Shorter Catheterization Time Research Articles

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

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

Endoscopic Resection Improved High-Intensity Focused Ultrasound Ablation Outcomes for Prostate Cancer: A Meta-Analysis of Comparative Studies.

High-intensity focused ultrasound ablation (HIFU) is emerging as more data on its efficacy arises for prostate cancer (PCa). However, it is indefinite whether to combine endoscopic resection and uncertain to say who the ideal candidates are for the combined treatment. Therefore, we aimed to conduct a meta-analysis to compare outcomes of sole HIFU therapy with that of HIFU in combination with endoscopic resection in patients with localized PCa. Electronic databases were searched following the PRISMA guidelines and PICOS formats. The inclusion criteria were as follows: 1) studies on HIFU for PCa patients; 2) comparative studies on HIFU in combination with endoscopic resection for localized PCa men. Exclusion criteria include non-comparative studies and salvage HIFU therapy. Meta-analysis results were mainly present using forest plots. Sensitivity analysis and Egger's test were adopted to determine the stability and assess the publication bias. Six comparative studies with 767 patients were eligible, including 487 cases in the combination therapy group and 280 cases in the monotherapy group. There was no statistical difference in age, preoperative PSA levels, and prostate volume between two groups. No statistical difference was found in postoperative PSA nadir (MD = -0.02, 95%CI: -0.35 to 0.31, P = 0.90), disease-free survival rate (RR = 0.95, 95%CI: 0.83 to 1.09, P = 0.47), and preoperative IPSS score (MD = -0.69, 95%CI: -1.63 to 0.26, P = 0.15; I2 = 8%) between two groups. The combination therapy group had significantly lower postoperative IPSS score (MD = -5.49, 95%CI: -6.47 to -4.51, P < 0.001) and shorter catheterization time (MD=-13.70, 95%CI: -19.24 to -8.16, P < 0.001) than the monotherapy group. The rates of urinary incontinence (7.4% vs. 13.9%, RR = 0.45, 95%CI: 0.29 to 0.70, P = 0.0004; I2=4%), acute urinary retention (6.8% vs. 10.5%, RR=0.36, 95%CI: 0.14 to 0.89, P = 0.03; I2 = 0%), urinary tract infection (10% vs. 33%, RR = 0.27, 95% CI: 0.18 to 0.4, P < 0.001; I2 = 0%), epididymitis (1.2% vs. 15.7%, RR=0.11, 95% CI: 0.02 to 0.59, P = 0.01; I2 = 0%), and urethral stricture (7.1% vs. 23.2%, RR = 0.3, 95%CI: 0.18 to 0.51, P < 0.001; I2 = 0%) in the combination therapy group were all significantly lower than that in the monotherapy group. Sensitivity analysis revealed findings were convincing and no publication bias (P = 0.62) was observed using Egger's test. It appears that the addition of endoscopic resection to the HIFU operation might not impact oncologic outcomes and could show better functional outcomes compared to the HIFU monotherapy in localized PCa patients.

Perioperative Outcome of Thulium Laser Enucleation of the Prostate versus Robot-Assisted Simple Prostatectomy: A Propensity Score-Matched Analysis

Introduction: The aim of this study was to investigate and compare clinical safety and efficiency of Thulium laser enucleation of the prostate (ThuLEP) and robot-assisted simple prostatectomy (RASP) for the treatment of large gland benign prostatic hyperplasia in a tertiary care center. Methods: Perioperative data of 39 patients who underwent RASP in our institution from 2015 to 2021 was collected. Propensity score matching using prostate volume, patient age, and body mass index (BMI) was performed from a database of 1,100 Patients treated by ThuLEP from 2009 to 2021. A total of 76 patients were matched. Preoperative parameters such as BMI, age, and prostate volume, as well as intra- and postoperative parameters such as operation time, resection weight, transfusion rate, postoperative catheterization time, length of hospital stay (LoS), hemoglobin drop, postoperative urinary retention (PUR), Clavien-Dindo Classification (CDC), and the Combined Complication Index (CCI), were evaluated. Results: There was no difference in mean hemoglobin drop (2.2 vs. 1.9 g/dL, p = 0.34), yet endoscopic surgery showed superiority in mean operation time (109 vs. 154 min, p < 0.001), mean postoperative catheterization time (3.3 vs. 7.2 days, p < 0.001), and mean LOS (5.4 vs. 8.4 days, p < 0.001). Complication rates evaluated by CDC (p = 0.11) and CCI (p = 0.89) were similar in both groups. Within the documented complications, transfusion rate (0 vs. 3, p = 0.08) and the occurrence of PUR (1 vs. 2, p = 0.5) showed no significant difference. Conclusion: ThuLEP and RASP show similar perioperative efficacy and a low rate of complications. ThuLEP had shorter operation times, shorter catheterization time, and a shorter LoS.

Retrospective analysis of 1470-/980-nm dual-wavelength laser en bloc resection versus transurethral resection of bladder tumor for primary non-muscle-invasive bladder cancer.

To compare the safety and efficacy of en bloc resection of non-muscle-invasive bladder cancer (NMIBC) using a 1470-/980-nm dual-wavelength laser (DwLRBT) compared to the gold standard, transurethral resection (TURBT). The study group included 251 patients with a confirmed diagnosis of NMIBC, 97 in the DwLRBT group and 154 in the TURBT group. Clinical characteristics, complications, and recurrence-free survival were compared between the two groups. There were no differences between the two groups with regard to age, sex, mean tumor size, mean tumor number, tumor location, risk, fever, and reoperation. Compared to TURBT, DwLRBT was associated with a shorter hospitalization time (mean±standard deviation: 5.81±1.48 days vs. 4.96±1.32, respectively, p=0.001), shorter catheterization time (4.98±1.47 vs. 4.20±1.48 days, respectively; p=0.035), and smaller volume of intraoperative bleeding (8.43±6.21 ml vs. 6.15±5.08, respectively; p=0.003). Recurrence-free survival (RFS) was better for DwLRBT than TURBT in the overall cohort (hazard ratio [HR], 0.4323; 95% confidence interval [CI], 0.2852-0.6554; p=0.0004) and for the following subgroups and tumor types: intermediate-risk (HR, 0.2654; 95%CI, 0.1020-0.6904; p=0.0245) and high-risk (HR, 0.4461; 95% CI, 0.2778-0.7162; p=0.0027) groups; and for pedunculate bladder tumors (HR, 0.4158; 95%CI, 0.2401-0.7202; p=0.0063), single bladder tumors (HR, 0.4136; 95%CI, 0.2376-0.7293; p=0.0072), and multiple bladder tumors (HR, 0.2727; 95%CI, 0.1408-0.5282; p=0.0014). DwLRBT is associated with better operative and postoperative outcomes, including, importantly, a longer RFS, compared to TURBT.

Endovascular navigation with Fiber Optic RealShape technology.

Fiber Optic RealShape (FORS) technology has recently been introduced as an adjunctive guidance technology that allows real-time three-dimensional visualization of dedicated endovascular devices while avoiding radiation exposure. It consists of equipment which sends pulses of light through hair-thin optical fibers that run within a dedicated hydrophilic wire and selective catheters. The purpose of the study was to report the observed benefits and limitations related to the first edition of FORS technology. Data were collected prospectively from the first 50 patients undergoing FORS-guided endovascular repair at a single center between February 2020 and February 2021 as part of the global multicenter FORS Learn registry. All consecutive, elective procedures with one or more navigation tasks attempted with FORS were included. Factors related to FORS navigation task success were assessed. The time required for the catheterization of each task as well as the amount of radiation exposure (fluoroscopy time, dose area product, and estimated skin dose) were collected. A per-task analysis was conducted. End points included the success rate in achieving a stable FORS-guided catheterization, catheterization time, and radiation dose during catheterization. During the study period from February 2020 to February 2021, 50 patients were treated using FORS technology. Forty-five patients were treated for aortic aneurysm, 4 for iliac artery aneurysm, and 1 for splenic artery aneurysm. Overall, 201 navigation tasks were completed for these procedures and FORS was used in 186 tasks (92.5%). No FORS-related complication was recorded and a success rate of 60.2% (n= 116) was observed. Target vessel (TV) angle of 45° or greater, TV stenosis, and the renal arteries as navigation tasks (compared with celiac artery or superior mesenteric artery) were associated with a lower success rate. Catheterization of a TV through a branch more frequently required a standard catheter in combination with the FORS-enabled guidewire. Successful task catheterization using FORS guidance was associated with a shorter catheterization time 6minutes (interquartile range, 3-11minutes) versus 16minutes (interquartile range, 10-24minutes) (P< .001) and lower radiation exposure compared with unsuccessful catheterization (dose area product, 4.4cGy/cm2 vs 12.5cGy/cm2; P< .001). FORS technology was implemented successfully as a new guidance technology in a complex endovascular aortic repair program and was associated with an encouraging success rate and a high potential for radiation reduction.

Holmium laser enucleation of the prostate: a 3-year single-center experience of 173 cases

BackgroundHolmium laser enucleation of the prostate (Holep) is a safe, effective, and prostate size-independent procedure for benign prostatic hyperplasia treatment (BPH). Holep has demonstrated comparable long-term outcomes with historical BPH mainstay treatments, namely open prostatectomy or transurethral resection of the prostate, as well as straightforward evidence of its low morbidity. In this study, we aimed to report our 3-year Holep experience based on 173 patients.MethodsWe conducted a retrospective descriptive single center study utilizing medical charts of 173 patients who underwent Holep between 2017 and 2020. Peri and postoperative measures included prostate volume, peak urinary flow rate (Qmax), prostate specific antigen, catheterization time, hospital stay, and complications.ResultsThe mean age and mean prostate weight at baseline were 71.3 ± 7.8 years and 64.2 g (17 and 380 g), respectively. Holep was associated with a short catheterization time and hospital stay (2.7 and 3 days, respectively). Qmax significantly improved after Holep (8.1 vs 20.4 ml/s, p < 0.05), and results sustained at 06 months postoperatively. Perioperative and postoperative complications were mainly represented by hematuria (29%). However, more than half of these patients were taking anticoagulation drug therapy at the time of surgery. Complications mostly occurred during the early years following Holep’s introduction and tended to decrease with time and experience.ConclusionHolep remains a safe and effective procedure for BPH treatment, with durable long-term results even in clinical settings where the procedure is new. The rate of complications, which is associated with the learning curve, improves with time and experience.

Comparison of outcomes of holmium laser versus bipolar enucleation of prostates weighing >80 g with bladder outlet obstruction

Transurethral enucleation of the prostate has been increasingly recognized as an effective minimally invasive technique for management of enlarged prostates. We aimed to compare holmium laser enucleation (HoLEP) and bipolar transurethral enucleation (B-TUEP) of large-volume prostates. A prospectively maintained database in two tertiary referral centers was reviewed for patients with HoLEP and B-TUEP for prostates >80 g. Operative data, perioperative complications, and early postoperative outcomes were compared. The study included 101 patients, 70 who underwent HoLEP and 31 who underwent B-TUEP. The operative enucleation rate (weight of adenoma enucleated in g/min) was higher in HoLEP compared to B-TUEP (P < 0.0001). The operative complication rate, hemoglobin drop, and readmission rate were comparable in both groups (P = 0.13, 0.35, 0.29, 0.59, respectively). The HoLEP arm had a shorter hospital stay and shorter catheterization time (P = 0.001, 0.012). Follow-up data showed a lower International Prostate Symptom Score and serum prostate-specific antigen level in the HoLEP group. The incontinence rate was comparable in both groups. In conclusion, both techniques were effective in managing a high-volume prostate, although HoLEP had a shorter enucleation time, better symptom score, lower postoperative prostate-specific antigen level, shorter catheterization time, and shorter hospital stay compared to B-TUEP.

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

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

Robot-Assisted Simple Prostatectomy vs Endoscopic Enucleation of the Prostate: A Systematic Review and Meta-Analysis of Comparative Trials.

Context: Robot-assisted simple prostatectomy (RASP) and endoscopic enucleation of the prostate (EEP) are two minimally invasive alternatives to simple prostatectomy, which is considered the standard treatment in large prostate glands. It remains unclear which of the two is superior in terms of outcome and complications. Objective: To compare perioperative and functional outcomes of RASP vs EEP. Evidence Acquisition: A systematic review and meta-analysis was conducted according to the recommendations of the Cochrane Collaboration and in line with the PRISMA criteria. The database search included clinicaltrials.gov, Medline (via PubMed), CINAHL, and Web of Science and was using the PICO criteria. All comparative trials were considered. Risk of bias was assessed with the revised ROBINS-I tool. Evidence Synthesis: Seven hundred sixty studies were identified, 4 of which were eligible for qualitative and quantitative analysis, reporting on a total of 901 patients with follow-up up to 24 months. Hemoglobin drop (mean difference [MD] confidence interval [CI]: 0.34 g/dL [0.09-0.58]), the rate of blood transfusions (odds ratio [OR] [CI]: 5.01 [1.60-15.61]) catheterization time (MD [CI]: 3.26 days [1.30-5.23]), and length of hospital stay (LoS) (MD [CI]: 1.94 days [1.11-2.76]) were significantly lower in EEP. No significant differences were seen in operating time and enucleation weight. No significant differences were observed in the incidence of postoperative urinary retention, postoperative transient incontinence, and complications graded according to the Clavien-Dindo classification. Functional results were similar, with no significant differences in International Prostate Symptom Score and maximum urinary flow rate at follow-up. Conclusion: Both EEP and RASP offer excellent improvement of symptoms due to prostatic hyperplasia. EEP has lower blood loss, shorter catheterization time, and LoS and should be the first choice if available. RASP remains an attractive alternative for extremely large glands, in concomitant diseases, or whenever EEP is not available. Review Registration Number (PROSPERO): CRD42021226901.

Comparison laser anatomical endoscopic enucleation of the prostate (LAEEP) and transurethral resection of the prostate (TURP) in BPH treatment: A meta-analysis

and objectives: Laser anatomical endoscopic enucleation of the prostate (LAEEP) is one of the alternative surgical procedures other than TURP for benign prostate hyperplasia (BPH). However, the consideration for clinical practice needs evidence in terms of efficacy and safety. Our meta-analysis based on the existing studies is to evaluate the efficacy and safety of the LAEEP and TURP for BPH treatment. Published randomized controlled trials (RCTs) were identified from PubMed, Science Direct, and Cochrane Library up to December 2021. The meta-analysis was performed by the requirements of PRISMA and after methodological quality assessment, the data was proceeded by RevMan V.5.4. 15 studies were identified with total of 733 patients who underwent LAEEP and 698 patients underwent TURP. There was no significant difference in IPSS at 1,3,6 month but at 12 months significantly better in LAEEP (MD = −0.43 [-0.81, −0.05] P = 0.03). At 6 and 12 months, the PVR data showed significantly lower in LAEEP (MD = −4.07 [-6.07, −2.07] P < 0.0001). QoL, Qmax, and IIEF-5 scores were no significant difference in both procedures. Duration of catheterization (MD = −25.01 [-30.47, −19.55] P = 0.00001) and hospital stay (MD = −30.26 [-40.71, −19.82] P = 0,00001) were significantly shorter in LAEEP. Operative duration was significantly shorter in TURP (MD = 14.69 [8.64, 20.75] P = 0.00001) but prostate specimen weight result was significantly higher in LAEEP procedure (MD = 4.77 [0.36, 9.17] P = 0.03). Hb drop level (MD = −0.58 [-0.85, −0.30] P = 0.0001), transfusion rate (OR = 0.37 [0.17, 0.84] P = 0.02) and UTI (OR = 0.35 [0.17, 0.71] P = 0.004) were significantly fewer in LAEEP. However, dysuria events less occurred in TURP (OR = 2.45 [1.51, 3.97] P = 0.0003). Compared with TURP, LAEEP showed better efficacy and safety with fewer hematological changes and complications, except for operative duration, dysuria events were better in TURP. LAEEP showed other advantages in shorter catheterization time and hospital stay.

Comparison of the efficacy and safety of transurethral laser versus open prostatectomy for patients with large-sized benign prostatic hyperplasia: A meta-analysis of comparative trials.

PurposeThe selection of open prostatectomy (OP) over transurethral laser surgery is controversial for large volume prostates. Thus, we aim to compare the efficacy and safety of transurethral laser versus OP, and provide the latest evidence of clinical practice for large-sized benign prostatic hyperplasia (BPH).Materials and MethodsThis meta-analysis used Review Manager V5.3 software and the systematic literature search of Cochrane Library, Embase, PubMed, and Web of Science datasets was performed for citations published from 2000 to 2020 that compared transurethral laser with OP for the treatment of large BPH. Variables of interest assessing the two techniques included clinical characteristics, and the perioperation-, effectiveness-, and complication-related outcomes.ResultsThe meta-analysis included twelve studies containing 1,514 patients, with 792 laser and 722 OP. The transurethral laser group was associated with shorter hospital stay and catheterization duration, and less hemoglobin decreased in the perioperative variables. There was no significant difference in the international prostate symptom score, post-void residual urine volume, maximum flow rate, and quality of life score. Transurethral laser group had a significantly lower incidence of blood transfusion than OP group (odds ratio, 0.10; 95% confidence interval, 0.05 to 0.19; p<0.001; I2=8%), and no statistical differences were found with respect to the other complications.ConclusionsBoth OP and transurethral laser prostatectomy are effective and safe treatments for large prostate adenomas. With these advantages of less blood loss and transfusion, and shorter catheterization time and hospital stay, laser may be a better choice for large BPH.

Post-Operative Acute Urinary Retention After Greenlight Laser. Analysis of Risk Factors from A Multicentric Database.

Greenlight laser is a mini-invasive technique used to treat Benign Prostatic Obstruction (BPO). Some of the advantages of GreenLight photoselective vaporization (PVP) are shorter catheterization time and hospital stay compared to TURP. Post-operative acute urinary retention (pAUR) leads to patients' discomfort, prolonged hospital stay and increased health care costs. We analyzed risk factors for urinary retention after GreenLight laser PVP. In a multicenter experience, we retrospectively analyzed the onset of early and late post-operative acute urinary retention in patients undergoing standard or anatomical PVP. The pre-, intra- and post-operative characteristics were compared betweene patients who started to void and the patients who developed post-operative urinary retention. The study included 434 patients suitable for the study. Post-operative acute urinary retention occurred in 39 (9%). Patients with a lower prostate volume (P < .001), an adenoma volume lower than 40 mL (P < .001), and lower lasing time (P = .013) had a higher probability to develop pAUR at the univariate analysis. The multivariate logistic regression confirmed that lower lasing time (95% CI: 0.86-0.99, OR = 0.93, P = .046) and adenoma volume (95% CI: 0.89-0.98, OR = 0.94, P = .006) are correlated to pAUR. Furthermore IPSS ≥ 19 (95% CI: 1.19- 10.75, OR = 2.27, P = .023) and treatment with 5-ARI (95% CI: 1.05-15.03, OR = 3.98, P = .042) are risk factors for pAUR. In our series, post-operative acute urinary retention was related to low adenoma volume and lasing time, pre-operative IPSS ≥ 19 and 5-ARI intake. These data should be considered in deciding the best timing for urethral catheters removal.

Contemporary practice patterns of transurethral therapies for benign prostate hypertrophy: results of a worldwide survey.

To perform a global survey to identify contemporary practice patterns of transurethral therapies for benign prostatic hypertrophy. A REDCap survey was distributed to the ~ 3500 members of the Endourological Society. Surgeons completed demographic information and then selected the BPH therapies they perform 10 cases/year. There were four categories of BPH therapies: ablation, enucleation, resection/vaporization, and MIST (minimally invasive surgical technique). Within each category, there were subcategories to account for different energy modalities. All statistical analyses were performed using SAS 9.4. A total of 175 surgeons responded to our survey. Prostate resection/vaporization remained the most commonly utilized technique (51.9%, n = 147/283) followed by enucleation (22.6%, n = 64/283). Bipolar TURP (bTURP) was the most common modality for prostate resection (69.4%, n = 102/147). Holmium laser enucleation (HoLEP) was the most common modality for enucleation (46.9%, n = 30/64). Urolift® was performed more often than Rezūm™ (55.9% vs. 44.1%, n = 19/34 vs. 15/34, respectively). Among surgeons performing ablation, country of practice was a significantly associated with length of stay (LOS), p < 0.0001. For surgeons performing enucleation, academic institution and completion of a fellowship were associated with postoperative day (POD) 1 catheter removal (p = 0.0240 and p = 0.020, respectively). In this contemporary, global survey of the Endourology Society, resection/vaporization techniques were the most commonly performed. Rates of MISTs remained relatively low at 12.1%. Academic institution and fellowship status were associated with shorter catheterization times and LOS for certain surgical categories.

Current Bladder Dysfunction Reports Thulium Laser Prostatectomy

The purpose of this review is to summarize the literature on safety and efficacy of minimally invasive thulium laser procedures for benign prostatic hypertrophy (BPH). Recent studies have confirmed long-term safety and efficacy of thulium laser prostatectomy. There has been recent literature published from around the world confirming safety and efficacy in treatment of large prostates, obese patients, and in patients taking oral anticoagulation. Newer thulium laser systems use a wavelength of 1.9μm instead of 2 μm. Thus far, no clinical differences have been seen in outcomes of thulium laser procedures done with this wavelength. The high-power thulium laser was first introduced in 2005 for treatment of BPH [1]. Thulium vapoenucleation (ThuVEP), thulium laser resection of the prostate-tangerine technique (TmLRP), thulium laser enucleation (ThuLEP), and thulium vaporization (ThuVP) are techniques for thulium laser prostatectomy that have been described. Studies using the 70W to 200W thulium laser systems demonstrated good efficacy of these procedures with low morbidity and few complications in prostates of small to medium sizes [2]. Comparative studies have been published comparing thulium laser prostatectomy to monopolar transurethral resection of prostate (TURP), bipolar TURP, and holmium laser enucleation of prostate (HoLEP) [1]. In general, thulium laser prostatectomy appears to have longer operative times, shorter catheterization times, shorter hospital stay, and lower transfusion rates compared to standard and bipolar TURP. Outcomes of HoLEP and thulium enucleation techniques appear to be similar. Overall, thulium laser prostatectomy appears to be very safe and effective with low morbidity [3].

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

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

Holmium laser enucleation versus bipolar transurethral enucleation for treating benign prostatic hyperplasia, which one is better?

Objective This study aims to evaluate the overall efficacy and safety between holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral enucleation of the prostate (B-TUEP) for the treatment of benign prostatic hyperplasia (BPH). Method We systematically searched electronic databases (PubMed, Scopus, Web of Science, and Cochrane Library) to identify eligible comparative studies as of July 2021. The parameters including perioperative results, complications, and functional outcomes were evaluated. RevMan version 5.4 was used for the analysis. Results A total of 10 studies involving 1725 patients were included. HoLEP had lower operative time (p = .03), shorter catheterization time (p = .007), lower bladder irrigation time (p = .01), and higher enucleation weight (p = .01) compared with B-TUEP. However, there were no significant differences between the techniques regarding the length of stay (LOS), hemoglobin drop, transfusion rates, and complications. Furthermore, no significant differences were also observed in postoperative functional outcomes at 1, 3, 6, 12, or 24 months. Conclusions HoLEP has more advantages in perioperative parameters compared with B-TUEP, but no significant differences are found regarding functional outcomes and complications. Large-scale studies with long-term follow-up are required to compare the outcomes of these two techniques.

Transurethral laser versus open simple prostatectomy for large volume prostates: a systematic review and meta-analysis of randomized controlled trials

The benefit of transurethral laser prostatectomy over open simple prostatectomy (OSP) is controversial in aged symptomatic benign prostatic hyperplasia (BPH) patients with large volume prostates, and the aim of this study is to compare the safety and efficiency of these two methods. Meta-analysis was applied using the Review Manager V5.3 software and the retrieved randomized controlled clinical trials (RCTs) comparing transurethral laser prostatectomy with OSP were analyzed for the treatment of large volume prostates from 2000 to 2019 in PubMed, Web of Science, Cochrane, and EMBASE datasets. Five RCTs assessing transurethral laser prostatectomy versus OSP were considered suitable for this meta-analysis, which included a total of 448 patients, with 232 patients undergoing laser and 216 patients undergoing OSP. Compared with OSP, although transurethral laser prostatectomy required a longer operative time (weighted mean difference (WMD) 27.49 mins; 95% confidence interval (CI) 16.54-38.44; P < 0.00001) and obtained a less resected prostate weight (WMD - 11.72g; 95% CI - 21.75 to - 1.70; P = 0.02), patients undergoing laser prostatectomy benefited from significantly less hemoglobin decline (- 0.97g/dL; 95% CI - 1.31 to - 0.64; P < 0.00001), shorter time of catheterization (WMD - 3.67days; 95% CI - 5.60 to - 1.75; P = 0.0002), shorter length of hospital stay (WMD - 4.75days; 95% CI - 6.57 to - 2.93; P < 0.00001), and less blood transfusion (odds ratio 0.10; 95% CI 0.03 to 0.35; P = 0.0003). During postoperative follow-up, no significant difference was observed between the two groups in IPSS, QoL, Qmax, and PVR. Both transurethral laser prostatectomy and OSP are safe and effective for large prostates that require prostate resection. Taking into account of less blood loss, shorter catheterization time and hospital stay, and less blood transfusion, transurethral laser prostatectomy may be a better treatment for patients with large prostates.

Bipolar Plasmakinetic Vaporization versus the Standard Monopolar Transurethral Resection of the Prostate for Management of Benign Prostate Hyperplasia: Long Term Follow-Up of a Randomized Controlled Study

Background: Monopolar Transurethral resection of the prostate (TURP) has dominated the surgical treatment of lower urinary tract symptoms (LUTS) due to BPH with relatively high TUR associated morbidity. Due to advanced technology, spurred the development of new surgical alternatives as plasmakinetic vaporization of the prostate to overcome the TURP related morbidity. Aim: To compare the outcomes of bipolar plasmakinetic vaporization of the prostate (PKVP) in saline with the standard monopolar TURP in-patients with bothersome LUTS. Patients and Methods: Two hundred and six patients with bothering LUTS were randomly divided into two groups, PKVP (GI) or TURP (GII). Patients demographics and preoperative data were compared, including prostate volume, international prostate symptoms score (IPSS), quality of life (QOL), maximum flow rate (Qmax), post voiding residual volume (PVR), prostate-specific antigen (PSA). Postoperative adverse events and long-term reoperation rates were also compared. Results: Preoperatively, both groups were comparable in demographic data, prostate volume, IPSS, Qmax, and PVR. Both groups showed comparative functional improvement in IPSS, QOL, Qmax, and PVR. Compared to GII patients, GI patients had a significantly lower operative time (62.3±17 vs. 68.6±20 min, p =0.03), catheterization time (3.4±1.3 vs. 4.5±1.4 d), and hospital stay (2.7±1.1 vs 3.3±1.3 d). Reduction in hemoglobin and serum sodium was significantly higher in GII patients. Clot retention occurs in 3.4% in G1 vs. 7.7% in G2 while blood transfusion needed for 8.9% of patients in GII. After a 36-month follow-up, 10.5% and 7.7% of patients needed reoperation in GI and GII, respectively (p>0.05). Conclusion: Long-term results revealed comparable safety and efficacy of PKVP and monopolar TURP in the management of bothersome LUTS secondary to BPH. However, PKVP seems to have lower perioperative morbidity (i.e. reduced blood loss, shorter catheterization time, shorter hospital stay, comparable reoperation rate, and better alternative to monopolar TURP.

Bipolar endoscopic enucleation versus bipolar transurethral resection of the prostate: an ESUT systematic review and cumulative analysis.

To perform a cumulative analysis of the current evidence on the surgical and functional outcomes of bipolar endoscopic enucleation of the prostate (b-EEP) versus bipolar transurethral resection of the prostate (b-TURP). A systematic review of the literature was performed on PubMed, Ovid®, and Scopus® according to Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA Statement). The meta-analysis was conducted using the Review Manager 5.3 software. Parameters of interest were surgical and functional outcomes. Weighted mean difference, and odds ratio with 95% confidence interval were calculated for continuous and binary variables, respectively. Pooled estimates were calculated using the random-effect model. Fourteen comparative studies were included. No statistically significant difference in terms of overall baseline characteristics was found. b-EEP had higher amount of resected tissue (p < 0.0001), shorter catheter time (p = 0.006), lower Hb drop (p = 0.03), and shorter length of stay (p < 0.0001). Equally, overall post-operative complications were lower (p = 0.01) as well as short (p = 0.04), and long-term complication rate (p = 0.04). There was higher re-intervention rate in the b-TURP group (p = 0.02) whereas b-EEP group had smaller residual prostate volume (p = 0.03), and lower post-operative PSA values (p < 0.00001). At long term, b-EEP presented lower IPSS (p = 0.04), higher Qmax (p = 0.002), and lower PVR (p < 0.00001). b-EEP is an effective and safe surgical treatment for BPO. This procedure might offer several advantages over standard b-TURP, including the resection of a larger amount of tissue within the same operative time, shorter hospitalization, lower risk of complications, and lower re-intervention rate. This was submitted to PROSPERO registry: CRD42019126748.

Comparison of Multipulse Laser Vaporesection versus Plasmakinetic Resection for Treatment of Benign Prostate Obstruction

We aimed to compare the efficacy and safety of Multipulse laser vaporesection of the prostate (MPVP) versus plasmakinetic resection of the prostate (PKRP) for treatment of patients with benign prostate obstruction (BPO) in a prospective trial. From January 2016 to April 2017, a total of 144 patients were included in the cohort study, of whom 73 patients underwent MPVP and 71 underwent PKRP. All patients received pre-operative evaluation and followed up at 1, 3, 6 and 12 months postoperatively. Baseline characteristics, perioperative data and postoperative outcomes were compared. Early (within 30 days postoperatively) and late complications were also recorded. Preoperative data, including age, prostate volume, international prostate symptom score (IPSS), International Index of Erectile Function Questionnaires (IIEF-5), the rate of anticoagulants use, Charlson comorbidity index were similar in two groups. Peri-operative parameters, including the rate of transfusion, and decrease in hemoglobin level were comparable. The operative time, the duration of catheterization and length of hospital stay were significantly shorter in the MPVP group. The voiding parameters and the quality-of-life scores (QoL) improved significantly in both groups postoperatively. There was a significantly difference in QoL at 1-year in the MPVP group (p < 0.001), under mixed model analysis with random effect and Bonferroni correction. There were no significant differences in improvement of IPSS, Qmax, IIEF-5, residual prostate volume ratio and PSA level reduction at the 1-year follow-up. MPVP was significantly superior to PKRP in terms of a reduction in overall complication rate (21.9% vs 45.0%, p = 0.004). Both treatments led to comparable symptomatic improvements. MPVP demonstrates satisfactory efficiency, shorter catheterization time and shorter hospital stay. Our data revealed that MPVP may be a promising technique which is safe and favorable alternative for patients with BPO.