1
|
Alharbi M, Alshamsan B, Almansour M, Alharbi A, Algaadi A, Abdelhafez MF. Early experience of " En bloc" holmium laser enucleation of the prostate in Saudi Arabia. Urol Ann 2024; 16:150-154. [PMID: 38818436 PMCID: PMC11135345 DOI: 10.4103/ua.ua_74_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 12/04/2023] [Indexed: 06/01/2024] Open
Abstract
Purpose Holmium laser enucleation of the prostate (HoLEP) showed higher efficacy than transurethral resection for treating benign prostatic hyperplasia (BPH). The present study aims to report the outcome of BPH treatment by HoLEP in a tertiary center. Patients and Methods An observational prospectively collected data for consecutive symptomatic BPH patients undergoing HoLEP between January 2020 and December 2021. Demographic and perioperative data were collected with the International Prostate Symptom Score (IPSS), quality of life, peak flow rate (Qmax), residual urine postvoid residual (PVR), and prostate-specific antigen (PSA) changes, in addition to perioperative and late adverse events. Results One hundred patients were included with a median age of 73 years (range 65-80). The IPSS improved by 80% postoperatively (25 vs. 5, P < 0.001). Similarly, Qmax significantly improved. Seven patients were found to have incidental prostate cancer. No patient needed a perioperative blood transfusion. Compared to its preoperative values, follow-up PSA has been reduced by 75% (P < 0.001). Urethral stricture and bladder neck contracture were noted in < 2% of the patients. Conclusions HoLEP is feasible for all prostate sizes and a safe and effective treatment for BPH patients; our results are consistent with the reported data in the literature regarding functional outcomes, complication rates, and urinary incontinence rates.
Collapse
Affiliation(s)
- Mohannad Alharbi
- Department of Surgery, College of Medicine, Qassim University, Buraidah, Qassim, Saudi Arabia
- Department of Urology, King Fahad Specialist Hospital, Buraidah, Qassim, Saudi Arabia
| | - Bader Alshamsan
- Department of Medicine, College of Medicine, Qassim University, Buraidah, Qassim, Saudi Arabia
| | - Mohammed Almansour
- Department of Urology, King Fahad Specialist Hospital, Buraidah, Qassim, Saudi Arabia
| | - Abdullah Alharbi
- Department of Urology, King Fahad Specialist Hospital, Buraidah, Qassim, Saudi Arabia
| | - Adel Algaadi
- Department of Urology, King Fahad Specialist Hospital, Buraidah, Qassim, Saudi Arabia
| | - Mohamed F. Abdelhafez
- Department of Urology, King Fahad Specialist Hospital, Buraidah, Qassim, Saudi Arabia
- Urology and Nephrology Center, Assiut University Hospital, Assiut, Egypt
| |
Collapse
|
2
|
Bohlok J, Söderberg R, Patschan O. Transurethral versus open enucleation of the prostate in Sweden - a retrospective comparative cohort study. Scand J Urol 2023; 58:126-132. [PMID: 38078514 DOI: 10.2340/sju.v58.15327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/24/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE To investigate if treatment with transurethral enucleation of the prostate (TUEP) during the learning curve is as efficient and safe in the short term as transvesical open prostate enucleation (OPE), in patients with benign prostatic obstruction (BPO) > 80 ml in a population in Sweden. Methods: 54 patients with ultrasound verified BPO > 80 ml and indication for surgery underwent TUEP or OPE between 2013 and 2019. Peri- and postoperative outcome variables regarding voiding efficiency and morbidity from 20 OPE at Skåne University Hospital (SUS) and from the first 34 TUEP performed at SUS and Ystad Hospital were retrospectively assembled. Follow-up data from the first 6 postoperative months were collected by chart review. RESULTS Intraoperative bleeding during TUEP was less than in OPE (225 ml vs. 1,000 ml). TUEP took longer surgery time than OPE (210 vs. 150 min.). Within 30 days postoperatively, bleeding occurred less often after TUEP (23% vs. 40%), requiring one fourth of the blood transfusions given after OPE. After TUEP, patients had shorter hospitalisation (3 days vs. 7 days) and catheterisation time (3 days vs. 12 days). During the 6-month follow-up period, incontinence and UTI defined as symtomatic significant bacteriuria (urinary culture) were observed as main complications after TUEP and OPE. Functional outcome data availability (International Prostate Symptom Score [IPSS] questionnaire, uroflowmetry, residual urine) were limited. CONCLUSIONS Treatment with TUEP during the learning curve led to less bleeding, shorter hospitalisation- and catheterisation time than treatment with OPE. However, surgery time was shorter with OPE. There were no major differences between the groups concerning mid-term functional outcomes, with the reservation of an inconsistent follow-up.
Collapse
Affiliation(s)
| | | | - Oliver Patschan
- Department of Translational Medicine, Faculty of Medicine, Lund University, Lund, Sweden
| |
Collapse
|
3
|
Blanco Fernández R, González Rodríguez I, Fernández-Pello Montes S, Sánchez Verdes P, Miranda García P, Suárez Sal PJ, Alonso Calvar L, Rodríguez Villamil L. Holmium laser enucleation of the prostate (HoLEP) as same-day surgery: A safe and feasible option. Actas Urol Esp 2023; 47:457-461. [PMID: 37369301 DOI: 10.1016/j.acuroe.2023.05.006] [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: 03/16/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE To study the feasibility of holmium laser enucleation (HoLEP) performed as a same-day surgery. MATERIAL AND METHODS Prospective observational study including 25 patients submitted to HoLEP. Patients were discharged the same day if they met the established criteria. RESULTS The mean age of the patients was 65.1 years and prostate volume was 45.8cc. All patients were discharged the same day of surgery. The overall complication rate at 30 days was 12% (Clavien I 100%). The rate of re-hospitalization was 0%. Patient satisfaction rate with the day surgery pathway was 95%. CONCLUSIONS The initial analysis of our results suggests that outpatient HoLEP is a safe and effective alternative with low rate of complications. According to satisfaction rates, patients prefer the day surgery pathway for the performance of HoLEP.
Collapse
Affiliation(s)
- R Blanco Fernández
- Departamento de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain.
| | - I González Rodríguez
- Departamento de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | | | - P Sánchez Verdes
- Departamento de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - P Miranda García
- Departamento de Anestesiología y Reanimación, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - P J Suárez Sal
- Departamento de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - L Alonso Calvar
- Departamento de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - L Rodríguez Villamil
- Departamento de Urología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| |
Collapse
|
4
|
Assmus MA, Krambeck AE. Moses Laser Enucleation of the Prostate (MoLEP): Use of Pulse Modulated Holmium Laser Technology for Prostate Enucleation. CURRENT BLADDER DYSFUNCTION REPORTS 2023. [DOI: 10.1007/s11884-023-00698-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
|
5
|
Elmansy H, Hodhod A, Elshafei A, Noureldin YA, Mehrnoush V, Zakaria AS, Hadi RA, Fathy M, Abbas L, Kotb A, Shahrour W. Comparative analysis of MOSES TM technology versus novel thulium fiber laser (TFL) for transurethral enucleation of the prostate: A single-institutional study. Arch Ital Urol Androl 2022; 94:180-185. [PMID: 35775343 DOI: 10.4081/aiua.2022.2.180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Novel laser technologies have been developed for the minimally invasive surgical management of benign prostatic hyperplasia (BPH). The objective of this study was to assess the safety and efficacy of MOSESTM technology versus the thulium fiber laser (TFL) in patients with BPH undergoing transurethral enucleation of the prostate. METHODS We conducted a retrospective review of prospectively collected data of eighty-two patients who underwent transurethral enucleation of the prostate using MOSESTM or TFL technologies from August 2020 to September 2021. Preoperative and intraoperative parameters, in addition to postoperative outcomes, were collected and analyzed. RESULTS Twenty patients underwent transurethral enucleation of the prostate with TFL, while 62 had MOSESTM HoLEP. No statistically significant difference in preoperative characteristics was observed between the groups. Patients in the TFL group had longer median enucleation, hemostasis, and morcellation times (p < 0.001) than those in the MOSESTM cohort. The longer morcellation time of TFL is mostly related to less visibility. The postoperative outcomes IPSS, QoL, Qmax, and post void residual (PVR), were comparable between the groups at 1, 3 and 6 months. The incidence of urge urinary incontinence (p = 0.79), stress urinary incontinence (p = 0.97), and hospital readmission rates (p = 0.1) were comparable between the two groups. CONCLUSIONS A satisfactory safety and efficacy profile with comparable postoperative outcomes was demonstrated for both techniques; though, MOSESTM technology was superior to TFL in terms of shorter overall operative time.
Collapse
Affiliation(s)
- Hazem Elmansy
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Amr Hodhod
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Ahmed Elshafei
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Yasser A Noureldin
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada; Urology Department, Benha University, Benha.
| | - Vahid Mehrnoush
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Ahmed S Zakaria
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Ruba Abdul Hadi
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Moustafa Fathy
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada; Urology Department, Menoufia University, Shebin Elkom.
| | - Loay Abbas
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Ahmed Kotb
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario.
| | - Walid Shahrour
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario.
| |
Collapse
|
6
|
Amenta M, Oliva F, Barone B, Corsaro A, Arcaniolo D, Scarpato A, Mattiello G, Romano L, Sciorio C, Silvestri T, Costa G, Crocetto F, Celia A. Minimally invasive simple prostatectomy: Robotic-assisted versus laparoscopy. A comparative study. Arch Ital Urol Androl 2022; 94:37-40. [PMID: PMID: 35352523 DOI: 10.4081/aiua.2022.1.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Robotic-assisted simple prostatectomy (RASP) is a novel surgical procedure for the management of obstructive symptoms caused by enlarged prostate glands. Before the introduction of minimally invasive techniques, the standard approach was the open simple prostatectomy (OSP). The aim of our study was to compare intraoperative and perioperative outcomes of robotic (RASP) and laparoscopic (LSP) simple prostatectomy. METHODS We retrospectively analyzed data from patients who underwent minimally invasive simple prostatectomy at the Urological Department of Portogruaro Hospital, Portogruaro, and at the Urological Department of "San Bassiano" Hospital, in Bassano del Grappa, from March 2015 to December 2020. Data collected from medical records included age, body mass index, prostate volume, operative time, preoperative International Prostatic Symptoms Score (IPSS), postoperative IPSS, time with drainage, blood transfusion, intraoperative complications, perioperative complications and length of hospital stay. RESULTS Robotic-assisted (n = 25) and laparoscopic simple prostatectomy (n = 25) were performed with a transvesical approach. No significant differences were observed regarding baseline characteristics, body mass index, prostate volume and IPSS. Operative time was lower in the laparoscopic group (122 min vs 139 min) (p = 0.024), while hospital stay was lower in the robotic group (4 days vs 6 days) (p = 0.047). CONCLUSIONS Robotic-assisted simple prostatectomy is a safe technique with results comparable to laparoscopic simple prostatectomy, encompassing the advantage of a shorter hospitalization. Considering the costs and the limited availability of robotic-assisted simple prostatectomy, laparoscopic simple prostatectomy is a valid and safe alternative for experienced surgeons.
Collapse
Affiliation(s)
- Michele Amenta
- Urology Unit, Azienda ULSS n.4 Veneto Orientale, Portogruaro.
| | - Francesco Oliva
- Urology Unit, Azienda ULSS n.4 Veneto Orientale, Portogruaro.
| | - Biagio Barone
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples.
| | - Alfio Corsaro
- Urology Unit, Azienda ULSS n.4 Veneto Orientale, Portogruaro.
| | - Davide Arcaniolo
- Department of Woman, Child and General and Specialized Surgery, Urology Unit, University of Campania Luigi Vanvitelli, Naples.
| | - Antonio Scarpato
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples.
| | - Gennaro Mattiello
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples.
| | - Lorenzo Romano
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples.
| | | | | | - Giovanni Costa
- Department of Urology, San Bassiano Hospital, Bassano del Grappa.
| | - Felice Crocetto
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples.
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa.
| |
Collapse
|