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Hagiuda J, Masuda T, Takahashi R, Tamaki S, Nakagawa K. Transurethral bipolar enucleation using a TUEB loop for large benign prostatic hyperplasia: a retrospective cohort study. World J Urol 2024; 42:183. [PMID: 38512532 DOI: 10.1007/s00345-024-04865-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/08/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE We aimed to assess the efficacy and safety of transurethral enucleation with bipolar system (TUEB) regardless of the prostate size using a specially developed TUEB loop. METHODS A total of 251 patients who underwent TUEB were categorized into two groups depending on the prostate volume (PV): small-PV (≤ 80 mL) group, 133 patients; large-PV (> 80 mL) group, 118 patients. Comparisons of background information and treatment outcomes were performed between the groups. RESULTS Operation (113.5 vs 166.4 min), enucleation (49.4 vs 68.1 min), and morcellation (11.4 vs 26.4 min) times were longer and hemoglobin decreased significantly (0.84 vs 1.30 g/dL) in the large PV group. However, the enucleation efficiency (enucleated weight per enucleation time; 0.71 vs 0.97 g/min) and prostate-specific antigen reduction rate (24.6% vs 16.1%) were significantly better in the large-PV group, with similar enucleation rates (enucleated weight per transitional zone volume; 82% vs 81%). The International Prostate Symptom Score, uroflowmetry maximum flow rate, and post-void residual urine in both groups improved at 3, 6, and 12 months compared with baseline. No patient underwent blood transfusion. There were no differences in the frequency of postoperative clot retention, urethral stricture, or stress incontinence at 3, 6, and 12 months. CONCLUSION TUEB using a TUEB loop resulted in high levels of satisfaction regarding the enucleation efficiency, efficacy, and safety for BPH surgery regardless of the prostate size. TUEB should be considered one of the best treatment options for large BPH that is uncontrollable with medication.
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Affiliation(s)
- Jun Hagiuda
- Department of Urology, Tokyo Dental College, Ichikawa General Hospital, Sugano 5-11-13, Ichikawa, Chiba, 2728513, Japan.
| | - Tsukasa Masuda
- Department of Urology, Tokyo Dental College, Ichikawa General Hospital, Sugano 5-11-13, Ichikawa, Chiba, 2728513, Japan
| | - Ryohei Takahashi
- Department of Urology, Tokyo Dental College, Ichikawa General Hospital, Sugano 5-11-13, Ichikawa, Chiba, 2728513, Japan
| | - Satoshi Tamaki
- Department of Urology, Tokyo Dental College, Ichikawa General Hospital, Sugano 5-11-13, Ichikawa, Chiba, 2728513, Japan
| | - Ken Nakagawa
- Department of Urology, Tokyo Dental College, Ichikawa General Hospital, Sugano 5-11-13, Ichikawa, Chiba, 2728513, Japan
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Tagreda I, Heikal M, Elatreisy A, Salman MF, Soliman AM, Koritenah AK, Abozied H, Algammal MI, Alrefaey AA, Elsalhy M, Shehab M, Ali MM, Eid AG, Abdrabuh AM, Eleweedy S. Evaluation of bipolar Transurethral Enucleation and Resection of the Prostate in terms of efficiency and patient satisfaction compared to retropubic open prostatectomy in prostates larger than 80 cc. A prospective randomized study. Arch Ital Urol Androl 2023; 95:11629. [PMID: 37990975 DOI: 10.4081/aiua.2023.11629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/31/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVES To compare the outcomes of bipolar Transurethral Enucleation Resection of the Prostate (TUERP) and simple retropubic prostatectomy in patients with prostate volumes larger than 80 cc. PATIENTS AND METHODS A prospective randomized study included all patients amenable to surgeries for benign prostate hyperplasia (BPH) with prostate size over 80 cc at a tertiary care hospital between January 2020 to February 2022. Bipolar TUERP and Retropubic open prostatectomy techniques were compared regarding patients' demographics, intraoperative parameters, outcomes, and peri-operative complications. RESULTS Ninety patients were included in our study and randomly assigned to bipolar TUERP (Group 1 = 45 patients) and retropubic open prostatectomy (Group 2 = 45 patients). The TUERP group demonstrated significantly lower operative time (77 ± 11 minutes vs. 99 ± 14 minutes, p < 0.001), hemoglobin drop (median = 1.1 vs. 2.5, p < 0.001), and resected tissue weight (71 ± 6.6 cc vs. 84.5 ± 10.6 cc, p < 0.001). Postoperatively, the TUERP group demonstrated significantly lower catheter time (median = 2 vs. 7 days, p < 0.001) and less hospital stay. IPSS, Qmax, and patient satisfaction were better in the TUERP group within six months of surgery. We reported 90-day complications after TUERP in 13.3% of patients compared to 17.8% after retropubic prostatectomy, with a statistically insignificant difference. Urethral stricture predominated after TUERP, while blood transfusion dominated in retropubic prostatectomy. CONCLUSIONS The present study found that TUERP had equivalent efficacy and safety to open retropubic prostatectomy for patients with BPH and prostate volumes > 80 ml.
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Affiliation(s)
- Ibrahim Tagreda
- Urology Department, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Mahmoud Heikal
- Urology Department, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Adel Elatreisy
- Urology Department, Faculty of Medicine, Al-Azhar University, Cairo.
| | | | | | | | - Hesham Abozied
- Urology Department, Faculty of Medicine, Al-Azhar University, Cairo.
| | | | - Ahmed A Alrefaey
- Urology Department, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Mohamed Elsalhy
- Urology Department, Faculty of Medicine, Al-Azhar University, Cairo.
| | - Mohamed Shehab
- Urology Department, Faculty of Medicine, Al-Azhar University, Cairo.
| | | | - Aly Gomaa Eid
- Urology Department, Faculty of Medicine, Al-Azhar University, Cairo.
| | | | - Sayed Eleweedy
- Urology Department, Faculty of Medicine, Al-Azhar University, Cairo.
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Gravas S, Gacci M, Gratzke C, Herrmann TRW, Karavitakis M, Kyriazis I, Malde S, Mamoulakis C, Rieken M, Sakalis VI, Schouten N, Speakman MJ, Tikkinen KAO, Cornu JN. Summary Paper on the 2023 European Association of Urology Guidelines on the Management of Non-neurogenic Male Lower Urinary Tract Symptoms. Eur Urol 2023; 84:207-222. [PMID: 37202311 DOI: 10.1016/j.eururo.2023.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/06/2023] [Indexed: 05/20/2023]
Abstract
CONTEXT Lower urinary tract symptoms (LUTS) are common, often bothersome, and have multifactorial aetiology. OBJECTIVE To present a summary of the 2023 version of the European Association of Urology guidelines on the management of male LUTS. EVIDENCE ACQUISITION A structured literature search from 1966 to 2021 selected the articles with the highest certainty evidence. The Delphi technique consensus approach was used to develop the recommendations. EVIDENCE SYNTHESIS The assessment of men with LUTS should be practical. A careful medical history and physical examination are essential. Validated symptom scores, urine test, uroflowmetry, and postvoid urine residual, as well as frequency-volume charts for patients with nocturia or predominately storage symptoms should be used. Prostate-specific antigen should be ordered if a diagnosis of prostate cancer changes the treatment plan. Urodynamics should be performed for selected patients. Men with mild symptoms are candidates for watchful waiting. Behavioural modification should be offered to men with LUTS prior to, or concurrent with, treatment. The choice of medical treatment depends on the assessment findings, predominant type of symptoms, ability of the treatment to change the findings, and the expectations to be met in terms of the speed of onset, efficacy, side effects, and disease progression. Surgery is reserved for men with absolute indications, and for patients who fail or prefer not to receive medical therapy. Surgical management has been divided into five sections: resection, enucleation, vaporisation, and alternative ablative and nonablative techniques. The choice of surgical technique depends on patient's characteristics, expectations, and preferences; surgeon's expertise; and availability of modalities. CONCLUSIONS The guidelines provide an evidence-based approach for the management of male LUTS. PATIENT SUMMARY A clinical assessment should identify the cause(s) of symptoms and define the clinical profile and patient's expectations. The treatment should aim to ameliorate symptoms and reduce the risk of complications.
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Affiliation(s)
- Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Christian Gratzke
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | | | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Iason Kyriazis
- Department of Urology, General University Hospital of Patras, Patras, Greece
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | | | - Vasileios I Sakalis
- Department of Urology, Hippokrateion General Hospital, Thessaloniki, Greece.
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Mark J Speakman
- Department of Urology, Taunton & Somerset Hospital, Taunton, UK
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | - Jean-Nicolas Cornu
- Department of Urology, CHU Hôpitaux de Rouen - Hôpital Charles Nicolle, Rouen, France
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Xiao K, Ma Y, Luo Z, Li H, Jin T. Network meta-analysis of the treatment safety and efficacy of different energy systems in prostate vaporization. Lasers Med Sci 2023; 38:150. [PMID: 37378687 DOI: 10.1007/s10103-023-03781-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 04/20/2023] [Indexed: 06/29/2023]
Abstract
Many clinical trials and meta-analyses have examined vaporization with different energy instruments has been recognized by the American Urological Association (AUA) and the European Association of Urology (EAU) as a promising treatment for benign prostate hyperplasia. However, there is still a lack of evidence for a network comparison between different vaporization devices. The PubMed, Embase, Cochrane and Web of Science databases were searched to identify randomized controlled trials (RCTs) of different energy systems for prostate vaporization. Pairwise and network meta-analyses (NMA) were performed to analyze the outcome regarding surgery time, complications, short-term maximum urine flow rate (Qmax), and long-term Qmax. The Stata software was used for paired meta-analysis. A Bayesian NMA model with ADDIS software was applied to achieve the indirect comparison of different energy systems. Node-splitting analysis and inconsistency factors were used to test inconsistency for closed-loop indirect comparison. Fifteen studies were included in this study, involving three types of energy systems used in prostate vaporization: diode laser (wavelength: 980 nm, power: 200-300 W, mode: continuous), green-light laser (wavelength: 532 nm, power: 80-180 W, mode: continuous), and bipolar plasma vaporization (bipolar electrode, power: 270-280 W, mode: pulsed). In the conventional paired meta-analysis, significantly better short-term efficacy was found in green light laser vaporization, while no significant difference was detected in other parameters. According to the results of the NMA, a greenlight laser is recommended for prostate vaporization rather than the other two systems. When considering operation time, overall complications, short-term Qmax, and long-term Qmax, there were no significant differences among green-light laser vaporization, diode laser vaporization, and bipolar vaporization in BPH treatment. However, according to the probability ranking and benefit-risk analysis results, the green-light laser might be the best energy system for prostate vaporization in BPH treatment.
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Affiliation(s)
- Kaiwen Xiao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yucheng Ma
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zhumei Luo
- Chengdu Third People's Hospital, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Tao Jin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
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Simple and Convenient Method for Assessing the Severity of Bleeding during Endoscopic Prostate Surgery and the Relationships between Its Corresponding Surgical Outcomes. Diagnostics (Basel) 2023; 13:diagnostics13040592. [PMID: 36832080 PMCID: PMC9955362 DOI: 10.3390/diagnostics13040592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
Bleeding during endoscopic prostate surgery is often overlooked, and appropriate measurement techniques are rarely applied. We proposed a simple and convenient method for assessing the severity of bleeding during endoscopic prostate surgery. We determined the factors affecting bleeding severity and whether they affected the surgical results and functional outcomes. Records from March 2019 to April 2022 were obtained for selected patients who underwent endoscopic prostate enucleation through either 120-W Vela XL Thulium:YAG laser or bipolar plasma enucleation of the prostate. The bleeding index was measured using the following equation: irrigant hemoglobin (Hb) concentration (g/dL) × irrigation fluid volume (mL)/preoperative blood Hb concentration (g/dL) × enucleated tissue (g). Our research revealed that patients who underwent surgery employing the thulium laser, those aged over 80 years, and those with a preoperative maximal flow rate (Qmax) of more than 10 cc/s experienced less surgical bleeding. The patients' treatment outcomes differed depending on the severity of the bleeding. Enucleating prostate tissue was easier in the patients with less severe bleeding, who also had a lower risk of developing urinary tract infections and an improved Qmax.
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Kobayashi Y, Arai H, Honda M. Influence of transurethral enucleation with bipolar of the prostate on erectile function: Prospective analysis of 51 patients at 12-month follow-up. PLoS One 2022; 17:e0272652. [PMID: 35951591 PMCID: PMC9371260 DOI: 10.1371/journal.pone.0272652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 07/25/2022] [Indexed: 11/20/2022] Open
Abstract
Background Transurethral enucleation with bipolar (TUEB) is a safe and effective surgery for benign prostatic obstruction (BPO). However, few data exist concerning the influence of TUEB on erectile function (EF) in patients with BPO. Objective To evaluate the influence of TUEB on EF in patients with BPO at 3- and 12-month follow-up. Material and methods We prospectively enrolled 51 patients who underwent TUEB from June 2016 to April 2020. We evaluated maximum urinary flow rate (Qmax), postvoid residual urine (PVR), International Prostate Symptom Score (IPSS), quality of life (QoL), and International Index of Erectile Function-5 (IIEF-5) preoperatively and at 3- and 12-month follow-up. We classified the patients according to their preoperative IIEF-5 score into group 1 (IIEF-5 ≥10; n = 24) and group 2 (IIEF-5 <10; n = 27), and for further evaluation of EF, into subgroups a: severe (IIEF-5 5–7), b: moderate (8–11), c: mild to moderate (12–16), d: mild (17–21), and e: no erectile dysfunction (22–25). Data are displayed as median or median (interquartile range). Results The study comprised 51 patients with a median age of 75 (70.5–79.5) years. Median prostate and transition zone volumes were 69.5 (46.5–78.8) mL and 30.5 (19–43) mL, respectively. Urinary function improved significantly when comparing respective preoperative, 3-month, and 12-month follow-up values: Qmax (7.6, 12.9, 15.2 mL/s), PVR (50, 0, 0 mL), IPSS (20.5, 9, 6), and QoL (5, 2, 2), respectively. There was no significant change in IIEF-5 score across the three time points: 9, 7, 8. The IIEF-5 score slightly but significantly increased between the preoperative and 12-month follow-up values in group 2 (5, 5, 6) and subgroup a (5, 5, 5). Conclusion TUEB was effective and safe surgery for patients with BPO and showed no significant influence on EF at 12-month follow-up after TUEB in patients with BPO.
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Affiliation(s)
- Yasuyuki Kobayashi
- Department of Urology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan
- * E-mail:
| | - Hiroki Arai
- Department of Urology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan
| | - Masahito Honda
- Department of Urology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Hyogo, Japan
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Laser enucleation of the prostate in men with very large glands ≥175 ml: A systematic review. Ann Med Surg (Lond) 2022; 80:104279. [PMID: 36045851 PMCID: PMC9422289 DOI: 10.1016/j.amsu.2022.104279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background Surgical treatment options for lower urinary tract symptoms can differ according to prostate size. There are few studies on the efficacy and safety of endoscopic enucleation of prostate (EEP) in patients with very large prostates focusing on laser as energy source. In this systematic review, we aimed to examine the efficacy and safety of laser-based EEP on prostate glands ≥150 ml. Methods A systematic search was conducted using Web of Science, PubMed-MEDLINE, Wiley Online Library and Cochrane Library databases with the following search terms solely or in combination: "large prostate", "laser enucleation", "laser prostatectomy"by combining PICO (population, intervention, comparison, and outcome) terms. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed. Results We retrieved 6 studies included 375 patients with prostate sizes ≥175 ml treated with laser-based EEP for symptomatic benign prostatic obstruction. Three studies examined Holmium laser enucleation of prostate (HoLEP) outcomes with a prostate volume (PV) >200 ml, one evaluated HoLEP outcomes with a PV of 200–299 and ≥ 300 ml, two studies evaluated HoLEP outcomes with a PV > 175 ml. We observed improvement in postoperative functional outcomes in patients with a PV > 175, >200 and >300 ml. The retreatment rate was 0–1.3% in all studies involving prostate size ≥175 ml. Most of the complications were Clavien-Dindo I (%0–9) and II (%12.7–16.6). Conclusions Laser-based EEP is an efficient, safe and feasible procedure even in very large prostates with good functional outcomes, low perioperative complication and retreatment rates. We observed better postoperative functional outcomes in prostates with a volume of ≥175, >200 and >300 ml in the present study. The retreatment rate was 0–1.3% in all studies involving prostate size ≥175 ml. Laser-based- endoscopic enucleation of the prostate is an efficient, safe and feasible procedure even in very large glands.
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8
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Urethral stricture following endoscopic prostate surgery: a systematic review and meta-analysis of prospective, randomized trials. World J Urol 2022; 40:1391-1411. [DOI: 10.1007/s00345-022-03946-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/21/2022] [Indexed: 12/19/2022] Open
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Wang YB, Yan SY, Xu XF, Huang X, Luo LS, Deng YQ, Li XH, Huang Q, Wang YY, Huang J, Jin YH, Zeng XT. Comparison on the Efficacy and Safety of Different Surgical Treatments for Benign Prostatic Hyperplasia With Volume >60 mL: A Systematic Review and Bayesian Network Meta-Analysis of Randomized Controlled Trials. Am J Mens Health 2021; 15:15579883211067086. [PMID: 34939514 PMCID: PMC8721735 DOI: 10.1177/15579883211067086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The objective of this study was to compare the efficacy and safety of 10 different surgical treatments for benign prostatic hyperplasia (BPH) with volume >60 mL. A systematic literature review and network meta-analysis of randomized controlled trials (RCTs) within a Bayesian framework was performed. A total of 52 parallel-group RCTs included, reporting on 6,947 participants, comparing open prostatectomy (OP), monopolar/bipolar transurethral resection of prostate (monopolar/ bipolar TURP), thulium, holmium and diode laser enucleation of prostate (LEP), bipolar enucleation of prostate, potassium titanyl phosphate laser vaporization of prostate (KTP LVP), bipolar vaporization of prostate (bipolar VP), and laparoscopic simple prostatectomy (laparoscope SP). Compared with OP, laparoscope SP identified better maximal flow rate (Qmax; mean differences [MDs] = 2.89 mL/s) at the 24th month, but bipolar VP demonstrated worse Qmax (MD = −3.20 mL/s) and International Prostate Symptom Score (IPSS; MD = 2.60) at the 12th month. Holmium LEP (MD = 1.37) demonstrated better International Index of Erectile Function–5 at the 12th month compared with OP. However, compared with OP, KTP LVP demonstrated worse postvoid residual volume (PVR) at the sixth (MD = 10.42 mL) and 12th month (MD = 5.89 mL) and monopolar TURP (MD = 6.9 mL) demonstrated worse PVR at the 12th month. Eight new surgical methods for BPH with volume >60 mL appeared to be superior in safety compared with OP and monopolar TURP due to fewer complications. Bipolar VP and KTP LVP maybe not suitable for prostates more than 60 mL due to short- and middle-term worse Qmax, IPSS, and PVR than OP.
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Affiliation(s)
- Yong-Bo Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Si-Yu Yan
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiao-Feng Xu
- Department of Urology, Xianyang Central Hospital, Xianyang, China
| | - Xing Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Li-Sha Luo
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yu-Qing Deng
- Department of Urology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xu-Hui Li
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yun-Yun Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Geriatrics, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Taratkin M, Shpikina A, Morozov A, Novikov A, Fokin I, Petov V, Rw Herrmann T, Misrai V, Lusuardi L, Teoh JY, McFARLAND J, Kozlov V, Enikeev D. Enucleation vs vaporization of benign prostatic hyperplasia: a head-to-head comparison of the various outcomes and complications. A systematic review and meta-analysis. Minerva Urol Nephrol 2021; 74:559-569. [PMID: 34791865 DOI: 10.23736/s2724-6051.21.04639-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Vaporization of the prostate (VP) and endoscopic enucleation of the prostate (EEP) are reliable and frequently used methods for BPO relief. Both surgeries utilize lasers and EAU recommends them in similar patient cohorts. Our objective was to compare intra- and perioperative results of patients who had undergone VP and EEP. EVIDENCE ACQUISITION A systematic literature search was performed in three databases (MEDLINE, Web of Science and Scopus). The detailed search strategy is available at Prospero, CRD42020204739. Primary outcomes were functional results (IPSS, QoL, PVR, Qmax), and secondary outcomes were intraoperative results, postoperative PSA and prostate volume, complications, and recurrence rate. EVIDENCE SYNTHESIS VP required less operative time compared to EEP, mean difference=-5.51 (95%CI -7.52; -3.50). IPSS and Qmax for VP were worse after 12-month follow-up, mean difference=0.89 (95%CI 0.52; 1.27) and -3.7 (95%CI -4.56; -2.85), respectively, while QoL did not differ significantly. Postoperative PSA level was higher in the VP group, mean difference=2.28 (95%CI 2.00; 2.55). VP was associated with reduced Clavien-Dindo grade I (OR=4.16; 95%CI 2.96; 5.84) and grade II (OR=3.79; 95%CI 2.25; 6.39) complication rate, especially in terms of the percentage of blood transfusion and transient urinary incontinence. The rate of complications grade IIIa and higher was similar (3 - 6%). Reoperation rate was only estimated in one study and was significantly higher in the PVP group at 60 months of follow-up, 2.7% vs 0%, p<0.05. CONCLUSIONS EEP and VP share the efficacy and safety in BPH management. Our meta-analysis shows comparable complication rate in Clavien-Dindo III, VP superiority in operation time, and EEP superiority in long-term functional outcomes and PSA reduction.
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Affiliation(s)
- Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Anastasia Shpikina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Alexey Novikov
- Moscow state clinical hospital named after Yudin, Moscow, Russia
| | - Igor Fokin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Vladislav Petov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Thomas Rw Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland.,Department of Urology, Hannover Medical School, Hannover, Germany
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Lukas Lusuardi
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Jeremy Y Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Jonathan McFARLAND
- Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia.,Faculty of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Vasiliy Kozlov
- Department of Public Health and Healthcare, Sechenov University, Moscow, Russia
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia -
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Pallauf M, Kunit T, Ramesmayer C, Deininger S, Herrmann TRW, Lusuardi L. Endoscopic enucleation of the prostate (EEP). The same but different-a systematic review. World J Urol 2021; 39:2383-2396. [PMID: 33956196 PMCID: PMC8332586 DOI: 10.1007/s00345-021-03705-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/17/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose Various techniques for EEP exist. They differ by surgical steps and the source of energy. It is assumed that the latter is of minor importance, whereas adherence to the anatomical enucleation template determines the postoperative result. So far, no systematic review highlights the differences between the energy sources in use for anatomical EEP. This study will address selfsame topic. Methods A systematic review of the literature was completed on September 1st, 2020. Studies comparing HoLEP, ThuLEP, DiLEP, or BipolEP with TUR-P providing 12 months of postoperative follow-up were included. Two frequentist network meta-analyses were created to compare the techniques of EEP indirectly. Results 31 studies, including 4466 patients, were found eligible for our meta-analysis. Indirect pairwise comparison showed differences in surgery time between BipolEP and HolEP (MD − 16.72 min., 95% CI − 27.75 to − 5.69) and DiLEP and HoLEP (MD − 22.41 min., 95% CI − 39.43 to − 5.39). No differences in the amount of resected prostatic tissue, major and minor complications and postoperative catheterization time were found. The odds for blood transfusions were threefold higher for BipolEP than for HoLEP (OR 3.27, 95% CI 1.02–10.5). The difference was not statistically significant when comparing prospective trials and matched-pair analysis only (OR 3.25, 95% CI 0.94–11.18). The Qmax 12 months after surgery was 2 ml/sec. higher for BipolEP than for DiLEP (MD 2.00, 95% CI 0.17–3.84) and 1.94 ml/sec. lower for DiLEP than for HoLEP (MD − 1.94, 95% CI − 3.65 to − 0.22). Conclusion The energy source used for EEP has an impact on the intervention itself. BipolEP promotes surgical efficiency; laser techniques lower the risk of bleeding. Registry This meta-analysis is registered in the PROSPERO international prospective register registry with the registration number CRD42020205836.
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Affiliation(s)
- M Pallauf
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - T Kunit
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - C Ramesmayer
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - S Deininger
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - T R W Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland
| | - L Lusuardi
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
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Neymark AI, Karpenko AA, Neymark BA, Tachalov MA, Arzamastsev DD, Torbik DV, Gameeva EV, Bobrov BY, Spivak LG, Korolev DO, Tsarichenko DG, Rapoport LM. Superselective prostatic artery embolization in the treatment of large benign prostatic hyperplasia. Urologia 2021; 88:374-381. [PMID: 33550913 DOI: 10.1177/0391560321993598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the use of prostatic artery embolization (PAE) as a treatment option for patients with symptomatic benign prostatic hyperplasia (BPH) with prostate volumes of 80 cc and more. MATERIALS AND METHODS The study included 75 patients with high anesthesia-related risks for conventional surgery (TURP). All patients were surveyed for symptom burden, using IPSS and quality of life score. The prostate volume was determined by transrectal ultrasonography (TRUS). At baseline, prostate-specific antigen (PSA) level was obtained in all patients. Urodynamics was evaluated using uroflowmetry. Clinical outcomes were assessed at follow-up 1, 3, 6, 12, and 24 months after PAE. RESULTS The prostate volume decreased significantly at months 1 and 3 post-treatment; the prostate continued shrinking until month 12, and the size was then stabilized. At month 24, prostate volume decreased by 40.82%, from 134.0 ± 8.3 mL at baseline to 79.3 ± 6.6 mL. Postvoid residual (PVR) urine volume was significantly decreased from 55.9 ± 5.3 mL to 22.0 ± 1.8 mL 1 month after PAE (p < 0.001). Qmax increased from 9.2 ± 0.3 mL/s to 15.7 ± 0.4 mL/s. IPSS score following PAE decreased from 28.2 ± 0.7 to 9.7 ± 0.8 (p < 0.001). QoL improvement was observed from 4.8 ± 0.2 at baseline to 1.8 ± 0.2 at month 24 (p < 0.001). Decreased activity and density of adenomatous tissue resulted in decreased total PSA levels: from 5.9 ± 1.1 ng/mL to 2.6 ± 0.2 ng/mL (p < 0.001). TURP became feasible in 35 patients due to reduction of prostate volumes below 80 mL after PAE. CONCLUSIONS PAE was effective in relieving LUTS and reducing prostate size, and may be considered as a preoperative approach for patients with large prostate.
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Affiliation(s)
- Alexander Izrailevich Neymark
- Department of Urology and Nephrology, Altai State Medical University (Federal State Budgetary Educational Institution of Higher Education), Barnaul, Russia
| | - Andrey Anatoljevich Karpenko
- E. Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Boris Alexandrovich Neymark
- Department of Urology and Nephrology, Altai State Medical University (Federal State Budgetary Educational Institution of Higher Education), Barnaul, Russia
| | - Mikhail Alexandrovich Tachalov
- Department of Urology and Nephrology, Altai State Medical University (Federal State Budgetary Educational Institution of Higher Education), Barnaul, Russia
| | - Denis Dmitrievich Arzamastsev
- Department of Urology and Nephrology, Altai State Medical University (Federal State Budgetary Educational Institution of Higher Education), Barnaul, Russia
| | - Demid Vjacheslavovich Torbik
- Department of Urology and Nephrology, Altai State Medical University (Federal State Budgetary Educational Institution of Higher Education), Barnaul, Russia
| | - Elena Vladimirovn Gameeva
- Federal State Budgetary Institution National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Moscow, Russia
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Yin X, Chen J, Sun H, Liu M, Wang Z, Shi B, Zheng X. Endoscopic enucleation vs endoscopic vaporization procedures for benign prostatic hyperplasia: how should we choose: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22882. [PMID: 33181656 PMCID: PMC7668528 DOI: 10.1097/md.0000000000022882] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/27/2020] [Accepted: 09/23/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To assess the safety and efficacy of different endoscopic procedures of the prostate techniques, by comparing endoscopic enucleation (EEP) and endoscopic vaporization procedures (EVP) of the prostate; and laser enucleation procedures (L-EEP) vs laser vaporization procedures (L-EVP) surgeries for benign prostatic hyperplasia. METHODS A systematic literature review was performed in December 2019 using PubMed, Embase and the Cochrane Library to identify relevant studies. Two analyses were carried out: (1) EEP vs EVP; and (2) L-EEP vs L-EVP. Efficacy and safety were evaluated using perioperative data, functional outcomes, including maximum urinary flow rate (Qmax), quality of life (QoL), international prostate symptom score (IPSS), postvoiding residual urine volume (PRV), and rate of complications. Meta-analyses were conducted using RevMan5.3. RESULTS Sixteen studies (4907 patients) evaluated EEP vs EVP, and 12 of them (4392 patients) evaluated L-EEP vs L-EVP. EEP showed improved functional outcomes compared with EVP. EEP was always presented a better Qmax at various follow-up times. EEP also associated with a reduced PRV and IPSS at 12 months postsurgery, an increased Qmax, and reduced IPSS and QoL score at both 24 and 36 months postsurgery. In addition, EEP was associated with less total energy utilized and retreatment for residual adenoma, but a longer catheterization time. Among other outcomes, there was no significant difference. L-EEP favors total energy used, retreatment for residual adenoma, and functional outcomes. L-EEP was associated with reduced PRV at 1, 6, and 12 months postsurgery, a greater Qmax at 6 and 12 months postsurgery, a lower IPSS at 12 months postsurgery, and higher Qmax and lower IPSS and QoL scores at 24 and 36 months postsurgery. However, there was no difference at 3 months postsurgery. No significant differences were observed for other perioperative data and complications. CONCLUSIONS Both EEP and EVP displayed sufficient efficacy and safety for treating benign prostatic hyperplasia. EEP and L-EEP were favored in perioperative data, rate of complications, and functional outcomes. However, the clinical significance of those statistical differences was unclear. Hence, higher-quality randomized controlled trials may be needed to provide a clear algorithm.
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Affiliation(s)
- Xinbao Yin
- Department of Urology, Qilu Hospital of Shandong University
| | - Jun Chen
- Department of Urology, Qilu Hospital of Shandong University
| | - Hui Sun
- Department of Urology, Qilu Hospital of Shandong University
| | - Ming Liu
- Department of Urology, Qilu Hospital of Shandong University
| | - Zehua Wang
- Department of Urology, Qilu Hospital of Shandong University
| | - Benkang Shi
- Department of Urology, Qilu Hospital of Shandong University
| | - Xueping Zheng
- Department of Geriatrics, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Dornbier R, Pahouja G, Branch J, McVary KT. The New American Urological Association Benign Prostatic Hyperplasia Clinical Guidelines: 2019 Update. Curr Urol Rep 2020; 21:32. [PMID: 32607874 DOI: 10.1007/s11934-020-00985-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW The goal of this paper was to analyze the efficacy of the current modalities available to surgically treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). RECENT FINDINGS There have been significant surgical advancements for the treatment of BPH, including an increasing development and utilization of minimally invasive surgical techniques (MISTs). These procedures have varying outcomes that are critical to understand. In addition, MISTs have important adverse effects, though have minimized effects on sexual function when compared to more invasive surgical techniques. It is important for all urologists to be familiar with the surgical techniques available to treat BPH and the updated American Urological Association (AUA) Guidelines. Further studies evaluating efficacy, safety, and sexual functioning will help guide care in the future and evolve practice.
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Affiliation(s)
- Ryan Dornbier
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA.
| | - Gaurav Pahouja
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
| | - Jeffrey Branch
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
| | - Kevin T McVary
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
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15
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Davis C, Golzarian J, White S, Fischman A, Rastinehad A, Isaacson A, Carnevale FC, Foster H, Findeiss L, Sapoval M, Borofsky M, Ayyagari R, Salem R, Bhatia S, Caridi T. Development of Research Agenda in Prostate Artery Embolization: Summary of Society of Interventional Radiology Consensus Panel. J Vasc Interv Radiol 2019; 31:108-113. [PMID: 31771895 DOI: 10.1016/j.jvir.2019.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/20/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To summarize the Society of Interventional Radiology Foundation's Research Consensus Panel development of a research agenda on prostate artery embolization (PAE). MATERIALS AND METHODS PAE for the treatment of lower urinary tract symptoms has been shown to be safe and effective in decreasing symptoms and prostate size. Lack of randomized controlled trials (RCTs) on PAE in the United States has prevented inclusion in American Urologic Association guideline recommendations for treatment of lower urinary tract symptoms resulting from benign prostatic hyperplasia. Recognizing the need for well-designed trials, the SIR Foundation funded a Research Consensus Panel to prioritize a research agenda. The panel included interventional radiologists, urologists, SIR Foundation leadership, and industry representatives. The goal of the meeting was to discuss weaknesses with current data and study design for development of US trials to report long-term outcomes data. RESULTS Final consensus on a research design could not be made because the group was split on 3 research designs: (i) RCT of PAE versus sham with crossover of the sham group. (ii) RCT of PAE versus simple prostatectomy. (iii) RCT of PAE versus holmium laser enucleation of the prostate/thulium laser enucleation of the prostate. The panel recommended a nonindustry-funded registry to obtain real-world data. CONCLUSIONS Level 1 data are required to be included in the American Urologic Association guidelines for treatment of benign prostatic hyperplasia. Because of concerns with all 3 study designs, the panel did not reach a consensus. Further meetings are planned with the panel to select among these research designs.
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Affiliation(s)
- Clifford Davis
- College of Medicine and Radiology, University of South Florida, Tampa, Florida.
| | - Jafar Golzarian
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Sarah White
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Aaron Fischman
- Department of Radiology and Surgery, Icahn School of Medicine at Mount Sinai, New York New York
| | - Ardeshir Rastinehad
- Department of Urology and Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ari Isaacson
- Department of Vascular and Interventional Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Harris Foster
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
| | - Laura Findeiss
- Department of Radiology and Imaging Services, Emory University School of Medicine, Atlanta, Georgia
| | - Marc Sapoval
- Vascular and Oncological Interventional Radiology, Hôpital Européen Georges-Pompidou, Paris, France
| | - Michael Borofsky
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - Raj Ayyagari
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Riad Salem
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Shivank Bhatia
- Department of Radiology, University of Miami, Miami, Florida
| | - Theresa Caridi
- Department of Radiology, MedStar Georgetown University, Washington, DC
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16
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Wroclawski ML, Teles SB, Amaral BS, Kayano PP, Cha JD, Carneiro A, Alfer W, Monteiro J, Gil AO, Lemos GC. A systematic review and meta-analysis of the safety and efficacy of endoscopic enucleation and non-enucleation procedures for benign prostatic enlargement. World J Urol 2019; 38:1663-1684. [DOI: 10.1007/s00345-019-02968-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/20/2019] [Indexed: 12/31/2022] Open
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17
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Arcaniolo D, Manfredi C, Veccia A, Herrmann TRW, Lima E, Mirone V, Fusco F, Fiori C, Antonelli A, Rassweiler J, Liatsikos E, Porpiglia F, De Sio M, Autorino R. Bipolar endoscopic enucleation versus bipolar transurethral resection of the prostate: an ESUT systematic review and cumulative analysis. World J Urol 2019; 38:1177-1186. [PMID: 31346761 DOI: 10.1007/s00345-019-02890-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/23/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To perform a cumulative analysis of the current evidence on the surgical and functional outcomes of bipolar endoscopic enucleation of the prostate (b-EEP) versus bipolar transurethral resection of the prostate (b-TURP). METHODS A systematic review of the literature was performed on PubMed, Ovid®, and Scopus® according to Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA Statement). The meta-analysis was conducted using the Review Manager 5.3 software. Parameters of interest were surgical and functional outcomes. Weighted mean difference, and odds ratio with 95% confidence interval were calculated for continuous and binary variables, respectively. Pooled estimates were calculated using the random-effect model. RESULTS Fourteen comparative studies were included. No statistically significant difference in terms of overall baseline characteristics was found. b-EEP had higher amount of resected tissue (p < 0.0001), shorter catheter time (p = 0.006), lower Hb drop (p = 0.03), and shorter length of stay (p < 0.0001). Equally, overall post-operative complications were lower (p = 0.01) as well as short (p = 0.04), and long-term complication rate (p = 0.04). There was higher re-intervention rate in the b-TURP group (p = 0.02) whereas b-EEP group had smaller residual prostate volume (p = 0.03), and lower post-operative PSA values (p < 0.00001). At long term, b-EEP presented lower IPSS (p = 0.04), higher Qmax (p = 0.002), and lower PVR (p < 0.00001). CONCLUSIONS b-EEP is an effective and safe surgical treatment for BPO. This procedure might offer several advantages over standard b-TURP, including the resection of a larger amount of tissue within the same operative time, shorter hospitalization, lower risk of complications, and lower re-intervention rate. This was submitted to PROSPERO registry: CRD42019126748.
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Affiliation(s)
| | | | - Alessandro Veccia
- Division of Urology, Department of Surgery, VCU Health, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA
- Urology Unit and Department of Medical and Surgical Specialties, Radiological Science, and Public Health, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Thomas R W Herrmann
- Department of Urology, Kantonsspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Estevão Lima
- Department of Urology, Braga Hospital, Braga, Portugal
| | - Vincenzo Mirone
- Department of Urology, Federico II University, Naples, Italy
| | | | - Cristian Fiori
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Alessandro Antonelli
- Urology Unit and Department of Medical and Surgical Specialties, Radiological Science, and Public Health, ASST Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Jens Rassweiler
- Department of Urology, University of Heidelberg, SLK Kliniken, Heilbronn, Germany
| | | | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Marco De Sio
- Urology Unit, Luigi Vanvitelli University, Naples, Italy
| | - Riccardo Autorino
- Urology Unit, Luigi Vanvitelli University, Naples, Italy.
- Division of Urology, Department of Surgery, VCU Health, VCU Medical Center, PO Box 980118, Richmond, VA, 23298-0118, USA.
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18
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Zheng X, Han X, Cao D, Wang Y, Xu H, Yang L, Wei Q, Ai J. Comparison of Short-Term Outcomes between Button-Type Bipolar Plasma Vaporization and Transurethral Resection for the Prostate: A Systematic Review and Meta-Analysis. Int J Med Sci 2019; 16:1564-1572. [PMID: 31839744 PMCID: PMC6909815 DOI: 10.7150/ijms.38618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 10/01/2019] [Indexed: 02/05/2023] Open
Abstract
Background: Previous meta-analysis evaluated a limited number of parameters regarding the comparison of BTPV and TURP for BPH. Method: PubMed, Embase and Cochrane Library were searched for literature comparing BTPV with TURP. Data of efficacy (IPSS, Qmax, PVR and QoL) and safety were extracted and evaluated using either SMD or OR with 95% CI. All analyses were performed by RevMan 5.3. Results: Eleven trials with 1690 patients were selected. Compare to BTPV, TURP had better 6-month IPSS (SMD=0.36, 95% CI 0.08 to 0.63), better 1- (SMD=-0.38, 95% CI -0.63 to -0.12), 6- (SMD=-0.73, 95% CI -0.99 to -0.46) and 12-month Qmax (SMD=-0.47, 95% CI -0.85 to -0.10), better 6-month PVR (SMD=1.18, 95% CI 0.87 to 1.48), as well as better 3- (SMD=-0.24, 95% CI -0.48 to -0.01) and 6-month QoL (SMD=-0.62, 95% CI -0.91 to -0.33). However, BTPV had shorter catheterization time (SMD=-0.96, 95% CI -1.12 to -0.79) and hospital stay (SMD=-0.71, 95% CI -0.89 to -0.53), less hemoglobin decrease (SMD=-1.09, 95% CI -1.27 to -0.91) and virtually shorter operation time (SMD=-0.15, 95% CI -0.31 to 0.01). Moreover, BTPV had fewer occurrence of overall complications (OR=0.52, 95% CI 0.40 to 0.69), Clavien III-IV complications (OR=0.61, 95% CI 0.37 to 1.02), blood transfusion (OR=0.25, 95% CI 0.09 to 0.69), hematuria (OR=0.27, 95% CI 0.13 to 0.56) and capsular perforation (OR=0.19, 95% CI 0.08 to 0.48). Subgroup analysis indicated BTPV and bipolar TURP had similar total complications (OR 1.08, 95% CI 0.40-2.88, P=0.88) and Clavien III-IV complications (OR 1.42, 95% CI 0.36-5.57, P=0.61) and blood transfusion rate (OR 0.28, 95% CI 0.04-1.73, P=0.17). Conclusion: Both TURP and BTPV could significantly improve IPPS, Qmax, PVR and QoL. TURP had slightly better short-term efficacy, while BTPV had better safety. However, subgroup analysis found bipolar TURP and BTPV had similar safety.
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Affiliation(s)
- Xiaonan Zheng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan. P.R. China
| | - Xin Han
- West China Medical School, Sichuan University, Chengdu, Sichuan. P.R. China
| | - Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan. P.R. China
| | - Yaping Wang
- West China Medical School, Sichuan University, Chengdu, Sichuan. P.R. China
| | - Hang Xu
- West China Medical School, Sichuan University, Chengdu, Sichuan. P.R. China
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan. P.R. China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan. P.R. China
| | - Jianzhong Ai
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan. P.R. China
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19
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Becker B, Herrmann TRW, Gross AJ, Netsch C. Thulium vapoenucleation of the prostate versus holmium laser enucleation of the prostate for the treatment of large volume prostates: preliminary 6-month safety and efficacy results of a prospective randomized trial. World J Urol 2018; 36:1663-1671. [DOI: 10.1007/s00345-018-2321-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/30/2018] [Indexed: 10/17/2022] Open
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20
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Bipolar transurethral enucleation and resection of the prostate: Whether it is ready to supersede TURP? Asian J Urol 2017; 5:48-54. [PMID: 29379737 PMCID: PMC5780288 DOI: 10.1016/j.ajur.2017.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 10/10/2017] [Indexed: 11/25/2022] Open
Abstract
Objective According to the EAU Guidelines, transurethral resection of the prostate (TURP) has so far still been considered as the gold standard for surgical treatment for patients with obstructing clinical benign prostate hyperplasia (BPH). However, its relatively high rate of complications and postoperative recurrence necessitates further modification and innovation on the surgery technique. We reported the patient outcomes with our technique. Methods We retrospectively analyzed 52 patients with obstructing clinical BPH who underwent bipolar transurethral enucleation and resection of the prostate (B-TUERP) between March 2015 and September 2015. Pre- and perioperative parameters were obtained from medical charts. Postoperative follow-ups were administrated at 1, 3, 6, 12 and 24 month(s) after surgery, respectively. Results All the operations were performed successfully with a mean operative time of 43.1 min and an average tissue removal rate of 74.7%. Qmax was significantly improved immediately after surgery, followed by a continuous improvement throughout the follow-ups. Following a steep decrease in mean prostate specific antigen (PSA) and post void residual (PVR) observed within the first half year after surgery, the serum PSA was then maintained at a constant level of 0.61 ng/mL. Temporary urinary retention was found in four cases (7.7%). Stress urinary incontinence occurred in five patients (9.6%), with the condition resolved in 1–2 weeks without extra treatment. Urethral strictures and bladder neck contractures, as the most commonly observed long-term complications, developed in four patients (7.7%). No recurrence was found during 2 years of follow-ups. An improvement in International Index of Erectile Function (IIEF-5) scores was witnessed in 17 patients preoperatively with normal sexual function during the first 6 months after surgery, and sustained throughout the 24-month period. Conclusions Enucleation reflects an improvement on surgical technique in many ways with a need for surgical equipment that can be broadly accessible in clinical practice. Currently, bipolar resection is a commonly employed procedure in clinical settings, and its similarity shared with bipolar enucleation technique warrants a quick learning of B-TUERP by urologists. Based on these findings, we believe that the substitution of TURP by TUERP as the gold standard for prostate endoscopic procedure can be expected in the future.
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Homma Y, Gotoh M, Kawauchi A, Kojima Y, Masumori N, Nagai A, Saitoh T, Sakai H, Takahashi S, Ukimura O, Yamanishi T, Yokoyama O, Yoshida M, Maeda K. Clinical guidelines for male lower urinary tract symptoms and benign prostatic hyperplasia. Int J Urol 2017; 24:716-729. [DOI: 10.1111/iju.13401] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/23/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Yukio Homma
- Department of Urology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Momokazu Gotoh
- Department of Urology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | | | - Yoshiyuki Kojima
- Department of Urology; Fukushima Prefectural University of Medicine; Fukushima Japan
| | - Naoya Masumori
- Department of Urology; Sapporo Medical University School of Medicine; Sapporo Japan
| | - Atsushi Nagai
- Department of Urology; Kawasaki Medical School; Kurashiki Japan
| | | | - Hideki Sakai
- Department of Urology; Nagasaki University; Nagasaki Japan
| | | | - Osamu Ukimura
- Department of Urology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | | | | | - Masaki Yoshida
- Department of Urology; National Center of Geriatrics and Gerontology; Obu Japan
| | - Kenji Maeda
- Department of Urology; Maeda Clinic of Internal Medicine; Ageo Japan
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Netsch C, Becker B, Tiburtius C, Moritz C, Becci AV, Herrmann TRW, Gross AJ. A prospective, randomized trial comparing thulium vapoenucleation with holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic obstruction: perioperative safety and efficacy. World J Urol 2017; 35:1913-1921. [PMID: 28698991 DOI: 10.1007/s00345-017-2071-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/07/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES To compare the perioperative outcomes of thulium vapoenucleation of the prostate (ThuVEP) with holmium laser enucleation of the prostate (HoLEP) for patients with symptomatic benign prostatic obstruction (BPO). METHODS Forty-eight and 46 patients were prospectively randomized to ThuVEP and HoLEP. All patients were assessed preoperatively and 4-week postoperatively. The complications were noted and classified according to the modified Clavien classification system. Patient data were expressed as median (interquartile range) or numbers (%). RESULTS Median age at surgery was 73 (67-76) years and median prostate volume was 80 (46.75-100) cc and not different between the groups (p = 0.207). The median operative time was 60 (41-79) minutes without significant differences between both groups (p = 0.275). There were no significant differences between the groups regarding catheterization time [2 (2-2) days, p = 0.966] and postoperative stay [2 (2-3) days, p = 0.80]). Clavien 1 (13.8%), Clavien 2 (3.2%), Clavien 3a (2.1%), and Clavien 3b (4.3%) complications occurred without significant differences between the groups. However, the occurrence of acute postoperative urinary retention was higher after HoLEP compared to ThuVEP (15.2 vs. 2.1%, p ≤ 0.022). At 1-month follow-up, peak urinary flow rates (10.7 vs. 22 ml/s), post-void residual volumes (100 vs. 20 ml), International Prostate Symptom Score (20 vs. 10) and Quality of Life (4 vs. 3) had improved significantly (p ≤ 0.005) without significant differences between the groups. CONCLUSIONS ThuVEP and HoLEP are safe and effective procedures for the treatment of symptomatic BPO. Both procedures give equivalent and satisfactory immediate micturition improvement with low perioperative morbidity.
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Affiliation(s)
- Christopher Netsch
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany.
| | - B Becker
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
| | - C Tiburtius
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
| | - C Moritz
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
| | - A Venneri Becci
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
| | - T R W Herrmann
- Department of Urology, MHH Medical School of Hannover, Hannover, Germany
| | - A J Gross
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
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Giulianelli R, Gentile BC, Mirabile G, Albanesi L, Tariciotti P, Rizzo G, Buscarini M, Falavolti C. Bipolar Plasma Enucleation of the Prostate (B-TUEP) in Benign Prostate Hypertrophy Treatment: 3-Year Results. Urology 2017; 107:190-195. [PMID: 28576667 DOI: 10.1016/j.urology.2017.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/02/2017] [Accepted: 05/10/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To investigate numerous endoscopic techniques that have been described for the treatment of benign prostate enlargement. Plasma-button enucleation of the prostate (B-TUEP) is a successful treatment option because the large surface creates a fast enucleation process, vaporization, and concomitant hemostasis. The aim of this study was to evaluate the efficacy of bipolar button electrode transurethral adenoma enucleation (B-TUEP) in saline solution. The second end point was to determine the change of International Prostate Symptom Score (IPSS), post-void residual urine, International Index of Erectile Function, transrectal ultrasound gland volume evaluation, and prostate-specific antigen. MATERIALS AND METHODS Between July 2011 and March 2012, 50 consecutive patients underwent B-TUEP in our facility, all performed by a single surgeon (R.G.). All patients were preoperatively assessed with maximum urinary flow rate, single-question quality of life assessment, IPSS and the International Index of Erectile Function questionnaires, transrectal ultrasound gland volume evaluation, prostate-specific antigen, and post-void residual urine. RESULTS We observed a significant improvement at 12, 24, and 36 months in terms of maximum urinary flow rate (22.3 ± 4.74 mL/s, 23.2 ± 0.30 mL/s, and 23.6 ± 1.26 mL/s, respectively, P <.01) and quality of life (5.28 ± 0.97, 5.69 ± 0.90, and 5.73 ± 0.87). IPSS and IEEF scores improved significantly (P <.05). Gland volume evaluation and post-void residue decreased (P <.001). The prostate-specific postoperative antigen levels were 0.76 ± 0.61 ng/mL, 0.7 ± 0.51 ng/mL, and 0.62 ± 0.18 ng/mL, at 12, 24, and 36 months, respectively. Two patients (4%) had persistent bladder outlet obstruction requiring reoperation. CONCLUSION After 3-year follow-up, B-TUEP represents an effective, durable, and safe form of surgical intervention. B-TUEP is an alternative treatment for symptomatic benign prostate enlargement.
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24
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Srivastava A, Dhayal IR, Rai P. Management of Large Prostate Gland in Men with Impaired Renal Function: Comparison of Safety, Efficacy and Outcomes of Monopolar, Bipolar Transurethral Resection and Open Prostatectomy. Urol Int 2016; 96:413-20. [DOI: 10.1159/000443670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 12/23/2015] [Indexed: 11/19/2022]
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Transurethral Bipolar Enucleation of the Prostate Is an Effective Treatment Option for Men With Urinary Retention. Urology 2016; 87:166-71. [DOI: 10.1016/j.urology.2015.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 09/27/2015] [Accepted: 10/05/2015] [Indexed: 11/21/2022]
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26
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Lin Y, Wu X, Xu A, Ren R, Zhou X, Wen Y, Zou Y, Gong M, Liu C, Su Z, Herrmann TRW. Transurethral enucleation of the prostate versus transvesical open prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials. World J Urol 2015; 34:1207-19. [PMID: 26699627 DOI: 10.1007/s00345-015-1735-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/17/2015] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of transurethral enucleation of the prostate (TUEP) versus transvesical open prostatectomy (OP) for the management of large benign prostatic hyperplasia (BPH). METHODS Randomized controlled trials (RCTs) comparing TUEP and OP were identified from PubMed, Embase and Web of Science up to February 28, 2015. A meta-analysis was conducted with the STATA 12.0 software. RESULTS Nine RCTs including 758 patients were enrolled in our meta-analysis. There were no significant differences between the two groups in the maximum urinary flow rate at 1, 3, 6 months, 1 and 2 years: postvoiding residual urinary volume, prostate-specific antigen, international prostate symptom score and quality of life score at 1, 3, 6 months and 1 year; or international index of erectile function at 3, 6 months and 1 year. Perioperative outcomes including hemoglobin level drop, catheter period, irrigation length and hospital stay favored TUEP, while operative time and resected prostate weight favored OP. There was significantly less blood transfusion with TUEP, but no significant differences were found in other complications such as recatheterization, urinary tract infection, reintervention for clots and bleeding control, incidence of pneumonia and infarction, transient incontinence, bladder neck contracture, urethral stricture and recurrent adenoma. CONCLUSIONS TUEP can be performed effectively and safely with functional outcomes and complications similar to OP for large BPH, whereas it has the advantages of a shorter catheter period, shorter hospital stays and less blood transfusion. These findings seem to support TUEP as the next-generation "gold standard" of surgery for large BPH.
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Affiliation(s)
- Youcheng Lin
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
- Department of Urology, Fujian Provincial Clinical College, Fujian Medical University, Fuzhou, China
| | - Xun Wu
- Department of Urology, The First Affiliated Hospital of Jinan University, No. 613, HuangPu Road (West), TianHe District, Guangzhou, 510630, China
- Department of Anatomy, School of Basic Medicine Science, Southern Medical University, Guangzhou, China
| | - Abai Xu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Rui Ren
- Department of Urology and Andrology, Zhongshan City People's Hospital of Sun Yat-sen University, Zhongshan, China
| | - Xueqiong Zhou
- Department of Occupational Health and Occupational Medicine, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Yong Wen
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Yong Zou
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China
| | - Mancheng Gong
- Department of Urology and Andrology, Zhongshan City People's Hospital of Sun Yat-sen University, Zhongshan, China
| | - Chunxiao Liu
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China.
| | - Zexuan Su
- Department of Urology, The First Affiliated Hospital of Jinan University, No. 613, HuangPu Road (West), TianHe District, Guangzhou, 510630, China.
- Department of Anatomy, School of Basic Medicine Science, Southern Medical University, Guangzhou, China.
| | - Thomas R W Herrmann
- Department of Urology and Urological Oncology, Hanover Medical School (MHH), Carl Neuberg Str. 1, 30625, Hanover, Germany.
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Bultitude M, Challacombe B. Simple Prostatectomy: A Step Too Far for Laparoscopy? Eur Urol 2014; 68:95-6. [PMID: 25544633 DOI: 10.1016/j.eururo.2014.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 12/10/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Matthew Bultitude
- Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
| | - Ben Challacombe
- Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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