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Heiman J, Snead WM, DiBianco JM. Persistent Lower Urinary Tract Symptoms After BPH Surgery. Curr Urol Rep 2024; 25:125-131. [PMID: 38578550 DOI: 10.1007/s11934-024-01202-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] [Accepted: 03/21/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE OF REVIEW Lower urinary tract symptoms (LUTS) after surgical management for BPH pose a significant clinical challenge for urologists. Despite high success rates in relieving LUTS, there is a subset of patients who experience persistent symptoms after intervention. In this review article, we describe the management of patients with new or persistent LUTS after endoscopic bladder outlet surgery. RECENT FINDINGS Previously, the goal for BPH management was to remove as much adenomatous tissue as possible. While potentially effective, this may lead to unwanted side effects. There has been a recent paradigm shift for new minimally invasive surgical therapies (MIST) that strategically treat adenomatous tissue, adding potential complexity in managing patients with new or residual symptoms in the postoperative setting. There is a paucity of literature to guide optimal workup and care of patients with persistent LUTS after surgical management. We characterize patients into distinct groups, defined by types of symptoms, irritative versus obstructive, and timing of the symptomatology, short term versus long term. By embracing this patient-centered approach with shared decision management, clinicians can optimize outcomes efficiently improving their patients' quality of life.
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Affiliation(s)
- Joshua Heiman
- Department of Urology, Indiana University, Indianapolis, IN, USA.
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Castellani D, Enikeev D, Gokce MI, Petov V, Gadzhiev N, Mahajan A, Maheshwari PN, Fong KY, Tursunkulov AN, Malkhasyan V, Zawadzki M, Sofer M, Cormio L, Busetto GM, Somani BK, Herrmann TR, Gauhar V. Influence of Prostate Volume on the Incidence of Complications and Urinary Incontinence Following Thulium Fiber Laser Enucleation of the Prostate: Results from Multicenter, Real-world Experience of 2732 patients. EUR UROL SUPPL 2024; 63:38-43. [PMID: 38558764 PMCID: PMC10981004 DOI: 10.1016/j.euros.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Background The use of the new thulium fiber laser in enucleation of the prostate (ThuFLEP) has been introduced recently. Objective To evaluate complications and urinary incontinence (UI) after ThuFLEP in small and large prostate volume (PV). Design setting and participants We retrospectively reviewed patients who underwent ThuFLEP in six centers (from January 2020 to January 2023). The exclusion criteria were concomitant lower urinary tract surgery, previous prostate/urethral surgery, prostate cancer, and pelvic radiotherapy. Outcome measurements and statistical analysis Patients were divided into two groups: group 1: PV ≤80 ml; group 2: PV >80 ml. Univariable and multivariable logistic regression analyses were performed to evaluate the independent predictors of overall UI. Results and limitations There were 1458 patients in group 1 and 1274 in group 2. There was no significant difference in age. The median PV was 60 (61-72) ml in group 1 and 100 (90-122) ml in group 2. En bloc enucleation was employed more in group 1, while the early apical release technique was used more in group 2. The rate of prolonged irrigation for hematuria, urinary tract infection, and acute urinary retention did not differ significantly. Blood transfusion rate was significantly higher in group 2 (0.5% vs 2.0%, p = 0.001). There was no significant difference in the overall UI rate (12.3% in group 1 vs 14.7% in group 2, p = 0.08). A multivariable regression analysis showed that preoperative postvoiding urine residual (odds ratio 1.004, 95% confidence interval 1.002-1.007, p < 0.01) was the only factor significantly associated with higher odds of UI. A limitation of this study was its retrospective nature. Conclusions Complications and UI rates following ThuFLEP were similar in patients with a PV up to or larger than 80 ml except for the blood transfusion rate that was higher in the latter. Patient summary In this study, we looked at outcomes after thulium fiber laser in enucleation of the prostate stratified by PV. We found that blood transfusion was higher in men with PV >80 ml, but urinary incontinence was similar.
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Affiliation(s)
- Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Mehmet Ilker Gokce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Vladislav Petov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation
| | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | - Abhay Mahajan
- Sai Urology Hospital and Mahatma Gandhi Mission’s Medical College and Hospital, Aurangabad, India
| | | | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Vigen Malkhasyan
- Urology Unit, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | | | - Mario Sofer
- Department of Urology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Luigi Cormio
- Andrology and Urology Unit, Bonomo Teaching Hospital, Andria, Italy
- Department of Urology, Ospedali Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Gian Maria Busetto
- Department of Urology, Ospedali Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Bhaskar Kumar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton, UK
| | - Thomas R.W. Herrmann
- Department of Urology, Spital Thurgau AG, Kantonspital Frauenfeld, Frauenfeld, Switzerland
- Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, South Africa
- Hannover Medical School, Hannover, Germany
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
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Wu YF, Li X, Ma J, Ma DY, Zeng XM, Yu QW, Chen WG. Primary prostate Burkitt's lymphoma resected with holmium laser enucleation of the prostate: A rare case report. World J Clin Cases 2023; 11:4406-4411. [PMID: 37449230 PMCID: PMC10336998 DOI: 10.12998/wjcc.v11.i18.4406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/10/2023] [Accepted: 05/24/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Primary prostate Burkitt's lymphoma is a rare and aggressive condition with a poor prognosis. Its clinical presentation can be challenging to differentiate from benign prostatic hyperplasia. Given the rarity of primary prostate Burkitt's lymphoma, its diagnosis and treatment remain unclear.
CASE SUMMARY This report presents a case of a 57-year-old male with primary prostate Burkitt's lymphoma, initially misdiagnosed as prostatic hyperplasia. This case's operative process, intraoperative findings and postoperative management are discussed in detail.
CONCLUSION Primary prostate lymphoma is difficult to distinguish from other prostate diseases. Holmium laser enucleation of the prostate (HoLEP), a minimally invasive procedure, is crucial in diagnosing and treating this rare disease. Clinicians should remain vigilant and thoroughly combine physical examination, imaging and test results when encountering patients of younger age with small prostate size but a rapid progression of lower urinary tract symptoms. HoLEP is an essential diagnostic and therapeutic tool in managing primary prostate Burkitt's lymphoma.
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Affiliation(s)
- Yu-Fan Wu
- Department of Urology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, Jiangsu Province, China
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Xiang Li
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
| | - Jun Ma
- Department of Urology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, Jiangsu Province, China
| | - Dan-Yu Ma
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Suzhou 215300, Jiangsu Province, China
| | - Xue-Ming Zeng
- Department of Urology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, Jiangsu Province, China
| | - Qi-Wei Yu
- Department of Urology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan 215300, Jiangsu Province, China
| | - Wei-Guo Chen
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
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Press B, Gardezi M, Kim DD, Lokeshwar S, Rahman S, Siev M, Ghiraldi E, Lerner L, Kellner D. Ejaculatory Preserving Holmium Laser Enucleation of the Median Lobe: Preserving Sexual Function While Improving Urinary Outcomes. Urology 2023; 173:175-179. [PMID: 36646177 DOI: 10.1016/j.urology.2022.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 12/11/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate perioperative outcomes related to sexual and urinary function in patients who underwent a holmium laser enucleation of the prostate (HoLEP) with selective laser enucleation of the median lobe. MATERIALS AND METHODS We retrospectively reviewed the first 450 HoLEP cases by a single surgeon from April 2019 to March 2022. Fifty-five patients with intravesical-prostatic protrusion or high bladder neck without obstructing lateral lobes underwent selective enucleation of the median lobe of the prostate. Patients were asked to comment on whether they had retrograde ejaculation during their follow-up appointment. Urinary function was assessed using the American Urological Association Symptom Score and subjective evaluation of urinary incontinence. RESULTS Median age of the cohort was 65 years (range: 44-91). Compared to preoperative, there was significant improvement in mean postoperative American Urological Association Symptom Score (22.5 vs 6.9, P < .001), mean postoperative quality of life scores (4 vs 1.2, P < .001), and mean postoperative post void residual volumes (244.1 vs 69.3 cc, P < .001). No patients reported stress urinary incontinence. Of the 55 patients who underwent selective enucleation of the median lobe, 40 were sexually active. Of those men, 35 reported normal ejaculation, 3 had retrograde ejaculation that was unchanged from pre-op, and 2 had new ejaculatory dysfunction. CONCLUSION In this case series of selective laser enucleation of the median lobe, urinary function significantly improved in short-term follow-up with preservation of ejaculation in approximately 90% of men.
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Affiliation(s)
- Benjamin Press
- Department of Urology, Yale School of Medicine, Yale University, New Haven, CT
| | | | - David D Kim
- Yale School of Medicine, Yale University, New Haven, CT
| | - Soum Lokeshwar
- Department of Urology, Yale School of Medicine, Yale University, New Haven, CT
| | - Syed Rahman
- Department of Urology, Yale School of Medicine, Yale University, New Haven, CT
| | - Michael Siev
- Department of Urology, Yale School of Medicine, Yale University, New Haven, CT
| | - Eric Ghiraldi
- Division of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | - Lori Lerner
- Division of Urology, VA Boston Healthcare System, Boston, MA
| | - Daniel Kellner
- Department of Urology, Yale School of Medicine, Yale University, New Haven, CT.
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Expression and Significance of D-Dimer and Fibrinogen in Hyperfibrinolysis of Elderly Patients with Bleeding after BPH Operation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:9387484. [PMID: 35911160 PMCID: PMC9328950 DOI: 10.1155/2022/9387484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/31/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022]
Abstract
Objective To explore the expression level and diagnostic efficacy of plasma D-dimer (DD) and fibrinogen (FIB) in hyperfibrinolysis of elderly patients with bleeding after benign prostatic hyperplasia (BPH) surgery. Methods 70 elderly BPH patients with postoperative hemorrhage and hyperfibrinolysis in our hospital were included into the observation group, and 75 elderly BPH patients with postoperative hemorrhage without hyperfibrinolysis were included into the control group. The serum levels of DD and FIB in the two groups of patients were compared, and the correlation of DD and FIB with clinical features and the diagnostic value of DD and FIB. Results Elderly BPH patients with hyperfibrinolysis showed significantly higher levels of DD and FIB than those without hyperfibrinolysis (P < 0.01). The increase in DD and the decrease of FIB were significantly correlated with the prolonged hospital stay and intensive care unit (ICU) monitoring (P < 0.05). The combination of DD and FIB showed high diagnostic value for postoperative hemorrhage with hyperfibrinolysis (AUC = 0.998). Conclusion The combination of plasma DD and FIB effectively and accurately diagnoses postoperative hemorrhage with hyperfibrinolysis. High levels of DD and FIB indicate prolonged hospital stay and postoperative ICU monitoring of elderly BPH patients with hyperfibrinolysis.
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Durant AM, Moore J, Voleti S, Wu S, Mi L, Narang G, Cheney S, Humphreys M. Salvage versus primary holmium laser enucleation of the prostate: trends, outcomes and safety analysis. World J Urol 2022; 40:2305-2312. [PMID: 35867143 DOI: 10.1007/s00345-022-04098-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To study the safety, efficacy and trends in index procedures leading to salvage holmium laser enucleation of the prostate (S-HoLEP). METHODS This was a single-institution retrospective review of HoLEPs performed between 2006 and 2020. Patients who underwent S-HoLEP were compared to those undergoing primary holmium laser enucleation of the prostate (P-HoLEP). The endpoint of primary interest were functional outcomes. Changes in index procedures over the study period were analyzed. RESULTS A total of 633 HoLEPs were performed during the study, with 217 being S-HoLEP. The S-HoLEP cohort was older than P-HoLEP cohort, 71.2 years vs 68.8 years (p = 0.03). All other factors were well matched. The most common index procedures prior to S-HoLEP included transurethral resection of the prostate (TURP) (87, 40.1%), transurethral microwave thermotherapy (TUMT) (44, 20.3%), photoselective vaporization of the prostate (PVP) (24, 11.1%) and prostatic urethral lift (PUL) (24, 11.1%). Preoperative prostate volume, IPSS and Qmax were similar between groups. Intra-operatively, S-HoLEP had longer procedure and morcellation times (p = 0.01 and 0.007). Postoperatively, the S-HoLEP cohort had longer catheter duration and hospitalization (both p < 0.001). Postoperative Qmax, IPSS and 90-day complication rates were similar. On temporal analysis, minimally invasive surgical therapies (MIST) have become more prevalent as index procedures. CONCLUSION S-HoLEP is safe and efficacious for patients requiring additional BPH surgical intervention. S-HoLEP patients had longer operative times and hospital stays but equivalent postoperative functional outcomes compared to P-HoLEP. As MIST mature and gain traction, it is expected that rates of S-HoLEP will continue to rise.
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Affiliation(s)
- Adri M Durant
- Department of Urology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA.
| | | | - Sandeep Voleti
- Department of Urology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Sarah Wu
- Department of Urology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Lanyu Mi
- Department of Quantitative Health Sciences, Scottsdale, AZ, USA
| | - Gopal Narang
- Department of Urology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Scott Cheney
- Department of Urology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Mitchell Humphreys
- Department of Urology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
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7
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Heiman J, Agarwal D, Komanapalli S, Nottingham C, Large T, Krambeck A, Rivera M. Outcomes of octogenarians undergoing holmium laser enucleation of prostate. World J Urol 2022; 40:1751-1754. [PMID: 35633402 DOI: 10.1007/s00345-022-04053-9] [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: 01/23/2022] [Accepted: 05/06/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Holmium laser enucleation of prostate (HoLEP) is an effective surgical procedure in men with BPH. Due to the increase in the use of medical therapy for BPH related lower urinary symptoms more octogenarians are presenting in a delayed fashion with significant symptoms and urinary retention. We evaluate the feasibility and safety of octogenarians undergoing HoLEP. METHODS We performed a retrospective review of HoLEPs at our institution from July 2018 to December 2019. Patients were stratified into two groups based on age: < 80 and ≥ 80. RESULTS A total of 458 patients were identified, with 74 (16.2%) ≥ 80. In patients ≥ 80, prostate volume was higher (p < 0.0005), there was a higher rate of antiplatelet/anticoagulation (p = 0.029) use, and a lower rate of alpha-blocker use (p = 0.0016). As expected, ASA scores which correlate with increasing number of concomitant diseases were greater in the ≥ 80 cohort (p = 0.016). There was no significant difference in intraoperative complications (p = 0.14), 90 day complication (p = 0.34), readmission rates (p = 0.425) or emergency room visits between groups (p = 0.15). CONCLUSIONS Despite higher medical comorbidities and increased rates of anticoagulation in octogenarians, there is no increase in operative or postoperative complication rates. Age alone should not be used as exclusion criteria for HoLEP.
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Affiliation(s)
- Joshua Heiman
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA.
| | - Deepak Agarwal
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA
| | - Sarah Komanapalli
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA
| | - Charles Nottingham
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA
| | - Tim Large
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA
| | - Amy Krambeck
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA
| | - Marcelino Rivera
- Department of Urology, Indiana University School of Medicine, 535 Barnhill Drive, Suite 150, Indianapolis, IN, 46202, USA
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Tao YC, Wei ZW, Chen Q, Chen YB, Gu M, Wang Z. “Fenestration and Tunnel Method” a Modification for the Holmium Laser Transurethral Prostatectomy of Large-Volume Prostates >80 ml: A Retrospective Study Based on 1-Year Follow-Up. Am J Mens Health 2022; 16:15579883221090826. [PMID: 35469495 PMCID: PMC9087263 DOI: 10.1177/15579883221090826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study was to promote the holmium laser enucleation of the
prostate (HoLEP) technology for large-volume prostates (>80 ml) and compare
it with the traditional method, we modified the technique and applied this
technology to clinical practice. A retrospective study comprising 118 patients
who underwent HoLEP surgery from February 2018 to December 2019 was conducted in
our center. Group A consisted of 57 patients with large-volume prostate (>80
ml) who received modified “fenestration and tunnel method” from February 2019
till December 2019, while group B consisted of 61 patients who received the
traditional trivalvular operation method from February 2018 to December 2018 for
comparison. Control subjects are selected such that they match the cases
concerning certain characteristics, and perioperative data, voiding outcomes,
and complications were evaluated at 1- and 12-month follow-up. The international
prostatic symptomatic score (IPSS), quality of life (QoL), and maximum flow rate
(Qmax) at 1 month and 12 months were both significantly improved compared with
the preoperative baseline, and no significant differences were found between
Groups A and B. The mean enucleation time, operation time, catheter indwelling
duration, and hemoglobin decrease during the operation of Group A showed
superiority compared with Group B (p<.05). The modified
“fenestration and tunnel method” of HoLEP was statistically superior to the
traditional trivalvular method in terms of the operation time, enucleation time,
catheter indwelling duration, and hemoglobin decrease. For large-volume
prostates (>80 ml), modified HoLEP was suggested to be a better treatment
option.
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Affiliation(s)
- Yu-Cheng Tao
- Department of Urology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Zi-Wei Wei
- Department of Urology, Jinshan Hospital, Fudan University, Shanghai, P.R. China
| | - Qi Chen
- Department of Urology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Yan-Bo Chen
- Department of Urology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Meng Gu
- Department of Urology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Zhong Wang
- Department of Urology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
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Surgical Complications in the Management of Benign Prostatic Hyperplasia Treatment. Curr Urol Rep 2022; 23:83-92. [PMID: 35262855 DOI: 10.1007/s11934-022-01091-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW There are a variety of treatment options for men with symptomatic benign prostatic hyperplasia (BPH); transurethral resection of the prostate (TURP) remains the gold standard surgical treatment. The field continues to evolve with the introduction of new energy and laser technologies, increasing adoption of enucleation techniques, in addition to the advent of minimally invasive surgical technologies (MIST) that enable office-based treatments. The choice in surgical management has become very nuanced depending on a variety of patient and anatomic factors. There continues to be high success rates for surgical treatment of BPH; however, the risk profiles vary across the various surgical treatments. We sought to evaluate contemporary series and summarize the experience of complications associated with BPH treatment and management of these complications. RECENT FINDINGS A comprehensive literature review was performed, and identified 79 manuscripts, published between 2005 and 2021 characterizing the diagnosis and management of complications following BPH surgery. Commonly cited issues included bleeding, ureteral orifice injury, bladder neck injury, rectal injury, TURP syndrome, bladder neck contractures, urethral stricture disease, refractory OAB symptoms, and complications unique to new modalities of treatment. The practicing urologist has multiple surgical options to choose from in treating patients with symptomatic BPH. The surgical management of BPH is generally well tolerated with high objective success rates that allow for significant improvement in urinary quality of life. It is critical to understand the potential complications associated with these various treatment options, which will enable trainees and practicing urologists to better counsel patients and manage these potential complications.
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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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Tuccio A, Grosso AA, Sessa F, Salvi M, Tellini R, Cocci A, Viola L, Verrienti P, Di Camillo M, Di Maida F, Mari A, Carini M, Minervini A. En-Bloc Holmium Laser Enucleation of the Prostate with Early Apical Release: Are We Ready for a New Paradigm? J Endourol 2021; 35:1675-1683. [PMID: 33567966 DOI: 10.1089/end.2020.1189] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Holmium laser enucleation of the prostate (HoLEP) is considered a safe and effective treatment in case of bladder outlet obstruction (BOO). Despite technical execution has evolved over time, from the standard three-lobes to the more recent en-bloc approaches, data comparing these two techniques are missing. The aim of the present study was to describe our en-bloc HoLEP with early apical release technique and compare peri- and postoperative results with the classical three-lobe approach in a single referral center. Materials and Methods: We prospectively analyzed all consecutive cases between 2017 and 2019 divided according to the type of approach. Patients were preoperatively studied through instrumental assessment and clinical evaluation, using validated questionnaires and then postoperatively at specific time frames. Linear regression analysis was performed to evaluate possible predictor of continuous variables. All the procedures were carried out by one single expert surgeon. Results: Overall, 168 patients were included, of which 81 were treated with classical three-lobes and 87 with en-bloc with early apical release technique. The two cohorts were comparable related to preoperative features and postoperative complication rate. Mean enucleation time (ET), lasing time, amount of energy delivered, and overall operative time were significantly lower in en-bloc procedures (p < 0.05). Stepwise multivariable linear regression showed that en-bloc strategy can significantly predict shorter ET and lower energy delivered. Stress incontinence rate at 1-month follow-up was found to be significantly reduced in the en-bloc group, compared with the counterpart. Conclusions: Both techniques are effective and safe treatment options for BOO, since peri- and postoperative surgical and functional outcomes were favorable. En-bloc strategy may significantly decrease ET and the amount of energy delivered leading to a reduced early stress incontinence rate compared with the standard approach.
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Affiliation(s)
- Agostino Tuccio
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Antonio Andrea Grosso
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Sessa
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Matteo Salvi
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Tellini
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Cocci
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Lorenzo Viola
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Pierangelo Verrienti
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Matteo Di Camillo
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Fabrizio Di Maida
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Mari
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Minervini
- Unit of Oncologic Minimally Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
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Dekalo S, Savin Z, Schreter E, Marom R, Bar-Yosef Y, Mano R, Yossepowitch O, Sofer M. Novel ultrasound-based volume estimation of prostatic benign enlargement to improve decision-making on surgical approach. Ther Adv Urol 2021; 13:1756287221993301. [PMID: 33633800 PMCID: PMC7887671 DOI: 10.1177/1756287221993301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/13/2020] [Indexed: 11/18/2022] Open
Abstract
Aim: To assess the precision of preoperative ultrasonography (US)-determined prostate volume and to propose formulas for improving it. Methods: This retrospective study comprised 155 consecutive men who underwent open prostatectomy for benign prostatic hyperplasia (BPH) between 2013 and 2019. Preoperative prostate volume was estimated by either abdominal US (AUS) (n = 92) or transrectal US (TRUS) (n = 63), and was compared with the weight of surgically enucleated tissue at a conversion rate of 1 ml (US) = 1 g tissue. Statistical analysis was conducted and a novel formula for prostate volume was constructed. Results: The median prostate volumes by AUS and TRUS were 140 ml [interquartile ratio (IQR) 111–182] and 108 ml (IQR 93–120), respectively. Enucleated tissue weight was lower than the AUS assessment by a median difference of 50 g (IQR 28.7–75.7; p < 0.001), and lower than the TRUS assessment by a median difference of 27 g, IQR 10–43, p < 0.001). Using a cutoff of 80 ml, 30 (33%) AUS patients and 23 (36%) TRUS patients underwent unneeded open procedures. Mathematical calculations revealed two formulas that significantly adjusted for the actual weight: 1.082*Age + 0.523*AUS − 53.845 for AUS and 0.138*age + 2.22*prostate-specific antigen + 0.453*TRUS + 11.682 for TRUS (p < 0.001). These formulas increased the overall US prostate volume accuracy from 65% to 85%. Conclusion: Assessment of prostate volume by US is imprecise for decision-making of whether to perform open simple prostatectomy for BPH. Our novel formulas may enhance stratification of patients with prostatic enlargement to a more optimal surgical approach. Future studies in larger cohorts are needed to substantiate our results.
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Affiliation(s)
- Snir Dekalo
- Department of Urology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv University, Weizman 6 Tel Aviv, Tel Aviv, 64239, Israel
| | - Ziv Savin
- Department of Urology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eran Schreter
- Department of Urology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ron Marom
- Department of Urology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yuval Bar-Yosef
- Department of Urology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Roy Mano
- Department of Urology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ofer Yossepowitch
- Department of Urology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Mario Sofer
- Department of Urology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Li P, Wang C, Tang M, Han P, Meng X. Holmium laser enucleation of prostate by using en-bloc and bladder neck preservation technique: technical consideration and influence on functional outcomes. Transl Androl Urol 2021; 10:134-142. [PMID: 33532303 DOI: 10.21037/tau-20-852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background This study aimed to evaluate the efficacy and safety of holmium laser enucleation of prostate (HoLEP) by using en-bloc and bladder neck preservation technique on benign prostatic hyperplasia (BPH) and assess the influence of this procedure on urinary and sexual functional outcomes. Methods A total of 704 patients with BPH undergoing HoLEP were retrospectively analysed. Amongst them, 213 who met the sexual function assessment criteria were further assessed the influence of the technique on sexual functional outcomes. Results The mean operative time, resected prostate weight and mean estimated blood loss were 69.3±14.8 min, 53.4±17.6 g and 62.1±23.7 mL, respectively. The mean duration of catheterization after surgery and mean hospital stay were 2.1±1 and 5.4±3.6 days, respectively. The post-void residual volume, maximum urinary flow rate, international prostate symptom score and quality of life score were all significantly improved postoperation (P<0.05). Amongst the 213 patients with normal antegrade ejaculation before surgery, postoperative international index of erectile function scores slightly improved, although the difference was insignificant (P>0.05). The difference in the Erection Hardness Grading Scale before and after surgery was statistically insignificant (P>0.05). A total of 25 (11.7%) patients had retrograde ejaculation after surgery. Conclusions HoLEP by an en-bloc and bladder neck preservation technique can obtain good functional outcome with small injury and high efficiency, especially for patients who need to preserve normal sexual function and anterograde ejaculation.
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Affiliation(s)
- Pu Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chengming Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Tang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Peng Han
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoxin Meng
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Chan PTK, Aubé M. Infertility due to ejaculatory duct obstruction can be surgically corrected-a forgotten lesson in male reproductive urology. Fertil Steril 2018; 110:1275-1276. [PMID: 30503126 DOI: 10.1016/j.fertnstert.2018.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Peter T K Chan
- Department of Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Mélanie Aubé
- Department of Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada
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