An update on holmium laser enucleation of the prostate and why it has stood the test of time

Gnessin, Ehud; Mandeville, Jessica A.; Lingeman, James E.

doi:10.1097/mou.0b013e32834120d7

Cited by 8 publications

(4 citation statements)

References 35 publications

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“…The over-deobstruction achieved by HoLEP, however, might induce postoperative incontinence at an early stage [ 10 ]. Because of a steep learning curve, the adoption rate for this technique is low, and only a few studies on large series of patients have been performed in limited centers [ 11 , 12 ]. The learning curve may be prolonged, and 50 cases are required for a surgeon to obtain an outcome that is comparable to that reported in the literature [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Vapoenucleation of the prostate using a high-power thulium laser: a one-year follow-up study

et al. 2015

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BackgroundProstate vaporization and enucleation is a novel treatment option for bladder outlet obstruction caused by benign prostate enlargement. This surgical technique, however, has not yet been standardized. We present our findings of using a high-power thulium laser to accomplish vapoenucleation of the prostate (ThuVEP).MethodsWe prospectively collected and analyzed data from 29 patients who underwent ThuVEP between August 2010 and May 2012. The control group included 30 patients who underwent traditional transurethral resection of the prostate (TURP). Operative variables, patient profiles, preoperative and postoperative urine flow rates, prostate volume (measured using transrectal ultrasonography), and the international prostate symptom score (IPSS) were recorded and analyzed using a two-tailed Student’s t-test and analysis of variance.ResultsThe ages (mean ± SD) of the patients were 76.1 ± 9.4 and 72.6 ± 7.4 years (p = 0.28) in the ThuVEP and TURP groups, respectively. The average urinary flow rates before and 12 months after the operation (volume/maximum flow/average flow) were 243.3/10.5/5.0 and 302.8/17.6/9.4 (in mL, mL/s, mL/s, respectively) in the ThuVEP group and 247.2/10.8/4.6 and 369.9/20.8/12.0, respectively, in the TURP group. Preoperative and postoperative IPSSs were 17.1 ± 5.0 and 6.5 ± 3.8, respectively, in the ThuVEP group and 18.2 ± 4.5 and 6.2 ± 3.3, respectively, in the TURP group. The mean ratio of the estimated postoperative residual prostate volume to the preoperative total volume was 0.47 (p = 0.449) in both groups. The overall complication rate was 20.7% in the ThuVEP group and 30.0% in the TURP group.ConclusionsOne year of follow-up showed that ThuVEP and TURP effectively alleviated subjective and objective voiding symptoms with a low rate of complications. Thus, vapoenucleation using a high-power laser is feasible in elderly patients.Trial registrationISRCTN registry with study ID ISRCTN52339705. Date assigned: 06/03/2015.

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Section: Introductionmentioning

confidence: 99%

Vapoenucleation of the prostate using a high-power thulium laser: a one-year follow-up study

et al. 2015

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“…In these patients, transurethral enucleation is superior to other techniques. 1 Different kinds of energy have been used in the enucleation procedure, including holmium YAG, 2 thulium, 3 Greenlight laser (532 nm), 4 and plasma kinetic energy, 5 ending by completely or partially detaching the intravesical adenoma. However, the techniques of prostate tissue retrieval, particularly intravesical morcellation of prostatic adenoma, are poorly evaluated.…”

Section: Introductionmentioning

confidence: 99%

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

Elshal

Mekkawy

Laymon

et al. 2015

CUAJ

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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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“…Transurethral approach is ideal for this purpose; however, several cases of recurrence after initial TUR have been shown in the literature; two cases with bladder leiomyoma6 and one case with prostatic leiomyoma with atypia 4. HoLEP is another effective transurethral surgery for BPH because its superior efficacy and safety for prostates of any size has been demonstrated over the last decade 7. Although there have been no published reports of performing HoLEP on prostatic leiomyoma, we selected HoLEP over conventional TUR because we had found several case reports published in Japanese describing the blunt dissection of leiomyoma as ‘quite easy’ during suprapubic open prostatectomy.…”

Section: Discussionmentioning

confidence: 99%

Difficulty in the intravesical morcellation procedure for leiomyoma of the prostate enucleated by HoLEP

Shinojima¹,

Yoshimine

2013

BMJ Case Reports

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Leiomyoma of prostate are rare benign neoplasms that are usually diagnosed incidentally through postoperative pathological examination. A 70-year-old man is presented with severe symptoms of lower urinary tract obstruction. Although a digital rectal examination and the prostate-specific antigen level did not suggest malignancy, transrectal ultrasonography showed an unusual homogenous echoic mass measuring 45×37 mm in size in the prostate. A needle biopsy was performed and pathological diagnosis was prostatic leiomyoma. Holmium laser enucleation of prostate (HoLEP) was chosen and performed to resect the tumour. Although the enucleation step presented no problems, the morcellation procedure using a conventional transurethral mechanical morcellator was very difficult owing to the firmness of the tissue. By using a bipolar erectrosurgical loop, fragmentation and removal of tissue was accomplished. This is the first case reported of these rare neoplasms in which HoLEP was offered as a less invasive surgical approach. We emphasise the firmness of the leiomyomatous tissue, which would lead to morcellation failure.

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An update on holmium laser enucleation of the prostate and why it has stood the test of time

Cited by 8 publications

References 35 publications

Vapoenucleation of the prostate using a high-power thulium laser: a one-year follow-up study

Vapoenucleation of the prostate using a high-power thulium laser: a one-year follow-up study

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

Difficulty in the intravesical morcellation procedure for leiomyoma of the prostate enucleated by HoLEP

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