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Preoperative predictors of enucleation time during en bloc 'no-touch' holmium laser enucleation of the prostate.

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 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. 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 antiplatelet agents were correlated with increased operative time.

SUBMITTER: Lin CH

PROVIDER: S-EPMC7661272 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Preoperative predictors of enucleation time during en bloc 'no-touch' holmium laser enucleation of the prostate.

Lin Chun-Hsuan CH Wu Wen-Jeng WJ Li Ching-Chia CC Wen Sheng-Chen SC

BMC urology 20201111 1

<h4>Background</h4>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 enucl ...[more]

PMID: 33176769

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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.

Dataset Information

Preoperative predictors of enucleation time during en bloc 'no-touch' holmium laser enucleation of the prostate.

Publications

Preoperative predictors of enucleation time during en bloc 'no-touch' holmium laser enucleation of the prostate.

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