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Comparison of Emergency Room Visits and Rehospitalization for Bleeding Complications following Transurethral Procedures for the Treatment of Benign Prostatic Hyperplasia: A Population-Based Retrospective Cohort Study. J Clin Med 2022; 11:jcm11195662. [PMID: 36233530 PMCID: PMC9570762 DOI: 10.3390/jcm11195662] [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: 08/30/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 12/02/2022] Open
Abstract
Background: The postoperative bleeding complications associated with laser surgery of the prostate and transurethral resection of the prostate (TURP) were compared. Methods: We used the Taiwan National Health Insurance Research Database to conduct an observational population-based cohort study. All eligible patients who received transurethral procedures between January 2015 and September 2018 were enrolled. Patients who received laser surgery or TURP were matched at a ratio of 1:1 by using propensity score matching, and the association of these procedures with bleeding events was evaluated. Results: A total of 3302 patients who underwent elective transurethral procedures were included. The multivariable Cox regression analysis revealed that diode laser enucleation of the prostate (DiLEP) resulted in significantly higher emergency room risks within 90 days after surgery due to clot retention than the Monopolar transurethral resection of the prostate (M-TURP) (Hazard Ratio: 1.52; 95% Confidence Interval [CI], 1.06–2.16, p = 0.022). Moreover, GreenLight photovaporization of the prostate (PVP) (0.61; 95% CI, 0.38–1.00 p = 0.050) and thulium laser vaporesection of the prostate (ThuVARP) (0.67; 95% CI, 0.47–0.95, p = 0.024) resulted in significantly fewer rehospitalization due to clot retention than did M-TURP. No significant increase in blood clots were observed in patients using comedications and those with different demographic characteristics and comorbidities. Conclusions: Among the investigated six transurethral procedures for Benign prostatic hyperplasia, PVP and ThuVARP were safer than M-TURP because bleeding events and clot retention were less likely to occur, even in patients receiving anticoagulant or antiplatelet therapy. However, DiLEP and holmium laser enucleation of the prostate (HoLEP) did not result in fewer bleeding events than M-TURP.
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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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Undie CU, Nnana EI, Torporo KR. Initial experience with holmium laser enucleation of the prostate in a urology specialist hospital in Nigeria. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00184-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract
Background
Holmium laser enucleation of the prostate (HoLEP) is a more recent procedure for the management of Benign Prostatic Hyperplasia compared to open prostatectomy or Transurethral Resection of the Prostate. HoLEP is not commonly done in Nigeria. The objective of the study was to determine whether our initial experience with HoLEP in Abuja, favourably compared to those of other centres across the world.
Methods
A retrospective study was done on 40 patients who had HoLEP between October 2018 and December 2019. Pre- and post-operative International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), prostate sizes, maximum flow rate (Qmax) and post-void residual urine volume (PVR) were collated. The duration of irrigation, catheterization and length of hospital stay were also recorded and analysed. Complications were documented.
Results
There were improvements in IPSS from 19.67 to 5.41, PSA from 8.07 to 2.03 ng/ml,Qmax from 11.27 to 29.67 ml/min, PVR from 88.99 to 32.8 ml, while average prostate sizes reduced from 116.54 to 30.3 g after surgery. Following HoLEP, the duration of irrigation was 18.00 h, catheterization was 26.76 h and length of hospital stay was 1.82 days. Two (5.0%) patients were recatheterized, 4 (10.0%) developed post-operative bladder neck stenosis.
Conclusions
The outcome of HoLEP in our experience compared favourably with those from other centres. With adequate training and requisite equipment in resource-poor environments, technical procedures like HoLEP can be embarked on with favourable results.
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[THE 10-YEAR OUTCOMES OF PVP (PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE) FOR TREATING BPH (BENIGN PROSTATIC HYPERPLASIA)]. Nihon Hinyokika Gakkai Zasshi 2018; 109:85-89. [PMID: 31006746 DOI: 10.5980/jpnjurol.109.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
(Purpose) Photoselective vaporization of the prostate (PVP) was introduced in Japan about 10 years ago, and there has been few studies regarding long-term outcomes so far. Herein we report our 10-year follow up result of PVP. (Patients and methods) From January 2006 to June 2006, 31 patients with benign prostatic hyperplasia (BPH) underwent PVP and 20 patients were evaluable in 10 years after PVP. Patients were evaluated preoperatively, at 6 months and at 10 years after surgery by International Prostate Symptom Score (IPSS) and Quality of life score (QOL score). The surgery used 80 watt potassium-titanyl-phosphate laser that was an old model. (Results) The mean IPSS preoperatively, at 6 months and at 10 years was 21.1, 5.5 and 9.4, respectively. The mean QOL score preoperatively, at 6 months and at 10 years was 5.3, 2.2 and 2.5, respectively. Both IPSS and QOL score were significantly improved at 6 months and at 10 years compared with preoperatively. However, among 20 patients re-operation for residual adenoma was required in 4 patients (20%) during the follow-up period. (Conclusion) PVP is an effective method for BPH treatment, allowing sustained long-term improvement of the voiding function.
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Shigemura K, Fujisawa M. Current status of holmium laser enucleation of the prostate. Int J Urol 2017; 25:206-211. [PMID: 29205507 DOI: 10.1111/iju.13507] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 09/26/2017] [Indexed: 02/01/2023]
Abstract
There are several options for the surgical management of benign prostatic hyperplasia representatively from transurethral resection of the prostate. Holmium laser enucleation of the prostate is one of those options, and many institutions and urologists have initiated this technique, and most of them have accomplished better outcomes compared with transurethral resection of the prostate. In contrast to transurethral resection of the prostate, which requires a similar procedure to transurethral resection of bladder tumors, holmium laser enucleation of the prostate requires a special surgical technique: enucleation and morcellation with around 10 years' history of experience, even in Japan. The present review introduces the current status of holmium laser enucleation of the prostate, so that it surely contributes to the knowledge of International Journal of Urology readers who could be experienced surgeons or beginners as well.
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Affiliation(s)
- Katsumi Shigemura
- Department of Urology, Kobe University Hospital, Kobe, Japan.,Department of International Health, Kobe University Graduate School of Health Sciences, Kobe, Japan.,Department of Infection Control and Prevention, Kobe University Hospital, Kobe, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Hospital, Kobe, Japan
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Miyazaki H, Hirano Y, Kato S, Ioritani N, Ichikawa T, Takamoto H, Homma Y. Early Experiences of Contact Laser Vaporization of the Prostate using the 980 nm High Power Diode Laser for Benign Prostatic Hyperplasia. Low Urin Tract Symptoms 2017; 10:242-246. [PMID: 28573791 DOI: 10.1111/luts.12173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 01/11/2017] [Accepted: 01/31/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We report early experiences of contact laser vaporization of the prostate for symptomatic benign prostatic hyperplasia (BPH). METHODS A total of 80 patients recruited at four institutions in Japan from April 2013 through September 2014 underwent contact laser vaporization of the prostate using 980 nm high power diode laser with an end-firing fiber in the contact mode. Patients were followed prospectively at 1 day, 2, 4, 8, 12, and 24 weeks, postoperatively per protocol, and at 1 and 2 years post-protocol. RESULTS Of 76 eligible patients, 64 (84.2%) achieved more than 50% decrease in International Prostate Symptom Score at 24 weeks (95% confidence interval: 74.0-91.6%), clearing the pre-fixed non-inferiority efficacy level to transurethral resection of the prostate (65%). Symptom scores, maximum flow rate, post-void residual urine, and prostate volume showed significant improvements at 12 and 24 weeks after the surgery. Perioperative complications included transient urinary retention (n = 20), retrograde ejaculation (5), bladder neck contracture (4), urethral stricture (3), stone in prostatic bed (3), bladder stone (2), bladder perforation (1), bladder deformity (1), and transient urgency incontinence (1). Urinary retention and bladder neck contracture occurred almost exclusively at one institution. Improved symptom scores, maximum flow rate, and post-void residual urine observed at 24 weeks remained virtually unchanged at 1 and 2 years. CONCLUSIONS Early experience of contact laser vaporization in Japan showed efficacy comparable to transurethral resection of the prostate as a surgical procedure for BPH at 24 weeks. Long-term efficacy of the procedure remains uncertain.
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Affiliation(s)
- Hideyo Miyazaki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Urology, The Fraternity Memorial Hospital, Tokyo, Japan
| | - Yoshikazu Hirano
- Department of Urology, The Fraternity Memorial Hospital, Tokyo, Japan
| | | | | | | | | | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Laser Vaporization of the Prostate With the 180-W XPS-Greenlight Laser in Patients With Ongoing Platelet Aggregation Inhibition and Oral Anticoagulation. Urology 2016; 91:167-73. [DOI: 10.1016/j.urology.2016.01.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 01/11/2016] [Accepted: 01/19/2016] [Indexed: 01/13/2023]
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Kim SH, Son HJ, Kim JW, Kong YG, Hwang JH, Kim YK. Severe postoperative dyspnea caused by neglected massive intraperitoneal fluid collection during laser enucleation and morcellation of the prostate: a case report. Korean J Anesthesiol 2016; 69:185-8. [PMID: 27066210 PMCID: PMC4823417 DOI: 10.4097/kjae.2016.69.2.185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/12/2015] [Accepted: 07/14/2015] [Indexed: 12/15/2022] Open
Abstract
Laser enucleation and morcellation of the prostate is an increasingly used surgical management of benign prostatic hyperplasia. However, it can cause several complications including capsular perforation, ureteral orifice injury, and bladder mucosal morcellation injury. Herein, we report a case of severe postoperative dyspnea caused by neglected massive intraperitoneal fluid collection during laser surgery of the prostate. The patient experienced massive abdominal distension and severe respiratory difficulty after the procedure. Although immediate postoperative cystogram showed no leakage of contrast dye, the computed tomography scan of the abdomen and pelvis showed massive fluid collection in the abdominal pelvic cavity suggesting bladder wall injury. After percutaneous drainage of intraperitoneal fluid, abdominal distention and dyspnea were relieved.
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Affiliation(s)
- Sung-Hoon Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyo-Jung Son
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Won Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu-Gyeong Kong
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jai-Hyun Hwang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Kug Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Bouabdallah Z, Kharbouchi A, Colau A, Cariou G. [Prostate laser photovaporisation in patients at high risk of bleeding]. Pan Afr Med J 2014; 16:2. [PMID: 24570773 PMCID: PMC3926760 DOI: 10.11604/pamj.2013.16.2.2853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 07/04/2013] [Indexed: 12/03/2022] Open
Abstract
Introduction Les patients sous traitement anticoagulant sont à risque élevé de saignement lors de la résection transurétrale de la prostate ou de l'adénomectomie par taille vésicale et ils se voient souvent récuser pour la chirurgie de l'hyperplasie bénigne de la prostate symptomatique. En Utilisant la photovaporisation de la prostate, les patients à haut risque peuvent subir en toute sécurité la chirurgie. Nous avons évalué l'innocuité et l'efficacité de la photovaporisation de la prostate (PVP) chez les patients sous anticoagulants en cours avec les dérivés de la coumarine, l'aspirine ou le clopidogrel, se plaignant de symptômes d'hypertrophie bénigne de la prostate. Méthodes Entre janvier 2009 et mai 2010, 47 hommes sous anticoagulation systémique ont subi une photovaporisation de la prostate. Les données ont été recueillies sur les caractéristiques démographiques, les comorbidités, les complications, la natrémie, l'hémoglobine, le débit urinaire maximal, le résidu post-mictionnel, l'IPSS et les complications. Résultats L'âge moyen était de 78 ans, le volume prostatique moyen était de 44g et le PSA était de 3.4ng/ml. Parmi les 10 patients (21.2%) étaient sous AVK, 27 (57.4%) étaient sous aspirine, 2 (4.2%) étaient sous clopidogrel, un sous fondaparinux et 6 (12.7%) étaient sous 2 anticoagulants ou plus. Le score ASA moyen était de 3. La durée moyenne de fonctionnement de l'appareil était de 38 minutes, l'énergie moyenne utilisée était de 200kJ. La durée moyenne d'hospitalisation était de 2 jours. Les complications survenant dans les 30 jours comprenaient une infection urinaire chez 5 patients (10.6%), une dysurie chez 4 patients et une hémorragie retardée chez 4 autres (8.5%). Un seul de ces patients a nécessité une transfusion sanguine et aucun patient n'a nécessité une réintervention. En 3 mois de suivi un seul patient a nécessité une incision du col vésical pour sclérose du col. Aucune incontinence ou sténose urétrale n'a été rapportée. Des améliorations significatives ont été notées dans l'IPSS, le débit urinaire maximal et le résidu post-mictionnel. Conclusion La PVP est caractérisé par d'excellentes propriétés hémostatiques et taux très faible de complications peropératoires même chez les patients sous 2 ou plusieurs agents anticoagulants. Sur la base de nos résultats péri-opératoires, nous recommandons la PVP comme traitement chirurgical de première intention chez les patients à haut risque de hémorragique souffrant de symptômes d'hypertrophie bénigne de la prostate.
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Affiliation(s)
- Zakaria Bouabdallah
- Service d'urologie, groupe hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Amine Kharbouchi
- Service d'urologie, groupe hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Alexandre Colau
- Service d'urologie, groupe hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Gerard Cariou
- Service d'urologie, groupe hospitalier Diaconesses Croix Saint-Simon, Paris, France
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Kim SH, Yoo C, Choo M, Paick JS, Oh SJ. Factors affecting de novo urinary retention after Holmium laser enucleation of the prostate. PLoS One 2014; 9:e84938. [PMID: 24465454 PMCID: PMC3897383 DOI: 10.1371/journal.pone.0084938] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 11/20/2013] [Indexed: 11/21/2022] Open
Abstract
Objective Patients can experience urinary retention (UR) after Holmium laser enucleation of the prostate (HoLEP) that requires bladder distension during the procedure. The aim of this retrospective study is to identify factors affecting the UR after HoLEP. Materials and Methods 336 patients, which underwent HoLEP for a symptomatic benign prostatic hyperplasia between July 2008 and March 2012, were included in this study. Urethral catheters were routinely removed one or two days after surgery. UR was defined as the need for an indwelling catheter placement following a failure to void after catheter removal. Demographic and clinical parameters were compared between the UR (n = 37) and the non-urinary retention (non-UR; n = 299) groups. Results The mean age of patients was 68.3 (±6.5) years and the mean operative time was 75.3 (±37.4) min. Thirty seven patients (11.0%) experienced a postoperative UR. UR patients voided catheter free an average of 1.9 (±1.7) days after UR. With regard to the causes of UR, 24 (7.1%) and 13 (3.9%) patients experienced a blood clot-related UR and a non-clot related UR respectively. Using multivariate analysis (p<0.05), we found significant differences between the UR and the non-UR groups with regard to a morcellation efficiency (OR 0.701, 95% CI 0.498–0.988) and a bleeding-related complication, such as, a reoperation for bleeding (OR 0.039, 95% CI 0.004–0.383) or a transfusion (OR 0.144, 95% CI 0.027–0.877). Age, history of diabetes, prostate volume, pre-operative post-void residual, bladder contractility index, learning curve, and operative time were not significantly associated with the UR (p>0.05). Conclusions De novo UR after HoLEP was found to be self-limited and it was not related to learning curve, patient age, diabetes, or operative time. Efficient morcellation and careful control of bleeding, which reduces clot formation, decrease the risk of UR after HoLEP.
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Affiliation(s)
- Sung Han Kim
- Department of Urology, National Cancer Center, Goyang, Gyeonggi, South Korea
| | - Changwon Yoo
- Departments of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, United States of America
| | - Minsoo Choo
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
| | - Jae-Seung Paick
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
- * E-mail:
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Kim HJ, Lee HY, Song SH, Paick JS. Relationship of postoperative recatheterization and intraoperative bladder distention volume in holmium laser enucleation of the prostate for benign prostatic hyperplasia. Korean J Urol 2013; 54:89-94. [PMID: 23549294 PMCID: PMC3580311 DOI: 10.4111/kju.2013.54.2.89] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 10/20/2012] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to identify the risk factors for recatheterization after holmium laser enucleation of the prostate (HoLEP). Materials and Methods A total of 166 consecutive patients treated with HoLEP by a single surgeon from January 2010 to June 2011 were enrolled in this study. We collected data on preoperative and intraoperative parameters, including intraoperative bladder distention volume. The patients were divided into two groups. Group 1 included patients who voided successfully after removal of the catheter, and group 2 included patients who required recatheterization. Analysis and comparison of the perioperative parameters of both groups was performed for identification of risk factors for recatheterization. Results Recatheterization was required in 9 of 166 (5.4%) patients. No significant differences in age or preoperative parameters, including prostate-specific antigen, prostate volume, International Prostate Symptom Score, peak flow rate, postvoid residual urine, maximal bladder capacity, and Abrahams Griffiths number, were observed between the two groups. Of the intraoperative parameters, intraoperative bladder distention volume was significantly smaller in group 1 than in group 2 (700.65 mL vs. 897.78 mL, p<0.001). In the multivariate logistic regression analysis, after adjustment for other variables, intraoperative bladder distention volume was found to be a statistically significant risk factor for postoperative recatheterization (hazard ratio, 1.006; confidence interval, 1.002 to 1.010; p=0.002). Conclusions Nine of 166 (5.4%) patients failed to void after HoLEP and required catheterization. Intraoperative bladder distention volume was found to be a statistically significant risk factor for recatheterization in this patient group.
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Affiliation(s)
- Hyeon Jun Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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12
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Hirasawa Y, Ide H, Yasumizu Y, Hoshino K, Ito Y, Masuda T. Comparison of transurethral enucleation with bipolar and transurethral resection in saline for managing benign prostatic hyperplasia. BJU Int 2012; 110:E864-9. [DOI: 10.1111/j.1464-410x.2012.11381.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sugihara T, Yasunaga H, Horiguchi H, Nakamura M, Nishimatsu H, Kume H, Ohe K, Matsuda S, Homma Y. In-hospital outcomes and cost assessment between bipolar versus monopolar transurethral resection of the prostate. J Endourol 2012; 26:1053-8. [PMID: 22296567 PMCID: PMC3412058 DOI: 10.1089/end.2011.0592] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We compared the in-hospital outcomes between bipolar and monopolar transurethral resection of the prostate (B-TURP and M-TURP, respectively) on a real-world practice using a large database. PATIENTS AND METHODS Patients who underwent TURP were extracted from the Diagnosis Procedure Combination database, which is a case-mix administrative claims database in Japan. TURP procedures were classified into M-TURP and B-TURP groups according to intraoperative use or nonuse of D-sorbitol solution, respectively, which is the only nonelectrolyte bladder irrigation fluid for M-TURP available in Japan. To exclude causality among autologous and homologous transfusion events, we confined eligible hospitals to those in which no autologous blood preparation was undertaken for TURP and whose annual surgical caseloads were 15 cases or more. Multivariate analyses were conducted for homologous transfusion, postoperative complications, operative time, postoperative length of stay, and total costs. RESULTS There were 5155 M-TURP and 1531 B-TURP patients identified. The results for M-TURP vs B-TURP (effect sizes were evaluated with reference to M-TURP) were 2.3% vs 1.3% for transfusion (odds ratio [OR]=0.54; P=0.013), 3.3% vs 1.7% for postoperative complications (OR=0.46; P<0.01), 98 vs 116 minutes for operative time (20.5% increase; P<0.001), 8.65 vs 8.45 days for postoperative stay (3.6% reduction; P=0.003), and $6103 vs $6062 for cost (1.7% reduction; P=0.018). CONCLUSION B-TURP had significantly lower rates of transfusion and postoperative complications, but a longer operative time. The impacts of B-TURP on shortening the hospital stay and lowering the costs were of little clinical significance.
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Affiliation(s)
- Toru Sugihara
- Department of Urology, Shintoshi Hospital, Iwata, Japan.
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Yamamoto T, Gotoh M, Kato M, Majima T, Toriyama K, Kamei Y, Iwaguro H, Matsukawa Y, Funahashi Y. Periurethral injection of autologous adipose-derived regenerative cells for the treatment of male stress urinary incontinence: Report of three initial cases. Int J Urol 2012; 19:652-9. [PMID: 22435469 DOI: 10.1111/j.1442-2042.2012.02999.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To report a novel cell therapy using autologous adipose tissue-derived regenerative cells for male stress urinary incontinence caused by urethral sphincteric deficiency, and the outcomes in the initial cases undergoing periurethral injection of adipose tissue-derived regenerative cells. METHODS Three patients with moderate stress incontinence after radical prostatectomy and holmium laser enucleation of the prostate were enrolled. Adipose tissue-derived regenerative cells were isolated from the abdominal adipose tissue by using the Celution system. Subsequently, the isolated adipose tissue-derived regenerative cells, and a mixture of adipose tissue-derived regenerative cells and adipose tissue were transurethrally injected into the rhabdosphincter and submucosal space of the urethra, respectively. Short-term outcomes during a 6-month follow up were assessed by a 24-h pad test, a validated patient questionnaire, urethral pressure profile, transrectal ultrasonography and magnetic resonance imaging. RESULTS Urinary incontinence progressively improved after 2 weeks of injection up to 6 months in terms of decreased leakage volume, decreased frequency and amount of incontinence, and improved quality of life. Both maximum urethral closing pressure and functional profile length increased. Magnetic resonance imaging suggested a sustained presence of the injected adipose tissue. Enhanced ultrasonography showed a progressive increase in the blood flow to the injected area. No significant adverse events were observed peri- and postoperatively. CONCLUSION These preliminary findings suggest that periurethral injection of the autologous adipose tissue-derived regenerative cells is a safe and feasible treatment modality for male stress urinary incontinence.
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Affiliation(s)
- Tokunori Yamamoto
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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15
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Chung DE, Wysock JS, Lee RK, Melamed SR, Kaplan SA, Te AE. Outcomes and Complications After 532 nm Laser Prostatectomy in Anticoagulated Patients With Benign Prostatic Hyperplasia. J Urol 2011; 186:977-81. [DOI: 10.1016/j.juro.2011.04.068] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Indexed: 10/17/2022]
Affiliation(s)
- Doreen E. Chung
- Section of Urology, University of Chicago and Department of Surgery, Mount Sinai Hospital, Chicago, Illinois
| | - James S. Wysock
- Department of Urology, Weill Cornell Medical College, Cornell University, New York, New York
| | - Richard K. Lee
- Department of Urology, Weill Cornell Medical College, Cornell University, New York, New York
| | - Scott R. Melamed
- Department of Urology, Weill Cornell Medical College, Cornell University, New York, New York
| | - Steven A. Kaplan
- Department of Urology, Weill Cornell Medical College, Cornell University, New York, New York
| | - Alexis E. Te
- Brady Prostate Center, Weill Cornell Medical College, Cornell University, New York, New York
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Okamura K, Nojiri Y. Response to Higher transfusion rate in bipolar transurethral resection of the prostate: Is it real? Int J Urol 2011. [DOI: 10.1111/j.1442-2042.2011.02832.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Kavanagh LE, Jack GS, Lawrentschuk N. Prevention and management of TURP-related hemorrhage. Nat Rev Urol 2011; 8:504-14. [PMID: 21844906 DOI: 10.1038/nrurol.2011.106] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Sugihara T, Yasunaga H, Homma Y. Higher transfusion rate in bipolar transurethral resection of the prostate: is it real? Int J Urol 2011; 18:677-8; author reply 678-9. [PMID: 21771103 DOI: 10.1111/j.1442-2042.2011.02818.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Pickard R. Editorial comment to "Perioperative management of transurethral surgery for benign prostate hyperplasia: a nationwide survey in Japan". Int J Urol 2011; 18:311. [PMID: 21355892 DOI: 10.1111/j.1442-2042.2010.02718.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Robert Pickard
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK,
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