Enucleation of the prostate as retreatment for recurrent or residual benign prostatic obstruction: a systematic review and a meta-analysis

Pyrgidis, Nikolaos; Mykoniatis, Ioannis; Lusuardi, Lukas; Schulz, Gerald Bastian; Sokolakis, Ioannis; Stief, Christian G.; Sountoulides, Petros

doi:10.1038/s41391-023-00677-z

Cited by 3 publications

(1 citation statement)

References 41 publications

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“…In recent years, different types of lasers have been developed and improved for prostate enucleation, becoming the most used type of energy for this purpose (14). More speci cally, holmium laser enucleation of the prostate (HoLEP) and thulium laser enucleation of the prostate (ThuLEP) are currently the most common enucleation procedures and, overall, both techniques have proven to be effective and safe, with no signi cant difference observed in most surgical and functional parameters (15). Only statistical but not clinical differences in haemoglobin drop and urinary incontinence (IU) rate were found in favor of ThuLEP in some studies (5,16).…”

Section: Introductionmentioning

confidence: 99%

Holmium and Thulium Fiber Laser Enucleation of the Prostate: A Prospective Randomized Multicenter Study

Otero,

Quintas,

Gómez

et al. 2023

Preprint

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Background: Benign Prostatic Hyperplasia (BPH) is a common condition causing lower urinary tract symptoms (LUTS) in men. Holmium (HoLEP) and thulium (ThuLEP) laser enucleation are established minimally invasive techniques to treat BPH. Recently, thulium fiber laser (TFL) has been proposed for prostate enucleation (ThuFLEP) with promising outcomes. Methods: We designed a prospective randomized multicenter study to compare the efficacy and safety of HoLEP and ThuFLEP. Patients with BPH-related lower urinary tract symptoms and failure of BPH medical therapy were enrolled. Preoperative, surgical, perioperative and postoperative data were recorded. Follow-up visits were scheduled at 3 and 6 months. Efficacy in terms of improvement of functional outcomes was chosen as the primary outcome, whereas safety in terms of intraoperative and postoperative complications was selected as the secondary outcome. Results: A total of 200 patients were included (HoLEP 100, ThuFLEP 100). No significant difference in baseline characteristics was found between the two groups. At 3 and 6 months we found statistically significant improvements from baseline for both HoLEP and ThuFLEP in IPSS, IPSS-QoL, Qmax, and PVR (p<0.05). At 6 months, mean±SD IPSS, IPSS-QoL, Qmax, and PVR for HoLEP vs. ThuFLEP were 5.8±4.9 vs. 4.8±5.0 points (p=0.57), 1.6±1.4 vs. 0.7±1.1 points (p=0.09), 29.9±12.5 vs. 29.6±8.0 mL/s (p=0.8), and 16.3±17.7 vs. 15.5±13.4 mL (p=0.92), respectively. No intraoperative complication was recorded. No Clavien-Dindo ≥ III complication occurred during hospitalization. After 6 months 8 (8%) and 6 (6%) patients reported mild stress urinary incontinence in HoLEP and ThuFLEP group, respectively (p=0.24). Urethral stenosis was observed in 3 men (3%) in the HoLEP group and 1 subject (1%) in the ThuFLEP group (p=0.72). Conclusions: Both HoLEP and ThuFLEP are effective and safe for benign prostatic hyperplasia treatment, with comparable functional outcomes and complications at 6 months. Further studies are needed to confirm our preliminary findings.

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Section: Introductionmentioning

confidence: 99%

Holmium and Thulium Fiber Laser Enucleation of the Prostate: A Prospective Randomized Multicenter Study

Otero,

Quintas,

Gómez

et al. 2023

Preprint

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Propensity score-matched evaluation of palliative transurethral resection and holmium laser enucleation of the prostate for bladder outlet obstruction in patients with prostate cancer

Tamalunas,

Keller,

Schott

et al. 2024

Prostate Cancer Prostatic Dis

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Background While transurethral resection of the prostate (TURP) is the standard-of-care, Holmium laser enucleation of the prostate (HoLEP) is widely accepted as a size-independent method for surgical treatment of patients with lower urinary tract symptoms (LUTS) secondary to bladder outlet obstruction (BOO). However, in an ageing society an increasing number of patients presents with BOO due to locally advanced prostate cancer. There is currently no guidelines recommendation as to the enucleation or resection technique. Therefore, we compared intraoperative performance, postoperative outcomes, and safety for palliative (p)TURP and (p)HoLEP. Methods We conducted a retrospective, propensity score-matched analysis of 1373 and 2705 men who underwent TURP or HoLEP for LUTS/BOO between 2014 and 2021, respectively. Patients were matched for age, prostate size and preoperative international prostate symptom score (IPSS). Patients were stratified by technique and groups were compared for perioperative parameters, safety, and functional outcomes. Results While postoperative symptoms and urodynamic parameters improved irrespective of technique, we report significantly increased resection and enucleation times for palliative indication. For corresponding efficiency parameters, we observed a two-fold higher surgical performance (g/min) for both techniques in patients without prostate cancer. While adverse events were comparable between groups, we found a two-fold higher hemoglobin drop in palliative patients. Conclusions Currently, there is no standard-of-care for patients with BOO and locally advanced prostate cancer. Our data show that both TURP and HoLEP offer adequate symptom improvement and comparable safety profiles. While HoLEP is feasible even in larger prostates, both procedures become more difficult in patients with prostate cancer. Taken together, this study covers an important gap in current literature, helping urological surgeons to make evidence-based decisions for the benefit of their patients.

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Prospective randomized multicenter study to evaluate holmium vs. new thulium fiber laser for prostate enucleation

ROMERO OTERO,

JUSTO QUINTAS,

GARCÍA GÓMEZ

et al. 2024

Minerva Urol Nephrol

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Enucleation of the prostate as retreatment for recurrent or residual benign prostatic obstruction: a systematic review and a meta-analysis

Cited by 3 publications

References 41 publications

Holmium and Thulium Fiber Laser Enucleation of the Prostate: A Prospective Randomized Multicenter Study

Holmium and Thulium Fiber Laser Enucleation of the Prostate: A Prospective Randomized Multicenter Study

Propensity score-matched evaluation of palliative transurethral resection and holmium laser enucleation of the prostate for bladder outlet obstruction in patients with prostate cancer

Prospective randomized multicenter study to evaluate holmium vs. new thulium fiber laser for prostate enucleation

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