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Tuncel A, Aykanat C, Akdemir S, Oksay T, Arslan M, Başboga S, Aslan Y, Balci M, Guzel O. Comparison of holmium laser enucleation with bipolar transurethral enucleation of the prostate in patients with benign prostatic hyperplasia: Results of a multicentre study. Andrologia 2022; 54:e14420. [PMID: 35285532 DOI: 10.1111/and.14420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 01/04/2023] Open
Abstract
To assess the efficacy and morbidity of the holmium laser enucleation of the prostate and bipolar transurethral enucleation of the prostate in patients with benign prostatic hyperplasia. The study included 60 (55%) and 49 (45%) patients who underwent laser and bipolar enucleation of the prostate respectively. According to the perioperative data, except for length of hospital stay and enucleated prostate weight, all the remaining parameters were similar between the groups. There were significant differences between the preoperative and the postoperative third and 12th month voiding parameters in both groups. In the laser group, the maximum urine flow rate value was better than the bipolar group at the postoperative third and 12th months. However, we did not find any statistically significant difference between the groups in terms of the serum prostate-specific antigen level, International Prostate Symptom Score and postvoid residual urine volume at the postoperative third and 12th months. Our results show that both laser and bipolar techniques are effective minimally invasive surgical treatment options for men with benign prostatic hyperplasia. When compared to bipolar technique, laser technique provides shorter hospital stay, more prostatic tissue enucleation and better maximum urine flow rate values.
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Affiliation(s)
- Altug Tuncel
- Department of Urology, Ankara State Hospital, University of Health Sciences School of Medicine, Ankara, Turkey
| | - Can Aykanat
- Department of Urology, Ministry of Health, Yozgat State Hospital, Yozgat, Turkey
| | - Serkan Akdemir
- Department of Urology, Tinaztepe Health Group Hospital, Izmir, Turkey
| | - Taylan Oksay
- Department of Urology, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Murat Arslan
- Department of Urology, Okan University School of Medicine, Istanbul, Turkey
| | - Serdar Başboga
- Department of Urology, Ankara State Hospital, University of Health Sciences School of Medicine, Ankara, Turkey
| | - Yilmaz Aslan
- Department of Urology, Ankara State Hospital, University of Health Sciences School of Medicine, Ankara, Turkey
| | - Melih Balci
- Department of Urology, Ankara State Hospital, University of Health Sciences School of Medicine, Ankara, Turkey
| | - Ozer Guzel
- Department of Urology, Ankara State Hospital, University of Health Sciences School of Medicine, Ankara, Turkey
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Mian A, Balzano FL, Pachorek M, Sam AP, Ruel N, Warner JN. Complications Based on Prostate Size After Plasmakinetic Enucleation of the Prostate. J Endourol 2022; 36:969-976. [PMID: 35018807 DOI: 10.1089/end.2021.0911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lower urinary tract symptoms among adult men can significantly impact quality of life. We evaluated complications based on prostate size following plasma kinetic enucleation of the prostate. METHODS Patients were grouped into small prostate group (SPG) <75 grams, and large prostate group (LPG) >75 grams based on preoperative imaging. Patient demographics, comorbidities, preoperative international prostate symptoms score (IPSS), bother index (BI), prostate specific antigen (PSA) if indicated, post void residual volume (PVR), indwelling catheter or self-catheterization status, and any prior surgical intervention were evaluated. Postoperatively IPSS, BI, and PVR was assessed at 6 weeks, 4 months, and yearly. Post-operative urge urinary incontinence (UUI), stress urinary incontinence (SUI) and pad use was assessed. RESULTS Between September 2015 and December 2020, 296 bipolar enucleation with minimum 4 month follow-up were evaluated. All postoperative IPSS, BI, PVR and PSA timepoints were significantly decreased compared to pre-operative values (p <0.05). There was no significant difference in the complications between groups. Univariable and multivariable analysis found size <75 grams was predictive of stricture formation and bladder neck contracture. UUI was more common at 6 weeks in the SPG, and SUI was more common at 6 weeks in the LPG, but no difference was noted at the 4 month and 1 year time point. Pad use was equal between the two groups at all time points. CONCLUSIONS PKEP provides an effective treatment option for all prostate sizes, however, prostates <75 grams have a higher rate of BNC and urethral strictures compared to those >75 grams.
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Affiliation(s)
- Abrar Mian
- Midwestern University Chicago College of Osteopathic Medicine, 70050, 555 31st Street, Downers Grove, Downers Grove, Illinois, United States, 60515-1235;
| | | | - Mark Pachorek
- Pasadena City College , Pasadena , California, United States;
| | - Andre-Philippe Sam
- University of California Riverside, 8790, Riverside, California, United States;
| | - Nora Ruel
- City of Hope Medical Center, Biostatistics, 1500 East Duarte Rd, Duarte, California, United States, 91010;
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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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Mian A, Pachorek M, Sam AP, Ruel NH, Yang D, Kohler TS, Warner JN. Predictors of Storage Symptom Improvement After Plasma Kinetic Enucleation of the Prostate. Urology 2021; 160:182-186. [PMID: 34813839 DOI: 10.1016/j.urology.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/21/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate which preoperative findings portend poor improvement in storage symptoms in patients undergoing plasma kinetic enucleation of prostate (PKEP). METHODS A single surgeon series of patients who had undergone PKEP with minimum 1 year follow up were evaluated. Patients were grouped into those with less than 33% improvement in storage symptoms (LIS) according to the international prostate symptom score (IPSS) and those with greater than 33% improvement in storage symptoms (GIS). Pre and postoperative factors were evaluated, along with IPSS, storage symptoms percentage (the total from frequency, urgency and nocturia divided by the total IPSS), bother index, and post void residual (PVR) at 6 weeks, 4 months, and yearly. RESULTS Two hundred sixty-eight patients had a minimum 1 year of follow up and had completed the IPSS. IPSS and bother index improved significantly from preoperatively to all time points post operatively in both groups, but the difference was greater in the GIS group. Patients in the GIS group had significantly larger prostates, more prostatic ingrowth, higher preoperative PVR, and a higher overall IPSS compared to the LIS group. Those in the LIS group had a higher incidence of prior prostate surgery, and a higher BMI. However, storage symptom percentages were equal between the GIS and LIS groups at all time points. CONCLUSION Greater prostatic ingrowth, larger prostate volume, higher preoperative PVR volume, and a higher overall IPSS was associated with greater improvement in storage symptoms. Prior prostate surgery and higher BMI portend less improvement in storage symptoms.
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Affiliation(s)
| | | | | | - Nora H Ruel
- Department of Biostatistics, City of Hope National Medical Center, Duarte, CA
| | - David Yang
- Department of Surgery, Division of Urology, Mayo Clinic, Rochester, MN; Departemnt of Urology, Mayo Clinic, Rochester, MN
| | - Tobias S Kohler
- Department of Surgery, Division of Urology, City of Hope National Medical Center, Duarte, CA; Departemnt of Urology, Mayo Clinic, Rochester, MN
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Cho CL, Teoh JYC, Cho SY, Ng ACF, Henkel R. Quest for the best-A move to Anatomical Endoscopic Enucleation of the Prostate. Andrologia 2021; 52:e13757. [PMID: 32969058 DOI: 10.1111/and.13757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Chak-Lam Cho
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.,Department of Surgery, Union Hospital, Tai Wai, Hong Kong, China
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Sung-Yong Cho
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Anthony Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Ralf Henkel
- Department of Medical Biosciences, University of the Western Cape, Bellville, South Africa
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Gómez-Sancha F. The constant search for the greater good: evolving from TURP to anatomic enucleation of the prostate is a safe bet. World J Urol 2021; 39:2401-2406. [PMID: 33625568 DOI: 10.1007/s00345-021-03637-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE In a troubling moment in history with an ongoing world pandemic and the impending economic crises, there is today a plethora of commercially available options for the minimally invasive treatment of BPH. New industry-driven evaluation criteria of these treatments, the logical marketing hype, a short follow-up for many of them, make challenging to interpret the role they will finally adopt in the armamentarium to treat BPH. METHOD The author comments on recently published literature based in own experience and insight. RESULTS AND CONCLUSIONS In this situation, choosing to evolve from TURP to the next step of endoscopic treatment, the size-independent anatomic endoscopic enucleation of the prostate is a safe bet. It is now exceedingly feasible when the paradigm of AEEP has changed, due to better learning opportunities and technological and surgical technique modifications that have refined this procedure significantly since its inception.
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