scholarly journals DrillCutTM vs. VersaCutTM prostate tissue morcellation devices after holmium laser enucleation: A prospective, randomized controlled trial

2018 ◽  
Vol 13 (8) ◽  
Author(s):  
Ahmed Ibrahim ◽  
Mostafa M. Elhilali ◽  
Mohammed A. Elkoushy ◽  
Sero Andonian ◽  
Serge Carrier
Keyword(s):  
Small Sample Size ◽  
Controlled Trial ◽  
Small Sample ◽  
Holmium Laser ◽  
Complication Rates ◽  
Symptomatic Benign Prostatic Hyperplasia ◽  
Significant Difference ◽  
Ethical Approval ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

Introduction: We aimed to compare efficacy, safety, and cost of disposables of the DrillCutTM morcellator with the VersaCutTM morcellator after holmium laser enucleation of the prostate (HoLEP).Methods: After obtaining ethical approval, consecutive patients undergoing HoLEP for symptomatic benign prostatic hyperplasia were randomized to have their enucleated prostates morcellated by either Karl Storz® DrillCutTM or Lumenis® VersaCutTM morcellators. All procedures were performed by two experienced urologists. Patients’ demographics and perioperative data were recorded. Both morcellators were compared for their safety, efficacy, and cost-effectiveness.Results: Eighty-two patients were included in the study (41 per each arm). Both groups were comparable in terms of age, preoperative prostate size (114 vs. 112 mL; p>0.05), enucleation time (95.3 vs. 91.7 minutes; p>0.05), and morcellation time (22.6 vs. 17.3 minutes; p>0.05). The DrillCutTM was associated with significantly lower morcellation rate when compared with the VersaCutTM(3.6 vs. 4.9 g/min; p= 0.03). In terms of safety, there was no significant difference between both morcellators in complication rates (2.4% vs. 7.3 %; p=0.1). However, there was one case of bladder perforation requiring exploration with the VersaCutTM. The DrillCutTM was associated with significantly higher cost of disposables when compared with the VersaCutTM ($247.5 vs. $160.9; p<0.01).Conclusions: Despite the small sample size, the DrillCutTM was associated with lower morcellation rate when compared with the VersaCutTM. However, this difference may not be clinically significant. Although both morcellators were comparable in their safety, the DrillCutTM was associated with higher cost of disposables when compared with the VersaCutTM.

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

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.

scholarly journals Nutritional Support and Clinical Outcome of Severe and Critical Patients With COVID-19 Pneumonia

2020 ◽  
Vol 7 ◽  
Author(s):  
Xiangfeng Yue ◽  
Min Li ◽  
Yu Wang ◽  
Jing Zhang ◽  
Xinyi Wang ◽  
...  
Keyword(s):  
Protein Intake ◽  
Small Sample Size ◽  
Controlled Trial ◽  
Antiviral Treatment ◽  
Small Sample ◽  
Nutrition Support ◽  
Calorie Intake ◽  
Viral Shedding ◽  
Significant Difference ◽  
Critical Patients

Background: In 2020, a novel coronavirus has spread throughout the world. More than four hundred thousand people have died of SARS-CoV-2 pneumonia, most of which were severe and critical patients. No effective antiviral treatment has been verified thus far. Nutrition support has become one of the important treatments for severe and critical patients.Methods: In this retrospective study, 26 severe patients and 22 critical patients with laboratory confirmed COVID-19 were enrolled. We recorded the diet and nutritional treatments in severe and critical patients. Baseline characteristics and clinical outcomes of severe and critical patients were also collected.Results: Average calorie intake of severe patients (19.3 kcal/kg/d) was higher than critical patients (15.3 kcal/kg/d) (P = 0.04). Protein intake was similar in the two groups (0.65 and 0.62 g/kg per day, respectively; P = 0.29). There was no significant difference in the median duration of viral shedding between the severe and critical patients (P = 0.354).Conclusions: A permissive underfeeding strategy that restricts non-protein calories but preserves protein intake is feasible for critical patients with SARS-CoV-2 pneumonia. Viral shedding duration of critical patients was the same as severe patients who received standard feeding. Nevertheless, evidence of the conclusion is not sufficient because of small sample size. To show the real clinical benefit of permissive low-calorie and adequate protein intake in critical SARS-CoV-2 pneumonia patients, a large and pragmatic randomized controlled trial is needed.

Holmium laser enucleation of the prostate using Moses 2.0 vs non‐Moses: a randomised controlled trial

2020 ◽  
Author(s):  
Amihay Nevo ◽  
Kassem S. Faraj ◽  
Scott M. Cheney ◽  
Jonathan P. Moore ◽  
Karen L. Stern ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Holmium Laser ◽  
Laser Enucleation ◽  
Randomised Controlled ◽  
Holmium Laser Enucleation

scholarly journals Effect of preoperative urethral dilatation on preventing urethral stricture after holmium laser enucleation of the prostate: A randomized controlled study

2018 ◽  
Vol 13 (11) ◽  
Author(s):  
Jong Kwan Park ◽  
Ji Yong Kim ◽  
Jae Hyung You ◽  
Bo Ram Choi ◽  
Sung Chul Kam ◽  
...  
Keyword(s):  
Urethral Stricture ◽  
Holmium Laser ◽  
Controlled Study ◽  
Urethral Dilatation ◽  
Significant Difference ◽  
Group A ◽  
Laser Enucleation ◽  
Group B ◽  
Transurethral Prostate Surgery ◽  
Holmium Laser Enucleation

Introduction: We aimed to evaluate the effect of preoperative urethral dilatation during holmium laser enucleation of the prostate (HoLEP) on the prevention of urethral stricture. Methods: A total of 72 patients without urethral stricture underwent HoLEP for benign prostatic hyperplasia (BPH). Recruited patients were randomly divided into two groups (groups A and B). Patients in group A (36 patients, experimental group) received preoperative urethral dilatation and patients in group B (36 patients, control group) did not. Each patient was evaluated at four weeks, 12 weeks, and 24 weeks after surgery. The effectiveness of preoperative urethral dilatation was evaluated based on the International Prostate Symptom Score (IPSS), peak urine flow rate (Qmax), voided volume, and post-void residual (PVR) volume. To diagnose urethral stricture, Qmax <10 mL/s, as assessed using uroflowmetry and findings of visualization through retrograde urethrography and urethroscopy, were used. Results: Among 72 initial participants, 33 patients in group A and 31 patients in group B completed the experiment. Preoperative characteristics were well-balanced between groups. At each postoperative visit, there was no significant difference in voiding symptoms between groups. Two patients (6.06%) in group A and five patients (15.15%) in group B showed a Qmax <10 mL/s on uroflowmetry (p=0.013). On urethroscopy, no patient in group A (0%) and two patients in group B (6.45%) (p=0.021) showed urethral stricture after HoLEP. Conclusions: Preoperative urethral dilatation during HoLEP decreased the incidence of urethral stricture. This procedure could be useful to reduce the risk of urethral stricture after transurethral prostate surgery. One limitation of the current study is the single-centre design. Also, we sought to determine the efficacy of preoperative urethral dilatation for the prevention of urethral stricture after transurethral prostate surgery within a short time period, which could be another limitation of the study. Despite these limitations, to the best of our knowledge, the present study is the first reported prospective, randomized trial analyzing the safety and efficacy of preoperative urethral dilatation for the prevention of urethral stricture after transurethral prostate surgery.

scholarly journals Towards optimizing prostate tissue retrieval following holmium laser enucleation of the prostate (HoLEP): Assessment of two morcellators and review of literature

2015 ◽  
Vol 9 (9-10) ◽  
pp. 618 ◽  
Author(s):  
Ahmed M. Elshal ◽  
Ramy Mekkawy ◽  
Mahmoud Laymon ◽  
Ahmed El-Assmy ◽  
Ahmed R. El-Nahas
Keyword(s):  
Perioperative Complications ◽  
Mucosal Injury ◽  
Prostate Tissue ◽  
Holmium Laser ◽  
Medline Search ◽  
Retrieval Rate ◽  
Significant Difference ◽  
Laser Enucleation ◽  
Prostate Adenoma ◽  
Holmium Laser Enucleation

Introduction: We assess different approaches to retrieve the enucleated adenoma after transurethral enucleation of the prostate, particularly using the holmium laser.Methods: A retrospective review through our prospectively maintained database was performed looking for safety and efficacy of two morcellators. The enucleation phase of the holmium laser enucleation of the prostate (HoLEP) was classically performed followed by retrieval of the intravesical adenoma using either the Piranha (Wolf Inc., Knittlingen, Germany) or VersaCut (Lumenis) morcellator. A PubMed-MEDLINE search was conducted for all transurethral enucleation procedures and relevant data regarding methods of prostate tissue retrieval were extracted.Results: Strictly limiting the study to 3 reusable blades with each morcellator, we performed 67 and 55 consecutive procedures with Piranha and VersaCut, respectively. There was no significant difference between the two morcellators regarding perioperative complications, apart from 5 bladder mucosal injuries with the VersaCut (9%). Furthermore, there were similar retrieved tissue weight, mechanical problems-rate, catheter-time and hospital-stay in both morcellators. However, the Piranha morcellator needed significantly less morcellation-time, needed to use cold loop to remove non-morcellated pieces and to score the adenoma by laser for better bite of the adenoma, and had a higher median morcellation-rate 6.2 (rate: 2.8–12) g/min. Despite little reporting on morcellation, we had data on the tissue retrieval rate (2.6 to 6.5 g/min with Piranha and 1.9 to 11 g/min with VersaCut. Furthermore, bladder mucosal injury was reported in 1.4% and 0.7 to 5.7% with Piranha and VersaCut, respectively; bladder perforation with VersaCut was experienced in about 0.1 to 1.5% of patients. Our study is limited by its non-randomization.Conclusion: The Piranha morcellator was the most efficient and safe way to retrieve tissue after a transurethral enucleation of a prostate adenoma.

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