Surgical blood loss during holmium laser enucleation of the prostate (HoLEP) is not affected by short-term pretreatment with dutasteride: a double-blind placebo-controlled trial on prostate vascularity

Busetto, Gian Maria; Giudice, Francesco Del; Maggi, Martina; Antonini, Gabriele; D’Agostino, Daniele; Romagnoli, Daniele; Rosso, Alessandro Del; Giampaoli, Marco; Corsi, Paolo; Palmer, Katie; Ferro, Matteo; Lucarelli, Giuseppe; Terracciano, Daniela; Cobelli, Ottavio De; Sciarra, Alessandro; Berardinis, Ettore De; Porreca, Angelo

doi:10.18632/aging.102883

Cited by 10 publications

(9 citation statements)

References 29 publications

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“…In our review, the rate of reoperations for clot evacuation is 0.7%. These values confirm the low postoperative rate of bleeding in HoLEP, which is not affected by short-term treatment with dutasteride [81]. In the case of HoLEP, in addition to bleeding, bladder injury on morcellation and the remains of free nonmorcellated adenoma are other causes of early re-intervention.…”

Section: Discussionsupporting

confidence: 71%

Perioperative Outcomes of Holmium Laser Enucleation of the Prostate: A Systematic Review

et al. 2021

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Introduction: The aim of the study was to systematically review the literature and describe perioperative complications of holmium laser enucleation of the prostate (HoLEP), including the Clavien-Dindo classification of surgical complications. Methods: All English language publications on HoLEP were evaluated. We followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines to evaluate PubMed®, Scopus®, and Web of Science™ databases from January 1, 1998, to June 1, 2020. Results: Fifty-seven studies were included, for a total of 10,371 procedures. We distinguished between intra-, peri-, and postoperative complications. Overall, the rate of complications is 0–7%. Intraoperative complications include incomplete morcellation (2.3%), capsular perforation (2.2%), bladder (2.4%), and ureteric orifice (0.4%) injuries. Perioperative complications include postoperative urinary retention (0.2%), hematuria and clot retention (2.6%), and cystoscopy for clot evacuation (0.7%). Postoperative complications include dysuria (7.5%), stress (4.0%), urge (1.8%), transient (7%) and permanent (1.3%) urinary incontinence, urethral stricture (2%) and bladder neck contracture (1%). Conclusions: HoLEP is a safe procedure, with a satisfactory low complication rate. The most common reported perioperative complications are not severe (Clavien-Dindo classification grades 1–2). Further randomized studies are certainly warranted to fully determine the predictor of surgical complications in order to prevent them and improve this technique.

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Section: Discussionsupporting

confidence: 71%

Perioperative Outcomes of Holmium Laser Enucleation of the Prostate: A Systematic Review

et al. 2021

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“…However, both the El Tayeb and Warner studies did not report which morcellators were utilized. Busetto et al used the VersaCut ™ morcellator and also reported no difference in morcellation efficiency for the 5-ARI group (5.34 vs. 5.65 g/ min, p=0.44, respectively) (8).…”

Section: Discussionmentioning

confidence: 98%

“…Thus, some men who undergo HoLEP may have had preoperative 5-ARI exposure if they failed combination therapy. The limited available evidence on perioperative outcomes of 5-ARIs prior to HoLEP suggests there are no effects on blood loss (8), enucleation time or morcellation time (9,10). We hypothesized that because 5-ARIs reduce prostate volume by ~20% (11) and increase collagen deposition, increased tissue density could result in prolonged morcellation.…”

Section: Introductionmentioning

confidence: 98%

Effects of 5-alpha reductase inhibitors prior to Holmium Laser Enucleation of the prostate: Does increased adenoma density result in prolonged morcellation times?

et al. 2022

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IntroductionThe use of 5-alpha reductase inhibitors (5-ARIs) has been shown to improve lower urinary tract symptoms (LUTS) and decrease prostate size in men with benign prostate hyperplasia (BPH). 5-ARI therapy could increase prostate tissue density through increased collagen deposition and contraction of stromal/epithelial components. Increased tissue density could prolong morcellation times, but the effects of preoperative 5-ARI exposure on morcellation efficiency during Holmium Laser Enucleation of the Prostate (HoLEP) are not well described. Herein, we examine outcomes after HoLEP of patients on pre-operative 5-ARIs.MethodsA retrospective review of patients undergoing HoLEP by an expert surgeon from Jan – Oct 2021 was performed. Student t-tests and chi-square tests were performed for continuous and categorical variables, respectively. Matched-pair analysis was performed using SPSS v28 (IBM, 2022). A p-value <0.05 was determined statistically significant. All other statistical analyses were performed using SAS v9.4 (SAS, 2019).ResultsA total of 322 patients underwent HoLEP during the study period and 84 patients had pre-operative 5-ARI exposure. Patients in the 5-ARI group had larger preoperative prostate size (p = 0.016). Morcellation time was longer (p=0.01), specimen weight was higher (p=0.02), and morcellation efficiency (p=0.02) was lower in the 5-ARI group. After matching, there were 67 patients in each chort (total 134) and these associations for size, morcellation time, specimen weight, and morcellation efficiency were no longer seen (p=0.8, 0.6, 0.5, and 0.7, respectively). Furthermore, no associations between 5-ARI and post-operative admissions or ED visits were noted.ConclusionIn this retrospective study, preoperative use of 5-ARIs did not affect enucleation or morcellation efficiency. Thus, preoperative 5-ARI therapy does not appear to alter outcomes after HoLEP.

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“…The most widely used are Green Light photoselective vaporization of the prostate (PVP) and laser enucleation techniques, such as Holmium Laser Enucleation of the Prostate (HoLEP) and Thulium Laser Enucleation of the Prostate (ThuLEP). 11 , 12 Even if these approaches have shown to achieve results comparable to the standard technique (ie, TURP) with regards to functional outcomes, only few studies have investigated the cost/ benefit ratio related to these procedures. Indeed, these innovative techniques might present an increased cost in terms of equipment and consumables.…”

Section: Introductionmentioning

confidence: 99%

A Cost–Benefit Analysis of Bipolar TURP for the Treatment of Bladder Outflow Obstruction

Pirola¹,

Maggi²,

Castellani³

et al. 2021

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Transurethral resection of the prostate (TURP) is the gold standard surgical technique for endoscopic treatment of benign prostatic hyperplasia (BPH). Introduced in 2001, the bipolar energy appeared to be a valid alternative to the classical monopolar one with reduced risk of complication related to the use of saline irrigation and to the increased hemostatic efficacy. More recently, raising attention has been given to laser enucleation and vaporization techniques, which appear to achieve further advantages in terms of reduced hospital stay and complications compared to the resection ones. Few studies have investigated the cost/benefit ratio related to these techniques. The aim of this systematic review was to analyze the cost/benefit ratio of bipolar TURP (B-TURP) compared with other endoscopic procedures.

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Surgical blood loss during holmium laser enucleation of the prostate (HoLEP) is not affected by short-term pretreatment with dutasteride: a double-blind placebo-controlled trial on prostate vascularity

Cited by 10 publications

References 29 publications

Perioperative Outcomes of Holmium Laser Enucleation of the Prostate: A Systematic Review

Perioperative Outcomes of Holmium Laser Enucleation of the Prostate: A Systematic Review

Effects of 5-alpha reductase inhibitors prior to Holmium Laser Enucleation of the prostate: Does increased adenoma density result in prolonged morcellation times?

A Cost–Benefit Analysis of Bipolar TURP for the Treatment of Bladder Outflow Obstruction

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