ABSTRACT
OBJECTIVE: To compare long-term reoperation rate and functional outcomes between EEP (endoscopic enucleation of the prostate) and TURP (transurethral resection of the prostate). EVIDENCE ACQUISITION: A systematic literature review of Medline, Scopus, and Web of Science was conducted with primary outcome assessed being reoperation rate and secondary outcomes after a long term (> 3 years) being functional outcomes or related values (prostate volume, PSA level, etc.). EVIDENCE SYNTHESIS: Five studies were found with long-term follow-up 4-7 years. EEP reoperation rate ranged from 0 to 1.27%, while from 1.7 to 17.6% for TURP. Meta-analysis showed significantly lower OR for EEP, 0.27 (95% CI 0.24-0.31), with notable homogeneity of the results, I2 = 0%. Long-term Qmax and IPSS were significantly better for EEP. Qmax pooled mean difference was 1.79 (95% CI 1.72-1.86) ml/s with a high concordance among the studies, I2 = 0%. IPSS mean difference -1.24 (95% CI - 1.28 to - 1.2) points, I2 = 57% but QoL did not differ, with mean difference being 0.01 (95% CI - 0.02 to 0.04), I2 = 0%. IIEF-5 score was also significantly better for EEP, mean difference 1.08 (95% CI 1.03-1.13), but heterogeneity was high, I2 = 70%. PSA level and prostate volume were only reported in one study and favored EEP slightly yet statistically significant. CONCLUSION: EEP had a significantly lower reoperation rate and better functional outcomes (Qmax and IPSS) at long term compared with TURP. It may also be beneficial in terms of IIEF-5, PVR, and PSA level.
Subject(s)
Prostatic Hyperplasia , Transurethral Resection of Prostate , Male , Humans , Transurethral Resection of Prostate/methods , Prostatic Hyperplasia/surgery , Prostatic Hyperplasia/complications , Quality of Life , Prostate-Specific Antigen , Treatment OutcomeABSTRACT
PURPOSE: To compare the short-term postoperative functional outcomes and severity of irritative symptoms following holmium and thulium fiber laser enucleation (HoLEP and ThuFLEP). METHODS: This prospective randomized single-blinded study was performed in accordance with CONSORT. The inclusion criteria were IPSS > 20 or Qmax < 10 ml/s. Patients were randomized between HoLEP and ThuFLEP. Demographics, objective data (PSA, prostate volume, etc.), data on urinary and sexual function (IPSS, IIEF, QoL, QUID, Qmax, ICIQ-MLUTS) were collected. Detailed perioperative information and postoperative data on functional outcomes at 1, 2, 3, 4, 6, 8, 10, 12 weeks and 6 months were collected. RESULTS: Data on 163 participants were included (77-HoLEP, 86-ThuFLEP). No differences were found in surgery duration; number of postoperative complications (Clavien-Dindo I-III), catheterization time and hospital stay. Functional outcomes up to 6 months didn't differ between the groups (IPPS, IIEF, QoL, QUID, ICIQ-MLUTS, Qmax, p > 0.05). Total ICIQ-MLUTS, bother and voiding scores at 1 and 3 months significantly increased compared with the baseline in both groups (p < 0.05). No difference between the groups were observed. In HoLEP the SUI series rate was 1.3% and 1.3% after 3 and 6 months following the procedure; in ThuFLEP: it was 3.5% and 2.3% respectively (p = 0.35 and p = 0.54). CONCLUSION: The preliminary results of the study showed no apparent differences in functional outcomes (IPSS, Qmax), rate of SUI or irritative symptoms. Both ThuFLEP and HoLEP are efficient ways of treating benign prostatic obstruction. Both surgeries are comparable in terms of duration and postoperative complication rates.
Subject(s)
Laser Therapy , Lasers, Solid-State , Prostatic Hyperplasia , Transurethral Resection of Prostate , Humans , Laser Therapy/methods , Lasers, Solid-State/therapeutic use , Male , Postoperative Complications/etiology , Prospective Studies , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/surgery , Quality of Life , Thulium , Transurethral Resection of Prostate/methods , Treatment OutcomeABSTRACT
Enucleation remains enucleation regardless of the device (same safety and efficiency in experienced hands). However, every laser brings something new (better cutting, shorter learning curve, superior hemostasis) and each surgeon should chose a laser according to their own experience, expectations, and demands.
Subject(s)
Laser Therapy , Lasers, Solid-State , Prostatic Hyperplasia , Transurethral Resection of Prostate , Humans , Male , Prostate/surgery , Prostatic Hyperplasia/surgeryABSTRACT
Objective: The objective of our study was to estimate the long-term efficacy and safety of thulium fiber laser enucleation of the prostate (ThuFLEP). Materials and Methods: We analyzed patients who underwent ThuFLEP due to lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). Both the pre- and perioperative data as well as the follow-up data for 3 years were evaluated: prostate volume, postvoid residual (PVR), maximum flow rate (Qmax), International Prostate Symptom Score (IPSS), quality of life (QoL), prostate-specific antigen level, and the complication rate. Intraoperative data relating to the weight of resected tissue, the duration of surgery, catheterization, and data on hospital stays were also collected. A subgroup analysis was performed to assess whether older patients (>65 years) or those with larger glands (>80 cc) are prone to increased complication risks. Results: A total of 1328 patients were included in the analysis. The mean age was 66.9 ± 7.5 years. Mean prostate volume was 86.9 ± 41.9 (20-330) cc. All the functional parameters (IPSS, QoL, PVR, Qmax) significantly improved after surgery (p < 0.05) and showed durable improvement up to 3 years of follow-up. The frequency of late complications was as follows: stress urinary incontinence-1.2%; urethral stricture-1.1%; and bladder neck contracture-0.9%. Subgroup analyses revealed increased urinary tract infection frequency in older patients (3.5% vs 0.8%, p = 0.003) as well as higher rate of stress urinary incontinence (0.4% vs 1.8%, p = 0.002) and higher rate of clot retention (11.3% vs 4.4%, p < 0.001) in those with larger glands. Conclusions: Irrespective of the patient's age and prostate volume, ThuFLEP represents an effective and durable technique of endoscopic enucleation characterized by a low incidence of complications after 3 years of follow-up. In the hands of an experienced surgeon, ThuFLEP can rightly be a promising alternative to holmium laser enucleation of the prostate for treatment of LUTS associated with BPO.
Subject(s)
Laser Therapy , Lasers, Solid-State , Prostatic Hyperplasia , Transurethral Resection of Prostate , Urinary Incontinence, Stress , Aged , Humans , Laser Therapy/methods , Lasers, Solid-State/therapeutic use , Male , Middle Aged , Prospective Studies , Prostate/surgery , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/surgery , Quality of Life , Thulium/therapeutic use , Transurethral Resection of Prostate/methods , Treatment Outcome , Urinary Incontinence, Stress/surgeryABSTRACT
INTRODUCTION: Vaporization of the prostate (VP) and endoscopic enucleation of the prostate (EEP) are reliable and frequently used methods for BPO relief. Both surgeries utilize lasers and EAU recommends them in similar patient cohorts. Our objective was to compare intra- and perioperative results of patients who had undergone VP and EEP. EVIDENCE ACQUISITION: A systematic literature search was performed in three databases (MEDLINE, Web of Science and Scopus). The detailed search strategy is available at Prospero, CRD42020204739. Primary outcomes were functional results (IPSS, QoL, PVR, Q
Subject(s)
Prostatic Hyperplasia , Transurethral Resection of Prostate , Humans , Male , Prostate-Specific Antigen , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/surgery , Quality of Life , Transurethral Resection of Prostate/adverse effects , Transurethral Resection of Prostate/methods , Treatment Outcome , VolatilizationABSTRACT
PURPOSE OF REVIEW: This review aims to highlight the pros and cons of each laser device and to consider additional possible milestones for the development of laser technologies in the surgical treatment of benign prostate hyperplasia. RECENT FINDINGS: Over the last three decades, lasers' role in endourology has gone from strength to strength. Specifically, the primary techniques where laser surgery for BPO relief is concerned are vaporization and enucleation. The idea behind vaporization is that lasers are able to vaporize substantial amounts of tissue due to deep ablation depth and increased power. The most efficient devices for vaporization are those affecting hemoglobin as primary chromophore and/or using a continuous firing mode (KTP/LBO:YAG, diode lasers, Tm:YAG). As for enucleation, multiple devices have been suggested for the adequate anatomical enucleation of the prostate (EEP). As it is a skill-dependent technique, the EEP is effective irrespective of which device the surgeon uses. However, some devices have shown significant advances where enucleation is concerned. SUMMARY: The choice of device should be based primarily on the technique the surgeon prefers. Although the most suitable lasers for vaporization are hemoglobin-targeting and/or continuous wave devices, the EEP may be done with any enough powered laser, yet some provides specific effects which you should be aware before the surgery.
Subject(s)
Laser Therapy , Lasers, Solid-State , Prostatic Hyperplasia , Transurethral Resection of Prostate , Humans , Laser Therapy/adverse effects , Male , Prostatic Hyperplasia/surgerySubject(s)
Lower Urinary Tract Symptoms , Prostatic Hyperplasia , Transurethral Resection of Prostate , Urinary Retention , Humans , Lasers , Lower Urinary Tract Symptoms/diagnosis , Lower Urinary Tract Symptoms/etiology , Lower Urinary Tract Symptoms/surgery , Male , Prostate , Prostatic Hyperplasia/complications , Prostatic Hyperplasia/diagnosis , Prostatic Hyperplasia/surgery , Thulium , Urinary Retention/diagnosis , Urinary Retention/etiologyABSTRACT
Objective: To analyze the long-term efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia. Materials and Methods: A total of 127 patients who underwent HoLEP at our institution between 2013 and 2015 were included. Patients were observed for 5 years postoperatively. We evaluated the length of the surgery, the mass of the removed tissue, prostate-specific antigen level, the maximal flow rate (Qmax), postvoid residual (PVR), the length of catheterization and hospitalization, and the International Prostate Symptom Score (IPSS) and IPSS quality of life (QoL) at each clinic visit. Results: PVR, Qmax, IPSS, and QoL all improved significantly immediately after the operation (p < 0.001). By the end of the 5th postoperative year, all the parameters showed a statistically meaningful decline: Qmax reduced by 5.8 mL/s (22.6%) and IPSS by 1.4 points (29.1%). Around 8.6% of the patients continued therapy with α-blockers. There were no differences in efficacy by the age of the patients or the volume of the prostate. Long-term complications and need for repeat operations were not affected by the volume of the prostate or patient age. Conclusions: The improvement of PVR, Qmax, IPSS, and QoL score seen in the early postoperative period after performing HoLEP remains evident at 5 years postoperatively. Long-term complications and the need for reoperation do not depend on the age of the patient or on the initial volume of the prostate.
Subject(s)
Laser Therapy , Lasers, Solid-State , Prostatic Hyperplasia , Transurethral Resection of Prostate , Holmium , Humans , Lasers, Solid-State/therapeutic use , Male , Prostatic Hyperplasia/surgery , Quality of Life , Treatment OutcomeABSTRACT
AIM: To assess efficacy and safety of monopolar enucleation of the prostate (MEP) and to compare it with the current treatment standard for medium-sized prostates, < 80 cc, transurethral resection of the prostate (TURP). METHODS: A prospective analysis patients undergoing a surgical procedure for their diagnosis of BPH (benign prostatic hyperplasia) (IPSS > 20, Qmax < 10; prostate volume < 80 cc) was performed. IPSS, Qmax were assessed preoperatively, at 6 and 12 months postoperatively. The complications were classified according to the modified Clavien-Dindo grading system. RESULTS: A total of 134 patients were included in the study: 70 underwent MEP and 64 - TURP for BPH (mean prostate volumes were comparable with p = 0.163). The mean surgery time was 44 min in the TURP group and 48.2 min in the MEP group, (p = 0.026). Catheterization time for MEP was 1.7 and 3.2 days for TURP (p < 0.001). Hospital stay for MEP was 3.2 days vs. 4.8 days for TURP (p < 0.001). Both techniques shown comparable efficiency in benign prostatic obstruction relief with IPSS drop in MEP from 23.1 to 5.9 and in TURP group from 22.8 to 7.3, whereas Qmax increased from 8.2 to 20.5 after MEP and from 8.3 and 19.9 after TURP. Urinary incontinence rate after catheter removal in TURP group was 9.0% and 7.8% in MEP group, at 1 year follow-up, it was 1.4% and 3.1% in MEP and TURP, respectively (p = 0.466). CONCLUSIONS: Our experience demonstrated that MEP is an effective and safe BPH treatment option combining the efficacy of endoscopic enucleation techniques and accessibility of conventional TURP.
Subject(s)
Prostate/pathology , Prostatic Hyperplasia/surgery , Transurethral Resection of Prostate/methods , Aged , Aged, 80 and over , Follow-Up Studies , Humans , Male , Middle Aged , Operative Time , Organ Size , Postoperative Period , Prospective Studies , Prostatectomy/methods , Prostatic Hyperplasia/diagnosis , Treatment OutcomeABSTRACT
OBJECTIVE: To compare the efficacy and safety of a novel thulium fiber laser for endoscopic enucleation of the prostate with monopolar transurethral resection of the prostate in patients with smaller glands (<80 cc). METHODS: A total of 51 patients underwent thulium fiber laser enucleation of the prostate, and 52 patients underwent monopolar transurethral resection of the prostate. All patients were assessed preoperatively, and at 3, 6, and 12 months postoperatively (International Prostate Symptom Score, maximum urine flow rate, International Prostate Symptom Score-quality of life). Preoperative prostate volumes and prostate-specific antigen levels were comparable (P = 0.543 and P = 0.078, respectively). The complications were graded according to the Clavien classification. RESULTS: Mean surgery time was longer in the thulium fiber laser enucleation of the prostate group (46.6 ± 10.2 vs 39.9 ± 8.6 min, P < 0.001), while catheterization and hospital stay were greater in the transurethral resection of the prostate group (P < 0.001). At 12 months, there were no differences in functional outcomes (International Prostate Symptom Score, maximum urine flow rate). Despite comparable prostate volumes at 12 months (P = 0.864), the prostate-specific antigen level in the thulium fiber laser enucleation of the prostate group (0.5 ± 0.5 ng/mL) was lower than in the transurethral resection of the prostate group (1.1 ± 1.0 ng/mL; P < 0.001). Hemoglobin and serum sodium decrease was lower in the thulium fiber laser enucleation of the prostate group (1.01 ± 0.4 g/dL and 1.1 ± 1.1 mmol/L) than in the transurethral resection of the prostate group (1.8 ± 0.8 g/dL and 4.1 ± 1.1 mmol/L; P < 0.001). Urinary incontinence rates at 12 months were comparable (P = 0.316). CONCLUSIONS: Thulium fiber laser enucleation of the prostate with novel thulium fiber laser in patients with smaller prostate glands (<80 cc) is comparable to transurethral resection of the prostate in voiding parameters improvement and complication rates. At the same time, the technique allows for a more substantial prostate-specific antigen decrease, indicating more complete removal of adenoma.
Subject(s)
Endoscopy/adverse effects , Laser Therapy/adverse effects , Prostatic Hyperplasia/surgery , Thulium , Transurethral Resection of Prostate/adverse effects , Urinary Incontinence/epidemiology , Aged , Aged, 80 and over , Endoscopy/instrumentation , Follow-Up Studies , Humans , Kallikreins/blood , Laser Therapy/instrumentation , Male , Middle Aged , Operative Time , Organ Size , Prospective Studies , Prostate/diagnostic imaging , Prostate/surgery , Prostate-Specific Antigen/blood , Prostatic Hyperplasia/blood , Quality of Life , Treatment Outcome , Ultrasonography , Urinary Incontinence/etiologyABSTRACT
BACKGROUND: The impact of number of endoscopic enucleation of the prostate techniques (holmium laser enucleation - HoLEP for example) on erectile function have already been investigated. However, the thulium-fiber laser, in this setting remains unstudied. In this study, we compared sexual function outcomes in patients with benign prostatic hyperplasia (BPH) treated with transurethral resection of the prostate (TURP) or thulium-fiber laser enucleation (ThuFLEP). METHODS: We performed a retrospective analysis of patients who underwent transurethral resection and endoscopic enucleation of the prostate for BPH; inclusion criteria was the presence of infravesical obstruction (IPSS > 20, Qmax < 10 mL/s). Erectile function (EF) was assessed using the International Index of Erectile Function (IIEF-5) both prior to endoscopic examination, and six months after. RESULTS: A total of 469 patients with BPH were included in the study; of these, 211 underwent to ThuFLEP, and 258 TURP. Preoperative IIEF-5 in TURP and ThuFLEP groups were 11.7 (±4.5) and 11.1 (±5.0), respectively (p = 0.17). At six month the IIEF-5 score was unchanged (p = 0.26 and p = 0.08) and comparable in both groups (p = 0.49). However, mean IIEF-5 score shown significant increase of 0.72 in ThuFLEP group, comparing to decrease of 0.24 in TURP patients (p < 0.001). CONCLUSIONS: Both TURP and ThuFLEP are effective modalities in the management of infravesical obstruction due to BPH. At six months follow-up after surgery, both techniques lead to comparable IIEF-5 score. However, our results demonstrated that the ThuFLEP is more likely to preserve the erectile function leading to increase of IIEF-5 at six months in contrast to TURP which lead to slight drop in IIEF-5 score.
Subject(s)
Endoscopy/adverse effects , Erectile Dysfunction/etiology , Lasers, Solid-State/therapeutic use , Prostate/surgery , Prostatic Hyperplasia/surgery , Transurethral Resection of Prostate/adverse effects , Aged , Endoscopy/instrumentation , Endoscopy/methods , Erectile Dysfunction/surgery , Humans , Male , Middle Aged , Penile Erection , Prostatectomy/adverse effects , Prostatectomy/methods , Quality of Life , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: To assess the differences in the learning curve associated with different techniques of endoscopic enucleation of the prostate. MATERIALS AND METHODS: Ninety patients were randomly assigned into 3 groups (30 patients in each): HoLEP, ThuFLEP or MEP. Inclusion criteria for the study included prostate volume <80 cc, IPSS > 20, or Qmax < 10. The EEPs were performed by 3 surgeons experienced in transurethral resection of the prostate. Assignment of surgeons to surgical technique was also randomized. None of the surgeons had prior experience in EEP. RESULTS: ThuFLEP was slightly superior (with no significant difference [P > .05]) to HoLEP and MEP in terms of overall enucleation rate-1.0 g/min vs 0.8 g/min and 0.7 g/min, respectively. We observed similar enucleation rates at the initial stages of training (first 20 surgeries) with insignificant increase in ThuFLEP efficiency. At next 10 surgeries ThuFLEP and HoLEP efficiency were higher than of MEP (P < .001) without significant difference between techniques of laser EEP (P = .07). CONCLUSION: Endoscopic enucleation of the prostate can be adopted safely and effectively within 30 surgeries if the technique is learned with a mentoring approach. EEP is shown to be safe and effective even in the initial stages of learning. Laser EEP (HoLEP, ThuFLEP) appears to lend itself to quicker adaptation compared MEP.
Subject(s)
Postoperative Complications , Prostate , Prostatic Hyperplasia/surgery , Transurethral Resection of Prostate , Ureteroscopy , Aged , Humans , Learning Curve , Male , Middle Aged , Operative Time , Organ Size , Outcome Assessment, Health Care , Patient Selection , Perioperative Care/methods , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Prostate/pathology , Prostate/surgery , Russia , Transurethral Resection of Prostate/adverse effects , Transurethral Resection of Prostate/education , Transurethral Resection of Prostate/methods , Ureteroscopy/adverse effects , Ureteroscopy/education , Ureteroscopy/methods , Urology/educationABSTRACT
BACKGROUND: Transurethral resection of the prostate (TURP) is considered to be the standard treatment for patients with benign prostatic obstruction (BPO) ≤80 mL. However, up to 14.7% of the patients require secondary TURP due to recurrent BPO. The aim of our study was to describe specific features of holmium laser enucleation of the prostate (HoLEP) and thulium laser enucleation of the prostate (ThuLEP) in patients with recurrent BPO after previous prostate surgery. MATERIALS AND METHODS: A total of 768 consecutive patients from our prospective collected database were retrospectively reviewed and divided into 4 groups: group A (489 patients) and group C (253 patients) underwent primary HoLEP and ThuLEP treatment, while group B (17 patients) and D (9 patients) included patients with recurrent BPO who were treated with HoLEP and ThuLEP, respectively. RESULTS: There were no significant differences in preoperative parameters between the groups at primary (A and C) and secondary (B and D) treatment except their age. At 6-month follow-up, voiding parameters and symptom scores showed statistically significant improvements compared to baseline without differences between the groups. The mean operative time was comparable between the groups and did not differ significantly (p > 0.05). CONCLUSIONS: Laser enucleation for the treatment of recurrent BPO is feasible and seems to be a safe and effective procedure.