Efficacy, safety, and perioperative outcomes of holmium laser enucleation of the prostate-a comparison of patients with lower urinary tract symptoms and urinary retention.

Holmium laser enucleation of the prostate (HoLEP) is a valid treatment option to relieve bladder outlet obstruction in patients with large prostate volumes (PV). Its efficacy, tolerability, and safety are comparable to the ones of other laser treatments of the prostate and resection techniques. However, safety and efficacy of HoLEP have not been compared between patients with and without preoperative urinary retention. We included 350 patients (mean age 71.2 years) who had undergone HoLEP due to lower urinary tract symptoms (LUTS) or urinary retention caused by prostatic hyperplasia. We evaluated the differences in peri- and postoperative outcomes and complications between patients with and patients without preoperative urinary retention. The mean PV was 115 cm3. PV was > 100 cm3 in 61.9% and < 100 cm3 in 38.1% of the patients. Perioperative complications occurred in 23 patients (6.6%), 15 of which (4.3%) required operative revision. We found no significant differences in terms of complication rates between patients with PV > 100 cm3 and patients with PV < 100 cm3. Mean catheterization-duration was 3.3 days. Preoperatively, 140 patients (40%) had a suprapubic or transurethral indwelling catheter; they did not differ from patients without preoperative catheter regarding postoperative catheter removal success rate, early postoperative complications, and functional outcomes. Prostate cancer was diagnosed in 43 patients (12.3%). Median postoperative PSA-decline was 6.1 ug/l (89.8% drop). HoLEP is a safe and effective treatment for patients with LUTS or urinary retention and large PV. PV > 100 cm3 was not associated with higher complication rates or successful catheter-removal. Furthermore, functional outcomes were independent of preoperative catheterization.

Identification of ureteral stones at reduced radiation exposure: a pilot study comparing conventional versus digital low-dosage linear slot scanning (Lodox®) radiography.

PURPOSE: Digital low-dosage, linear slot scanning radiography (Lodox®) is an imaging modality that can emit down to one-tenth the radiation of conventional X-ray systems. We prospectively evaluated Lodox® as a diagnostic imaging modality in patients with ureterolithiasis. METHODS: Conventional kidney-ureter-bladder (KUB) X-ray and Lodox® were performed in 41 patients presenting with acute flank pain due to unilateral ureteral stone confirmed by computed tomography. KUB X-ray and Lodox® images were then reviewed by four blinded readers (urology expert/resident, radiology expert/resident). Identification rates were compared using Pearson's Chi square test. The impact of different parameters on stone identification by Lodox® was evaluated using logistic regression and generalized linear mixed models. Inter-reader agreement was tested using Cohen's kappa coefficient. RESULTS: Median stone size was 5 mm (range 2-12), median stone density was 800 HU (range 200-1500). The identification rates of the urology expert were 68% for KUB X-ray and 90% for Lodox® (p = 0.014), and for all four readers 61% for KUB X-ray and 62% for Lodox® (p = 0.8). Radiation exposure for KUB X-ray and Lodox® was 0.45 mSv (SD ± 0.64) and 0.027 mSv (SD ± 0.038), respectively. Multivariable analyses showed an association between stone identification by Lodox® and stone size (p < 0.001), stone density (p = 0.005), lower body mass index (p = 0.005), and reader (p < 0.001). CONCLUSIONS: The high identification rates and low radiation doses of Lodox® make it a promising imaging modality for the diagnosis of ureteral stones. Further validation in larger cohorts, including performance evaluation for renal stones, is warranted. TRIAL REGISTRATION: http://www.controlled-trails.com/ISRCTN12915426.