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Romero Otero J, Justo Quintas J, García Rojo E, Sopeña Sutil R, Peña Vallejo E, Lista Mateos F, Bozzini G, Saenz Calzada D, Rodríguez Antolín A, García Gómez B. Initial experience with thulium fiber laser for prostate enucleation: Analysis of the intraoperative and short-term outcomes in a prospective, multicenter cohort. Actas Urol Esp 2024; 48:371-376. [PMID: 38369292 DOI: 10.1016/j.acuroe.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Holmium laser enucleation of the prostate has rapidly become the gold standard for the surgical treatment of benign prostate hyperplasia, although thulium fiber laser (TFL) has also been postulated as an effective and safe alternative for prostate enucleation. The aim of this study is to describe our initial experience with the TFL for endoscopic enucleation of the prostate. MATERIAL AND METHODS All patients proposed to TFL prostate enucleation were included in the analysis, regardless their prostate volume, catheter status and severity of symptoms, in 3 centers. Preoperative characteristics, intraoperative times and functional 3-months follow-up variables were collected, along with complications. RESULTS Fifty-six patients were available, with a mean age of 68.7 years. Enucleation and morcellation efficiencies were 2.04 and 7.47 g/min, respectively. Median hospital stay was one day. Comparable functional data, pre and 3-month post-surgery was: mean prostate volume 88.9 vs 21.3 g, maximum urinary flow 13.2 vs 27.3 ml/s, post-void residual volume 149 vs 7.8 ml, prostatic specific antigen level 11.2 vs 1 ng/ml, and International Prostate Symptom Score 20.75 vs 3.96. Fourteen out of 56 (25%) patients presented with complications grade ≤2, according to the Clavien-Dindo classification. DISCUSSION With wider evidence for other urological indications, very recent evidence about the suitability of TFL for prostate enucleation has arisen, since the first case described in 2021. Our results seem to back up these previous successful experiences as long as we obtained good intraoperative and short term follow-up functional results. However, there is still a need of longer follow-up data. CONCLUSIONS TFL represents a novel technology for prostate enucleation, with a good intraoperative and short follow-up functional results, and a safety profile similar to the observed for those techniques that have been wider used for this indication. Further studies with longer follow-up periods and comparative with these other techniques are necessary.
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Affiliation(s)
- J Romero Otero
- Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales y ROC Clinic, Madrid, Spain; Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain.
| | - J Justo Quintas
- Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales y ROC Clinic, Madrid, Spain; Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain
| | - E García Rojo
- Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales y ROC Clinic, Madrid, Spain; Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain
| | - R Sopeña Sutil
- Servicio de Urología, Hospital Universitario HM Montepríncipe, HM Hospitales y ROC Clinic, Boadilla del Monte, Madrid, Spain
| | - E Peña Vallejo
- Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales y ROC Clinic, Madrid, Spain
| | - F Lista Mateos
- Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Villafranca del Castillo, Madrid, Spain; Servicio de Urología, Hospital Universitario HM Montepríncipe, HM Hospitales y ROC Clinic, Boadilla del Monte, Madrid, Spain
| | - G Bozzini
- Servicio de Urología, Hospital Sant'Anna, San Fermo della Battaglia, Como, Italy
| | - D Saenz Calzada
- Servicio de Urología, Hospital Universitario HM Puerta del Sur, HM Hospitales y ROC Clinic, Móstoles, Madrid, Spain
| | - A Rodríguez Antolín
- Servicio de Urología, Hospital Universitario HM Sanchinarro, HM Hospitales y ROC Clinic, Madrid, Spain
| | - B García Gómez
- Servicio de Urología, Hospital Universitario HM Montepríncipe, HM Hospitales y ROC Clinic, Boadilla del Monte, Madrid, Spain
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Maresca G, Mc Clinton S, Swami S, El‐Mokadem I, Donaldson JF. Do men with bladder stones benefit from treatment of benign prostatic obstruction? BJU Int 2022; 130:619-627. [PMID: 35482471 PMCID: PMC9790555 DOI: 10.1111/bju.15761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To identify whether men aged ≥40 years with bladder stones (BS) benefit from treatment of benign prostatic obstruction (BPO). PATIENTS AND METHODS A regional, retrospective study of patients undergoing BS surgery between January 2011 and December 2018 was performed using a prospectively collected database. The primary outcome was BS recurrence after successful removal. Kruskal-Wallis and chi-squared statistical tests were used. RESULTS A total of 174 patients underwent BS removal and 71 (40.8%) were excluded due to BS formation secondary to causes other than BPO. Hence, 103 men aged ≥40 years had BS successfully removed, of which 40% had a history of upper tract urolithiasis. These men were divided into three groups: those undergoing contemporaneous medical, surgical, or no BPO treatment. Age, diabetes, previous urolithiasis and previous BPO surgery were well matched between the BPO treatment groups. In all, 18 of these men (17%) had BS recurrence after 46 months follow-up. Recurrences were significantly lower following BPO surgery; one of 34 (3%) men versus five of 28 (18%) with no BPO treatment (P = 0.048) and 12 of 41 (29%) with medical BPO treatment (P = 0.003). Recurrences after medical and no BPO treatment were similar (P = 0.280). In all, 34 men (33%) had BPO complications that were similar between groups (P = 0.378). CONCLUSION This is the largest reported cohort of men, with the longest follow-up after BS removal. Most men aged ≥40 years with BS benefit from BPO surgery. However, the study findings also support a multifactorial aetiology for BS, which questions the dogma that BS are an 'absolute indication' for BPO surgery, as is stated in the Non-neurogenic Male Lower Urinary Tract Symptoms European Association of Urology Guideline. Assessment and management of all causative factors is likely to enable selection of which men will benefit from BPO surgery and to reduce BS recurrence rates.
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Affiliation(s)
- Gianluca Maresca
- Department of UrologyAberdeen Royal Infirmary – NHS GrampianAberdeenUK,Academic Urology Unit (AUU)University of AberdeenAberdeenUK
| | - Samuel Mc Clinton
- Department of UrologyAberdeen Royal Infirmary – NHS GrampianAberdeenUK,Academic Urology Unit (AUU)University of AberdeenAberdeenUK
| | - Satchi Swami
- Department of UrologyAberdeen Royal Infirmary – NHS GrampianAberdeenUK,Academic Urology Unit (AUU)University of AberdeenAberdeenUK
| | - Ismail El‐Mokadem
- Department of UrologyAberdeen Royal Infirmary – NHS GrampianAberdeenUK,Academic Urology Unit (AUU)University of AberdeenAberdeenUK
| | - James F. Donaldson
- Department of UrologyAberdeen Royal Infirmary – NHS GrampianAberdeenUK,Academic Urology Unit (AUU)University of AberdeenAberdeenUK
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Lv J, Wang N, Zhu Y, Luo Q, Li Y, Li J. A meta-analysis and systematic review of holmium laser treatment of bladder stones. Transl Androl Urol 2021; 10:3465-3475. [PMID: 34532271 PMCID: PMC8421822 DOI: 10.21037/tau-21-563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022] Open
Abstract
Background Holmium lasers have been used to treat bladder stones and achieve good therapeutic effects, but its efficacy remains to be explored. Methods The PubMed, Embase, Medline, Ovid, Springer, and Web of Sciences databases were searched from their establishment to December 31, 2020. Studies of randomized control trials (RCTs) examining the treatment of vesical calculi by holmium laser lithotripsy were identified. The Cochrane Handbook for Systematic Reviews of Intervention 5.0.2 was used to assess risk bias, and Rev Man5.3 was used to conduct the meta-analysis. Results A total of 10 studies, comprising 1,642 subjects, were included. The meta-analysis results showed that the surgery time and the hospitalization time of patients treated with holmium laser lithotripsy decreased, and the calculus removal rate increased. The experimental group had a lower incidence of adverse reactions, such as postoperative urinary tract infection, mucosal damage, vesical perforation, residual calculi, hematuria, and abdominal pain than the control group; however, no notable difference was observed in relation to surgery time, hospital stay, the calculus removal rate, mucosal damage, bladder perforation, hematuria, and abdominal pain between the 2 groups. Discussion Holmium laser lithotripsy significantly reduced the hospitalization time of patients treated with holmium laser lithotripsy and elevated the removal rate.
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Affiliation(s)
- Jie Lv
- Department of Urology, Luzhou People's Hospital, Luzhou, China
| | - Ning Wang
- Department of Urology, Luzhou People's Hospital, Luzhou, China
| | - Yongsheng Zhu
- Department of Urology, Affiliated Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
| | - Qian Luo
- Department of Urology, Luzhou People's Hospital, Luzhou, China
| | - Yongxian Li
- Department of Urology, Luzhou People's Hospital, Luzhou, China
| | - Jian Li
- Department of Urology, Luzhou People's Hospital, Luzhou, China
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Bhat A, Katz JE, Banerjee I, Blachman-Braun R, Alter K, Shah RH, Smith NA, Shah HN. A prospective evaluation of high- and low-power holmium laser settings for transurethral lithotripsy in the management of adults with large bladder calculi. World J Urol 2021; 39:3481-3488. [PMID: 33624144 DOI: 10.1007/s00345-021-03617-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/25/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To prospectively investigate the efficacy and safety of high-power (100 W) vs low-power (20 W) laser settings for transurethral laser lithotripsy in the management large vesical calculi (> 4 cm). METHODS All patients with vesical calculi > 4 cm in the maximum dimension and scheduled for transurethral holmium laser lithotripsy were invited to participate in the study. Every alternate patient was treated with either the low- or high-power laser settings. We used a continuous irrigation resectoscope with laser bridge or a laser working element (Karl Storz) for laser lithotripsy of bladder stones. We compared the operative time, intra-operative/post-operative complications (up to 1 year), and stone-free rates between the treatment groups using IBM SPSS Statistics 24 software. Comparisons between treatment groups for continuous variables were assessed using the Welch test, while categorical variables were compared with either the Chi-square or Fisher's exact test. A p value < 0.05 was considered statistically significant. RESULTS Twenty patients with ten in each cohort were recruited. Preoperative data and mean bladder stone size were comparable in both groups. The duration of surgery was significantly reduced from 70.80 ± 25.28 min in low-power cohort to 40.90 ± 15.01 min in the high-power group (p = 0.005). There were no significant intra-operative complications in either group. All patients were stone-free following the procedure. CONCLUSION High-power laser setting of up to 100 W results in a significant reduction in duration of surgery without any increase in the complication rate for treatment of large bladder stones.
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Affiliation(s)
- Abhishek Bhat
- Department of Urology, Miller School of Medicine, University of Miami, Miami, USA
| | - Jonathan E Katz
- Department of Urology, Miller School of Medicine, University of Miami, Miami, USA
| | - Indraneel Banerjee
- Department of Urology, Miller School of Medicine, University of Miami, Miami, USA
| | - Ruben Blachman-Braun
- Department of Urology, Miller School of Medicine, University of Miami, Miami, USA
| | - Kevin Alter
- Department of Urology, Miller School of Medicine, University of Miami, Miami, USA
| | - Rashmi H Shah
- Urolap Superspeciality Clinic and S. L. Raheja (Fortis Associate Hospital), Mumbai, India
| | | | - Hemendra N Shah
- Department of Urology, Miller School of Medicine, University of Miami, Miami, USA.
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Videourology Abstracts. J Endourol 2020. [DOI: 10.1089/end.2020.29083.vid] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lwin AA, Zeng J, Evans P, Phung MC, Hynes KA, Price ET, Twiss CO, Tzou DT, Funk JT. Holmium Laser Enucleation of the Prostate Is Safe and Feasible as a Same Day Surgery. Urology 2020; 138:119-124. [PMID: 31962119 DOI: 10.1016/j.urology.2020.01.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the safety, feasibility and treatment outcomes of holmium laser enucleation of the prostate (HoLEP) as a same day surgery (SDS). METHODS HoLEPs performed from November 2013 to December 2018 at our institution were reviewed retrospectively. Inclusion criteria for same day surgery (SDS) included living in the local metropolitan area with access to local hospital and Eastern Cooperative Oncology Group (ECOG) 0-2, regardless of prostate size and anticoagulation status. Those patients who were discharged directly from the postoperative care unit were identified as SDS cases. Patients admitted overnight after HoLEP during the same period were used as a matched cohort. Patient demographics, disease characteristics and treatment outcomes were compared. RESULTS A total of 377 patients were identified, including 199 SDS and 178 non-SDS patients. No statistical difference was present between the 2 groups regarding the post-op complication and readmission rates. The non-SDS group had a significantly higher percentage of patients with history of urinary retention, lower pre-op Qmax, and larger prostate volume. The SDS group had shorter operative time, length of stay (LOS), and catherization time (all P <.05). At 1-year follow-up, no statistically different change in Qmax, PVR, or IPSS score was noted between the 2 groups. CONCLUSION Same day outpatient surgery for HoLEP is safe in patients who live in close proximity and have ECOG status 0-2. Our readmission rate and complication rate are comparable to those reported in the literature with markedly decreased LOS. Long-term functional outcome is not compromised by SDS.
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Affiliation(s)
- Aye A Lwin
- Department of Urology, University of Arizona, Tucson, AZ
| | - Jiping Zeng
- Department of Urology, University of Arizona, Tucson, AZ
| | - Patrick Evans
- Department of Urology, University of Arizona, Tucson, AZ
| | | | - Kieran A Hynes
- Division of Urology, University of Mississippi Medical Center, Jackson, MS
| | | | | | - David T Tzou
- Department of Urology, University of Arizona, Tucson, AZ
| | - Joel T Funk
- Department of Urology, University of Arizona, Tucson, AZ.
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