Large Volume Benign Prostatic Hyperplasia Research Articles

Urethral-sparing laparoscopic simple prostatectomy for the treatment of benign prostatic hyperplasia with asymptomatic urethral stricture after urethral stricture surgery

ObjectiveTo evaluate the efficacy of urethral-sparing laparoscopic simple prostatectomy (US-LSP) for the treatment of large-volume (>80 ml) benign prostatic hyperplasia (BPH) with asymptomatic urethral stricture (urethral lumen > 16 Fr) after urethral stricture surgery.MethodsWe retrospectively analyzed clinical data of 39 large-volume BPH patients with asymptomatic urethral stricture after urethral stricture surgery who underwent US-LSP from January 2016 to October 2021. Postoperative follow-ups were scheduled at 1, 3, and 6 months.ResultsAll patients affected by significant BPH-related lower urinary tract symptoms (LUTS) including 22 cases with asymptomatic anterior urethral stricture and 17 cases with asymptomatic posterior urethral stricture. Median operative time was 118 min (interquartile range [IQR]100–145). Median estimated blood loss was 224 ml (IQR: 190–255). 33 patients(84.6%) avoided continuous bladder irrigation. Postoperative complications occurred in 5 patients (12.8%), including 4 cases with Clavien-Dindo grade 1 and grade 2 and 1 case with grade 3a. During follow-up, US-LSP presented statistically significant improvements in LUTS compared to baseline (P < 0.05). A total of 25 patients had normal ejaculation preoperatively and 3 patients (12%) complained retrograde ejaculation postoperatively. Two patients (5.1%) reported stress urinary incontinence (SUI) and no patient reported aggravated urethral stricture during follow-up.ConclusionsUS-LSP was safe and effective in treating large-volume BPH with asymptomatic urethral stricture after urethral stricture surgery. Meanwhile, US-LSP could reduce the risk of SUI in patients with asymptomatic posterior urethral stricture and maintain ejaculatory function in a high percentage of patients.

A prospective analysis of thulium laser enucleation in benign prostatic hyperplasia comparing low- and high-power approaches for prostates exceeding 80 g

Introduction and objectivesTo compare the perioperative and functional outcomes of low-power and high-power thulium:YAG VapoEnucleation (ThuVEP) of the prostate for the treatment of large-volume benign prostatic hyperplasia (BPH) (> 80 ml).Patients and methodsA prospective analysis of 80 patients with symptomatic BPO and prostatic enlargement (more than 80 ml) was conducted. They were divided randomly into two groups (40 patients in each group). One group was treated with low-power ThuVEP, and the other group was treated with high-power ThuVEP.All patients were assessed preoperatively and early postoperatively, and 12-month follow-up data were analyzed. The complications were noted and classified according to the modified Clavien classification system.ResultsThe mean age at surgery was 68 (± 6.1) years, and the mean prostate volume was 112 (± 20.1) cc, and there were no differences between the groups (p = 0.457). The mean operative time was 88.4 ± 11.79 min for group A and 93.4 ± 16.34 min for group B, while the mean enucleation time was 59.68 ± 7.24 min for group A and 63.13 ± 10.75 min for group B. There were no significant differences between the groups regarding catheterization time and postoperative stay. The quality of life (QoL), International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoiding residual urine (PVR), and prostate volume improved significantly after treatment and were not significantly different between those treated with the different energies. The incidence of complications was low and did not differ between both the groups.ConclusionLow-power ThuVEP is feasible, safe, and effective with comparable results with high-power ThuVEP in the treatment of BPO.

Comparative analysis of the safety and efficacy of 1470-nm diode laser enucleation of the prostate and plasmakinetic resection of prostate in the treatment of large volume benign prostatic hyperplasia (>80 ml)

Objective To compare the efficacy and safety of 1470-nm diode laser enucleation of the prostate (DiLEP) with that of plasmakinetic resection of the prostate (PKRP) in treating patients with large benign prostatic hyperplasia (BPH > 80ml). Methods The clinical data from 211 cases of BPH (>80 ml) were collected for analysis. The patients were divided into two groups: the PKRP group (n = 118) and the DiLEP group (n = 93), based on the surgical method used. Result The DiLEP group demonstrated significantly lower surgical time (p < 0.001), intraoperative bleeding (p < 0.001), bladder flushing time (p = 0.003), indwelling catheter time (p < 0.005), and length of hospital stay (p = 0.018) compared to the PKRP group. However, the quality of the prostatectomy was significantly higher in the DiLEP group (p = 0.005). The Qmax for the DiLEP group was significantly higher than that of the PKRP group (p < 0.05). Compared to the PKRP group, the incidence of urinary incontinence in the DiLEP group increased significantly 4 weeks post-surgery (p = 0.026), although the need for blood transfusion during surgery was significantly reduced (p = 0.037). Conclusion Both DiLEP and PKRP are safe and effective methods for treating large-volume BPH. However, DiLEP offers advantages such as more thorough glandular resection, shorter surgical time, reduced bleeding, quicker recovery, and fewer complications.

Modified laparoscopic simple prostatectomy combined with temporary internal iliac arteries clamping and urethrocystoanastomosis for large-volume benign prostatic hyperplasia: evaluation of efficacy and safety

Introduction. Laparoscopic simple prostatectomy is the method of choice for surgical treatment of large-volume benign prostatic hyperplasia (BPH). However, the existing limitations of standard approaches are the reason for the development of new modifications.Objective. To evaluate the efficacy and safety of a modified laparoscopic simple prostatectomy (LSP), supplemented by temporary internal iliac arteries (IIA) clamping and vesicourethral anastomosis (VUA).Materials &amp; methods. This multicenter open study included 195 patients (mean age 68.1 ± 6.4 years) who underwent LSP combined with temporary IIA clamping and VUA. The primary efficacy criterias during one follow-up year were the severity of urinary symptoms (IPSS), quality of life, maximum flow rate and post-void residual volume. All complications that developed during the 12-month postoperative follow-up period were registered. Statistical calculations were performed using IBM SPSS 23.2 software.Results. The average surgery time was 91.5 ± 23.2 minutes. Complications of Clavien-Dindo I, II, III grades were noted in 1.0%, 1.0% and 3.6% of patients, respectively; no complications of group IV developed. The mean bed-days were 5.2 ± 1.5 days, the decrease in hemoglobin was 0.6 ± 1.1 g/dL. No patient needed to use an irrigation system. Based on the results of 12 months postoperative follow-up, positive dynamics was established for average IPSS score (p = 0.003), QoL (p = 0.035), maximum urine flow rate (p = 0.012), residual urine volume (p = 0.004). The maximum urine flow rate one year after surgery reached 24.6 ± 2.8 ml/s, the post-void residual urine volume was 15.1 ± 11.9 ml, the average IPSS score was 9.1 ± 1.5, and the QoL score – 1.0 ± 0.7. During the 12-month follow-up period, a low amount of long-term complications was noted in 4 (2.1%) cases: 3 (1.6%) patients had stress urinary incontinence, 1 (0.5%) patient had bladder neck contracture.Conclusion. Modified LSP combined with temporary IIA clamping and VUA is associated with favorable efficacy and safety profile of the intervention in patients with large-volume BPH.

Efficacy and safety of transurethral thulium laser enucleation versus robot-assisted prostatectomy for large-volume benign prostatic hyperplasia: a systematic review and meta-analysis.

To compare perioperative outcomes between Holmium laser enucleation of the prostate (HoLEP) and robotic-assisted simple pasta-ectomy (RASP)for large-volume benign prostatic hyperplasia(> 80ml). In August 2023, we undertook a comprehensive search of major global databases including PubMed, Embase, and Google Scholar, focusing solely on articles written in English. Studies that were merely reviews or protocols without any specific published data were omitted. Furthermore, articles that comprised conference abstracts or content not pertinent to our subject of study were also disregarded. To calculate the inverse variances and 95% confidence intervals (CIs) for categorical variables' mean differences, we employed the Cochran-Mantel-Haenszel approach along with random-effects models. The findings were denoted in the form of odds ratios (ORs) and 95% CIs. A p-value less than 0.05 was deemed to indicate statistical significance. Our finalized meta-analysis incorporated six articles, including one randomized controlled trial (RCT) and five cohort studies. These studies accounted for a total of 1218 patients, 944 of whom underwent Holmium Laser Enucleation of the Prostate (HoLEP) and 274 who underwent Robotic-Assisted Simple Prostatectomy (RASP). The pooled analysis from these six papers demonstrated that compared to RASP, HoLEP had a shorter hospital stay, shorter catheterization duration, and a lower blood transfusion rate. Moreover, HoLEP patients exhibited a smaller reduction in postoperative hemoglobin levels. Statistically, there were no significant differences between the two procedures regarding operative time, postoperative PSA, the weight of prostate specimens, IPSS, Qmax, PVR, QoL, and postoperative complications. (HoLEP) and (RASP) are both effective and safe procedures for treating large-volume benign prostatic hyperplasia. HoLEP, with its benefits of shorter catheterization and hospitalization duration, lesser decline in postoperative hemoglobin, and reduced blood transfusion needs, stands as a preferred choice for treating extensive prostate enlargement. However, further validation through more high-quality clinical randomized trials is required.

A Comparative Study of the Efficacy of Thulium Fiber Laser Enucleation and Transurethral Resection for Medium- to Large-Size Prostate

Abstract Purpose: The objective of this study was to evaluate the efficacy and safety of the newer, thulium fiber laser enucleation of the prostate (ThuFLEP) versus the transurethral resection of the prostate (TURP) for medium- to large-volume benign prostatic hyperplasia (BPH). Materials and Methods: We performed a single-center retrospective study between May 2020 and June 2021. Among these, we included patients &gt;50 years of age, with prostate size &gt;80 cc, International Prostate Symptom Score (IPSS) &gt;19, and maximum urine flow rate (Qmax) &lt;15 mL/s. All patients underwent either TURP or ThuFLEP. Preoperative parameters such as IPSS score, quality of life (QoL) score, Qmax, and residual urine were assessed. Results: Of the total of 101 patients, 29 underwent ThuFLEP and 72 TURP. The mean prostate volume was significantly higher in the ThuFLEP group compared to the TURP (P = 0.01). The mean operative time was longer for ThuFLEP compared to TURP (P &lt; 0.0001). No significant difference was noted in the postoperative hematuria (P = 0.29) and mean postoperative hemoglobin (P = 0.37). The QoL scores were significantly improved with ThuFLEP than TURP (P = 0.0006). Compared to a day after catheter removal, the proportion of patients with stress, urge, and total incontinence was significantly reduced at the end of 1 month in the ThuFLEP group (P &lt; 0.00001); however, it was significantly greater than with TURP (P &lt; 0.05). At 3 months, no significant difference was found between IPSS (P = 0.37) and Qmax (P = 0.98) scores between the groups; however, the decrease from baseline was significant for IPSS (P &lt; 0.0001). The Clavien–Dindo Grade I and II complications were 31% and 13.8%, respectively, for ThuFLEP and 8.3% and 1.4% for TURP. There was no significant difference of patients with late complications. Conclusion: ThuFLEP demonstrated efficacy similar to TURP in medium- to larger-size BPH in terms of IPSS and Qmax but had significant improvement in QoL scores. The overall complications with ThuFLEP were higher as compared to TURP.

Combination therapy for benign prostate hyperplasia-related urinary symptoms

Introduction. Non-neurogenic lower urinary tract symptoms (LUTS) are a serious polyetiologic problem in the male population. The side effects of the medication agents used to treat LUTS significantly reduce treatment compliance. According to the literature data, the frequency of refusal for the proposed treatment during the year varies from 20 to 80%. Several studies have shown the benefits of herbal medicine for LUTS concerning the fewer side effects and increased adherence to treatment. However, to obtain a high-level recommendation base, clinical trials are required.Purpose of the study. To evaluate the effectiveness of Gardaprost® in LUTS combination therapy.Materials and methods. The study included 57 men aged 60 – 70 years with diagnosed medium- or large-volume benign prostatic hyperplasia (BPH) and moderate-to-severe LUTS according to I-PSS, morphologically excluded prostate cancer, without urinary infection signs. The patients were randomized into two follow-up groups. Tamsulosin 0.4 mg q.d. was prescribed to patients in the control group. Patients of the main group received Gardaprost® 0.4 mg q.d. in addition to Tamsulosin. The follow-up period in both groups was one-year. The statistical analysis includes data from 56 men. To evaluate therapy at the screening visit and on days 180 and 360, I-PSS, urination diary, IIEF-5, urinalysis, prostate-specific antigen, uroflowmetry, ultrasound were analyzed. Paired t-test and one-way ANOVA test were used to determine intergroup differences in normally distributed variables. For variables with a distribution other than normal, Friedman's two-way ANOVA for related samples was used. Events with a probability greater than 95% were considered statistically significant.Results. At the time of inclusion in the study, the groups were comparable concerning the control parameters. In the main group, there was a more pronounced positive dynamics in the I-PSS score, maximum urine flow rate, and post-void residual urine volume, which corresponded to 7.9 ± 2.1 points, 18.0 ± 7.3 ml/sec, 23.6 ± 13.6 ml vs 19.7 ± 7.2 points, 10 ± 3.5 ml/sec, 65.9 ± 33.2 ml in the main and control groups, respectively (p &lt; 0.001). Additionally, in the main observation group, a decrease in prostate volume was recorded by 18.8% (p &lt; 0.001) was recorded.Conclusion. We have obtained encouraging long-term results from the use of Gardaprost® in combination therapy of moderate-to-severe LUTS caused by medium- and large-volume BPH.

Application of ureteral access sheath in the operation of middle and lower ureteral calculi in patients with massive benign prostatic hyperplasia

Objective: To examine the effectiveness and safety of application of the ureteral access sheath in the treatment of middle or lower ureteral calculi in patients with large-volume benign prostatic hyperplasia above grade Ⅲ, which is expected to avoid the simultaneous or staged treatment of benign prostatic hyperplasia via eliminate the difficult angle and resistance of ureteroscopy caused by severe prostatic hyperplasia. Methods: From April 2018 to December 2020, the clinical data of 27 patients with massive benign prostatic hyperplasia above grade Ⅲ and middle and lower ureteral calculi treated with indwelling ureteral access sheath plus ureteroscopy holmium laser lithotripsy at Department of Urology, Zhejiang Quhua Hospital were retrospectively analyzed and followed up. All the patients were male, aged (69.7±12.8) years (range: 55 to 87 years). Prostate volume measured by transrectal ultrasound was (94.8±16.2) cm3 (range: 85 to 186 cm3). The ureteral access sheath was indwelled in advance, and then the semirigid ureteroscopy was introduced through the working channel of the sheath. Holmium laser lithotripsy was performed, and intraoperative and postoperative complications were recorded. Urinary abdominal plain X-ray or CT urography were performed at 1-and 2-month postopaerative to evaluate the residual stones and clinical efficacy. Results: The ureteral access sheath was placed and holmium laser lithotripsy under a semirigid ureteroscopy was performed successfully in all the 27 patients. In 2 patients, a second session of auxiliary procedure was required due to the large load of preoperative stones and residual stones after surgery, among whom 1 patient received extracorporeal shock wave lithotripsy and 1 patient underwent extracorporeal shock wave lithotripsy plus ureteroscopic lithotripsy. The stone free rate at 1-and 2-month postoperative were 92.6% (25/27) and 100% (27/27), respectively. There were no severe complications such as ureteral avulsion and perforation, perirenal hematoma, septic shock, severe hematuria, urinary retention, iatrogenic ureteral stricture occurred during and after the surgery. The ureteral calculus was wrapped by polyps heavily in 1 patient, he was diagnosed as ureteral stenosis 1 month postoperative, receiving laparoscopic resection of ureteral stricture plus anastomosis 3 months postoperative. Conclusions: In the operations of middle and lower ureteral calculi in patients with large-volume prostatic hyperplasia above grade Ⅲ, the ureteral access sheath can be placed first to effectively eliminate the difficult angle and resistance of ureteroscopy caused by severe prostatic hyperplasia, and then semirigid ureteroscopic lithotripsy can be safely performed. It could avoid the treatment of benign prostatic hyperplasia at the same time or by stages.

Robotic simple prostatectomy is a safe and effective technique for benign prostatic hyperplasia: Our single center initial short-term follow-up results for 42 patients.

Benign prostatic hyperplasia is one of the biggest problems of aging men. Prostate surgery is now well defined in the case of failure of medical therapy. Robotic simple prostatectomy is a minimally invasive surgical method with an alternative to open simple prostatectomy in large prostate volumes. We present our simple prostatectomy technique with robot, perioperative, and short-term functional result in our clinic. Between January 2017 and January 2021, 42 patients underwent simple robotic prostatectomy were retrospectively evaluated. Preoperative, perioperative, and post-operative clinical data were analyzed. Post-operative continence status, voiding, and erectile functions were evaluated using uroflowmetry and international prostate symptom score (IPSS) at sixth week and third month. The mean age of the patients was 71 (66-78) years. No major complications were observed in any of the patients. Urethral catheters were removed on the fourth post-operative day. Except for one case, all of the cases urinated spontaneously after the catheter was removed. One case could not urinate spontaneously, and urethral catheter was placed again. Three days later, the urethral catheter was removed, and patient urinated spontaneously. None of the patients reported stress urinary incontinence or erectile dysfunction. The mean operative time was 112minutes, the mean hospital stay was 1.6 days, the mean post-operative IPSS was 6, and the mean post-operative Q max was 24.4mL s 1. Robotic simple prostatectomy may be an effective and safe alternative minimally invasive technique in the treatment of large-volume benign prostatic hyperplasia.

Holmium Laser Enucleation Versus Bipolar Plasmakinetic Resection for Management of Lower Urinary Tract Symptoms in Patients with Large-Volume Benign Prostatic Hyperplasia: Randomized-Controlled Trial.

Objectives: To compare the safety and efficacy of holmium laser enucleation of prostate (HoLEP) vs bipolar plasmakinetic resection of prostate (BPRP) in the management of large-sized (≥75 g) benign prostatic hyperplasia (BPH). Methods: This randomized-controlled trial recruited 145 symptomatic BPH patients who had failed medical management, and who had undergone either HoLEP (Versa pulse® 100 W; n = 73) or BPRP (AUTOCON® II 400 ESU; n = 72). Both groups were compared using the Mann-Whitney, chi-square, Student-t, or Fisher exact tests as appropriate. Preoperative vs postoperative findings (24 months) were compared using paired t-test or Wilcoxon signed-rank test. Results: The two groups were comparable for most preoperative findings including prostate size (p = 0.629), although HoLEP included more patients on anticoagulants (p = 0.001). HoLEP was associated with significantly less operative duration (p < 0.001), hemoglobin loss (p < 0.001), catheterization duration (p = 0.009), and hospital stay (p < 0.001). There was no significant difference in total complications (p = 0.291) and each separate complication. Blood transfusion was reported only with BPRP (p = 0.058). At 24 months of follow-up, there was significant improvement in all the parameters in each group (International Prostate Symptom Score [IPSS], maximum urinary flow rate [Qmax], quality of life [QoL], and postvoid residual urine [PVRU]; p < 0.001). There was no significant difference between both groups in postoperative IPSS (p = 0.08), Qmax (p = 0.051), QoL (p = 0.057), or PVRU (p = 0.069). There was significantly better percentage improvement of both IPSS (p = 0.006) and QoL (p = 0.025) in HoLEP. HoLEP and smaller removed (resected or enucleated) tissues were associated with a reduction in the primary outcomes (hemoglobin loss and operative duration) in logistic regression analysis. Conclusion: HoLEP showed better safety profile with significantly less operative duration, hemoglobin loss, hospital stay, and catheterization duration. Although both procedures were effective, HoLEP showed significantly better percentage improvement of both IPSS and QoL. ClinicalTrials.gov Identifier: NCT04143399.

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

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

MP25-16 HOLMIUM ENUCLEATION OF THE PROSTATE WITH A GLAND VOLUME OVER 200CC

INTRODUCTION AND OBJECTIVE: Holmium laser enucleation of the prostate (HoLEP) is recommended as a treatment option for bladder outlet obstruction for large volume benign prostatic hyperplasia in AUA, UK and European guidelines. It is unclear whether prostate volume (PV) limits HoLEP in terms of safety, efficacy or outcomes. The objectives of this study are to assess the feasibility, outcomes and techniques for HoLEP of prostates with a specimen weight over 150g (equivalent to a preoperative PV >200cc). METHODS: A retrospective review of a prospectively maintained database was conducted at a tertiary HoLEP center in the UK. All HoLEP procedures on glands with a specimen weight >150g were identified and reviewed. Outcomes measured included laser and morcellation times, use of cystotomy, change in serum hemoglobin (Hb), blood transfusion rates, and changes in IPSS, Qmax and PVR at 3 months. RESULTS: 127 patients were identified as having undergone HoLEP with a specimen weight 150g or above over a 14 year period. These were subdivided into three groups by specimen weight of 150-189g or 200-250cc (n= 70), 190-225g or 250-300cc (n=34) and >225g or >300cc (n=23). The median specimen weight was 185g (equivalent to pre-op PV = 250cc). Median enucleation and morcellation time was 70 minutes (range 40-150) and 45 minutes (range 12-240) respectively. Six patients underwent a concomitant cystotomy to remove lobes, four of whom had a specimen weight >225g. The mean length of stay was 1 day (range 0-14). The median change in Hb was 18g/L. The transfusion rate was 1.6%. The median preoperative IPSS in patients without an indwelling catheter was 19 versus 6 at 3 months postoperatively. 85% had a successful initial trial without catheter rising to 95% by second trial. The median preoperative Qmax in patients (without a catheter) was 8mL/s versus 22mL/s postoperatively. Outcomes stratified by specimen weight/equivalent preoperative PV are detailed in Table 1. CONCLUSIONS: HoLEP is feasible and safe for a PV >200cc. PV need not be a barrier to HoLEP in specialist centers. Most HoLEP outcomes are independent of PV, although the use of cystotomy is more common in men with prostates > 300cc. For a PV from 200-300cc and >300cc, we propose the terms mega- and ultra-HoLEP respectively.Source of Funding: No funding received

Endoscopic transvesical adenomectomy of the prostate, a new minimally invasive approach for large benign prostatic hyperplasia. What has our experience taught us?

IntroductionRecent technical advances have made new minimally invasive techniques possible to treat large volume (>80 ml) benign prostatic hyperplasia (BPH). The endoscopic transperitoneal adenomectomy of the prostate (ETAP) is a new minimally invasive technique developed in our centre. The aim of this study was to describe the safety, efficacy and to evaluate our learning curve in ETAP.Material and methodsThis was a single-centre study that enrolled eighty-eight consecutive patients with large BPH who underwent ETAP. Pre-, per- and postoperative data were prospectively collected. Statistical analysis compared the first 40 patients submitted to ETAP (Group A) with the subsequent 48 patients (Group B).ResultsThere were no significant differences in the surgical procedure between groups. The median operating time was 94 (80–110) minutes and the estimated blood loss 150 (100–300) ml. There were no perioperative blood transfusions nor any conversions to open approach needed. Median hospital stay was 3 (3–5) days and catheter was removed mainly at day 9 (5–11). The median Qmax improved from 8.0 (6.2–9.9) ml/s to 15.0 (11.5–23.0) ml/s postoperatively and the median International Prostate Symptom Score (IPSS) score decreased from 20 (15–24) to 6 (4–11) after the procedure.ConclusionsETAP is a secure and feasible minimally invasive technique for treatment of large BPH. The functional outcomes of this technique are consistent and promising.

The clinical application of combination suprapubic prostatectomy with transurethral resection of the prostate (TURP) in patients with large volume benign prostatic hyperplasia (BPH)

To investigate the safety and efficacy of the combination of suprapubic prostatectomy with transurethral resection of the prostate (TURP) for the treatment of large volume benign prostatic hyperplasia (BPH). We retrospectively analyzed the clinical data of two methods of treatment with 60 cases of a large volume BPH (>100 g) from January 2011 to 2017; the methods were suprapubic prostatectomy and suprapubic prostatectomy combination with TURP, in which the single open group comprised 30 cases, treated using the former method, and the combined open group comprised the other 30 cases, treated using the latter method. In the combined open group, the residual prostate gland was removed by TURP. We compared both the groups of patients using age, prostate volume, international prostate symptom score (IPSS), prostate-specific antigen (PSA), maximum flow rate, residual urine, operation time, hospitalization time, postoperative washing time, blood transfusion rate, and decreased amount of intraoperative hemoglobin in operation, and compared the preoperative and postoperative IPSS, maximum flow rate, and residual urine volume. There was no significant difference between the two groups in age, prostate volume, IPSS, PSA, maximum flow rate, residual urine, and other clinical data (P > 0.05); the single group operation time, postoperative bladder irrigation time, hospitalization time, blood transfusion rate, and decreased amount of intraoperative hemoglobin were significantly greater in the single open group than in the combined open group, and statistically significant differences were observed between both the groups (P < 0.05). Postoperative voiding function improved significantly compared with the preoperative, and a statistically significant difference was observed (P < 0.05). The combination of suprapubic prostatectomy with TURP is an effective and a safe surgical method for the treatment of patients with large volume BPH. It is certainly worthy of clinical application.

Evaluation of the super-selective prostate artery embolization combined with TURP for patients with large volume (>80 ml) benign prostatic hyperplasia

Objective To explore the safety and efficacy of super-selective prostate artery embolization (PAE) combined with TURP (transurethral resection of prostate) as an alternative method for patients with severe large BPH (>80 ml). Methods From March 2015 to June 2017, a total of 40 patients with large benign prostatic hyperplasia who failed in medical treatment were selected for PAE combined with TURP (18 cases)and TURP (22 cases). In the PAE combined with TURP group, the mean age was (75.0±8.7) years (ranging 60-88 years) and the mean prostatic volume was (111.0±23.3) ml, ranged from 83 to 145 ml). The international prostate symptom score (IPSS), quality of life (QOL), maximal urine flow rate (Qmax)and postvoid residual urine(PVR) were(25.2±3.6), (5.1±1.0), (6.4±2.3)ml/s and (107.7±32.6)ml, respectively. In the TURP group, the mean age was (76.0±6.9) years (ranging 62-85 years) and the mean prostatic volume was (107.5±27.4) ml, ranged from 80 to 150 ml). The IPSS, QOL, Qmax and PVR were(24.3±4.2), (4.9±0.9), (6.7±2.2)ml/s and (106.6±32.2)ml, respectively. Clinical data of all of patients were analyzed retrospectively, including operative time, estimate blood loss, weight and efficacy of resected tissue, time of continuous bladder irrigation and catheterization, IPSS, QOL, PVR, Qmax and postoperative complications. Results There were significant differences in the operative time [(75.8±25.1)min vs.(103.2±27.7) min], estimate blood loss [(122.8±33.9)ml vs.(447.6±36.0)ml], weight of resected tissue [(99.9±24.2)g vs.(82.9±15.5)g], efficacy of resected tissue [(76.9±20.7)g/h vs.(41.7±14.2)g/h], continuous bladder irrigation time [(1.4±0.5) d vs.(2.4±0.8) d] and catheterization time [(2.2±0.4)d vs.(3.4±0.6)d] between PAE combined TURP group and TURP group(P 0.05). Conclusions PAE combined TURP could be used a safe and effective therapy for treating patients with LUTS due to large volume (>80 ml) BPH. It has been a priority in less blood, more efficient of resected tissue and less postoperative complications. Key words: Benign prostatic hyperplasia; Prostatic artery embolization; Low urinary tract symptoms

MRI features after prostatic artery embolization for the treatment of medium- and large-volume benign hyperplasia.

To assess magnetic resonance imaging (MRI) features after prostatic artery embolization (PAE) for the treatment of medium- and large-volume benign prostatic hyperplasia and to correlate prostate volume with clinical indexes. We retrospectively evaluated 28 patients who underwent PAE. MRI examinations of the prostate were performed to evaluate signal intensity changes and the characteristics of infarcted areas. Prostate volume and the apparent diffusion coefficient (ADC) were measured at an average of 10days post-PAE and at 1, 3, 6, and 12months post-PAE. Some clinical indexes were evaluated before and 12months after PAE. The paired t test, ANOVA, and multiple linear correlation analyses were performed by using the statistical software, SPSS. All patients experienced prostatic infarction. The prostate volume decreased continuously (p < 0.05). The ADC values before and after 1, 3, 6, or 12months of embolization (b = 1000 and 2000s/mm2) were statistically significantly different. The ADC values (b = 3000s/mm2) were also statistically significantly different before and at each interval time after embolization (p < 0.05). Prostate volume changes correlated significantly with patient age and post-void residual urine volume (p < 0.05). MRI can be used for assessing changes in signal intensity and ADC values of infarction as well as the volume of the prostate after PAE. After PAE, ultrahigh b value diffusion-weighted imaging (DWI) can show early infarction better than lower b value DWI.

Thulium vapoenucleation of the prostate versus holmium laser enucleation of the prostate for the treatment of large volume prostates: preliminary 6-month safety and efficacy results of a prospective randomized trial.

We compared the perioperative and postoperative characteristics of thulium vapoenucleation and holmium laser enucleation of the prostate for the treatment of large volume benign prostatic hyperplasia. A total of 94 patients with benign prostatic hyperplasia and a median prostate size of 80 (IQR 46.75-100)cc were either randomized to thulium vapoenucleation or holmium laser enucleation of the prostate. Patients were assessed preoperatively, 1 and 6months postoperatively. The median operative time was 60 (IQR 41-79)min without significant differences between the groups. There were no significant differences between the groups regarding catheter time [2 (IQR 2-2)days] and postoperative stay [2 (IQR 2-3)days]. Clavien 1 (13.8%), 2 (3.2%), 3a (2.1%), and Clavien 3b (4.3%) complications occurred without significant differences between the groups. At 6-month follow-up, median maximum flow rate (10.7 vs. 25.9ml/s), post-void residual urine (100 vs. 6.5ml), I-PSS (20 vs. 5), quality of life (4 vs. 1), PSA (4.14 vs. 0.71µg/l), and prostate volume (80 vs. 16ml) had improved significantly (p < 0.001) compared to baseline without significant differences between the groups. Median PSA decrease was 79.7% (58.8-90.6%) and prostate volume reduction was 74.5% (68.57-87.63%) without differences between the groups. The reoperation rate was zero at 6-month follow-up. Thulium vapoenucleation and holmium laser enucleation of the prostate are safe and effective procedures for the treatment of large volume benign prostatic hyperplasia. Both procedures give satisfactory micturition improvement with low morbidity and sufficient prostate volume reduction at 6-month follow-up.

A Novel Modification of Transurethral Enucleation and Resection of the Prostate in Patients With Prostate Glands Larger than 80 mL: Surgical Procedures and Clinical Outcomes

To evaluate the efficacy and safety of the modified transurethral enucleation and resection of the prostate (M-TUERP) vs the conventional bipolar transurethral resection of the prostate (B-TURP) for the treatment of prostates larger than 80 mL. From April 2012 to May 2014, 86 patients with a prostate volume of >80 mL were divided into 2 groups to undergo M-TUERP and B-TURP. In the M-TUERP group, we proposed combining the 12-mm trocar suprapubic cystostomy and using the techniques of "umbrella-shaped resection," "point resection," and "segmental enucleation" to modify the transurethral enucleation and resection of the prostate procedure. The perioperative clinical data were recorded and analyzed. There were no significant differences in preoperative characteristics between the 2 groups. Both groups were similar with the operative time. The M-TUERP group was significantly superior to the B-TURP group in terms of the weight of the resected tissue, the mean intraoperative bladder pressure, hemoglobin decrease, bladder irrigation duration, and urethral catheterization time. No transurethral resection syndrome and incontinence occurred in either group. Compared with the B-TURP group, none of the patients in the M-TUERP group suffered blood transfusion, clot retention, recatheterization, dysuria and reoperation. At the 3-year follow-up, patients who underwent M-TUERP had better international prostate symptom scores, maximum urinary flow rates, and quality of life scores. Our modification of the transurethral enucleation and resection of the prostate procedure is a safe and effective method for the surgical treatment of large-volume benign prostatic hyperplasia. It can simplify the surgical procedures, reduce complications, lower difficulties and shorten the learning curve. At 3-year follow-up, the M-TUERP shows a superior and durable clinical outcome than the B-TURP.

Prospective study comparing laparoscopic and open adenomectomy: Surgical and functional results

IntroductionOpen adenomectomy (OA) is the surgery of choice for large volume benign prostatic hyperplasia, and laparoscopic adenomectomy (LA) represents a minimally invasive alternative. We present a long-term, prospective study comparing both techniques. Patients and methodsThe study consecutively included 199 patients with benign prostatic hyperplasia and prostate volumes >80g who were followed for more than 12 months. The patients underwent OA (n=97) or LA (n=102). We recorded and compared demographic and perioperative data, functional results and complications using a descriptive statistical analysis. ResultsThe mean age was 69.2±7.7 years (range 42–87), and the mean prostate volume (measured by TRUS) was 112.1±32.7mL (range 78–260). There were no baseline differences among the groups in terms of age, ASA scale, prostate volume, PSA levels, Qmax, IPSS, QoL or treatments prior to the surgery. The surgical time (p<.0001) and catheter time (p<0.0002) were longer in the LA group. Operative bleeding (p<0.0001), transfusion rate (p=0.0015) and mean stay (p<0.0001) were significantly lower in the LA group. The LA group had a lower rate of complications (p=0.04), but there were no significant differences between the groups in terms of major complications (Clavien score≥3) (p=0.13) or in the rate of late complications (at one year) (p=0.66). There were also no differences between the groups in the functional postoperative results: IPSS (p=0.17), QoL (p=0.3) and Qmax (p=0.17). ConclusionsLA is a reasonable, safe and effective alternative that results in less bleeding, fewer transfusions, shorter hospital stays and lower morbidity than OA. LA has similar functional results to OA, at the expense of longer surgical times and longer catheter times.

Efficacy and safety of prostate artery embolization on lower urinary tract symptoms related to benign prostatic hyperplasia: a systematic review and meta-analysis.

BackgroundProstate artery embolization (PAE) is emerging and is a promising minimally invasive therapy that improves lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). The purpose of this article was to evaluate the efficacy and safety of PAE on LUTS related to BPH.Materials and methodsA literature review was performed to identify all published articles of PAE for BPH. The sources included MEDLINE, EMBASE and Cochrane Library from 1980 to 2016. A systematic review and meta-analysis was conducted. The outcome measurements were combined by calculating the mean difference with 95% confidence interval. Statistical analysis was carried out using Review Manager 5.3.0.ResultsTwelve studies involving 840 participants were included. Compared with baseline, the International Index of Erectile Function (IIEF-5; International Prostate Symptom Score) scores, the quality of life scores, peak urinary flow rate (Qmax) and postvoid residual volume all had significant improvements during the 24-month follow-up (all P<0.00001). Both prostate volume (PV) and prostate-specific antigen had significant decrease during the 12-month follow-up (P<0.00001 and P=0.005, respectively), except postoperative 24 months (P=0.47 and P=0.32, respectively). The IIEF-5 short form scores had significant increase at postoperative 6 months (P=0.002) and 12 months (P<0.0001), except postoperative 1 month (P=0.23) and 24 months (P=0.21). For large volume (PV ≥80 mL) BPH, the results were similar. There were no life-threatening complications.ConclusionPAE is an effective, safe and well-tolerable treatment for LUTS related to BPH, including large volume (PV ≥80 mL) BPH, with a good short-term follow-up. Studies with large number of cases and longer follow-up time are needed to validate our results.