Clinical Comparison of Holmium Laser Enucleation of the Prostate and Bipolar Transurethral Enucleation of the Prostate in Patients Under Either Anticoagulation or Antiplatelet Therapy

Boeri, Luca; Capogrosso, Paolo; Ventimiglia, Eugenio; Fontana, Matteo; Sampogna, G.; Zanetti, S.P.; Pozzi, Edoardo; Zuabi, Rani; Schifano, Nicolò; Chierigo, Francesco; Longo, Fabrizio; Gadda, Franco; Dell’Orto, P.; Scattoni, Vincenzo; Montorsi, Francesco; Montanari, Emanuele; Salonia, Andrea

doi:10.1016/j.euf.2019.03.002

Cited by 30 publications

(19 citation statements)

References 29 publications

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“…4 Enucleation as a surgical technique for the treatment of BPH has been safely performed with a variety of energy sources including: bipolar electrocautery, GreenLight laser, Thulium, and Holmium laser energy. [5][6][7] Advancements in holmium laser technology have been limited and have mostly been centered around total power output by the laser units, however, modulated pulsed laser energy in high powered units has been introduced to optimize the efficacy of the laser. A specific example of this innovation has been developed and distributed by Lumenis as the MOSES laser platform.…”

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confidence: 99%

Comparative Study of Holmium Laser Enucleation of the Prostate With MOSES Enabled Pulsed Laser Modulation

Large

Nottingham

Stoughton

et al. 2020

Urology

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To compare outcomes for patients undergoing holmium laser enucleation of the prostate (HoLEP) for lower urinary tract symptoms secondary to benign prostate hyperplasia using 3 different laser fibers and 2 different laser energy modes. MATERIALS AND METHODS This is a review of a clinic registry of men with lower urinary tract symptoms secondary to benign prostate hyperplasia who underwent HoLEP between August 2018 and January 2019. Patients were assigned to group 1 (50 patients), group 2 (50 patients), and group 3 (50 patients) based on the HoLEP being completed with either a Slimline 550mm, Slimline 1000mm, or MOSES 550 mm laser, respectively. The groups were compared using SSPS for ANOVA comparison of means and multivariate logistic regression. RESULTS Ten patients who underwent concomitant stone surgery (2 PCNL, 8 ureteroscopy , 3 bilateral cases) and 11 patients had bladder stones removed; ancillary procedures did not significantly differ between groups(P = .2). Prostate enucleation times differed significantly (22.5 + 7.3, 16.4 + 6.9, 18.1 + 8.6 minutes P ≤.001) between groups. However, statistical significance was lost once enucleation time was indexed against enucleated tissue weight. Time to achieve hemostasis (minutes) was statistically different between groups (10.6 + 6.1, 7.7 + 5.2, 6.3 + 4.8 P <.001). This difference in hemostatic time was maintained on multilogistic regression demonstrating that MOSES laser enucleation was associated with a 3.9-minute decrease time to achieve hemostasis after enucleation compared to Slimline 550 HoLEP (P <.001). CONCLUSION Our findings suggest that modulated pulsed laser energy can improve hemostasis during the enucleation phase of a HoLEP resulting in shorter Operating Room times.

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confidence: 99%

Comparative Study of Holmium Laser Enucleation of the Prostate With MOSES Enabled Pulsed Laser Modulation

Large

Nottingham

Stoughton

et al. 2020

Urology

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Section: Evidence Synthesismentioning

confidence: 99%

“…There were numerous elderly patients with BPH who need long‐term anticoagulant/antiplatelet therapy due to underlying diseases, and drug withdrawal is usually required before TURP (Boeri et al, ). Previous studies suggested that anticoagulant/ antiplatelet therapy might increase the risk of haemorrhage in patients undergoing AEEP (Boeri et al, ; Kuebker & Miller, ). However, Rivera, Krambeck, and Lingeman () reported that although patients undergoing anticoagulation/antiplatelet therapy experienced prolonged bladder irrigation after HoLEP due to bleeding, the overall surgical outcome was not inferior to those without anticoagulation/antiplatelet therapy.…”

Section: Evidence Synthesismentioning

confidence: 99%

Complications of anatomical endoscopic enucleation of the prostate

Wei

et al. 2020

Andrologia

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Transurethral resection of the prostate (TURP) remains the 'gold standard' for surgical treatment of benign prostatic obstruction (BPO). Recently, anatomical endoscopic enucleation of the prostate (AEEP) using holmium laser, thulium laser and plasma, etc., is extensively applied in clinical practice. However, perioperative complications of AEEP are inevitable in spite of lower incidence compared with TURP. This study reviewed the literature related to the aetiology, prevention and treatment of common complications of AEEP, which would contribute to the diagnosis and treatment of BPO.

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“…Bei HoLEP zeigt sich im Vergleich zu TURP ein geringerer Blutverlust (*p = 0,001; [29]). Auch bei Patienten unter AC/TAH konnten Boeri et al [5] 2019 HoLEP sicher durchführen: Im Vergleich zur nicht-antikoagulierten Kontrollgruppe hatten die Patienten mit AC/TAH eine länger andauernde Phase von Katheterversorgung (*p < 0,01) und Krankenhausaufenthalt (p* < 0,01), ansonsten ergab sich kein Unterschied im postoperativen Outcome.…”

Section: Transurethrale Laserbasierte Techniken Zu Vaporisation Enukunclassified

Die chirurgische Therapie der benignen Prostataobstruktion (BPO) beim antikoagulierten Patienten: eine Übersichtsarbeit über die Blutungsrisiken etablierter Techniken

Deininger

Herrmann

Schönburg

et al. 2020

Urologe

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Zusammenfassung Hintergrund Bei einer alternden Gesellschaft ist mit einer Zunahme der therapiebedürftigen benignen Prostataobstruktion (BPO) zu rechnen, auch der Anteil an Patienten mit kardiovaskulären Komorbiditäten unter Antikoagulation steigt an. Hier kann die operative Therapie der BPO problematisch sein. Die blutstillende Wirkung der Techniken ist von besonderer Bedeutung. Fragestellung Die folgende Übersichtsarbeit diskutiert die Datenlage zum Blutungsrisiko etablierter operativer Techniken und die Stellungnahme der EAU-Leitlinie „EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract symptoms (LUTS) incl. Benign Prostatic Obstruction (BPO)“ zu diesem Thema. Material und Methoden Es wurde eine Datenanalyse aus PubMed erstellt. Ergebnisse Die EAU-Leitlinie gibt der transurethralen Vaporisation der Prostata mittels Greenlight‑, Thulium- oder Diodenlaser und der Enukleation mittels Holmium- oder Thuliumlaser bei diesem Patientengut den Vorzug. Die bipolare ist der monopolaren transurethralen Resektion der Prostata (TURP) bei der Blutstillung überlegen. Die bipolare Enukleation der Prostata (BipoLEP) kann bei guter Hämostase zukünftig eine Alternative darstellen. Neuere minimal-invasive Techniken wie Urolift® (NeoTract, Pleasanton, USA), I‑TIND© (MediTate, Or-Akiva, Israel) und Rezūm™ (Boston Scientific, Boston, USA) zeigen ein geringes Blutungsrisiko, dies gilt auch für die Prostataarterienembolisation. Nicht geeignet erscheint die Aquaablation/AquaBeam® bei häufigen Nachblutungen. Die chirurgische Adenomektomie kann mit hoher Blutungsgefahr verbunden sein. Schlussfolgerung Transurethrale Laservaporisation und -enukleation der Prostata sind die Therapie der Wahl beim antikoagulierten Patienten, jedoch haben auch andere transurethrale Techniken, wie die BipoLEP, ein akzeptables Blutungsrisiko und können je nach lokalen Ressourcen eine Alternative darstellen. Neuere minimal-invasive Ansätze können zukünftig mehr an Bedeutung gewinnen.

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Clinical Comparison of Holmium Laser Enucleation of the Prostate and Bipolar Transurethral Enucleation of the Prostate in Patients Under Either Anticoagulation or Antiplatelet Therapy

Cited by 30 publications

References 29 publications

Comparative Study of Holmium Laser Enucleation of the Prostate With MOSES Enabled Pulsed Laser Modulation

Comparative Study of Holmium Laser Enucleation of the Prostate With MOSES Enabled Pulsed Laser Modulation

Complications of anatomical endoscopic enucleation of the prostate

Die chirurgische Therapie der benignen Prostataobstruktion (BPO) beim antikoagulierten Patienten: eine Übersichtsarbeit über die Blutungsrisiken etablierter Techniken

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