Low-Power Vs High-Power Holmium Laser Enucleation of the Prostate: Critical Assessment through Randomized Trial.

OBJECTIVE: To assess the non-inferiority of Low-power Holmium laser enucleation of the prostate (LP-HoLEP) to high-power (HP-HoLEP) for enucleation efficiency pertaining to the advantages of lower cost and minimal postoperative dysuria, storage symptoms, and negative sexual impact. PATIENTS AND METHODS: HoLEP was performed using 100W Versapulse, Luminis Inc., with 2J/25Hz for LP-HoLEP (61 patients) and 2J/50Hz for HP-HoLEP (60 patients). Two surgeons with different experience performed equal number of both procedures. Non-inferiority of enucleation efficiency (enucleated weight/min) was evaluated. All perioperative parameters were recorded and compared. Dysuria was assessed at 2 weeks by dysuria visual analog scale, urinary (Q.max and IPSS) and sexual (sexual health inventory for men score) outcome measures were evaluated at 1, 4, and 12 months. RESULTS: Baseline and perioperative parameters were comparable between the two groups. Mean enucleation efficiency was 1.42±0.6 vs 1.47±0.6 gm/min, P = .6 following LP-HoLEP and HP-HoLEP, respectively. Patients reported postoperative dysuria similarly in both groups as per dysuria visual analog scale. There was significant comparable improvement in IPSS (international prostate symptom score) and Q.max in both groups at different follow-up points. At one year, median IPSS and Q.max were comparable in both groups (P = .4 and .7 following LP-HoLEP and HP-HoLEP, respectively). Median postoperative reduction in prostate specific antigen was 89% (42:99) following LP-HoLEP vs 81% (62:94) after HP-HoLEP, P = .92. Both groups showed comparable perioperative and late postoperative complications. There were no statistically significant changes in the last follow-up sexual health inventory for men score in comparison to baseline score. CONCLUSION: LP-HoLEP is non-inferior to HP-HoLEP in terms of all efficiency parameters regardless level of surgeon experience.

Prospective controlled assessment of men's sexual function changes following Holmium laser enucleation of the prostate for treatment of benign prostate hyperplasia.

OBJECTIVES: To assess how much Holmium laser enucleation of the prostate (HoLEP) is detrimental on men sexuality. METHODS: Between January and December 2013, all patients presented for BPH surgery were assessed using IIEF-15 (international index of erectile function-15) and Ej-MSHQ (ejaculatory domain-male sexual health questionnaire). Changes in men's sexuality following HoLEP in relation to control procedure were prospectively assessed. Intervention group included legible consecutive patients treated by HoLEP. Control group included legible patients presented for diagnostic cystoscopy. Changes in IIEF-15, its subdomains and Ej-MSHQ scores were compared between HoLEP group and control. RESULTS: At one year 80 and 70 subjects were included for final analysis following HoLEP and control groups, respectively. Regardless of the baseline erectile function (EF/IIEF) score, there was an increase in EF score similar to control following HoLEP (P = 0.6). However, among subjects with normal preoperative EF (score >25), in comparison with control, there was similar decline in EF score following HoLEP (P = 0.07). Regarding the orgasm domain, there was a significant reduction in orgasm perception following HoLEP in relation to control (P = 0.01). Patients reported desire changes, intercourse satisfaction and overall satisfaction scores similar to control following HoLEP. Using Ej-MSHQ score, there was no statistically significant difference between HoLEP and control groups in percentage of subjects reporting ejaculatory dysfunction at baseline. However, at 12 months, there was statistically significant more ejaculatory dysfunction reporting following HoLEP. The most common ejaculatory abnormality was volume abnormality. Orgasm perception was significantly decreased among subjects with newly reported ejaculatory dysfunction (5.3 ± 1.4 vs. 8.6 ± 1.3, P = 0.001). CONCLUSIONS: Controlled short-term assessment of HoLEP showed potential negative impact on EF in patients with normal preoperative EF. Apart from orgasm perception, sexual function changes following HoLEP were similar to control. High prevalence of postoperative ejaculatory dysfunction following HoLEP remained notable finding.

Pretransplant native nephrectomy in patients with end-stage renal failure: assessment of the role of laparoscopy.

OBJECTIVES: To evaluate the outcome and morbidity of laparoscopic nephrectomy in patients with end-stage renal disease. METHODS: Between August 1991 and September 2001, 64 laparoscopic nephrectomies were carried out for the native kidneys of 62 patients with end-stage renal failure. The procedures were performed in preparation for renal transplantation. The indications were vesicoureteral reflux with persistent or recurrent urinary tract infection in 26 renal units, uncontrolled hypertension in 15, chronic pyelonephritis or hydronephrosis with urinary tract infection in 8, renal calculi in 13, heavy proteinuria in 1, and small renal tumor in 1. The left side was removed in 52 procedures and the right side was removed in 12. Forty-eight and 16 renal units were removed through the retroperitoneal and transperitoneal approach, respectively. RESULTS: Sixty procedures were successfully performed (94%). Four patients required open exploration (6%). Four major complications were recorded: pneumothorax in 1, large hematoma in 1, colonic injury in 1, and bleeding in 1. No mortality related to the procedures or their complications occurred. The patients received allograft transplantation shortly after the procedure, with a mean of 26 days. Both transperitoneal and retroperitoneal approaches were effectively used with satisfactory outcome. CONCLUSIONS: Laparoscopy should be considered as the procedure of choice for pretransplant nephrectomy. The high success rate, low morbidity, early recovery, and short duration between nephrectomy and transplantation all are considered as real advantages for this patient population.