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Kumar N, Somani B. Monopolar Transurethral Enucleoresection of Prostate: Feasibility of Modified Nesbit's Enucleoresection with Apical Release. J Clin Med 2024; 13:1455. [PMID: 38592292 PMCID: PMC10932116 DOI: 10.3390/jcm13051455] [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: 01/29/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Transurethral resection of the prostate (TURP) has been the standard surgical treatment for Benign Hyperplasia of the Prostate (BPH) for decades. Our objective was to evaluate the outcome of our new technique: Monopolar Transurethral Enucleoresection of the Prostate (TUERP) with apical release (bring it all to centre). Methods: A prospective study of all cases undergoing TUERP at a tertiary centre from January 2020 to October 2022 was performed. Patient demographics, intraoperative variables and postoperative results along with follow-up data were collected. Data of all the cases who had completed a one-year follow-up post-surgery were included and analysed. Results: A total of 240 patients with complete data including a one-year follow-up were included. Mean prostatic volume was 55.3 ± 11.6 gm, and 28 (11.67%) cases were >100 gm. The mean operative time was 31.7 ± 7.6, and mean haemoglobin drop at 24 h was 0.73 ± 1.21 gm/dL. The overall complication rate was 16.67%, with only two (0.83%) Clavien-Dindo III complications (haematuria and clots needing evacuation) and the other complications being Clavien-Dindo I/II complications. Sustained improvement at 1 year of follow-up was noted: Qmax: 25.2 ± 5.6 mL/s, IPSS: 4.7 ± 2.5 and PVR: 22.5 ± 9.6 mL. Conclusions: Monopolar TUERP with a modified Nesbit's enucleoresection with apical release can be considered a promising technique, which needs further studies to be validated with appropriate comparisons.
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Affiliation(s)
- Nitesh Kumar
- Ford Hospital and Research Centre, Patna 800027, India;
| | - Bhaskar Somani
- University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
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El-Shaer W, Alhefnawy M, Ebrahim Y, Elshazly A, Abdel-Lateef S. Bipolar Needlescopic Enucleation Versus Bipolar Vapoenucleation of the prostate: A prospective single Centre Randomized Study. J Endourol 2022; 36:1452-1459. [PMID: 35838130 DOI: 10.1089/end.2022.0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Endoscopic enucleation of the prostate (EEP) is a safe and effective interventional option for the management of variable-sized adenomas. PURPOSE To point out the safety and efficacy of needlescopic enucleation of the prostate (BNEP) in comparison with vapoenucleation of the prostate (BVEP). MATERIALS AND METHODS This is a prospective randomized trial. In all, 214 patients with variable size adenoma were randomly assigned (1:1) to either: the BNEP group (108 patients underwent Bipolar-EEP (BEEP) using a needle electrode, or a vapoenucleation one (BVEP) group (106 patients underwent BEEP using vaporization electrodes). Intra & intergroup objective and subjective outcomes were compared at different time points for 1 year. Also, all other procedure's related events and mishaps were registered and compared. RESULTS The median (interquartile range (IQR)) operative time, resected tissue weight, postoperative irrigation time, and Hb drop were: 60 (50-88) Vs 80 (60 - 98) minutes, 67 (56 - 86) Vs 46 (40- 61) grams, 10 (8 - 12) Vs 12 (10 -18) hours, and 1 (0.6 - 1.3) Vs 1.2 (0.88 - 1.9) g/dl, for BNEP and BVEP groups, respectively, (P<0.05). Both subjective and objective parameters were analogously improved in the two groups (P> 0.5). However, the post-operative irritative symptoms and urinary infections were lower in BNEP group (P<0.05). CONCLUSIONS Our results revealed that although both BNEP and BVEP are effective and safe in the management of benign prostatic obstruction, BNEP is superior in terms of less operative time, intra-operative blood loss, irrigation time, irritative symptoms and urinary infections.
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Geng JH, Chang CK, Lee CH, Lin CH, Li CC, Wen SC, Yeh HC. Monopolar transurethral resection of the prostate versus holmium laser enucleation in men with prostate volume greater than 100 mL. UROLOGICAL SCIENCE 2022. [DOI: 10.4103/uros.uros_114_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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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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Enikeev D, Rapoport L, Gazimiev M, Allenov S, Inoyatov J, Taratkin M, Laukhtina E, Sung JM, Okhunov Z, Glybochko P. Monopolar enucleation versus transurethral resection of the prostate for small- and medium-sized (< 80 cc) benign prostate hyperplasia: a prospective analysis. World J Urol 2019; 38:167-173. [PMID: 30963229 DOI: 10.1007/s00345-019-02757-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/02/2019] [Indexed: 12/11/2022] Open
Abstract
AIM To assess efficacy and safety of monopolar enucleation of the prostate (MEP) and to compare it with the current treatment standard for medium-sized prostates, < 80 cc, transurethral resection of the prostate (TURP). METHODS A prospective analysis patients undergoing a surgical procedure for their diagnosis of BPH (benign prostatic hyperplasia) (IPSS > 20, Qmax < 10; prostate volume < 80 cc) was performed. IPSS, Qmax were assessed preoperatively, at 6 and 12 months postoperatively. The complications were classified according to the modified Clavien-Dindo grading system. RESULTS A total of 134 patients were included in the study: 70 underwent MEP and 64 - TURP for BPH (mean prostate volumes were comparable with p = 0.163). The mean surgery time was 44 min in the TURP group and 48.2 min in the MEP group, (p = 0.026). Catheterization time for MEP was 1.7 and 3.2 days for TURP (p < 0.001). Hospital stay for MEP was 3.2 days vs. 4.8 days for TURP (p < 0.001). Both techniques shown comparable efficiency in benign prostatic obstruction relief with IPSS drop in MEP from 23.1 to 5.9 and in TURP group from 22.8 to 7.3, whereas Qmax increased from 8.2 to 20.5 after MEP and from 8.3 and 19.9 after TURP. Urinary incontinence rate after catheter removal in TURP group was 9.0% and 7.8% in MEP group, at 1 year follow-up, it was 1.4% and 3.1% in MEP and TURP, respectively (p = 0.466). CONCLUSIONS Our experience demonstrated that MEP is an effective and safe BPH treatment option combining the efficacy of endoscopic enucleation techniques and accessibility of conventional TURP.
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Affiliation(s)
- Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St, Moscow, 119991, Russian Federation.
| | - Leonid Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St, Moscow, 119991, Russian Federation
| | - Magomed Gazimiev
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St, Moscow, 119991, Russian Federation
| | - Sergey Allenov
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St, Moscow, 119991, Russian Federation
| | - Jasur Inoyatov
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St, Moscow, 119991, Russian Federation
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St, Moscow, 119991, Russian Federation
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St, Moscow, 119991, Russian Federation
| | - John M Sung
- Department of Urology, University of California, Irvine, USA
| | | | - Petr Glybochko
- Institute for Urology and Reproductive Health, Sechenov University, 2/1 Bolshaya Pirogovskaya St, Moscow, 119991, Russian Federation
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Bai F, Feng S, Xu C, Xu Z, Chen J, Zheng Y. Transurethral resection versus holmium laser enucleation of the prostate: A prospective randomized trial comparing perioperative thrombin generation and fibrinolysis. Medicine (Baltimore) 2019; 98:e15223. [PMID: 30985725 PMCID: PMC6485898 DOI: 10.1097/md.0000000000015223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/11/2019] [Accepted: 03/20/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The purpose of this study was to compare transurethral resection of the prostate (TURP) versus holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH) focusing on perioperative thrombin generation and fibrinolysis. METHODS Sixty-five BPH patients were prospectively randomly assigned to undergo TURP (n = 32) or HoLEP (n = 33). The prothrombin fragment (PF) 1+2, thrombin-antithrombin complex (TAT), tissue plasminogen activator (t-PA), and plasminogen activator inhibitor-1 (PAI-1) were measured preoperatively, at the 1st day and 3rd day after surgery. RESULTS PF1+2, TAT, t-PA, and PAI-1 significantly elevated at day 1 and day 3 after surgery (P < .05) and remarkedly decreased from the 1st day to the 3rd day (P < .05). The levels of PF1+2 and TAT were higher in TURP group postoperatively than that in HoLEP group (P < .05). There is no significant difference between 2 groups in regard of t-PA and PAI-1 (P > .05). CONCLUSION The activation of thrombin generation and fibrinolysis system were noticed in BPH patients after TURP or HoLEP. TURP may associate with a higher hypercoagulable thrombotic risk than HoLEP.
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Affiliation(s)
- Fuding Bai
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine
| | - Sheng Feng
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310009, Zhejiang, China
| | - Congcong Xu
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine
| | - Zhen Xu
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine
| | - Jijun Chen
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine
| | - Yichun Zheng
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine
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