Prostate Laser Enucleation Research Articles

Evaluation of noise hazard during the holmium laser enucleation of prostate

BackgroundTo evaluate noise hazard during holmium laser enucleation of the prostate (HoLEP), we designed a study to detect such a risk in this procedure.MethodsThis study was conducted over a 12-month period on 223 patients with benign prostatic hyperplasia (BPH), 121 of whom underwent HoLEP while those remaining underwent transurethral resection of the prostate (TURP). A sound level meter was used to detect the exposure of surgeons to noise. The recordings used were in accordance with the standards set by the Occupational Safety and Health Administration (OSHA) and the United States Environmental Protection Agency. Moreover, each of the 43 surgeons participating in a BPH discussion conference answered the questionnaire on the influence of noise, and 33 surgeons in our department volunteered for blood pressure monitoring post-surgically.ResultsThe sound level produced by a high-powered holmium laser emitter during HoLEP was 67.37 ± 0.13 dB, which was significantly higher than the sound heard during TURP (46.41 ± 0.29 dB, P < 0.01). The 65–70 dB noise during HoLEP was proved to be a safe level in accordance with the OSHA standards. However, this level was considerably greater than the stated 55 dB. Moreover, it exceeded the normal communication protective level of 60 dB. In the analysis of responses from the surgeons, the HoLEP group obtained an average score that reflected disturbance caused by the laser emitter and an increase in average systolic pressure relative to that in the TURP group.ConclusionsThe noise level during HoLEP is within hearing conservation levels. However, the noise disturbs intrateam communication and concentration during surgery. Some surgeons may experience discomfort post-surgically, but no significant difference among the groups is indicated. The findings suggest that measures should be taken to address the noise caused by the laser emitter during HoLEP.

Therapeutic plasma exchange for perioperative management of patients with congenital factor XI deficiency.

Factor XI (FXI) deficiency (hemophilia C [HEM-C]) is a bleeding disorder with unpredictable severity that correlates poorly with FXI coagulation activity (FXI:C). It poses a perioperative hemostatic management challenge. For US patients with severe disease, fresh frozen plasma (FFP) or, in current use, thawed plasma is the most readily available option but comes with risk of volume overload. We report our experience of using therapeutic plasma exchange (TPE) as an alternative perioperative management strategy. A retrospective review of all HEM-C patients who underwent surgical procedures. Data were collected, including demographics, bleeding history, surgical site, perioperative hemostatic intervention, and outcome. Between July 1997 and September 2014, 28 HEM-C patients (12 men) were identified, 4 with severe disease (FXI:C <2% or excessive bleeding). Nineteen patients underwent 91 invasive procedures. For nearly 60% of the procedures, no periprocedural hemostatic intervention was provided; before 4 procedures (3 patients), 1 plasma volume TPE preoperatively with FFP was administered. Patient 1, a 28-year-old woman (FXI:C, 35%) with a history of excessive surgical bleeding, underwent 2 TPE procedures before laparoscopic pelvic biopsy and subsequent abdominal hysterectomy with salpingo-oophorectomy that increased her FXI:C to 48%. Patient 2, a 79-year-old man (FXI:C, <2%), had TPE before total hip arthroplasty, increasing his FXI:C to 24%. Patient 3, a 59-year-old man (FXI:C, <2%), had TPE before prostate laser enucleation, increasing his FXI:C to 46%. Patients 1 and 3 had mild reactions during TPE; no patient had evidence of volume overload. All patients had adequate intraoperative surgical hemostatic outcomes. TPE is an effective alternative presurgical hemostatic intervention in HEM-C with potentially lower risk of circulatory volume overload.

298 - Thulium laser prostate enucleation in refractory urinary retention: Operative and functional outcomes in a large cohort of patients

298 - Thulium laser prostate enucleation in refractory urinary retention: Operative and functional outcomes in a large cohort of patients

Thulium Laser Prostate Enucleation in Refractory Urinary Retention: Operative and Functional Outcomes in a Large Cohort of Patients

To evaluate the functional and operative results of thulium laser enucleation of the prostate (ThuLEP) in patients with indwelling catheters for refractory urinary retention. Patients with indwelling catheter, undergoing ThuLEP for benign prostate hyperplasia, were prospectively enrolled. Every episode of urinary retention was treated with urinary catheter positioning followed by at least 2 attempts of catheter removal. Patients were investigated with flowmetry and the self-administered International Prostate Symptom Score questionnaire at 30 and 90 days following ThuLEP. Three hundred eighty-one patients underwent ThuLEP, and 99 of these had indwelling catheters, but only 93 (24%) were eligible according to the inclusion criteria. In 46 patients the bladder catheter was removed on the first postoperative day, in 31 patients on the second postoperative day, in 5 patients on the third postoperative day, in 6 patients on the fourth postoperative day, in 1 patient on the fifth postoperative day, and in 2 patients each on the sixth and seventh postoperative days. The average hospital stay was 2.3 (±1.7) days. No patients undergoing ThuLEP, at the 90-day follow-up, required further catheterization. Flowmetry showed significant improvement in all parameters, and the mean International Prostate Symptom Score dropped from 21.33 preoperatively to 3.2 (P = .004) at 90 days postoperatively. This prospective study shows that ThuLEP is a safe and effective approach in refractory urinary retention patients. In our case series, no patients required postoperative intermittent catheterization. All functional outcomes investigated reported a statistical significant improvement.

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 Apr 2016This Month in Adult Urology Joseph A. Smith Joseph A. SmithJoseph A. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.01.013AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "This Month in Adult Urology." The Journal of Urology, 195(4 Part 1), pp. 815–816 References 1 : Unplanned hospital return for infection following ureteroscopy—can we identify modifiable risk factors?. J Urol2016; 195: 931. Link, Google Scholar 2 : Root causes and modifiability of 30-day hospital readmissions after radical cystectomy for bladder cancer. J Urol2016; 195: 894. Link, Google Scholar 3 : Multi-institutional experience with robotic nephrectomy with inferior vena cava tumor thrombectomy. J Urol2016; 195: 865. Link, Google Scholar 4 : Comorbid disease burden is independently associated with higher risk disease at prostatectomy in patients eligible for active surveillance. J Urol2016; 195: 919. Link, Google Scholar 5 : Final pathological stage after neoadjuvant chemotherapy and radical cystectomy for bladder cancer—does pT0 predict better survival than pTa/Tis/T1?. J Urol2016; 195: 886. Link, Google Scholar 6 : Comparison of holmium laser prostate enucleation outcomes in patients with or without preoperative urinary retention. J Urol2016; 195: 1021. Link, Google Scholar 7 : Outcomes of laparoscopic partial nephrectomy in patients continuing aspirin therapy. J Urol2016; 195: 859. Link, Google Scholar 8 : Natural history, complications and re-intervention rates of asymptomatic residual stone fragments after ureteroscopy: a report from the EDGE Research Consortium. J Urol2016; 195: 982. Link, Google Scholar 9 : A retrospective analysis of the effect on survival of time from diagnosis to neoadjuvant chemotherapy to cystectomy for muscle invasive bladder cancer. J Urol2016; 195: 880. Link, Google Scholar © 2016 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 195Issue 4 Part 1April 2016Page: 815-816 Advertisement Copyright & Permissions© 2016 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph A. Smith More articles by this author Expand All Advertisement PDF downloadLoading ...

116 Holmium laser enucleation of prostate (HoLEP) and morcellation

116 Holmium laser enucleation of prostate (HoLEP) and morcellation

Comparison of Holmium Laser Prostate Enucleation Outcomes in Patients with or without Preoperative Urinary Retention

We determine whether outcomes of holmium laser enucleation of the prostate are similar in patients with and those without preoperative urinary retention. From May 2008 to July 2014, 231 patients underwent holmium laser prostate enucleation for symptomatic benign prostatic hyperplasia. Retrospective analysis was performed to evaluate for differences in postoperative outcomes for patients with and those without preoperative urinary retention. Overall 95 patients (41%) had urinary retention before holmium laser prostate enucleation while 136 (59%) did not. Mean followup for all patients was 15.3 months. Patients with retention tended to be older, have larger prostates, and have higher scores on the AUA SS and bother questionnaires (all p<0.05). Postoperatively there was no difference in rates of complications, including urinary retention. Both groups showed significant improvement in AUA SS and bother score after the procedure at all postoperative points. Median post-void residual was less than 60 ml and median maximum flow rate on uninstrumented uroflow was greater than 18 ml per second at all postoperative points for all patients regardless of preoperative retention status. No patients required long-term catheterization and rates of postoperative complications did not differ significantly during the followup period. This study represents the first direct comparison to our knowledge of holmium laser prostate enucleation outcomes in patients with or without urinary retention. There was no increased risk of postoperative urinary retention in patients with preoperative retention, and both groups demonstrated significant postoperative improvement in subjective and objective voiding measures.

Direct Comparison of GreenLight Laser XPS Photoselective Prostate Vaporization and GreenLight Laser En Bloc Enucleation of the Prostate in Enlarged Glands Greater than 80 ml: a Study of 120 Patients

We compare patient outcomes after 180 W XPS™ GreenLight™ photoselective vaporization of the prostate and GreenLight laser enucleation of the prostate used to surgically manage benign prostatic obstruction. Two groups of 60 consecutive patients with enlarged glands (greater than 80 ml) underwent GreenLight laser prostate enucleation or photoselective prostate vaporization (performed by the same surgeon and including the learning curve) and were retrospectively evaluated. Perioperative data from both groups were compared. The operative time was significantly shorter in the GreenLight laser prostate enucleation group (60 vs 82 minutes, p <0.0001). Complication rates were comparable between the groups. At 2 months the rate of urinary incontinence was significantly higher in the GreenLight laser prostate enucleation group (25% vs 3.4%, p <0.0001) but incontinence rates were similar at 6 months (3.4% vs 0%, p=0.50). At 6 months International Prostate Symptom Score quality of life and post-void residual urine volume had similarly decreased in the 2 groups after the procedure (compared to baseline), whereas the maximum urinary flow rate had greatly improved, significantly favoring the GreenLight laser prostate enucleation group (+78% vs +64%, p <0.0001). Prostate size and prostate specific antigen reductions were significantly higher in the GreenLight laser prostate enucleation group (74% vs 57%, p <0.0001 and 67% vs 40%, respectively, p=0.007). The unplanned hospital readmission rates were similar in both groups (16.7% vs 6.7%, p=0.16). Photoselective vaporization of the prostate and GreenLight laser enucleation of the prostate are safe and provide satisfactory short-term functional outcomes in patients with a prostate volume greater than 80 ml. However, the surgical time was longer in the photoselective prostate vaporization group, which also had a higher rate of unplanned hospital readmission, and lower decreases in prostate specific antigen and prostate size.

V49 Successful ‘salvage' holmium laser enucleation of prostate in a patient with failed prostate arterial embolization clinical response

V49 Successful ‘salvage' holmium laser enucleation of prostate in a patient with failed prostate arterial embolization clinical response

130 Randomized control trial comparing high power and medium power settings for holmium laser enucleation of prostate

130 Randomized control trial comparing high power and medium power settings for holmium laser enucleation of prostate

V8-11 HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR GLANDS GREATER THAN 200 GRAMS

tissue with incorporated stent pieces and stent particles were removed mechanically with grasping forceps and remaining prostate adenoma was morcellated. The detail surgical technique is shown in the video. Literature review was performed focusing on articles on removal of permanent prostatic stent. RESULTS: At 10 month of follow-up, patients had symptomatically improved with American urological association symptom score of 3, maximum uroflow rate of 21.7 ml/sec and post void residual urine of 31 ml. In the literature, we could identify only two case reports employing low power holmium laser for fragmenting prostatic stent. CONCLUSIONS: High power holmium laser can be successfully used to remove a permanent metallic stent in prostate during holmium laser enucleation of prostate.

Lernkurve bei Laserverfahren in der Behandlung des benignen Prostatasyndroms: Ein systematischer Review

The aim of the present systematic review was to evaluate the evidence of a potential learning curve for laser treatment of benign prostatic hyperplasia. A systematic literature search was conducted in November 2011 using The Cochrane Library, EMBASE and MEDLINE. Overall, 18 sources (mostly case series) were included for further assessment. The majority of publications assume that a general learning curve exists. It is estimated that a range of 20 to 50 cases is needed to achieve a stable outcome level. For the most part, these findings are based on the HoLEP (Holmium laser enucleation of prostate) technique and intraoperative measures, such as enucleation efficiency. Valid conclusions regarding patient-related end-points are difficult to make, although some studies report a decreasing trend for complication rates with increasing experience of the surgeon. No statistically significant differences were found for postoperative outcomes such as IPSS (International Prostate Symptom Score), Qmax (peak flow rate) or Quality of Life. Overall, the present results are highly limited by the low evidence level and methodological problems of the publications available. Several publications suggest that adequate training during the implementation phase is relevant.

Experience With More Than 1,000 Holmium Laser Prostate Enucleations for Benign Prostatic Hyperplasia

Holmium laser prostate enucleation is a contemporary treatment for benign prostatic hyperplasia. We report our experience with more than 1,000 procedures. From June 1998 to March 2009 we performed 1,065 holmium laser prostate enucleations. After receiving institutional review board approval we retrospectively reviewed the database. Reported short-term, intermediate term and long-term results are 0 to 6, 6 to 12 and greater than 12 months, respectively. Bladder stones were present in 50 patients (4.7%) and 87 of the 717 (12.1%) with laboratory studies available had renal insufficiency. Preoperative urinary retention was present in 411 cases (38.7%). Significant preoperative stress and urge incontinence was noted in 8 and 16 patients, respectively. Mean transrectal ultrasound prostate volume was 99.3 gm (range 9 to 391). Mean preoperative American Urological Association symptom score was 20.3 (range 1 to 35) and maximum urinary flow was 8.4 cc per second (range 1.1 to 39.3). Intraoperative or postoperative complications occurred in 24 cases (2.3%). Mean followup was 287 days (range 6 to 3,571). At short-term, intermediate term and long-term followup the mean symptom score was 8.7, 5.9 and 5.3, and maximum urinary flow was 17.9, 19.5 and 22.7 cc per second, respectively. At the most recent followup 3 patients (0.3%) were in urinary retention. One patient with maximum urinary flow 20 cc per second required a second procedure for bleeding prostatic regrowth. Urethral stricture was noted in 9 (0.9%), 11 (1.3%), 4 (1.3%) and 0 patients, and bladder neck contracture was found in 0, 7 (0.8%), 4 (1.3%) and 5 (6.0%) at short-term, intermediate term, long-term and greater than 5-year followup, respectively. At the most recent followup significant stress and urge incontinence was noted in 9 and 6 patients, respectively. Holmium laser prostate enucleation is safe and effective for benign prostatic hyperplasia. The complication rate is low, and incontinence and the need for ancillary procedures are rare for holmium laser prostate enucleation with durable long-term results.

Prostate Volume Did Not Affect Voiding Function Improvements in Diode Laser Enucleation of the Prostate

We compared safety and surgical outcomes in patients with different prostate sizes treated with diode laser enucleation of the prostate. From 2008 to 2012 consecutive patients with benign prostatic obstruction undergoing diode laser prostate enucleation at our institution were enrolled for analysis. A single surgeon performed diode laser prostate enucleation with an end firing, continuous wave diode laser (980 nm). Based on preoperative prostate volume on transrectal ultrasound, patients were stratified into 2 groups, including group 1-65 with less than 60 ml and group 2-55 with 60 ml or greater. Baseline and perioperative characteristics, and postoperative surgical outcomes were compared between the 2 groups. A total of 120 men with a mean ± SD age of 70.2 ± 9.0 years were enrolled for analysis. Compared with group 1 patients, those in group 2 had larger mean total prostate volume (85.0 ± 24.6 vs 40.9 ± 10.8 ml), longer mean operative time (117.7 ± 48.2 vs 60.7 ± 25.0 minutes), higher mean retrieved prostate weight (37.3 ± 16.1 vs 12.5 ± 7.3 gm) and a higher mean tissue retrieval ratio (74.4% ± 22.2% vs 58.8% ± 23.2%, p <0.01). There was no significant difference in the postoperative hemoglobin decrease in the 2 groups (median 0.5 vs 0.9 mg/dl, p = 0.11). The rate of temporary postoperative urinary retention after Foley catheter removal was significantly lower in group 2 (15.4% vs 3.6%, p = 0.04). Postoperative improvements in the peak flow rate, post-void residual urine volume and International Prostate Symptom Score were comparable in the 2 groups. Although patients with a larger prostate required significantly longer operative time and laser energy, voiding function improvements and surgical complication rates of diode laser prostate enucleation were comparable in patients with a larger vs smaller prostate.

Transurethral Holmium Laser Enucleation Versus Transurethral Resection of the Prostate and Simple Open Prostatectomy—Which Procedure is Faster?

The longer operative time of holmium laser enucleation of the prostate compared to transurethral resection of the prostate or simple open prostatectomy reported in the literature might have been biased by the unavailability of a soft tissue morcellator, limited surgical experience with holmium laser prostate enucleation or the fact that significantly more tissue was removed by enucleation than by resection. We objectively compared the resection speed of contemporary holmium laser enucleation vs transurethral resection of the prostate and of holmium laser enucleation vs simple open prostatectomy. The study cohort consisted of 100 cases of transurethral prostate resection and 60 of simple open prostatectomy from our previous randomized, controlled trials. These cases were subjected to matched pair analysis with greater than 1,000 from our prospective contemporary database on holmium laser prostate enucleation. Exact matches were made for the same amount of resected tissue. In all contemporary holmium laser enucleation cases a mechanical soft tissue morcellator was used. We calculated and compared the specific resection speed in gm per minute and operative time for the same amount of resected tissue. In groups 1 and 2 we matched 99 exact laser enucleation-transurethral resection pairs and 53 exact laser enucleation-simple open prostatectomy pairs, respectively. Resection speed and operative time for laser enucleation were statistically significantly faster than for resection (0.61 vs 0.51 gm per minute and 62 vs 73 minutes, p <0.01) and similar to those of simple open prostatectomy (0.92 vs 1.0 gm per minute and 101 vs 90 minutes, respectively, p ≥0.21). Resection speed seems to be an objective criterion for comparing the efficacy of prostatic tissue removal. Based on resection speed holmium laser enucleation of the prostate is faster than transurethral resection of the prostate and similar to simple open prostatectomy.

Safety and Efficacy of Eraser Laser Enucleation of the Prostate: Preliminary Report

We ascertained the safety and efficacy of the 1,318 nm diode Eraser laser (Rolle and Rolle, Salzburg, Austria) for transurethral enucleation of the prostate. This laser has been successfully used to resect lung metastasis. It cuts and coagulates vascular rich tissue safely and effectively. We describe a prospective, randomized trial of Eraser laser prostate enucleation vs bipolar transurethral prostate resection. A total of 60 patients with lower urinary tract symptoms suggesting bladder outlet obstruction and a mean prostate size of 59.5 ml on transrectal ultrasound were randomized to Eraser laser prostate enucleation or bipolar transurethral prostate resection. Patients were assessed preoperatively, and 1 and 6 months postoperatively. Eraser laser prostate enucleation was equivalent to bipolar transurethral prostate resection in improvement in International Prostate Symptom Score, maximal flow rate and quality of life. Laser enucleation was significantly superior to bipolar transurethral resection for measured blood loss (mean ± SD 116.83 ± 97.02 vs 409.83 ± 148.61 ml), catheter time (mean 32.80 ± 8.74 vs 65.73 ± 13.72 hours) and hospital time (mean 45.13 ± 14.77 vs 91.20 ± 11.76 hours, each p <0.05). Using the validated Clavien-Dindo system there were 3 grade Id and 1 grade II complications. Eraser laser prostate enucleation and bipolar transurethral prostate resection were equally safe and effective to relieve bladder outflow obstruction and lower urinary tract symptoms. This laser technique has the advantage of less blood loss, and shorter catheter time and hospital stay.

POD-04.01 Comparing Holmium Laser Enucleation of Prostate (HoLEP) with Bipolar Transurethral Resection of Prostate: A Prospective Randomized Controlled Trial

POD-04.01 Comparing Holmium Laser Enucleation of Prostate (HoLEP) with Bipolar Transurethral Resection of Prostate: A Prospective Randomized Controlled Trial

HOLMIUM LASER PROSTATE ENUCLEATION (HOLEP) VERSUS TRANS-URETHRAL RESECTION OF PROSTATE (TURP) IN TREATMENT OF SYMPTOMATIC PROSTATIC ENLARGEMENT; A HEALTH TECHNOLOGY ASSESSMENT

Introduction: Our aim was to compare the cost effectiveness of holmium laser prostate enucleation (HOLEP) versus trans-urethral resection of prostate. Materials and Methods: We searched all available databases for any controlled trials comparing HOLEP and TURP from January 2000 to February 2009. Two independent reviewers studied and appraised the selected evidences. Then, effectiveness and cost effectiveness of HOLEP was evaluated. Results: We identified four randomized controlled trials and one systematic review according to the inclusion criteria. Most of the studies had moderate quality of evidence with limited sample sizes. Overall success rate of HOLEP was comparable with TURP; but, some secondary outcomes such as pick flow rate twelve months after the surgery was better in HOLEP. A comparison between the original costs and those obtained from sensitivity analysis showed that the cost parameters were sensitive to the number of the patients treated. Increasing the number of the patients from 200 to 300 changed the study’s results in favor of the new techniques. Conclusion: Since the holmium and thulium laser sets are sensitive to the number of the patients and multipurpose, they potentially can be applied for stone fragmentation. Thus, utilization of these equipments will divide the costs between two groups of the services. In economic terms, these properties lower overhead costs and justify the purchasing of these equipments.

Laser ablation of the prostate: a safe effective treatment of obstructive benign prostatic disease

Laser ablation of the prostate: a safe effective treatment of obstructive benign prostatic disease

Experience With More Than 1,000 Holmium Laser Prostate Enucleations for Benign Prostatic Hyperplasia

Holmium laser prostate enucleation is a contemporary treatment for benign prostatic hyperplasia. We report our experience with more than 1,000 procedures. From June 1998 to March 2009 we performed 1,065 holmium laser prostate enucleations. After receiving institutional review board approval we retrospectively reviewed the database. Reported short-term, intermediate term and long-term results are 0 to 6, 6 to 12 and greater than 12 months, respectively. Bladder stones were present in 50 patients (4.7%) and 87 of the 717 (12.1%) with laboratory studies available had renal insufficiency. Preoperative urinary retention was present in 411 cases (38.7%). Significant preoperative stress and urge incontinence was noted in 8 and 16 patients, respectively. Mean transrectal ultrasound prostate volume was 99.3 gm (range 9 to 391). Mean preoperative American Urological Association symptom score was 20.3 (range 1 to 35) and maximum urinary flow was 8.4 cc per second (range 1.1 to 39.3). Intraoperative or postoperative complications occurred in 24 cases (2.3%). Mean followup was 287 days (range 6 to 3,571). At short-term, intermediate term and long-term followup the mean symptom score was 8.7, 5.9 and 5.3, and maximum urinary flow was 17.9, 19.5 and 22.7 cc per second, respectively. At the most recent followup 3 patients (0.3%) were in urinary retention. One patient with maximum urinary flow 20 cc per second required a second procedure for bleeding prostatic regrowth. Urethral stricture was noted in 9 (0.9%), 11 (1.3%), 4 (1.3%) and 0 patients, and bladder neck contracture was found in 0, 7 (0.8%), 4 (1.3%) and 5 (6.0%) at short-term, intermediate term, long-term and greater than 5-year followup, respectively. At the most recent followup significant stress and urge incontinence was noted in 9 and 6 patients, respectively. Holmium laser prostate enucleation is safe and effective for benign prostatic hyperplasia. The complication rate is low, and incontinence and the need for ancillary procedures are rare for holmium laser prostate enucleation with durable long-term results.