Analysis of Holmium Laser Enucleation of the Prostate in a High-Volume Center: The Impact of Concomitant Holmium Laser Cystolitholapaxy

Romero-Otero, Javier; García-González, L.; García‐Gómez, Borja; Alonso-Isa, Manuel; García‐Rojo, Esther; Gil-Moradillo, J.; Duarte-Ojeda, J.M.; Rodrı́guez-Antolı́n, A.

doi:10.1089/end.2019.0019

Cited by 9 publications

(3 citation statements)

References 25 publications

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“…Three contemporary, retrospective studies report outcomes in men undergoing BPO surgery vs TUCL and BPO surgery concomitantly: they all report no difference in intraoperative or major postoperative complications and 100% SFRs [ 25 , 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…Two studies compared men undergoing holmium laser enucleation of prostate with or without concomitant TUCL: 54 of 963 men and 41 of 320 men underwent concomitant TUCL [ 25 , 31 ]. The larger study found higher UTI (7.4%) and sepsis (1.9%) rates in patients who underwent concomitant TUCL (3.1% and 0.1%) [ 31 ]. The smaller study found a higher rate of transient postoperative urinary incontinence (26.8% vs 12.5%, P = 0.03).…”

Section: Discussionmentioning

confidence: 99%

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Do men with bladder stones benefit from treatment of benign prostatic obstruction?

et al. 2022

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To identify whether men aged ≥40 years with bladder stones (BS) benefit from treatment of benign prostatic obstruction (BPO). Patients and methodsA regional, retrospective study of patients undergoing BS surgery between January 2011 and December 2018 was performed using a prospectively collected database. The primary outcome was BS recurrence after successful removal. Kruskal-Wallis and chi-squared statistical tests were used. ResultsA total of 174 patients underwent BS removal and 71 (40.8%) were excluded due to BS formation secondary to causes other than BPO. Hence, 103 men aged ≥40 years had BS successfully removed, of which 40% had a history of upper tract urolithiasis. These men were divided into three groups: those undergoing contemporaneous medical, surgical, or no BPO treatment. Age, diabetes, previous urolithiasis and previous BPO surgery were well matched between the BPO treatment groups. In all, 18 of these men (17%) had BS recurrence after 46 months follow-up.Recurrences were significantly lower following BPO surgery; one of 34 (3%) men versus five of 28 (18%) with no BPO treatment (P = 0.048) and 12 of 41 (29%) with medical BPO treatment (P = 0.003). Recurrences after medical and no BPO treatment were similar (P = 0.280). In all, 34 men (33%) had BPO complications that were similar between groups (P = 0.378). ConclusionThis is the largest reported cohort of men, with the longest follow-up after BS removal. Most men aged ≥40 years with BS benefit from BPO surgery. However, the study findings also support a multifactorial aetiology for BS, which questions the dogma that BS are an 'absolute indication' for BPO surgery, as is stated in the Non-neurogenic Male Lower Urinary Tract Symptoms European Association of Urology Guideline. Assessment and management of all causative factors is likely to enable selection of which men will benefit from BPO surgery and to reduce BS recurrence rates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Do men with bladder stones benefit from treatment of benign prostatic obstruction?

et al. 2022

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“…2 HLC can be effectively performed at the time of benign prostatic hyperplasia (BPH) treatment by holmium laser enucleation of the prostate (HoLEP) and has been shown to be safe. [3][4][5] Moses laser technology has been demonstrated to have improved efficiency of lithotripsy for contact and distance modes. 6 A unique mode, Moses Optimized for BPH, has been developed to optimize this performance for tissue and had been shown beneficial with HoLEP.…”

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Moses Augmented Holmium Laser Cystolitholapaxy Is an Effective Safe Method for Treatment of Intravesical Calculi

et al. 2020

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Introduction: Management of intravesical calculi is not uncommon at the time of bladder outlet surgery. 1 With advancement of endourologic surgery and laser technology for lithotripsy, holmium laser cystolitholapaxy (HLC) was first reported in 1997 that helped transform a traditionally open procedure into an endoscopic one. 2 HLC can be effectively performed at the time of benign prostatic hyperplasia (BPH) treatment by holmium laser enucleation of the prostate (HoLEP) and has been shown to be safe. [3][4][5] Moses laser technology has been demonstrated to have improved efficiency of lithotripsy for contact and distance modes. 6 A unique mode, Moses Optimized for BPH, has been developed to optimize this performance for tissue and had been shown beneficial with HoLEP. 7,8 This mode has not been studied for intravesical lithotripsy. Herein, we present our Moses augmented HLC (m-HLC) experience using Moses Optimized for BPH. Materials and Methods: We performed a retrospective review of patients at our institution undergoing HoLEP using Moses laser with concomitant cystolitholapaxy. Moses Optimized for BPH was used for all cases and laser settings of 2 J and 40-60 Hz were utilized for both m-HLC and enucleation. All HoLEPs were performed through a ''bottom-up'' approach per our standard procedure. 9 Patient demographics, operative characteristics, and postoperative outcomes are presented. Results: Twenty patients are included in our cohort from December 2018 through January 2020 who underwent concomitant HoLEP and m-HLC. Median age was 69.6 (interquartile range 62.9-73.0) years, preoperative prostate volume was 96.5 (60-139.5) mL, and bladder stone burden was 3.0 (1.9-4.5) cm. Five (25%) of patients had an indwelling catheter preoperatively. Median procedure time Downloaded by 44.224.250.200 from www.liebertpub.com at 05/09/21. For personal use only.was 103 (80-130) minutes, enucleation time was 48.5 (38.3-58.8) minutes, morcellation time was 7 (3-16) minutes, and enucleated tissue was 63.5 (38.3-100) g. Three (15%) patients underwent concomitant upper tract calculus surgery and six (30%) had a history of nephrolithiasis. There were no intraoperative complications. Nine procedures (45%) were performed as same day dismissal. Eighteen (90%) underwent voiding trial on postoperative day 1. There was one Clavien II complication of spontaneous urinary retention requiring catheterization 10 weeks after HoLEP. The catheter was removed 3 days after placement and patient has had no voiding issues for 6 months. Conclusions: m-HLC is safe and feasible, with excellent lithotrite abilities for intravesical calculi. Moses for BPH is effective for lithotripsy as well as HoLEP. Bladder stones should not require open surgical management if undergoing HoLEP. D.K.A. and C.U.N. have no disclosures. A.E.K. and M.E.R. are paid consultants of Boston Scientific and Lumenis. T.L. is Boston Scientific's paid consultant. This study was IRB approved. Authors have received and archived patient consent for video recording/publication before video ...

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A prospective evaluation of high- and low-power holmium laser settings for transurethral lithotripsy in the management of adults with large bladder calculi

et al. 2021

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Analysis of Holmium Laser Enucleation of the Prostate in a High-Volume Center: The Impact of Concomitant Holmium Laser Cystolitholapaxy

Cited by 9 publications

References 25 publications

Do men with bladder stones benefit from treatment of benign prostatic obstruction?

Do men with bladder stones benefit from treatment of benign prostatic obstruction?

Moses Augmented Holmium Laser Cystolitholapaxy Is an Effective Safe Method for Treatment of Intravesical Calculi

A prospective evaluation of high- and low-power holmium laser settings for transurethral lithotripsy in the management of adults with large bladder calculi

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