scholarly journals Hip Corticosteroid/Anesthetic Injections—Are the reported rates of osteoarthritis progression and femoral head collapse real?

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0024
Author(s):  
Paul Abraham ◽  
Nathan Varady ◽  
Kirstin Small ◽  
Nehal Shah ◽  
Luis Beltran ◽  
...  
Keyword(s):  
Femoral Head ◽  
Selection Bias ◽  
Insufficiency Fracture ◽  
Case Series ◽  
Unknown Etiology ◽  
Control Group ◽  
Complication Rates ◽  
Matched Pairs ◽  
Femoral Head Collapse ◽  
Group 2

Objectives: In the absence of definitive Level I evidence regarding the safety of hip CSI, there have been an increasing number of retrospective case series studying outcomes after hip corticosteroid injection (CSI). Recent studies have suggested that hip CSI may be associated with increased rates of avascular necrosis (AVN), subchondral insufficiency fracture (SIF), femoral head articular surface collapse, and accelerated progression of osteoarthritis (OA), but these studies do not compare against a control arm matched for baseline OA severity or exclude patients with pre-injection AVN or SIF from analysis, causing selection bias. The purpose of this study was to compare complication rates in patients treated with and without CSI, while minimizing the aforementioned selection bias. Methods: For all patients at our institution who had undergone hip CSI between 2007 and 2019 and hip magnetic resonance imaging (MRI) within the preceding 12 months (CSI cohort), two musculoskeletal radiologists retrospectively reviewed hip radiographs taken within 12 months prior to and after CSI and graded OA severity (modified Kellgren-Lawrence classification) and femoral head collapse, blinded to cohort and timepoint. The same was done for a hip control cohort (matched for age, sex, BMI, and OA severity on baseline radiograph reports) that had undergone hip MRI and pre- and post-MRI hip radiographs within 12 months. A third reader arbitrated discrepant reads. OA progression was defined as an increase in modified Kellgren-Lawrence grade ≥1 between radiographs. Matched pairs with at least one incidence of pre-existing AVN or SIF on index MRI were excluded for analysis. Results: 186 hips in the CSI group [mean ±95% CI age: 55.8±2.1, mean±95% CI BMI: 27.5±0.8, 69 (37.1%) males, 100 (53.8%) right hips] and 186 hips in the control group [mean ±95% CI age: 55.7±2.3, mean±95% CI BMI: 28.0±0.8, 69 (37.1%) males, 96 (51.6%) right hips] were included in this study. There were no significant differences between groups in age, gender, BMI, laterality, baseline OA severity, or baseline AVN/SIF on index MRI. Analysis of adjudicated radiographic outcomes were performed after exclusion of 61 matched pairs with at least 1 instance of pre-existing AVN or SI (Table 1). Rates of OA progression (5.6% vs. 2.4%; p=0.33), new AVN or SIF (1.6% vs. 0.0%; p=0.50), and new femoral head collapse (3.2% vs. 2.4%; p=1.000) were all similar between groups. Of the 4 cases of new femoral head collapse in the CSI group, 2 were classified as femoral head remodeling secondary to OA, leaving only two (1.6%) definitive femoral head collapses secondary to AVN or SIF. Of the 3 cases of new femoral head collapse in the control group, 2 were classified as femoral head remodeling due to an unknown etiology, leaving only one (0.8%) definitive femoral head collapses secondary to AVN or SIF. (Tables 1, 2, 3) Conclusions: When controlling for baseline OA severity and pre-existing AVN or SIF, patients treated by CSI in our study showed OA progression in only 6% of cases and new femoral head collapse in only 3% of cases, which was not significantly greater than control and similar to the expected progression of natural disease. Future multicenter, randomized, double-blind, placebo-controlled trials investigating safety of hip CSI are needed. [Table: see text][Table: see text][Table: see text]

scholarly journals The significance of polymorphisms of gene coagulation factors VII and XIII in the pathogenesis of non-traumatic avascular necrosis of the femoral head

2021 ◽  
Vol 27 (1) ◽  
pp. 43-47
Author(s):  
M.A. Panin ◽  
◽  
N.V Zagorodnii ◽  
A.V. Boiko ◽  
L.M. Samokhodskaya ◽  
...  
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Coagulation Factors ◽  
Group Differences ◽  
Unknown Etiology ◽  
Control Group ◽  
Study Group ◽  
Control Groups ◽  
Aseptic Necrosis ◽  
And Control

Introduction Non-traumatic avascular necrosis of the femoral head (ANFH) is a poly-etiologic and socially significant disease in the age of 20 to 50 years and is associated with disability. Research on the identification of necrosis causes/predictors is a relevant issue. Purpose To study the contribution of polymorphisms in the genes of coagulation factors F7 and F13 in the aetiology of non-traumatic avascular necrosis of the femoral head. Methods Polymorphisms of the genes of coagulation factors F7 and F13 were studied; comparative analysis of the frequency of important allelic variants of F7genes (Arg353Gln) and F13 (Val134Leu) in patients with a verified diagnosis of aseptic necrosis (study group) and in healthy patients (control group) was performed. The study group included 41 patients (all males) with aseptic necrosis of the femoral head of unknown etiology. Results The frequency of gene alleles in the F7 Arg353Gln in the study group were: GG in 30 out of 41 patients (73.2 %), GA in 11 out of 41 patients (26.8 %), and none of 41 patients had a polymorphic variant AA. The frequency of alleles of this type of gene in the control group was as follows: GG in 7 out of 320 subjects (2.2 %), GA in 66 out of 320 patients (20.6 %), AA in 247 out of 320 (77.2 %). Significant differences were identified in the frequencies of homozygous genotypes, AA (χ2 = 100.215, p < 0.001) and GG (χ2 = 205.770, p < 0.001) in the study and control groups respectively. As for the heterozygous GA genotype, the differences were not significant (χ2 = 0.834, p = 0.362). The GG genotype of the gene Val134Leu F13 WAS 2.8 times more frequent in patients of the study group, differences were statistically significant (26.8 % against 9.7 %, χ2 = 10.388; p = 0.002). The presence of the TT genotype of the gene Val134Leu F13 was almost five times more frequent (χ2 = 18.956, p < 0.001) in healthy individuals (control group). Differences in the frequency of allele T in homo/ and heterozygous combinations (TT and GT) in the study and control groups was also significant (72.7 % vs 90.1 %, respectively, χ2 = 4.946, p = 0.027). Discussion Polymorphisms of coagulation factors genes F7 and F13 have a significant effect on the genesis of non-traumatic avascular necrosis of the femoral head. Risk factor of ANFH development is homozygous GG genotype in the gene Arg353Gln F7. Low probability of the disease is due to a protective role of AA genotype of the gene Arg353Gln F7 and TT genotype of the gene Val134Leu F13.

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.

scholarly journals Pathological progress of traumatic femur head necrosis after femoral neck fracture in children and adolescents: a case series study

2021 ◽  
Author(s):  
Fan Yang ◽  
Zhikun Zhuang ◽  
Yonggang Tu ◽  
Zhinan Hong ◽  
Fengxiang Pang ◽  
...  
Keyword(s):  
High Risk ◽  
Femoral Head ◽  
Femoral Neck ◽  
Case Series ◽  
Femur Head ◽  
Children And Adolescent ◽  
Femoral Head Collapse ◽  
Femur Head Necrosis ◽  
Hip Deformity ◽  
Neck Fracture

Abstract The pathological progression and prognosis of traumatic femur head necrosis (TFHN) after femoral neck fracture (FNF) in children and adolescent is relatively unknown and has never been specifically characterized. As we speculated, the prognosis in such population would be poor and characterized as the high risk of femoral head collapse, hip deformity and degeneration in a short term. This retrospective case series enrolled 64 children and adolescent with TFHN who treated with observational treatment from 2000.1 to 2018.1. The primary outcomes, the progression of femoral head collapse, hip deformity (Stulberg classification) and hip degeneration (Tönnis grade), and their prognostic factors were analysed. Sixty-four patients with a mean age of 13 years (6–16 years) were included. A total of 28 hips (44%) showed unsatisfactory outcome and 25 (39%) hips collapsed progressively during a mean follow-up of 48 months (24–203 months). Finally, 38 hips (59%) experienced hip deformity, 20 of them were Class IV/V. Thirty-four hips (53%) generally progressed to osteoarthritis, 14 of them were classified as Grades II/III. The location of the lesion and the presence of subluxation were found to be related to progression of collapse; however, the presence of subluxation was the only independent risk factor of severe hip deformity and degeneration. TFHN in children and adolescent is a rapidly progressing disease with a poor prognosis characterized by a high risk of femoral head collapse progression. If the subluxation emerged, collapsed cases showed increasingly tendency towards hip deformity and degeneration.

scholarly journals The natural history of traumatic femur head necrosis after femoral neck fracture in children and adolescent: a retrospective case series of 64 patients

2020 ◽  
Author(s):  
Fan Yang ◽  
Yonggang Tu ◽  
Zhinan Hong ◽  
Fengxiang Pang ◽  
Wei He ◽  
...  
Keyword(s):  
Femoral Head ◽  
Natural History ◽  
Case Series ◽  
Retrospective Case ◽  
Children And Adolescent ◽  
Femoral Head Collapse ◽  
Lateral Subluxation ◽  
Hip Deformity ◽  
Neck Fracture ◽  
History Of

Abstract Background: The natural history of traumatic femur head necrosis (TFHN) after femoral neck fracture (FNF) in children and adolescent is relatively unknown and has never been specifically characterized. As we speculated, the natural history in such population would be poor and characterized as the high risk of femoral head collapse, hip deformity and degeneration in a short term. Methods: This retrospective case series enrolled 64 children and adolescent with TFHN who treated with observational treatment from 2000.1 to 2018.1. The primary outcomes, such as the progression of femoral head collapse, hip deformity (Stulberg classification) and hip degeneration (Tönnis grade), and their prognostic factors were analysed. Results: 42 males and 22 females with a mean age of 13 years (6-16 years), were included. A total of 28 hips (44%) showed unsatisfactory outcome and Twenty-five (39%) hips collapsed progressively during a mean follow-up of 48 months (24-203 months). Finally, 38 hips (59%) experienced hip deformity, 20 of them were class IV/V. 34 hips (53%) generally progressed to osteoarthritis, 14 of them were classified as grades II/III. The location of the lesion and the presence of lateral subluxation were found to be independently related to progression of femoral head collapse; however, the presence of lateral subluxation was the only independent risk factor of severe hip deformity and degeneration. Conclusion: TFHN in children and adolescent is a rapidly progressing disease with a poor natural history characterized by a high risk of femoral head collapse progression. If the lateral subluxation emerged, collapsed cases showed increasingly tendency towards severe hip deformity and degeneration.

scholarly journals Pathological progress and prognosis of traumatic femur head necrosis after femoral neck fracture in children and adolescent: a retrospective case series of 64 patients

2020 ◽  
Author(s):  
Fan Yang ◽  
Yonggang Tu ◽  
Zhinan Hong ◽  
Fengxiang Pang ◽  
Wei He ◽  
...  
Keyword(s):  
Femoral Head ◽  
Case Series ◽  
Femur Head ◽  
Retrospective Case ◽  
Children And Adolescent ◽  
Femoral Head Collapse ◽  
Femur Head Necrosis ◽  
Lateral Subluxation ◽  
Hip Deformity ◽  
Neck Fracture

Abstract Background: The pathological progression and prognosis of traumatic femur head necrosis (TFHN) after femoral neck fracture (FNF) in children and adolescent is relatively unknown and has never been specifically characterized. As we speculated, the prognosis in such population would be poor and characterized as the high risk of femoral head collapse, hip deformity and degeneration in a short term.Methods: This retrospective case series enrolled 64 children and adolescent with TFHN who treated with observational treatment from 2000.1 to 2018.1. The primary outcomes, such as the progression of femoral head collapse, hip deformity (Stulberg classification) and hip degeneration (Tönnis grade), and their prognostic factors were analysed.Results: 42 males and 22 females with a mean age of 13 years (6-16 years), were included. A total of 28 hips (44%) showed unsatisfactory outcome and Twenty-five (39%) hips collapsed progressively during a mean follow-up of 48 months (24-203 months). Finally, 38 hips (59%) experienced hip deformity, 20 of them were class IV/V. 34 hips (53%) generally progressed to osteoarthritis, 14 of them were classified as grades II/III. The location of the lesion and the presence of lateral subluxation were found to be independently related to progression of femoral head collapse; however, the presence of lateral subluxation was the only independent risk factor of severe hip deformity and degeneration.Conclusion: TFHN in children and adolescent is a rapidly progressing disease with a poor prognosis characterized by a high risk of femoral head collapse progression. If the lateral subluxation emerged, collapsed cases showed increasingly tendency towards severe hip deformity and degeneration.

Livebirths With Placental Hemorrhagic Endovasculitis

2002 ◽  
Vol 126 (2) ◽  
pp. 157-164 ◽  
Author(s):  
C. Maureen Sander ◽  
Dennis Gilliland ◽  
Cheryl Akers ◽  
Ann McGrath ◽  
Tarek A. Bismar ◽  
...  
Keyword(s):  
Fetal Distress ◽  
Unknown Etiology ◽  
Control Group ◽  
Case Group ◽  
Clinical Implications ◽  
Complication Rates ◽  
Perinatal Complications ◽  
Associated Lesions ◽  
Maternal Hypertension ◽  
Clinical Records

Abstract Background and Objective.—Hemorrhagic endovasculitis (HEV) is a vasodisruptive alteration of fetal-placental blood vessels that has been associated with perinatal morbidity and mortality and abnormalities of growth and development. Clinicopathologic conditions that are often identified in pregnancies with HEV-affected placentas include villitis of unknown etiology, chorionic vessel thrombi, villous erythroblastosis, meconium staining, and maternal hypertension. The clinical implications of HEV are often disputed. This case-control study assesses the clinical relevance of HEV in placentas of viable infants and examines the interplay of coexistent intraplacental lesions. Methods.—We reviewed clinical records and slides from 104 livebirths with placentas affected by HEV above a specified severity level (cases) and 104 matched livebirths with placentas that were not affected by HEV (controls). We evaluated incidences of perinatal complications with increasing HEV severity indices in placentas with and without coexistent lesions. Interlesional relationships were established by matching HEV severity indices with severity indices of coexistent lesions. Hemorrhagic endovasculitis was subcategorized into active, bland, and healed forms and clustered capillary lesions (hemorrhagic villitis). Results.—Lesions that were frequently coexistent in HEV-affected placentas included villitis of unknown etiology, chorionic thrombi, villous fibrosis, erythroblastosis, and primary infarcts. Compared with the control group, the case group had higher incidences of abnormal fetal heart rate tracings (P &lt; .003), fetal distress (P &lt; .001), and growth restriction (P &lt; .001). Increasing severities of HEV and coexistent lesions were associated with higher rates of perinatal complications. Complication rates were higher in HEV cases, with or without coexistent lesions. The complication rate was higher in cases affected by HEV and hemorrhagic villitis than in cases affected by HEV alone (P &lt; .03). Significant interlesional relationships were evident between HEV and villitis of unknown etiology, chorionic thrombi, villous fibrosis, and erythroblastosis. Conclusions.—Severe forms of HEV can occur in placentas of livebirths. The severity of HEV and associated lesions and the presence of hemorrhagic villitis have important clinical implications. Interlesional relationships between HEV and thrombotic, chronic inflammatory, and chronic vaso-occlusive lesions exist. Pregnancies with HEV-affected placentas with or without coexistent lesions are at risk for perinatal complications.

scholarly journals Retrograde Intrarenal Surgery in Patients Who Previously Underwent Open Renal Stone Surgery

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Erdal Alkan ◽  
Ali Saribacak ◽  
Ahmet Oguz Ozkanli ◽  
Mehmet Murad Başar ◽  
Oguz Acar ◽  
...  
Keyword(s):  
Renal Stone ◽  
Perioperative Complications ◽  
Renal Stones ◽  
Control Group ◽  
Complication Rates ◽  
Retrograde Intrarenal Surgery ◽  
Renal Stone Surgery ◽  
Recorded Data ◽  
Group 2 ◽  
Control Group Group

Purpose. To ascertain whether retrograde intrarenal surgery (RIRS) is as effective in patients treated previously with open renal stone surgery (ORSS) on the same kidney as in patients with no previous ORSS.Methods. There were 32 patients with renal stones who had previous ORSS and were treated with RIRS in the study group (Group 1). A total of 38 patients with renal stones who had no previous ORSS and were treated with RIRS were selected as the control group (Group 2). Recorded data regarding preoperative characteristics of the patients, stone properties, surgical parameters, outcomes, SFRs (no fragments or small fragments <4 mm), and complications between groups were compared.Results. Mean age, mean BMI, mean hospital stay, and mean operative time were not statistically different between groups. Mean stone size (10.1 ± 5.6 versus 10.3 ± 4.2;p=0.551) and mean stone burden (25.4 ± 14.7 versus 23.5 ± 9.9;p=0.504) were also similar between groups. After the second procedures, SFRs were 100% and 95% in groups 1 and 2, respectivelyp=0.496. No major perioperative complications were seen.Conclusion. RIRS can be safely and effectively performed with acceptable complication rates in patients treated previously with ORSS as in patients with no previous ORSS.

Reduced fluence corneal cross-linking in mild to moderate keratoconus: One year-follow-up

2020 ◽  
pp. 112067212096656
Author(s):  
Seyed Reza Ghaffari ◽  
Saeed Khaheshi ◽  
Fateme Alipour ◽  
Somayye Mashhadi Farahani ◽  
Amir-Hooshang Beheshtnejad ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Eligible Patient ◽  
Case Series ◽  
Control Group ◽  
Data Analyst ◽  
Cell Counts ◽  
Group 2 ◽  
One Year ◽  
And Control

Purpose: To evaluate the safety and efficacy of reduced fluence CXL (lower dose of UV-A irradiation) in mild to moderate keratoconus. Setting: Farabi Eye Hospital, Tehran, Iran. Design: Non-randomized prospective comparative interventional case series. Every eligible patient included in the study (mild to moderate progressive keratoconus) was randomly allocated to case (reduced fluence) and control (standard) groups, except for bilateral patients. In these patients the eye with more advanced disease was allocated to control group and the other eye was randomly assigned in either case or control group. Operators performing refraction and images and the data analyst were masked, but patients and physicians were not. Methods: Forty-six eyes of 38 patients were recruited. Group 1 received 7 min (fluence of 3.8 J/cm2), while group 2 received 10 min of 9 mW/cm2 UV-A (fluence of 5.4 J/cm2). Visual, keratometric and biomechanical outcomes were compared between groups. Results: At last follow-up (mean12 months, range 6–24 months), there were no statistically significant differences in changes in uncorrected visual acuity, best corrected distance visual acuity, Kmax, Kmean, corneal hysteresis, corneal resistance factor, endothelial cell counts, demarcation line depth, and intraoperative pain scores between groups (all p-values < 0.05). Conclusion: The results of this study show comparable one-year outcomes between 3.8 and 5.4 J/cm2 accelerated CXL in mild to moderate keratoconus. Should the results of this study be confirmed in longer follow-ups, using a reduced fluence setting could be considered as an alternative to standard treatment in these patients.

How long does a hip-preserving surgery with vascularized pedicle iliac bone grafts for femur head necrosis last? A systematic review and meta-analysis of case series with an average more than 5-year follow-up

2020 ◽  
Author(s):  
Xingyang Zhu ◽  
Haitao Zhang ◽  
Xiaobo Sun ◽  
Yuqing Zeng ◽  
Feilong Li ◽  
...  
Keyword(s):  
Femoral Head ◽  
Meta Analysis ◽  
Case Series ◽  
Bone Grafts ◽  
Iliac Bone ◽  
Complication Rates ◽  
Success Rates ◽  
Conversion Rates ◽  
Hip Preserving Surgery

Abstract Background: Hip-preserving surgeries with vascularized pedicle iliac bone grafts (VPIBG) are effective for osteonecrosis of the femoral head (ONFH). However, few studies exist about the long-term efficacy of this procedure. The aim of this meta analysis was to investigate how long does this hip-preserving surgery last. Methods: A comprehensive search was carried out through PubMed, Embase and Cochrane Collaboration Library for all relevant studies up to November 2019. The literature search strategy contained Medical Subject Headings and terms relating to ONFH and bone transplantation. All included studies were articles on VBIPG for ONFH, with an average follow-up of more than 5 years. Interesting outcomes included clinical success rates, complications, and conversion rates of THA. The data from eligible studies were then extracted and synthesized. The pooled effect size (ES) and 95% confidence intervals (CIs) were calculated. Results: Ten studies were finally selected. Eight studies including 3413 hips were pooled into the meta-analysis of success rates, the overall ES was 0.89 (95% CI, 0.86–0.92). In subgroup analysis, the ES was 0.88 (95% CI, 0.78–0.98) and 0.90 (95% CI, 0.87–0.92) at an average 5-10 years and 10-15 years follow-up, respectively. Pooled analysis of THA conversion rates derived from 7 studies (3389 hips) showed the overall ES of 0.10 (95% CI, 0.09–0.11). Seven studies (3396 hips) were included in a meta-analysis of complication rates, and the overall ES was 0.12 (95% CI, 0.08–0.18). The most common complications were secondary wound healing (37.6%), numbness or paresthesia of the lateral thigh (22.4%), and deep vein thrombosis (19.6%). Conclusions: The hip-preserving surgery with VPIBG is a safe and effective treatment for early-stage ONFH, but it should be used with caution in the treatment of advanced femoral head necrosis. The pooled data from this study suggested that 90% of the hips in patients with ONFH lasted 10 years after this surgery. However, most of the included studies are case series, and these conclusions will need the support of high-quality research in the future.

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.

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