Objective:The aim of this research was to evaluate the efficiency of reciprocating morcellation for removing giant benign prostatic hyperplasia during holmium laser enucleation of the prostate,investigate whether perf...Objective:The aim of this research was to evaluate the efficiency of reciprocating morcellation for removing giant benign prostatic hyperplasia during holmium laser enucleation of the prostate,investigate whether performing morcellation as a two-stage procedure improves tissue retrieval efficiency,and seek to determine the optimal interval between the two surgeries.Methods:This study included nine cases of holmium laser enucleation of the prostate with an enucleated prostate weight exceeding 200 g,indicative of substantial prostate enlargement.Morcellation was performed on Day 0(n=4),Day 4(n=1),Day 6(n=1),and Day 7(n=3).The intervals were compared regarding the morcellation efficiency,beach ball presence,and pathology.Results:The mean estimated prostate volume was 383(range 330e528)mL;the median enucleation weight was 252(interquartile range[IQR]222,342)g;and the median enucleation time was 83(IQR 62,100)min.The mean morcellation efficiency was 1.44(SD 0.55)g/min on Day 0 and 13.69(SD 2.46)g/min on day 7.The morcellation efficiency was 4.15 g/min and 10.50 g/min on Day 4 and Day 6,respectively,with significantly higher in the two-stage group compared to one-stage group(11.0 g/min vs.1.5 g/min;p=0.014).Efficiency was strongly correlated with intervals(p<0.001);the incidences of beach balls were 100%(4/4)and 60%(3/5)in the immediate and two-stage surgery groups,respectively.Conclusion:The efficiency of two-stage morcellation with reciprocating morcellators was highly related to the postoperative interval,with the maximum efficiency reached on Day 7.展开更多
BACKGROUND Primary prostate Burkitt's lymphoma is a rare and aggressive condition with a poor prognosis.Its clinical presentation can be challenging to differentiate from benign prostatic hyperplasia.Given the rar...BACKGROUND Primary prostate Burkitt's lymphoma is a rare and aggressive condition with a poor prognosis.Its clinical presentation can be challenging to differentiate from benign prostatic hyperplasia.Given the rarity of primary prostate Burkitt's lymphoma,its diagnosis and treatment remain unclear.CASE SUMMARY This report presents a case of a 57-year-old male with primary prostate Burkitt's lymphoma,initially misdiagnosed as prostatic hyperplasia.This case's operative process,intraoperative findings and postoperative management are discussed in detail.CONCLUSION Primary prostate lymphoma is difficult to distinguish from other prostate diseases.Holmium laser enucleation of the prostate(HoLEP),a minimally invasive procedure,is crucial in diagnosing and treating this rare disease.Clinicians should remain vigilant and thoroughly combine physical examination,imaging and test results when encountering patients of younger age with small prostate size but a rapid progression of lower urinary tract symptoms.HoLEP is an essential diagnostic and therapeutic tool in managing primary prostate Burkitt's lymphoma.展开更多
Objective:To provide the first large single-operator case series of patients who undergo“en bloc”thulium laser enucleation of the prostate(ThuLEP)and to demonstrate an improvement in enucleation efficacy with experi...Objective:To provide the first large single-operator case series of patients who undergo“en bloc”thulium laser enucleation of the prostate(ThuLEP)and to demonstrate an improvement in enucleation efficacy with experience.Methods:We prospectively evaluated a cohort of patients with symptomatic benign prostatic hyperplasia(BPH)who underwent“en bloc”ThuLEP between May 2015 and November 2017.Association between dependent variables(delivered energy and operating time)and independent variables(adenoma volume and experience)were estimated with regression analysis.The experience was calculated as the time interval between the date of the first operation of the series and the date of the operation being considered.Results:A total of 100 patients were registered for the study.Median operative time was 56.5 min(interquartile range[IQR]:40-85 min).Median enucleation time was 17.4 min(IQR:15-21.5 min).Median enucleation index(enucleation time per adenoma gram)was 0.3 min/g(0.2-0.3 min/g).The overall operative time is not influenced by experience,but we registered a significant trend towards a reduction in the total amount of energy delivered energy normalized per adenoma gram(p=0.0148).Conclusion:We believe that further attention is needed for these new“en bloc”prostatic enucleation techniques,which can facilitate some surgical steps,leading to a widespread use of laser technology for BPH surgical treatment.展开更多
Treatment of patients with lower urinary tract symptoms （LUTS） secondary to benign prostatic hyperplasia （BPH） may affect the quality of sexual function and ejaculation. The effect of new surgical procedures, whic...Treatment of patients with lower urinary tract symptoms （LUTS） secondary to benign prostatic hyperplasia （BPH） may affect the quality of sexual function and ejaculation. The effect of new surgical procedures, which are currently available to treat BPH, on erection and ejaculation, has been poorly studied. This study aimed to assess the effect of thulium laser enucleation of the prostate （ThuLEP） on sexual function and retrograde ejaculation in patients with LUTS secondary to BPH. We performed a prospective study in 110 consecutive patients who had undergone ThuLEP to analyze changes in sexual function and urinary symptoms. To evaluate changes in erection and ejaculation, and the effect of urinary symptoms on the quality of life （QoL）, five validated questionnaires were used： the ICIQ-MLUTSsex, MSHQ-EjD, International Index of Erectile Function 5, International Prognostic Scoring System （IPSS） questionnaire, and QoL index of the intraclass correlation coefficients. Patients also underwent IPSS and flowmetry to assess the outcome of flow. Patients were evaluated before surgery and 3-6 months after ThuLEP, whereas those with previous abdominal surgery were excluded. The patients＇ mean age was 67.83 years. Postoperative urinary symptoms improved after surgery. No significant differences in erectile function before and after surgery were observed. As compared with other techniques described in the literature, the percentage of patients with conserved ejaculation increased by 52.7% after ThuLEP. ThuLEP positively affects urinary symptoms and their effect on the QoL of patients as assessed by questionnaire scores. While endoscopic management of BPH （e.g. transurethral resection of the prostate） causes retrograde ejaculation in most patients, those who undergo ThuLEP have conserved ejaculation and erectile function.展开更多
Background:We compared the safety and efficacy of treating benign prostatic hyperplasia with photoselective greenlight vaporization(PVP)versus holmium laser enucleation of the prostate(HoLEP).Methods:Databases(PubMed,...Background:We compared the safety and efficacy of treating benign prostatic hyperplasia with photoselective greenlight vaporization(PVP)versus holmium laser enucleation of the prostate(HoLEP).Methods:Databases(PubMed,Embase,Cochrane Library,Chinese CBM,and CNKI)were searched for eligible studies evaluating HoLEP or PVP outcomes,published until May 2022.We analyzed the incidence of relative complications and postoperative outcomes,including the international prostate symptomscore,maximum flow rate(Qmax),postvoid residual urine volume,quality of life index,and prostate-specific antigen levels.Results:Eleven studies involving 4763 patients were included in thismeta-analysis.The significant differences in postoperativeQmax at 1 month(mean difference[MD],3.31,95% confidence interval[CI],0.45-6.16,p=0.02,I^(2),92%),3 months(MD,2.78,95%CI,0.53-5.02,p=0.02,I^(2),89%),6 months(MD,2.13,95%CI,1.11-3.15,p<0.0001,I^(2),87%),and 12 months(MD,3.98,95%CI,2.06-5.89,p<0.0001,I^(2),58%)further confirmed unique advantage of HoLEP over PVP.We used forest plots to determine significant differences in the severe complication rates among patients in the PVP and HoLEP groups(odds ratio,0.05,95%CI,0.01 to 0.28,p=0.0005).Conclusions:Holmium laser enucleation of the prostate and PVP showed comparable international prostate symptom scores,quality of life index,postvoid residual urine volumes,prostate-specific antigen levels,perioperative factors,and total complication rates.Compared with PVP,HoLEP had a greater Qmax 1 year postoperatively,decreased energy expenditure,and fewer high-grade complications.These results need to be verified in long-term follow-up studies with well-structured randomized controlled trials.展开更多
Background:The prevalence of benign prostatic hyperplasia(BPH)in older men increases with age,beginning at 40-45 years and reaching to 60% by 60 years and 80% by 80 years.Surgical procedures such as holmium laser enuc...Background:The prevalence of benign prostatic hyperplasia(BPH)in older men increases with age,beginning at 40-45 years and reaching to 60% by 60 years and 80% by 80 years.Surgical procedures such as holmium laser enucleation of the prostate(HoLEP)and transurethral resection of the prostate(TURP)are the preferred treatments for BPH.Nevertheless,there is disagreement regarding the most efficient and safe treatment for BPH.The objective of this meta-analysis was to assess the efficacy and safety of HoLEP and TURP based on existing evidence.Materials and methods:This meta-analysis was performed in accordance with the PRISMA guidelines.In February 2023,a literature review was conducted using PubMed,ScienceDirect,and the Cochrane Library,and the meta-analysis was performed using RevMan V.5.4.Results:A total of 656 patients underwent HoLEP,and 653 patients underwent TURP.There was no statistically significant difference in the International Prostate Symptom Score at 1 month or at 3,6,18,24,and 36 months;the HoLEP group showed a significant difference at 12 months.The pooled data from the maximum urinary flow rate at 1-12 months revealed no significant findings,but the TURP group showed significant results at 24months.Meanwhile,the HoLEP group showed significant postvoid residual results.There was no significant difference in the quality of life between the groups.Patients who underwent HoLEP had shorter hospital stay and catheter usage period and had lower hemoglobin drop.The operating time was shorter in the TURP group.The difference in specimen weight between the 2 groups was not statistically significant.The overall complications were similar in both groups,but the HoLEP group received significantly fewer blood transfusions.Conclusions:Holmiumlaser enucleation of the prostate demonstrated excellent efficacy and safety,with fewer hematological changes and complications;however,TURP had a shorter operating time.展开更多
Objective:Minimally invasive treatments for benign prostatic hyperplasia (BPH) have seen an increase in usage in recent years. We aimed to determine what types of events may influence patient search habits related to ...Objective:Minimally invasive treatments for benign prostatic hyperplasia (BPH) have seen an increase in usage in recent years. We aimed to determine what types of events may influence patient search habits related to surgical BPH treatments.Methods:Google Trends was used to determine the frequency of searches for different minimally invasive and prostatic ablative treatments for BPH in the United States. The procedures including transurethral resection of the prostate (TURP), Aquablation therapy (Aquablation), Greenlight laser therapy (Greenlight), transurethral needle ablation, transurethral microwave thermotherapy, Urolift (prostatic urethral lift [PUL]), Rezum, iTind, holmium laser enucleation of the prostate, simple prostatectomy, and prostatic artery embolization were compared.Results:From January 1, 2004 to February 28, 2023, the number of internet search queries have increased for TURP, PUL, Rezum, prostatic artery embolization, and holmium laser enucleation of the prostate. There has been a slight decrease in searches for Greenlight, transurethral needle ablation, transurethral microwave thermotherapy, iTind, simple prostatectomy, and Aquablation.Conclusion:Despite increased searches of alternatives, TURP remains the most searched BPH procedure. Additionally, search habits may be influenced by several factors including government approval, corporate acquisition, and marketing campaigns. It is important for physicians to understand the types of events that may cause patients to inquire about certain treatments for better quality health information and clinical visits.展开更多
<strong>Introduction:</strong> Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one among the foremost common diseases affecting the aging man with, almost 80% of the ...<strong>Introduction:</strong> Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one among the foremost common diseases affecting the aging man with, almost 80% of the lads greater than 70 affected. BPH is caused by unregulated proliferation within the prostate, which may cause physical obstruction of the prostatic urethra and result in anatomic bladder outlet obstruction (BOO). Transurethral resection of the prostate (TURP) has been the historical gold standard up till now to which all endoscopic procedures for benign prostatic hyperplasia (BPH) are compared with a mean hospital stay of three days. This surgery although efficacious has been related with increased morbidity and increased day case failure rates as compared to newer techniques. These shortcomings have prompted the utilization of newer methods like Transurethral enucleation and resection of the prostate (TUERP), Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP). This review will discuss the enucleation techniques, advantages and therefore the predictive factors for a successful day case prostate surgery. <strong>Materials and Methods:</strong> During this review, we discuss the newer techniques utilized in day case BPH surgery as well as the predictive factors for a successful BPH surgery, both enucleation, benefits and morcellation are covered also. <strong>Results:</strong> TUERP, ThuLEP and HoLEP have literature supporting the advantages of these techniques, which demonstrates its ability in day case BPH surgeries in specially selected cases with favorable factors and a 61% overall success rate. <strong>Conclusion:</strong> TUERP, ThuLEP and HoLEP Have proven to show favorable outcomes in day case BPH surgery with urologist’s experience, prostate size, duration of operation, age, use of anticoagulants, morning theatre list and ASA score being the key factors for a successful day case surgery.展开更多
Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retro...Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retrospective observational case series.Methods:One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated.Among them,76 were eligible for this study and underwent reconstructive surgery.Preoperative and postoperative assessments were done with symptom scores,uroflowmetry,ultrasound for post-void residue,and urethrogram.Any intervention during follow-up was classed as a failure.The recurrence and 95%confidence interval for recurrence percentage were calculated.Results:The following five categories of patients were identified:Bulbo-membranous(33[43.4%]),navicular fossa(21[27.6%]),penile/peno-bulbar(8[10.5%]),bladder neck stenosis(6[7.9%]),and multiple locations(8[10.5%]).The average age was 69 years(range:60-84 years).Overall average symptom score,flow rate,and post-void residue changed from 21 to 7,6 mL/s to 19 mL/s,and 210 mL to 20 mL,respectively.The average follow-up was 34 months(range:12-58 months).Overall recurrence and complication rates were 10.5%and 9.2%,respectively.The recurrence in each category was seen in 3,1,2,1,and 1 patient,respectively.Overall 95% confidence interval for recurrence percentage was 4.66-19.69.Conclusion:Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH.The bulbo-membranous strictures need continence preserving approach.Navicular fossa strictures require minimally invasive and cosmetic consideration.Peno-bulbar strictures require judicious use of grafts and flaps.Bladder neck stenosis in this cohort could be treated with endoscopic measures.Multiple locations need treatment based on their sites in single-stage as far as possible.展开更多
The holmium:yttrium aluminum garnet laser,the gold standard for lithotripsy,is widely used in various endourological fields.Their physical characteristics contribute to the Moses effect.This narrative review aimed to ...The holmium:yttrium aluminum garnet laser,the gold standard for lithotripsy,is widely used in various endourological fields.Their physical characteristics contribute to the Moses effect.This narrative review aimed to analyze the current knowledge of the Moses effect and its applications in endourology.The Moses effect involves the rapid formation of a vapor bubble that allows the remaining energy to reach the target with less attenuation.Lumenis®developed pulse modulation technology,the MOSES^(TM) technology,that harnesses the Moses effect to optimize holmium energy.Preclinical studies concluded that the new technology improves stone retropulsion,allowing for reduced lithotripsy duration.However,the heterogeneity of clinical studies and the lack of randomized controlled trials do not allow definitive conclusions.The MOSES^(TM) technology has also been applied in holmium laser enucleation of the prostate,reducing enucleation and hemostasis times,leading to improved enucleation efficiency.However,minimal changes occurred in hemoglobin or hematocrit levels and no significant differences were noted in complications or functional outcomes.Further research is needed to fully evaluate the benefits and limitations of MOSES^(TM) technology in clinical practice.展开更多
The aim of this study was to explore the optimal timing of holmium laser enucleation of the prostate(HoLEP)in patients presenting benign prostatic hyperplasia(BPH)with lower urinary tract symptoms(LUTS).A retrospectiv...The aim of this study was to explore the optimal timing of holmium laser enucleation of the prostate(HoLEP)in patients presenting benign prostatic hyperplasia(BPH)with lower urinary tract symptoms(LUTS).A retrospective analysis was conducted based on the perioperative and postoperative outcome data of 1212 patients who underwent HoLEP in Shanghai Ninth People’s Hospital(Shanghai,China)between January 2009 and December 2018.According to the preoperative International Prostate Symptom Score(IPSS),all patients whom we analyzed were divided into Group A(IPSS of 8–18)and Group B(IPSS of 19–35).Peri-and postoperative outcome data were obtained during the 1-year follow-up.IPSS changes were the main postoperative outcomes.The postoperative IPSS,quality of life,peak urinary flow rate,postvoid residual,and overactive bladder symptom score(OABSS)improved significantly.The IPSS improved further in the group with severe LUTS symptoms,but the postoperative IPSS was still higher than that in the moderate LUTS group.OABSSs showing moderate and severe cases after follow-up were more frequent in Group B(9.1%)than in Group A(5.2%)(P<0.05).There were no significant intergroup differences in the intraoperative American Society of Anesthesiologists or hospitalization expense scores,and the medication costs,as well as the total costs,were significantly higher in Group B.In this retrospective study,HoLEP was an effective treatment for symptomatic BPH.For patients with LUTS,earlier surgery in patients with moderate severity may result in a marginally better 12-month IPSS than that in men with severe symptoms.展开更多
文摘Objective:The aim of this research was to evaluate the efficiency of reciprocating morcellation for removing giant benign prostatic hyperplasia during holmium laser enucleation of the prostate,investigate whether performing morcellation as a two-stage procedure improves tissue retrieval efficiency,and seek to determine the optimal interval between the two surgeries.Methods:This study included nine cases of holmium laser enucleation of the prostate with an enucleated prostate weight exceeding 200 g,indicative of substantial prostate enlargement.Morcellation was performed on Day 0(n=4),Day 4(n=1),Day 6(n=1),and Day 7(n=3).The intervals were compared regarding the morcellation efficiency,beach ball presence,and pathology.Results:The mean estimated prostate volume was 383(range 330e528)mL;the median enucleation weight was 252(interquartile range[IQR]222,342)g;and the median enucleation time was 83(IQR 62,100)min.The mean morcellation efficiency was 1.44(SD 0.55)g/min on Day 0 and 13.69(SD 2.46)g/min on day 7.The morcellation efficiency was 4.15 g/min and 10.50 g/min on Day 4 and Day 6,respectively,with significantly higher in the two-stage group compared to one-stage group(11.0 g/min vs.1.5 g/min;p=0.014).Efficiency was strongly correlated with intervals(p<0.001);the incidences of beach balls were 100%(4/4)and 60%(3/5)in the immediate and two-stage surgery groups,respectively.Conclusion:The efficiency of two-stage morcellation with reciprocating morcellators was highly related to the postoperative interval,with the maximum efficiency reached on Day 7.
基金Supported by the Kunshan Research and Development Project,No.KSZ2203the Kunshan Research and Development Project,No.KZYY2205.
文摘BACKGROUND Primary prostate Burkitt's lymphoma is a rare and aggressive condition with a poor prognosis.Its clinical presentation can be challenging to differentiate from benign prostatic hyperplasia.Given the rarity of primary prostate Burkitt's lymphoma,its diagnosis and treatment remain unclear.CASE SUMMARY This report presents a case of a 57-year-old male with primary prostate Burkitt's lymphoma,initially misdiagnosed as prostatic hyperplasia.This case's operative process,intraoperative findings and postoperative management are discussed in detail.CONCLUSION Primary prostate lymphoma is difficult to distinguish from other prostate diseases.Holmium laser enucleation of the prostate(HoLEP),a minimally invasive procedure,is crucial in diagnosing and treating this rare disease.Clinicians should remain vigilant and thoroughly combine physical examination,imaging and test results when encountering patients of younger age with small prostate size but a rapid progression of lower urinary tract symptoms.HoLEP is an essential diagnostic and therapeutic tool in managing primary prostate Burkitt's lymphoma.
文摘Objective:To provide the first large single-operator case series of patients who undergo“en bloc”thulium laser enucleation of the prostate(ThuLEP)and to demonstrate an improvement in enucleation efficacy with experience.Methods:We prospectively evaluated a cohort of patients with symptomatic benign prostatic hyperplasia(BPH)who underwent“en bloc”ThuLEP between May 2015 and November 2017.Association between dependent variables(delivered energy and operating time)and independent variables(adenoma volume and experience)were estimated with regression analysis.The experience was calculated as the time interval between the date of the first operation of the series and the date of the operation being considered.Results:A total of 100 patients were registered for the study.Median operative time was 56.5 min(interquartile range[IQR]:40-85 min).Median enucleation time was 17.4 min(IQR:15-21.5 min).Median enucleation index(enucleation time per adenoma gram)was 0.3 min/g(0.2-0.3 min/g).The overall operative time is not influenced by experience,but we registered a significant trend towards a reduction in the total amount of energy delivered energy normalized per adenoma gram(p=0.0148).Conclusion:We believe that further attention is needed for these new“en bloc”prostatic enucleation techniques,which can facilitate some surgical steps,leading to a widespread use of laser technology for BPH surgical treatment.
文摘Treatment of patients with lower urinary tract symptoms （LUTS） secondary to benign prostatic hyperplasia （BPH） may affect the quality of sexual function and ejaculation. The effect of new surgical procedures, which are currently available to treat BPH, on erection and ejaculation, has been poorly studied. This study aimed to assess the effect of thulium laser enucleation of the prostate （ThuLEP） on sexual function and retrograde ejaculation in patients with LUTS secondary to BPH. We performed a prospective study in 110 consecutive patients who had undergone ThuLEP to analyze changes in sexual function and urinary symptoms. To evaluate changes in erection and ejaculation, and the effect of urinary symptoms on the quality of life （QoL）, five validated questionnaires were used： the ICIQ-MLUTSsex, MSHQ-EjD, International Index of Erectile Function 5, International Prognostic Scoring System （IPSS） questionnaire, and QoL index of the intraclass correlation coefficients. Patients also underwent IPSS and flowmetry to assess the outcome of flow. Patients were evaluated before surgery and 3-6 months after ThuLEP, whereas those with previous abdominal surgery were excluded. The patients＇ mean age was 67.83 years. Postoperative urinary symptoms improved after surgery. No significant differences in erectile function before and after surgery were observed. As compared with other techniques described in the literature, the percentage of patients with conserved ejaculation increased by 52.7% after ThuLEP. ThuLEP positively affects urinary symptoms and their effect on the QoL of patients as assessed by questionnaire scores. While endoscopic management of BPH （e.g. transurethral resection of the prostate） causes retrograde ejaculation in most patients, those who undergo ThuLEP have conserved ejaculation and erectile function.
文摘Background:We compared the safety and efficacy of treating benign prostatic hyperplasia with photoselective greenlight vaporization(PVP)versus holmium laser enucleation of the prostate(HoLEP).Methods:Databases(PubMed,Embase,Cochrane Library,Chinese CBM,and CNKI)were searched for eligible studies evaluating HoLEP or PVP outcomes,published until May 2022.We analyzed the incidence of relative complications and postoperative outcomes,including the international prostate symptomscore,maximum flow rate(Qmax),postvoid residual urine volume,quality of life index,and prostate-specific antigen levels.Results:Eleven studies involving 4763 patients were included in thismeta-analysis.The significant differences in postoperativeQmax at 1 month(mean difference[MD],3.31,95% confidence interval[CI],0.45-6.16,p=0.02,I^(2),92%),3 months(MD,2.78,95%CI,0.53-5.02,p=0.02,I^(2),89%),6 months(MD,2.13,95%CI,1.11-3.15,p<0.0001,I^(2),87%),and 12 months(MD,3.98,95%CI,2.06-5.89,p<0.0001,I^(2),58%)further confirmed unique advantage of HoLEP over PVP.We used forest plots to determine significant differences in the severe complication rates among patients in the PVP and HoLEP groups(odds ratio,0.05,95%CI,0.01 to 0.28,p=0.0005).Conclusions:Holmium laser enucleation of the prostate and PVP showed comparable international prostate symptom scores,quality of life index,postvoid residual urine volumes,prostate-specific antigen levels,perioperative factors,and total complication rates.Compared with PVP,HoLEP had a greater Qmax 1 year postoperatively,decreased energy expenditure,and fewer high-grade complications.These results need to be verified in long-term follow-up studies with well-structured randomized controlled trials.
文摘Background:The prevalence of benign prostatic hyperplasia(BPH)in older men increases with age,beginning at 40-45 years and reaching to 60% by 60 years and 80% by 80 years.Surgical procedures such as holmium laser enucleation of the prostate(HoLEP)and transurethral resection of the prostate(TURP)are the preferred treatments for BPH.Nevertheless,there is disagreement regarding the most efficient and safe treatment for BPH.The objective of this meta-analysis was to assess the efficacy and safety of HoLEP and TURP based on existing evidence.Materials and methods:This meta-analysis was performed in accordance with the PRISMA guidelines.In February 2023,a literature review was conducted using PubMed,ScienceDirect,and the Cochrane Library,and the meta-analysis was performed using RevMan V.5.4.Results:A total of 656 patients underwent HoLEP,and 653 patients underwent TURP.There was no statistically significant difference in the International Prostate Symptom Score at 1 month or at 3,6,18,24,and 36 months;the HoLEP group showed a significant difference at 12 months.The pooled data from the maximum urinary flow rate at 1-12 months revealed no significant findings,but the TURP group showed significant results at 24months.Meanwhile,the HoLEP group showed significant postvoid residual results.There was no significant difference in the quality of life between the groups.Patients who underwent HoLEP had shorter hospital stay and catheter usage period and had lower hemoglobin drop.The operating time was shorter in the TURP group.The difference in specimen weight between the 2 groups was not statistically significant.The overall complications were similar in both groups,but the HoLEP group received significantly fewer blood transfusions.Conclusions:Holmiumlaser enucleation of the prostate demonstrated excellent efficacy and safety,with fewer hematological changes and complications;however,TURP had a shorter operating time.
文摘Objective:Minimally invasive treatments for benign prostatic hyperplasia (BPH) have seen an increase in usage in recent years. We aimed to determine what types of events may influence patient search habits related to surgical BPH treatments.Methods:Google Trends was used to determine the frequency of searches for different minimally invasive and prostatic ablative treatments for BPH in the United States. The procedures including transurethral resection of the prostate (TURP), Aquablation therapy (Aquablation), Greenlight laser therapy (Greenlight), transurethral needle ablation, transurethral microwave thermotherapy, Urolift (prostatic urethral lift [PUL]), Rezum, iTind, holmium laser enucleation of the prostate, simple prostatectomy, and prostatic artery embolization were compared.Results:From January 1, 2004 to February 28, 2023, the number of internet search queries have increased for TURP, PUL, Rezum, prostatic artery embolization, and holmium laser enucleation of the prostate. There has been a slight decrease in searches for Greenlight, transurethral needle ablation, transurethral microwave thermotherapy, iTind, simple prostatectomy, and Aquablation.Conclusion:Despite increased searches of alternatives, TURP remains the most searched BPH procedure. Additionally, search habits may be influenced by several factors including government approval, corporate acquisition, and marketing campaigns. It is important for physicians to understand the types of events that may cause patients to inquire about certain treatments for better quality health information and clinical visits.
文摘<strong>Introduction:</strong> Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is one among the foremost common diseases affecting the aging man with, almost 80% of the lads greater than 70 affected. BPH is caused by unregulated proliferation within the prostate, which may cause physical obstruction of the prostatic urethra and result in anatomic bladder outlet obstruction (BOO). Transurethral resection of the prostate (TURP) has been the historical gold standard up till now to which all endoscopic procedures for benign prostatic hyperplasia (BPH) are compared with a mean hospital stay of three days. This surgery although efficacious has been related with increased morbidity and increased day case failure rates as compared to newer techniques. These shortcomings have prompted the utilization of newer methods like Transurethral enucleation and resection of the prostate (TUERP), Holmium laser enucleation of the prostate (HoLEP) and Thulium laser enucleation of the prostate (ThuLEP). This review will discuss the enucleation techniques, advantages and therefore the predictive factors for a successful day case prostate surgery. <strong>Materials and Methods:</strong> During this review, we discuss the newer techniques utilized in day case BPH surgery as well as the predictive factors for a successful BPH surgery, both enucleation, benefits and morcellation are covered also. <strong>Results:</strong> TUERP, ThuLEP and HoLEP have literature supporting the advantages of these techniques, which demonstrates its ability in day case BPH surgeries in specially selected cases with favorable factors and a 61% overall success rate. <strong>Conclusion:</strong> TUERP, ThuLEP and HoLEP Have proven to show favorable outcomes in day case BPH surgery with urologist’s experience, prostate size, duration of operation, age, use of anticoagulants, morning theatre list and ASA score being the key factors for a successful day case surgery.
文摘Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retrospective observational case series.Methods:One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated.Among them,76 were eligible for this study and underwent reconstructive surgery.Preoperative and postoperative assessments were done with symptom scores,uroflowmetry,ultrasound for post-void residue,and urethrogram.Any intervention during follow-up was classed as a failure.The recurrence and 95%confidence interval for recurrence percentage were calculated.Results:The following five categories of patients were identified:Bulbo-membranous(33[43.4%]),navicular fossa(21[27.6%]),penile/peno-bulbar(8[10.5%]),bladder neck stenosis(6[7.9%]),and multiple locations(8[10.5%]).The average age was 69 years(range:60-84 years).Overall average symptom score,flow rate,and post-void residue changed from 21 to 7,6 mL/s to 19 mL/s,and 210 mL to 20 mL,respectively.The average follow-up was 34 months(range:12-58 months).Overall recurrence and complication rates were 10.5%and 9.2%,respectively.The recurrence in each category was seen in 3,1,2,1,and 1 patient,respectively.Overall 95% confidence interval for recurrence percentage was 4.66-19.69.Conclusion:Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH.The bulbo-membranous strictures need continence preserving approach.Navicular fossa strictures require minimally invasive and cosmetic consideration.Peno-bulbar strictures require judicious use of grafts and flaps.Bladder neck stenosis in this cohort could be treated with endoscopic measures.Multiple locations need treatment based on their sites in single-stage as far as possible.
文摘The holmium:yttrium aluminum garnet laser,the gold standard for lithotripsy,is widely used in various endourological fields.Their physical characteristics contribute to the Moses effect.This narrative review aimed to analyze the current knowledge of the Moses effect and its applications in endourology.The Moses effect involves the rapid formation of a vapor bubble that allows the remaining energy to reach the target with less attenuation.Lumenis®developed pulse modulation technology,the MOSES^(TM) technology,that harnesses the Moses effect to optimize holmium energy.Preclinical studies concluded that the new technology improves stone retropulsion,allowing for reduced lithotripsy duration.However,the heterogeneity of clinical studies and the lack of randomized controlled trials do not allow definitive conclusions.The MOSES^(TM) technology has also been applied in holmium laser enucleation of the prostate,reducing enucleation and hemostasis times,leading to improved enucleation efficiency.However,minimal changes occurred in hemoglobin or hematocrit levels and no significant differences were noted in complications or functional outcomes.Further research is needed to fully evaluate the benefits and limitations of MOSES^(TM) technology in clinical practice.
基金This research was supported by grant from the multi-center clinical research project of Shanghai Jiao Tong University School of Medicine(grant No.DLY201809)grant from the 2021 Shanghai Science and Technology Innovation Cooperation Program of Science and Technology Commission of Shanghai Municipality(grant No.21015801700)。
文摘The aim of this study was to explore the optimal timing of holmium laser enucleation of the prostate(HoLEP)in patients presenting benign prostatic hyperplasia(BPH)with lower urinary tract symptoms(LUTS).A retrospective analysis was conducted based on the perioperative and postoperative outcome data of 1212 patients who underwent HoLEP in Shanghai Ninth People’s Hospital(Shanghai,China)between January 2009 and December 2018.According to the preoperative International Prostate Symptom Score(IPSS),all patients whom we analyzed were divided into Group A(IPSS of 8–18)and Group B(IPSS of 19–35).Peri-and postoperative outcome data were obtained during the 1-year follow-up.IPSS changes were the main postoperative outcomes.The postoperative IPSS,quality of life,peak urinary flow rate,postvoid residual,and overactive bladder symptom score(OABSS)improved significantly.The IPSS improved further in the group with severe LUTS symptoms,but the postoperative IPSS was still higher than that in the moderate LUTS group.OABSSs showing moderate and severe cases after follow-up were more frequent in Group B(9.1%)than in Group A(5.2%)(P<0.05).There were no significant intergroup differences in the intraoperative American Society of Anesthesiologists or hospitalization expense scores,and the medication costs,as well as the total costs,were significantly higher in Group B.In this retrospective study,HoLEP was an effective treatment for symptomatic BPH.For patients with LUTS,earlier surgery in patients with moderate severity may result in a marginally better 12-month IPSS than that in men with severe symptoms.
