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Outcome of simultaneous thulium laser enucleation of bladder tumor and prostate in patients with non-muscle invasive bladder tumor and benign prostatic hyperplasia: a matched-pair comparison with a long-term follow-up
摘要： Objective To access the surgical and oncological outcomes of simultaneous thulium laser enucleation of bladder tumor (ThuLEBT) and thulium laser enucleation of prostate (ThuLEP) in patients with non-muscle invasive bladder tumor (NMIBC) and benign prostatic hyperplasia (BPH). Patients and methods Between June 2009 and June 2017, 118 men with NMIBC who underwent simultaneous ThuLEBT and ThuLEP and fulfilled the inclusion criteria were matched with 118 patients who received ThuLEBT alone. Clinico-pathological parameters, surgical outcome data and oncological outcomes were retrospectively analyzed and compared. Results The patients who underwent simultaneous ThuLEBT and ThuLEP experienced a longer length of operation time (70.4 vs. 25.5 min; p < 0.001), but there were no statistically significant differences in catheterization period, hospital stay and complication between the two groups. At a mean follow-up of 58.7 and 55.8 months in ThuLEBT/ThuLEP group and ThuLEBT group, no significant differences in overall recurrence rates, progression rates, recurrence in the bladder neck/prostatic fossa and mean elapsed time to recurrence were detected. The 5-year recurrence-free probability was 73.2% for ThuLEBT/ThuLEP and 69.2% for ThuLEBT (p = 0.361). Conclusions Our results indicate that simultaneous ThuLEBT and ThuLEP can be safely performed without increasing the surgical risk and the risk of tumor recurrence and progression in patients with NMIBC and BPH, and it may be preferred alternative for select patients.
关键词： Bladder tumor,Tumor recurrence,Benign prostatic hyperplasia,Laser therapy,Thulium laser enucleation of bladder tumor,Thulium laser enucleation of prostate
更新于2025-09-23 15:21:01
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Perioperative Safety and Efficacy of Holmium Laser Enucleation of the Prostate in Patients Receiving Antithrombotic Therapy: A Prospective Cohort Study
摘要： We investigated the efficacy of and risk from holmium laser enucleation of the prostate (HoLEP) due to discontinuation of antithrombotics in patients with benign prostatic hyperplasia (BPH). Patients in the prospective SNUH-BPH Database Registry who underwent HoLEP between December 2010 and December 2017 were enrolled. Preoperative evaluation included symptom score questionnaires, laboratory tests, urine tests, prostate-specific antigens, urodynamic study, and transrectal ultrasonography. Postoperative evaluation was performed at 2 weeks, 3 months, and 6 months. Information regarding the types of antithrombotics and their use, underlying disease, and antithrombotic management during surgery was collected. The study included 55 patients. The mean age and preoperative prostate volume were 68.7 ± 6.4 years and 70.3 ± 32.2 mL, respectively. The mean preoperative hemoglobin level was 13.5 ± 2.6 g/dL in the patients receiving antithrombotics. Of the patients, 71% were taking aspirin. Seventy-five (66.5%) and 70 patients (28.2%) discontinued the antithrombotic therapy 5–7 days and <1 week preoperatively, respectively. Three patients (1.21%) were switched to low-molecular-weight heparin therapy, and 10 (4.03%) continued antithrombotic therapy. No significant differences were found in the incidence rates of postoperative transfusion (p = 0.894) or complications from antithrombotic use, thrombosis (p = 0.946), haemorrhage requiring bladder irrigation (p = 0.959), transurethral coagulation (p = 0.894), cardiovascular events (p = 0.845), and cerebrovascular events (p = 0.848). Efficacy and complications related to the short-term antithrombotic withdrawal before and after HoLEP also showed no significant differences. HoLEP may be a beneficial surgical technique for patients with BPH who are receiving antithrombotics.
关键词： Benign Prostatic Hyperplasia,Perioperative Safety,Antithrombotic Therapy,Holmium Laser Enucleation of the Prostate,Efficacy
更新于2025-09-23 15:21:01
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Holmium laser enucleation of the prostate for very large benign prostatic hyperplasia (a?￥a??200??cc)
摘要： Purpose Patients presenting with prostate gland sizes greater than 200?cc pose a unique surgical challenge to both patients and surgeons. The objective of this study is to critically assess the efficacy and risks associated with performing holmium laser enucleation of the prostate (HoLEP) on glands ≥ 200?cc. Materials and methods Using a prospective maintained database, all consecutive benign prostatic hyperplasia (BPH) patients with gland size ≥ 200?cc who underwent HoLEP were included. We reported patient preoperative, intraoperative, postoperative outcomes and complications. Subgroup analysis of outcomes was stratified by gland sizes 200–299?cc and ≥ 300?cc. Univariate analysis using Kruskal–Wallis and Fisher exact test was performed to compare the two groups. Results There were 88 patients with a mean preoperative gland size of 255.9?cc (200–770?cc). Mean operative (171 vs 182?min) and enucleation time (77 vs 83?min) were not different between the two subgroups (200–299?cc vs ≥ 300?cc). Enucleation efficiency was greater for glands ≥ 300?cc (2.6?cc/min vs 2.0?cc/min, p = 0.04). Morcellation time was longer in the ≥ 300?cc group (74.5?min vs 46.8?min, p = 0.021). Mean length of stay was 1.8 ± 1.2?days and catheter duration was 2.6 ± 2.7?days. 1 (1.1%) patient required retreatment of BPH at last follow-up. The main limitation of this study is the retrospective data analysis. Conclusions Holmium laser enucleation for prostate glands volume > 200?cc is feasible with minimal morbidity. These data further reinforce the size independence success of this procedure for BPH.
关键词： Transurethral resection of prostate,Laser,Benign prostate hyperplasia,Holmium,Prostate,Holmium laser enucleation of the prostate,Lower urinary tract symptoms
更新于2025-09-23 15:19:57
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Laser enucleation of the prostate versus transurethral resection of the prostate: perioperative outcomes from the ACS NSQIP database
摘要： Purpose To compare the perioperative outcomes associated with laser enucleation of the prostate (LEP) and transurethral resection of the prostate (TURP) using a national database. Methods The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for patients who underwent TURP or LEP from 2008 to 2016. Baseline demographics, comorbidities, and predisposition to bleeding were compared between TURP and LEP. The 30-day perioperative outcomes including operative time, length of hospital stay (LOS), return to the operating room (OR), bleeding requiring transfusion, and organ system-specific complications were compared between the procedures. A multivariate logistic regression analysis was performed, adjusting for the type of surgery and other covariates. Results The series included 37,577 TURP and 2869 LEP procedures. While TURP was associated with a shorter operative time (55.20 ± 37.80 min) than LEP (102.80 ± 62.30 min), the latter was associated with a shorter hospital stay (1.29 ± 2.73 days) than TURP (2.05 ± 5.20 days). Compared to TURP, LEP had 0.52 (0.47–0.58) times the odds of a LOS > 1 day and 0.67 (0.54–0.83) times the odds of developing urinary tract infections. Nevertheless, no difference was found for other postoperative complications, need for transfusion, and return to OR. Conclusion Real-life data from a large national database confirmed that LEP is a safe and reproducible procedure to treat benign prostatic obstruction. Compared to TURP, LEP was associated with a lower rate of infectious complications and a shorter LOS at the expense of an increased operative time.
关键词： Transurethral resection of the prostate,Laser enucleation of the prostate,Prostatic adenoma,Benign prostatic obstruction
更新于2025-09-19 17:13:59
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Holmium laser enucleation of the prostate: Problem-based evolution of the technique
摘要： Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive and size-independent treatment for benign prostatic hyperplasia with excellent long-term surgical outcome. Considered difficult to learn, different modifications of the technique have been proposed in the last 21 years to overcome the most common problems encountered during this procedure. We present a step-by-step technique including the reasons and advantages of each modification we have progressively adopted until we evolved into our totally en-bloc no-touch low-power HoLEP.
关键词： holmium laser,EEP,Enucleation,HoLEP,benign prostatic hyperplasia
更新于2025-09-19 17:13:59
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Holmium laser enucleation versus bipolar plasmakinetic enucleation of a large volume benign prostatic hyperplasia: a randomised controlled trial
摘要： Objectives: To compare safety and efficacy of bipolar plasmakinetic enucleation (BPEP) versus holmium laser enucleation (HoLEP) for management of large BPH (>80gm). Patients and methods: Patients with failed medical treatment, International Prostate Symptom Score (IPSS)>13, peak urinary flow rate (Qmax)<15ml/sec and prostate size ≥80gm were enrolled in this randomised controlled trial from from November 2016 to February 2018 and managed by HoLEP (Group A; 33patients) or BPEP (Group B; 31patients). Patients on anticoagulants were not excluded. Patients were followed‐up for 12 months. Perioperative data was compared between both groups using Student‐t, Mann‐Whitney, Paired‐t, Wilcoxon signed rank, Chi‐Square, or Fisher‐Exact tests as appropriate. Results: There was no significant difference between both groups in age, rate of presentation with urinary retention, recurrent hematuria, frequency of patients on anticoagulants/antiplatelets, prostate size, PSA, Qmax, IPSS, quality of life (QoL) and post‐void residual urine (PVRU). Operative time was significantly longer in BPEP (p=0.003) as well as catheterization duration (p=0.019). Other perioperative parameters including level of Na+ and hemoglobin, resected tissue weight, hospital stay and complications were not significantly different between both groups. There was no need for blood transfusion in all patients. There was significant postoperative improvement in IPSS, PVRU, QoL, PSA and Qmax in each group. However, there was no significant difference between both groups in these parameters. Conclusion: HoLEP and BPEP are comparable regarding safety and efficacy for treatment of BPH (>80gm) including patients on anticoagulants. However, BPEP required a longer catheterization duration and operative time.
关键词： TURP,Plasmakinetic enucleation,Large volume prostate,BPH,anticoagulants,HoLEP
更新于2025-09-12 10:27:22
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Current surgical techniques of enucleation in holmium laser enucleation of the prostate
摘要： Holmium laser enucleation of the prostate (HoLEP) has been accepted as the most efficient method of transurethral surgery for benign prostatic hyperplasia. The originally developed three-lobe technique has popularized this surgery; this method is based on three longitudinal incisions, by which the median lobe is removed, and subsequently, both lateral lobes are enucleated. To maintain a consistent surgical plane and to minimize sphincteric damage, the traditional three-lobe technique is continuously being refined and evolving. A few modifications of the original technique have been developed, and several en bloc enucleation methods have been introduced. However, more clinical evidence is required to show the superiority of newer techniques over the original three-lobe technique in terms of efficacy and long-term side effects. To date, none of the newer techniques have been accepted as a standard technique for HoLEP.
关键词： Enucleation,Laser therapy,Prostatic hyperplasia,Transurethral resection of prostate,Holmium
更新于2025-09-12 10:27:22
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Comparison Between 1-Day and Inpatient Procedure of Holmium Laser Enucleation in Patients With Benign Prostate Hyperplasia
摘要： Holmium laser enucleation of the prostate (HoLEP) is one of the minimally invasive procedures that is used for patients with benign prostate hyperplasia. The procedure usually requires patients to stay in the hospital 2 nights or longer. The present study evaluated the safety and feasibility of HoLEP with discharge of the patients on Day 1 after surgery (1-day surgery). A total of 1,164 patients were included in the study, with 510 of them planned for 1-day surgery and others planned for inpatient surgery. The primary outcomes included complication rate and clinical outcomes. A total 489 out of 510 patients received 1-day HoLEP and were discharged on Day 1 after surgery. In a 30-day follow-up period, no significant differences were found between the 1-day and inpatient surgery groups in terms of the rate of complications and clinical outcomes. Patients in the 1-day surgery group had a significantly shorter waiting time for admission (9.5 ± 4.8 vs. 17.6 ± 7.4 days, p < .05), and the mean hospitalization cost was lower (CNY$ 9140.6 ± 1452.2 vs. 10533.4 ± 1594, p < .05).The 1-day HoLEP surgery was safe and had satisfactory clinical outcomes. This treatment strategy could reduce the waiting time for admission and cost of hospitalization. Majority of the patients found this 1-day surgery beneficial, especially elderly patients who prefer to have an early return home and rapid resumption of activities.
关键词： holmium laser enucleation of the prostate,benign prostate hyperplasia,lower urinary tract symptoms,1-day surgery
更新于2025-09-12 10:27:22
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Standardization of 532 nm Laser Terminology for Surgery in Benign Prostatic Hyperplasia (BPH): A Systematic Review
摘要： Introduction: The use of GreenLight? laser technology to remove the prostatic transitional zone (TZ) transurethrally has grown considerably in recent years, and with it an increase in the number of terms that are used to describe similar techniques. Varying terminology complicates literature analysis and publication, which can cause confusion when performing reviews of the literature. It has become necessary to simplify and standardize terminology used to describe transurethral prostate debulking procedures using the 532 nm laser in order to simplify communication on these techniques. Materials and Methods: We conducted a search on September 17th, 2019 in the following databases: Ovid MEDLINE?; Ovid EMBASE; and PubMed. Results: Of the 1115 unique records found in our database search, a total of 27 articles were selected for inclusion. Of the 16 search terms used, we found that 4 terms could be used to describe the fundamental technique associated with each search term. These terms include “vaporization”, “vaporesection”, “vapoenucleation”, and “enucleation”. Conclusions: Standardizing terminology leads to an efficient consolidation of terms based on the above outcomes. This will streamline the literature search process for future publications and facilitate comparison of varying techniques.
关键词： vapoenucleation,enucleation,532 nm laser,vaporesection,prostate,terminology,benign prostatic hyperplasia,laser prostatectomy,vaporization,GreenLight laser
更新于2025-09-12 10:27:22
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Thulium Laser Enucleation of the Prostate: Median Lobe Enucleation, Step by Step, for a Beginner Surgeon
摘要： Introduction and Objectives: Since 2010, Herrmann and colleagues1 introduced thulium laser enucleation of the prostate (ThuLEP) as a versatile minimally invasive enucleation procedure, followed by number of studies that have con?rmed its feasibility and ef?cacy such as holmium laser enucleation of the prostate (HoLEP). Our aim is to present a self-taught, ThuLEP, learning curve for a single surgeon with no previous HoLEP2 experience. Methods: Between February and August 2018, a well-trained endourologist, who did not perform laser enucleation of the prostate before, started reviewing the available literature, attended >15 procedures at another hospital, and participated in 3 laser enucleation of prostate workshop. A total of 18 patients with prostate size between 80 and 120 g underwent ThuLEP for the ?rst time. We used Revolix DUO(cid:2) machine with a 40 watt setting for both cutting and coagulation with a 550lm ?ber for all cases. Results: In the ?rst four cases, the surgeon was unable to completely enucleate the ?rst lobe and ended with open prostatectomy. In the following four cases, one lobe was completely enucleated and morcellated, whereas the other lobe was ?nished by bipolar resection. The remaining cases were effectively enucleated and morcellated. All patients had a satisfactory voiding outcome with mean Qmax of 24.5 after surgery. Conclusion: ThuLEP extraordinary hemostatic effect and its limited penetration depth may allow it to be an appropriate start for a beginner surgeon, while the after effect charring outcome may mask the capsular outline and would be its major drawback that could be avoided with lower watt and limited incisions.
关键词： laser,prostate,enucleation,thulium
更新于2025-09-12 10:27:22