1235 patients were included in the analysis. Resected adenoma weight was similar in LEP than RASP group. Operative time [mean difference (MD) - 67.96; 95% confidence interval [CI] - 131.66 to - 4.25; p = 0.04], catheterization time (MD -6.31; 95% CI - 9.44 to - 3.18; p < 0.0001), and length of stay (MD - 2.44; 95% CI - 3.55 to - 1.34; p < 0.0001) were lower in LEP. The International Prostate Symptom Score, maximum urinary flow rate, prostate-specific antigen, and post-void residual urine volume were also comparable between two groups. Furthermore, LEP demonstrated lesser hemoglobin decrease (MD - 0.50; 95% CI - 0.96 to - 0.05; p = 0.03), lower blood transfusion rate [odd ratio (OR) 0.23, 95% CI 0.08-0.66; p = 0.006], and lower rate of Clavien-Dindo Grade ≥ 3 complications (OR 0.435, 95% CI 0.189-0.998; p = 0.049). Finally, there was no significant difference in overall complications between two groups. Current evidence shows that LEP offers favorable perioperative outcomes compared with RASP. However, there was no conclusive evidence that LEP was advantaged in terms of efficacy outcomes.
Collapse
Affiliation(s)
- Hui Shuai
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Wenhua Road 57, Shunqing District, Nanchong, 637000, Sichuan, People's Republic of China
| | - Pengjun Xu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Wenhua Road 57, Shunqing District, Nanchong, 637000, Sichuan, People's Republic of China
| | - Qian Xu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Wenhua Road 57, Shunqing District, Nanchong, 637000, Sichuan, People's Republic of China
| | - Jia Luo
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Wenhua Road 57, Shunqing District, Nanchong, 637000, Sichuan, People's Republic of China
| | - Lin Zhou
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Wenhua Road 57, Shunqing District, Nanchong, 637000, Sichuan, People's Republic of China
| | - Junjie Zhou
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Wenhua Road 57, Shunqing District, Nanchong, 637000, Sichuan, People's Republic of China
| | - Tao Wu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan South Road, Wenhua Road 57, Shunqing District, Nanchong, 637000, Sichuan, People's Republic of China.
| |
Collapse
|
4
|
Kim HS, Shin YS. Robotic Assisted Simple Prostatectomy versus Holmium Laser Enucleation of the Prostate for Patients with Huge Benign Prostatic Hyperplasia. World J Mens Health 2023; 41:753-758. [PMID: 37635340 PMCID: PMC10523113 DOI: 10.5534/wjmh.230054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/27/2023] [Accepted: 05/22/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Hye Soo Kim
- Department of Urology, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea
- Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Yu Seob Shin
- Department of Urology, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea
- Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea.
| |
Collapse
|
5
|
Smith WJ, VanDyke ME, Venishetty N, Langford BT, Franzen BP, Morey AF. Surgical Management of Male Stress Incontinence: Techniques, Indications, and Pearls for Success. Res Rep Urol 2023; 15:217-232. [PMID: 37366389 PMCID: PMC10290851 DOI: 10.2147/rru.s395359] [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: 02/01/2023] [Accepted: 06/03/2023] [Indexed: 06/28/2023] Open
Abstract
Purpose Male stress urinary incontinence (SUI) has detrimental and long-lasting effects on patients. Management of this condition is an evolving field with multiple options for surgical treatment. We sought to review the pre-operative evaluation, intra-operative considerations, post-operative care, and future directions for treatment of male SUI. Methods A literature review was performed using the PubMed platform to identify peer-reviewed, English-language articles published within the last 5 years pertaining to management of male stress urinary incontinence with an emphasis on devices currently on the market in the United States including the artificial urinary sphincter (AUS), male urethral slings, and the ProACTTM system. Patient selection criteria, success rates, and complications were compared between the studies. Results Twenty articles were included in the final contemporary review. Pre-operative workup most commonly included demonstration of incontinence, PPD, and cystoscopy. Definition of success varied by study; the most common definition used was social continence (0-1 pads per day). Reported rates of success were higher for the AUS than for male urethral slings (73-93% vs 70-90%, respectively). Complications for these procedures include urinary retention, erosions, infections, and device malfunction. Newer treatment options including adjustable balloon systems and adjustable slings show promise but lack long-term follow-up. Conclusion Patient selection remains the primary consideration for surgical decision-making for management of male SUI. The AUS continues to be the gold standard for moderate-to-severe male SUI but comes with inherent risk of need for revision. Male slings may be a superior option for appropriately selected men with mild incontinence but are inferior to the AUS for moderate and severe incontinence. Ongoing research will shed light on long-term results for newer options such as the ProACT and REMEEX systems.
Collapse
Affiliation(s)
- Wesley J Smith
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Maia E VanDyke
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nikit Venishetty
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Brian T Langford
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bryce P Franzen
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Allen F Morey
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
6
|
Riveros C, Di Valerio E, Bacchus M, Chalfant V, Leelani N, Thomas D, Jazayeri SB, Costa J. Predictors of readmission and impact of same-day discharge in holmium laser enucleation of the prostate. Prostate Int 2023; 11:20-26. [PMID: 36910904 PMCID: PMC9995658 DOI: 10.1016/j.prnil.2022.07.003] [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: 03/20/2022] [Revised: 06/22/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background Holmium enucleation of the prostate (HoLEP) is becoming the gold standard for the treatment of benign prostatic hyperplasia (BPH). Our objective was to identify predictors of 30-day readmission and the impact of same-day discharge after HoLEP. Methods Using NSQIP data from 2011 to 2019, we identified men who underwent HoLEP for the treatment of BPH. We compared patients based on time of discharge and readmission status. We used multivariable logistic regression analysis (MLRA) to identify independent factors associated with 30-day readmission. Results A total of 3,489 patients met inclusion criteria with 833 (23.88%) being discharged within 24 hours and 2,656 (76.12%) discharged after 24 hours. There were 158 (4.53%) 30-day readmissions, mostly due to hematuria and urinary tract infection. Patients being readmitted were older (72 vs. 70 years old, P = 0.001), were more likely to have preoperative anemia (36.7% vs. 23.1%; P < 0.001), chronic kidney disease (29.7% vs. 19.7%; P < 0.001), bleeding disorder (10.8% vs. 2.8%; P < 0.001), higher American Society of Anesthesiologists (ASA) scores (≥3: 70.3% vs. 46.7%; P < 0.001) and a higher frailty burden (5-item modified frailty index [5i-mFI] ≥ 2: 36.1% vs. 19.1%; P < 0.001) compared to their counterparts. Factors independently associated with 30-day readmission were bleeding disorder (OR 2.89; 95% CI 1.63-5.11; P < 0.001), 5i-mFI ≥ 2 (OR 1.67; 95% CI 1.03-2.71; P = 0.038) and an ASA score ≥3 (OR 1.80; 95% CI 1.21-2.70; P = 0.004); however, same-day discharge was not found to be a significant predictor of 30-day readmissions. Conclusion The overall readmission rate after HoLEP is low. Patients discharged within 24 hours have similar rates of readmission compared to patients discharged after 24 hours. We found bleeding disorder, frailty burden, and ASA score to be independent predictors of 30-day readmission.
Collapse
Affiliation(s)
- Carlos Riveros
- Department of Urology, University of Florida, Jacksonville, FL, USA
| | | | - Michael Bacchus
- Department of Urology, University of Florida, Gainesville FL, USA
| | - Victor Chalfant
- Department of Urology, University of Florida, Jacksonville, FL, USA
| | - Navid Leelani
- Department of Urology, University of Florida, Jacksonville, FL, USA
| | - Devon Thomas
- Department of Urology, University of Florida, Jacksonville, FL, USA
| | | | - Joseph Costa
- Department of Urology, University of Florida, Jacksonville, FL, USA
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|