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Hu H, Chen W, Ma W, Yu C, He Q, Tang J, Yu G. Optimizing hemostasis in HoLEP surgery: retrospective review of selective bipolar plasmakinetic technology guided by bladder irrigation fluid color. World J Urol 2024; 42:419. [PMID: 39023815 PMCID: PMC11258058 DOI: 10.1007/s00345-024-05130-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: 10/28/2023] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECT To evaluate the effectiveness of selective bipolar plasmakinetic technology based on bladder irrigation fluid color on hemostasis in HoLEP surgwery METHODS: A total of 209 patients who underwent HoLEP surgery from October 2021 to July 2023 were included and divided into Hemostasis Management Group and control group. the color of the irrigation fluid was categorized into 5 levels and the bipolar plasmakinetic technology was applied when the color came to level 4 or up. The following was analyzed: postoperative use of balloon compression, blood loss, irrigation time, length of hospital stay, and the number of a second operation. RESULTS Only 4 patients in Hemostasis Management Group required postoperative urinary catheter balloon compression, while there are 15 in the control group(p=0.03). The average irrigation time for patients in the HM Group with bipolar plasmakinetic hemostasis was 21.88±13.76 hours, compared to that in patients with catheter balloon compression(p=0.007). CONCLUSION Based on the bladder irrigation color chart, the selective application of bipolar plasmakinetic hemostasis led to a significant reduction in the number of patients requiring postoperative bladder catheter balloon compression. Secondly, the irrigation time of patients who underwent bipolar plasmakinetic hemostasis also decreased.
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Affiliation(s)
- Hengda Hu
- Department of Urology, Shanghai Jinshan District Central Hospital, Jinshan District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences, Jinshan Branch of the Sixth People's Hospital of Shanghai, 147 Jiankang Road, Jinshan District, Shanghai, China
| | - Wenpu Chen
- Department of Urology, Shanghai Jinshan District Central Hospital, Jinshan District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences, Jinshan Branch of the Sixth People's Hospital of Shanghai, 147 Jiankang Road, Jinshan District, Shanghai, China
| | - Weixiong Ma
- Department of Urology, Shanghai Jinshan District Central Hospital, Jinshan District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences, Jinshan Branch of the Sixth People's Hospital of Shanghai, 147 Jiankang Road, Jinshan District, Shanghai, China
| | - Chengshuai Yu
- Department of Urology, Shanghai Jinshan District Central Hospital, Jinshan District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences, Jinshan Branch of the Sixth People's Hospital of Shanghai, 147 Jiankang Road, Jinshan District, Shanghai, China
| | - Qirui He
- Department of Urology, Shanghai Jinshan District Central Hospital, Jinshan District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences, Jinshan Branch of the Sixth People's Hospital of Shanghai, 147 Jiankang Road, Jinshan District, Shanghai, China
| | - Jinrong Tang
- Department of Urology, Shanghai Jinshan District Central Hospital, Jinshan District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences, Jinshan Branch of the Sixth People's Hospital of Shanghai, 147 Jiankang Road, Jinshan District, Shanghai, China
| | - Guofeng Yu
- Department of Urology, Shanghai Jinshan District Central Hospital, Jinshan District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences, Jinshan Branch of the Sixth People's Hospital of Shanghai, 147 Jiankang Road, Jinshan District, Shanghai, China.
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Branchu B, Léon P, Fournier R, Lasserre T, Tambwe R, Hoquetis L, Joncour C, Larré S. [Impact of antiplatelet and anticoagulant treatments on bleeding complications in patients treated with HoLEP]. Prog Urol 2020; 30:639-645. [PMID: 32409241 DOI: 10.1016/j.purol.2020.04.018] [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: 01/02/2020] [Revised: 04/10/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION We aimed to assess the impact of antiplatelet and anticoagulation therapy for patients undergoing HoLEP. METHODS We performed a study during the learning curve on a consecutive series of patients who underwent HoLEP surgery from 2015 to 2018. The patients were divided into 3 groups: a control group, patients with antiplatelet therapy and patients with anticoagulation therapy. RESULTS A total of 223 patients underwent HoLEP surgery during this period: 124 in the control group, 63 in the antiplatelet group and 36 in the anticoagulant group. In the anticoagulant group, we observe significant differences with the control group for the catheterization time (2.05 days vs 5.17 days; P<0.001), the hospital length of stay (1.5 nights vs 4.49 nights; P<0.001) and complications (8.9% vs 58%; P<0.001). No difference between the control and antiplatelet groups in terms of catheterization time, hospital length of stay and complications (2.05 days vs 2.68 days; 1.5 nights vs 1.6 nights) but variation in terms of complications and bleeding complications (8.9% vs 21%; P<0,001; 8.1% vs 19%; P<0,001) CONCLUSION: Our study shows that HoLEP is therefore associated with a higher risk of bleeding for patients treated with anticoagulation therapy. Complications increase morbidity with longer catheterization time, hospitalization times and higher transfusion's rates, revision surgery and readmission. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- B Branchu
- Service d'urologie, CHU de Reims, rue Cognacq-Jay, 51100 Reims, France.
| | - P Léon
- Service d'urologie, clinique Pasteur, 17200 Royan, France
| | - R Fournier
- Service d'urologie, CHU de Reims, rue Cognacq-Jay, 51100 Reims, France
| | - T Lasserre
- Service d'urologie, CHU de Reims, rue Cognacq-Jay, 51100 Reims, France
| | - R Tambwe
- Service d'urologie, CHU de Reims, rue Cognacq-Jay, 51100 Reims, France
| | - L Hoquetis
- Service d'urologie, CHU de Reims, rue Cognacq-Jay, 51100 Reims, France
| | - C Joncour
- Service d'urologie, CHU de Reims, rue Cognacq-Jay, 51100 Reims, France
| | - S Larré
- Service d'urologie, CHU de Reims, rue Cognacq-Jay, 51100 Reims, France
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Gazel E, Kaya E, Yalçın S, Tokas T, Yılmaz S, Aybal HÇ, Aydoğan TB, Tunç L. The role of laparoscopic experience on the learning curve of HoLEP surgery: A questionnaire-based study. Turk J Urol 2019; 46:129-133. [PMID: 31658014 DOI: 10.5152/tud.2019.19102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/29/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Holmium laser enucleation of the prostate (HoLEP) is an established method for treating benign prostatic obstruction. Nonetheless, its steep learning curve limits its wide distribution. The purpose of the present study was to demonstrate the impact of laparoscopic experience on HoLEP learning curve by evaluating the association between learning curves of surgeons performing both laparoscopy and HoLEP surgery. MATERIAL AND METHODS A questionnaire was prepared to identify surgeon's experience on laparoscopy and HoLEP, as well as their learning curves. This questionnaire was then distributed via e-mail to 110 urologists who are actively involved in endourology/laparoscopy. RESULTS Of the 110 urologists, 80 (72.7%) responded and completed the questionnaire. Of the 80 surgeons, 47 (58.8%) reported that they had completed the HoLEP learning curve with <20 cases. Moreover, 33 (41.2%) reported that they were able to complete the learning curve by performing >20 cases. Completion of the HoLEP learning curve in <20 cases was reached at 1.3%, 13.8%, and 43.8% by beginner, moderate skilled, and experienced laparoscopists, respectively (p<0.001). CONCLUSION Laparoscopic experience appears to be beneficial for surgeons while learning HoLEP. Highly experienced laparoscopic surgeons have a shorter HoLEP learning curve.
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Affiliation(s)
- Eymen Gazel
- Department of Urology, Acıbadem University Ankara Hospital, Ankara, Turkey
| | - Engin Kaya
- Department of Urology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Serdar Yalçın
- Department of Urology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria
| | - Sercan Yılmaz
- Department of Urology, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Halil Çağrı Aybal
- Department of Urology, Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | | | - Lütfi Tunç
- Department of Urology, Gazi University School of Medicine, Ankara, Turkey
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Stutz J, Kleinguetl C, El Tayeb M. Re: “Management of Suspected Bladder Injury and Capsular Perforation After Holmium Laser Enucleation of the Prostate” by Lwin et al. (J Endourol Case Rep 2018;4:87–90). J Endourol Case Rep 2018; 4:147-148. [PMID: 30263964 PMCID: PMC6156687 DOI: 10.1089/cren.2018.0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Colin Kleinguetl
- Department of Urology, Scott and White Medical Center Temple, Temple, Texas
| | - Marawan El Tayeb
- Department of Urology, Scott and White Medical Center Temple, Temple, Texas
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Roger M, Goris-Gbenou M, Guillermet A, Vial R, Cunin N, Tomas J, Bourgue L, Combe M, Lopez JG, Combe C. Évaluation prospective des coûts directs de l’énucléation prostatique par le laser HoLEP ® pendant la courbe d’apprentissage. Prog Urol 2017; 27:319-324. [DOI: 10.1016/j.purol.2017.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 02/26/2017] [Accepted: 03/11/2017] [Indexed: 10/19/2022]
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