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Abid A, Piperdi H, Babar M, Loloi J, Moutwakil A, Azhar U, Maria P, Small A. Minimally invasive surgical therapies for benign prostatic hyperplasia in the geriatric population: A systematic review. Prostate 2024; 84:895-908. [PMID: 38656693 DOI: 10.1002/pros.24717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/21/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Geriatric patients, prone to adverse events (AEs) and low compliance with drugs, may benefit from minimally invasive surgical therapies (MISTs) for managing benign prostatic hyperplasia (BPH). We evaluated the efficacy, safety, and procedural characteristics of MISTs in geriatric patients with BPH. METHODS PubMed/MEDLINE database was systematically searched for relevant articles through October 1, 2023. Eligible studies focused on geriatric patients (≥65 years) with BPH who were treated with MISTs and evaluated follow-up surgical, micturition, and/or sexual outcomes. Studies were included if there was separate reporting for age subgroups ≥65 years, or if the mean age minus standard deviation was ≥65 years, or if the first quartile was ≥65 years. RESULTS Out of 292 screened studies, 32 (N = 3972 patients) met inclusion criteria and assessed prostatic artery embolization (PAE), Rezum, GreenLight, holmium laser enucleation of the prostate (HoLEP), thulium laser enucleation of the prostate (ThuLEP), diode laser enucleation of the prostate (DiLEP), and Aquablation. Except for Rezum, all MISTs required a planned overnight stay. While PAE and Rezum could be performed under local anesthesia, the other MISTs needed general or spinal anesthesia. Postoperative catheterization duration was longest for PAE (median 14 days) and Rezum (21 days) and shortest for GreenLight (1.9 days). At 12 months postoperatively, all MISTs exhibited significant percent changes in International Prostate Symptom Score (median -69.9%) and quality of life (median -72.5%). Clavien-Dindo Grade 1 AEs ranged widely, with PAE (5.8%-36.8%), Rezum (0%-62.1%), and GreenLight (0%-67.6%) having the largest range, and HoLEP (0%-9.5%), ThuLEP (2%-6.9%), and DiLEP (5%-17.5%) having the smallest. PAE, Rezum, DiLEP, and Aquablation reported no significant changes in the International Index of Erectile Function. CONCLUSIONS Although all the MISTs reviewed in this study effectively treat BPH in geriatric patients, differences in procedural characteristics and safety profiles across MISTs were considerable. Physicians should use shared decision-making processes, considering risks and patient characteristics, when choosing a suitable treatment option for their patients.
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Affiliation(s)
- Ahmad Abid
- Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Huzaifa Piperdi
- Touro College of Osteopathic Medicine, New York, New York, USA
| | - Mustufa Babar
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Justin Loloi
- Department of Urology, Montefiore Medical Center, Bronx, New York, USA
| | | | - Umair Azhar
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Pedro Maria
- Department of Urology, Montefiore Medical Center, Bronx, New York, USA
| | - Alexander Small
- Department of Urology, Montefiore Medical Center, Bronx, New York, USA
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Tamalunas A, Keller P, Schott M, Stadelmeier LF, Kidess M, Atzler M, Ebner B, Hennenberg M, Stief CG, Magistro G. Propensity score-matched evaluation of palliative transurethral resection and holmium laser enucleation of the prostate for bladder outlet obstruction in patients with prostate cancer. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00831-1. [PMID: 38600321 DOI: 10.1038/s41391-024-00831-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND While transurethral resection of the prostate (TURP) is the standard-of-care, Holmium laser enucleation of the prostate (HoLEP) is widely accepted as a size-independent method for surgical treatment of patients with lower urinary tract symptoms (LUTS) secondary to bladder outlet obstruction (BOO). However, in an ageing society an increasing number of patients presents with BOO due to locally advanced prostate cancer. There is currently no guidelines recommendation as to the enucleation or resection technique. Therefore, we compared intraoperative performance, postoperative outcomes, and safety for palliative (p)TURP and (p)HoLEP. METHODS We conducted a retrospective, propensity score-matched analysis of 1373 and 2705 men who underwent TURP or HoLEP for LUTS/BOO between 2014 and 2021, respectively. Patients were matched for age, prostate size and preoperative international prostate symptom score (IPSS). Patients were stratified by technique and groups were compared for perioperative parameters, safety, and functional outcomes. RESULTS While postoperative symptoms and urodynamic parameters improved irrespective of technique, we report significantly increased resection and enucleation times for palliative indication. For corresponding efficiency parameters, we observed a two-fold higher surgical performance (g/min) for both techniques in patients without prostate cancer. While adverse events were comparable between groups, we found a two-fold higher hemoglobin drop in palliative patients. CONCLUSIONS Currently, there is no standard-of-care for patients with BOO and locally advanced prostate cancer. Our data show that both TURP and HoLEP offer adequate symptom improvement and comparable safety profiles. While HoLEP is feasible even in larger prostates, both procedures become more difficult in patients with prostate cancer. Taken together, this study covers an important gap in current literature, helping urological surgeons to make evidence-based decisions for the benefit of their patients.
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Affiliation(s)
| | - Patrick Keller
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Melanie Schott
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | | | - Marc Kidess
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Atzler
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Benedikt Ebner
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Martin Hennenberg
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Giuseppe Magistro
- Department of Urology, Asklepios Westklinikum Hamburg, Hamburg, Germany
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Tayeb W, Azhar RA, Subahi M, Munshi S, Qarni A, Bakhsh A, Sejiny M, Almohaisen T, Alammari A, Elkoushy MA. Rezŭm water vaporization therapy versus transurethral resection of the prostate in the management of refractory urine retention: matched pair comparative multicenter experience. World J Urol 2024; 42:48. [PMID: 38244100 DOI: 10.1007/s00345-023-04739-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/15/2023] [Indexed: 01/22/2024] Open
Abstract
PURPOSE To compare the efficacy of Rezūm with a matched cohort of patients undergoing transurethral resection of the prostate (TURP) for catheter-dependent urine retention secondary to benign prostate hyperplasia (BPH). METHODS A retrospective review was performed for consecutive catheter-dependent patients who underwent Rezūm for BPH. Patients were matched and compared with a similar cohort undergoing TURP, using non-inferiority analysis on propensity score-matched patient pairs. Patients were followed up at 1, 3, 6 and 12 months by international prostate symptoms score (IPSS), quality of life (QoL) index, peak flow rate (Qmax) and postvoid residual urine (PVR). RESULTS Eighty-one patients undergoing Rezūm were compared with equal number of matched patients who undergoing TURP. Patients undergoing Rezūm experienced significantly shorter operation time (25.5 ± 8.7 vs. 103.4 ± 12.6 min; p < 0.001), lower intraoperative bleeding (2.4% vs. 20.7%, p < 0.001), shorter hospital stay (1.2 ± 0.9 vs. 2.4 ± 1.3 d, p < 0.001) and longer catheter time (12.6 ± 6.0 vs. 2.3 ± 1.2 d, p < 0.001), with no need for transfusion. Successful postoperative voiding was comparable between both arms (90.2% vs. 92.7%, p = 0.78), respectively. Despite patients undergoing TURP had significantly better voiding outcomes after 1 and 3 months, both groups were comparable after six and 12 months in terms of mean IPSS (11.1 ± 6.4 vs. 10.8 ± 3.4, p = 0.71), QoL indices (2.4 ± 1.6 vs. 2.1 ± 2.3, p = 0.33) and Qmax (22.0 ± 7.7 v. 19.8 ± 6.9 ml/sec, p = 0.06). CONCLUSION This study supports the safety and efficacy of Rezūm in the management of catheter-dependent patients secondary to BPH, with comparable functional outcomes to TURP. Until a randomized clinical comparison is available, long-term data are crucially recommended to compare the recurrence and reoperation rates.
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Affiliation(s)
- Waseem Tayeb
- Department of Surgery, Division of Urology, King Abdullah Medical City at Holy Capital, Makkah, Saudi Arabia.
| | - Raed A Azhar
- Faculty of Medicine, Urology Department, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohnna Subahi
- Department of Surgery, Division of Urology, King Abdullah Medical City at Holy Capital, Makkah, Saudi Arabia
| | - Sameer Munshi
- Department of Surgery, Division of Urology, King Abdullah Medical City at Holy Capital, Makkah, Saudi Arabia
| | - Abdulrahman Qarni
- Urology Department, Dr Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
| | - Abdulaziz Bakhsh
- Urology Department, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Majid Sejiny
- Urology Department, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Turkey Almohaisen
- Urology Department, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Adel Alammari
- Urology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohamed A Elkoushy
- Faulty of Medicine, Urology Department, Suez Canal University, Ismailia, Egypt
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Codelia-Anjum AJ, Berjaoui MB, Khondker A, Elterman D, Zorn KC, Bhojani N, Lerner LB, Chughtai B. Procedural Intervention for Benign Prostatic Hyperplasia in Men ≥ Age 70 Years - A Review of Published Literature. Clin Interv Aging 2023; 18:1705-1717. [PMID: 37849957 PMCID: PMC10577238 DOI: 10.2147/cia.s414799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/25/2023] [Indexed: 10/19/2023] Open
Abstract
Objective We set out to review studies reporting on the use of surgical intervention to treat Benign Prostatic Hyperplasia in elderly men ≥70 years of age. Methods A systematic literature search was conducted using Scopus, PubMed-MEDLINE, Cochrane, and Wiley Online Library databases including studies published between January 2012 through December 2022. This 10-year interval was chosen given the recent plethora of new modalities that have entered the BPH armamentarium, many of which have been marketed as appropriate for older and high-risk patients. The following database search words were used either individually or in conjunction: "BPH", "elderly", "surgical", "ablation", "resection", "embolization", and "aging". Results We identified 28 studies for inclusion in this review. The pros and cons of these modalities are presented, specifically as applicable to an older and higher risk population. Conclusion There are a wide variety of surgical procedures available for surgically treating BPH in elderly men with varying states of health. Each of these comes with different risks and benefits, supporting that individualized approaches are important. Long-term data and further studies comparing modalities, specifically as regards the elderly and frail, would enhance our approaches to BPH treatment in this patient population.
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Affiliation(s)
- Alia J Codelia-Anjum
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA
| | - Mohamad Baker Berjaoui
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Adree Khondker
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Dean Elterman
- Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Lori B Lerner
- Department of Urology, VA Boston Healthcare System, Boston, MA, USA
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA
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Savin Z, Veredgorn Y, Taha T, Alsaraia N, Lifshitz K, Nevo A, Yossepowitch O, Sofer M. En bloc holmium laser enucleation of prostate in octogenarians and nonagenarians: clinical characteristics and outcome. Lasers Med Sci 2023; 38:196. [PMID: 37644242 DOI: 10.1007/s10103-023-03866-3] [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: 05/12/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023]
Abstract
Extended longevity leads to greater numbers of elderly patients with benign prostatic hyperplasia (BPH) who seek surgical solutions. We assessed the clinical characteristics and outcomes of octogenarians and nonagenarians with BPH who underwent en bloc holmium laser enucleation of prostate (HoLEP). Retrospective cohort of all consecutive HoLEP patients treated in our medical center between January 2020 and January 2023. Cohort was divided into group aged < 80 years (n = 290) and group aged ≥ 80 years (n = 77). Their demographics, presentations, indications, and outcomes were compared. Octogenarians and nonagenarians had higher rates of indwelling catheters (p = 0.00001), chronic retention (p = 0.00006), larger prostates (p = 0.03), higher American Anesthesiology Association scores (p = 0.000001), and more antiplatelet medications (p = 0.0003) at presentation. They had longer operations (median 115 vs 90 min, respectively, p = 0.0008), longer hospital stay (median 2 vs 1 day, p = 0.01E-7), a higher complication rate (17% vs 7%, p = 0.02), and a higher transitory urinary incontinence (TUI) rate (54% vs 9%, p = 0.00001). TUI was more prevalent in the older group with indwelling catheters (61% vs, 13%, p = 0.00001). The functional outcome was similar for both age groups, and all patients could void spontaneously after the procedure. En-bloc HoLEP improves urinary symptoms and quality of life in patients ≥ 80 years of age despite larger prostates, more comorbidities, and higher complications rate, compared to younger men. HoLEP bestows a significant improvement in urologic quality of life regardless of age.
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Affiliation(s)
- Ziv Savin
- Endourology Unit, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel.
| | - Yotam Veredgorn
- Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Tarek Taha
- Endourology Unit, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nimer Alsaraia
- Endourology Unit, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Karin Lifshitz
- Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Amihay Nevo
- Endourology Unit, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Ofer Yossepowitch
- Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Mario Sofer
- Endourology Unit, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Urology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel-Aviv, Israel
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Takeuchi Y, Sawada Y, Watanabe S, Ni-Itsu Y, Sekido N. Age-specific effect of transurethral holmium laser enucleation of the prostate on overactive bladder in men with benign prostatic hyperplasia: An investigation using an overactive bladder symptom score. Low Urin Tract Symptoms 2023; 15:38-49. [PMID: 36507559 DOI: 10.1111/luts.12469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/14/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate the age-specific effect of transurethral holmium laser enucleation of the prostate (HoLEP) on overactive bladder (OAB). METHODS A total of 186 consecutive patients who underwent HoLEP were included. They were divided into three groups: patients aged less than 65 years, between 65 and 74, and 75 or older. The OAB symptom score as well as other relevant variables of lower urinary tract symptoms and function were assessed before and 1, 3, 6, and 12 months after surgery. Age-specific prevalence of OAB, the proportion of resolution of OAB, and de novo OAB were evaluated. RESULTS The mean age of patients was 70.7 years, and the mean total prostate volume was 75.8 ml. The mean OAB symptom scores before surgery of patients aged less than 65 years, between 65 and 74, and 75 or older were 6.0, 5.2, and 5.7, respectively. At 12 months after surgery, the scores for the respective groups had significantly decreased to 2.1, 2.5, and 3.5. The prevalence of OAB based on the score in the respective groups was 45.8%, 56.9%, and 54.0% (p = .6391) preoperatively and 9.1%, 11.3%, and 15.8% at 12 months after the surgery (p = .7613). Of those with preoperative OAB, 75.0%, 79.2%, and 75.0% of the respective groups showed resolution of OAB at 12 months postoperatively (p = .9427). CONCLUSIONS In candidates for surgical deobstruction of benign prostatic hyperplasia, HoLEP has potential to improve OAB symptoms regardless of age.
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Affiliation(s)
- Yasuharu Takeuchi
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yoshitomo Sawada
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Shoutarou Watanabe
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasuo Ni-Itsu
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Noritoshi Sekido
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
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Soyster ME, Agarwal D, Slade A, Sahm E, Large T, Rivera M. Impact of American Society of Anesthesiologists score on postoperative holmium enucleation of the prostate outcomes and complications. Prostate 2023; 83:316-322. [PMID: 36415930 DOI: 10.1002/pros.24463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/13/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTIONS The American Society of Anesthesiologists Physical Status Classification System (ASA) is a validated risk stratification method for patients undergoing surgery. There is an increased prevalence of benign prostatic hyperplasia and comorbidities in our aging population. The role of ASA related to postoperative complications in patients undergoing holmium laser enucleation of the prostate (HoLEP) has not been described. METHODS A review of our database was performed for patients who underwent HoLEP from July 2018 to December 2020. Patients were stratified based on ASA score. Preoperative, perioperative, and complication data were analyzed using SAS analytics software. RESULTS Of 472 patients undergoing HoLEP, 320 (67.8%) were ASA 3-4 patients. There was a statistically significant difference found in age (72.3 ± 9.8 vs. 69.1 ± 9.0 years, p < 0.001), body mass index (BMI) (29.0 ± 5.9 vs. 27.3 ± 4.2, p = 0.004), and use of antiplatelet/anticoagulant medications (14.6% vs. 2.6%, p < 0.001) in the ASA 3-4 group. There was no significant difference between prostate volume (p = 0.158) or catheter-dependent urinary retention (p = 0.376). No difference was found in enucleation time (52.76 ± 24.8 vs. 54.16 ± 23.7 min, p = 0.587), OR specimen weight (70.24 ± 58.5 vs. 81.53 ± 65.9, p = 0.094). or intraoperative complications (2.8% vs. 1.3%, p = 0.330). There were higher postoperative complications in the ASA 3-4 group (12.8% vs. 7.9%, p = 0.03), but no difference in Clavien ≥3 complications (p = 0.068). ASA 3-4 patients had similar postoperative international prostate symptom score (p = 0.159). CONCLUSION HoLEP is feasible and effective in patients who are ASA 3-4. The high-risk cohort had an increased rate of low-grade complications. Patients with an ASA score of 3-4 should be counseled regarding a higher rate of low-grade complications.
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Affiliation(s)
- Mary E Soyster
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Deepak Agarwal
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Austen Slade
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Erica Sahm
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Tim Large
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
| | - Marcelino Rivera
- Department of Urology, Indiana University Health, Indianapolis, Indiana, USA
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8
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Tamalunas A, Schott M, Keller P, Atzler M, Ebner B, Hennenberg M, Stief CG, Magistro G. Efficacy, Efficiency, and Safety of En-bloc vs Three-lobe Enucleation of the Prostate: A Propensity Score-matched Analysis. Urology 2023:S0090-4295(23)00172-3. [PMID: 36828266 DOI: 10.1016/j.urology.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/25/2023] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To assess efficacy, efficiency, and safety in holmium laser enucleation of the prostate (HoLEP), we directly compared intraoperative performance, postoperative outcomes, and safety in the original 3-lobe enucleation technique with the more recent en-bloc method. As HoLEP is widely accepted as a size-independent method for surgical treatment of patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO), detailed understanding of its benefits is mandatory. METHODS We conducted a retrospective, propensity score-matched analysis of 1,396 men who underwent HoLEP for LUTS/BPO between 2017 and 2020. We included 606 patients in the final analysis (en-bloc n = 303; 3-lobe n = 303), who were matched for prostate size (50 cc), age, body mass index, and preoperative international prostate symptom score. Patients were then stratified by technique, and groups were compared for perioperative parameters, safety, and short-term functional outcomes. RESULTS While postoperative symptoms and urodynamic parameters improved irrespective of technique, we report significantly less adverse events (Clavien-Dindo classification ≥II vs <II) for patients receiving en-bloc enucleation. Additionally, en-bloc enucleation was more efficient, that is, less than half of total laser energy (kJ), twice shorter enucleation time, and surgical performance (g/kJ/min) significantly increased 4-fold with prostate volume, compared to 3-lobe enucleation. CONCLUSION While HoLEP in general is a safe and effective procedure, en-bloc enucleation techniques offer better surgical performance.
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Affiliation(s)
| | - Melanie Schott
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Patrick Keller
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Atzler
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Benedikt Ebner
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Martin Hennenberg
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Giuseppe Magistro
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
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Deyirmendjian C, Nguyen DD, Law KW, Nguyen ALV, Sadri I, Arezki A, Bouhadana D, Ibrahim A, Bhojani N, Elterman DS, Chughtai B, Bruyère F, Cindolo L, Ferrari G, Vasquez-Lastra C, Borelli-Bovo T, Becher EF, Cash H, Reimann M, Rijo E, Misrai V, Zorn KC. Safety and efficacy of GreenLight PVP in octogenarians: evaluation of the Global GreenLight Group database. World J Urol 2023; 41:1133-1140. [PMID: 36821011 DOI: 10.1007/s00345-023-04334-x] [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: 11/13/2022] [Accepted: 02/09/2023] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION The present study analyzes the largest international GreenLight database, the Global GreenLight Group (GGG), to evaluate the functional and safety profile of GreenLight photoselective vaporization of the prostate (PVP) in octogenarians. METHODS The GGG is a database comprised of patients that underwent GreenLight PVP from 2011 to 2019 performed by 8 experienced urologists at 7 international hospitals. Patients 80 years or older at the time of surgery were categorized as octogenarians. They were compared to a similar group of PVP patients below the age of 80. RESULTS Among 3,648 patients, 586 men were above the age of 80. Compared to patients under the age of 80, octogenarians had larger prostates (76.0 vs 71.9 ml, p = 0.02) and a lower BMI (25.6 vs 26.7, p = 0.045). Operative time was not significantly longer in octogenarians. The improvement in functional outcomes between 80-year-old patients and control patients was not significantly different at one-year follow-up, with the exception of maximum urinary flow (Qmax) that favoured younger patients (10.3 vs 12.6 ml/s, p = 0.02). The odds of transfusion were greater for older patients [OR 8.2 (95% CI 3.6-18.9, p < 0.01)], but they were not at increased risk of hematuria. Octogenarians had higher readmission rates (23.0 vs 11.9%, p < 0.01). CONCLUSIONS GreenLight PVP is a safe option in well-selected octogenarians in a cohort of patients treated by surgeons experienced with the technology. The odds of transfusion were higher in patients over 80, but the absolute risk remains low. The 30-day hospital readmission rate was higher in octogenarians.
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Affiliation(s)
| | | | - Kyle W Law
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Anna-Lisa V Nguyen
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Iman Sadri
- Division of Urology, McGill University, Montreal, QC, Canada
| | - Adel Arezki
- Division of Urology, McGill University, Montreal, QC, Canada
| | - David Bouhadana
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Ahmed Ibrahim
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Dean S Elterman
- Division of Urology, University Health Network, Toronto, ON, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Franck Bruyère
- Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Centre-Val de Loire, France
| | - Luca Cindolo
- Department of Urology, Hesperia Hospital, "Cure Group", Modena, Italy
| | - Giovanni Ferrari
- Department of Urology, Hesperia Hospital, "Cure Group", Modena, Italy
| | | | | | | | - Hannes Cash
- Prouro, Urology Berlin, Berlin, Germany.,Department of Urology, University of Magdeburg, Magdeburg, Germany
| | - Maximillian Reimann
- Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Enrique Rijo
- Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
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10
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Functional and surgical outcomes of Aquablation in elderly men. World J Urol 2022; 40:2515-2520. [PMID: 36040501 DOI: 10.1007/s00345-022-04137-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/11/2022] [Indexed: 10/14/2022] Open
Abstract
PURPOSE As benign prostatic hyperplasia (BPH) is an age-related process, growing interest in surgical management for elderly men has emerged. Recently, Aquablation was approved for treatment of BPH associated lower urinary tract symptoms (LUTS) and utilizes robotic ultrasound guided surgeon-controlled waterjet ablation. We assessed the differences in functional and surgical outcomes between elderly and young men undergoing Aquablation for BPH/LUTS. MATERIALS AND METHODS We retrospectively assessed prospectively collected data from the WATER I (NCT02505919) and WATER II (NCT03123250) clinical trials reporting safety and efficacy of Aquablation in the treatment of LUTS/BPH in men 45-80 years with a prostate between 30 and 80 cc, and 80 cc and 150 cc, respectively. Men ≥ 65 years were defined as elderly and men < 65 years as young. RESULTS Of 217 patients included, 83 (38.2%) were young and 134 (61.8%) were elderly. Mean age (SD) was 59.3 (± 3.4) years and 71.2 (± 4.2) years for young and elderly men, respectively. At 3 years of follow-up compared to baseline, elderly men showed similar reductions in total IPSS (7.68 points vs 7.12 points, p > 0.05) and similar increases in Qmax (20.6 mL/s vs 19.3 mL/s, p > 0.05) compared to young men. The ejaculatory dysfunction rate was similar for both cohorts (12.0% vs 9.7%, p > 0.05). Elderly men experienced similar annual retreatment rates compared to young men (1.5% vs 0.8% p > 0.05). CONCLUSIONS Elderly men undergoing Aquablation have similar functional and surgical outcomes as young men. Elderly patient BPH surgical counseling should, therefore, consider Aquablation as a treatment option for LUTS/BPH.
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11
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Heiman J, Agarwal D, Komanapalli S, Nottingham C, Large T, Krambeck A, Rivera M. Outcomes of octogenarians undergoing holmium laser enucleation of prostate. World J Urol 2022; 40:1751-1754. [PMID: 35633402 DOI: 10.1007/s00345-022-04053-9] [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: 01/23/2022] [Accepted: 05/06/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Holmium laser enucleation of prostate (HoLEP) is an effective surgical procedure in men with BPH. Due to the increase in the use of medical therapy for BPH related lower urinary symptoms more octogenarians are presenting in a delayed fashion with significant symptoms and urinary retention. We evaluate the feasibility and safety of octogenarians undergoing HoLEP. METHODS We performed a retrospective review of HoLEPs at our institution from July 2018 to December 2019. Patients were stratified into two groups based on age: < 80 and ≥ 80. RESULTS A total of 458 patients were identified, with 74 (16.2%) ≥ 80. In patients ≥ 80, prostate volume was higher (p < 0.0005), there was a higher rate of antiplatelet/anticoagulation (p = 0.029) use, and a lower rate of alpha-blocker use (p = 0.0016). As expected, ASA scores which correlate with increasing number of concomitant diseases were greater in the ≥ 80 cohort (p = 0.016). There was no significant difference in intraoperative complications (p = 0.14), 90 day complication (p = 0.34), readmission rates (p = 0.425) or emergency room visits between groups (p = 0.15). CONCLUSIONS Despite higher medical comorbidities and increased rates of anticoagulation in octogenarians, there is no increase in operative or postoperative complication rates. Age alone should not be used as exclusion criteria for HoLEP.
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Affiliation(s)
- Joshua Heiman
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA.
| | - Deepak Agarwal
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA
| | - Sarah Komanapalli
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA
| | - Charles Nottingham
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA
| | - Tim Large
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA
| | - Amy Krambeck
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA
| | - Marcelino Rivera
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA
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12
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Yilmaz M, Esser J, Suarez-Ibarrola R, Gratzke C, Miernik A. Safety and Efficacy of Laser Enucleation of the Prostate in Elderly Patients - A Narrative Review. Clin Interv Aging 2022; 17:15-33. [PMID: 35035216 PMCID: PMC8754464 DOI: 10.2147/cia.s347698] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/20/2021] [Indexed: 01/27/2023] Open
Abstract
Benign prostatic hyperplasia (BPH) is a common health condition in aging men resulting in lower urinary tract symptoms (LUTS) and low quality of life (QoL). We aimed to review studies on laser enucleation of the prostate (LEP) due to LUTS in elderly patients (>65 years) comparing different age groups, particularly considering functional outcomes, safety, and perioperative complications. A comprehensive search was conducted using the PubMed-MEDLINE, Web of Science, Wiley Online Library and Cochrane Library databases over the last 10 years until 7 October 2021 with the following search terms solely or in combination: “laser enucleation”, “prostate”, “laser prostatectomy”, “aging”, “elderly patients”, “older patients” and “age”. We identified 12 articles for inclusion in our analysis. Five studies focussed mainly on holmium laser enucleation of the prostate (HoLEP), one compared HoLEP to other laser prostatectomy procedures, two studies examined thulium laser enucleation of the prostate (ThuLEP), and two studies focused on GreenLight laser, one study focussed on potassium-titanyl-phosphate (KTP) laser, and another study compared laser prostatectomy to transurethral resection of the prostate (TURP). These studies showed that LEP improved IPSS, Qmax and QoL compared to baseline regardless of age; no significant difference was reported among age groups. Although ASA scores and anticoagulation/antiplatelet therapy rates are higher in elderly patients, studies revealed no significant difference in perioperative complication rates between age groups. Laser enucleation of the prostate is an effective and safe procedure in elderly patients, resulting in good functional outcomes, low morbidity, and few perioperative complications.
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Affiliation(s)
- Mehmet Yilmaz
- University of Freiburg - Medical Centre, Faculty of Medicine, Department of Urology, Freiburg, Germany
| | - Julia Esser
- University of Freiburg - Medical Centre, Faculty of Medicine, Department of Urology, Freiburg, Germany
| | - Rodrigo Suarez-Ibarrola
- University of Freiburg - Medical Centre, Faculty of Medicine, Department of Urology, Freiburg, Germany
| | - Christian Gratzke
- University of Freiburg - Medical Centre, Faculty of Medicine, Department of Urology, Freiburg, Germany
| | - Arkadiusz Miernik
- University of Freiburg - Medical Centre, Faculty of Medicine, Department of Urology, Freiburg, Germany
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13
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Tamalunas A, Westhofen T, Schott M, Keller P, Atzler M, Stief CG, Magistro G. The impact of preoperative lower urinary tract symptoms medication on the functional performance of holmium laser enucleation of the prostate. Cent European J Urol 2021; 74:429-436. [PMID: 34729233 PMCID: PMC8552942 DOI: 10.5173/ceju.2021.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/13/2021] [Accepted: 06/30/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction Medical treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) targets prostate size, to prevent disease progression, and prostate smooth muscle tone for rapid relieve of LUTS. Holmium laser enucleation of the prostate (HoLEP) is a size-independent method for surgical treatment of LUTS/BPO in medication-refractory patients and offers durable long-term results with reduced perioperative morbidity. As up to 50% of patients receive medical treatment for LUTS/BPO prior to surgery, we analyzed the impact of alpha-blockers and 5-alpha reductase inhibitors (5-ARI) on outcomes and perioperative morbidity in patients undergoing HoLEP for LUTS. Material and methods We retrospectively gathered data of 1,057 patients, who underwent HoLEP for LUTS/BPO from 2013–2018, and divided patients into group 1 (no medication), group 2 (α-blockers), and group 3 (5-ARI and α-blockers). Perioperative parameters, short-term functional outcomes and safety were assessed and statistical analysis was performed using SPSS V26.0 software. Results Even though preoperative LUTS profile was significantly different between groups, all patients improved significantly after HoLEP, irrespective of preoperative LUTS medication. Median improvement of IPSS was 9, 8 and 7 points, of Qmax was 10, 12 and 9.5 ml/s, with significant improvement of quality of life (QoL) and reduction of post-void residual volume (PVR) for groups 1–3, respectively, 30 days after surgery. With only 4.0% (42/1,057) of patients experiencing a Clavien-Dindo grade ≥II complication, there was no difference in prevalence of perioperative complications between groups (p = 0.943). Conclusions Although preoperative LUTS medication does not impair efficacy of HoLEP with acceptable perioperative morbidity, the time gap between medical therapy and surgical treatment may favor an earlier response.
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Affiliation(s)
| | - Thilo Westhofen
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Melanie Schott
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Patrick Keller
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Atzler
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Giuseppe Magistro
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
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14
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Tamalunas A, Westhofen T, Schott M, Keller P, Atzler M, Stief CG, Magistro G. How obesity affects the benefits of holmium laser enucleation of the prostate for the treatment of male lower urinary tract symptoms. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211043007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Holmium laser enucleation of the prostate (HoLEP) can be used regardless of prostate size and offers durable long-term results for patients suffering from lower urinary tract symptoms (LUTS)/benign prostatic obstruction (BPO), with reduced perioperative morbidity. In most western societies almost half of the population are overweight, and obesity itself is often a risk factor for surgical treatment of patients. We therefore analysed the impact of body mass index (BMI) on outcomes and perioperative morbidity in patients undergoing HoLEP for LUTS at our tertiary referral centre. Methods: We retrospectively collected data for 877 patients who underwent HoLEP for LUTS/BPO between 2014 and 2018 and divided patients into group 1 (BMI<25), 2 (BMI 25<30), and 3 (BMI⩾30). We analysed perioperative parameters, safety, and short-term functional outcomes. Results: In preoperative patient characteristics we observed a similar LUTS profile throughout our patient cohorts. The highest proportion of ASA score ⩾III was observed in the obese patient cohort. Enucleation time was significantly prolonged in morbidly obese patients and operative speed was significantly slower, without difference in perioperative complications. Functional outcomes were assessed 30 days post-surgery with significant improvement in IPSS, quality of life (QoL) and Qmax for all groups. Conclusion: Although operating on overweight and obese patients takes significantly longer, HoLEP is efficient and offers acceptable perioperative complication rates even in morbidly obese patients (BMI⩾30). Level of evidence: Not applicable.
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15
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Tamalunas A, Westhofen T, Schott M, Keller P, Atzler M, Stief CG, Magistro G. Holmium laser enucleation of the prostate: A truly size-independent method? Low Urin Tract Symptoms 2021; 14:17-26. [PMID: 34323002 DOI: 10.1111/luts.12404] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/13/2021] [Accepted: 07/07/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the impact of prostate size on functional outcomes and perioperative morbidity, we analyzed patients undergoing holmium laser enucleation of the prostate (HoLEP) for lower urinary tract symptoms (LUTS). As LUTS secondary to benign prostatic obstruction (BPO) are a chronic progressive disease, prevalence and prostate size increase with age. HoLEP is a size-independent method for surgical treatment of LUTS/BPO and can be offered in medication-refractory patients with durable long-term results and reduced perioperative morbidity. METHODS We retrospectively collected data of 852 patients who underwent HoLEP for LUTS secondary to BPO between 2014-2018. Patients were divided into group 1 (≤60 cc), group 2 (>60 < 120 cc), group 3 (≥120 cc). Perioperative parameters, safety and short-term functional outcomes were assessed and analyzed. RESULTS Patients in group 3 were significantly older and showed a significantly higher median prostate-specific antigen level. Perioperative parameters, such as enucleation time and morcellation time significantly differed in favor of smaller prostate sizes, while enucleation and morcellation speed showed favorable results for larger prostate sizes. Larger prostates ≥120 cc showed a significantly higher postoperative drop in hemoglobin. However, patients did not differ in postoperative functional outcomes or Clavien-Dindo grade ≥II complications (4.8% of all patients [41/852]). There was no difference in perioperative complications between all groups (P = 0.760). CONCLUSION While larger prostates take significantly longer to operate on, postoperative functional outcomes show no difference between all sizes. In conclusion, HoLEP is a size-independent and effective method for surgical treatment of LUTS/BPO in prostates ≥30 cc.
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Affiliation(s)
| | - Thilo Westhofen
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Melanie Schott
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Patrick Keller
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Atzler
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Giuseppe Magistro
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
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16
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Gild P, Lenke L, Pompe RS, Vetterlein MW, Ludwig TA, Soave A, Chun FKH, Ahyai S, Dahlem R, Fisch M, Rink M, Meyer CP, Becker A. Assessing the Outcome of Holmium Laser Enucleation of the Prostate by Age, Prostate Volume, and a History of Blood Thinning Agents: Report from a Single-Center Series of >1800 Consecutive Cases. J Endourol 2021; 35:639-646. [PMID: 33040607 DOI: 10.1089/end.2020.0605] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose: To assess perioperative outcomes of holmium laser enucleation of the prostate (HoLEP) in a real-world scenario and with a focus on demanding patient factors, such as large prostate size, advanced patient age, and anticoagulation therapy (AT). Materials and Methods: We retrospectively analyzed HoLEP procedures at our institution between 2010 and 2016. After stratification by prostate volume, age, and AT, perioperative and early voiding characteristics were compared. A multivariable regression model was employed to identify predictors of prolonged time of catheterization (defined as being above group's median). Results: The study cohort consisted of 1816 men with a median age of 71 years (interquartile range [IQR]: 66-76), a median prostate volume of 80 mL (IQR: 58-105), and American Society of Anesthesiologists score ≥3 in 618 men (34%). Median time of enucleation and morcellation was 43 minutes (IQR: 31-60) and 10 minutes (IQR: 6-18), respectively. Perioperative blood transfusions were administered in 44 (2.4%) cases, severe postoperative complications (Clavien-Dindo grade ≥3b) occurred in 61 (3.3%) cases. The median time of catheterization was 2 days (IQR: 2-2), with prolonged catheterization occurring in 277 (15%) cases. After adjustment, large prostates (fourth volume quartile [106-280 mL]) (odds ratio [OR]: 1.8, 95% confidence interval [CI]: 1.3-2.6, p = 0.001), therapeutic low-molecular-weight heparin bridging regimen (OR: 2.2, 95% CI: 1.4-3.6, p = 0.037), low-dose acetylsalicylic acid (OR: 1.5, 95% CI: 1.0-2.2, p = 0.015), and a history of direct oral anticoagulation (OR: 2.3, 95% CI: 1.2-4.0, p = 0.022), but not patient age, were independently associated with prolonged catheterization. Conclusions: We confirm HoLEP as safe and efficient; however, patients with large prostates and patients with a history of AT are at risk of prolonged catheterization.
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Affiliation(s)
- Philipp Gild
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Lenke
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raisa S Pompe
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Martini-Klinik Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim A Ludwig
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Armin Soave
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix K-H Chun
- Department of Urology, University Medical Center Frankfurt, University Hospital Frankfurt, Frankfurt, Germany
| | - Sascha Ahyai
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian P Meyer
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Becker
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Urology, University Medical Center Frankfurt, University Hospital Frankfurt, Frankfurt, Germany
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17
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Tamalunas A, Westhofen T, Schott M, Keller P, Atzler M, Stief CG, Magistro G. The clinical value of holmium laser enucleation of the prostate in octogenarians. Low Urin Tract Symptoms 2020; 13:279-285. [PMID: 33260275 DOI: 10.1111/luts.12366] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/28/2020] [Accepted: 11/06/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES With holmium laser enucleation of the prostate (HoLEP) a size-independent method for surgical treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) has been introduced. HoLEP offers durable long-term results with reduced perioperative morbidity. As the risk of disease progression increases with age, the main goals, when offering surgery to an elderly population, are reducing perioperative morbidity and preserving quality of life (QoL). We therefore analyzed the impact of age on outcomes and perioperative morbidity in patients undergoing HoLEP for LUTS at our tertiary referral center. METHODS We retrospectively collected data of 487 patients who underwent HoLEP for LUTS secondary to BPO between 2018 and 2019. Patients were divided into group 1 (<70 years), group 2 (70-79 years), and group 3 (≥80 years). Perioperative parameters, safety, and short-term functional outcomes were assessed and analyzed. RESULTS Perioperative Clavien-Dindo grade ≥II complications were seen in 4.1% of patients (20/487). There was no difference in perioperative complications between all age groups (P = .176). Functional outcome was assessed 30 days post surgery. There was significant improvement in median International Prostate Symptom Score of 14, 10, and 8 points for groups 1, 2, and 3 (P < .001), respectively, with constant improvement of median QoL of 3 points for all groups. Median maximum flow rate (Qmax ) showed significant improvement of 14.5, 10.5, and 13 mL/s for groups 1 to 3 (P = .467), respectively. CONCLUSION HoLEP offers acceptable perioperative complication rates even in the oldest patient cohort (≥80 years). Therefore, HoLEP is a safe and efficient option even in oldest patients.
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Affiliation(s)
| | - Thilo Westhofen
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Melanie Schott
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Patrick Keller
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Atzler
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Giuseppe Magistro
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
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18
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The role of photovaporization of the prostate in small volume benign prostatic hyperplasia and review of the literature. Asian J Urol 2019; 6:353-358. [PMID: 31768321 PMCID: PMC6872824 DOI: 10.1016/j.ajur.2019.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/23/2018] [Accepted: 10/17/2018] [Indexed: 11/24/2022] Open
Abstract
Objective Our objective was to characterize the safety and efficacy of the 180 W XPS-GreenLight laser in men with lower urinary tract symptoms secondary to a small volume benign prostatic hyperplasia (BPH). Methods A retrospective analysis was performed for all patients who underwent 180 W XPS-laser photoselective vaporization of the prostate (PVP) vaporization of the prostate between 2012 and 2016 at two-tertiary medical centers. Data collection included baseline comorbidities, disease-specific quality of life scores, maximum urinary flow rate (Qmax), postvoid residual (PVR), complications, prostate volume and prostate-specific antigen (PSA). The secondary endpoints were the incidence of intraoperative and postoperative adverse events. Complications were stratified using the Clavien-Dindo grading system up to 90 days after surgery. Results Mean age of men was 67.8 years old, with a mean body mass index of 29.7 kg/m2. Mean prostate volume as measured by transrectal ultrasound was 29 mL. Anticoagulation use was 47% and urinary retention with catheter at time of surgery was 17%. Mean hospital stay and catheter time were 0.5 days. Median follow-up time was 6 months with the longest duration of follow-up being 22.5 months (interquartile range, 3–22.5 months). The International Prostate Symptom Score improved from 22.8 ± 7.0 at baseline to 10.7 ± 7.4 (p < 0.01) and 6.3 ± 4.4 (p < 0.01) at 1 and 6 months, respectively. The Qmax improved from 7.70 ± 4.46 mL/s at baseline to 17.25 ± 9.30 mL/s (p < 0.01) and 19.14 ± 7.19 mL/s (p < 0.001) at 1 and 6 months, respectively, while the PVR improved from 216.0 ± 271.0 mL preoperatively to 32.8 ± 45.3 mL (p < 0.01) and 26.2 ± 46.0 mL (p < 0.01) at 1 and 6 months, respectively. The PSA dropped from 1.97 ± 1.76 ng/mL preoperatively to 0.71 ± 0.61 ng/mL (p < 0.01) and 0.74 ± 0.63 ng/mL at 1 and 6 months, respectively. No patient had a bladder neck contracture postoperatively and no capsular perforations were noted intraoperatively. Conclusion The 180 W GreenLight XPS system is safe and effective for men with small volume BPH. PVP produced improvements in symptomatic and clinical parameters without any safety concern. It represents a safe surgical option in this under studied population.
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19
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Are Outcomes of Thulium Laser Enucleation of the Prostate Different in Men Aged 75 and Over? A Propensity Score Analysis. Urology 2019; 132:170-176. [DOI: 10.1016/j.urology.2019.06.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/30/2019] [Accepted: 06/17/2019] [Indexed: 12/30/2022]
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20
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Moiroud M, Ait Said K, Vaudreuil L, Alharbi F, Leon G, Tillou X. Prostate Laser Photovaporization in Older People With and Without Bladder Catheter. J Am Geriatr Soc 2019; 67:1888-1894. [PMID: 31188479 DOI: 10.1111/jgs.16019] [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: 02/20/2019] [Revised: 05/12/2019] [Accepted: 05/13/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare results of prostate laser photovaporization (PVP) by age groups to evaluate morbidity and functional results. Then, to specifically analyze surgical data for patients with an indwelling bladder catheter. DESIGN Monocentric retrospective study of a prospective maintained database of all laser PVPs performed at our university hospital between December 2012 and June 2017. SETTINGS AND PARTICIPANTS A total of 305 patients (three groups: younger than 70, 70-80, and older than 80 years) were operated on in our hospital center for the treatment of urinary tract disorders related to benign prostatic hyperplasia. RESULTS A difference was found between the three age groups, with a higher rate of complications for patients older than 80 years (45%) (P = .013). Rate of patients with postoperative bladder catheters at 1 year was higher for patients older than 80 years (15%) (P = .004). Postoperative quality-of-life (QoL) score was worse for patients older than 80 years (P = .04). For patients with an indwelling bladder catheter undergoing surgery, morbidity was greater in patients older than 80 years, but the difference was not significant. International Prostate Symptom Score and QoL score were not significantly different between the three groups. Rate of patients with a remaining bladder catheter at 1 year was higher for patients older than 80 years (17.1% vs 7.1% for patients between 70 and 80, and 4.8% for patients under 70.) but with no statistical difference. CONCLUSION PVP had a greater morbidity in octogenarians compared to younger subjects. Functional results were less satisfactory for patients older than 80 years compared to younger ones. For subjects operated on with an indwelling bladder catheter, no significant difference in outcome and morbidity was found between the three groups. J Am Geriatr Soc 67:1888-1894, 2019.
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Affiliation(s)
- Martin Moiroud
- Department of Urology and Transplantation, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Khelifa Ait Said
- Department of Urology and Transplantation, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Lionel Vaudreuil
- Department of Urology and Transplantation, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Feras Alharbi
- Department of Urology and Transplantation, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Gregoire Leon
- Department of Urology and Transplantation, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Xavier Tillou
- Department of Urology and Transplantation, Centre Hospitalier Universitaire de Caen, Caen, France
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Wallace B, Breau RH, Cnossen S, Knee C, Mcisaac D, Mallick R, Cagiannos I, Morash C, Lavallée LT. Age-stratified perioperative mortality after urological surgeries. Can Urol Assoc J 2018; 12:256-259. [PMID: 29629861 DOI: 10.5489/cuaj.5022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION More elderly patients are presenting for surgical consultation. Understanding the risk of mortality by age group after urological surgery is important for patient selection and counselling. METHODS A historical cohort study of The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2006-2015 was performed. Current procedural terminology (CPT) codes for similar surgical procedures were grouped for analyses. Urological procedures commonly performed in elderly patients were identified and stratified by patient age and surgical approach (open vs. laparoscopic/robotic). The primary outcome was the absolute risk of death by 30 days stratified by age for each surgical procedure. The secondary outcome was risk of death by surgical approach (open vs. laparoscopic/robotic). RESULTS Twelve urological procedures were reviewed including 124 262 patients. A total of 1011 (0.8%) deaths occurred by 30 days after surgery. The procedure with the highest incidence of mortality by 30 days was open nephroureterectomy (2.9 %). In patients 80 years and over, the procedure with the highest incidence of death was open radical nephrectomy (5.32%). There was an increased risk of mortality with increasing age group for all procedures. Unadjusted risk of mortality was consistently higher in patients who receive open compared to laparoscopic surgery. CONCLUSIONS There is an increasing risk of mortality with age and with open surgical approach in urology. Knowledge regarding the absolute risk of mortality in patients receiving common urological surgeries may improve patient selection and counselling.
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Affiliation(s)
- Brendan Wallace
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Rodney H Breau
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sonya Cnossen
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Christopher Knee
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Daniel Mcisaac
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Ranjeeta Mallick
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ilias Cagiannos
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Christopher Morash
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Luke T Lavallée
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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El-Shaer W, Abou-Taleb A, Kandeel W. Transurethral bipolar plasmakinetic vapo-enucleation of the prostate: Is it safe for patients on chronic oral anticoagulants and/or platelet aggregation inhibitors? Arab J Urol 2017; 15:347-354. [PMID: 29234539 PMCID: PMC5717451 DOI: 10.1016/j.aju.2017.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/20/2017] [Accepted: 09/16/2017] [Indexed: 02/02/2023] Open
Abstract
Objectives To assess the safety and efficacy of bipolar plasmakinetic enucleation and resection of the prostate (PKERP) for the management of benign prostatic hyperplasia (BPH) in patients on oral anticoagulant (OAC) therapy and/or platelet aggregation inhibitors (PAIs). Patients and methods In all, 91 patients were recruited and underwent PKERP whilst they were receiving PAIs (aspirin, 56 patients; clopidogrel, three; aspirin and clopidogrel, 11). In all, 15 patients were receiving an OAC drug perioperatively, whilst another six patients were on dual PAIs and OACs. The primary outcomes were the perioperative morbidity and mortality rates. The secondary outcomes were functional outcomes including maximum urinary flow rate (Qmax), International Prostate Symptoms Score (IPSS), and post-void residual urine volume (PVR). Results The mean (SD) age of the patients was 65 (5.9) years, preoperative adenoma volume was 80.9 (30.4) mL, and the operative time was 67 (23) min. No patient developed serious perioperative cardiovascular complications. The mean (SD) duration of hospital stay was 1.79 (1) days and the postoperative catheterisation time was 1.14 (0.76) days. The mean (SD) haemoglobin drop was 0.74 (0.61) g/dL, blood transfusion rate was 2.2%, and the clot retention rate was 2.2%. The mean (SD) postoperative Qmax was 18.6 (4.37) mL/s as compared to 7.2 (3.2) mL/s preoperatively (P < 0.001), and the preoperative IPSS was reduced from 24.3 (6.1) to 5.7 (2.3) postoperatively (P < 0.05). Prostate volume measured by transrectal ultrasonography was significantly reduced from a mean (SD) of 80.9 (30.4) mL preoperatively to 29.5 (10.6) mL postoperatively (P < 0.001). Conclusion Minimally invasive PKERP may be considered as a safe and effective treatment option for managing patients with BPH receiving OAC/PAI drugs.
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Key Words
- Anticoagulant
- BPH
- Hb, haemoglobin
- HoLEP, holmium laser enucleation of the prostate
- INR, international normalised ratio
- LUTS
- M-TURP, monopolar TURP
- OA, oral anticoagulant
- PAI, platelet aggregation inhibitor
- PKERP
- PKERP, plasmakinetic enucleation and resection of the prostate
- PVR, post-void residual urine volume
- Qmax, maximum urinary flow rate
- ThuVARP, thulium vaporesection of the prostate
- ThuVEP, thulium vapoenucleation of the prostate
- UI, urinary incontinence
- US, ultrasonography
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Affiliation(s)
- Waleed El-Shaer
- Department of Urology, Banha University Hospital, Banha, Egypt
| | | | - Wael Kandeel
- Department of Urology, Banha University Hospital, Banha, Egypt
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23
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Elshal AM, El-Assmy A, Mekkawy R, Taha DE, El-Nahas AR, Laymon M, El-Kappany H, Ibrahiem EH. Prospective controlled assessment of men's sexual function changes following Holmium laser enucleation of the prostate for treatment of benign prostate hyperplasia. Int Urol Nephrol 2017; 49:1741-1749. [PMID: 28780626 DOI: 10.1007/s11255-017-1649-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 06/30/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess how much Holmium laser enucleation of the prostate (HoLEP) is detrimental on men sexuality. METHODS Between January and December 2013, all patients presented for BPH surgery were assessed using IIEF-15 (international index of erectile function-15) and Ej-MSHQ (ejaculatory domain-male sexual health questionnaire). Changes in men's sexuality following HoLEP in relation to control procedure were prospectively assessed. Intervention group included legible consecutive patients treated by HoLEP. Control group included legible patients presented for diagnostic cystoscopy. Changes in IIEF-15, its subdomains and Ej-MSHQ scores were compared between HoLEP group and control. RESULTS At one year 80 and 70 subjects were included for final analysis following HoLEP and control groups, respectively. Regardless of the baseline erectile function (EF/IIEF) score, there was an increase in EF score similar to control following HoLEP (P = 0.6). However, among subjects with normal preoperative EF (score >25), in comparison with control, there was similar decline in EF score following HoLEP (P = 0.07). Regarding the orgasm domain, there was a significant reduction in orgasm perception following HoLEP in relation to control (P = 0.01). Patients reported desire changes, intercourse satisfaction and overall satisfaction scores similar to control following HoLEP. Using Ej-MSHQ score, there was no statistically significant difference between HoLEP and control groups in percentage of subjects reporting ejaculatory dysfunction at baseline. However, at 12 months, there was statistically significant more ejaculatory dysfunction reporting following HoLEP. The most common ejaculatory abnormality was volume abnormality. Orgasm perception was significantly decreased among subjects with newly reported ejaculatory dysfunction (5.3 ± 1.4 vs. 8.6 ± 1.3, P = 0.001). CONCLUSIONS Controlled short-term assessment of HoLEP showed potential negative impact on EF in patients with normal preoperative EF. Apart from orgasm perception, sexual function changes following HoLEP were similar to control. High prevalence of postoperative ejaculatory dysfunction following HoLEP remained notable finding.
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Affiliation(s)
- Ahmed M Elshal
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed El-Assmy
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Ramy Mekkawy
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Diaa-Eldin Taha
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed R El-Nahas
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mahmoud Laymon
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Hamdy El-Kappany
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Suskind AM, Walter LC, Zhao S, Finlayson E. Functional Outcomes After Transurethral Resection of the Prostate in Nursing Home Residents. J Am Geriatr Soc 2016; 65:699-703. [PMID: 27918098 DOI: 10.1111/jgs.14665] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To understand outcomes of transurethral resection of the prostate (TURP) or transurethral laser incision of the prostate (TULIP) for the treatment of bladder outlet obstruction in men with high levels of functional dependence, which are poorly understood. DESIGN Retrospective cohort study. SETTING U.S. nursing homes (NHs). PARTICIPANTS Male NH residents aged 65 and older who underwent TURP or TULIP in the United States between 2005 and 2008 (N = 2,869). MEASUREMENTS Changes in activities of daily living (ADLs), Foley catheter status, and survival up to 12 months after surgery were examined. Multivariate regression was used to determine risk of having a Foley catheter 1 year after surgery. RESULTS Sixty-one percent of the cohort had a Foley catheter before the procedure. Of men with a Foley catheter at baseline, 64% had a Foley catheter, 4% had no Foley catheter, and 32% had died by 1-year after the procedure. Having a Foley catheter at baseline (risk ratio (RR) = 1.39, 95% confidence interval (CI) = 1.29-1.50) and poor baseline functional status (RR = 1.34, 95% CI = 1.18-1.52 for individuals in the worst quartile of function) were associated with greater risk of having a Foley catheter at 1-year. CONCLUSION Poor baseline functional status and having a Foley catheter preoperatively were associated with greater risk of TURP or TULIP failure, as measured by the presence of a Foley catheter at 1 year. Preoperative measurement of ADLs may aid in surgical decision-making in this population.
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Affiliation(s)
- Anne M Suskind
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Louise C Walter
- Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, California.,Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Shoujun Zhao
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Emily Finlayson
- Department of Surgery, University of California San Francisco, San Francisco, California
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25
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Elkoushy MA, Elshal AM, Elhilali MM. Changing patients' profile presenting for surgical management of benign prostatic hyperplasia over the past 16 years: A single-centre perspective. Can Urol Assoc J 2015; 9:372-8. [PMID: 26788224 DOI: 10.5489/cuaj.3066] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION We assessed the change of patients' profile presenting for symptomatic benign prostatic hyperplasia (BPH) over 16 years and its impact on surgical outcomes over this time. METHODS We reviewed a prospectively maintained database of patients treated with laser for symptomatic BPH since March 1998. Patients were divided into 3 consecutive time-based groups: Group 1 for patients who underwent surgery before April 2004; Group 2, between April 2004 and March 2009; and for Group 3 from April 2009 to August 2014. We reviewed demographic and preoperative data, including prostate volume; international prostate symptoms score (IPSS), quality of life (QoL), and peak flow rate (Qmax). We also recorded any perioperative and long-term complications. RESULTS A total of 1835 patients were included in our study, including 542 (29.5%) in Group 1, 614 (33.5%) in Group 2, and 679 (37%) in Group 3. Preoperative prostate volume was positively correlated with age at surgery (r = 0.62, p < 0.001), total energy used (r = 0.47, p < 0.001), and total operative time (r = 0.47, p < 0.001). Patients in Group 3 were significantly older (75.28 ± 8.47 in Group 3 vs. 71.11 ± 8.9 in Group 2 vs. 65.3 ± 9.04 years in Group 1, p <0.001), were more coagulopathic (18.7% Group 3 vs. 12.3% Group 2 vs. 5.9% Group 1, p < 0.001), and had significantly larger prostates (87.96 ± 49.80 in Group 3 vs. 78.44 ± 50.84 in Group 2 vs. 74.50 ± 46.53 Group 1, p < 0.001). Preoperative prostatic medications significantly increased over time (72.6% in Group 1 vs. 85.5% in Group 2, vs. 87.4% Group 3, p < 0.001). IPSS, QoL and Qmax were significantly abnormal in patients in Group 3 (p < 0.001). After a mean follow-up of 3 years, the number of patients who did not require reoperation progressively increased (94.1% Group 1 vs. 96.1% Group 2 vs. 98.3% Group 3). Age (>72 years), prostate volume (>80 cc), operative time (>95 minutes), and preoperative PSA (>6 ng/dL) were significantly associated with postoperative urinary incontinence. CONCLUSIONS Patients presenting for surgery due to symptomatic BPH over the last 16 years were significantly older, more morbid, and had larger prostates and more abnormal voiding parameters. Over time, patients used prostatic medications more frequently. Despite the changes in patient profiles, perioperative safety and complication rates between groups were comparable, likely due to advancements in laser technology and techniques. Age (>72 years), prostate volume (>80 cc), operative time (>95 minutes), and preoperative PSA (>6 ng/dL) were significantly associated with reversible postoperative urinary incontinence.
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Affiliation(s)
- Mohamed A Elkoushy
- Department of Surgery, Division of Urology, McGill University Health Centre, Montreal, QC;; Department of Urology, Suez Canal University, Ismailia, Egypt
| | - Ahmed M Elshal
- Department of Surgery, Division of Urology, McGill University Health Centre, Montreal, QC;; Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mostafa M Elhilali
- Department of Surgery, Division of Urology, McGill University Health Centre, Montreal, QC
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26
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Dołowy Ł, Krajewski W, Dembowski J, Zdrojowy R, Kołodziej A. The role of lasers in modern urology. Cent European J Urol 2015; 68:175-82. [PMID: 26251737 PMCID: PMC4526611 DOI: 10.5173/ceju.2015.537] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/03/2015] [Accepted: 04/17/2015] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The functioning of modern urological departments and the high level of service they provide is possible through, among other things, the use of modern laser techniques. MATERIAL AND METHODS Open operations have been replaced by minimally invasive procedures, and classical surgical tools by advanced lasers. The search for new applications with lasers began as technology developed. Among many devices available, holmium, diode and thulium lasers are currently the most popular. RESULTS Depending on the wavelength, the absorption by water and hemoglobin and the depth of penetration, lasers can be used for coagulation, vaporization and enucleation. In many centres, after all the possibilities of pharmacological treatment have been exhausted, lasers are used as the primary treatment for patients with benign prostatic hyperplasia, with therapeutic results that are better than those obtained through open or endoscopic operations. The use of lasers in the treatment of urolithiasis, urinary strictures and bladder tumours has made treatment of older patients with multiple comorbidities safe, without further necessity to modify the anticoagulant drug treatment. Laser procedures are additionally less invasive, reduce hospitalization time and enable a shorter bladder catheterization time, sometimes even eliminating the need for bladder catherterization completely. Such procedures are also characterized by more stable outcomes and a lower number of reoperations. CONCLUSIONS There are also indications that with the increased competition among laser manufacturers, decreased purchase and maintenance costs, and increased operational safety, laser equipment will become mandatory and indispensable asset in all urology wards.
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Affiliation(s)
- Łukasz Dołowy
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Wojciech Krajewski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Janusz Dembowski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Romuald Zdrojowy
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Anna Kołodziej
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
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Majumdar R, Mirheydar HS, Palazzi KL, Lakin CM, Albo ME, Parsons JK. Prostate laser vaporization is safe and effective in elderly men. Urol Ann 2015; 7:36-40. [PMID: 25657541 PMCID: PMC4310114 DOI: 10.4103/0974-7796.148595] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/23/2014] [Indexed: 11/22/2022] Open
Abstract
Introduction: There are few data on the safety and efficacy of laser photoselective vaporization (LVP) in elderly men. We compared the safety and efficacy of LVP for the treatment of symptomatic benign prostatic hyperplasia (BPH) in men ≥75 years, who we defined as elderly, to those <75 years. Materials and Methods: Safety and efficacy outcomes in elderly men undergoing LVP for lower urinary tract symptoms secondary to BPH from 2005 to 2012 were compared with men <75 years. Differences between-groups in demographics, perioperative outcomes, complications, and postoperative changes in International Prostate Symptom Score (I-PSS) were calculated. Results: Of 202 patients, 49 (24%) were elderly (range: 75-95 years) and 153 (76%) were <75 years. Preoperatively, elderly men were more likely to have heart disease (35% vs. 20%, P = 0.03), gross hematuria (6.1% vs. 0.7%, P = 0.05), urinary retention (57% vs. 41%, P = 0.07), and take anti-coagulants (61% vs. 35%, P = 0.002). Elderly men had a longer median length of stay (1 day vs. 0 day, P = 0.001). There were no significant between-group differences in transfusion frequency (4.4% vs. 0.7%, P = 0.14) or Clavien III complications (2% vs. 2.6%, P = 1.0). One month postsurgery, elderly patients reported smaller median decreases in I-PSS (5.5 vs. 9, P = 0.02) and urinary bother (1 point vs. 2, P = 0.03) compared with preoperative values. At till 9 months follow-up, there were no significant between-group differences in median I-PSS or urinary bother scores. Conclusions: Despite a higher prevalence of preoperative comorbidity and urinary retention, elderly LVP patients experienced perioperative safety and shorter term efficacy outcomes comparable to younger men.
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Affiliation(s)
- Rohit Majumdar
- University of California, San Diego School of Medicine, La Jolla, USA
| | - Hossein S Mirheydar
- University of California, San Diego School of Medicine, La Jolla, USA ; Department of Urology, UC San Diego Health System, San Diego, USA
| | - Kerrin L Palazzi
- Urologic Cancer, UC San Diego Moores Cancer Center, La Jolla, USA
| | - Charles M Lakin
- University of California, San Diego School of Medicine, La Jolla, USA ; Department of Urology, UC San Diego Health System, San Diego, USA
| | - Michael E Albo
- University of California, San Diego School of Medicine, La Jolla, USA ; Department of Urology, UC San Diego Health System, San Diego, USA
| | - J Kellogg Parsons
- University of California, San Diego School of Medicine, La Jolla, USA ; Department of Urology, UC San Diego Health System, San Diego, USA ; Urologic Cancer, UC San Diego Moores Cancer Center, La Jolla, USA ; Section of Urology, VA San Diego Healthcare System, San Diego, CA, USA
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28
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Chughtai BI, Simma-Chiang V, Lee R, Isaacs A, Te AE, Kaplan SA, Sedrakyan A. Trends and Utilization of Laser Prostatectomy in Ambulatory Surgical Procedures for the Treatment of Benign Prostatic Hyperplasia in New York State (2000-2011). J Endourol 2014; 29:700-6. [PMID: 25353692 DOI: 10.1089/end.2014.0692] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION There has been a significant change in surgical treatment of benign prostatic hypertrophy (BPH) over the last two decades. Most importantly, laser surgery (coagulation, vaporization, or enucleation) has been growing in popularity as an alternative to standard transurethral prostatectomy (TURP) or other procedures. Our goal was to analyze the trends of BPH surgeries and compare outcomes of laser surgery to TURP, the two most common alternative surgeries. MATERIALS AND METHODS We used the New York Statewide Planning and Research Cooperation System (SPARCS) data to identify patients diagnosed as having BPH who underwent BPH-related surgery from October 2000 to December 2011. Age, insurance, individual comorbidities, and average hospital volumes were assessed. Bivariate and multivariate regression models were used to analyze predictors of laser use. In-hospital outcomes were then compared between laser and TURP in a balanced propensity-matched cohort. RESULTS Ninety thousand six hundred seventy patients underwent BPH surgery. Laser surgery usage increased from 6.4% to 44.5% over 10 years (p<0.0001). TURP declined significantly from 72.2% to 48.3% (p<0.0001). Patients with Medicaid were less likely to undergo laser therapy than those with private insurance (odds ratio [OR]: 0.58, 95% confidence interval [CI]: 0.48, 0.69). Mid- and high-volume institutions were more likely to use laser treatment than low-volume centers (OR: 2.26, 95% CI: 1.22, 4.2; OR: 4.07, 95% CI: 1.75, 9.46, respectively). In the matched cohort, both laser and TURP patients had similar complication rates with more frequent electrolyte disorders in TURP patients (2.9% vs 2.3%, p=0.001). CONCLUSIONS TURP remains the most common procedure. However, the rate of use has declined over time. In contrast, laser use has significantly increased. Laser treatment was utilized more in younger patients, in those privately insured, in hospitals with high volumes of BPH procedures, and in patients with fewer comorbid conditions. Both surgeries are safe with no differences in terms of occurrences of morbidity and complications.
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Affiliation(s)
- Bilal I Chughtai
- 1 Department of Urology, Weill Medical College of Cornell University , New York, New York
| | - Vannita Simma-Chiang
- 1 Department of Urology, Weill Medical College of Cornell University , New York, New York
| | - Richard Lee
- 1 Department of Urology, Weill Medical College of Cornell University , New York, New York
| | - Abby Isaacs
- 2 Department of Healthcare Policy and Research, Weill Medical College of Cornell University , New York, New York
| | - Alexis E Te
- 1 Department of Urology, Weill Medical College of Cornell University , New York, New York
| | - Steven A Kaplan
- 1 Department of Urology, Weill Medical College of Cornell University , New York, New York
| | - Art Sedrakyan
- 2 Department of Healthcare Policy and Research, Weill Medical College of Cornell University , New York, New York
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Peyronnet B, Pradere B, Brichart N, Bodin T, Bertrand P, Bruyère F, Atassi A, Benmeziani R, Bodin T, Breque M, Brichart N, Bron J, Bruyere F, Cloche P, Corbel L, Cormier L, Cuvelier G, Delporte G, Fennouri M, Ferhi K, Fournier G, Gabbay G, Hurtes X, Laplace B, Le Gal S, Lecouteux A, Lesur G, Lokmane M, Mathieu R, Metois P, Miaadi N, Misrai V, Moreau J, Mouly P, Muyshondt C, Obringer L, Perrouin-Verbe M, Peyronnet B, Pradere B, Prezelin Y, Rigaud P, Salin A, Tabchouri N, Tanchoux C, Theveniaud P, Thoulouzan M, Thuillier C, Verhoest G. Complications Associated With Photoselective Vaporization of the Prostate: Categorization by a Panel of GreenLight Users According to Clavien Score and Report of a Single-center Experience. Urology 2014; 84:657-64. [DOI: 10.1016/j.urology.2014.05.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 05/21/2014] [Accepted: 05/23/2014] [Indexed: 11/16/2022]
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30
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Elshal AM, Elkoushy MA, Elmansy HM, Sampalis J, Elhilali MM. Holmium:YAG Transurethral Incision Versus Laser Photoselective Vaporization for Benign Prostatic Hyperplasia in a Small Prostate. J Urol 2014; 191:148-54. [DOI: 10.1016/j.juro.2013.06.113] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Ahmed M. Elshal
- Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed A. Elkoushy
- Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
- Urology Department, Suez Canal University, Ismailia, Egypt
| | - Hazem M. Elmansy
- Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - John Sampalis
- Division of Epidemiology & Biostatistics, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Mostafa M. Elhilali
- Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada
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31
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Elshal AM, El-Nahas AR, Barakat TS, Elsaadany MM, El-Hefnawy AS. Transvesical open prostatectomy for benign prostatic hyperplasia in the era of minimally invasive surgery: Perioperative outcomes of a contemporary series. Arab J Urol 2013; 11:362-8. [PMID: 26558107 PMCID: PMC4442976 DOI: 10.1016/j.aju.2013.06.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 06/18/2013] [Accepted: 06/21/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the perioperative morbidity of transvesical open prostatectomy (OP) and its predictors as a treatment for benign prostatic hyperplasia (BPH), and to update knowledge about the morbidity of OP using a standardised morbidity scale (Clavien), thus providing a platform for comparison with the newly developed techniques. PATIENTS AND METHODS We retrospectively review men with BPH who were treated with transvesical OP between April 2002 and December 2012. Preoperative patients' data were reviewed for relevant variables. Operative details, the postoperative course, and 30-day relevant data were assessed. The study cohort was stratified based on the resected prostate weight, with group 1 having a resected weight of ⩽120 g and group 2 >120 g. RESULTS The review identified 163 patients. The mean (SD, range) duration of catheterisation after OP was 7.9 (2.2, 5-20) days and the duration of hospitalisation after OP was 8.1 (1.8, 5-15) days; both were significantly longer in group 2. All patients were able to void spontaneously by the first follow-up visit. Of 163 OP procedures, there were 106 perioperative complications in 69 (42.3%). Low-grade complications (grade ⩽2) included 38 (45.2%) and 53 (67%) in groups 1 and 2, respectively (P = 0.8). High-grade complications (⩾3) included 3 (3.5%) and 12 (15.1%) in groups 1 and 2, respectively (P = 0.02). The blood transfusion rate was 24.5%, the perioperative mortality rate was 1.2% and the re-admission rate within the first 30 days after OP was 1.2%. High-grade complications were significantly associated with a greater resected prostate weight (odds ratio 1.08, 95% CI 1.001-1.17, P = 0.046). CONCLUSION The OP procedure is associated with a significant perioperative morbidity that correlated significantly with the resected prostate weight, especially for high-grade complications.
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Affiliation(s)
- Ahmed M. Elshal
- Mansoura Urology & Nephrology Center, Mansoura University, Egypt
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Li Z, Hou R, Li J. The efficacy and safety of simultaneous transurethral GreenLight photoselective vaporization of bladder tumor and prostate in patients with bladder tumor and lower urinary tract symptoms. Int Urol Nephrol 2013; 46:691-4. [PMID: 24097277 DOI: 10.1007/s11255-013-0572-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 09/18/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE We compared the safety and efficacy of simultaneous transurethral GreenLight photoselective vaporization of bladder tumor and prostate (PVBT/PVP) in patients with bladder tumor and bladder outlet obstruction caused by benign prostate hyperplasia (BPH). METHODS Sixty-two patients with bladder tumor were enrolled in our prospective and randomized trial. A total of 37 men underwent simultaneous transurethral PVBT/PVP, and 25 patients underwent PVBT alone. The clinicopathological parameters and the recurrence of bladder tumor on the bladder neck/prostatic fossa were evaluated in all patients. RESULTS Clinicopathological parameters of both groups were similar. The rates of recurrence, progression and tumor recurrence of bladder neck/prostatic fossa were 16.0, 4.0 and 4.0 % in the simultaneous resection group, and 18.9, 5.4 and 8.1 % in the group PVBT, respectively. No statistically significant differences were found between the two groups (P > 0.05). CONCLUSIONS Simultaneous PVBT/PVP may help decrease the overall recurrence rate and tumor recurrence in bladder neck/prostatic fossa. PVBT/PVP can be performed effectively and safely in patients with bladder tumor and BPH.
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Affiliation(s)
- Zhaoyi Li
- Department of Urology, The Union Medical Center of Tianjin, Tianjin, 300121, China
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