Bipolar Transurethral Enucleation Research Articles

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.

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. 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. 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. 1.4g/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. EEP can be safely performed under both GA and SA. GA offers better outcomes in terms of perioperative bleeding and 3-month functional outcomes.

Clinical-radiomics combination model for predicting the short-term efficacy of bipolar transurethral enucleation of the prostate in patients with benign prostatic hyperplasia

Abstract Background Bipolar transurethral enucleation of the prostate (B-TUEP) is a well-established surgical treatment for benign prostatic hyperplasia (BPH); however, its efficacy may vary depending on patient characteristics. Magnetic resonance imaging with radiomics analysis can offer comprehensive and quantitative information about prostate characteristics that may relate to surgical outcomes. This study aimed to explore the value of magnetic resonance imaging and radiomics analysis in predicting the short-term efficacy of B-TUEP for BPH. Materials and methods A total of 137 patients with BPH who underwent B-TUEP at 2 institutions were included. Radiological features were measured in the magnetic resonance images, and the radiomics score was developed from 1702 radiomics features extracted from the prostate and transitional zone regions of interest. Three prediction models were developed and validated based on clinical-radiological features, radiomic features, and their combinations. The models were evaluated using the area under the receiver operating characteristic curve, calibration curve, and decision curve analysis. Results The combination model exhibited the highest area under curve in both the training set (0.838) and the external validation set (0.802), indicating superior predictive performance and robustness. Furthermore, the combination model demonstrated good calibration (p &gt; 0.05) and optimal clinical utility. The combination model indicated that a higher maximum urine flow rate, lower transitional zone index, and higher radiomics score were associated with an increased risk of poor efficacy. Conclusions Magnetic resonance imaging with radiomic analysis can offer valuable insights for predicting the short-term efficacy of B-TUEP in patients with BPH. A combination model based on clinical and radiomics features can assist urologists in making more precise clinical decisions.

Evaluation of the clinical efficacy of transurethral bipolar surgery and laser technologies in the treatment of patients with benign prostatic hyperplasia

BACKGROUND: Benign prostatic hyperplasia (BPH) is common middle-aged and elderly men. In modern urology, transurethral resection and its modifications are used in surgical treatment of BPH. In the last decades, an active tendency of laser technologies development in urology was noted. The search for the most appropriate techniques of transurethral removal of prostate adenoma by comparing the results of treatment of patients with the use of different technologies remains relevant. AIM: This study aimed to evaluate the clinical effectiveness of transurethral bipolar surgery and laser technologies in the treatment of BPH. MATERIALS AND METHODS: Transurethral enucleation of the prostate using various technologies was performed in 273 patients with BPH between 2021 and 2023: 94 patients underwent bipolar transurethral enucleation of the prostate, 87 underwent thulium enucleation of the prostate (ThuLEP), and 92 underwent holmium enucleation of the prostate (HoLEP). RESULTS: Clinical evaluation showed the absence of intraoperative complications. For ThuLEP, a trend toward shorter operative times compared to other techniques was observed. In the early postoperative period, significant bleeding was noted in six cases of using bipolar technology, three cases of using a thulium laser, and five cases of using a holmium laser. An examination of patients 6 months postsurgery showed pronounced positive dynamics in all three groups. No significant differences were found in clinical parameters 6 months postsurgery in patients of different groups. CONCLUSIONS: Bipolar enucleation of the prostate, ThuLEP, and HoLEP are comparable in effectiveness and the number of complications in the surgical treatment of BPH. Study results indicated that it is advisable to actively use these methods in wide clinical practice.

Efficacy and Recovery in BPH Surgery: Insights from Transurethral Bipolar Enucleation

Efficacy and Recovery in BPH Surgery: Insights from Transurethral Bipolar Enucleation

It is not the best option to perform transurethral enucleation of the prostate immediately after biopsy in patients with histological inflammation.

This study seeks to investigate the impact of histopathological evidence of histological prostatic inflammation (PI) on the surgical outcomes of patients with benign prostatic hyperplasia (BPH) undergoing transurethral bipolar enucleation of the prostate (BiLEP) after biopsy. We conducted a prospective study in which data were collected from 112 patients with BPH who underwent BiLEP immediately after prostate biopsy at the Department of Urology in our hospital between October 2020 and October 2023. This cohort included 52 patients with histopathological prostatic inflammation (BPH + PI group) and 60 patients with simple BPH (BPH group). Baseline characteristics, surgical details, International Prostate Symptom Score (IPSS), quality of life (QoL), post-void residual volume (PVR), maximum flow rate (Qmax), International Index of Erectile Function-5 (IIEF-5), postoperative pathology results, and surgical complications were compared between the two groups. The study findings indicate that in patients with BPH who underwent BiLEP, various parameters in the BPH + PI group including operation time, intraoperative flushing volume, hemoglobin drop value, postoperative white blood cells, postoperative C-reactive protein, and average pain score at 3 days postoperatively were significantly higher compared to those in the BPH group (p < 0.01). In addition, the IPSS and IIEF-5 scores of the BPH + PI group were significantly worse before surgery and at 2 weeks postoperatively compared to the BPH group (p < 0.01); however, no significant differences were observed between the two groups at 1 and 3 months postoperatively (p > 0.05). At 2 weeks postoperatively, the BPH + PI group exhibited significantly worse outcomes in terms of QoL, PVR, and Qmax compared to the BPH group (p < 0.01). However, there were no statistically significant differences between the two groups at 1 and 3 months postoperatively (p > 0.05). The incidence rates of postoperative complications, such as fever, prostatic capsule perforation, urinary tract irritation, bladder spasm, acute epididymitis, urinary tract infection, and urethral stricture, were higher in the BPH + PI group compared to the BPH group (p < 0.05). Nevertheless, there was no significant difference in the overall complication rates between the two groups (p > 0.05). There were no statistically significant differences observed between the two groups in postoperative irrigation volume, extubation time, hospitalization time, proportion of secondary operations, proportion of bladder injury, and proportion of urinary incontinence (p > 0.05). However, the proportion of reported prostate cancer after surgery in the BPH + PI group was significantly higher than that in the BPH group (p < 0.05). Histopathological prostatic inflammation does not have a significant impact on the long-term efficacy of BiLEP surgery immediately after biopsy. However, it does prolong surgery time, increase surgery-related complications, and influence short-term surgical outcomes and patient treatment experience. Therefore, it may be advisable to administer a course of anti-inflammatory treatment before performing BiLEP in such patients. Nevertheless, further high-quality studies are necessary to validate this approach.

Comparison between bipolar transurethral enucleation versus bipolar transurethral resection of the prostate from 60 to 100 gm: A prospective randomized study

Comparison between bipolar transurethral enucleation versus bipolar transurethral resection of the prostate from 60 to 100 gm: A prospective randomized study

Comparison of the results of bipolar transurethral enucleation and resection of the prostate with and without morcellation in treatment of benign prostatic hyperplasia

Objective: To compare the result of bipolar transurethral enucleation and resection of the prostate with morcellation (B-TUERP-M) and without morcellation (B-TUERP) in treatment of benign prostatic hyperplasia. Materials and Methods: This was a prospective single centre cohort study of 101 patients with prostate enlargement of more than 60 ml who underwent B-TUERP by a single surgeon between January 2020 and June 2022. Patients were divided into two groups, a B-TUERP group of 49 patients and a second group of 52 patients classed as B-TUERP-M. The perioperative outcomes followed up at 1, 3 and 6 months after surgery were evaluated. Results: There were no significant differences in the preoperative parameters of the two groups. Comparisons between the two groups showed a shorter operative time (63.94 ± 12.01 vs 77.77 ± 11.80 min, p-value 0.000), more resected prostate tissue (65.73 ± 14.67 vs 60.73 ± 5.45 gm, p-value 0.027) and a higher post-operative hematocrit level (35.16 ± 3.97 vs 33.18 ± 3.22%, p-value 0.007) in the patients who underwent B-TUERP with morcellation. At 6 months after the procedure, better results were found in patients who had undergone B-TUERP-M regarding urine flow rate (26.33 ± 5.33 vs 20.66 ± 5.08 ml/sec, p-value 0.000), post-void residual urine volume (24.19 ± 10.93 vs 36.04 ± 16.90 ml, p-value 0.000), post-operative PSA (0.72 ± 0.43 vs 1.22 ± 0.54 mg/ml, p-value 0.000) and International Prostate Symptom Scores (5.01 ± 1.36 vs 5.71 ± 1.33, p-value 0.001). Conclusion: Better outcomes occurred following B-TUERP with morcellation with regard to operative time, resection weight of prostatic adenoma, post-operative urine flow rate, Post-void residual urine volume, PSA and International Prostate Symptom Score than in patients treated with B-TUERP without morcellation.

Initial experience with prostatic urethral lift versus enucleation of the prostate: a retrospective comparative study

BackgroundThis study aimed to assess initial results and patient characteristics of prostatic urethral lift (PUL) compared with those of bipolar transurethral enucleation of the prostate (TUEB) in the treatment of benign prostatic hyperplasia (BPH) in older patients.MethodsThis retrospective study was conducted at a single institution and involved 25 consecutive patients with BPH who underwent PUL between April 2022 and May 2023. Patient characteristics, operative details, and pre- and postoperative symptom scores were evaluated. The results were compared with those of a previously reported TUEB group (n = 55).ResultsThe mean age of the patients in the PUL group was 74.6 years, and the mean prostate volume was 47.5 ml. The PUL procedure significantly improved urinary symptoms, particularly incomplete emptying (p = 0.041), intermittency (p = 0.005), and weak stream (p = 0.001). The PUL group had higher comorbidity scores (p = 0.048) and included older patients (p = 0.002) than the TUEB group. TUEB showed better improvements in some symptoms and maximum flow rate (p = 0.01) than PUL; however, PUL had a shorter operative time and fewer complications than TUEB (p < 0.001).ConclusionThe initial results demonstrate the efficacy and safety of PUL in older patients with BPH. Despite TUEB showing better outcomes in certain aspects than PUL, PUL offers advantages such as shorter operative time and fewer complications. Therefore, PUL can be considered a viable option for high-risk older patients with BPH.

Comparative Study between Bipolar Transurethral Resection and Bipolar Transurethral Enucleation of the Prostate for Managing Benign Prostatic Hyperplasia

Introduction: Benign prostatic hyperplasia is considered a common disorder that occurs with advancing age inmales. The bladder outlet obstruction is the main complaint associated with this condition that could be managedwith different endoscopic approaches the traditional one is the transurethral prostatic resection and recently thetransurethral prostatic enucleation has emerged. This study aimed to compare between both techniques.Methods: This was a clinical trial performed at Ahmed Maher Teaching hospital. Patients were randomized toeither Group (1): (TUEP) patients subjected to the bipolar transurethral enucleation of prostate and Group (2):(TURP) patients subjected to the bipolar transurethral resection of the prostate. After the surgical procedures,the patients were compared regarding the success rate and the perioperative complications. Three months aftersurgery, assessment was done through uroflowmetry studies, post-voiding residual volume of urine and theInternational Prostate Symptom Score.Results: The mean duration of the procedure showed no significant differences between both groups in TUEP(82.8±8.4 min) vs (79.7±8.80 min) TURP (P=0.262). Post-operative drop of haemoglobin level was less in TUEPvs TURP (0.79±.14 vs 1.41±.42) g/dl (P=0.007), in addition to shorter time needed for catheters (46.10±10.18 vs56.65±13.14 hr; P=0.036) and less duration of hospital stay (53.70±9.13 vs 62.40±12.06 hr; P=0.001). A significantimprovement was observed between baseline and 3 months postoperatively regarding uroflowmetry (Qmax),IPSS and PVR in both groups.Conclusion: The mean operative time was nearly similar in both groups, however TUEP was associated with lessbleeding, shorter time needed for catheters, less time needed for hospital stay. After 3 month, uroflowmetry Qmax,PVR and IPSS were similar in both procedures.

Diode Laser Enucleation vs. Bipolar Transurethral Enucleation of Prostate for Benign Prostatic Hyperplasia: A Retrospective Comparative Study with Three-Year Follow Up.

To assess the clinical outcome of 1470 nm diode laser enucleation of the prostate (DiLEP) vs. bipolar transurethral enucleation of prostate (TUEP) for benign prostatic hyperplasia (BPH). One hundred and fifty-seven patients were retrospectively involved in this study. Eighty-two patients underwent DiLEP while 75 underwent bipolar TUEP. Seventy-three patients in DiLEP and sixty-nine in bipolar TUEP completed the 3-year follow-up, respectively. The baseline properties, perioperative data, and postsurgical outcomes were evaluated. No statistically significant differences were found between DiLEP and bipolar TUEP in preoperative parameters. Significantly shorter operating time was noted in DiLEP group (p = 0.000). No patient suffered dangerous complications, and none in either group required a blood transfusion. No statistically significant differences were found between DiLEP and bipolar TUEP in the decrease in hemoglobin or sodium. During the 3-year postoperative follow-up, ongoing and significant improvements were found in both groups without any difference. Both DiLEP and bipolar TUEP can improve low urinary tract symptoms (LUTS) secondary to BPH in a comparable way with high efficacy. Compared with bipolar TUEP, DiLEP with a morcellator required a shorter operative time.

Comparison of outcomes of holmium laser versus bipolar enucleation of prostates weighing >80 g with bladder outlet obstruction

Transurethral enucleation of the prostate has been increasingly recognized as an effective minimally invasive technique for management of enlarged prostates. We aimed to compare holmium laser enucleation (HoLEP) and bipolar transurethral enucleation (B-TUEP) of large-volume prostates. A prospectively maintained database in two tertiary referral centers was reviewed for patients with HoLEP and B-TUEP for prostates >80 g. Operative data, perioperative complications, and early postoperative outcomes were compared. The study included 101 patients, 70 who underwent HoLEP and 31 who underwent B-TUEP. The operative enucleation rate (weight of adenoma enucleated in g/min) was higher in HoLEP compared to B-TUEP (P < 0.0001). The operative complication rate, hemoglobin drop, and readmission rate were comparable in both groups (P = 0.13, 0.35, 0.29, 0.59, respectively). The HoLEP arm had a shorter hospital stay and shorter catheterization time (P = 0.001, 0.012). Follow-up data showed a lower International Prostate Symptom Score and serum prostate-specific antigen level in the HoLEP group. The incontinence rate was comparable in both groups. In conclusion, both techniques were effective in managing a high-volume prostate, although HoLEP had a shorter enucleation time, better symptom score, lower postoperative prostate-specific antigen level, shorter catheterization time, and shorter hospital stay compared to B-TUEP.

Long-term outcomes of bipolar transurethral enucleation and resection of the prostate on patients with benign prostatic obstruction: a 10-year follow-up.

We aimed to explore the long-term outcomes of bipolar transurethral enucleation and resection of the prostate (B-TUERP) in patients with benign prostatic hyperplasia (BPH). A total of 1195 patients with BPH who underwent B-TUERP from July 2006 to June 2010 were enrolled in this retrospective study. Preoperative data, particularly urodynamic study (UDS) parameters, were collected by questionnaire and examination. Postoperative follow-up was performed at 3, 6, 12, 36, 60 and 120 months, respectively. Demographic, perioperative and functional data were analysed. International Prostate Symptom Score, quality of life and overactive bladder syndrome score (OABSS) were used to assess the functional scores. Predictors of postoperative urgency incontinence were identified by univariate analysis. Long-term outcomes of functional score were significantly better than the preoperative values. All UDS variables, including maximum urinary flow rate, postvoid residual urine volume, compliance, maximum cystometric capacity (MCC), bladder outlet obstruction index, prostatic urethral pressure and detrusor pressure at maximum urinary flow rate, were all significantly improved. No one required reoperation due to recurrent BPH. The postoperative rate of transient urinary incontinence was 31.7%, while the long-term incontinence rate was 0%. Retrograde ejaculation occurred in 44.3% patients who remained sexually active after operation. Patients who had transient urge incontinence were older with preoperative higher OABSS, prostate-specific antigen (PSA) and detrusor overactivity rate and lower MCC. B-TUERP is a safe, successful and highly effective treatment for BPH at 10-year follow-up. Increased age, OABSS, PSA level and detrusor overactivity rate are potential predictors for urge incontinence after B-TUERP.

The Efficacy and Safety of HoLEP for Benign Prostatic Hyperplasia With Large Volume: A Systematic Review and Meta-Analysis

This meta-analysis was to evaluate the efficacy and safety of holmium laser enucleation of prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) with large volume. PubMed, Embase, and Cochrane Library databases (until March 2022) were used to search related randomized controlled trials. A total of 11 studies including 1,258 patients were involved. HoLEP could significantly decrease the length of hospital stay and accelerate recovery. In subanalysis, HoLEP had better perioperative outcomes than bipolar transurethral resection of the prostate (B-TURP) and bipolar transurethral enucleation of the prostate (BPEP). The improvement in operative time and enucleation time was better in thulium laser enucleation of the prostate (ThuLEP) than HoLEP. In the follow-up period, the HoLEP decreased post-void residual urine (PVR) in short-term intervals and improved patients’ maximum flow rate (Qmax) and prostate-specific antigen (PSA) in mid- and long-term intervals. In subanalysis, HoLEP presented significant improvements in Qmax, PSA, and quality of life (QoL) than B-TURP, and HoLEP could also improve Qmax than ThuLEP after 6 months of surgery. The HoLEP reduced the risk of postoperative bleeding compared with other surgeries in safety. In our study, we confirmed the advantages of HoLEP in treating BPH when the prostate size was larger than 80 mL, which indicated that HoLEP could be the best choice for treatment of large volume of prostate.

MP29-12 TRANSURETHRAL BIPOLAR ENUCLEATION (TUBE): IMPROVED OUTCOMES VERSUS STANDARD BIPOLAR TRANSURETHRAL PROSTATE RESECTION (TURIS) WITHOUT A SIGNIFICANT LEARNING CURVE MAY EASE ADOPTION OF ENUCLEATION TECHNIQUES INTO CLINICAL PRACTICE

You have accessJournal of UrologyCME1 May 2022MP29-12 TRANSURETHRAL BIPOLAR ENUCLEATION (TUBE): IMPROVED OUTCOMES VERSUS STANDARD BIPOLAR TRANSURETHRAL PROSTATE RESECTION (TURIS) WITHOUT A SIGNIFICANT LEARNING CURVE MAY EASE ADOPTION OF ENUCLEATION TECHNIQUES INTO CLINICAL PRACTICE Zachary Tully, Brian Barnes, Ryan Steinberg, and Bradley Erickson Zachary TullyZachary Tully More articles by this author , Brian BarnesBrian Barnes More articles by this author , Ryan SteinbergRyan Steinberg More articles by this author , and Bradley EricksonBradley Erickson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002572.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Despite ample evidence of safety and superiority, transurethral enucleation procedures, most commonly with the holmium laser (HOLEP), have not been widely adopted (<5% in US), likely due to a combination of a steep learning curve and technological barriers. Herein we present our experience with transurethral enucleation using the Olympus® bipolar electrode, a technology with wide availability, use, and surgeon familiarity. METHODS: We reviewed consecutive transurethral outlet procedures using bipolar energy for benign prostatic hyperplasia (BPH) from a single institution from 2010-20 and divided them into two cohorts: standard transurethral resection in saline (TURis; n = 383) and transurethral bipolar enucleation (TUBE; n = 208). All TUBE procedures were performed by a single surgeon. Perioperative characteristics between the two cohorts were compared with unpaired two-tailed t-tests and Chi-squared tests. A separate learning curve analysis was performed for the TUBE procedures that determined the impact that case number had on operative time and tissue resection. RESULTS: Comparisons are shown in the Table. The TUBE cohort was more likely to be catheter dependent pre-operatively and have a higher pre-op PSA. TURis operative time was 10 minutes less on average, but TUBE tissue resection weights were significantly greater. Hospital and catheter times were statistically similar. Post-operatively, TUBE led to a greater reduction in PSA, catheter dependence and BPH medication use. De novo incontinence and need for secondary outlet procedures were higher in TURis. De novo PDE-5 use was greater in TUBE. Cancer detection was greater after TURis. The variability in TUBE operative time (r2 = 0.0024) and resection weight (r2 = 0.007) was not related to surgery number/surgeon experience. CONCLUSIONS: Utilizing the same instrumentation and electrodes, the TUBE technique offers significant advantages to a standard TURis loop resection without an appreciable learning curve. Widespread instrument familiarity, as well as the ability to perform both resection and enucleation maneuvers in the same case, may increase the likelihood of adoption into clinical practice for those hesitant to learn HOLEP. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e473 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary Tully More articles by this author Brian Barnes More articles by this author Ryan Steinberg More articles by this author Bradley Erickson More articles by this author Expand All Advertisement PDF DownloadLoading ...

Comparison of holmium laser enucleation with bipolar transurethral enucleation of the prostate in patients with benign prostatic hyperplasia: Results of a multicentre study.

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.

Is the Peripheral Zone Thickness an Indicator of a Learning Curve in Bipolar Transurethral Plasma Enucleation of the Prostate?-A Single Center Cohort Study.

BackgroundWe 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.MethodsFor 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.ResultsOne-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).ConclusionLower 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.

Comparison of Outcome and Quality of Life Between Thulium Laser (VelaTM XL) Enucleation of Prostate and Bipolar Transurethral Enucleation of the Prostate (B-TUEP).

Background and PurposeIn this study, we compared patient outcomes between the 120-W thulium laser (Vela™XL) prostate enucleation (ThuLEP) and bipolar transurethral enucleation of the prostate (B-TUEP) techniques.MethodsWe excluded patients with concomitant prostate cancer and bladder cancer and prospectively analyzed patients with benign prostatic obstruction (BPO) who underwent ThuLEP and B-TUEP from October 2018 to January 2021 in our institution. Patients’ demographics, comorbidities, prostate volumes, prostate-specific antigen (PSA) levels, and International Prostate Symptoms Score (IPSS) were recorded. Perioperative outcomes including intraoperative blood loss, prostate resection percentage of the transition zone, postoperative pain score (numeric rating scale, NRS), complications, changes in postoperative uroflowmetry parameters, IPSS, and the rate of reuse of BPH medications were also evaluated.ResultsThe data of a total of 111 patients (ThuLEP: 49, B-TUEP: 62) met the inclusion criteria were collected and analyzed prospectively. Our results revealed no significant differences between ThuLEP and B-TUEP in terms of operation time, prostate tissue enucleated, and days of hospitalization. However, patients in the ThuLEP group reported less pain after surgery than those in the B-TUEP group, and a higher proportion of patients in the B-TUEP group returned to the emergency department due to complications within one month postoperatively, with hematuria being the main cause. No significant differences were observed between the groups in changes in uroflowmetry parameters and IPSS at 2 weeks, 3 months, and 6 months postoperatively.ConclusionThe efficacy of ThuLEP was comparable to that of B-TUEP in terms of maximal flow rate, voiding volume, IPSS, and quality of life. ThuLEP also had several advantages over B-TUEP, including less blood loss and less postoperative pain. Therefore, ThuLEP can be considered a treatment of choice for BPH/bladder outlet obstruction, specifically for patients with a bleeding tendency and fear of pain.

Clinical Outcome of Endoscopic Enucleation of the Prostate Compared With Robotic-Assisted Simple Prostatectomy for Prostates Larger Than 80 cm3 in Aging Male.

This study investigated and compared the surgical outcomes of using endoscopic enucleation (thulium: YAG laser and bipolar plasma; ThuLEP) with robotic-assisted simple prostatectomy (RASP) in the treatment of prostates larger than 80 cm3. Records were obtained for the period from January 2014 to December 2020 for selected patients with BPO who underwent RASP, ThuLEP, or bipolar transurethral enucleation of the prostate (B-TUEP). Patients were excluded if they had active malignant disease, neurogenic bladder, lower urinary tract syndrome for reasons other than BPO, and a history of prostate surgery. Data of 396 patients who underwent B-TUEP, ThuLEP, and RASP were examined. A total of 112 patients met the including criteria, 85 of whom (B-TUEP: 29; ThuLEP: 41; RASP: 15) completed the final visit. The mean operation time and duration of postoperative hospital stays in the RASP group were significantly longer than those of the B-TUEP and ThuLEP groups. Only 1 patient in the RASP group required blood transfusion. The RASP group was superior to the other groups in voiding improvement including Qmax and IPSS voiding score. The pain score of the ThuLEP group after surgery was significantly lower than that of the other two groups during hospitalization, whereas the QoL scores were identical between the three groups at 2 weeks, 3 months, and 6 months post operation. The rates of returning to ER within the first postoperative month did not differ significantly between the three groups, and all the reasons for return involved minor complications that required no additional invasive treatment. These three surgical methods (B-TUEP, ThuLEP, and RASP) are all effective and safe for treating prostates larger than 80 cm3, with each having its particular advantages. B-TUEP requires the shortest operation time, ThuLEP causes the lowest postoperative pain, and RASP results in superior voiding function improvement.

Minimally invasive surgery for benign prostatic hyperplasia: causes, forms, and prevention of urinary disorders (literature review)

Benign prostatic hyperplasia (BPH) ranks 4th among all diagnoses in the group of men 50 years of age and older. With an increase in prostate volume of more than 20 cm³, patients develop lower urinary tract symptoms (LUTS), which negatively affect the quality of life of men. Currently, minimally invasive endovideosurgical methods of treating BPH have proven themselves successfully: transurethral resection (TUR) of monopolar or bipolar type, transurethral bipolar enucleation of the prostate (TUEP), holmium laser enucleation of the prostate (HoLEP). However, despite the clinical efficiency of endoscopic operations, the incidence of postoperative complications remains quite significant. After surgical intervention, the main causes of urinary disorders are detrusor overactivity or a decrease in its functional activity, as well as bladder obstruction. Prolonged bladder catheterization in the postoperative period prevents early recovery of independent urination, which is a risk factor for the development of urinary disorders. Stress urinary incontinence has a significant impact on patients, both physically and mentally. For the treatment of postoperative stress urinary incontinence, behavioral therapy, drug treatment of disorders, minimally invasive methods of treatment are used: injections of hyaluronic acid into the submucous layer of the urethra, botulinum toxin into the detrusor, as well as the technique of sacral neuromodulation. Surgical methods include the implantation of a synthetic sphincter or the installation of male sling.

Assessment of copulative function and severity of lower urinary tract symptoms in patients with benign prostatic hyperplasia after transurethral enucleation

AIM: was to conduct a comparative assessment of copulative function and the severity of lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) who underwent laser and bipolar transurethral enucleation of the prostate and who treated conservatively.&#x0D; MATERIALS AND METHODS: 143 BPH patients aged 50 to 80 years (mean age 65 years) with complaints of copulatory and urinary disorders were under observation. All patients were divided into two groups. The 1st (main) group included 102 patients who underwent surgical treatment: transurethral laser enucleation of the prostate (n = 55) and transurethral bipolar enucleation of the prostate (n = 47). Patients of the 2nd group (n = 41) received conservative treatment. Control examinations were performed before treatment, 4, 12 and 24 weeks after it.&#x0D; RESULTS: All 102 patients of group 1, regardless of the type of surgery, noted retrograde ejaculation four weeks after surgery. In the majority of patients of the 1st group during these periods weakening of orgasm was noted, in a significant number deterioration of erection and decreased libido were noted. Upon further observation, by the 12th week after the operation, restoration of all components of the copulatory function was noted, with the exception of ejaculation. By the 24th week of observation, only in 2 patients of the 1st group the normal mechanism of ejaculation was restored. Surgical treatment of patients in group 1, regardless of the method of surgery, led to a significant decrease in the severity of LUTS, an increase in the maximum urine flow rate, a decrease in the volume of the prostate gland and the amount of residual urine. There were no significant differences in the dynamics of these indicators depending on the method of transurethral enucleation. The patients of the 2nd group also had an improvement in clinical parameters, but it was much less pronounced than in the 1st group.&#x0D; CONCLUSION: Laser and bipolar transurethral enucleation of the prostate are effective surgical techniques that significantly improve the outflow of urine from the bladder, reduce the severity of LUTS and improve the sexual function of patients. Surgery is well tolerated by patients. At the same time, almost all patients operated on by these methods develop retrograde ejaculation.