Current surgical techniques of enucleation in holmium laser enucleation of the prostate.
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SUBMITTER: Oh SJ
PROVIDER: S-EPMC6722407 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveTo demonstrate how bladder ultrasound can be useful in completing morcellation during difficult Holmium Laser Enucleation of the Prostate (HoLEP). As HoLEP has emerged as a standard of care for the treatment of benign prostatic hyperplasia, multiple studies have reported the potentially catastrophic complication of bladder injury during morcellation. This video aims to assist any urologist performing HoLEP by providing step-by-step instruction for using ultrasound to complete morcellation safely.MethodsEnucleation is performed using a 26-French continuous flow scope, off-set laser bridge with a laser stabilization catheter, and a 550 µm holmium laser fiber. Once the median and lateral lobes have been enucleated, the outer sheath is removed and the nephroscope is inserted to facilitate morcellation. Under dual inflow irrigation, the Piranha morcellator (Richard Wolf, Knittlingen, Germany) is introduced and set to the manufacturer's recommended settings of 1500 rpm. A 3.5-MHz convex abdominal ultrasound transducer (Hitachi Prosound Alpha 7; Hitachi Aloka Medical America, Wallingford, CT) under B-mode is used to visualize the bladder, predominantly in the sagittal orientation. Morcellation proceeds under simultaneous ultrasound and direct cystoscopic guidance.ResultsThe distended bladder is visualized concurrently with the ultrasound and via the nephroscope as the Piranha engages the adenoma and begins morcellation. Once the adenoma is engaged, the operator then drops their hands to place the morcellator in the center of the bladder. Ultrasound provides real-time feedback as to the location of the morcellator in relation to the adenoma and bladder.ConclusionThis video highlights the use of intraoperative bladder ultrasound as a visual aid to assist during the morcellation portion of HoLEP. This proof of concept demonstrates that ultrasound can be an additional tool to utilize during difficult cases when cystoscopic visualization during morcellation is limited.
| S-EPMC8021387 | biostudies-literature
Project description:BackgroundTo 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.ResultThe average (range) enucleation time was 46.1 (12-220) minutes, and the overall operation time was 71 (18-250) minutes. History of antiplatelet agents, 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.ConclusionEn 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 antiplatelet agents were correlated with increased operative time.
| S-EPMC7661272 | biostudies-literature
Project description:Several therapeutic approaches such as holmium laser enucleation of the prostate (HoLEP) have been introduced to relieve bladder outlet obstruction caused by benign prostatic hyperplasia (BPH). Compared with other techniques including the transurethral resection of the prostate (TURP) and simple open prostatectomy, HoLEP results in a shorter hospital stay and catheterization time and fewer blood loss and transfusions. HoLEP is a size-independent treatment option for BPH with average gland size from 36 g to 170 g. HoLEP is a safe procedure in patients receiving an anticoagulant and has no significant influence on the hemoglobin level. Also, HoLEP is an easy and safe technique in patients with a prior history of prostate surgery and a need for retreatment because of adenoma regrowth. The postoperative erectile dysfunction rate of patients treated with HoLEP is similar to TURP or open prostatectomy and about 77% of these patients experience loss of ejaculation. Patients with transitional zone volume less than 30 mL may suffer from persistent stress urinary incontinence following HoLEP so other surgical techniques like bipolar TURP are a good choice for these patients. In young patients, considering HoLEP with high prostate-specific antigen density and a negative standard template prostate biopsy, multiparametric MRI needs to be considered to exclude prostate cancer.
| S-EPMC7118502 | biostudies-literature
Project description:PurposeThere isscarce evidence to date on how temperature develops during holmium laser enucleation of the prostate (HoLEP). We aimed to determine the potential heat generation during HoLEP under ex vivo conditions.MethodsWe developed two experimental setups. Firstly, we simulated HoLEP ex vivo using narrow-neck laboratory bottles mimicking enucleation cavities and a prostate resection trainer. Seven temperature probes were placed at different locations in the experimental setup, and the heat generation was measured separately during laser application. Secondly, we simulated high-frequency current-based coagulation of the vessels using a roller probe.ResultsWe observed that the larger the enucleated cavity, the higher the temperature rises, regardless of the irrigation flow rate. The highest temperature difference with an irrigation flow was approximately + 4.5 K for a cavity measuring 100ccm and a 300 ml/min irrigation flow rate. The higher flow rate generates faster removal of the generated heat, thus cooling down the artificial cavity. Furthermore, the temperature differences at different irrigation flow rates (except at 0 ml/min) were consistently below 5 K. Within the resection trainer, the temperature increase with and without irrigation flow was approximately 0.5 K and 3.0 K, respectively. The mean depth of necrosis (1084 ± 176 µm) achieved by the roller probe was significantly greater when using 144 W energy.ConclusionCarefully adjusted irrigation and monitoring during HoLEP are crucial when evacuating the thermal energy generated during the procedure. We believe this study of ours provides evidence with the potential to facilitate clinical studies on patient safety.
| S-EPMC9236967 | biostudies-literature
Project description:Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure and a size-independent treatment for benign prostatic hyperplasia with excellent long-term surgical outcome. HoLEP has become an alternative to conventional transurethral resection of the prostate or open prostatectomy owing to its efficacy and safety. Although HoLEP is known to have a steep learning curve, very few articles have addressed the technical aspects of HoLEP. Herein, we described detailed techniques and tips for HoLEP as performed at Seoul National University Hospital in a step-by-step manner with extensive review of the literature.
| S-EPMC3773585 | biostudies-literature
Project description:ObjectiveTo investigate patient satisfaction after holmium laser enucleation of the prostate (HoLEP) in a prospective study.Subjects and methodsFrom May 2012 to December 2014, 397 patients underwent HoLEP by a single surgeon and enrolled in our prospective registry. Baseline data included age, PSA, transrectal ultrasonography, the international prostate symptom score (IPSS), and overactive bladder symptom score (OABSS). Subjective assessment of surgical outcomes was performed at 6 months postoperatively using self-administered questionnaires consisting of 'satisfaction with treatment question' (STQ), 'overall response assessment' (ORA), and 'willingness to undergo surgery question' (WSQ).ResultsA total of 331 patients (mean age 69.6±7.0 years) were included in the analysis. Mean total prostate volume was 69.5 (±42.2) ml. Mean preoperative IPSS score was 18.5 (±7.8). The STQ showed that most patients (91.8%) were satisfied after the surgery. Only 11 (3.3%) patients responded with 'dissatisfied', and no patients replied with 'very dissatisfied'. The WSQ showed that 311 (94.0%) patients were willing to undergo the surgery again if they had to reconsider the surgical decision. The ORA showed that all patients (99.4%) experienced an improvement. When compared with satisfied patients, neutral/dissatisfied patients had lower IPSS quality of life scores (2.7 vs. 0.9, p<0.001), higher IPSS voiding symptom scores (7.0 vs. 1.4, p<0.001), and more frequent episodes of urgency urinary incontinence in OABSS (1.0 vs. 0.3, p = 0.017) at 6 months postoperatively.ConclusionsThe overall level of satisfaction after HoLEP was high. The most common reason for dissatisfaction was the occurrence of urgency urinary incontinence after the surgery.
| S-EPMC5549990 | biostudies-literature
Project description:Laser enucleation of the prostate represents the endoscopic response to open simple prostatectomy for the treatment of large benign prostatic hyperplasia (BPH) and an advanced technique for prostate surgery. To date, no more than 20 cases of giant prostatic hyperplasia (GPH) have been reported in the literature. We report a successful holmium laser enucleation of a 696 cc prostate in a 78 year-old patient on anticoagulation that was embolized prior to the intervention, urinary catheter was removed on the first day post-operatively and the patient was discharged home on the second day. This is considered the largest prostate treated endoscopically.
| S-EPMC9450164 | biostudies-literature
Project description:This study was aimed to compare serial long-term postoperative changes in quality-of-life (QoL) between photoselective-vaporization (PVP) using 120W-High-Performance-System and holmium-laser-enucleation (HoLEP) in benign-prostatic-hyperplasia (BPH) patients and to identify factors influencing the QoL improvement at the short-term, mid-term and long-term follow-up visits after surgery. We analyzed 1,193 patients with a baseline QoL-index ≥2 who underwent PVP (n = 439) or HoLEP (n = 754). Surgical outcomes were serially compared between the two groups at up to 60-months using the International-Prostatic-Symptom-Score (I-PSS), uroflowmetry, and serum PSA. We used logistic regression analysis to identify predictors of QoL improvement (a reduction in the QoL-index ≥50% compared with baseline) at the short-term (12-months), mid-term (36-months), and long term (60-months) follow-up after surgery. In both groups, the QoL-index was decreased throughout the entire follow-up period compared with that at baseline. There were no significant differences in postoperative changes from the baseline QoL-index between the two groups during the 48-month follow-up, except at 60-months. The degree of improvement in QoL at 60-months after HoLEP was greater than that after PVP. A lower baseline storage-symptom-subscore and a higher bladder-outlet-obstruction-index (BOOI) were independent factors influencing QoL improvement at the short-term. No independent factor influences QoL improvement at the mid- or long-term.
| S-EPMC6547661 | biostudies-literature
Project description:Background Holmium laser enucleation of the prostate (HoLEP) is a new alternative method for the treatment of benign prostatic hyperplasia (BPH); however, most surgeons are hesitant to use this new technique due to its steep learning curve. Notably, most beginners start with the traditional multi-incisional method rather than the en bloc method. Thus, we sought to explore the feasibility of beginners adopting the en bloc method in HoLEP. Methods A clinical development project was established at Department of Urology, Affiliated Nantong Rehabilitation Hospital of Nantong University in December 2019 to promote HoLEP. The study included 1st 132 consecutive patients treated by a single surgeon between January and December 2020. The overall pre-, peri-, and post-operative metrics were documented and evaluated. The 132 patients were divided into Group A (1st 50 patients) and Group B (the following 82 patients), and these two groups were compared to each other. Results No conversion of operative methods occurred. The major significant differences between Groups A and B related to the enucleation time and enucleation efficiency. We found that 20–30 procedures needed to be performed for the surgeon to become relatively comfortable with the en bloc method. Further, skill improvement was continuous but tended to stabilize with case accumulation. The main short-term complications observed in the hospital and 30 days post-operatively included acute urinary retention, urinary tract infection, transient incontinence, and gross hematuria. In the 18-month follow-up period, the complications consisted of urethral stricture and bladder-neck contracture, which required endoscopic urethrotomy or bladder-neck incisions. Conclusions The en bloc HoLEP provided a significantly improved voiding with low complications and recurrence, and this technique could feasibly be adopted to teach beginners.
| S-EPMC10080358 | biostudies-literature
Project description:Video 1We present a case of a 76 year old patient undergoing holmium laser enucleation of an esophageal leiomyoma in endoscopic tunnel technique.
| S-EPMC8185999 | biostudies-literature