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Ajami T, Blachman-Braun R, Porto JG, Ritch CR, Gonzalgo ML, Punnen S, Shah HN, Parekh DJ, Nahar B. Combined holmium laser enucleation of the prostate with high-intensity focused ultrasound in treating patients with localized prostate cancer in a prostate with volume > 60 g: Oncological and functional outcomes from single-institution study. Urol Oncol 2024:S1078-1439(24)00442-3. [PMID: 38789378 DOI: 10.1016/j.urolonc.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/31/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE To assess the efficacy and safety of combined High-Intensity Focused Ultrasound (HIFU) and Holmium Laser Enucleation of the Prostate (HoLEP) in treating patients with both localized prostate cancer (PCa) and prostate > 60 g. METHODS All patients who underwent HIFU for treatment of localized PCa were prospectively enrolled in our study. We reviewed records of patients undergoing procedures from January 2016 to January 2023. For patients with prostate sizes > 60 g, HoLEP was offered before HIFU to prevent worsened urinary symptoms post-treatment. Oncological outcomes-prostatic-specific (PSA) kinetics, recurrence rates, treatment failure - and functional results-Sexual Health Inventory for Men (SHIM), International Prostate Symptoms Score (IPSS), and urinary complications were compared between patients undergoing combined HoLEP and HIFU with those underwent HIFU-monotherapy. RESULTS Among 100 patients, 74 underwent HIFU-monotherapy and 26 underwent the combined HoLEP and HIFU. The majority had intermediate-risk PCa (67%). Pathologic assessment of HoLEP specimens showed no tumor evidence in 57% of cases. In comparison to the HIFU-only group, the combined group exhibited significantly lower PSA metrics across various intervals, however, no differences were found regarding overall and infield recurrences and treatment failure rates. While the combined treatment initially resulted in higher incontinence rates and shorter catheterization durations (P < 0.001), no significant difference in IPSS was observed during subsequent follow-ups. CONCLUSION HoLEP and HIFU can be safely combined for the treatment of PCa in patients with >60 g prostate volume without compromising early oncological outcomes thereby expanding the therapeutic scope of HIFU in treating patients with localized PCa and large adenomas.
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Affiliation(s)
- Tarek Ajami
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL
| | - Ruben Blachman-Braun
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL
| | - Joao G Porto
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL
| | - Chad R Ritch
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL
| | - Mark L Gonzalgo
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL
| | - Sanoj Punnen
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL
| | - Hemendra N Shah
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL
| | - Dipen J Parekh
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL
| | - Bruno Nahar
- Desai Sethi Urology Institute, University of Miami, Miller School of Medicine, Miami, FL.
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Öztürk H. A novel technique for thulium laser enucleation of the prostate: anterior releasing with ThuLEP (ARTh technique). Lasers Med Sci 2024; 39:126. [PMID: 38714553 PMCID: PMC11076363 DOI: 10.1007/s10103-024-04071-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/29/2024] [Indexed: 05/10/2024]
Abstract
Thulium laser enucleation of the prostate (ThuLEP) is a highly effective approach to the treatment of benign prostatic hyperplasia. We present here a description of the "ARTh Technique" and the benefits it offers in terms of improved visualization, short operation times, and easy recognition of the dissection plane, describing specifically the anterior release (AR) technique using ThuLEP(Th). Included in this retrospective study were 32 consecutive patients operated on between January 2022-November 2022. Parameters were measured before and after the procedure: the International Prostate Symptom Score(IPSS), maximum flow rate(Qmax), post-void residual urine(PVR) prostate-specific antigen(PSA), prostate volume, operation-time, morcellation-time, catheterization-time and presence of transient urinary incontinence, and compared. The median age of patients undergoing enucleation of the prostate using the ARTh technique was 64 years (range: 44-83). The median prostate volume of the patients was 83.5 ml(50-128 ml), preoperative-IPSS was 24.8(15-33), postoperative-IPSS was 7(5-11), preoperative-Qmax was 8.1 ml/Sects. (5-11.5 ml/sec), postoperative-Qmax was 26.9 ml/Sect. (20.8-34 ml/sec), preoperative-PVR was 145 ml(75-258 ml), postoperative-PVR was 36.2 ml(0-66 ml), total operation time was 51.4 min(28-82 min), enucleation time was 36.9 min(19-51 min) and morcellation time was 15.3 min(8-27 min). The ARTh technique is a safe procedure that allows the surgeon to easily recognize and adhere to the defined dissection plane, thus decreasing operation times, significantly reducing the rate of postoperative transient urinary incontinence (TUI).
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Affiliation(s)
- Hakan Öztürk
- Department of Urology, Izmir University of Economics, Izmir, Turkey.
- Izmir University of Economics Medicalpoint Hospital, Yeni Girne Boulevard 1825 St. No: 12, Karsiyaka-Izmir, 35350, Turkey.
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Heiman J, Snead WM, DiBianco JM. Persistent Lower Urinary Tract Symptoms After BPH Surgery. Curr Urol Rep 2024:10.1007/s11934-024-01202-y. [PMID: 38578550 DOI: 10.1007/s11934-024-01202-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE OF REVIEW Lower urinary tract symptoms (LUTS) after surgical management for BPH pose a significant clinical challenge for urologists. Despite high success rates in relieving LUTS, there is a subset of patients who experience persistent symptoms after intervention. In this review article, we describe the management of patients with new or persistent LUTS after endoscopic bladder outlet surgery. RECENT FINDINGS Previously, the goal for BPH management was to remove as much adenomatous tissue as possible. While potentially effective, this may lead to unwanted side effects. There has been a recent paradigm shift for new minimally invasive surgical therapies (MIST) that strategically treat adenomatous tissue, adding potential complexity in managing patients with new or residual symptoms in the postoperative setting. There is a paucity of literature to guide optimal workup and care of patients with persistent LUTS after surgical management. We characterize patients into distinct groups, defined by types of symptoms, irritative versus obstructive, and timing of the symptomatology, short term versus long term. By embracing this patient-centered approach with shared decision management, clinicians can optimize outcomes efficiently improving their patients' quality of life.
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Affiliation(s)
- Joshua Heiman
- Department of Urology, Indiana University, Indianapolis, IN, USA.
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Bultó Gonzalvo R, Bernardello Ureta M, Cervera Alcaide J, Sanchez Rodriguez M, Franco M, Freixa Sala R, Areal Calama J, Agreda Castañeda F. Evaluating the effects of preoperative treatment with 5-alpha reductase inhibitors in holmium laser enucleation of the prostate. Actas Urol Esp 2024; 48:150-154. [PMID: 37604401 DOI: 10.1016/j.acuroe.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION AND AIM Patients treated with HoLEP are frequently treated with previous treatments, including 5-alpha-reductase inhibitors (5-ARIs). We investigated the impact of pretreatment with 5-ARIs on perioperative and immediate postoperative parameters in patients treated with HoLEP. MATERIAL AND METHODS A retrospective study was performed using a prospectively collected database including all patients treated with HoLEP at our center between January 2017 and January 2023. The resected tissue weight, enucleation and morcellation efficiency (enucleation weight/time and morcellation weight/ time), postoperative complications, hospital stay and hemoglobin drop have been analyzed. RESULTS A total of 327 patients were included. Of these, 173 (52.9%) were treated with 5-ARIs. No differences were found among the perioperative parameters investigated to determine efficiency. No differences were observed in peri- or postoperative complications, hospital stay or hemoglobin drop. CONCLUSIONS Therapy with 5-ARIs had no impact on the immediate postoperative outcomes of patients treated with HoLEP. In our cohort, we observed that the use of 5-ARIs did not affect surgical efficiency, enucleation or morcellation. Further multicenter studies will be necessary to validate these findings.
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Affiliation(s)
- R Bultó Gonzalvo
- Servicio de Urología, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain.
| | - M Bernardello Ureta
- Servicio de Urología, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - J Cervera Alcaide
- Servicio de Urología, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - M Sanchez Rodriguez
- Servicio de Urología, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - M Franco
- Servicio de Urología, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - R Freixa Sala
- Servicio de Urología, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - J Areal Calama
- Servicio de Urología, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - F Agreda Castañeda
- Servicio de Urología, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain
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Kim DH, Kang CS, Choi JW, Jeh SU, Choi SM, Lee CW, Kam SC, Hwa JS, Hyun JS. The Efficacy and Safety of 'Inverted Omega En-bloc' Holmium Laser Enucleation of the Prostate (HoLEP) for Benign Prostatic Hyperplasia: A Size-Independent Technique for the Surgical Treatment of LUTS. World J Mens Health 2023; 41:951-959. [PMID: 37118958 PMCID: PMC10523129 DOI: 10.5534/wjmh.220225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 04/30/2023] Open
Abstract
PURPOSE To evaluate the safety, efficiency, and size-dependency of the 'Inverted omega En-bloc (Ʊ)' holmium laser enucleation of the prostate (HoLEP) in benign prostate hyperplasia (BPH) with lower urinary tract symptoms. MATERIALS AND METHODS A retrospective analysis of 716 consecutive patients who underwent HoLEP under the care of a single surgeon from 2014-2021. These patients were treated using the 'Inverted omega En-bloc' HoLEP technique for BPH. The patients were divided into 3 groups: Group 1 (<40 mL, n=328), Group 2 (40-60 mL, n=221), and Group 3 (≤60 mL, n=167). Perioperative parameters, safety, and functional outcomes were assessed and analyzed. RESULTS The perioperative parameters, like enucleation time (45.8±26.9 min), morcellation time (13.2±47.5 min), and catheterization duration (1.6±1.2 d) significantly differed to favor smaller prostate sizes (p<0.01). Significant improvements in the IPSS (total, voiding, storage, and quality of life), post-void residual urine, and maximum flow rate were observed 3 months post-HoLEP and continued during the 1-year follow-up period in all groups (p<0.01). The postoperative complications included urethral stricture in 11 patients (1.5%), bladder neck contracture in 12 (1.7%), urinary incontinence in 14 (2.0%), and bladder injuries in 4 (0.6%). Bladder neck contractures occurred only in Group 1. The postoperative surgical management for complications included urethral sounding (n=9, 1.3%), endoscopic internal urethrotomy (n=2, 0.3%), and re-HoLEP for bladder neck contractures in (n=12, 1.7%). The rate of re-HoLEP for regrowing adenomas was 15 (2.1%). Postoperative medications exceeding 6 months were α-blocker (n=22, 3.1%), cholinergics (n=16, 2.2%), anticholinergics (n=58, 8.1%), antidiuretics (n=18, 2.5%), and daily PDE5 inhibitor (n=38, 5.3%). Thirty-four patients (4.7%) had postoperative incidental prostate cancer. CONCLUSIONS The inverted omega En-bloc HoLEP technique is safe and effective for the treatment of BPH. Moreover, 'Inverted omega En-bloc' HoLEP is a size-independent and effective method for all prostate sizes.
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Affiliation(s)
- Dae Hyun Kim
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Medical Science, Jinju, Korea
| | - Chang Suk Kang
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Medical Science, Jinju, Korea
| | - Jae Whi Choi
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Medical Science, Jinju, Korea
| | - Seong Uk Jeh
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Medical Science, Jinju, Korea
| | - See Min Choi
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Medical Science, Jinju, Korea
| | - Chun Woo Lee
- Department of Urology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Sung Chul Kam
- Department of Urology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jeong Seok Hwa
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Medical Science, Jinju, Korea
| | - Jae Seog Hyun
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine and Institute of Medical Science, Jinju, Korea.
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Banno T, Nakamura K, Ozaki A, Kouchi Y, Ohira T, Shimmura H. Robot-assisted radical prostatectomy following holmium laser enucleation of the prostate: perioperative, functional, and oncological outcomes. J Robot Surg 2023; 17:2125-2133. [PMID: 37247118 DOI: 10.1007/s11701-023-01621-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/14/2023] [Indexed: 05/30/2023]
Abstract
Robot-assisted radical prostatectomy with previous holmium laser enucleation of the prostate is challenging, and few studies have analyzed its perioperative, functional, and oncological outcomes. Here we retrospectively evaluated 298 robot-assisted radical prostatectomies, including 25 with and 273 without previous holmium laser enucleation of the prostate, performed in 2015-2022. Regarding perioperative outcomes, operative and console times were significantly longer in the previous holmium laser enucleation of the prostate group. In contrast, the estimated blood loss was similar between groups, and there were no transfusions or intraoperative complications. Multivariable Cox hazard regression analysis of the functional outcomes of postoperative urinary continence showed that body mass index, intraoperative bladder neck repair, and nerve sparing were independently associated factors, whereas a history of holmium laser enucleation of the prostate was not. Similarly, a history of holmium laser enucleation of the prostate was not associated with biochemical recurrence; however, positive surgical margins and seminal vesicle invasion were independent risk factors of biochemical recurrence. Our findings revealed that robot-assisted radical prostatectomy after holmium laser enucleation of the prostate was safe and raised no concerns of postoperative urinary incontinence or biochemical recurrence. Therefore, robot-assisted radical prostatectomy may be a treatment option for patients with prostate cancer after holmium laser enucleation of the prostate.
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Affiliation(s)
- Taro Banno
- Department of Urology, Jyoban Hospital of Tokiwa foundation, 57 Kaminodai, Nagaya-machi, Jobankamiyu, Iwaki-shi, Fukushima, 972-8322, Japan.
| | - Kazutaka Nakamura
- Department of Urology, Jyoban Hospital of Tokiwa foundation, 57 Kaminodai, Nagaya-machi, Jobankamiyu, Iwaki-shi, Fukushima, 972-8322, Japan
| | - Akihiko Ozaki
- Department of Breast Surgery, Jyoban Hospital of Tokiwa foundation, Iwaki, Japan
| | - Yukiko Kouchi
- Department of Urology, Jyoban Hospital of Tokiwa foundation, 57 Kaminodai, Nagaya-machi, Jobankamiyu, Iwaki-shi, Fukushima, 972-8322, Japan
| | | | - Hiroaki Shimmura
- Department of Urology, Jyoban Hospital of Tokiwa foundation, 57 Kaminodai, Nagaya-machi, Jobankamiyu, Iwaki-shi, Fukushima, 972-8322, Japan
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Tai JCJ, Pervaiz M, Deen S, Tasleem A, Nkwam N. A rare case of hyperchloraemic normal anion gap metabolic acidosis due to absorption of normal saline irrigation fluid during holmium laser enucleation of prostate. Urol Case Rep 2023; 50:102470. [PMID: 37455779 PMCID: PMC10338294 DOI: 10.1016/j.eucr.2023.102470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/12/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Holmium laser enucleation of the prostate (HoLEP) is the preferred technique for surgical management of benign prostatic hyperplasia in prostates over 80 cc in size. A 72-year-old male underwent a HoLEP for catheter-dependent urinary retention in the context of a 204 cc prostate. At the end of the procedure he was clinically overloaded and had developed a combined respiratory and hyperchloremic normal anion gap metabolic acidosis secondary to excessive absorption of normal saline irrigation fluid. He was transferred to the ICU for diuresis and supportive care where he made a full recovery.
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Capogrosso P, Ventimiglia E, Fallara G, Schifano N, Costa A, Candela L, Pellegrino F, Colandrea G, Cignoli D, De Angelis M, Belladelli F, Longoni M, Avesani G, Lanzaro F, Scattoni V, Dehò F, Salonia A, Briganti A, Montorsi F. Holmium Laser Enucleation of the Prostate Is Associated with Complications and Sequelae Even in the Hands of an Experienced Surgeon Following Completion of the Learning Curve. Eur Urol Focus 2023; 9:813-821. [PMID: 37069007 DOI: 10.1016/j.euf.2023.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Holmium laser enucleation of the prostate (HoLEP) is considered a challenging procedure even for surgeons who have completed the learning curve. OBJECTIVES To assess outcomes and complications following HoLEP performed by a highly experienced surgeon. DESIGN, SETTING, AND PARTICIPANTS This was a single-institution prospective study (NCT03583034) performed at a tertiary referral centre that included 243 consecutive patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) treated with HoLEP by a single experienced surgeon (>1600 cases). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients were assessed using validated questionnaires and uroflowmetry at baseline and several follow-up dates. Intraoperative and postoperative complications were recorded. Kaplan-Meier analysis was used to estimate recovery rates for urinary continence and erectile function. Logistic regression models were constructed to assess predictors of postoperative complications. RESULTS AND LIMITATIONS Of the 243 patients, 78 (32.1%) had an indwelling urethral catheter. The median prostate volume (PV) was 87 cm3 (interquartile range 60-115) and 146 patients (59.8%) had PV >80 cm3. At 3-mo follow-up, 219 patients (90.1%) had a peak flow rate >20 ml/s and 182 (74.9%) had no postvoid residual urine. The improvement in subjective symptoms was significant at 1-mo follow-up and was maintained until 12 mo after surgery. Urinary continence recovery was slow, with an estimated rate of 68% (95% confidence interval [CI] 62-74%) at 1 mo and 94% (95% CI 91-97%) at 12 mo after HoLEP. The recovery rate for erectile function was 53% (95% CI 46-61%) at 1 mo and 85% (95% CI 77-90%) at 12 mo. Postoperative complications occurred in 36 patients (14.8%) during their hospital stay, in 34 (14%) within 1 mo following discharge from hospital, and in ten (4.1%) at later follow-up dates. Clinically significant complications (Clavien-Dindo ≥2) were observed in 44 cases (18%) and were more common for patients with an indwelling catheter at baseline (odds ratio 5.05; p = 0.006). CONCLUSIONS HoLEP is an effective procedure for treating LUTS due to BPE, although it is not devoid of complications and sequelae, even in the hands of a highly experienced surgeon. PATIENT SUMMARY Holmium laser treatment of the prostate to reduce its size has positive results for urinary function when performed by an experienced surgeon, even in complex cases, although there can be complications.
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Affiliation(s)
- Paolo Capogrosso
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Nicolò Schifano
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Antonio Costa
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Luigi Candela
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Pellegrino
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Gianmarco Colandrea
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Daniele Cignoli
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Mario De Angelis
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Mattia Longoni
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Giulio Avesani
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Lanzaro
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Vincenzo Scattoni
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Federico Dehò
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
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Tricard T, Xia S, Xiao D, Tong Z, Gaillard V, Sun J. Outcomes of holmium laser enucleation of the prostate (HoLEP) for very large-sized benign prostatic hyperplasia (over 150 mL): open simple prostatectomy is dead. World J Urol 2023; 41:2249-2253. [PMID: 37391668 DOI: 10.1007/s00345-023-04486-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/06/2023] [Indexed: 07/02/2023] Open
Abstract
INTRODUCTION Our study aimed to describe the outcomes of transurethral enucleation of the prostate (HoLEP) for large-sized benign prostatic hyperplasia over 150 mL (bBPH). METHODS We conducted a retrospective, descriptive, and analytical study of patients undergoing HoLEP for bBPH. The primary endpoint was the success of the procedure, defined by a mixed criteria: complete endoscopic enucleation of the prostate, absence of blood transfusion or reoperation for bleeding, post-operative improvement of quality of life (assessed by a ≥ 2 points increase at in the 8th question of the IPSS test) and post-operative continence (no pads use) at 3 months. RESULTS Eighty-one patients were included with a mean age of 73.9 ± 7.3 and a mean measured prostate volume of 183.3 ± 34.5 cc. The mean operative time was 57.5 ± 29.7 min and the average wet weight of resected tissue removed was 151.8 ± 44.7 g. Mean hospitalization stay was 1.3 ± 0.7 days with a mean post-operative catheterization period of 1.9 ± 0.9 days. The success of the surgery was achieved in 77 patients (95%). Functional improvements were found at 1 and 6 months for Qmax, post-void residual, IPSS and QoL-IPSS. The 30-day complication rate was 9.9%. The average PSA level dropped from 14.8 ± 11.6 ng/mL at baseline to 0.8 ± 0.5 ng/mL at 6 months. CONCLUSION HoLEP for bBPH is both safe and efficient. Regarding the benefit/risk balance, it should be highlighted as the gold standard for the management of big BPH.
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Affiliation(s)
- Thibault Tricard
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Pudong District, Shanghai, 200127, China.
- Department of Urology, Nouvel Hôpital Civil, CHRU Strasbourg, 1 place de l'Hôpital, 67000, Strasbourg, France.
| | - ShengQiang Xia
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Pudong District, Shanghai, 200127, China
| | - DongDong Xiao
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Pudong District, Shanghai, 200127, China
| | - Zhen Tong
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Pudong District, Shanghai, 200127, China
| | - Victor Gaillard
- Department of Urology, Nouvel Hôpital Civil, CHRU Strasbourg, 1 place de l'Hôpital, 67000, Strasbourg, France
| | - Jie Sun
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Pudong District, Shanghai, 200127, China
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10
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Morishige S, Ohyama T, Fujita N, Kameda M, Yonekura Y, Endo F, Abe S. Risk Factors for Intraoperative Hypothermia during Holmium Laser Enucleation of the Prostate. Urol Int 2023; 107:672-677. [PMID: 36996791 DOI: 10.1159/000528721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/12/2022] [Indexed: 04/01/2023]
Abstract
INTRODUCTION Holmium laser enucleation of the prostate (HoLEP) is considered a size-independent gold standard for benign prostatic hyperplasia (BPH), and there is no upper limit of prostate weight that can be treated. Tissue retrieval can be time-consuming in cases of significant prostatic enlargement, which may lead to intraoperative hypothermia. As there are few studies on perioperative hypothermia in HoLEP, we conducted a retrospective study of patients who underwent HoLEP at our hospital. METHODS The data of 147 patients who underwent HoLEP at our hospital were retrospectively collected and analyzed for the occurrence of intraoperative hypothermia (temperature <36°C); age, body mass index (BMI), anesthesia method, body temperature, total fluid infusion, operation time, and irrigation fluid were the explanatory variables. RESULTS Intraoperative hypothermia was observed in 46 of 147 patients (31.3%). Simple logistic regression analysis showed that age (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 1.01-1.13, p = 0.021), BMI (OR: 0.84, 95% CI: 0.72-0.96, p = 0.017), spinal anesthesia (OR: 4.92, 95% CI: 1.86-14.99, p = 0.002), and surgical time (OR: 1.04, 95% CI: 1.01-1.06, p = 0.006) were predictors of hypothermia. The decrease in body temperature was more pronounced with longer-duration surgery and reached 0.58°C at 180 min. CONCLUSION General anesthesia, instead of spinal anesthesia, is recommended in high-risk patients with advanced age or low BMI to avoid intraoperative hypothermia during HoLEP. Two-stage morcellation may be considered for large adenomas, when a prolonged operative time and hypothermia are anticipated.
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Affiliation(s)
- Sae Morishige
- From the Department of Anesthesiology, St. Luke's International Hospital, Tokyo, Japan
| | - Takehiro Ohyama
- From the Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Nobuko Fujita
- From the Department of Anesthesiology, St. Luke's International Hospital, Tokyo, Japan
| | - Megumi Kameda
- From the Department of Anesthesiology, St. Luke's International Hospital, Tokyo, Japan
| | - Yuuki Yonekura
- From the Department of Graduate School of Nursing Science, St. Luke's International Hospital, Tokyo, Japan
| | - Fumiyasu Endo
- From the Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Seiki Abe
- From the Department of Anesthesiology, St. Luke's International Hospital, Tokyo, Japan
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11
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Riveros C, Di Valerio E, Bacchus M, Chalfant V, Leelani N, Thomas D, Jazayeri SB, Costa J. Predictors of readmission and impact of same-day discharge in holmium laser enucleation of the prostate. Prostate Int 2023; 11:20-26. [PMID: 36910904 PMCID: PMC9995658 DOI: 10.1016/j.prnil.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/22/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022] Open
Abstract
Background Holmium enucleation of the prostate (HoLEP) is becoming the gold standard for the treatment of benign prostatic hyperplasia (BPH). Our objective was to identify predictors of 30-day readmission and the impact of same-day discharge after HoLEP. Methods Using NSQIP data from 2011 to 2019, we identified men who underwent HoLEP for the treatment of BPH. We compared patients based on time of discharge and readmission status. We used multivariable logistic regression analysis (MLRA) to identify independent factors associated with 30-day readmission. Results A total of 3,489 patients met inclusion criteria with 833 (23.88%) being discharged within 24 hours and 2,656 (76.12%) discharged after 24 hours. There were 158 (4.53%) 30-day readmissions, mostly due to hematuria and urinary tract infection. Patients being readmitted were older (72 vs. 70 years old, P = 0.001), were more likely to have preoperative anemia (36.7% vs. 23.1%; P < 0.001), chronic kidney disease (29.7% vs. 19.7%; P < 0.001), bleeding disorder (10.8% vs. 2.8%; P < 0.001), higher American Society of Anesthesiologists (ASA) scores (≥3: 70.3% vs. 46.7%; P < 0.001) and a higher frailty burden (5-item modified frailty index [5i-mFI] ≥ 2: 36.1% vs. 19.1%; P < 0.001) compared to their counterparts. Factors independently associated with 30-day readmission were bleeding disorder (OR 2.89; 95% CI 1.63-5.11; P < 0.001), 5i-mFI ≥ 2 (OR 1.67; 95% CI 1.03-2.71; P = 0.038) and an ASA score ≥3 (OR 1.80; 95% CI 1.21-2.70; P = 0.004); however, same-day discharge was not found to be a significant predictor of 30-day readmissions. Conclusion The overall readmission rate after HoLEP is low. Patients discharged within 24 hours have similar rates of readmission compared to patients discharged after 24 hours. We found bleeding disorder, frailty burden, and ASA score to be independent predictors of 30-day readmission.
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Affiliation(s)
- Carlos Riveros
- Department of Urology, University of Florida, Jacksonville, FL, USA
| | | | - Michael Bacchus
- Department of Urology, University of Florida, Gainesville FL, USA
| | - Victor Chalfant
- Department of Urology, University of Florida, Jacksonville, FL, USA
| | - Navid Leelani
- Department of Urology, University of Florida, Jacksonville, FL, USA
| | - Devon Thomas
- Department of Urology, University of Florida, Jacksonville, FL, USA
| | | | - Joseph Costa
- Department of Urology, University of Florida, Jacksonville, FL, USA
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12
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Seizilles de Mazancourt E, Pagnoux G, Codas Duarte R, Moldovan PC, Ruffion A, Colombel M, Badet L, Fassi-Fehri H. Prostatic arterial embolization versus holmium laser enucleation of the prostate: 1-year outcomes. World J Urol 2023; 41:151-157. [PMID: 36451037 DOI: 10.1007/s00345-022-04225-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/11/2022] [Indexed: 12/05/2022] Open
Abstract
PURPOSE Holmium Laser Enucleation of the Prostate (HoLEP) and Prostatic Artery Embolization (PAE) are novel techniques for the treatment of benign prostatic hyperplasia lower urinary tract symptoms (BPH-LUTS). The objective of this study was to describe and compare the functional results and complications of these two techniques at one year follow-up. MATERIALS AND METHODS We performed a retrospective, monocentric study of all patients consecutively treated in our center with HoLEP or PAE for symptomatic or complicated BPH between January 2016 and December 2019. Data regarding patient and perioperative characteristics, follow-up biological results, functional questionnaires and uroflowmetry were collected from medical records. RESULTS A total of 490 and 57 patients were treated with HoLEP and PAE, respectively. The demographic and clinical characteristics of the two groups were similar. The operative time was significantly higher for PAE (p < 0.001) and hospitalization time longer after HoLEP (p = 0.0006). The urinary catheterization time was longer after PAE (p < 0.001). The prostatic volume treated was higher with HoLEP than with PAE (56% versus 26%, p < 0.001). The mean difference in IPSS from baseline to 12 months was significantly higher after HoLEP than after PAE: - 17.58 versus - 8 (p < 0.001). The mean difference in QoL-IPSS from baseline to 12 months was significantly higher after HoLEP: - 4.09 versus - 2.27 (p < 0.001). The rate of postoperative adverse events in the first three months was similar between the two groups:35% after HoLEP and 33% after PAE (p = 0.88). CONCLUSIONS HoLEP and PAE both significantly improved BPH-LUTS, with HoLEP having an advantage over PAE.
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Affiliation(s)
| | - Gaelle Pagnoux
- Department of Urinary and Vascular Imaging, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Ricardo Codas Duarte
- Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Paul Cezar Moldovan
- Department of Urinary and Vascular Imaging, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Alain Ruffion
- Department of Urology, Lyon Sud Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Marc Colombel
- Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Lionel Badet
- Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Hakim Fassi-Fehri
- Department of Urology and Transplant Surgery, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
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Gauhar V, Gilling P, Pirola GM, Chan VWS, Lim EJ, Maggi M, Teoh JYC, Krambeck A, Castellani D. Does MOSES Technology Enhance the Efficiency and Outcomes of Standard Holmium Laser Enucleation of the Prostate? Results of a Systematic Review and Meta-analysis of Comparative Studies. Eur Urol Focus 2022; 8:1362-1369. [PMID: 35105516 DOI: 10.1016/j.euf.2022.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/15/2021] [Accepted: 01/14/2022] [Indexed: 02/08/2023]
Abstract
CONTEXT Holmium laser enucleation of the prostate (HoLEP) is currently the size-independent gold standard for surgical treatment of benign prostate enlargement (BPE). OBJECTIVE To systematically review the current literature and compare perioperative parameters, early outcomes, and complications after HoLEP with MOSES technology LEP (MoLEP) for BPE. EVIDENCE ACQUISITION This study was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework using the PICOS (Patient, Intervention Comparison, Outcome, Study) model to frame the clinical question. The population was adults undergoing LEP for BPE, with standard HoLEP as the intervention and MoLEP as the comparison. The outcomes were enucleation time, surgical time, haemostasis time, energy used, hospital length of stay (LOS), recatheterisation, urethral stricture rate, and functional outcomes. The study type included randomised, prospective nonrandomised, and retrospective studies. EVIDENCE SYNTHESIS Seven studies were included for meta-analysis after screening. Mean enucleation time was significantly shorter for MoLEP (mean difference [MD] -7.27 min, 95% confidence interval [CI] -11.26 to -3.28; p = 0.0004). Postoperative LOS was significantly longer in the HoLEP group (MD 0.3 d, 95% CI -0.24-0.85,p<0.0001). Although not statistically significant, there was a trend for higher incidence of recatheterisation (odds ratio [OR] 1.39, 95% CI 0.47-4.09; p = 0.55) and urethral stricture (OR 1.81, 95% CI 0.45-7.37; p = 0.41) in the HoLEP group. The mean maximum peak flow favoured HoLEP (MD 0.95 ml/s, 95% CI -1.66 to 3.57; p = 0.47) and a lower mean postvoid residual volume was noted in the MoLEP group (MD -10.08 ml, 95% CI -53.54 to 33.37; p = 0.65). CONCLUSIONS MoLEP performed better in terms of intraoperative outcomes compared to standard HoLEP, resulting in shorter enucleation, haemostasis, and total surgical times for similar energy delivered. In addition, postoperative LOS with an early trial of catheter favours MoLEP, making it appealing as a day surgery procedure. PATIENT SUMMARY We reviewed the literature for early outcomes of laser treatment of the prostate for tissue removal using a MOSES system in comparison to standard treatment with a holmium laser for BPE. We found that the MOSES laser system can improve intraoperative performance, making prostate treatment a same-day discharge surgery.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Jurong East, Singapore
| | - Peter Gilling
- University of Auckland, Bay of Plenty Clinical Campus, Tauranga, New Zealand
| | | | - Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore
| | - Martina Maggi
- Department of Urology, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Amy Krambeck
- Division of Endourology, Northwestern University, Chicago, IL, USA
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy.
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Chen Y, Xu H, Gao D, Gu M, Liu C, Zhan M, Cai Z, Chen Q, Wang Z. A prospective randomized controlled trial comparing the effect and safety of Piranha and VersaCut morcellation devices in transurethral holmium laser enucleation of the prostate. Int Urol Nephrol 2022; 54:2977-2981. [PMID: 35596886 DOI: 10.1007/s11255-022-03218-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/15/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Holmium laser enucleation of the prostate (HoLEP) is reported to be widely used in the surgical treatment of benign prostatic hyperplasia (BPH), which consists of two procedures: enucleation and morcellation. This study is to examine the efficiency and safety of two different morcellator systems within a cohort of men undergoing HoLEP for BPH. METHODS A total of 210 consecutive patients undergoing HoLEP and morcellation procedures were enrolled. Individuals were randomly divided into 2 separated groups: the first group (105 patients) was performed with a nephroscope using a mechanical Versacut morcellator and the second (105 patients) was performed with the new morcellation system, nephroscopes and Piranha morcellator. Perioperative characteristics were studied and analyzed. RESULTS The morcellation time and the morcellation rate was similar when the prostate volume (PV) ≤ 60 mL while the morcellation time was significantly shorter and the morcellation rate was higher in the Piranha group with PV > 60 mL. No significant difference was observed according to the bladder irrigation time, indwelling catheter time, and discharge time. CONCLUSION Piranha morcellator presents a higher efficiency for the prostate over 60 mL.
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Affiliation(s)
- Yanbo Chen
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Huan Xu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Dajun Gao
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Meng Gu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Chong Liu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Ming Zhan
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Zhikang Cai
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Qi Chen
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Zhong Wang
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
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15
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Ottaiano N, Shelton T, Sanekommu G, Benson CR. Surgical Complications in the Management of Benign Prostatic Hyperplasia Treatment. Curr Urol Rep 2022. [PMID: 35262855 DOI: 10.1007/s11934-022-01091-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW There are a variety of treatment options for men with symptomatic benign prostatic hyperplasia (BPH); transurethral resection of the prostate (TURP) remains the gold standard surgical treatment. The field continues to evolve with the introduction of new energy and laser technologies, increasing adoption of enucleation techniques, in addition to the advent of minimally invasive surgical technologies (MIST) that enable office-based treatments. The choice in surgical management has become very nuanced depending on a variety of patient and anatomic factors. There continues to be high success rates for surgical treatment of BPH; however, the risk profiles vary across the various surgical treatments. We sought to evaluate contemporary series and summarize the experience of complications associated with BPH treatment and management of these complications. RECENT FINDINGS A comprehensive literature review was performed, and identified 79 manuscripts, published between 2005 and 2021 characterizing the diagnosis and management of complications following BPH surgery. Commonly cited issues included bleeding, ureteral orifice injury, bladder neck injury, rectal injury, TURP syndrome, bladder neck contractures, urethral stricture disease, refractory OAB symptoms, and complications unique to new modalities of treatment. The practicing urologist has multiple surgical options to choose from in treating patients with symptomatic BPH. The surgical management of BPH is generally well tolerated with high objective success rates that allow for significant improvement in urinary quality of life. It is critical to understand the potential complications associated with these various treatment options, which will enable trainees and practicing urologists to better counsel patients and manage these potential complications.
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16
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Lin CH, Wu WJ, Li CC, Ke HL, Jhan JH, Wen SC. Comparison of different en bloc holmium laser enucleation of the prostate techniques to reduce the rate of postoperative transient urinary incontinence. J Int Med Res 2021; 49:3000605211037488. [PMID: 34407683 PMCID: PMC8381441 DOI: 10.1177/03000605211037488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objective To investigate postoperative risk factors for transient urinary incontinence
(TUI) after different en bloc holmium laser enucleation of the prostate
(HoLEP) techniques. Methods We retrospectively analyzed 169 consecutive patients who underwent HoLEP
using the original en bloc technique (n = 41), en bloc with early mucosal
strip detachment technique (n = 72), and three horseshoe-shaped incisions
technique (n = 56) to treat bladder outlet obstruction from January 2017 to
October 2019. Preoperative variables and surgical quality indexes were
compared between the groups. TUI was defined as any hygienic or social
problem caused by involuntary loss of urine at 2 weeks postoperatively. The
postvoid residual urine volume, maximum urinary flow rate, and International
Prostate Symptom Score (IPSS) were assessed. Results Among all three techniques, the three horseshoe-shaped incisions technique
was significantly associated with the lowest incidence of TUI and the lowest
IPSS. Although not statistically significant, the three horseshoe-shaped
incisions group also showed a trend toward a faster enucleation time. No
life-threatening intraoperative complications occurred in any group. Conclusion Use of three horseshoe-shaped incisions in en bloc HoLEP prevented urethral
sphincter damage with a low rate of postoperative TUI. Further long-term,
multicenter comparative assessment is required. Research Registry number: 6848
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Affiliation(s)
- Chun-Hsuan Lin
- Department of Urology, 38023Kaohsiung Medical University, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
| | - Wen-Jeng Wu
- Department of Urology, 38023Kaohsiung Medical University, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,Department of Urology, 38023Kaohsiung Medical University, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Ching-Chia Li
- Department of Urology, 38023Kaohsiung Medical University, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,Department of Urology, 38023Kaohsiung Medical University, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Hung-Lung Ke
- Department of Urology, 38023Kaohsiung Medical University, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,Department of Urology, 38023Kaohsiung Medical University, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Jhen-Hao Jhan
- Department of Urology, 38023Kaohsiung Medical University, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung.,Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung
| | - Sheng-Chen Wen
- Department of Urology, 38023Kaohsiung Medical University, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.,Department of Urology, 38023Kaohsiung Medical University, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
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Piazza P, Bianchi L, Giampaoli M, Droghetti M, Casablanca C, Ercolino A, Beretta C, Recenti D, Balestrazzi E, Puliatti S, Rosiello G, Amato M, Romagnoli D, D'Agostino D, Gaudiano C, Golfieri R, Porreca A, Mottrie A, Schiavina R. Short Time Delay Between Previous Prostate Biopsy for Prostate Cancer Assessment and Holmium Laser Enucleation of the Prostate Correlates with Worse Perioperative Outcomes. Eur Urol Focus 2021; 8:563-571. [PMID: 33858812 DOI: 10.1016/j.euf.2021.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/08/2021] [Accepted: 04/04/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND No data are available regarding the impact of time between a previous transrectal prostate biopsy (PB) and holmium laser enucleation of the prostate (HoLEP) on perioperative outcomes. OBJECTIVE To evaluate the impact of time from PB to HoLEP on perioperative outcomes. DESIGN, SETTING, AND PARTICIPANTS A total of 172 consecutive patients treated with HoLEP within 12 mo of a single previous transrectal PB at two tertiary centers were included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients were stratified into two groups according to the median time from PB to HoLEP (namely, ≤6 and >6 mo). The primary outcome was intraoperative complications. Multivariate logistic regressions were used to identify the predictors of intraoperative complications. Linear regressions were used to test the association between the time from PB to HoLEP and intraoperative complications, enucleation efficiency, and enucleation time. RESULTS AND LIMITATIONS In total, 93 (54%) and 79 (46%) patients had PB ≤ 6 and >6 mo before HoLEP, respectively. Patients in PB ≤ 6 mo group experienced higher rates of intraoperative complications than those in PB > 6 mo group (14% vs 2.6%, p = 0.04). At multivariable analysis, time between PB and HoLEP was an independent predictor of intraoperative complications (odds ratio: 0.74; 95% confidence interval: 0.6-0.9; p = 0.006). Finally, the risk of intraoperative complications reduced by 1.5%, efficiency of enucleation increased by 4.1%, and enucleation time reduced by 1.7 min for each month passed from PB to HoLEP (all p ≤ 0.006). Selection of patients with only one previous PB represents the main limitation. CONCLUSIONS The time from PB to HoLEP of ≤6 mo is associated with a higher risk of intraoperative complications, lower enucleation efficacy, and longer enucleation time. PATIENT SUMMARY Patients with a prostate biopsy (PB) ≤6 mo before holmium laser enucleation of the prostate (HoLEP) had significantly worse outcomes than those with a PB > 6 mo before HoLEP.
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Affiliation(s)
- Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy; ORSI Academy, Melle, Belgium
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy.
| | - Marco Giampaoli
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Matteo Droghetti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Carlo Casablanca
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Amelio Ercolino
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Carlo Beretta
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Dario Recenti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Eleonora Balestrazzi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Stefano Puliatti
- ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Rosiello
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Amato
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Caterina Gaudiano
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rita Golfieri
- Università degli Studi di Bologna, Bologna, Italy; Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Angelo Porreca
- Department of Urology, Veneto Institute of Oncology IOV - IRCCS, 35128 Padua, Italy
| | | | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
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Yıldız A, Akdemir S, Anıl H, Arslan M. Safety and Efficacy of High-Powered Holmium Laser Enucleation of the Prostate within 1-3 Weeks Following Prostate Biopsy. Urol Int 2021; 105:852-857. [PMID: 33780959 DOI: 10.1159/000514422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/09/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE We aim to document the feasibility, perioperative safety, and the 12-month efficacy of holmium laser enucleation of the prostate (HoLEP) within 1-3 weeks following transrectal ultrasound (TRUS)-guided prostate biopsy. METHODS Data of the patients who underwent HoLEP following TRUS-guided prostate biopsy between March 2017 and July 2020 were analyzed retrospectively. Patients were divided into 2 groups: group 1 had undergone HoLEP in the early period after TRUS-guided prostate biopsy, while group 2 patients were biopsy-naive ("control group"). All patients were assessed preoperatively by a physical examination with the digital rectal examination; time from biopsy to HoLEP; measurement of Qmax, postvoiding residual volume, and prostate volume by transabdominal ultrasonography; serum prostate-specific antigen level, the International Prostate Symptom Score (IPSS); the International Index of Erectile Function-5 questionnaire; and urine analysis. The patients were reevaluated at 3- and 12-month follow-up. Perioperative and postoperative complications were documented according to the modified Clavien-Dindo System. RESULTS Group 1 comprised 66 patients with a mean age of 67.3 ± 6.7 (range, 53-86) years, and group 2 comprised 114 patients with a mean age of 69.4 ± 9.4 (range, 36-95) years. The operation, enucleation, and morcellation efficiencies were not statistically significant between the groups. Preoperative Qmax and IPSS values were significantly improved after HoLEP surgery in the 3rd and 12th months in all patients. Our complication rates were similar in both groups. CONCLUSION High-powered HoLEP using 140 W energy within 1-3 weeks following TRUS-guided prostate biopsy is a feasible procedure with high enucleation efficiency, low perioperative morbidity, and excellent functional outcomes. A recent TRUS-guided prostate biopsy is not a contraindication to HoLEP.
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Affiliation(s)
- Ali Yıldız
- Department of Urology, Faculty of Medicine, Okan University Hospital, Istanbul, Turkey
| | - Serkan Akdemir
- Department of Urology, Private Tinaztepe Hospital, Izmir, Turkey
| | - Hakan Anıl
- Department of Urology, Adana City Training and Research Hospital, Adana, Turkey
| | - Murat Arslan
- Department of Urology, Faculty of Medicine, Okan University Hospital, Istanbul, Turkey
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Westhofen T, Weinhold P, Kolb M, Stief CG, Magistro G. Evaluation of Holmium Laser Enucleation of the Prostate Learning Curves with and without a Structured Training Programme. Curr Urol 2021; 14:191-199. [PMID: 33488337 DOI: 10.1159/000499239] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022] Open
Abstract
Background/Aims To evaluate perioperative parameters, early functional outcomes, and the safety profile of holmium laser enucleation of the prostate learning curves with and without mentoring. Methods The learning curves of 2 surgeons of their first 100 consecutive patients treated with holmium laser enucleation of the prostate were retrospectively analyzed. We analyzed demographic parameters, clinical outcomes, adverse events, and the progress during each learning experience. Results The only statistically significant differences between the two learning curves were found for operation time (138.2 ± 60.7 vs. 98.2 ± 37.7 min; p < 0.001) in favor of the supervised approach, the total weight of resected prostatic tissue (81.5 ± 50.5 vs. 65.0 ± 6.7 g; p < 0.001) with more tissue removal by the surgeon without guidance, and the perioperative hemoglobin drop (1.9 ± 1.4 vs. 1.1 ± 1.0 g/dl; p < 0.001) in favor of the learning curve with a training programme. In multivariate logistic regression, the time factor was independently associated with a higher drop in hemoglobin levels (OR 1.015; 95% CI 1.000-1.023; p = 0.001). The improvements of clinical outcomes as determined by International Prostate Symptom Score, quality of life, peak urinary flow rate and postvoid residual volume were comparable. After the first 50 procedures the mean operation time significantly improved from 147 to 107.5 minutes for the learning curve without supervision (p < 0.001), whereas the surgical time was consistent throughout the 100 cases with a mentoring programme. The overall incidence of treatment-related adverse events was significantly higher without the training programme (16 vs. 5%; p = 0.008). Conclusions Our study clearly showed the benefits of a structured training programme to overcome the steep learning curve.
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Affiliation(s)
- Thilo Westhofen
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Philipp Weinhold
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Maurice Kolb
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Giuseppe Magistro
- Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
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Agarwal DK, Large T, Tong Y, Stoughton CL, Damler EM, Nottingham CU, Rivera ME, Krambeck AE. Same Day Discharge is a Successful Approach for the Majority of Patients Undergoing Holmium Laser Enucleation of the Prostate. Eur Urol Focus 2021:S2405-4569(20)30320-5. [PMID: 33414073 DOI: 10.1016/j.euf.2020.12.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/03/2020] [Accepted: 12/18/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Limited research has focused on success with hospital discharge on the same day of surgery after holmium laser enucleation of the prostate (HoLEP). OBJECTIVE To determine the success of same-day discharge in our HoLEP cohort and factors associated with this approach. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of our prospectively maintained HoLEP database demonstrated that 473 adult males underwent HoLEP from July 2018 to December 2019 at a tertiary referral center and high-volume HoLEP hospital. Patients were divided into groups according to planned inpatient admission (PIA), successful same-day discharge (SDD), or unplanned admission (UA). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The PIA, SDD, and UA groups were assessed for differences in preoperative demographic data, perioperative surgical data, and postoperative follow-up data. SDD and UA were then compared to determine if any specific factors predicted UA, including univariate and multivariate logistic regression analyses. RESULTS AND LIMITATIONS Age (p = 0.0049), use of anticoagulation (p = 0.037), American Society of Anesthesiologists score of 3-4 (p = 0.0017), and enucleation time (p=0.0178) were significantly higher in the PIA group. Morcellation time (p = 0.0059) and the rate of bedside catheter irrigation (p = 0.04) were higher in the UA group. The SDD group had the highest rate of successful voiding trial (p = 0.0001). Among the three groups, there was no difference in the rate of postoperative complications (p = 0.141). In a comparison of the SDD and UA groups, morcellation time (p = 0.041), the rate of bedside clot evacuation (p = 0.004), and successful voiding trial (p = 0.003) all favored SDD. There was no difference in 90-d complications (p = 0.536). A limitation is the retrospective nature of this study. CONCLUSIONS HoLEP can be successfully performed as day surgery without an increase in postoperative complications. HoLEP as day surgery is possible for any patient who does not require admission for medical comorbidities. PATIENT SUMMARY Same-day discharge (SDD) after holmium laser enucleation of the prostate (HoLEP) is possible and is successful in 87.4% of patients. Patients with longer morcellation times and with post-procedure hematuria with clots are more likely to have an unplanned admission. Use of a 120-W modulated-pulse laser resulted in a higher rate of SDD success. The culture change to day surgery is time-intensive owing to education of the postsurgical care units and clinic staff, and in our experience took approximately 9 mo to seamlessly integrate SDD as our HoLEP standard of care.
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Gunseren KO, Akdemir S, Çiçek MC, Yıldız A, Arslan M, Yavaşcaoğlu İ, Vuruskan H. Holmium Laser Enucleation, Laparoscopic Simple Prostatectomy, or Open Prostatectomy: The Role of the Prostate Volume in terms of Operation Time. Urol Int 2020; 105:285-290. [PMID: 33227804 DOI: 10.1159/000511637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/11/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To compare the prostate removal speeds of 3 enucleation techniques and to evaluate how the operating times change depending on the prostate volume. METHODS Medical records of patients with 80-g or larger prostates who underwent holmium laser enucleation of the prostate (HoLEP), laparoscopic simple prostatectomy (LSP), or open prostatectomy (OP) due to medical treatment-resistant benign prostatic hyperplasia (BPH) were reviewed retrospectively. Patients were classified into 3 groups according to the surgical procedure. Age, BMI, prostate weights, total operation times, prostate removal speeds, hospitalization and catheterization days, complications, and improvements on functional outcomes in the 3rd month of follow-up were compared between groups. In addition, the association between prostate weight and total operation time was analyzed for each group. RESULTS HoLEP, LSP, and OP groups consisted of 60, 61, and 37 patients, respectively. While HoLEP was similar to OP in terms of prostate removal speed and total operation time, LSP was statistically slower and required more operation time than HoLEP and OP. There was a relationship between prostate weight and total operation time only in HoLEP. CONCLUSION LSP, one of the enucleation techniques in the treatment of large prostates, was slower and required more operation time than HoLEP and OP in terms of total operation time and prostate removal speed. HoLEP seems going to be the fastest candidate for the rapid removal of large prostates in the future.
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Affiliation(s)
- Kadir Omur Gunseren
- Department of Urology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey,
| | | | - Mehmet Cagatay Çiçek
- Department of Urology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Ali Yıldız
- Department of Urology, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| | - Murat Arslan
- Department of Urology, Faculty of Medicine, Istanbul Okan University, Istanbul, Turkey
| | - İsmet Yavaşcaoğlu
- Department of Urology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Hakan Vuruskan
- Department of Urology, Faculty of Medicine, Bursa Uludag University, Bursa, Turkey
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Lin CH, Wu WJ, Li CC, Wen SC. Preoperative predictors of enucleation time during en bloc 'no-touch' holmium laser enucleation of the prostate. BMC Urol 2020; 20:185. [PMID: 33176769 PMCID: PMC7661272 DOI: 10.1186/s12894-020-00758-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/02/2020] [Indexed: 11/26/2022] Open
Abstract
Background To evaluate preoperative predictors of enucleation time during en bloc ‘no-touch’ holmium laser enucleation of the prostate (HoLEP) Methods We enrolled 135 patients with symptomatic benign prostatic hyperplasia (BPH) treated with en bloc ‘no-touch’ HoLEP from July 2017 to March 2019 by a single surgeon. Preoperative, perioperative, and postoperative clinical variables were examined. Stepwise linear regression was performed to determine clinical variables associated with enucleation times.
Result The average (range) enucleation time was 46.1 (12–220) minutes, and the overall operation time was 71 (18–250) minutes. History of antiplatelet agents, history of urinary tract infection (UTI), and increasing specimen weight were each significantly associated with increasing enucleation time. No category IV complications were recorded, and all complications were evenly distributed among the groups according to the HoLEP specimen weight. Conclusion En bloc ‘no-touch’ HoLEP was found to be an efficient and reproducible surgical method for treating BPH. Prostatic gland size was significantly associated with increased enucleation times. Similarly, history of UTI and antiplatelet agents were correlated with increased operative time.
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Affiliation(s)
- Chun-Hsuan Lin
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan.,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Chen Wen
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan. .,Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Trotsenko P, Wetterauer C, Grimsehl P, Möltgen T, Meierhans S, Manka L, Seifert H, Wyler S, Kwiatkowski M. Efficacy, safety, and perioperative outcomes of holmium laser enucleation of the prostate-a comparison of patients with lower urinary tract symptoms and urinary retention. Lasers Med Sci 2021; 36:1397-402. [PMID: 33125581 DOI: 10.1007/s10103-020-03170-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/21/2020] [Indexed: 12/11/2022]
Abstract
Holmium laser enucleation of the prostate (HoLEP) is a valid treatment option to relieve bladder outlet obstruction in patients with large prostate volumes (PV). Its efficacy, tolerability, and safety are comparable to the ones of other laser treatments of the prostate and resection techniques. However, safety and efficacy of HoLEP have not been compared between patients with and without preoperative urinary retention. We included 350 patients (mean age 71.2 years) who had undergone HoLEP due to lower urinary tract symptoms (LUTS) or urinary retention caused by prostatic hyperplasia. We evaluated the differences in peri- and postoperative outcomes and complications between patients with and patients without preoperative urinary retention. The mean PV was 115 cm3. PV was > 100 cm3 in 61.9% and < 100 cm3 in 38.1% of the patients. Perioperative complications occurred in 23 patients (6.6%), 15 of which (4.3%) required operative revision. We found no significant differences in terms of complication rates between patients with PV > 100 cm3 and patients with PV < 100 cm3. Mean catheterization-duration was 3.3 days. Preoperatively, 140 patients (40%) had a suprapubic or transurethral indwelling catheter; they did not differ from patients without preoperative catheter regarding postoperative catheter removal success rate, early postoperative complications, and functional outcomes. Prostate cancer was diagnosed in 43 patients (12.3%). Median postoperative PSA-decline was 6.1 ug/l (89.8% drop). HoLEP is a safe and effective treatment for patients with LUTS or urinary retention and large PV. PV > 100 cm3 was not associated with higher complication rates or successful catheter-removal. Furthermore, functional outcomes were independent of preoperative catheterization.
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Kretschmer A, Mazzone E, Barletta F, Leni R, Heidegger I, Tsaur I, van den Bergh RCN, Valerio M, Marra G, Kasivisvanathan V, Buchner A, Stief CG, Briganti A, Montorsi F, Tilki D, Gandaglia G. Initial Experience with Radical Prostatectomy Following Holmium Laser Enucleation of the Prostate. Eur Urol Focus 2020; 7:1247-1253. [PMID: 32962962 DOI: 10.1016/j.euf.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/12/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although an increasing number of prostate cancer (PCa) patients received holmium laser enucleation of the prostate (HoLEP) previously for benign prostatic obstruction (BPO), there is still no evidence regarding the outcomes of radical prostatectomy (RP) in this setting. OBJECTIVE To assess functional and oncological results of RP in PCa patients who received HoLEP for BPO previously in a contemporary multi-institutional cohort. DESIGN, SETTING, AND PARTICIPANTS A total of 95 patients who underwent RP between 2011 and 2019 and had a history of HoLEP were identified in two institutions. Functional as well as oncological follow-up was prospectively assessed and retrospectively analyzed. INTERVENTION RP following HoLEP compared with RP without previous transurethral surgery. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients with complete follow-up data were matched with individuals with no history of BPO surgery using propensity score matching. Complications were assessed using the Clavien-Dindo scale. RESULTS AND LIMITATIONS The median follow-up was 50.5 mo. We found no significant impact of previous HoLEP on positive surgical margin rate (14.0% [HoLEP] vs 18.8% [no HoLEP], p = 0.06) and biochemical recurrence-free survival (hazard ratio 0.74, 95% confidence interval [CI] 0.32-1.70, p = 0.4). Patients with a history of HoLEP had increased 1-yr urinary incontinence rates after RP. After adjusting for confounders, no significant impact of previous HoLEP was found (odds ratio [OR] 0.87, 95% CI 0.74-1.01; p = 0.07). Previous HoLEP did not hamper 1-yr erectile function recovery (OR 1.22, 95% CI 1.05-1.43; p = 0.01). Limitations include retrospective design and small sample size. CONCLUSIONS RP after previous HoLEP is surgically feasible, with low complication rates and no negative impact on biochemical recurrence-free survival. However, in a multivariable analysis, we observed significantly worse 1-yr continence rates in patients after previous HoLEP. PATIENT SUMMARY In the current study, we assessed the oncological and functional outcomes of radical prostatectomy in patients who underwent holmium laser enucleation of the prostate (HoLEP) previously due to prostatic bladder outlet obstruction. A history of HoLEP did not hamper oncological results, 1-yr continence, and erectile function recovery.
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Affiliation(s)
- Alexander Kretschmer
- Department of Urology, Ludwig-Maximilians University of Munich, Munich, Germany.
| | - Elio Mazzone
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Barletta
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Riccardo Leni
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - Igor Tsaur
- Department of Urology and Pediatric Urology, Mainz University Medicine, Mainz, Germany
| | | | | | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Veeru Kasivisvanathan
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, Ludwig-Maximilians University of Munich, Munich, Germany
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital-Hamburg Eppendorf, Hamburg, Germany
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
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Rosenhammer B, Schönhärl M, Mayr R, Schnabel MJ, Burger M, Eichelberg C. Introduction of a New Score to Assess Surgical Efficiency in Holmium Laser Enucleation of the Prostate. Urol Int 2020; 104:914-922. [PMID: 32877914 PMCID: PMC7845428 DOI: 10.1159/000510135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION While holmium laser enucleation of the prostate (HoLEP) is accepted as safe and efficient, a long learning curve is considered the main reason for its slow adoption in clinical practice. So far, no standardized and easy-to-use parameter has been implemented to measure surgical experience or efficiency which could be useful for training and quality control purposes. The aim of the present study was to evaluate the learning curves of 2 HoLEP beginners and to identify applicable efficiency outcome measures as well as potentially complicating factors in performing HoLEP. PATIENTS AND METHODS A total of 594 patients treated by HoLEP between September 2016 and May 2019 were enrolled. The procedures were initially performed by 1 HoLEP expert (reference surgeon); over time, 2 further surgeons were trained. Baseline characteristics, enucleation weight, morcellation and enucleation time, laser energy usage, and postoperative results were recorded prospectively. The learning curves of the 2 novices were analyzed and compared to the reference surgeon. Logistic regression analyses were performed to identify predictors for postoperative grade ≥2 complications. RESULTS Median enucleation ratio and complication rates did not significantly alter along the learning curves. Median enucleation speed and laser energy application of the 2 novices significantly improved with growing experience. Combining these variables, we introduced the "HoLEP efficiency score" (HES) which demonstrated the most appropriate value to reflect the surgical experience and efficiency. The median HES for the reference surgeon was 82.8 min kJ/g. For the 2 novices, a drop from 130 and 124.4 min kJ/g by -57 and -30%, respectively, was observed. Among several tested clinical parameters, the presence of prostate cancer (p = 0.047) and the surgical caseload (p < 0.001) influenced the HES. On multivariable logistic regression, American Society of Anesthesiologists score and prostate cancer were independent predictors for grade ≥2 complications (p = 0.002, odds ratio [OR] 2.042 and p = 0.038, OR 1.940). CONCLUSION We introduce the HES as an objective and measurable tool to quantify surgical efficiency. In clinical practice, the HES may find application in training and quality control purposes as well as in comparing surgical modifications and hardware. Patients with prostate cancer seem to be more challenging cases and have a higher risk for complications, and may preferably be treated by experienced surgeons.
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Affiliation(s)
- Bernd Rosenhammer
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany,
| | - Maximilian Schönhärl
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Roman Mayr
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Marco J Schnabel
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Christian Eichelberg
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
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Fallara G, Capogrosso P, Schifano N, Costa A, Candela L, Cazzaniga W, Boeri L, Belladelli F, Scattoni V, Salonia A, Montorsi F. Ten-year Follow-up Results After Holmium Laser Enucleation of the Prostate. Eur Urol Focus 2020; 7:612-617. [PMID: 32576532 DOI: 10.1016/j.euf.2020.05.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/16/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Scarce data are available about long-term follow-up (FU) in men undergoing holmium laser enucleation of the prostate (HoLEP). OBJECTIVE To investigate the risk of being symptomatic at 10-yr FU after HoLEP. DESIGN, SETTING, AND PARTICIPANTS Perioperative data from 125 patients submitted to HoLEP in 2007-2010 by a single, highly experienced surgeon were analyzed. Patients were assessed by International Prostate Symptoms Score (IPSS), prostate-specific antigen (PSA), and uroflowmetry at 6-mo and 10-yr FU. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Logistic regression models tested the association between clinically significant predictors and the risk of being symptomatic at long-term FU (defined as IPSS≥8 and/or peak flow rate [PFR]<15ml/s and/or postvoid residual volume [PVR]>20ml, need for symptomatic medical treatment, or redo surgery). RESULTS AND LIMITATIONS At surgery, median (interquartile range) age was 66 years (61, 69), prostate volume was 78ml (56, 105), and PFR was 9ml/s (7, 12). All patients showed favorable outcomes (ie, IPSS and uroflowmetry parameters) 6 months after surgery. At median 126-month FU, PFR was 16ml/s (13, 23), PVR was 10ml (5, 15), total IPSS was 5 (1-7), and PSA was 0.7 ng/ml (0.4, 1.3). Of all, 32 patients (26%) were symptomatic at long-term FU, seven (5.7%) reported urinary incontinence, and six (4.7%) underwent redo surgery throughout the FU period due to either bladder neck contracture or urethral stricture. Older patients at surgery (odds ratio [OR]: 1.12; 95% confidence interval [CI]: 1.03-1.22; p=0.006) and patients who never recovered full continence postoperatively (OR: 0.49; 95% CI: 0.01-0.27; p=0.001) were at a higher risk of being symptomatic at very long-term FU, after adjusting for baseline clinical characteristics. CONCLUSIONS HoLEP ensures a durable relief of urinary symptoms in almost 75% of patients up to 10 years after surgery. Older patients and those who do not recover from incontinence after surgery should be counseled carefully regarding a higher risk of symptom recurrence at long-term assessment. PATIENT SUMMARY Consistent symptom relief is preserved even 10 years after holmium laser enucleation of the prostate in almost 75% of patients. Older age and incomplete continence recovery after surgery were the two most relevant risk factors for being symptomatic at long-term follow-up. Postoperative functional outcomes are kept in three out of four patients at 10-yr follow-up after holmium laser enucleation of the prostate. Conversely, the older the patient at surgery and the presence of incomplete continence recovery throughout the postoperative period, the greater the probability of being symptomatic at long-term follow-up.
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Affiliation(s)
- Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicolò Schifano
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Antonio Costa
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Luigi Candela
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Walter Cazzaniga
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Luca Boeri
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Vincenzo Scattoni
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
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He G, Sun C, Shu Y, Wang B, Du C, Chen J, Wen J. The diagnostic value of prostate cancer between holmium laser enucleation of the prostate and transurethral resection of the prostate for benign prostatic hyperplasia: A retrospective comparative study. Int J Surg 2020; 79:217-221. [PMID: 32447004 DOI: 10.1016/j.ijsu.2020.05.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/09/2020] [Accepted: 05/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND To compare the diagnostic value of prostate cancer (PCa) between holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP). METHODS We retrospectively analyzed the clinical data of 2909 patients who underwent surgery for benign prostatic hyperplasia (BPH) from January 2008 to June 2018. A total of 1362 patients received HoLEP, and 1547 patients received TURP. The baseline patient characteristics were collected. We then compared the perioperative outcomes of these patients who diagnosed with incidentally diagnosed prostatic carcinoma (IDPC) or PCa after BPH surgeries. RESULTS The total detection rate of PCa in HoLEP group was higher than that in TURP group (85/6.24% vs. 61/3.94%, p = 0.005). Specifically, 55(4.6%) patients were diagnosed with IDPC in HoLEP group with prostate-specific antigen (PSA) less than 4 ng/ml, and 37(2.7%) patients in TURP group (p = 0.014). For the patients with PSA between 4 and 10 ng/ml, 15(13.9%) patients were diagnosed with PCa after HoLEP, and 6(5.0%) patients after TURP (p = 0.023). But the detection rate of PCa was not significantly different between the two groups when PSA was over 10 ng/ml. On the other hand, 57 in 1215 patients with no prostate biopsy preoperatively were diagnosed with PCa after HoLEP, while 42 in 1370 patients after TURP (4.7% vs. 3.1%, p = 0.040), respectively. Twenty-six patients received once biopsy and diagnosed with PCa in HoLEP group, while 15 patients in TURP group (18.4% vs. 8.9%, p = 0.018), respectively. However, no significant difference was observed for patients who received twice prostate biopsy in the two groups. CONCLUSIONS The present study showed that HoLEP can provide a higher total detection rate of PCa when compared with TURP. Besides, this superiority was especially embodied in patients with PSA less than 10 ng/ml.
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Affiliation(s)
- Gaofei He
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chengfang Sun
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuanyuan Shu
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Bohan Wang
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chuanjun Du
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jimin Chen
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiaming Wen
- Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Anan G, Kaiho Y, Iwamura H, Kohada Y, Mikami J, Ito J, Sato M. Anteroposterior dissection three-lobe technique: an effective surgical method for inexperienced surgeons performing holmium laser enucleation of the prostate. Int Urol Nephrol 2020; 52:1821-1828. [PMID: 32409975 DOI: 10.1007/s11255-020-02493-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/02/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the effectiveness of anteroposterior dissection three-lobe technique for surgeons with no prior experience of holmium laser enucleation of the prostate (HoLEP) METHODS: In this retrospective single-center study, we compared perioperative complications and postoperative urinary conditions between an experienced surgeon and surgeons with no prior experience of HoLEP. Forty patients were operated by one experienced surgeon (group A), and another 40 patients were operated by four inexperienced surgeons (group B) under the guidance of the instructor. The enucleation procedure was performed by anteroposterior dissection three-lobe technique. RESULTS Patient characteristics were comparable in the two groups in age, body mass index, and preoperative prostate volume. The enucleation efficiency rate [0.96 vs 0.56 g/min (P < 0.001)] was significantly different between groups A and B. However, there were no significant differences in enucleate prostate weight, hemoglobin decrease, or postoperative catheter-indwelling period between the two groups. There were no significant differences with respect to postoperative urinary incontinence rate at 1 month [43 vs 50% (P = 0.65)], 3 months [13 vs 20% (P = 0.55)], and 6 months [0 vs 3% (P = 1.00)] between the two groups. Both groups showed a significant improvement in the maximum flow rate and postvoid residual volume after HoLEP compared with baseline levels (P < 0.01). CONCLUSION Anteroposterior dissection HoLEP three-lobe technique was found to be a safe and effective enucleation method for surgeons with no prior experience of HoLEP under the guidance of the instructor.
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Affiliation(s)
- Go Anan
- Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, 983-8536, Japan.
| | - Yasuhiro Kaiho
- Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, 983-8536, Japan
| | - Hiromichi Iwamura
- Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, 983-8536, Japan
| | - Yuki Kohada
- Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, 983-8536, Japan
| | - Jotaro Mikami
- Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, 983-8536, Japan
| | - Jun Ito
- Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, 983-8536, Japan
| | - Makoto Sato
- Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, 983-8536, Japan
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Zell MA, Abdul-Muhsin H, Navaratnam A, Cumsky J, Girardo M, Cornella J, Nevo A, Cheney S, Humphreys MR. Holmium laser enucleation of the prostate for very large benign prostatic hyperplasia (≥ 200 cc). World J Urol 2020; 39:129-134. [PMID: 32206890 DOI: 10.1007/s00345-020-03156-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 03/03/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Patients presenting with prostate gland sizes greater than 200 cc pose a unique surgical challenge to both patients and surgeons. The objective of this study is to critically assess the efficacy and risks associated with performing holmium laser enucleation of the prostate (HoLEP) on glands ≥ 200 cc. MATERIALS AND METHODS Using a prospective maintained database, all consecutive benign prostatic hyperplasia (BPH) patients with gland size ≥ 200 cc who underwent HoLEP were included. We reported patient preoperative, intraoperative, postoperative outcomes and complications. Subgroup analysis of outcomes was stratified by gland sizes 200-299 cc and ≥ 300 cc. Univariate analysis using Kruskal-Wallis and Fisher exact test was performed to compare the two groups. RESULTS There were 88 patients with a mean preoperative gland size of 255.9 cc (200-770 cc). Mean operative (171 vs 182 min) and enucleation time (77 vs 83 min) were not different between the two subgroups (200-299 cc vs ≥ 300 cc). Enucleation efficiency was greater for glands ≥ 300 cc (2.6 cc/min vs 2.0 cc/min, p = 0.04). Morcellation time was longer in the ≥ 300 cc group (74.5 min vs 46.8 min, p = 0.021). Mean length of stay was 1.8 ± 1.2 days and catheter duration was 2.6 ± 2.7 days. 1 (1.1%) patient required retreatment of BPH at last follow-up. The main limitation of this study is the retrospective data analysis. CONCLUSIONS Holmium laser enucleation for prostate glands volume > 200 cc is feasible with minimal morbidity. These data further reinforce the size independence success of this procedure for BPH.
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Affiliation(s)
- Michael A Zell
- Department of Urology, Mayo Clinic in Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Haidar Abdul-Muhsin
- Department of Urology, Mayo Clinic in Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA.
| | - Anojan Navaratnam
- Department of Urology, Mayo Clinic in Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Jameson Cumsky
- Department of Urology, Mayo Clinic in Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Marlene Girardo
- Department of Biostatistics, Mayo Clinic in Arizona, 5777 E Mlvd, Phoenix, AZ, 85054, USA
| | - Joseph Cornella
- Department of Urology, Mayo Clinic in Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Amihay Nevo
- Department of Urology, Mayo Clinic in Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Scott Cheney
- Department of Urology, Mayo Clinic in Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Mitchell R Humphreys
- Department of Urology, Mayo Clinic in Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
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Ahyai SA, Marik I, Ludwig TA, Becker A, Asdjodi S, Kluth L, Chun F, Fisch M, Schmid M. Super early detailed assessment of lower urinary tract symptoms after holmium laser enucleation of the prostate (HoLEP): a prospective study. World J Urol 2020; 38:3207-17. [PMID: 32086571 DOI: 10.1007/s00345-020-03126-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/03/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To prospectively investigate early and consecutive changes of lower urinary tract symptoms (LUTS), specifically storage symptoms after holmium laser enucleation of the prostate (HoLEP). METHODS Patients referred for HoLEP completed the International Prostatic Symptom Score (IPSS) the day before, at discharge, and 1, 2, 3, 4, 6, 8, 12, 16, 20, 24, and 52 weeks after HoLEP. Total IPSS was stratified into mild (score 0-7), moderate (8-19), and severe (20-35) LUTS. Storage symptoms were sub-stratified into storage "negative" and "positive". IPSS changes served as the main postoperative outcome. Mixed linear models identified risk factors affecting postoperative recovery of LUTS. RESULTS Between December 2010 and 2012, 144 consecutive HoLEP patients were prospectively included in the study. Preoperatively 57.6% of the cohort reported severe storage symptoms (mean total IPSS: 22.6 ± 5.0). Total IPSS decreased significantly immediately after surgery (p < 0.001). Patients with severe LUTS, storage-positive sub-score, and high maximum urinary flow rate were affected by a rebound of mainly storage symptoms 6-8 weeks after HoLEP and prolonged recovery from LUTS. Of these, about 7.4% presented persisting urge complaints. Finally, 12 weeks following HoLEP, the vast majority of patients were symptom-free. Limitations of this study include missing urodynamic workup and a comparative patient cohort. CONCLUSION Immediately after HoLEP, patients experience a significant decrease of LUTS. Continuous symptom recovery seems to be hampered in patients with severe and storage-positive baseline symptoms. (De-novo) storage symptoms slightly affect postoperative recovery. Quality of life is restored to a stable and significantly improved status 3 months after surgery.
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Selim A, Nottingham CU, York NE, Dauw CA, Borofsky MS, Boris RS, Lingeman JE. Holmium laser enucleation of the prostate in Jehovah's Witness patients. Int Urol Nephrol 2019; 52:455-460. [PMID: 31745707 DOI: 10.1007/s11255-019-02331-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/29/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate if HoLEP is a viable option for male patients with medication-refractory urinary symptoms due to an enlarged prostate who are surgical candidates, but do not accept blood product transfusion. MATERIALS AND METHODS Between August 2008 and March 2019, nine Jehovah's Witness patients were undergoing HoLEP for relief of lower urinary tract symptoms and urinary retention. We described change in hemoglobin, change in PSA, enucleated prostate weight, enucleation and morcellation times, length of stay, and postoperative retention rate. RESULTS The average age was 71.4 years (range 53-87). Urinary retention requiring catheterization was present in seven patients (78%). Two patients had a known diagnosis of prostate cancer preoperatively. The mean preoperative PSA on average was 21.6 ng/dL. Patients had a wide range of gland sizes, with a mean enucleated weight of 141 g (range 18-344 g). Mean reduction in hemoglobin was 16.9% following HoLEP. All patients managed to void postoperatively. All but one patient went home on postoperative day 1, and this patient went home on postoperative day 2. No patients required blood product transfusion or return to the operating room for clot irrigation postoperatively. CONCLUSION HoLEP is a reasonable option for Jehovah's Witness and other patients with contraindications to blood product transfusion requiring surgical management of urinary symptoms due to enlarged prostate.
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Affiliation(s)
- Ashraf Selim
- Department of Urology, University College London, London, UK
| | - Charles U Nottingham
- Department of Urology, Indiana University School of Medicine, 1801 Senate Blvd. Suite 220, Indianapolis, IN, 46202, USA.
| | - Nadya E York
- Urology, Auckland City Hospital, 2 Park Road, Grafton, 1023, Auckland, New Zealand
| | - Casey A Dauw
- Department of Urology, University of Michigan Health Systems, 1500 E Medical Center Dr SPC 5330, Ann Arbor, Michigan, 48109, USA
| | - Michael S Borofsky
- Department of Urology, University of Minnesota, 420 Delaware Street SE, Minneapolis, Minnesota, 55455, USA
| | - Ronald S Boris
- Department of Urology, Indiana University School of Medicine, 1801 Senate Blvd. Suite 220, Indianapolis, IN, 46202, USA
| | - James E Lingeman
- Department of Urology, Indiana University School of Medicine, 1801 Senate Blvd. Suite 220, Indianapolis, IN, 46202, USA
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Boeri L, Capogrosso P, Ventimiglia E, Fontana M, Sampogna G, Zanetti SP, Pozzi E, Zuabi R, Schifano N, Chierigo F, Longo F, Gadda F, Dell'Orto PG, Scattoni V, Montorsi F, Montanari E, Salonia A. Clinical Comparison of Holmium Laser Enucleation of the Prostate and Bipolar Transurethral Enucleation of the Prostate in Patients Under Either Anticoagulation or Antiplatelet Therapy. Eur Urol Focus 2019; 6:720-728. [PMID: 30872124 DOI: 10.1016/j.euf.2019.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 02/18/2019] [Accepted: 03/01/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND A significant number of patients who require surgery for benign prostatic hyperplasia are under either anticoagulation (AC) or antiplatelet (AP) therapy. OBJECTIVE To assess the efficacy and morbidity of holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral enucleation of the prostate (B-TUEP) in patients who required AC/AP therapy. DESIGN, SETTING, AND PARTICIPANTS This study included 296 (67.6%) and 142 (32.4%) patients who underwent HoLEP and B-TUEP, respectively. The AC/AP group included patients whose AP therapy was not interrupted pre-, peri-, and/or postoperatively, and patients who underwent perioperative AC therapy bridging with low-molecular-weight heparin. INTERVENTION HoLEP and B-TUEP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We tested the hypothesis that AC/AP therapy had a limited impact on the efficacy of HoLEP and B-TUEP. To adjust for potential baseline confounders, propensity-score matching was performed. Clinical characteristics were compared among groups using the Kruskal-Wallis or chi-square test. Logistic regression analyses tested the association between clinical variables and the odds of Clavien-Dindo ≥2 complications after surgery. RESULTS AND LIMITATIONS Overall, 28 (9.5%) and 46 (15.5%) patients in the HoLEP group and 15 (10.5%) and 24 (16.9%) men in the B-TUEP group had AC and AP therapy, respectively (p=0.9). HoLEP patients under either AC or AP therapy deserved longer catheter maintenance and a longer hospital stay (HS) than those without AC/AP therapy (all p≤0.01). Operative time, rates of postoperative complications, and 2-mo International Prostate Symptoms Score (IPSS) were similar between patients with and without AC/CP. Among B-TUEP patients, HS was longer (p=0.03) and the rate of complications was higher (p<0.001) in patients under AC or AP therapy. Postoperative haemoglobin drop and 2-mo IPSS were similar among groups and surgical techniques. Limitations are the retrospective nature of the study, and the lack of long-term complications and functional outcomes. CONCLUSIONS HoLEP and B-TUEP can safely be performed in patients deserving continuous AP/AC therapy with only a slight increase in HS and catheterisation time. PATIENT SUMMARY We assessed the safety and efficacy of holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral enucleation of the prostate (B-TUEP) in men under chronic anticoagulation/antiplatelet therapy. Both HoLEP and B-TUEP could safely be performed as minimally invasive treatment options in this subset of patients at a high risk of bleeding from benign prostatic hyperplasia surgery.
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Affiliation(s)
- Luca Boeri
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Matteo Fontana
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Gianluca Sampogna
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Stefano Paolo Zanetti
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Rani Zuabi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Nicolò Schifano
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Chierigo
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Fabrizio Longo
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Franco Gadda
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Guido Dell'Orto
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Vincenzo Scattoni
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
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Rosenhammer B, Lausenmeyer EM, Mayr R, Burger M, Eichelberg C. Holmium Laser Enucleation of the Prostate Provides Similar Incidental Prostate Cancer Detection Rates as Open Prostatectomy: A Matched Pair Analysis. Urol Int 2018; 101:382-386. [PMID: 30235460 DOI: 10.1159/000492923] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 08/10/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Whereas the excellent functional outcomes after Holmium laser enucleation of the prostate (HoLEP) and its equivalency to open prostatectomy (OP) have been studied in detail in the past years, the oncological equivalency has yet to be investigated. Therefore, we conducted a matched pair analysis to evaluate and compare incidental prostate cancer detection rates after HoLEP and OP. PATIENTS AND METHODS Preoperative patient age, total prostate-specific antigen (PSA), and prostate volume were used as primary matching criteria. Descriptive statistics were used to confirm matching quality. Statistical analyses were performed using Fisher´s exact test and T-test or Mann-Whitney U-test for dichotomous and continuous variables, respectively. RESULTS After the matching procedure, 72 out of 145 patients after HoLEP and 72 out of 477 patients after OP were included. Mean patient age (70 vs. 71 years), median prostate volume (106 vs. 107 mL), and median preoperative total PSA (4.32 vs. 4.36 ng/mL) were almost identical. The amount of removed tissue did not differ between HoLEP and OP. Incidental prostate cancer detection rate was similar with 9.7% after HoLEP and 8.3% after OP (p = 1.000). CONCLUSION This first matched pair analysis shows that HoLEP does not have a disadvantage regarding cancer detection rate during desobstructive surgery for large prostates.
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Xu H, Cai Z, Chen Y, Gu M, Chen Q, Wang Z. Benign prostatic hyperplasia surgical scoring (BPHSS): an novel scoring system for the perioperative outcomes of holmium laser enucleation of the prostate. Lasers Med Sci 2018; 33:589-595. [PMID: 29313161 DOI: 10.1007/s10103-017-2425-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/19/2017] [Indexed: 10/18/2022]
Abstract
To develop a standardized scoring system, the BPH surgical scoring (BPHSS) system, to quantify the ability to predict the perioperative outcomes resulting from an enlarged prostate. There are two parts included in this study: the retrospective observational study (875 patients treated with holmium laser enucleation of the prostate, HoLEP) and the prospective observational study (111 patient underwent HoLEP). All the outcome data included the following: the basic patient preoperative characteristics, operation time (OT), pre- and post- surgery hemoglobin decrease, Na+ variation, hospital stay duration, duration of bladder irrigation, catheterization time, and hospitalization time. The BPHSS, consisting of prostatic volume (PV), prostate-specific antigen (PSA), bladder stones, intravesical prostatic protrusion (IPP), and metabolic syndrome (MetS), was observed regarding the perioperative outcomes. In the retrospective study, patients in high BPHSS group (6-8 points) showed significant increase in the OT (74.61, 95%CI = 16.98-327.84, P < 0.001), hemochrome reduction (416.50, 95%CI = 35.48-4889.88, P < 0.001), hospital stay (1.80, 95%CI = 1.35-2.41, P < 0.001), and bladder irrigation duration (4.04, 95%CI = 1.35-12.10, P = 0.013) compared with the low BPHSS group (0-2 points). In the prospective study, there also existed significant differences between the three scoring grades (P < 0.01) in OT, hemochrome decrease, and the hospital stay. The BPHSS is suitable to predict the perioperative outcomes in patients undergoing HoLEP. It may help urologist to prepare more before surgery to treat the enlarged prostates. Further studies are needed to validate this scoring system in BPH patients in multiple centers.
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Affiliation(s)
- Huan Xu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Zhikang Cai
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Yanbo Chen
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Meng Gu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Qi Chen
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Zhong Wang
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
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Abstract
PURPOSE OF REVIEW Holmium laser enucleation of the prostate (HoLEP) is a proven technique to alleviate bladder outlet obstruction (BOO) from benign prostatic hyperplasia (BPH). Herein, we review factors relevant to selecting patients who will benefit from this procedure and expected outcomes. RECENT FINDINGS New randomized trials have validated the excellent outcomes achieved by HoLEP in the management of BOO from BPH. Its success has been reproduced in a diverse array of patients including those on anticoagulation, with detrusor underactivity/acontractility, prostate cancer, and in the retreatment setting. HoLEP can be applied to the majority of patients with BOO from BPH regardless of prostate size, previous operations, or the condition of the detrusor. HoLEP can also be carefully considered in patients requiring anticoagulation or who are undergoing active surveillance for low-risk prostate cancer. Immediate complication rate is low and incontinence is rare. Retrograde ejaculation occurs in approximately 75% patients. Furthermore, the retreatment rate for HoLEP is lower than reported for other endoscopic BPH procedures demonstrating its durability.
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Affiliation(s)
- Joseph M Kuebker
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 MCN, Nashville, TN, 37232, USA.
| | - Nicole L Miller
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 MCN, Nashville, TN, 37232, USA
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Abstract
Benign prostatic hypertrophy (BPH) is a common cause of voiding dysfunction. BPH may lead to bladder outlet obstruction and resultant troublesome lower urinary tract symptoms. Initial management of BPH and bladder outlet obstruction is typically conservative. However, when symptoms are severe or refractory to medical therapy or when urinary retention, bladder stone formation, recurrent urinary tract infections, or upper urinary tract deterioration occur, surgical intervention is often necessary. Numerous options are available for surgical management of BPH ranging from simple office-based procedures to transurethral operative procedures and even open and robotic surgeries. This article reviews the current, most commonly used techniques available for surgical management of BPH.
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Affiliation(s)
- Jessica Mandeville
- Department of Urology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, USA.
| | - Arthur Mourtzinos
- Department of Urology, Lahey Hospital and Medical Center, 41 Mall Road, Burlington, MA 01805, USA
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Abstract
Clinical benign prostatic hyperplasia (BPH), often identified as a worsening ability of a male to pass urine, is a significant problem for men in our society. In 2015, the use of personalised medicine is tailoring treatment to individual patient needs and to genetic characteristics. Technological advances in surgical treatment are changing the way BPH is treated and are resulting in less morbidity. The future of BPH treatments is exciting, and a number of novel techniques are currently under clinical trial.
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Affiliation(s)
- Simon van Rij
- Guy's & St. Thomas NHS Trust, Great Maze Pond, London, SE1 9RT, UK
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38
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Soto-Mesa D, Amorín-Díaz M, Pérez-Arviza L, Fernández-Pello Montes S, Martín-Huéscar A. Holmium laser enucleation of the prostate and retropubic prostatic adenomectomy: morbidity analysis and anesthesia considerations. Actas Urol Esp 2015; 39:535-45. [PMID: 26007624 DOI: 10.1016/j.acuro.2015.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/24/2015] [Accepted: 03/25/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Holmium laser enucleation of the prostate (HoLEP) is an alternative to prostatic adenomectomy for the surgical treatment of benign prostatic hypertrophy. We analyzed our learning curve for this technique, and we compared it in a secondary manner with prostatic adenomectomy. MATERIALS AND METHODS A retrospective comparative study was conducted that included the first 100 cases of HoLEP performed in our center and the latest 50 cases of retropubic adenomectomy. We collected data on the patients, the surgery, the anesthesia, the perioperative variables, the anesthesia complications and the postoperative variables, with a 6-month follow-up. We analyzed the learning curve without mentors for HoLEP and compared the characteristics of HoLEP in 2 separate phases (learning and stabilization phases) with the latest retropubic prostatic adenomectomies performed. RESULTS Intradural anesthesia was the most common technique. The transfusion needs, length of stay (P<.01) and postoperative morbidity were lower for HoLEP than for adenomectomy. However, the retropubic adenomectomy group had larger initial prostate volumes (P<.001) and shorter surgical times (P<.001). Better surgical performance (P<.001) and a lower incidence of complications were observed in the HoLEP-B group (once the learning curve had been overcome) compared with the HoLEP-A group. CONCLUSION In our center, HoLEP was introduced as a valid alternative to open retropubic adenomectomy, with excellent results in terms of morbidity and reduced hospital stay. In terms of the learning curve, we consider that approximately 50 patients (without mentor) is an appropriate cutoff. Local anesthesia is a good choice for the anesthesia technique.
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Affiliation(s)
- D Soto-Mesa
- Servicio de Anestesiología y Reanimación, Hospital de Cabueñes, Gijón, España.
| | - M Amorín-Díaz
- Servicio de Neurología, Fundación Hospital de Jove, Gijón, España
| | - L Pérez-Arviza
- Servicio de Anestesiología y Reanimación, Hospital de Cabueñes, Gijón, España
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Sáez ID, de la Llera JF, Horn CD, López JF, Chacón RA, Figueroa PA, Vivaldi BI, Coz F. Best surgical treatment for very large benign prostatic obstruction. World J Clin Urol 2014; 3:370-375. [DOI: 10.5410/wjcu.v3.i3.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 06/27/2014] [Accepted: 07/29/2014] [Indexed: 02/05/2023] Open
Abstract
AIM: To investigate the best surgical treatment for very large benign prostatic obstruction (BPO).
METHODS: A revision of literature was conducted in PubMed database with 167 search results. Key words for the search were benign prostatic hyperplasia, surgical treatment, large, and volume. Inclusion criteria for this study were surgical treatment of benign prostatic obstruction for prostates equal to or larger than 80 cc. Among article search results, 9 completed inclusion criterion and were revised. Each surgical technique included in those articles was compared to each other. The results were observed, and conclusions derived from this are presented. There is no statistical analysis.
RESULTS: Of the 5 techniques presented in the revised articles [open transvesical enucleation, holmium laser enucleation of the prostate (HoLEP), photoselective vaporization of the prostate using potassium titanyl phospate laser, transurethral resection with bipolar energy, and transurethral enucleation with bipolar energy], open transvesical enucleation best permits the resolution of obstructive symptoms. It presents excellent maximum flow rates, high resected tissue volume and maintenance of results over time. These characteristics explain why it has been the gold standard treatment for prostates greater than 80 cc. However, it is at the expense of greater blood loss, urethral catheter and hospital stay times. Since its initial application in 1996, the transurethral enucleation of the prostate by means of a holmium laser has become a procedure that has similar surgical outcomes with fewer complications when compared to open surgery making it an interesting alternative for very large BPO. Nonetheless, no procedure has removed open surgery as the gold standard for very large BPO.
CONCLUSION: Open surgery has proved to be the gold standard for very large BPO. HoLEP appears as a minimally invasive alternative with same benefits but less morbidity.
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Kim M, Lee HE, Oh SJ. Technical aspects of holmium laser enucleation of the prostate for benign prostatic hyperplasia. Korean J Urol 2013; 54:570-9. [PMID: 24044089 PMCID: PMC3773585 DOI: 10.4111/kju.2013.54.9.570] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 08/26/2013] [Indexed: 11/18/2022] Open
Abstract
Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure and a size-independent treatment for benign prostatic hyperplasia with excellent long-term surgical outcome. HoLEP has become an alternative to conventional transurethral resection of the prostate or open prostatectomy owing to its efficacy and safety. Although HoLEP is known to have a steep learning curve, very few articles have addressed the technical aspects of HoLEP. Herein, we described detailed techniques and tips for HoLEP as performed at Seoul National University Hospital in a step-by-step manner with extensive review of the literature.
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Affiliation(s)
- Myong Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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Bapat S, Umranikar S, Satav V, Bapat A, Joshi A, Ranade G. Comparison of fluid absorption during transurethral resection of prostate and Holmium-Yag laser enucleation of benign adenoma of prostate using breath ethanol concentration. Indian J Urol 2011; 23:126-9. [PMID: 19675787 PMCID: PMC2721519 DOI: 10.4103/0970-1591.32061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: We conducted a study to detect, quantify and compare irrigation fluid absorption in transurethral resection of the prostate (TURP) and Holmium laser enucleation of the prostate (HoLEP), using BEC. Materials and Methods: The study included 50 patients of lower urinary tract symptoms, secondary to benign enlargement of prostate. The patients were nonrandomly allocated to undergo TURP and HoLEP. Twenty-six patients underwent TURP and the remaining 24 underwent HoLEP. Sterile water tagged with 1% ethanol w/v was used for irrigation. Absorption was detected and quantified every 10min by BEC levels. Data was analyzed using standard nomograms. Results: In HoLEP, 14/24 had no fluid absorption. The remaining 10/24 showed fluid absorption ranging from 95 ml to 300 ml. In TURP, all had fluid absorption ranging from 250-980 ml. Three TURP patients developed overt symptoms, while none did in the HoLEP group. Conclusions: Fluid absorption observed in our study in the HoLEP group was lower than in the TURP group.
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Affiliation(s)
- Shivadeo Bapat
- Dr. Y. G. Bodhe Department of Urology, Maharashatra Medical Foundation's Ratna Memorial Hospital, S. Bapat Road, Pune, India
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