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

2019 ◽  
Vol 8 (7) ◽  
pp. 1007 ◽  
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.

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

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

scholarly journals Holmium laser prostatectomy in a tertiary Italian center: A prospective cost analysis in comparison with bipolar TURP and open prostatectomy

2020 ◽  
Vol 92 (2) ◽  
Author(s):  
Riccardo Schiavina ◽  
Lorenzo Bianchi ◽  
Marco Giampaoli ◽  
Marco Borghesi ◽  
Hussam Dababneh ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Prostate Volume ◽  
Indirect Costs ◽  
Holmium Laser ◽  
Transurethral Resection Of Prostate ◽  
Open Prostatectomy ◽  
Global Cost ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

Objective: To assess the economic impact of Holmium laser enucleation of prostate (HoLEP) in comparison with transurethral resection of prostate (TURP) and open prostatectomy (OP). Methods: Between January 2017 and January 2018, we prospectively enrolled 151 men who underwent HoLEP, TURP or OP at tertiary Italian center, due to bladder outflow obstruction symptoms. Patients with prostate volume ≤ 70 cc and those with prostate volume > 70 cc were scheduled for TURP or HoLEP and OP or HoLEP, respectively. Intraoperative and early post-operative functional outcomes were recorded up to 6 months follow up. Cost analysis was carried out considering direct costs (operating room [OR] utilization costs, nurse, surgeons and anesthesiologists’ costs, OR disposable products costs and OR products sterilization costs), indirect costs (hospital stay costs and diagnostics costs) and global costs as sum of both direct and indirect plus general costs related to hospitalization. Cost analysis was performed comparing patients referred to TURP and HoLEP with prostate volume ≤ 70 cc and men underwent OP and HoLEP with prostate volume > 70 cc respectively. Results: Overall, 53 (35.1%), 51 (33.7%) and 47 (31.1%) were scheduled to HoLEP, TURP and OP, respectively. Both TURP, HoLEP and OP proved to effectively improve urinary symptoms related to BPE. Considering patients with prostate volume ≤ 70 cc, median global cost of HoLEP was similar to median global cost of TURP (2151.69 € vs. 2185.61 €, respectively; p = 0.61). Considering patients with prostate volume > 70 cc, median global cost of HoLEP was found to be significantly lower than median global cost of OP (2174.15 € vs. 4064.97 €, respectively; p ≤ 0.001). Conclusions: Global costs of HoLEP are comparable to those of TURP, offering a cost saving of only 11.4 € in favor of HoLEP. Conversely, HoLEP proved to be a strong competitor of OP because of significant global cost sparing amounting to 1890.82 € in favor of HoLEP.

Holmium laser enucleation of prostate for patients with acute urinary retention due to benign prostate hyperplasia: Efficacy and safety

2019 ◽  
Author(s):  
Pu Li(Former Corresponding Author) ◽  
Jun Tao ◽  
Chengming Wang ◽  
Min Tang ◽  
Xiaoxin Meng(New Corresponding Author)
Keyword(s):  
Urinary Retention ◽  
Acute Urinary Retention ◽  
Benign Prostate Hyperplasia ◽  
Holmium Laser ◽  
Common Disease ◽  
Urinary Flow ◽  
Prostate Hyperplasia ◽  
Laser Enucleation ◽  
Benign Prostate ◽  
Holmium Laser Enucleation

Abstract Background Benign prostate hyperplasia (BPH) is a common disease in older men, and part of patients develop acute urinary retention (AUR) at the time of initial treatment. The aim of this study was to evaluate the effectiveness and safety of holmium laser enucleation of prostate (HoLEP) for patients with BPH in setting of AUR. Methods The clinical data of 88 patients with BPH who underwent HoLEP surgery in our center were retrospectively analyzed. AUR existed in 34 patients and the other 54 patients had no AUR. The general information, prostate volume, urodynamic parameters and intraoperative parameters were recoeded and compared. The outcome were recorded and analysed including the international prostate symptom score (IPSS), quality of life score (QoL), maximum urinary flow rate (Qmax), and post-voiding residual (PVR). Results In both groups, the preoperative parameters were equivalent except for the white blood cell in urinalysis. All the HoLEP procedures were smoothly carried out. The intr- and post-operative complications were low in both groups and no difference were detected. All the patients were followed up for at least 6 months. IPSS, QoL, Qmax and PVR were all improved in both groups. No statistical differences were obtained in these parameters between groups. Conclusion s HoLEP could be a safe and effective treatment for BPH patients either with or without AUR. The efficacy was immediate and sustained during the short-term follow-up session in both groups.

scholarly journals Holmium Laser Enucleation of the Prostate versus Laparoscopic Transcapsular Prostatectomy: Perioperative Results and Three-Month Follow-Up

2016 ◽  
Vol 10 (2) ◽  
pp. 81-86 ◽  
Author(s):  
Arnaud Baldini ◽  
Hakim Fassi-Fehri ◽  
Ricardo C. Duarte ◽  
Sebastien Crouzet ◽  
René Ecochard ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Prostate Volume ◽  
Average Length ◽  
Benign Prostatic Hypertrophy ◽  
Prostatic Hypertrophy ◽  
Holmium Laser ◽  
Perioperative Outcomes ◽  
Average Length Of Stay ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

Purpose: Symptomatic benign prostatic hypertrophy greater than 70 cc used to be treated by invasive procedures. Holmium laser enucleation of prostate (HoLEP) and laparoscopic transcapsular prostatectomy (LTP) are two techniques whose efficacy has been demonstrated compared to standard onesmore invasive standard procedures. The objective was to evaluate and compare perioperative results from these two techniques for the treatment of benign prostatic hypertrophy greater than 70 cc. Methods: This was a non-randomized retrospective study comparing the HoLEP technique with LTP. From January 2012 to January 2015, 39 patients had HoLEP and 28 had LTP. Perioperative outcomes, complications, and functional results at 3 months were compared. A chi-2 squared test and Student's t test were used for statistical analysis. Results: In multivariate analysis, there was a statistically significant difference in favor of HoLEP for the duration of catheterization (1.9 vs. 3.7 days; p = 0.004) and the average length of stay (2.8 vs. 4.0 days, p = 0.010). There was a trend towards a greater decrease in postoperative hemoglobin levels in LTP (138 vs. 218 g/l; p = 0.082), which was statistically significant in univariate analysis (p = 0.033). Other endpoints were not significant, particularly the enucleated prostate volume compared to the total prostate volume (61.8 vs. 68.4%; p = 0.319) and postoperative complications. Conclusion: There was no increased morbidity for LTP compared to the HoLEP technique. However, the HoLEP technique appeared to be a less invasive technique, reducing the duration of catheterization, blood loss, and the average length of stay while maintaining good efficacy for the enucleated prostate volume.

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

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