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Tsai K, Xu P, Guo J, Dean N, Khondakar N, Michael J, Neill C, Krambeck A. Do Prostate Imaging-Reporting and Data System (PIRADS) lesions predict holmium laser enucleation of prostate outcomes? Prostate 2024. [PMID: 39045792 DOI: 10.1002/pros.24771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 07/05/2024] [Accepted: 07/15/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION AND OBJECTIVES Prostate magnetic resonance imaging (MRI) is used for prostate cancer (PCa) screening and risk stratification and is helpful for surgical planning for patients undergoing holmium laser enucleation of the prostate (HoLEP). There are few studies investigating the correlation between MRI Prostate Imaging-Reporting and Data System (PIRADS) lesion characteristics and HoLEP pathology and outcomes. METHODS We performed retrospective review of patients who underwent HoLEP between January 2021 and August 2023 by a single surgeon. Preoperative, intraoperative, and postoperative characteristics and outcomes were analyzed for all patients who had a documented preoperative prostate MRI. RESULTS There were 334 patients without a pre-existing diagnosis of PCa and with a preoperative prostate MRI, of which 140 (42%) had at least one PIRADS lesion. There was a total of 203 PIRADS lesions: 91 (45%) in the peripheral zone (PZ), 106 (52%) in the transition zone (TZ), and 6 (2%) not specified. Incidental PCa was noted in 44 (13%) patients at time of HoLEP. Presence or location of lesion was not significantly associated with rate or grade of incidental PCa on pathology. Greater number of lesions and lesion size correlated with longer procedure times. Lesion number, size, or grade were not found to correlate with cancer grade or rate of cancer. CONCLUSIONS Grade, presence, location, size, and number of PIRADS lesions on preoperative prostate MRI for patients with an appropriate prior PCa workup were not significantly associated with incidental PCa or higher PCa grade on HoLEP pathology.
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Affiliation(s)
- Kyle Tsai
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Perry Xu
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jenny Guo
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nicholas Dean
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Urology, University of Alberta, Edmonton, Alberta, Canada
| | - Nabila Khondakar
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jamie Michael
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Clayton Neill
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amy Krambeck
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Herzberg H, Savin Z, Fahoum I, Lifshitz K, Schwarztuch Gildor O, Veredgorn Y, Marom R, Yossepowitch O, Sofer M. Revisiting the issue of "beach balls" in holmium laser enucleation of prostate: clinical and histological characterization. World J Urol 2024; 42:201. [PMID: 38546885 DOI: 10.1007/s00345-024-04902-9] [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: 01/17/2024] [Accepted: 02/21/2024] [Indexed: 04/02/2024] Open
Abstract
PURPOSE To clinically and histologically characterize prostatic nodules resistant to morcellation ("beach balls," BBs). PATIENTS AND METHODS We reviewed a consecutive cohort of 559 holmium laser enucleation of the prostate (HoLEP) procedures performed between January 2020 and November 2023. The BBs group comprised 55 men (10%) and the control group comprised 504 men (90%). The clinical, intraoperative, outcome, and histologic data were statistically processed for the prediction of the presence of BBs and their influence on the perioperative course and outcome. RESULTS The BBs group in comparison to the controls was older (75 vs 73 years, respectively, p = 0.009) and had higher rates of chronic retention (51 vs 29%, p = 0.001), larger prostates on preoperative abdominal ultrasound (AUS) (140 vs 80 cc, p = 0.006E-16), longer operating time (120 vs 80 min, p = 0.001), higher weights of removed tissue (101 vs 60 gr, p = 0.008E-10), higher complication rates (5 vs 1%, p = 0.03), and longer hospitalization (p = 0.014). A multivariate analysis revealed that larger prostates on preoperative AUS and older age independently predicted the presence of BBs which would prolong operating time. ROC analyses revealed that a threshold of 103 cc on AUS predicted BBs with 94% sensitivity and 84% specificity. BBs were mostly characterized histologically by stromal component (p = 0.005). CONCLUSIONS BBs are expected in older patients and cases of chronic retention. Prostatic volume is the most reliable predictor of their presence. They contribute to prolonged operating time and increased risk of complications. The predominantly stromal composition of the BBs apparently confers their resistance to morcellation.
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Affiliation(s)
- Haim Herzberg
- Department of Urology, Faculty of Medical & Health Sciences, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizmann St., 6423906, Tel-Aviv, Israel
| | - Ziv Savin
- Department of Urology, Faculty of Medical & Health Sciences, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizmann St., 6423906, Tel-Aviv, Israel
| | - Ibrahim Fahoum
- Department of Pathology, Faculty of Medial & Health Sciences, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Karin Lifshitz
- Department of Urology, Faculty of Medical & Health Sciences, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizmann St., 6423906, Tel-Aviv, Israel
| | - Omri Schwarztuch Gildor
- Department of Urology, Faculty of Medical & Health Sciences, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizmann St., 6423906, Tel-Aviv, Israel
| | - Yotam Veredgorn
- Department of Urology, Faculty of Medical & Health Sciences, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizmann St., 6423906, Tel-Aviv, Israel
| | - Ron Marom
- Department of Urology, Faculty of Medical & Health Sciences, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizmann St., 6423906, Tel-Aviv, Israel
| | - Ofer Yossepowitch
- Department of Urology, Faculty of Medical & Health Sciences, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizmann St., 6423906, Tel-Aviv, Israel
| | - Mario Sofer
- Department of Urology, Faculty of Medical & Health Sciences, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizmann St., 6423906, Tel-Aviv, Israel.
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Yoon HS, Chung DH, Cho SY, Cho MC, Paick JS, Oh SJ. Risk Factors of Salvage Procedure for Refractory Morcellation During Holmium Laser Enucleation of the Prostate. Int Neurourol J 2023; 27:200-206. [PMID: 37798887 PMCID: PMC10556432 DOI: 10.5213/inj.2346076.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/22/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE We aimed to identify the risk factors for salvage procedure (SP) required for refractory adenomatous tissue resistant to morcellation during holmium laser enucleation of the prostate (HoLEP). METHODS Patients who underwent HoLEP between January 2010 and April 2020 at Seoul National University Hospital were analyzed. SPs were defined as cases of conversion to resection of the prostatic tissue using an electrosurgical loop after morcellation or secondary morcellation a few days after surgery or conversion to open cystotomy. RESULTS Among a total of 2,427 patients, 260 were identified as having SP (SP group) (transurethral resection-nodule [n = 250, 96.1%], secondary morcellation a few days after surgery [n = 9, 3.5%], and conversion to open cystotomy [n = 1, 0.4%]). Patients in the SP group were older and had higher 5-α reductase inhibitors use, higher prostate-specific antigen, larger total prostate volume, and larger transition zone volume (TZV) than those in the non-SP group. In the multivariable logistic regression analysis, only age and TZV were associated with SP. Compared to 40s and 50s, the odds ratios (ORs) were 3.84 in 60s (95% confidence interval [CI] 1.37-10.78, P = 0.011), 4.53 in 70s (95% CI, 1.62-12.62, P = 0.004), and 6.59 in 80s or older (95% CI, 2.23-19.46, P = 0.001). The ORs of the SP were analyzed per TZV quartile. Compared to TZV ≤ 20.3 mL, the OR was 3.75 in 32.0 mL < TZV ≤ 50.4 mL (95% CI, 2.00-7.04, P < 0.001) and 8.25 in 50.4 mL < TZV (95% CI, 4.06-16.77, P < 0.001). CONCLUSION The risk of refractory morcellation increased in patients aged > 60 years or those with TZV > 32 mL. In order to more efficiently remove these resistant adenomas, it is necessary to develop more efficient morcellators in the future.
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Affiliation(s)
- Hyun Sik Yoon
- Department of Urology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Dae Hyuk Chung
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Yong Cho
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Min Chul Cho
- Department of Urology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Seung Paick
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Oh S, Shitara T. Enucleation of the prostate: An anatomical perspective. Andrologia 2020; 52:e13744. [DOI: 10.1111/and.13744] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- Seung‐June Oh
- Department of Urology Seoul National University College of Medicine Seoul National University Hospital Seoul Korea
| | - Toshiya Shitara
- Department of Urology Fuchinobe General Hospital Sagamihara Kanagawa Japan
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Electrophysiological differences between typical and dense benign prostatic hyperplasia tissues retrieved after holmium laser enucleation of the prostate. J INCL PHENOM MACRO 2019. [DOI: 10.1007/s10847-019-00895-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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The effect of prostatic tissue density on the perioperative outcomes of Holmium laser enucleation of prostate (HoLEP): a pilot study. World J Urol 2019; 38:455-461. [PMID: 31076849 DOI: 10.1007/s00345-019-02802-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 05/04/2019] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To evaluate the effect of prostate tissue density (PTD) on perioperative Holmium laser enucleation of prostate (HoLEP) outcomes. METHODS Two hundred fourteen patients underwent HoLEP between December 2016 and August 2018 (group 1: PTD < 1 g/mL and group 2: PTD ≥ 1 g/mL). Enucleation time (ET), morcellation time (MT), total operation time (TOT), total laser energy (TLE), efficiency of laser (EL), efficiency of enucleation (EE), efficiency of morcellation (EM), enucleation rate (ER), and enucleated tissue weight (ETW) were recorded. RESULTS The mean ages of the groups 1, 2 were 61.36±5.92 and 63.1±7.52 years, respectively. TOT (76.4 vs 86.21 min), ET (69.18 vs 79.94 min), EE (0.80 vs 0.91 g/min), and ETW (55.8 vs 70.23 g) were not significantly different between the two groups. However, the MT was longer in group 2 (11.27 ± 8.57 min and 7.22 ± 5.46 min, p = 0.0001). Furthermore, EM was higher in group 1 (9.81 ± 5.61 g/min and 7.45 ± 4.14 g/min, p = 0.0003). The EL and TLE were similar in both groups. PTD positively correlated with MT (ρ = 0.272, p = 0.0005) and negatively correlated with EM (ρ = - 0.315, p = 0.0001). No correlations were identified between the PTD and EL or EE. CONCLUSIONS PTD is a factor that influences the HoLEP on perioperative outcomes. The PTD particularly affects the morcellation phase of the surgery. Patients with higher PTD will have a longer duration of MT and lesser EM. Future studies with the use of different imaging methods will give insight into the duration and difficulty of the HoLEP.
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Lee YJ, Oh SA, Kim SH, Oh SJ. Patient satisfaction after holmium laser enucleation of the prostate (HoLEP): A prospective cohort study. PLoS One 2017; 12:e0182230. [PMID: 28793314 PMCID: PMC5549990 DOI: 10.1371/journal.pone.0182230] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 07/16/2017] [Indexed: 12/20/2022] Open
Abstract
Objective To investigate patient satisfaction after holmium laser enucleation of the prostate (HoLEP) in a prospective study. Subjects and methods From May 2012 to December 2014, 397 patients underwent HoLEP by a single surgeon and enrolled in our prospective registry. Baseline data included age, PSA, transrectal ultrasonography, the international prostate symptom score (IPSS), and overactive bladder symptom score (OABSS). Subjective assessment of surgical outcomes was performed at 6 months postoperatively using self-administered questionnaires consisting of ‘satisfaction with treatment question’ (STQ), ‘overall response assessment’ (ORA), and ‘willingness to undergo surgery question’ (WSQ). Results A total of 331 patients (mean age 69.6±7.0 years) were included in the analysis. Mean total prostate volume was 69.5 (±42.2) ml. Mean preoperative IPSS score was 18.5 (±7.8). The STQ showed that most patients (91.8%) were satisfied after the surgery. Only 11 (3.3%) patients responded with ‘dissatisfied’, and no patients replied with ‘very dissatisfied’. The WSQ showed that 311 (94.0%) patients were willing to undergo the surgery again if they had to reconsider the surgical decision. The ORA showed that all patients (99.4%) experienced an improvement. When compared with satisfied patients, neutral/dissatisfied patients had lower IPSS quality of life scores (2.7 vs. 0.9, p<0.001), higher IPSS voiding symptom scores (7.0 vs. 1.4, p<0.001), and more frequent episodes of urgency urinary incontinence in OABSS (1.0 vs. 0.3, p = 0.017) at 6 months postoperatively. Conclusions The overall level of satisfaction after HoLEP was high. The most common reason for dissatisfaction was the occurrence of urgency urinary incontinence after the surgery.
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Affiliation(s)
- Young Ju Lee
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
| | - Shin Ah Oh
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
| | - Sung Han Kim
- Department of Urology, Prostate Cancer Center, Research Institute and National Cancer Center, Goyang, South Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University Hospital, Seoul, South Korea
- * E-mail:
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McAdams S, Nunez-Nateras R, Martin CJ, Cha S, Humphreys MR. Morcellation Efficiency in Holmium Laser Enucleation of the Prostate: Oscillating Morcellator Outperforms Reciprocating Morcellator With no Apparent Learning Curve. Urology 2017; 106:173-177. [DOI: 10.1016/j.urology.2017.05.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 05/08/2017] [Accepted: 05/10/2017] [Indexed: 12/22/2022]
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Holmium Laser Enucleation of the Prostate is Safe for Patients Above 80 Years: A Prospective Study. Int Neurourol J 2016; 20:143-50. [PMID: 27377947 PMCID: PMC4932640 DOI: 10.5213/inj.1630478.239] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 01/27/2016] [Indexed: 12/02/2022] Open
Abstract
Purpose: To evaluate the effect of age on the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for the treatment of symptomatic benign prostatic hyperplasia (BPH). Methods: A total of 579 patients underwent HoLEP procedure performed by a single surgeon (SJO) between December 2009 and May 2013. The perioperative and functional outcomes of patients in the age groups of 50–59 (group A, n=44), 60–69 (group B, n=253), 70–79 (group C, n=244), and ≥80 years (group D, n=38) were compared. The Clavien-Dindo system was used to evaluate clinical outcomes. The International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoid residual (PVR) urine volume, and urinary continence were used to assess functional outcomes. Results: In this study, the patients ≥80 years had significantly higher presence of hypertension (P=0.007), total prostate volumes (P=0.024), transitional zone volume (P=0.002), American Society of Anesthesiologists scores (P=0.006), urinary retention (P=0.032), and anticoagulation use (P=0.008) at preoperative period. Moreover, the mean values of operation time, enucleation time, morcellation time, and enucleation weight were higher in group D compared with other group patients (P=0.002, P=0.010, P<0.01, and P=0.009, respectively). Patients aged ≥80 years had a longer hospital stay time (2.9±1.8 days) than other groups (group A, 2.3±0.7 days; group B, 2.3±0.7 days vs. group C, 2.4±0.7 days; P=0.001). All groups were similar in regard to the incidence of complications (Clavien-Dindo grade) post operatively (P>0.05). All the patients in the present study showed improvement in functional outcomes after HoLEP. By the sixth month, there were no significant differences in IPSS, quality of life, Qmax, and PVR among the groups (P>0.05). Conclusions: Compared with younger patients, the patients aged ≥80 years had a similar overall morbidity and 6-month functional outcomes of HoLEP. HoLEP is a safe and effective treatment for BPH among the elderly.
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Elshal AM, Eldemerdash Y, Mekkawy R, Taha DE, Laymon M, El-Nahas AR, El-Assmy A. Prostate tissue retrieval after holmium laser enucleation of the prostate; assessment of non-morcellation approaches. Arab J Urol 2016; 14:147-55. [PMID: 27489742 PMCID: PMC4963166 DOI: 10.1016/j.aju.2016.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 01/23/2016] [Accepted: 02/13/2016] [Indexed: 12/17/2022] Open
Abstract
Objectives To review non-morcellation approaches for tissue retrieval after holmium laser enucleation of the prostate (HoLEP) and whether these approaches demolish the advantages of the HoLEP procedure. Patients and methods We reviewed our prospectively maintained laser prostate database for HoLEP procedures where non-morcellation approaches were used for retrieval of the enucleated adenoma. Non-morcellation approaches were adopted in cases of morcellator malfunction or whenever concomitant pathology indicated laparotomy. Patients were stratified into the laparotomy group (Group I) or the transurethral resection (TUR) group (Group II). Safety and efficacy of each approach were assessed and compared. Results Between August 2012 and July 2015, of 392 HoLEP procedures non-morcellation approaches were used for tissue retrieval in 37 (9.4%). In 19 procedures a laparotomy approach was adopted (17 mini-laparotomies and two conventional laparotomies for concomitant diverticulectomy). TUR of the enucleated adenoma was adopted in 18 patients. Baseline demographic data and indications for surgery were comparable between the groups. However, significantly larger prostates were treated in Group I. There were no significant differences between the groups for tissue retrieval time, histopathological findings of retrieved tissue, and peri-procedure biochemical changes. However, significantly more tissue was retrieved (median tissue weight 115 vs 38 g) and at a faster rate (4.6 vs 1.09 g/min) in Group I. The median hospital stay was similar in both groups, but the median time to catheter removal was longer in Group I (5 vs 2 days). Minimal and similar peri-procedure complications were reported in both groups and in both groups there was a significant and comparable improvement in all urinary outcome measures. Conclusion In the absence or malfunction of a tissue morcellator, or whenever concomitant pathology indicates laparotomy, non-morcellation tissue retrieval approaches are feasible options for endourologists practicing transurethral enucleation of prostate adenoma. These approaches are valid alternatives retaining most of the advantages of the transurethral prostate enucleation procedure.
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Affiliation(s)
- Ahmed M Elshal
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Yasser Eldemerdash
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ramy Mekkawy
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Diaa-Eldin Taha
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mahmoud Laymon
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed R El-Nahas
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed El-Assmy
- Prostate Unit, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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