Treatment Of Large Prostates Research Articles

MP59-04 HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR VERY LARGE BENIGN PROSTATIC HYPERPLASIA (>200 ML): LONG TERM OUTCOME OF A LARGE SERIES.

You have accessJournal of UrologyCME1 Apr 2023MP59-04 HOLMIUM LASER ENUCLEATION OF THE PROSTATE FOR VERY LARGE BENIGN PROSTATIC HYPERPLASIA (>200 ML): LONG TERM OUTCOME OF A LARGE SERIES. Matteo Tallè, Francesco Mengoni, Roberto Orciani, Donato Dente, and Angelo Cafarelli Matteo TallèMatteo Tallè More articles by this author , Francesco MengoniFrancesco Mengoni More articles by this author , Roberto OrcianiRoberto Orciani More articles by this author , Donato DenteDonato Dente More articles by this author , and Angelo CafarelliAngelo Cafarelli More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003312.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients presenting with very large prostates (>200 ml of total volume) are a challenge to both patients and surgeons. Nowadays, although the efficacy and the less invasiveness of HoLEP compared to open techniques has been proven, still high level evidences for the best treatment of large prostates are limited. Aim of the study is to evaluate the short and long term outcomes of patients with very large prostates (>200 cc) in the largest series available so far. METHODS: Clinical data were collected in a prospective maintained database, we performed 183 HoLEP procedures on prostates greater than 200 gr in 86 months. We reported patient preoperative, intraoperative, postoperative outcomes and complications. Surgical technique: we used a Gilling modified technique with a three-lobe enucleation with a high power 120 W Holmium laser (Lumenis Pulse). Morcellation is conducted with a 7 gr/min morcellator (Lumenis VersaCut) together with basket for removal of the small prostate chips, in order to reduce operating time. Patients results were collected in a proper database Patients with limited follow-up and with data unavailable were excluded. RESULTS: We collected retrospectivally data of consecutive male patients who underwent HoLEP from July 2015 to September 2022 (86 months). There were 183 patients with a mean preoperative gland size of 218.9 cc (200-366 cc). Mean operative (145 min) and enucleation time (83 min) .Enucleation efficiency was greater for glands ≥300 cc (4.5 cc/min). Mean length of stay was 2.2±days and catheter duration was 2.8±days. Mean haemoglobin loss was (3,6 gr/dl, SD 0,1 - 6 gr/dl). 7 cases required blood transfusion (3.8%). 52 patients (28.4%) had indwelling catheter before surgery for urinary retention; this population experienced higher incidence of post-operative UTI and fever (42% vs 13%; p=0.001) Mean variation of Qmax was+14 ml/s (p<0,05) and IPSS score -16 points (p<0.05) at long term follow-up, these results stayed stable for during time with a mean follow 24 months (range 2-86) 3 (7.1%) patient required retreatment of BPH at last follow-up. CONCLUSIONS: HoLEP for giant prostate is a minimally invasive option with low morbidity and good post-operative outcomes. These data support the feasibility of HoLEP regardless the size of the prostate and suggest that HoLEP could become the “gold standard” approach for prostate >200 cc. Source of Funding: 1) World Journal of Urology © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e807 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matteo Tallè More articles by this author Francesco Mengoni More articles by this author Roberto Orciani More articles by this author Donato Dente More articles by this author Angelo Cafarelli More articles by this author Expand All Advertisement PDF downloadLoading ...

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, Laparoscopic Simple Prostatectomy, or Open Prostatectomy: The Role of the Prostate Volume in terms of Operation Time

Introduction: To compare the prostate removal speeds of 3 enucleation techniques and to evaluate how the operating times change depending on the prostate volume. Methods: Medical records of patients with 80-g or larger prostates who underwent holmium laser enucleation of the prostate (HoLEP), laparoscopic simple prostatectomy (LSP), or open prostatectomy (OP) due to medical treatment-resistant benign prostatic hyperplasia (BPH) were reviewed retrospectively. Patients were classified into 3 groups according to the surgical procedure. Age, BMI, prostate weights, total operation times, prostate removal speeds, hospitalization and catheterization days, complications, and improvements on functional outcomes in the 3rd month of follow-up were compared between groups. In addition, the association between prostate weight and total operation time was analyzed for each group. Results: HoLEP, LSP, and OP groups consisted of 60, 61, and 37 patients, respectively. While HoLEP was similar to OP in terms of prostate removal speed and total operation time, LSP was statistically slower and required more operation time than HoLEP and OP. There was a relationship between prostate weight and total operation time only in HoLEP. Conclusion: LSP, one of the enucleation techniques in the treatment of large prostates, was slower and required more operation time than HoLEP and OP in terms of total operation time and prostate removal speed. HoLEP seems going to be the fastest candidate for the rapid removal of large prostates in the future.

Two-year Follow-up in Bipolar Transurethral Enucleation and Resection of the Prostate in Comparison with Bipolar Transurethral Resection of the Prostate in Treatment of Large Prostates. Randomized Controlled Trial

ObjectiveTo assess the safety and long-term efficacy of bipolar transurethral enucleation and resection of the prostate (B-TUERP) in the treatment of enlarged prostate in comparison with bipolar transurethral resection of the prostate (B-TURP). Materials and MethodsFrom June 2015 to March 2019, a total of 240 patients with enlarged prostates of more than 80 gm were randomized into 2 groups, each containing 120 patients. Patients in group A were subjected to B-TUERP while those in group B underwent B-TURP. The perioperative data and postoperative outcomes followed at 1, 6, and 24 months after surgery at which points they were analyzed, and a comparison made between the 2 groups. ResultsThere were no significant differences in the preoperative parameters of the 2 groups. Comparing with B-TURP, B-TUERP had longer operative time (105.09 ± 31.08 vs 61.09 ± 29.28 min), more resected prostatic tissue (50.41 ± 13.07 vs41.12 ± 8.91 g) and had less hemoglobin drop (1.5 vs 2g/dL). In addition, indwelling catheter time, postoperative bladder irrigation duration, and hospital stay were significantly shorter in the B-TUERP group than in the B-TURP group. At 24 month after the procedure, patients with B-TUERP achieved better results of International Prostate Symptom Score (6 vs 7 P = .008), quality of life (1 vs 2, P = .243), maximal flow rate (24.9 ± 5.74 vs 20.09 ± 3.27mL/sec, P = .034), post-voiding residual urine volume (18.64 ± 3.28 vs 24.74 ± 4.02 mL, P = .001), and residual prostate volume (18.64 ± 3.28 vs 20.74 ± 4.02 mL, P < .001). On the other hand, there were no significant differences in postoperative complications between both groups. ConclusionB-TUERP is a more effective modality in the treatment of enlarged prostate compared to B-TURP with almost no variation in safety.

The Effectiveness and Safety of Transurethral (Bipolar) Plasmakinetic Resection of Prostate Combined with Thulium Laser for Large Benign Prostatic Hyperplasia (>80ml).

To evaluate the clinical curative effect and safety of transurethral (bipolar) plasmakinetic resection of theprostate (PKRP) combined with thulium laser in the treatment of large prostates (> 80mL). From January 2014 to December 2015, 61 patients with benign prostate hyperplasia(BPH) were treated with PKRP combined with thulium laser (n = 25) or PKRP only (n = 36). We retrospectivelyanalyzed the perioperative status of patients status during 3-month follow-up. There was no significant difference between the two groups before treatment (P > .05). PKRP combinedwith thulium laser was significantly superior to PKRP in terms of surgical duration, intraoperative blood loss,postoperative bladder washing time, postoperative complications and time of hospital stay (P < .05). There were nosignificant improvements at international prostatic symptom score (IPSS), quality of life (QOL), maximum flowrate (Qmax), and post-void residual (PVR) urine between two groups after 3 months (P > .05). PKRP combined with thulium laser is superior than PKRP only for better surgical duration, lessbleeding, higher efficiency and much quicker recovery. It may be a better choice for the treatment of BPH withlarge prostate (> 80mL).

A 63 element 1.75 dimensional ultrasound phased array for the treatment of benign prostatic hyperplasia

BackgroundProstate cancer and benign prostatic hyperplasia are very common diseases in older American men, thus having a reliable treatment modality for both diseases is of great importance. The currently used treating options, mainly surgical ones, have numerous complications, which include the many side effects that accompany such procedures, besides the invasive nature of such techniques. Focused ultrasound is a relatively new treating modality that is showing promising results in treating prostate cancer and benign prostatic hyperplasia. Thus this technique is gaining more attention in the past decade as a non-invasive method to treat both diseases.MethodsIn this paper, the design, construction and evaluation of a 1.75 dimensional ultrasound phased array to be used for treating prostate cancer and benign prostatic hyperplasia is presented. With this array, the position of the focus can be controlled by changing the electrical power and phase to the individual elements for electronically focusing and steering in a three dimensional volume. The array was designed with a maximum steering angle of ± 13.5° in the transverse direction and a maximum depth of penetration of 11 cm, which allows the treatment of large prostates. The transducer piezoelectric ceramic, matching layers and cable impedance have been designed for maximum power transfer to tissue.ResultsTo verify the capability of the transducer for focusing and steering, exposimetry was performed and the results correlated well with the calculated field. Ex vivo experiments using bovine tissue were performed with various lesion sizes and indicated the capability of the transducer to ablate tissue using short sonications.ConclusionA 1.75 dimensional array, that overcame the drawbacks associated with one-dimensional arrays, has been designed, built and successfully tested. Design issues, such as cable and ceramic capacitances, were taken into account when designing this array. The final prototype overcame also the problem of generating grating lobes at unwanted locations by tapering the array elements.

Design And Evaluation if A 3×21 Element 1.75 Dimensional Tapered Ultra- Sound Phased Array For The Treatment Of Prostate Disease

This paper describes the design, construction, and evaluation of a 1.75 dimensional (1.75-D) tapered ultrasound phased array to be used in the treatment of benign prostatic hyperplasia and prostate cancer. The array was designed to be able to focus and steer in a three dimensional volume with a maximum steering angle of ±13.5° in the transverse direction and a maximum depth of penetration of 11 cm, which allows the treatment of large prostates. A piezoelectric ceramic (PZT-8) at a frequency of 1.2 MHz was used as the material of the transducer since it can handle the high power needed for tissue ablation and two matching layers were used for maximum acoustic power transmission to tissue. To verify the capability of the transducer for focusing and steering, exposimetry was performed and the results correlated well with the calculated field.