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Morozov A, Taratkin M, Shpikina A, Ehrlich Y, McFarland J, Dymov A, Kozlov V, Fajkovic H, Rivas JG, Lusuardi L, Teoh JYC, Herrmann T, Baniel J, Enikeev D. Comparison of EEP and TURP long-term outcomes: systematic review and meta-analysis. World J Urol 2023; 41:3471-3483. [PMID: 37980297 DOI: 10.1007/s00345-023-04666-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/28/2023] [Indexed: 11/20/2023] Open
Abstract
OBJECTIVE To compare long-term reoperation rate and functional outcomes between EEP (endoscopic enucleation of the prostate) and TURP (transurethral resection of the prostate). EVIDENCE ACQUISITION A systematic literature review of Medline, Scopus, and Web of Science was conducted with primary outcome assessed being reoperation rate and secondary outcomes after a long term (> 3 years) being functional outcomes or related values (prostate volume, PSA level, etc.). EVIDENCE SYNTHESIS Five studies were found with long-term follow-up 4-7 years. EEP reoperation rate ranged from 0 to 1.27%, while from 1.7 to 17.6% for TURP. Meta-analysis showed significantly lower OR for EEP, 0.27 (95% CI 0.24-0.31), with notable homogeneity of the results, I2 = 0%. Long-term Qmax and IPSS were significantly better for EEP. Qmax pooled mean difference was 1.79 (95% CI 1.72-1.86) ml/s with a high concordance among the studies, I2 = 0%. IPSS mean difference -1.24 (95% CI - 1.28 to - 1.2) points, I2 = 57% but QoL did not differ, with mean difference being 0.01 (95% CI - 0.02 to 0.04), I2 = 0%. IIEF-5 score was also significantly better for EEP, mean difference 1.08 (95% CI 1.03-1.13), but heterogeneity was high, I2 = 70%. PSA level and prostate volume were only reported in one study and favored EEP slightly yet statistically significant. CONCLUSION EEP had a significantly lower reoperation rate and better functional outcomes (Qmax and IPSS) at long term compared with TURP. It may also be beneficial in terms of IIEF-5, PVR, and PSA level.
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Affiliation(s)
- Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Anastasia Shpikina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Yaron Ehrlich
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan McFarland
- Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia
- Faculty of Medicine, Universidad Autónoma Madrid, Madrid, Spain
| | - Alim Dymov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Vasiliy Kozlov
- Department of Public Health and Healthcare, Sechenov University, Moscow, Russia
| | - Harun Fajkovic
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Juan Gomez Rivas
- Department of Urology, Clinico San Carlos University Hospital, Madrid, Spain
| | - Lukas Lusuardi
- Department of Urology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Thomas Herrmann
- Department of Urology, Spital Thurgau AG, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland
- Department of Urology, Hannover Medical School, Hannover, Germany
| | - Jack Baniel
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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He W, Ding T, Niu Z, Hao C, Li C, Xu Z, Jing Y, Qin W. Reoperation after surgical treatment for benign prostatic hyperplasia: a systematic review. Front Endocrinol (Lausanne) 2023; 14:1287212. [PMID: 38027158 PMCID: PMC10665564 DOI: 10.3389/fendo.2023.1287212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Context Surgical treatment is important for male lower urinary tract symptom (LUTS) management, but there are few reviews of the risks of reoperation. Objective To systematically evaluate the current evidence regarding the reoperation rates of surgical treatment for LUTS in accordance with current recommendations and guidelines. Evidence acquisition Eligible studies published up to July 2023, were searched for in the PubMed® (National Library of Medicine, Bethesda, MD, USA), Embase® (Elsevier, Amsterdam, the Netherlands), and Web of Science™ (Clarivate™, Philadelphia, PA, USA) databases. STATA® (StataCorp LP, College Station, TX, USA) software was used to conduct the meta-analysis. Random-effects models were used to calculate the pooled incidences (PIs) of reoperation and the 95% confidence intervals (CIs). Evidence synthesis A total of 119 studies with 130,106 patients were included. The reoperation rate of transurethral resection of the prostate (TURP) at 1, 2, 3, and 5 years was 4.0%, 5.0%, 6.0%, and 7.7%, respectively. The reoperation rate of plasma kinetic loop resection of the prostate (PKRP) at 1, 2, 3, and 5 years was 3.5%, 3.6%, 5.7%, and 6.6%, respectively. The reoperation rate of holmium laser enucleation of the prostate (HoLEP) at 1, 2, 3, and 5 years was 2.4%, 3.3%, 5.4%, and 6.6%, respectively. The reoperation rate of photoselective vaporization of the prostate (PVP) at 1, 2, 3, and 5 years was 3.3%, 4.1%, 6.7%, and 7.1%, respectively. The reoperation rate of surgery with AquaBeam® at 1, 2, 3, and 5 years was 2.6%, 3.1%, 3.0%, and 4.1%, respectively. The reoperation rate of prostatic artery embolization (PAE) at 1, 2, 3, and 5 years was 12.2%, 20.0%, 26.4%, and 23.8%, respectively. The reoperation rate of transurethral microwave thermotherapy (TUMT) at 1, 2, 3, and 5 years was 9.9%, 19.9%, 23.3%, and 31.2%, respectively. The reoperation rate of transurethral incision of the prostate (TUIP) at 5 years was 13.4%. The reoperation rate of open prostatectomy (OP) at 1 and 5 years was 1.3% and 4.4%, respectively. The reoperation rate of thulium laser enucleation of the prostate (ThuLEP) at 1, 2, and 5 years was 3.7%, 7.7%, and 8.4%, respectively. Conclusion Our results summarized the reoperation rates of 10 surgical procedures over follow-up durations of 1, 2, 3, and 5 years, which could provide reference for urologists and LUTS patients. Systematic review registration https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023445780.
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Affiliation(s)
- Weixiang He
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Ting Ding
- Department of Clinical Laboratory Medicine, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Zhiping Niu
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Chunlin Hao
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Chengbin Li
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Zhicheng Xu
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Yuming Jing
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Weijun Qin
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
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Tunc L, Herrmann T, Guven S, Scoffone CM, Bozzini G, Yilmaz S, Romero-Otero J, Misrai V, Porreca A, Ahyai S, Gozen AS. A Delphi consensus to standardize the technique of anatomical endoscopic enucleation of prostate: a study by ESUT endoscopic enucleation of prostate study group. World J Urol 2023; 41:2303-2309. [PMID: 37421419 DOI: 10.1007/s00345-023-04496-8] [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: 04/23/2023] [Accepted: 06/13/2023] [Indexed: 07/10/2023] Open
Abstract
PURPOSE Our objective was to establish a standardized technique for Anatomical Endoscopic Enucleation of Prostate (AEEP) utilizing a consensus statement to provide robust recommendations for urologists who are new to this procedure. METHODS The participants were electronically sent a questionnaire in three consecutive rounds. In the second and third rounds, the anonymous aggregate results of the previous round were presented. Experts' feedback and comments were then incorporated to refine existing questions or to explore more controversial topics in greater depth. RESULTS Forty-one urologists participated in the first round. In the second round, all Round 1 participants received a 22-question survey, resulting in a consensus on 21 items. In the third round, 76% (19/25) of the second-round respondents also participated, reaching a consensus on 22 additional items. The panelists consensually agreed on detaching the urethral sphincter at the beginning of the enucleation and not at the end of the enucleation. To prevent incontinence, it was recommended that the apical mucosa be preserved through various approaches between 11 and 1 o'clock while gently disrupting the lateral lobes in their apical part, avoiding an excess energy delivery approximation to the apical mucosa. CONCLUSION To optimize laser AEEP procedures, urologists must follow expert guidelines on equipment and surgical technique, including early apical release, using the 3-lobe technique for enucleation, preserving apical mucosa with appropriate approaches, gently disrupting lateral lobes at their apical regions, and avoiding excessive energy delivery near the apical mucosa. Following these recommendations can lead to improved outcomes and patient satisfaction.
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Affiliation(s)
- Lutfi Tunc
- Department of Urology, Acibadem University School of Medicine, Ankara, Turkey
| | - Thomas Herrmann
- Department of Urology, Spital Thurgau AG, Frauenfeld, Münsterlingen, Switzerland
| | - Selcuk Guven
- Department of Urology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | | | - Giorgio Bozzini
- Department of Urology, ASST Valle Olona, Busto Arsizio, Italy
| | - Sercan Yilmaz
- Department of Urology, Kolan Hospital, Istanbul, Turkey
| | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, 31300, Toulouse, France
| | - Angelo Porreca
- Department of Urology, Policlinico Abano Terme, Abano Terme, Italy
| | - Sacha Ahyai
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Ali Serdar Gozen
- Department of Urology, Medius-Kliniken Ruit, University of Tubingen, Ostfildern, Germany.
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Black M, Slade A, Caras RJ, DeLeon GA, Large T, Shelton TM, Tong Y, Rivera M. Evaluation of Renal Function Recovery After Holmium Laser Enucleation of the Prostate in Patients with Chronic Kidney Disease. J Endourol 2023; 37:817-822. [PMID: 37212242 DOI: 10.1089/end.2023.0062] [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] [Indexed: 05/23/2023] Open
Abstract
Introduction: Holmium laser enucleation of the prostate (HoLEP) has become a new surgical gold standard treatment for benign prostatic hyperplasia (BPH). It is known that untreated BPH can lead to bladder outlet obstruction (BOO). A positive correlation exists between BOO and chronic kidney disease (CKD), but stability or recovery of renal function after HoLEP remains unknown. We sought to describe changes in renal function after HoLEP in men with CKD. Methods: A retrospective study was conducted of patients who underwent HoLEP with glomerular filtration rates (GFRs) <60, CKD stages III to V. Pre- and postoperative GFRs were selected within 3 months before the operation and within 1 year postoperatively. The presence of an indwelling catheter, preoperative hydronephrosis, history of kidney stones, and prostate size were also reviewed. Data were analyzed in accordance with preoperative CKD stage. Results: Of the reviewed patients, 138 met inclusion criteria with CKD stages III to V. Each CKD group was without significant postoperative complications. There was a significant increase between pre- and postoperative GFR for patients in CKD stages III (n = 116) and IV (n = 17) (p < 0.0001 and p = 0.010, respectively). The mean increase between pre- and postoperative GFR for the CKD stages III and IV patients were 6.4 and 6.49, respectively. There was no correlation between presence of preoperative hydronephrosis, history of kidney stones, catheter dependency, nor prostate size on change in postoperative GFR (p > 0.05). Conclusion: These findings suggest that patients in CKD stages III or IV undergoing HoLEP experience an increase in GFR. It is noteworthy that there appears to be no decline in renal function postoperatively in any group. HoLEP represents an excellent surgical option for patients with preoperative CKD and may prevent further renal decline.
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Affiliation(s)
- Morgan Black
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Austen Slade
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ronald Joseph Caras
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Genaro A DeLeon
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tim Large
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Thomas M Shelton
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Yan Tong
- Department of Biostatistics, Indiana University School of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Marcelino Rivera
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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De la Cuadra-Grande A, Rioja-Zuazu J, Domínguez-Esteban M, Torres E, Blissett R, Woodward E, Oyagüez I, Fernández-Arjona M. Budget impact analysis of transurethral water vapor therapy for treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia in the Spanish national healthcare system. Expert Rev Pharmacoecon Outcomes Res 2023; 23:499-510. [PMID: 36897833 DOI: 10.1080/14737167.2023.2189591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND Several surgical treatments are available for managing lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH). Water vapor thermal therapy (WVTT) is a new minimally invasive therapy. This study estimates the budget impact of introducing WVTT for LUTS/BPH into the Spanish health care system. METHODS A model simulated the evolution of men over 45 years of age with moderate-severe LUTS/BPH after surgical treatment, over a 4-year time horizon, from the Spanish public health care service´s perspective. The technologies in scope included those most used in Spain: WVTT, transurethral resection (TURP), photoselective laser vapourization (PVP) and holmium laser enucleation (HoLEP). Transition probabilities, adverse events and costs were identified from the scientific literature and validated by a panel of experts. Sensitivity analyses were performed by varying the most uncertain parameters. RESULTS Per intervention, WVTT resulted in savings of €3,317, €1,933 and €2,661 compared to TURP, PVP and HoLEP. Over a 4-year time horizon, when performed in 10% of the cohort of 109,603 Spanish males with LUTS/BPH, WVTT saved €28,770,125 against the scenario without WVTT availability. CONCLUSIONS WVTT could reduce the cost of managing LUTS/BPH, increase the quality of health care and reduce the length of procedure and hospital stay.
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Affiliation(s)
| | - Jorge Rioja-Zuazu
- Urology Department, Clínica Universitaria de Navarra, Navarra, Spain
| | | | - Esperanza Torres
- Health Economics & Market Access, Boston Scientific Inc, Madrid, Spain
| | - Rob Blissett
- Health Economics & Economic Evaluation, MedTech Economics Ltd, Winchester, UK
| | - Emily Woodward
- Health Economics & Market Access, Boston Scientific AG, Solothurn, Switzerland
| | - Itziar Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
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Elsaqa M, Slade A, Lingeman J, Piroozi A, Wagner K, Jhavar S, El Tayeb MM. Holmium Laser Enucleation of Prostate in Patients with Pre-Existing Localized Prostate Cancer, Dual Center Study. J Endourol 2023; 37:330-334. [PMID: 36463424 DOI: 10.1089/end.2022.0571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Background: Holmium laser enucleation of the prostate (HoLEP) has been used as an effective minimally invasive technique for management of enlarged prostates. We aimed to report the role of HoLEP in prostate cancer (PCa) patients either on active surveillance with bothersome lower urinary tract symptoms (LUTS) or for prostate debulking before radiation therapy and the impact on PCa management plans. Methods: Prospectively maintained database in two institutions was reviewed for patients with localized PCa managed by HoLEP with at least a follow-up of 1 year. We assessed prostate-specific antigen (PSA) trends, effect on international prostate symptom score (IPSS) and further management of PCa. Results: Out of >2000 HoLEP patients, 117 patients with a median follow-up of 30 months were included. Mean (standard deviation) age was 72.3 (±8.3) years with median (interquartile range, IQR) IPPS of 22 (16-28) and median (IQR) PSA at 7.6 (5.3-14.9) ng/mL. Gleason grade group was 1, 2, 3, and 4 in 47 (73.2%), 32 (27.35%), 7 (5.9%), and 4 (3.4%) patients, respectively. Median (IQR) PSA has significantly dropped to 1.3 (0.6-3.1), 1.4 (0.75-2.9), and 1.7 (0.86-2.75) ng/mL at 6-week, 3-month, and 1-year follow-up, respectively (p < 0.001). IPSS scores post-HoLEP obviously improved with mean (IQR) IPSS of 10 (5-13), 7 (3-12), and 3 (2-5) at 6-week, 3-month, and 1-year, respectively (p < 0.001). Eighty-eight (72%) patients stayed on active surveillance, whereas 27 (23%) patients had radiotherapy ± androgen deprivation therapy for persistently high or relapsing PSA. Within 36 intermediate-risk patients, 15 (41.6%) and patients had radiotherapy, whereas 21 (58.3%) patients continued active surveillance. Conclusions: HoLEP is beneficial in debulking large prostate in PCa patients with bothersome LUTS on active surveillance or before radiotherapy. HoLEP reduces the contribution of large adenoma to PSA level, thus reflecting PSA level better and helping reduce overtreatment.
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Affiliation(s)
- Mohamed Elsaqa
- Division of Urology, Department of Surgery, Baylor Scott and White Health, Temple, Texas, USA.,Department of Urology, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Austen Slade
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - James Lingeman
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alex Piroozi
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kristofer Wagner
- Division of Urology, Department of Surgery, Baylor Scott and White Health, Temple, Texas, USA
| | - Sameer Jhavar
- Department of Radiation Oncology, Baylor Scott and White Health, Temple, Texas, USA
| | - Marawan M El Tayeb
- Division of Urology, Department of Surgery, Baylor Scott and White Health, Temple, Texas, USA
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Kanne M, Beutel H, Krediet J, Kössler R, Kittner B, Schmuck N, Spreu T, Friedersdorff F, Maxeiner A. [Quality of life and outcome after holmium laser enucleation of the prostate (HoLEP)]. Aktuelle Urol 2023; 54:24-29. [PMID: 36096141 DOI: 10.1055/a-1921-9485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Holmium Laser Enucleation of the Prostate (HoLEP) was established 20 years ago as an alternative to Transurethral Resection of the Prostate (TUR-P) based on improved morbidity in patients with benign prostate syndrome (BPS). HoLEP can be applied independently to almost all sizes of prostate glands and is recommended in national and international guidelines. Although the HoLEP procedure has a good reputation, many patients still prefer conservative treatment due to fears of side-effects such as pain and urinary incontinence. The aim of this study was to identify patients' feelings, fears and perception of their HoLEP treatment based on Patient-reported Outcome Measures (PROMs) via questionnaires. MATERIAL UND METHODS During the time period from June to December 2020, 152 consecutive patients were treated by HoLEP due to BPS and were interviewed based on questionnaires right after their surgical treatment and 3 months later concerning their satisfaction as well as micturition and continence. Based on a written informed consent, 112 patients were included in the study, and a complete 3-month follow-up was available for 88 patients. RESULTS The mean volume of enucleated prostate tissue was 62.1 [g] and the mean prostate volume estimated pre-operatively (trans-rectal ultrasound) was 83.1 [cm3]. Overall patient-reported satisfaction with the hospital stay including surgical treatment was 94.6%; after 3 months it was 91.8%. Concerning micturition, 76.5% of the patients reported satisfaction after surgery and 80.4% were satisfied after 3 months. Urinary incontinence was reported in 8.3% initially and in 9.1% after 3 months. Positive answers to questions concerning the quality of life index [L] were obtained in 62.1% initially and their number increased to 85.7% after 3 months. The share of negative answers decreased from 11.7% after surgery to 3.4% within the 3-month follow-up. DISCUSSION HoLEP is a well-established treatment of BPS with lower side-effects compared with TUR-P according to the literature. To address doubts and misgivings, it is important to perform surveys on subjective patient satisfaction after the surgical procedure and over time. The high patient satisfaction could help future patients and the urologists treating them to establish the indication for HoLEP treatment earlier in order to avoid severe LUTS or catheterization.
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Affiliation(s)
- Martin Kanne
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Holger Beutel
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Jorien Krediet
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Robert Kössler
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Beatrice Kittner
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Nils Schmuck
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Thomas Spreu
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany.,Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Maxeiner
- Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Petov V, Babaevskaya D, Taratkin MS, Chuvalov L, Lusuardi L, Misrai V, Sukhanov R, Scoffone C, Enikeev D. Thulium fiber laser enucleation of the prostate (ThuFLEP). Prospective study of mid- and long-term outcomes in 1328 patients. J Endourol 2022; 36:1231-1236. [PMID: 35414204 DOI: 10.1089/end.2022.0029] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective of our study was to estimate the long-term efficacy and safety of thulium fiber laser enucleation of the prostate (ThuFLEP). MATERIALS AND METHODS We analysed patients who underwent ThuFLEP due to LUTS related to BPO. Both the pre- and perioperative data as well as the follow-up data for 3 years were evaluated: prostate volume, post-void residual (PVR), Qmax, IPSS and QoL, PSA level and the complication rate. Intraoperative data relating to the weight of resected tissue, the duration of surgery, catheterization and data on hospital stays were also collected. A sub-group analysis was performed to assess whether older patients (>65 years) or those with larger glands (>80 cc) are prone to increased complication risks. RESULTS A total of 1328 patients were included in the analysis. The mean age was 66.9±7.5 years. Mean prostate volume was 86.9±41.9 (20-330) cc. All the functional parameters (IPSS, QoL, PVR, Qmax) significantly improved after surgery (p<0.05) and showed durable improvement up to 3-years of follow-up. The frequency of late complications was as follows: stress urinary incontinence - 1.2%; urethral stricture -1.1%; bladder neck contracture - 0.9%. Sub-group analyses revealed increased UTI frequency in older patients (3.5% vs 0.8%, p=0.003) as well as higher rate of SUI (0.4% vs 1.8%, p=0.002) and higher rate of clot retention (11.3% vs 4.4%, p<0.001) in those with larger glands. CONCLUSIONS Irrespective of the patient's age and prostate volume, ThuFLEP represents an effective and durable technique of endoscopic enucleation characterized by a low incidence of complications after 3 years of follow-up. In the hands of an experienced surgeon, ThuFLEP can rightly be considered to be a promising alternative to HoLEP for treatment of LUTS associated with BPO.
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Affiliation(s)
- Vladislav Petov
- Sechenov University, Institute for Urology and Reproductive Health, Moscow, Russian Federation;
| | - Diana Babaevskaya
- Sechenov University, 68477, Institute for Clinical Medicine, Trubetskaya, 8, Moscow, Russian Federation, 119048;
| | - Mark Sergeevich Taratkin
- Sechenov University, Institute for Urology and Reproductive Health, 2/1 Bolshaya Pirogovskaya St., Moscow, Russian Federation, 119991;
| | - Leonid Chuvalov
- Sechenov University, Institute for Urology and Reproductive Health, Moscow, Russian Federation;
| | - Lukas Lusuardi
- Paracelsius Medical University, Urology and Andrology, Müllner Hauptstraße 48, Salzburg, Austria, 5020;
| | - Vincent Misrai
- Clinique Pasteur, 54918, Service d'Urologie, Toulouse, Midi-Pyrénées, France;
| | - Roman Sukhanov
- Sechenov University, 68477, Institute for Urology and Reproductive Health, Moskva, Moskva, Russian Federation;
| | - Cesare Scoffone
- Cottolengo Hospital, Division of Urology, via Cottolengo 9, Torino, Torino, Italy, 10152;
| | - Dmitry Enikeev
- I.M. Sechenov First Moscow State Medical University, Research Institute of Uronephrology and Reproductive Health, Bolshaya Pirogovskaya street 2, building 1, Moscow, Russian Federation, 119435;
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Li J, Cao D, Huang Y, Meng C, Peng L, Xia Z, Li Y, Wei Q. Holmium laser enucleation versus bipolar transurethral enucleation for treating benign prostatic hyperplasia, which one is better? Aging Male 2021; 24:160-170. [PMID: 34895034 DOI: 10.1080/13685538.2021.2014807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE This study aims to evaluate the overall efficacy and safety between holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral enucleation of the prostate (B-TUEP) for the treatment of benign prostatic hyperplasia (BPH). METHOD We systematically searched electronic databases (PubMed, Scopus, Web of Science, and Cochrane Library) to identify eligible comparative studies as of July 2021. The parameters including perioperative results, complications, and functional outcomes were evaluated. RevMan version 5.4 was used for the analysis. RESULTS A total of 10 studies involving 1725 patients were included. HoLEP had lower operative time (p = .03), shorter catheterization time (p = .007), lower bladder irrigation time (p = .01), and higher enucleation weight (p = .01) compared with B-TUEP. However, there were no significant differences between the techniques regarding the length of stay (LOS), hemoglobin drop, transfusion rates, and complications. Furthermore, no significant differences were also observed in postoperative functional outcomes at 1, 3, 6, 12, or 24 months. CONCLUSIONS HoLEP has more advantages in perioperative parameters compared with B-TUEP, but no significant differences are found regarding functional outcomes and complications. Large-scale studies with long-term follow-up are required to compare the outcomes of these two techniques.
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Affiliation(s)
- Jinze Li
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, PR China
- West China School of Clinical Medicine, Sichuan University, Chengdu, PR China
| | - Dehong Cao
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yin Huang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, PR China
- West China School of Clinical Medicine, Sichuan University, Chengdu, PR China
| | - Chunyang Meng
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, PR China
| | - Lei Peng
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, PR China
| | - Zhongyou Xia
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, PR China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, PR China
| | - Qiang Wei
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, PR China
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Bar-Yaakov N, Hertzberg H, Marom R, Jikia J, Mano R, Beri A, Yossepowitch O, Sofer M. Introducing in clinical practice a new laser suction handpiece for percutaneous nephrolithotomy. Urologia 2021; 89:570-574. [PMID: 34256620 PMCID: PMC9551316 DOI: 10.1177/03915603211031874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective: To assess a novel combined laser suction handpiece (LSH) for performing PCNL
in a clinical setting. Methods: The study comprised 40 consecutive PCNLs performed between May 2019 and
February 2020. The first 20 procedures (Group A) were performed with
conventional ultrasonic or pneumatic devices and the other 20 (Group B) were
performed with the use of the new LSH. All patients were treated by tubeless
supine PCNL. The groups were compared for demographics, clinical data,
operative time, lithotrite effectiveness, stone clearance rate (SCR), and
outcome. Results: Groups A and B were similar in age, and in stone size, complexity, and
density (Hounsfield units) (p < 0.05). The average
operative time was 99 and 78 min, SCR 143 and 200 mm3/min,
hospital stay 1.6 and 1.1 days, and stone-free rate 90% and 95%,
respectively. Despite a trend toward better results with the new LSH, none
of these comparisons reached statistical significance. Ineffective
lithotripsy with the initial device (ultrasonic) requiring conversion to
another modality (ballistic) occurred in six (30%) procedures in Group A,
while all procedures were effectively accomplished with the LSH in Group B
(p = 0.02). There were two complications in Group A and
none in Group B (p > 0.05). Conclusions: The LSH is as effective and safe as the traditional lithotrites for
performing PCNLs. This new tool completes the capabilities of the holmium
laser high-power machines, enabling them to serve as the sole platform for
all endourological treatments.
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Affiliation(s)
- Noam Bar-Yaakov
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Hertzberg
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Marom
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jemal Jikia
- Endourology Unit, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Mano
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Beri
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Yossepowitch
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mario Sofer
- Department of Urology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Endourology Unit, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Minimally invasive percutaneous nephrolithotomy with SuperPulsed Thulium-fiber laser. Urolithiasis 2021; 49:485-491. [PMID: 33655346 DOI: 10.1007/s00240-021-01258-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/18/2021] [Indexed: 12/19/2022]
Abstract
We aimed to assess the efficacy and safety of minimally invasive percutaneous nephrolithotomy (PCNL) with SuperPulsed Thulium-fiber laser (SP TFL) using different frequency settings. 125 patients with solitary kidney calculi of up to 55 mm in the maximum diameter underwent mini-PCNL with the SP TFL. Stone-free rate, laser-on time, ablation efficacy, energy consumption, ablation speed and complications were all analyzed. Negative low-dose computed tomography scan or asymptomatic patients with stone fragments < 2 mm were the criteria for assessing the stone-free status. In 36 patients (28.8%) low frequency regimens were used (LF: 3-19 Hz-0.5-6 J), in 75 patients (60%) high frequency regimens were chosen (HF: 20-49 Hz-0.2-2 J) and in 14 (11.2%) patients higher frequency (HRF: 50-200 Hz-0.1-0.5 J) regimens were preferred. The mean age was 52 ± 1.8 years. Median stone diameter and median stone volume were larger at low frequency regimens compared to high frequency regimens. Ablation efficacy (J/mm3) was lower at low rather than at high frequency regimens. Ablation speed (mm3/sec) was higher at low compared to high frequency regimens. Surgeons reported minimal and absent retropulsion at higher frequency regimens. The best visibility was observed at high frequency regimens. The overall stone free rate (SFR) at 3 months was 85%. The majority of the postoperative complications were classified between Clavien grades I-II. SP TFL is an effective and safe tool for performing mini-PCNL regardless of the laser settings.
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