Endoscopic Enucleation Of The Prostate Research Articles

Real-world experience with the new pulsed solid-state Thulium: YAG laser (Thulio) for endoscopic enucleation of the prostate

PurposeThe solid-state Thulium laser (Tm: YAG) is a novel alternative to the widely used Holmium laser for endoscopic enucleation of the prostate (EEP) due to its relatively high peak power. The aim of this study was to examine the efficacy and safety of a new pulsed Tm: YAG laser in its first application in humans.MethodsData were retrospectively collected for the first 103 patients who underwent EEP with a new pulsed solid-state Tm: YAG laser (Thulio®, Dornier MedTech Systems GmbH, Weßling, Germany). Peri- and postoperative data were assessed. Procedure-specific complications were graded using Clavien-Dindo Classifications (CDC). Patients were interviewed 15 months after the surgery to evaluate functional and long-term outcomes. Statistical analysis was performed with Statistical Package for the Social Sciences (SPSS®).ResultsThe mean preoperative prostate volume was 105.6 ± 55.0 ml. Median enucleation speed was 4.1 g per minute (range 1.1–9.7). Short-term postoperative complications occurred in 21 patients (20.4%), but no high-grade complications (CDC ≥ IV) were observed. Five patients suffered gross haematuria and required reintervention (CDC IIIb; 4.9%). After 15 months, 76 patients (73.8%) participated in the follow-up interview, where seven patients (9.2%) reported complications, including two reinterventions for urethral strictures (CDC IIIb; 2.6%). Most patients reported an improvement in continence (54.0%) and urine stream (93.4%), but no difference in erectile function (81.6%). No persistent dysuria was reported. Patient satisfaction with the surgery results was very high (96.1%).ConclusionEndoscopic enucleation of the prostate with the new pulsed solid-state Tm: YAG laser is a safe and effective option for surgical BPH treatment.Trial registrationGerman Clinical Trials Register number: DRKS00031676. Registration date: 10 May 2023, retrospectively registered.

Prospective study of urinary incontinence recovery following endoscopic enucleation of the prostate.

To investigate the clinical trajectories and identify risk factors linked to post-enucleation urinary incontinence (UI). In this prospective study (April 2020 to March 2022) at a single institution, 316 consecutive patients receiving endoscopic enucleation due to benign prostatic enlargement were included. Patient information and perioperative details were collected. Follow-ups, from 1 to 6 months, assessed postoperative UI using International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form and a four-item pad questionnaire, classified per International Continence Society definitions. Logistic regression analysed predictors at 1 week, while generalised estimating equation assessed risk factors from 1 to 3 months postoperatively. Patients with a median prostate volume of 57 mL underwent enucleation, with 22.5% experiencing postoperative UI at 1 week, 5.6% at 3 months, decreasing to 1.9% at 6 months. Multivariable analysis identified age (>80 years), specimen weight (>70 g), en bloc with anteroposterior dissection, and anal tone (Digital Rectal Examination Scoring System score <3) as potential factors influencing UI. Subgroup analysis revealed that specimen weight was associated with both continuous and stress UI. Anal tone was related to both other types and stress UI, while overactive bladder symptoms were associated with urge UI. In summary, our study elucidates transient risk factors contributing to temporary post-enucleation UI after prostatectomy. Informed decisions and personalised interventions can effectively alleviate concerns regarding postoperative UI.

The safety and efficacy of five surgical treatments in prostate enucleation: a network meta-analysis

PurposeThe aim of our study was to investigate the comparative outcomes of five different energy types on surgical efficacy and postoperative recovery in patients with benign prostate hyperplasia.MethodsThe literature was systematically reviewed on December 1st, 2023, encompassing studies retrieved from PubMed, Embase, Web of Science, and The Cochrane Library databases that incorporated clinical studies of holmium laser enucleation of the prostate (HoLEP), Thulium:YAG laser enucleation of the prostate (ThuLEP), transurethral plasmakinetic enucleation of prostate (PKEP), diode laser enucleation of the prostate (DiLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP) in the treatment of prostatic hyperplasia. Two independent reviewers extracted study data and conducted quality assessments using the Cochrane Collaboration's Risk of Bias tool and Newcastle–Ottawa Scale (NOS). Network meta-analysis (NMA) was employed to indirectly analyze the outcomes of endoscopic enucleation of the prostate (EEP) techniques.ResultsThe study included a total of 38 studies, comprising 21 non-randomized controlled trials (nRCTs) and 17 randomized controlled trials (RCTs), incorporating five distinct techniques: holmium laser, Thulium:YAG laser, bipolar plasma, diode laser and thulium fiber laser. In comparing treatment durations, ThuLEP and HoLEP had shorter overall hospital stays than PKEP, while the enucleation time of ThuLEP and HoLEP was shorter than that of ThuFLEP. Moreover, the enucleation tissue weight of both thulium fiber laser and holmium laser was heavier than bipolar plasma. However, the analysis did not reveal any statistically significant variation in complications among the various types of enucleation. In postoperative follow-up, the IPSS at 3 months post-operation was superior in the Thulium:YAG laser group compared to the holmium laser group. The thulium fiber laser technique demonstrated significant advantages over other enucleation methods in terms of QoL and PVR at 12 months after surgery.ConclusionTheoretical properties may vary among different energy sources; however, there are no discernible clinical differences in operation-related parameters, postoperative complications, and postoperative follow-up. Therefore, the choice of laser does not significantly impact the outcome. However, due to the limited number of included studies, future research should focus on larger sample sizes and multicenter investigations to further validate the findings of this study.

Incidence of complications and urinary incontinence following endoscopic enucleation of the prostate in men with a prostate volume of 80 ml and above: results from a multicenter, real-world experience of 2512 patients

PurposeTo evaluate complications and urinary incontinence (UI) after endoscopic enucleation of the prostate (EEP) stratified by prostate volume (PV).MethodsWe retrospectively reviewed patients with benign prostatic hyperplasia who underwent EEP with different energy sources in 14 centers (January 2019–January 2023). Inclusion criteria: prostate volume ≥ 80 ml. Exclusion criteria: prostate cancer, previous prostate/urethral surgery, pelvic radiotherapy.Primary outcome: complication rate. Secondary outcomes: incidence of and factors affecting postoperative UI. Patients were divided into 3 groups. Group 1: PV = 80–100 ml; Group 2 PV = 101–200 ml; Group 3 PV > 200 ml. Multivariable logistic regression analysis was performed to evaluate independent predictors of overall incontinence.ResultsThere were 486 patients in Group 1, 1830 in Group 2, and 196 in Group 3. The most commonly used energy was high-power Holmium laser followed by Thulium fiber laser in all groups. Enucleation, morcellation, and total surgical time were significantly longer in Group 2. There was no significant difference in overall 30-day complications and readmission rates. Incontinence incidence was similar (12.1% in Group 1 vs. 13.2% in Group 2 vs. 11.7% in Group 3, p = 0.72). The rate of stress and mixed incontinence was higher in Group 1. Multivariable regression analysis showed that age (OR 1.019 95% CI 1.003–1.035) was the only factor significantly associated with higher odds of incontinence.ConclusionsPV has no influence on complication and UI rates following EEP. Age is risk factor of postoperative UI.

Influence of Early Apical Release on Outcomes in Endoscopic Enucleation of the Prostate: Results From a Multicenter Series of 4392 Patients

ObjectiveTo evaluate outcomes after laser Endoscopic enucleation of the prostate (EEP) stratified by whether early apical release (EAR) was performed or not. MethodsWe retrospectively reviewed patients with clinical benign prostatic hyperplasia who underwent EEP with holmium or thulium fiber laser in 8 centers (January 2020-January 2022). Exclusion criteria: previous prostate/urethral surgery, prostate cancer, pelvic radiotherapy, concomitant lower urinary tract surgery. One-to-one propensity score-matching was performed between patients with EAR versus no EAR, with covariates including age, prostate volume, diabetes mellitus, hypertension, preoperative indwelling catheter, IPSS, Qmax, enucleation and laser types. Multivariable logistic regression analyses were performed to evaluate independent predictors of 30-day postoperative complications and urinary incontinence. ResultsEAR was performed in 2094 of 4392 included patients. The matched cohort consisted of 787 patients per arm. Total operation time was significantly longer in the EAR group (median 75 vs 67 minutes, p=0.004). Early complications were higher in the EAR group (18.6% vs 12.5%, p=0.001), while postoperative incontinence rates were similar (14.1% vs 13.1%, p=0.61). Multivariable regression analysis showed that 3-lobe enucleation and operation time were significant predictors of postoperative complications; preoperative indwelling catheterization, higher prostate volume, and en-bloc enucleation were associated with higher odds of postoperative incontinence. Limitation: retrospective nature. ConclusionsPerforming EAR during EEP is associated with a greater incidence of early complications, which was mainly driven by higher rates of postoperative hematuria and perioperative transfusion. The risk of postoperative incontinence and its duration are not affected by EAR.

Incidence of urinary incontinence following endoscopic laser enucleation of the prostate by en-bloc and non- en-bloc techniques: a multicenter, real-world experience of 5068 patients.

We aim to evaluate the incidence of incontinence following laser endoscopic enucleation of the prostate (EEP) comparing en-bloc (Group 1) versus 2-lobe/3-lobe techniques (Group 2). We performed a retrospective review of patients undergoing EEP for benign prostatic enlargement in 12 centers between January 2020 and January 2022. Data were presented as median and interquartile range (IQR). Univariable and multivariable logistic regression analysis was performed to evaluate factors associated with stress urinary incontinence (SUI) and mixed urinary incontinence (MUI). There were 1711 patients in Group 1 and 3357 patients in Group 2. Patients in Group 2 were significantly younger (68 [62-73] years vs 69 [63-74] years, P = 0.002). Median (interquartile range) prostate volume (PV) was similar between the groups (70 [52-92] ml in Group 1 vs 70 [54-90] ml in Group 2, P = 0.774). There was no difference in preoperative International Prostate Symptom Score, quality of life, or maximum flow rate. Enucleation, morcellation, and total surgical time were significantly shorter in Group 1. Within 1 month, overall incontinence rate was 6.3% in Group 1 versus 5.3% in Group 2 ( P = 0.12), and urge incontinence was significantly higher in Group 1 (55.1% vs 37.3% in Group 2, P < 0.001). After 3 months, the overall rate of incontinence was 1.7% in Group 1 versus 2.3% in Group 2 ( P = 0.06), and SUI was significantly higher in Group 2 (55.6% vs 24.1% in Group 1, P = 0.002). At multivariable analysis, PV and IPSS were factors significantly associated with higher odds of transient SUI/MUI. PV, surgical time, and no early apical release technique were factors associated with higher odds of persistent SUI/MUI.

Comparison of EEP and TURP long-term outcomes: systematic review and meta-analysis.

To compare long-term reoperation rate and functional outcomes between EEP (endoscopic enucleation of the prostate) and TURP (transurethral resection of the prostate). A systematic literature review of Medline, Scopus, and Web of Science was conducted with primary outcome assessed being reoperation rate and secondary outcomes after a long term (> 3years) being functional outcomes or related values (prostate volume, PSA level, etc.). Five studies were found with long-term follow-up 4-7years. EEP reoperation rate ranged from 0 to 1.27%, while from 1.7 to 17.6% for TURP. Meta-analysis showed significantly lower OR for EEP, 0.27 (95% CI 0.24-0.31), with notable homogeneity of the results, I2 = 0%. Long-term Qmax and IPSS were significantly better for EEP. Qmax pooled mean difference was 1.79 (95% CI 1.72-1.86) ml/s with a high concordance among the studies, I2 = 0%. IPSS mean difference -1.24 (95% CI - 1.28 to - 1.2) points, I2 = 57% but QoL did not differ, with mean difference being 0.01 (95% CI - 0.02 to 0.04), I2 = 0%. IIEF-5 score was also significantly better for EEP, mean difference 1.08 (95% CI 1.03-1.13), but heterogeneity was high, I2 = 70%. PSA level and prostate volume were only reported in one study and favored EEP slightly yet statistically significant. EEP had a significantly lower reoperation rate and better functional outcomes (Qmax and IPSS) at long term compared with TURP. It may also be beneficial in terms of IIEF-5, PVR, and PSA level.

Is day-case surgery feasible for laser endoscopic enucleation of the prostate? A systematic review

PurposeLaser endoscopic enucleation of the prostate (EEP) for benign prostatic obstruction has become increasingly prevalent worldwide. Considering the medical cost-savings and concomitantly fewer nosocomial infections, the feasibility of same-day postoperative discharge of patients who have undergone laser EEP in terms of its safety and effectiveness has become a subject matter of growing interest. We aimed to review those studies focussing on day-case surgery (DCS) in patients undergoing laser EEP.MethodsA systematic search was conducted using PubMed-MEDLINE and Web of Science databases until October 2022 with the following search terms: “same day discharge AND laser enucleation of the prostate”, “day-case AND laser enucleation of the prostate”, “same day surgery AND laser enucleation of the prostate” and “one day surgery AND laser enucleation of the prostate” by combining PICO (population, intervention, comparison, outcome) terms. We identified 15 eligible studies.ResultsWhile 14 of the studies focussed on holmium laser EEP, one focused on thulium laser vapoenucleation of the prostate. We observed an improvement in functional parameters in all studies we reviewed, and DCS success and readmission rates ranged between 35.3–100% and 0–17.8%, respectively. The complication rates varied between 0 and 36.7%, most of the complicatons were Clavien-Dindo (CD) I and II. CD ≥ III complications did not significantly differ between same day discharge (SDD) and non-SDD groups in the studies.ConclusionLaser EEP is feasible and promising DCS treatment option delivering improved functional parameters compared to baseline values, and lower perioperative complication and readmission rates in certain patients.

The use of statins is related to a lower PSA level after endoscopic enucleation of the prostate with holmium laser (HoLEP) for the treatment of BPH.

To determine the factors that may be associated with a 2-month high baseline level of Total Prostatic Specific Antigen (PSA) after endoscopic enucleation of the prostate with Holmium Laser (HoLEP). Retrospective study of a prospectively collected database of adult males undergoing HoLEP at a single tertiary institution from September 2015 to February 2021. Pre-operative epidemiological, clinical characteristics and post-operative factors were analyzed and a multivariate analysis was performed to determine factors independently related to PSA decline. A total of 175 men aged 49-92years with a prostate size ranging from 25 to 450cc underwent HoLEP, and after excluding data from patients due to loss of follow-up or incomplete data, 126 patients were included in the final analysis. The patients were divided into group A (n = 84), which included patients with postoperative PSA nadir lower than 1ng/ml, and group B(n = 42), with postoperative PSA levels greater than 1ng/ml. In the univariate analysis there was a correlation between the variation of the PSA value and the percentage of resected tissue (p = 0.028), for each 1g of resected prostate there was a reduction of 0.104ng/mL, furthermore there was a difference between the means of age of group A (71.56years) and group B (68.17years) (p = 0.042). In the multivariate analysis, the use of statins and lower postoperative PSA levels (p = 0.024; HR = 3.71) were correlated. Our results indicate that PSA after HoLEP is correlated with patient's age, the presence of incidental prostate cancer, and the use of statins.

LBA01-03 A SCRUTINIZED ANALYSIS OF DYSURIA IN THE FIRST WEEKS AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP): WHO SHOULD WE BLAME?

You have accessJournal of UrologyCME1 Apr 2023LBA01-03 A SCRUTINIZED ANALYSIS OF DYSURIA IN THE FIRST WEEKS AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP): WHO SHOULD WE BLAME? Oswaldo Oliveira Neto, Sabrina Thalita Dos Reis, William C Nahas, Miguel Srougi, and Alberto A Antunes Oswaldo Oliveira NetoOswaldo Oliveira Neto More articles by this author , Sabrina Thalita Dos ReisSabrina Thalita Dos Reis More articles by this author , William C NahasWilliam C Nahas More articles by this author , Miguel SrougiMiguel Srougi More articles by this author , and Alberto A AntunesAlberto A Antunes More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003360.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: After the end of the learning curve, dysuria currently represents the main problem after endoscopic enucleation of the prostate with Holmium Laser (HoLEP). So far, no analysis has actively evaluated its occurrence in the first postoperative weeks and the literature is scarce in defining its risk factors. To evaluate the incidence of dysuria in the first weeks after HoLEP and the main risk factors involved. METHODS: We performed a prospective cohort study with patients diagnosed with benign prostatic hyperplasia (BPH) and undergoing HoLEP. The surgeries were performed by a high skilled surgeon in the method. The occurrence of dysuria was actively evaluated using a Likert scale, where scores from 0 to 3 were classified as mild dysuria and scores from 4 to 10 as moderate to severe dysuria. Patients were assessed weekly. For the analysis of risk factors, we selected 6 categorical clinical variables and 14 continuous clinical variables. For the analysis of categorical variables, we used Fisher's exact and Chi-square tests. For analysis of continuous variables, we used Student's and Mann-Whitney's t tests. The homogeneity of the samples was evaluated using the Levene test. For statistical significance we considered a p<0.05. RESULTS: To date, 23 patients have reached a sufficient follow-up period for the study. The prevalence of moderate to severe dysuria was 66.7% in the first week and 33.3% in the fourth week (Figure 1). In the first week, no variable was relevant in the occurrence of dysuria. At week four, the mean age among patients with moderate to severe dysuria was statistically lower (62.5 vs 68.4 years; p=0.02), and the prevalence of moderate to severe dysuria was statistically higher among patients with a history of preoperative prostate biopsy (66.7% vs 14.3%, p=0.037). Symptom score, prostatic volume, energy density used, surgical time, use of Moses technology, among others, were not related to the intensity of dysuria (Table 1). CONCLUSIONS: When actively and early evaluated, the prevalence of moderate to severe dysuria is significant in the first weeks after HoLEP. Younger patients and cases with a history of prostate biopsy have higher rates of dysuria in the fourth postoperative week. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1176 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Oswaldo Oliveira Neto More articles by this author Sabrina Thalita Dos Reis More articles by this author William C Nahas More articles by this author Miguel Srougi More articles by this author Alberto A Antunes More articles by this author Expand All Advertisement PDF downloadLoading ...

Urinary incontinence after endoscopic enucleation of the prostate with the Holmium laser: Evolutionary aspects and associated predictive factors

To study the evolutionary aspects of stress urinary incontinence and urinary incontinence by urgency after HoLEP through a series of 200consecutive cases of the same surgeon then to seek secondarily the predictive factors of occurrence in the service of urology of the Hospital Center of Martigues. This was a monocentric, retrospective, descriptive and analytical study conducted in the urology department of the Martigues Hospital. All patients who were treated with HoLEP for benign prostatic hypertrophy (BPH) between September 2017and March 2021were included in the study. Patients with an age greater than 75years, obese (BMI>30) or with neurological disease were excluded from this study. Between September 2017and March 2021, 204patients were included in our study. The average urinary incontinence rate was 21.2% 12.2% 7.4% and 2.7% at 1month, 3months, 6months and 12months respectively. The rate of stress urinary incontinence was 5.4%, 9.2%, 5.6% and 1.8% at 1month, 3months, 6months and 12months post HoLEP respectively. Urge urinary incontinence was estimated at 13.3%, 3%, 1.8% and 0.9% at M1, M3, M6and M12post-HoLEP respectively. Preoperative erectile dysfunction, delivered energy, enucleated prostate weight and total intraoperative time were statistically associated with the occurrence of stress urinary incontinence postoperatively. The operative time and a low operative Qmax were statistically associated with the occurrence of postoperative stress urinary incontinence. HoLEP is at risk of postoperative urinary incontinence. Preoperative information of the patients on the risk of urinary incontinence is essential.

Peri- and post-operative outcomes, complications, and functional results amongst different modifications of endoscopic enucleation of the prostate (EEP): a systematic review and meta-analysis.

To investigate and assess outcomes, complications, and functional results amongst different modifications of endoscopic enucleation of the prostate (EEP). We conducted a systematic review and meta-analysis according to the PRISMA checklist. We searched the Medline, Cochrane, and Embase databases. We included only randomised-controlled trials (RCT) comparing modifications of EEPs and assessed the risk of bias (RoB). Seven RCTs were included in the study. Overall, 1266 patients were treated with Holmium laser enucleation of the prostate (HoLEP) and 80 patients with thulium laser vapo-enucleation of the prostate (ThuVEP). The operative time during pulse shape-modified HoLEP was shorter when compared to standard pulse HoLEP (MD 18.08min, 95% CI 8.11-28.05min, p = 0.0004). The decrease in haemoglobin was significantly lower for two-lobe HoLEP when compared to three-lobe HoLEP (MD 0.16g/dl, 95% CI 0.22-0.1g/dl, p < 0.00001). Virtual Basket (VB) HoLEP showed a smaller haemoglobin decrease when compared to standard pulse HoLEP (1.12 ± 1.78 vs. 2.54 ± 1.23g/dl, p = 0.03). When directly comparing one- vs. two- vs. three-lobe HoLEP, surgical time (p < 0.001) and enucleation efficiency (p = 0.006) were significantly different and favouring one- and two-lobe HoLEP in the study with the largest patient population included. No significant differences for complications were observed; however, Clavien-Dindo IVa events were reported for two patients. All variations of EEP improve symptoms and functional parameters with a low incidence of high-grade complications. One- and two-lobe approaches and pulse shape-modified HoLEP seem to be beneficial in terms of operative time and blood loss.

Anterior fibromuscular stroma-preserved endoscopic enucleation of the prostate: a precision anatomical approach.

Benign prostate obstruction (BOO) is becoming increasingly important in this aging society. Some urge/stress urinary incontinence (UUI/SUI) still occurs after endoscopic enucleation of the prostate (EEP). It remains unclear how post-EEP incontinence can be avoided. Currently, early apical release to ameliorate the traction of the external sphincter is the best technique for incontinence prevention. To describe our surgical technique of anterior fibromuscular stroma (AFS)-preserved EEP for BOO. The medical records of 60 consecutive patients who underwent AFS-preserved EEP for BOO in our center from September 2019 to December 2019 were retrospectively reviewed. AFS-preserved EEP starts at the 12 o'clock position of the urethra, and the junction between the AFS and transitional zone (T-zone) was identified. The AFS and T-zone were separated first to protect the AFS in the initial operative procedure. Then, following the usual enucleation procedure, AFS-preserved EEP could be achieved. Postoperative prostate-specific antigen (PSA), testosterone, urethral stricture, and voiding status, such as incontinence, uroflow, and postvoiding residual urine were assessed. The data show that AFS-preserved EEP could achieve similar surgical outcomes as other early apical release approaches. The preserved AFS provides a nice landmark at the 12 o'clock position during EEP.

Thulium fiber laser in BPH surgery: Bench to bedside - a systematic review on behalf of YAU Urotechnology Working Group

IntroductionThe Thulium fiber laser (TFL) is a new device that in contrast to the other solid-state YAG-based lasers takes a different approach to pulse formation allowing for two different modes: in the QCW (quasi-continuous wave) function, TFL is convenient for soft tissue surgery and in the SP (Superpulsed) mode it is highly effective in lithotripsy. Thus, unlike the other thulium lasers (Tm : YAG), TFL can be used in a wide range of surgical procedures.Materials and MethodsWe conducted a systematic search in 3 databases: Medline, Scopus and Cochrane library. All original articles (both preclinical and clinical) on TFL application in soft tissue surgery were included in data analysis.ResultsIn terms of its cutting properties, QCW TFL is not inferior to the other thulium lasers, and in fact allows for decreased carbonization (due to lower heat production) compared to continuous lasers (e.g. Tm : YAG). It has been used successfully in endoscopic enucleation of the prostate (EEP) and in en bloc resection of bladder tumors (ERBT). The efficacy and safety of this laser is comparable to TURP and simple prostatectomy, but the recovery period is shorter and the learning curve is slightly superior to other endoscopic procedures. There are no significant differences between TFL and Ho : YAG in terms of efficacy and safety during EEP. Unfortunately, there are no clinical studies that analyse the efficacy and safety of SP TFL in EEP or ERBT.ConclusionTFL is a safe and effective tool for BPH surgery. In terms of parameters, it is in no way inferior to Tm : YAG or Ho : YAG during EEP. However, TFL surpasses these lasers in terms of usability and serviceability. These advantages are likely to render it more popular over time.

Robotic assisted simple prostatectomy versus other treatment modalities for large benign prostatic hyperplasia: a systematic review and meta-analysis of over 6500 cases.

Current guidelines recommend simple prostatectomy or endoscopic enucleation of the prostate (EEP) as treatment of choice for bladder prostatic obstruction (BPO) caused by large prostate glands. We aimed to provide a wide-ranging analysis of the currently available evidence, comparing safety and effectiveness of robot-assisted simple prostatectomy (RASP) versus open simple prostatectomy (OSP), laparoscopic simple prostatectomy (LSP), and laser EEP. A systematic search was performed across MEDLINE, EMBASE, and Web of Science databases for retrospective and prospective studies comparing RASP to OSP or LSP or laser EEP (HoLEP/ThuLEP). Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) recommendations were followed to design the search strategies, selection criteria, and evidence report. A meta-analysis evaluated perioperative safety and effectiveness outcomes. The weighted mean difference and risk ratio were used to compare continuous and dichotomous variables, respectively. Quality was assessed using the Newcastle-Ottawa scale and the Cochrane Collaboration's tool for RCT article assessing risk of bias. 15 studies, including 6659 patients, were selected for meta-analysis: 13 observational studies, 1 non-randomized prospective study, and 1 randomized controlled trial. RASP was associated with statistically significant longer operative time (OT) and lower postoperative complication rate, length of stay (LOS), estimated blood loss (EBL), and transfusion rate (TR) compared to OSP. LSP showed longer LOS and lower postoperative SHIM score, with no difference in OT, EBL, and complications. Compared to laser EEP, RASP presented longer LOS and catheterization time and higher TR. ThuLEP presented shorter OT than RASP. No difference were found in functional outcomes between groups both subjectively (IPSS, QoL) and objectively (Qmax, PVR). RASP has become a size-independent treatment for the management of BPO caused by a large prostate gland. It can duplicate the functional outcomes of OSP while offering a better safety profile. When compared to LSP, the latter still stands as a valid lower-cost option, but it requires solid laparoscopic skill sets and therefore it is unlikely to spread on larger scale. When compared to laser EEP, RASP offers a shorter learning curve, but it still suffers from longer catheterization time and LOS.

Endoscopic Enucleation of the Prostate – A Retrospective Single-center Study: Early Outcomes

Abstract Purpose: This clinical study was designed to present our initial experience of holmium laser enucleation of the prostate (HoLEP) with the use of the Quanta Litho Cyber Ho 150 W™ (Quanta System, Samarate, Italy). Materials and Methods: The data of the current study including all the patients who underwent HoLEP from April 2022 to December 2022 were retrospectively collected. All the operations were performed by the same experienced surgeon and the surgical technique was similar in all the cases. The successful completion of the operations, the operative time, and the major complications were the primary endpoints of this study. Results: Fifteen patients underwent HoLEP from April 2022 to December 2022 in our department. The completion of all the surgeries was successful. The average enucleation time was calculated to be 47.13 (±8.44) min, while the morcellation phase was completed in a mean time of 29.8 (±5.35) min. No major complications were noticed. The average hemoglobin drop was 1.4 (±0.69) g/dL. Conclusion: Our initial experience and early outcomes of the use of Quanta Litho Cyber Ho 150 W™ (Quanta System, Samarate, Italy) in HoLEP were presented. All the cases were completed successfully, without major complications or significant blood loss.

Defining minimal invasive surgical therapy for benign prostatic obstruction surgery: Perspectives from a global knowledge, attitude, and practice survey

ObjectiveTo scrutinize the definitions of minimal invasive surgical therapy (MIST) and to investigate urologists’ knowledge, attitudes, and practices for benign prostatic obstruction surgeries. MethodsA 36-item survey was developed with a Delphi method. Questions on definitions of MIST and attitudes and practices of benign prostatic obstruction surgeries were included. Urologists were invited globally to complete the online survey. Consensus was achieved when more than or equal to 70% responses were “agree or strongly agree” and less than or equal to 15% responses were “disagree or strongly disagree” (consensus agree), or when more than or equal to 70% responses were “disagree or strongly disagree” and less than or equal to 15% responses were “agree or strongly agree” (consensus disagree). ResultsThe top three qualities for defining MIST were minimal blood loss (n=466, 80.3%), fast post-operative recovery (n=431, 74.3%), and short hospital stay (n=425, 73.3%). The top three surgeries that were regarded as MIST were Urolift® (n=361, 62.2%), Rezum® (n=351, 60.5%), and endoscopic enucleation of the prostate (EEP) (n=332, 57.2%). Consensus in the knowledge section was achieved for the superiority of Urolift®, Rezum®, and iTIND® over transurethral resection of the prostate with regard to blood loss, recovery, day surgery feasibility, and post-operative continence. Consensus in the attitudes section was achieved for the superiority of Urolift®, Rezum®, and iTIND® over transurethral resection of the prostate with regard to blood loss, recovery, and day surgery feasibility. Consensus on both sections was achieved for EEP as the option with the better symptoms and flow improvement, lower retreatment rate, and better suitable for prostate more than 80 mL. ConclusionMinimal blood loss, fast post-operative recovery, and short hospital stay were the most important qualities for defining MIST. Urolift®, Rezum®, and EEP were regarded as MIST by most urologists.

Transurethral plasmakinetic resection versus enucleation for benign prostatic hyperplasia: comparison of intraoperative safety profiles based on endoscopic surgical monitoring system

ObjectiveTo compare the intraoperative safety profiles of transurethral plasmakinetic resection of the prostate (PK-TURP) with transurethral plasmakinetic endoscopic enucleation of the prostate (PK-EEP) in the treatment of benign prostatic hyperplasia (BPH) based on endoscopic surgical monitoring system (ESMS).MethodsA total of 128 patients who were diagnosed with BPH were stratified based on prostate volume (PV) and accepted PK-EEP or PK-TURP treatment at 1:1 ratio. The ESMS as a novel method was used to monitor blood loss and fluid absorption during the operation. Clinical parameters such as intraoperative blood loss volume, fluid absorption volume, operation time, tissue weight of resection, preoperative and postoperative red blood cell count (RBC), hemoglobin concentration (HB), hematocrit (HCT), electrolyte, postoperative bladder irrigation time, indwelling catheter time, hospital stay time and other associated complications were documented and compared between two groups.ResultsNo significant differences in majority of baseline characteristics were observed among patients with different prostate volumes between two surgical methods. For patients with prostate volume < 40 ml, the average operation time of patients who received PK-EEP treatment was much more than those who received PK-TURP (P = 0.003). On the other hand, for patients with prostate volume > 40 ml, the PK-TURP surgery was associated with a significant increase in intraoperative blood loss (P = 0.021, in PV 40–80 ml group; P = 0.014, in PV > 80 ml group), fluid absorption (P = 0.011, in PV 40–80 ml group; P = 0.006, in PV > 80 ml group) and postoperative bladder irrigation time as well as indwelling catheter time but decrease in resected tissue weight compared to the PK-EEP treatment.ConclusionThe ESMS plays an important role in comparison of intraoperative safety profiles between PK-TURP and PK-EEP. Our data suggest that PK-TURP treatment is associated with a decreased operation time in patients with prostate volume < 40 ml and the PK-EEP treatment is associated with decreased intraoperative blood loss, fluid absorption and increased tissue resection for patients with prostate volume > 40 ml. Our results indicate that the size of prostate should be considered when choosing the right operation method.

Endoscopic Enucleation of the Prostate Is Better than Robot-assisted Simple Prostatectomy

In 2022, endoscopic enucleation of the prostate (EEP) is the treatment of choice for benign prostatic obstruction (BPO) for glands >80 ml and is a valid alternative for patients with bleeding disorders. Unlike robot-assisted radical prostatectomy, EEP has no additional access-related trauma and can be performed using the same instruments as for bipolar enucleoresection. With favorable costs, EEP can serve as a global solution for BPO treatment.

Robot-assisted Simple Prostatectomy Is Better than Endoscopic Enucleation of the Prostate

Robot-assisted simple prostatectomy represents a solid treatment option for benign prostatic obstruction in patients with large prostate glands. This procedure offers multiple attractive features that make it a strong competitor against endoscopic enucleation of the prostate.