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Comparison of 3 Different Enucleation Techniques of Holmium Laser Enucleation of Prostate (HoLEP)

Zafer Tokatl?, Bar?? Esen, Önder Yaman, Remzi Sa?lam
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Abstract

Purpose:

To evaluate the effect of different enucleation techniques on operation time, enucleation efficacy and postoperative results.

Materials and Methods:

178 HoLEP cases performed by two senior surgeons were evaluated retrospectively. All patients were evaluated for age, IPSS, preoperative PSA, prostate size, maximum flow rate (Qmax) postvoid residual volume (PVR), enucleation time, morcellation time, enucleated tissue weight, enucleation ratio (enucleated tissue weight/prostate volume) and enucleation time efficacy (enucleated weight/enucleation time). Patients were categorized into three groups according to performed enucleation techniques; Retrograde Low Tension (RLT) two-lobe, traditional three-lobe, and en bloc techniques. IPSS, Qmax, PVR and transient urine leakage (TUL) were evaluated during postoperative follow up. All preoperative, intraoperative and postoperative results were compared between 3 groups.

Results:

Mean age was 70.52 (52-85) years. Baseline data were comparable between groups.  Enucleation time was significantly shorter in RLT two-lobe (median; 50, 60 and 60 min; RLT two-lobe, traditional three-lobe, and en bloc HoLEP techniques, respectively. (P = .031). Morcellation time was comparable between groups (P = .532). No significant difference was observed between morcellated prostate weights (P = .916) Significant improvements in IPSS, Qmax, and PVR were noted in all groups (P < .001). TUL was significantly increased in en bloc technique (P = .034). Postoperative stricture rates were similar between groups. (P = .769)

Conclusion:

Shorter enucleation time was observed in the RLT HoLEP technique and increased TUL rate was observed in the en bloc technique.


References

Calogero AE, Burgio G, Condorelli RA, Cannarella R, La Vignera S. Epidemiology and risk factors of lower urinary tract symptoms/benign prostatic hyperplasia and erectile dysfunction. Aging Male. 2019;22:12-9.

Gravas S, Bachmann A, Reich O, Roehrborn CG, Gilling PJ, De La Rosette J. Critical review of lasers in benign prostatic hyperplasia (BPH). BJU Int. 2011;107:1030-43.

Cornu JN, Ahyai S, Bachmann A, et al. A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update. Eur Urol. 2015;67:1066-96.

Elzayat E, Habib E, Elhilali M. Holmium laser enucleation of the prostate in patients on anticoagulant therapy or with bleeding disorders. J Urol. 2006;175:1428-32.

Gilling PJ, Cass CB, Malcolm AR, Fraundorfer MR. Combination holmium and Nd:YAG laser ablation of the prostate: initial clinical experience. J Endourol. 1995;9:151-3.

Baazeem AS, Elmansy HM, Elhilali MM. Holmium laser enucleation of the prostate: modified technical aspects. BJU Int. 2010;105:584-5.

Scoffone CM, Cracco CM. The en-bloc no-touch holmium laser enucleation of the prostate (HoLEP) technique. World J Urol. 2016;34:1175-81.

Glybochko PV, Rapoport LM, Enikeev ME, Enikeev DV. Holmium laser enucleation of the prostate (HoLEP) for small, large and giant prostatic hyperplasia: tips and tricks. Urologia. 2017;84:169-73.

Hurle R, Vavassori I, Piccinelli A, Manzetti A, Valenti S, Vismara A. Holmium laser enucleation of the prostate combined with mechanical morcellation in 155 patients with benign prostatic hyperplasia. Urology. 2002;60:449-53.

Gu M, Chen YB, Liu C, et al. Comparison of Holmium Laser Enucleation and Plasmakinetic Resection of Prostate: A Randomized Trial with 72-Month Follow-Up. J Endourol. 2018;32:139-43.

Krambeck AE, Handa SE, Lingeman JE. Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol. 2010;183:1105-9.

Gilling PJ, Wilson LC, King CJ, Westenberg AM, Frampton CM, Fraundorfer MR. Long-term results of a randomized trial comparing holmium laser enucleation of the prostate and transurethral resection of the prostate: results at 7 years. BJU Int. 2012;109:408-11.

Tan A, Liao C, Mo Z, Cao Y. Meta-analysis of holmium laser enucleation versus transurethral resection of the prostate for symptomatic prostatic obstruction. Br J Surg. 2007;94:1201-8.

Yin L, Teng J, Huang CJ, Zhang X, Xu D. Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. J Endourol. 2013;27:604-11.

Lourenco T, Pickard R, Vale L, et al. Alternative approaches to endoscopic ablation for benign enlargement of the prostate: systematic review of randomised controlled trials. BMJ. 2008;337:a449.

Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol. 2008;53:160-6.

Shah HN, Mahajan AP, Sodha HS, Hegde S, Mohile PD, Bansal MB. Prospective evaluation of the learning curve for holmium laser enucleation of the prostate. J Urol. 2007;177:1468-74.

Placer J, Gelabert-Mas A, Vallmanya F, et al. Holmium laser enucleation of prostate: outcome and complications of self-taught learning curve. Urology. 2009;73:1042-8.

Robert G, Cornu JN, Fourmarier M, et al. Multicentre prospective evaluation of the learning curve of holmium laser enucleation of the prostate (HoLEP). BJU Int. 2016;117:495-9.

Nam JK, Kim HW, Lee DH, Han JY, Lee JZ, Park SW. Risk Factors for Transient Urinary Incontinence after Holmium Laser Enucleation of the Prostate. World J Mens Health. 2015;33:88-94.

Shah HN, Mahajan AP, Hegde SS, Bansal MB. Peri-operative complications of holmium laser enucleation of the prostate: experience in the first 280 patients, and a review of literature. BJU Int. 2007;100:94-101.

Hwang JC, Park SM, Lee JB. Holmium laser enucleation of the prostate for benign prostatic hyperplasia: effectiveness, safety, and overcoming of the learning curve. Korean J Urol. 2010;51:619-24.

Vavassori I, Valenti S, Naspro R, et al. Three-year outcome following holmium laser enucleation of the prostate combined with mechanical morcellation in 330 consecutive patients. Eur Urol. 2008;53:599-604.

Fraundorfer MR, Gilling PJ. Holmium:YAG laser enucleation of the prostate combined with mechanical morcellation: preliminary results. Eur Urol. 1998;33:69-72.




DOI: http://dx.doi.org/10.22037/uj.v0i0.5211

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