Incidence of complications and urinary incontinence following endoscopic enucleation of the prostate in men with a prostate volume of 80 ml and above: results from a multicenter, real-world experience of 2512 patients.

PURPOSE: To evaluate complications and urinary incontinence (UI) after endoscopic enucleation of the prostate (EEP) stratified by prostate volume (PV). METHODS: We retrospectively reviewed patients with benign prostatic hyperplasia who underwent EEP with different energy sources in 14 centers (January 2019-January 2023). INCLUSION CRITERIA: prostate volume ≥ 80 ml. EXCLUSION CRITERIA: prostate cancer, previous prostate/urethral surgery, pelvic radiotherapy. PRIMARY OUTCOME: complication rate. SECONDARY OUTCOMES: incidence of and factors affecting postoperative UI. Patients were divided into 3 groups. Group 1: PV = 80-100 ml; Group 2 PV = 101-200 ml; Group 3 PV > 200 ml. Multivariable logistic regression analysis was performed to evaluate independent predictors of overall incontinence. RESULTS: There were 486 patients in Group 1, 1830 in Group 2, and 196 in Group 3. The most commonly used energy was high-power Holmium laser followed by Thulium fiber laser in all groups. Enucleation, morcellation, and total surgical time were significantly longer in Group 2. There was no significant difference in overall 30-day complications and readmission rates. Incontinence incidence was similar (12.1% in Group 1 vs. 13.2% in Group 2 vs. 11.7% in Group 3, p = 0.72). The rate of stress and mixed incontinence was higher in Group 1. Multivariable regression analysis showed that age (OR 1.019 95% CI 1.003-1.035) was the only factor significantly associated with higher odds of incontinence. CONCLUSIONS: PV has no influence on complication and UI rates following EEP. Age is risk factor of postoperative UI.

High-power holmium laser versus thulium fiber laser for endoscopic enucleation of the prostate in patients with glands larger than 80 ml: Results from the Prostate Endoscopic EnucLeation study group.

Background: Endoscopic enucleation of the prostate (EEP) has gained acceptance as an equitable alternative to transurethral resection of the prostate for benign prostate hyperplasia (BPH). Our primary aim is to compare peri-operative outcomes of EEP using thulium fiber laser (TFL) against high-power holmium laser (HPHL) in hands of experienced surgeons for large prostates (≥80 ml in volume). Secondary outcomes were assess complications within 1 year of follow up. Materials and Methods: We retrospectively reviewed patients with benign prostatic hyperplasia who underwent EEP with TFL or HPHL in 13 centers (January 2019-January 2023). Patients with prostate volume ≥80 ml were included, while those with concomitant prostate cancer, previous prostate/urethral surgery, and pelvic radiotherapy were excluded. Results: Of 1,929 included patients, HPHL was utilized in 1,459 and TFL in 470. After propensity score matching (PSM) for baseline characteristics, 247 patients from each group were analyzed. Overall operative time (90 [70, 120] vs. 52.5 [39, 93] min, P < 0.001) and enucleation time (90 [70, 105] vs. 38 [25, 70] min, P < 0.001) were longer in the TFL group, with comparable morcellation time (13 [10, 19.5] vs. 13 [10, 16.5] min, P = 0.914). In terms of postoperative outcomes, there were no differences in 30-day complications such as acute urinary retention, urinary tract infection or sepsis. In the PSM cohort, univariable analyses showed that higher age, lower preoperative Qmax, higher preoperative PVRU, and longer operation time were associated with higher odds of postoperative incontinence, while 2-lobe enucleation had lower odds of incontinence compared to 3-lobe enucleation. Conclusions: This real-world study reaffirms that HPHL and TFL in large prostates are equally efficacious in terms of 30-day complications. TFL with the en-bloc technique has a shorter operative time which significantly improves short- and medium-term functional outcomes.

Applicability of the Clavien-Dindo grading system for assessing the postoperative complications of endoscopic surgery for nephrolithiasis: a critical review.

OBJECTIVE: Adaptation of the Clavien-Dindo classification for assessing the severity of complications following the endoscopic treatment of nephrolithiasis and evaluation of its versatility and objectivity. MATERIAL AND METHODS: We retrospectively reviewed the medical records of 1027 patients who presented stones located in upper urinary tract (597 males, 58.1% and 430 females, 41.9%), mean age 38.9±15.6 (range, 4 to 84) years. The age ranged from 4 to 15 years in 46 (4.5%) of the patients. The mean size of the stones was 30.3±0.6 (range, 3 to 150) mm. Percutaneous nephrolithotomy (PNL) and ureteroscopy (URS) were performed by three experienced surgeons, PNL with the patients in the prone position. Fragmentation of stones was carried out using a pneumatic lithotripter. The outcomes were compared using Fisher's exact test and Student's t-test. The Clavien-Dindo grading system was used. RESULTS: We observed 195 (19.0%) patients who presented a total of 250 complications during the postoperative period. Additional interventions have been performed to eliminate 74 complications: 41 under general anesthesia and 33 without it. "Stone free status" was reached in 879 (85.6%) patients. Postoperative complications were assessed using Clavien grading system: Grade I for 64 complications (6.2%); Grade II for 111 (10.8%); Grade IIIa for 33 (3.2%); Grade IIIb for 39 (3.8%); Grade IVa for 3 (0.3%); Grade IVb for 0; and Grade V for 0. CONCLUSION: There is no ideal classification system for assessing the severity of surgical complications. The Clavien-Dindo classification can be adapted to assess the severity of postoperative complications following endoscopic procedures for nephrolithiasis if certain corrections are made.