Holmium Laser Enucleation Of Prostate Research Articles

MP20-07 Comparative efficacy and safety of Aquablation versus Holmium Laser Enucleation of Prostate for surgical treatment of Benign Prostatic Hyperplasia: A network meta-analysis

MP20-07 Comparative efficacy and safety of Aquablation versus Holmium Laser Enucleation of Prostate for surgical treatment of Benign Prostatic Hyperplasia: A network meta-analysis

Revisiting the issue of "beach balls" in holmium laser enucleation of prostate: clinical and histological characterization.

To clinically and histologically characterize prostatic nodules resistant to morcellation ("beach balls," BBs). We reviewed a consecutive cohort of 559 holmium laser enucleation of the prostate (HoLEP) procedures performed between January 2020 and November 2023. The BBs group comprised 55 men (10%) and the control group comprised 504 men (90%). The clinical, intraoperative, outcome, and histologic data were statistically processed for the prediction of the presence of BBs and their influence on the perioperative course and outcome. The BBs group in comparison to the controls was older (75 vs 73years, respectively, p = 0.009) and had higher rates of chronic retention (51 vs 29%, p = 0.001), larger prostates on preoperative abdominal ultrasound (AUS) (140 vs 80cc, p = 0.006E-16), longer operating time (120 vs 80min, p = 0.001), higher weights of removed tissue (101 vs 60gr, p = 0.008E-10), higher complication rates (5 vs 1%, p = 0.03), and longer hospitalization (p = 0.014). A multivariate analysis revealed that larger prostates on preoperative AUS and older age independently predicted the presence of BBs which would prolong operating time. ROC analyses revealed that a threshold of 103cc on AUS predicted BBs with 94% sensitivity and 84% specificity. BBs were mostly characterized histologically by stromal component (p = 0.005). BBs are expected in older patients and cases of chronic retention. Prostatic volume is the most reliable predictor of their presence. They contribute to prolonged operating time and increased risk of complications. The predominantly stromal composition of the BBs apparently confers their resistance to morcellation.

Holmium Laser Enucleation of Prostate: Is novel En Bloc Enucleation Technique Better Than the Traditional 2-Lobe Technique-A Prospective Randomized Study.

To compare the safety and efficacy of the en bloc technique with the standard 2-lobe technique for holmium laser enucleation of the prostate (HoLEP). This prospective study included patients with benign prostatic hyperplasia (BPH) who underwent HoLEP from September 2020 to March 2022, by en bloc or 2-lobe technique. Patient demographics, prostate volume, enucleation, morcellation and operative time, and incidence of postoperative incontinence were compared between the 2 groups. We included 64 patients (30 en bloc and 34 2-lobe techniques) who underwent HoLEP in this study. The mean age, prostate volume, creatinine, and PSA of patients were comparable in both groups [(68.53 vs. 67.55 years; P=.62), (79.43 vs. 79.88 g, P=.92), (1.08 mg/dL vs. 1.20 mg/dL, P=.35), (3.78 vs. 4.63 ng/mL; P=.376), respectively]. The enucleation time was significantly shorter in the en bloc group than in the 2-lobe group (54.2 vs. 61.67; P=.03). Additionally, the mean operative time was also comparatively shorter in the en bloc group than the 2-lobe group (72.36 vs. 80.50; P=.057). The improvement in the quality-of-life (QoL) score was significantly better with en bloc than the 2-lobe group (3.80 vs. 2.11; P=.01). There was a significant difference in stress urinary incontinence on days 1, 7, and 30 (P .001) with en bloc compared to the two-lobe technique. Although the outcomes of en bloc and 2-lobe endoscopic enucleation of prostate techniques were comparable, the en bloc technique seems to be a better option in most patients undergoing HoLEP due to less enucleation and operative time and lowered stress urinary incontinence incidence.

Clinical outcome and safety of holmium laser prostate enucleation after transrectal prostate biopsies for benign prostatic hyperplasia.

This study aimed to assess the clinical outcome and safety of holmium laser enucleation of the prostate (HoLEP) following transrectal ultrasound-guided prostate biopsy (TR biopsy) in the treatment of benign prostate hyperplasia. We retrospectively analyzed data from 556 patients who underwent HoLEP between 2014 and 2021. The patients were categorized into six groups: Group 1-A (n=45) underwent HoLEP within four months post TR biopsy. Group 1-B (n=94) underwent HoLEP more than four months post TR biopsy. Group 1-C (n=120) underwent HoLEP after a single TR biopsy. Group 1-D (n=19) underwent HoLEP after two or more TR biopsies. Group 1-total (n=139, group 1-A+group 1-B or group 1-C+group 1-D) underwent HoLEP post TR biopsy. Group 2 (control group, n=417) underwent HoLEP without prior TR biopsy. We examined perioperative parameters, safety, and functional outcomes. The age, body mass index, International Prostate Symptom Score (IPSS), uroflowmetry, and comorbid diseases between group 1-total and group 2 were comparable. However, group 1-total exhibited significantly elevated prostate-specific antigen levels and larger prostate volumes (p<0.01). Perioperative factors like enucleation time, enucleation weight, and catheterization duration were notably higher in group 1-total (p<0.01). All groups showed significant improvements in IPSS, postvoid residual urine, and maximum flow rate during the 1-year postoperative period (p<0.05). The rates of postoperative complications were similar between group 1-total and group 2. Enucleation time and catheterization duration were significantly longer in the TR biopsy group. However, postoperative complications were not significantly different between TR biopsy and non-TR biopsy groups.

Preoperative Frailty Scores Predict the Early Postoperative Complications of Holmium Laser Enucleation of Prostate.

Background: Frailty is a recent multidimensional concept of a contemporary growing interest for understanding the complex health status of elderly population. We aimed to assess the impact of frailty scores on the outcome and complication rate of holmium laser enucleation of prostate (HoLEP). Methods: A 7-year data of HoLEP patients in a single tertiary referral center were reviewed. The preoperative, operative, early, and late postoperative outcome data were collected and compared according to the preoperative frailty scores. Frailty was assessed preoperatively using the Modified Hopkins frailty score. Results: The study included 837 patients categorized into two groups: group I included 533 nonfrail patients (frailty score = 0), whereas group II included 304 frail patients (frailty score ≥1). The median (interquartile range) age was 70 (11) and 75 (11) years for groups I and II, respectively (<0.001). The 30-day perioperative complication rate (p = 0.005), blood transfusion (p = 0.013), failed voiding trial (p = 0.0015), and 30-day postoperative readmission (p = 0.0363) rates were significantly higher in frail patients of group II. The two groups were statistically comparable regarding postoperative international prostate symptom score (p = 0.6886, 0.6308, 0.9781), incontinence rate (p = 0.475, 0.592, 0.1546), postvoid residual (p = 0.5801, 0.1819, 0.593) at 6 weeks and 3 months, and 1-year follow-up intervals, respectively. Conclusion: In elderly patients undergoing HoLEP, the preoperative frailty scores strongly correlate with the risk of perioperative complications. Frail patients should be counseled regarding their relative higher risk of early perioperative complications although they gain the same functional profit of HoLEP as nonfrail patients.

775 Incidental Prostate Cancer Following Holmium Laser Enucleation of Prostate

Abstract Aim  To review the incidence and predictors of incidental prostate cancer (IPCa) following Holmium Laser Enucleation of Prostate (HoLEP). Method  This was a departmental retrospective review of 148 patients undergoing HoLEP between 2017 to 2022. Demographic, perioperative, and pathologic data were gathered. For patients diagnosed with IPCa, information on work up, management, and oncologic outcome were gathered. Univariate and multivariate logistic regression were used to identify predictors of IPCa.  Results  13 patients had IPCa (8.78%). The mean age was 73.4 years (SD 6.6); pre-procedural prostate volume 85.3ml (SD 32.9); pre-procedural PSA 6.7ng/ml (SD 6.1); PSA density 0.08ng/mL2 (SD 0.06); weight of enucleated tissue 52.8g (SD 39.4); enucleated tissue PSA density 0.14ng/mL2 (SD 0.10). Prostate volume was strongly correlated with weight of enucleated tissue (Pearson 0.8, P = 0.006). Lower pre-procedure prostate volume was the only significant predictor of IPCa (P = 0.018). A prostate volume of &amp;lt;99.0ml had sensitivity of 0.67 and specificity of 0.63 (Area under ROC = 0.70). Mean reduction in post-procedural PSA was 5.6ng/ml (SD 6.3). 61.5% (n = 8) patients had clinically significant IPCa (Gleason≥GG2 or &amp;gt;5% volume). 3 patients had radical treatment, and 5 patients were under active surveillance. The other 5 patients with insignificant IPCa continue on active surveillance (AS) (n = 3) and watchful waiting (WW) (n = 2). None with insignificant disease had disease progression.  Conclusions  Of patients with IPCa, 61.5% (n = 8) patients had clinically significant IPCa, and the optimal mode of detecting incidental clinically significant prostate cancer, prior to HoLEP might include pre-operative MRI in selected patients based on gland size.

1116 An Institutional Review of Holmium LASER Enucleation of the Prostate Morbidity

Abstract Aim To review morbidity rate of Holmium Laser Enucleation of Prostate (HoLEP) in at a single institution in the UK. Method A retrospective review of 148 patients who underwent HoLEP between 2017 and 2022 was performed. Demographic, intraoperative, immediate postoperative and postoperative follow up data were recorded to determine the incidence of complications. Mean data are presented. Results The mean age was 71.4 years (SD 7.5), prostate volume 109.7ml (SD 38.5), weight of enucleated tissue 61.4g (SD 41.4), and length of stay 1.5 days (SD 0.9). 76 patients (51.4%) had long term catheter and 18 patients (12.2%) had intermittent self-catheterization preoperatively. 114 patients (77%) had successful TWOC prior to discharge. 4 patients (2.7%) never had a successful TWOC. Clavien-Dindo II complications included urinary infection (2.8%, n = 4) and lavage for haematuria (2.7%, n = 4), and of those, clot retention in 1.4% (n = 2). Clavien-Dindo III complications included urethral stricture (1.4%, n = 2) and clot evacuation for hematuria (0.7%, n = 1). The 30-day readmission rate was 2.7 % (n = 4), all for clot retention. Among 5 patients (3.4%) with haematuria or clot retention, 4 patients were treated with lavage/irrigation, and 1 required bladder washout in theatre. There were 3 patients on anticoagulant medications and 1 patient on an antiplatelet within 30 days of HoLEP. Conclusions HoLEP is associated with low incidence of morbidity and low rate of readmission, however pre-operative anticoagulant use was associated with readmission due to haematuria.

En bloc holmium laser enucleation of prostate in octogenarians and nonagenarians: clinical characteristics and outcome.

Extended longevity leads to greater numbers of elderly patients with benign prostatic hyperplasia (BPH) who seek surgical solutions. We assessed the clinical characteristics and outcomes of octogenarians and nonagenarians with BPH who underwent en bloc holmium laser enucleation of prostate (HoLEP). Retrospective cohort of all consecutive HoLEP patients treated in our medical center between January 2020 and January 2023. Cohort was divided into group aged < 80 years (n = 290) and group aged ≥ 80 years (n = 77). Their demographics, presentations, indications, and outcomes were compared. Octogenarians and nonagenarians had higher rates of indwelling catheters (p = 0.00001), chronic retention (p = 0.00006), larger prostates (p = 0.03), higher American Anesthesiology Association scores (p = 0.000001), and more antiplatelet medications (p = 0.0003) at presentation. They had longer operations (median 115 vs 90 min, respectively, p = 0.0008), longer hospital stay (median 2 vs 1 day, p = 0.01E-7), a higher complication rate (17% vs 7%, p = 0.02), and a higher transitory urinary incontinence (TUI) rate (54% vs 9%, p = 0.00001). TUI was more prevalent in the older group with indwelling catheters (61% vs, 13%, p = 0.00001). The functional outcome was similar for both age groups, and all patients could void spontaneously after the procedure. En-bloc HoLEP improves urinary symptoms and quality of life in patients ≥ 80 years of age despite larger prostates, more comorbidities, and higher complications rate, compared to younger men. HoLEP bestows a significant improvement in urologic quality of life regardless of age.

Mini-HoLEP (MILEP) vs HoLEP: a propensity score-matched analysis.

Minimal invasiveness improves outcome in many surgical fields including urology. We aimed to assess intraoperative performance and clinical outcome of miniaturized holmium laser enucleation of prostate (MiLEP) (22FR). We ran a propensity score-matched analysis among all consecutive laser enucleations of prostate performed between 9/2022 and 2/2023. It resulted in two matched comparison groups: MiLEP 22 FR (n = 40) and holmium laser enucleation of prostate (HoLEP 26 Fr) (n = 40). Statistical analysis was performed. MiLEP was associated with significantly less intraoperative irrigation (20.5 L vs 15 L,p = 0.002E-3), less decrease in body core temperature (0.6°C vs 0.1°C,p = 0.003E-5), and less need for meatal dilation (25% vs 78%,p = 0.01E-3). These parameters were identified as being independent in the multivariate analysis. There was a trend toward less and a shorter period of postoperative stress incontinence (SI) for the MiLEP group compared to the HoLEP group: 15% and 42% (p = 0.01) at 1 month, 8% and 14% (p = 0.07) at 2 months, and 0 and 0.3% (p = 1) at 3 months, respectively. There were no differences in prostatic enucleation effectiveness, operative time, hospital stay, complications, and improvement in the international prostate symptom score and quality of life score. MiLEP is feasible and provides better maintenance of body core temperature, reduction in amount of fluid irrigation, and decrease in need for meatal dilation without affecting effectiveness in comparison with HoLEP. MiLEP may reduce early postoperative stress incontinence, thereby shortening the recovery period.

Comparison of holmium laser enucleation and transurethral resection of prostate in benign prostatic hyperplasia: a systematic review and meta-analysis.

Transurethral resection of the prostate (TURP) is the gold-standard classical method for the treatment of benign prostatic hyperplasia (BPH). In minimally invasive surgery, holmium laser enucleation of the prostate (HoLEP) is considered an alternative option. In this systematic review and meta-analysis, we aimed to comprehensively evaluate the advantages and disadvantages of TURP and HoLEP the treating BPH. We comprehensively searched PubMed, Cochrane Library, EMBASE, and Web of Science databases for all randomized controlled trials published before 1 December 2022 comparing HoLEP and TURP. The study protocol is registered on INPLASY (DOI: 10.37766/inplasy2023.5.0065). Compared with TURP, HoLEP required longer operation time but shorter catheter duration, hospital stay, and bladder irrigation time, as well as less postoperative irrigation. With HoLEP, maximum urinary flow rate at 12 and 24 months after surgery; post-void residual volume at 1, 6, and 12 months; and International Prostate Symptom Score at 12 months after surgery were superior to those with TURP. HoLEP was associated with significantly lower risk of hyponatremia, blood transfusion, and urethral stricture but greater risk of postoperative dysuria. Compared with TURP, HoLEP had better curative efficacy at 6, 12, and 24 months after operation and lower incidence of adverse events in patients with BPH.

Predictive factors for postoperative medication therapy for overactive bladder symptoms after holmium laser enucleation of prostate.

To preoperative factors that could predict the persisting storage symptoms after Holmium laser enucleation of the prostate (HoLEP). Medical records of 257 patients who underwent HoLEP between December 2014 and January 2021 were reviewed. Participants with a follow-up period exceeding 6 months were included. Preoperative data, including International Prostate Symptom Score (IPSS), uroflowmetry, prostate size, and prostate-specific antigen, were collected. All participants underwent a preoperative urodynamic study. The correlation between perioperative variables and postoperative medication therapy (antimuscarinics or beta-3 agonists) was assessed. Out of 257 participants in the study, 46 (18.6%) were allocated to the medication group, of which 25 (54.3%) initiated medication therapy postoperatively. The medication group showed worse postoperative IPSS storage symptom score and quality of life score compared to the medication-free group (p = 0.048 and p = 0.002, respectively), but no significant differences were observed in complications or operative variables. In the de-novo medication group, patients had lower preoperative Qmax , larger prostate volume, and smaller maximum cystometric capacity (MCC) compared to the persisting medication group (p = 0.020, p = 0.009, and p = 0.008, respectively). Overactive bladder (OAB) history, terminal detrusor overactivity (DO), and IPSS urgency item were identified as possible predictive factors for post-HoLEP medication use. Preoperative factors such as OAB history, terminal DO, and IPSS urgency item may predict the need for post-HoLEP medication therapy. Further follow-up studies are warranted to understand the characteristics of the de-novo medication group due to the significant discomfort it can cause to patients.

Holmium laser enucleation of prostate in nonagenarians and octogenarians Impact of age and frailty on surgical outcomes.

Holmium laser enucleation of the prostate (HoLEP) is a well-established technique for management of benign prostatic hyperplasia (BPH). With the growing aging population, a considerable percentage of octogenarians (80-90 years old) and nonagenarians (>90 years old) require surgical management for BPH. We aimed to assess the outcomes of HoLEP in those age groups. We reviewed a maintained database for HoLEP patients in a tertiary center. Patients were assigned to two groups: above (group A) and below (group B) 80 years old. Perioperative outcome and postoperative followup data were compared between both groups. The study included 1090 patients, 201 and 889 in groups A and B, respectively. Median age was 83 and 70 years in groups A and B, respectively. Group A showed longer operative time, longer catheterization time, and higher 30-day emergency room visits and readmission rates. Hemoglobin drop was comparable, although associated with higher rate of blood transfusion in group A. Overall, 30-day postoperative complications were higher in group A (20.8% vs. 9.3%, p=0.008), although the majority of complications in both groups were grade I and II. The rate of complications over Clavien-Dindo grade II were statistically comparable (3.4% vs. 1.79%, p=0.133). Followup at six weeks, three months, and one year showed comparable functional outcomes in both groups. HoLEP is a safe and effective option in the geriatric population of octogenarians and even nonagenarians. HoLEP is associated with higher overall complication rate in older age groups; however, most complications were minor.

31 - Bipolar-TURP versus holmium laser enucleation of prostate: Functional outcomes and complications in frail elderly (>75 y.o.) patients: A prospective randomized study

31 - Bipolar-TURP versus holmium laser enucleation of prostate: Functional outcomes and complications in frail elderly (>75 y.o.) patients: A prospective randomized study

MP59-05 PERI-OPERATIVE AND SHORT-TERM FUNCTIONAL OUTCOMES COMPARISON BETWEEN HOLEP AND ROBOTIC SIMPLE PROSTATECTOMY FOR LARGE PROSTATE

You have accessJournal of UrologyCME1 Apr 2023MP59-05 PERI-OPERATIVE AND SHORT-TERM FUNCTIONAL OUTCOMES COMPARISON BETWEEN HOLEP AND ROBOTIC SIMPLE PROSTATECTOMY FOR LARGE PROSTATE Giovanni Cochetti, Morgan Roupret, Alessio Paladini, Thomas Seisen, Christophe Vaessen, Ugo Pinar, Sara Ciarletti, Angelica Tancredi, Eleonora Saqer, Liliana Guadagni, Emmanuel Chartier-kastler, and Ettore Mearini Giovanni CochettiGiovanni Cochetti More articles by this author , Morgan RoupretMorgan Roupret More articles by this author , Alessio PaladiniAlessio Paladini More articles by this author , Thomas SeisenThomas Seisen More articles by this author , Christophe VaessenChristophe Vaessen More articles by this author , Ugo PinarUgo Pinar More articles by this author , Sara CiarlettiSara Ciarletti More articles by this author , Angelica TancrediAngelica Tancredi More articles by this author , Eleonora SaqerEleonora Saqer More articles by this author , Liliana GuadagniLiliana Guadagni More articles by this author , Emmanuel Chartier-kastlerEmmanuel Chartier-kastler More articles by this author , and Ettore MeariniEttore Mearini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium Laser enucleation of Prostate (HoLEP) and open simple prostatectomy (OSP) are recommended treatments for large benign prostate hyperplasia (BPH). Robot-assisted simple prostatectomy (RASP) seems comparable to open simple prostatectomy (OSP) in terms of efficacy and safety, providing similar improvements in Qmax and IPSS, but with advantages of minimally invasive technique. It remains unclear which is the best treatment between HoLEP and RASP. The aim of the study was to compare these techniques in terms of perioperative data, short-term functional outcomes in patients (pts) with prostate larger than 100 cc. METHODS: From January 2016 to January 2022, data from 94 pts with BPH >100 cc who underwent HoLEP or RASP were retrospectively analyzed. Overall, 47 pts underwent HoLEP and 47 underwent RASP. Operative time (OT), blood loss evaluated as ΔHb, length of catheterization (LOC), length of stay (LOS), IPSS, quality of life (QoL) index, urgency, maximum flow rate (Qmax), PSA, complications and urinary continence were analyzed at 30 and 90 days after surgery. Statistical analysis was made with T-test or Wilcoxon test for parametric and non-parametric continuous variables, respectively. Chi-square test was used for percentage variables. Statistical significance was set at p<0.05. RESULTS: The groups were comparable in terms of age, BMI, pre-operative IPSS and QoL index. The mean prostate volume was similar even if in HoLEP group was slightly lower (128.4±23.9 vs 144±34.1 cc, p>0.05). LOC (2.4±0.9 vs 4.5±1.5 days, p=0.003) and LOS (3.5±1.1 vs 5±1.8 days, p=0.002) were significantly shorter for HoLEP group. No differences were observed in post-operative ΔHb, QoL, IPSS, urgency and urinary continence at 30 and 90 days after surgery. Otherwise, OT of RASP was significantly lower than HoLEP (107,5±20,1 vs 178,9±62 min, p<0.05), while at 3 months Qmax and PSA value were higher and lower, respectively, in HoLEP group (33.2±12.4 vs 24.5±15.3 ml/sec, p=0.03 and 0.8± vs 1.6± ng/ml, p=0.003). No intraoperative complication according to EAUiaiC occurred and only minor postoperative complications according to Clavien Dindo classification were observed without significant differences (4,25% for HoLEP vs 10.6% for RASP, p=0.27). CONCLUSIONS: Compared to RASP, HoLEP shows advantages in reducing LOC and LOS, but needs of longer OT. Lower levels of PSA in HoLEP, that could be the result of more tissue removal, and the better Qmax do not affect IPSS and QoL in peri-operative and short-term outcomes. HoLEP and RASP are both safe and effective enucleative techniques. Probably, RASP could be more useful for pts with larger BPH and multiple vesical lithiasis or large diverticulum. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e807 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giovanni Cochetti More articles by this author Morgan Roupret More articles by this author Alessio Paladini More articles by this author Thomas Seisen More articles by this author Christophe Vaessen More articles by this author Ugo Pinar More articles by this author Sara Ciarletti More articles by this author Angelica Tancredi More articles by this author Eleonora Saqer More articles by this author Liliana Guadagni More articles by this author Emmanuel Chartier-kastler More articles by this author Ettore Mearini More articles by this author Expand All Advertisement PDF downloadLoading ...

MP13-14 ROBOT-ASSISTED SIMPLE PROSTATECTOMY VERSUS HOLMIUM LASER ENUCLEATION FOR THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA IN LARGE (&gt;100 ML) PROSTATES: UPDATED COMPARATIVE ANALYSIS FROM A HIGH-VOLUME CENTER

You have accessJournal of UrologyCME1 Apr 2023MP13-14 ROBOT-ASSISTED SIMPLE PROSTATECTOMY VERSUS HOLMIUM LASER ENUCLEATION FOR THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA IN LARGE (>100 ML) PROSTATES: UPDATED COMPARATIVE ANALYSIS FROM A HIGH-VOLUME CENTER Mottaran Angelo, Eleonora Balestrazzi, Carlo Andrea Bravi, Luigi Nocera, Marco Paciotti, Adele Piro, Maria Peraire Lores, Luca Sarchi, Federico Piramide, Pieter De Backer, Ruben De Groote, Geert De Naeyer, Peter Schatteman, and Alexandre Mottrie Mottaran AngeloMottaran Angelo More articles by this author , Eleonora BalestrazziEleonora Balestrazzi More articles by this author , Carlo Andrea BraviCarlo Andrea Bravi More articles by this author , Luigi NoceraLuigi Nocera More articles by this author , Marco PaciottiMarco Paciotti More articles by this author , Adele PiroAdele Piro More articles by this author , Maria Peraire LoresMaria Peraire Lores More articles by this author , Luca SarchiLuca Sarchi More articles by this author , Federico PiramideFederico Piramide More articles by this author , Pieter De BackerPieter De Backer More articles by this author , Ruben De GrooteRuben De Groote More articles by this author , Geert De NaeyerGeert De Naeyer More articles by this author , Peter SchattemanPeter Schatteman More articles by this author , and Alexandre MottrieAlexandre Mottrie More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003233.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In patients with large benign prostatic hyperplasia (BPH), both Holmium Laser Enucleation of Prostate (HoLEP) and Robot-Assisted Simple Prostatectomy (RASP) are possible treatment options. While both techniques have advantages and disadvantages, comparative evidence on peri-operative outcomes of these operations for the treatment of large prostates (>100 ml) is still limited. Therefore, our aim was to update our comparative analysis of HoLEP vs. RASP for the treatment of BPH in patients with large (>100 ml) prostate volumes. METHODS: We analyzed data of 339 patients with symptomatic BPH due to large (>100 ml) prostates glands who underwent RASP (n=130, 35%) and Holep (n=239, 65%) at OLV Hospital, Aalst (Belgium) between 2011 and 2021. We collected pre-operative baseline characteristics and peri-operative outcomes; peri-operative complications were reported according to the Clavien-Dindo classification. Functional parameters were assessed postoperatively 3 months after surgery. We compared pre-operative characteristics, operative time and peri- and post-operative outcomes between the groups. RESULTS: Baseline characteristics – including age, BMI, preoperative IPSS score, preoperative maximum flow and post-voidal residue (PVR) – did not differ between patients receiving RASP vs. HoLEP (all p>0.05). As compared to HoLEP, patients treated with RASP had bigger prostates at preoperative imaging (median: 159 (115, 200) ml vs. 120 (110, 140) ml; p<0.001). Median operation time (100 min vs. 120 min), catheterization time (2 vs. 3 days) and length of stay (2 vs. 4 days) were slightly shorter in the HoLEP group (all p<0.001). On final pathology, median prostate weight was similar between the groups (100 gr vs. 105 gr; p=0.4). Complication rates were similar in both groups (rate of all Clavien-Dindo complications: 23% vs. 22%; p=0.2). At 3 months follow up, both groups showed an improvement of maximum flow rate (+12 vs. +13.3 ml/s; p=0.4), a reduction of PVR (-93 vs. -75 ml; p=0.9) and IPSS score (-16 vs. -12; p=0.2). CONCLUSIONS: Our study provided relevant data on peri-operative outcomes of RASP and Holep, and might help clinicians in preoperative counselling for men with large (>100 ml) prostates requiring surgery for BPH. While patients receiving RASP had slightly longer hospital stay, both techniques achieved excellent results in this patient population, and represent valuable treatment option according to physician preferences and expertise. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e178 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mottaran Angelo More articles by this author Eleonora Balestrazzi More articles by this author Carlo Andrea Bravi More articles by this author Luigi Nocera More articles by this author Marco Paciotti More articles by this author Adele Piro More articles by this author Maria Peraire Lores More articles by this author Luca Sarchi More articles by this author Federico Piramide More articles by this author Pieter De Backer More articles by this author Ruben De Groote More articles by this author Geert De Naeyer More articles by this author Peter Schatteman More articles by this author Alexandre Mottrie More articles by this author Expand All Advertisement PDF downloadLoading ...

MP59-15 ANALYSIS OF RISK FACTORS FOR FORMATION OF BLADDER NECK CONTRACTURE AFTER HOLMIUM ENUCLEATION OF PROSTATE

You have accessJournal of UrologyCME1 Apr 2023MP59-15 ANALYSIS OF RISK FACTORS FOR FORMATION OF BLADDER NECK CONTRACTURE AFTER HOLMIUM ENUCLEATION OF PROSTATE Susan Talamini, Adam Ostergar, Hayden Hill, Alethea Paradis, Joel Vetter, and Charles Nottingham Susan TalaminiSusan Talamini More articles by this author , Adam OstergarAdam Ostergar More articles by this author , Hayden HillHayden Hill More articles by this author , Alethea ParadisAlethea Paradis More articles by this author , Joel VetterJoel Vetter More articles by this author , and Charles NottinghamCharles Nottingham More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium laser enucleation of prostate (HoLEP) offers a size independent approach to the treatment of benign prostatic hyperplasia (BPH). Bladder neck contracture (BNC) is a known complication after endoscopic intervention for BPH. This study aims to evaluate the incidence and risk factors associated with the formation of postoperative BNC after HoLEP. METHODS: A retrospective review was conducted from 2020 to 2022 of men undergoing HoLEP by a single surgeon. Exclusion criteria included patients with follow up of less than 1 month. Patients with postoperative BNC were identified, and Chi-square and Mann-Whitney U tests were used to test for significant associations between categorical and continuous variables of interest and bladder neck contracture respectively. Pre- and perioperative factors were compared between groups including catheter dependence, history of radiation, previous outlet procedures, concurrent procedures, laser type, enucleated gland weight, and energy usage. RESULTS: A total of 184 men were identified for the study. An incidence of BNC occurred in 9% of patients (n=17). On univariate analysis, enucleated gland weight was significantly associated with BNC (70 vs 38.9, p=0.029), though this association was not seen on multivariate analysis. Amongst men with glands less than 40gm, 13.3% had BNCs. The presence of bladder stones at time of HoLEP was a significant risk factor associated with the development of BNC, as 17.6% of men with BNCs had bladder stones (p=0.039). Urethral dilation was also significantly associated with BNC (11.8%, p=0.023). Mean time to diagnosis of BNC was 6.5 months. Mean follow up was 6.5 months. CONCLUSIONS: Our study identified smaller gland size, as well as concurrent bladder stones and previous stricture disease, as significant risk factors for the development of BNC after HoLEP. This study underscores the importance of preoperative anatomical evaluation in patient counseling and discussion of individual risk factors. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e813 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Susan Talamini More articles by this author Adam Ostergar More articles by this author Hayden Hill More articles by this author Alethea Paradis More articles by this author Joel Vetter More articles by this author Charles Nottingham More articles by this author Expand All Advertisement PDF downloadLoading ...

MP51-07 IMPACT OF AGE AND FRAILTY ON SURGICAL OUTCOMES OF HOLMIUM LASER ENUCLEATION OF PROSTATE (HOLEP) IN NONAGENARIANS AND OCTOGENARIANS PATIENTS

You have accessJournal of UrologyCME1 Apr 2023MP51-07 IMPACT OF AGE AND FRAILTY ON SURGICAL OUTCOMES OF HOLMIUM LASER ENUCLEATION OF PROSTATE (HOLEP) IN NONAGENARIANS AND OCTOGENARIANS PATIENTS Mohamed Elsaqa, Yu Zhang, and Marawan M. El Tayeb Mohamed ElsaqaMohamed Elsaqa More articles by this author , Yu ZhangYu Zhang More articles by this author , and Marawan M. El TayebMarawan M. El Tayeb More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: With the growing population aging, BPH burden has increased with considerable percentage of octogenarian (80-90 years) and nonagenarian (>90 years) patients requiring surgical management. We aimed to assess the difference in complication rate and functional outcome of Holmium laser enucleation of prostate (HoLEP) in these age groups. METHODS: Maintained database was reviewed for HoLEP patients with follow up of 1 year. Patients were divided into 2 groups according to age: ≥80 years (G I) and<80 years (G II). Perioperative complications and functional outcomes were compared between both groups. RESULTS: Total 1090 patients were included, 201 and 889 in GI and II respectively. Median age was 84 and 70 years in GI and GII respectively. GI had significantly higher frailty score, lower baseline hemoglobin and more anticoagulant use. GI showed significantly longer operative time, higher rate of blood transfusion, longer catheterization time and higher rates of failed 1st voiding trial, emergency room (ER) visits and readmission. Clavien-Dindo complications within 30-days were statistically higher in GI (20.8% vs 9.3%, p=0.008) although over-grade II complications were comparable in both groups (3.4% vs 1.79%, p=0.133). (Tables 1 and 2) Follow up IPSS and incontinence rates were comparable in both groups. (Figure 1) CONCLUSIONS: HoLEP is a safe and very effective option in the geriatric population of octogenarians and nonagenarians. HoLEP is associated with higher overall complication rate in octogenarians and nonagenarians, however most complications are minor with comparable over-grade II complication rate to younger age group. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e695 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Elsaqa More articles by this author Yu Zhang More articles by this author Marawan M. El Tayeb More articles by this author Expand All Advertisement PDF downloadLoading ...

MP51-20 PREDICTORS OF URINARY TRACT INFECTION POST-HOLMIUM LASER ENUCLEATION OF PROSTATE (HOLEP)

You have accessJournal of UrologyCME1 Apr 2023MP51-20 PREDICTORS OF URINARY TRACT INFECTION POST-HOLMIUM LASER ENUCLEATION OF PROSTATE (HOLEP) Mohamed Elsaqa, Katherine Dowd, Amr Elmekresh, and Marawan M. El Tayeb Mohamed ElsaqaMohamed Elsaqa More articles by this author , Katherine DowdKatherine Dowd More articles by this author , Amr ElmekreshAmr Elmekresh More articles by this author , and Marawan M. El TayebMarawan M. El Tayeb More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Irritative urinary symptoms and urinary tract infection (UTI) are among the most common complications following Holmium Laser Enucleation of Prostate (HoLEP). We aimed to study the incidence and risk factors for early irritative urinary symptoms and postoperative UTI post-HoLEP. METHODS: A maintained HoLEP database of over 5 years at our institution was reviewed. Patients' demographics, perioperative characteristics, post-operative irritative symptoms, and UTI rates (defined by irritative symptoms with positive urine culture) were analyzed. RESULTS: Total 473 patients with complete follow-up data were included. Tables 1 and 2 show the baseline and postoperative data of included patients respectively. Preoperative positive urine culture and urine retention were seen in 128 (27%) and 111 (23.4%) patients respectively. At 6-week follow-up, irritative urinary symptoms were reported by 153 (32.3%) patients, while urine culture was positive in only 64 (13.5%) patients. Multivariate analysis showed that high body mass index (BMI) (HR=2.02; CI=1.36-2.58, p=0.023), weak grip strength within preoperative frailty assessment (HR=1.36; CI=1.06-2.13, p=0.042), preoperative positive urine culture (HR=1.92; CI=1.3-3.38, p=0.025) and postoperative incontinence (HR=2.82; CI=1.8-5.67, p=0.002) were associated with statistically significant risk of positive urine within 1st 6 weeks post-HoLEP. CONCLUSIONS: Irritative urinary symptoms are common complaints post-HoLEP; however, it may be caused by inflammatory rather than infective process in significant percentage of patients. Irritative Symptoms can be associated with over-treatment with empirical antibiotics. Possible predictors of early UTI post-HoLEP are high BMI, preoperative positive urine culture, higher frailty scale, and postoperative urinary incontinence. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e701 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Elsaqa More articles by this author Katherine Dowd More articles by this author Amr Elmekresh More articles by this author Marawan M. El Tayeb More articles by this author Expand All Advertisement PDF downloadLoading ...

MP51-01 COMPARING THE TREATMENT OF PATIENTS WITH AQUABEAM® AND HOLEP FOR BENIGN PROSTATE HYPERPLASIA

You have accessJournal of UrologyCME1 Apr 2023MP51-01 COMPARING THE TREATMENT OF PATIENTS WITH AQUABEAM® AND HOLEP FOR BENIGN PROSTATE HYPERPLASIA Carlos Toribio-Vázquez, Ramon Cansino, Esaú Fernández-Pascual, Aritz Eguibar, Hector Ayllon, Pablo Solano-Heranz, Jose Ramon Perez-Carral, Juan Antonio Mainez, Alvaro Yebes, Andrea Rodriguez, Maria Alonso, and Luis Martinez-Piñeiro Carlos Toribio-VázquezCarlos Toribio-Vázquez More articles by this author , Ramon CansinoRamon Cansino More articles by this author , Esaú Fernández-PascualEsaú Fernández-Pascual More articles by this author , Aritz EguibarAritz Eguibar More articles by this author , Hector AyllonHector Ayllon More articles by this author , Pablo Solano-HeranzPablo Solano-Heranz More articles by this author , Jose Ramon Perez-CarralJose Ramon Perez-Carral More articles by this author , Juan Antonio MainezJuan Antonio Mainez More articles by this author , Alvaro YebesAlvaro Yebes More articles by this author , Andrea RodriguezAndrea Rodriguez More articles by this author , Maria AlonsoMaria Alonso More articles by this author , and Luis Martinez-PiñeiroLuis Martinez-Piñeiro More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.01AboutAbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic prostatic hydroablation (AquaBeam®) is a novel technique for the surgical treatment of benign prostatic hyperplasia (BPH). The objective of this study is to compare perioperative morbidity and treatment efficacy of prostatic hydroablation and Holmium laser prostate enucleation (HoLEP). METHODS: A total of 202 patients were analysed (101 by AquaBeam® and 101 by HoLEP) were analysed. A propensity score matching system was generated to obtain comparable cases from the HoLEP database at our institution. Patients included for analysis had undergone surgery in our department from April 2016 to October 2021. The following parameters where analysed: surgical time, haemoglobin (Hb) loss, length of stay, variation in Q-max, PSA, International Prostate Symptoms Score (IPSS), change in IPSS and in IPSS QoL, sexual function measured by the International Index of Erectile Function-5 item (IIEF-5), presence of ejaculation and perioperative morbidity. Median follow up was 12 months (IQR 12-36). RESULTS: Preoperative parameters were comparable between both groups (including prostate size, p=0.548). The perioperative and follow-up variables are shown in the following Table. No major differences in intraoperative complications were observed between both groups. With regards to postoperative complications, 17.3% vs 20.5% presented early urinary incontinence (AquaBeam® vs. HoLEP; p=0.62). 5 patients in the AquaBeam® group and 1 patient treated with HoLEP required blood transfusion (p=0.02). 2 patients treated with HoLEP and 5 with AquaBeam® required reoperation due to haematuria (p=0.03). 1 rectal perforation occurred and 1 patient died after a pneumonic process in the AquaBeam® group. CONCLUSIONS: Hydroablation surgery is an effective technique for patients with benign prostate hyperplasia. It offers good functional results whilst allowing the preservation of ejaculation. AquaBeam® presents a longer hospital admission mainly due to haematuria. The data presented compare our initial experience and learning curve with AquaBeam® with a well-established HoLEP technique in our department. Therefore, it must be regarded as preliminary. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e692 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carlos Toribio-Vázquez More articles by this author Ramon Cansino More articles by this author Esaú Fernández-Pascual More articles by this author Aritz Eguibar More articles by this author Hector Ayllon More articles by this author Pablo Solano-Heranz More articles by this author Jose Ramon Perez-Carral More articles by this author Juan Antonio Mainez More articles by this author Alvaro Yebes More articles by this author Andrea Rodriguez More articles by this author Maria Alonso More articles by this author Luis Martinez-Piñeiro More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Low- vs. High-Power Laser for Holmium Laser Enucleation of Prostate.

Holmium laser enucleation of the prostate (HoLEP) constitutes an established technique for treating patients with symptomatic bladder outlet obstruction. Most surgeons perform surgeries using high-power (HP) settings. Nevertheless, HP laser machines are costly, require high-power sockets, and may be linked with increased postoperative dysuria. Low-power (LP) lasers could overcome these drawbacks without compromising postoperative outcomes. Nevertheless, there is a paucity of data regarding LP laser settings during HoLEP, as most endourologists are hesitant to apply them in their clinical practice. We aimed to provide an up-to-date narrative looking at the impact of LP settings in HoLEP and comparing LP with HP HoLEP. According to current evidence, intra- and post-operative outcomes as well as complication rates are independent of the laser power level. LP HoLEP is feasible, safe, and effective and may improve postoperative irritative and storage symptoms.