scholarly journals Holmium Laser enucleation of the prostate (HoLEP) versus Transurethral Resection of the Prostate (TURP)

2015 ◽  
Vol 42 (3) ◽  
pp. 165-170 ◽  
Author(s):  
Luís Eduardo Durães Barboza ◽  
Osvaldo Malafaia ◽  
Luiz Edison Slongo ◽  
Fernando Meyer ◽  
Paulo Afonso Nunes Nassif ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Symptom Score ◽  
Flow Rate ◽  
Transurethral Resection ◽  
International Prostate Symptom Score ◽  
Peak Flow ◽  
Prostatic Hyperplasia ◽  
Peak Flow Rate ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

<sec><title>OBJECTIVE:</title><p>to evaluate the effectiveness and applicability of Holmium laser enucleation of the prostate (HoLEP) - in the treatment of benign prostatic hyperplasia (BPH) - in comparison to transurethral resection of the prostate (TURP).</p></sec><sec><title>METHODS:</title><p>patients with symptomatic prostatic hyperplasia and candidates for surgical treatment were selected. Both procedures were explained and they had choosen HoLEP or TURP. At the hospital were collected: age, date of birth, international prostate symptom score, urinary peak flow rate, prostate volume, post-voiding residual urine, globular volume and serum PSA. At the procedure operating time, morcellating time (HoLEP), bladder mucosal injury and intercurrences were collected. At the first postoperative day, globular volume and sodium. Besides that were observed the catheter indwelling time and hospital stay and after 90 days, urinary peak flow rate and international prostate symptom score. Statistical analisys have been done partially by Sinpe(r) and also by a professional team.</p></sec><sec><title>RESULTS:</title><p>twenty patients in HoLEP group and 21 at TURP were operated. Baseline urinary peak flow rate was 8 ml/s in both groups and preoperative international prostate symptom score was 22 in HoLEP and 20 in TURP, very similar. Operative time was 85 minutes in HoLEP and 60 in TURP, p<0.05. Hospital stay was 47 hours for HoLEP and 48 hours to TURP, p<0.05. At 90 day the urinary peak flow rate was raised to 21.5 ml/s in HoLEP group and to 20 ml/s in TURP and the median of international prostate symptom score had been reduced to score 3 in both groups.</p></sec><sec><title>CONCLUSION:</title><p>HoLEP is a feasible technique and is as effective as TURP on symptomatic prostatic hyperplasia surgical treatment.</p></sec>

scholarly journals Determining the correlation between transition zone index with international prostate symptom score and peak flow rate on clinical outcome after transurethral resection of the prostate in benign prostatic hyperplasia

2019 ◽  
Vol 6 (12) ◽  
pp. 4517
Author(s):  
Nalinikanta Mohanty ◽  
Samir Swain ◽  
Arshad Hasan ◽  
Gyanprakash Singh ◽  
Datteswar Hota
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Symptom Score ◽  
Flow Rate ◽  
International Prostate Symptom Score ◽  
Peak Flow ◽  
Prostatic Hyperplasia ◽  
Yttrium Aluminium Garnet ◽  
Peak Flow Rate ◽  
Flow Rates ◽  
Yttrium Aluminium

Background: Benign prostatic hyperplasia (BPH) is a pathologic process which has common contribution to lower urinary tract symptoms (LUTS) in aging men. International Prostate Symptom Score (IPSS) is an important means of assesment in the clinical research of LUTS and BPH. Free flow rates (peak flow rate or Qmax) give an indirect measure for the probability of obstruction whereas subvesical obstruction only can be measured by invasive pressure-flow studies. Among the various surgical or minimally invasive techniques available for BPH like Intraprostatic stents (temporary/permanent), transurethral needle ablation (TUNA), transurethral microwave thermotherapy (TUMT), transurethral electrovaporization of prostate (TUVP), Transurethral incision of prostate (TUIP), lasers (Nd: YAG (Neodymium-doped yttrium aluminium garnet), Ho: YAG (Holmium yttrium aluminium garnet), potassium titanyl phosphate (KTP), diode, thulium laser) etc, transurethral resection of the prostate (TURP) is a safe and effective procedure. Comparison of difference in the pre and postoperative ultrasonic prostatic volume with amount of tissue resected at operation has established the accuracy of the method. The aims of present study are to determine the correlation between transition zone index with international prostate symptom score (IPSS) and peak flow rate (Qmax) on clinical outcome after TURP in BPH patients.Methods: A prospective study was conducted to determine the effect of the extent of tissue resection on symptom improvement after TURP in men and to evaluate any potential correlation between prostate size and outcome.Results: Total of 52 patients studied prospectively. Transitional zone (TZ) index was found to have a significant correlation with the clinical outcome.Conclusions: Symptomatic improvement after TURP will depend on the amount of tissue resected in terms of IPSS and peak flow rates.

Ejaculation preserving HoLEP/TURP for benign prostatic hyperplasia: myth or reality

2021 ◽  
pp. 205141582110001
Author(s):  
Malik Abdul Rouf ◽  
Venkatesh Kumar ◽  
Anshuman Agarwal ◽  
Suresh Rawat
Keyword(s):  
Sexual Satisfaction ◽  
Transurethral Resection ◽  
International Prostate Symptom Score ◽  
Specific Antigen ◽  
Prostatic Hyperplasia ◽  
Holmium Laser ◽  
Peripheral Vascular ◽  
Prostate Size ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

Objectives: To analyze whether technical modifications during transurethral resection of the prostate/holmium laser enucleation of the prostate results in preservation of antegrade ejaculation, at the same time providing effective relief from bladder outlet obstruction. Materials and methods: A total of 119 patients with benign prostatic hyperplasia were included in the study carried out at our center between March 2016 and December 2018. The patients were divided into two groups, with 56 (47.06%) patients in the ejaculation-preserving transurethral resection of the prostate group and 63 (52.94%) patients in the ejaculation-preserving holmium laser enucleation of the prostate group. The patients in the two groups were assessed with respect to age, prostate size, serum prostate-specific antigen and any comorbidity. The parameters assessed pre and postoperatively include Qmax, international prostate symptom score, peripheral vascular resistance, overall sexual satisfaction and overall ejaculation. All patients were regularly followed up during the study period and were included in the final analysis. Results: The mean (standard deviation) age, prostate size, serum prostate-specific antigen of patients who underwent ejaculation-preserving transurethral resection of the prostate and patients who underwent ejaculation-preserving holmium laser enucleation of the prostate was 61.67 (5.26)/61.48 (5.40) years, 59.75 (10.61) ml/74.44 (20.27) ml, 2.38 (0.77) ng/ml/2.47 (0.83) ng/ml, respectively. Postoperatively there was a statistically significant improvement in Qmax, international prostate symptom score and peripheral vascular resistance in both groups. The overall sexual satisfaction after surgery improved significantly in the ejaculation-preserving transurethral resection of the prostate group; however, it deteriorated significantly in the ejaculation-preserving holmium laser enucleation of the prostate group, which was statistically significant at 6 months. After treatment, the overall ejaculation assessed by asking question 9 of the international index of erectile function 15 questionnaire was unchanged in patients from the ejaculation-preserving transurethral resection of the prostate group and deteriorated in the ejaculation-preserving holmium laser enucleation of the prostate group and the difference between the two groups was statistically significant. Conclusion: An ejaculation preserving technique seems to be more feasible in small prostate glands when appreciable apical tissue is spared. However, holmium laser enucleation of the prostate is basically a size-independent procedure and enables the complete removal of the adenoma tissue like an open prostatectomy. To compromise the extent of tissue removal or candidate selection for a better ejaculation preservation outcome might damage the indigenous value of the holmium laser enucleation of the prostate. To conclude, if the preservation of sexual satisfaction and ejaculatory function is a priority, patients should be offered ejaculation-preserving transurethral resection of the prostate as the treatment of choice over ejaculation-preserving holmium laser enucleation of the prostate.

scholarly journals Clinical Significance of Intravesical Prostatic Protrusion in Patients with Benign Prostatic Hyperplasia

2015 ◽  
Vol 3 (1) ◽  
pp. 6-10 ◽  
Author(s):  
Ghanshyam Sigdel ◽  
WK Belokar
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Symptom Score ◽  
Flow Rate ◽  
International Prostate Symptom Score ◽  
Prostate Volume ◽  
Maximum Flow ◽  
Prostatic Hyperplasia ◽  
Medical Sciences ◽  
Residual Urine ◽  
Intravesical Prostatic Protrusion

INTRODUCTION: Intravesical prostatic protrusion is a morphological change due to excessive growth of the median and lateral lobes of the prostate into the bladder in benign prostatic hyperplasia. It causes a 'ball-valve' type of obstruction during voiding. It is a useful parameter to assess the severity of the disease process, selection of treatment modality and its possible outcome in benign prostatic hyperplasia.MATERIAL AND METHODS: A prospective, non-randomized, observational study was carried out from January 2014 to June 2014 in the Department of Urology, College of Medical Sciences, Nepal. Total of 50 patients with benign prostatic hyperplasia were evaluated to assess the correlation of intravesical prostatic protrusion with international prostate symptom score, prostate volume, maximum flow rate and post void residual urine. Correlation between parameters of interest was quantified with Pearson correlation test.RESULTS: A positive correlation was demonstrated between intravesical prostatic protrusion, international prostate symptom score, prostate volume and post void residual urine. There was a negative correlation between intravesical prostatic protrusion and maximum flow rate.CONCLUSION: Intravesical prostatic protrusion is correlated with international prostate symptom score, prostate volume, maximum flow rate, and post void residual urine volume and hence can be used to assess the severity of benign prostatic hyperplasia.Journal of Universal College of Medical Sciences Vol. 3, No. 1, 2015: 6-10

scholarly journals Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis

BMJ ◽  
2019 ◽  
pp. l5919 ◽  
Author(s):  
Shi-Wei Huang ◽  
Chung-You Tsai ◽  
Chi-Shin Tseng ◽  
Ming-Chieh Shih ◽  
Yi-Chun Yeh ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Benign Prostatic Hyperplasia ◽  
Diode Laser ◽  
Meta Analysis ◽  
Prostatic Hyperplasia ◽  
Efficacy And Safety ◽  
Laser Enucleation ◽  
Randomised Controlled ◽  
Surgical Treatments ◽  
Holmium Laser Enucleation

Abstract Objective To assess the efficacy and safety of different endoscopic surgical treatments for benign prostatic hyperplasia. Design Systematic review and network meta-analysis of randomised controlled trials. Data sources A comprehensive search of PubMed, Embase, and Cochrane databases from inception to 31 March 2019. Study selection Randomised controlled trials comparing vapourisation, resection, and enucleation of the prostate using monopolar, bipolar, or various laser systems (holmium, thulium, potassium titanyl phosphate, or diode) as surgical treatments for benign prostatic hyperplasia. The primary outcomes were the maximal flow rate (Qmax) and international prostate symptoms score (IPSS) at 12 months after surgical treatment. Secondary outcomes were Qmax and IPSS values at 6, 24, and 36 months after surgical treatment; perioperative parameters; and surgical complications. Data extraction and synthesis Two independent reviewers extracted the study data and performed quality assessments using the Cochrane Risk of Bias Tool. The effect sizes were summarised using weighted mean differences for continuous outcomes and odds ratios for binary outcomes. Frequentist approach to the network meta-analysis was used to estimate comparative effects and safety. Ranking probabilities of each treatment were also calculated. Results 109 trials with a total of 13 676 participants were identified. Nine surgical treatments were evaluated. Enucleation achieved better Qmax and IPSS values than resection and vapourisation methods at six and 12 months after surgical treatment, and the difference maintained up to 24 and 36 months after surgical treatment. For Qmax at 12 months after surgical treatment, the best three methods compared with monopolar transurethral resection of the prostate (TURP) were bipolar enucleation (mean difference 2.42 mL/s (95% confidence interval 1.11 to 3.73)), diode laser enucleation (1.86 (−0.17 to 3.88)), and holmium laser enucleation (1.07 (0.07 to 2.08)). The worst performing method was diode laser vapourisation (−1.90 (−5.07 to 1.27)). The results of IPSS at 12 months after treatment were similar to Qmax at 12 months after treatment. The best three methods, versus monopolar TURP, were diode laser enucleation (mean difference −1.00 (−2.41 to 0.40)), bipolar enucleation (0.87 (−1.80 to 0.07)), and holmium laser enucleation (−0.84 (−1.51 to 0.58)). The worst performing method was diode laser vapourisation (1.30 (−1.16 to 3.76)). Eight new methods were better at controlling bleeding than monopolar TURP, resulting in a shorter catheterisation duration, reduced postoperative haemoglobin declination, fewer clot retention events, and lower blood transfusion rate. However, short term transient urinary incontinence might still be a concern for enucleation methods, compared with resection methods (odds ratio 1.92, 1.39 to 2.65). No substantial inconsistency between direct and indirect evidence was detected in primary or secondary outcomes. Conclusion Eight new endoscopic surgical methods for benign prostatic hyperplasia appeared to be superior in safety compared with monopolar TURP. Among these new treatments, enucleation methods showed better Qmax and IPSS values than vapourisation and resection methods. Study registration CRD42018099583.

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