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Juliebø-Jones P, Gauhar V, Castellani D, Fong KY, Sofer M, Zawadzki M, Gadzhiev N, Pirola GM, Mahajan AD, Maheshwari PN, Malkhasyan V, Biligere S, Gökce Mİ, Cormio L, Enikeev D, Gómez Sancha F, Herrmann TRW, Somani BK. Real world propensity score matched analysis evaluating the influence of en-bloc vs. non en-bloc techniques, energy and instrumentation on enucleation outcomes for large and very large prostates. World J Urol 2024; 42:299. [PMID: 38710824 PMCID: PMC11074046 DOI: 10.1007/s00345-024-04959-6] [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: 12/16/2023] [Accepted: 03/25/2024] [Indexed: 05/08/2024] Open
Abstract
PURPOSE The primary aim of the study was to evaluate if en-bloc vs. non en-bloc made a difference to intra-, peri- and post-operative surgical outcomes of anatomical endoscopic enucleation (AEEP) in large (> 80 cc) and very large prostates (> 200 cc). The secondary aim was to determine the influence of energy and instruments used. METHODS Data of patients with > 80 cc prostate who underwent surgery between 2019 and 2022 were obtained from 16 surgeons across 13 centres in 9 countries. Propensity score matching (PSM) was used to reduce confounding. Logistic regression was performed to evaluate factors associated with postoperative urinary incontinence (UI). RESULTS 2512 patients were included with 991 patients undergoing en-bloc and 1521 patients undergoing non-en-bloc. PSM resulted in 481 patients in both groups. Total operation time was longer in the en-bloc group (p < 0.001), enucleation time was longer in the non en-bloc group (p < 0.001) but morcellation times were similar (p = 0.054). Overall, 30 day complication rate was higher in the non en-bloc group (16.4% vs. 11.4%; p = 0.032). Rate of late complications (> 30 days) was similar (2.3% vs. 2.5%; p > 0.99). There were no differences in rates of UI between the two groups. Multivariate analysis revealed that age, Qmax, pre-operative, post-void residual urine (PVRU) and total operative time were predictors of UI. CONCLUSIONS In experienced hands, AEEP in large prostates by the en-bloc technique yields a lower rate of complication and a slightly shorter operative time compared to the non en-bloc approach. However, it does not have an effect on rates of post-operative UI.
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
- Department of Urology, Haukeland University Hospital, Bergen, Norway.
- Department of Urology, University Hospital Southampton, Southampton, UK.
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong Hospital, Singapore, Singapore
| | - Daniele Castellani
- Urology Division, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Ancona, Italy
| | - Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mario Sofer
- Department of Urology, Sackler Faculty of Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Nariman Gadzhiev
- Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | - Giacomo Maria Pirola
- Urology Unit, IRCCS Multimedica, Multimedica Group, San Giuseppe Hospital, Milan, Italy
| | - Abhay D Mahajan
- Sai Urology Hospital and Mahatma Gandhi Mission's Medical College and Hospital, Aurangabad, India
| | | | - Vigen Malkhasyan
- Urology Unit, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | | | - Mehmet İlker Gökce
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Luigo Cormio
- Andrology and Urology Unit, Bonomo Teaching Hospital, Andria, Italy
- Department of Urology, Ospedali Riuniti di Foggia, University of Foggia, Foggia, Italy
| | - Dmitry Enikeev
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Urology Department, Rabin Medical Center, Petah Tikva, Israel
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Thomas R W Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
- Department of Clinical Medicine, Hannover Medical School, Hannover, Germany
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton, Southampton, UK
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Chen S, Chen J, Zhang J, Wang K, Wei J, Weng M, Zhu L. Laparoscopic prostatectomy with complete urethral reconstruction for sexual active BPH patients. MINIM INVASIV THER 2024; 33:29-34. [PMID: 37971312 DOI: 10.1080/13645706.2023.2264390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 09/14/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To describe our technique of transvesical laparoscopic simple prostatectomy (LSP) plus complete urethral reconstruction(CUR). MATERIAL AND METHODS From May 2019 to May 2021, 28 BPH patients with prostate volumes > 80 ml and the requirement to preserve the ejaculatory function (EF) received LSP plus CUR. Baseline demographics, pathology data, perioperative and postoperative complications, and functional outcomes were assessed. Data were analyzed with the Wilcoxon test. RESULTS The median prostate volume was 106 ml. All patients successfully underwent LSP with no intraoperative complications or conversions to open surgery. The median operative time was 146 min. A total of five Clavien-Dindo Grade1-2 postoperative complications were noted, including infection, prolonged urine leakage and cardiac arrhythmia. No patient reported postoperative urgent or stress urinary incontinence. Functional outcomes at one-year follow-up demonstrated significant improvement from baseline with median IPSS and Qmax (p both < 0.001). Compared with baseline, no significant difference was observed in IIEF and MSHQ-EjD-SF at 6 and 12 months postoperatively. CONCLUSIONS Our data support transperitoneal-transvesical LSP plus CUR as a safe and effective surgical technique for treating BPH with large prostate adenoma, regardless of the volume of the median lobe, especially for patients requiring to preserve antegrade ejaculation.
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Affiliation(s)
- Shushang Chen
- Department of Urology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
| | - Jin Chen
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
- Institute of Transplantation Medicine, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Jianping Zhang
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
- Department of Urology, Affiliated Haixia Hospital of Huaqiao University, Quanzhou, China
| | - Kuanyin Wang
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
- Department of Urology, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Junjie Wei
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
| | - Mingfang Weng
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
| | - Lingfeng Zhu
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
- Department of Urology, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
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3
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Guldibi F, Altunhan A, Aydın A, Sonmez MG, Çakır ÖO, Balasar M, Guven S, Ahmed K. What is the effect of laser anatomical endoscopic enucleation of the prostate on the ejaculatory functions? A systematic review. World J Urol 2023; 41:3493-3501. [PMID: 37921935 DOI: 10.1007/s00345-023-04660-0] [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: 06/05/2023] [Accepted: 09/21/2023] [Indexed: 11/05/2023] Open
Abstract
INTRODUCTION Laser anatomical endoscopic enucleation of the prostate (LAEEP) has emerged as a promising new approach in endoscopic surgery for BPH. LAEEP could still result in ejaculatory dysfunction. AIM This systematic review aimed to examine the impact of LAEEP on male ejaculatory functions. METHODS The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and 15 records were included. Outcomes of interest included ejaculatory dysfunction (retrograde ejaculation, painful ejaculation, etc.) and validated questionnaire scores. The quality of studies included in the systematic review was determined using QUADAS scoring. RESULTS We retrieved data for 1877 men in 15 clinical studies investigating LAEEP surgery and reporting EjD rates. While only three of the obtained studies were on thulium fiber (ThuLEP), the rest were on holmium (HoLEP). The definition of "Ejaculatory Dysfunction" was not standardized, but in most works, it is referred to as retrograde ejaculation (RE). There were no data on the relationship between other LAEEP techniques and ejaculation functions. The authors compared the outcomes of used standard laser enucleation techniques with the modified techniques. The RE rate in LAEEP was 62.1 ± 25.1%, 71.3 ± 16.1% in standard techniques, and 27.2 ± 18.1% in ejaculation-preserving modified techniques (p < 0.001). CONCLUSION This review demonstrated that ejaculation-preserving techniques, i.e., modified techniques are superior to standard techniques. Studies have also shown that ejaculatory dysfunction rates gradually decrease with long-term follow-ups. Future well-designed studies could further investigate the ejaculation-preserving modification of LAEEP techniques and how they impact EjD rates and other sexual function outcomes.
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Affiliation(s)
- Furkan Guldibi
- Meram School of Medicine, Urology Department, Necmettin Erbakan University, Konya, Turkey
| | - Abdullah Altunhan
- Meram School of Medicine, Urology Department, Necmettin Erbakan University, Konya, Turkey
| | | | - Mehmet Giray Sonmez
- Meram School of Medicine, Urology Department, Necmettin Erbakan University, Konya, Turkey
| | - Ömer Onur Çakır
- Department of Urology, King's College Hospitals, London, UK
- MRC Centre for Transplantation, King's College London, Guy's Hospital Campus, London, UK
| | - Mehmet Balasar
- Meram School of Medicine, Urology Department, Necmettin Erbakan University, Konya, Turkey
| | - Selcuk Guven
- Meram School of Medicine, Urology Department, Necmettin Erbakan University, Konya, Turkey.
| | - Kamran Ahmed
- Meram School of Medicine, Urology Department, Necmettin Erbakan University, Konya, Turkey
- Sheikh Khalifa Medical City, Abu Dhabi, UAE
- Khalifa University, Abu Dhabi, UAE
- Department of Urology, King's College Hospitals, London, UK
- MRC Centre for Transplantation, King's College London, Guy's Hospital Campus, London, UK
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Bozzini G, Berti L, Maltagliati M, Besana U, Micali S, Roche JB, Romero-Otero J, Pacchetti A, Perri D, Morini E, Saredi G, Mazzoleni F, Sighinolfi MC, Buizza C, Rocco B. Thulium: YAG vs continuous-wave thulium fiber laser enucleation of the prostate: do potential advantages of thulium fiber lasers translate into relevant clinical differences? World J Urol 2023; 41:143-150. [PMID: 36357602 DOI: 10.1007/s00345-022-04201-1] [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: 03/13/2022] [Accepted: 10/25/2022] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To compare endoscopic enucleation of the prostate using a thulium: yttrium-aluminum-garnet (Tm:YAG) laser and a super-pulsed thulium fiber laser set in continuous-wave (CW) mode, and to evaluate whether theoretical advantages of thulium fiber lasers, related to their shorter wavelength, translate into relevant clinical differences. METHODS In total, 110 patients suffering from lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia were randomized to undergo either thulium:YAG laser enucleation of the prostate (ThuLEP) or CW thulium fiber laser enucleation of the prostate (CW-ThuFLEP). Intraoperative and postoperative variables and complications were compared. Micturition improvement was assessed at 3-month follow-up using the International Prostate Symptom Score (IPSS), post-void residual urine (PVR) and maximum flow rate (Qmax). Erectile function was evaluated using the International Index of Erectile Function-5 (IIEF-5). RESULTS No significant differences between the ThuLEP and CW-ThuFLEP groups were found in terms of operative time (70.69 vs 72.41 min), enucleation time (50.23 vs 53.33 min), enucleated tissue weight (40.2 vs 41.9 g), enucleation efficiency (0.80 vs 0.79 g/min), catheterization time (2.45 vs 2.57 days), hospital stay (2.82 vs 2.95 days) and hemoglobin drop (1.05 vs 1.27 g/dl). At 3-month follow-up, no significant differences were found in IPSS (5.09 vs 5.81), Qmax (26.51 vs 27.13 ml/s), PVR (25.22 vs 23.81 ml) and IIEF-5 (14.01 vs 14.54). CONCLUSION ThuLEP and CW-ThuFLEP were equivalent in relieving patients from LUTS and improving micturition. Theoretical advantages of the TFL, such as shallower penetration depth and improved vaporization capacity, did not translate into relevant perioperative outcomes or clinical differences.
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Affiliation(s)
- Giorgio Bozzini
- Department of Urology, ASST-Lariana, Ospedale Sant'Anna, San Fermo della Battaglia, CO, Italy.
| | - Lorenzo Berti
- Department of Urology, ASST-Valle Olona, Ospedale di Busto Arsizio, Busto Arsizio, VA, Italy.,Department of Urology, Università degli Studi di Modena e Reggio Emilia, Modena, MO, Italy
| | - Matteo Maltagliati
- Department of Urology, ASST-Valle Olona, Ospedale di Busto Arsizio, Busto Arsizio, VA, Italy.,Department of Urology, Università degli Studi di Modena e Reggio Emilia, Modena, MO, Italy
| | - Umberto Besana
- Department of Urology, ASST-Valle Olona, Ospedale di Busto Arsizio, Busto Arsizio, VA, Italy
| | - Salvatore Micali
- Department of Urology, Università degli Studi di Modena e Reggio Emilia, Modena, MO, Italy
| | | | | | - Andrea Pacchetti
- Department of Urology, ASST-Lariana, Ospedale Sant'Anna, San Fermo della Battaglia, CO, Italy
| | - Davide Perri
- Department of Urology, ASST-Lariana, Ospedale Sant'Anna, San Fermo della Battaglia, CO, Italy
| | - Elena Morini
- Department of Urology, ASST-Lariana, Ospedale Sant'Anna, San Fermo della Battaglia, CO, Italy
| | - Giovanni Saredi
- Department of Urology, ASST-Valle Olona, Ospedale di Busto Arsizio, Busto Arsizio, VA, Italy
| | - Federica Mazzoleni
- Department of Urology, ASST-Lariana, Ospedale Sant'Anna, San Fermo della Battaglia, CO, Italy
| | | | - Carlo Buizza
- Department of Urology, ASST-Valle Olona, Ospedale di Busto Arsizio, Busto Arsizio, VA, Italy
| | - Bernardo Rocco
- Department of Urology, ASST-Santi Paolo e Carlo, Milan, MI, Italy
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5
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Thulium YAG is the Best Laser for the Prostate Because of Versatility. EUR UROL SUPPL 2022; 48:18-21. [PMID: 36583181 PMCID: PMC9793213 DOI: 10.1016/j.euros.2022.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 12/24/2022] Open
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6
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Cheng YT, Hong JH, Lu YC, Chang YK, Hung SC, Feng KK, Liu SP, Chow PM, Chang HC, Chen CH, Pu YS. Clinical Implications of Nadir Serum Prostate-Specific Antigen Levels After Transurethral Enucleation of the Prostate. Front Oncol 2022; 12:949275. [PMID: 35912236 PMCID: PMC9334729 DOI: 10.3389/fonc.2022.949275] [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] [Received: 05/20/2022] [Accepted: 06/24/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Prostate-specific antigen levels after transurethral enucleation of the prostate may serve as indicators of residual cancer foci. The objective of this study was to investigate the association between the post-transurethral enucleation of the prostate nadir prostate-specific antigen level and prostate cancer. Materials and Methods We retrospectively reviewed the data of 428 men who underwent transurethral enucleation of the prostate between March 2015 and April 2021. Based on the following exclusion criteria, we excluded 106 men from our analysis: men with metastatic prostate cancer, incomplete transurethral enucleation of the prostate, and missing prostate-specific antigen or prostate size data. Three hundred and twenty-two patients were finally enrolled in our study. These patients were classified into four groups according to the surgical pathology: benign, transition zone (cancer only in the adenoma or transition zone), peripheral zone, and transition and peripheral zones. The optimal cutoff post-transurethral enucleation of the prostate nadir prostate-specific antigen level that predicted residual prostate cancer was determined using receiver operating characteristic curve analysis. Results In total, 71 (22.0%) men exhibited prostate cancer (median follow-up, 38.0 months). The benign and combined cancer groups showed similar adenoma removal rates (103.0% and 106.7%, respectively). The median nadir prostate-specific antigen levels after transurethral enucleation of the prostate were 0.76, 0.63, 1.79, and 1.70 ng/ml in the benign, transition zone, peripheral zone, and transition and peripheral zone groups, respectively (p < 0.001), with no difference between the benign and transition zone groups (p = 0.458); this suggested that complete transurethral enucleation of the prostate removed all cancer nests in the adenoma in the transition zone group. Receiver operating characteristic curve analysis showed that nadir prostate-specific antigen ≧1.7 ng/ml predicted residual cancer (area under the curve: 0.787) or cancer with a Gleason score of ≧7 (area under the curve: 0.816) in the remaining prostate. Limitations include the retrospective design and the perioperative peripheral zone biopsy rate. Conclusions The post-transurethral enucleation of the prostate nadir prostate-specific antigen ≧1.7 ng/ml after complete transurethral enucleation of the prostate can predict significant residual cancer. Prostate cancer patients with low post-transurethral enucleation of the prostate prostate-specific antigen levels can be conservatively managed.
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Affiliation(s)
- Yung-Ting Cheng
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Urology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Jian-Hua Hong
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Chuan Lu
- Department of Urology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Yi-Kai Chang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Chun Hung
- Department of Urology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Kuo-Kang Feng
- Department of Urology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Shih-Ping Liu
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Ming Chow
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hong-Chiang Chang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Hsin Chen
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
- *Correspondence: Yeong-Shiau Pu, ; Chung-Hsin Chen,
| | - Yeong-Shiau Pu
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
- *Correspondence: Yeong-Shiau Pu, ; Chung-Hsin Chen,
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Endoscopic Enucleation of the Prostate Is Better than Robot-assisted Simple Prostatectomy. Eur Urol Focus 2022; 8:365-367. [PMID: 35396196 DOI: 10.1016/j.euf.2022.03.020] [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: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 11/04/2022]
Abstract
In 2022, endoscopic enucleation of the prostate (EEP) is the treatment of choice for benign prostatic obstruction (BPO) for glands >80 ml and is a valid alternative for patients with bleeding disorders. Unlike robot-assisted radical prostatectomy, EEP has no additional access-related trauma and can be performed using the same instruments as for bipolar enucleoresection. With favorable costs, EEP can serve as a global solution for BPO treatment.
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Taratkin M, Shpikina A, Morozov A, Novikov A, Fokin I, Petov V, Rw Herrmann T, Misrai V, Lusuardi L, Teoh JY, McFARLAND J, Kozlov V, Enikeev D. Enucleation vs vaporization of benign prostatic hyperplasia: a head-to-head comparison of the various outcomes and complications. A systematic review and meta-analysis. Minerva Urol Nephrol 2021; 74:559-569. [PMID: 34791865 DOI: 10.23736/s2724-6051.21.04639-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Vaporization of the prostate (VP) and endoscopic enucleation of the prostate (EEP) are reliable and frequently used methods for BPO relief. Both surgeries utilize lasers and EAU recommends them in similar patient cohorts. Our objective was to compare intra- and perioperative results of patients who had undergone VP and EEP. EVIDENCE ACQUISITION A systematic literature search was performed in three databases (MEDLINE, Web of Science and Scopus). The detailed search strategy is available at Prospero, CRD42020204739. Primary outcomes were functional results (IPSS, QoL, PVR, Qmax), and secondary outcomes were intraoperative results, postoperative PSA and prostate volume, complications, and recurrence rate. EVIDENCE SYNTHESIS VP required less operative time compared to EEP, mean difference=-5.51 (95%CI -7.52; -3.50). IPSS and Qmax for VP were worse after 12-month follow-up, mean difference=0.89 (95%CI 0.52; 1.27) and -3.7 (95%CI -4.56; -2.85), respectively, while QoL did not differ significantly. Postoperative PSA level was higher in the VP group, mean difference=2.28 (95%CI 2.00; 2.55). VP was associated with reduced Clavien-Dindo grade I (OR=4.16; 95%CI 2.96; 5.84) and grade II (OR=3.79; 95%CI 2.25; 6.39) complication rate, especially in terms of the percentage of blood transfusion and transient urinary incontinence. The rate of complications grade IIIa and higher was similar (3 - 6%). Reoperation rate was only estimated in one study and was significantly higher in the PVP group at 60 months of follow-up, 2.7% vs 0%, p<0.05. CONCLUSIONS EEP and VP share the efficacy and safety in BPH management. Our meta-analysis shows comparable complication rate in Clavien-Dindo III, VP superiority in operation time, and EEP superiority in long-term functional outcomes and PSA reduction.
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Affiliation(s)
- Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Anastasia Shpikina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Alexey Novikov
- Moscow state clinical hospital named after Yudin, Moscow, Russia
| | - Igor Fokin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Vladislav Petov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Thomas Rw Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland.,Department of Urology, Hannover Medical School, Hannover, Germany
| | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Lukas Lusuardi
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Jeremy Y Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Jonathan McFARLAND
- Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia.,Faculty of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Vasiliy Kozlov
- Department of Public Health and Healthcare, Sechenov University, Moscow, Russia
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia -
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9
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Yang K, Meng Y, Zhang K. Educational value of YouTube Surgical Videos of Thulium Laser Enucleation of The Prostate (ThuLEP): the quality assessment. Transl Androl Urol 2021; 10:2848-2856. [PMID: 34430387 PMCID: PMC8350234 DOI: 10.21037/tau-21-263] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/20/2021] [Indexed: 01/05/2023] Open
Abstract
Background To assess the educational value of YouTube surgical videos of thulium laser enucleation of the prostate (ThuLEP). Methods A comprehensive search of “ThuLEP” or “thulium laser enucleation of the prostate” was performed on YouTube on October 31, 2020. According to the LAParoscopic surgery Video Educational GuidelineS, we created a checklist to assess the educational value of these videos. The checklist included 20 options. Each option represented one point. The total score was the sum of all the points. The higher score represents the higher educational value. Results A total of 70 videos were included. The average number of views were 1,366 (range, 11–30,884). The mean video length was 16.59 mins (range, 1.20–70.35 mins). Only 22.9% (16/70) videos had audio or/and written commentary in English language. Although 67.4% (47/70) videos were present step by step, only 21.4% (15/70) videos did the detailed explanation of critical steps. The mean score of the videos was 5.5 points (range, 1–15). No videos met all the points of the checklist. The mean percentage conformity of the videos was 28% (range, 5–75%). The educational score of the videos had no significant positive correlation with the number of views. Conclusions The majority of ThuLEP videos on YouTube platform have low educational value. Videos often lack important and detailed explanations about surgical procedures. The ThuLEP learner should watch these videos selectively. These findings remind us that a global effort should be made to improve the educational value of YouTube surgical videos, and more reporting guidelines about urological endoscopic surgery are still needed.
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Affiliation(s)
- Kunlin Yang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Yisen Meng
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Kai Zhang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
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10
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Cho CL, Teoh JYC, Cho SY, Ng ACF, Henkel R. Quest for the best-A move to Anatomical Endoscopic Enucleation of the Prostate. Andrologia 2021; 52:e13757. [PMID: 32969058 DOI: 10.1111/and.13757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Chak-Lam Cho
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.,Department of Surgery, Union Hospital, Tai Wai, Hong Kong, China
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Sung-Yong Cho
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Anthony Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Ralf Henkel
- Department of Medical Biosciences, University of the Western Cape, Bellville, South Africa
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Herrmann TR, Gravas S, de la Rosette JJMCH, Wolters M, Anastasiadis AG, Giannakis I. Lasers in Transurethral Enucleation of the Prostate-Do We Really Need Them. J Clin Med 2020; 9:E1412. [PMID: 32397634 PMCID: PMC7290840 DOI: 10.3390/jcm9051412] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 04/20/2020] [Accepted: 04/30/2020] [Indexed: 12/21/2022] Open
Abstract
The acronym EEP, coding for transurethral Endoscopic Enucleation of the Prostate, was introduced in 2016 by the European Association of Urology (EAU) guidelines panel on management of non-neurogenic male lower urinary tract symptoms (LUTS) and benign prostatic obstruction (BPO). Since then, a laser-based treatment, Holmium Laser Enucleation of the Prostate (HoLEP), and the current-based treatment of bipolar enucleation of the prostate (BipoLEP) are equally appreciated as valuable options for the management of benign prostatic obstruction (BPO). This was mainly inspired by the results of two meta-analyses on randomized controlled trials, comparing open prostatectomy with either Holmium Laser Enucleation of the Prostate (HoLEP) or bipolar enucleation of the prostate (BipoLEP). Prior to that, HoLEP was embraced as the only valid option for transurethral enucleation, although evidence for equivalence existed as early as 2006, but was not recognized due to a plethora of acronyms for bipolar energy-based treatments and practiced HoLEP-centrism. On the other hand, the academic discourse focused on different (other) laser approaches that came up, led by Thulium:Yttrium-Aluminum-Garnet (Tm:YAG) Vapoenucleation (ThuVEP) in 2009 and, finally, transurethral anatomical enucleation with Tm:YAG support (thulium laser enucleation of the prostate, ThuLEP) in 2010. Initially, the discourse on lasers focused on the different properties of lasers rather than technique or surgical anatomy, respectively. In and after 2016, the discussion ultimately moved towards surgical technique and accepting anatomical preparation as the common of all EEP techniques (AEEP). Since then, the unspoken question has been raised, whether lasers are still necessary to perform EEP in light of existing evidence, given the total cost of ownership (TCO) for these generators. This article weighs the current evidence and comes to the conclusion that no evidence of superiority of one modality over another exists with regard to any endpoint. Therefore, in the sense of critical importance, AEEP can be safely and effectively performed without laser technologies and without compromise.
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Affiliation(s)
- Thomas R.W. Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, 8569 Münsterlingen, Switzerland; (A.G.A.); (I.G.)
- Department of Urology, Hannover Medical School, 30625 Hannover, Germany;
| | - Stavros Gravas
- Department of Urology, University Hospital of Larisa, 41500 Larisa, Greece;
| | | | - Mathias Wolters
- Department of Urology, Hannover Medical School, 30625 Hannover, Germany;
| | | | - Ioannis Giannakis
- Department of Urology, Spital Thurgau AG, Frauenfeld, 8569 Münsterlingen, Switzerland; (A.G.A.); (I.G.)
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