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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bove AM, Brassetti A, Ochoa M, Anceschi U, D’Annunzio S, Ferriero M, Tuderti G, Misuraca L, Mastroianni R, Cartolano S, Torregiani G, Lombardo R, De Nunzio C, Simone G. Robotic simple prostatectomy vs HOLEP, a 'multi single-center' experiences comparison. Cent European J Urol 2023; 76:128-134. [PMID: 37483855 PMCID: PMC10357823 DOI: 10.5173/ceju.2023.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/23/2023] [Accepted: 03/29/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction The aim of this study was to compare peri-operative and mid-term outcomes of patients who underwent robot-assisted simple prostatectomy (RASP) vs holmium laser enucleation of the prostate (HOLEP). RASP and HOLEP are the treatments of choice for men with symptomatic benign prostatic obstruction (BPO) and a prostate ≥80 g, achieving comparable short and mid-term efficacy. No randomized controlled studies have proved the superiority of one technique over the other. Material and methods The prospectively maintained databases of the participating institutions were queried for patients with a prostate volume (PV) ≥80 g, who underwent surgery for BPO between 2011 and 2021. The study population was divided into two subgroups based on surgical approach. Demographics, baseline characteristics, and 12 months outcomes were compared between groups: χ2 and Student t-tests were used for categorical and continuous variables, respectively. The Trifecta composite outcome (post-operative Q-max >15 ml/sec, International Prostate Symptom Score (IPSS) <8 and absence of complications) was used to define surgical quality and the two groups were compared accordingly. Logistic regression analyses investigated predictors of Trifecta achievement. Results We included 97 patients with comparable pre-operative features (all p >0.30): 43 underwent RASP, 54 HOLEP. Median PV was 102 g (IQR 89-120) and Q-max was 7.2 ml/s (IQR 5.4-9.0). The Trifecta rate was 43% overall, higher in the RASP subgroup (56% vs 33%; p = 0.02). The endoscopic approach was its only independent predictor (OR 0.5; 95% CI 0.28-0.88; p = 0.016). Conclusions At univariable regression analysis, surgical approach was the only independent predictor of Trifecta achievement, which was significantly higher in the RASP group compared to HOLEP.
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Affiliation(s)
- Alfredo Maria Bove
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Aldo Brassetti
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Mario Ochoa
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Umberto Anceschi
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Simone D’Annunzio
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Marilia Ferriero
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Leonardo Misuraca
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Silvia Cartolano
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | - Giulia Torregiani
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
| | | | - Cosimo De Nunzio
- Department of Urology, Sant Andrea University Hospital, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS ‘Regina Elena’ National Cancer Institute, Rome, Italy
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Tamalunas A, Schott M, Keller P, Atzler M, Ebner B, Buchner A, Stief CG, Magistro G. How does symptom severity impact clinical outcomes of men with lower urinary tract symptoms after holmium laser enucleation or transurethral resection of the prostate? Cent European J Urol 2022; 75:387-394. [PMID: 36794034 PMCID: PMC9903167 DOI: 10.5173/ceju.2022.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/12/2022] [Accepted: 11/12/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction International Prostate Symptom Score (IPSS) is a validated outcome measure for the evaluation of patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). When treating patients with transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate (HoLEP), patient selection is key to achieve the best clinical outcome. Therefore, we analyzed how the severity of LUTS as determined by IPSS influenced postoperative functional outcomes. Material and methods We conducted a retrospective, matched-pair analysis of 2,011 men who underwent HoLEP or TURP for LUTS/BPO between 2013-2017. We included 195 patients in the final analysis (HoLEP n = 97; TURP n = 98), who were matched for prostate size (50 cc), age, and body mass index. Patients were then stratified by IPSS. Groups were compared for perioperative parameters, safety and short-term functional outcomes. Results While preoperative symptom severity was a significant predictor of postoperative clinical improvement, patients who received HoLEP showed superior postoperative functional results with higher peak flow rates and 2-fold greater improvement in IPSS. In patients presenting with severe symptoms, we observed 3- to 4-fold less Clavien-Dindo grade ≥II and overall complications after receiving HoLEP compared to TURP. Conclusions Patients with severe LUTS were more likely to experience clinically significant improvement after surgery than patients with moderate LUTS, and HoLEP showed superior functional outcomes than TURP. However, patients with moderate LUTS should not be denied surgery, but may warrant a more comprehensive clinical work-up.
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Affiliation(s)
| | - Melanie Schott
- University Hospital, LMU Munich, Department of Urology, Munich, Germany
| | - Patrick Keller
- University Hospital, LMU Munich, Department of Urology, Munich, Germany
| | - Michael Atzler
- University Hospital, LMU Munich, Department of Urology, Munich, Germany
| | - Benedikt Ebner
- University Hospital, LMU Munich, Department of Urology, Munich, Germany
| | - Alexander Buchner
- University Hospital, LMU Munich, Department of Urology, Munich, Germany
| | - Christian G Stief
- University Hospital, LMU Munich, Department of Urology, Munich, Germany
| | - Giuseppe Magistro
- University Hospital, LMU Munich, Department of Urology, Munich, Germany
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Napier-Hemy TP, Liu AKL, Floyd MS, McNulty S, Omar AM, Mistry R, Gana HB. Acute urinary retention in a 27-year-old male secondary to benign prostatic hyperplasia treated with Holmium Enucleation of the Prostate ( HOLEP). Urologia 2021:3915603211016613. [PMID: 34006156 DOI: 10.1177/03915603211016613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Benign prostatic hyperplasia (BPH) is common in the ageing male. Clinical manifestations like retention impact on a patient's quality of life. Alterations in androgen activity at the androgen receptor complex level in the prostate contribute to prostatic hyperplasia with the highest incidence occurring in males in their 70's. There remains a paucity of cases in young males who develop acute urinary retention secondary to BPH. We present a case of a 27-year-old male who developed acute urinary retention secondary to BPH who required a Holmium Laser Enucleation of his Prostate (HOLEP). CASE DESCRIPTION A 27 year old man was admitted in acute urinary retention. BPH was diagnosed via way of radiological imaging and histological assessment. After pre-operative sperm banking and suprapubic catheterisation, the patient underwent a HOLEP. He had biochemically confirmed hypogonadotrophic hypogonadism which was at odds with his muscular, physical appearance. Total testosterone levels had fluctuated following admission suggesting an exogenous substance was interfering with the hypothalamic-pituitary-gonadal axis but he denied exogenous steroid use. RESULT The patient successfully passed his voiding trial on the second post-operative day and remained catheter free. Post-operative uroflowmetry and sexual function remain unknown as patient disengaged with follow up. CONCLUSION HOLEP prostatectomy is a safe and effective way of managing BPH in younger patients following sperm banking and assessment by endocrinology.
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Affiliation(s)
- Timothy P Napier-Hemy
- Department of Urology, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Liverpool, UK
| | - Alan King Lun Liu
- Department of Urology, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Liverpool, UK
| | - Michael S Floyd
- Department of Urology, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Liverpool, UK
| | - Sid McNulty
- Department of Endocrinology, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Liverpool, UK
| | - Ahmad M Omar
- Department of Urology, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Liverpool, UK
| | - Rahul Mistry
- Department of Urology, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Liverpool, UK
| | - Hosea By Gana
- Department of Urology, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, Liverpool, UK
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Wenzel M, Welte MN, Grossmann L, Preisser F, Theissen LH, Humke C, Deuker M, Bernatz S, Gild P, Ahyai S, Karakiewicz PI, Bodelle B, Kluth LA, Chun FKH, Mandel P, Becker A. Multiparametric MRI may Help to Identify Patients With Prostate Cancer in a Contemporary Cohort of Patients With Clinical Bladder Outlet Obstruction Scheduled for Holmium Laser Enucleation of the Prostate ( HoLEP). Front Surg 2021; 8:633196. [PMID: 33718429 PMCID: PMC7947872 DOI: 10.3389/fsurg.2021.633196] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/25/2021] [Indexed: 01/15/2023] Open
Abstract
Objective: To investigate the value of standard [digital rectal examination (DRE), PSA] and advanced (mpMRI, prostate biopsy) clinical evaluation for prostate cancer (PCa) detection in contemporary patients with clinical bladder outlet obstruction (BOO) scheduled for Holmium laser enucleation of the prostate (HoLEP). Material and Methods: We retrospectively analyzed 397 patients, who were referred to our tertiary care laser center for HoLEP due to BOO between 11/2017 and 07/2020. Of those, 83 (20.7%) underwent further advanced clinical PCa evaluation with mpMRI and/or prostate biopsy due to elevated PSA and/or lowered PSA ratio and/or suspicious DRE. Logistic regression and binary regression tree models were applied to identify PCa in BOO patients. Results: An mpMRI was conducted in 56 (66%) of 83 patients and revealed PIRADS 4/5 lesions in 14 (25%) patients. Subsequently, a combined systematic randomized and MRI-fusion biopsy was performed in 19 (23%) patients and revealed in PCa detection in four patients (5%). A randomized prostate biopsy was performed in 31 (37%) patients and revealed in PCa detection in three patients (4%). All seven patients (9%) with PCa detection underwent radical prostatectomy with 29% exhibiting non-organ confined disease. Incidental PCa after HoLEP (n = 76) was found in nine patients (12%) with advanced clinical PCa evaluation preoperatively. In univariable logistic regression analyses, PSA, fPSA ratio, and PSA density failed to identify patients with PCa detection. Conversely, patients with a lower International Prostate Symptom Score (IPSS) and PIRADs 4/5 lesion in mpMRI were at higher risk for PCa detection. In multivariable adjusted analyses, PIRADS 4/5 lesions were confirmed as an independent risk factor (OR 9.91, p = 0.04), while IPSS did not reach significance (p = 0.052). Conclusion: In advanced clinical PCa evaluation mpMRI should be considered in patients with elevated total PSA or low fPSA ratio scheduled for BOO treatment with HoLEP. Patients with low IPSS or PIRADS 4/5 lesions in mpMRI are at highest risk for PCa detection. In patients with a history of two or more sets of negative prostate biopsies, advanced clinical PCa evaluation might be omitted.
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Affiliation(s)
- Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Maria N. Welte
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Lina Grossmann
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Lena H. Theissen
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Clara Humke
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Marina Deuker
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Simon Bernatz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Philipp Gild
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sascha Ahyai
- Department of Urology, University Hospital Goettingen, Goettingen, Germany
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC, Canada
| | - Boris Bodelle
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Luis A. Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Felix K. H. Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt, Germany
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Affiliation(s)
- Stavros Gravas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
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Abstract
Clinical benign prostatic hyperplasia (BPH), often identified as a worsening ability of a male to pass urine, is a significant problem for men in our society. In 2015, the use of personalised medicine is tailoring treatment to individual patient needs and to genetic characteristics. Technological advances in surgical treatment are changing the way BPH is treated and are resulting in less morbidity. The future of BPH treatments is exciting, and a number of novel techniques are currently under clinical trial.
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Affiliation(s)
- Simon van Rij
- Guy's & St. Thomas NHS Trust, Great Maze Pond, London, SE1 9RT, UK
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