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Carvalho BRG, Gabrich PN, de Marins RL, Damião R, Oliveira RV. Same-day Catheter Removal and Hospital Discharge After Holmium Laser Enucleation of the Prostate: A Prospective Study. Urology 2024:S0090-4295(24)00446-1. [PMID: 38871305 DOI: 10.1016/j.urology.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/21/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE To assess the feasibility, safety, and predictive factors for the success of holmium laser enucleation of the prostate (HoLEP) with catheter removal and hospital discharge on the same day of the procedure. METHODS This prospective study included 34 patients who underwent HoLEP using a 60-W holmium laser device and the Wolf Piranha morcellation system. Surgeries began at 10:30 am and the patients were expected to be discharged by 5 pm on the same day. The patients underwent a voiding trial to remove the urinary catheter before hospital discharge. Functional outcomes were assessed 90 days after the procedure. RESULTS Mean (range) age, prostate-specific antigen value, and prostate weight were as follows: 63.4 (50-80) years, 4.81 (0.19-14) ng/mL, and 89.3 (33-258) g, respectively. The mean (range) enucleation and morcellation times were 56.2 (29-91) minutes and 14.67 (3-45) minutes, respectively. Thirty-one patients (91.1%) were discharged on the same day of the procedure after urinary catheter removal. CONCLUSION The performance of HoLEP is safe on an outpatient basis. Same-day catheter removal is feasible and does not affect hospital discharge.
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Affiliation(s)
| | | | | | - Ronaldo Damião
- University of the State of Rio de Janeiro, Rio de Janeiro
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Ramos-Carpinteyro R, Soputro N, Pedraza AM, Mikesell C, Chavali JS, Beksac AT, Eltemamy M, Schwen ZR, Kaouk J. Predictors of Same-day Discharge After Single-Port Transvesical Enucleation of the Prostate. Urology 2024:S0090-4295(24)00358-3. [PMID: 38762143 DOI: 10.1016/j.urology.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/09/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE To determine the rate of outpatient cases and identify predictors for same-day discharge (SDD) after single-port transvesical enucleation of the prostate (STEP). METHODS Retrospective analysis of all consecutive STEP cases performed at a single center by 3 surgeons from February 2019 to October 2023. The cohort was categorized into SDD cases (<8 hours until discharge) and inpatient cases. Group comparisons were made and logistic regression was used to identify predictors of SDD. RESULTS A total of 152 STEP cases were performed successfully without additional ports or conversions. Fifty-two patients were pre-planned admissions, leaving 100 planned outpatient cases, of which 86% were discharged on the same day (median length of stay of 4.7 hours). Comparing the groups, inpatient cases were older, had higher Charlson Comorbidity Index (CCI) scores, higher estimated blood loss (EBL) during surgery, and more intraoperative complications than SDD patients. Univariate logistic regression identified age and CCI as the predictors associated with SDD after STEP. Notably, there were no major postoperative complications or readmissions in either group. CONCLUSION In our 4-year experience with STEP, lower age and CCI score were significant predictors of SDD. The comprehensive evaluation criteria for discharge foster a safe recovery at home, coupled with a 0% rate of major postoperative complications and readmissions. These findings underscore the safety and efficacy of STEP, guiding patient counseling and surgeon expectations.
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Yilmaz M, Karaaslan M, Polat ME, Tonyali S, Aybal HÇ, Şirin ME, Toprak T, Tunç L, Gratzke C, Miernik A. Is day-case surgery feasible for laser endoscopic enucleation of the prostate? A systematic review. World J Urol 2023; 41:2949-2958. [PMID: 37689604 PMCID: PMC10632304 DOI: 10.1007/s00345-023-04594-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 08/23/2023] [Indexed: 09/11/2023] Open
Abstract
PURPOSE Laser endoscopic enucleation of the prostate (EEP) for benign prostatic obstruction has become increasingly prevalent worldwide. Considering the medical cost-savings and concomitantly fewer nosocomial infections, the feasibility of same-day postoperative discharge of patients who have undergone laser EEP in terms of its safety and effectiveness has become a subject matter of growing interest. We aimed to review those studies focussing on day-case surgery (DCS) in patients undergoing laser EEP. METHODS A systematic search was conducted using PubMed-MEDLINE and Web of Science databases until October 2022 with the following search terms: "same day discharge AND laser enucleation of the prostate", "day-case AND laser enucleation of the prostate", "same day surgery AND laser enucleation of the prostate" and "one day surgery AND laser enucleation of the prostate" by combining PICO (population, intervention, comparison, outcome) terms. We identified 15 eligible studies. RESULTS While 14 of the studies focussed on holmium laser EEP, one focused on thulium laser vapoenucleation of the prostate. We observed an improvement in functional parameters in all studies we reviewed, and DCS success and readmission rates ranged between 35.3-100% and 0-17.8%, respectively. The complication rates varied between 0 and 36.7%, most of the complicatons were Clavien-Dindo (CD) I and II. CD ≥ III complications did not significantly differ between same day discharge (SDD) and non-SDD groups in the studies. CONCLUSION Laser EEP is feasible and promising DCS treatment option delivering improved functional parameters compared to baseline values, and lower perioperative complication and readmission rates in certain patients.
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Affiliation(s)
- Mehmet Yilmaz
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany
| | | | - Muhammed Emin Polat
- Department of Urology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Senol Tonyali
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany
- Department of Urology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | | | - Mehmet Emin Şirin
- Department of Urology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Tuncay Toprak
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Lütfi Tunç
- Faculty of Medicine, Department of Urology, Gazi University, Ankara, Turkey
| | - Christian Gratzke
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Medical Centre - University of Freiburg, Faculty of Medicine, Hugstetter Str. 55, 79106, Freiburg, Germany.
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Elmansy H, Abbas L, Fathy M, Hodhod A, Shabana W, Alkandari A, Habib E, Meshref A, Roshdy MA, Shahrour W. Top-down holmium laser enucleation of the prostate (HoLEP) versus traditional HoLEP for the treatment of benign prostatic hyperplasia (BPH): 1-year outcomes of a randomized controlled trial. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00730-x. [PMID: 37783838 DOI: 10.1038/s41391-023-00730-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND The top-down holmium laser enucleation of the prostate (HoLEP) technique recently emerged as a safe and effective modification of traditional HoLEP. In our randomized controlled trial, we compared intraoperative and postoperative outcomes of traditional and top-down HoLEP for the treatment of benign prostatic hyperplasia (BPH) in patients with a prostate size ≥80 g. METHODS One-hundred patients with BPH and a prostate volume ≥80 cc participated in this prospective randomized controlled trial. Outcome measures were collected and compared, including IPSS, QoL, flow rate, PVR, IIEF-15, PSA, and TRUS prostate volume changes. Perioperative complications were also recorded. All patients were followed up at 1, 3, 6, and 12 months. RESULTS There were no significant differences in preoperative baseline characteristics between the two surgical groups. The median prostate volume for the traditional and top-down HoLEP groups was 107 and 102 cc, respectively. The operative parameters and postoperative outcomes were comparable for both cohorts. The median enucleation time for traditional HoLEP was 60 min, which was not significantly longer than that of top-down HoLEP (52 min) (p = 0.07). At 3 months follow-up, there was no statistically significant difference in transient stress urinary incontinence (SUI) in the traditional HoLEP (4.1%) versus the top-down HoLEP group (2.2%), (p = 0.61). There were no significant differences in functional and sexual outcomes between the two groups at 12 months. CONCLUSIONS The HoLEP procedure significantly improves patients' urinary functional outcomes and has comparable postoperative outcomes regardless of the technique utilized.
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Affiliation(s)
- Hazem Elmansy
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada.
| | - Loay Abbas
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
- Urology Department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Moustafa Fathy
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Amr Hodhod
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Waleed Shabana
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Abdulrahman Alkandari
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Enmar Habib
- Urology Department, Cairo University, Cairo, Egypt
| | - Alaa Meshref
- Urology Department, Cairo University, Cairo, Egypt
| | - Mamdouh A Roshdy
- Urology Department, Theodor Bilharz Research Institute, Giza, Egypt
| | - Walid Shahrour
- Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
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Blanco Fernández R, González Rodríguez I, Fernández-Pello Montes S, Sánchez Verdes P, Miranda García P, Suárez Sal PJ, Alonso Calvar L, Rodríguez Villamil L. Holmium laser enucleation of the prostate (HoLEP) as same-day surgery: A safe and feasible option. Actas Urol Esp 2023; 47:457-461. [PMID: 37369301 DOI: 10.1016/j.acuroe.2023.05.006] [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: 03/16/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE To study the feasibility of holmium laser enucleation (HoLEP) performed as a same-day surgery. MATERIAL AND METHODS Prospective observational study including 25 patients submitted to HoLEP. Patients were discharged the same day if they met the established criteria. RESULTS The mean age of the patients was 65.1 years and prostate volume was 45.8cc. All patients were discharged the same day of surgery. The overall complication rate at 30 days was 12% (Clavien I 100%). The rate of re-hospitalization was 0%. Patient satisfaction rate with the day surgery pathway was 95%. CONCLUSIONS The initial analysis of our results suggests that outpatient HoLEP is a safe and effective alternative with low rate of complications. According to satisfaction rates, patients prefer the day surgery pathway for the performance of HoLEP.
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Affiliation(s)
- R Blanco Fernández
- Departamento de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain.
| | - I González Rodríguez
- Departamento de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | | | - P Sánchez Verdes
- Departamento de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - P Miranda García
- Departamento de Anestesiología y Reanimación, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - P J Suárez Sal
- Departamento de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - L Alonso Calvar
- Departamento de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - L Rodríguez Villamil
- Departamento de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
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Diana P, Baboudjian M, Saita A, Uleri A, Gallioli A, Casale P, Buffi N, Pradere B, Misrai V, Gondran-Tellier B, Boissier R, Schwartzmann I, Breda A, Del Dago PJ. Same-day discharge for endoscopic enucleation of the prostate: a systematic review and meta-analysis. World J Urol 2023; 41:2099-2106. [PMID: 37395755 DOI: 10.1007/s00345-023-04471-3] [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: 12/26/2022] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
PURPOSE To systematically review studies focused on the feasibility and outcomes of outpatient endoscopic enucleation of the prostate for benign prostatic obstruction. METHODS A literature search was conducted through December 2022 using PubMed/Medline, Web of Science, and Embase databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. Risk of bias assessment was performed according to the Newcastle-Ottawa Scale for case control studies. RESULTS Of 773 studies, ten were included in the systematic review (n = 1942 patients) and four in the meta-analysis (n = 1228 patients). The pooled incidence of successful same-day discharge was 84% (95% CI 0.72-0.91). Unplanned readmission was recorded in 3% (95% CI 0.02-0.06) of ambulatory cases. In the reported criteria-selected patients submitted to SDD surgery, the forest plot suggested a lower rate of postoperative readmission (OR 0.56, 95% CI 0.34-0.91, p = 0.02) and complications (OR 0.69, 95% CI 0.48-1, p < 0.05) rates compared to standard protocols. CONCLUSION We provide the first systematic review and meta-analysis on SDD for endoscopic prostate enucleation. Despite the lack of randomized controlled trials, we confirm the feasibility and safety of the protocol with no increase in complications or readmission rate in well-selected patients.
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Affiliation(s)
- Pietro Diana
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain.
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy.
- Department of Urology, Hospitales Universitarios San Roque, Las Palmas de Gran Canaria, Spain.
- GUA Gabinete de Urología y Andrología, Las Palmas de Gran Canaria, Spain.
| | - Michael Baboudjian
- Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France
- Department of Urology and Renal Transplantation, La Conception University Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Alberto Saita
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Alessandro Uleri
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Paolo Casale
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Nicolomaria Buffi
- Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy
| | - Benjamin Pradere
- Department of Urology, La Croix du Sud Hospital, 31130, Quint Fonsegrives, France
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Bastien Gondran-Tellier
- Department of Urology and Renal Transplantation, La Conception University Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Romain Boissier
- Department of Urology and Renal Transplantation, La Conception University Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Ivan Schwartzmann
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Cartagena 340-350, 08025, Barcelona, Spain
| | - Pablo Juarez Del Dago
- Department of Urology, Hospitales Universitarios San Roque, Las Palmas de Gran Canaria, Spain
- GUA Gabinete de Urología y Andrología, Las Palmas de Gran Canaria, Spain
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Badreddine J, Sun H, Tay K, Rhodes S, Chen D, Zell M, Jaeger I, Nevo A. The outcomes of same-day discharge following holmium laser enucleation of the prostate (HoLEP) surgeries: our experience during the COVID-19 pandemic. World J Urol 2023:10.1007/s00345-023-04410-2. [PMID: 37160451 PMCID: PMC10169120 DOI: 10.1007/s00345-023-04410-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE To describe the outcomes of Same-Day Discharge (SDD) following Holmium Laser Enucleation of the Prostate (HoLEP) in patients during the COVID-19 pandemic. METHODS A retrospective review of HoLEP surgeries at a single institution between January 2021 and March 2022 was performed. Patient demographic and operative data were collected, and postoperative outcomes were evaluated in terms of safety and efficacy and compared in both groups using a t-test and chi-square test. Logistic regression was also performed to identify factors that correlate with the failure of SDD. RESULTS A total of 155 patients were identified; 135 patients were successfully discharged on the same day and 20 were admitted (87% SDD rate). Admitted HoLEP patients had a significantly higher median prostate-specific antigen (5.7 vs 3.9 ng/dL, P < 0.001), prostate volume (152.3 vs 100.6 mL, P < 0.001), and enucleated tissue weight (90.3 vs 56.9 g, P = 0.04) compared to the SDD group. The SDD group had a 2.9% (n = 4) readmission rate and a 5.2% (n = 7) Emergency Department (ED) visit rate. There was no significant difference in the rate of postoperative ED visits (P = 0.64), readmissions (P = 0.98), complications, and catheterization time (P = 0.98) between both groups. Preoperative predictors of SDD failure included prostate gland volume > 150 mL (OR = 7.17; CI 2.01-25.67; P < 0.01) and history of antiplatelet/anticoagulation use (OR = 6.59; CI 2.00-21.67; P < 0.01). CONCLUSION Same-day discharge following HoLEP is a safe and effective approach that can be performed in most patients using a liberal discharge criteria and relying on postoperative findings only.
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Affiliation(s)
- Jad Badreddine
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Helen Sun
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kimberly Tay
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Stephen Rhodes
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Daniel Chen
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Michael Zell
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Irina Jaeger
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Amihay Nevo
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Assmus MA, Krambeck AE. Moses Laser Enucleation of the Prostate (MoLEP): Use of Pulse Modulated Holmium Laser Technology for Prostate Enucleation. CURRENT BLADDER DYSFUNCTION REPORTS 2023. [DOI: 10.1007/s11884-023-00698-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Hao Y, Chen D, Shen X, Chen Y, Hao Z. No bladder irrigation versus continuous bladder irrigation after HoLEP: a propensity score matching analysis. BMC Urol 2023; 23:20. [PMID: 36805718 PMCID: PMC9936765 DOI: 10.1186/s12894-023-01187-9] [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: 11/27/2022] [Accepted: 02/10/2023] [Indexed: 02/19/2023] Open
Abstract
PURPOSE In this study, the feasibility of a no bladder irrigation strategy after transurethral holmium laser enucleation of the prostate (HoLEP) for the treatment of benign prostatic hyperplasia (BPH) was studied. METHODS From August 2021 to December 2021, the clinical data of 62 patients who received no bladder irrigation after HoLEP (Group A) were studied. The control group contained the clinical data of 150 patients in the same therapy group (from January 2021 to July 2021) who received continuous bladder irrigation after HoLEP (Group B). The baseline was consistent after using the propensity score matching (PSM) method, and the differences between groups were compared. The pre- and postoperative complications, international prostate symptom score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax), and postvoid residual urine (PVR) of the two groups were compared, accompanied by a follow-up evaluation of surgical effects. RESULTS 47 pairs of patients were successfully matched by PSM. There was no statistically significant difference in the intraoperative conditions and the incidence of early postoperative complications between the two groups (P > 0.05). Before and one month after the surgery, significant differences were also found in the IPSS, QOL, Qmax, and PVR of both groups (P < 0.05). Within one month after the surgery, no statistically significant difference was found in IPSS, QOL, Qmax, PVR, or the incidence of early postoperative complications between the two groups (P > 0.05). CONCLUSION For appropriately selected patients according to the exclusion criteria, the no bladder irrigation strategy after HoLEP for BPH is safe and effective.
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Affiliation(s)
- Yunwu Hao
- grid.412679.f0000 0004 1771 3402Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 Anhui China ,grid.186775.a0000 0000 9490 772XDepartment of Urology, Lu’an Hospital Affiliated of Anhui Medical University, Lu’an, 237000 Anhui China
| | - Degang Chen
- grid.186775.a0000 0000 9490 772XDepartment of Urology, Lu’an Hospital Affiliated of Anhui Medical University, Lu’an, 237000 Anhui China
| | - Xudong Shen
- grid.412679.f0000 0004 1771 3402Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 Anhui China ,grid.186775.a0000 0000 9490 772XInstitute of Urology, Anhui Medical University, Hefei, 230022 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, 230022 Anhui China
| | - Yang Chen
- grid.412679.f0000 0004 1771 3402Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022 Anhui China ,grid.186775.a0000 0000 9490 772XInstitute of Urology, Anhui Medical University, Hefei, 230022 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, 230022 Anhui China
| | - Zongyao Hao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China. .,Institute of Urology, Anhui Medical University, Hefei, 230022, Anhui, China. .,Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, 230022, Anhui, China.
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Seizilles de Mazancourt E, Pagnoux G, Codas Duarte R, Moldovan PC, Ruffion A, Colombel M, Badet L, Fassi-Fehri H. Prostatic arterial embolization versus holmium laser enucleation of the prostate: 1-year outcomes. World J Urol 2023; 41:151-157. [PMID: 36451037 DOI: 10.1007/s00345-022-04225-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022] Open
Abstract
PURPOSE Holmium Laser Enucleation of the Prostate (HoLEP) and Prostatic Artery Embolization (PAE) are novel techniques for the treatment of benign prostatic hyperplasia lower urinary tract symptoms (BPH-LUTS). The objective of this study was to describe and compare the functional results and complications of these two techniques at one year follow-up. MATERIALS AND METHODS We performed a retrospective, monocentric study of all patients consecutively treated in our center with HoLEP or PAE for symptomatic or complicated BPH between January 2016 and December 2019. Data regarding patient and perioperative characteristics, follow-up biological results, functional questionnaires and uroflowmetry were collected from medical records. RESULTS A total of 490 and 57 patients were treated with HoLEP and PAE, respectively. The demographic and clinical characteristics of the two groups were similar. The operative time was significantly higher for PAE (p < 0.001) and hospitalization time longer after HoLEP (p = 0.0006). The urinary catheterization time was longer after PAE (p < 0.001). The prostatic volume treated was higher with HoLEP than with PAE (56% versus 26%, p < 0.001). The mean difference in IPSS from baseline to 12 months was significantly higher after HoLEP than after PAE: - 17.58 versus - 8 (p < 0.001). The mean difference in QoL-IPSS from baseline to 12 months was significantly higher after HoLEP: - 4.09 versus - 2.27 (p < 0.001). The rate of postoperative adverse events in the first three months was similar between the two groups:35% after HoLEP and 33% after PAE (p = 0.88). CONCLUSIONS HoLEP and PAE both significantly improved BPH-LUTS, with HoLEP having an advantage over PAE.
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Affiliation(s)
| | - Gaelle Pagnoux
- Department of Urinary and Vascular Imaging, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Ricardo Codas Duarte
- Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Paul Cezar Moldovan
- Department of Urinary and Vascular Imaging, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Alain Ruffion
- Department of Urology, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Marc Colombel
- Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Lionel Badet
- Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Hakim Fassi-Fehri
- Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
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Garden EB, Ravivarapu KT, Levy M, Chin CP, Omidele O, Tomer N, Al-Alao O, Araya JS, Small AC, Palese MA. The utilization and safety of same-day discharge after transurethral benign prostatic hyperplasia surgery: a case-control, matched analysis of a national cohort. Urology 2022; 165:59-66. [DOI: 10.1016/j.urology.2022.01.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 12/21/2022]
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Factors Predicting Successful Same-Day Trial of Void (TOV) after Laser Vaporization of the. Urology 2022; 165:280-284. [DOI: 10.1016/j.urology.2022.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 11/20/2022]
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Slade A, Agarwal D, Large T, Sahm E, Schmidt J, Rivera ME. Expanded Criteria Same Day Catheter Removal Following Holmium Laser Enucleation of the Prostate (HoLEP). J Endourol 2022; 36:977-981. [PMID: 35045752 DOI: 10.1089/end.2022.0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Introduction and Objectives Holmium laser enucleation of the prostate (HoLEP) is a highly effective treatment of benign prostatic hyperplasia (BPH). Technical advances and improved hemostatic properties of Holmium lasers have allowed for increased efficiency and outcomes. Same day catheter removal following HoLEP was described at our institution in 2020 following a 30-patient pilot trial. We now present an expanded update following widespread adoption at our facility. Methods We reviewed patients who underwent same day catheter removal after HoLEP between 1/1/2020 and 3/21/2021. Unlike previous trials, there were no limitations to prostate size. Other changes included catheter removal in phase two of recovery when nursing was available rather than the urology clinic. Descriptive statistics are presented of preoperative, operative, and postoperative data. Univariate and multivariate analysis was performed to assess associations with failure of same day void trial. Results The success rate of same-day catheter removal for the 114 identified patients was 87.7%. Mean age was 69.1 8.6 years and prostate volume was 109.2 61.5cc, 35% were dependent on catheterization for urinary retention preoperatively and 9% were on antiplatelet/anticoagulant therapy. A total of 26.5% of patients with ASA 3 or 4 failed catheter removal compared to 3.9% of patients with ASA 1 or 2 (Likelihood ratio 9.32, p=0.002), ASA status lost significance on multivariate analysis (p=0.076). Successful catheter removal was not significantly associated with age, BMI, prostate size, catheter dependency, anticoagulation/antiplatelet therapy, AUA symptom score, prior BPH surgery, or prostate cancer in final pathology. Conclusion Regardless of prostate size, same day catheter removal is a safe and reliable method of post-HoLEP patient management. Patients with an ASA 3 or 4 should be counseled regarding potential risks of temporary re-catheterization. Given ongoing nationwide shortages in hospital beds and staffing, same day discharge and catheter removal may allow for wider availability of surgical treatment for BPH.
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Affiliation(s)
- Austen Slade
- Indiana University School of Medicine, 12250, Urology, 535 N Barnhill Drive, Suite 150, Indianapolis, Indiana, United States, 46202-5114;
| | - Deepak Agarwal
- Indiana University School of Medicine, 12250, Urology, Indianapolis, Indiana, United States;
| | - Tim Large
- Indiana University School of Medicine, 12250, Urology, 1801 N Senate Blvd, Suite 220, Indianapolis, Indiana, United States, 46202;
| | - Erica Sahm
- Indiana University School of Medicine, 12250, Urology, Indianapolis, Indiana, United States;
| | - Jonathan Schmidt
- Indiana University School of Medicine, 12250, Urology, Indianapolis, Indiana, United States;
| | - Marcelino E Rivera
- Indiana University School of Medicine, 12250, Urology, Indianapolis, Indiana, United States;
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Deyirmendjian C, Elterman D, Chughtai B, Zorn KC, Bhojani N. Surgical treatment options for benign prostatic obstruction: beyond prostate volume. Curr Opin Urol 2022; 32:102-108. [PMID: 34669611 DOI: 10.1097/mou.0000000000000937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Many surgical treatment options are available for patients who present with benign prostatic obstruction (BPO). This article reviews the current treatment options available and distinguishes them based on five clinical considerations: antithrombotic therapy, sexual function preservation, ambulatory procedures, anesthesia-related risks and duration of catheterization. RECENT FINDINGS A comprehensive review of the literature was performed on 10 BPO procedures. Laser enucleation of the prostate (LEP), bipolar plasma transurethral vaporization of the prostate and photoselective vaporization (PVP) of the prostate reduces the risk of bleeding, which is recommended for anticoagulated men. Ejaculatory function is more likely to be preserved following transurethral incision of the prostate, Rezūm, Aquablation, UroLift and iTind. Same-day discharge is possible for LEP, PVP and prostatic arterial embolization (PAE). For patients with high anesthesia-related risks, procedures compatible with local anesthesia (UroLift, Rezūm, iTind and PAE) should be favored. Catheterization duration is shorter with UroLift, PVP and LEP. SUMMARY BPO treatment options are growing rapidly. The optimal procedure for a given patient is based on factors such as associated risks, recovery and expected outcomes. Besides prostate volume, the clinical considerations in the present article can help elucidate the best surgical BPO treatment option for each patient based on their values, preferences, and risk tolerance.
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Affiliation(s)
| | - Dean Elterman
- Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
| | - Kevin C Zorn
- Division of Urology, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, University of Montreal, Montreal, Quebec, Canada
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Barriers to Implementation of a Same-Day Discharge Pathway for Holmium Laser Enucleation of the Prostate. Urology 2021; 161:105-110. [PMID: 34973241 DOI: 10.1016/j.urology.2021.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate perceived barriers to successful same-day discharge (SDD) after holmium laser enucleation of the prostate (HoLEP) from the perspective of surgical and nursing staff members. METHODS A 17-question survey was administered to intraoperative and postoperative surgical staff in June 2021 after a six-month period of implementing a SDD HoLEP pathway with same-day catheter removal. McNemar's and Stuart-Maxwell tests were performed for statistical analysis. RESULTS Surveys were completed by 30 respondents. The majority of respondents had less than 5 years of surgical experience (63%). Almost all respondents (96%) felt that HoLEP patients could be discharged safely on day of surgery. Overall, 60% felt that HoLEP had a lower risk of post-operative bleeding compared to other transurethral surgeries. There was a significant decrease in number of respondents that felt apprehensive when comparing initiation of SDD HoLEP pathway to 6-months post-implementation (43% vs 7%, P = .003). The most common factors causing apprehension both pre- and post-implementation included: degree of hematuria (43% vs 40%, P = .56), risk of failure of trial of void (40% vs 30%, P = .26), and risk of readmission or unplanned emergency department (ED) visit (33% vs 30%, P = .48). There was a significant decrease in the number of respondents who were apprehensive about lack of experience with SDD after HoLEP comparing pre- and post-implementation (20% vs 0%, P = .01). CONCLUSION While staff report initial apprehension regarding implementation of a SDD HoLEP pathway, adequate support to intraoperative and postoperative teams helps build experience that alleviates these concerns.
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Michaud C, Codas-Duarte R, Matillon X, Crouzet S, Badet L, Fassi-Fehri H. One-year Functional Outcomes after Holmium Laser Enucleation of the Prostate (HoLEP): Introduction of a Composite Score (Hexafecta). Prog Urol 2021; 32:189-197. [PMID: 34656450 DOI: 10.1016/j.purol.2021.09.001] [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: 06/02/2021] [Revised: 08/11/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the efficiency (micturition symptoms, continence, erection) and safety of Holmium Laser Enucleation of the Prostate (HoLEP) with a single composite score (the Hexafecta score) one year postprocedure. PATIENTS AND METHODS We conducted a single-center retrospective study including all patients who had undergone HoLEP for the treatment of benign prostate hyperplasia (BPH) between May 2013 and August 2017. Data were obtained preoperatively and at the 6- and 12-month visits. We also reported all 90-day complications. The Hexafecta score included 6 criteria: peak urine flow of at least 15ml/s, 30% reduction in International Prostate Symptoms Score (IPSS) score, quality of life via the IPSS less than 2, no incontinence (International Consultation Incontinence Questionnaire), no significant change in erectile function (International Index of Erectile Function), and no grade III or more complications according to the Clavien-Dindo classification. RESULTS Two hundred thirty-five patients were included, of whom 197 (83.8%) completed the 12-month visit. Complete data were available to assess the Hexafecta score for 178 of them (75.7%). Most of the missing data were for uroflowmetry and the erectile function assessment. Hundred three patients (58%) met all 6 criteria, while 45 (25%) met 5 of them. None were retreated for BPH in the follow-up period. The de novo incontinence rate was 4.1%. CONCLUSION The Hexafecta score is a simple, transversal method for comprehensively evaluating functional outcomes after HoLEP surgery. Such an evaluation could be used to compare other types of procedures for BPH treatment. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- C Michaud
- Hôpital Édouard-Herriot, Service d'Urologie et de la Transplantation, Hospices civils de Lyon, faculté de médecine Lyon Est, Université Lyon Claude Bernard, 5, place d'Arsonval, 69003 Lyon, France.
| | - R Codas-Duarte
- Hôpital Édouard-Herriot, Service d'Urologie et de la Transplantation, Hospices civils de Lyon, faculté de médecine Lyon Est, Université Lyon Claude Bernard, 5, place d'Arsonval, 69003 Lyon, France
| | - X Matillon
- Hôpital Édouard-Herriot, Service d'Urologie et de la Transplantation, Hospices civils de Lyon, faculté de médecine Lyon Est, Université Lyon Claude Bernard, 5, place d'Arsonval, 69003 Lyon, France
| | - S Crouzet
- Hôpital Édouard-Herriot, Service d'Urologie et de la Transplantation, Hospices civils de Lyon, faculté de médecine Lyon Est, Université Lyon Claude Bernard, 5, place d'Arsonval, 69003 Lyon, France
| | - L Badet
- Hôpital Édouard-Herriot, Service d'Urologie et de la Transplantation, Hospices civils de Lyon, faculté de médecine Lyon Est, Université Lyon Claude Bernard, 5, place d'Arsonval, 69003 Lyon, France
| | - H Fassi-Fehri
- Hôpital Édouard-Herriot, Service d'Urologie et de la Transplantation, Hospices civils de Lyon, faculté de médecine Lyon Est, Université Lyon Claude Bernard, 5, place d'Arsonval, 69003 Lyon, France
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Porreca A, Colicchia M, Tafuri A, D'Agostino D, Busetto GM, Crestani A, Odorizzi K, Amigoni N, Rizzetto R, Gozzo A, Gallina S, Bianchi L, Ferro M, Falabella R, Romagnoli D, Antonelli A, Corsi P, Schiavina R. Perioperative Outcomes of Holmium Laser Enucleation of the Prostate: A Systematic Review. Urol Int 2021; 106:979-991. [PMID: 34569529 DOI: 10.1159/000518560] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/25/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The aim of the study was to systematically review the literature and describe perioperative complications of holmium laser enucleation of the prostate (HoLEP), including the Clavien-Dindo classification of surgical complications. METHODS All English language publications on HoLEP were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines to evaluate PubMed®, Scopus®, and Web of Science™ databases from January 1, 1998, to June 1, 2020. RESULTS Fifty-seven studies were included, for a total of 10,371 procedures. We distinguished between intra-, peri-, and postoperative complications. Overall, the rate of complications is 0-7%. Intraoperative complications include incomplete morcellation (2.3%), capsular perforation (2.2%), bladder (2.4%), and ureteric orifice (0.4%) injuries. Perioperative complications include postoperative urinary retention (0.2%), hematuria and clot retention (2.6%), and cystoscopy for clot evacuation (0.7%). Postoperative complications include dysuria (7.5%), stress (4.0%), urge (1.8%), transient (7%) and permanent (1.3%) urinary incontinence, urethral stricture (2%) and bladder neck contracture (1%). CONCLUSIONS HoLEP is a safe procedure, with a satisfactory low complication rate. The most common reported perioperative complications are not severe (Clavien-Dindo classification grades 1-2). Further randomized studies are certainly warranted to fully determine the predictor of surgical complications in order to prevent them and improve this technique.
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Affiliation(s)
- Angelo Porreca
- Oncological Urology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Michele Colicchia
- Department of Urology, Policlinico Abano Terme, Abano Terme (PD), Abano Terme, Italy
| | - Alessandro Tafuri
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Daniele D'Agostino
- Department of Urology, Policlinico Abano Terme, Abano Terme (PD), Abano Terme, Italy
| | - Gian Maria Busetto
- Department of Urology, Sapienza Rome University Policlinico Umberto I, Rome, Italy
| | | | - Katia Odorizzi
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Nelia Amigoni
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Riccardo Rizzetto
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Alessandra Gozzo
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Sebastian Gallina
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Lorenzo Bianchi
- Department of Urology, University of Bologna, Bologna, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology (IEO), Milan, Italy
| | - Roberto Falabella
- Department of Urology, Azienda Ospedaliera Regionale di Potenza, Potenza, Italy
| | - Daniele Romagnoli
- Department of Urology, Policlinico Abano Terme, Abano Terme (PD), Abano Terme, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Paolo Corsi
- Oncological Urology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
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Atamian A, Fourmarier M, Alegorides C, Bottet F, Arroua F, Eghazarian C, Baboudjian M. Holmium laser enucleation and water vapor thermal therapy for the treatment of symptomatic benign prostatic hyperplasia: A cost analysis. Prog Urol 2021; 32:198-204. [PMID: 34148770 DOI: 10.1016/j.purol.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE To perform a cost analysis of the current gold standard operation of Holmium Laser Enucleation of the prostate (HoLEP) compared to the new technique of water vapor thermal therapy with the Rezum™ system for the treatment of symptomatic benign prostatic hyperplasia (BPH). PATIENTS AND METHODS Between October 2017 and January 2020, consecutive patients with invalidating lower urinary tract symptoms due to BPH who underwent Rezūm™ and HoLEP procedures from the Aix regional hospital were identified. The outcome of each technique was assessed in terms of cost from the institutional perspective. Detailed expense reports based were provided by the accounts department of the hospital. These were used to compare in-hospital costs for each procedure. RESULTS A total of 53 and 94 consecutive patients underwent respectively water vapor thermal therapy and HoLEP. The median costs for the surgical procedure were €1344 (IQR 1331-1361) and €669 (IQR 584-824), respectively for Rezūm™ and HoLEP (median difference €675; P<0.001). The median costs of the hospital stay were €869 (IQR 869-869) for Rezūm™ and €1295 (IQR 1295-1330) for HoLEP (median difference €426; P<0.001). Finally, the median total costs per patient were lower for HoLEP (€2005 [IQR 1902-2150]) than for Rezūm™ (€2228 [IQR 2209-2243]) procedure, and the median difference of €233 was significant (P<0.001). CONCLUSIONS One of the anticipated benefits of Rezūm™, reduced length of hospital stay with an associated reduction in cost, did not materialize within this study. The patient's clinical condition and expectations should also be taken into account when deciding between Rezum™ and standard therapies. LEVEL OF PROOF 3.
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Affiliation(s)
- A Atamian
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - M Fourmarier
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - C Alegorides
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - F Bottet
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - F Arroua
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - C Eghazarian
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - M Baboudjian
- Department of urology, Aix-en-Provence Hospital, Aix-en-Provence, France; Department of urology and kidney transplantation, La Conception Hospital, Aix-Marseille University, AP-HM, Marseille, France.
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Nottingham CU, Large T, Agarwal DK, Rivera ME, Krambeck A. Comparison of Newly-Optimized Moses Technology Versus Standard Holmium:YAG for Endoscopic Laser Enucleation of the Prostate. J Endourol 2021; 35:1393-1399. [PMID: 33813861 DOI: 10.1089/end.2020.0996] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The purpose of this study was to describe our initial experience of using a newly-optimized Moses technology that is part of the second generation Moses platform specifically designed for holmium laser enucleation of the prostate M2-HoLEP, and compare it to patients undergoing holmium laser enucleation of the prostate (HoLEP) using standard holmium:YAG technology (S-HoLEP). METHODS We retrospectively collected data on patients who underwent M2-HoLEP and compared it to the last 50 patients in whom we performed S-HoLEP. Specifically, we compared preoperative symptom scores for lower urinary tract symptoms (LUTS) and erectile dysfunction (ED), preoperative objective voiding metrics, as well as intraoperative characteristics, perioperative characteristics, postoperative complications, postoperative symptom scores for LUTS and ED, and postoperative objective voiding metrics. Additionally we evaluated the ability for same day discharge following surgery in the M2-HoLEP group. RESULTS We included 104 total patients for analysis. We compared the first 54 patients undergoing M2-HoLEP to 50 patients undergoing S-HoLEP. Both groups had similar age, BMI, use of anticoagulation medication, LUTS and ED scores, and objective voiding metrics. Operations performed with M2-HoLEP had faster mean hemostasis time (8.7 vs 10.6 ± 6 minutes, p=0.03) as well as hemostasis rate (0.13 vs 0.30 grams/minute, p=0.01). Same day discharge was successful in 69.4% of patients in the M2-HoLEP group. Postoperatively, both groups also had similar and low rates of urinary retention and complications. At follow-up, both groups had similar symptom scores for LUTS and ED, as well as similar objective voiding metrics. CONCLUSION The newly optimized Moses pulse modulation technology is safe and efficient for the treatment of BPH. Such technologic improvements in the laser have greatly enhanced the feasibility of same day discharge of patients undergoing HoLEP.
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Affiliation(s)
- Charles Upshur Nottingham
- Washington University in St Louis School of Medicine, 12275, Urology, St Louis, Missouri, United States;
| | - Tim Large
- Indiana University School of Medicine, 12250, Urology, Indianapolis, Indiana, United States;
| | - Deepak Kumar Agarwal
- Indiana University School of Medicine, Urology, Indianapolis, Indiana, United States;
| | - Marcelino E Rivera
- Indiana University Health Methodist Hospital, 22535, Urology, 1801 Senate Blvd, Ste 220, Indianapolis, Indiana, United States, 46202;
| | - Amy Krambeck
- Northwestern University Feinberg School of Medicine, 12244, Urology, Chicago, Illinois, United States;
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Nasri J, Beraud F, Seguier D, Delporte G, Behal H, Olivier J, Villers A, Marcelli F, Biardeau X. Artificial urinary sphincter implantation in non-neurogenic men: a place for out-patient surgery. World J Urol 2021; 39:3541-3547. [PMID: 33772605 DOI: 10.1007/s00345-021-03673-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: 11/12/2020] [Accepted: 03/13/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess feasibility, safety and risk factors for failure associated with out-patient surgery for artificial urinary sphincter (AUS) implantation/revision in non-neurogenic men. MATERIALS In the present retrospective monocentric study conducted between May 2016 and March 2020, 81 patients undergoing AUS implantation or revision during an out-patient surgery were included. The primary outcome was the success rate of out-patient surgery. Success was assessed using two distinct definitions, a narrow definition, where success was defined as a one-day hospitalization and the absence of any unscheduled consultation or re-hospitalization within the 3 days following surgery, a broad definition, where success was defined as a one-day hospitalization and the absence of any unscheduled re-hospitalization within the 3 days following surgery. In parallel, risk factors for failure of out-patient surgery, as well as efficacy and safety were assessed. RESULTS Eighty-one patients were enrolled, with a mean age of 71.2 years ± 5.9. Out-patient surgery was successfully completed in 58 men (71.6% [95% CI 60.5-81.1]) and in 76 men (93.8% [95% CI 86.2-97.9]) according to the narrow and the broad definition, respectively. After multivariate analysis, anticoagulant therapy (OR 25.97 [95% CI 4.44-152.04]) and low socio-professional status (OR 22.1 [95% CI 3.701-131.95]) were statistically associated with failure of out-patient surgery. The continence rate after a 90-day follow-up was 79%. CONCLUSION AUS implantation/revision in non-neurogenic men could be safely proposed in out-patient surgery. Special attention may however be paid to patients undergoing anticoagulant therapy or belonging to a low socio-professional category. TRIAL REGISTRATION NUMBER DEC20-173 (French National Commission for Data Protection and Liberties).
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Affiliation(s)
- Jordan Nasri
- Department of Urology, CHU Lille, Claude Huriez Hospital, Univ. Lille, 59000, Lille, France.
| | - Florian Beraud
- Department of Urology, CHU Lille, Claude Huriez Hospital, Univ. Lille, 59000, Lille, France
| | - Denis Seguier
- Department of Urology, CHU Lille, Claude Huriez Hospital, Univ. Lille, 59000, Lille, France
| | - Gauthier Delporte
- Department of Urology, CHU Lille, Claude Huriez Hospital, Univ. Lille, 59000, Lille, France
| | - Hélène Behal
- ULR 2694-METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, CHU Lille, Univ. Lille, 59000, Lille, France
| | - Jonathan Olivier
- Department of Urology, CHU Lille, Claude Huriez Hospital, Univ. Lille, 59000, Lille, France
| | - Arnauld Villers
- Department of Urology, CHU Lille, Claude Huriez Hospital, Univ. Lille, 59000, Lille, France
| | - François Marcelli
- Department of Urology, CHU Lille, Claude Huriez Hospital, Univ. Lille, 59000, Lille, France
| | - Xavier Biardeau
- Department of Urology, CHU Lille, Claude Huriez Hospital, Univ. Lille, 59000, Lille, France
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21
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Assmus MA, Large T, Lee MS, Agarwal DK, Rivera ME, Krambeck AE. Same-Day Discharge Following Holmium Laser Enucleation in Patients Assessed to Have Large Gland Prostates (≥175 cc). J Endourol 2021; 35:1386-1392. [PMID: 33567989 DOI: 10.1089/end.2020.1218] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Holmium laser enucleation of the prostate (HoLEP) is a highly effective and durable minimally invasive surgery for benign prostatic hyperplasia. Historically, alternative treatments for large glands (≥175 cc) are associated with prolonged length of stay (LOS) and postoperative catheterization. However, advances in laser technology combined with surgical technique optimization have early evidence supporting same-day discharge. We look to examine contemporary same-day discharge outcomes for large glands. Materials and Methods: With Institutional Review Board (IRB) approval we queried our electronic medical record and retrospective clinical registry to examine perioperative outcomes of large gland (≥175 cc) prostates that underwent HoLEP with consideration for same-day discharge. Results: From December 10, 2019 to September 29, 2020 we identified 55 patients with a preoperative prostate size ≥175 cc (39 CT, 12 MRI, 4 transrectal ultrasound), of which 45 were scheduled for same-day discharge and 10 for admission. Mean preoperative prostate size was 229.9 cc (range 175-535 cc) and 36 (65.5%) were in urinary retention. Mean preoperative prostate-specific antigen (PSA) was 8.58 ng/mL, American Urological Association Symptom Score (AUASS) 22.3, and Qmax 8.8 mL/second. At 3 months postoperative follow-up mean AUASS was 6.7, PSA 0.87 ng/mL and Qmax 20.4 mL/second. All comer same-day discharge rate was 70% (38/55). Of patients planned for same-day discharge 38/45 (84%) were effective. Average LOS for all patients was 11.8 hours with catheterization of 21.2 hours. When compared with 2010 published large gland outcomes, our current LOS represents a 220% reduction. Looking specifically at patients planned for same-day discharge, average LOS and catheter duration was 8.8 and 17.0 hours, whereas LOS and catheter duration for patients planned for admission was 25.7 and 39.4 hours, respectively. Conclusions: We report the first outcomes of preoperatively planned same-day discharge for HoLEP in large glands (≥175 cc). A combination of technologic advances and optimization of technique have allowed for a safe adoption of same-day discharge, providing additional advantages over alternative large gland treatments.
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Affiliation(s)
- Mark A Assmus
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tim Large
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Matthew S Lee
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Deepak K Agarwal
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Marcelino E Rivera
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amy E Krambeck
- Department of Urology, Northwestern University, Chicago, Illinois, USA
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22
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Salciccia S, Del Giudice F, Maggi M, Eisenberg ML, Chung BI, Conti SL, Kasman AM, Vilson FL, Ferro M, Lucarelli G, Viscuso P, Di Pierro G, Busetto GM, Luzi M, Sperduti I, Ricciuti GP, De Berardinis E, Sciarra A. Safety and Feasibility of Outpatient Surgery in Benign Prostatic Hyperplasia: a Systematic Review and Meta-Analysis. J Endourol 2021; 35:395-408. [PMID: 33081521 DOI: 10.1089/end.2020.0538] [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: 11/13/2022] Open
Abstract
Purpose: Most of the endourologic procedures along the urinary tract have been widely practiced as outpatient operations, including surgery for benign prostatic hyperplasia (BPH). This systematic review and meta-analysis was conducted to assess safety and feasibility of outpatient surgery for patients suffering from symptomatic BPH candidate for endoscopic disobstruction. Materials and Methods: PubMed, Web of Science, Cochrane, and Embase were searched up until March 30, 2020. Methodological index for nonrandomized studies (MINORS) tool was utilized to assess the quality of included studies, and a pooled measure of failure rate (FR) or event rate (ER) estimate was calculated. Further sensitivity analysis, subgroup analysis, and meta-regression were conducted to investigate contribution of moderators to heterogeneity. Results: Twenty studies with a total of 1626 patients treated according to outpatient criteria for endoscopic BPH surgery were included. In total, 18 studies reporting data on immediate hospital readmission and/or inability to discharge after endoscopic procedure presented FR estimates ranging from 1.7% to 51.1%. Pooled FR estimate was 7.8% (95% confidence interval [CI]: 5.2-10.3); Heterogeneity: Q = 76.85; degree of freedom = 17, p < 0.001; I2 = 75.12%. Subgroup analysis according to surgical technique revealed difference among the three approaches with pooled FR of 3% (95% CI: 1-4.9), 7.1% (95% CI: 3.9-10.4), and 11.8% (95% CI: 7-16.7) for transurethral resection of the prostate, Green-light, and holmium laser vaporesection, respectively (p < 0.001). At meta-regression analysis, none of the retrieved covariates was able to significantly influence the cumulative outcomes reported. ER for postoperative complications and early outpatient visit showed a pooled estimate of 18.6% (95% CI: 13.2-23.9) and 7.7% (95% CI: 4.3-11), respectively. Conclusions: Our analysis revealed how transurethral procedures for BPH on an outpatient setting are overall reliable and safe. Of note, there were significant outcome differences between groups with regard to type of surgical procedure, perioperative prostate volume, and discharge protocol suggesting the need for further prospective analysis to better elucidate the best strategy in such outpatient conduct.
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Affiliation(s)
- Stefano Salciccia
- Department of Maternal Infant and Urologic Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy.,Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Martina Maggi
- Department of Maternal Infant and Urologic Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Benjamin I Chung
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Simon L Conti
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Alex M Kasman
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Fernandino L Vilson
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation-Urology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Pietro Viscuso
- Department of Maternal Infant and Urologic Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Giovanni Di Pierro
- Department of Maternal Infant and Urologic Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Gian Maria Busetto
- Department of Maternal Infant and Urologic Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Marta Luzi
- Department of Cardiovascular Surgery, Respiratory Medicine, Nephrology, Anesthesiology and Geriatrics, Policlinico Umberto I, Rome, Italy
| | - Isabella Sperduti
- Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Gian Piero Ricciuti
- Department of Maternal Infant and Urologic Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Ettore De Berardinis
- Department of Maternal Infant and Urologic Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal Infant and Urologic Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
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Klein C, Marquette T, Comat V, Alezra E, Capon G, Bladou F, Ferriere JM, Bensadoun H, Bernhard JC, Robert G. Evolution of Day-Case Holmium Laser Enucleation of the Prostate Success Rate Over Time. J Endourol 2021; 35:342-348. [PMID: 32935563 DOI: 10.1089/end.2020.0337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objectives: To describe the evolution of day-case success rate over the years and to identify predictive factors for prolonged hospitalization or readmissions. Methods: Retrospective review of all consecutive day-case holmium laser enucleation of the prostate (HoLEP) performed by a single surgeon between January 2013 and February 2019 using a prospective database. Day-case success was defined as discharge within less than 12 hours from admission without any readmission within 48 hours after discharge. Protocol for day-case treatment included systematic bladder catheter insertion with continuous irrigation for ∼2 hours and catheter removal on postoperative day 1. Patients were reached by phone on postoperative day 1 to ensure voiding. For the descriptive statistics, an analysis of variance was performed. Univariate and multivariate analyses were used to identify risk factors. Results: A total of 266 patients were retrieved and dispatched as follows: group 1 (n = 88) from January 2013 to July 2015, group 2 (n = 89) from August 2015 to June 2017, and group 3 (n = 89) from July 2017 to February 2019. The overall success rate was 80.5% (214/266) over the study period. It significantly improved over time from 70% in group 1 to 84% in group 2 and 87% in group 3 (p = 0.014). In the meantime, the operating time and the total energy delivered to the tissue decreased from 77 minutes in the first group to 60.4 minutes in the second group and 55.4 minutes in the third group (p < 0.001), and from 95.2 kJ in the first group to 84 kJ in the second group and 77.9 kJ in the third group (p = 0.041). On multivariate analysis, the only risk factor significantly associated with day-case failure was prostate volume greater than 90 cc (odds ratio = 2.041, p = 0.047). Conclusion: Day-case HoLEP is a reliable and safe procedure with a high success rate. The surgeon's experience seems to be crucial to improve perioperative outcomes, but prostate volume greater than 90 cc remains associated with higher failure rates.
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Affiliation(s)
- Clément Klein
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Thibault Marquette
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Vincent Comat
- Department of Urology, Bayonne Hospital, Bayonne, France
| | - Eric Alezra
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Gregoire Capon
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Franck Bladou
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Jean-Marie Ferriere
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Henri Bensadoun
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Jean-Christophe Bernhard
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Grégoire Robert
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France.,University of Bordeaux, Bordeaux, France
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24
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Lebdai S, Chevrot A, Doizi S, Pradère B, Barry Delongchamps N, Baumert H, Benchikh A, Della Negra E, Fourmarier M, Gas J, Misraï V, Rouscoff Y, Theveniaud PE, Vincendeau S, Wilisch J, Descazeaud A, Robert G. [Surgical and interventional management of benign prostatic obstruction: Guidelines from the Committee for Male Voiding Disorders of the French Urology Association]. Prog Urol 2021; 31:249-265. [PMID: 33478868 DOI: 10.1016/j.purol.2020.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/24/2020] [Accepted: 12/04/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of the Male Lower Urinary Tract Symptoms Committee (CTMH) of the French Urology Association was to propose an update of the guidelines for surgical and interventional management of benign prostatic obstruction (BPO). METHODS All available data published on PubMed® between 2018 and 2020 were systematically searched and reviewed. All papers assessing surgical and interventional management of adult patients with benign prostatic obstruction (BPO) were included for analysis. After studies critical analysis, conclusions with level of evidence and French guidelines were elaborated in order to answer the predefined clinical questions. RESULTS/GUIDELINES Offer a trans-uretral incision of the prostate to treat patients with moderate to severe lower urinary tract symptoms (LUTS) with a prostate volume<30cm3, without a middle lobe. TUIP increases the chances of preserving ejaculation. Propose mono- or bipolar trans-urethral resection of the prostate (TURP) to treat patients with moderate to severe LUTS with a prostate volume between 30 and 80cm3. Vaporization by Greenlight™ or by bipolar energy can be offered as an alternative to TURP. Offer a Greenlight™ laser vaporization to patients at risk of bleeding. Offer endoscopic prostate enucleation to surgically treat patients with moderate to severe LUTS as an alternative to TURP and open prostatectomy (OP). Minimally invasive prostatectomy is an alternative to OP in centers without access to adequate endoscopic procedures. Embolization of the prostatic arteries may be offered in the event of a contraindication or refusal of surgery for prostates with a volume>80cm3. Prostatic uretral lift is an alternative in patients interested in preserving their ejaculatory function and with a prostate volume<70cm3 without a middle lobe. Aquablation and Rezum™ are under evaluation and should be offered in research protocols. CONCLUSION Major changes in surgical management of BPO have occurred and aim at reducing morbidity and improving quality of life of patients.
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Affiliation(s)
- S Lebdai
- Service d'urologie, CHU d'Angers, Angers, France.
| | - A Chevrot
- Service d'urologie, CHU de Nîmes, Nîmes, France
| | - S Doizi
- Service d'urologie, hôpital européen Georges-Pompidou, Paris, France
| | - B Pradère
- Service d'urologie, CHU de Tours, Tours, France
| | | | - H Baumert
- Service d'urologie, hôpital Ambroise-Paré, Paris, France
| | - A Benchikh
- Service d'urologie, Clinique les Martinets, Versailles, France
| | - E Della Negra
- Service d'urologie, hôpital des Côtes d'Armor, Saint-Brieuc, France
| | - M Fourmarier
- Service d'urologie, hôpital Aix-en-Provence, Aix-en-Provence, France
| | - J Gas
- Service d'urologie, CHU de Toulouse, Toulouse, France
| | - V Misraï
- Service d'urologie, clinique Pasteur, Toulouse, France
| | - Y Rouscoff
- Service d'urologie, polyclinique Saint-Georges, Nice, France
| | - P E Theveniaud
- Service d'urologie, CHR de Metz Thionville, Metz, France
| | - S Vincendeau
- Service d'urologie, CHU de Rennes, Rennes, France
| | - J Wilisch
- Service d'urologie, hôpital privé Natecia, Lyon, France
| | - A Descazeaud
- Service d'urologie, CHU de Limoges, Limoges, France
| | - G Robert
- Service d'urologie, CHU de Bordeaux, Bordeaux, France
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25
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Same Day Discharge is a Successful Approach for the Majority of Patients Undergoing Holmium Laser Enucleation of the Prostate. Eur Urol Focus 2021; 8:228-234. [PMID: 33414073 DOI: 10.1016/j.euf.2020.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/03/2020] [Accepted: 12/18/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Limited research has focused on success with hospital discharge on the same day of surgery after holmium laser enucleation of the prostate (HoLEP). OBJECTIVE To determine the success of same-day discharge in our HoLEP cohort and factors associated with this approach. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of our prospectively maintained HoLEP database demonstrated that 473 adult males underwent HoLEP from July 2018 to December 2019 at a tertiary referral center and high-volume HoLEP hospital. Patients were divided into groups according to planned inpatient admission (PIA), successful same-day discharge (SDD), or unplanned admission (UA). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The PIA, SDD, and UA groups were assessed for differences in preoperative demographic data, perioperative surgical data, and postoperative follow-up data. SDD and UA were then compared to determine if any specific factors predicted UA, including univariate and multivariate logistic regression analyses. RESULTS AND LIMITATIONS Age (p = 0.0049), use of anticoagulation (p = 0.037), American Society of Anesthesiologists score of 3-4 (p = 0.0017), and enucleation time (p=0.0178) were significantly higher in the PIA group. Morcellation time (p = 0.0059) and the rate of bedside catheter irrigation (p = 0.04) were higher in the UA group. The SDD group had the highest rate of successful voiding trial (p = 0.0001). Among the three groups, there was no difference in the rate of postoperative complications (p = 0.141). In a comparison of the SDD and UA groups, morcellation time (p = 0.041), the rate of bedside clot evacuation (p = 0.004), and successful voiding trial (p = 0.003) all favored SDD. There was no difference in 90-d complications (p = 0.536). A limitation is the retrospective nature of this study. CONCLUSIONS HoLEP can be successfully performed as day surgery without an increase in postoperative complications. HoLEP as day surgery is possible for any patient who does not require admission for medical comorbidities. PATIENT SUMMARY Same-day discharge (SDD) after holmium laser enucleation of the prostate (HoLEP) is possible and is successful in 87.4% of patients. Patients with longer morcellation times and with post-procedure hematuria with clots are more likely to have an unplanned admission. Use of a 120-W modulated-pulse laser resulted in a higher rate of SDD success. The culture change to day surgery is time-intensive owing to education of the postsurgical care units and clinic staff, and in our experience took approximately 9 mo to seamlessly integrate SDD as our HoLEP standard of care.
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26
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Xu M, Sun C, Zang Y, Zhu J, Xue B, Tao W. The feasibility and safety of photoselective vaporization for prostate using a 180-W XPS Greenlight laser in day-surgery pattern in China. Lasers Med Sci 2020; 36:1421-1426. [PMID: 33118126 DOI: 10.1007/s10103-020-03174-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/23/2020] [Indexed: 12/14/2022]
Abstract
To evaluate the feasibility and safety of photoselective vaporization for prostate (PVP) with a 180-W XPS Greenlight laser as day surgery in the Chinese population. We retrospectively collected 114 cases undergoing the day surgery PVP and 198 cases undergoing conventional inpatient surgery PVP from April 2017 to March 2020. All patients' data including baseline characteristics, peri-operative data, post-operative outcomes, and complications were recorded and evaluated. The day-surgery procedures were successful in 110 patients. There were no significant differences in baseline characteristics in both groups. The catheterization time and hospitalization time were much shorter and economic cost was much lower in the day-surgery group than in the conventional inpatient surgery group. As for the post-operative complications, the incidence rate of the urinary retention is higher in the day-surgery group than in conventional inpatient surgery group. During the follow-up periods, the International Prostate Symptom Score (IPSS), quality of life (QoL), maximal urinary flow rate (Qmax), and post-void residual urine (PVR) improved significantly in both groups, and no differences were observed between the two groups. Compared to the conventional inpatient surgery, the day-surgery PVP is feasible and safe, which can reduce the hospitalization time and economic cost.
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Affiliation(s)
- Ming Xu
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chuanyang Sun
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yachen Zang
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jin Zhu
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Boxin Xue
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China.
| | - Wei Tao
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China.
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27
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Catheter Removal on the Same Day of Holmium Laser Enucleation of the Prostate: Outcomes of a Pilot Study. Urology 2020; 146:225-229. [PMID: 33045290 PMCID: PMC7547315 DOI: 10.1016/j.urology.2020.09.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 11/23/2022]
Abstract
Objective To determine if same day catheter removal is feasible in a select population after holmium laser enucleation of the prostate (HoLEP). Methods We performed an analysis of patients undergoing HoLEP at our institution who underwent same-day catheter removal after HoLEP. All HoLEPs were performed with Moses 2.0 Optimized for BPH. Patients were dismissed from postoperative recovery unit to the clinic for catheter removal and voiding trial. Results To date, 30 patients have undergone same day catheter removal. Median age is 68.6 years (interquartile range [IQR] 61.8-73.3) and preoperative prostate volume 81 mL (IQR 53-114.8). Median enucleation time was 39.5 minutes (IQR 30.5-53), morcellation time was 5 minutes (IQR 4-12 minutes), and enucleated specimen weight was 52.5 g (IQR 33-81). Twenty-seven (90%) patients successfully voided on the same day without requiring catheter replacement. All patients were catheter free by POD1. For patients who successfully passed their voiding trial, the median time from the end of the procedure to hospital discharge was 2.6 hours (IQR [2.1-2.9]) and from the end of the HoLEP to catheter removal was 4.9 hours (IQR [3.5-6.0]). Conclusion We present for the first time that same day catheter removal is a feasible option in a select population of patients undergoing HoLEP. With more study, this has the potential for transforming the management of BPH, especially larger glands.
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28
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Mouton M, Michel C, Bourgi A, Baumert H. [Holmium laser enucleation of the prostate: Analysis of early complications. Patient selection for day-case surgery]. Prog Urol 2020; 30:89-96. [PMID: 31959571 DOI: 10.1016/j.purol.2019.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 10/30/2019] [Accepted: 11/28/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the complications and the risk factors of Holmium LASER Enucleation of the prostate (HoLEP) and to propose selection criteria for day-case surgery. MATERIAL AND METHODS We included retrospectively all consecutive single-center HoLEP procedures performed between January 1, 2012 and December 31, 2016. We reported the pre-operative characteristics of the patients (age, BMI, ASA score, estimated prostate volume, presence of a preoperative catheter, operative indication, antiplatelet or anticoagulant intake) and the peri operative data (duration of intervention, catheterization, hospitalization, transfusion, histopathological findings, 30-day postoperative complications given to Clavien-Dindo classification, presence of a catheter at discharge, urologist experience). Uni- and multi-variate analyzes were performed to investigate risk factors for complications. RESULTS One thousand two hundred and one patients were included. The overall complication rate was 19.15 %. The transfusion rate was 3.7%. We demonstrated that the age at procedure (P=0.019), an ASA score>2 (P=0.0019), a high prostatic volume (P=0.011), an anticoagulant intake (P=<0.0001), a poor-urologist experience (P=0.048) and a long operative time (P=0.0144) were at risks of complications. CONCLUSION The identification of postoperative complication risk factors after HoLEP could help to better select patients who are offered day-case surgery and minimize the risk of failure or early readmission. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- M Mouton
- Service d'urologie, groupe hospitalier Diaconesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France.
| | - C Michel
- Service d'urologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - A Bourgi
- Service d'urologie, hôpital français du Levant, rue Fouad Chehab, Sin El-Fil, Beyrouth, Liban
| | - H Baumert
- Service d'urologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
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29
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Lwin AA, Zeng J, Evans P, Phung MC, Hynes KA, Price ET, Twiss CO, Tzou DT, Funk JT. Holmium Laser Enucleation of the Prostate Is Safe and Feasible as a Same Day Surgery. Urology 2020; 138:119-124. [PMID: 31962119 DOI: 10.1016/j.urology.2020.01.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the safety, feasibility and treatment outcomes of holmium laser enucleation of the prostate (HoLEP) as a same day surgery (SDS). METHODS HoLEPs performed from November 2013 to December 2018 at our institution were reviewed retrospectively. Inclusion criteria for same day surgery (SDS) included living in the local metropolitan area with access to local hospital and Eastern Cooperative Oncology Group (ECOG) 0-2, regardless of prostate size and anticoagulation status. Those patients who were discharged directly from the postoperative care unit were identified as SDS cases. Patients admitted overnight after HoLEP during the same period were used as a matched cohort. Patient demographics, disease characteristics and treatment outcomes were compared. RESULTS A total of 377 patients were identified, including 199 SDS and 178 non-SDS patients. No statistical difference was present between the 2 groups regarding the post-op complication and readmission rates. The non-SDS group had a significantly higher percentage of patients with history of urinary retention, lower pre-op Qmax, and larger prostate volume. The SDS group had shorter operative time, length of stay (LOS), and catherization time (all P <.05). At 1-year follow-up, no statistically different change in Qmax, PVR, or IPSS score was noted between the 2 groups. CONCLUSION Same day outpatient surgery for HoLEP is safe in patients who live in close proximity and have ECOG status 0-2. Our readmission rate and complication rate are comparable to those reported in the literature with markedly decreased LOS. Long-term functional outcome is not compromised by SDS.
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Affiliation(s)
- Aye A Lwin
- Department of Urology, University of Arizona, Tucson, AZ
| | - Jiping Zeng
- Department of Urology, University of Arizona, Tucson, AZ
| | - Patrick Evans
- Department of Urology, University of Arizona, Tucson, AZ
| | | | - Kieran A Hynes
- Division of Urology, University of Mississippi Medical Center, Jackson, MS
| | | | | | - David T Tzou
- Department of Urology, University of Arizona, Tucson, AZ
| | - Joel T Funk
- Department of Urology, University of Arizona, Tucson, AZ.
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30
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Large T, Nottingham C, Stoughton C, Williams J, Krambeck A. Comparative Study of Holmium Laser Enucleation of the Prostate With MOSES Enabled Pulsed Laser Modulation. Urology 2019; 136:196-201. [PMID: 31790785 DOI: 10.1016/j.urology.2019.11.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/19/2019] [Accepted: 11/25/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare outcomes for patients undergoing holmium laser enucleation of the prostate (HoLEP) for lower urinary tract symptoms secondary to benign prostate hyperplasia using 3 different laser fibers and 2 different laser energy modes. MATERIALS AND METHODS This is a review of a clinic registry of men with lower urinary tract symptoms secondary to benign prostate hyperplasia who underwent HoLEP between August 2018 and January 2019. Patients were assigned to group 1 (50 patients), group 2 (50 patients), and group 3 (50 patients) based on the HoLEP being completed with either a Slimline 550µm, Slimline 1000µm, or MOSES 550 µm laser, respectively. The groups were compared using SSPS for ANOVA comparison of means and multivariate logistic regression. RESULTS Ten patients who underwent concomitant stone surgery (2 PCNL, 8 ureteroscopy , 3 bilateral cases) and 11 patients had bladder stones removed; ancillary procedures did not significantly differ between groups(P = .2). Prostate enucleation times differed significantly (22.5 + 7.3, 16.4 + 6.9, 18.1 + 8.6 minutes P ≤.001) between groups. However, statistical significance was lost once enucleation time was indexed against enucleated tissue weight. Time to achieve hemostasis (minutes) was statistically different between groups (10.6 + 6.1, 7.7 + 5.2, 6.3 + 4.8 P <.001). This difference in hemostatic time was maintained on multilogistic regression demonstrating that MOSES laser enucleation was associated with a 3.9-minute decrease time to achieve hemostasis after enucleation compared to Slimline 550 HoLEP (P <.001). CONCLUSION Our findings suggest that modulated pulsed laser energy can improve hemostasis during the enucleation phase of a HoLEP resulting in shorter Operating Room times.
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Affiliation(s)
- Tim Large
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Charles Nottingham
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Christa Stoughton
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - James Williams
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Amy Krambeck
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
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31
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Enikeev D, Netsch C, Rapoport L, Gazimiev M, Laukhtina E, Snurnitsyna O, Alekseeva T, Becker B, Taratkin M, Glybochko P. Novel thulium fiber laser for endoscopic enucleation of the prostate: A prospective comparison with conventional transurethral resection of the prostate. Int J Urol 2019; 26:1138-1143. [DOI: 10.1111/iju.14115] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/01/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Dmitry Enikeev
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | | | - Leonid Rapoport
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Magomed Gazimiev
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Olesya Snurnitsyna
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Tatyana Alekseeva
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Benedikt Becker
- Department of Urology Asklepios Hospital Barmbek Hamburg Germany
| | - Mark Taratkin
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Petr Glybochko
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
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Abdul-Muhsin H, Critchlow W, Navaratnam A, Gnecco J, Tay K, Girardo M, Andrews P, Cheney S, Humphreys M. Feasibility of holmium laser enucleation of the prostate as a 1-day surgery. World J Urol 2019; 38:1017-1025. [DOI: 10.1007/s00345-019-02831-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 05/29/2019] [Indexed: 10/26/2022] Open
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A Systematic Review and Meta-analysis of Efficacy and Safety Following Holmium Laser Enucleation of Prostate and Transurethral Resection of Prostate for Benign Prostatic Hyperplasia. Urology 2019; 131:14-20. [PMID: 31129190 DOI: 10.1016/j.urology.2019.03.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/13/2019] [Accepted: 03/21/2019] [Indexed: 12/12/2022]
Abstract
Transurethral resection of prostate (TURP) still remains the "gold standard" surgical treatment for benign prostatic hyperplasia (BPH). In recent years, holmium laser enucleation of prostate (HoLEP) gets more and more popularity in the world. Our objective is to compare the efficacy and safety of HoLEP and TURP for BPH. Eleven studies met our eligibility criteria including 1339 patients. The prostate sizes of the all included studies were smaller than 100 g. Overall, in patients with small to mid-sized prostates, HoLEP offers safer clinical outcomes with less blood drop and potentially better long-term relief of bladder outlet obstruction.
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Müllhaupt G, Hechelhammer L, Engeler DS, Güsewell S, Betschart P, Zumstein V, Kessler TM, Schmid HP, Mordasini L, Abt D. In-hospital cost analysis of prostatic artery embolization compared with transurethral resection of the prostate: post hoc analysis of a randomized controlled trial. BJU Int 2019; 123:1055-1060. [PMID: 30578705 PMCID: PMC6850481 DOI: 10.1111/bju.14660] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To perform a post hoc analysis of in-hospital costs incurred in a randomized controlled trial comparing prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP). PATIENTS AND METHODS In-hospital costs arising from PAE and TURP were calculated using detailed expenditure reports provided by the hospital accounts department. Total costs, including those arising from surgical and interventional procedures, consumables, personnel and accommodation, were analysed for all of the study participants and compared between PAE and TURP using descriptive analysis and two-sided t-tests, adjusted for unequal variance within groups (Welch t-test). RESULTS The mean total costs per patient (±sd) were higher for TURP, at €9137 ± 3301, than for PAE, at €8185 ± 1630. The mean difference of €952 was not statistically significant (P = 0.07). While the mean procedural costs were significantly higher for PAE (mean difference €623 [P = 0.009]), costs apart from the procedure were significantly lower for PAE, with a mean difference of €1627 (P < 0.001). Procedural costs of €1433 ± 552 for TURP were mainly incurred by anaesthesia, whereas €2590 ± 628 for medical supplies were the main cost factor for PAE. CONCLUSIONS Since in-hospital costs are similar but PAE and TURP have different efficacy and safety profiles, the patient's clinical condition and expectations - rather than finances - should be taken into account when deciding between PAE and TURP.
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Affiliation(s)
- Gautier Müllhaupt
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Lukas Hechelhammer
- Department of Radiology and Nuclear Medicine, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Daniel S Engeler
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Sabine Güsewell
- Clinical Trials Unit, St. Gallen Cantonal Hospital, St Gallen, Switzerland
| | - Patrick Betschart
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Valentin Zumstein
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Livio Mordasini
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Dominik Abt
- Department of Urology, St Gallen Cantonal Hospital, St. Gallen, Switzerland
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Robert G, de la Taille A, Descazeaud A. [Surgical treatment of BPO: Standard and innovations]. Prog Urol 2018; 28:856-867. [PMID: 30297185 DOI: 10.1016/j.purol.2018.07.287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND OBJECTIVE Surgical management of benign prostatic hyperplasia has dramatically changed in the recent years towards higher proportion of endoscopic treatment and fewer perioperative complications. Nevertheless the question of urinary and sexual quality of life after surgical treatment remains partially unresolved with a high proportion of retrograde ejaculation after conventional surgical treatments. Therefore mini-invasive alternatives to conventional surgery have been proposed. The objective of this literature review was to provide an overview of the alternatives to monopolar TURP currently available in France. MATERIAL AND METHOD A non-systematic review of the scientific literature was conducted from the PubMed database to retrieve the most relevant scientific publications. A first research was cross-referenced with the results of literature reviews already published and enriched by the authors of this review. A synthesis is proposed for each alternative technique mentioning its level of clinical development, but also its potential advantages and disadvantages compared to conventional surgical techniques. RESULTS The quality of life of patients after surgical or interventional management has become the main priority of urologists since the risks of perioperative complication have been reduced by the use of laser or bipolar endoscopic techniques. Thanks to the development of minimally invasive alternatives that are better and better evaluated by randomized trials versus interventional simulation and conventional surgical treatment, more personalized care is possible. Patients' expectations and their individual risk factors can thus be placed at the center of the therapeutic decision and the preoperative information. CONCLUSION The surgical and interventional management of LUTS due to BPH has evolved to lower perioperative morbidity with the help of numerous technological developments. Mini-invasive alternatives to standard treatment have also been proposed in order to improve the quality of postoperative sexual life. These alternatives provide significant improvement in LUTS that remains lower than after conventional treatments. Somme of these alternative are also not fully supported by clinical trials, which should urge urologists to act with caution when proposing these alternatives in daily clinical practice.
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Affiliation(s)
- G Robert
- Service d'urologie, CHU de Bordeaux, 33000 Bordeaux, France.
| | - A de la Taille
- Service d'urologique, CHU Henri Mondor, AP-HP, 94000 Créteil, France
| | - A Descazeaud
- Service d'urologie, CHU de Limoges, 87042 Limoges, France
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36
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Gury L, Robert G, Bensadoun H. [Where do we stand with benign prostatic hyperplasia day-case surgery: A laser effect?]. Prog Urol 2018; 28:509-514. [PMID: 29907496 DOI: 10.1016/j.purol.2018.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/18/2018] [Accepted: 05/15/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION AND OBJECTIVES Despite its feasibility has been proven, Benign Prostatic Hyperplasia (BPH) day-case surgery remains uncommon. Our objective was to describe the evolution of BPH day-case surgery in France according to the surgical technique employed. MATERIALS AND METHODS We extracted data from the Information System of Medicalization Program (PMSI) including all of the hospital stays in France from 2010 to 2016. Patients belonging to the transurethral prostatectomy homogeneous group of patients (GHM 12C04) and having as a main diagnosis prostatic hyperplasia (N40) or benign prostatic tumor (D291) were included in the analysis. From March 2016, specific codes were introduced to differentiate laser surgery and other types of surgery: JGFE023 (resection without laser), JGFE365 (laser resection) and JGNE171 (laser vaporization). We described the rates of day case surgery and the average length of stay from 2010 to 2016. From March 2016 we could study the influence of laser surgery on day-case and length of stay. RESULTS Regarding the all dataset analysis we found 328,781 hospital stays (318,549 patients) for BPH surgery, of which 2.7% (9047 hospital stays) were day-case. From 2010 to 2016, the lengths of stay decreased from 5.78 to 4.29 days. In the meantime, the number of day-case procedures increased from 14 patients (0.03%) to 3035 patients (5.63%). Regarding the last 9 months of 2016, we found 38,930 hospital stays including 5.4% (2104) day-cases. In total, 92.7% of day-case procedures had been performed with a laser technique, of which 47.9% (1008) were laser vaporization and 44.8% (944) were laser resection. There were only 7.1% (151.8%) of day-case procedures performed without laser. CONCLUSION The exponential development of the day-case procedures seems to be linked with the advent of laser technology. This tendency is expected to increase in the coming years according to the spreading of laser surgery. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- L Gury
- Service d'urologie, CHU de Bordeaux, université de Bordeaux, 33000 Bordeaux, France.
| | - G Robert
- Service d'urologie, CHU de Bordeaux, université de Bordeaux, 33000 Bordeaux, France
| | - H Bensadoun
- Service d'urologie, CHU de Bordeaux, université de Bordeaux, 33000 Bordeaux, France
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Netsch C, Gross AJ. Letter to the Editor: 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; 36:501-502. [PMID: 29256018 DOI: 10.1007/s00345-017-2158-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/11/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Christopher Netsch
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany.
| | - A J Gross
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
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