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Bultó Gonzalvo R, Bernardello Ureta M, Cervera Alcaide J, Sanchez Rodriguez M, Franco M, Freixa Sala R, Areal Calama J, Agreda Castañeda F. Evaluating the effects of preoperative treatment with 5-alpha reductase inhibitors in holmium laser enucleation of the prostate. Actas Urol Esp 2024; 48:150-154. [PMID: 37604401 DOI: 10.1016/j.acuroe.2023.08.008] [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: 05/19/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION AND AIM Patients treated with HoLEP are frequently treated with previous treatments, including 5-alpha-reductase inhibitors (5-ARIs). We investigated the impact of pretreatment with 5-ARIs on perioperative and immediate postoperative parameters in patients treated with HoLEP. MATERIAL AND METHODS A retrospective study was performed using a prospectively collected database including all patients treated with HoLEP at our center between January 2017 and January 2023. The resected tissue weight, enucleation and morcellation efficiency (enucleation weight/time and morcellation weight/ time), postoperative complications, hospital stay and hemoglobin drop have been analyzed. RESULTS A total of 327 patients were included. Of these, 173 (52.9%) were treated with 5-ARIs. No differences were found among the perioperative parameters investigated to determine efficiency. No differences were observed in peri- or postoperative complications, hospital stay or hemoglobin drop. CONCLUSIONS Therapy with 5-ARIs had no impact on the immediate postoperative outcomes of patients treated with HoLEP. In our cohort, we observed that the use of 5-ARIs did not affect surgical efficiency, enucleation or morcellation. Further multicenter studies will be necessary to validate these findings.
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Affiliation(s)
- R Bultó Gonzalvo
- Servicio de Urología, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain.
| | - M Bernardello Ureta
- Servicio de Urología, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - J Cervera Alcaide
- Servicio de Urología, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - M Sanchez Rodriguez
- Servicio de Urología, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - M Franco
- Servicio de Urología, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - R Freixa Sala
- Servicio de Urología, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - J Areal Calama
- Servicio de Urología, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - F Agreda Castañeda
- Servicio de Urología, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
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Liu K, Zhao X, Xiao R, Zhao L, Xiao C, Zhang S, Ma L. Factors predicting indistinct plane of surgical capsule in patients underwent HoLEP procedures. World J Urol 2024; 42:26. [PMID: 38206399 DOI: 10.1007/s00345-023-04736-x] [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: 07/31/2023] [Accepted: 11/01/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To evaluate factors that effectively predict indistinct plane (IP) in patients who underwent holmium laser enucleation of the prostate (HoLEP). METHODS Data of 208 consecutive patients from our HoLEP database were reviewed and analyzed. IP was defined in 107 cases, as the plane could be identified only depending on endoscopic beak dissection rather than laser dissection in the initial stage of HoLEP, whereas the control group consisted of 101 cases. Variables including age, body mass index, prostatic volume (PV), intravesical prostatic protrusion, prostate-specific antigen, prostate-specific antigen density, bladder stones, urinary tract infection, microscopic hematuria, prior biopsy (PB), diabetes, hypertension, history of acute urinary retention, 5-alpha reductase inhibitor treatment, catheter dependency, residual urine, region, smoking, and alcohol consumption were compared between the two groups. The risk factors for predicting the presence of IP were determined using a multivariable binary logistic regression model using a forward selection approach with a focus on improvement in the area under the receiver operating characteristic curve (AUC). RESULTS The incidence of IP was 51.4% (107/208). PV (OR = 0.977, p < 0.001) and PB (OR = 0.297, p = 0.028) were identified as the independent predictors of capsule plane status. PV with a cutoff of 54 ml had the best predictive effectiveness for IP based on AUC (0.727; 95% CI 0.659-0.795). The specificity and sensitivity of this cutoff were 82.2% and 53.3%, respectively. CONCLUSION PV is the most reliable factor to predict IP during HoLEP procedures. There is a high possibility of IP in patients with a PV less than 54 ml.
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Affiliation(s)
- Ke Liu
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China
| | - Xun Zhao
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China
| | - Ruotao Xiao
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China
| | - Lei Zhao
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China
| | - Chunlei Xiao
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China.
| | - Shudong Zhang
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, 100191, China
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V.I.P. Score: A Comprehensive Grading System to Predict Difficulty of HoLEP Procedure for Small-to-Moderate Sized Prostate (<120 ml). Urology 2023:S0090-4295(23)00208-X. [PMID: 36907469 DOI: 10.1016/j.urology.2023.02.037] [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: 12/14/2022] [Revised: 02/21/2023] [Accepted: 02/28/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVES To develop a comprehensive scoring system in addition to the conventionally used prostatic volume (PV), for predicting the difficulty of holmium laser enucleation of the prostate (HoLEP) that may arise with small-to-moderate sized prostate. METHODS We retrospectively reviewed 151 consecutive patients who underwent HoLEP and had a PV less than 120 ml. Based on previous literature, a difficult procedure was defined as a prolonged operative time (OT>90 min) in 88 cases, while the control group (OT≤90 min) consisted of 63 patients. The clinical data, including age, body mass index, PV, intravesical prostatic protrusion (IPP), prostate specific antigen (PSA), prostate specific antigen density, urinary tract infection, microscopic hematuria, prior biopsy, diabetes mellitus, hypertension, history of acute urinary retention, catheter dependency and use of antiplatelet / anticoagulation drugs or 5-alpha reductase inhibitor were compared between the two groups. RESULTS Univariate analysis revealed significant differences between the two groups. Multivariate analysis identified three main independent predictors for difficulty, including volume (V) (60-90 ml OR=9.812, P<0.001) (≥90 ml OR=18.173, P=0.01), IPP (I) (OR=3.157, P=0.018), and PSA (P) (≥4 ng/ml OR=16.738, P<0.001). Therefore, a V.I.P. score was developed based on the regression model and ranged from 0 to 7 points. The area under the curve showed preferable predictive ability of the V.I.P. score compared to PV (0.906 versus 0.869). CONCLUSIONS We developed a V.I.P. score that can accurately predict the difficulty of the HoLEP procedure for PV less than 120 ml in order to optimize clinical outcomes.
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Chung JS, Seo WI, Oh CK, Kim SC, Park MC, Park SH, Yu J, Lee CH, Kim W, Park TY, Min KS, Chung JI. Effect of 5α-reductase inhibitors on the efficiency of thulium:yttrium-aluminium-garnet (RevoLix®) vaporesection for treating benign prostatic hyperplasia. Investig Clin Urol 2019; 61:67-74. [PMID: 31942465 PMCID: PMC6946814 DOI: 10.4111/icu.2020.61.1.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/08/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose Preoperative use of 5α-reductase inhibitors (5ARIs) may cause fibrosis of the prostate tissue and reduce the efficiency of thulium laser surgery for treating benign prostate hyperplasia (BPH). Thus, we investigated the effects of preoperative 5ARI use in this setting. Materials and Methods This retrospective study examined 184 patients who underwent thulium laser surgery for BPH during 2012–2017. Patients were grouped according to their 5ARI use in order to compare their preoperative and intraoperative characteristics and subsequent outcomes. Surgical efficiency was assessed using vaporesection efficiency. The total operation time, vaporesection time and prostate volume change were measured. Results The 5ARI+ group included 83 patients (45.1%) and the 5ARI− group included 101 patients (54.9%). There were no significant differences in the two groups' preoperative characteristics, postoperative prostate size, thulium laser energy use, or prostate volume reduction rate. However, relative to the 5ARI− group, the 5ARI+ group had a significant shorter total operative time (65.0 min vs. 70.0 min, p=0.013) and a significantly shorter vaporesection time (48.0 min vs. 54.0 min, p=0.014), which resulted in significantly higher vaporesection efficiency in the 5ARI+ group (0.66 mL/min vs. 0.51 mL/min, p<0.001). Both groups exhibit significant improvements in their quality of life score and International Prostate Symptom Score during the 12-month follow-up. Conclusions In contrast with our expectations, the preoperative use of 5ARI increased the efficiency of thulium laser surgery for BPH. Thus, it may not be necessary to stop 5ARI treatment before performing thulium laser surgery in this setting.
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Affiliation(s)
- Jae Seung Chung
- Department of Urology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Won Ik Seo
- Department of Urology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Cheol Kyu Oh
- Department of Urology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seong Cheol Kim
- Department of Urology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Myung Chan Park
- Department of Urology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Hyun Park
- Department of Urology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jihyeong Yu
- Department of Urology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Chan Ho Lee
- Department of Urology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Wansuk Kim
- Department of Urology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Tae Yong Park
- Department of Urology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kweon Sik Min
- Department of Urology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae Il Chung
- Department of Urology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Romero-Otero J, García-González L, García-Gómez B, Justo-Quintas J, García-Rojo E, González-Padilla DA, Sopeña-Sutil R, Duarte-Ojeda JM, Rodríguez-Antolín A. Factors Influencing Intraoperative Blood Loss in Patients Undergoing Holmium Laser Enucleation of the Prostate (HoLEP) for Benign Prostatic Hyperplasia: A Large Multicenter Analysis. Urology 2019; 132:177-182. [PMID: 31252004 DOI: 10.1016/j.urology.2019.06.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/02/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess blood loss during holmium laser enucleation of the prostate (HoLEP) and investigate the factors influencing it. PATIENTS AND METHODS Analysis of patients with benign prostatic hyperplasia (BPH) treated with HoLEP at 3 centers. Hemoglobin and hematocrit were measured before surgery and hospital discharge. All blood transfusions performed during and after HoLEP were recorded. Blood loss outcomes were analyzed regarding antithrombotic (antiplatelet/anticoagulant) therapies and drug treatments for BPH and other conditions. RESULTS The analysis included 963 patients with a mean age of 72 years. Mean (range) prostate size was 102 (40-316) g; 28% of patients were receiving antiplatelets and 11% anticoagulants. Mean (range) prostate-specific antigen was 6.0 (0.3-43.5) ng/dL. Mean (range) operation time was 77 (28-178) minutes. Bladder calculi were found in 54 (5.6%) patients; all of them were successfully treated with cystolitholapaxy. Forty-eight (5%) patients required blood transfusion during or immediately after the HoLEP procedure. Overall, mean (SD) hemoglobin decreased from 14.6 (1.5) g/dL to 12.3 (2.1) g/dL (P <.001), and mean (SD) hematocrit decreased from 44.3% (4.7) to 37.7% (6.5) (P <.001). Neither hemoglobin nor hematocrit decreases were significantly different between patients receiving and not receiving antithrombotic therapy or BPH therapy. CONCLUSION HoLEP is safe and has no remarkable impact on blood loss. Patients at high risk, such as those receiving antithrombotic therapy, had the same outcome than the rest regarding blood loss, although showed a higher transfusion rate. Operating time may influence hemoglobin decrease; therefore, it should be considered in patients with higher risk of bleeding.
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Affiliation(s)
- Javier Romero-Otero
- Hospital Universitario 12 Octubre. Grupo de Investigación Salud Integral del Varón i+D+I, Madrid, Spain; Hospital Universitario Montepríncipe, Madrid, Spain; Hospital Universitario La Luz, Madrid, Spain.
| | - Lucía García-González
- Hospital Universitario 12 Octubre. Grupo de Investigación Salud Integral del Varón i+D+I, Madrid, Spain; Hospital Universitario La Luz, Madrid, Spain
| | - Borja García-Gómez
- Hospital Universitario 12 Octubre. Grupo de Investigación Salud Integral del Varón i+D+I, Madrid, Spain; Hospital Universitario Montepríncipe, Madrid, Spain
| | - Juan Justo-Quintas
- Hospital Universitario 12 Octubre. Grupo de Investigación Salud Integral del Varón i+D+I, Madrid, Spain
| | - Esther García-Rojo
- Hospital Universitario 12 Octubre. Grupo de Investigación Salud Integral del Varón i+D+I, Madrid, Spain
| | | | - Raquel Sopeña-Sutil
- Hospital Universitario 12 Octubre. Grupo de Investigación Salud Integral del Varón i+D+I, Madrid, Spain; Hospital Universitario Montepríncipe, Madrid, Spain
| | - Jose Manuel Duarte-Ojeda
- Hospital Universitario 12 Octubre. Grupo de Investigación Salud Integral del Varón i+D+I, Madrid, Spain; Hospital Universitario La Luz, Madrid, Spain
| | - Alfredo Rodríguez-Antolín
- Hospital Universitario 12 Octubre. Grupo de Investigación Salud Integral del Varón i+D+I, Madrid, Spain; Hospital Universitario Montepríncipe, Madrid, Spain
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Dimopoulos P, Christopoulos P, Kampantais S. A Focused Review on the Effects of Preoperative 5α-Reductase Inhibitors Treatment in Patients Undergoing Holmium Laser Enucleation of the Prostate: What Do We Know So Far? J Endourol 2018; 32:79-83. [PMID: 29161905 DOI: 10.1089/end.2017.0734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The effects of medical therapy with finasteride or dutasteride during transurethral enucleation of prostate and tissue morcellation are not well defined. In theory, the risk of prostatic fibrosis versus the potential benefit of reduced intraoperative bleeding has been addressed as potential competing factors. The aim of this review was to provide evidence whether 5α-reductase inhibitors (5-ARIs) put the surgeon at a disadvantage or impact on patient outcomes. MATERIALS AND METHODS We performed a literature search of PubMed, Scopus, and Web of Science databases. All articles in English language related to the topic were reviewed to provide data on the influence of preoperative 5-ARIs in holmium laser enucleation of prostate (HoLEP). RESULTS Parameters of surgical efficiency such as enucleation time and efficiency, morcellation time, operating time, prostate tissue volume resected, energy, and saline usage were evaluated in the included studies. The review failed to show any definite impact of preoperative 5-ARI use on the mentioned parameters. One study, assessing the surgical difficulty using retrospective video recording analysis, showed that use of dutasteride increases the difficulty of enucleation step, which did not translate in statistical difference of surgical efficiency in an experienced level of surgeons. CONCLUSIONS Overall, 5-ARIs do not seem to affect HoLEP. However, the quality of evidence is still quite poor in comparison with other surgical techniques. Further well-designed studies are required before making any definite recommendations on the use of 5-ARIs in patients undergoing HoLEP.
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Affiliation(s)
- Panagiotis Dimopoulos
- 1 Department of Urology, Southend University Hospital , Southend-on-Sea, Essex, United Kingdom
| | | | - Spyridon Kampantais
- 1 Department of Urology, Southend University Hospital , Southend-on-Sea, Essex, United Kingdom
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