scholarly journals A Modified Technique of Thulium Laser Enucleation for Benign Prostatic Hyperplasia With Non-morcellator Approach

2021 ◽  
Vol 8 ◽  
Author(s):  
Yifeng Jing ◽  
Qian Sun ◽  
Wenhuan Guo ◽  
Dapeng Zhou ◽  
Yiping Zhu ◽  
...  
Keyword(s):  
Specific Antigen ◽  
Urine Volume ◽  
Operation Time ◽  
Bladder Injury ◽  
Thulium Laser ◽  
Modified Technique ◽  
Total Operation Time ◽  
Postvoid Residual Urine ◽  
Laser Enucleation

Background: Until recently, most enucleation techniques of the prostate were performed with the application of morcellator. We introduce a modified enucleation technique of thulium laser with non-morcellator approach, which is about incising and vaporizing remaining prostate tissue instead of a morcellator.Methods: A retrospective evaluation of 223 patients undergoing ThuLEP from January 2014 to December 2015 was performed in our institution. One hundred five of the patients used morcellator while the other 118 used non-morcellator approach. All patients were assessed with the International Prostate Symptom Score (IPSS), quality of life (Qol), ultrasonography, serum prostate-specific antigen (PSA), maximal urine flow rate (Qmax), and postvoid residual urine volume (PVR). We reassessed these parameters at 1-, 3-, 6-, and 12-months after operation. Operative time, perioperative, and postoperative complications were also recorded.Results: Significant improvement was noted in the IPSS, QoL, Qmax, and PVR in both groups at the 12-month follow-up, and assessment showed no differences in these parameters between the two groups. Comparisons of the total operation time and enucleation time demonstrated no significant differences between the two groups. Our non-morcellator approach needed more time to incise and vaporize the enucleated tissue compared to morcellation when the prostate volume was about 40–80 ml (p < 0.05), while it showed a significant lower rate of superficial bladder injury than using morcellator (p < 0.05). There were no significant differences in other complications between the two groups (p > 0.05).Conclusions: Our modified technique is a safe and effective procedure for the treatment of BPH avoiding the potential complications caused by morcellator.

Plasmakinetic Vapor Enucleation of the Prostate with Button Electrode versus Plasmakinetic Resection of the Prostate for Benign Prostatic Enlargement >90 ml: Perioperative and 3-Month Follow-Up Results of a Prospective, Randomized Clinical Trial

2015 ◽  
Vol 95 (3) ◽  
pp. 260-264 ◽  
Author(s):  
Keqin Zhang ◽  
Dingqi Sun ◽  
Hui Zhang ◽  
Qingwei Cao ◽  
Qiang Fu
Keyword(s):  
Urine Volume ◽  
Operation Time ◽  
Urinary Flow ◽  
Benign Prostatic Enlargement ◽  
Effective Technique ◽  
Prostatic Enlargement ◽  
Postvoid Residual Urine ◽  
Maximum Urinary Flow

Objective: To evaluate plasmakinetic vapor enucleation of the prostate (PVEP) with button electrode and plasmakinetic resection of the prostate (PKRP) in patients with urinary symptoms due to benign prostatic enlargement (BPE) >90 ml. Methods: A total of 112 patients with symptomatic BPE were randomly assigned to either PKRP or PVEP prospectively from August 2012 to May 2014 in our department. Perioperative and postoperative data were investigated during a 3-month follow-up. Results: PVEP was significantly superior to PKRP in terms of operation time (63.9 ± 7.7 vs. 78.1 ± 13.6 min, p < 0.001), hemoglobin loss (1.18 ± 0.30 vs. 1.63 ± 0.38 g/dl, p < 0.001), serum sodium decrease (2.9 ± 0.7 vs. 4.3 ± 0.8 mmol/l, p < 0.001), catheterization duration (49.3 ± 12.2 vs. 78.1 ± 14.8 h, p < 0.001) and hospital stay (100.2 ± 28.3 vs. 116.0 ± 29.2 h, p = 0.004). There were no statistical differences in blood transfusion between the two groups. In addition, there were no statistical differences in maximum urinary flow rate, International Prostate Symptom Score, postvoid residual urine volume, quality-of-life score, transient incontinence, and urethral stricture at 3 months postoperatively. Conclusions: PVEP with button electrode is an equally effective technique for treatment of large BPE with PKRP, with more safety and faster recovery. It may become the superior alternative to PKRP for patients with large BPE.

scholarly journals Holmium laser versus thulium laser enucleation of the prostate: a matched-pair analysis from two centers

2018 ◽  
Vol 10 (8) ◽  
pp. 223-233 ◽  
Author(s):  
Giacomo Maria Pirola ◽  
Giovanni Saredi ◽  
Ricardo Codas Duarte ◽  
Lorraine Bernard ◽  
Andrea Pacchetti ◽  
...  
Keyword(s):  
Specific Antigen ◽  
Group Versus ◽  
Holmium Laser ◽  
Matched Pair ◽  
Urinary Flow ◽  
Thulium Laser ◽  
Homogeneous Groups ◽  
Matched Pair Analysis ◽  
Laser Enucleation ◽  
Pair Analysis

Background: The aim of our study was to compare perioperative and functional outcomes of two different prostatic laser enucleation techniques performed in two high-volume centers: 100 W holmium laser enucleation of the prostate (HoLEP) (Lyon, France) and 110 W thulium laser enucleation of the prostate (ThuLEP) (Varese, Italy). Materials and Methods: A nonrandomized, observational, retrospective and matched-pair analysis was performed on two homogeneous groups of 117 patients that underwent prostate laser enucleation in the HoLEP or ThuLEP centers between January 2015 and April 2017, following the classical ‘three lobes’ enucleation technique. The American Society of Anesthesiologists (ASA) score and prostate volume were the main parameters considered for matching the patients between the two groups. Patients on anticoagulant therapy, with documented detrusor hypoactivity or hyperactivity or with the finding of concurrent prostate cancer were excluded from the study. Follow up was assessed at 3, 6 and 12 months after surgery. Results: Median enucleation and morcellation time was 75.5 and 11.5 min, respectively, in the HoLEP group versus 70.5 and 12 min, respectively, in the ThuLEP group ( p = 0.001 and 0.49, respectively). Enucleated adenoma weight was comparable (44 g versus 45.6 g, p = 0.60). Energy index (3884.63 versus 4137.35 J/g, p = 0.30) and enucleation index (0.57 versus 0.6 g/min, p = 0.81) were similar in the two groups. Catheterization time was comparable (1 versus 1 day; p = 0.14). The International Prostate Symptom Score and Quality of Life score significantly decreased, as well as maximal urinary flow rate. Median prostate-specific antigen (PSA) drop 1 year after surgery was 2.1 ng/ml in the HoLEP group (−52.83%) versus 1.75 ng/ml in the ThuLEP group (−47.85%) ( p = 0.013). Conclusion: Both HoLEP (100 W) and ThuLEP (110 W) relieve lower urinary tract symptoms in a comparable way with high efficacy and safety, with negligible clinical differences.

scholarly journals Vaginal apical and anterior reconstruction using ultralight weight mesh: two-year follow-up

2018 ◽  
Vol 67 (3) ◽  
pp. 55-63
Author(s):  
Dmitry D. Shkarupa ◽  
Nikita D. Kubin ◽  
Eduard N. Popov ◽  
Ekaterina A. Shapovalova ◽  
Gleb V. Kovalev ◽  
...  
Keyword(s):  
Quality Of Life ◽  
De Novo ◽  
Urine Volume ◽  
Operation Time ◽  
Pelvic Organ ◽  
Stage Ii ◽  
Apical Prolapse ◽  
Pelvic Floor Reconstruction

Introduction. Anterior and apical prolapse is the most common type of pelvic organ prolapse. The insufficient  effectiveness of native tissue repair in the pelvic organs leads to the search of new methods of the pelvic floor reconstruction. Objective. The current analysis was undertaken to evaluate the efficiency of the use of the Pelvix anterior mesh system (Lintex) with sacrospinous fixation of the apex in the treatment of anterior and apical prolapse. Methods. This study involved 150 women suffering from anterior-apical prolapse (stages III and IV). Reconstruction with the use of the mesh was performed in all the patients. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, bladder ultrasound, and validated questionnaires (PFDI-20, PFIQ-7, PISQ-12) were used. All the listed parameters were determined before the surgery and on follow-up visits in 1, 6, 12, and 24 months after the treatment. Results. Mean operation time was 47 minutes. No cases of intraoperative clinically significant bleeding were reported. Anatomical cure rate (< stage II / asymptomatic stage II, according to the Baden-Walker system) at 12 months was found to be 94.4%, and at 24 months — 92.7%. Within the first month of follow-up, de novo stress urinary incontinence and de novo urgency occurred in 8.0% and 7.2% of patients, respectively. Statistically significant (p < 0.05) improvement in uroflowmetry parameters and decreased post-voiding urine volume were achieved after the surgery and did not change by 24 months. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period. Conclusion. The use of the Pelvix anterior mesh system in the surgical correction of the anterior and apical prolapse is a safe uterus-sparing technique. At two-year follow-up, it provides a high anatomical efficiency, normalizes urodynamic parameters and improves quality of life.

scholarly journals Prostate-Specific Antigen Velocity Predicts Surgical Outcome of Thulium Laser Enucleation of the Prostate

2022 ◽  
Vol 8 ◽  
Author(s):  
Po-You Chen ◽  
Shao-Ming Chen ◽  
Horng-Heng Juang ◽  
Chen-Pang Hou ◽  
Yu-Hsiang Lin ◽  
...  
Keyword(s):  
Prostate Specific Antigen ◽  
Surgical Outcome ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Area Under The Curve ◽  
Maximum Flow ◽  
Thulium Laser ◽  
Laser Enucleation ◽  
Male Patients

Background: We determined the effect of prostate-specific antigen velocity (PSAV) on the surgical outcome of thulium laser enucleation of the prostate (ThuLEP) in patients with benign prostatic hyperplasia (BPH).Methods: A retrospective review was performed of prospectively collected data of patients with BPH who underwent ThuLEP at any time from 2017 to 2019. Patients who had undergone BPH surgery or had prostate cancer previously were excluded, and patients with prostate-specific antigen (PSA) &gt; 4 ng/ml were examined through transrectal ultrasound-guided prostate biopsy to rule out prostatic malignancy. Furthermore, patients were excluded if prostatic malignancy was diagnosed during postsurgery follow-up.Results: The PSA level, International Prostate Symptom Score (IPSS), and quality of life (QoL) of 27 male patients at 3 and 15 months postsurgery differed significantly from those at presurgery; the maximum flow rate (Qmax) and postvoid residual (PVR) significantly differed between 3 months postsurgery and presurgery; and 22 and 5 patients had good to excellent and fair to poor outcomes, respectively, at 15 months postsurgery. Patients were divided into two groups (fair and poor vs. good and excellent outcomes at 15 months postsurgery), which significantly differed with respect to PSAV at 3 months postsurgery (P = 0.04), IPSS presurgery (P &lt; 0.02), surgical length (P = 0.01), and hospitalization duration (P = 0.04). In a receiver operating characteristic (ROC) analysis, the optimal cutoff value of PSAV of −0.52 ng/ml characterized effectiveness at 15 months after ThuLEP, and the area under the curve (AUC), sensitivity, and specificity were 0.82 (P &lt; 0.02), 0.80, and 0.82, respectively. For PSAV &lt; -0.52 and ≥-0.52 ng/ml, the percentages of reduction for IPSS, QoL, Qmax, and PVR were −78.6 and −71.4%, −33.3 and 0.0%, 94.4 and 40.0%, and −85.1 and −38.7%, respectively.Conclusions: Postsurgical PSAV was positively correlated with surgical success, and the PSAV cutoff was −0.52 ng/ml. PSAV can, thus, be used to guide the postsurgical follow-up treatment at 3 months after BPH surgery.

Exploitation Assessment of New Holland CX780 Combine Harvester

2016 ◽  
Vol 20 (2) ◽  
pp. 43-51
Author(s):  
Anna Dębska ◽  
Jerzy Bieniek ◽  
Emil Fabrykowski ◽  
Franciszek Molendowski ◽  
Leszek Romański
Keyword(s):  
Technological Progress ◽  
Operation Time ◽  
Wheat Grain ◽  
Combine Operation ◽  
Effective Time ◽  
Yield Value ◽  
Total Operation Time ◽  
Combine Harvester ◽  
Time Structures

AbstractThe article presents an exploitation assessment of New Holland CX780 combine operation. Significant technical and technological progress is visible in modern harvesters. Inter alia, performance increased and elements improving the quality of work of harvesters appeared. The objective of the paper was to determine efficiency of the New Holland CX780 harvester operation including factors which affect its operation. Time structures of particular activities of combine operation and ratios of these times use were determined during tests. Yield value and moisture of collected seeds was determined. Studies proved that effective time of combine operation in the process of rapeseed and wheat grain harvesting was less than 50% and was caused by long preparation of a machine for operation. Preparation for operation of a combine influences its performance in the total time. It was 22% of the total operation time in case of wheat harvesting and 20% in case of rapeseed harvesting.

scholarly journals Initial experience with holmium laser enucleation of the prostate in a urology specialist hospital in Nigeria

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Celsus Ukelina Undie ◽  
Ewomazino Ibanga Nnana ◽  
Kalenebari Raymond Torporo
Keyword(s):  
Hospital Stay ◽  
Specific Antigen ◽  
Urine Volume ◽  
Length Of Hospital Stay ◽  
Maximum Flow ◽  
Holmium Laser ◽  
Initial Experience ◽  
Residual Urine Volume ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

Abstract Background Holmium laser enucleation of the prostate (HoLEP) is a more recent procedure for the management of Benign Prostatic Hyperplasia compared to open prostatectomy or Transurethral Resection of the Prostate. HoLEP is not commonly done in Nigeria. The objective of the study was to determine whether our initial experience with HoLEP in Abuja, favourably compared to those of other centres across the world. Methods A retrospective study was done on 40 patients who had HoLEP between October 2018 and December 2019. Pre- and post-operative International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), prostate sizes, maximum flow rate (Qmax) and post-void residual urine volume (PVR) were collated. The duration of irrigation, catheterization and length of hospital stay were also recorded and analysed. Complications were documented. Results There were improvements in IPSS from 19.67 to 5.41, PSA from 8.07 to 2.03 ng/ml,Qmax from 11.27 to 29.67 ml/min, PVR from 88.99 to 32.8 ml, while average prostate sizes reduced from 116.54 to 30.3 g after surgery. Following HoLEP, the duration of irrigation was 18.00 h, catheterization was 26.76 h and length of hospital stay was 1.82 days. Two (5.0%) patients were recatheterized, 4 (10.0%) developed post-operative bladder neck stenosis. Conclusions The outcome of HoLEP in our experience compared favourably with those from other centres. With adequate training and requisite equipment in resource-poor environments, technical procedures like HoLEP can be embarked on with favourable results.

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

2021 ◽  
Vol 49 (8) ◽  
pp. 030006052110374
Author(s):  
Chun-Hsuan Lin ◽  
Wen-Jeng Wu ◽  
Ching-Chia Li ◽  
Hung-Lung Ke ◽  
Jhen-Hao Jhan ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Intraoperative Complications ◽  
Urine Volume ◽  
Outlet Obstruction ◽  
Holmium Laser ◽  
Urinary Flow ◽  
En Bloc ◽  
Postvoid Residual Urine ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

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

Holmium Laser Enucleation, Laparoscopic Simple Prostatectomy, or Open Prostatectomy: The Role of the Prostate Volume in terms of Operation Time

2020 ◽  
pp. 1-6
Author(s):  
Kadir Omur Gunseren ◽  
Serkan Akdemir ◽  
Mehmet Cagatay Çiçek ◽  
Ali Yıldız ◽  
Murat Arslan ◽  
...  
Keyword(s):  
Prostate Volume ◽  
Operation Time ◽  
Holmium Laser ◽  
Open Prostatectomy ◽  
Prostate Weight ◽  
Total Operation Time ◽  
Simple Prostatectomy ◽  
Laser Enucleation ◽  
Rapid Removal ◽  
Holmium Laser Enucleation

<b><i>Introduction:</i></b> To compare the prostate removal speeds of 3 enucleation techniques and to evaluate how the operating times change depending on the prostate volume. <b><i>Methods:</i></b> Medical records of patients with 80-g or larger prostates who underwent holmium laser enucleation of the prostate (HoLEP), laparoscopic simple prostatectomy (LSP), or open prostatectomy (OP) due to medical treatment-resistant benign prostatic hyperplasia (BPH) were reviewed retrospectively. Patients were classified into 3 groups according to the surgical procedure. Age, BMI, prostate weights, total operation times, prostate removal speeds, hospitalization and catheterization days, complications, and improvements on functional outcomes in the 3rd month of follow-up were compared between groups. In addition, the association between prostate weight and total operation time was analyzed for each group. <b><i>Results:</i></b> HoLEP, LSP, and OP groups consisted of 60, 61, and 37 patients, respectively. While HoLEP was similar to OP in terms of prostate removal speed and total operation time, LSP was statistically slower and required more operation time than HoLEP and OP. There was a relationship between prostate weight and total operation time only in HoLEP. <b><i>Conclusion:</i></b> LSP, one of the enucleation techniques in the treatment of large prostates, was slower and required more operation time than HoLEP and OP in terms of total operation time and prostate removal speed. HoLEP seems going to be the fastest candidate for the rapid removal of large prostates in the future.

scholarly journals Comparison of α-Blocker Monotherapy and α-Blocker plus 5α-Reductase Inhibitor Combination Therapy Based on Prostate Volume for Treatment of Benign Prostatic Hyperplasia

2012 ◽  
Vol 40 (3) ◽  
pp. 899-908 ◽  
Author(s):  
K-J Joo ◽  
W-S Sung ◽  
S-H Park ◽  
W-J Yang ◽  
T-H Kim
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Combination Therapy ◽  
Reductase Inhibitor ◽  
Prostate Volume ◽  
Specific Antigen ◽  
Urine Volume ◽  
Prostatic Hyperplasia ◽  
Urinary Flow ◽  
Volume Transition ◽  
Postvoid Residual Urine

OBJECTIVE: This study compared α-blocker monotherapy with combination therapy involving an α-blocker and a 5-α reductase inhibitor for benign prostatic hyperplasia (BPH), according to baseline prostate volume. METHODS: Korean men diagnosed with BPH were randomized to 12 months' treatment with 0.2 mg tamsulosin or 0.2 mg tamsulosin plus 0.5 mg dutasteride. Prostate specific antigen (PSA), prostate volume, transition zone volume (TZV), International Prostate Symptom Score (IPSS), maximal urinary flow rate ( Qmax), postvoid residual urine volume and sexual function were assessed at baseline and after 12 months' treatment. Variables were analysed based on baseline prostate volumes of ≤ 35 ml or > 35 ml. RESULTS: In total, 216 men with BPH were included. Combination therapy resulted in significant improvements in prostate volume, TZV, PSA, IPSS and Qmax, which were most pronounced in men with a prostate volume > 35 ml. CONCLUSIONS: Tamsulosin monotherapy was sufficient treatment for BPH in Korean men with a prostate volume ≤ 35 ml. Combination tamsulosin and dutasteride therapy provided greater benefits than tamsulosin monotherapy in men with BPH whose prostate volume was > 35 ml.

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