Enucleation Group Research Articles

Evaluation of cyst treatment technique, cyst type, size differences and healing by fractal analysis

AimThe aim of the study was to evaluate the trabeculation increase of treated mandibular cysts.Material and methodThe study included 26 female and 33 male patients (age mean: 38,4 years) with cysts larger than 3 cm in the posterior region of the mandible who were admitted to the same center. Two groups in treatment technique: marsupialization (n = 29) and enucleation (n = 30). Four groups in cyst types: dentigerous cyst (n = 21), keratocyst (n = 19), radicular cyst (n = 15) and residual cyst (n = 4). Cyst size was divided into two categories: smaller than 5.5 cm (n = 31) and larger than 5.5 cm (n = 28). Panoramic radiographs (PR) of the patients were analyzed at the beginning, 6. month and 12. month.ResultAt the end of the treatment, there was no statistically significant difference in terms of Fractal Analysis (FA) between patients treated with marsupialization and enucleation, but considering that the cysts in the marsupialization group were larger in size, a faster increase in FA was observed in the marsupialization group. When the cysts were grouped according to their size, it was observed that healing tissues in cysts smaller than 5.5 cm reached normal FA values faster, while healing in the middle of cysts larger than 5.5 cm took more time.ConclusionsFA is a reproducible and reliable method. In large cysts, marsupialization results in a faster recovery, but FA values at the end of treatment are similar to the enucleation group. Cysts larger than 5.5 cm show a more rapid increase in Fractal Dimension (FD). The centre of the cysts is the area that heals the latest. Studies with larger sample sizes are needed to evaluate the difference in healing between cyst types.Clinical trial numberClinical trial number: Not applicable

Decompression-first or direct enucleation: The choice of treatment for medium-sized odontogenic jaw cysts

BackgroundThe treatment of medium-sized odontogenic jaw cysts is inconsistent at present. Two main treatments, namely decompression and enucleation, are used overlappingly. This retrospective analysis aims to provide useful references for technique selection for future management of medium-sized odontogenic jaw cysts. MethodsOdontogenic cysts with lesion sizes ranging 2–4 cm were included. The clinical and radiological data of the patients were reviewed. Decompression-first and direct enucleation treatments were the two main surgical techniques. The preoperative parameters and postoperative outcomes were compared between the two groups. ResultsOut of 69 patients included, 40 (58 %) were in the decompression group and 29 (42 %) in direct enucleation group. The logistic regression analysis of preoperative parameters demonstrated that the maximum lesion size and the chief surgeon's preference could affect the selection of surgical techniques for medium-sized cysts (P < 0.05). Receiver operating characteristic curve analyses demonstrated that a lesion size >2.5 cm was the best cutoff value for predicting a decompression selection. Most postoperative outcomes differed significantly between the two groups (P < 0.05). Lower-risk anesthesia, shorter hospitalization, tooth function protection, and fewer neurosensory impairments were decompression-favoring outcomes. However, more follow-up visits, more postoperative X-rays, and longer postoperative care were outcomes against decompression. The recurrence rate was low and did not differ significantly between the two groups (P > 0.05). ConclusionsThere is no apparent preference for treating medium-sized jaw cysts. The maximum lesion size is a moderate-impact factor for treatment selection. A tendency to prefer decompression-first with larger lesion size was found in medium-sized jaw cysts. The advantages of teeth preservation and low neurosensory impairment of decompression were verified in the medium-size jaw cysts. The burden of postoperative care should be considered when selecting decompression.

Reoperation Rate for Residual/Regrowth Adenoma Following Transurethral Interventions for Benign Prostatic Enlargement: Results from a Systematic Review and Meta-Analysis of Comparative Randomized Studies.

Objective: To perform a systematic review to assess the incidence of reoperation rate for residual/regrowth adenoma after transurethral surgeries for benign prostatic enlargement. Materials and Methods: A systematic literature search was performed on November 12, 2023, using Cochrane Central Register of Controlled Trials, PubMed, and Scopus. We only included randomized studies comparing monopolar (M)/bipolar (B) transurethral resection of the prostate (TURP) vs ablation vs enucleation procedures. Incidence of reoperation was assessed using the Cochran-Mantel-Haenszel Method and reported as risk ratio (RR), 95% confidence interval (CI), and p-values. Statistical significance was set at p < 0.05. Evidence synthesis: Forty-eight studies were included. Six studies compared enucleation vs TURP, 41 ablation vs TURP, and 1 study enucleation vs ablation vs TURP, encompassing 457 patients in enucleation, 2259 in ablation, and 2517 in the TURP group. The pooled incidence of reoperation was 6.2%, 0.7%, 2.3%, and 4.3% after ablation, enucleation, M-TURP, and B-TURP, respectively. Meta-analysis showed that the incidence of reoperation was significantly lower in the enucleation group (RR 0.28, 95% CI 0.10-0.81, p = 0.02), but the difference accounted only in studies with follow-up between 1 and 3 years (RR 0.18, 95% CI 0.04-0.85, p = 0.03). The incidence of reoperation was significantly lower in the enucleation compared with the B-TURP group (RR 0.14, 95% CI 0.03-0.77, p = 0.02). Meta-analysis showed that the incidence of reoperation was significantly higher in the ablation group (RR 1.81, 95% CI 1.33-2.47, p = 0.0002), but there was no difference in studies with follow-up up to 1 year (odds ratio 1.78 95% CI 0.97-3.29, p = 0.06) longer than 5 years (RR 2.02, 95% CI 0.71-5.79, p = 0.19). The incidence of reoperation was significantly higher in the ablation compared with the M-TURP group (RR 1.91, 95% CI 1.44-2.54, p < 0.0001). Conclusions: In mid-term follow-up, reoperation rate for residual/regrowth adenoma was significantly lower after enucleation, although was significantly higher after ablation compared with TURP.

Solid Pseudopapillary Tumor of the Pancreas: Is Enucleation Safe?

While solid pseudopapillary tumor (SPT) of the pancreas are oncologically low-risk tumors, their resection with pancreaticoduodenectomy (PD) or partial pancreatectomy (PP) carries a significant risk for morbidity. To balance the favorable prognosis with the surgical morbidity of pancreas resection, this study explores the oncologic safety of enucleation(EN). The National Cancer Database (NCDB) was queried for resected SPT from January 2004 through December 2020. Perioperative outcomes and survival were analyzed with Kruskal-Wallis tests, and Kaplan-Meier analysis (with log-rank test). Survival analysis was performed to compare patients with and without lymph node (LN) metastases and binary logistic regression for predictors of LN metastasis. A total of 922 patients met inclusion criteria; 18 patients (2%) underwent EN, 550 (59.6%) underwent PP, and 354 (38.4%) underwent PD. Mean tumor size was 57.6 mm. Length of hospital stay was significantly shorter for EN compared with PP and PD groups (3.8 versus 6.2 versus 9.4 days, p < 0.001). There was a nonsignificant improvement in unplanned readmission [0% versus 8% versus 10.7% (p = 0.163)], 30-day mortality [0% versus 0.5% versus 0% (p = 0.359)], and 90-day mortality [0% versus 0.5% versus 0% (p = 0.363)] between EN, PP, and PD groups. Survival analyses showed no difference in OS when comparing EN versus PP (p = 0.443), and EN versus PD (p = 0317). Patients with LN metastases (p < 0.001) fared worse, and lymphovascular invasion, higher T category (T3-4) and M1 status were found as predictors for LN metastasis. EN may be considered for select patients leading to favorable outcomes. Because survival was worse in the rare cohort of patients with LN metastases, the predictors for LN metastasis identified here may aid in stratifying patients to EN versus resection.

Updated retinoblastoma incidence and outcome in children in Taiwan from 1980 to 2019: a 40-year nationwide study.

Retinoblastoma is a potentially fatal disease, and its incidence and mortality varies among different countries and periods. This is a nationwide population-based retrospective study from January 1980 to December 2019 in Taiwan. Patients diagnosed as retinoblastoma were identified from the Taiwan National Cancer Registry. To update the literature on retinoblastoma incidence, mortality and trends in Taiwan, we analysed changes in incidence and survival rates over time according to sex, diagnostic age, laterality and treatment. During 1980-2019, the incidence of retinoblastoma in Taiwan was 1 per 16 489 live births (95% CI: 13 415-19 564). The diagnostic age decreased from 2.21 ± 0.26 during 1980-1984 to 1.24 ± 0.26 during 1985-2019. Compared with that observed during 1980-1989, the incidence rate observed after 1990 increased significantly in children aged <10 years (RR: 1.62-2.40, P = 0.0049 to < 0.0001). From 1980 to 2019, the incidence rate for the 0-4-year age group increased and that for the 5-9-year age group remained constant. The mean diagnostic age for bilateral retinoblastoma (0.36 ± 0.47 years) was significantly less than that for unilateral retinoblastoma (1.37 ± 0.35 years) during 2007-2019 (P < 0.0001). The 10-year survival rate was highest in the enucleation group (89.8%) compared with radiotherapy (52.2%) and others (70.0%; P < 0.0001). During 1980-2019 in Taiwan, the incidence of retinoblastoma increased significantly, and the diagnostic age decreased, which are similar to the ones from other developed countries. However, the survival rate was still lower than that of most developed countries.

Short-term and Long-term Outcomes of Robotic Enucleation of Tumors Located in the Pancreatic Head and Uncinate Process.

To assess short-term and long-term outcomes following robotic enucleation (REn) of tumors in the proximal pancreas. Despite the advantages of preserving function via pancreatic enucleation, controversies persist, since this can be associated with severe complications, such as clinically relevant postoperative pancreatic fistula, especially when performed near the main pancreatic duct. The safety and efficacy of REn in this context remain largely unknown. A retrospective analysis was performed of all patients who underwent REn for benign and low-grade malignant neoplasms in the pancreatic head and uncinate process between January 2005 and December 2021. Clinicopathologic, perioperative, and long-term outcomes were compared with a similar open enucleation (OEn) group. Of 146 patients, 92 underwent REn with a zero conversion-to-open rate. REn was superior to OEn in terms of shorter operative time (90.0minutes vs 120.0minutes, P<0.001), decreased blood loss (20.0mL vs 100.0min, P=0.001), and lower clinically relevant postoperative pancreatic fistula rate (43.5% vs 61.1%, P=0.040). Bile leakage rate, major morbidity, 90-day mortality, and length of hospital stay were comparable between groups. No post-REn grade C POPF or grade IV/V complication was identified. Subgroup analyses for uncinate process tumors and proximity to the main pancreatic duct did not demonstrate inferior postoperative outcomes. In a median follow-up period of 50 months, REn outcomes were comparable to OEn regarding recurrence rate and pancreatic endocrine or exocrine function. REn for pancreatic head and uncinate process tumors improved clinically relevant outcomes without increased major complications compared to OEn, while demonstrating comparable long-term oncological and functional outcomes.

Direct medical costs of globe salvage in group C-E retinoblastoma and implications for cost-effectiveness

To determine the direct medical costs and cost-effectiveness of globe salvage compared with primary enucleation in patients with advanced retinoblastoma. Patients with International Classification of Retinoblastoma groups C-E retinoblastoma at a single institution from 2001 to 2021 were categorized into two groups: primary enucleation and globe salvage. Hospital visits and treatments were compared to determine differences in care utilization. Costs per encounter were derived from billing data and multiplied by number of encounters to determine total costs in the first year of treatment. Groups were stratified by unilateral or bilateral retinoblastoma, and visual acuity-based utility values were used to compare quality-adjusted life years to determine cost-effectiveness. Of 74 group C-E eyes of 70 patients, 55 eyes underwent primary enucleation and 19 eyes underwent globe salvage, 12 of which ultimately underwent secondary enucleation. Patients who underwent globe salvage had higher usage of systemic chemotherapy (P=0.001), more examinations under anesthesia (P < 0.001), fewer outpatient visits (P= 0.03), and a higher total cost of care (301,151 vs 104,764 USD [P < 0.001]) in the first year of treatment compared with the primary enucleation group. At an average life expectancy of 76 years, the incremental cost-effectiveness ratio was 118,347 USD per QALY in unilateral retinoblastoma and 32,987 USD per QALY in bilateral retinoblastoma, meeting the <150,000 USD/QALY threshold of cost-effectiveness. Incurring additional costs may save the eye in advanced retinoblastoma, but the possibility of secondary enucleation should be disclosed for informed decision making. Despite this risk, globe salvage was cost-effective in unilateral and bilateral retinoblastoma.

Laparoscopic and Open Nephron-Sparing Surgery for Radius Exophytic/Endophytic Nearness Anterior/ Posterior Location Nephrometry Score 7 and Higher Kidney Tumors: A Comparison of Oncological and Functional Outcomes Using the Pentafecta Score.

This study aimed to evaluate oncological and functional outcomes of nephron- sparing surgery by comparing open and laparoscopic approaches in a consecutive series of patients with intermediate and high complexity renal masses. We retrospectively reviewed all nephron-sparing surgery cases in 2 referral centers from January 2013 to January 2020. Tumor complexity was graded according to radius exophytic/endophytic nearness anterior/posterior location nephrometry score. Patients with a single kidney tumor with a radius exophytic/endophytic nearness anterior/posterior location score ≥ 7 were evaluated. Exclusion criteria were solitary kidney, multiple/bilateral tumors, and a low radius exophytic/endophytic nearness Anterior/Posterior location score (<7). Patients were divided according to the surgical approach: the laparoscopic tumor enucleation and the open wedge resection groups. The Trifecta and Pentafecta score achievement rates were assessed. Two hundred thirteen patients were included in the analysis, 76 in laparoscopic tumor enucleation group and 137 in the open wedge resection group. There were no statistically significant differences in preoperative data between laparoscopic tumor enucleation and open wedge resection groups, except for the higher percentage of T1a masses in the latter group. The mean 24-hour blood loss and length of stay were higher in the open wedge resection group. Minor and major postoperative complication rates were comparable. No significant difference in terms of the Trifecta score was reported. Pentafecta score was achieved in 35/76 (46.1%) and 61/137 (44.5%) cases in the laparoscopic tumor enucleation and open wedge resection groups, respectively. Our study showed that laparoscopic tumor enucleation was associated with significantly lower blood and length of stay. Postoperative complications and the achievement of the Pentafecta score were similar in both surgical approaches.

Surgery for symptomatic hepatic hemangioma: Resection vs. enucleation, an experience over two decades.

Hemangiomas are the most common benign liver lesions; however, they are usually asymptomatic and seldom require surgery. Enucleation and resection are the most commonly performed surgical procedures for symptomatic lesions. This study aims to compare the outcomes of these two surgical techniques. A retrospective analysis of symptomatic hepatic hemangiomas (HH) operated upon between 2000 and 2021. Patients were categorized into the enucleation and resection groups. Demographic profile, intraoperative bleeding, and morbidity (Clavien-Dindo Grade) were compared. Independent t-test and chi-square tests were used for continuous and categorical variables respectively. p-value of < 0.05 was considered significant. Sixteen symptomatic HH patients aged 30 to 66 years underwent surgery (enucleation = 8, resection = 8) and majority were females (n = 10 [62.5%]). Fifteen patients presented with abdominal pain, and one patient had an interval increase in the size of the lesion from 9 to 12 cm. The size of hemangiomas varied from 6 to 23 cm. The median blood loss (enucleation: 350 vs. resection: 600 mL), operative time (enucleation: 5.8 vs. resection: 7.5 hours), and postoperative hospital stay (enucleation: 6.5 vs. resection: 11 days) were greater in the resection group (statistically insignificant). In the resection group, morbidity was significantly higher (62.6% vs. 12.5%, p = 0.05), including one mortality. All patients remained asymptomatic during the follow-up. Enucleation was simpler with less morbidity as compared to resection in our series. However, considering the small number of patients, further studies are needed with comparable groups to confirm the superiority of enucleation over resection.

Can the Sandwich Method Be an Alternative Treatment Choice for BPH Patients With Large Prostates?

ObjectiveTo compare the efficacy and safety of the sandwich method with GreenLight photoselective vaporization (GLPVP) and bipolar transurethral resection (B-TURP) with those of the enucleation method in patients with BPH and a prostate volume ≥ 80 g. MethodsPatients with BPH who underwent either the sandwich method with GLPVP and B-TURP or the enucleation method between 2014 and 2021 were included in the analysis. The primary outcome was the comparison of uroflowmetry results between the 2 groups. Safety analysis of the complication rates was also compared. ResultsThe cohort included 55 patients in the sandwich group and 41 patients in the enucleation group. In the efficacy analysis, both groups showed comparable uroflowmetry results, except for a higher postoperative average flow rate in the enucleation group. Regarding perioperative parameters, the sandwich method required a longer operating time, and the enucleation group had a higher incidence of manual Foley irrigation. Both groups demonstrated similar postoperative complications. ConclusionThe sandwich method exhibited comparable efficacy and safety to the enucleation method in patients with BPH with a prostate volume ≥ 80 g. Thus, for surgeons who are familiar with GLPVP and B-TURP, the sandwich method may be an alternative surgical approach for BPH patients with large prostates.

Outcomes of planned versus emergent enucleation procedures with primary orbital implants

ObjectifNotre étude avait pour objectif principal d'examiner les résultats de la pose d'un implant intraorbitaire primaire au décours d'une énucléation prévue ou réalisée en urgence. MéthodesOn a procédé à un examen rétrospectif des dossiers médicaux portant sur 128 énucléations pour lesquelles on disposait d'un suivi postopératoire d'au moins 1 an (entre novembre 2008 et mai 2019). La pose de l'implant a été réalisée par un seul chirurgien oculoplasticien au Albany Medical Center. Les cas urgents étaient définis comme suit : perforation non refermée du globe oculaire secondaire à un traumatisme aigu, à une déhiscence ou à l’échec du rapprochement des berges d'une plaie, ou encore à l'exposition d'une plaie chirurgicale s'accompagnant d'une déhiscence de la sclère sous-jacente. Ont été enregistrées les données démographiques, cliniques et postopératoires de chaque patient. L'incidence d'exposition de l'implant a servi d'indicateur des résultats cliniques, et les données ont par la suite été analysées à l'aide du test t. RésultatsParmi les 128 énucléations examinées, 32 (25 %) avaient été réalisées en urgence; dans 2 de ces cas (6,25 %), il y a eu exposition de l'implant. En revanche, sur les 96 énucléations qui avaient été planifiées, on a dénombré seulement 3 cas (3,1 %) d'exposition de l'implant. On n'a pas relevé de lien significatif entre le taux d'exposition de l'implant et le moment où a eu lieu l’énucléation (prévue ou réalisée en urgence; p = 0,4047). ConclusionsEn dépit des effets d'une perforation du globe oculaire, notre analyse a permis de constater qu'il n'existe pas de corrélation significative entre le moment de la pose d'un implant intraorbitaire primaire (en situation d'urgence ou planifiée) et l'exposition de l'implant. De ce fait, les médecins ne devraient pas hésiter à insérer un implant intraorbitaire primaire au moment même de l’énucléation chez les 2 types de patients et peuvent s'en remettre aux présentes données pour conseiller leurs patients en ce qui a trait au risque de complications postopératoires.

MP04-06 INCIDENCE OF URETHRAL STRICTURE FOLLOWING ENDOSCOPIC PROSTATE SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF PROSPECTIVE, RANDOMIZED TRIALS

You have accessJournal of UrologyCME1 May 2022MP04-06 INCIDENCE OF URETHRAL STRICTURE FOLLOWING ENDOSCOPIC PROSTATE SURGERY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF PROSPECTIVE, RANDOMIZED TRIALS Ee Jean Lim, Vineet Gauhar, Giacomo Maria Pirola, Emanuele Rubilotta, Marcelo Langer Wroclawski, Dong Le Quy, Marilena Gubbiotti, Vinson Wai, Shun Chan, Mariela Corrales, Esther Garcia Rojo, Thomas R.W. Herrman, Jeremy Yuen, Chun Teoh, Hong Kong, and Daniele Castellani Ee Jean LimEe Jean Lim More articles by this author , Vineet GauharVineet Gauhar More articles by this author , Giacomo Maria PirolaGiacomo Maria Pirola More articles by this author , Emanuele RubilottaEmanuele Rubilotta More articles by this author , Marcelo Langer WroclawskiMarcelo Langer Wroclawski More articles by this author , Dong Le QuyDong Le Quy More articles by this author , Marilena GubbiottiMarilena Gubbiotti More articles by this author , Vinson WaiVinson Wai More articles by this author , Shun ChanShun Chan More articles by this author , Mariela CorralesMariela Corrales More articles by this author , Esther Garcia RojoEsther Garcia Rojo More articles by this author , Thomas R.W. HerrmanThomas R.W. Herrman More articles by this author , Jeremy YuenJeremy Yuen More articles by this author , Chun TeohChun Teoh More articles by this author , Hong KongHong Kong More articles by this author , and Daniele CastellaniDaniele Castellani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002521.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral stricture (US) is a well-known long-term complication of endoscopic procedures for benign prostatic hyperplasia (BPH). This systematic review aims to evaluate the incidence and influencing factors of US in relation to different surgical endoscopic techniques for treating clinical BPH. METHODS: We performed a systemic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. The PICOS (Patient Intervention Comparison Outcome Study type) model was used to frame and answer the clinical question. The incidence of urethral stricture was estimated by comparing the results of the studies that used different endoscopic techniques. Patients were assigned in groups according to the type of surgery and regardless of energy used (enucleation, ablation and resection group). The incidences of US were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Risk Ratio (RR), 95% Confidence Intervals (CI), and p-values. Analyses were two-tailed, and the significance was set at p <0.05 and a 95% CI. Study heterogeneity was assessed utilizing the I2 value. Substantial heterogeneity was defined as an I2 value >50% or a Chi2 p-value <0.10. RESULTS: A total of 80 studies were included for meta-analysis. There was no significant heterogeneity among the studies, with an I2 0%, Chi2 16.98, p=0.88 for Enucleation vs TURP studies and I2 0%, Chi2 27.71, p=0.99 for the Ablation vs TURP ones. The pooled incidence of US was 1.7% after enucleation, 2.1% after ablation, 3.8% after monopolar (M)-TURP and 2.1% after bipolar (B)-TURP. The incidence of US was significantly lower after Enucleation than after TURP (RR 0.58 95% CI 0.39-0.84, p=0.004). US incidence was lower for Ablation procedures than after TURP, but the difference did not reach significance (RR 0.79 95% CI 0.61-1.3, p=0.08). However, this was significant in the subgroup of M-TURP studies (RR 0.67, 95% CI, 0.49-0.91, p=0.01). Sub-analysis showed that the risk of US was significantly lower after Enucleation than after TURP within 12 months after surgery (RR 0.51 95% CI 0.33-0.81, p=0.004). The mean postoperative catheterization was significantly shorter in laser treatments than in TURP also potentially influencing US incidence. CONCLUSIONS: The study shows an increased incidence of US after TURP compared to enucleation and ablation procedures. The main factors related to increased US incidence are the use of monopolar energy, instrument caliber and duration of postoperative catheterization. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e59 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ee Jean Lim More articles by this author Vineet Gauhar More articles by this author Giacomo Maria Pirola More articles by this author Emanuele Rubilotta More articles by this author Marcelo Langer Wroclawski More articles by this author Dong Le Quy More articles by this author Marilena Gubbiotti More articles by this author Vinson Wai More articles by this author Shun Chan More articles by this author Mariela Corrales More articles by this author Esther Garcia Rojo More articles by this author Thomas R.W. Herrman More articles by this author Jeremy Yuen More articles by this author Chun Teoh More articles by this author Hong Kong More articles by this author Daniele Castellani More articles by this author Expand All Advertisement PDF DownloadLoading ...

Urethral stricture following endoscopic prostate surgery: a systematic review and meta-analysis of prospective, randomized trials.

This systematic review aims to evaluate the incidence and influencing factors of urethral stricture (US) in relation to different BPH endoscopic techniques. We performed a systematic literature review using MEDLINE, EMBASE, and Cochrane Central Controlled Register of Trials. The incidence of US was estimated through comparative studies between different endoscopic techniques. Patients were assigned into groups according to the type of surgery (enucleation, ablation and resection group). Incidences of US were pooled using the Cochran-Mantel-Haenszel Method with the random effect model and reported as Risk Ratio (RR), 95% Confidence Intervals (CI), and p-values. A total of 80 studies were included for meta-analysis. The pooled incidence of US was 1.7% after enucleation, 2.1% after ablation, 3.8% after monopolar (M)-TURP and 2.1% after bipolar (B)-TURP. The incidence of US was significantly lower after Enucleation than after TURP (RR 0.58 95% CI 0.39-0.84, p = 0.004). US incidence was lower for Ablation procedures than TURP, but the difference did not reach significance (RR 0.79 95% CI 0.61-1.3, p = 0.08). However, this was significant in the subgroup of M-TURP studies (RR 0.67, 95% CI, 0.49-0.91, p = 0.01). Sub-analysis showed that the risk of US was significantly lower after Enucleation than after TURP within 12months after surgery (RR 0.51 95% CI 0.33-0.81, p = 0.004). The study shows an increased incidence of US after TURP compared to enucleation and ablation procedures. The main factors related to increased US incidence are the use of monopolar energy, instrument caliber and duration of postoperative catheterization.

Eye-Preserving Therapies for Advanced Retinoblastoma: A Multicenter Cohort of 1678 Patients in China

This study attempted to estimate the impact of eye-preserving therapies for the long-term prognosis of patients with advanced retinoblastoma with regard to overall survival and ocular salvage. Retrospective cohort study covering all 31 provinces (38 retinoblastoma treating centers) of mainland China. One thousand six hundred seventy-eight patients diagnosed with group D or E retinoblastoma from January 2006 through May2016. Chart review was performed. The patients were divided into primary enucleation and eye-preserving groups, and they were followed up for survival status. The impact of initial treatment on survival was evaluated by Cox analyses. Overall survival and final eye preservation. After a median follow-up of 43.9 months, 196 patients (12%) died, and the 5-year overall survival was 86%. In total, the eyeball preservation rate was 48%. In this cohort, 1172 patients (70%) had unilateral retinoblastoma, whereas 506 patients (30%) had bilateral disease. For patients with unilateral disease, 570 eyes (49%) underwent primary enucleation, and 602 patients (51%) received eye-preserving therapies initially. During the follow-up (median, 45.6 months), 59 patients (10%) from the primary enucleation group and 56 patients (9.3%) from the eye-preserving group died. Multivariate Cox analyses indicated no significant difference in overall survival between the 2 groups (hazard ratio [HR], 1.25; 95% confidence interval [CI], 0.85-1.84; P= 0.250). For patients with bilateral disease, 95 eyes (19%) underwent primary enucleation, and 411 patients (81%) received eye-preserving therapies initially. During the follow-up (median, 40.1 months), 12 patients (13%) from the primary enucleation group and 69 patients (17%) from the eye-preserving group died. For bilateral retinoblastoma with the worse eye classified as group E, patients undergoing primary enucleation exhibited better overall survival (HR, 2.35; 95% CI, 1.10-5.01; P= 0.027); however, this survival advantage was not evident until passing 22.6 months after initial diagnosis. Eye-preserving therapies have been used widely for advanced retinoblastoma in China. Patients with bilateral disease whose worse eye was classified as group E and who initially underwent eye-preserving therapies exhibited a worse overall survival. The choice of primary treatment for advanced retinoblastoma should be weighed carefully.

MP09-08 COMPARISON OF VAPORIZATION AND ENUCLEATION TECHNIQUES BASED ON THE FUNCTIONAL OUTCOMES AND COMPLICATIONS OF PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA: SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II (MP09)1 Sep 2021MP09-08 COMPARISON OF VAPORIZATION AND ENUCLEATION TECHNIQUES BASED ON THE FUNCTIONAL OUTCOMES AND COMPLICATIONS OF PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA: SYSTEMATIC REVIEW AND META-ANALYSIS Anastasia Shpikina, Andrey Morozov, Mark Taratkin, Alexey Novikov, and Dmitry Enikeev Anastasia ShpikinaAnastasia Shpikina More articles by this author , Andrey MorozovAndrey Morozov More articles by this author , Mark TaratkinMark Taratkin More articles by this author , Alexey NovikovAlexey Novikov More articles by this author , and Dmitry EnikeevDmitry Enikeev More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001982.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nowadays the most commonly used methods of BPH surgical treatment are vaporization (PVP) and enucleation of the prostate (EEP). We aimed to compare intra- and perioperative results of the patients who underwent PVP and EEP. METHODS: A systematic literature search was performed in 3 databases (MEDLINE, Web of Science and Scopus) on a search query: (EEP OR «prostate enucleation» OR «BPH enucleation») AND (PVP OR prostate AND vaporization) according to PRISMA guidelines. The detailed search strategy is available at Prospero, CRD42020204739. The scope of the review according to PICO process is as follows: P - patients with BPH. I - any types of EEP or PVP C - preoperative data, operation characteristics, outcomes of different types of EEP and PVP O - functional outcomes, effectiveness of the procedures, safety. Primary outcomes were functional results (IPSS, QoL, PVR, Qmax). Secondary outcomes were intraoperative results, postoperative PSA and prostate volume, complications, and recurrence rate. RESULTS: The search identified 436 articles, and the final sample contained 15 articles covering a period 2011-2020 years. Functional outcomes (IPSS, QoL и Qmax) were comparable at 12 months follow-up (figure 1). Elkoushy et al. showed benefit of EEP over PVP at 36 months follow-up, IPSS 7.2±8.4 vs 3.1±4.6, p=0.01, and Qmax 24.3±16.2 ml/s vs 28.1±10.2 ml/s, p=0.001. While EEP and PVP duration did not differ significantly in BPH <80 cm3, higher BPH volume was associated with longer operative time. Complication rate (Clavien-Dindo I and II) was higher in the EEP group (13–42%) comparing to PVP (10.3–21.7%), especially the percentage of blood transfusion and transient urinary incontinence. But the rate of complications grade IIIa and higher was similar (3–6%). Reoperation rate was significantly higher in the PVP group at 60 mo. follow-up, 2.7% vs 0%, p <0.05. Postoperative prostate volume and PSA level were also higher in the PVP group. CONCLUSIONS: Short-term outcomes of the patients were comparable in both enucleation and vaporization groups. Long-term results including the percentage of relapse were better in patients who underwent enucleation of the prostate. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e162-e162 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anastasia Shpikina More articles by this author Andrey Morozov More articles by this author Mark Taratkin More articles by this author Alexey Novikov More articles by this author Dmitry Enikeev More articles by this author Expand All Advertisement Loading ...

Comparison of Surgical Outcomes Between Enucleation and Standard Resection in Robot-Assisted Partial Nephrectomy for Completely Endophytic Renal Tumors Through a 1:1 Propensity Score-Matched Analysis.

Objective: Robot-assisted laparoscopic partial nephrectomy (RAPN) for completely endophytic renal tumors is challenging because of the tumor complexity. The enucleation technique is an ideal resection method to maximally preserve the renal parenchyma. In the present study, we investigated the surgical outcomes of RAPN for completely endophytic renal tumors and compared them between the enucleation and standard resection techniques. Methods: One hundred and forty-four patients who underwent RAPN for completely endophytic tumors were the subjects of this study. The subjects were divided into two groups according to the Surface-Intermediate-Base margin score (SIB score): the enucleation group (SIB score 0-2) and the standard resection group (SIB score 3-5). To minimize selection bias between the two surgical methods, patient variables such as age, sex, body mass index, American Society of Anesthesiologists score, tumor size, RENAL nephrometry score (RENAL NS), and preoperative renal function were adjusted using 1:1 propensity score matching. Results: Of the 144 patients, 72 were assigned to the enucleation group and 72 to the standard resection group. After matching, 45 patients were included in each group. The mean tumor size was 26-27 mm and the mean RENAL NS was 9.0-9.1, after matching. The enucleation group showed significantly better preservation of the estimated glomerular filtration rate in the early postoperative period (-4.9% vs -16%, p = 0.0005) and at 6-12 months after surgery (-4.9% vs -9.2%, p = 0.0327) than the standard resection group. In addition, a shorter operation time (140 vs 167 minutes, p = 0.0028) was observed in the enucleation group. Other outcomes, including estimated blood loss, positive surgical margin rate, incidence rate of complications, and length of hospital stay, were not significantly different between the two groups. Conclusion: The enucleation technique showed better surgical outcomes for completely endophytic renal tumors in terms of preservation of renal function and operation time than the standard resection technique.

Analysis of risk factors of bladder neck contracture following transurethral surgery of prostate

BackgroundsThe aim of the present study was to investigate the perioperative parameters associated with bladder neck contracture (BNC) after transurethral surgery of the prostate and to compare the incidence of BNC after transurethral resection of the prostate (TURP) or Thulium vaporesection (resection group) versus Thulium vapoenucleation or enucleation of the prostate (enucleation group).MethodsBetween March 2008 and March 2020, 2363 patients received TURP and 1656 patients received transurethral surgery of the prostate with Thulium laser (ThuP) at Mackay Memorial Hospital. A total of 62 patients developed BNC. These BNC patients were age-and operation-matched to 124 randomly sampled TURP/ThuP controls without BNC. A 1:1 propensity score matching model was used to evaluate the difference in incidence of BNC.ResultsOur study demonstrated that a greater proportion of BNC patients had history of cerebrovascular accidents (11/62 vs. 7/124, p = 0.009), coronary artery disease (14/48 vs. 16/108, p = 0.03), chronic kidney disease (14/62 vs. 11/124, p = 0.01), and two or more comorbidities (29/62 vs. 27/124, p = 0.001) compared with NBNC patients. Multivariate analysis showed that smaller prostate volume (OR 0.96 (0.94–0.99), p = 0.008) and recatherization (OR 5.6 (1.02–30.6), p = 0.047) were significantly associated with BNC. A ROC curve predicted that a prostate volume < 42.9 cm3 was associated with a notably higher rate of BNC. The propensity score matching model reported there was no difference in incidence between resection and enucleation groups.ConclusionThis study demonstrated that incidence of BNC was the same in different surgical techniques and that low prostate volume, recatherization and ≥ 2 comorbidities were positively correlated with the development of BNC after TURP or ThuP.

Nefrectomía parcial vs enucleación tumoral

Antecedentes y objetivo: La cirugía conservadora de nefronas se ha convertido en la técnica quirúrgica estándar para masas renales de pequeño tamaño, desbancando la tradicional nefrectomía radical. El objetivo del estudio es comparar nefrectomía parcial y enucleación tumoral en función de morbilidad y resultados oncológicos.&#x0D; Material y métodos: Estudio de cohortes retrospectivo de pacientes sometidos a nefrectomía parcial o enucleación en el Hospital Clínico Universitario Lozano Blesa de Zaragoza, entre agosto de 2011 y octubre de 2019. Variables demográficas, clínicas, quirúrgicas y resultados oncológicos han sido analizadas.&#x0D; Resultados: 48 pacientes fueron seguidos 36.1±28.0 meses. Los pacientes sometidos a enucleación tumoral, respecto al grupo de nefrectomía parcial presentaron valores inferiores de sangrado medio (117.7±95.1 ml y 221±293.1 ml, p=0.488), isquemia (46% y 95%, p&lt;0.001), tiempo de isquemia medio (24.6±7.2 min y 25.1±10.4 min, p=0.844) y complicaciones (11.5% y un 22.7%, p=0.442) respectivamente. No se observó recidiva local.&#x0D; Conclusiones: Ambos grupos son comparables en cuanto a estadio tumoral, presentando en el grupo de enucleación un menor sangrado, menor necesidad de clampaje vascular y un tiempo de isquemia similar al grupo de nefrectomía parcial. Ambas técnicas son seguras a nivel oncológico, con una baja tasa de márgenes afectos. Ambas técnicas presentan una baja morbilidad postoperatoria.

Evaluation of postoperative changes in the course of mandibular canals impacted by cystic lesions

BackgroundThis study aims to determine the positional alterations in the course of mandibular canal, which were caused by the common cystic lesions in the posterior mandible. Also, the effects of treatment methods on bone formation were evaluated. MethodsWe designed a retrospective cohort study with patients which were treated due to cystic lesions in the maxillofacial region between the years 2012–2018. Forty eight subjects were included and grouped regarding histopathologic diagnoses (radicular dentigerous and odontogenic keratocyst) and treatment methods (enucleation and marsupialization). The mean (range) of patients’ age was 31.25 (18–66) years, and there were 32 male and 16 female individuals. The displacement of mandibular canals was verified on preoperative cone-beam computed tomographic images. The measurements of displacement and bone formation were performed on panoramic radiographs. In the statistical analysis of the data, descriptive statistics, parametric independent sample t-test, non-parametric Kruskal Wallis test, and one-way analysis of variance test were utilized. ResultsAll the evaluated mandibular canals were replaced by a mean(SD) of 5.46(2.59) mm after the lesions eliminated, which was significant in the marsupialization group (p = 0.002). The bone formation was significantly higher in the enucleation group (p = 0.003). The multiple regression analyses revealed that the treatment methods significantly influenced the replacement of mandibular canal (p < 0.001) and the bone formation (p = 0.026). ConclusionIn cases where there is an adequate distance between the lesion and the mandibular canal, the enucleation technique was found to be superior in terms of bone formation and the amount of bone height obtained.

Two-Dimensional Change in the Cystic Defects after Decompression and Enucleation of Jaw Cysts - A Comparative Study.

Introduction:To compare the treatment methods of enucleation and decompression with regards to reduction of the dimension of the cystic defect with the aid of a software program.Materials and Methods:Thirty patients with regular controls of 3, 6, and 12 months treated between January 1, 2013, and January 1, 2021, were selected and included in the study. Sixteen patients were treated with enucleation and 14 patients with decompression. All preoperative and control radiographic and clinical data were retrieved from the archives. The area measurement of cystic cavities was made on panoramic radiographs taken at preoperative (T0), 3-month (T1), 6-month (T2), and 12-month (T3) control periods with a software program. Intra-group and inter-group analyses were made to compare the reduction of cystic defects between two treatment methods.Results:The mean age of study patients was 45.2 ± 7.3. Eighteen of them were male and 12 of them were female. Statistically, a significant difference was not observed between decompression and enucleation groups at T0, T1, T2, and T3 control periods (P > 0.05). There was a statistically significant difference in the defect dimensions between all control periods in both decompression and enucleation groups (P < 0.05).Discussion:Decompression and enucleation of jaw cysts are both successful in reducing cystic cavities. However, there is no superiority between the two treatment modalities regarding the defect reduction at the 12-month control period.