Factors Influencing Intraoperative Blood Loss in Patients Undergoing Holmium Laser Enucleation of the Prostate (HoLEP) for Benign Prostatic Hyperplasia: A Large Multicenter Analysis.

OBJECTIVE: To assess blood loss during holmium laser enucleation of the prostate (HoLEP) and investigate the factors influencing it. PATIENTS AND METHODS: Analysis of patients with benign prostatic hyperplasia (BPH) treated with HoLEP at 3 centers. Hemoglobin and hematocrit were measured before surgery and hospital discharge. All blood transfusions performed during and after HoLEP were recorded. Blood loss outcomes were analyzed regarding antithrombotic (antiplatelet/anticoagulant) therapies and drug treatments for BPH and other conditions. RESULTS: The analysis included 963 patients with a mean age of 72 years. Mean (range) prostate size was 102 (40-316) g; 28% of patients were receiving antiplatelets and 11% anticoagulants. Mean (range) prostate-specific antigen was 6.0 (0.3-43.5) ng/dL. Mean (range) operation time was 77 (28-178) minutes. Bladder calculi were found in 54 (5.6%) patients; all of them were successfully treated with cystolitholapaxy. Forty-eight (5%) patients required blood transfusion during or immediately after the HoLEP procedure. Overall, mean (SD) hemoglobin decreased from 14.6 (1.5) g/dL to 12.3 (2.1) g/dL (P <.001), and mean (SD) hematocrit decreased from 44.3% (4.7) to 37.7% (6.5) (P <.001). Neither hemoglobin nor hematocrit decreases were significantly different between patients receiving and not receiving antithrombotic therapy or BPH therapy. CONCLUSION: HoLEP is safe and has no remarkable impact on blood loss. Patients at high risk, such as those receiving antithrombotic therapy, had the same outcome than the rest regarding blood loss, although showed a higher transfusion rate. Operating time may influence hemoglobin decrease; therefore, it should be considered in patients with higher risk of bleeding.

Analysis of Holmium Laser Enucleation of the Prostate in a High-Volume Center: The Impact of Concomitant Holmium Laser Cystolitholapaxy.

Purpose: To assess the influence of holmium laser cystolitholapaxy (HLC) concomitantly with holmium laser prostate enucleation (HoLEP) on patients with benign prostatic hyperplasia (BPH) presenting bladder calculi. Materials and Methods: We present a retrospective analysis of patients with BPH (with or without concomitant HLC) at three Spanish centers. Intraoperative variables (e.g., time and resected tissue), changes in functional parameters of the prostate, and frequency of complications (intraoperative, early postoperative, and at 12 months) in patients with and without HLC were compared. Results: The analysis included 963 patients aged 48 to 91 years, of which 54 (5.6%) underwent HLC to treat vesical lithiasis. Mean (range) prostate size (measured by transrectal ultrasound) was 79 (43-173) g and 91 (35-247) g for patients with and without concomitant HLC, respectively (p = 0.080). All bladder calculi were effectively removed. No significant differences were found regarding enucleation and morcellation times, but total operation time was significantly higher in patients with HLC: mean (standard deviation [SD]) of 78 (27) minutes vs 95 (41) minutes (p < 0.001). Three patients underwent conversion to open surgery because of bladder perforation, all of them from the group without HLC. Rates of intraoperative, early, and 12-month complications were similar in both groups. No significant differences in International Prostate Symptom Scale, maximum flow rate (Qmax), and mean flow were observed between groups 12 months after surgery. Conclusions: Simultaneous HoLEP and HLC increases the total operation time, but does not influence the risk of clinically relevant perioperative and postoperative complications.

[Mitomycin C HIVEC. Update and results in high risk patients.] / HIVEC con mitomicina C. Actualización y resultados en pacientes de alto riesgo.

Adjuvant endovesical treatment is a research field in constant exploration with the aim to minimize the risk of recurrence and progression of non muscle invasive bladder tumors. Over the last years, the administration of chemotherapy in a chemo hyperthermia regimen has been added to the existing regimens. There are various systems for its administration, but this article focus on HIVEC (Hyperthermic IntraVEsical Chemotherapy) and its current status. In this review article we update the results of this system in the case-scenarios it has been used (preoperative with ablative intention and as adjuvant therapy with prophylactic purposes), tolerance and security issues, on-going clinical trials and future perspectives.