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Wenk MJ, Hartung FO, Egen L, Netsch C, Kosiba M, Grüne B, Herrmann J. The long-term learning curve of holmium laser enucleation of the prostate (HoLEP) in the en-bloc technique: a single surgeon series of 500 consecutive cases. World J Urol 2024; 42:436. [PMID: 39046537 PMCID: PMC11269500 DOI: 10.1007/s00345-024-05097-9] [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: 03/06/2024] [Accepted: 05/29/2024] [Indexed: 07/25/2024] Open
Abstract
PURPOSE To evaluate perioperative parameters, clinical outcomes, and the learning curve of holmium laser enucleation of the prostate (HoLEP) of a single surgeon in 500 consecutive cases. METHODS Demographic parameters, outcomes, and adverse events were evaluated. The learning curve for HoLEP in en-bloc technique of the first 500 consecutive patients was analyzed in clusters of 100 (clusters 1-5) using the Wilcoxen rank test, Chi² test and Kruskal Wallis test. RESULTS Enucleation weight was similar in the clusters 1,2,3, and 5 (62 g, 63 g, 61 g, 61 g), in cluster 4 it was slightly higher at 73 g. There was a significant reduction in operating time from 67 min (cluster 1) to 57 min (cluster 2), 46 min (cluster 3), 53 min (cluster 4), and 43 min (cluster 5), p < 0.001. Enucleation efficiency (g/min) showed a steady increase (1.72, 2.24, 2.79, 2.92 vs. 2.99, p < 0.001). Laser energy efficiency also improved (2.17 vs. 2.12 vs. 1.71 vs. 1.65 vs. 1.55; p < 0.001). There was no measurable learning curve regarding the length of hospital stay (mean 2.5 days), catheterization time (1.9 days), hemoglobin drop (approx. 1 g/dl) or complications (p > 0.1). CONCLUSIONS HoLEP using the en-bloc technique is a safe and highly effective method. Over time, a slight but steady learning curve and improvement in operation time, enucleation efficiency and laser energy efficiency were shown even for an experienced surgeon - after 500 cases, still no plateau was reached. There was no measurable learning curve regarding blood loss, complications, length of hospital stay, and catheterization time.
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Affiliation(s)
- M J Wenk
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - F O Hartung
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - L Egen
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - C Netsch
- Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - M Kosiba
- Department of Urology, University Hospital Frankfurt, Frankfurt Main, Germany
| | - B Grüne
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jonas Herrmann
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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2
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Hartung FO, Egen L, Grüne B, Netsch C, Patroi P, Kriegmair MC, von Hardenberg J, Rassweiler-Seyfried MC, Michel MS, Wenk MJ, Herrmann J. Perioperative Outcomes and Complication Rates in Holmium Laser Enucleation of the Prostate Patients After Prior Prostate Biopsy-Does It Really Make a Difference? A Propensity Score Matched Analysis. J Endourol 2024; 38:675-681. [PMID: 38717963 DOI: 10.1089/end.2024.0008] [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] [Indexed: 05/22/2024] Open
Abstract
Introduction: Before holmium laser enucleation of the prostate (HoLEP), many patients have undergone short-term prostate biopsy (PB) to rule out the presence of prostate cancer. The aim of this study is to determine whether a short-term PB before HoLEP has an impact on the perioperative outcomes or complications of HoLEP. Methods: In total, 734 consecutive patients treated with HoLEP at a tertiary care university hospital between January 2021 and July 2023 were retrospectively enrolled. Patients who had PB within 6 months before HoLEP were matched to patients who underwent PB more than 6 months or had no PB before HoLEP using propensity score matching (PSM) based on age, prostate volume (PV), prostate-specific antigen (PSA), preoperative urinary tract infection (UTI), and surgeon. Perioperative parameters, such as operation time (OT), enucleation efficiency (EF), as well as complications according to the Satava classification, the Clavien-Dindo classification (CDC), and the Comprehensive Complication Index (CCI) were evaluated. Results: In total, 206 patients were matched. Age, PV, PSA, as well as the presence of a preoperative UTI and surgeons did not differ significantly between both groups after PSM. There were no significant differences in mean OT (75 vs. 81 minutes, p = 0.28) and EF (2.13 vs. 2.13 g/min, p = 0.99). No differences were noted regarding intraoperative (16 vs. 25, p = 0.16) or postoperative complications graded by CDC (p = 0.53) and CCI (p = 0.92). Conclusion: PB within 6 months preoperatively before HoLEP showed no effect on perioperative outcomes or intra- and postoperative complications.
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Affiliation(s)
- Friedrich Otto Hartung
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Luisa Egen
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Britta Grüne
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Paul Patroi
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | | | | | | | - Maurice Stephan Michel
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maren Julianne Wenk
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jonas Herrmann
- Department of Urology and Urological Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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3
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Breyer J, Eckstein M, Sikic D, Wezel F, Roghmann F, Brehmer M, Wirtz RM, Jarczyk J, Erben P, Bahlinger V, Goldschmidt F, Fechner G, Chen J, Paxinos E, Bates M, Haas M, Zengerling F, Bolenz C, Burger M, Hartmann A, Kriegmair MC. Xpert bladder cancer monitor to predict the need for a second TURB (MoniTURB trial). Sci Rep 2023; 13:15437. [PMID: 37723173 PMCID: PMC10507065 DOI: 10.1038/s41598-023-42088-z] [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: 12/20/2022] [Accepted: 09/05/2023] [Indexed: 09/20/2023] Open
Abstract
To determine whether Xpert bladder cancer monitor, a noninvasive PCR-based biomarker test, can predict the need for 2nd transurethral resection of the bladder (TURB) better than clinical assessment. Patients scheduled for TURB were prospectively screened. After initial TURB, patients were assigned to 2nd TURB or follow-up cystoscopy at 3 months (FU) by clinicians' discretion. Central urine cytology and Xpert monitor tests were performed prior to the 1st TURB and 2nd TURB or FU, respectively. Statistical analysis to compare clinical assessment and Xpert monitor comprised sensitivity (SENS), specificity (SPEC), NPV and PPV. Of 756 screened patients, 171 were included (114 with 2nd TURB, 57 with FU). Residual tumors were detected in 34 patients who underwent 2nd TURB, and recurrent tumors were detected in 2 patients with FU. SENS and SPEC of Xpert monitor were 83.3% and 53.0%, respectively, PPV was 32.6% and NPV was 92.1%. Clinical risk assessment outperformed Xpert monitor. In patients with pTa disease at initial TURB, Xpert monitor revealed a NPV of 96%. Xpert monitor was not superior than clinical assessment in predicting the need for 2nd TURB. It might be an option to omit 2nd TURB for selected patients with pTa disease.
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Affiliation(s)
- Johannes Breyer
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany.
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany.
| | - Markus Eckstein
- Institute of Pathology, Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Danijel Sikic
- Department of Urology and Pediatric Urology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Felix Wezel
- Department of Urology and Pediatric Urology, University Hospital Ulm, Ulm, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Florian Roghmann
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Mirco Brehmer
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Ralph M Wirtz
- Stratifyer Molecular Pathology GmbH, Cologne, Germany
- Institute of Pathology, St. Elisabeth Hospital Köln-Hohenlind, Cologne, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Jonas Jarczyk
- Department of Urology and Urosurgery, University Hospital Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Philipp Erben
- Department of Urology and Urosurgery, University Hospital Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Veronika Bahlinger
- Institute of Pathology, Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Franziska Goldschmidt
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Guido Fechner
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Jack Chen
- Biostatistics, Cepheid Inc., Sunnyvale, CA, USA
| | - Ellen Paxinos
- Medical and Scientific Affairs, Cepheid Inc., Sunnyvale, CA, USA
| | - Michael Bates
- Medical and Scientific Affairs, Cepheid Inc., Sunnyvale, CA, USA
| | - Maximilian Haas
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Friedemann Zengerling
- Department of Urology and Pediatric Urology, University Hospital Ulm, Ulm, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Christian Bolenz
- Department of Urology and Pediatric Urology, University Hospital Ulm, Ulm, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Arndt Hartmann
- Institute of Pathology, Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology and Urosurgery, University Hospital Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
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4
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Les complications en chirurgie urologique. Recueil et classification. Prog Urol 2022; 32:906-918. [DOI: 10.1016/j.purol.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/12/2022] [Accepted: 09/05/2022] [Indexed: 11/21/2022]
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Himmler M, Grüne B, von Hardenberg J, Hartung FO, Kowalewski KF, Rassweiler-Seyfried MC, Michel MS, Herrmann J. Switching lasers: learning curve of HoLEP in surgeons experienced in ThuLEP. J Endourol 2022; 36:1444-1451. [PMID: 35822547 DOI: 10.1089/end.2022.0262] [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
OBJECTIVE To evaluate perioperative parameters, clinical outcomes, and the learning curve of holmium laser enucleation of the prostate (HoLEP) in surgeons with experience in thulium laser enucleation of the prostate (ThuLEP). MATERIALS AND METHODS The learning curves for HoLEP of the first 50 consecutive patients of two surgeons experienced in ThuLEP were analyzed. In addition, demographic parameters, clini¬cal outcomes and adverse events were evaluated. RESULTS Mean operation time was 70.9 + 29.7 min (SD) (Surgeon 1) and 74.4 + 35.4 min (Surgeon 2), the mean enucleation efficiency was 1.5 + 0.6 g/min (Surgeon 1) and 1.5 + 0.7 g/min (Surgeon 2). The hemoglobin loss was 0.9 + 0.8 g/dl and 0.8 + 0.8 g/dl. For both surgeons, there was a significant learning curve in enucleation efficiency within the first 50 cases (Surgeon 1: p = .034, Surgeon 2: p = .006, both: p = .0003, Spearman's ρ = .351). Both surgeons started with an enucleation efficiency of around 1g/min in their first 10 cases. No significant correlation between hemoglobin loss and experience could be found (p = .823, ρ = .025). While there was no significant learning curve for morcellation efficiency (p = .785, ρ = .028), a significant progress was found for one of the two surgeons regarding laser energy efficiency (p = .014). The overall incidence of all grade treatment-related adverse events was very low at 10.0%, and extremely low for significant complications with Clavien-Dindo Grade > II at 1%. CONCLUSIONS In our analysis, switching to HoLEP is uncomplicated and safe for experienced ThuLEP surgeons. The enucleation efficiency was high from the beginning, but a learning curve was present for both surgeons. No learning curve was noticeable in hemoglobin loss and the incidence of complications, both of which were very low throughout the study.
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Affiliation(s)
- Maren Himmler
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Baden-Württemberg, Germany;
| | - Britta Grüne
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Germany;
| | - Jost von Hardenberg
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Germany;
| | - Friedrich Otto Hartung
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Baden-Württemberg, Germany;
| | - Karl-Friedrich Kowalewski
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Baden-Württemberg, Germany;
| | | | - Maurice Stephan Michel
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Baden-Württemberg, Germany;
| | - Jonas Herrmann
- University Medical Centre Mannheim, 36642, Department of Urology and Urosurgery, Mannheim, Baden-Württemberg, Germany;
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Albisinni S, Diamand R, Mjaess G, Aoun F, Assenmacher G, Assenmacher C, Verhoest G, Holz S, Naudin M, Ploussard G, Mari A, Minervini A, Tay A, Issa R, Roumiguie M, Bajeot AS, Simone G, Anceschi U, Umari P, Sridhar A, Kelly J, Hendricksen K, Einerhand S, Sandel N, Sanchez-Salas R, Colore A, Quackels T, Peltier A, Montorsi F, Briganti A, Teoh JYC, Pradere B, Moschini M, Roumeguere T. Defining the morbidity of Robotic-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion: adoption of the Comprehensive Complication Index. J Endourol 2022; 36:785-792. [PMID: 35109696 DOI: 10.1089/end.2021.0843] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND & OBJECTIVE The Clavien-Dindo Classification (CDC) only reports the post-operative complication of highest grade. It is thus of limited value for radical cystectomy after which patients usually experience multiple complications. The CCI is a novel scoring system which incorporates all post-operative events in one single value. To adopt the Comprehensive Complication Index (CCI) for the evaluation of complications in patients undergoing Robot-Assisted Radical Cystectomy (RARC) with Intra-Corporeal Urinary Diversion (ICUD) and explore its advantages in the analysis of the morbidity of RARC with ICUD. PATIENTS AND METHODS Multicentric cohort of 959 patients undergoing RARC+ICUD between 2015-2020, whose complications are encoded in local prospective registries. Post-operative complications at 30 days were assessed using both the CDC and CCI. The CCI was calculated using an online tool (assessurgery.com). Risk factors for overall, major complications (CDC≥III) and CCI were evaluated using uni- and multivariable logistic and linear regressions. To analyse the potential advantage of using the CCI in clinical trials, a sample size calculation of a hypothetic clinical trial was performed using as endpoint reduction of morbidity with either the CDC or CCI. RESULTS Overall, 885 post-operative complications were reported in 507 patients (53%). The CCI improved the definition of post-operative morbidity in 22.6% of patients. Male sex and neobladder were associated to major complications and to a significant increase in CCI on adjusted regressions. In a hypothetical clinical trial, 80 patients would be needed to demonstrate a ten point reduction in CCI, compared to 186 needed to demonstrate an absolute risk reduction of 20% in overall morbidity using the CDC. CONCLUSION CCI improves the evaluation of post-operative morbidity by considering the cumulative aspect of complications compared to the CDC. Implementing the CCI for radical cystectomy would help reducing sample sizes in clinical trials.
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Affiliation(s)
- Simone Albisinni
- Hopital Erasme, 70496, Route de Lennik 808, Bruxelles, Belgium, 1070;
| | - Romain Diamand
- Institut Jules Bordet, 60210, Bruxelles, Bruxelles, Belgium;
| | | | | | | | | | | | - Serge Holz
- Ambroise Pare Ziekenhuis, 82241, Mons, Wallonie, Belgium;
| | - Michel Naudin
- Ambroise Pare Ziekenhuis, 82241, Mons, Wallonie, Belgium;
| | - Guillaume Ploussard
- Clinique Capio La Croix du Sud, 538719, Quint-Fonsegrives, Occitanie, France;
| | - Andrea Mari
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Urology, Largo Brambilla 3, Firenze, Italy, 50100.,University of Florence, Careggi Hospital, Florence, Italy.;
| | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy., Urology, Clinica Urologica I, Azienda Ospedaliera Careggi, Università di Firenze., Largo Brambilla 3 - San Luca Nuovo Padiglione 16/Settore C/Piano II, Florence, Italy, 50134;
| | - Andrea Tay
- St George's Healthcare NHS Trust, 4968, London, London, United Kingdom of Great Britain and Northern Ireland;
| | - Rami Issa
- St George's Healthcare NHS Trust, 4968, London, London, United Kingdom of Great Britain and Northern Ireland;
| | | | | | - Giuseppe Simone
- Regina Elena, urology, via elio chianesi 53, Roma, Italy, 00144.,Italy;
| | | | - Paolo Umari
- University of Eastern Piedmont Amedeo Avogadro Department of Translational Medicine, 370891, Department of Urology, Via Solaroli 17, 28100, Novara, Italy, Novara, Italy, 28100.,United States;
| | - Ashwin Sridhar
- UCLH, 8964, London, London, United Kingdom of Great Britain and Northern Ireland;
| | - John Kelly
- UCLH, 8964, London, London, United Kingdom of Great Britain and Northern Ireland;
| | - Kees Hendricksen
- Netherlands Cancer Institute, 1228, Amsterdam, Noord-Holland, Netherlands;
| | - Sarah Einerhand
- Netherlands Cancer Institute, 1228, Amsterdam, Noord-Holland, Netherlands;
| | - Noah Sandel
- Netherlands Cancer Institute, 1228, Amsterdam, Noord-Holland, Netherlands;
| | - Rafael Sanchez-Salas
- Institute Mutualiste Monsouris, Urology, 142, Bd. Jourdan, Paris, Not Applicable, France, 75014;
| | - Anne Colore
- Institut Mutualiste Montsouris, 26953, Paris, Île-de-France, France;
| | | | | | | | | | - Jeremy Y C Teoh
- Prince of Wales Hospital, Surgery, 30-32 Ngan Shing Street, Shatin, New Territories., Hong Kong, Hong Kong;
| | - Benjamin Pradere
- Medical University of Vienna, 27271, Department of urology, Wien, Wien, Austria;
| | - Marco Moschini
- Luzerner Kantonsspital, 30748, Luzern, Switzerland.,Vita-Salute University, urology, Milan, Italy;
| | - Thierry Roumeguere
- Hôpital Erasme, 70496, Urology, route de Lennik 808, Bruxelles, Belgium, 1070.,United States;
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Kowalewski KF, Hartung FO, Von Hardenberg J, Haney C, Kriegmair M, Nuhn P, Patroi P, Westhoff N, Honeck P, Herrmann T, Michel MS, Herrmann J. Robot assisted simple prostatectomy versus endoscopic enucleation of the prostate: A systematic review and meta-analysis of comparative trials. J Endourol 2022; 36:1018-1028. [PMID: 35029124 DOI: 10.1089/end.2021.0788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Robot assisted simple prostatectomy (RASP) and endoscopic enucleation of the prostate (EEP) are two minimally invasive alternatives to simple prostatectomy, which is considered the standard treatment in large prostate glands. It remains unclear which of the two is superior in terms of outcome and complications. To compare perioperative and functional outcomes of robot assisted simple prostatectomy (RASP) versus endoscopic enucleation of the prostate (EEP) systematic review and meta-analysis was conducted according to the recommendations of the Cochrane Collaboration and in line with the PRISMA criteria. The database search included clinicaltrials.gov, Medline (via PubMed), CINAHL and Web of Science and was using the PICO criteria. All comparative trials were considered. Risk of bias was assessed with the revised ROBINS-I tool. 760 studies were identified, four of which were eligible for qualitative and quantitative analysis, reporting on a total of 901 patients with follow-up up to 24 months. Hemoglobin drop (MD[CI]: 0.34 g/dl [0.09; 0.58]), the rate of blood transfusions (OR[CI]: 5.01 [1.60; 15.61]) catheterization time (MD[CI]: 3.26 d [1.30; 5.23]) and length of hospital stay (LoS) (MD[CI]: 1.94 d [1.11; 2.76]) were significantly lower in EEP. No significant differences were seen in operating time and enucleation weight. No significant differences were observed in the incidence of postoperative urinary retention, postoperative transient incontinence and complications graded according to the Clavien-Dindo Classification. Functional results were similar, with no significant differences in International Prostate Symptom Score and maximum urinary flow rate at follow-up. Conclusion: Both EEP and RASP offer excellent improvement of symptoms due to prostatic hyperplasia. EEP has lower blood loss, shorter catheterization time and LoS and should be the first choice if available. RASP remains an attractive alternative for extremely large glands, in concomitant diseases or whenever EEP is not available.
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Affiliation(s)
- Karl-Friedrich Kowalewski
- University Medical Center Mannheim, Heidelberg University, Department of Urology & Urosurgery, Mannheim, Germany;
| | - Friedrich Otto Hartung
- University Medical Center Mannheim, Heidelberg University, Department of Urology & Urosurgery, Mannheim, Baden-Württemberg, Germany;
| | - Jost Von Hardenberg
- Department of Urology, University Hospital Mannheim, Mannheim, Germany, Mannheim, Germany;
| | - Caelan Haney
- Universitätsklinikum Carl Gustav Carus Klinik und Poliklinik für Urologie, 536480, Dresden, Saxony, Germany;
| | - Maximilian Kriegmair
- University Medical Center Mannheim, Heidelberg University, Department of Urology & Urosurgery Mannheim, DE, Mannheim, Germany;
| | - Philipp Nuhn
- University Medical Center Mannheim, Heidelberg University, Department of Urology & Urosurgery Mannheim, DE, Mannheim, Germany;
| | - Paul Patroi
- University Medical Center Mannheim, Heidelberg University, Mannheim, Germany;
| | - Niklas Westhoff
- University Medical Center Mannheim, Heidelberg University, Department of Urology & Urosurgery Mannheim, DE Mannheim, DE, Mannheim, Germany;
| | - Patrick Honeck
- University Medical Center Mannheim, Heidelberg University, Department of Urology & Urosurgery Mannheim, DE, Mannheim, Germany;
| | - T Herrmann
- Hannover Medical School, Urology and Urooncology, Division of Endourology und minimal invasive therapy (MIT), Carl Neuberg Str. 1, Hannover, Germany, 30625.,United States;
| | - Maurice Stephan Michel
- University Medical Center Mannheim, Heidelberg University, Department of Urology & Urosurgery Mannheim, DE Mannheim, DE, Mannheim, Germany;
| | - Jonas Herrmann
- University Medical Center Mannheim, Heidelberg University, Department of Urology & Urosurgery, Mannheim, Germany;
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8
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Hartung FO, Kowalewski KF, von Hardenberg J, Worst TS, Kriegmair MC, Nuhn P, Herrmann TRW, Michel MS, Herrmann J. Holmium Versus Thulium Laser Enucleation of the Prostate: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Eur Urol Focus 2021; 8:545-554. [PMID: 33840611 DOI: 10.1016/j.euf.2021.03.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/01/2021] [Accepted: 03/28/2021] [Indexed: 11/04/2022]
Abstract
CONTEXT Holmium (HoLEP) and thulium laser enucleation of the prostate (ThuLEP) are the two methods most commonly applied for endoscopic enucleation of the prostate. It remains unclear which of the two is superior in terms of outcome and complications. OBJECTIVE To compare perioperative and functional outcomes between HoLEP and ThuLEP. EVIDENCE ACQUISITION A systematic review and meta-analysis were performed according to the recommendations of the Cochrane Collaboration and in line with the PRISMA criteria. A comprehensive database search including MEDLINE, Web of Science, CINAHL, ClinicalTrials.gov, and CENTRAL was conducted according to the PICO criteria. Only randomized controlled trials (RCTs) were considered. All review steps were conducted by two independent reviewers. Risk of bias was assessed using the revised Cochrane tool for RCTs. EVIDENCE SYNTHESIS The search identified 556 studies, of which four were eligible for qualitative and quantitative analysis, reporting on a total of 579 patients with follow-up of up to 18 months. No significant differences in operating time, enucleation weight, catheterization time, or hospital stay were observed between ThuLEP and HoLEP. The decrease in hemoglobin was significantly lower for ThuLEP (mean difference -0.54 g/dl, 95% confidence interval [CI] -0.93 to -0.15; p < 0.001), but with low certainty of evidence. Transient urinary incontinence was more common for HoLEP (odds ratio 0.56, 95% CI 0.32-0.99; p = 0.045), again with low certainty of evidence. Furthermore, no significant differences were observed for other complications or for functional measures and symptom scores. CONCLUSIONS ThuLEP and HoLEP offer comparable improvement in symptoms and postoperative voiding parameters. Both procedures are safe and major complications are rare. ThuLEP showed minor advantages for blood loss and the incidence of transient incontinence. This should be interpreted with caution owing to the low certainty of evidence. Therefore, treatment choice should be based on surgeon expertise and local conditions. PATIENT SUMMARY We reviewed four clinical trials that compared holmium and thulium lasers for treatment to reduce the size of the prostate gland. Our review assessed outcomes and complications. We found that both laser techniques are safe and suitable for reducing symptoms due to an enlarged prostate. Blood loss and short-lasting urinary incontinence were slightly lower after thulium compared to holmium laser treatment.
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Affiliation(s)
- Friedrich O Hartung
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Karl-Friedrich Kowalewski
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jost von Hardenberg
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Thomas S Worst
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Nuhn
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Thomas R W Herrmann
- Department of Urology, Spital Thurgau AG Frauenfeld, Münsterlingen, Switzerland; Department of Urology, Hanover Medical School, Hannover, Germany
| | - Maurice S Michel
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jonas Herrmann
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
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