Holmium Laser Enucleation of the Prostate Combined with Mechanical Morcellation: Two Years of Experience with 196 Patients

Vavassori, Ivano; Hurle, Rodolfo; Vismara, Alberto; Manzetti, Alberto; Valenti, Sergio

doi:10.1089/089277904322836767

Cited by 46 publications

(26 citation statements)

References 17 publications

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“…Vavassori et al [19] reported a 6.6% rate of bladder wall injuries during morcellation of prostate tissue. We did not observe morcellator-related bleeding complications in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Thulium Laser (Revolix) Vapoenucleation of the Prostate Is a Safe Procedure in Patients with an Increased Risk of Hemorrhage

et al. 2012

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Purpose: To evaluate the feasibility and safety of thulium:yttrium-aluminium-garnet laser vapoenucleation of the prostate (ThuVEP) in patients with chronic anticoagulation and bleeding disorders. Methods: We retrospectively analyzed the clinical data (transfusion rate, hemoglobin changes, residual urine, bleeding complications, complications and residual urine) of patients with chronic anticoagulation and bleeding disorders treated with ThuVEP. Anticoagulation was not paused for surgery. Results: We identified 39 patients who fulfilled the inclusion criteria (32 with chronic anticoagulation, 3 with bleeding disorder, and 4 with both). Mean preoperative hemoglobin was 12.9 g/l; the postoperative hemoglobin was 11.7 g/l. One patient received a blood transfusion. Mean residual urine was 166 ml preoperatively and 47 ml postoperatively, respectively; spontaneous voiding postoperatively was feasible in 36 patients. During follow-up, 5 patients suffered from gross hematuria, which was treated conservatively. Conclusions: ThuVEP is a safe procedure in patients with therapeutic anticoagulation, bleeding disorders and platelet aggregation inhibitor medication.

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“…Vavassori et al [19] reported a 6.6% rate of bladder wall injuries during morcellation of prostate tissue. We did not observe morcellator-related bleeding complications in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Thulium Laser (Revolix) Vapoenucleation of the Prostate Is a Safe Procedure in Patients with an Increased Risk of Hemorrhage

et al. 2012

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“…Similar results have been reported with other lasers. 10,11 The 980 nm diode laser has good coagulative properties and the incidence of bleeding during the procedure was minimal. The patient, in whom haematuria occurred, had bleeding from large vessels at the bladder neck.…”

Section: Discussionmentioning

confidence: 99%

Preliminary results on selective light vaporization with the side-firing 980 nm diode laser in benign prostatic hyperplasia: an ejaculation sparing technique

Leonardi¹

2009

Prostate Cancer Prostatic Dis

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This study examined efficacy and safety of the 980 nm side-firing diode laser operating at a power of 100 W in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). Patients were selected for surgery on the basis of maximum urinary flow rate (Qmax) p15 ml/s or transvesically measured post-voiding residual volume (PVR) 4100 ml in conjunction with an International Prostate Symptom Score (IPSS) 47. Laser therapy was conducted under spinal anaesthesia. Qmax, IPSS, prostate volume, PVR, IPSS-Quality of Life (QoL) questionnaire and ejaculatory function were measured at baseline and at 1, 3, 6 and 12 months post-laser therapy. A total of 52 consecutive patients aged 52-65 years with mean (s.d.) prostate volume of 45.14 (9.15) g were treated. All patients were able to leave the hospital at a mean (s.d.) of 5 (2) h after the procedure. Mean (s.d.) follow-up was 100 (75.49) days. A significant reduction in IPPS was reported at 1 month (Po0.0001) and this was maintained through to 6 months. Significant durable improvements in Qmax, PVR and IPSS-QoL score were also reported for all patients (Po0.0001). No severe complications were reported, including any cases of urinary incontinence or significant irritative symptoms. None of the patients complained of a worsening of erectile function. This early experience in a pilot study with the 980 nm diode laser seems promising in the short-term and long-term outcome is being monitored.

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“…A large cohort series of patients who underwent HoLEP (n = 196) was published by Vavassori et al [17] in 2004. Because the functional results were comparable to those of HoLEP-RCTs, bladder mucosa injury was reported in 6.6% patients, transient dysuria in 23%, and UTI in 4.4%.…”

Section: Discussionmentioning

confidence: 99%

Tissue Effects Resulting from Eraser Laser Enucleation of the Prostate: In vivo Investigation

Lusuardi

Hager²,

Kloss³

et al. 2013

Urol Int

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Background/Aims/Objectives: To describe the depth of the laser coagulation zone in vivo based on histological examinations and the functional outcome of a 1,318-nm diode laser for enucleation in benign prostatic enlargement (BPE). Methods: A total of 20 patients with BPE were treated by laser Eraser® enucleation of the prostate (ELEP). Prostatic tissue wedges were evaluated to assess the depth of the ELEP coagulation zones. Additionally, patients were assessed preoperatively and 12 months postoperatively. Results: The coagulation zones were 0.36 ± 0.17 mm in epithelial tissue, 0.28 ± 0.15 mm in stromal tissue, and 0.25 ± 0.12 mm in mixed tissue. The coagulation area at the cutting edge completely sealed capillary vessels, reaching a depth of 0.35 ± 0.15 mm. The diameter of the coagulated vessels measured 1.75 ± 0.83 mm. Mean blood loss was 115.54 ± 93.12 ml, catheter time 1.35 ± 0.33 days, and hospital stay 1.89 ± 0.52 days. The International Prostate Symptom Score, maximal flow rate, and quality of life significantly improved 12 months after the procedure. Conclusions: ELEP is safe and effective for BPE treatment and yields good results at a follow-up of 1 year. Because of the limited penetration depth, damage to the urinary sphincter is not expected.

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Holmium Laser Enucleation of the Prostate Combined with Mechanical Morcellation: Two Years of Experience with 196 Patients

Abstract: The HoLEP procedure is an efficacious surgical intervention for symptomatic bladder outlet obstruction with minimal associated morbidity. Wider application and technical refinement will allow the surgeon to reduce the operative time and to render mechanical morcellation safer.

Cited by 46 publications

References 17 publications

Thulium Laser (Revolix) Vapoenucleation of the Prostate Is a Safe Procedure in Patients with an Increased Risk of Hemorrhage

Thulium Laser (Revolix) Vapoenucleation of the Prostate Is a Safe Procedure in Patients with an Increased Risk of Hemorrhage

Preliminary results on selective light vaporization with the side-firing 980 nm diode laser in benign prostatic hyperplasia: an ejaculation sparing technique

Tissue Effects Resulting from Eraser Laser Enucleation of the Prostate: In vivo Investigation

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