Update on the use of diode laser in the management of benign prostate obstruction in 2014

Lusuardi, Lukas; Mitterberger, Michael; Hruby, Stephan; Kunit, Thomas; Kloss, B.; Engelhardt, Paul F.; Sieberer, Manuela; Janetschek, Günter

doi:10.1007/s00345-014-1327-0

Cited by 22 publications

(9 citation statements)

References 21 publications

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“…ThuVEP focuses on the favorable vaporization effect of continuous-wave lasers to perform a fast, effective and safe enucleation, whereas ThuLEP focuses on almost blunt mechanical enucleation using the laser only for dissection of adherences and mucosa. The latter on anatomy focusing approach was mimicked by other continuous-wave lasers (LBO/"Greenlight" and 980 nm diode laser) that had not been found suitable for enucleation at the initial point of the discussion [5,6].…”

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Enucleation is enucleation is enucleation is enucleation

Herrmann

2016

World J Urol

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followed in 2004 [2], then later in the end of the 2000s all other transurethral laser-based enucleation techniques: Tm:YAG Vapoenucleation (ThuVEP) [3], transurethral anatomical enucleation with Tm:YAG Support (ThuLEP) [4], diode laser enucleation of the prostate (DiLEP) [5] and finally Lithium-Borate "Greenlight" enucleation of the prostate (GreenLEP) [6] appeared on the market to finally replace open prostatectomy (OP) and TURP. It took Thulium:YAG as the challenger to initiate a discussion about the impact of laser in transurethral enucleation. The surgical twins "ThuVEP" and "ThuLEP" demonstrated the whole spectrum of laser action in enucleating techniques. ThuVEP focuses on the favorable vaporization effect of continuous-wave lasers to perform a fast, effective and safe enucleation, whereas ThuLEP focuses on almost blunt mechanical enucleation using the laser only for dissection of adherences and mucosa. The latter on anatomy focusing approach was mimicked by other continuous-wave lasers (LBO/"Greenlight" and 980 nm diode laser) that had not been found suitable for enucleation at the initial point of the discussion [5,6].The most famous quotation from Gertrude Stein's poem Sacred Emily "Rose is a rose is a rose is a rose." is often interpreted as "things are what they are." When reviewing all meta-analyses and structured reviews of the past 3 years, the energy source seems to be secondary and a result of resources and personal preference of a skilled surgeon, today [7]. The time has come to move from sophistical marketing of a single energy source to the overarching principle of anatomical enucleation to focus all efforts to establish enucleation as the de facto standard treatment 32 years after Hiraoka [8] laid the cornerstone for all anatomical transurethral enucleation techniques of the prostate with his monopolar transurethral detachment prostatectomy technique (TUE). Abstract The latest update of the EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms, incl. Benign Prostatic Obstruction in 2016 announced a novel acronym for transurethral Endoscopic Enucleation of the Prostate (EEP). This was inspired by a meta-analysis on randomized controlled trials on HolmiumLaser Enucleation of the Prostate (HolEP) and bipolar enucleation versus open simple prostatectomy. EEP codes for the common ground of both techniques: "anatomical enucleation." Although study quality with regard to the availability of long-term randomized controlled trials is at the moment mostly available for HoLEP, and bipolar enucleation, the existing data of all other enucleating techniques that have been demonstrated to perform anatomical enucleation as well should also been summarized under the same term. This editorial is a call for embracing this acronym of EEP for all anatomical enucleating techniques in order to serve for the transition from the age of TURP and open prostatectomy toward the age of EEP. Editorial,The great merit of holmium laser enucleation of the prostate (HoLEP) is to have laid out the re...

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confidence: 99%

Enucleation is enucleation is enucleation is enucleation

Herrmann

2016

World J Urol

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“…Transient stress urinary incontinence is often encountered after endosurgery for prostate enucleation, and was found in 3.3%–7.5% cases after DiLEP. 24 This study demonstrated that DiLEP occurrence was 6.6%, compared with 3.9% in the PKRP group ( P = 0.468), similar to HoLEP and thulium laser vaporization enucleation of the prostate (ThuVEP). 25,26 Stress urinary incontinence disappeared at 3 months postoperatively by exercising the levator ani muscle.…”

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confidence: 57%

1470 nm Diode Laser Enucleation vs Plasmakinetic Resection of the Prostate for Benign Prostatic Hyperplasia: A Randomized Study

Zhang

Wang

Zhang

et al. 2019

Journal of Endourology

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Objective: The purpose of the current work was to comparatively assess 1470 nm diode laser enucleation of the prostate (DiLEP) and plasmakinetic resection of the prostate (PKRP) for treating benign prostatic hyperplasia (BPH). Patients and Methods: From January 2016 to March 2017, 157 individuals with bladder outflow obstruction caused by BPH were randomized to DiLEP and PKRP groups, for prospective analysis. Of these, 152 cases were evaluated before operation and at 3, 6, and 12 months postsurgery. Patient baseline properties, presurgery data, and postsurgical outcomes were comparatively assessed, as well as complications. Results: There were no significant preoperative differences between surgical groups. DiLEP-treated cases showed remarkable reduced operative time, postsurgical bladder irrigation time, catheterization duration, and hospital stay compared with the PKRP group ( P < 0.001). Hemoglobin amount decrease was markedly less pronounced after DiLEP ( P = 0.004). However, no patients needed blood transfusion in either group. The decrease in sodium level showed no marked differences between the DiLEP and PKRP groups ( P = 0.380). In addition, complications were comparable and no significant differences in both groups. At 3, 6, and 12 months, International Prostate Symptom Score (IPSS), quality of life (QoL), maximum flow rate (Qmax), and postvoid residual (PVR) were similar in both groups ( P > 0.05). Conclusions: DiLEP and PKRP are similar in efficacy and safety for relieving obstruction and low urinary tract symptoms. Compared with PKRP, DiLEP has decreased risk of hemorrhage, operative time, bladder irrigation time, catheterization duration, and hospital stay. However, IPSS, QoL, Qmax, and PVR were similar for both procedures within 12 postoperative months.

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“…TUERP combined with the concept of conventional open surgery and transurethral resection of the prostate, can not only completely remove the gland but can also reduce bleeding; it is less invasive to the body and has been recognized by clinical experts [29]. Although the energies used for enucleation of the prostate by urologists may be different, such as holmium laser [30], thulium laser [31], diode laser [32], or plasma kinetic energy [14,33], the principle is similar which include identification of the tissue plane between the adenoma and the surgical capsule, and anatomical enucleation of the adenoma, and this technique has the advantage of being an extravesical procedure, better controlling the bleeding and avoiding bladder incision. TUERP can reduce wound repair time, thus shortening bladder irrigation time, catheterization time, and postoperative hospital stay [12,34].…”

Section: Discussionmentioning

confidence: 99%

Multivariate Analysis of the Failure of Removal of the Urinary Catheter within 48 Hours after Transurethral Enucleation and Resection of the Prostate

Chen

Liu

2020

BioMed Research International

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Objective. To assess the value of clinically relevant data for predicting the failure of removal of the urinary catheter within 48 hours after TUERP. Materials and Methods. We retrospectively analyzed the medical records of 357 patients who underwent TUERP between January 2015 and July 2018, all of whom stopped bladder irrigation and removed urinary catheter within 48 hours after the operation. According to whether the removal of the catheter was successful, the patients were classified into 2 groups: Group A was successful and group B was a failure. Univariate analysis was performed to determine the association between the failure of removal of the catheter and the patients’ preoperative clinical characteristics. Logistic regression analysis and receiver operating characteristic analysis (ROC) were conducted to establish the prediction model. Then the area under the curve (AUC) and the cut-off value were calculated. Results. 357 patients were divided into group A (n = 305, 85.4%) and group B (n = 52, 14.6%). The patients’ drug medication (P=0.006), history of acute urinary retention (AUR) (P≤0.001), smoke (P=0.045), IPSS (P≤0.001), IPP (P=0.006), PSA (P=0.047), residual urine volume (P≤0.001), QoL (P≤0.001), and TPV (P=0.043) were significantly different between the 2 groups. A predictive model using logistic regression was defined as follows: INDEX = 10.862–1.376 × (IPSS) − 1.185 × (QoL) − 1.062 × (drug medication) + 1.079 × (history of AUR) + 0.030 × (TPV) − 0.867 × (IPP) with area under the curve of 0.860 obtained from the ROC curve analysis. The predictive model had a cut-off value of 1.7725, and the sensitivity for predicting the failure of removal of the urethra was 74.1% and the specificity was 84.6%. Conclusion. This study demonstrated that IPSS, QoL, drug medication, history of AUR, TPV, and IPP are independent factors associated with the failure of removal of the urethral catheter within 48 hours after TUERP.

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Update on the use of diode laser in the management of benign prostate obstruction in 2014

Abstract: More randomized controlled studies are needed to determine the position and the ideal technique of diode laser treatment for BPH.

Cited by 22 publications

References 21 publications

Enucleation is enucleation is enucleation is enucleation

Enucleation is enucleation is enucleation is enucleation

1470 nm Diode Laser Enucleation vs Plasmakinetic Resection of the Prostate for Benign Prostatic Hyperplasia: A Randomized Study

Multivariate Analysis of the Failure of Removal of the Urinary Catheter within 48 Hours after Transurethral Enucleation and Resection of the Prostate

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