Bipolar Transurethral Enucleation Research Articles

Bipolar Transurethral Enucleation of the Prostate: Is it a size-independent endoscopic treatment option for symptomatic benign prostatic hyperplasia?

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. 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. 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. 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.

Bipolar transurethral enucleation of the prostate combined with open cystolithotomy in the treatment of large and giant prostate with bladder stones: Case series.

The surgical management of large or giant prostate still has challenges to urologists, especially if combined with bladder stones, and the traditional techniques by open prostatectomy and cystolithotomy have significant morbidity rates. The endoscopic procedure might not be feasible to treat both conditions in a single procedure, despite advances in surgical techniques and instrumentation, we present a one-session procedure by a combined endoscopic and open approach for treating benign prostatic hyperplasia (BPH) larger than 100 g combined with bladder stones in the elderly patient with other comorbidities. Between May 2017 and January 2020, bipolar transurethral plasma kinetic enucleation of the prostate (TUEP) followed by open cystolithotomy was performed to six patients at our institution, three of them combined with a big bladder stone(s). All the patients have other chronic chest and heart diseases; we retrospectively collected the data. All the patients diagnosed as BPH of big size or giant prostate over 100 g, with bladder stone, and all the patients treated with the same procedure. We founded that the combination methods showed a significant effect in terms of surgery time, patient outcomes and recovery, hospital discharge. The mean age of patients was 78.16 ± 4.2 (73-84) years, and the mean prostate-specific antigen (PSA) value was 16.27 ± 10.01 (8.32-32.17) ng/mL. The mean size of the prostate measured by MRI/US was 266.16 ± 89.1 (169-405) mL. The mean total operation time was 70.5 ± 10.9 (60-90) min, while the mean enucleation time was 28.38 ± 6.61 (23-40) min. The mean intraoperative blood loss was 193.33 ± 19.66 (170-220) mL. The mean resected prostate weight was 217.166 ± 94.67 (117-365) g. The mean post-operative hospital stay was 2.6 ± 0.81 (2-4) days. One patient was readmitted 2 months later due to urinary tract infection, and one patient complains of urine incontinence who spontaneously subsided in 4 months after surgery, other that no severe postoperative complications observed, a significant reduction of serum PSA and IPSS recorded at 3 months, postoperatively. Although simple open prostatectomy remains the reference standard for the treatment. Of excessively large or giant prostatic hyperplasia, the combination procedure not only facilitates the management of selected cases of hyperplasia but further imparts significant benefits to patients and surgeons alike. This treatment plan is safe, time-consuming, and could revolutionize future treatment approaches to giant prostate.

IJU this issue

This issue deals with a wide range of clinical topics of urology, and contains 14 Original Articles. Percutaneous nephrolithotomy (PCNL) is a minimally invasive endourological procedure recommended as first-line therapy for kidney stones >2 cm in diameter. In general, however, nephrectomy is carried out in patients with large stones within non-functioning atrophic kidneys. Su et al. (Beijing, China) evaluated outcomes in patients who underwent total ultrasound-guided PCNL for the management of large stones (>2 cm) within non-functioning atrophic kidneys. Their results showed that ultrasound-guided PCNL is safe and feasible, even for stones >2 cm in diameter within non-functioning atrophic kidneys. However, PCNL is not recommended for patients with diabetes. Several energy sources have been used for stone fragmentation during ureteroscopy. Nowadays, the holmium:YAG laser is a standard method that provides effective and safe disintegration of all stone types. However, it has some disadvantages, such as relatively high retropulsion (which might lead to relocation of the stone into the renal pelvis). Enikeev et al. (Moscow, Russia) estimated the efficacy and safety of SuperPulsed thulium-fiber laser ureteral lithotripsy, and identified optimal laser settings. Their results showed that the SuperPulsed thulium-fiber laser provides effective and safe lithotripsy during ureteroscopy regardless of stone density. Fiber diameter and laser frequency do not influence visibility or safety. Optimal laser settings are 0.5 J × 30 Hz for fragmentation and 0.15 J × 100 Hz for dusting. Subclinical Cushing syndrome is defined as a condition of hypercorticolism in patients with adrenal tumors in the absence of clinical features of Cushing syndrome. Although surgical removal of adrenal tumors for subclinical Cushing syndrome patients has been reported to be beneficial with the improvement of comorbidities, such as hypertension, diabetes mellitus and obesity, the surgical benefit is still controversial. Sato et al. (Chiba, Japan) retrospectively investigated whether the result of the 1-mg dexamethasone suppression test could predict the improvement of comorbidities after adrenalectomy in patients with subclinical Cushing syndrome. Their results showed that the greatest reduction of prescribed drugs is observed in patients whose serum cortisol levels are between 1.8 and 3.0 μg/dL after the 1-mg dexamethasone suppression test, implicating that the 1-mg dexamethasone suppression test can be a useful factor predicting the improvement of comorbidities after adrenalectomy. Today, it is well known that approximately half of cases of infertility are attributable to male factors. Recently, the European Association of Urology guideline for male infertility emphasized that oral anti-oxidants were associated with a significant increase in markers of sperm quality. Among the anti-oxidants, one of the elements perhaps most familiar and well known to the general public is zinc. Tsujimura et al. (Chiba, Japan) tried to clarify the factors associated with semen quality, and confirm whether there was an association between semen quality and serum zinc concentration. Although there was no significant correlation between serum zinc concentration and semen quality, the independent predictors for having values below the World Health Organization criteria for assessing sperm quality in binomial logistic regression analysis were follicle-stimulating hormone and serum zinc concentration. They suggested that semen analysis might be considered in men with a low level of serum zinc and high level of follicle-stimulating hormone when developing a reproductive life plan for fertilization. Yasuda et al. (Tokyo, Japan) developed the gasless approach as another type of minimally invasive endoscopic surgery, and applied it to many kinds of urological surgeries, including partial nephrectomy. In gasless partial nephrectomy, they prioritized clampless and sutureless surgery, if feasible, as an attempt to obtain maximal functional preservation. They investigated the outcomes and feasibilities of gasless laparoendoscopic single-port clampless sutureless partial nephrectomy. Their results showed that clampless and sutureless partial nephrectomy can be safely accomplished in most patients undergoing gasless laparoendoscopic single-port surgery, yielding favorable oncological and functional outcomes. Transurethral resection of the prostate represents the standard surgical technique for the management of benign prostatic hyperplasia with a prostate size <80 mL. However, considerable morbidities are associated with larger sizes. Higazy et al. (Cairo, Egypt) evaluated the safety, efficacy and cost-effectiveness of holmium enucleation of the prostate and bipolar transurethral enucleation of the prostate. Their results showed that both holmium enucleation of the prostate and bipolar enucleation of the prostate are safe and effective in the surgical management of large prostatic adenomas. However, holmium enucleation of the prostate has a shorter operative time and hospital stay, with an earlier catheter removal time, and is more cost-effective than bipolar enucleation of the prostate. None declared.

Holmium laser enucleation versus bipolar transurethral enucleation for treating benign prostatic hyperplasia, which one is better?

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.

Holmium laser enucleation of the prostate versus bipolar transurethral enucleation of the prostate in management of benign prostatic hyperplasia: A randomized controlled trial

To evaluate the safety, efficacy and cost-effectiveness of holmium enucleation of the prostate and bipolar transurethral enucleation of the prostate. In our randomized controlled trial, 120 patients were allocated into two equal groups representing holmium enucleation of the prostate and bipolar enucleation of the prostate. Operative parameters were recorded according to operative, enucleation and resection time in addition to the intraoperative complications. Patients were followed up at 1, 3 and 12months postoperative to assess the prostate size, post-voiding residual urine, International Prostate Symptom Score, peak urine flow rate and quality of life, and compared with the preoperative parameters. Cost analysis was evaluated for both procedures. We evaluated 107 patients who finished our follow up and their data were analyzed. The prostate size was 135.2±34.8mL and 125±26.9mL for holmium enucleation of the prostate and bipolar enucleation of the prostate, respectively. Holmium enucleation of the prostate was associated with a shorter operative time of 83.43±6.92min compared with 94.7±12.2min in bipolar enucleation of the prostate groups. Holmium enucleation of the prostate was associated with an earlier catheter removal time and shorter hospital stay compared with bipolar enucleation of the prostate. Postoperative International Prostate Symptom Score, quality of life, post-voiding residual urine, peak urine flow rate, prostate-specific antigen and prostate volume reduction were comparable between both groups, and they both showed statistically significant improvement compared with their preoperative parameters. In the cost analysis, holmium enucleation of the prostate was more cost-effective than bipolar enucleation of the prostate. Both holmium enucleation of the prostate and bipolar enucleation of the prostate are safe and effective in the surgical management of large prostatic adenomas. Holmium enucleation of the prostate has a shorter operative time and hospital stay with earlier catheter removal time, and is more cost-effective than bipolar enucleation of the prostate.

Sexual and ejaculatory function after holmium laser enucleation of the prostate and bipolar transurethral enucleation of the prostate: a single-center experience.

Currently available surgical treatments for Lower Urinary Tract Symptoms (LUTS) due to Benign Prostatic Obstruction (BPO) are associated with an increased risk of sexual dysfunction. The aim of our study is to compare sexual and ejaculatory function after Holmium Laser Enucleation of the Prostate (HoLEP) and Bipolar Transurethral Enucleation of the Prostate (B-TUEP). We performed a retrospective analysis of data prospectively collected from 62 (44.9%) and 76 (55.1%) patients who underwent HoLEP and B-TUEP, respectively. Erectile function and ejaculation characteristics were assessed with the International Index of Erectile Function-Erectile Function (IIEF-EF) domain and the Male Sexual Health Questionnaire-Ejaculatory function (MSHQ-EJ) questionnaires. Our study recorded no change in erectile function and no significant difference in rates of preserved antegrade ejaculation after both surgeries. One month after surgery, rates of physical pain/discomfort and perceived decreased physical pleasure during ejaculation were higher in HoLEP than B-TUEP patients (all p < 0.03). Moreover, HoLEP patients were more bothered by their ejaculatory difficulties than B-TUEP men (p = 0.03). At 3- and 12-months follow-up, all ejaculation-related differences disappeared. In conclusion, both procedures are valid alternatives for BPO treatment as they offer comparable urinary and sexual outcomes in the long term. However, in the first month after surgery, HoLEP patients present with more ejaculatory difficulties.

Bipolar plasmakinetic transurethral enucleation and resection versus bipolar plasmakinetic transurethral resection for surgically treating large (≥60 g) prostates: a propensity score-matched analysis with a 3-year follow-up.

Background There are extremely limited published studies comparing bipolar plasmakinetic transurethral resection of prostate (BP-TURP) and bipolar plasmakinetic transurethral enucleation and resection of prostate (BP-TUERP) for enlarged prostates. Our purpose is to evaluate the safety and efficiency of BP-TUERP and BP-TURP for large (≥ 60 g) prostates with a 3-year follow-up. Methods We retrospectively identified 229 patients according to inclusion criteria between 2014 and 2016. After applying propensity score matching method, preoperative results and three-year follow-up outcomes in International Prostate Symptom Score (IPSS), urinary peek flow rate (Qmax), postvoid residual urine (PVRU) volume and quality of life (QoL) score were compared. Results Finally, within the well-balanced matched cohort, the BP-TUERP was significantly associated with longer mean operating time (OT) (p = 0.039), shorter mean catheter time (CT) (p = 0.001) and lower mean hemoglobin decrease (p = 0.002) with more prostatic tissue removed (p = 0.001) than the BP-TURP, but the median hospital stay lengths and the short- and long-term complication rates were similar between the two series. The patients in the BP-TUERP group had better long-term outcomes in IPSS, Qmax and PVRU volume than these in the BP-TURP group, but not in QoL score. Conclusions For patients with large (≥ 60 g) prostates, BP-TUERP and BP-TURP are safe options, but the former is a more effective choice in long-term follow-up outcomes. BP-TUERP is related to reduced CT and hemoglobin decrease with more removal of prostatic tissue at the expense of longer OT than BP-TURP.

MONOPOLAR VERSUS BIPOLAR TRANSURETHRAL ENUCLEATION OF THE PROSTATE FOR LARGE VOLUME BENIGN PROSTATIC HYPERPLASIA

Background: The choice of treatment modality in patients with Benign Prostatic Hyperplasia (BPH) is one of the most discussed issues in urology. In recent years, the surgical treatment of prostates of large sizes by means of enucleation has become increasingly popular. The emergence of special loops to perform bipolar and monopolar enucleation using standard equipment for TURP has opened up new possibilities for the treatment of patients by transurethral monopolar enucleation.Aim of the Work: To evaluate the efficacy and safety of Monopolar versus Bipolar Transurethral Enucleation of the Prostatefor Large volume Benign Prostatic Hyperplasia. Patients and Methods: 40 patients with BPH were randomly divided into two groups: Group 1 underwent Monopolar Transurethral Enucleation of the Prostate (M-TUEP) (n=20), and Group 2 underwent Bipolar Transurethral Enucleation of the Prostate (B-TUEP) (n=20). Operation time, incidence of hyponatremia,estimated blood loss by drop of haemoglobin, improvement of International Prostate Symptom Score (IPSS) and Quality of Life (QoL) score, Uroflowmetry (Qmax and Qave), Post Voiding Residual Urine (PVR) and Prostate volume and other complications ( as reintervention for clots and bleeding control, recatheterization, UTI, incidence of TUR syndrome, incidence of infarction, incontinence, bladder neck contracture and urethral stricture) were compared. Results: Operation was successfully performed in all 40 cases, and no open surgery was converted in any case or blood transfusion was needed. There was no statistically significant difference between both groups in operative time, postoperative haemoglobin and serum sodium levels decline, or improvement in postoperative IPSS, QoL score, Qmax, Qave, Prostate volume and PVR. All patients were followed up to 6 months postoperatively, and no complications occurred except one patient in Group 1 (5% of Group 1 and 2.5 % of the whole study) developed Urethral stricture. Conclusion: M-TUEP was shown to be a safe and highly effective technique for relief of Bladder Outlet Obstruction (BOO). The clinical efficacy of M-TUEP is sustainable for up to 6 months of follow-up. Our single-center results show that M-TUEP has the same efficacy as B-TUEP for the surgical treatment of symptomatic BPH, so M-TUEP can replace B-TUEP with the same efficacy and comparable safety.

The Initial Clinical Experience of a New Generation Bipolar Electrosurgical and Morcellator Unit for Bipolar Transurethral Enucleation of the Prostate

Background and Objective To assess the feasibility and safety of performing bipolar transurethral enucleation of the prostate (BIPO-LEP) with a new generation of bipolar electrosurgical and morcellator system. Material and Methods Forty-five consecutive patients scheduled for endoscopic surgery for benign prostatic obstruction were pro-spectively recruited. BIPOLEP was performed with the use of the third generation Karl Storz AUTOCON III 400 and morcellator unit. All patients had a trial without a catheter on Day-1 after surgery. Demographical, preoperative, intraoperative and follow-up data up to 3 months post-surgery were collected and analyzed. Results Between May 2018 and April 2019, 45 consecutive patients underwent BIPOLEP in our institution were prospectively recruited for this study. The mean age was 76 years old. Thirty-four patients (75.6%) were in refractory retention or obstructive uropathy. The mean enucleation efficiency was 1.76 grams per minute of enucleation time (SD = 0.7 gram per minute). The mean bladder irrigation and catheterization times were 5.3 hours and 20.7 hours respectively. Only one patient failed voiding trial on Day-1 after surgery. The postoperative Day-1 discharge rate was 73.3% (n = 33). The median length of hospital stay was 1 day. No patient required clot evacuation or blood transfusion. Seven patients (15.6%) were readmitted within thirty days postoperatively for complications, due to hematuria (8.9%, n = 4) and febrile urinary tract infection (6.7%, n = 3). Nevertheless, none was readmitted for acute urinary retention. Conclusion The use of a new generation of bipolar electrosurgical and morcellator unit for BIPOLEP was safe and the majority could be discharged without catheter within one day after surgery.

Эффективность новых эндоскопических методов лечения доброкачественной гиперплазии простаты средних и крупных размеров

The article presents the results of the study of the effectiveness of new endosurgical methods of treatment of benign prostatic hyperplasia of large size (on average 137.4 cm3) - bipolar transurethral enucleation (TUEB; 8 patients) in comparison with retroperitoneoscopic prostatectomy (RPS PE; 7) and medium size (78.2 cm3) - bipolar transurethral resection (BTUR; 110) in comparison with monopolar transurethral resection MTUR; 95). The smallest volume of blood loss during surgery, frequency of intra- and postoperative complications, duration of postoperative bladder drainage and hospital stay were noted for BTUR. At the same time, all the studied new methods have shown almost equal efficacy in radical treatment and removal of infravesical obstruction, which indicates the appropriateness of their choice in accordance with the initial size of prostate hyperplasia instead of the previously used traumatic open surgeries and MTUR.

Результаты внедрения биполярных методов трансуретральной резекции в хирургическую практику лечения доброкачественной гиперплазии простаты

The evaluation of medium-term clinical results of the implementation of bipolar technique of transurethral resection and enucleation for the treatment of benign prostatic hyperplasia is presented. The study included 34 patients with a prostate volume of 60 cm3, was operated by the method of bipolar transurethral resection and 30 patients with 60 to 180 cm3 volume, operated by the method of bipolar transurethral enucleation. In the application of new endoscopic methods, the average term of postoperative catheterization was 3.1 days, hospitalization - 7.9 days, intra- and postoperative complications (bleeding, acute urinary retention, acute orchoepididymitis) were isolated. Two patients underwent repeated surgery to eliminate urinary retention and scarring of the bladder neck. 1 month after surgery, urine flow rate increased by 9.8 ml/s, residual urine volume decreased by 81.1 ml, the average score on the IPSS scale - by 20 points. Comparison with the results of open operations performed in the clinic earlier with similar volumes of the prostate gland showed high efficiency and safety of new endoscopic methods.

Two-year Follow-up in Bipolar Transurethral Enucleation and Resection of the Prostate in Comparison with Bipolar Transurethral Resection of the Prostate in Treatment of Large Prostates. Randomized Controlled Trial

ObjectiveTo assess the safety and long-term efficacy of bipolar transurethral enucleation and resection of the prostate (B-TUERP) in the treatment of enlarged prostate in comparison with bipolar transurethral resection of the prostate (B-TURP). Materials and MethodsFrom June 2015 to March 2019, a total of 240 patients with enlarged prostates of more than 80 gm were randomized into 2 groups, each containing 120 patients. Patients in group A were subjected to B-TUERP while those in group B underwent B-TURP. The perioperative data and postoperative outcomes followed at 1, 6, and 24 months after surgery at which points they were analyzed, and a comparison made between the 2 groups. ResultsThere were no significant differences in the preoperative parameters of the 2 groups. Comparing with B-TURP, B-TUERP had longer operative time (105.09 ± 31.08 vs 61.09 ± 29.28 min), more resected prostatic tissue (50.41 ± 13.07 vs41.12 ± 8.91 g) and had less hemoglobin drop (1.5 vs 2g/dL). In addition, indwelling catheter time, postoperative bladder irrigation duration, and hospital stay were significantly shorter in the B-TUERP group than in the B-TURP group. At 24 month after the procedure, patients with B-TUERP achieved better results of International Prostate Symptom Score (6 vs 7 P = .008), quality of life (1 vs 2, P = .243), maximal flow rate (24.9 ± 5.74 vs 20.09 ± 3.27mL/sec, P = .034), post-voiding residual urine volume (18.64 ± 3.28 vs 24.74 ± 4.02 mL, P = .001), and residual prostate volume (18.64 ± 3.28 vs 20.74 ± 4.02 mL, P < .001). On the other hand, there were no significant differences in postoperative complications between both groups. ConclusionB-TUERP is a more effective modality in the treatment of enlarged prostate compared to B-TURP with almost no variation in safety.

Protocol for a comparison study of 1-day (single dose) versus 2-day prophylactic antibiotic administration in Holmium Laser enucleation of the prostate (HoLEP): a randomized controlled trial.

Background: The best method of antimicrobial prophylaxis administration for surgical site infection (SSI) in transurethral holmium laser resection and enucleation of the prostate (HoLEP)/bipolar transurethral enucleation (TUEB) remains controversial. The purpose of this study is to compare one-day and two-day cefazolin in a randomized 2 nd-phase study to help establish a protocol with a 95% confidence interval (CI) for SSI prevention. Methods: Patients undergoing HoLEP/TUEB for benign prostate hyperplasia without preoperative pyuria will be enrolled and randomized to receive prophylactic antibiotic administration for HoLEP/TUEB in two groups, 1-day (single dose) cefazolin and 2-day cefazolin. The primary endpoint is the occurrence rate of postoperative urinary tract infection or urogenital infection within 30 days after HoLEP/TUEB with a statistical 95% CI in comparison between those groups. Secondary outcomes include the kind of infectious disease and evidence of diagnosis, day of diagnosis of infectious disease, performance of urine or blood culture, detection of bacteria, treatments, duration of treatments, AEs other than surgical site infection, and drug-induced AEs. Discussion: The results of this study will provide evidence for defining the optimal duration of cefazolin prophylactic antibiotic administration for SSI. Trial registration: This study was registered in the University Hospital Medical Information Network-Clinical Trial Registry ( UMIN000027955) based on recommendations from the International Committee of Medical Journal Editors (ICMJE) on July 1 st 2017.

Protocol for a comparison study of 1-day (single dose) versus 2-day prophylactic antibiotic administration in Holmium Laser enucleation of the prostate (HoLEP): a randomized controlled trial

Background: The best method of antimicrobial prophylaxis administration for surgical site infection (SSI) in transurethral holmium laser resection and enucleation of the prostate (HoLEP)/bipolar transurethral enucleation (TUEB) remains controversial. The purpose of this study is to compare one-day and two-day cefazolin in a randomized 2 nd-phase study to help establish a protocol with a 95% confidence interval (CI) for SSI prevention. Methods: Patients undergoing HoLEP/TUEB for benign prostate hyperplasia without preoperative pyuria will be enrolled and randomized to receive prophylactic antibiotic administration for HoLEP/TUEB in two groups, 1-day (single dose) cefazolin and 2-day cefazolin. The primary endpoint is the occurrence rate of postoperative urinary tract infection or urogenital infection within 30 days after HoLEP/TUEB with a statistical 95% CI in comparison between those groups. Secondary outcomes include the kind of infectious disease and evidence of diagnosis, day of diagnosis of infectious disease, performance of urine or blood culture, detection of bacteria, treatments, duration of treatments, AEs other than surgical site infection, and drug-induced AEs. Discussion: The results of this study will provide evidence for defining the optimal duration of cefazolin prophylactic antibiotic administration for SSI. Trial registration: This study was registered in the University Hospital Medical Information Network-Clinical Trial Registry ( UMIN000027955) based on recommendations from the International Committee of Medical Journal Editors (ICMJE) on July 1 st 2017.

Clinical Comparison of Holmium Laser Enucleation of the Prostate and Bipolar Transurethral Enucleation of the Prostate in Patients Under Either Anticoagulation or Antiplatelet Therapy

BackgroundA significant number of patients who require surgery for benign prostatic hyperplasia are under either anticoagulation (AC) or antiplatelet (AP) therapy. ObjectiveTo assess the efficacy and morbidity of holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral enucleation of the prostate (B-TUEP) in patients who required AC/AP therapy. Design, setting, and participantsThis study included 296 (67.6%) and 142 (32.4%) patients who underwent HoLEP and B-TUEP, respectively. The AC/AP group included patients whose AP therapy was not interrupted pre-, peri-, and/or postoperatively, and patients who underwent perioperative AC therapy bridging with low-molecular-weight heparin. InterventionHoLEP and B-TUEP. Outcome measurements and statistical analysisWe tested the hypothesis that AC/AP therapy had a limited impact on the efficacy of HoLEP and B-TUEP. To adjust for potential baseline confounders, propensity-score matching was performed. Clinical characteristics were compared among groups using the Kruskal-Wallis or chi-square test. Logistic regression analyses tested the association between clinical variables and the odds of Clavien-Dindo ≥2 complications after surgery. Results and limitationsOverall, 28 (9.5%) and 46 (15.5%) patients in the HoLEP group and 15 (10.5%) and 24 (16.9%) men in the B-TUEP group had AC and AP therapy, respectively (p=0.9). HoLEP patients under either AC or AP therapy deserved longer catheter maintenance and a longer hospital stay (HS) than those without AC/AP therapy (all p≤0.01). Operative time, rates of postoperative complications, and 2-mo International Prostate Symptoms Score (IPSS) were similar between patients with and without AC/CP. Among B-TUEP patients, HS was longer (p=0.03) and the rate of complications was higher (p<0.001) in patients under AC or AP therapy. Postoperative haemoglobin drop and 2-mo IPSS were similar among groups and surgical techniques. Limitations are the retrospective nature of the study, and the lack of long-term complications and functional outcomes. ConclusionsHoLEP and B-TUEP can safely be performed in patients deserving continuous AP/AC therapy with only a slight increase in HS and catheterisation time. Patient summaryWe assessed the safety and efficacy of holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral enucleation of the prostate (B-TUEP) in men under chronic anticoagulation/antiplatelet therapy. Both HoLEP and B-TUEP could safely be performed as minimally invasive treatment options in this subset of patients at a high risk of bleeding from benign prostatic hyperplasia surgery.

PT191 - Clinical comparison of holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral enucleation of the prostate (BTUEP) in patients under either anticoagulation or antiplatelet therapy

PT191 - Clinical comparison of holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral enucleation of the prostate (BTUEP) in patients under either anticoagulation or antiplatelet therapy

Protocol for a comparison study of 1-day versus 2-day prophylactic antibiotic administration in Holmium Laser enucleation of the prostate (HoLEP): a randomized controlled trial

Background: The best method of antimicrobial prophylaxis administration for surgical site infection (SSI) in transurethral holmium laser resection and enucleation of the prostate (HoLEP)/bipolar transurethral enucleation (TUEB) remains controversial. The purpose of this study is to compare one-day and two-day cefazolin in a randomized 2nd-phase study to help establish a protocol with a 95% confidence interval (CI) for SSI prevention. Methods: Patients undergoing HoLEP/TUEB for benign prostate hyperplasia without preoperative pyuria will be enrolled and randomized to receive prophylactic antibiotic administration for HoLEP/TUEB in two groups, 1-day cefazolin and 2-day cefazolin. The primary endpoint is the occurrence rate of postoperative urinary tract infection or urogenital infection within 30 days after HoLEP/TUEB with a statistical 95% CI in comparison between those groups. Secondary outcomes include the kind of infectious disease and evidence of diagnosis, day of diagnosis of infectious disease, performance of urine or blood culture, detection of bacteria, treatments, duration of treatments, AEs other than surgical site infection, and drug-induced AEs. Discussion: The results of this study will provide evidence for defining the optimal duration of cefazolin prophylactic antibiotic administration for SSI. Trial registration: This study was registered in the University Hospital Medical Information Network-Clinical Trial Registry (UMIN000027955) based on recommendations from the International Committee of Medical Journal Editors (ICMJE) on July 1st 2017.

Safety and efficacy of Transurethral Bipolar Enucleation of prostate (TUBE) in BPH

Objectives: To evaluate the safety and efficacy of transurethral bipolar enucleation of the prostate due to benign prostatic hyperplasia. Methods: This is a prospective study and 37 patients undergoing Transurethral bipolar enucleation of the prostate (TUBE) for BPH will be taken for the study. Preoperative factors evaluated included International Prostate Symptom Score (IPSS), postvoid residual volume (PVR), estimated blood loss, operative time, pathologic weight, and complications. Postoperative evaluation was performed at 1month, 6 months and 12months. Results: Preoperative, 1 month, 6 months, and 12 months mean postvoid residual volumes were 235 mL, 33.6 mL, 20 mL and 20 mL; mean IPSS were 31.6, 2.97, 2.97 and 2.97; mean Q max was 5.8ml/sec, 20.23ml/sec,25.5ml/sec, and 25.5ml/sec; preoperative and post operative mean quality of life scores were 5.4 and 2.2; mean operative time was 87.5 minutes. Hemoglobin drop was 0.6g/dl, and pathologic weight was 45.45 g. 10 patients underwent partial enucleation. Early stress incontinence occurred in 9 patients (24.3%).Urinary tract infection occurred in 1 patient, and Superficial mucosal bladder injury in 1 patient. Conclusions: International Prostate Symptom Score, quality of life, Qmax, and postvoid residual volume (PVR) showed statistically significant improvements from baseline. TUBE is a safe, effective, and reproducible procedure for BPH.

P83 - Bipolar transurethral enucleation versus resection of the prostate – An ESUT cumulative analysis of over 1600 cases

P83 - Bipolar transurethral enucleation versus resection of the prostate – An ESUT cumulative analysis of over 1600 cases

Bipolar transurethral enucleation and resection of the prostate: Whether it is ready to supersede TURP?

ObjectiveAccording to the EAU Guidelines, transurethral resection of the prostate (TURP) has so far still been considered as the gold standard for surgical treatment for patients with obstructing clinical benign prostate hyperplasia (BPH). However, its relatively high rate of complications and postoperative recurrence necessitates further modification and innovation on the surgery technique. We reported the patient outcomes with our technique. MethodsWe retrospectively analyzed 52 patients with obstructing clinical BPH who underwent bipolar transurethral enucleation and resection of the prostate (B-TUERP) between March 2015 and September 2015. Pre- and perioperative parameters were obtained from medical charts. Postoperative follow-ups were administrated at 1, 3, 6, 12 and 24 month(s) after surgery, respectively. ResultsAll the operations were performed successfully with a mean operative time of 43.1 min and an average tissue removal rate of 74.7%. Qmax was significantly improved immediately after surgery, followed by a continuous improvement throughout the follow-ups. Following a steep decrease in mean prostate specific antigen (PSA) and post void residual (PVR) observed within the first half year after surgery, the serum PSA was then maintained at a constant level of 0.61 ng/mL. Temporary urinary retention was found in four cases (7.7%). Stress urinary incontinence occurred in five patients (9.6%), with the condition resolved in 1–2 weeks without extra treatment. Urethral strictures and bladder neck contractures, as the most commonly observed long-term complications, developed in four patients (7.7%). No recurrence was found during 2 years of follow-ups. An improvement in International Index of Erectile Function (IIEF-5) scores was witnessed in 17 patients preoperatively with normal sexual function during the first 6 months after surgery, and sustained throughout the 24-month period. ConclusionsEnucleation reflects an improvement on surgical technique in many ways with a need for surgical equipment that can be broadly accessible in clinical practice. Currently, bipolar resection is a commonly employed procedure in clinical settings, and its similarity shared with bipolar enucleation technique warrants a quick learning of B-TUERP by urologists. Based on these findings, we believe that the substitution of TURP by TUERP as the gold standard for prostate endoscopic procedure can be expected in the future.