Enucleation ratio efficacy might be a better predictor to assess learning curve of holmium laser enucleation of the prostate

Jeong, Chang Wook; Oh, Jin Kyu; Cho, Min Chul; Bae, Jonghee; Oh, Seung June

doi:10.1590/s1677-55382012000300009

Cited by 48 publications

(40 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The enucleated tissue weight in this study tended to be less than that of transition zone volume on TRUS, likely owing to the vaporization caused by the laser. These findings were similar to those from other studies [1] and our previous study [17]. Hence, we believe that complete removal of adenoma tissue in extremely large prostates is feasible.…”

Section: Discussionsupporting

confidence: 93%

See 1 more Smart Citation

Efficacy and safety of holmium laser enucleation of the prostate for extremely large prostatic adenoma in patients with benign prostatic hyperplasia

et al. 2015

Self Cite

View full text Add to dashboard Cite

PurposeTo evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for extremely large prostates.Materials and MethodsPatients undergoing HoLEP between July 2008 and December 2013 from the Seoul National University Hospital Benign Prostatic Hyperplasia Database Registry were retrospectively analyzed. The patients were divided into three groups according to their total prostate volume (TPV): group A (TPV<100 mL), group B (100 mL≤TPV<200 mL), and group C (TPV≥200 mL); the clinical data of the three groups were compared. All patients were followed up 2 weeks, 3 months, and 6 months after surgery.ResultsA total of 502 patients (group A, 426; group B, 70; group C, 6) with a mean age of 69.0 (standard deviation, ±7.3) years were included in our analysis. The mean prostate volume and prostate-specific antigen level were 68.7±36.9 mL and 4.15±4.24 ng/mL, respectively. The enucleation and morcellation times were longer in group C (p<0.001), and the enucleation efficacy was higher in this group (p<0.001, R2=0.399). Moreover, the mean postoperative catheterization and hospitalization periods were significantly longer in group C (p=0.004 and p=0.011, respectively). However, there were no significant differences between the groups in any other postoperative events, including recatheterization, reoperation, urinary tract infection, clot retention, and bladder neck contracture (p range, 0.516-0.913). One patient in group C experienced recurrence of the urethral stricture.ConclusionsHoLEP in patients with an extremely large prostate can be performed efficiently and safely.

show abstract

Section: Discussionsupporting

confidence: 93%

“…This is consistent with the short-term results of previous studies of HoLEP in smallor moderate-sized prostates, which reported significant improvements of IPSS and uroflowmetric parameters [8,17,18]. The discordance of PVR is likely owing to the small sample size (n=6) in the present study.…”

Section: Discussionsupporting

confidence: 93%

Efficacy and safety of holmium laser enucleation of the prostate for extremely large prostatic adenoma in patients with benign prostatic hyperplasia

et al. 2015

Self Cite

View full text Add to dashboard Cite

show abstract

“…Morcellation efficiency was defined as enucleated prostate weight divided by morcellation time [14]. Continuous variables were analyzed using the t-test and the Mann-Whitney test, and nominal and categorical variables using the Chi-square test and Fisher's exact test.…”

Section: Methodsmentioning

confidence: 99%

Factors Affecting De Novo Urinary Retention after Holmium Laser Enucleation of the Prostate

et al. 2014

Self Cite

View full text Add to dashboard Cite

ObjectivePatients can experience urinary retention (UR) after Holmium laser enucleation of the prostate (HoLEP) that requires bladder distension during the procedure. The aim of this retrospective study is to identify factors affecting the UR after HoLEP.Materials and Methods336 patients, which underwent HoLEP for a symptomatic benign prostatic hyperplasia between July 2008 and March 2012, were included in this study. Urethral catheters were routinely removed one or two days after surgery. UR was defined as the need for an indwelling catheter placement following a failure to void after catheter removal. Demographic and clinical parameters were compared between the UR (n = 37) and the non-urinary retention (non-UR; n = 299) groups.ResultsThe mean age of patients was 68.3 (±6.5) years and the mean operative time was 75.3 (±37.4) min. Thirty seven patients (11.0%) experienced a postoperative UR. UR patients voided catheter free an average of 1.9 (±1.7) days after UR. With regard to the causes of UR, 24 (7.1%) and 13 (3.9%) patients experienced a blood clot-related UR and a non-clot related UR respectively. Using multivariate analysis (p<0.05), we found significant differences between the UR and the non-UR groups with regard to a morcellation efficiency (OR 0.701, 95% CI 0.498–0.988) and a bleeding-related complication, such as, a reoperation for bleeding (OR 0.039, 95% CI 0.004–0.383) or a transfusion (OR 0.144, 95% CI 0.027–0.877). Age, history of diabetes, prostate volume, pre-operative post-void residual, bladder contractility index, learning curve, and operative time were not significantly associated with the UR (p>0.05).ConclusionsDe novo UR after HoLEP was found to be self-limited and it was not related to learning curve, patient age, diabetes, or operative time. Efficient morcellation and careful control of bleeding, which reduces clot formation, decrease the risk of UR after HoLEP.

show abstract

“…The surgical procedure for HoLEP at our institution has been previously described in detail [10,11,12,13,14]. Patients were instructed to discontinue anticoagulant medication at least 5 days before surgery.…”

Section: Methodsmentioning

confidence: 99%

Transurethral Surgical Anatomy of the Arterial Bleeder in the Enucleated Capsular Plane of Enlarged Prostates During Holmium Laser Enucleation of the Prostate

et al. 2014

Self Cite

View full text Add to dashboard Cite

PurposeTo identify the endoscopic vascular anatomy of the prostate during Holmium laser enucleation of the prostate (HoLEP), and analyze the clinical risk factors associated with significant arterial bleeding.MethodsWe identified 107 consecutive patients with benign prostatic hyperplasia who underwent HoLEP between September 2009 and August 2010, performed by a single surgeon (S.J.O.). Two independent reviewers reviewed the surgery video database and completed a prespecified form. The location of bleeding arteries was marked at the level of the bladder neck, proximal prostate, distal prostate, and verumontanum. Arterial bleeding was classified into one of three grades according to bleeding severity (grades 2 and 3 indicate significant bleeding).ResultsThe mean prostate volume was 65.1±31.5 mL, and the mean prostate-specific antigen (PSA) level was 3.69±3.58 ng/mL. During the HoLEP procedure, the most common locations of significant bleeders were the 2-5 and 7-10 o'clock positions in the proximal prostate. The average number of bleeding arteries was 12.1±7.9 per procedure, and 1.93±1.20 per 10 mL of prostate volume. Multivariate analysis revealed that prostate volume and serum PSA were significant parameters for estimating the number of bleeding vessels.ConclusionsDuring the HoLEP procedure, the most common locations of significant bleeders were the 2-5 and 7-10 o'clock positions in the proximal prostate. Prostate volume was associated with the number of bleeders. A careful approach to the capsular plane of the proximal prostate facilitates early hemostasis during the HoLEP procedure, especially with larger adenomas.

show abstract

Enucleation ratio efficacy might be a better predictor to assess learning curve of holmium laser enucleation of the prostate

Abstract: ARTIcLe InfO ___________________________________________ _

Cited by 48 publications

References 27 publications

Efficacy and safety of holmium laser enucleation of the prostate for extremely large prostatic adenoma in patients with benign prostatic hyperplasia

Efficacy and safety of holmium laser enucleation of the prostate for extremely large prostatic adenoma in patients with benign prostatic hyperplasia

Factors Affecting De Novo Urinary Retention after Holmium Laser Enucleation of the Prostate

Transurethral Surgical Anatomy of the Arterial Bleeder in the Enucleated Capsular Plane of Enlarged Prostates During Holmium Laser Enucleation of the Prostate

Contact Info

Product

Resources

About

Enucleation ratio efficacy might be a better predictor to assess learning curve of holmium laser enucleation of the prostate

Abstract: ARTIcLe InfO _______________________________________________________________ _____________________

Cited by 48 publications

References 27 publications

Efficacy and safety of holmium laser enucleation of the prostate for extremely large prostatic adenoma in patients with benign prostatic hyperplasia

Efficacy and safety of holmium laser enucleation of the prostate for extremely large prostatic adenoma in patients with benign prostatic hyperplasia

Factors Affecting De Novo Urinary Retention after Holmium Laser Enucleation of the Prostate

Transurethral Surgical Anatomy of the Arterial Bleeder in the Enucleated Capsular Plane of Enlarged Prostates During Holmium Laser Enucleation of the Prostate

Contact Info

Product

Resources

About

Abstract: ARTIcLe InfO ___________________________________________ _