Early anterior detachment of the adenoma: a novel approach for en bloc thulium laser enucleation of the prostate.
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ABSTRACT:
SUBMITTER: Saredi G
PROVIDER: S-EPMC7848832 | biostudies-literature | 2020
REPOSITORIES: biostudies-literature
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Early anterior detachment of the adenoma: a novel approach for en bloc thulium laser enucleation of the prostate.
Saredi Giovanni G Pacchetti Andrea A Dotta Federico F Annino Filippo F Capogrosso Paolo P Dehò Federico F Pirola Giacomo Maria GM
Central European journal of urology 20200925 4
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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: Not available
| S-EPMC8318026 | biostudies-literature
Project description:BackgroundHolmium 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.MethodsA 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.ResultsNo 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.ConclusionsThe 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:BackgroundThis study aimed to evaluate the efficacy and safety of holmium laser enucleation of prostate (HoLEP) by using en-bloc and bladder neck preservation technique on benign prostatic hyperplasia (BPH) and assess the influence of this procedure on urinary and sexual functional outcomes.MethodsA total of 704 patients with BPH undergoing HoLEP were retrospectively analysed. Amongst them, 213 who met the sexual function assessment criteria were further assessed the influence of the technique on sexual functional outcomes.ResultsThe mean operative time, resected prostate weight and mean estimated blood loss were 69.3±14.8 min, 53.4±17.6 g and 62.1±23.7 mL, respectively. The mean duration of catheterization after surgery and mean hospital stay were 2.1±1 and 5.4±3.6 days, respectively. The post-void residual volume, maximum urinary flow rate, international prostate symptom score and quality of life score were all significantly improved postoperation (P<0.05). Amongst the 213 patients with normal antegrade ejaculation before surgery, postoperative international index of erectile function scores slightly improved, although the difference was insignificant (P>0.05). The difference in the Erection Hardness Grading Scale before and after surgery was statistically insignificant (P>0.05). A total of 25 (11.7%) patients had retrograde ejaculation after surgery.ConclusionsHoLEP by an en-bloc and bladder neck preservation technique can obtain good functional outcome with small injury and high efficiency, especially for patients who need to preserve normal sexual function and anterograde ejaculation.
| S-EPMC7844485 | biostudies-literature
Project description:PurposeHolmium laser enucleation of the prostate (HoLEP) represents the current standard procedure for size-independent surgical therapy of benign prostatic obstruction (BPO). With advent of the novel laser technology thulium fiber laser (TFL), we hypothesized that the functional outcome of TFL enucleation of the prostate (ThuFLEP) is non-inferior compared to HoLEP.MethodsFrom October 2021 to October 2022, 150 patients with BPO were recruited for the prospective randomized trial in accordance with CONSORT. Stratified randomization into the arms ThuFLEP (n = 74) or HoLEP (n = 76) was carried out. The primary endpoint was non-inferior international prostate symptom score (IPSS) and quality of life (QoL) at three months after treatment. Secondary endpoints were rates of complications, peak flow, residual urine and operation times.ResultsPreoperative characteristics showed no significant differences. Overall IPSS and QoL improved from 21 to 8 and 4 to 1.5, respectively, after three months of follow-up. No statistically significant differences between ThuFLEP and HoLEP were observed regarding median postoperative IPSS (8.5 vs. 7, p > 0.9), QoL (1 vs. 2, p = 0.6), residual urine (48 vs. 30ml, p = 0.065) and peak flow (19 vs. 17ml/s, p > 0.9). Similarly, safety profile was comparable with no statistically significant differences regarding rate of major complications (5.3 vs. 5.4%, p = 0.5), laser hemostasis time (3 vs. 2min, p = 0.2), use of additive electric coagulation (74 vs. 87%, p = 0.06) or electric coagulation time (8 vs. 8min, p = 0.4).ConclusionsIn this prospective, randomized trial ThuFLEP showed non-inferior results compared to HoLEP in terms of functional outcomes measured by IPSS and QoL as primary endpoint.Trial registration numberDRKS00032699 (18.09.2023, retrospectively registered).
| S-EPMC10799774 | biostudies-literature
Project description:PurposeThe thulium laser is the most recently introduced technology for the surgical treatment of benign prostatic hyperplasia (BPH). Until recently, most thulium laser enucleation of the prostate (ThuLEP) was performed by use of the three-lobe technique. We introduce a novel one-lobe enucleation technique for ThuLEP called the "All-in-One" technique. We report our initial experiences here.Materials and methodsFrom June 2013 to May 2014, a total of 47 patients underwent the All-in-One technique of ThuLEP for symptomatic BPH performed by a single surgeon. All patients were assessed with the International Prostate Symptom Score (IPSS), transrectal ultrasonography, serum prostate-specific antigen (PSA), maximal urine flow rate (Qmax), and postvoid residual urine volume (PVR) before and 1 month after surgery. We reassessed IPSS, Qmax, and PVR 3 months after surgery. To assess the efficacy of the All-in-One technique, we checked the PSA reduction ratio, transitional zone volume reduction ratio, and enucleation failure rate.ResultsThe mean operative time was 82.1±33.3 minutes. The mean enucleation time and morcellation time were 52.7±21.7 minutes and 8.2±7.0 minutes, respectively. The mean resected tissue weight and decrease in hemoglobin were 36.9±24.6 g and 0.4±0.8 g/dL, respectively. All perioperative parameters showed significant improvement (p<0.05). No major complications were observed. The PSA reduction ratio, transitional zone volume reduction ratio, and enucleation failure rate were 0.81, 0.92, and 4.3%, respectively.ConclusionsThe All-in-One technique of ThuLEP showed efficacy and effectiveness comparable to that of other techniques. We expect that this new technique could reduce the operation time and the bleeding and improve the effectiveness of enucleation.
| S-EPMC4643173 | biostudies-literature
Project description:PurposeThe aim of this study was to compare the enucleation performances of four different types of laser devices in an ex-vivo experiment: a novel, pulsed Tm:YAG solid-state laser evaluation model (p-Tm:YAG), chopped thulium fibre laser (TFL), low-power Ho:YAG laser (LP-Ho:YAG), and a high-power Ho:YAG laser (HP-Ho:YAG).MethodsOur primary aim was to endoscopically separate the fascial layers of a porcine belly using laser fibres within a time period of 60 s. The size of a "tissue pocket" was assessed numerically. The enucleation characteristics reflecting the surgeon's experience were evaluated via the NASA Task Load Index (TLX) questionnaire and a questionnaire based on Likert scale.ResultsHP-Ho:YAG achieved with the available laser settings the largest overall "tissue pocket" (31.5 cm2) followed by p-Tm:YAG (15 cm2), TFL (12 cm2), and LP-Ho:YAG (6 cm2). The coagulation performances of p-Tm:YAG and TFL were rated the best. In the performance evaluation by the Likert questionnaire, HP-Ho:YAG (average score of 4.06) was rated highest, followed by p-Tm:YAG (3.94), TFL (3.38), and LP-Ho:YAG (3.25). The evaluation of the NASA-TLX performance questionnaire revealed average scores for HP-Ho:YAG, LP-Ho:YAG, TFL and p-Tm:YAG of 4.38, 4.09, 3.92 and 3.90, respectively.ConclusionWe are the first to compare different laser devices and settings in an ex-vivo study. We found that the surgeons were most satisfied with the HP-Ho:YAG laser device, followed by the p-Tm:YAG. These findings could be highly relevant for future research and for the practical utilisation of laser systems in endourology.
| S-EPMC8921029 | biostudies-literature
Project description:BackgroundTo assess the educational value of YouTube surgical videos of thulium laser enucleation of the prostate (ThuLEP).MethodsA comprehensive search of "ThuLEP" or "thulium laser enucleation of the prostate" was performed on YouTube on October 31, 2020. According to the LAParoscopic surgery Video Educational GuidelineS, we created a checklist to assess the educational value of these videos. The checklist included 20 options. Each option represented one point. The total score was the sum of all the points. The higher score represents the higher educational value.ResultsA total of 70 videos were included. The average number of views were 1,366 (range, 11-30,884). The mean video length was 16.59 mins (range, 1.20-70.35 mins). Only 22.9% (16/70) videos had audio or/and written commentary in English language. Although 67.4% (47/70) videos were present step by step, only 21.4% (15/70) videos did the detailed explanation of critical steps. The mean score of the videos was 5.5 points (range, 1-15). No videos met all the points of the checklist. The mean percentage conformity of the videos was 28% (range, 5-75%). The educational score of the videos had no significant positive correlation with the number of views.ConclusionsThe majority of ThuLEP videos on YouTube platform have low educational value. Videos often lack important and detailed explanations about surgical procedures. The ThuLEP learner should watch these videos selectively. These findings remind us that a global effort should be made to improve the educational value of YouTube surgical videos, and more reporting guidelines about urological endoscopic surgery are still needed.
| S-EPMC8350234 | biostudies-literature
Project description:BACKGROUND:The efficacy of thulium laser prostate enucleation (ThuLEP) for large prostates is unclear. This study aimed to explore the expanded utility of 150-200-W ThuLEP by studying patients with a large prostate (>?80?mL). METHODS:We retrospectively reviewed records of 125 patients with large prostate glands (>?80?mL) who underwent ThuLEP performed by a single surgeon from June 2012 to June 2016. The ThuLEP data from our previous pilot study were used as the control. Operative variables, patient profiles, preoperative and postoperative urine flow rates, prostate volume, and the international prostate symptom score (IPSS) were recorded and analyzed using Student's t-test, the z-test, and logistic regression analysis. RESULTS:Of 366 patients who underwent ThuLEP, 125 (34.15%) were enrolled. The ages and estimated prostate volumes were compared with those of the control. Overall, 39.2% underwent Foley placement and 4% received an anticoagulant agent preoperatively. Maximum urinary flow rates before and 3 and 12?months postoperatively were 9.93, 23.20, and 19.00?mL/s, respectively, which were generally equal to those of the control groups (P =?0.68, 0.18, 0.98, respectively). Preoperative and postoperative IPSSs were 27.09 and 7.35, respectively. The postoperative prostate-specific antigen was reduced by 85.59% in comparison to the preoperative level. The estimated prostate size was reduced by 74.17% postoperatively. The modified Clavien-Dindo classification system was used to identify the overall rate of complications, which was approximately 22.4%. The mortality rate was 0.8%. CONCLUSIONS:High-power ThuLEP is safe and effective for patients with large prostate glands (>?80?mL). Prostate enucleation using a high-power thulium laser is feasible for patients who exhibit contraindications for surgery.
| S-EPMC6341629 | biostudies-literature
Project description:Open resection of a large lipoma requires a large incision that may result in disfigurement from the scar. Endoscopic resection of the lipoma can have better cosmetic results. However, piecemeal removal of the lipoma has the disadvantage of fragmentation of the tumor before it can be determined whether it is benign or malignant. In this Technical Note, the technical details of endoscopically assisted en bloc resection of an anterior knee lipoma are described. This can provide a whole-block specimen for histologic examination.
| S-EPMC8252843 | biostudies-literature