Safety and Efficacy of High-Powered Holmium Laser Enucleation of the Prostate within 1–3 Weeks Following Prostate Biopsy

2021 ◽  
pp. 1-6
Author(s):  
Ali Yıldız ◽  
Serkan Akdemir ◽  
Hakan Anıl ◽  
Murat Arslan
Keyword(s):  
Prostate Biopsy ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Holmium Laser ◽  
Control Group ◽  
Complication Rates ◽  
Laser Enucleation ◽  
Group 2 ◽  
Holmium Laser Enucleation ◽  
Group 1

<b><i>Purpose:</i></b> We aim to document the feasibility, perioperative safety, and the 12-month efficacy of holmium laser enucleation of the prostate (HoLEP) within 1–3 weeks following transrectal ultrasound (TRUS)-guided prostate biopsy. <b><i>Methods:</i></b> Data of the patients who underwent HoLEP following TRUS-guided prostate biopsy between March 2017 and July 2020 were analyzed retrospectively. Patients were divided into 2 groups: group 1 had undergone HoLEP in the early period after TRUS-guided prostate biopsy, while group 2 patients were biopsy-naive (“control group”). All patients were assessed preoperatively by a physical examination with the digital rectal examination; time from biopsy to HoLEP; measurement of <i>Q</i><sub>max</sub>, postvoiding residual volume, and prostate volume by transabdominal ultrasonography; serum prostate-specific antigen level, the International Prostate Symptom Score (IPSS); the International Index of Erectile Function-5 questionnaire; and urine analysis. The patients were reevaluated at 3- and 12-month follow-up. Perioperative and postoperative complications were documented according to the modified Clavien-Dindo System. <b><i>Results:</i></b> Group 1 comprised 66 patients with a mean age of 67.3 ± 6.7 (range, 53–86) years, and group 2 comprised 114 patients with a mean age of 69.4 ± 9.4 (range, 36–95) years. The operation, enucleation, and morcellation efficiencies were not statistically significant between the groups. Preoperative <i>Q</i><sub>max</sub> and IPSS values were significantly improved after HoLEP surgery in the 3rd and 12th months in all patients. Our complication rates were similar in both groups. <b><i>Conclusion:</i></b> High-powered HoLEP using 140 W energy within 1–3 weeks following TRUS-guided prostate biopsy is a feasible procedure with high enucleation efficiency, low perioperative morbidity, and excellent functional outcomes. A recent TRUS-guided prostate biopsy is not a contraindication to HoLEP.

scholarly journals Salvage Holmium laser enucleation of prostate to treat recurring benign prostatic hyperplasia

2014 ◽  
Vol 8 (3-4) ◽  
pp. 235 ◽  
Author(s):  
Jin Kyu Oh ◽  
Jungbum Bae ◽  
Chang Wook Jeong ◽  
Jae-Seung Paick ◽  
Seung-June Oh
Keyword(s):  
Operation Time ◽  
Holmium Laser ◽  
Time Duration ◽  
Prostate Hyperplasia ◽  
Laser Enucleation ◽  
Group 2 ◽  
Benign Prostate ◽  
Holmium Laser Enucleation ◽  
Anatomical Plane ◽  
Group 1

Introduction: The Holmium laser enucleation of the prostate (HoLEP) technique to remove residual adenoma has not been reported. Salvage HoLEP enables anatomical enucleation of residual adenoma in patients who have previously undergone surgical treatment. We describe not only anatomical insights into the frequent location of adenoma recurrence, but also the feasibility of the salvage HoLEP technique.Methods: We retrospectively reviewed a database containing HoLEP video records for 35 patients out of a total of 535 individuals on whom HoLEP was performed by 2 surgeons (SJO & JSP) between July 2008 and June 2011. Group 1 consisted of patients who underwent salvage HoLEP due to recurring adenoma and Group 2 of patients who underwent HoLEP as an initially surgical management to treat benign prostate hyperplasia (BPH). We compared the dataset of pre-, intra- and postoperative parameters between Groups 1 and 2.Results: In the analysis of the video records of Group 1 (n = 35), there was significant remnant tissue around the verumontanum and the lateral lobes were also incompletely removed by previous conventional procedures. When we compared pre-, intra- and postoperative parameters between the 2 groups, there were no significant differences, including operation time, duration of hospital stay. However, the duration of the catheterization of Group 1 was shorter than that of Group 2 (1.38 ± 0.55 vs. 1.90 ± 1.81 days, p < 0.001).Conclusions: Even for cases of residual BPH, salvage HoLEP is a feasible and effective procedure for treating residual adenoma along the anatomical plane.

Holmium Laser Enucleation of the Prostate (HoLEP) for Small, Large and Giant Prostatic Hyperplasia: Tips and Tricks

2017 ◽  
Vol 84 (3) ◽  
pp. 169-173 ◽  
Author(s):  
Petr V. Glybochko ◽  
Leonid M. Rapoport ◽  
Mikhail E. Enikeev ◽  
Dmitry V. Enikeev
Keyword(s):  
Holmium Laser ◽  
Tips And Tricks ◽  
Laser Enucleation ◽  
Group 3 ◽  
Group 2 ◽  
Postvoid Residual Volume ◽  
Holmium Laser Enucleation ◽  
Group 1

Introduction Holmium laser enucleation of the prostate (HoLEP) allows to treat extremely large prostates (>200 cm3). The aim of the study was to compare the efficiency of HoLEP for prostates of different sizes. Methods Four hundred and fifty-nine patients were divided into three groups: group 1 included 278 patients (<100 cm3); group 2 included 169 patients (100-200 cm3); group 3 included 12 patients (>200 cm3). Results The duration of enucleation in group 1 was 56.5 ± 10.7 min; in group 2 was 96.4 ± 24.9 min; in group 3 was 120.9 ± 35 min. The duration of morcellation in group 1 was 37.5 ± 7.3 min; in group 2 was 63.3 ± 11.2 min; in group 3 was 84.0 ± 25.6 min. The enucleation efficiency in group 3 (1.70 g/min) was higher (p<0.05) than in group 1 (1.05 g/min) and group 2 (1.23 g/min). Morcelation efficiency was lower in groups 1 and 2 (1.58 and 1.87 g/min, respectively) than in group 3 (2.45 g/min) (p<0.05). Follow-up period lasted 18 months. There were no significant differences (p>0.05) in International Prostate Symptom Score, Qmax, quality of life and postvoid residual volume for 1, 3, 6, 12 and 18 months after surgery. Conclusions HoLEP is a safe, highly efficacious and a size-independent procedure.

scholarly journals Safety and efficacy of Holmium laser enucleation of the prostate (HoLEP) in patients with previous transperineal biopsy (TPB): outcomes from a dual-centre case-control study

BMC Urology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Chris Bell ◽  
Sacha L. Moore ◽  
Amarit Gill ◽  
Obinna Obi-Njoku ◽  
Stephen F. Hughes ◽  
...  
Keyword(s):  
Holmium Laser ◽  
Operative Outcomes ◽  
Significant Difference ◽  
Laser Enucleation ◽  
Baseline Characteristics ◽  
Group 2 ◽  
Transperineal Biopsy ◽  
Holmium Laser Enucleation ◽  
Control Study ◽  
Group 1

Abstract Background We investigated the surgical feasibility, safety and effectiveness of 50 W (low power) Holmium Laser enucleation of the prostate (HoLEP) in patients who have undergone previous template biopsy of the prostate (TPB). Methods Data encompassing pre-operative baseline characteristics, intra-operative measures and post-operative outcomes was collected for 109 patients undergoing HoLEP across two UK centres. Patients were stratified into two groups; group 1 (n = 24) had undergone previous TPB were compared with ‘controls’ (no previous TPB) in group 2 (n = 85). The primary outcome was successful HoLEP. Results There were no statistically significant differences in either key baseline characteristics or mass of prostate enucleated between groups 1 and 2. There was no statistically significant difference in enucleation or morcellation times parameters between the two groups other than enucleation efficiency in favour of group 1 (p = 0.024). Functional outcomes improved, without any statistically significant difference, in both groups. Conclusions In patients with a previous TPB, HoLEP is surgically feasible, safe and effective. TPB should not be considered a contraindication to HoLEP. Our work provides a strong foundation for further research in this area.

scholarly journals Multiparametric MRI may Help to Identify Patients With Prostate Cancer in a Contemporary Cohort of Patients With Clinical Bladder Outlet Obstruction Scheduled for Holmium Laser Enucleation of the Prostate (HoLEP)

2021 ◽  
Vol 8 ◽  
Author(s):  
Mike Wenzel ◽  
Maria N. Welte ◽  
Lina Grossmann ◽  
Felix Preisser ◽  
Lena H. Theissen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Logistic Regression ◽  
Prostate Biopsy ◽  
Bladder Outlet Obstruction ◽  
Tertiary Care ◽  
Digital Rectal Examination ◽  
Outlet Obstruction ◽  
Holmium Laser ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

Objective: To investigate the value of standard [digital rectal examination (DRE), PSA] and advanced (mpMRI, prostate biopsy) clinical evaluation for prostate cancer (PCa) detection in contemporary patients with clinical bladder outlet obstruction (BOO) scheduled for Holmium laser enucleation of the prostate (HoLEP).Material and Methods: We retrospectively analyzed 397 patients, who were referred to our tertiary care laser center for HoLEP due to BOO between 11/2017 and 07/2020. Of those, 83 (20.7%) underwent further advanced clinical PCa evaluation with mpMRI and/or prostate biopsy due to elevated PSA and/or lowered PSA ratio and/or suspicious DRE. Logistic regression and binary regression tree models were applied to identify PCa in BOO patients.Results: An mpMRI was conducted in 56 (66%) of 83 patients and revealed PIRADS 4/5 lesions in 14 (25%) patients. Subsequently, a combined systematic randomized and MRI-fusion biopsy was performed in 19 (23%) patients and revealed in PCa detection in four patients (5%). A randomized prostate biopsy was performed in 31 (37%) patients and revealed in PCa detection in three patients (4%). All seven patients (9%) with PCa detection underwent radical prostatectomy with 29% exhibiting non-organ confined disease. Incidental PCa after HoLEP (n = 76) was found in nine patients (12%) with advanced clinical PCa evaluation preoperatively. In univariable logistic regression analyses, PSA, fPSA ratio, and PSA density failed to identify patients with PCa detection. Conversely, patients with a lower International Prostate Symptom Score (IPSS) and PIRADs 4/5 lesion in mpMRI were at higher risk for PCa detection. In multivariable adjusted analyses, PIRADS 4/5 lesions were confirmed as an independent risk factor (OR 9.91, p = 0.04), while IPSS did not reach significance (p = 0.052).Conclusion: In advanced clinical PCa evaluation mpMRI should be considered in patients with elevated total PSA or low fPSA ratio scheduled for BOO treatment with HoLEP. Patients with low IPSS or PIRADS 4/5 lesions in mpMRI are at highest risk for PCa detection. In patients with a history of two or more sets of negative prostate biopsies, advanced clinical PCa evaluation might be omitted.

scholarly journals Is Holmium Laser Enucleation of the Prostate a Good Surgical Alternative in Benign Prostatic Hyperplasia Management? A Review Article

2020 ◽  
Vol 11 (2) ◽  
pp. 197-203 ◽  
Author(s):  
Amirreza Abedi ◽  
Mohammad Reza Razzaghi ◽  
Amirhossein Rahavian ◽  
Ebrahim Hazrati ◽  
Fereshte Aliakbari ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Specific Antigen ◽  
Young Patients ◽  
Outlet Obstruction ◽  
Prostatic Hyperplasia ◽  
Holmium Laser ◽  
Safe Procedure ◽  
Open Prostatectomy ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

Several therapeutic approaches such as holmium laser enucleation of the prostate (HoLEP) have been introduced to relieve bladder outlet obstruction caused by benign prostatic hyperplasia (BPH). Compared with other techniques including the transurethral resection of the prostate (TURP) and simple open prostatectomy, HoLEP results in a shorter hospital stay and catheterization time and fewer blood loss and transfusions. HoLEP is a size-independent treatment option for BPH with average gland size from 36 g to 170 g. HoLEP is a safe procedure in patients receiving an anticoagulant and has no significant influence on the hemoglobin level. Also, HoLEP is an easy and safe technique in patients with a prior history of prostate surgery and a need for retreatment because of adenoma regrowth. The postoperative erectile dysfunction rate of patients treated with HoLEP is similar to TURP or open prostatectomy and about 77% of these patients experience loss of ejaculation. Patients with transitional zone volume less than 30 mL may suffer from persistent stress urinary incontinence following HoLEP so other surgical techniques like bipolar TURP are a good choice for these patients. In young patients, considering HoLEP with high prostate-specific antigen density and a negative standard template prostate biopsy, multiparametric MRI needs to be considered to exclude prostate cancer.

Does the sequential addition of accelerometer-based navigation and sensor-guided ligament balancing improve outcomes in TKA?

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 24-30
Author(s):  
Andrew T. Livermore ◽  
Jill A. Erickson ◽  
Brenna Blackburn ◽  
Christopher L. Peters
Keyword(s):  
Patient Reported Outcomes ◽  
Control Group ◽  
Complication Rates ◽  
Ligament Balancing ◽  
Patient Reported ◽  
Distal Femoral Resection ◽  
Sequential Addition ◽  
Group 2 ◽  
Femoral Resection ◽  
Group 1

Aims A significant percentage of patients remain dissatisfied after total knee arthroplasty (TKA). The aim of this study was to determine whether the sequential addition of accelerometer-based navigation for femoral component preparation and sensor-guided ligament balancing improved complication rates, radiological alignment, or patient-reported outcomes (PROMs) compared with a historical control group using conventional instrumentation. Methods This retrospective cohort study included 371 TKAs performed by a single surgeon sequentially. A historical control group, with the use of intramedullary guides for distal femoral resection and surgeon-guided ligament balancing, was compared with a group using accelerometer-based navigation for distal femoral resection and surgeon-guided balancing (group 1), and one using navigated femoral resection and sensor-guided balancing (group 2). Primary outcome measures were Patient-Reported Outcomes Measurement Information System (PROMIS) and Knee injury and Osteoarthritis Outcome (KOOS) scores measured preoperatively and at six weeks and 12 months postoperatively. The position of the components and the mechanical axis of the limb were measured postoperatively. The postoperative range of motion (ROM), haematocrit change, and complications were also recorded. Results There were 194 patients in the control group, 103 in group 1, and 74 in group 2. There were no significant differences in baseline demographics between the groups. Patients in group 2 had significantly higher baseline mental health subscores than control and group 1 patients (53.2 vs 50.2 vs 50.2, p = 0.041). There were no significant differences in any PROMs at six weeks or 12 months postoperatively (p > 0.05). There was no difference in the rate of manipulation under anaesthesia (MUA), complication rates, postoperative ROM, or blood loss. There were fewer mechanical axis outliers in groups 1 and 2 (25.2%, 14.9% respectively) versus control (28.4%), but this was not statistically significant (p = 0.10). Conclusion The sequential addition of navigation of the distal femoral cut and sensor-guided ligament balancing did not improve short-term PROMs, radiological outcomes, or complication rates compared with conventional techniques. The costs of these added technologies may not be justified. Cite this article: Bone Joint J 2020;102-B(6 Supple A):24–30.

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