ABSTRACT
ABSTRACT Purpose The predictors of trifecta achievement in partial nephrectomy (PN) were poorly inquired and remained a controversial area of discovery. To evaluate predictive factors of trifecta achievement in patients undergoing PN. Materials and Methods A systematic literature search was performed to identify relevant articles. Only studies focusing on postoperative trifecta achievement and exploring its predictor with multivariable analyses were included. The trifecta achievement was defined as negative surgical margins, warm ischemia time <25 minutes, and no complications. Merged odds ratio (OR) and 95% confidence interval (CI) were used to evaluate the predictive effect. Results Thirteen studies with 7066 patients meeting the inclusion criteria were included. The rate of trifecta achievement ranged from 43.3% to 78.6%. Merged results showed that preoperative eGFR (OR: 1.01, 95% CI: 1.00, 1.02, P=0.02), operative time (OR: 0.99, 95% CI: 0.99, 1.00, P=0.02), estimated blood loss (OR: 1.00, 95% CI: 1.00, 1.00, P <0.001), tumor size (OR: 0.70, 95% CI: 0.58, 0.84, P <0.001), medium (OR: 0.39, 95% CI: 0.18, 0.84, P=0.02) and high PADUA score (OR: 0.23, 95% CI: 0.08, 0.64, P=0.005) were independently associated with trifecta achievement. A publication bias was identified for tumor size. Sensitivity analysis confirmed the stability of result for tumor size. Conclusions Larger tumor size, medium and high PADUA score are associated with decreased probability of trifecta achievement. After verifying by further high-quality studies, these variables can be incorporated into tools to predict probability of trifecta achievement during clinical practice.
ABSTRACT
Introduction: Transurethral resection ofthe prostate (TURP) has been considered asthe gold standard treatment for obstructivevoiding dysfunction in men with benignprostatic hyperplasia. This standard treatmenthas been challenged by consistent datademonstrating the superiority of Holmiumenucleation of the prostate (HoLEP). Wereview summarizes the literature comparingHoLEP to traditional therapies TURP, openprostatectomy (OP) for BPH these are widelyused and have long term efficacy data.Patients undergoing HoLEP have significantshortened catheterization times, decreasedlength of hospital stay, fewer serious postoperativecomplications, greater reduction inpost-operative IPSS, greater improvementsin post-operative Qmax and lower rates ofrepeat endoscopic procedures for recurrentsymptoms compared with TURP and OP.Furthermore, HoLEP can be used to resectmore than 100 grams tissue and it isequivalent efficacy to open prostatectomy.Conclusion: HoLEP as the new goldstandard treatment for surgical BPH therapyfurther. HoLEP remains its difficult learningcurve when compared with traditionaltransurethral resection.
ABSTRACT
Introduction: Transurethral resection of the prostate (TURP) has been considered as the gold standard treatment for obstructive voiding dysfunction in men with benign prostatic hyperplasia. This standard treatment has been challenged by consistent data demonstrating the superiority of Holmium enucleation of the prostate (HoLEP). We review summarizes the literature comparing HoLEP to traditional therapies TURP, open prostatectomy (OP) for BPH these are widely used and have long term efficacy data. Patients undergoing HoLEP have significant shortened catheterization times, decreased length of hospital stay, fewer serious postoperative complications, greater reduction in post-operative IPSS, greater improvements in post-operative Qmax and lower rates of repeat endoscopic procedures for recurrent symptoms compared with TURP and OP. Furthermore, HoLEP can be used to resect more than 100 grams tissue and it is equivalent efficacy to open prostatectomy. Conclusion: HoLEP as the new gold standard treatment for surgical BPH therapy further. HoLEP remains its difficult learning curve when compared with traditional transurethral resection.