Comparison of different en bloc holmium laser enucleation of the prostate techniques to reduce the rate of postoperative transient urinary incontinence

Objective To investigate postoperative risk factors for transient urinary incontinence (TUI) after different en bloc holmium laser enucleation of the prostate (HoLEP) techniques. Methods We retrospectively analyzed 169 consecutive patients who underwent HoLEP using the original en bloc technique (n = 41), en bloc with early mucosal strip detachment technique (n = 72), and three horseshoe-shaped incisions technique (n = 56) to treat bladder outlet obstruction from January 2017 to October 2019. Preoperative variables and surgical quality indexes were compared between the groups. TUI was defined as any hygienic or social problem caused by involuntary loss of urine at 2 weeks postoperatively. The postvoid residual urine volume, maximum urinary flow rate, and International Prostate Symptom Score (IPSS) were assessed. Results Among all three techniques, the three horseshoe-shaped incisions technique was significantly associated with the lowest incidence of TUI and the lowest IPSS. Although not statistically significant, the three horseshoe-shaped incisions group also showed a trend toward a faster enucleation time. No life-threatening intraoperative complications occurred in any group. Conclusion Use of three horseshoe-shaped incisions in en bloc HoLEP prevented urethral sphincter damage with a low rate of postoperative TUI. Further long-term, multicenter comparative assessment is required. Research Registry number: 6848

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MP02-14 FIRST POST-VOID RESIDUAL URINE VOLUME FOLLOWING HOLMIUM LASER ENUCLEATION OF THE PROSTATE: PREDICTOR OF DE NOVO URINARY INCONTINENCE

The Journal of Urology ◽

10.1016/j.juro.2017.02.110 ◽

2017 ◽

Vol 197 (4S) ◽

Author(s):

Jun Seok Kim ◽

Dong Hoon Yoo ◽

Dong Hoon Lim ◽

Myung Ki Kim ◽

Hee Jong Jeong ◽

...

Keyword(s):

Urinary Incontinence ◽

De Novo ◽

Urine Volume ◽

Holmium Laser ◽

Residual Urine Volume ◽

Residual Urine ◽

Laser Enucleation ◽

Holmium Laser Enucleation

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Holmium laser enucleation of the prostate: A single-centre case series of 1000 patients

Journal of Clinical Urology ◽

10.1177/20514158211033741 ◽

2021 ◽

pp. 205141582110337

Author(s):

Danielle Whiting ◽

Branimir Penev ◽

Katherine Guest ◽

Mark Cynk

Keyword(s):

Case Series ◽

Reoperation Rate ◽

Late Complications ◽

Holmium Laser ◽

Urinary Flow ◽

Single Centre ◽

Level Of Evidence ◽

Laser Enucleation ◽

Holmium Laser Enucleation

Objective: To describe the short and long-term complications of over 1000 cases of Holmium laser enucleation of the prostate (HoLEP) in a single centre. Methods: A prospective database of all HoLEP procedures performed between December 2003 and March 2017 was analysed. Results: A total of 1016 HoLEP procedures were performed. Median patient age was 72 years (range 41–95). There was a significant improvement in urinary flow, post-void residual volume, IPSS and QoL score ( p < 0.0001). Pre-operative acute urinary retention was present in 403 patients (39.7%). Post-operatively five patients (1.2%) continued with a long-term catheter. Early and late complications consisted of failed initial voiding trial (10.6%), stress incontinence (transient 6.5%; persistent 0.3%), frequency/dysuria (5.6%), urinary tract infection (5.3%), urethral stricture (4.8%), submeatal stenosis (1.9%), return to theatre (1.5%), bladder neck stenosis (1.3%), bleeding (1.2%), epididymitis (0.7%), confusion (0.3%), transurethral resection of the prostate conversion (0.2%), ureteric obstruction (0.2%), vomiting (0.2%), anuric renal failure (0.1%), chest infection (0.1%), chest pain (0.1%), myocardial infarction (0.1%), rectoprostatic fistula (0.1%), supraventricular tachycardia (0.1%) and urinary sepsis (0.1%). Five-year reoperation rate was 3.7%. Conclusion: HoLEP is a safe treatment for bladder outflow obstruction secondary to an enlarged prostate. It is associated with few early and late complications and has a low reoperation rate. Level of evidence: 4

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Holmium laser enucleation of the prostate with Virtual Basket mode: faster and better control on bleeding

BMC Urology ◽

10.1186/s12894-021-00797-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Giorgio Bozzini ◽

Matteo Maltagliati ◽

Umberto Besana ◽

Lorenzo Berti ◽

Albert Calori ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Operative Time ◽

Randomized Study ◽

Urine Volume ◽

Holmium Laser ◽

Laser Enucleation ◽

Holmium Laser Enucleation ◽

Irrigation Volume

Abstract Background To compare clinical intra and early postoperative outcomes between conventional Holmium laser enucleation of the prostate (HoLEP) and Holmium laser enucleation of the prostate using the Virtual Basket tool (VB-HoLEP) to treat benign prostatic hyperplasia (BPH). Methods This prospective randomized study enrolled consecutive patients with BPH, who were assigned to undergo either HoLEP (n = 100), or VB-HoLEP (n = 100). All patients were evaluated preoperatively and postoperatively, with particular attention to catheterization time, operative time, blood loss, irrigation volume and hospital stay. We also evaluated the patients at 3 and 6 months after surgery and assessed maximum flow rate (Qmax), postvoid residual urine volume (PVR), the International Prostate Symptom Score (IPSS) and the Quality of Life score (QOLS). Results No significant differences in preoperative parameters between patients in each study arm were found. Compared to HoLEP, VB-HoLEP resulted in less hemoglobin decrease (2.54 vs. 1.12 g/dl, P = 0.03) and reduced operative time (57.33 ± 29.71 vs. 42.99 ± 18.51 min, P = 0.04). HoLEP and VB-HoLEP detrmined similar catheterization time (2.2 vs. 1.9 days, P = 0.45), irrigation volume (33.3 vs. 31.7 l, P = 0.69), and hospital stay (2.8 vs. 2.7 days, P = 0.21). During the 6-month follow-up no significant differences in IPSS, Qmax, PVR, and QOLS were demonstrated. Conclusions HoLEP and VB-HoLEP are both efficient and safe procedures for relieving lower urinary tract symptoms. VB-HoLEP was statistically superior to HoLEP in blood loss and operative time. However, procedures did not differ significantly in catheterization time, hospital stay, and irrigation volume. No significant differences were demonstrated in QOLS, IPSS, Qmax and PVR throughout the 6-month follow-up. Trial Registration: Current Controlled Trials ISRCTN72879639; date of registration: June 25th, 2015. Retrospectively registred.

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

Journal of lasers in medical sciences ◽

10.34172/jlms.2020.33 ◽

2020 ◽

Vol 11 (2) ◽

pp. 197-203 ◽

Cited By ~ 1

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.

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Preoperative predictors of enucleation time during en bloc no-touch holmium laser enucleation of the prostate

10.21203/rs.3.rs-36182/v1 ◽

2020 ◽

Author(s):

Chun-Hsuan Lin ◽

Ching-Chia Li ◽

Wen-Jeng Wu ◽

Sheng-Chen Wen

Keyword(s):

Operation Time ◽

Holmium Laser ◽

En Bloc ◽

Symptomatic Benign Prostatic Hyperplasia ◽

Clinical Variables ◽

Specimen Weight ◽

History Of ◽

Laser Enucleation ◽

Holmium Laser Enucleation ◽

Preoperative Predictors

Abstract Background To evaluate preoperative predictors of enucleation time during en bloc no-touch holmium laser enucleation of the prostate (HoLEP) Methods We enrolled 135 patients with symptomatic benign prostatic hyperplasia (BPH) treated with en bloc no-touch HoLEP from July 2017 to March 2019 by a single surgeon. Preoperative, perioperative, and postoperative clinical variables were examined. Stepwise linear regression was performed to determine clinical variables associated with enucleation times. Result The average (range) enucleation time was 46.1 (12–220) minutes, and the overall operation time was 71 (18–250) minutes. History of anticoagulation, history of urinary tract infection (UTI), and increasing specimen weight were each significantly associated with increasing enucleation time. No category IV complications were recorded, and all complications were evenly distributed among the groups according to the HoLEP specimen weight. Conclusion En bloc no-touch HoLEP was found to be an efficient and reproducible surgical method for treating BPH. Prostatic gland size was significantly associated with increased enucleation times. Similarly, history of UTI and anticoagulation were correlated with increased operative time.

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MP27-03 PREDICTION OF URGE URINARY INCONTINENCE (UUI) AFTER HOLMIUM LASER ENUCLEATION OF PROSTATE (HOLEP): REVISITING THE URODYNAMIC DETRUSOR OVERACTIVITY (DO)

The Journal of Urology ◽

10.1016/j.juro.2017.02.795 ◽

2017 ◽

Vol 197 (4S) ◽

Author(s):

Myong Kim ◽

Tai Young Ahn ◽

Myung-Soo Choo

Keyword(s):

Urinary Incontinence ◽

Detrusor Overactivity ◽

Urge Urinary Incontinence ◽

Holmium Laser ◽

Laser Enucleation ◽

Holmium Laser Enucleation

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Significance of Membranous Urethral Length for Recovery From Postoperative Urinary Incontinence Following Holmium Laser Enucleation of the Prostate

International Neurourology Journal ◽

10.5213/inj.2040042.021 ◽

2020 ◽

Vol 24 (4) ◽

pp. 358-364

Author(s):

Shintaro Oka ◽

Keita Kobayashi ◽

Kenji Matsuda ◽

Kimio Takai

Keyword(s):

Urinary Incontinence ◽

Recovery Time ◽

Spin Echo ◽

Recovery Period ◽

Holmium Laser ◽

Fast Spin Echo ◽

Rank Test ◽

Early Recovery ◽

Laser Enucleation ◽

Holmium Laser Enucleation

Purpose: The aim of this study was to determine the significance of the membranous urethral length (MUL), including the thickness of the urethral sphincter, for recovery from postoperative stress urinary incontinence (SUI) following holmium laser enucleation of the prostate (HoLEP).Methods: We analyzed 78 patients who underwent HoLEP between June 2013 and September 2018, all of whom preoperatively received magnetic resonance imaging. MUL was measured using sagittal T2-weighted fast spin-echo images. The clinical and anatomical factors associated with MUL were evaluated. The recovery time of urinary incontinence was compared between patients with a long MUL (≥14 mm) and a short MUL (<14 mm). SUI included both stress and mixed urinary incontinence. Continence was defined as complete dryness.Results: The median MUL in patients without incontinence at 1 month postoperatively was significantly longer than the MUL in patients with incontinence (15.3 mm vs. 12.7 mm, P<0.001). The continence rates at 1 month after HoLEP in patients with longer MULs and shorter MULs were 80.4% and 30.0%, respectively. The recovery time of urinary incontinence in patients with longer MULs (≥14 mm) was significantly shorter than that in patients with shorter MULs (<14 mm) (log-rank test, P=0.001). After 6 months, the continence rates in patients with longer MULs and shorter MULs were similar (97%). MUL was significantly correlated with the recovery period of urinary incontinence (r=-0.459, P<0.001).Conclusions: MUL was useful for predicting early recovery from urinary incontinence following HoLEP. This study provides evidence that postoperative urinary incontinence following a transurethral procedure for benign prostatic hyperplasia was associated with anatomical factors. A long MUL was associated with better tolerance to urinary sphincter damage by the transurethral procedure.

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Comparison of Bipolar Plasma Vaporization versus Standard Holmium Laser Enucleation of the Prostate: Surgical Procedures and Clinical Outcomes for Small Prostate Volumes

Journal of Clinical Medicine ◽

10.3390/jcm8071007 ◽

2019 ◽

Vol 8 (7) ◽

pp. 1007 ◽

Cited By ~ 1

Author(s):

Kang Sup Kim ◽

Sung Hyun Lee ◽

Hyuk Jin Cho ◽

Hong Jin Suh ◽

Dong Hwan Lee ◽

...

Keyword(s):

Statistical Significance ◽

Benign Prostatic Hypertrophy ◽

Holmium Laser ◽

Patient Comfort ◽

Attractive Alternative ◽

Transurethral Resection Of Prostate ◽

Urinary Flow ◽

Surgical Safety ◽

Laser Enucleation ◽

Holmium Laser Enucleation

Bipolar plasma vaporization of the prostate (BPVP) is an attractive alternative to resection. There are numerous studies comparing transurethral resection of prostate or photoselective vaporization of the prostate with BPVP; however, there is a lack of data comparing holmium laser enucleation of the prostate (HoLEP) with BPVP. We aimed to compare HoLEP and BPVP with a focus on functional outcomes, safety, and complications. Methods: From January 2017 to June 2018, patients who underwent HoLEP or BPVP for benign prostatic hypertrophy were enrolled in this study. Inclusion criteria were a prostate volume <40 mL measured by transrectal ultrasound, international prostate symptom score (IPSS) >7, maximum urinary flow rate (Qmax) <15 mL/s, and postvoiding residual volume (PVR) >100 mL. Perioperative and postoperative parameters including IPSS, Qmax, quality of life, PVR, and complications were compared between groups. Results: Sixty-three patients were enrolled in this study. There were small differences in perioperative parameters. Hospital stays and catheterization periods were significantly shorter in the BPVP group. The postoperative complications were comparable between groups. PVR was comparable in both groups except for 1 month postoperatively. The incontinence rate was higher in the HoLEP group, but without statistical significance. Conclusion: In terms of surgical safety and efficacy as well as patient comfort, BPVP is comparable with HoLEP for small prostate volumes. BPVP can be a viable alternative technique in small BPH surgical treatment.

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