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Perri D, Pacchetti A, Morini E, Besana U, Mazzoleni F, Verzotti E, Maltagliati M, Romero-Otero J, Pastore AL, Broggini P, Rocco B, Gozen AS, Kallidonis P, Bozzini G. Evaluation of the learning curve for Thulium laser enucleation of the prostate in a contemporary cohort. World J Urol 2024; 42:246. [PMID: 38643250 DOI: 10.1007/s00345-024-04958-7] [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: 12/12/2023] [Accepted: 03/25/2024] [Indexed: 04/22/2024] Open
Abstract
PURPOSE To assess the learning curve of Thulium laser enucleation of the prostate (ThuLEP) of a single surgeon. METHODS Hundred patients suffering from benign prostatic hyperplasia were treated by the same surgeon. In all cases, a well-trained urologist was present in the operating room. Patients urinary function was assessed preoperatively using the International Prostate Symptoms Score (IPSS), maximum flow rate and Post-Void Residual volume. Preoperative prostate volume was recorded. Enucleation and morcellation efficiency and complication rate were evaluated. Patients were divided into 5 cohorts of 20 consecutive cases to assess changes in outcomes through time. RESULTS Mean age of patients was 73.1 years (SD 17.5) and mean prostate volume was 89.7 ml (SD 55.1). Overall, mean enucleation and morcellation efficiency were 1.7 (SD 2.9) and 5.1 (SD 2.7) g/min. A statistically significant increase in enucleation efficiency was observed when comparing cohort 1 vs 2 (0.9 vs 1.3 g/min, p = 0.03) and cohort 2 vs 3 (1.3 vs 1.7 g/min, p = 0.02). A statistically significant increase in morcellation efficiency was observed when comparing cohort 1 vs 2 (2.8 vs 3.7 g/min, p = 0.02) and cohort 2 vs 3 (3.7 vs 4.9 g/min, p = 0.03). In both cases, no significant differences were observed when comparing the following cohorts. Complication rate showed no significant differences throughout the caseload. CONCLUSIONS In our single-surgeon experience, we observed a learning curve of nearly 60 cases for the ThuLEP procedure in presence of a well-trained surgeon. Complication rate was low from the beginning of surgical experience.
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Affiliation(s)
- D Perri
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy.
| | - A Pacchetti
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
| | - E Morini
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
| | - U Besana
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
| | - F Mazzoleni
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
| | - E Verzotti
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
| | - M Maltagliati
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
| | - J Romero-Otero
- Department of Urology, Hospital Universitario, 12 De Octubre, Madrid, Spain
| | - A L Pastore
- Department of Urology, Sapienza University, Rome, Italy
| | - P Broggini
- Sant'Anna Clinic, Lugano, Swiss, Switzerland
| | - B Rocco
- Department of Urology, ASST Santi Paolo e Carlo, Milan, Italy
| | - A S Gozen
- Department of Urology, SLK-Kliniken Heilbronn, Heilbronn, Germany
| | - P Kallidonis
- Department of Urology, University Hospital of Patras, Patras, Greece
| | - G Bozzini
- Division of Urology, Sant'Anna Hospital, Via Ravona 20, 22042, San Fermo della Battaglia, Italy
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Alharbi M, Alshamsan B, Almansour M, Alharbi A, Algaadi A, Abdelhafez MF. Early experience of " En bloc" holmium laser enucleation of the prostate in Saudi Arabia. Urol Ann 2024; 16:150-154. [PMID: 38818436 PMCID: PMC11135345 DOI: 10.4103/ua.ua_74_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 12/04/2023] [Indexed: 06/01/2024] Open
Abstract
Purpose Holmium laser enucleation of the prostate (HoLEP) showed higher efficacy than transurethral resection for treating benign prostatic hyperplasia (BPH). The present study aims to report the outcome of BPH treatment by HoLEP in a tertiary center. Patients and Methods An observational prospectively collected data for consecutive symptomatic BPH patients undergoing HoLEP between January 2020 and December 2021. Demographic and perioperative data were collected with the International Prostate Symptom Score (IPSS), quality of life, peak flow rate (Qmax), residual urine postvoid residual (PVR), and prostate-specific antigen (PSA) changes, in addition to perioperative and late adverse events. Results One hundred patients were included with a median age of 73 years (range 65-80). The IPSS improved by 80% postoperatively (25 vs. 5, P < 0.001). Similarly, Qmax significantly improved. Seven patients were found to have incidental prostate cancer. No patient needed a perioperative blood transfusion. Compared to its preoperative values, follow-up PSA has been reduced by 75% (P < 0.001). Urethral stricture and bladder neck contracture were noted in < 2% of the patients. Conclusions HoLEP is feasible for all prostate sizes and a safe and effective treatment for BPH patients; our results are consistent with the reported data in the literature regarding functional outcomes, complication rates, and urinary incontinence rates.
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Affiliation(s)
- Mohannad Alharbi
- Department of Surgery, College of Medicine, Qassim University, Buraidah, Qassim, Saudi Arabia
- Department of Urology, King Fahad Specialist Hospital, Buraidah, Qassim, Saudi Arabia
| | - Bader Alshamsan
- Department of Medicine, College of Medicine, Qassim University, Buraidah, Qassim, Saudi Arabia
| | - Mohammed Almansour
- Department of Urology, King Fahad Specialist Hospital, Buraidah, Qassim, Saudi Arabia
| | - Abdullah Alharbi
- Department of Urology, King Fahad Specialist Hospital, Buraidah, Qassim, Saudi Arabia
| | - Adel Algaadi
- Department of Urology, King Fahad Specialist Hospital, Buraidah, Qassim, Saudi Arabia
| | - Mohamed F. Abdelhafez
- Department of Urology, King Fahad Specialist Hospital, Buraidah, Qassim, Saudi Arabia
- Urology and Nephrology Center, Assiut University Hospital, Assiut, Egypt
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Hout M, Gurayah A, Arbelaez MCS, Blachman-Braun R, Shah K, Herrmann TRW, Shah HN. Incidence and risk factors for postoperative urinary incontinence after various prostate enucleation procedures: systemic review and meta-analysis of PubMed literature from 2000 to 2021. World J Urol 2022; 40:2731-2745. [PMID: 36194286 DOI: 10.1007/s00345-022-04174-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the risk of urinary incontinence (UI) after various prostate enucleation procedures (PEP). METHODS PubMed was searched from January 2000 to July 2021 for studies investigating UI after PEP. The articles were divided into 5 subgroups: holmium, thulium, greenlight laser, electrocautery, and simple prostatectomy. Meta-analysis was performed to examine rate of stress (SUI), urge (UUI) or unspecified UI at short (< 3 months), intermediate (3-6 months), and long-term (> 6 months). The impact of age, prostate size, surgery time, laser time, postoperative nadir PSA level and technical modifications on UI was analyzed. RESULTS Most (69.4%) of 49 articles included employed holmium laser. There was no significant difference in incidence of short-, intermediate-, and long-term UI, SUI and UUI between five sub-groups and within different technical modifications. Although not statistically significant, the incidence of UI was higher (15%) at short-term with green-light and simple prostatectomy (95% CI 9-23 and 1-84), and higher (4%) at intermediate-term with holmium laser (95% CI 2-8). SUI was more prevalent at short-term with holmium laser (4%; 95% CI 2-5%), and at intermediate term with simple prostatectomy (3%; 95% CI 1-14). UUI was higher in the thulium group (10%, 95% CI 7-16). Increased age, surgery time, laser time and prostate size up to 80 cc were associated with higher UI. There was no correlation between postoperative PSA and UI. CONCLUSIONS There is no significant difference in incidence of UI, SUI and UUI after various PEP. Patients age, prostate size, surgery and laser time are linearly associated with UI.
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Affiliation(s)
- Mohammad Hout
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | - Aaron Gurayah
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | - Maria Camila Suarez Arbelaez
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | - Ruben Blachman-Braun
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | - Khushi Shah
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA
| | | | - Hemendra N Shah
- Desai SethI Urology Institute, University of Miami Miller School of Medicine, 1120 NW 14Th St, Miami, FL, 33136, USA.
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Acikgoz O, Yilmaz M, Aybal HC, Yilmaz S, Gazel E, Yalcin S, Duvarci M, Kaya E, Miernik A, Tunc L. Impact of diabetes mellitus on urinary continence after holmium laser enucleation of the prostate due to lower urinary tract symptoms: a retrospective study. Cent European J Urol 2022; 74:535-540. [PMID: 35083073 PMCID: PMC8771128 DOI: 10.5173/ceju.2021.0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Diabetes mellitus (DM) is known as a risk factor of stress urinary incontinence after Holmium laser enucleation of the prostate (HoLEP). We aimed to compare the postoperative continence status of patients with and without DM, after HoLEP surgery. Material and methods A total of 214 patients who underwent HoLEP between January 2017 and January 2020 were retrospectively assessed. Functional outcomes, perioperative total operation time (TOT)(min), enucleation time (ET)(min), enucleation efficiency (EE)(g/min), enucleated tissue weight (ETW)(g), morcellation efficiency (ME)(g/min), morcellation time (MT)(min), continence status, intraoperative and postoperative complications according to Clavien–Dindo classification were recorded. Results A total of 96 patients had DM additional to benign prostate hyperplasia (BPH) (Group 1), while 118 patients had only benign prostate hyperplasia without DM (Group 2). When comparing preoperative and postoperative functional outcomes, a statistically significant improvement was observed in both groups from baseline to the 1st and 6th month follow-up (p ≤0.001). There were no statistically significant differences between groups in postoperative stress urinary incontinence at postoperative months 1 and 6 (1.7% vs 2.1%, p = 1 and 0.8% vs 1%, p = 1; respectively). There was no significant difference between groups in intraoperative and postoperative complications (p >0.05). Conclusions HoLEP is safe to perform in patients with DM at low complication and urinary incontinence rates.
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Affiliation(s)
- Onur Acikgoz
- Department of Urology, Pendik State Hospital, Istanbul, Turkey
| | - Mehmet Yilmaz
- Department of Urology, University of Freiburg-Medical Centre, Faculty of Medicine, Freiburg, Germany
| | - Halil Cagri Aybal
- Department of Urology, Kahramankazan Hamdi Eris State Hospital, Ankara, Turkey
| | - Sercan Yilmaz
- Department of Urology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Eymen Gazel
- Department of Urology, Acibadem University Ankara Hospital, Ankara, Turkey
| | - Serdar Yalcin
- Department of Urology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Mehmet Duvarci
- Department of Urology, University of Health Sciences, Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Engin Kaya
- Department of Urology, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Arkadiusz Miernik
- Department of Urology, University of Freiburg-Medical Centre, Faculty of Medicine, Freiburg, Germany
| | - Lutfi Tunc
- Department of Urology, Gazi University Faculty of Medicine, Ankara, Turkey
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Bebi C, Turetti M, Lievore E, Ripa F, Rocchini L, Spinelli MG, De Lorenzis E, Albo G, Longo F, Gadda F, Dell’Orto PG, Salonia A, Montanari E, Boeri L. Bipolar Transurethral Enucleation of the Prostate: Is it a size-independent endoscopic treatment option for symptomatic benign prostatic hyperplasia? PLoS One 2021; 16:e0253083. [PMID: 34106986 PMCID: PMC8189479 DOI: 10.1371/journal.pone.0253083] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/27/2021] [Indexed: 12/23/2022] Open
Abstract
Background Bipolar Transurethral Enucleation of the Prostate (B-TUEP) is recommended as a first-choice treatment for benign prostatic obstruction in prostates >80 ml. Differently, B-TUEP is only considered as an alternative option after TURP for smaller prostates (30–80 ml). The aim of our study is to assess the relation between prostate size and surgical outcomes after B-TUEP. Methods We performed a retrospective analysis of data collected from 172 patients submitted to B-TUEP. Patients were segregated according to tertiles of prostate volume (PV) (≤60 ml, 61–110 ml, >110 ml). For each group we evaluated enucleation efficacy (enucleated weight/enucleation time), complication rates, urinary and sexual function parameters. Functional and sexual parameters were compared between groups at baseline, 1 and 3 months follow up. Descriptive statistics and linear and logistic regression models tested the association between PV and postoperative complications/outcomes. Results Operative time and weight of enucleated adenomas increased along with prostate volumes (all p≤0.01). Enucleation efficacy was higher in men with PV >110 ml compared to other groups (p≤0.001). Length of hospital stay, catheterization time and rates of postoperative complications, such as transfusion and clot evacuation rates and bladder neck/urethral strictures, were comparable between groups. Urinary symptoms improved at 1-and 3-months in each group as compared to baseline evaluation (all p<0.01) but they did not differ according to PV. In each group maximum urinary flow and post-void residual volume significantly improved at 3 months compared to baseline (all p≤0.01), without differences according to PV. Sexual symptoms were similar between groups at each follow up assessment. At multivariable linear and logistic regression analysis, prostate volume was not associated with postoperative functional outcomes and complications. Conversely, patient’s comorbid status and antiplatelet/anticoagulation use were independently associated with postoperative complications. Conclusion According to our findings, B-TUEP should be considered a “size independent procedure” as it can provide symptom relief in men with prostates of all sizes with the same efficacy and safety profile.
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Affiliation(s)
- Carolina Bebi
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Matteo Turetti
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elena Lievore
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Francesco Ripa
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Lorenzo Rocchini
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Matteo Giulio Spinelli
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elisa De Lorenzis
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, 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, University of Milan, Milan, Italy
| | - Franco Gadda
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Guido Dell’Orto
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca’ Granda–Ospedale Maggiore Policlinico, University of Milan, Milan, 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, University of Milan, Milan, Italy
- * E-mail:
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Franz J, Suarez-Ibarrola R, Pütz P, Sigle A, Lusuardi L, Netsch C, Lehrich K, Herrmann TRW, Gratzke C, Miernik A. Morcellation After Endoscopic Enucleation of the Prostate: Efficiency and Safety of Currently Available Devices. Eur Urol Focus 2021; 8:532-544. [PMID: 33858810 DOI: 10.1016/j.euf.2021.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/12/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022]
Abstract
CONTEXT Although several studies have compared different morcellators and enucleation techniques for the management of benign prostatic hyperplasia (BPH), there is sparse literature on morcellation, so further experimental and clinical research is required for its optimization. OBJECTIVE To critically appraise the contemporary literature on prostate morcellation and to evaluate the safety and efficiency of currently available morcellators for endoscopic enucleation of the prostate (EEP) in the context of BPH. EVIDENCE ACQUISITION A comprehensive review of the English and French literature relevant to prostate morcellation was performed using the PubMed-MEDLINE, Cochrane Library, Web of Science, and Wiley Online Library database from 1998 to 2020 using PICOS (patient population, intervention, comparison, outcome, and study design) criteria. EVIDENCE SYNTHESIS We retrieved 26 studies involving 5652 patients treated with a morcellator that were eligible for data extraction and analysis. The mean patient age was 67.4 (range 61.4-72.8) yr. The weighted mean efficiency of Piranha, VersaCut, and DrillCut morcellators was 5.29, 3.95, and 5.3 g/min, respectively. Several approaches, such as en bloc, two-lobe, inverse, and improved techniques, may increase morcellation efficiency and safety. The lowest weighted mean rate of bladder wall injury was 1.24% for Piranha, followed by 1.98% for DrillCut, and 5.23% for VersaCut, while the VersaCut morcellator had the lowest weighted mean rate of device malfunction at 0.74%, compared to 2.07% for Piranha and 7.86% for DrillCut. CONCLUSIONS All three morcellators are efficient and safe for prostatic morcellation after EEP. Further development of devices and techniques may improve the efficiency and safety profile of morcellation. To increase safety, surgeon expertise, technical equipment, and patient characteristics should be considered. Therefore, interdisciplinary exchange of knowledge and further technological innovations are strongly encouraged. PATIENT SUMMARY We reviewed the safety and efficacy of devices called morcellators. These devices cut tissue into small pieces that are easier to remove from the body, and are used during laser surgery for benign enlargement of the prostate. Three morcellators are currently available on the market and are comparable in safety and efficacy.
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Affiliation(s)
- Julia Franz
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Rodrigo Suarez-Ibarrola
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Philipp Pütz
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - August Sigle
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Lukas Lusuardi
- Department of Urology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Karin Lehrich
- Department of Urology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | | | - Christian Gratzke
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Centre, Freiburg, Germany.
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Yılmaz S, Yalçın S, Yılmaz M, Açıkgöz O, Aybal HÇ, Gazel E, Kaya E, Tunç L. Comparison of outcomes of Holmium enucleation of the prostate for small- and moderate-sized prostates. Andrologia 2021; 53:e13970. [PMID: 33432683 DOI: 10.1111/and.13970] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 12/25/2020] [Accepted: 12/28/2020] [Indexed: 12/16/2022] Open
Abstract
There is an ongoing discussion in the literature on the surgical treatment option for small prostate size benign prostate hyperplasia (BPH) patients. This study aimed to evaluate the efficacy of Holmium laser enucleation of the prostate (HoLEP) surgery in small (<30 ml) and moderate (30-80 ml) prostate size as accepted in European Association of Urology guideline. We retrospectively analysed our database between May 2016 and May 2019 and patients who underwent HoLEP surgery. Patients who have prostate size <80 ml were included the study. These patients were divided into two group: group 1 with prostate size <30 ml (n: 64) and group 2 with prostate size 30-80 ml (n: 101). Enucleation time (ET), morcellation time (MT), total operation time (OT), enucleation efficiency (EE), morcellation efficiency (ME), intra- and post-operative complications were analysed. While EE and Hb drop were better in favour of group 2; PSA drop, ET, MT, OT and ME were superior in favour of group 1. In group 1, intra-operative complications were higher (6 vs. 2; p < .05) and post-operative complications did not differ statistically between groups (p = .14). No statistically significant finding was found between groups regarding incontinence. In conclusion, HoLEP is a reliable method in terms of its results in patients with small prostates.
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Affiliation(s)
- Sercan Yılmaz
- Department of Urology, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Serdar Yalçın
- Department of Urology, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Mehmet Yılmaz
- Department of Urology, Zile State Hospital, Tokat, Turkey
| | - Onur Açıkgöz
- Department of Urology, Pendik State Hospital, Istanbul, Turkey
| | - Halil Çağrı Aybal
- Department of Urology, Kahramankazan Hamdi Eris State Hospital, Ankara, Turkey
| | - Eymen Gazel
- Department of Urology, Acıbadem University Ankara Hospital, Ankara, Turkey
| | - Engin Kaya
- Department of Urology, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Lütfi Tunç
- Department of Urology, Gazi University Faculty of Medicine, Ankara, Turkey
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Reasons to overthrow TURP: bring on Aquablation. World J Urol 2020; 39:2291-2299. [PMID: 32740805 DOI: 10.1007/s00345-020-03390-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE In this review, we will discuss the state of the literature regarding Aquablation, its limitations, and opportunities for its application in the treatment of benign prostatic enlargement (BPE). METHODS A comprehensive review of original research on Aquablation was conducted. Articles related to transurethral resection of the prostate, holmium laser enucleation of the prostate, greenlight photoselective vaporization of the prostate, and simple prostatectomy were reviewed for discussion. RESULTS For small-medium prostates (30-80 mL), Aquablation's main advantages include better ejaculatory function and similar functional outcomes compared to TURP. For large prostates (80-150 mL), Aquablation demonstrates shorter operative time and superior ejaculatory function when compared to simple prostatectomy, HoLEP, and Greenlight PVP. In addition, Aquablation displays shorter hospital stays than simple prostatectomy. The integration of software programming and semi-automatic technology increases the reproducibility of the procedure and helps standardize overall outcomes, while also accelerating the learning curve. Its ability to preserve antegrade ejaculation makes Aquablation a very compelling option for sexually active patients. However cost and postoperative bleeding risks remain a concern. CONCLUSION The current evidence suggests that Aquablation is a safe and effective alternative for BPE for small to large prostates. Further prospective clinical trials, with comparisons to other BPE modalities, and data from longer follow-up periods are still required.
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