You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology II (MP32)1 Apr 2020MP32-08 IMPACT OF ADENOMA VOLUME ON THE INTRAOPERATIVE FEATURES OF 3 NEWLY DEVELOPED APPROACHES FOR HOLMIUM LASER ENUCLEATION OF THE PROSTATE Cecilia Cracco*, Giovanni Cattaneo, Angela Sica, Drilona Ndrevataj, and Cesare Marco Scoffone Cecilia Cracco*Cecilia Cracco* More articles by this author , Giovanni CattaneoGiovanni Cattaneo More articles by this author , Angela SicaAngela Sica More articles by this author , Drilona NdrevatajDrilona Ndrevataj More articles by this author , and Cesare Marco ScoffoneCesare Marco Scoffone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000876.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To compare the intraoperative features of 3 newly developed approaches (partially-en-bloc high-power, partially-en-bloc low-power and totally-en-bloc low-power techniques) for Holmium Laser Enucleation of the Prostate (HoLEP), performed for small, medium-sized and large prostatic adenomas. METHODS: 538 patients underwent HoLEP by a single surgeon previous informed consent: G1 (group 1, n=212, 01/2013-12/2015) = partially-en-bloc (single 5 o’clock incision) high-power (100W) technique; G2 (group 2, n=108, 07/2015-02/2017) = partially-en-bloc low-power (about 40W) technique, G3 (group 3, n=218, 02/2017-08/2019) = totally-en-bloc (early liberation of the sphincteric mucosa, no incisions of the prostatic urethra, late opening of the bladder neck) low-power technique. Within each group small ( <30 g), medium-sized (31-79 g) and large ( >80 g) adenomas were considered separately (fresh weight). A retrospective database with enucleation efficiency (g/minutes), laser energy employed for enucleation and kJ/g ratio was created and analyzed. RESULTS: Real weight of freshly enucleated adenomas was lower in G2 (53.3 +/- 37.4 g G1, 44.4 +/- 32.2 g G2, 51.2 +/- 34.1 g G3). Enucleation efficiency increased in all groups consensually with increasing adenoma size: G1 1.1 +/- 0.4 small (n=65), 1.8 +/- 0.6 medium-sized (n=108), 2.9 +/- 0.9 large (n=39); G2 0.9 +/- 0.5 small (n=47), 1.5 +/- 0.5 medium-sized (n=47), 2.2 +/- 0.7 large (n=14); G3 1.2 +/- 0.5 small (n=72), 1.6 +/- 0.5 medium-sized (n=111), 2.1 +/- 0.7 large (n=35). Laser energy used (G1, 58.8 +/- 25.0 kJ small, 80.2 +/- 23.8 medium-sized, 103.3 +/- 28.7 large; G2 41.9 +/- 17.2 kJ small, 64.7 +/- 31.7 medium-sized, 94.8 +/- 39.6 kJ large; G3 40.8 +/- 16.7 kJ small, 57.5 +/- 21.4 kJ medium-sized, 73.5 +/- 20.6 kJ large) increased consensually with adenoma size, being lower in G2 and G3, G3 displaying the lowest kJ/g ratio. Small adenomas in all groups had no transfusions nor hemostatic revisions, recatheterization rate was 6% G1, 0.2% G2 and 5% G3. Medium-sized adenomas had 2.8% G1, 4% G2 and 0.9% G3 complication rates (Clavien 2 blood transfusions and Clavien 3 hemostatic revisions), higher in large adenomas (G1 8%, G2 7%, G3 2.8%), but the lowest in G3. CONCLUSIONS: All HoLEP groups were more efficient for large adenomas, consuming more energy than for small ones, in progressive reduction from G1 to G3, with a minimal kJ/g ratio in G3. Complications were reduced in G2 and G3, especially for large adenomas. The totally-en-bloc- low-power HoLEP is a very good compromise between efficiency and safety. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e487-e488 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cecilia Cracco* More articles by this author Giovanni Cattaneo More articles by this author Angela Sica More articles by this author Drilona Ndrevataj More articles by this author Cesare Marco Scoffone More articles by this author Expand All Advertisement PDF downloadLoading ...
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