Holmium Laser Enucleation Of The Prostate Group Research Articles

A meta-analysis comparing treatment of benign prostatic hyperplasia with holmium laser enucleation and photoselective greenlight vaporization

Abstract Background We compared the safety and efficacy of treating benign prostatic hyperplasia with photoselective greenlight vaporization (PVP) versus holmium laser enucleation of the prostate (HoLEP). Methods Databases (PubMed, Embase, Cochrane Library, Chinese CBM, and CNKI) were searched for eligible studies evaluating HoLEP or PVP outcomes, published until May 2022. We analyzed the incidence of relative complications and postoperative outcomes, including the international prostate symptom score, maximum flow rate (Qmax), postvoid residual urine volume, quality of life index, and prostate-specific antigen levels. Results Eleven studies involving 4763 patients were included in this meta-analysis. The significant differences in postoperative Qmax at 1 month (mean difference [MD], 3.31, 95% confidence interval [CI], 0.45–6.16, p = 0.02, I 2 = 92%), 3 months (MD, 2.78, 95% CI, 0.53 to 5.02, p = 0.02, I 2 = 89%), 6 months (MD, 2.13, 95% CI, 1.11 to 3.15, p < 0.0001, I 2 = 87%), and 12 months (MD, 3.98, 95% CI, 2.06 to 5.89, p < 0.0001, I 2 = 58%) further confirmed unique advantage of HoLEP over PVP. We used forest plots to determine significant differences in the severe complication rates among patients in the PVP and HoLEP groups (odds ratio, 0.05, 95% CI, 0.01 to 0.28, p = 0.0005). Conclusions Holmium laser enucleation of the prostate and PVP showed comparable international prostate symptom scores, quality of life index, postvoid residual urine volumes, prostate-specific antigen levels, perioperative factors, and total complication rates. Compared with PVP, HoLEP had a greater Qmax 1 year postoperatively, decreased energy expenditure, and fewer high-grade complications. These results need to be verified in long-term follow-up studies with well-structured randomized controlled trials.

MOSES™ Technology vs Non-Moses Holmium Laser Enucleation of the Prostate: A Randomized Controlled Trial From a High-Volume Center

ObjectivesBenign prostatic hyperplasia (BPH) management has evolved from transurethral resection of the prostate (TURP) to holmium laser enucleation of the prostate (HoLEP). Recent innovation introduces MosesTM technology in holmium lasers, with the Lumenis PulseTM system. MethodsTo compare Moses-augmented HoLEP (MoLEP) to non-Moses HoLEP in terms of enucleation efficiency, hemostasis, and applicability in day surgery settings. A single-blind, prospective, parallel randomized controlled trial was conducted in Shanghai, China, from March to December 2022. Ethical approval (SK2020-038) was obtained, and 100 consenting men over 50 with BPH indications were randomized (1:1) into MoLEP and HoLEP groups. Surgical procedures were standardized, and outcomes were assessed by blinded analysts. ResultsData from 80 participants (38 MoLEP, 42 HoLEP) were analyzed. Baseline characteristics were comparable. MoLEP demonstrated superior enucleation efficiency (3.5±0.8 g/min) and shorter enucleation time (22.5±7.6 minutes) compared to HoLEP, although not statistically significant. MoLEP achieved hemostasis in less time (6.6±4.2 minutes) than HoLEP (11.2±5.1 minutes). Postoperative care demands varied, with MoLEP requiring less bladder irrigation. MoLEP exhibited a shorter average catheterization time (1.3±0.1 days) and reduced hospitalization compared to HoLEP. Both groups showed significant postoperative improvements in functional outcomes. ConclusionWhile statistical significance was not achieved in certain outcome measures, MoLEP exhibited potential advantages in postoperative care demands, shorter catheterization time, and reduced hospitalization, suggesting its feasibility and safety in day surgery settings. Postoperative functional outcomes improved significantly in both groups.

Comparison of perioperative and short-terms outcomes of en-bloc Holmium laser enucleation of the prostate (HoLEP) and robot-assisted simple prostatectomy: a propensity-score matching analysis.

Surgical treatment of symptomatic benign prostatic hyperplasia (BPH) has seen an evolution during the last decades. On one hand, en-bloc HoLEP emerged as a valid endoscopic treatment regardless prostate size. On the other hand, robot-assisted simple prostatectomy (RASP) has gained attention in larger prostates showing encouraging results. Herein, for the first time in the scientific scenario, we sought to compare the outcomes of RASP and en-bloc HoLEP cases after propensity-score matching (PSM) analysis. We retrospectively queried our prospectively database of patients treated with HoLEP or RASP between 2017 and 2022 among two high-volume centers. PSM was applied based on the International Prostate Symptom Score (IPSS) questionnaire, prostate volume and max-flow rate. All procedures were performed by a single surgeon per center. Outcomes were assessed at 1, 3, and 6-month postoperatively and therefore annually. Trifecta definition was used to assess "success" in surgical procedures and was defined as the contemporary presence of: a) no postoperative complications within the first postoperative month; b) 1-month postoperative Qmax >15 ml/s and c) no urinary incontinence at 3-month evaluation. Overall, 48 HoLEP and 47 RASPs were matched. Operative time, hospitalization time (median 4 vs 5 days) and catheterization time (median 3 vs 2 day) were found to be shorter in the HoLEP group as compared to the counterpart (p < 0.05). Early postoperative complication rate was also lower in the HoLEP cohort (6.2% vs 12.6%; p = 0.03) as well as postoperative haemoglobine blood level drop (1.4 vs 2.4 g/dL; p = 0.03). On the other hand, postoperative antegrade ejaculation (55.3% vs 6.8%) 1-month max flow (median 28 vs 24 ml/sec) and continence rates (0% vs 20.8%) favored RASP (p < 0.05). Overall, Trifecta rate was similar in the two groups (76.1% vs 82.6%). Both HoLEP and RASP are safe and effective treatments for symptomatic BPH. HoLEP demonstrated to have lower perioperative risks while is affecting by a higher probability of transient early UI. On the other hand, RASP is more effective in reducing postoperative ejaculatory dysfunction.

Top-down holmium laser enucleation of the prostate (HoLEP) versus traditional HoLEP for the treatment of benign prostatic hyperplasia (BPH): 1-year outcomes of a randomized controlled trial.

The top-down holmium laser enucleation of the prostate (HoLEP) technique recently emerged as a safe and effective modification of traditional HoLEP. In our randomized controlled trial, we compared intraoperative and postoperative outcomes of traditional and top-down HoLEP for the treatment of benign prostatic hyperplasia (BPH) in patients with a prostate size ≥80 g. One-hundred patients with BPH and a prostate volume ≥80 cc participated in this prospective randomized controlled trial. Outcome measures were collected and compared, including IPSS, QoL, flow rate, PVR, IIEF-15, PSA, and TRUS prostate volume changes. Perioperative complications were also recorded. All patients were followed up at 1, 3, 6, and 12 months. There were no significant differences in preoperative baseline characteristics between the two surgical groups. The median prostate volume for the traditional and top-down HoLEP groups was 107 and 102 cc, respectively. The operative parameters and postoperative outcomes were comparable for both cohorts. The median enucleation time for traditional HoLEP was 60 min, which was not significantly longer than that of top-down HoLEP (52 min) (p = 0.07). At 3 months follow-up, there was no statistically significant difference in transient stress urinary incontinence (SUI) in the traditional HoLEP (4.1%) versus the top-down HoLEP group (2.2%), (p = 0.61). There were no significant differences in functional and sexual outcomes between the two groups at 12 months. The HoLEP procedure significantly improves patients' urinary functional outcomes and has comparable postoperative outcomes regardless of the technique utilized.

Holmium Laser Enucleation of the Prostate vs Robot-Assisted Simple Prostatectomy for Lower Urinary Tract Symptoms in Patients with Extremely Large Prostates ≥200 cc: A Comparative Analysis.

Introduction and Objectives: Robot-assisted simple prostatectomy (RASP) and holmium laser enucleation of the prostate (HoLEP) are both well-established, minimally invasive surgical treatment options for lower urinary tract symptoms caused by benign prostatic enlargement. We have reported the first comparative analysis of both techniques in patients with prostates of ≥200 cc. Materials and Methods: Between 2009 and 2020 a total of 53 patients with a prostate volume of ≥200 cc were surgically treated at OLV Hospital Aalst (Belgium): 31 underwent RASP and 22 underwent HoLEP. Preoperative and postoperative assessments included uroflowmetry with maximum urinary flow rate (Qmax) and postvoid residual volume (PVR), as well as the International Prostate Symptom Score (IPSS) and quality of life (IPSS-QoL). The complication rates were evaluated according to the Clavien-Dindo Classification. Results: Patients treated with RASP had significantly larger prostate volumes compared with HoLEP (median 226 cc vs 204.5 cc, p = 0.004). After a median follow-up of 14 months, both groups showed a significant improvement in the maximum flow rate (+10.60 mL/s vs +10.70 mL/s, p = 0.724) and a reduction of the IPSS score (-12.50 vs -9, p = 0.246) as well as improvement of the QoL (-3 vs -3, p = 0.880). Median operative time was similar in both groups (150 minutes vs 132.5 minutes, p = 0.665). The amount of resected tissue was lower in the RASP group (134.5 g vs 180 g, p = 0.029) and there was no significant difference in postoperative prostate-specific antigen (1.2 ng/mL vs 0.8 ng/mL, p = 0.112). Despite a similar median catheterization time (3 days vs 2 days, p = 0.748), the median hospitalization time was shorter in the HoLEP group (4 days vs 3 days, p = 0.052). Complication rates were similar in both groups (32% vs 36%, p = 0.987). Conclusion: Our results suggest similar outcomes for RASP and HoLEP in patients with very large prostates ≥200 cc. These findings will require external validation at other high-volume centers.

MP59-01 A PROSPECTIVE MULTICENTER COMPARISON BETWEEN HOLMIUM LASER ENUCLEATION OFTHE PROSTATE (HOLEP) AND AQUABEAM ROBOTIC SYSTEM FOR THE TREATMENT OF BENIGNPROSTATIC HYPERPLASIA

You have accessJournal of UrologyCME1 Apr 2023MP59-01 A PROSPECTIVE MULTICENTER COMPARISON BETWEEN HOLMIUM LASER ENUCLEATION OFTHE PROSTATE (HOLEP) AND AQUABEAM ROBOTIC SYSTEM FOR THE TREATMENT OF BENIGNPROSTATIC HYPERPLASIA Javier Romero Otero, Juan Justo Quintas, Raquel Sopeña Sutil, Borja García Gómez, Ricardo Brime Menendez, Javier Amalio Feltes Ochoa, David Saenz Calzada, Gino Marcelo Espinales Catro, Laura Avilleira García, Elena Peña Vallejo, Cristina Calzas Montalvo, Alfredo Rodríguez Antolín, and Esther Garcia Rojo Javier Romero OteroJavier Romero Otero More articles by this author , Juan Justo QuintasJuan Justo Quintas More articles by this author , Raquel Sopeña SutilRaquel Sopeña Sutil More articles by this author , Borja García GómezBorja García Gómez More articles by this author , Ricardo Brime MenendezRicardo Brime Menendez More articles by this author , Javier Amalio Feltes OchoaJavier Amalio Feltes Ochoa More articles by this author , David Saenz CalzadaDavid Saenz Calzada More articles by this author , Gino Marcelo Espinales CatroGino Marcelo Espinales Catro More articles by this author , Laura Avilleira GarcíaLaura Avilleira García More articles by this author , Elena Peña VallejoElena Peña Vallejo More articles by this author , Cristina Calzas MontalvoCristina Calzas Montalvo More articles by this author , Alfredo Rodríguez AntolínAlfredo Rodríguez Antolín More articles by this author , and Esther Garcia RojoEsther Garcia Rojo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostatic enucleation is considered the gold standard for the surgical treatment of benign prostatic hyperplasia(BPH). Emerging minimally invasive technologies aim to maintain functional results whilst decreasing adverseevents. Aquablation is a novel heat-free therapy using a high-velocity waterjet and real-time ultrasound imaging with robotic assistance for removal of prostate tissue. Our objective is to compare for the first time the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) and Aquablation for the surgical treatment of BPH. METHODS: Prospective comparative non-randomized multicenter study of 100 consecutive patients treated with HoLEP or Aquabeam system. HoLEP was performed by 3 expert surgeons and a standard Aquablation was performed with the AquaBeam system by 2 surgeons. Inclusion criteria: patients with moderate/severe symptoms due to BPH. Exclusion criteria: previous surgical treatment for BPH, concomitant urethral stenosis, bladder tumor, or lithiasis and prostates >120cc. The data were prospectively collected. A descriptive analysis was performed and data onthe efficacy and safety of both techniques were compared. RESULTS: The groups are comparable (p>0.05) in prostate size; mean HoLEP vs Aquabeam; 78.95 vs 77.10cc, preoperative IPSS (24.26 vs 22.68), Q max (8.44 vs 9.83) and IIEF15 (41.10 vs 58.15), as well as in the rest preoperative variables (age, personal history, PSA, ASA risk and ejaculation function). Treatment time was longer in the HoLEP group with a mean of 23 minutes for enucleation vs. 5.99 minutes in the Aquabeam group (p<0.05). However, no statistically significant differences in total operating theatre time (53 vs 60 minutes). No intraoperative complications. More significant haematic loss (haemoglobin drop) in the Aquabeam group but none of the patients required a transfusion. As for the perioperative outcomes: no differences were observed between the two groups in bladder catheterization time: 30.53 vs 46.91 hours and hospitalization time 1.4 vs 1.74 days. No differences in rehospitalization, emergency room visits, recatheterization, or infection. At the 6-month follow-up, no statistically significant differences were found in Q-max, BOO, IPSS, complication rates or incontinence. On the other hand, statistically significant differences were found in prostate volume (16.86 vs 42.43 p=0.012) and PSA(0.51 vs 4.2 p<0.01). All patients with Aquabeam retain anterograde ejaculation, while only one patient in the HoLEP group preserves it. CONCLUSIONS: The Aquabeam System appears to be a safe technique that provides comparable early functional and perioperative results to HoLEP with a similar complication rate. Advantages of this technique include reduced resection time as well as the possibility of preserving sexual function. Source of Funding: no © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e806 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Javier Romero Otero More articles by this author Juan Justo Quintas More articles by this author Raquel Sopeña Sutil More articles by this author Borja García Gómez More articles by this author Ricardo Brime Menendez More articles by this author Javier Amalio Feltes Ochoa More articles by this author David Saenz Calzada More articles by this author Gino Marcelo Espinales Catro More articles by this author Laura Avilleira García More articles by this author Elena Peña Vallejo More articles by this author Cristina Calzas Montalvo More articles by this author Alfredo Rodríguez Antolín More articles by this author Esther Garcia Rojo More articles by this author Expand All Advertisement PDF downloadLoading ...

No bladder irrigation versus continuous bladder irrigation after HoLEP: a propensity score matching analysis

PurposeIn this study, the feasibility of a no bladder irrigation strategy after transurethral holmium laser enucleation of the prostate (HoLEP) for the treatment of benign prostatic hyperplasia (BPH) was studied.MethodsFrom August 2021 to December 2021, the clinical data of 62 patients who received no bladder irrigation after HoLEP (Group A) were studied. The control group contained the clinical data of 150 patients in the same therapy group (from January 2021 to July 2021) who received continuous bladder irrigation after HoLEP (Group B). The baseline was consistent after using the propensity score matching (PSM) method, and the differences between groups were compared. The pre- and postoperative complications, international prostate symptom score (IPSS), quality of life (QOL), maximum urinary flow rate (Qmax), and postvoid residual urine (PVR) of the two groups were compared, accompanied by a follow-up evaluation of surgical effects.Results47 pairs of patients were successfully matched by PSM. There was no statistically significant difference in the intraoperative conditions and the incidence of early postoperative complications between the two groups (P > 0.05). Before and one month after the surgery, significant differences were also found in the IPSS, QOL, Qmax, and PVR of both groups (P < 0.05). Within one month after the surgery, no statistically significant difference was found in IPSS, QOL, Qmax, PVR, or the incidence of early postoperative complications between the two groups (P > 0.05).ConclusionFor appropriately selected patients according to the exclusion criteria, the no bladder irrigation strategy after HoLEP for BPH is safe and effective.

B-TURP versus HoLEP: Peri-Operative Outcomes and Complications in Frail Elderly (>75 y.o.) Patients: A Prospective Randomized Study

Background: The aim of this study was to compare the peri-operative and functional results between trans-urethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS) in middle-old patients. Materials and Methods: This prospective single-center study included patients over 75 years old treated with B-TURP or HoLEP for BPH associated with LUTS with prostate volume (PV) <100 mL. Primary endpoints were the intra-operative blood loss, percentage of loss of hemoglobin, blood transfusion, complications, and the comparison of functional outcomes. All patients were evaluated at 1, 3, 6, and 12 months of follow-up. Results: Overall, 96 patients undergoing HoLEP and 104 B-TURP were eligible and enrolled for the study. Post-operative results showed statistically significant differences between the two groups, all in favor of HoLEP group, specifically in terms of removed prostate tissue, PV reduction rate, hemoglobin values at 24 h, hemoglobin loss, operative time, length of hospitalization, days of catheterization, and urinary flow rates. There was no significant difference in terms of postvoid residual urine volume, perioperative complication, blood transfusion, International Prostate Symptom Score (IPSS), and IPSS quality of life scores. Conclusions: In middle-old patients, the HoLEP technique represents a prostate size-independent treatment option with a more favorable safety profile defined by less bleeding, lower blood transfusions, and a significantly lower hemoglobin drop than B-TURP.

Robotic-assisted simple prostatectomy versus holmium laser enucleation of the prostate for large benign prostatic hyperplasia: A single-center preliminary study in Korea.

BackgroundHolmium laser enucleation of the prostate (HoLEP) and robotic-assisted simple prostatectomy (RASP) are the two most important therapeutic modalities for large benign prostatic hyperplasia. However, there are currently no studies comparing these two treatments in a Korean setting. In this study, the authors seek to compare the safety and efficacy associated with these procedures.MethodsThe authors retrospectively analyzed 59 male patients who underwent HoLEP (n = 26) or RASP (n = 33) at single center. The following preoperative data were compared: age, the International Prostatic Symptom Score (IPSS), transrectal ultrasonography, uroflowmetry, and hemoglobin. Intraoperative data included operation time and specimen weight. Postoperative data included change in IPSS, uroflowmetry, and hemoglobin. Length of stay, catheterization time, and complications were also reviewed.ResultsNo significant differences between the two groups were found in terms of age, total prostate, and transitional volume. Postoperatively, both groups showed similar improvement in the maximum flow rate, post-void residual urine, IPSS, and quality of life. Intraoperatively, there were no differences regarding operation time and resected prostate volume. Catheter removal time and length of stay were significantly shorter in the HoLEP group than the RASP group. In addition, postoperative hemoglobin changes were significantly lower in the HoLEP group. However, incontinence rates at 1 month and 2 months postoperative in the RASP group were lower than the HoLEP group.ConclusionsBoth HoLEP and RASP can produce excellent postoperative outcomes. However, catheter removal time, length of stay, and hemoglobin changes were more favorable in the HoLEP group. On the other hand, postoperative incontinence was more favorable in the RASP group. These factors must be heavily considered when deciding surgical the method for large benign prostatic hyperplasia.

MP04-18 ROBOT-ASSISTED SIMPLE PROSTATECTOMY VERSUS HOLMIUM LASER ENUCLEATION FOR LARGE PROSTATE GLANDS (&gt;100ML): COMPLICATIONS AND PERIOPERATIVE OUTCOMES

You have accessJournal of UrologyCME1 May 2022MP04-18 ROBOT-ASSISTED SIMPLE PROSTATECTOMY VERSUS HOLMIUM LASER ENUCLEATION FOR LARGE PROSTATE GLANDS (>100ML): COMPLICATIONS AND PERIOPERATIVE OUTCOMES Louis Vignot, Julien Anract, Imad Bentellis, Albert Semaan, Fabrizio Sartorio, Brannwel Tibi, Youness Ahallal, Michael Peyromaure, Daniel Chevallier, Nicolas Barry Delongchamps, and Matthieu Durand Louis VignotLouis Vignot More articles by this author , Julien AnractJulien Anract More articles by this author , Imad BentellisImad Bentellis More articles by this author , Albert SemaanAlbert Semaan More articles by this author , Fabrizio SartorioFabrizio Sartorio More articles by this author , Brannwel TibiBrannwel Tibi More articles by this author , Youness AhallalYouness Ahallal More articles by this author , Michael PeyromaureMichael Peyromaure More articles by this author , Daniel ChevallierDaniel Chevallier More articles by this author , Nicolas Barry DelongchampsNicolas Barry Delongchamps More articles by this author , and Matthieu DurandMatthieu Durand More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002521.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot-assisted simple prostatectomy (RASP) and Holmium laser enucleation of the prostate (HoLEP) are two different mini-invasive surgical techniques for the management of large prostate adenomas. We aimed to compare the early postoperative complications and the predictive factors of complications, as well as the perioperative results between these two techniques. METHODS: A retrospective multicentric comparative study between two cohorts was performed on all patients operated between January 2018 and December 2020. Inclusion criteria were age > 45 years, lower urinary tract symptoms (LUTS) with surgical indication. RESULTS: A total of 360 patients were included, 171 excluded and 189 analyzed with a prostate volume > 100mL, 99 RASP and 90 HoLEP. The two groups were comparable overall with an initial prostate volume of 133.3 mL for the RASP group and 130.4 mL for the HoLEP group (p=0.56). The early complication rate was 17.2% and 6.7% for the RASP and HoLEP groups, respectively (p=0.047), and multivariate analysis did not reveal any predictive factor for complication. Mean length of hospitalization (3.3 days vs. 2.3 days) and catheterization time (5 days vs. 1.5 days) were significantly lower for the HoLEP group (p < 0.001). The rate of prostate cancer detection (7.1% vs 7.8%) was comparable between the RASP and HoLEP groups (Table 1). CONCLUSIONS: Our study revealed a lower complication rate in the HoLEP group for high-volume adenomas (>100 mL) without demonstrating a predictive factor for the occurrence of complications. The average length of stay and the duration of the catheter were lower for the HoLEP group. RASP remains a safe and effective technique with a majority of low-grade complications and a significant improvement of functional urinary parameters. A more comprehensive study integrating the experiences of the center and the operators would be interesting to corroborate these results. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e64 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Louis Vignot More articles by this author Julien Anract More articles by this author Imad Bentellis More articles by this author Albert Semaan More articles by this author Fabrizio Sartorio More articles by this author Brannwel Tibi More articles by this author Youness Ahallal More articles by this author Michael Peyromaure More articles by this author Daniel Chevallier More articles by this author Nicolas Barry Delongchamps More articles by this author Matthieu Durand More articles by this author Expand All Advertisement PDF DownloadLoading ...

LBA01-05 SURGICAL TREATMENT OF LOWER URINARY TRACT SYMPTOMS DUE TO BENIGN PROSTATIC ENLARGEMENT BY HOLMIUM LASER ENUCLEATION OF THE PROSTATE VERSUS TRANSURETHRAL RESECTION OF THE PROSTATE AND OPEN ADENOMECTOMY

You have accessJournal of UrologyCME1 May 2022LBA01-05 SURGICAL TREATMENT OF LOWER URINARY TRACT SYMPTOMS DUE TO BENIGN PROSTATIC ENLARGEMENT BY HOLMIUM LASER ENUCLEATION OF THE PROSTATE VERSUS TRANSURETHRAL RESECTION OF THE PROSTATE AND OPEN ADENOMECTOMY Miguel Beltran, Yoni Pallas, Ivan Povo, Sara Mitjana, Kevin Rechi, Marta Diranzo, Fernando Martinez, Rosa Gras, and Emilio Lopez Miguel BeltranMiguel Beltran More articles by this author , Yoni PallasYoni Pallas More articles by this author , Ivan PovoIvan Povo More articles by this author , Sara MitjanaSara Mitjana More articles by this author , Kevin RechiKevin Rechi More articles by this author , Marta DiranzoMarta Diranzo More articles by this author , Fernando MartinezFernando Martinez More articles by this author , Rosa GrasRosa Gras More articles by this author , and Emilio LopezEmilio Lopez More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002669.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) is a novel technique for the treatment of lower urinary tract symptoms (LUTS) resulting from benign prostatic enlargement (BPE). Current literature proposes that it can replace other techniques as a size-independent surgical treatment of BPE.The aim of the study was to analyse the improvement in uroflowmetry (Qmax), hospitalization days, postoperative catheterisation, urinary incontinence and erectile dysfunction (ED) in patients treated with transurethral resection of the prostate (TURP) and HoLEP for prostates <90cc and in those treated with open adenomectomy and HoLEP for prostates >90cc. METHODS: 180 patients were enrolled in this prospective study from January 2020 to October 2021 in our centre. 38 and 51 patients underwent TURP and HoLEP respectively with prostate volume <90cc. 51 and 40 patients underwent open adenomectomy and HoLEP respectively with prostate volumes >90cc. RESULTS: In patients with prostate volumes >90cc, HoLEP achieved a mean improvement in Qmax at 6-12 months of 27.4 mL/s vs. 20.9 mL/s for adenomectomy (p=0.03), a mean hospital stay of 2.4 days vs. 4.6 days (p< 0.001) and a mean postoperative catheterization of 4.1 days vs. 10 days for adenomectomy (p< 0.001). During follow-up, ED was found in 4 patients (10%) in the HoLEP group and in 7 (13.7%) in the adenomectomy group.In patients with prostate volumes <90cc, HoLEP showed a mean improvement in Qmax at 6-12 months of 23.2 mL/s vs. 14.35 mL/s in the TURP group (p=0.001), a mean hospital stay of 1.71 days vs. 2 days (p=0.072) and a mean postoperative catheterization of 3.9 days vs. 3.97 days in the TURP group (p=0.83). As for the occurrence of ED during follow-up, it was found in 8 patients (15%) treated by HoLEP and in 3 patients (7.8%) treated by TURP. CONCLUSIONS: HoLEP had a greater uroflowmetry improvement compared to open adenomectomy and TURP (p=0.03 and p=0.001 respectively). The mean hospital stay and postoperative catheterization days were reduced compared to open adenomectomy, but there were no differences in this aspect with TURP. Source of Funding: No source of funding © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1037 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Miguel Beltran More articles by this author Yoni Pallas More articles by this author Ivan Povo More articles by this author Sara Mitjana More articles by this author Kevin Rechi More articles by this author Marta Diranzo More articles by this author Fernando Martinez More articles by this author Rosa Gras More articles by this author Emilio Lopez More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD45-10 OUTCOMES AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE, OPEN SIMPLE PROSTATECTOMY, AND ROBOTIC SIMPLE PROSTATECTOMY: EXPERIENCE FROM A LARGE ACADEMIC MEDICAL CENTER

You have accessJournal of UrologyCME1 May 2022PD45-10 OUTCOMES AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE, OPEN SIMPLE PROSTATECTOMY, AND ROBOTIC SIMPLE PROSTATECTOMY: EXPERIENCE FROM A LARGE ACADEMIC MEDICAL CENTER Matthew Lee, Meera Ganesh, Joshua Han, Quan Mai, Mark Assmus, Jessica Helon, Briana Kaplunov, and Amy Krambeck Matthew LeeMatthew Lee More articles by this author , Meera GaneshMeera Ganesh More articles by this author , Joshua HanJoshua Han More articles by this author , Quan MaiQuan Mai More articles by this author , Mark AssmusMark Assmus More articles by this author , Jessica HelonJessica Helon More articles by this author , Briana KaplunovBriana Kaplunov More articles by this author , and Amy KrambeckAmy Krambeck More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002613.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Per AUA guidelines, large prostates (defined as ≥80g in size) can be managed with Holmium Laser Enucleation of the Prostate (HoLEP), Open simple prostatectomy (OSP) or robotic simple prostatectomy (RSP). While these modalities have been previously compared to one another, one study only compared 32 RSPs to 600 HoLEPs. To our knowledge, the three modalities have never been compared against each other in the same cohort. Furthermore, in any published studies, the authors were not performing same-day catheter removal and discharge after HoLEP, indicating the studies must be updated. Herein, we present our experience performing HoLEP, OSP, and RSP for large prostates at a large academic medical center. METHODS: The Northwestern Enterprise Data Warehouse (EDW) is a system-wide electronic medical record based data platform. We queried the EDW for all patients undergoing HoLEP, OSP, and RSP from Jan 2011 to Oct 2021 for prostates ≥80g. Patients were identified by CPT code (52649, 55831/ 55821, 55899, respectively). Variables were abstracted from the EDW and medical record. Statistical analysis was performed using SAS studio (2021). Multiple comparisons for continuous variables were performed using ANOVA with Tukey’s corrections. Chi-square tests were used for categorical variables. P-value <0.05 was determined to be statistically significant. RESULTS: The three cohorts were similar in age, BMI, and Carlson comorbidity index. There was no difference in preoperative Hgb, Cr or prostate volume. PSA was higher in the OSP group (p=0.0077). Surgery duration, estimated blood loss (EBL), length of stay (LOS) and catheter duration were all shortest in the HoLEP group (p<0.0001). OSP had the highest EBL and HoLEP had the lowest EBL (P<0.0001) which also translated into less RBC transfusions for HoLEP and RSP compared to OSP (p<0.0001). There were no differences in ED visits, but RSP had the highest readmission rate (p<0.0001). CONCLUSIONS: In this cohort where HoLEP patients underwent same-day catheter removal and discharge, despite similar preoperative characteristics, HoLEP was associated with shorter surgery duration, LOS and catheter duration. HoLEP also had the lowest EBL and RBCs transfused with an increase in ED visits or readmissions. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e786 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Lee More articles by this author Meera Ganesh More articles by this author Joshua Han More articles by this author Quan Mai More articles by this author Mark Assmus More articles by this author Jessica Helon More articles by this author Briana Kaplunov More articles by this author Amy Krambeck More articles by this author Expand All Advertisement PDF DownloadLoading ...

A systematic review and meta-analysis of efficacy and safety comparing holmium laser enucleation of the prostate with transurethral resection of the prostate for patients with prostate volume less than 100 mL or 100 g.

BackgroundTo assess the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) for patients with prostate volume less than 100 mL or 100 g.MethodsWe searched PubMed, Embase, Cochrane Library and Web of Science from inception to July 2021 to collect randomized controlled trials. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies by using the Cochrane risk of bias tool. Review Manager 5.3 software was used for meta-analysis. We synthesised effect estimates using risk ratios (RR), mean difference (MD), and standardized mean differences (SMD).ResultsA total of eight studies were included, involving 764 patients, 384 patients in the HoLEP group and 380 patients in the TURP group. The meta-analysis showed that the catheterization time (SMD =−1.44; 95% CI: −2.17 to −0.70; P=0.0001), hospital stay (SMD =−1.01; 95% CI: −1.58 to −0.44; P=0.0005), haemoglobin loss (MD =−0.29; 95% CI: −0.52 to −0.07; P=0.01), and transfusion rate (RR =0.16; 95% CI: 0.05–0.49; P=0.001) in the HoLEP group were lower than those in the TURP group. In addition, the 12-month postvoid residual volume (PVR) of the HoLEP group (MD =−9.93 95% CI: −18.59 to −1.27; P=0.02) were superior to the TURP group. Although the operation time of the HoLEP group was longer (MD =17.89; 95% CI: 9.18–26.60; P<0.0001), more tissues were removed (SMD =0.47; 95% CI: 0.10–0.85; P=0.01).DiscussionCompared with TURP, HoLEP has a shorter catheterization time and hospital stay, with more tissue removed, a lower blood transfusion rate and better results in the short-term follow-up after surgery. Therefore, HoLEP has better efficacy and safety in the treatment of small- and medium-sized benign prostatic obstruction. Our results found that HoLEP is also suitable for patients with prostate volume <100 mL/100 g, suggesting that it is necessary to redefine the prostate size that is best for HoLEP. Overall, the certainty of evidence was assessed to be moderate to low due to potential risk of bias and inconsistent outcome indicators in some studies. More data on the efficacy of HoLEP and TURP on small- and medium-sized prostates are needed to determine the optimal prostate volume of HoLEP.

Monopolar Transurethral Resection of the Prostate Versus Holmium Laser Enucleation in Men with Prostate Volume Greater than 100 mL

Purpose: The surgical treatment for severe benign prostatic hyperplasia is challenging. The aim of our study was to compare the safety and efficacy of monopolar transurethral resection of the prostate (M-TURP) and holmium laser enucleation of the prostate (HOLEP) for prostate size &gt;100 ml. Materials and Methods: We retrospectively evaluated our database of two groups of patients. Thirteen patients underwent M-TURP (group 1), and 27 underwent HOLEP (group 2). Results: The mean prostate size was 163.1 ± 49.0 ml in group 1 and 143.4 ± 40.9 ml in group 2 (P = 0.19). There was no significant difference in resected tissue volume, days of catheter removal, admission days, and postoperative serum hemoglobin between treatment groups. However, in group 1, mean postoperative serum sodium dropped from 137.1 mmol/L to 131.4 mmol/L, which was significantly lower than postoperative serum sodium in group 2 (P &lt; 0.0001). There were more complications in group 1 than group 2, especially for patients undergoing transfusion (76.9% in group 1 and 22.2% in group 2) and with hyponatremia (15.4% in group 1 and 0% in group 2). At 3-month follow-up, the international prostate symptom score, quality of life score, and residual urine volume revealed no significant differences between groups. Conclusion: M-TURP and HOLEP in men with prostate volume greater 100 ml had similar operative time, admission days and postoperative functional outcomes. However, higher transfusion rates and postoperative hyponatremia were noted in the M-TURP group comparing to the HOLEP group.

A Cost Comparison of Holmium Laser Enucleation of the Prostate with and without Moses™.

Holmium laser enucleation of the prostate (HoLEP) is a size-independent treatment option for the treatment of benign prostatic hyperplasia. HoLEP has been shown to have excellent improvements in prostate symptom scores and maximum flow rates that have been durable for 2 decades. However, the steep learning curve associated with HoLEP has prevented its widespread adoption. New advancements in lasers, specifically the Moses™ pulse-modulation technology, have resulted in improvements in hemostasis and achieving same-day discharges and catheter removals. We aimed to perform a cost-comparison to analyze if Moses-augmented HoLEP (m-HoLEP) resulted in cost-savings. A retrospective review was performed of a single expert surgeon's experience from May 2018 to November 2020, comparing m-HoLEP with HoLEP. Perioperative and postoperative variables were abstracted from the medical record. Univariate and multivariate analyses were performed using SAS® 9.4. Two-sided significance was set at p <0.05. A total of 312 men underwent HoLEP during the study period (192 in m-HoLEP group and 120 in HoLEP group). The m-HoLEP group had more same-day discharges (p <0.001) and emergency department visits (6.3% vs 1.7%, p=0.0071). m-HoLEP resulted in hospital cost savings of $840 for the initial surgical episode (p=0.0297). When factoring in emergency department visits/readmissions, the cost savings decreased to $747 per case (p=0.0574). m-HoLEP was associated with same-day discharge and hospital cost savings of $840 for the initial surgical episode. Further study in other institutions with surgeons of varying experience levels will need to be performed to see if these findings can be replicated.

Laser enucleation for prostates larger than 100 mL: Comparison of HoLEP and ThuLEP.

Recently, with the advancements in laser technology, Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP) have come to the fore in the surgical treatment of benign prostatic hyperplasia (BPH). We aimed to evaluate and compare the outcomes of HoLEP and ThuLEP in patients with >100ml prostate volume. Patients who underwent HoLEP and ThuLEP between July 2017 and March 2020 were reviewed retrospectively. The patients were divided into two groups as HoLEP (Group 1, n=121) and ThuLEP (Group 2, n=104). Perioperative parameters, functional outcomes, continence status, intra and post-operative complications were compared between groups in the post-operative 1st and 6th month. No significant difference was found in terms of total laser energy (TLE), morcellation efficiency (ME), enucleated tissue weight (ETW), complication rates (CR) and continence status of patients between both groups (p>.05). In favour of ThuLEP group, there were statistically significant differences regarding total operation time (TOT), laser efficiency (LE), enucleation time (ET) and enucleation efficiency (EE) between groups (p≤.05). HoLEP and ThuLEP can be used safely and effectively in prostates larger than 100ml.

Two-year follow-up after holmium laser enucleation of the prostate and bipolar transurethral resection of the prostate: a prospective randomized study

BackgroundDifferent treatment options are available for the management of BPH. Our study aimed to compare the surgical outcomes of a holmium laser enucleation of the prostate (HoLEP) and a bipolar transurethral resection of the prostate (Bipolar-TURP) after 2 years.MethodsOur prospective randomized study included 114 patients: 55 patients underwent HoLEP procedure and 59 patients underwent bipolar TURP procedure. All patients underwent a complete preoperative assessment and a physical examination. The postoperative follow-up data included Q max and IPSS recordings at 1, 3, 6, 12, and 24 months and PVR urinary volume recordings at 6 and 12 months. Any postoperative complications were also recorded.ResultsThere were no statistically significant differences between both groups regarding IPSS and Q max scores at one and 24 months postoperative. Also, there were no statistically significant differences between both groups regarding postoperative PVR at 6 and 12 months. One patient in the HoLEP group developed total incontinence after surgery.ConclusionOur study did not show a significant difference between HoLEP and bipolar TURP regarding postoperative Q max and IPSS scores at 24 months of follow-up.

Holmium laser enucleation of the prostate vs monopolar transurethral resection of the prostate in management of benign prostatic hyperplasia

Objective The aim was to compare the efficacy, safety, and cost-effectiveness of holmium laser enucleation of the prostate (HoLEP) vs monopolar transurethral resection of the prostate (TURP) in the management of benign prostatic hyperplasia. Materials and methods Between February 2018 and February 2020, 70 patients who underwent surgical treatment for benign prostatic hyperplasia were randomized into two equal groups, representing HoLEP and monopolar TURP. All the patients were assessed preoperatively and followed up for 12 months postoperatively. The primary preoperative and postoperative parameters were the international prostate symptom score (IPSS) and maximum urine flow rate (Qmax), whereas the secondary parameters were operative time, resected volume, postoperative drop in hemoglobin level, postoperative change in sodium level, postoperative catheterization time, duration of hospital stay, and postvoiding residual urine. All complications were recorded. Cost analysis was evaluated. Results A total of 60 patients (30 HoLEP and 30 TURP) of the initial 70 patients completed our study. Mean baseline prostate sizes were similar in both groups. HoLEP group had longer operative time of 80 min compared with 60 min in the TURP group. HoLEP was associated with shorter postoperative catheter time and hospital stay compared with those of TURP group. There were no statistically significant differences between both groups regarding perioperative parameters such as resected volume, hemoglobin drop, and sodium level drop. Moreover, postoperative international prostate symptom score, Qmax, postvoiding residual urine, prostatic specific antigen, and quality of life were comparable in both groups. There was no statistically significant difference between both groups regarding postoperative complications. Regarding cost analysis, HoLEP was more cost-effective than TURP. Conclusion Both HoLEP and monopolar TURP are safe and effective. However, HoLEP has shorter catheterization time and hospital stay and was more cost-effectiveness but had longer operative time than monopolar TURP.

Holmium Laser Enucleation, Laparoscopic Simple Prostatectomy, or Open Prostatectomy: The Role of the Prostate Volume in terms of Operation Time

Introduction: To compare the prostate removal speeds of 3 enucleation techniques and to evaluate how the operating times change depending on the prostate volume. Methods: Medical records of patients with 80-g or larger prostates who underwent holmium laser enucleation of the prostate (HoLEP), laparoscopic simple prostatectomy (LSP), or open prostatectomy (OP) due to medical treatment-resistant benign prostatic hyperplasia (BPH) were reviewed retrospectively. Patients were classified into 3 groups according to the surgical procedure. Age, BMI, prostate weights, total operation times, prostate removal speeds, hospitalization and catheterization days, complications, and improvements on functional outcomes in the 3rd month of follow-up were compared between groups. In addition, the association between prostate weight and total operation time was analyzed for each group. Results: HoLEP, LSP, and OP groups consisted of 60, 61, and 37 patients, respectively. While HoLEP was similar to OP in terms of prostate removal speed and total operation time, LSP was statistically slower and required more operation time than HoLEP and OP. There was a relationship between prostate weight and total operation time only in HoLEP. Conclusion: LSP, one of the enucleation techniques in the treatment of large prostates, was slower and required more operation time than HoLEP and OP in terms of total operation time and prostate removal speed. HoLEP seems going to be the fastest candidate for the rapid removal of large prostates in the future.

MP32-01 COMPARISON OF SAFETY AND EFFICACY OF BIPOLAR PLASMAKINETIC TRANSURETHRAL ENUCLEATION AND HOLMIUM LASER ENUCLEATION OF PROSTATE GLAND GREATER THAN 80ML IN PATIENTS: A RANDOMIZED TRIAL WITH 36-MONTH FOLLOW-UP

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II (MP32)1 Apr 2020MP32-01 COMPARISON OF SAFETY AND EFFICACY OF BIPOLAR PLASMAKINETIC TRANSURETHRAL ENUCLEATION AND HOLMIUM LASER ENUCLEATION OF PROSTATE GLAND GREATER THAN 80ML IN PATIENTS: A RANDOMIZED TRIAL WITH 36-MONTH FOLLOW-UP YiJun Guo* YiJun Guo*YiJun Guo* More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000876.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate the safety and efficacy of plasmakinetic enucleation (PKEP) and holmium laser enucleation of the prostate (HoLEP) in the treatment of prostates larger than 80ml. METHODS: In this paper, randomized, controlled trial 180 patients with benign prostatic hyperplasia and a prostate of larger than 80 ml were assigned to plasmakinetic enucleation (PKEP) and holmium laser enucleation (HoLEP) from January 2013 to June 2017 in our institution. The data including age, hypertension history, diabetes history, coronary heart disease, IPSS, QOL, prostate volume, preoperative Qmax, prostatectomy time, tissue removal time, overall operation time, resected adenoma weight, bleeding volume, postoperative hospital stay, postoperative IPSS, QOL and postoperative complications such as urinary incontinence, urinary tract infection and postoperative urination were recorded and compared. Patients were followed 12, 24, 36 months after surgery. RESULTS: There were no significant differences in baseline data between the two surgical groups preoperatively. The PKEP group had a longer the prostatectomy time (83.6±12.2 min vs 70.7±8.5 min, p<0.05), the tissue removal time (46.2±8.4 min vs 36.0±8.4 min, p<0.05) and the overall operation time (130.4±15.4 min vs 106.7±12.3 min, p<0.05) than the HoLEP group, which were statistically significant. The Perioperative inadvertent hypothermia (PIH) in patients (5 vs 0, p<0.05) were fewer in the HoLEP group, and the bleeding volume (95.6±25.3 ml vs 88.4±25.1 ml, p>0.05) and resected adenoma weight (72.1±17.6 g vs 68.9±12.8g, p>0.05) were similar between the PKEP and HoLEP groups. The hospital stay (6.0±1.3 d vs 5.5±1.1 d, P<0.05) was observed in the PKEP group and HoLEP group, respectively, which was statistically significant. No significant difference was found in the postoperative IPSS, QOL and the postoperative complications such as the urinary incontinence (32 vs 22, p>0.05), the urinary tract infection (14 vs 16, p>0.05) and the urethral stricture (3 vs 1, p>0.05) between the PKEP and HoLEP groups. At the 12, 24, 36 months follow-up, no significant difference were found in the Qmax between them. There were also no serious complications such as transurethral resection syndrome (TURS), massive hemorrhage and secondary operation in both groups. CONCLUSIONS: The long-term follow-up data of this randomized trial confirm that HoLEP and PKEP are both effective and durable surgical interventions for the treatment of lower urinary tract symptoms due to BPE. Given the clinically relevant advantages associated with HoLEP, the operation time and postoperative hospital stay can be improved. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e484-e484 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information YiJun Guo* More articles by this author Expand All Advertisement PDF downloadLoading ...