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Kimura S, Katayama H, Ohara E, Aoki H, Shibuya R, Naganuma H, Ishidoya S, Ito A. Prostate-specific antigen follow-up and management for patients undergoing holmium laser enucleation of the prostate. Int J Urol 2024; 31:82-87. [PMID: 37803911 DOI: 10.1111/iju.15315] [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: 04/04/2023] [Accepted: 09/20/2023] [Indexed: 10/08/2023]
Abstract
OBJECTIVES To investigate who needs a careful postoperative monitoring for prostate cancer (PCa) after holmium laser enucleation of the prostate (HoLEP). We examined characteristics and oncological outcomes of HoLEP-related PCa. METHODS Patients who underwent HoLEP during 2002-2017 in a Japanese tertiary center were retrospectively analyzed. Patients were divided into non-PCa, PCa with HoLEP specimen (PCa-Ope), and PCa diagnosed during follow-up (PCa-Post). Outcomes of all HoLEP-related PCa were monitored. RESULTS Of the total 758, 60 (7.9%) were diagnosed with PCa from resected specimen of HoLEP and 9 (1.2%) were diagnosed postoperatively. Preoperative prostate-specific antigen (iPSA), postoperative PSA (pPSA), and PSA density were significantly higher in both PCa groups than those in non-PCa group. While iPSA significantly correlated to prostate volume (PV), pPSA was not associated with PV. A receiver-operating-characteristics curve demonstrated that pPSA 1.2 ng/mL achieved the optimal cut-off (AUC 0.95) for the incidence of PCa-Post. In addition to the incidence of PCa and iPSA, lower enucleation efficiency (enucleated volume /PV) was significantly associated with pPSA >1.2 ng/mL. Among PCa-Ope, 51 were Grade Group (GG) ≤2 and 42 were followed-up with active surveillance, whereas 8 of 9 PCa-Post were GG ≥3 and 2 progressed to death. CONCLUSIONS Patients undergoing HoLEP are associated with some risk of potential PCa. While oncological outcomes were favorable among PCa-Ope, postoperative PSA should be carefully monitored even if not diagnosed with PCa with HoLEP specimen. Enucleation efficiency should be also considered not to misread pPSA value.
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Affiliation(s)
- Shingo Kimura
- Department of Urology, Sendai City Hospital, Sendai, Japan
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiromichi Katayama
- Department of Urology, Sendai City Hospital, Sendai, Japan
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Eiichiro Ohara
- Department of Urology, Sendai City Hospital, Sendai, Japan
| | - Hiroshi Aoki
- Department of Urology, Sendai City Hospital, Sendai, Japan
| | - Rie Shibuya
- Department of Pathology, Sendai City Hospital, Sendai, Japan
| | | | | | - Akihiro Ito
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Shoma AM, Ghobrial FK, El-Tabey N, El-Hefnawy AS, El-Kappany HA. A randomized trial of holmium laser vs thulium laser vs bipolar enucleation of large prostate glands. BJU Int 2023; 132:686-695. [PMID: 37667842 DOI: 10.1111/bju.16174] [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: 09/06/2023]
Abstract
OBJECTIVE To compare the outcome and morbidity of bipolar transurethral enucleation of the prostate (B-TUEP) and thulium laser enucleation of the prostate (ThuLEP) with those of holmium laser enucleation of the prostate (HoLEP) in the treatment of large symptomatic benign prostatic obstruction (BPO) through a non-inferiority randomized controlled trial (NCT03916536). PATIENTS AND METHODS A total of 155 patients were recruited from a single centre between February 2019 and August 2020. All had BPO, with a prostate volume ≥80 ml. Patients were randomly assigned to HoLEP, ThuLEP or B-TUEP using computer-generated random tables in a 1:1:1 ratio. Participants, investigators and surgeons were blinded to group assignment until the date of the operation. Thereafter, the patients were followed up at 1, 3, 6 and 12 months. The primary outcome was maximum urinary flow rate (Qmax ) at 6 months. Secondary outcomes included assessment of other functional urinary variables, peri-operative records, and adverse events. RESULTS There were 138 and 120 patients available for analysis at 6 and 12 months. There was no significant difference in Qmax between the groups at 6 and 12 months (P = 0.4 and P = 0.7, respectively), and no significant difference regarding International Prostate Symptom Score (IPSS), quality of life (QoL) or postvoid residual urine volume (PVR). The median (interquartile range) prostate-specific antigen (PSA) reductions (ng/ml) were similar in the three groups at last follow-up point (4.7 [2.2-7.1]; 5.6 [2.3-9.5] and 5 [3.4-10] after HoLEP, ThuLEP and B-TUEP, respectively). Differences in enucleation time, enucleation efficiencies and auxiliary manoeuvres were statistically insignificant (P = 0.1, 0.8 and 0.07, respectively). At 1 year, patients with prostate volumes >120 ml showed significant IPSS improvement in favour of HoLEP and ThuLEP (P = 0.01). Low- and high-grade adverse effects were recorded in 31 and five cases, respectively, with no statistically significant difference between the groups. CONCLUSIONS We conclude that ThuLEP and B-TUEP are as safe and effective as HoLEP for the treatment of large-sized BPO. Significant PSA reductions indicate that there was effective adenoma enucleation with all three approaches. The study provides objective evidence that endoscopic enucleation of the prostate is a technique rather than energy dependent procedure.
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Affiliation(s)
- Ahmed M Shoma
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Fady K Ghobrial
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
- Department of Urology, Faculty of Medicine, Damietta University, Damietta, Egypt
| | - Nasr El-Tabey
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Yıldırım Ü, Ezer M, Uslu M, Örs B. En bloc enucleation of the prostate with early apical release using a high-power (200 W) thulium device: studying a learning curve. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230325. [PMID: 37729364 PMCID: PMC10508896 DOI: 10.1590/1806-9282.20230325] [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: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE The aim of this study was to reveal the learning curve of early apical release en bloc laser prostatectomy using a high-power thulium (200 W) laser device. METHODS We obtained data on the initial 60 patients who had thulium laser enucleation of the prostate by a single surgeon between October 2021 and August 2022 to treat the signs and symptoms of benign prostatic hyperplasia at our clinic. The cases were split into three groups, each consisting of 20 patients. Prostate volumes, prostate-specific antigen and hemoglobin levels, the International Prostate Symptom Score, Quality of Life scores, the International Index of Erectile Function-5 scores, and uroflowmetry parameters were documented preoperatively. The enucleation weight, the enucleation and morcellation times, as well as the efficiency, hospitalization, and catheterization durations were calculated. The patients were re-evaluated at 6 months postoperatively, examined for functional results, and compared to baseline conditions. RESULTS Enucleation times, morcellation times, enucleation weight, and enucleation efficiency were significantly different among the groups. However, there was no statistically significant difference in total operative time and morcellation efficiency. In terms of postoperative statistics, the reduction in hemoglobin was significantly greater in Group 1 compared to Group 2. Six months after surgery, all groups had comparable validated ratings (International Prostate Symptom Score, Quality of Life, and the International Index of Erectile Function-5) on postoperative examinations. There were no long-term complications in either group throughout the perioperative period. CONCLUSION Completing 40 first cases would be sufficient for managing the learning curve for early apical release en bloc thulium laser enucleation of the prostate.
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Affiliation(s)
- Ümit Yıldırım
- Kafkas University, Medical School, Department of Urology – Kars, Turkey
| | - Mehmet Ezer
- Kafkas University, Medical School, Department of Urology – Kars, Turkey
| | - Mehmet Uslu
- Kafkas University, Medical School, Department of Urology – Kars, Turkey
| | - Bumin Örs
- Özel Sağlık Hospital, Department of Urology – İzmir, Turkey
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Livingston AJ, Dvergsten T, Morgan TN. Initial Postoperative Prostate Specific Antigen and PSA Velocity Are Important Indicators of Underlying Malignancy After Simple Prostatectomy. J Endourol 2023; 37:1057-1062. [PMID: 37376750 DOI: 10.1089/end.2023.0101] [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: 06/29/2023] Open
Abstract
Background: There is a paucity of guidelines for prostate-specific antigen (PSA) monitoring after simple prostatectomy (SP) despite these patients remaining at risk for prostate cancer (PCa). Our objective was to determine if PSA kinetics can be a potential indicator of PCa after SP. Methods: A retrospective review was performed of all simple prostatectomies at our institution from 2014 to 2022. All patients who met criteria were included in the study. Relevant clinical variables were collected preoperatively, including PSA value, prostate size, and voiding symptoms. Surgical and urinary function outcomes were analyzed. Results: A total of 92 patients were divided into two groups based on malignancy status. Sixty-eight patients did not have PCa, while 24 patients had known PCa before surgery (14) or were diagnosed as having incidental PCa from the pathological specimen (10). Patients with benign prostates had an initial postoperative PSA value of 0.76 ng/mL compared with 1.68 ng/mL for those with cancer (p < 0.01). PSA velocity for the first 24 months after surgery was 0.042 ± 1.61 ng/(mL·year) for the benign cohort compared with 1.29 ± 1.02 ng/(mL·year) for the malignant cohort (p = 0.01). Voiding improvements were noted by objective (postvoid residual and flow rate) and subjective (American Urological Association symptom score and quality of life score) measures in both groups. Conclusions: PSA interpretation and monitoring after SP have not been well established. Our study indicates that initial postoperative PSA value and PSA velocity are important indicators of underlying malignancy in patients after SP. Further efforts are needed to establish threshold values and formal guidelines.
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Affiliation(s)
- Austin J Livingston
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Thomas Dvergsten
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Tara N Morgan
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Suartz CV, Braz NDSF, Dos Anjos GC, Dos Reis ST, Nahas WC, Antunes AA. The use of statins is related to a lower PSA level after endoscopic enucleation of the prostate with holmium laser (HoLEP) for the treatment of BPH. World J Urol 2023; 41:2149-2154. [PMID: 37326653 DOI: 10.1007/s00345-023-04462-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/29/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE To determine the factors that may be associated with a 2-month high baseline level of Total Prostatic Specific Antigen (PSA) after endoscopic enucleation of the prostate with Holmium Laser (HoLEP). MATERIALS AND METHODS Retrospective study of a prospectively collected database of adult males undergoing HoLEP at a single tertiary institution from September 2015 to February 2021. Pre-operative epidemiological, clinical characteristics and post-operative factors were analyzed and a multivariate analysis was performed to determine factors independently related to PSA decline. RESULTS A total of 175 men aged 49-92 years with a prostate size ranging from 25 to 450 cc underwent HoLEP, and after excluding data from patients due to loss of follow-up or incomplete data, 126 patients were included in the final analysis. The patients were divided into group A (n = 84), which included patients with postoperative PSA nadir lower than 1 ng/ml, and group B(n = 42), with postoperative PSA levels greater than 1 ng/ml. In the univariate analysis there was a correlation between the variation of the PSA value and the percentage of resected tissue (p = 0.028), for each 1 g of resected prostate there was a reduction of 0.104 ng/mL, furthermore there was a difference between the means of age of group A (71.56 years) and group B (68.17 years) (p = 0.042). In the multivariate analysis, the use of statins and lower postoperative PSA levels (p = 0.024; HR = 3.71) were correlated. CONCLUSIONS Our results indicate that PSA after HoLEP is correlated with patient's age, the presence of incidental prostate cancer, and the use of statins.
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Affiliation(s)
- Caio Vinícius Suartz
- Division of Urology, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil.
- Divisão de Clínica Urológica, Hospital das Clínicas da Universidade de São Paulo, Avenida Dr. Éneas de Carvalho Aguiar, 255-Sala 710F, 7º Andar, São Paulo, SP, CEP 05403-000, Brasil.
| | | | | | - Sabrina Thalita Dos Reis
- Division of Urology, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - William Carlos Nahas
- Division of Urology, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - Alberto Azoubel Antunes
- Division of Urology, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil
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Ogawa K, Kitabayashi R, Kurokawa M, Okada Y, Uno S, Shibuya S, Okubo K. Metastatic prostate cancer with low PSA levels diagnosed after holmium laser enucleation of the prostate. Int Cancer Conf J 2023; 12:104-108. [PMID: 36896202 PMCID: PMC9989107 DOI: 10.1007/s13691-022-00586-3] [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: 08/08/2022] [Accepted: 11/19/2022] [Indexed: 12/04/2022] Open
Abstract
Holmium laser enucleation of the prostate is a widely accepted surgical treatment method for benign prostate hyperplasia, but its effect on prostate cancer remains unclear. In this study, we report the cases of two patients with metastatic prostate cancer diagnosed during follow-up after holmium laser enucleation of the prostate. Case 1 was a 74 year-old man who underwent holmium laser enucleation of the prostate. Prostate-specific antigen levels declined from 4.3 to 1.5 ng/mL at 1 month after surgery, but after 19 months, they increased to 6.6 ng/mL. Based on pathological and radiological findings, he was diagnosed as having prostate cancer, with Gleason score 5 + 4 with neuroendocrine differentiation, cT3bN1M1a. Case 2 was a 70 year-old man who also underwent holmium laser enucleation of the prostate. Prostate-specific antigen levels declined from 7.2 to 2.9 ng/mL at 6 months after surgery, but after 12 months, they increased to 12 ng/mL. Based on pathological and radiological findings, he was diagnosed as having prostate cancer, with Gleason score 4 + 5 with intraductal carcinoma of the prostate, cT3bN1M1a. This report suggests that advanced prostate cancer may be newly diagnosed after holmium laser enucleation of the prostate. Even if prostate cancer had not been demonstrated in the enucleated specimen, and postoperative PSA levels were below the standard values, physicians should regularly monitor prostate-specific antigen levels after holmium laser enucleation of the prostate, and further examination should be considered keeping in mind prostate cancer progression.
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Affiliation(s)
- Kosuke Ogawa
- Department of Urology, Kyoto Katsura Hospital, 17 Yamada-Hiraocho Nishikyo-Ku, Kyoto, Japan
| | - Ryota Kitabayashi
- Department of Urology, Kyoto Katsura Hospital, 17 Yamada-Hiraocho Nishikyo-Ku, Kyoto, Japan
| | - Masayuki Kurokawa
- Department of Urology, Kyoto Katsura Hospital, 17 Yamada-Hiraocho Nishikyo-Ku, Kyoto, Japan
| | - Yoshiyuki Okada
- Department of Urology, Kyoto Katsura Hospital, 17 Yamada-Hiraocho Nishikyo-Ku, Kyoto, Japan
| | - Shunsuke Uno
- Department of Diagnostic Pathology, Kyoto Katsura Hospital, Nishikyo-Ku, Kyoto, Japan
| | - Shinsuke Shibuya
- Department of Diagnostic Pathology, Kyoto Katsura Hospital, Nishikyo-Ku, Kyoto, Japan
| | - Kazutoshi Okubo
- Department of Urology, Kyoto Katsura Hospital, 17 Yamada-Hiraocho Nishikyo-Ku, Kyoto, Japan
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Elsaqa M, Slade A, Lingeman J, Piroozi A, Wagner K, Jhavar S, El Tayeb MM. Holmium Laser Enucleation of Prostate in Patients with Pre-Existing Localized Prostate Cancer, Dual Center Study. J Endourol 2023; 37:330-334. [PMID: 36463424 DOI: 10.1089/end.2022.0571] [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: 12/07/2022] Open
Abstract
Background: Holmium laser enucleation of the prostate (HoLEP) has been used as an effective minimally invasive technique for management of enlarged prostates. We aimed to report the role of HoLEP in prostate cancer (PCa) patients either on active surveillance with bothersome lower urinary tract symptoms (LUTS) or for prostate debulking before radiation therapy and the impact on PCa management plans. Methods: Prospectively maintained database in two institutions was reviewed for patients with localized PCa managed by HoLEP with at least a follow-up of 1 year. We assessed prostate-specific antigen (PSA) trends, effect on international prostate symptom score (IPSS) and further management of PCa. Results: Out of >2000 HoLEP patients, 117 patients with a median follow-up of 30 months were included. Mean (standard deviation) age was 72.3 (±8.3) years with median (interquartile range, IQR) IPPS of 22 (16-28) and median (IQR) PSA at 7.6 (5.3-14.9) ng/mL. Gleason grade group was 1, 2, 3, and 4 in 47 (73.2%), 32 (27.35%), 7 (5.9%), and 4 (3.4%) patients, respectively. Median (IQR) PSA has significantly dropped to 1.3 (0.6-3.1), 1.4 (0.75-2.9), and 1.7 (0.86-2.75) ng/mL at 6-week, 3-month, and 1-year follow-up, respectively (p < 0.001). IPSS scores post-HoLEP obviously improved with mean (IQR) IPSS of 10 (5-13), 7 (3-12), and 3 (2-5) at 6-week, 3-month, and 1-year, respectively (p < 0.001). Eighty-eight (72%) patients stayed on active surveillance, whereas 27 (23%) patients had radiotherapy ± androgen deprivation therapy for persistently high or relapsing PSA. Within 36 intermediate-risk patients, 15 (41.6%) and patients had radiotherapy, whereas 21 (58.3%) patients continued active surveillance. Conclusions: HoLEP is beneficial in debulking large prostate in PCa patients with bothersome LUTS on active surveillance or before radiotherapy. HoLEP reduces the contribution of large adenoma to PSA level, thus reflecting PSA level better and helping reduce overtreatment.
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Affiliation(s)
- Mohamed Elsaqa
- Division of Urology, Department of Surgery, Baylor Scott and White Health, Temple, Texas, USA.,Department of Urology, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Austen Slade
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - James Lingeman
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alex Piroozi
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kristofer Wagner
- Division of Urology, Department of Surgery, Baylor Scott and White Health, Temple, Texas, USA
| | - Sameer Jhavar
- Department of Radiation Oncology, Baylor Scott and White Health, Temple, Texas, USA
| | - Marawan M El Tayeb
- Division of Urology, Department of Surgery, Baylor Scott and White Health, Temple, Texas, USA
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Schober JP, Stensland KD, Moinzadeh A, Canes D, Mandeville J. Holmium laser enucleation of the prostate in men on active surveillance for prostate cancer with refractory lower urinary tract symptoms secondary to enlarged prostates. Prostate 2023; 83:39-43. [PMID: 36063405 DOI: 10.1002/pros.24433] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/01/2022] [Accepted: 08/05/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The surgical treatment of men with lower urinary tract symptoms (LUTS) and significantly enlarged symptomatic prostates on active surveillance (AS) for low-risk prostate cancer (PCa) is not well defined. We report our single-institution initial experience with holmium laser enucleation of the prostate (HoLEP) for LUTS in men with low-risk PCa being managed with AS. MATERIALS AND METHODS Men on AS who underwent HoLEP between 2013 and 2019 were identified. Data regarding preoperative cancer workup, prostate-specific antigen (PSA), perioperative outcomes, and voiding parameters were analyzed. Postoperative surveillance for PCa including PSA nadir, prostate magnetic resonance imaging, prostate biopsy (PBx), and PSA at last follow-up were evaluated. RESULTS Twenty men met the inclusion criteria. Preoperative mean max flow 7.9 ml/s, median postvoid residual 101 cc, and mean transrectal ultrasound prostate size 99 cc. Patients had a median adjusted preoperative PSA of 8.5 (interquartile range [IQR]: 4.8-13.2) ng/ml. Mean resected tissue weight was 65.5 g with improved postoperative flow rate and significantly decreased residual. A total of 5/20 men had PCa in the specimen (all Gleason Grade Group 1). The median postoperative PSA nadir was 1.2 (IQR: 0.5-1.8) ng/ml at median of 5 months. At the last follow-up (median 18.5 months, IQR: 10.5-37.8), the median postoperative PSA was 1.4 (IQR: 0.63-2.48) ng/ml. Nine men underwent postoperative multiparametric magnetic resonance imaging (mpMRI) with the identification of a new prostate imaging reporting and data system 5 lesion in one patient who underwent negative fusion biopsy. Five men underwent post-HoLEP PBx with progression in two patients, who both successfully underwent radical prostatectomy. CONCLUSIONS Men on AS for low-risk PCa can safely undergo HoLEP with significantly improved voiding parameters. Postoperative monitoring with PSA, mpMRI, and PBx can detect disease progression requiring definitive treatment. Further research is needed to optimize surveillance strategies and long-term cancer-specific outcomes.
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Affiliation(s)
- Jared P Schober
- Department of Urology, Lahey Hospital and Medical Center, Institute of Urology, Burlington, Massachusetts, USA
| | - Kristian D Stensland
- Department of Urology, Lahey Hospital and Medical Center, Institute of Urology, Burlington, Massachusetts, USA
| | - Alireza Moinzadeh
- Department of Urology, Lahey Hospital and Medical Center, Institute of Urology, Burlington, Massachusetts, USA
| | - David Canes
- Department of Urology, Lahey Hospital and Medical Center, Institute of Urology, Burlington, Massachusetts, USA
| | - Jessica Mandeville
- Department of Urology, Lahey Hospital and Medical Center, Institute of Urology, Burlington, Massachusetts, USA
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Ericson CA, Baird BA, Mauler DJ, Lyon TD, Ball CT, Dora CD. Early apical release versus En-bloc no touch technique for holmium laser enucleation of the prostate: a high-volume single-surgeon cohort study. World J Urol 2023; 41:167-172. [PMID: 36357603 DOI: 10.1007/s00345-022-04206-w] [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: 05/17/2022] [Accepted: 10/06/2022] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To determine whether the early apical release (EAR) technique for holmium laser enucleation of the prostate (HOLEP) is associated with improved perioperative outcomes compared to the En-bloc no touch (EBNT) technique. METHODS Consecutive men treated with HOLEP by a single surgeon from August 2018 to March 2021 were identified. Beginning in June 2021 all procedures were performed using the EAR technique, and these were compared to the preceding cases done with the EBNT technique. Intraoperative outcomes included operative time, need for open conversion, enucleation efficiency (tissue removed per minute of OR time), and enucleation ratio (tissue removed relative to preoperative gland size on imaging). Postoperative outcomes included catheter reinsertion, blood transfusion, and complications classified by the Clavien-Dindo scale. RESULTS We identified 801 men, including 571 (71%) treated with EBNT and 230 (29%) with EAR. Median preoperative characteristics were similar between groups. The EAR approach was associated with significantly longer mean operating room time, 100.5 min versus 91.9 min, p = 0.003. However, EAR patients had a much lower rate of conversion to open cystotomy (0.43% versus 3.0%). There were no significant differences in rate of catheter reinsertion or perioperative complications between groups (p > 0.05). CONCLUSION EAR technique by an experienced HoLEP surgeon resulted in longer operative times, potentially reflecting an initial learning curve, but essentially eliminated the need for open cystotomy. Perioperative results including catheter reinsertion rate and bleeding complications were similar between the two cohorts. These data support continued use of the EAR technique for HOLEP to minimize risk of open conversion.
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Affiliation(s)
- Christian A Ericson
- Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Bryce A Baird
- Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | | | - Timothy D Lyon
- Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Colleen T Ball
- Department of Biostatistics, Mayo Clinic, Jacksonville, FL, USA
| | - Chandler D Dora
- Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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10
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Relationships between holmium laser enucleation of the prostate and prostate cancer. Nat Rev Urol 2022; 20:226-240. [PMID: 36418491 DOI: 10.1038/s41585-022-00678-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/27/2022]
Abstract
Holmium laser enucleation of the prostate (HoLEP) is a size-independent surgical option for treating benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS) with excellent, durable functional outcomes. The prevalence of LUTS secondary to BPH and prostate cancer both increase with age, although the two diseases develop independently. Urologists often face a diagnostic dilemma, as men with LUTS secondary to BPH might also present with an elevated PSA and, therefore, need a diagnostic work-up to exclude prostate cancer. Nevertheless, ~15% of men with a negative elevated PSA work-up will undergo HoLEP and will be diagnosed with incidental prostate cancer at the time of HoLEP. Indeed, prostate cancer is often found in men undergoing HoLEP, and this situation can be challenging to manage. Variables associated with the detection of incidental prostate cancer, strategies to reduce incidental prostate cancer, as well as the natural history and management of this condition have been extensively studied, but further work in this area is still needed.
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Cheng YT, Hong JH, Lu YC, Chang YK, Hung SC, Feng KK, Liu SP, Chow PM, Chang HC, Chen CH, Pu YS. Clinical Implications of Nadir Serum Prostate-Specific Antigen Levels After Transurethral Enucleation of the Prostate. Front Oncol 2022; 12:949275. [PMID: 35912236 PMCID: PMC9334729 DOI: 10.3389/fonc.2022.949275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/24/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Prostate-specific antigen levels after transurethral enucleation of the prostate may serve as indicators of residual cancer foci. The objective of this study was to investigate the association between the post-transurethral enucleation of the prostate nadir prostate-specific antigen level and prostate cancer. Materials and Methods We retrospectively reviewed the data of 428 men who underwent transurethral enucleation of the prostate between March 2015 and April 2021. Based on the following exclusion criteria, we excluded 106 men from our analysis: men with metastatic prostate cancer, incomplete transurethral enucleation of the prostate, and missing prostate-specific antigen or prostate size data. Three hundred and twenty-two patients were finally enrolled in our study. These patients were classified into four groups according to the surgical pathology: benign, transition zone (cancer only in the adenoma or transition zone), peripheral zone, and transition and peripheral zones. The optimal cutoff post-transurethral enucleation of the prostate nadir prostate-specific antigen level that predicted residual prostate cancer was determined using receiver operating characteristic curve analysis. Results In total, 71 (22.0%) men exhibited prostate cancer (median follow-up, 38.0 months). The benign and combined cancer groups showed similar adenoma removal rates (103.0% and 106.7%, respectively). The median nadir prostate-specific antigen levels after transurethral enucleation of the prostate were 0.76, 0.63, 1.79, and 1.70 ng/ml in the benign, transition zone, peripheral zone, and transition and peripheral zone groups, respectively (p < 0.001), with no difference between the benign and transition zone groups (p = 0.458); this suggested that complete transurethral enucleation of the prostate removed all cancer nests in the adenoma in the transition zone group. Receiver operating characteristic curve analysis showed that nadir prostate-specific antigen ≧1.7 ng/ml predicted residual cancer (area under the curve: 0.787) or cancer with a Gleason score of ≧7 (area under the curve: 0.816) in the remaining prostate. Limitations include the retrospective design and the perioperative peripheral zone biopsy rate. Conclusions The post-transurethral enucleation of the prostate nadir prostate-specific antigen ≧1.7 ng/ml after complete transurethral enucleation of the prostate can predict significant residual cancer. Prostate cancer patients with low post-transurethral enucleation of the prostate prostate-specific antigen levels can be conservatively managed.
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Affiliation(s)
- Yung-Ting Cheng
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Urology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Jian-Hua Hong
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Chuan Lu
- Department of Urology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Yi-Kai Chang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Chun Hung
- Department of Urology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Kuo-Kang Feng
- Department of Urology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Shih-Ping Liu
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Ming Chow
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hong-Chiang Chang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Hsin Chen
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
- *Correspondence: Yeong-Shiau Pu, ; Chung-Hsin Chen,
| | - Yeong-Shiau Pu
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
- *Correspondence: Yeong-Shiau Pu, ; Chung-Hsin Chen,
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Chen PY, Chen SM, Juang HH, Hou CP, Lin YH, Yang PS, Chen CL, Chang PL, Lin KY, Tsui KH. Prostate-Specific Antigen Velocity Predicts Surgical Outcome of Thulium Laser Enucleation of the Prostate. Front Med (Lausanne) 2022; 8:783221. [PMID: 35047531 PMCID: PMC8761894 DOI: 10.3389/fmed.2021.783221] [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: 09/25/2021] [Accepted: 11/23/2021] [Indexed: 11/14/2022] Open
Abstract
Background: We determined the effect of prostate-specific antigen velocity (PSAV) on the surgical outcome of thulium laser enucleation of the prostate (ThuLEP) in patients with benign prostatic hyperplasia (BPH). Methods: A retrospective review was performed of prospectively collected data of patients with BPH who underwent ThuLEP at any time from 2017 to 2019. Patients who had undergone BPH surgery or had prostate cancer previously were excluded, and patients with prostate-specific antigen (PSA) > 4 ng/ml were examined through transrectal ultrasound-guided prostate biopsy to rule out prostatic malignancy. Furthermore, patients were excluded if prostatic malignancy was diagnosed during postsurgery follow-up. Results: The PSA level, International Prostate Symptom Score (IPSS), and quality of life (QoL) of 27 male patients at 3 and 15 months postsurgery differed significantly from those at presurgery; the maximum flow rate (Qmax) and postvoid residual (PVR) significantly differed between 3 months postsurgery and presurgery; and 22 and 5 patients had good to excellent and fair to poor outcomes, respectively, at 15 months postsurgery. Patients were divided into two groups (fair and poor vs. good and excellent outcomes at 15 months postsurgery), which significantly differed with respect to PSAV at 3 months postsurgery (P = 0.04), IPSS presurgery (P < 0.02), surgical length (P = 0.01), and hospitalization duration (P = 0.04). In a receiver operating characteristic (ROC) analysis, the optimal cutoff value of PSAV of −0.52 ng/ml characterized effectiveness at 15 months after ThuLEP, and the area under the curve (AUC), sensitivity, and specificity were 0.82 (P < 0.02), 0.80, and 0.82, respectively. For PSAV < -0.52 and ≥-0.52 ng/ml, the percentages of reduction for IPSS, QoL, Qmax, and PVR were −78.6 and −71.4%, −33.3 and 0.0%, 94.4 and 40.0%, and −85.1 and −38.7%, respectively. Conclusions: Postsurgical PSAV was positively correlated with surgical success, and the PSAV cutoff was −0.52 ng/ml. PSAV can, thus, be used to guide the postsurgical follow-up treatment at 3 months after BPH surgery.
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Affiliation(s)
- Po-You Chen
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shao-Ming Chen
- Department of Urology, Heping Campus, Taipei City Hospital, Taipei, Taiwan
| | - Horng-Heng Juang
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Anatomy, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-Pang Hou
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Hsiang Lin
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Anatomy, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei-Shan Yang
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Urology, Heping Campus, Taipei City Hospital, Taipei, Taiwan
| | - Chien-Lun Chen
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Phei-Lang Chang
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuo-Yen Lin
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ke-Hung Tsui
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Urology, Shuang Ho Hospital, School of Medicine, College of Medical, Taipei Medical University, Taipei, Taiwan.,TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan
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13
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Are all procedures for benign prostatic hyperplasia created equal? A systematic review on post-procedural PSA dynamics and its correlation with relief of bladder outlet obstruction. World J Urol 2021; 40:889-905. [PMID: 34212237 DOI: 10.1007/s00345-021-03771-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/18/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To evaluate and provide a comprehensive literature review of Prostate specific antigen (PSA) dynamics after various surgical procedures for benign prostatic hyperplasia (BPH). METHODS A thorough PubMed database search was performed over last 30 years including terms "PSA" and various surgical procedures for BPH. PSA nadir after various procedure was evaluated. The post-operative improvement in International Prostate Symptom Score, maximum void rates and post-void residue after surgeries were recorded. An indirect correlation was made between PSA nadir and outcome of various BPH surgical procedures. RESULTS Enucleation procedures like simple prostatectomy and endoscopic enucleation of prostate (EEP) produced maximum drop in PSA level after surgery and were associated with the highest improvement in post-operative parameters. The PSA nadir following resection techniques like transurethral resection of prostate and Holmium laser resection of prostate and vaporization technique was variable and less robust when compared to EEP. Newer techniques like Aquablation, Rezum, Urolift, Prostate artery embolization and Temporary implantable nitinol devices (iTIND) produce relatively less reduction in PSA and lesser percentile improvement in post-operative parameters. CONCLUSIONS Various surgical procedures for BPH result in varying PSA nadirs level. Enucleation procedures and simple prostatectomy produce the most drastic and sustained decrease in PSA. There is a possible indirect evidence suggesting that the level of PSA nadir corresponds closely with the degree of post-operative improvement and durability of the procedure. Establishing the new PSA nadir at 3-6 months after the procedure is recommended as a part of routine surveillance for prostate cancer in eligible patients.
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Undie CU, Nnana EI, Torporo KR. Initial experience with holmium laser enucleation of the prostate in a urology specialist hospital in Nigeria. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00184-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract
Background
Holmium laser enucleation of the prostate (HoLEP) is a more recent procedure for the management of Benign Prostatic Hyperplasia compared to open prostatectomy or Transurethral Resection of the Prostate. HoLEP is not commonly done in Nigeria. The objective of the study was to determine whether our initial experience with HoLEP in Abuja, favourably compared to those of other centres across the world.
Methods
A retrospective study was done on 40 patients who had HoLEP between October 2018 and December 2019. Pre- and post-operative International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), prostate sizes, maximum flow rate (Qmax) and post-void residual urine volume (PVR) were collated. The duration of irrigation, catheterization and length of hospital stay were also recorded and analysed. Complications were documented.
Results
There were improvements in IPSS from 19.67 to 5.41, PSA from 8.07 to 2.03 ng/ml,Qmax from 11.27 to 29.67 ml/min, PVR from 88.99 to 32.8 ml, while average prostate sizes reduced from 116.54 to 30.3 g after surgery. Following HoLEP, the duration of irrigation was 18.00 h, catheterization was 26.76 h and length of hospital stay was 1.82 days. Two (5.0%) patients were recatheterized, 4 (10.0%) developed post-operative bladder neck stenosis.
Conclusions
The outcome of HoLEP in our experience compared favourably with those from other centres. With adequate training and requisite equipment in resource-poor environments, technical procedures like HoLEP can be embarked on with favourable results.
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15
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Martos M, Katz JE, Parmar M, Jain A, Soodana‐Prakash N, Punnen S, Gonzalgo ML, Miao F, Reis IM, Smith N, Shah HN. Impact of perioperative factors on nadir serum prostate‐specific antigen levels after holmium laser enucleation of prostate. BJUI COMPASS 2021; 2:202-210. [PMID: 35475131 PMCID: PMC8988639 DOI: 10.1002/bco2.68] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022] Open
Abstract
Objective To investigate the relationship of preoperative prostate size, urinary retention, positive urine culture, and histopathological evidence of prostatitis or incidental prostate cancer on baseline and 3‐month nadir prostate‐specific antigen (PSA) value after Holmium laser enucleation of prostate (HoLEP). Patients and methods Data from 90 patients who underwent a HoLEP by En‐bloc technique were analyzed. PSA values at baseline and at 3‐month follow‐up, preoperative urinary retention and urine culture status, weight of resected tissue, and histopathological evidence of prostatitis or prostate cancer were recorded. We performed univariable and multivariable gamma‐regression analyses to determine the impact of the aforementioned perioperative variables on preoperative PSA, 3‐month postoperative PSA, and change in PSA. Results Serum PSA reduced significantly at 3 months from 6.3 ± 5.9 ng/mL to 0.6 ± 0.6 ng/mL. On both univariable and multivariable analysis, 3‐month nadir level was independent of all preoperative factors examined, except preoperative urinary retention status. Although patients with smaller prostate (resected tissue weight <40 g) had less percentile reduction in PSA when compared with those with larger prostate (resected tissue weight >80 g) (77.67% vs 89.06%; P < .001), patients from both these groups noted a similar PSA nadir level after 3 months (0.54 vs 0.56 ng/dL). The drop in PSA level after HoLEP remained stable up to 1‐year follow‐up. Conclusions PSA nadir 3 months after HoLEP remains relatively consistent across patients, regardless of preoperative prostate size, PSA value, urine culture status, and histopathological evidence of prostatitis or incidental prostate cancer.
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Affiliation(s)
- Mary Martos
- Miller School of Medicine University of Miami Miami FL USA
| | - Jonathan E. Katz
- Department of Urology Miller School of Medicine University of Miami Miami FL USA
| | | | - Anika Jain
- Miller School of Medicine University of Miami Miami FL USA
| | | | - Sanoj Punnen
- Department of Urology Sylvester Comprehensive Cancer Center Miller School of Medicine University of Miami Miami FL USA
| | - Mark L. Gonzalgo
- Department of Urology Sylvester Comprehensive Cancer Center Miller School of Medicine University of Miami Miami FL USA
| | - Feng Miao
- Division of Biostatistics Department of Public Health Sciences Sylvester Biostatistics and Bioinformatics Shared Resource Miller School of Medicine University of Miami Miami FL USA
| | - Isildinha M. Reis
- Division of Biostatistics Department of Public Health Sciences Sylvester Biostatistics and Bioinformatics Shared Resource Miller School of Medicine University of Miami Miami FL USA
| | - Nicholas Smith
- Miller School of Medicine University of Miami Miami FL USA
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16
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Changes in serum PSA after endoscopic enucleation of the prostate are predictive for the future diagnosis of prostate cancer. World J Urol 2020; 39:2621-2626. [PMID: 32997261 DOI: 10.1007/s00345-020-03444-0] [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] [Received: 06/14/2020] [Accepted: 09/05/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE After Endoscopic Enucleation of the Prostate (EEP) for benign prostatic obstruction (BPO), men remain at risk for prostate cancer (PCa). Significant PSA changes occur after enucleation, which interfere with later screening for PCa. It remains unclear which patients need further diagnostic investigations for PCa after EEP. The goal of this study was to identify an independent predictor for PCa diagnosis after Holmium Laser Enucleation of the Prostate (HoLEP) in patients whose HoLEP resection specimen did not show PCa. METHODS Data of 773 patients who underwent HoLEP for BPO between 2010 and 2018 in a referral center were analyzed. Exclusion criteria were PCa detection in the HoLEP specimen or absence of post-operative PSA values. Patients were divided in a PCa group and Control group depending on whether or not PCa was detected during follow-up after HoLEP. The predictive value for future diagnosis of PCa of different forms of PSA-change after HoLEP was analyzed by multivariate Cox regression and ROC analysis. RESULTS Overall, 24 (4.2%) patients developed PCa after HoLEP. At 5 year follow-up, the PCa-free survival rate was 85%. First post-operative PSA was an independent predictor of PCa diagnosis after HoLEP (HR 1.106, 95% CI 1.074-1.139, p < 0.001, ROC AUC 0.903) with an optimal cut-off value of 1.73 ng/ml (sensitivity 83.3%, specificity 82.3%). CONCLUSIONS For patients who underwent HoLEP for BPO, post-operative PSA after HoLEP is an independent predictor for future PCa diagnosis. When PSA is > 1.73 ng/ml within the first year after HoLEP, rigorous follow-up and diagnostic investigations for PCa are indicated.
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Enikeev D, Netsch C, Rapoport L, Gazimiev M, Laukhtina E, Snurnitsyna O, Alekseeva T, Becker B, Taratkin M, Glybochko P. Novel thulium fiber laser for endoscopic enucleation of the prostate: A prospective comparison with conventional transurethral resection of the prostate. Int J Urol 2019; 26:1138-1143. [DOI: 10.1111/iju.14115] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/01/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Dmitry Enikeev
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | | | - Leonid Rapoport
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Magomed Gazimiev
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Olesya Snurnitsyna
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Tatyana Alekseeva
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Benedikt Becker
- Department of Urology Asklepios Hospital Barmbek Hamburg Germany
| | - Mark Taratkin
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Petr Glybochko
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
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18
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Tominaga Y, Sadahira T, Mitsui Y, Maruyama Y, Tanimoto R, Wada K, Munemasa S, Kusaka N, Nishiyama Y, Kurashige T, Nasu Y, Hayata S. Favorable long-term oncological and urinary outcomes of incidental prostate cancer following holmium laser enucleation of the prostate. Mol Clin Oncol 2019; 10:605-609. [PMID: 31031975 DOI: 10.3892/mco.2019.1839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 03/14/2019] [Indexed: 12/31/2022] Open
Abstract
The aim of the present study was to investigate the impact of incidental prostate cancer (IPCa), which was diagnosed by holmium laser enucleation of the prostate (HoLEP), on long-term oncological and functional outcomes. A total of 482 patients who underwent HoLEP for benign prostatic hyperplasia (BPH) between 2008 and 2016 at our institution were retrospectively reviewed. We defined IPCa as prostate cancer (PCa) according to the enucleated tissue of transitional zone. Therefore, 64 patients were excluded for the following reasons: Prostate-specific antigen (PSA) ≥4.0 ng/ml and no prostate biopsy (n=46); and PSA ≥4.0 ng/ml and diagnosed with PCa by prostate biopsy performed during HoLEP (n=18). Notably, 418 patients were included in the study and divided into two groups: The BPH group and the IPCa group. For 5 years, postoperative PSA and functional outcomes were evaluated. Of 418 patients, 25 (6%) were diagnosed with IPCa by HoLEP, 21 patients (84%) had a Gleason score ≤6 and 5 patients (20%) received adjuvant therapy for PCa following HoLEP. No significant differences were observed between groups for preoperative PSA, PSA density, or urinary and sexual function outcomes; however, age at the time of HoLEP significantly differed between groups (71.7 vs. 75.5 years, P=0.026). Long-term (5-year) urinary outcomes demonstrated sustained improvement. Postoperative PSA increased gradually in the IPCa group (3-year, P=0.033; 4-year, P=0.037); International Index of Erectile Function 5 conversely decreased (5-year, P=0.068). According to the present results, if standard PSA screening and prostate biopsy are performed, watchful waiting for IPCa is feasible, and IPCa does not impact on 5-year urinary outcomes.
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Affiliation(s)
- Yusuke Tominaga
- Department of Urology, Tottori Municipal Hospital, Tottori, Tottori 680-0873, Japan
| | - Takuya Sadahira
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Okayama 700-8558, Japan
| | - Yosuke Mitsui
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Okayama 700-8558, Japan
| | - Yuki Maruyama
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Okayama 700-8558, Japan
| | - Ryuta Tanimoto
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Okayama 700-8558, Japan
| | - Koichiro Wada
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Okayama 700-8558, Japan
| | - Shuhei Munemasa
- Department of Urology, Tottori Municipal Hospital, Tottori, Tottori 680-0873, Japan
| | - Nobuyuki Kusaka
- Department of Urology, Tottori Municipal Hospital, Tottori, Tottori 680-0873, Japan
| | - Yasuhiro Nishiyama
- Department of Urology, Kochi Health Sciences Center, Kochi, Kochi 781-8555, Japan
| | - Takushi Kurashige
- Department of Immunology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Yasutomo Nasu
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Okayama 700-8558, Japan
| | - Shunji Hayata
- Department of Urology, Tottori Municipal Hospital, Tottori, Tottori 680-0873, Japan
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Kida K, Shimizu Y, Ogawa K, Emura M, Kanamaru S, Ito N. A case of rapidly progressing prostate cancer diagnosed 20 months after holmium laser enucleation of the prostate. Int Cancer Conf J 2018; 7:81-83. [DOI: 10.1007/s13691-018-0324-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/28/2018] [Indexed: 11/30/2022] Open
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21
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Horiuchi A, Muto S, Horie S. Holmium laser enucleation of the prostate followed by high-intensity focused ultrasound treatment for patients with huge prostate adenoma and localized prostate cancer: 5-Year follow-up. Prostate Int 2016; 4:49-53. [PMID: 27358843 PMCID: PMC4916062 DOI: 10.1016/j.prnil.2016.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/12/2016] [Accepted: 01/17/2016] [Indexed: 11/29/2022] Open
Abstract
Background To evaluate the efficacy of holmium laser enucleation of the prostate (HoLEP) followed by high-intensity focused ultrasound (HIFU) for patients with huge prostate adenoma and localized prostate cancer (CaP) and compare the morbidity and efficacy results with those observed in a similar population treated only with HIFU for a follow-up period of up to 5 years. Methods The present retrospective study included 30 CaP patients who underwent HIFU alone and 10 patients who underwent HoLEP followed by HIFU. Selection criteria for this study were no previous treatment for CaP, aged 60 years or older, cT1c-T2N0M0, prostate volume of 30 mL or more, and a follow-up period of 5 years or more. Prostate-specific antigen (PSA) biochemical recurrence-free survival (RFS) rates and functional outcomes including complications and uroflowmetry after HIFU were compared between the HIFU monotherapy and HoLEP + HIFU groups. Results The enrolled patients had a mean age of 70.3 years and 68.8 years in the HIFU monotherapy and HoLEP + HIFU groups, respectively. The 5-year PSA biochemical RFS rates of the two groups were similar (HIFU monotherapy group: 57.2%; HoLEP + HIFU group: 67.5%). The duration of indwelling urethral catheter after HIFU significantly decreased in the HoLEP + HIFU group compared with the HIFU monotherapy group (15.5 ± 2.7 days vs. 27.5 ± 2.3 days, P = 0.022). In terms of functional outcomes, patients who received HoLEP + HIFU had significantly higher maximum (12 months: P = 0.015, 36 months: P = 0.014) and average (36 months: P = 0.002, 60 months: P = 0.047) flow rates than those who received HIFU monotherapy. The frequency of urethral stricture (13.3% vs. 0%), symptomatic urinary tract infection (10.0% vs. 0%), and bladder stone and urethrorectal fistula (3.3% vs. 0%) tended to be higher in the HIFU monotherapy group as compared with the HoLEP + HIFU group. Conclusion The HoLEP + HIFU treatment decreases urinary catheterization time and improves post-treatment urinary status without additional morbidity.
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Affiliation(s)
| | - Satoru Muto
- Department of Urology, Teikyo University, Tokyo, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
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Otsuki H, Kuwahara Y, Kosaka T, Nakamura K, Tsukamoto T. Sufficient Volume Ablation with Photoselective Vaporization of the Prostate Delivers 5-Year Durability and Improves Symptom Relief for Larger Prostates. J Endourol 2016; 30:102-8. [DOI: 10.1089/end.2014.0466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hideo Otsuki
- Department of Urology, Nagakubo Hospital, Tokyo, Japan
| | | | - Takeo Kosaka
- Department of Urology, Nagakubo Hospital, Tokyo, Japan
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Bhojani N, Boris RS, Monn MF, Mandeville JA, Lingeman JE. Coexisting prostate cancer found at the time of holmium laser enucleation of the prostate for benign prostatic hyperplasia: predicting its presence and grade in analyzed tissue. J Endourol 2015; 29:41-6. [PMID: 25046691 DOI: 10.1089/end.2014.0359] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To determine the incidence of prostate cancer identified on holmium laser enucleation of the prostate (HoLEP) specimens and evaluate variables associated with prostate cancer identification. PATIENTS AND METHODS All patients undergoing HoLEP between 1998 and 2013 were identified. Patients with a known history of prostate cancer were excluded. Multivariable logistic regression assessed variables associated with identification of prostate cancer on HoLEP specimens and Gleason 7 or higher prostate cancer among the malignant cases. The Gleason grade was used as a proxy for disease severity. Each of the models was adjusted for age, preoperative prostate-specific antigen (PSA), and HoLEP specimen weight. RESULTS The cohort comprised 1272 patients, of whom 103 (8.1%) had prostate cancer identified. Prostate cancer cases had higher pre-HoLEP PSA (p=0.06) but lower HoLEP specimen weight (p=0.01). On multivariate logistic regression, age and preoperative PSA were associated with increased odds of prostate cancer being present (p<0.01 each), while increasing HoLEP specimen weight was associated with decreased odds of prostate cancer (p<0.001). Men older than 80 had 20% predicted probability of being diagnosed with prostate cancer. Seventy-eight percent of prostate cancer cases were Gleason 6 or less. The pre-HoLEP PSA was associated with increased adjusted odds of intermediate- or high-grade prostate cancer. CONCLUSION Prostate cancer identified by HoLEP is not uncommon, but is generally a low-risk disease. Older patients with smaller prostate glands have the highest odds of prostate cancer identification.
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Affiliation(s)
- Naeem Bhojani
- 1 Department of Urology, Centre Hospitalier de l'Université de Montréal , Montréal, Québec, Canada
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Fossati N, Sjoberg DD, Capitanio U, Gandaglia G, Larcher A, Nini A, Mirone V, Vickers AJ, Montorsi F, Briganti A. Extended pelvic lymph node dissection in patients with prostate cancer previously treated with surgery for lower urinary tract symptoms. BJU Int 2015; 116:366-72. [DOI: 10.1111/bju.12912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Nicola Fossati
- Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
- Department of Epidemiology and Biostatistics; Memorial Sloan-Kettering Cancer Center; New York NY USA
| | - Daniel D. Sjoberg
- Department of Epidemiology and Biostatistics; Memorial Sloan-Kettering Cancer Center; New York NY USA
| | - Umberto Capitanio
- Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - Alessandro Larcher
- Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - Alessandro Nini
- Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | | | - Andrew J Vickers
- Department of Epidemiology and Biostatistics; Memorial Sloan-Kettering Cancer Center; New York NY USA
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
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Gellhaus PT, Monn MF, Leese J, Flack CK, Lingeman JE, Koch MO, Boris RS. Robot-Assisted Radical Prostatectomy in Patients with a History of Holmium Laser Enucleation of the Prostate: Feasibility and Evaluation of Initial Outcomes. J Endourol 2015; 29:764-9. [PMID: 25423412 DOI: 10.1089/end.2014.0767] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To evaluate outcomes of post-holmium laser enucleation of the prostate (HoLEP) robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS Using an institutional database, we identified 11 HoLEP patients who subsequently underwent RARP. These were matched 1:2 to RARP patients without a previous transurethral surgical procedure. Variables matched were age, pre-RARP prostate-specific antigen level, and biopsy Gleason score. Urinary continence and sexual function were evaluated by physician questioning, American Urological Association symptom score, and Sexual Health in Men (SHIM) scores. Descriptive statistics were used to compare cohorts. RESULTS RARP pathologic outcomes were similar between cases and controls. Twenty-seven percent of previous HoLEP patients reached strict urinary continence (leak free, pad free) at last follow-up compared with 64% of matched controls (P=0.071). The average (range) SHIM score at last follow-up was 2.6 (1-5) for previous HoLEP patients compared with 13.9 (5-20) (P<0.001). The posterior bladder neck and apical dissections were significantly more challenging in the setting of previous HoLEP and necessitated a low threshold for wider resection to minimize positive surgical margins. CONCLUSIONS Post-HoLEP RARP is challenging but preliminarily appears safe and feasible when performed by an experienced robotic surgeon. Patients should be counseled regarding expectations of urinary continence and sexual function in this setting.
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Affiliation(s)
- Paul T Gellhaus
- Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - M Francesca Monn
- Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Joshua Leese
- Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Chandra K Flack
- Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - James E Lingeman
- Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Michael O Koch
- Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
| | - Ronald S Boris
- Department of Urology, Indiana University School of Medicine , Indianapolis, Indiana
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Significance of prostate-specific antigen-related factors in incidental prostate cancer treated by holmium laser enucleation of the prostate. World J Urol 2014; 33:329-33. [DOI: 10.1007/s00345-014-1310-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 04/22/2014] [Indexed: 10/25/2022] Open
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Lebdai S, Prezelin Y, Pereira H, Bruyere F. Prostate-Specific Antigen Evolution After Photoselective Vaporization of the Prostate. J Endourol 2014; 28:347-52. [DOI: 10.1089/end.2013.0522] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Souhil Lebdai
- Urology Department, University Hospital of Angers, Angers, France
| | - Yohann Prezelin
- Urology Department, University Hospital of Tours, Tours, France
| | - Helder Pereira
- Urology Department, University Hospital of Tours, Tours, France
| | - Franck Bruyere
- Urology Department, University Hospital of Tours, Tours, France
- Centre d'Innovations Technologiques, CHU Bretonneau, Tours, France
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28
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Rivera ME, Frank I, Viers BR, Rangel LJ, Krambeck AE. Holmium laser enucleation of the prostate and perioperative diagnosis of prostate cancer: an outcomes analysis. J Endourol 2014; 28:699-703. [PMID: 24484284 DOI: 10.1089/end.2014.0009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Our objective is to assess the outcomes of patients with prostate cancer (PCa) diagnoses undergoing holmium laser enucleation of the prostate (HoLEP). METHODS From 2009 to 2012, 450 patients underwent HoLEP at our institution. We performed a retrospective review of these patients to identify those with PCa. RESULTS PCa was diagnosed in 57 (12.7%) HoLEP patients: 11 (19.2%) preoperatively, 43 (75.4%) in the operative specimen, and 3 (5.4%) during follow-up. Mean time to PCa development in the postoperative group was 16 months (9-23). There was no difference in patient characteristics for those diagnosed with PCa at the time of HoLEP or in the postoperative period. There were 5 patients with a Gleason score (GS)>8 and 52 with GS<8 PCa. In the operative group, 39 (91%) elected for active surveillance and 4 (9%) elected to have cancer treatment. In subgroup analysis, men diagnosed with GS>8 intraoperatively or postoperatively had significantly elevated preoperative, postoperative, and percent change prostate-specific antigen (PSA) levels when compared to patients diagnosed GS ≤ 7 (P=0.01, 0.02, and 0.01, respectively). There were no complications, all voided spontaneously, and one patient had persistent incontinence. CONCLUSION HoLEP for the treatment of lower urinary tract symptoms (LUTS) in selectively chosen men with known PCa can safely improve urination. Furthermore, PCa is diagnosed at the time of or post HoLEP in nearly 12% of patients. Those patients with persistently elevated post HoLEP PSA levels or low percent change PSA levels should raise suspicion for high GS PCa. Finally, HoLEP does not preclude active surveillance or treatment for PCa when appropriate.
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29
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Koguchi D, Nishi M, Satoh T, Shitara T, Matsumoto K, Fujita T, Yoshida K, Iwamura M. Bone dissemination of prostate cancer after holmium laser enucleation of the prostate: a case report and a review of the literature. Int J Urol 2013; 21:215-7. [PMID: 23944756 DOI: 10.1111/iju.12248] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 07/04/2013] [Indexed: 11/28/2022]
Abstract
We report a case of dissemination of prostate cancer after holmium laser enucleation of the prostate in an 80-year-old patient. The patient presented at hospital because of nocturia. Transrectal ultrasound-guided biopsy was carried out because of high serum prostate-specific antigen (3.55 ng/mL), but it showed no malignancies. Benign prostate hyperplasia was diagnosed, and he was started on an α1-blocker. Although the urinary symptom improved with silodosin, acute urinary retention occurred 3 years after therapy began. Holmium laser enucleation of the prostate for relief of bladder outlet obstruction enabled discharge of urine. Pathological examination of the resected tissue found adenocarcinoma with a high Gleason score, 4 + 5. Serum alkaline phosphatase increased rapidly after holmium laser enucleation, and bone scintigraphy confirmed multiple bone metastases. Prostate cancer, T1bN0M1b, was diagnosed.
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Affiliation(s)
- Dai Koguchi
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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Elmansy HM, Kotb A, Elhilali MM. Holmium Laser Enucleation of the Prostate: Long-Term Durability of Clinical Outcomes and Complication Rates During 10 Years of Followup. J Urol 2011; 186:1972-6. [DOI: 10.1016/j.juro.2011.06.065] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Indexed: 12/18/2022]
Affiliation(s)
- Hazem M. Elmansy
- Division of Urology, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ahmed Kotb
- Division of Urology, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Mostafa M. Elhilali
- Division of Urology, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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31
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Current world literature. Curr Opin Urol 2010; 21:84-91. [PMID: 21127406 DOI: 10.1097/mou.0b013e328341a1a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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33
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Elmansy HM, Elzayat E, Elhilali MM. Holmium Laser Ablation Versus Photoselective Vaporization of Prostate Less Than 60 cc: Long-Term Results of a Randomized Trial. J Urol 2010; 184:2023-8. [DOI: 10.1016/j.juro.2010.06.107] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Hazem M. Elmansy
- Division of Urology, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ehab Elzayat
- Division of Urology, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Mostafa M. Elhilali
- Division of Urology, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Enucleación prostática con láser de holmio. Experiencia del Hospital Germans Trias i Pujol. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2010.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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35
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Medications and Surgical Interventions for Benign Prostatic Hyperplasia Are Potential Confounders of Prostate-Specific Antigen. Curr Urol Rep 2010; 11:224-7. [DOI: 10.1007/s11934-010-0113-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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36
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Herrmann TRW, Bach T, Imkamp F, Georgiou A, Burchardt M, Oelke M, Gross AJ. Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction. World J Urol 2010; 28:45-51. [DOI: 10.1007/s00345-009-0503-0] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Accepted: 12/23/2009] [Indexed: 10/20/2022] Open
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