Three-Year Outcome following Holmium Laser Enucleation of the Prostate Combined with Mechanical Morcellation in 330 Consecutive Patients

Vavassori, Ivano; Valenti, Sergio; Naspro, Richard; Vismara, Alberto; Dell’Acqua, V.; Manzetti, Alberto; Hurle, Rodolfo

doi:10.1016/j.eururo.2007.10.059

Cited by 121 publications

(86 citation statements)

References 27 publications

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“…On the other hand, the OT was significantly longer for ThuVEP compared to ThuVARP (72 vs. 46 min, p ≤ 0.031), which was presumably based on the additional morcellation procedure in ThuVEP. However, the total OT for ThuVEP in this study (median prostate volume 62.5 g) is in line with the HoLEP literature [18,29]: Vavassori et al [29] had a mean total OT of 74.8 min in 330 patients with a mean prostate volume of 62 g. In Tyson and Lerner's study [18], the total time spent in the OR was 169 and 150 min in patients, who were treated by HoLEP under aspirin (mean prostate volume 65 g) or under coumadin (mean prostate volume 50.3 g). The OT for ThuVARP (median OT 46 min, median prostate volume 63.5 ml) in this study is well comparable to that in the ThuVARP study by Xia et al [26] (mean OT 46.3 min, mean prostate volume 59.2 ml).…”

Section: Discussionsupporting

confidence: 76%

Thulium Vaporesection of the Prostate and Thulium Vapoenucleation of the Prostate in Patients on Oral Anticoagulants: A Retrospective Three-Centre Matched-Paired Comparison

et al. 2015

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Introduction: To evaluate the short-term results of thulium vaporesection of the prostate (ThuVEP) and thulium vapoenucleation of the prostate (ThuVARP) in patients with benign prostatic obstruction on oral anticoagulants (OA). Methods: A 3-centre retrospective matched-paired comparison of patients treated by ThuVEP (n = 26) or ThuVARP (n = 26) was performed. Thirty-four patients were on aspirin/ticlopidin, 7 on clopidogrel or clopidogrel and aspirin, and 11 on phenprocoumon at the time of surgery. Results: Haemoglobin decrease was higher after ThuVEP compared to ThuVARP (1.5 vs. 0.3 g/dl, p < 0.001). The rate of postoperative blood transfusions (3.9 vs. 0%), clot retention (3.9 vs. 0%), and re-operation (7.7 vs. 0%) was not different between ThuVEP and ThuVARP (p = 0.274). Catheterization time was shorter for ThuVARP (1 vs. 2 days, p < 0.01). Q_max was significantly higher after ThuVEP at 6-month follow-up (31 vs. 21.5 ml/s, p < 0.001), while improvements in International Prostate Symptom Score, quality of life, and post-voiding residual urine showed no differences between the groups. Urethral or bladder neck strictures did not occur during the 6-month follow-up in both groups. Conclusions: ThuVEP and ThuVARP are safe and efficacious procedures in patients on OA. Although patients assigned to ThuVEP had higher Q_max at 6-month follow-up, ThuVARP resulted in similar functional outcomes.

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Section: Discussionsupporting

confidence: 76%

Thulium Vaporesection of the Prostate and Thulium Vapoenucleation of the Prostate in Patients on Oral Anticoagulants: A Retrospective Three-Centre Matched-Paired Comparison

et al. 2015

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“…The median number of procedures done per blade was 22 (range: 20-25) and 18 (17)(18)(19)(20) with the Piranha and VersaCut morcellators, respectively (p = 0.01). The median number of grams of prostate tissue retrieved per blade was 1499 (range: 1388-1539) and 943 (833-1248) with the Piranha and VersaCut morcellators, respectively (p = 0.04).…”

Section: Resultsmentioning

confidence: 99%

Towards optimizing prostate tissue retrieval following holmium laser enucleation of the prostate (HoLEP): Assessment of two morcellators and review of literature

Elshal

Mekkawy

Laymon

et al. 2015

CUAJ

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Introduction: We assess different approaches to retrieve the enucleated adenoma after transurethral enucleation of the prostate, particularly using the holmium laser. Methods: A retrospective review through our prospectively maintained database was performed looking for safety and efficacy of two morcellators. The enucleation phase of the holmium laser enucleation of the prostate (HoLEP) was classically performed followed by retrieval of the intravesical adenoma using either the Piranha (Wolf Inc., Knittlingen, Germany) or VersaCut (Lumenis) morcellator. A PubMed-MEDLINE search was conducted for all transurethral enucleation procedures and relevant data regarding methods of prostate tissue retrieval were extracted. Results: Strictly limiting the study to 3 reusable blades with each morcellator, we performed 67 and 55 consecutive procedures with Piranha and VersaCut, respectively. There was no significant difference between the two morcellators regarding perioperative complications, apart from 5 bladder mucosal injuries with the VersaCut (9%). Furthermore, there were similar retrieved tissue weight, mechanical problems-rate, catheter-time and hospital-stay in both morcellators. However, the Piranha morcellator needed significantly less morcellation-time, needed to use cold loop to remove non-morcellated pieces and to score the adenoma by laser for better bite of the adenoma, and had a higher median morcellation-rate 6.2 (rate: 2.8-12) g/min. Despite little reporting on morcellation, we had data on the tissue retrieval rate (2.6 to 6.5 g/min with Piranha and 1.9 to 11 g/min with VersaCut. Furthermore, bladder mucosal injury was reported in 1.4% and 0.7 to 5.7% with Piranha and VersaCut, respectively; bladder perforation with VersaCut was experienced in about 0.1 to 1.5% of patients. Our study is limited by its non-randomization. Conclusion: The Piranha morcellator was the most efficient and safe way to retrieve tissue after a transurethral enucleation of a prostate adenoma.

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“…A PubMed ® search for HoLEP-related articles revealed many reports on the technique, with long-term results and reports of re-operation for re-growing adenoma; however; the nature of intervention for these cases is often missing [ 15 ] . In 2011, Gilling et al .…”

Section: Discussionmentioning

confidence: 99%

Feasibility of holmium laser enucleation of the prostate (HoLEP) for recurrent/residual benign prostatic hyperplasia (BPH)

2012

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E 8 4 5What ' s known on the subject? and What does the study add? The major advantage of holmium laser enucleation of the prostate (HoLEP) depends on the ability to use the native anatomical plane between the prostate adenoma and surgical capsule, peeling each prostatic lobe from the capsule. HoLEP is associated with less catheterisation time, hospital stay and blood loss than transurethral resection of the prostate (TURP) or open prostatectomy. Urodynamic relief of obstruction has been reported to be better with HoLEP than TURP. However, surgical treatment of recurrent prostatic obstruction after previous transurethral surgery for symptomatic benign prostatic hyperplasia is more challenging because of loss of anatomical landmarks resulting in either incomplete removal or incontinence.HoLEP for recurrent symptoms due to residual or re-growing prostatic adenoma seems to be as safe, feasible and effi cient as HoLEP for de novo cases. The surgical plane between the adenoma and the surgical capsule was still accessible resulting in a durable long-term outcome with minimal side-effects. Previous transurethral prostatic surgery is not a contraindication for HoLEP. OBJECTIVE• To assess the technical feasibility, functional outcome and morbidity of holmium laser enucleation of the prostate (HoLEP) for symptomatic benign prostatic hyperplasia (BPH) in patients with previous transurethral prostate surgery. ' Redo ' surgery for recurrent or residual BPH poses a technical challenge with uncertain outcome as a result of disturbed anatomical landmarks with no clear surgical limits. PATIENTS AND METHODS• We retrospectively reviewed 1054 patients who underwent HoLEP for symptomatic BPH.• Patients were stratifi ed into two groups, group-I with no previous prostate surgery or primary-HoLEP (978 patients) and group-II with history of previous prostate surgery or secondary-HoLEP (76).• All patients ' variables as well as follow-up data were assessed and compared. RESULTS• There were no signifi cant differences in baseline criteria between the two groups ( P > 0.05).• In group-II, HoLEP was done after a median (range) of 66 (13 -121) months from previous prostate surgeries, including transurethral resection of the prostate (48 patients), HoLEP (eight), transurethral incision of the prostate (nine), photoselective vaporization of the prostate (four) and other procedures (seven).• In both groups, routine HoLEP technique was adopted, the plane of enucleation could be identifi ed without extra diffi culty. However, more energy per gram of prostate tissue was needed in group-II ( P < 0.05).• Operative auxiliary procedures were indicated in 1.9% of group-I, and 1.3% of group-II ( P > 0.05). There were no operative complications or blood transfusion in group-II. The mean hospital stay and catheter time was similar in both groups. Early and late postoperative complications were not statistically different ( P > 0.05).• At 1 month the mean maximum urinary fl ow rate (Q max ) was 22.3 and 18.8 mL/s, postvoid residual urine volume (PVR) was 4...

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Three-Year Outcome following Holmium Laser Enucleation of the Prostate Combined with Mechanical Morcellation in 330 Consecutive Patients

Cited by 121 publications

References 27 publications

Thulium Vaporesection of the Prostate and Thulium Vapoenucleation of the Prostate in Patients on Oral Anticoagulants: A Retrospective Three-Centre Matched-Paired Comparison

Thulium Vaporesection of the Prostate and Thulium Vapoenucleation of the Prostate in Patients on Oral Anticoagulants: A Retrospective Three-Centre Matched-Paired Comparison

Towards optimizing prostate tissue retrieval following holmium laser enucleation of the prostate (HoLEP): Assessment of two morcellators and review of literature

Feasibility of holmium laser enucleation of the prostate (HoLEP) for recurrent/residual benign prostatic hyperplasia (BPH)

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