Efficacy and Safety of 1470 nm Diode Laser Enucleation of the Prostate in Elderly Benign Prostatic Hyperplasia Patients

A comparative study of transurethral 450 nm DiLVP and 1470 nm DiLEP in the treatment of benign prostatic hyperplasia

To compare the clinical effects of 450 nm diode laser vaporisation of the prostate (450 nm DiLVP) and 1470 nm diode laser enucleation of the prostate (1470 nm DiLEP) in the surgical treatment of benign prostate hyperplasia (BPH). BPH patients who were treated with 450 nm DiLVP or 1470 nm DiLEP in the Department of Urology of Jinan Central Hospital from November in 2021 to November in 2023 were selected for retrospective analysis. The assessment indexes included: (1) Preoperative general information; (2) Perioperative indicators; (3) Postoperative follow-up indicators(followed up at 1 and 3 months after surgery). A total of 128 BPH patients were included in the study, 63 in the experimental group with 450 nm DiLVP and 65 in the control group with 1470 nm DiLEP. There was no significant difference in the baseline information between the two groups (P > 0.05). Compared with the 1470 nm DiLEP group, the operation time, the laser energy consumption and bladder irrigation time were significantly reduced in the 450 nm DiLVP group (P < 0.001). At 3 months postoperatively, Qmax relief was significant in the 1470 nm DiLEP group (P = 0.023). (1) Perioperatively, compared with the 1470 nm DiLEP, 450 nm DiLVP has shorter operation time, irrigation time, and laser energy consumption; (2)Postoperative follow-up: 450 nm DiLVP and 1470 nm DiLEP have similar efficacy in improving BPH symptoms; 1470 nm DiLEP may have greater impact on max urinary flow rate in long-tem follow-up, which needs further verification.

Application trends and research hotspots of endoscopic enucleation of the prostate: a bibliometric and visualization analysis

PURPOSE

Endoscopic enucleation of the prostate (EEP) is a preferred treatment for benign prostatic hyperplasia (BPH). This bibliometric analysis aims to analyze the application trends and research hotspots of EEP.

METHODS

We conducted a bibliometric analysis of publications indexed in the Web of Science Core Collection from 1989 to 2023. The techniques examined include holmium laser enucleation (HoLEP), thulium laser enucleation (ThuLEP/ThuFLEP), bipolar/monopolar transurethral enucleation (b-TUEP/m-TUEP), GreenLight laser enucleation (GreenLEP), and diode laser enucleation (DiLEP). We utilized VOSviewer, CiteSpace, and the R package 'bibliometrix' for the analysis.

RESULTS

A total of 739 English-language studies were analyzed, revealing a steady increase in EEP-related publications. HoLEP was the most extensively studied technique, followed by ThuLEP and b-TUEP, while ThuFLEP gaining emerging interest. There has been a notable lack of high-quality randomized controlled trials (RCTs) for GreenLEP, DiLEP and m-TUEP. China, the United States, and Germany led in publication volume and collaboration networks. Key contributors in the field were identified, with recent research focusing on topics like postoperative transient urinary incontinence (TUI) and the role of robot-assisted simple prostatectomy (RASP) in comparison to EEP.

CONCLUSIONS

EEP is gaining widespread clinical acceptance for BPH treatment. Future research should focus on addressing the gap in high-quality RCTs, especially for underexplored techniques like GreenLEP, DiLEP and m-TUEP, and explore strategies to reduce postoperative TUI. Prospective comparisons between RASP and EEP will be crucial for optimizing surgical approaches in BPH management.

Comparative analysis of the safety and efficacy of 1470-nm diode laser enucleation of the prostate and plasmakinetic resection of prostate in the treatment of large volume benign prostatic hyperplasia (>80 ml)

OBJECTIVE

To compare the efficacy and safety of 1470-nm diode laser enucleation of the prostate (DiLEP) with that of plasmakinetic resection of the prostate (PKRP) in treating patients with large benign prostatic hyperplasia (BPH > 80ml).

METHODS

The clinical data from 211 cases of BPH (>80 ml) were collected for analysis. The patients were divided into two groups: the PKRP group (n = 118) and the DiLEP group (n = 93), based on the surgical method used.

RESULT

The DiLEP group demonstrated significantly lower surgical time (p < 0.001), intraoperative bleeding (p < 0.001), bladder flushing time (p = 0.003), indwelling catheter time (p < 0.005), and length of hospital stay (p = 0.018) compared to the PKRP group. However, the quality of the prostatectomy was significantly higher in the DiLEP group (p = 0.005). The Qmax for the DiLEP group was significantly higher than that of the PKRP group (p < 0.05). Compared to the PKRP group, the incidence of urinary incontinence in the DiLEP group increased significantly 4 weeks post-surgery (p = 0.026), although the need for blood transfusion during surgery was significantly reduced (p = 0.037).

CONCLUSION

Both DiLEP and PKRP are safe and effective methods for treating large-volume BPH. However, DiLEP offers advantages such as more thorough glandular resection, shorter surgical time, reduced bleeding, quicker recovery, and fewer complications.

Minimally invasive surgical therapies for benign prostatic hyperplasia in the geriatric population: A systematic review

BACKGROUND

Geriatric patients, prone to adverse events (AEs) and low compliance with drugs, may benefit from minimally invasive surgical therapies (MISTs) for managing benign prostatic hyperplasia (BPH). We evaluated the efficacy, safety, and procedural characteristics of MISTs in geriatric patients with BPH.

METHODS

PubMed/MEDLINE database was systematically searched for relevant articles through October 1, 2023. Eligible studies focused on geriatric patients (≥65 years) with BPH who were treated with MISTs and evaluated follow-up surgical, micturition, and/or sexual outcomes. Studies were included if there was separate reporting for age subgroups ≥65 years, or if the mean age minus standard deviation was ≥65 years, or if the first quartile was ≥65 years.

RESULTS

Out of 292 screened studies, 32 (N = 3972 patients) met inclusion criteria and assessed prostatic artery embolization (PAE), Rezum, GreenLight, holmium laser enucleation of the prostate (HoLEP), thulium laser enucleation of the prostate (ThuLEP), diode laser enucleation of the prostate (DiLEP), and Aquablation. Except for Rezum, all MISTs required a planned overnight stay. While PAE and Rezum could be performed under local anesthesia, the other MISTs needed general or spinal anesthesia. Postoperative catheterization duration was longest for PAE (median 14 days) and Rezum (21 days) and shortest for GreenLight (1.9 days). At 12 months postoperatively, all MISTs exhibited significant percent changes in International Prostate Symptom Score (median -69.9%) and quality of life (median -72.5%). Clavien-Dindo Grade 1 AEs ranged widely, with PAE (5.8%-36.8%), Rezum (0%-62.1%), and GreenLight (0%-67.6%) having the largest range, and HoLEP (0%-9.5%), ThuLEP (2%-6.9%), and DiLEP (5%-17.5%) having the smallest. PAE, Rezum, DiLEP, and Aquablation reported no significant changes in the International Index of Erectile Function.

CONCLUSIONS

Although all the MISTs reviewed in this study effectively treat BPH in geriatric patients, differences in procedural characteristics and safety profiles across MISTs were considerable. Physicians should use shared decision-making processes, considering risks and patient characteristics, when choosing a suitable treatment option for their patients.

1470 nm laser is better for prostate hyperplasia treatment with different volume size via transurethral enucleation

INTRODUCTION

The large amount of intraoperative bleeding and the high incidence of postoperative hematuria are still common factors affecting the prostate surgery treatment effect. Our research aimed to observe the effect of prostatic enucleation using 1,470 nm semiconductor laser on the amount of bleeding in patients with different sizes of prostate hyperplasia.

METHODS

According to the size of the prostate, forty eligible patients with benign prostatic hyperplasia (BPH) were enrolled and divided into low and high volume group in this study. Hemoglobin decline, urinating condition, complications and erectile function were collected and compared before and after surgery.

RESULTS

Our data showed that hemoglobin decline was (10.0 ± 6.2) g/L and (12.1 ± 7.8) g/L, respectively for two group after surgery (P = 0.363). Urination was significantly improved following surgery in both groups of patients (P < 0.05), and no permanent urinary incontinence and sexual dysfunction and so no serious complications occurred.

CONCLUSION

The above results suggested that prostatic enucleation using 1,470 nm semiconductor laser can be safe and effective for prostatic hyperplasia, and this surgery produced no significant effect on the amount of bleeding in whatever size of the prostate.