Top-down Holmium Laser Enucleation of the Prostate: Technical Aspects and Early Outcomes

Elmansy, Hazem; Hodhod, Amr; Kotb, Ahmed; Prowse, Owen; Shahrour, Walid

doi:10.1016/j.urology.2019.01.019

Cited by 15 publications

(9 citation statements)

References 4 publications

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“…Several HoLEP techniques have been reported since the rst procedure described by Gilling [14] : 2-lobes technique [21], En-Bloc technique [22], white line technique [23,24], anteroposterior dissection HoLEP [25], Top-Down HoLEP [26] . In a non-randomized retrospective monocentric study, Endo and al [25] reported a decrease of incontinence rate (2.7% vs 25.2%) in favour of anteroposterior dissection HoLEP versus Gilling's method. However, these results have not yet been con rmed.…”

Section: Discussionmentioning

confidence: 99%

Stress Urinary Incontinence After Holmium Laser Enucleation of Prostate: Incidence and Risk Factors

Codas

daily

et al. 2021

Preprint

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Objectives: To evaluate the incidence and the risk factors of stress urinary incontinence (SUI) during the first year after HoLEP.Patients and Methods: This study presents a monocentric and retrospective study including 155 patients who underwent HoLEP for benign prostatic hyperplasia. The surgeries were performed by 2 expert surgeons. The continence was evaluated at 1, 3, 6 and 12 months. The predictive factors of SUI were analysed by logistic regression.Results:The SUI rate at 1, 3 and 6 months was 11.3%, 10.7% and 4.1% respectively. SUI remained present in 4 patients (2.6%) at 12 months. The mean ICIQ-SF scores in patients with SUI were 10.3±6.09 and 8±4.24 at 1 and 12 months respectively (p <0.05). BMI>30 (OR, 4.69; 95% CI, 1.51–14.52; p=0.007) and patients over 70 years old (OR, 16.23; 95% CI, 1.96–134.09; p=0.010) were identified as independent risk factors for SUI at 1 and 3 months respectively.Conclusion: SUI after HoLEP is transitory in most cases. It is favoured by a high BMI and an age over 70. These criteria should be considered before choosing the operative technique and preventive measures must be taken in high-risk patients.

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Section: Discussionmentioning

confidence: 99%

Stress Urinary Incontinence After Holmium Laser Enucleation of Prostate: Incidence and Risk Factors

Codas

daily

et al. 2021

Preprint

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“…However, its assessment in several studies is only based on patient reported data (Table 4, Ref. [3,5,7,10,[12][13][14][20][21][22][23][24][25]), and one possible explanation for the variation of reported SUI rates is the lack of a standardized evaluation. Without the use of a validated questionnaire, incidence and prevalence of postoperative urinary incontinence could be underestimated, and precise determination of the type of incontinence is difficult [18].…”

Section: Discussionmentioning

confidence: 99%

Stress urinary incontinence after holmium laser enucleation of prostate: incidence and risk factors

Ye¹,

Codas²,

Daily³

et al. 2021

JOMH

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Background and objective: To evaluate the incidence and the risk factors of stress urinary incontinence (SUI) during the first year following Holmium Laser Enucleation of the Prostate (HoLEP). Materials and methods:Our monocentric and retrospective study includes 155 patients who underwent HoLEP for benign prostatic hyperplasia. Surgeries were performed by 2 expert surgeons.The continence was evaluated before and after surgery at 1, 3, 6 and 12 months. The predictive factors of SUI were analysed using logistic regression. Results:The SUI rate at 1, 3, 6 and 12 months was respectively 7.3%, 8.1%, 3.4% and 2.7%. SUI remained present in 4 patients (2.6%) at 12 months. The mean International Consultation Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-SF) score for patients with SUI was respectively 11.69 ± 5.28, 8.70 ± 4.24, 1.81 ± 3.53 and 8 ± 4.24 at 1, 3, 6 and 12 months (p < 0.05). Body Mass Index (BMI) >30 (Odds Ratio (OR), 4.69; 95% Confidence Interval (CI), 1.51-14.52; p = 0.007) and patients over 70 years old (OR, 16.23; 95% CI, 1.96-134.09; p = 0.010) were respectively identified as independent risk factors for SUI at 1 and 3 months.Conclusions: SUI after HoLEP is transitory in most cases. It is favoured by a high BMI and an age over 70. These criteria should be considered before choosing the operative technique and preventive measures must be taken in high-risk patients.

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“…It also eliminates the need for the encircling technique. We previously presented the 3-month outcomes of Top-Down HoLEP [ 11 ]. In the present study, we evaluate the 12-month outcomes of the Top-Down technique in terms of the operative data and postoperative outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Cystoscopy was preoperatively performed in patients who underwent previous TURP to exclude bladder neck (BN) contracture and/or urethral strictures. The technique of the Top-Down HoLEP is similar to that described previously [ 11 ].…”

Section: Methodsmentioning

confidence: 99%

‘Top-Down’ holmium laser enucleation of the prostate. Report of initial cases performed by a single surgeon

Hodhod

Oquendo

Tablowski

et al. 2020

Arab Journal of Urology

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Objectives To present the 12-month outcomes of ‘Top-Down’ holmium laser enucleation of the prostate (HoLEP). Patients and methods We retrospectively reviewed the charts of prospectively collected patients who underwent Top-Down HoLEP between 2017 and 2018. All cases were operated upon by a single urologist (H.E), using a 100-W holmium:YAG laser with a 550-μm laser fibre. We recorded the enucleation time, morcellation time, intraoperative, and postoperative complications. All patients had postoperative follow-up visits at 1, 3, 6 and 12 months. The evaluation included the International Prostate Symptom Score (IPSS), quality-of-life (QoL) assessment, measurement of maximum urinary flow rate (Q max ) and the post-void residual urine volume (PVR). Results A total of 60 consecutive patients were recruited. The median (range) prostatic volume, resected prostatic weight, and percentage of resected prostatic tissue were 124 (70–266) mL, 90 (44–242) g and 76 (46–97)%, respectively. The median (range) enucleation and morcellation times were 80 (25–200) and 14.5 (4–58) min, respectively. One patient had a simple bladder mucosal injury and another developed clot retention. At 3 months, three patients (5%) had stress urinary incontinence (SUI) and eight patients (13.3%) presented with urge UI (UUI). At the last follow-up visit, one patient (1.7%) presented with persistent SUI, while three patients (5%) presented with UUI. The IPSS and QoL significantly improved during the follow-up period ( P = 0.045 and P = 0.04, respectively). Conclusion The results of the Top-Down technique are comparable to those of traditional HoLEP. However, the Top-Down technique may reduce the complexity, operating time, and SUI rates. Abbreviations BN: bladder neck; HoLEP: holmium laser enucleation of the prostate; PVR: post-void residual urine volume; Q max : maximum urinary flow rate; QoL: quality of life; TOV: trial of voiding; (S)(U)UI: (stress) (urge) urinary incontinence

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Top-down Holmium Laser Enucleation of the Prostate: Technical Aspects and Early Outcomes

Cited by 15 publications

References 4 publications

Stress Urinary Incontinence After Holmium Laser Enucleation of Prostate: Incidence and Risk Factors

Stress Urinary Incontinence After Holmium Laser Enucleation of Prostate: Incidence and Risk Factors

Stress urinary incontinence after holmium laser enucleation of prostate: incidence and risk factors

‘Top-Down’ holmium laser enucleation of the prostate. Report of initial cases performed by a single surgeon

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