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Silvani C, Lucignani G, Bebi C, Turetti M, Ripa F, Zanetti SP, De Lorenzis E, Albo G, Longo F, Gadda F, Montanari E, Boeri L. General anesthesia is associated with lower perioperative bleeding and better functional outcomes than spinal anesthesia for endoscopic enucleation of the prostate: a single-center experience. World J Urol 2024; 42:569. [PMID: 39382595 DOI: 10.1007/s00345-024-05271-z] [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: 12/20/2023] [Accepted: 09/05/2024] [Indexed: 10/10/2024] Open
Abstract
PURPOSE Holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral enucleation of the prostate (B-TUEP) are safe and effective treatment options for benign prostatic hyperplasia (BPH). Spinal anesthesia (SA) is widely used for endoscopic enucleation of the prostate (EEP) in place of general anesthesia (GA). We aimed to assess the impact of GA vs. SA on blood loss, postoperative course and functional outcomes after HoLEP and B-TUEP. METHODS After propensity score matching, we analyzed data from 148 patients treated with EEP in our centre for symptomatic BPH. We recorded patient's characteristics, procedural data, type of anesthesia (SA vs. GA). Postoperatively we evaluated hemoglobin drop, catheterization time (CT), and length of hospital stay (LOS). Functional outcomes were evaluated with the International Prostate Symptoms Score (IPSS) at baseline and 3 months after surgery. Descriptive statistics and linear regression models tested the association between anesthesia type and EEP outcomes. RESULTS After matching groups were comparable in terms of pre- and intra-operative variables. Of all, 111 (75%) patients were treated under SA. Haemoglobin drop was lower in GA compared to SA group (1 vs. 1.4 g/dL, p < 0.01). CT was shorter in the GA group (1 vs. 2 days, p = 0.01). Postoperative IPSS score was lower in GA group (4 vs. 8, p = 0.04). Multivariable linear regression models revealed that prostate volume (p = 0.01) and SA vs. GA (p = 0.01) were associated with higher haemoglobin drop, after accounting for age and use of anticoagulants/antiplatelets. Similarly, SA vs. GA (p = 0.02) and postoperative complications occurrence (p < 0.001) were associated with a longer LOS, after accounting for age, prostate volume and use of anticoagulants/antiplatelets. CONCLUSION EEP can be safely performed under both GA and SA. GA offers better outcomes in terms of perioperative bleeding and 3-month functional outcomes.
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Affiliation(s)
- Carlo Silvani
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via della Commenda 15, Milan, 20122, Italy
| | - Gianpaolo Lucignani
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via della Commenda 15, Milan, 20122, Italy
| | - Carolina Bebi
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via della Commenda 15, Milan, 20122, Italy
| | - Matteo Turetti
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via della Commenda 15, Milan, 20122, Italy
| | - Francesco Ripa
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via della Commenda 15, Milan, 20122, Italy
| | - Stefano Paolo Zanetti
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via della Commenda 15, Milan, 20122, Italy
| | - Elisa De Lorenzis
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via della Commenda 15, Milan, 20122, Italy
| | - Giancarlo Albo
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via della Commenda 15, Milan, 20122, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Fabrizio Longo
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via della Commenda 15, Milan, 20122, Italy
| | - Franco Gadda
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via della Commenda 15, Milan, 20122, Italy
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via della Commenda 15, Milan, 20122, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via della Commenda 15, Milan, 20122, Italy.
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Song B, Song SH, Jeong SJ. The learning curve for transurethral enucleation with bipolar energy for benign prostate hyperplasia: a single-surgeon experience of 494 patients. Asian J Androl 2024; 26:288-294. [PMID: 38146948 PMCID: PMC11156458 DOI: 10.4103/aja202359] [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: 05/22/2023] [Accepted: 10/13/2023] [Indexed: 12/27/2023] Open
Abstract
This study was performed to investigate the learning curve of transurethral enucleation with bipolar energy (TUEB) for benign prostatic hyperplasia. The study involved 494 consecutive patients who underwent TUEB for benign prostatic hyperplasia from August 2018 to March 2022 by one surgeon (SJJ, Seoul National University Bundang Hospital, Seongnam, Korea). The patients were followed up at 1 week, 1 month, 3 months, and 6 months postoperatively. To evaluate the learning curve of TUEB, perioperative parameters including the enucleation ratio (enucleated tissue weight/transitional zone volume), TUEB efficiency (enucleated tissue weight/operation time), and enucleation efficiency (enucleated tissue weight/enucleation time) were analyzed. Functional outcomes and postoperative complications were also assessed, including the International Prostate Symptom Score (IPSS), IPSS quality-of-life (QoL) score, and uroflowmetry outcomes. The patients' median age was 72 (interquartile range [IQR]: 66-78) years, and the estimated prostate volume and transitional zone volume were 63.0 (IQR: 46.0-90.6) ml and 37.1 (IQR: 24.0-60.0) ml, respectively. The enucleation ratio, TUEB efficiency, and enucleation efficiency were 0.60 (IQR: 0.46-0.54) g ml -1 , 0.33 (IQR: 0.22-0.46) g min -1 , and 0.50 (IQR: 0.35-0.72) g min -1 , respectively, plateauing after 70 cases. The functional outcomes, including total IPSS, IPSS QoL score, and uroflowmetry outcomes, significantly improved at 6 months after TUEB (all P < 0.05), but without significant differences over the learning curve. Sixty-five (13.2%) patients developed complications after TUEB, 21.5% of whom experienced major complications (Clavien-Dindo grade ≥3). The rate of major complications declined as the number of TUEB cases increased ( P = 0.013). Our results suggest that the efficiency of TUEB stabilized within 70 procedures.
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Affiliation(s)
- Byeongdo Song
- Department of Urology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Sang Hun Song
- Department of Urology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
| | - Seong Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam 13620, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul 03080, Korea
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Hagiuda J, Masuda T, Takahashi R, Tamaki S, Nakagawa K. Transurethral bipolar enucleation using a TUEB loop for large benign prostatic hyperplasia: a retrospective cohort study. World J Urol 2024; 42:183. [PMID: 38512532 DOI: 10.1007/s00345-024-04865-x] [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: 08/28/2023] [Accepted: 02/08/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE We aimed to assess the efficacy and safety of transurethral enucleation with bipolar system (TUEB) regardless of the prostate size using a specially developed TUEB loop. METHODS A total of 251 patients who underwent TUEB were categorized into two groups depending on the prostate volume (PV): small-PV (≤ 80 mL) group, 133 patients; large-PV (> 80 mL) group, 118 patients. Comparisons of background information and treatment outcomes were performed between the groups. RESULTS Operation (113.5 vs 166.4 min), enucleation (49.4 vs 68.1 min), and morcellation (11.4 vs 26.4 min) times were longer and hemoglobin decreased significantly (0.84 vs 1.30 g/dL) in the large PV group. However, the enucleation efficiency (enucleated weight per enucleation time; 0.71 vs 0.97 g/min) and prostate-specific antigen reduction rate (24.6% vs 16.1%) were significantly better in the large-PV group, with similar enucleation rates (enucleated weight per transitional zone volume; 82% vs 81%). The International Prostate Symptom Score, uroflowmetry maximum flow rate, and post-void residual urine in both groups improved at 3, 6, and 12 months compared with baseline. No patient underwent blood transfusion. There were no differences in the frequency of postoperative clot retention, urethral stricture, or stress incontinence at 3, 6, and 12 months. CONCLUSION TUEB using a TUEB loop resulted in high levels of satisfaction regarding the enucleation efficiency, efficacy, and safety for BPH surgery regardless of the prostate size. TUEB should be considered one of the best treatment options for large BPH that is uncontrollable with medication.
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Affiliation(s)
- Jun Hagiuda
- Department of Urology, Tokyo Dental College, Ichikawa General Hospital, Sugano 5-11-13, Ichikawa, Chiba, 2728513, Japan.
| | - Tsukasa Masuda
- Department of Urology, Tokyo Dental College, Ichikawa General Hospital, Sugano 5-11-13, Ichikawa, Chiba, 2728513, Japan
| | - Ryohei Takahashi
- Department of Urology, Tokyo Dental College, Ichikawa General Hospital, Sugano 5-11-13, Ichikawa, Chiba, 2728513, Japan
| | - Satoshi Tamaki
- Department of Urology, Tokyo Dental College, Ichikawa General Hospital, Sugano 5-11-13, Ichikawa, Chiba, 2728513, Japan
| | - Ken Nakagawa
- Department of Urology, Tokyo Dental College, Ichikawa General Hospital, Sugano 5-11-13, Ichikawa, Chiba, 2728513, Japan
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Tokat E, Acar C, Gurocak S, Sinik Z. The prospective evaluation of learning curve of bipolar anatomic endoscopic prostate enucleation (AEEP) with Herrmann's vapoenucleation probe. World J Urol 2024; 42:121. [PMID: 38446229 DOI: 10.1007/s00345-024-04804-w] [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: 09/09/2023] [Accepted: 01/16/2024] [Indexed: 03/07/2024] Open
Abstract
PURPOSE We aimed to evaluate the learning curve of Bipolar Endoscopic Prostate Enucleation (BIPOLEP) in benign prostate enlargement without a mentorship. METHODS The prospective data of 55 patients underwent BIPOLEP surgery by a single surgeon during 3 years were evaluated. The demographic, peri-operative and follow-up data were recorded. Trifecta was defined as a combination of complete enucleation and morcellation within < 90 min and without any conversion to standard TURP. Pentafecta was defined as a combination of Trifecta without postoperative complications or stress urinary incontinence at 3 months. The learning curve was considered to have been overcome when the surgeon obtained Trifecta/Pentafecta in four consecutive patients. RESULTS The mean age of the study group was 67.9 ± 6.8 years with mean prostate volume of 102.3 ± 56.4 ml. The mean operation time and enucleation time were 103.5 ± 41.1 and 65.78 ± 22.6 min, respectively. Trifecta and Pentafecta were achieved in 23rd (from 19th to 23rd) and 34th (from 30 to 34th) patients, respectively. Among the seven consecutive patients between Trifecta and Pentafecta, prostate capsule perforation was occurred during the surgery in four patients (26th, 27th and 29th patients). The mean follow-up duration was 16.7 ± 6.4 (3-24 months, range) months. Urethral stricture was observed in four (7. 2%) patients while bladder neck contracture was observed 1 (1.8%) patient. After the 3rd month, no patient reported stress incontinence. CONCLUSION Bipolar endoscopic enucleation of prostate is a safe surgical method and has similar and/or short learning curve compared to HOLEP even without a mentorship program.
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Affiliation(s)
- Eda Tokat
- University of Health Sciences, Ankara Training and Research Hospital, Department of Urology, Ankara, Turkey.
| | - Cenk Acar
- Hisar Intercontinental Hospital, Department of Urology, Istanbul, Turkey
| | - Serhat Gurocak
- Gazi University School of Medicine, Department of Urology, Section of Pediatric Urology, Ankara, Turkey
| | - Zafer Sinik
- Odak Hospital, Department of Urology, Denizli, Turkey
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Song B, Song SH, Jeong SJ. Evaluation of the efficiency of transurethral enucleation with bipolar energy according to prostate volume for patients with benign prostate hyperplasia. Prostate Int 2023; 11:204-211. [PMID: 38196550 PMCID: PMC10772191 DOI: 10.1016/j.prnil.2023.08.001] [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] [Received: 05/23/2023] [Revised: 07/29/2023] [Accepted: 08/17/2023] [Indexed: 01/11/2024] Open
Abstract
Background This study evaluated the efficiency and safety of transurethral enucleation with bipolar energy (TUEB) using a spatula loop according to prostate volume. Methods We retrospectively evaluated 398 patients who underwent TUEB for benign prostatic hyperplasia at a single tertiary hospital between August 2018 and December 2022. The patients were divided into three groups according to estimated prostate volume (ePV): ≤40 mL (n = 67), 40-80 mL (n = 200), and ≥80 mL (n = 131). To compare the efficiency of TUEB, perioperative parameters including TUEB and enucleation efficiencies, were calculated as enucleated tissue weight per operation time and enucleated tissue weight per enucleation time, respectively. Preoperative and postoperative functional outcomes such as the International Prostate Symptom Score (IPSS), quality-of-life (QoL) score, maximum flow rate (Qmax), and post-void residual urine volume (PVR), were also compared. Results The IPSS total score, voiding sub-score, Qmax, and PVR improved after TUEB in all groups (all p < 0.05). The TUEB and enucleation efficiencies increased with increasing ePVs (all P < 0.001). When comparing the three prostate volume groups, there were no significant differences in functional outcomes within 12 months after TUEB (all-Bonferroni adjusted P > 0.017). A total of 57 patients experienced adverse events after TUEB, with no significant differences between the three groups (p = 0.507). Conclusion As prostate volume increases, the perioperative efficiency of TUEB is enhanced. Meanwhile, small prostates did not show significant differences in the improvement of functional outcomes and complications in comparison with larger prostates.
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Affiliation(s)
- Byeongdo Song
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Hun Song
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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El-Shaer W, Alhefnawy M, Ebrahim Y, Elshazly A, Abdel-Lateef S. Bipolar Needlescopic Enucleation Versus Bipolar Vapoenucleation of the prostate: A prospective single Centre Randomized Study. J Endourol 2022; 36:1452-1459. [PMID: 35838130 DOI: 10.1089/end.2022.0302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Endoscopic enucleation of the prostate (EEP) is a safe and effective interventional option for the management of variable-sized adenomas. PURPOSE To point out the safety and efficacy of needlescopic enucleation of the prostate (BNEP) in comparison with vapoenucleation of the prostate (BVEP). MATERIALS AND METHODS This is a prospective randomized trial. In all, 214 patients with variable size adenoma were randomly assigned (1:1) to either: the BNEP group (108 patients underwent Bipolar-EEP (BEEP) using a needle electrode, or a vapoenucleation one (BVEP) group (106 patients underwent BEEP using vaporization electrodes). Intra & intergroup objective and subjective outcomes were compared at different time points for 1 year. Also, all other procedure's related events and mishaps were registered and compared. RESULTS The median (interquartile range (IQR)) operative time, resected tissue weight, postoperative irrigation time, and Hb drop were: 60 (50-88) Vs 80 (60 - 98) minutes, 67 (56 - 86) Vs 46 (40- 61) grams, 10 (8 - 12) Vs 12 (10 -18) hours, and 1 (0.6 - 1.3) Vs 1.2 (0.88 - 1.9) g/dl, for BNEP and BVEP groups, respectively, (P<0.05). Both subjective and objective parameters were analogously improved in the two groups (P> 0.5). However, the post-operative irritative symptoms and urinary infections were lower in BNEP group (P<0.05). CONCLUSIONS Our results revealed that although both BNEP and BVEP are effective and safe in the management of benign prostatic obstruction, BNEP is superior in terms of less operative time, intra-operative blood loss, irrigation time, irritative symptoms and urinary infections.
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Wang Q, Alshayyah R, He Y, Wen L, Yu Y, Yang B. Is the Peripheral Zone Thickness an Indicator of a Learning Curve in Bipolar Transurethral Plasma Enucleation of the Prostate?—A Single Center Cohort Study. Front Surg 2022; 8:795705. [PMID: 35187047 PMCID: PMC8847292 DOI: 10.3389/fsurg.2021.795705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background We conducted this cohort study to assess the differences in the learning curve of bipolar transurethral plasma enucleation of the prostate (B-TUEP) associated with prostatic peripheral zone thickness (PZT) under MRI quantitative measurements. Methods For the study, 60 patients with benign prostatic hyperplasia (BPH) were involved. PZT are defined as “Thin” (<7 mm), “Thick” (>10 mm), and “Medium” (in between), with 20 patients in each group. Learning stages were defined as Group 1 (No. 1–20), Group 2 (No. 21–40), and Group 3 (No. 41–60). We measured parameters of the prostate, such as PZT and transitional zone thickness (TZT), with MRI. A learner with no experience in enucleation performed the operations. Statistical analyses were performed to compare the differences. Pearson correlation analysis and multiple linear regression analysis evaluated the relationship between characteristics of patients. P < 0.05 was deemed statistically significant. Results One-Way ANOVA revealed different enucleation efficiency (0.811 ± 0.18 vs. 0.748 ± 0.14 vs. 0.634 ± 0.16), prostate volume (58.9 ± 15.33 vs. 57.3 ± 15.58 vs. 46.6 ± 14.10), and thickness of transition zone (44.45 ± 7.60 vs. 42.45 ± 6.08 vs. 34.78 ± 6.04) among Thin, Medium, and Thick groups. The enucleation efficiency is different between groups divided by learning stages (Group 1 vs. Group 3, 0.658 vs. 0.783; Group 2 vs. Group 3, 0.751 vs. 0.783). Pearson correlation analysis reveals that PZT was negatively correlated with prostate volume (r = −0.427), resection weight (r = −0.35), enucleation efficiency (r = −0.445), and TZT (r = −0.533), and was positively correlated with Q-max (r = 0.301) and bladder outlet obstruction index (BOOI) (r = 0.388). The regression coefficients of PZT, TZT, prostate volume, and Q-max were −0.012, 0.008, 0.007, and 0.013, respectively (all P < 0.05). Conclusion Lower PZT is independent of higher enucleation efficiency, larger adenoma, and higher TZT. PZT may be an important factor on the learning curve of B-TUEP. Higher TZT, prostate volume. and Q-max may also relate to higher enucleation efficiency. For B-TUEP learners, it seems easier to perform the operation when the PZT is low, though more care should be taken with the capsule perforation. Further, the capsule plane should be maintained more attentively if the PZT is high.
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Endo Y, Shimizu H, Akatsuka J, Minaguchi S, Hasegawa H, Toyama Y, Suzuki Y, Hamasaki T, Oki M, Hasegawa J, Kondo Y. Efficacy and Safety of Transurethral Enucleation with Bipolar Energy for the Treatment of Benign Prostatic Hyperplasia: Does Prostate Volume Matter? J NIPPON MED SCH 2022; 89:436-442. [DOI: 10.1272/jnms.jnms.2022_89-411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Yuki Endo
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | | | - Jun Akatsuka
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | | | | | - Yuka Toyama
- Department of Urology, Nippon Medical School, Tokyo, Japan
| | | | | | | | | | - Yukihiro Kondo
- Department of Urology, Nippon Medical School, Tokyo, Japan
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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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