Morcellation After Endoscopic Enucleation of the Prostate: Efficiency and Safety of Currently Available Devices

Franz, Julia; Suarez-Ibarrola, Rodrigo; Pütz, Philipp; Sigle, August; Lusuardi, Lukas; Netsch, Christopher; Lehrich, Karin; Herrmann, Thomas; Gratzke, Christian; Miernik, Arkadiusz

doi:10.1016/j.euf.2021.03.021

Cited by 12 publications

(5 citation statements)

References 56 publications

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“…The efficiency thereof is low, especially for large prostates (>200 g) 12 ; second‐stage surgery is often required to avoid complications such as hypothermia, which can occur because the operative time is long. One review found that the efficiency of morcellation was 3.95 g/min 13 , but in our one case, the efficiency was significantly lower at 1.97 g/min. However, this was countered by the fact that enucleation was rapid because the surgeon was very experienced in HoLEP.…”

Section: Discussioncontrasting

confidence: 61%

Japanese giant benign prostatic hyperplasia: Sibling cases

Ohyama

Shimbo

2022

IJU Case Reports

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Introduction The pathophysiology of benign prostatic hyperplasia (BPH) remains incompletely understood but is likely multifactorial. Inflammation and metabolic factors may increase the risk of BPH. Several studies have evaluated the possible roles played by genetic factors. Here, we describe two cases of suspected familial BPH. Case presentations We report the cases of two brothers, aged 77 and 69 years, with giant BPH. As both exhibited urinary retention, we performed Holmium Laser Enucleation of the Prostate (HoLEP) and obtained tissue samples weighing 276 g and 153 g, respectively. The postoperative courses were good. Conclusion We experienced two cases of sibling BPH with volumes exceeding 200 mL and successfully treated them with HoLEP.

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Section: Discussioncontrasting

confidence: 61%

Japanese giant benign prostatic hyperplasia: Sibling cases

Ohyama

Shimbo

2022

IJU Case Reports

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“…It is, therefore, not the technique but the visibility in large, often vascular prostates, which may be contributory to slower morcellation [ 19 ]. We also acknowledge that the type of morcellator and surgical setup influences these outcomes too [ 20 ]. Further evaluation is needed to investigate the differences in enucleation and total operative time between the techniques.…”

Section: Discussionmentioning

confidence: 99%

Real world propensity score matched analysis evaluating the influence of en-bloc vs. non en-bloc techniques, energy and instrumentation on enucleation outcomes for large and very large prostates

Juliebø-Jones,

Gauhar,

Castellani

et al. 2024

World J Urol

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Purpose The primary aim of the study was to evaluate if en-bloc vs. non en-bloc made a difference to intra-, peri- and post-operative surgical outcomes of anatomical endoscopic enucleation (AEEP) in large (> 80 cc) and very large prostates (> 200 cc). The secondary aim was to determine the influence of energy and instruments used. Methods Data of patients with > 80 cc prostate who underwent surgery between 2019 and 2022 were obtained from 16 surgeons across 13 centres in 9 countries. Propensity score matching (PSM) was used to reduce confounding. Logistic regression was performed to evaluate factors associated with postoperative urinary incontinence (UI). Results 2512 patients were included with 991 patients undergoing en-bloc and 1521 patients undergoing non-en-bloc. PSM resulted in 481 patients in both groups. Total operation time was longer in the en-bloc group (p < 0.001), enucleation time was longer in the non en-bloc group (p < 0.001) but morcellation times were similar (p = 0.054). Overall, 30 day complication rate was higher in the non en-bloc group (16.4% vs. 11.4%; p = 0.032). Rate of late complications (> 30 days) was similar (2.3% vs. 2.5%; p > 0.99). There were no differences in rates of UI between the two groups. Multivariate analysis revealed that age, Qmax, pre-operative, post-void residual urine (PVRU) and total operative time were predictors of UI. Conclusions In experienced hands, AEEP in large prostates by the en-bloc technique yields a lower rate of complication and a slightly shorter operative time compared to the non en-bloc approach. However, it does not have an effect on rates of post-operative UI.

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“…Since the first description of transurethral enucleation of the prostate by Hiraoka in 1986, who performed it with monopolar energy, there has been reconsideration of the old open enucleation technique [ 8 , 10 , 13 ]. Within a few years, lasers, bipolar energy and morcellators entered the market and endoscopic enucleation became an established technique for BPH, especially for glands >80 gms [ 14 , 15 , 16 ]. But the availability, cost and a long steep learning curve became a barrier in its universal adoption [ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Monopolar Transurethral Enucleoresection of Prostate: Feasibility of Modified Nesbit’s Enucleoresection with Apical Release

Kumar,

Somani

2024

JCM

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Background: Transurethral resection of the prostate (TURP) has been the standard surgical treatment for Benign Hyperplasia of the Prostate (BPH) for decades. Our objective was to evaluate the outcome of our new technique: Monopolar Transurethral Enucleoresection of the Prostate (TUERP) with apical release (bring it all to centre). Methods: A prospective study of all cases undergoing TUERP at a tertiary centre from January 2020 to October 2022 was performed. Patient demographics, intraoperative variables and postoperative results along with follow-up data were collected. Data of all the cases who had completed a one-year follow-up post-surgery were included and analysed. Results: A total of 240 patients with complete data including a one-year follow-up were included. Mean prostatic volume was 55.3 ± 11.6 gm, and 28 (11.67%) cases were >100 gm. The mean operative time was 31.7 ± 7.6, and mean haemoglobin drop at 24 h was 0.73 ± 1.21 gm/dL. The overall complication rate was 16.67%, with only two (0.83%) Clavien–Dindo III complications (haematuria and clots needing evacuation) and the other complications being Clavien–Dindo I/II complications. Sustained improvement at 1 year of follow-up was noted: Qmax: 25.2 ± 5.6 mL/s, IPSS: 4.7 ± 2.5 and PVR: 22.5 ± 9.6 mL. Conclusions: Monopolar TUERP with a modified Nesbit’s enucleoresection with apical release can be considered a promising technique, which needs further studies to be validated with appropriate comparisons.

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Morcellation After Endoscopic Enucleation of the Prostate: Efficiency and Safety of Currently Available Devices

Cited by 12 publications

References 56 publications

Japanese giant benign prostatic hyperplasia: Sibling cases

Japanese giant benign prostatic hyperplasia: Sibling cases

Real world propensity score matched analysis evaluating the influence of en-bloc vs. non en-bloc techniques, energy and instrumentation on enucleation outcomes for large and very large prostates

Monopolar Transurethral Enucleoresection of Prostate: Feasibility of Modified Nesbit’s Enucleoresection with Apical Release

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