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Chen YY, Hua WX, Huang YH, Shen XY, You JN, Ding X. The safety and efficacy of five surgical treatments in prostate enucleation: a network meta-analysis. BMC Urol 2024; 24:128. [PMID: 38886739 PMCID: PMC11181543 DOI: 10.1186/s12894-024-01517-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
PURPOSE The aim of our study was to investigate the comparative outcomes of five different energy types on surgical efficacy and postoperative recovery in patients with benign prostate hyperplasia. METHODS The literature was systematically reviewed on December 1st, 2023, encompassing studies retrieved from PubMed, Embase, Web of Science, and The Cochrane Library databases that incorporated clinical studies of holmium laser enucleation of the prostate (HoLEP), Thulium:YAG laser enucleation of the prostate (ThuLEP), transurethral plasmakinetic enucleation of prostate (PKEP), diode laser enucleation of the prostate (DiLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP) in the treatment of prostatic hyperplasia. Two independent reviewers extracted study data and conducted quality assessments using the Cochrane Collaboration's Risk of Bias tool and Newcastle-Ottawa Scale (NOS). Network meta-analysis (NMA) was employed to indirectly analyze the outcomes of endoscopic enucleation of the prostate (EEP) techniques. RESULTS The study included a total of 38 studies, comprising 21 non-randomized controlled trials (nRCTs) and 17 randomized controlled trials (RCTs), incorporating five distinct techniques: holmium laser, Thulium:YAG laser, bipolar plasma, diode laser and thulium fiber laser. In comparing treatment durations, ThuLEP and HoLEP had shorter overall hospital stays than PKEP, while the enucleation time of ThuLEP and HoLEP was shorter than that of ThuFLEP. Moreover, the enucleation tissue weight of both thulium fiber laser and holmium laser was heavier than bipolar plasma. However, the analysis did not reveal any statistically significant variation in complications among the various types of enucleation. In postoperative follow-up, the IPSS at 3 months post-operation was superior in the Thulium:YAG laser group compared to the holmium laser group. The thulium fiber laser technique demonstrated significant advantages over other enucleation methods in terms of QoL and PVR at 12 months after surgery. CONCLUSION Theoretical properties may vary among different energy sources; however, there are no discernible clinical differences in operation-related parameters, postoperative complications, and postoperative follow-up. Therefore, the choice of laser does not significantly impact the outcome. However, due to the limited number of included studies, future research should focus on larger sample sizes and multicenter investigations to further validate the findings of this study.
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Affiliation(s)
- Yun-Yi Chen
- Department of Urinary Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
| | - Wen-Xi Hua
- Department of Hematopathology, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, China
| | - Yu-Hua Huang
- Department of Urinary Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
| | - Xin-Yu Shen
- Department of Urinary Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
| | - Jia-Nan You
- Department of Urinary Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China
| | - Xiang Ding
- Department of Urinary Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China.
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Reasons to go for thulium-based anatomical endoscopic enucleation of the prostate. World J Urol 2021; 39:2363-2374. [PMID: 33948694 DOI: 10.1007/s00345-021-03704-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 04/17/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To summarize the current evidence and the reasons to go for thulium-based anatomical endoscopic enucleation of the prostate (AEEP). METHODS This review discusses the available literature on thulium-based AEEP. RESULTS Thulium lasers operate at a wavelength between 1940 and 2013 nm. This wavelength, which has a low penetration depth in water, allows to perform smooth cuts in the prostatic tissue and allows urologists to perform various procedures: resection, vaporization, enucleation, or vapoenucleation of the prostate. Depending on the type of thulium laser, it can be used either in a continuous, or pulsed mode. CONCLUSION In recent years, an increasing amount of evidence has described the thulium laser as a minimally invasive and size-independent treatment option for benign prostatic enlargement with excellent long-term results.
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Huusmann S, Lafos M, Meyenburg I, Muschter R, Teichmann HO, Herrmann T. Tissue effects of a newly developed diode pumped pulsed Thulium:YAG laser compared to continuous wave Thulium:YAG and pulsed Holmium:YAG laser. World J Urol 2021; 39:3503-3508. [PMID: 33728503 PMCID: PMC8510916 DOI: 10.1007/s00345-021-03634-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/05/2021] [Indexed: 12/23/2022] Open
Abstract
Purpose The objective of this study is to evaluate the laser-tissue effects of laser radiation emitted by a newly developed high frequency pulsed Tm:YAG laser in comparison to the continuous wave Tm:YAG laser and the pulsed Ho:YAG laser. Methods Ex-vivo experiments were performed on freshly slaughtered porcine kidneys in a physiological saline solution. Experiments were performed using two different laser devices in different settings: A Tm:YAG laser was operated in a pulsed mode up to 300 Hz and in a continuous wave (CW) mode. Results were compared with a 100 W standard pulsed Ho:YAG laser system. Comparative tissue experiments were performed at 5 W, 40 W and 80 W. The incision depth and the laser damage zone were measured under a microscope using a calibrated ocular scale. Results Increased laser power resulted in increased incision depth and increased laser damage zone for all investigated lasers in this set-up. The Ho:YAG created the largest combined tissue effect at the 5 W power setting and seems to be the least controllable laser at low power for soft tissue incisions. The CW Tm:YAG did not incise at all at 5 W, but created the largest laser damage zone. For the new pulsed Tm:YAG laser the tissue effect grew evenly with increasing power. Conclusion Among the investigated laser systems in this setting the pulsed Tm:YAG laser shows the most controllable behavior, insofar as both the incision depth and the laser damage zone increase evenly with increasing laser power. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03634-4.
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Affiliation(s)
- Stephan Huusmann
- Department of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Marcel Lafos
- Hannover Medical School, Institute for Pathology, Hannover, Germany
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Maruccia S, Fulgheri I, Montanari E, Casellato S, Boeri L. Nomenclature in thulium laser treatment of benign prostatic hyperplasia: it's time to pull the rabbit out of the hat. Lasers Med Sci 2021; 36:1355-1367. [PMID: 33389305 DOI: 10.1007/s10103-020-03227-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022]
Abstract
We performed a narrative review with the focus on laser settings and surgical procedure with thulium laser. Our primary goal was to define the most valid settings of each surgical procedure to overcome the inconsistency about nomenclature of thulium surgery and to ensure comparability of future publications. A literature search of articles on thulium laser treatment of benign prostatic hyperplasia (BPH) was conducted between 2009 and 2019. We proposed a new classification standard for laser settings and associated surgical procedure. Each article was analyzed and categorized as concordant or discordant referring to the new classification. In total, 74 papers were included in this narrative review. Overall, 43% and 42% of included studies reported discordant laser parameters and surgical description, respectively. Most of the studies on vaporization were categorized as discordant because they reported a medium/low laser setting instead of high power. Conversely, 93.3% of studies on enucleation were deemed as discordant for laser setting because they reported high power parameters instead of medium-low power setting. Most of the studies on laser enucleation and vapo/enucleation were considered discordant for surgical procedure since authors did not mention the use of mechanical vs. laser method for enucleation. The current literature lacks a uniform definition and standardization of the terminology of thulium laser settings and surgical techniques to guarantee comparability between different approaches. We found a huge heterogeneity in 10 years of surgery with thulium laser. We proposed a new classification of laser setting and procedural description for categorization of thulium laser surgery for BPH.
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Affiliation(s)
- Serena Maruccia
- Department of Urology, Istituti Clinici Zucchi, Monza, Italy
| | - Irene Fulgheri
- Department of Pharmacy, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy
| | | | - Luca Boeri
- Department of Urology, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milan, Italy.
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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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Castellani D, Pirola GM, Pacchetti A, Saredi G, Dellabella M. State of the Art of Thulium Laser Enucleation and Vapoenucleation of the Prostate: A Systematic Review. Urology 2020; 136:19-34. [DOI: 10.1016/j.urology.2019.10.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 02/06/2023]
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Abstract
OBJECTIVE: The present study reports a retrospective evaluation of the first Holmium laser prostate enucleation (HoLEP) cases and their results in our clinic. METHODS: Twenty four patients who underwent HoLEP surgery between April 2017 and November 2017 were evaluated for demographic characteristics, duration of operation, amount of hemorrhage, amount of energy used, tissue weight removed, catheterization time and complications. IPSS and uroflowmetry results were compared before and after the surgery. RESULTS: Patients with hemoglobin, IPSS, uroflowmetry, and voiding speeds (Qmean, Qmax) were compared before and after the surgery. There was a significant difference in IPSS, Qmean and hemoglobin values but not in Qmax, statistically. Our complications rates were correlated with the literature. CONCLUSION: HoLEP stands out as a surgical method that can be applied with high confidence in the treatment of benign prostatic hyperplasia and it has similar functional results to gold standard surgeries, causes fewer complications, improves patient comfort due to short catheterization and hospitalization and is more advantageous regarding cost.
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Ren XL, Xia HB. Development of Medical Lasers for Treatment on Benign Prostatic Hyperplasia. Chin Med J (Engl) 2018; 131:2265-2268. [PMID: 30203813 PMCID: PMC6144847 DOI: 10.4103/0366-6999.240804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Xiao-Lei Ren
- Department of Urology, The Second Affiliated Hospital of Chifeng College, Chifeng, Inner Mongolia Autonomous Region 024000, China
| | - Hai-Bo Xia
- Department of Urology, The Second Affiliated Hospital of Chifeng College, Chifeng, Inner Mongolia Autonomous Region 024000, China
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Wang X, Zhang YG, Zhu SC, Wan B, Liu M, Wang JY. Photoselective Vaporesection of the Prostate via an End-firing Lithium Triborate Crystal Laser. J Vis Exp 2018. [PMID: 29806840 DOI: 10.3791/57336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem with a high incidence in the aging male population. Although it is not a life-threatening disease, BPH causes problems that seriously impact the quality of life. Here, we introduce a new technique called photoselective vaporesection of the prostate (PVRP) in treating BPH, which can be seen as a variation of photoselective vaporization of the prostate (PVP). This procedure presents several advantages compared to the PVP technique including less laser energy loss, less intraoperative complications as well as more tissue resection rate.
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Affiliation(s)
- Xin Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology
| | - Yao-Guang Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology
| | - Sheng-Cai Zhu
- Department of Urology, Beijing Hospital, National Center of Gerontology
| | - Ben Wan
- Department of Urology, Beijing Hospital, National Center of Gerontology
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology;
| | - Jian-Ye Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology
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Giulianelli R, Gentile BC, Mirabile G, Albanesi L, Tariciotti P, Rizzo G, Buscarini M, Falavolti C. Bipolar Plasma Enucleation of the Prostate (B-TUEP) in Benign Prostate Hypertrophy Treatment: 3-Year Results. Urology 2017; 107:190-195. [PMID: 28576667 DOI: 10.1016/j.urology.2017.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/02/2017] [Accepted: 05/10/2017] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To investigate numerous endoscopic techniques that have been described for the treatment of benign prostate enlargement. Plasma-button enucleation of the prostate (B-TUEP) is a successful treatment option because the large surface creates a fast enucleation process, vaporization, and concomitant hemostasis. The aim of this study was to evaluate the efficacy of bipolar button electrode transurethral adenoma enucleation (B-TUEP) in saline solution. The second end point was to determine the change of International Prostate Symptom Score (IPSS), post-void residual urine, International Index of Erectile Function, transrectal ultrasound gland volume evaluation, and prostate-specific antigen. MATERIALS AND METHODS Between July 2011 and March 2012, 50 consecutive patients underwent B-TUEP in our facility, all performed by a single surgeon (R.G.). All patients were preoperatively assessed with maximum urinary flow rate, single-question quality of life assessment, IPSS and the International Index of Erectile Function questionnaires, transrectal ultrasound gland volume evaluation, prostate-specific antigen, and post-void residual urine. RESULTS We observed a significant improvement at 12, 24, and 36 months in terms of maximum urinary flow rate (22.3 ± 4.74 mL/s, 23.2 ± 0.30 mL/s, and 23.6 ± 1.26 mL/s, respectively, P <.01) and quality of life (5.28 ± 0.97, 5.69 ± 0.90, and 5.73 ± 0.87). IPSS and IEEF scores improved significantly (P <.05). Gland volume evaluation and post-void residue decreased (P <.001). The prostate-specific postoperative antigen levels were 0.76 ± 0.61 ng/mL, 0.7 ± 0.51 ng/mL, and 0.62 ± 0.18 ng/mL, at 12, 24, and 36 months, respectively. Two patients (4%) had persistent bladder outlet obstruction requiring reoperation. CONCLUSION After 3-year follow-up, B-TUEP represents an effective, durable, and safe form of surgical intervention. B-TUEP is an alternative treatment for symptomatic benign prostate enlargement.
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Wang X, Liu M, Zhang YG, Zhu SC, Wan B, Wang JY. Photoselective Vaporesection of the Prostate with an End-firing Lithium Triborate Crystal Laser. Chin Med J (Engl) 2017; 130:636-641. [PMID: 28303843 PMCID: PMC5358410 DOI: 10.4103/0366-6999.201593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Photoselective vaporization of the prostate is a technique that is widely used for the treatment of benign prostatic hyperplasia (BPH) and has pronounced advantages compared to the traditional transurethral resection of the prostate. Following the recent introduction of end-firing lithium triborate lasers, we have created a new technique called photoselective vaporesection of the prostate (PVRP). This study described our initial experience using the PVRP technique for the treatment of BPH. Methods: This prospective study included a total of 35 patients with BPH who underwent PVRP from August 2013 to July 2014. The chief clinical parameters were obtained and evaluated during the perioperative period and follow-up, including the International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum urinary flow rate, and prostate volume. All variables were evaluated for statistically significant differences compared to baseline values using the analysis of variance. Results: The mean subgroup IPSS and QoL scores significantly improved during follow-up; the respective decreases in IPSS storage score, IPSS voiding score, IPSS nocturia score, and QoL score were 75.3%, 83.6%, 51.4%, and 71.7%, respectively (all P < 0.001 compared with baseline). Three patients were diagnosed with prostate cancer based on postoperative pathological examinations. There were no serious perioperative complications. Conclusion: The PVRP technique demonstrates satisfactory short-term clinical outcomes and perioperative safety in the treatment of BPH.
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Affiliation(s)
- Xin Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Yao-Guang Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Sheng-Cai Zhu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Ben Wan
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Jian-Ye Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
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Comparison of 120 W 2-μm laser resection of the prostate outcomes in patients with or without preoperative urinary retention. Wideochir Inne Tech Maloinwazyjne 2016; 11:223-228. [PMID: 28194240 PMCID: PMC5299077 DOI: 10.5114/wiitm.2016.63352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/14/2016] [Indexed: 12/30/2022] Open
Abstract
Introduction The 2-μm (thulium) laser is a new surgical laser for benign prostatic hyperplasia (BPH). Aim To report on the long-term outcome of 120 W TmLRP-TT in BPH patients with or without preoperative urinary retention. Material and methods The study was conducted from May 2013 to April 2015 among patients who were diagnosed with BPH and underwent TmLRP-TT. Patients were divided into two groups: with and without preoperative urinary retention. Pre- and post-operative data were evaluated for prostate-specific antigens (PSA), International Prostate Symptom Score (IPSS), Quality Of Life Score (QOLS), maximum flow rate (Qmax), and post-void residual urine volume (PVR). Results A total of 310 patients were enrolled for a follow-up period of more than 12 months. Overall 95 (30.6%) patients had urinary retention before TmLRP-TT, while 215 (69.4%) did not. We found that patients with urinary retention tended to have larger prostates and a higher PSA score. So a longer operation time and catheterization time were observed in them. Yet there was no difference in other perioperative and postoperative parameters. Postoperatively IPSS, QOLS, Qmax, and PVR showed a significant improvement in each group, but no significant difference was identified between the two groups. Conclusions This study represents the first direct comparison of TmLRP-TT outcomes in patients with or without urinary retention. With safe use, resultant excellent homeostasis, high cutting efficiency and rapid vaporization, 120 W 2-μm laser resection of the prostate has been proved to be safe and effective, and there was no increased risk for patients with urinary retention.
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Herrmann TRW. Enucleation is enucleation is enucleation is enucleation. World J Urol 2016; 34:1353-5. [DOI: 10.1007/s00345-016-1922-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/10/2016] [Indexed: 12/01/2022] Open
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Kim YJ, Lee YH, Kwon JB, Cho SR, Kim JS. A novel one lobe technique of thulium laser enucleation of the prostate: 'All-in-One' technique. Korean J Urol 2015; 56:769-74. [PMID: 26568795 PMCID: PMC4643173 DOI: 10.4111/kju.2015.56.11.769] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/06/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The thulium laser is the most recently introduced technology for the surgical treatment of benign prostatic hyperplasia (BPH). Until recently, most thulium laser enucleation of the prostate (ThuLEP) was performed by use of the three-lobe technique. We introduce a novel one-lobe enucleation technique for ThuLEP called the "All-in-One" technique. We report our initial experiences here. MATERIALS AND METHODS From June 2013 to May 2014, a total of 47 patients underwent the All-in-One technique of ThuLEP for symptomatic BPH performed by a single surgeon. All patients were assessed with the International Prostate Symptom Score (IPSS), transrectal ultrasonography, serum prostate-specific antigen (PSA), maximal urine flow rate (Qmax), and postvoid residual urine volume (PVR) before and 1 month after surgery. We reassessed IPSS, Qmax, and PVR 3 months after surgery. To assess the efficacy of the All-in-One technique, we checked the PSA reduction ratio, transitional zone volume reduction ratio, and enucleation failure rate. RESULTS The mean operative time was 82.1±33.3 minutes. The mean enucleation time and morcellation time were 52.7±21.7 minutes and 8.2±7.0 minutes, respectively. The mean resected tissue weight and decrease in hemoglobin were 36.9±24.6 g and 0.4±0.8 g/dL, respectively. All perioperative parameters showed significant improvement (p<0.05). No major complications were observed. The PSA reduction ratio, transitional zone volume reduction ratio, and enucleation failure rate were 0.81, 0.92, and 4.3%, respectively. CONCLUSIONS The All-in-One technique of ThuLEP showed efficacy and effectiveness comparable to that of other techniques. We expect that this new technique could reduce the operation time and the bleeding and improve the effectiveness of enucleation.
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Affiliation(s)
- Yeon Joo Kim
- Department of Urology, Daegu Fatima Hospital, Daegu, Korea
| | - Yoon Hyung Lee
- Department of Urology, Daegu Fatima Hospital, Daegu, Korea
| | - Joon Beom Kwon
- Department of Urology, Daegu Fatima Hospital, Daegu, Korea
| | - Sung Ryong Cho
- Department of Urology, Daegu Fatima Hospital, Daegu, Korea
| | - Jae Soo Kim
- Department of Urology, Daegu Fatima Hospital, Daegu, Korea
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