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Bulut EC, Elmas B, Koparal MY, Coşkun Ç, Aydın U, Erten KŞ, Çetin S, Alishov S, Atan A, Yeşil S, Küpeli B. A Comparison of the First 60 Enucleation Cases Using a Thulium Fiber Laser without a Mentor to a Transurethral Resection of the Prostate (TURP) and Open Prostatectomy, and the Learning Curve. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1356. [PMID: 39202637 PMCID: PMC11356040 DOI: 10.3390/medicina60081356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/13/2024] [Accepted: 08/19/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: In the surgical treatment of benign prostatic hyperplasia (BPH), laser enucleation of the prostate is recommended as an alternative to transurethral resection (TURP) and open prostatectomy (OP). The thulium fiber laser, with its superficial penetration depth, can offer a rapid learning process by causing less heat injury and capsule damage. This study compares the first 60 cases of an endourologist performing thulium fiber enucleation of the prostate (ThuFLEP) without a mentor to the results of OP and TURP performed by experienced surgeons. It also identifies the case number at which the operation time for ThuFLEP starts to plateau. Materials and Methods: Between 1 November 2021 and 1 November 2023, the initial 60 ThuFLEP cases of an endourologist with no prior enucleation experience were compared with TURP and OP operations performed by experienced surgeons. Since the first 60 ThuFLEP cases involved 80-120 cc prostates, TURP and OP operations within this size range performed during the same period were included in the study. The groups were assessed for age, preoperative and postoperative prostate volume, PSA levels, the IPSS, the IPSS Quality of Life (QoL), and maximum urinary flow (Qmax). The 60 consecutive ThuFLEP cases were divided into three groups of 20 (Groups 1, 2, and 3) and compared for operation time, IPSS, and Qmax. Results: The operation time for TURP was shorter than for ThuFLEP and OP (p < 0.001). There was no significant difference between ThuFLEP and OP in postoperative Qmax and IPSS, while TURP had lower values than the other two methods. For ThuFLEP, the operation time was longer in the first 20 cases but plateaued in groups 2 and 3 (p < 0.001). Postoperative Qmax and IPSS values showed no significant differences among the three ThuFLEP groups (p > 0.05). Conclusions: For large prostates, ThuFLEP provides better postoperative results than TURP and offers shorter catheterization and hospital stay times than OP. Its short learning curve makes it a preferable method for treating BPH compared to other laser techniques.
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Affiliation(s)
- Ender Cem Bulut
- Urology Department, School of Medicine, Gazi University, Ankara 06560, Türkiye; (B.E.); (M.Y.K.); (K.Ş.E.); (S.Ç.); (A.A.); (S.Y.); (B.K.)
| | - Burak Elmas
- Urology Department, School of Medicine, Gazi University, Ankara 06560, Türkiye; (B.E.); (M.Y.K.); (K.Ş.E.); (S.Ç.); (A.A.); (S.Y.); (B.K.)
| | - Murat Yavuz Koparal
- Urology Department, School of Medicine, Gazi University, Ankara 06560, Türkiye; (B.E.); (M.Y.K.); (K.Ş.E.); (S.Ç.); (A.A.); (S.Y.); (B.K.)
| | - Çağrı Coşkun
- Urology Department, Ağrı Training and Research Hospital, Ağrı 04200, Türkiye; (Ç.C.); (U.A.)
| | - Uğur Aydın
- Urology Department, Ağrı Training and Research Hospital, Ağrı 04200, Türkiye; (Ç.C.); (U.A.)
| | - Kadir Şerefhan Erten
- Urology Department, School of Medicine, Gazi University, Ankara 06560, Türkiye; (B.E.); (M.Y.K.); (K.Ş.E.); (S.Ç.); (A.A.); (S.Y.); (B.K.)
| | - Serhat Çetin
- Urology Department, School of Medicine, Gazi University, Ankara 06560, Türkiye; (B.E.); (M.Y.K.); (K.Ş.E.); (S.Ç.); (A.A.); (S.Y.); (B.K.)
| | - Sabuhi Alishov
- Urology Department, Parkhayat Kütahya Hospital, Kütahya 43020, Türkiye;
| | - Ali Atan
- Urology Department, School of Medicine, Gazi University, Ankara 06560, Türkiye; (B.E.); (M.Y.K.); (K.Ş.E.); (S.Ç.); (A.A.); (S.Y.); (B.K.)
| | - Süleyman Yeşil
- Urology Department, School of Medicine, Gazi University, Ankara 06560, Türkiye; (B.E.); (M.Y.K.); (K.Ş.E.); (S.Ç.); (A.A.); (S.Y.); (B.K.)
| | - Bora Küpeli
- Urology Department, School of Medicine, Gazi University, Ankara 06560, Türkiye; (B.E.); (M.Y.K.); (K.Ş.E.); (S.Ç.); (A.A.); (S.Y.); (B.K.)
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Al Barajraji M, Moussa I, Soscia GL, Naudin M, Lempereur L, Coscarella M. Evaluation of the learning curve for Thulium fiber laser enucleation of prostate (ThuFLEP): retrospective study of a single-surgeon experience in real-world settings. World J Urol 2024; 42:444. [PMID: 39060790 DOI: 10.1007/s00345-024-05167-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
PURPOSE To assess the learning curve of Thulium Fiber Laser Enucleation of prostate (ThuFLEP) of a single surgeon inexperienced in laser endoscopic enucleation of prostate (EEP). METHODS We retrospectively analyzed all patients with benign prostate hyperplasia undergoing ThuFLEP at our center between January 2022 and August 2023 by one surgeon. Inclusion criteria were International Prostate Symptom Score > 7, prostate volume < 200 g, and maximal urinary flow rate < 15 mL/s. The surgeon was inexperienced in laser EEP and trained by watching educational videos of ThuFLEP before starting to perform the procedure under mentoring during the first 4 cases. Procedural data (enucleation and morcellation efficiency, complications) and functional results up to 3 months were evaluated. Patients were divided into 4 cohorts of 20 consecutive cases to evaluate outcomes evolution throughout time. RESULTS The mean age of the patients was 69.9 years (SD 7.8) and mean prostate volume was 89.9 g (SD 25.8). Preoperative functional parameters were comparable between the groups. Mean enucleation efficiency (EE) ratio and morcellation efficiency (ME) ratio reached respectively 0.78 g/min (SD 0.55) and 2.49 g/min (SD 1.03) and both variables significantly increased from group 1 to group 3 (p < 0,001). Perioperative complications remained low throughout the caseload with similar significant 3-month functional improvements between all groups. CONCLUSION This is the first study to evaluate ThuFLEP learning curve for a single surgeon inexperienced in laser EEP with limited mentoring. Under these real-world conditions, nearly 60 cases were needed to complete the learning curve with a complications rate remaining low throughout the training process.
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Affiliation(s)
- Moncef Al Barajraji
- Department of Urology, CHU Ambroise Paré Hospital, Université Libre de Bruxelles, 808, Route de Lennik Bruxelles, Mons, 1070, Belgium.
| | - Ilan Moussa
- Department of Urology, CHU Ambroise Paré Hospital, Université Libre de Bruxelles, 808, Route de Lennik Bruxelles, Mons, 1070, Belgium
| | - Gian-Luca Soscia
- Department of Urology, CHU Ambroise Paré Hospital, Université Libre de Bruxelles, 808, Route de Lennik Bruxelles, Mons, 1070, Belgium
| | - Michel Naudin
- Department of Urology, CHU Ambroise Paré Hospital, Université Libre de Bruxelles, 808, Route de Lennik Bruxelles, Mons, 1070, Belgium
| | - Louise Lempereur
- Department of Urology, CHU Ambroise Paré Hospital, Université Libre de Bruxelles, 808, Route de Lennik Bruxelles, Mons, 1070, Belgium
| | - Mathieu Coscarella
- Department of Urology, CHU Ambroise Paré Hospital, Université Libre de Bruxelles, 808, Route de Lennik Bruxelles, Mons, 1070, Belgium
- Department of Urology, Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre Bruxelles, Brussels, Belgium
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Chen YY, Hua WX, Huang YH, Shen XY, You JN, Ding X. The safety and efficacy of five surgical treatments in prostate enucleation: a network meta-analysis. BMC Urol 2024; 24:128. [PMID: 38886739 PMCID: PMC11181543 DOI: 10.1186/s12894-024-01517-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
PURPOSE The aim of our study was to investigate the comparative outcomes of five different energy types on surgical efficacy and postoperative recovery in patients with benign prostate hyperplasia. METHODS The literature was systematically reviewed on December 1st, 2023, encompassing studies retrieved from PubMed, Embase, Web of Science, and The Cochrane Library databases that incorporated clinical studies of holmium laser enucleation of the prostate (HoLEP), Thulium:YAG laser enucleation of the prostate (ThuLEP), transurethral plasmakinetic enucleation of prostate (PKEP), diode laser enucleation of the prostate (DiLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP) in the treatment of prostatic hyperplasia. Two independent reviewers extracted study data and conducted quality assessments using the Cochrane Collaboration's Risk of Bias tool and Newcastle-Ottawa Scale (NOS). Network meta-analysis (NMA) was employed to indirectly analyze the outcomes of endoscopic enucleation of the prostate (EEP) techniques. RESULTS The study included a total of 38 studies, comprising 21 non-randomized controlled trials (nRCTs) and 17 randomized controlled trials (RCTs), incorporating five distinct techniques: holmium laser, Thulium:YAG laser, bipolar plasma, diode laser and thulium fiber laser. In comparing treatment durations, ThuLEP and HoLEP had shorter overall hospital stays than PKEP, while the enucleation time of ThuLEP and HoLEP was shorter than that of ThuFLEP. Moreover, the enucleation tissue weight of both thulium fiber laser and holmium laser was heavier than bipolar plasma. However, the analysis did not reveal any statistically significant variation in complications among the various types of enucleation. In postoperative follow-up, the IPSS at 3 months post-operation was superior in the Thulium:YAG laser group compared to the holmium laser group. The thulium fiber laser technique demonstrated significant advantages over other enucleation methods in terms of QoL and PVR at 12 months after surgery. CONCLUSION Theoretical properties may vary among different energy sources; however, there are no discernible clinical differences in operation-related parameters, postoperative complications, and postoperative follow-up. Therefore, the choice of laser does not significantly impact the outcome. However, due to the limited number of included studies, future research should focus on larger sample sizes and multicenter investigations to further validate the findings of this study.
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Affiliation(s)
- Yun-Yi Chen
- Department of Urinary Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
| | - Wen-Xi Hua
- Department of Hematopathology, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, China
| | - Yu-Hua Huang
- Department of Urinary Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
| | - Xin-Yu Shen
- Department of Urinary Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
| | - Jia-Nan You
- Department of Urinary Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
| | - Xiang Ding
- Department of Urinary Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China.
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Aybal HC, Yilmaz M, Barlas IS, Duvarci M, Tuncel A, Tunc L. Comparison of HoLEP, ThuLEP and ThuFLEP in the treatment of benign prostatic obstruction: a propensity score-matched analysis. World J Urol 2024; 42:374. [PMID: 38871959 DOI: 10.1007/s00345-024-05082-2] [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: 03/30/2024] [Accepted: 05/23/2024] [Indexed: 06/15/2024] Open
Abstract
PURPOSE To compare the efficacy and safety of Holmium laser enucleation of the prostate (HoLEP), Thulium laser enucleation of prostate (ThuLEP) and Thulium fibre laser enucleation of prostate (ThuFLEP) by performing propensity score matched analysis (PSM). METHODS We retrospectively analysed the patients who underwent HoLEP (Group 1, n = 696), ThuLEP (Group 2, n = 146) and ThuFLEP (Group 3, n = 193) surgery because of benign prostatic obstruction (BPO). A 1:1:1 HoLEP: ThuLEP: ThuFLEP group matching was performed using PSM analysis. Perioperative, postoperative functional outcomes and complications were analysed and compared. RESULTS We observed significant improvement in functional parameters regarding IPSS, Qmax, PVR and quality of life in all groups compared to baseline values at the 1st, 6th and 12th postoperative months. There was no significant difference between different laser types in terms of urge (UUI) and stress urinary incontinence (SUI) at 1st postoperative month. In all three groups, no patient had postoperative SUI or UUI at 6th and 12th postoperative months. In addition, no significant difference was observed between laser types in terms of postoperative complications. CONCLUSION HoLEP, ThuLEP and ThuFLEP are safe and effective LEP methods with improvement in functional parameters and low complication rates. Similar results in terms of functional outcomes and complications clearly show that these surgeries are alternatives to each other for the patients with BPO. Experts' opinions, practices and enucleation techniques should also be taken into consideration when choosing a laser for BPO surgery.
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Affiliation(s)
| | - Mehmet Yilmaz
- Department of Urology, SLK Kliniken Heilbronn, Heilbronn, Germany.
| | - Irfan Safak Barlas
- Department of Urology, Acıbadem University Ankara Hospital, Ankara, Turkey
| | - Mehmet Duvarci
- Department of Urology, University of Health Sciences, Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Altug Tuncel
- Ankara Bilkent City Hospital, Department of Urology, University of Health Sciences, Ankara, Turkey
| | - Lutfi Tunc
- Department of Urology, Acıbadem University Ankara Hospital, Ankara, Turkey
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Spinos T, Tatanis V, Peteinaris A, Somani B, Kartalas Goumas I, Liatsikos E, Kallidonis P. Thulium fiber laser enucleation of the prostate: a systematic review of the current outcomes. Minerva Urol Nephrol 2024; 76:157-165. [PMID: 38742551 DOI: 10.23736/s2724-6051.24.05654-4] [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: 05/16/2024]
Abstract
INTRODUCTION One recent addition to different lasers used for endoscopic enucleation of the prostate is the thulium fiber laser (TFL). The purpose of this systematic review is to present the feasibility, safety and efficacy of TFL Enucleation of the Prostate (ThuFLEP). EVIDENCE ACQUISITION PubMed®, Scopus® and Cochrane® primary databases were systematically screened. The search strategy used the PICO (Patients, Intervention, Comparison, Outcome) criteria. Patients should be adults with benign prostatic obstruction (BPO) undergoing ThuFLEP. While comparative studies reporting comparison of ThuFLEP to other BPO treatments were included, cohort studies with no comparison group were also accepted. Outcomes including enucleation time and complication rates were reported. EVIDENCE SYNTHESIS Twelve studies met all the predefined criteria and were included in the final qualitative synthesis. Mean operative time and enucleation time ranged from 46.6±10.2 to 104.5±33.6 and from 38.8±17.9 to 66.0±24.9 minutes, respectively. Most of the complications were Grade I or Grade II ones. Although TFL was found to present some advantages over older BPO treatments, its outcomes were comparable with other endoscopic enucleation approaches. CONCLUSIONS ThuFLEP seems to be a feasible, safe and efficient approach for BPO symptoms management. Limited evidence showed that although ThuFLEP was associated with a reduced total operative time, it was also associated with worse IPSS improvement at 1-year follow-up, when compared with MOSESTM Holmium Laser Enucleation of the Prostate (HoLEP). These findings confirm the well-established opinion that the enucleation technique itself is more important than the technology which is used.
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Affiliation(s)
- Theodoros Spinos
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - Vasileios Tatanis
- Department of Urology, University Hospital of Patras, Patras, Greece
| | | | - Bhaskar Somani
- Department of Urology, University Hospital of Southampton, Southampton, UK
| | | | - Evangelos Liatsikos
- Department of Urology, University Hospital of Patras, Patras, Greece
- Department of Urology, Medical University of Vienna, Vienna, Austria
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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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Enikeev D, Taratkin M. Thulium Fiber Laser: Bringing Lasers to a Whole New Level. EUR UROL SUPPL 2022; 48:31-33. [PMID: 36588770 PMCID: PMC9795521 DOI: 10.1016/j.euros.2022.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Dmitry Enikeev
- Department of Urology, Medical University of Vienna, Vienna, Austria,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia,Corresponding author. Department of Urology, Medical University of Vienna, Vienna, Austria. Tel. +7 925 5177926.
| | - Mark Taratkin
- Department of Urology, Medical University of Vienna, Vienna, Austria
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Opportunities of using oral intraluminal laser lithotripsy for a large calculus of the common bile duct (clinical report). BIOMEDICAL PHOTONICS 2022. [DOI: 10.24931/2413-9432-2022-11-2-33-38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Doizi S. Lasers for benign prostatic hyperplasia (hybrid, blue diode, TFL, Moses). Which one to choose? Curr Opin Urol 2022; 32:438-442. [PMID: 35674689 DOI: 10.1097/mou.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To present the evidence of latest developments of lasers for the surgical treatment of benign prostatic hyperplasia (BPH). We focused on recent advancements in Ho:YAG laser such as Moses technology, the Thulium Fiber Laser (TFL), the blue diode laser, and hybrid laser. RECENT FINDINGS Laser enucleation of prostate techniques using either Ho:YAG laser with the Moses technology and Moses 2.0, or TFL seem efficient and safe compared with the standard enucleation using Ho:YAG laser. Only in vitro studies evaluated the blue diode laser and hybrid laser (combination of a continuous wave TFL and blue diode laser). Blue diode laser showed intermediate incision depth and minimal coagulation depth compared with Ho:YAG laser and Super Pulse TFL. Hybrid laser showed deep incision depth and small coagulation area compared with Ho:YAG laser and continuous wave TFL. SUMMARY Surgical treatment of BPH using Moses technology, Moses 2.0, and TFL shows encouraging results comparable to the standard enucleation using Ho:YAG laser. Only in vitro data are currently available for blue diode laser and hybrid laser. Future well-designed studies comparing these technologies and evaluating them on specific risk groups of patients as well as the long-term durability of outcomes are needed.
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Affiliation(s)
- Steeve Doizi
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire.,Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, Paris, France
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10
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Randomized prospective trial of the severity of irritative symptoms after HoLEP vs ThuFLEP. World J Urol 2022; 40:2047-2053. [PMID: 35690952 DOI: 10.1007/s00345-022-04046-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/06/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To compare the short-term postoperative functional outcomes and severity of irritative symptoms following holmium and thulium fiber laser enucleation (HoLEP and ThuFLEP). METHODS This prospective randomized single-blinded study was performed in accordance with CONSORT. The inclusion criteria were IPSS > 20 or Qmax < 10 ml/s. Patients were randomized between HoLEP and ThuFLEP. Demographics, objective data (PSA, prostate volume, etc.), data on urinary and sexual function (IPSS, IIEF, QoL, QUID, Qmax, ICIQ-MLUTS) were collected. Detailed perioperative information and postoperative data on functional outcomes at 1, 2, 3, 4, 6, 8, 10, 12 weeks and 6 months were collected. RESULTS Data on 163 participants were included (77-HoLEP, 86-ThuFLEP). No differences were found in surgery duration; number of postoperative complications (Clavien-Dindo I-III), catheterization time and hospital stay. Functional outcomes up to 6 months didn't differ between the groups (IPPS, IIEF, QoL, QUID, ICIQ-MLUTS, Qmax, p > 0.05). Total ICIQ-MLUTS, bother and voiding scores at 1 and 3 months significantly increased compared with the baseline in both groups (p < 0.05). No difference between the groups were observed. In HoLEP the SUI series rate was 1.3% and 1.3% after 3 and 6 months following the procedure; in ThuFLEP: it was 3.5% and 2.3% respectively (p = 0.35 and p = 0.54). CONCLUSION The preliminary results of the study showed no apparent differences in functional outcomes (IPSS, Qmax), rate of SUI or irritative symptoms. Both ThuFLEP and HoLEP are efficient ways of treating benign prostatic obstruction. Both surgeries are comparable in terms of duration and postoperative complication rates.
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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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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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Meng C, Peng L, Li J, Li J, Li Y, Yang J, Wu J. Comparison of enucleation between thulium laser and holmium laser for benign prostatic hyperplasia: A systematic review and meta-analysis. Asian J Surg 2021; 45:689-697. [PMID: 34384678 DOI: 10.1016/j.asjsur.2021.07.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/24/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
To compare the clinical efficacy and safety of Thulium laser enucleation of prostate (ThuLEP) and Holmium laser enucleation of prostate (HoLEP). We systematically searched PubMed, Embase, and Cochrane Library databases within a period from the date of database establishment to October 2020. RevMan 5.4. was used for calculation and statistical analyses. 8 studies of 2125 patients were included. ThuLEP provided less hemoglobin decrease (MD: -0.37, 95%CI -0.61 to -0.14, P = 0.002) and shorter length of hospital stay (MD: -0.41, 95%CI -0.72 to -0.10, P = 0.01). During the postoperative follow-ups, statistically significant differences only were found in IPSS (MD: -0.96; 95%CI -1.27 to -0.65; P < 0.00001) at the 3rd month. In conclusion, our study demonstrates that ThuLEP, compared with HoLEP, has better security, faster improvement of symptoms. However, our conclusions still require a larger sample size, multi-center, and longer follow-up randomized controlled trials to verify.
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Affiliation(s)
- Chunyang Meng
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
| | - Lei Peng
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
| | - Jinze Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
| | - Jinming Li
- Department of Urology, The Affiliated Hospital of Medical College, North Sichuan Medical College(University), Sichuan, 637000, China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China.
| | - Junbao Yang
- Department of medical genetics and cell biology, North Sichuan Medical College, Nanchong, 63700, Sichuan, China.
| | - Ji Wu
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, China
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Maruccia S, Fulgheri I, Montanari E, Casellato S, Boeri L. Nomenclature in thulium laser treatment of benign prostatic hyperplasia: it's time to pull the rabbit out of the hat. Lasers Med Sci 2021; 36:1355-1367. [PMID: 33389305 DOI: 10.1007/s10103-020-03227-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022]
Abstract
We performed a narrative review with the focus on laser settings and surgical procedure with thulium laser. Our primary goal was to define the most valid settings of each surgical procedure to overcome the inconsistency about nomenclature of thulium surgery and to ensure comparability of future publications. A literature search of articles on thulium laser treatment of benign prostatic hyperplasia (BPH) was conducted between 2009 and 2019. We proposed a new classification standard for laser settings and associated surgical procedure. Each article was analyzed and categorized as concordant or discordant referring to the new classification. In total, 74 papers were included in this narrative review. Overall, 43% and 42% of included studies reported discordant laser parameters and surgical description, respectively. Most of the studies on vaporization were categorized as discordant because they reported a medium/low laser setting instead of high power. Conversely, 93.3% of studies on enucleation were deemed as discordant for laser setting because they reported high power parameters instead of medium-low power setting. Most of the studies on laser enucleation and vapo/enucleation were considered discordant for surgical procedure since authors did not mention the use of mechanical vs. laser method for enucleation. The current literature lacks a uniform definition and standardization of the terminology of thulium laser settings and surgical techniques to guarantee comparability between different approaches. We found a huge heterogeneity in 10 years of surgery with thulium laser. We proposed a new classification of laser setting and procedural description for categorization of thulium laser surgery for BPH.
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Affiliation(s)
- Serena Maruccia
- Department of Urology, Istituti Clinici Zucchi, Monza, Italy
| | - Irene Fulgheri
- Department of Pharmacy, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | | | - Luca Boeri
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.
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Higazy A, Tawfeek AM, Abdalla HM, Shorbagy AA, Mousa W, Radwan AI. Holmium laser enucleation of the prostate versus bipolar transurethral enucleation of the prostate in management of benign prostatic hyperplasia: A randomized controlled trial. Int J Urol 2020; 28:333-338. [PMID: 33327043 DOI: 10.1111/iju.14462] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the safety, efficacy and cost-effectiveness of holmium enucleation of the prostate and bipolar transurethral enucleation of the prostate. METHODS In our randomized controlled trial, 120 patients were allocated into two equal groups representing holmium enucleation of the prostate and bipolar enucleation of the prostate. Operative parameters were recorded according to operative, enucleation and resection time in addition to the intraoperative complications. Patients were followed up at 1, 3 and 12 months postoperative to assess the prostate size, post-voiding residual urine, International Prostate Symptom Score, peak urine flow rate and quality of life, and compared with the preoperative parameters. Cost analysis was evaluated for both procedures. RESULTS We evaluated 107 patients who finished our follow up and their data were analyzed. The prostate size was 135.2 ± 34.8 mL and 125 ± 26.9 mL for holmium enucleation of the prostate and bipolar enucleation of the prostate, respectively. Holmium enucleation of the prostate was associated with a shorter operative time of 83.43 ± 6.92 min compared with 94.7 ± 12.2 min in bipolar enucleation of the prostate groups. Holmium enucleation of the prostate was associated with an earlier catheter removal time and shorter hospital stay compared with bipolar enucleation of the prostate. Postoperative International Prostate Symptom Score, quality of life, post-voiding residual urine, peak urine flow rate, prostate-specific antigen and prostate volume reduction were comparable between both groups, and they both showed statistically significant improvement compared with their preoperative parameters. In the cost analysis, holmium enucleation of the prostate was more cost-effective than bipolar enucleation of the prostate. CONCLUSION Both holmium enucleation of the prostate and bipolar enucleation of the prostate are safe and effective in the surgical management of large prostatic adenomas. Holmium enucleation of the prostate has a shorter operative time and hospital stay with earlier catheter removal time, and is more cost-effective than bipolar enucleation of the prostate.
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Taratkin M, Kovalenko A, Laukhtina E, Paramonova N, Spivak L, Wachtendorf LJ, Eminovic S, Afyouni AS, Okhunov Z, Karagezyan M, Mikhailov V, Strakhov Y, Herrmann TR, Enikeev D. Ex vivo study of Ho:YAG and thulium fiber lasers for soft tissue surgery: which laser for which case? Lasers Med Sci 2020; 37:149-154. [PMID: 33175250 DOI: 10.1007/s10103-020-03189-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/04/2020] [Indexed: 12/11/2022]
Abstract
The goal of this study was to assess the ablation, coagulation, and carbonization characteristics of the holmium:YAG (Ho:YAG) laser and thulium fiber lasers (TFL). The Ho:YAG laser (100 W av.power), the quasi-continuous (QCW) TFL (120 W av.power), and the SuperPulsed (SP) TFL (50 W av.power) were compared on a non-frozen porcine kidney. To control the cutting speed (2 or 5 mm/s), an XY translation stage was used. The Ho:YAG was tested using E = 1.5 J and Pav = 40 W or Pav = 70 W settings. The TFL was tested using E = 1.5 J and Pav = 30 W or Pav = 60 W settings. After ex vivo incision, histological analysis was performed in order to estimate thermal damage. At 40 W, the Ho:YAG displayed a shallower cutting at 2 and 5 mm/s (1.1 ± 0.2 mm and 0.5 ± 0.2 mm, respectively) with virtually zero coagulation. While at 70 W, the minimal coagulation depth measured 0.1 ± 0.1 mm. The incisions demonstrated zero carbonization. Both the QCW and SP TFL did show effective cutting at all speeds (2.1 ± 0.2 mm and 1.3 ± 0.2 mm, respectively, at 30 W) with prominent coagulation (0.6 ± 0.1 mm and 0.4 ± 0.1 mm, respectively, at 70 W) and carbonization. Our study introduced the TFL as a novel efficient alternative for soft tissue surgery to the Ho:YAG laser. The SP TFL offers a Ho:YAG-like incision, while QCW TFL allows for fast, deep, and precise cutting with increased carbonization.
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Affiliation(s)
- Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
| | - Anastasia Kovalenko
- NTO "IRE-Polus", One Vvedenskogo Sq, Fryazino, Moscow Region, Russia, 141120
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Nina Paramonova
- Centralized Pathology Department, Sechenov University, Moscow, Russia
| | - Leonid Spivak
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Semil Eminovic
- Faculty of Medicine, Philipps University Marburg, Marburg, Germany
| | | | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, CA, USA
| | - Marina Karagezyan
- Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia
| | - Vasily Mikhailov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Yuriy Strakhov
- Centralized Pathology Department, Sechenov University, Moscow, Russia
| | - Thomas Rw Herrmann
- Department of Urology, Spital Thurgau AG, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Enikeev D, Taratkin M, Morozov A, Singla N, Gabdulina S, Tarasov A, Sukhanov R, Rivas JG, Laukhtina E, Arshiev M, Mikhailov V, Glybochko P. Long-Term Outcomes of Holmium Laser Enucleation of the Prostate: A 5-Year Single-Center Experience. J Endourol 2020; 34:1055-1063. [DOI: 10.1089/end.2020.0347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Svetlana Gabdulina
- Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia
| | - Alexander Tarasov
- Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia
| | - Roman Sukhanov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Juan Gomez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Vasiliy Mikhailov
- 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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Taratkin M, Netsch C, Enikeev D, Gross AJ, Herrmann TRW, Korolev D, Laukhtina E, Glybochko P, Becker B. The impact of the laser fiber-tissue distance on histological parameters in a porcine kidney model. World J Urol 2020; 39:1607-1612. [PMID: 32607593 DOI: 10.1007/s00345-020-03326-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 06/22/2020] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To evaluate the impact of the fiber-tissue distance on histological parameters in a porcine kidney model. METHODS Four lasers were tested at 60 W using a 600-µm bare-ended fiber: a continuous wave (cw) thulium fiber laser (TFL), a super pulsed (SP) TFL, a Ho:YAG laser, and a blue diode laser (BDL). All tissue samples were mounted on a motorized XY-translation stage. The fiber-tissue distance was changed within a range from 0to 6 mm. Ten incisions were made with each laser at each distance. Afterwards, the tissue samples were sliced with a microtome for lactate dehydrogenase staining to determine zones of thermal damage. RESULTS In contact mode, the largest incision depth was found for the cw TFL (1.7 ± 0.1 mm) compared to the SP TFL (1.0 ± 0.1 mm), BDL (0.9 ± 0.1 mm) and HoYAG laser (1.1 ± 0.1 mm), respectively. With regard to the coagulative properties, the SP TFL and the Ho:YAG laser showed comparable coagulation depths with 0.7 ± 0.1 and 0.6 ± 0.1 mm, respectively. At 2 mm fiber-tissue distance, the Ho:YAG laser was the only laser that vaporized tissue (incision depth: 0.2 ± 0.1 mm). The BDL was the only laser that caused coagulation at a distance of 3-5 mm. CONCLUSION Our results support the clinical observation that cw TFL must be defocused for best coagulation, while the coagulation depth of the SP TFL remains nearly constant within the range of 0-3 mm. Increasing the distance of the laser fiber to the tissue up to 5 mm did not cause significant differences with regard to coagulation depth using the BDL.
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Affiliation(s)
- Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Christopher Netsch
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Andreas J Gross
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany
| | | | - Dmitry Korolev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Petr Glybochko
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Benedikt Becker
- Department of Urology, Asklepios Hospital Barmbek, Rübenkamp 220, 22291, Hamburg, Germany.
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Castellani D, Pirola GM, Pacchetti A, Saredi G, Dellabella M. State of the Art of Thulium Laser Enucleation and Vapoenucleation of the Prostate: A Systematic Review. Urology 2020; 136:19-34. [DOI: 10.1016/j.urology.2019.10.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023]
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21
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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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En bloc and two-lobe techniques for laser endoscopic enucleation of the prostate: retrospective comparative analysis of peri- and postoperative outcomes. Int Urol Nephrol 2019; 51:1969-1974. [PMID: 31432393 DOI: 10.1007/s11255-019-02259-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Various techniques can be used for endoscopic enucleation of the prostate (EEP): removal of all nodes as a single unit (en bloc) or a step-by-step removal of adenomatous nodes (two- and three-lobe techniques). The objective of this study was to perform a comparative analysis of en bloc and two-lobe techniques for holmium laser enucleation of the prostate (HoLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP). METHODS Retrospective assessment included patients with bladder outlet obstruction (IPSS > 20, Qmax < 10) secondary to BPH treated from January 2013 to December 2018. All the patients were assessed prior to surgery, as well as at 1, 3 and 6 months after surgery. RESULTS The data of 1115 patients who underwent HoLEP or ThuFLEP were analyzed. Two techniques were used: en bloc (406 patients) and two-lobe (709 patients). Mean prostate volumes were comparable between groups. Mean surgery times (68.8 ± 30.6 min vs 67.4 ± 30.1 min; p = 0.604) and enucleation rates (1.9 ± 0.74 g/min vs 1.9 ± 0.69 g/min; p = 0.217) were also comparable. Morcellation rate was lower in en bloc patients with prostate > 150 cc (2.8 ± 1.1 g/min vs 3.7 ± 2.3 g/min; p < 0.001). At 6 months, no differences in functional outcomes (IPSS, PVR, Qmax and QoL) were found. CONCLUSIONS Outcomes and complication rates of en bloc and two-lobe EEP techniques were comparable. En bloc technique was found to have less favorable outcomes in morcellation rate for prostates > 150 cc. The choice of the technique should depend on surgeon's preferences.
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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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Xiao KW, Zhou L, He Q, Gao XS, Chen G, Ma YC, Li H, Wang KJ. Enucleation of the prostate for benign prostatic hyperplasia thulium laser versus holmium laser: a systematic review and meta-analysis. Lasers Med Sci 2019; 34:815-826. [PMID: 30604345 DOI: 10.1007/s10103-018-02697-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/23/2018] [Indexed: 02/05/2023]
Abstract
To evaluate the clinical efficacy and safety of thulium laser vapoenucleation/enucleation of the prostate (ThuEP) versus holmium laser enucleation of the prostate (HoLEP) in the management of benign prostatic hyperplasia (BPH). A systematic literature search was performed using PubMed, Embase, and Web of Science to identify eligible studies published before July 2018. Meta-analysis of extracted data was performed with RevMan version 5.3. We chose the fixed- or random-effect model to fit the pooled heterogeneity. Five eligible studies including two randomized controlled trials (RCTs) and three non-RCTs involving 1010 patients were enrolled in our meta-analysis. ThuEP provided less enucleation time when compared with HoLEP (WMD = - 7.73, 95% CI - 14.39-1.07, P = 0.02). During the 1st, 6th, and 12th months of postoperative follow-ups, statistically significant differences were found in Qmax (WMD = 2.05, 95% CI 0.52~3.58) and PVR (WMD = - 6.50, 95% CI - 7.35~- 5.66, P < 0.001) in the 1st month after the operation, also in IPSS (IPSS: WMD = - 1.29, 95% CI - 2.39~- 0.19, P = 0.02) in the 12th month after the operation. As regards other perioperative, postoperative parameters, and complication rates, we found no significant difference. Both ThuEP and HoLEP provided satisfactory micturition improvement with low morbidity after the 1st and 6th months of the operation. However, ThuEP showed higher enucleation efficacy and less intraoperative blood loss and may get a better outcome as compared to the HoLEP group in the early postoperative period with regard to Qmax/PVR and IPSS after the 1st and 12th months of the operation respectively.
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Affiliation(s)
- Kai-Wen Xiao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Liang Zhou
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Qing He
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Xiao-Shuai Gao
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Guo Chen
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Yu-Cheng Ma
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Hong Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Kun-Jie Wang
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China.
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Enikeev D, Okhunov Z, Rapoport L, Taratkin M, Enikeev M, Snurnitsyna O, Capretz T, Inoyatov J, Glybochko P. Novel Thulium Fiber Laser for Enucleation of Prostate: A Retrospective Comparison with Open Simple Prostatectomy. J Endourol 2019; 33:16-21. [DOI: 10.1089/end.2018.0791] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dmitry Enikeev
- Institute of Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine, California
| | - Leonid Rapoport
- Institute of Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mark Taratkin
- Institute of Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mikhail Enikeev
- Institute of Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Olesya Snurnitsyna
- Institute of Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Taylor Capretz
- Department of Urology, University of California, Irvine, California
| | - Jasur Inoyatov
- Institute of Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Petr Glybochko
- Institute of Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Need for upper urinary tract stenting in cases of ureteral orifice injury during laser enucleation of the prostate. Int Urol Nephrol 2018; 50:2173-2177. [DOI: 10.1007/s11255-018-2007-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/08/2018] [Indexed: 10/28/2022]
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Enikeev D, Glybochko P, Rapoport L, Okhunov Z, O'Leary M, Potoldykova N, Sukhanov R, Enikeev M, Laukhtina E, Taratkin M. Impact of endoscopic enucleation of the prostate with thulium fiber laser on the erectile function. BMC Urol 2018; 18:87. [PMID: 30314492 PMCID: PMC6186032 DOI: 10.1186/s12894-018-0400-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/02/2018] [Indexed: 11/16/2022] Open
Abstract
Background The impact of number of endoscopic enucleation of the prostate techniques (holmium laser enucleation - HoLEP for example) on erectile function have already been investigated. However, the thulium-fiber laser, in this setting remains unstudied. In this study, we compared sexual function outcomes in patients with benign prostatic hyperplasia (BPH) treated with transurethral resection of the prostate (TURP) or thulium-fiber laser enucleation (ThuFLEP). Methods We performed a retrospective analysis of patients who underwent transurethral resection and endoscopic enucleation of the prostate for BPH; inclusion criteria was the presence of infravesical obstruction (IPSS > 20, Qmax < 10 mL/s). Erectile function (EF) was assessed using the International Index of Erectile Function (IIEF-5) both prior to endoscopic examination, and six months after. Results A total of 469 patients with BPH were included in the study; of these, 211 underwent to ThuFLEP, and 258 TURP. Preoperative IIEF-5 in TURP and ThuFLEP groups were 11.7 (±4.5) and 11.1 (±5.0), respectively (p = 0.17). At six month the IIEF-5 score was unchanged (p = 0.26 and p = 0.08) and comparable in both groups (p = 0.49). However, mean IIEF-5 score shown significant increase of 0.72 in ThuFLEP group, comparing to decrease of 0.24 in TURP patients (p < 0.001). Conclusions Both TURP and ThuFLEP are effective modalities in the management of infravesical obstruction due to BPH. At six months follow-up after surgery, both techniques lead to comparable IIEF-5 score. However, our results demonstrated that the ThuFLEP is more likely to preserve the erectile function leading to increase of IIEF-5 at six months in contrast to TURP which lead to slight drop in IIEF-5 score.
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Affiliation(s)
- Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
| | - Petr Glybochko
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Leonid Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Zhamshid Okhunov
- Department of Urology, University of California, Irvine; Orange, CA, USA
| | - Mitchel O'Leary
- Department of Urology, University of California, Irvine; Orange, CA, USA
| | - Natalya Potoldykova
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Roman Sukhanov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mikhail Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Enikeev D, Glybochko P, Rapoport L, Gahan J, Gazimiev M, Spivak L, Enikeev M, Taratkin M. A Randomized Trial Comparing The Learning Curve of 3 Endoscopic Enucleation Techniques (HoLEP, ThuFLEP, and MEP) for BPH Using Mentoring Approach-Initial Results. Urology 2018; 121:51-57. [PMID: 30053397 DOI: 10.1016/j.urology.2018.06.045] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 05/30/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To assess the differences in the learning curve associated with different techniques of endoscopic enucleation of the prostate. MATERIALS AND METHODS Ninety patients were randomly assigned into 3 groups (30 patients in each): HoLEP, ThuFLEP or MEP. Inclusion criteria for the study included prostate volume <80 cc, IPSS > 20, or Qmax < 10. The EEPs were performed by 3 surgeons experienced in transurethral resection of the prostate. Assignment of surgeons to surgical technique was also randomized. None of the surgeons had prior experience in EEP. RESULTS ThuFLEP was slightly superior (with no significant difference [P > .05]) to HoLEP and MEP in terms of overall enucleation rate-1.0 g/min vs 0.8 g/min and 0.7 g/min, respectively. We observed similar enucleation rates at the initial stages of training (first 20 surgeries) with insignificant increase in ThuFLEP efficiency. At next 10 surgeries ThuFLEP and HoLEP efficiency were higher than of MEP (P < .001) without significant difference between techniques of laser EEP (P = .07). CONCLUSION Endoscopic enucleation of the prostate can be adopted safely and effectively within 30 surgeries if the technique is learned with a mentoring approach. EEP is shown to be safe and effective even in the initial stages of learning. Laser EEP (HoLEP, ThuFLEP) appears to lend itself to quicker adaptation compared MEP.
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Affiliation(s)
- Dmitry Enikeev
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation.
| | - Petr Glybochko
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
| | - Leonid Rapoport
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
| | - Jeffrey Gahan
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
| | - Magomed Gazimiev
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
| | - Leonid Spivak
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
| | - Mikhail Enikeev
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
| | - Mark Taratkin
- Sechenov University, Research Institute for Uronephrology and Reproductive Health, Russian Federation
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