Enucleation Of Prostate Research Articles

Comparing surgical techniques: ThuLEP and transurethral BPEP for prostate over 80 grams. Intraoperative and postoperative results. A prospective randomized trial

ABSTRACT Background and purpose Though TURP remains the primary treatment for BPH, advancements in energy and technology have introduced innovative transurethral surgical options. In this study, we assessed and compared the effectiveness and safety of using thulium laser and bipolar for endoscopic enucleation of prostate exceeding 80 g. Patients and methods Between January 2022 and July 2023, this study enrolled patients with LUTS due to BPH and a prostate size of ≥80 g. Group A underwent the BPEP procedure using a 26 Fr continuous flow resectoscope with plasma kinetic system enucleation loops, while Group B underwent the ThuLEP procedure using a 120–200 W Revolix DUO® Thulium laser. Data collection included prostate size, PSA levels, enucleation and morcellation time, and postoperative IPSS and IIEF-5 scores at one, 3, 6, and 12 months. Results A total of 108 patients, divided into Group A (BPEP) and Group B (ThuLEP), completed a 12-month follow-up. The mean age for group A was 67.72 ± 7.02 compared to group B which was 62.33 ± 5.86. While Group A compared to group B had higher mean enucleation (75.22 ± 10.55 vs. 67 ± 12.18) and total operative times (117.22 ± 17.76 vs.90.5 ± 18.29) (p = 0.037 & <0.001 respectively), no significant differences were observed in resected tissue weight, blood transfusion, and morcellation time. The ThuLEP group exhibited a shorter mean catheter period 2.94 ± 0.94 d compared to BPEP 3.33 ± 0.91 d and shorter mean hospital stay period of 1.94 ± 0.54 compared to2.11 ± 0.32, though not statistically significant. Postoperative outcomes, including IPSS, Qmax, PVRU, and IIEF-5 at 1, 3, 6, and 12 months, showed no differences between the groups. Conclusion ThuLEP shows better perioperative parameters in comparison to BPEP. Nevertheless, there are no notable differences in functional results and complications between the two techniques.

Prospective results of the minimally invasive laser enucleation of the prostate (MiLEP).

The objective of the present study is to prospectively analyze the prostate enucleation procedure with Holmium Laser using the minimally invasive technique (MiLEP), comparing the outcomes and their variables pre- and postoperatively. We studied men aged 40 years or over, with prostate volumes greater than or equal to 35 cm³ with lower urinary tract symptoms due to BPH. We performed flowmetry and administered the IPSS questionnaire before and 6 months after the MiLEP procedure. The patients were operated on with a 60 W Holmium Laser (Cyber-Ho Quanta System®) using 54 W of power (energy 1.8 J and frequency of 30 Hz). Enucleation was performed using the en bloc technique with early sphincter release. After enucleation, the tissue was morcellated using a 22 Fr morcescope (RZ-Medizintechnik GmbH, Tuttlingen, Germany) and Piranha (Richard Wolf) morcellator. The final Hemostasis after morcelation was made using laser with 30wW power, energy at 1,0 joules and frequency at 30 Hertz. Student's T test and Man-Whitney was used to statistical analysis (p < 0.05). After selection we submitted 73 patients (mean age= 68.2 years) to MiLEP procedure with a follow up of 6 months. The prostate volume presented an average of 94.53 cm³ (65 to 112 cm³, SD = 5.363) preoperatively. The urinary continence rate after the procedure was greater than 95% after 1 week and 99% in the 1st month. All patients were continent after 6 months. The IPSS questionnaire before (mean = 21.18 points/SD = 6.557) and after (mean = 7.92 points/SD = 2.408) the MiLEP had statistical significance (p < 0.001). The flowmetry(ml/s) before (9.02/SD = 2.842) and after (21.07/SD = 6.228) the MiLEP had statistical significance (p < 0.001). The average time of the procedure was 78.5 min and the bladder catheter was removed after 18 h in mean. In 4 patients (5.8%) we observed hematuria and in 1 case (1.47%) the patient needs urinary catheterization. MiLEP is a safe and effective procedure, with significant improvement in urinary flow and symptoms in the short term. Although the results of this study were satisfactory and the urinary incontinence rate was lower compared to HoLEP data found in the literature, multicenter studies with longer follow-up are needed to confirm these findings.

Comparative Analysis of Three Surgical Instruments in the Treatment of High Critical Enucleation of Prostate.

We conducted a study to assess the effectiveness and safety of three different surgical instruments for enucleation in treating high-risk benign prostatic hyperplasia (BPH). These instruments include red laser, green laser, and plasma surgical equipment for enucleation of the prostate. In a retrospective analysis, 237 patients diagnosed with high-risk benign prostatic hyperplasia (BPH) underwent prostate enucleation using three different groups of surgical instruments at the Department of Urology, the First Affiliated Hospital of Jinzhou Medical University. These groups included the red laser device group (n = 67), the green laser device group (n = 61), and the plasma device group (n = 109). The study evaluated changes in prostate mass, blood loss, operation time, and postoperative efficacy at 1- and 6-month intervals, as well as any associated complications. The red and green laser surgical instrument groups demonstrated superiority over the plasma group in several aspects. (1) Operation Time: *1* Red laser group: 87.9 ± 14.7 minutes; *1* Green laser group: 86.1 ± 15.3 minutes. (2) Blood Loss: *1* Red laser group: 30.1 ± 5.9 mL; *2*Green laser group: 30.9 ± 6.1 mL. (3) Temporary Urinary Incontinence: *1*Red laser group: 3 cases (4.48%); *2*Green laser group: 2 cases (3.28%). These differences were statistically significant. Additionally, postoperative indicators such as IPSS(International Prostate Prostate Symptom Score), QoL(Quality of Life), Q max(The Maximum Flow Rate), and RUV(Residual Urine Volume) showed significant improvement in all three groups compared to the preoperative state. Red laser, green laser and plasma surgical devices were safe and effective in the treatment of high critical benign prostatic hyperplasia; laser surgical devices showed better performance in terms of operation time, intraoperative bleeding and complications.

Fluid Overload Syndrome in Patients Undergoing Holmium Laser Enucleation of the Prostate (HoLEP)

Introduction: Fluid overload syndrome is a potentially serious complication that can arise during holmium laser prostate enucleation (HoLEP) surgery. This minimally invasive surgical technique is used to treat benign prostatic hyperplasia (BPH) and is known for efficacy and safety. Fluid overload occurs when the patient receives excessive volume of intravenous fluids during the surgical procedure. This can occur due to a variety of factors, such as inadequate fluid administration by the medical team, excessive fluid absorption during irrigation, or systemic absorption of solutions used during surgery. Material And Methods: A descriptive, observational, single-center and retrospective study was performed in patients undergoing prostatic enucleation with Holmium laser (HoLEP) who developed water overload syndrome, between April 2023-2024 in the Hospital Juarez of Mexico. The demographic data and the dependent variables will be tested for normality according to the Kolmogorov-Smirnov test with Lilliefors correction. If the data are normally distributed, factorial ANOVA will be used for more than two independent samples where the Bonferroni test will be used post Hoc for the multiple pairwise comparison in a parametric manner, considering p&lt;0.05 as statistically significant; if the data are not normally distributed, the Kruskal- Wallis test will be used for more than two independent samples where the Dunn's test will be used post hoc for the multiple pairwise comparison in a non-parametric way, considering p&lt;0.05 as statistically significant. Results: We analyzed 142 files of patients who underwent HoLEP, of which only 49 met the expected inclusion criteria. Of the remaining 49 files, 100% were men with a median age 69 years (58-79 years), weight 62 kg (58-78 kg), height 1.67 m (1.55-1.74 m), BMI 22.1 kg/m2 (21.7-25.8 kg/m2) and body surface area 1.69 m2 (1.61-1.71 m2). The hemodynamic and gasometrical variables were recorded at the anesthesia beginning, at 30, 60, 90, 120, 150 minutes and at the anesthesia end: At 60 minutes after Holmium enucleation the hemodynamic variables: systolic blood pressure 116 mm Hg (110-119 mm Hg), Diastolic blood pressure 63.5 mm Hg (56.5-67 mm Hg), Mean arterial blood pressure 81 mm Hg (76.3-83.3 mm Hg), Heart Rate 68.6 beats/minute (62.6-73.6 beats/minute), Pulse Variability 4.45% (1.7-7.2%) and Plethysmographic variability 5.2% (2.2-8.2%). As for the gasometrical variables: pH 7.34±0.02, CO2 partial pressure 32.24±1.80 mm Hg, O2 partial pressure 61.61±1.80 mm Hg, Arterial Bicarbonate 17.84±1.26 mmol/L, Base deficit -3.95±0.53 mmol/L, Arterial Sodium 135.78±1.41 mmol/L, Arterial Potassium 3.02±0.15 mmol/L, Arterial Chlorine 103.97±1.95 mmol/L, Arterial Lactate 1.76±0.22 mmol/L and Coefficient p50 26.59±0.98 mm Hg. After statistical analysis with Kruskal-Wallis and Dunn-Bonferroni method, the hemodynamic and gasometrical changes occurring after 60 minutes are statistically significant (p&lt;0.05). Discusion: In this cohort of patients with fluid overload, they respond to myocardial fiber distension to a variable degree by increasing cardiac output and stroke volume until dysfunction occurs due to myocardial insufficiency. Myocardial depression in turn produces microvascular dysfunction with alterations in the regulatory functions of the endothelium. This behavior is demonstrated by changes in systolic, diastolic, and average blood pressure that compensate for fluid overload within the first 90 minutes of surgery. Few studies have reported the clinical outcomes of patients undergoing HoLEP, with hemodynamic behavior variables being the least described. If this fluid infusion is continued through prostatic reabsorption of sodium chloride, heart failure occurs due to activation of the sympathetic nervous system accompanied by a greater predisposition to ventricular and supraventricular arrhythmias, which in our study occurred from a median of 71.5 Lt of NaCl and with a utilization rate of 0.27-0.49 lt/min. Conclusions: Fluid overload syndrome due to HoLEP is a rarely diagnosed entity that leads to the appearance of hyperchloremic metabolic acidosis after 90 minutes of enucleation that can appear in up to 23.6% of patients, with an average of fluids infused of NaCl from 43.9 liters and in prostate resections from 48 gr. The rapid identification of this fluid overload syndrome will allow negative assessments, administration of drugs such as diuretics and even the diagnosis of ischemia-reperfusion that can be harmful in patients with previous renal failure.

Modern predictors and management of incidental prostate cancer at holmium enucleation of prostate.

To evaluate contemporary preoperative risk factors and subsequent postoperative management of incidental prostate cancer (iPCa) and incidental clinically significant prostate cancer (icsPCa, Grade Group [GG] ≥ 2 PCa). A retrospective cohort of 811 men undergoing Holmium enucleation of the prostate (HoLEP) (January 2021-July 2022) were identified. Advanced preoperative testing was defined as prostate health index (PHI), prostate MRI, and/or negative preoperative biopsy. Descriptive statistics (Whitney-Mann U test, Chi-squared test) and multivariable logistic regression were performed. iPCa and icsPCa detection rates were 12.8% (104/811) and 4.4% (36/811), respectively. Advanced preoperative testing (406/811, 50%) was associated with younger age and higher (prostate specific antigen) PSA, prostate volume, and PSA density. On multivariable analysis, PHI ≥ 55 was associated with iPCa (OR 6.91, 95% CI 1.85-26.3, p = 0.004), and % free PSA (%fPSA) was associated with icsPCa (OR 0.83, 95% CI 0.67, 0.94, p = 0.01). GG1 disease comprised the majority of iPCa (65%, 68/104) with median 1% involvement. iPCa patients were followed with active surveillance (median follow up 9.3 months), with higher risk patients receiving prostate MRI and confirmatory biopsy. Three patients proceeded to radical prostatectomy or radiation. In the era of MRI and advanced biomarkers, the majority of iPCa following HoLEP is low volume GG1 suitable for active surveillance. A tentative follow-up strategy is proposed. Patients with PHI ≥ 55 or low %fPSA, even with negative prostate MRI, can consider preoperative prostate biopsy before HoLEP.

Prospective randomized multicenter study to evaluate holmium vs. new thulium fiber laser for prostate enucleation.

Benign prostatic hyperplasia (BPH) commonly causes lower urinary tract symptoms (LUTS) in men. Holmium (HoLEP) and thulium (ThuLEP) laser enucleation are established techniques for BPH treatment. Thulium fiber laser (TFL) for prostate enucleation (ThuFLEP) shows promising outcomes. A prospective randomized multicenter study was conducted. Patients with BPH and LUTS unresponsive to medical therapy were enrolled. Preoperative, surgical, perioperative and postoperative data were recorded with follow-up at 3 and 6 months. The primary outcome was functional improvement, and the secondary outcome was safety in terms of complications. Two hundred patients were included (HoLEP 100, ThuFLEP 100). No significant baseline difference was found between groups. At 3 and 6 months we found statistically significant improvements from baseline for both HoLEP and ThuFLEP in efficacy: International Prostatic Symptoms Score (IPSS), IPSS-Quality of Life (QoL), maximum urinary flow rate (Q<inf>max</inf>), and post-void residual volume (PVR; P<0.05). At 6 months, mean±SD IPSS, IPSS-QoL, Q<inf>max</inf>, and PVR for HoLEP vs. ThuFLEP were 5.8±4.9 vs. 4.8±5.0 points (P=0.57), 1.6±1.4 vs. 0.7±1.1 points (P=0.09), 29.9±12.5 vs. 29.6±8.0 mL/s (P=0.8), and 16.3±17.7 vs. 15.5±13.4 mL (P=0.92), respectively. No intraoperative complication was recorded. No Clavien-Dindo ≥III complications occurred during hospitalization. After 6 months, 8 (8%) and 6 (6%) patients reported mild stress urinary incontinence in HoLEP and ThuFLEP groups, respectively (P=0.24). Urethral stenosis was observed in 3 men (3%) in the HoLEP group and 1 subject (1%) in the ThuFLEP group (P=0.72). HoLEP and ThuFLEP are effective and safe for BPH treatment, with comparable functional outcomes and complication rates at 6 months. Further research is needed to confirm these findings.

Evaluation of safety and efficacy of insulated-gate bipolar transistor holmium laser technology for prostate enucleation in canine model: a preliminary study.

The evolution of laser medical devices for benign prostatic hyperplasia (BPH) treatment aims to enhance vaporization, coagulation, or tissue removal. In this study, we aim to evaluate the effectiveness and safety of the innovative application of insulated-gate bipolar transistor (IGBT) xenon lamp-pulsed drive technology holmium laser in endoscopic prostate enucleation operations using canine models. Six canines were used as an experimental unit, the breed of the canine unit used was beagle. Each canine served as its own control to minimize the number of experimental units. Endoscopic enucleation, performed by a single surgeon, involved enucleating the left hemi-prostate, leaving the right hem-prostate untouched to serve as the control. Throughout the study period, all canines maintained good health. No adverse events were observed in all six canines. Postoperatively, there were no indications of redness, swelling, or other adverse effects at the surgical sites. No abnormalities were observed in the appearance and morphology of major organs. The prostate and bladder, removed for further pathological evaluation, exhibited no abnormalities in size, color, or texture. No abnormalities or inflammation were observed, and the tissues were free of adhesions, indicating successful healing. In conclusion, our comparison of preoperative and postoperative parameters in canines suggests that the IGBT pulsed laser, at a power setting of 100W, demonstrates characteristics of safety, efficacy, minimal tissue damage, and no major postoperative complications. This study establishes a theoretical foundation for future applications in human settings, encouraging further exploration of the IGBT holmium laser's potential in clinical practice.

Evaluation of the learning curve for Thulium fiber laser enucleation of prostate (ThuFLEP): retrospective study of a single-surgeon experience in real-world settings.

To assess the learning curve of Thulium Fiber Laser Enucleation of prostate (ThuFLEP) of a single surgeon inexperienced in laser endoscopic enucleation of prostate (EEP). We retrospectively analyzed all patients with benign prostate hyperplasia undergoing ThuFLEP at our center between January 2022 and August 2023 by one surgeon. Inclusion criteria were International Prostate Symptom Score > 7, prostate volume < 200g, and maximal urinary flow rate < 15 mL/s. The surgeon was inexperienced in laser EEP and trained by watching educational videos of ThuFLEP before starting to perform the procedure under mentoring during the first 4 cases. Procedural data (enucleation and morcellation efficiency, complications) and functional results up to 3 months were evaluated. Patients were divided into 4 cohorts of 20 consecutive cases to evaluate outcomes evolution throughout time. The mean age of the patients was 69.9 years (SD 7.8) and mean prostate volume was 89.9g (SD 25.8). Preoperative functional parameters were comparable between the groups. Mean enucleation efficiency (EE) ratio and morcellation efficiency (ME) ratio reached respectively 0.78g/min (SD 0.55) and 2.49g/min (SD 1.03) and both variables significantly increased from group 1 to group 3 (p < 0,001). Perioperative complications remained low throughout the caseload with similar significant 3-month functional improvements between all groups. This is the first study to evaluate ThuFLEP learning curve for a single surgeon inexperienced in laser EEP with limited mentoring. Under these real-world conditions, nearly 60 cases were needed to complete the learning curve with a complications rate remaining low throughout the training process.

Comparing the clinical efficacy of prostate enucleation by the Millin method and enucleation performed using a holmium laser (HoLEP) with a prostate volume more than 80 cm3

Purpose of the study was to compare of the average long-term results of classical prostate enucleation using the Millin method and enucleation performed using a holmium laser (HoLEP). Patients and methods. This study, conducted on the basis of the Endocrinology Research Center of the Ministry of Health of the Russian Federation, included 100 patients operated on for obstruction of the prostatic part of the urethra over the period 2020–2023. The main indication for surgery was benign prostatic hyperplasia. The selection criterion for patients was a prostate volume of more than 80 cm3. The patients were divided into 2 groups depending on the intervention performed: in the 1st group Millin surgery was performed (n = 50), in group 2n laser enucleation of the prostate was done (n = 50). The data obtained during the operation in the early postoperative period, as well as the results of postoperative follow-up of patients were analyzed. Results. In the mid-term period, 4–6 months after surgery, patients from both groups were observed to improve their condition and reduce complaints of dysuric phenomena. The results were obtained illustrating a shorter inpatient stay for patients who underwent HoLEP (4.3 ± 0.6 days versus 10.0 ± 2.4 during Millin surgery), which is correspondingly associated with a faster recovery after this intervention compared with the classic one. A statistically significant (p-value &lt; 0.05) problem of patients from the HoLEP group was urethral stricture, which occurred in 6 % of the subjects from this group and did not occur in the Millin surgery group. In fact, scarring of the bladder neck was more commonly obserbed (10 % vs. 8 %) in the Millin surgery group. However, these complications were not more than 10 %. As a result of the study, there was no statistically significant effect of using HoLEP on erectile dysfunction in patients, which suggests the potential of this technique for a lower incidence of worsening erectile dysfunction compared with open intervention. Conclusions. HoLEP is a safe method of prostate enucleation, applicable for its large volume, in particular, up to 80 cm3. This procedure is an alternative to classical open surgery, and can be recommended for patients with polymorbidity to reduce the risk of perioperative complications and reduce rehabilitation time. Millin surgery is also a reliable treatment method with high sensitivity to the detection of cellular atypia and a large volume of cytoreduction. The decision on the surgical procedure used must be made individually for each patient.

The safety and efficacy of five surgical treatments in prostate enucleation: a network meta-analysis

PurposeThe aim of our study was to investigate the comparative outcomes of five different energy types on surgical efficacy and postoperative recovery in patients with benign prostate hyperplasia.MethodsThe literature was systematically reviewed on December 1st, 2023, encompassing studies retrieved from PubMed, Embase, Web of Science, and The Cochrane Library databases that incorporated clinical studies of holmium laser enucleation of the prostate (HoLEP), Thulium:YAG laser enucleation of the prostate (ThuLEP), transurethral plasmakinetic enucleation of prostate (PKEP), diode laser enucleation of the prostate (DiLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP) in the treatment of prostatic hyperplasia. Two independent reviewers extracted study data and conducted quality assessments using the Cochrane Collaboration's Risk of Bias tool and Newcastle–Ottawa Scale (NOS). Network meta-analysis (NMA) was employed to indirectly analyze the outcomes of endoscopic enucleation of the prostate (EEP) techniques.ResultsThe study included a total of 38 studies, comprising 21 non-randomized controlled trials (nRCTs) and 17 randomized controlled trials (RCTs), incorporating five distinct techniques: holmium laser, Thulium:YAG laser, bipolar plasma, diode laser and thulium fiber laser. In comparing treatment durations, ThuLEP and HoLEP had shorter overall hospital stays than PKEP, while the enucleation time of ThuLEP and HoLEP was shorter than that of ThuFLEP. Moreover, the enucleation tissue weight of both thulium fiber laser and holmium laser was heavier than bipolar plasma. However, the analysis did not reveal any statistically significant variation in complications among the various types of enucleation. In postoperative follow-up, the IPSS at 3 months post-operation was superior in the Thulium:YAG laser group compared to the holmium laser group. The thulium fiber laser technique demonstrated significant advantages over other enucleation methods in terms of QoL and PVR at 12 months after surgery.ConclusionTheoretical properties may vary among different energy sources; however, there are no discernible clinical differences in operation-related parameters, postoperative complications, and postoperative follow-up. Therefore, the choice of laser does not significantly impact the outcome. However, due to the limited number of included studies, future research should focus on larger sample sizes and multicenter investigations to further validate the findings of this study.

Comparison of HoLEP, ThuLEP and ThuFLEP in the treatment of benign prostatic obstruction: a propensity score-matched analysis.

To compare the efficacy and safety of Holmium laser enucleation of the prostate (HoLEP), Thulium laser enucleation of prostate (ThuLEP) and Thulium fibre laser enucleation of prostate (ThuFLEP) by performing propensity score matched analysis (PSM). We retrospectively analysed the patients who underwent HoLEP (Group 1, n = 696), ThuLEP (Group 2, n = 146) and ThuFLEP (Group 3, n = 193) surgery because of benign prostatic obstruction (BPO). A 1:1:1 HoLEP: ThuLEP: ThuFLEP group matching was performed using PSM analysis. Perioperative, postoperative functional outcomes and complications were analysed and compared. We observed significant improvement in functional parameters regarding IPSS, Qmax, PVR and quality of life in all groups compared to baseline values at the 1st, 6th and 12th postoperative months. There was no significant difference between different laser types in terms of urge (UUI) and stress urinary incontinence (SUI) at 1st postoperative month. In all three groups, no patient had postoperative SUI or UUI at 6th and 12th postoperative months. In addition, no significant difference was observed between laser types in terms of postoperative complications. HoLEP, ThuLEP and ThuFLEP are safe and effective LEP methods with improvement in functional parameters and low complication rates. Similar results in terms of functional outcomes and complications clearly show that these surgeries are alternatives to each other for the patients with BPO. Experts' opinions, practices and enucleation techniques should also be taken into consideration when choosing a laser for BPO surgery.

Preconceived Impressions Regarding Holmium:YAG Laser Safety in the Urology Operating Theatre.

Since its introduction over two decades ago, the surgical laser has served in the lithotripsy of urinary calculi, resection of bladder tumours, bladder neck incisions, and prostate enucleation. Concerns regarding the safe use of holmium lasers have resulted in potentially excessive and overly precautious theatre regulations. We aimed to evaluate the preconceived impressions and practice patterns at a single site surrounding laser use in endourology. We designed a three-part online questionnaire that could be accessed using a smart device or computer. This survey was distributed to all theatre staff involved in laser surgery at our single site, including surgical, nursing, and anaesthetic staff of varying seniority. It asked questions regarding holmium laser safety, provided an up-to-date summary of published literature surrounding the safe use of lasers, and finally gave participants further option to alter the answers to several previously encountered questions. A total of 54 theatre staff completed the survey, including 17 theatre nurses (31.5%), 10 urology consultants (18.5%), 8 urology registrars (14.8%), 7 anaesthetic registrars (13%), 4 anaesthetic consultants (7.4%). About 51.9% of participants believed that current laser safety protocols were adequate, with 38.9% finding them excessive. After reading recently published information on laser safety, 22.2% thought current laser safety measures were adequate (57% decrease) and 77.8% found them to be excessive (100% increase). About 74.1% of participants found that laser safety goggles impair their vision and that 79.6% would choose not to wear them if they were optional. Strict laser safety guidelines reflect an overestimated risk associated with using holmium laser in operating theatres. Laser safety regulations should be re-evaluated to align with current research and potential hazards inherent to the device. In doing so, a more effective distribution of staff could enable greater access to laser surgery, thereby reducing patient morbidity and hospital wait times.

Impact of untreated preoperative asymptomatic bacteriuria in patients undergoing holmium laser enucleation of prostate.

Treatment of preoperative asymptomatic bacteriuria (ASB) before endoscopic surgery is recommended by European Association of Urology (EAU) guidelines. United Kingdom (UK) practice varies, however, owing to the historical nature of the evidence behind the guidelines, risk of increased antimicrobial resistance, the paradoxical view that treatment of ASB leads to increased infection and inefficiencies in rescheduling. We do not routinely treat ASB in our practice before holmium enucleation of the prostate (HoLEP). To determine the safety of this, we examined our experience focusing on the infective complications. Retrospective data collection was performed on consecutive patients undergoing HoLEP between 2015 and 2020. Indication, preoperative urine cultures and infective complications were recorded. No patients were pretreated with oral antibiotics. All patients received intravenous antibiotics on induction and routine postoperative oral antibiotics at the surgeon's discretion. Some 443 patients were studied. No urosepsis occurred in the 125 patients with ASB compared with 2 of 318 patients (0.6%) with no growth on preoperative urine culture. Twenty-nine (7%) patients were treated with oral antibiotics for symptomatic postoperative complications (urinary tract infection without fever, epididymitis and haematuria). ASB did not predict for infective complications (urosepsis odds ratio [OR]: 0.50 p=0.66; oral antibiotics OR: 0.97 p=0.93). Not treating ASB before a HoLEP procedure is safe. This supports the judicious use of antimicrobials preoperatively. Other modalities of endoscopic surgery should be similarly assessed.

Analysis of urinary retention after endoscopic prostate enucleation and its subsequent impact on surgical outcomes

Analysis of urinary retention after endoscopic prostate enucleation and its subsequent impact on surgical outcomes

Impact of age and anterior fibromuscular stroma preservation on post-enucleation voided volume.

This study is centered on the critical role of anterior fibromuscular stroma (AFS) preservation in prostate enucleation, an emerging strategy aimed at minimizing postoperative urinary incontinence-a common concern in benign prostatic hyperplasia (BPH) surgeries. By focusing on postoperative voiding volumes (VV), our research investigates the efficacy of AFS preservation. This approach, distinct in its methodology, is hypothesized to improve urinary function post-surgery, thereby offering a potentially significant advancement in BPH surgical treatments. A retrospective analysis was conducted, comparing patients who underwent prostate enucleation in 2017 without intentional AFS preservation to those in 2019 with this technique. We examined variables including age, BMI, diabetes, hypertension, and preoperative VV to assess their effect on post-catheter removal VV. The study's methodology includes a thorough review of the primary statistical analysis methods employed. Our analysis indicates that while the 2017 and 2019 cohorts were similar in most preoperative parameters, the 2019 group that underwent AFS-preserved surgery showed a significant improvement in postoperative VVs. This was less pronounced in the patient group aged over 70, underscoring the importance of this demographic in our study. The study concludes that intentional preservation of AFS during prostate enucleation positively impacts early postoperative VVs, with limited improvement in older patients. These findings highlight the potential of AFS preservation not only in enhancing urinary outcomes post-surgery but also in shaping future BPH surgical procedures and research directions.

MP20-16 Benign Prostatic Hyperplasia Patient Outcomes in Robotic Assisted Simple Prostatectomy vs. Prostate Enucleation: A Systematic Review and Bayesian Network Meta-analysis

MP20-16 Benign Prostatic Hyperplasia Patient Outcomes in Robotic Assisted Simple Prostatectomy vs. Prostate Enucleation: A Systematic Review and Bayesian Network Meta-analysis

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

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

Thulium or holmium laser or both: where will the journey take us?

The Holmium:YAG laser has been the gold standard for laser lithotripsy over the past three decades and, since the late 1990s, also for prostate enucleation. Pulsed thulium fibre lasers (TFL) demonstrated their efficacy in in-vitro experiments and were introduced to the market a few years ago. Initial clinical results for TFL in lithotripsy and enucleation are very promising. In addition to TFL, a pulsed Thulium:YAG solid-state laser has been introduced, but clinical data for this laser are currently limited. This article aims to review the key technological differences between Ho:YAG lasers and pulsed thulium lasers and compare/discuss the initial clinical results for stone lithotripsy and laser enucleation.In-vitro studies have demonstrated the technical superiority of TFL compared with Ho:YAG lasers. However, as TFL is still a new technology, only limited studies are available to date, and optimal settings for lithotripsy have not been established. For enucleation, the differences of TFL compared with a high-power Ho:YAG laser seem to be clinically irrelevant. Initial studies on pulsed Tm:YAG lasers show good results, but there continues to be a lack of comparative studies.Based on the current literature, pulsed thulium lasers have the potential of being an alternative to Ho:YAG lasers. However, further studies are necessary to determine the optimal laser technology for enucleation and lithotripsy of urinary stones, considering all parameters, including efficacy, safety, and cost.

Antegrade ejaculation preservation in surgical treatment for benign prostatic hyperplasia: quest for balance between voiding and sexual function.

Surgical treatment of benign prostatic hyperplasia (BPH) carries a significant risk of ejaculation dysfunction. Preservation of antegrade ejaculation while providing effective, well tolerated, and durable treatment of BPH is a paramount component of physical and sexual well being for significant number of men. We reviewed available literature with an aim of providing status on antegrade ejaculation preserving BPH surgical therapies. Minimally invasive surgical therapies for BPH have been developed over the last decade, with significant marketing emphasis on their potential for preservation of antegrade ejaculation. However, the question about durability of relief of bladder outlet obstruction remains. Parallel to this technological development, the understanding of anatomical structures involved in ejaculation have resulted in technical modifications of well established surgical treatments modalities like transurethral resection of prostate, endoscopic enucleation of prostate and simple prostatectomy, thereby providing safe and durable relief of bladder outlet obstruction secondary to BPH with a satisfactory preservation of antegrade ejaculation. Preservation of antegrade ejaculation is an important goal for significant number of men needing BPH surgery. Novel minimally invasive surgical technologies have been developed for this purpose; but understanding of the anatomical structures essential for antegrade ejaculation have allowed technical modification of existing surgical techniques with excellent preservation of antegrade ejaculation.

Surgical outcomes of endoscopic enucleation of the prostate in community aging males with or without preoperative urinary retention

ObjectivesThis study aims to investigate the surgical outcomes of endoscopic enucleation of the prostate in older males with or without preoperative urinary retention (UR).Material and methodsWe conducted a study on selected patients with symptomatic benign prostatic hyperplasia (BPH) who underwent either thulium:YAG laser (vela XL) prostate enucleation (ThuLEP) or bipolar plasma enucleation of the prostate (B-TUEP) at the geriatric urology department of our institution. The studied patients were categorized into two groups, namely the UR group and the non-UR group, on the basis of whether they experienced UR in the 1 month preceding their surgery. Their clinical outcomes following prostate endoscopic surgery were evaluated and analyzed.ResultsOur results revealed comparable outcomes for operation time, length of hospital stay, percentage of tissue removed, re-catheterization rate, and urinary tract infection rate within the 1 month between the B-TUEP and ThuLEP surgery groups, regardless of UR history. However, the non-UR B-TUEP group experienced more blood loss relative to the non-UR ThuLEP group (P = .004). Notably, patients with UR exhibited significantly greater changes in IPSS total, IPSS voiding, and prostate-specific antigen values relative to those without UR.ConclusionsBoth ThuLEP and B-TUEP were effective in treating BPH-related bladder outlet obstruction. Our study identified more pronounced changes in IPSS total, IPSS voiding, and prostate-specific antigens within the UR group. Moreover, the rate of postoperative UR in this group was not higher than that observed in the non-UR group. Our study also revealed that the presumed benefits of laser surgery in reducing blood loss were less pronounced for patients with UR.